«Geh weg mit der Nadel!» : Angstreduktion bei Kindern vor und während Venenpunktionen

Darstellung des Themas: Die Venenpunktion ist eine der am häufigsten durchgeführten Interventionen bei Kindern im Spital und kann ein hohes Level von Angst auslösen. Um die Angst, welche oft mit Schmerz assoziiert ist, zu reduzieren, existieren viele verschiedene Methoden. Ziel: Das Ziel dieser Arbeit ist, herauszufinden, wie die Angst von Kindern bei Venenpunktionen während einer Hospitalisierung gelindert werden kann. Dazu werden pflegerische Massnahmen zur Reduktion von Angst bei Venenpunktionen aufgezeigt und kritisch beurteilt. Methode: Zur Beantwortung der Fragestellung wurde in verschiedenen Datenbanken eine systematisierte Literaturrecherche durchgeführt. Die ausgewählten Studien wurden anhand spezifischer Kriterien auf ihre Güte und Evidenz geprüft und anschliessend diskutiert. Ergebnisse: Aus den eingeschlossenen Studien konnten acht verschiedene effektive Interventionen zur Angstreduktion von zwei- bis zwölfjährigen Kindern im Akutspital gefunden werden. Die Effektivität von einzelnen Interventionen zur Angstreduktion bei Kindern ist in der Forschung umstritten. Schlussfolgerung: Es existieren verschiedene wirksame Interventionen zur Angstreduktion bei Kindern, welche jedoch individuell auf die Kinder abgestimmt werden müssen. Die aktuelle Evidenzlage der Literatur würde von weiterer, qualitativ hochstehender, Forschung profitieren

Minimisation des retards dans le séquencement des véhicules sur une ligne d'assemblage multi modèles

National audienceDans cet article, nous considérons le problème du séquencement sur une ligne d'assemblage à transport continu de véhicules industriels. Pour équilibrer au mieux la charge dynamique, nous proposons de minimiser les retards à l'issue de chaque véhicule. Nous proposons une formalisation par un modèle de type programmation linéaire. Le modèle est testé sur des instances du cas d'étude de l'usine de montage de Renault Trucks à Bourg en Bresse

La rééducation des filles en internat (1945-1965)

Les années d’après-guerre constituent une période déterminante pour le renouvellement des méthodes de prise en charge des mineures délinquantes ou inadaptées placées en institution spécialisées. Le but n’est plus de sanctionner, mais de réellement éduquer ces jeunes filles placées pour des raisons qui relèvent de la transgression de la loi, mais aussi, et surtout, du non-respect des normes sociales, particulièrement celles de genre. Ces critères moraux et sexués impriment leur marque sur l’éducation réalisée en internat comme le révèle une analyse, d’une part, des modèles féminins qui sous-tendent la prise en charge – celui de travailleuse, et, surtout, celui de maîtresse de maison – et, d’autre part, des méthodes spécifiques de la rééducation féminine, telles que la fiction familiale et l’éducation morale, associées à un silence sur le corps et la sexualité.The post-war years were a decisive period in the renewal of methods for dealing with delinquent or maladjusted girls placed in specialized institutions. The purpose was no longer to punish but to educate in earnest these young inmates who had been placed not only for transgressions of the law but also, and above all, for the non respect of social norms, particularly those related to gender. These moral and sex-specific criteria left their mark on the education dispensed in these institutions as can be seen from an analysis of, on the one hand, the feminine models that underpinned this education – the working woman and, above all, the housewife – and, on the other hand, the specific methods of female rehabilitation, such as the fiction of the family and moral education, associated with silence concerning the body and sexuality.Die Betreuungsmethoden für straffällig gewordene oder schwer erziehbare minderjährige Mädchen in eigens dafür geschaffenen Einrichtungen verändern sich in der Nachkriegszeit in bemerkenswerter Weise. Es geht nun nicht mehr allein um Bestrafung, sondern um eine wirkliche Erziehung dieser jungen Mädchen, die aus Gründen, die in den wenigsten Fällen in einer Übertretung von Gesetzen, sondern meist in einer Verletzung sozialer und geschlechtlicher Normen liegen, in staatliche Einrichtungen eingewiesen wurden. Diese moralischen Kriterien normkonformen geschlechtlichen Verhaltens drücken der Internatserziehung ihren Stempel auf, wie der Beitrag durch einen zweifachen Ansatz zu zeigen versucht: zum einen durch eine Analyse der Modelle weiblichen Verhaltens, die in der Internatserziehung vermittelt werden sollen: das Modell der Arbeiterin und, vor allem, das der Hausfrau; zum anderen durch eine Untersuchung der spezifischen Inhalte der Umerziehung von Mädchen, wie die Fiktion der Familie und die Moralerziehung, gepaart mit einer Nichterwähnung von Körperlichkeit und Sexualität.Los años de posguerra constituyen un período determinante para la renovación de los métodos necesarios al hacerse cargo de las menores de edad delincuentes o inadaptadas, colocadas en instituciones especializadas. La finalidad no es castigar, pero realmente educar a estas chicas encerradas por haber transgredido la ley, pero también, y sobre todo por no respetar las normas sociales, particularmente las de género. Estos criterios morales y sexuados imprimen su sello sobre la educación llevada a cabo en internado, como lo revela un análisis, por una parte, de los modelos femeninos sobre los que se apoya esta colocación – el de trabajadora, y, sobre todo, el de ama de casa- y, por otra parte, de los métodos específicos de la reeducación femenina, como la ficción familiar y la educación moral, asociadas a un silencio en lo relativo al cuerpo y a la sexualidad

Glutamatergic synaptic deficits in the prefrontal cortex of the Ts65Dn mouse model for Down syndrome

Down syndrome (DS), the most prevalent cause of intellectual disability, stems from a chromosomal anomaly resulting in an entire or partial extra copy of chromosome 21. This leads to intellectual disability and a range of associated symptoms. While there has been considerable research focused on the Ts65Dn mouse model of DS, particularly in the context of the hippocampus, the synaptic underpinnings of prefrontal cortex (PFC) dysfunction in DS, including deficits in working memory, remain largely uncharted territory. In a previous study featuring mBACtgDyrk1a mice, which manifest overexpression of the Dyrk1a gene, a known candidate gene linked to intellectual disability and microcephaly in DS, we documented adverse effects on spine density, alterations in the molecular composition of synapses, and the presence of synaptic plasticity deficits within the PFC. The current study aimed to enrich our understanding of the roles of different genes in DS by studying Ts65Dn mice, which overexpress several genes including Dyrk1a, to compare with our previous work on mBACtgDyrk1a mice. Through ex-vivo electrophysiological experiments, including patch-clamp and extracellular field potential recordings, we identified alterations in the intrinsic properties of PFC layer V/VI pyramidal neurons in Ts65Dn male mice. Additionally, we observed changes in the synaptic plasticity range. Notably, long-term depression was absent in Ts65Dn mice, while synaptic or pharmacological long-term potentiation remained fully expressed in these mice. These findings provide valuable insights into the intricate synaptic mechanisms contributing to PFC dysfunction in DS, shedding light on potential therapeutic avenues for addressing the neurocognitive symptoms associated with this condition

Total shoulder arthroplasty – Arthroplasty for glenohumeral arthropathies: Results and complications after a minimum follow-up of 8years according to the type of arthroplasty and etiology

SummaryIntroductionArthroplasty for glenohumeral arthropathies have specific complications and the final results are sometimes more dependent upon the type of shoulder arthroplasty than the initial etiology. The aim of our study was to evaluate the rate of complications and the functional improvement with different types of shoulder arthroplasties after a minimum follow-up of 8years.Materials and methodsThis was a multicenter retrospective study of 198 shoulders including 85 primary osteoarthritis of the shoulder, 76 cuff tear arthropathies, 19 avascular necrosis and 18 rheumatoid arthritis. Arthroplasties included 104 anatomic total shoulder arthroplasties (TSA), 77 reverse arthroplasties and 17 hemiarthroplasties. Ten patients had their arthroplasty revised, and 134 patients with TSA were able to be present at the final follow-up or provide information on their case. Function was evaluated by the Constant-Murley score and loosening by standard radiographs.ResultsIn the group with primary osteoarthritis of the shoulder, there were eight complications (11%) including six (8.3%) requiring implant revision. In the group of rotator cuff arthropathies, there were nine (14.7%) complications including four (6.5%) requiring implant revision. In the group with rheumatoid arthritis, there was one complication, and no surgical revision was necessary. There were no complications in the group with avascular necrosis. Glenoid migration occurred in 28.5% of anatomic TSA, and 3.4% of reverse arthroplasties. This difference was significant (P<0.001). The Constant-Murley score was significantly improved in all etiologies.ConclusionsGlenohumeral arthropathies can be successfully treated by arthroplasty. Anatomic TSA was shown to be associated with a high risk of glenoid loosening at radiographic follow-up, which makes us hesitate to use the cemented polyethylene implant, especially in young patients.Level of evidenceIV – Retrospective study

How long should arthroscopic clavicular resection be in acromioclavicular arthropathy? A radiological-clinical study (with computed tomography) of 18 cases at a mean 4 years’ follow-up

AbstractIntroductionEndoscopic clavicular resection is a common procedure, but few studies have analyzed predictive factors for outcome.Hypotheses1) Computed tomography (CT) of clavicular resection is reproductible; 2) Functional outcome correlates with resection length; 3) Other factors also influence outcome.Material and methodsPatients operated on between 2005 and 2010 were called back to establish functional scores (Constant, Simple Shoulder Test [SST], satisfaction) and undergo low-dose bilateral comparative computed tomography (CT) centered on the acromioclavicular joints. The assessment criteria were resection edge parallelism and resection length, measured using OsiriX® software. Radiological and clinical data were correlated.Results18 out of 21 patients (85%: 3 female, 15 male) were assessed. Mean age at surgery was 49 years (range, 40–62 yrs); mean follow-up was 4.2 years (1.6–7.2 yrs). Mean Constant score rose from 57.7 (25–85) to 70.2 (30–96); mean postoperative SST was 9.3 (3–12). 11 patients had very good and 4 poor results. CT resection length was reproducible, with intraclass, intra- and interobserver correlation coefficients >95%. There was no significant correlation between articular resection length on CT and functional scores (P=0.2). Functional scores were negatively influenced by an occupational pathologic context (P<0.01) and by associated tendinopathy.Discussion and conclusionLow-dose CT enabled reproducible analysis of clavicular resection. The hypothesized correlation between resection length and functional result was not confirmed. Work accidents and occupational disease emerged as risk factors.Level of evidenceSingle-center retrospective analytic cohort study. Level 4, guideline grade C

Expression of atrophy mRNA relates to tendon tear size in supraspinatus muscle

Skeletal muscle atrophy and fatty infiltration develop after tendon tearing. The extent of atrophy serves as one prognostic factor for the outcome of surgical repair of rotator cuff tendon tears. We asked whether mRNA of genes involved in regulation of degradative processes leading to muscle atrophy, ie, FOXOs, MSTN, calpains, cathepsins, and transcripts of the ubiquitin-proteasome pathway, are overexpressed in the supraspinatus muscle in patients with and without rotator cuff tears. We evaluated biopsy specimens collected during surgery of 53 consecutive patients with different sizes of rotator cuff tendon tears and six without tears. The levels of corresponding gene transcripts in total RNA extracts were assessed by semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. Supraspinatus muscle atrophy was assessed by MRI. The area of muscle tissue (or atrophy), decreased (increased) with increasing tendon tear size. The transcripts of CAPN1, UBE2B, and UBE3A were upregulated more than twofold in massive rotator cuff tears as opposed to smaller tears or patients without tears. These atrophy gene products may be involved in cellular processes that impair functional recovery of affected muscles after surgical rotator cuff repair. However, the damaging effects of gene products in their respective proteolytic processes on muscle structures and proteins remains to be investigated