116 research outputs found
SchmerzbewÀltigung bei TEP-OP Patienten
Abstract
Objectives:
Up to 20% of total knee arthroplasty (TKA) patients remain dissatisfied, with chronic pain as the most frequently named cause. A pilot study was conducted to assess the progress of peri-operative pain intensity after TKA and the parallel development of different psychological factors and coping strategies, as well as correlations indicating potential interrelationships.
Design and Methods:
Prior to TKA surgery, individual psychological experience and pain history, and the presence of chronic pain not concerning the knee (e.g. migraine, back pain) were inquired. Also, progressive changes of pain (11-point numeric rating scale; NRS), psychological impairment ( âquestionnaire to record pain processing and pain impairmentâ, German acronym: FESV BE), and pain coping strategies (âquestionnaire to record pain processing and coping repertoireâ, German acronym: FESV BW) were assessed from 5 days before to 31 days after TKA. After distinguishing participants with pain improvement (group 1) from those without improvement or even aggravation (group 2) a possible contribution of dysfunctional coping strategies to the lack of pain improvement was addressed by comparing the results of the German versions of the âToronto Alexithymia Scaleâ (TAS) and âscreening for somatoform disordersâ(SOMS) questionnaires in group 2 to standard values.
Observations and Results:
Pain intensity in group 1 decreased from significantly higher pre-operative and early post-operative levels to significantly lower long-term post-operative values, whereas group 2 did not show significant changes. Concurrently, the psychological impairment parameter anxiety (AN) significantly decreased and the pain coping parameter relaxation (RE) significantly increased in group 1, but not in group 2. Whereas pre-operative pain was positively and significantly correlated with AN throughout time in group 2, it was negatively correlated with RE at day 36 in group 1. Concerning TAS and SOMS, considerable percentages of the participants in group 2 (37.5% and 68.75%, respectively) showed values > 50 % of those in normal controls.
Conclusions:
Parallel (or anti-parallel) and partially correlated developments of pain improvement and parameters of psychological impairment or coping strategies after TKA suggest a pre-operative screening with tools like the FESV BE and BW or TAS and SOMS questionnaires in order to classify individuals for peri-operative psychological training.Hintergrund und Ziele
Ein hĂ€ufiges Problem der totalen Endoprothesen Operation des Kniegelenkes ist die Tatsache, dass ca. 20 % der Patienten unzufrieden mit dem Operationsergebnis sind, wobei chronische Schmerzen der am hĂ€ufigsten genannte Grund fĂŒr die Unzufriedenheit sind. Um ein besseres VerstĂ€ndnis fĂŒr die psychologischen Faktoren, die das Ergebnis einer TEP Operation beeinflussen, zu bekommen und um die Fragebögen FESV, SOMS und TAS 26 als Screening Werkzeuge zur Identifikation von Risikopatienten zu erproben, wurde diese prospektive Pilotstudie mit 52 Patienten durchgefĂŒhrt.
Methoden (Patienten, Material und Untersuchungsmethoden)
An der Studie nahmen nach Ausschluss von 5 Patienten 52 Patienten teil, bei denen auf Grund von chronischer Kniegelenksarthrose eine TEP Operation durchgefĂŒhrt wurde. Das Durchschnittsalter der Probanden betrug 67,2 Jahre.
Nach Analyse des Verlaufs der SchmerzintensitĂ€t mit Hilfe einer numerischen Ratingskala fĂŒr 36 Tage nach der Operation wurden die Probanden in drei Gruppen eingeteilt: Abnahme der SchmerzintensitĂ€t, Zunahme der SchmerzintensitĂ€t und konstante SchmerzintensitĂ€t. Daraufhin wurden die drei Gruppen bezĂŒglich ihrer psychischen BeeintrĂ€chtigung, ihren BewĂ€ltigungsstrategien, somatoformen Störungen und Alexithymie verglichen. HierfĂŒr wurden die Werte aus dem Fragenbogen zur Erfassung der Schmerzverarbeitung (FESV), dem Screening fĂŒr somatoforme Störungen(SOMS) und der Toronto-Alexithymie-Skala (TAS26) herangezogen.
Ergebnisse und Beobachtungen
Es stellte sich heraus, dass psychologische Faktoren wie Depression, Angst oder Wut entscheidenderen Einfluss auf das Resultat der Operation haben als BewÀltigungsstrategien. Sehr geringe Messwerte von psychologischer BeeintrÀchtigung, Alexithymie und somatoforme Störungen korrelieren am stÀrksten mit schlechteren Behandlungsergebnissen.
Praktische Schlussfolgerungen
Die Ergebnisse der Studie sprechen fĂŒr ein prĂ€operatives Screening auf psychologische BeeintrĂ€chtigung, schwache BewĂ€ltigungsstrategien, somatoforme Störungen und Alexithymie. Dieses Screening kann unter Zuhilfenahme von Fragebögen wie dem FESV, SOMS und TAS 26 durchgefĂŒhrt werden
Full length interleukin 33 aggravates radiation-induced skin reaction
The interleukin (IL)-1 family member IL-33 has been described as intracellular alarmin with broad roles in wound healing, skin inflammation but also autoimmunity. Its dichotomy between full length (fl) IL-33 and the mature (m) form of IL-33 and its release by necrosis is still not fully understood. Here, we compare functional consequences of both forms in the skin in vivo, and therefore generated two lines of transgenic mice which selectively overexpress mmIL-33 and flmIL-33 in basal keratinocytes. Transgene mRNA was expressed at high level in skin of both lines but not in organs due to the specific K14 promoter. We could demonstrate that transgenic overexpression of mmIL-33 in murine keratinocytes leads to a spontaneous skin inflammation as opposed to flmIL-33. K14-mmIL-33 mice synthesize and secrete high amounts of mmIL-33 along with massive cutaneous manifestations, like increased epidermis and dermis thickness, infiltration of mast cells in the epidermis and dermis layers and marked hyperkeratosis. Using skin inflammation models such as IL-23 administration, imiquimod treatment, or mechanical irritation did not lead to exacerbated inflammation in the K14-flmIL-33 strain. As radiation induces a strong dermatitis due to apoptosis and necrosis, we determined the effect of fractionated radiation (12âGy, 4 times). In comparison to wild-type mice, an increase in ear thickness in flmIL-33 transgenic mice was observed 25âdays after irradiation. Macroscopic examination showed more severe skin symptoms in irradiated ears compared to controls. In summary, secreted mmIL-33 itself has a potent capacity in skin inflammation whereas fl IL-33 is limited due to its intracellular retention. During tissue damage, fl IL-33 exacerbated radiation-induced skin reaction
Feasibility of a blended group treatment (bGT) for major depression : uncontrolled interventional study in a university setting
Objective: This study investigated the feasibility of a novel blended (face-to-face and computer-based) group intervention for the reduction of depressive symptoms in major depression.
Design: Patient-centred uncontrolled interventional study.
Setting: University setting in a general community sample. A multimodal recruitment strategy (public health centres and public areas) was applied.
Participants: Based on independent interviews, 26 participants, diagnosed with major depressive disorder (81% female; 23% comorbidity >1 and 23% comorbidity >2), entered treatment.
Intervention: Acceptance and mindfulness based, as well as self-management and resource-oriented psychotherapy principles served as the theoretical basis for the low-threshold intervention. The blended format included face-to-face sessions, complemented with multimedia presentations and a platform featuring videos, online work sheets, an unguided group chat and remote therapistpatient communication.
Main outcome measures: The Center for Epidemiological Studies-Depression scale and the 12-item General Health Questionnaire.
Results: Large to very large within group effect sizes were found on self-reported depression (F(2, 46.37)=25.69, p<0.001; d=1.80), general health (F(2,46.73)=11.47, p<0.001; d=1.32), personal resources (F(2,43.36)=21.17, p<0.001; d=0.90) and mindfulness (F(2,46.22)=9.40, p<0.001; d=1.12) after a follow-up period of 3 months. Treatment satisfaction was high, and 69% ranked computer and multimedia use as a therapeutic factor. Furthermore, participants described treatment intensification as important advantage of the blended format. Half of the patients (48%) would have preferred more time for personal exchange.
Conclusion: The investigated blended group format seems feasible for the reduction of depressive symptoms in major depression. The development of blended interventions can benefit from assuring that highly structured treatments actually meet patients needs. As a next step, the intervention should be tested in comparative trials in routine care.(VLID)249289
Weight statistics controls dynamics in recurrent neural networks
Recurrent neural networks are complex non-linear systems, capable of ongoing activity in the absence of driving inputs. The dynamical properties of these systems, in particular their long-time attractor states, are determined on the microscopic level by the connection strengths wij between the individual neurons. However, little is known to which extent network dynamics is tunable on a more coarse-grained level by the statistical features of the weight matrix. In this work, we investigate the dynamics of recurrent networks of Boltzmann neurons. In particular we study the impact of three statistical parameters: density (the fraction of non-zero connections), balance (the ratio of excitatory to inhibitory connections), and symmetry (the fraction of neuron pairs with wij = wji). By computing a âphase diagramâ of network dynamics, we find that balance is the essential control parameter: Its gradual increase from negative to positive values drives the system from oscillatory behavior into a chaotic regime, and eventually into stationary fixed points. Only directly at the border of the chaotic regime do the neural networks display rich but regular dynamics, thus enabling actual information processing. These results suggest that the brain, too, is fine-tuned to the âedge of chaosâ by assuring a proper balance between excitatory and inhibitory neural connections
Bacterial Growth Kinetics under a Novel Flexible Methacrylate Dressing Serving as a Drug Delivery Vehicle for Antiseptics
A flexible methacrylate powder dressing (AltrazealÂź) transforms into a wound contour conforming matrix once in contact with wound exudate. We hypothesised that it may also serve as a drug delivery vehicle for antiseptics. The antimicrobial efficacy and influence on bacterial growth kinetics in combination with three antiseptics was investigated in an in vitro porcine wound model. Standardized in vitro wounds were contaminated with Staphylococcus aureus (MRSA; ATCC 33591) and divided into six groups: no dressing (negative control), methacrylate dressing alone, and combinations with application of 0.02% Polyhexamethylene Biguanide (PHMB), 0.4% PHMB, 0.1% PHMB + 0.1% betaine, 7.7 mg/mL Povidone-iodine (PVP-iodine), and 0.1% Octenidine-dihydrochloride (OCT) + 2% phenoxyethanol. Bacterial load per gram tissue was measured over five days. The highest reduction was observed with PVP-iodine at 24 h to log10 1.43 cfu/g, followed by OCT at 48 h to log10 2.41 cfu/g. Whilst 0.02% PHMB resulted in a stable bacterial load over 120 h to log10 4.00 cfu/g over 120 h, 0.1% PHMB + 0.1% betaine inhibited growth during the first 48 h, with slightly increasing bacterial numbers up to log10 5.38 cfu/g at 120 h. These results indicate that this flexible methacrylate dressing can be loaded with various antiseptics serving as drug delivery system. Depending on the selected combination, an individually shaped and controlled antibacterial effect may be achieved using the same type of wound dressing
Hold Tight: Identifying Behavioral Patterns During Prolonged Work in VR through Video Analysis
VR devices have recently been actively promoted as tools for knowledge
workers and prior work has demonstrated that VR can support some knowledge
worker tasks. However, only a few studies have explored the effects of
prolonged use of VR such as a study observing 16 participant working in VR and
a physical environment for one work-week each and reporting mainly on
subjective feedback. As a nuanced understanding of participants' behavior in VR
and how it evolves over time is still missing, we report on the results from an
analysis of 559 hours of video material obtained in this prior study. Among
other findings, we report that (1) the frequency of actions related to
adjusting the headset reduced by 46% and the frequency of actions related to
supporting the headset reduced by 42% over the five days; (2) the HMD was
removed 31% less frequently over the five days but for 41% longer periods; (3)
wearing an HMD is disruptive to normal patterns of eating and drinking, but not
to social interactions, such as talking. The combined findings in this work
demonstrate the value of long-term studies of deployed VR systems and can be
used to inform the design of better, more ergonomic VR systems as tools for
knowledge workers
Digitale Heilsversprechen in Gesundheitsberufen
Dieser Beitrag geht der Frage nach, welche Heilsversprechen unter angehenden Gesundheitsfachpersonen bezuÌglich digitaler Medien vorherrschen und wodurch sie bedingt sind. Er stuÌtzt sich auf Daten einer Erhebung unter Bachelor-Studierenden einer Gesundheitshochschule in der Schweiz. Die Resultate zeigen, dass 59 % der Befragten die Vorteile digitaler Medien mit der Erbringung von Gesundheitsleistungen assoziieren und 41 % ihre Vorteile auf Seite der PatientInnen sehen. Aus der statistischen Analyse geht hervor, dass die Studierenden gehobener Herkunft und die Studierenden fruÌher akademisierter Studienrichtungen die Vorteile digitaler Medien wesentlich haÌufiger mit der Dienstleistungserbringung als mit den PatientInnen verbinden. Dies scheint nicht nur anzuzeigen, dass in Gesundheitsberufen ein Zusammenhang zwischen den vorherrschenden sozialen KraÌften und der Assoziation digitaler Medien mit der Dienstleistungserbringung besteht. Es duÌrfte auch darauf hin- weisen, dass die âDigitalisierungâ im Gesundheitssektor die herkunftsbedingte kulturelle Spaltung in Gesundheitsberufen befoÌrdert
NotfĂ€lle in der Augenheilkunde : Vermittlung anhand interaktiver Key-feature-FĂ€lle fĂŒr Medizinstudierende
Hintergrund
Wichtiges Ziel eines Curriculums fĂŒr Medizinstudierende ist, die FĂ€higkeit zum selbststĂ€ndigen Erkennen und Einordnen von NotfĂ€llen zu vermitteln. Die Augenheilkunde steht hierbei aufgrund fachspezifischer âred flagsâ, also Warnsymptomen und -zeichen, vor der Herausforderung, dass solche selten von anderen Organsystemen hierauf ĂŒbertragen werden können. Um Medizinstudierende dabei zu fördern, die âred flagsâ der Augenheilkunde in ihrer spĂ€teren TĂ€tigkeit zu erkennen, entwickelten wir fĂŒr unser eLearning-Angebot leitsymptomorientierte interaktive Fallvignetten.
Material und Methoden
Es wurden 7 interaktive Fallvignetten zu potenziell bedrohlichen ophthalmologischen Symptomen und Zeichen wie âschmerzloser Visusverlustâ oder ârotes Augeâ entwickelt. Hierbei werden Studierende mit Bild und Text durch einen Fall gefĂŒhrt und zu entscheidenden Aspekten (âkey featuresâ) mit verschiedenen Frageformaten geprĂŒft. Die interaktiven FĂ€lle wurden mithilfe von eLearning-Authoring-Software umgesetzt und als Lernmodule in der Learning-Management-PrĂ€senz der Augenklinik integriert. Die PatientenfĂ€lle waren Teil unseres Praktikums der Augenheilkunde. Die FĂ€lle wurden im Anschluss von den Studierenden evaluiert.
Ergebnisse
Die FĂ€lle wurden im Mittel mit einer Note von 1,51âŻÂ±â0,68 (MittelwertâŻÂ±âStandardabweichung) bewertet (nâŻ=â163). Auf einer Likert-Skala wurden sie mit 1,60âŻÂ±â0,81 als hilfreich fĂŒr das eigene Lernen empfunden (1âŻ=âsehr hilfreich, 7âŻ=âgar nicht hilfreich; nâŻ=â164). Die Informationsmenge und Auswahl der Szenarien wurden ebenfalls positiv evaluiert.
Diskussion
Um Studierenden im engen zeitlichen Rahmen eines Kurses mehr Sicherheit im Erkennen und der primÀren Versorgung von augenÀrztlichen NotfÀllen verschaffen zu können, können praxisorientierte Key-feature-FÀlle Bestandteil eines eLearning-Angebotes sein
Umsetzung eines digitalen Semesters Augenheilkunde wÀhrend der COVID-19-Pandemie
Hintergrund
Die erste Welle der COVID-19-Pandemie stellte Lehrende und Studierende vor groĂe Herausforderungen, da die studentische Lehre trotz EinschrĂ€nkung des PrĂ€senzunterrichts stattzufinden hatte. FĂŒr PrĂ€senzunterricht und Veranstaltungen mit Patientenkontakt mussten kurzfristig zwischen Mitte MĂ€rz und Beginn des Semesters im April Alternativen gestaltet werden.
Ziel der Arbeit
Beschreibung von Konzept und Umsetzung der studentischen Lehre an der Augenklinik der UniversitÀtsmedizin Mainz in kompletter digitaler Form im Sommersemester 2020.
Konzeptvorstellung
Vorlesung, Untersuchungskurs und Praktikum der Augenheilkunde finden an der UniversitĂ€tsmedizin Mainz im 5. und 6. Semester im Studiengang Humanmedizin statt. Grundlage der Neukonzeption war der bisherige Kursaufbau. Das umgesetzte Konzept umfasste Vorlesungen als Videopodcasts, Untersuchungsvideos, Online-Untersuchungskonferenzen, leitsymptomorientierte interaktive PatientenfĂ€lle, Operationsvideos, Anamnesevideos von Patienten und die Gestaltung eines âLive-Patientenzimmersâ, in dem PatientenfĂ€lle inklusive Live-Ăbertragung des Spaltlampenbefundes und der Fundoskopie prĂ€sentiert wurden. Die Evaluation durch Studierende zeigte eine sehr gute Annahme des Konzeptes.
Diskussion
Es gelang innerhalb eines Zeitrahmens von 4 Wochen eine vollstĂ€ndige Ăberarbeitung und Digitalisierung des Kurses Augenheilkunde. Der gröĂte Anteil der Neugestaltung beinhaltete die mediale Produktion von Untersuchungsvideos, interaktiven PatientenfĂ€llen und Videopodcasts der Vorlesungen. Diese digitalen Lehrkonzepte können auch in den nĂ€chsten Semestern nach Wiederaufnahme des PrĂ€senzunterrichts genutzt werden und die PrĂ€senzlehre in der Augenheilkunde unterstĂŒtzen.Background
The first wave of the COVID-19 pandemic posed great challenges for teachers and students, as teaching had to take place despite the restriction of classroom teaching. For attendance lessons and events with patient contact alternatives had to be arranged at short notice between mid-March and the beginning of the semester in mid-April.
Objective
Description of the concept and implementation in the student teaching at the Department of Ophthalmology of the University Medical Center Mainz in complete digital form in spring 2020.
Presentation of concept
Lectures, examination course and practical training in ophthalmology take place in the 5th and 6th semester of the study of human medicine. The basis of the new concept were the former course curricula. Implemented concepts included a complete revision and implementation of lectures as video podcasts, examination videos, online examination conferences, interactive patient cases, narrated videos of surgery, anamnesis videos of patients and the design of the virtual patient room, a live online practice with presentation and examination of patients including transmission of the slit-lamp image to reproduce anterior and posterior segment examination. An evaluation showed a very positive reception of the new concept by students.
Discussion
Within a tight timeframe of 4 weeks a complete revision of the ophthalmology course was achieved. The implementation was time-consuming, with the largest share in the media production of examination videos, interactive patient cases and video podcasts of the lectures. We consider a reduction of classroom teaching for parts of the learning objectives that can be represented by such videos to be possibly useful. An independent digital appropriation of such content may enable a more productive learning environment in face-to-face teaching
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