Epilepsie und Familie - Familialer Umgang mit chronischer Krankheit und Krankenrolle

Steffen H-T. Epilepsie und Familie - Familialer Umgang mit chronischer Krankheit und Krankenrolle. Bielefeld: Universität Bielefeld; 2015.Obgleich psychosoziale Aspekte bei Epilepsie in den letzten Jahren mehr und mehr Beachtung finden, liegen nur wenige wissenschaftliche Erkenntnisse zur Situation von Familien mit einem erwachsenen epilepsiekranken Angehörigen vor. Diese Leerstelle verwundert, gilt doch die Familie als primäre Sorge- und Hilfeinstanz bei chronischer Krankheit. Ziel der Arbeit war es, den familialen Umgang mit Epilepsie und Krankenrolle zu beleuchten und das Augenmerk insbesondere auf die Unterstützungs-funktionen – angesichts einer strukturellen Überforderung des Kranken im Umgang mit einer Krankenrolle –, die Familien neben ihren alltagsbezogenen Aufgaben wahrnehmen, zu richten. Um dieses Thema zu explorieren, erfolgte zunächst eine Darstellung des Forschungsstands zu Epilepsie und Familie. Dabei wurde deutlich, dass vorliegende Studien primär entweder aus externer Perspektive formuliert sind, mithin dem familialen Krankheitserleben und Handeln kaum Aufmerksamkeit zollen, oder aber aus dem Blickwinkel eines Familienmitglieds auf das Gesamtsystem schließen, also keinen systemischen Einblick nehmen. Zur theoretischen Annäherung wurde die Familie als Bewältigungsinstanz chronischer Krankheit vorgestellt, um vor dem Hintergrund der traditionellen, primär an akuter Krankheit ausgerichteten ‚sick role‘ die Ambiguität der Rollenperformanz bei chronischer Krankheit zu beleuchten und mit der nachfolgenden Empirie die familialen Herausforderungen in diesem Spannungsfeld zu erhellen. Um Einblick in das das familiale Handeln bei chronischer Krankheit nehmen zu können, wurde als methodische Vorgehensweise ein qualitativ exploratives Forschungsdesign, orientiert an den Prämissen fallrekonstruktiver Familienforschung, gewählt. Insgesamt wurden acht Familien mit einem epilepsiekranken erwachsenen Angehörigen interviewt und vier Familien aus diesem Sample mittels iterativer Kontrastierung für die Darstellung ausgewählt. Die Analyse erfolgte mithilfe einer Kombination des Methodeninventars der Objektiven Hermeneutik und Grounded Theory. Die Ergebnisse der Untersuchung zeigten die vielschichtigen Monitoring-, Unterstützungs-, und Kompensationsanstrengungen, die Familien hinsichtlich der Integration chronischer Krankheit unternehmen. Die Aneignung und Gestaltung einer Krankenrolle wurde dabei als zentraler Aspekt im Umgang mit chronischer Krankheit identifiziert. Um eine Einbettung angesichts besagter Ambiguität in das familiale Gefüge und den Alltag zu ermöglichen, setzten die Familien vielfältige, zeitlich und situativ moderierte Strategien – von ‚drängend konfrontierend‘ über ‚resignativ erduldend‘ bis ‚zögerlich austarierend‘ – ein, die alle auf ein gemeinsames Ziel ausgerichtet waren: Den Kranken in der Auseinandersetzung mit seiner ambiguitären Situation zu unterstützen und gleichzeitig die Stabilität der familialen Lebenswelt zu sichern. Der familiale Umgang mit chronischer Krankheit und Krankenrolle ließ sich dabei als von Kranken und Familien gleichermaßen zu vollziehender Lernprozess erkennen, der von unterschiedlicher Dauer, den Familien maximale Flexibilität abverlangt, die mitunter ihre Potenziale überbeanspruchen kann. Die Relevanz der Arbeit zeigt sich zum einen in der Ergänzung der Wissensbestände zum familialen Umgang mit chronischer Krankheit angesichts einer ambivalenten Situation, die den Familien eine sensible, zweifache Mission auferlegt, um sowohl die Wohlfahrt des Kranken als auch des Gesamtsystems im Auge zu behalten. Zum anderen im Hinblick auf die gesundheitliche Versorgung, die vor dem Hintergrund der Erkenntnisse auf eine stärkere Partizipation und Unterstützung von Familien mit einem chronisch kranken Erwachsenen auszurichten ist

ECG sonification to support the diagnosis and monitoring of myocardial infarction

Aldana Blanco AL, Grautoff S, Hermann T. ECG Sonification to support the diagnosis and monitoring of myocardial infarction. Journal on Multimodal User Interfaces. 2020;14:207-218.This paper presents the design and evaluation of four sonification methods to support monitoring and diagnosis in Electrocardiography (ECG). In particular we focus on an ECG abnormality called ST-elevation which is an important indicator of a myocardial infarction. Since myocardial infarction represents a life-threatening condition it is of essential value to detect an ST-elevation as early as possible. As part of the evaluated sound designs, we propose two novel sonifications: (i) Polarity sonification, a continuous parameter-mapping sonification using a formant synthesizer and (ii) Stethoscope sonification, a combination of the ECG signal and a stethoscope recording. The other two designs, (iii) the water ambience sonification and the (iv) morph sonification, were presented in our previous work about ECG sonification [ref]. The study evaluates three components across the proposed sonifications (1) detection performance, meaning if participants are able to detect a transition from healthy to unhealthy states, (2) classification accuracy, that evaluates if participants can accurately classify the severity of the pathology, and (3) aesthetics and usability (pleasantness, informativeness and long-term listening). The study results show that the polarity design had the highest accuracy rates in the detection task whereas the stethoscope sonification obtained the better score in the classification assignment. Concerning aesthetics, the water ambience sonification was regarded as the most pleasant. Furthermore, we found a significant difference between sound/music experts and non-experts in terms of the error rates obtained in the detection task using the morph sonification and also in the classification task using the stethoscope sonification. Overall, the group of experts obtained lower error rates than the group of non-experts, which means that further training could improve accuracy rates and, particularly for designs that rely mainly on pitch variations, additional training is needed in the non-experts group

CardioSounds: A portable system to sonify ECG rhythm disturbances in real-time

CardioSounds is a portable system that allows users to measure and sonify their electrocardiogram signal in real-time. The ECG signal is acquired using the hardware platform BITalino and subsequently analyzed and sonified using a Raspberry Pi. Users can control basic features from the system (start recording, stop recording) using their smartphone. The system is meant to be used for diagnostic and monitoring of cardiac pathologies, providing users with the possibility to monitor a signal without occupying their visual attention. In this paper, we introduce a novel method, anticipatory mapping, to sonify rhythm disturbances such as Atrial Fibrillation, Atrial flutter and Ventricular Fibrillation. Anticipatory mapping enhances perception of rhythmic details without disrupting the direct perception of the actual heart beat rhythm. We test the method on selected pathological data involving three of the most known rhythm disturbances. A preliminary perception test to assess aesthetics of the sonifications and its possible use in medical scenarios shows that the anticipatory mapping method is regarded as informative discerning healthy and pathological states, however there is no agreement about a preferred sonification type

Magnetic resonance imaging features of craniofacial fibrous dysplasia

Purpose: To assess the value of magnetic resonance imaging (MRI) in detecting craniofacial fibrous dysplasia (CFD) and diagnosing and differentiating it from intraosseous meningioma. Additionally, the MRI appearance of the typical computed tomography (CT) imaging feature, the ground glass phenomenon, was evaluated. Material and methods: MRI datasets of 32 patients with CFD were analysed retrospectively. Detectability in MRI was assessed by analysis of 10 randomly selected patients with CFD and 10 normal controls by two blinded readers. Changes of affected bone, internal lesion structure, T1 and T2 signal intensity, and contrast enhancement of the lesion in general and ground glass areas in particular were assessed. Ten patients with intraosseous meningioma (one in each) served as differential diagnosis for CFD. Results: All 10 CFD lesions were reliably detected in MRI. In 32 patients 36 CFD lesions were evaluated. In 66.7% CFD were iso- to hypointense in T1 and hyperintense in T2; this proportion was similar for ground glass areas (65.7%). Ground glass areas were more homogeneously structured than the whole CFD lesion in both T1 (100% vs. 56%, respectively) and T2 (91% vs. 61%, respectively). Contrast enhancement was found in 97% of complete CFD lesions and 93% of ground glass areas. The accuracy for CFD vs. intraosseous meningioma was 100% for 'no soft-tissue component' and 98% for ‘bone broadening' in MRI. Conclusions: Distinct morphological changes of CFD are reliably detected in MRI and allow differentiation from intraosseous meningioma. Areas with ground glass phenomenon in CT show a predominantly homogenous internal structure in MRI with contrast enhancement

Heart Alert: ECG Sonification for supporting the detection and diagnosis of ST segment deviations

Aldana Blanco AL, Grautoff S, Hermann T. Heart Alert: ECG Sonification for supporting the detection and diagnosis of ST segment deviations. Presented at the Interactive Sonification workshop (ISon 2016), Bielefeld, Germany.This paper presents two novel sonification designs for Electrocardiography (ECG) data: (a) Water Ambience soundscapes aim at turning heart activity into an ambience which exhibits salient patterns as specific ECG properties deviate from a normal heartbeat, (b) Timbre Morphing sonification aims at supporting analysts to quickly assess if an abnormality in terms of the frequency, rhythm or amplitude in the signal occurs. Both methods are embedded into an interactive setting where the users can upload a dataset and interactively adjust sonification parameters, for instance in search of settings that optimize the contrast between a baseline (regular) and abnormal (ST deviated) case, based on pre-recorded real ECG data sets. In result, we qualitatively analyze how a small group of users interacts with the system and what their overview regarding the proposed methods is. Also, we conduct a study with eight participants in which they are asked to classify a set of sonifications according to two categories; healthy or unhealthy. The study results suggest that the proposed sonification designs allow users to correctly classify the datasets without having prior knowledge about ECG signals

CardioSounds: Real-time Auditory Assistance for Supporting Cardiac Diagnostic and Monitoring

Aldana Blanco AL, Grautoff S, Hermann T. CardioSounds: Real-time Auditory Assistance for Supporting Cardiac Diagnostic and Monitoring. Presented at the Audio Mostly 2017, London, UK.This paper presents a real-time sonification system for Electrocardiography (ECG) monitoring and diagnostic. We introduce two novel sonification designs: (a) Auditory magnification loupe, a method to sonify important beat-to-beat variations when doing sports activities, and (b) ST-segment water sonification, which aims to assist clinicians in the diagnostic process by building a soundscape that exhibits ECG signal abnormalities as the analysed signal deviates from a healthy ECG. The proposed methods were designed to assist users to unobtrusively monitor their own (or their patients') heart signal in situations when a visual-only representation is not convenient for the proper fulfilment of a given task. Using CardioSounds users receive auditory feedback in order to monitor important heart rhythm disturbances (e.g. Arrhythmia) or pathologies due to a blocking of the heart's vessels

Computerized clinical decision system and mobile application with expert support to optimize management of vertigo in primary care: study protocol for a pragmatic cluster-randomized controlled trial

Vertigo and dizziness are amongst the most common symptoms in medicine and often have a major impact on activities of daily life. Although many causes of vertigo and dizziness can easily be recognized, patients often receive inappropriate and ineffective treatment. The reasons for this are various. Because vertigo/dizziness is an interdisciplinary symptom and there is a lack of standardised diagnostic tools, it is easy to lose the overview of the possible differential diagnoses. There is evidence though, that the management of patients with vertigo/dizziness can be optimized using standardized care pathways with digital support. The present study (within the framework of \textquotedblPoiSe-prevention, online feedback, and interdisciplinary therapy of acute vestibular syndromes by e-health\textquotedbl) aims to evaluate the implementation of a program with several interlocking components. The three main components are a computerized clinical decision system, a mobile application, a counselling and interdisciplinary educational program developed by the German Center for Vertigo and Balance Disorders (DSGZ). The study is a cluster-randomized controlled trial with a parallel-group design, as well as a detailed process evaluation. Clusters comprise of primary care physician practices in Bavaria, Germany. In the scope of the study the effectiveness, acceptability and efficiency of the intervention will be evaluated. It is anticipated that the intervention will improve the quality and efficiency of the management of dizzy patients. A higher diagnostic accuracy, optimized treatment, and disease progression monitoring is expected to improve patient-relevant outcomes and reduce health-care costs

P-576: Differential effects of selective cyclooxygenase-2 inhibitors on endothelial function in salt-induced hypertension

In view of the ongoing controversy of potential differences in cardiovascular safety of selective COX-2 inhibitors (coxibs), we compared the effects of two different coxibs and a traditional NSAID on endothelial dysfunction, a well established surrogate of cardiovascular disease, in salt-induced hypertension. Salt-sensitive (DS) and salt-resistant (DR) Dahl rats were treated with a high-sodium diet (4% NaCl) for 56 days. From days 35 to 56, diclofenac (6 mg/kg/d; DS-diclofenac), rofecoxib (2 mg/kg/d; DS-rofecoxib), celecoxib (25 mg/kg/d; DS-celecoxib) or placebo (DS-placebo) were added to the chow. Vascular reactivity of isolated aortic rings was assessed by isometric tension recording. Blood pressure increased with high sodium diet in the DS-groups which was more pronounced after diclofenac and rofecoxib treatment (p<0.005 vs DS-placebo), but slightly blunted by celecoxib (p<0.001 vs DS-placebo). Sodium diet markedly reduced NO-mediated endothelium-dependent relaxations to acetylcholine (ACh, 10−10−10−5 mol/L) in untreated hypertensive rats (p<0.0001 vs DR-placebo). Relaxation to ACh improved after celecoxib (p<0.005 vs DS-placebo and DS-rofecoxib), but remained unchanged after rofecoxib and diclofenac treatment. Vasoconstriction after NOS inhibition with Nω-Nitro-L-Arginine Methyl Ester (10-4 mol/L) was blunted in DS rats (p<0.05 vs DR-placebo), normalized by celecoxib, but not affected by rofecoxib or diclofenac. Protein expression of eNOS was decreased in DS rats with a trend for increased eNOS levels in the DS-celecoxib group (97.8±25.6 vs 54.8±2.8 %, p=0.088 vs DS-placebo). Indicators of oxidative stress, 8-isoprostane levels, were elevated in untreated DS rats on 4% NaCl (6.55±0.58 vs 3.65±1.05 ng/ml, p<0.05) and normalized by celecoxib only (4.29±0.58 ng/ml), while SOD protein expression was decreased in DS rats and not affected by any treatment. Plasma levels of prostaglandines did not change during high sodium diet or any treatment. These data show that celecoxib, but not rofecoxib or diclofenac, improves endothelial dysfunction and reduces oxidative stress, thus pointing to differential effects of coxibs in salt-sensitive hypertension. Am J Hypertens (2004) 17, 243A-243A; doi: 10.1016/j.amjhyper.2004.03.65

Humic Substance Photosensitized Degradation of Phthalate Esters Characterized by 2H and 13C Isotope Fractionation

The photosensitized transformation of organic chemicals is an important degradation mechanism in natural surface waters, aerosols, and water films on surfaces. Dissolved organic matter including humic-like substances (HS), acting as photosensitizers that participate in electron transfer reactions, can generate a variety of reactive species, such as OH radicals and excited triplet-state HS (3HS*), which promote the degradation of organic compounds. We use phthalate esters, which are important contaminants found in wastewaters, landfills, soils, rivers, lakes, groundwaters, and mine tailings. We use phthalate esters as probes to study the reactivity of HS irradiated with artificial sunlight. Phthalate esters with different side-chain lengths were used as probes for elucidation of reaction mechanisms using 2H and 13C isotope fractionation. Reference experiments with the artificial photosensitizers 4,5,6,7-tetrachloro-2′,4′,5′,7′-tetraiodofluorescein (Rose Bengal), 3-methoxy-acetophenone (3-MAP), and 4-methoxybenzaldehyde (4-MBA) yielded characteristic fractionation factors (−4 ± 1, −4 ± 2, and −4 ± 1‰ for 2H; 0.7 ± 0.2, 1.0 ± 0.4, and 0.8 ± 0.2‰ for 13C), allowing interpretation of reaction mechanisms of humic substances with phthalate esters. The correlation of 2H and 13C fractions can be used diagnostically to determine photosensitized reactions in the environment and to differentiate among biodegradation, hydrolysis, and photosensitized HS reaction