Preoperative information for ICU patients to reduce anxiety during and after the ICU-stay: protocol of a randomized controlled trial [NCT00151554]

BACKGROUND: According to current evidence and psychological theorizing proper information giving seems to be a promising way to reduce patient anxiety. In the case of surgical patients, admission to the intensive care unit (ICU) is strongly associated with uncertainty, unpredictability and anxiety for the patient. Thus, ICU specific information could have a high clinical impact. This study investigates the potential benefits of a specifically designed ICU-related information program for patients who undergo elective cardiac, abdominal or thoracic surgery and are scheduled for ICU stay. METHODS/DESIGN: The trial is designed as a prospective randomized controlled trial including an intervention and a control group. The control group receives the standard preparation currently conducted by surgeons and anesthetists. The intervention group additionally receives a standardized information program with specific procedural, sensory and coping information about the ICU. A measurable clinical relevant difference regarding anxiety will be expected after discharge from ICU. Power calculation (α = 0.05; β = 0.20; Δ = 8.50 score points) resulted in a required sample size of N = 120 cardiac surgical patients (n = 60 vs. n = 60). Furthermore, N = 20 abdominal or thoracic surgical patients will be recruited (n = 10 vs. n = 10) to gain insight to a possible generalization to other patient groups. Additionally the moderating effect of specific patient attributes (need for cognition, high trait anxiety) will be investigated to identify certain patient groups which benefit most. DISCUSSION: The proposed study promises to strengthen evidence on effects of a specific, concise information program that addresses the information needs of patients scheduled for ICU stay

The Hunt for New Physics at the Large Hadron Collider

The Large Hadron Collider presents an unprecedented opportunity to probe the realm of new physics in the TeV region and shed light on some of the core unresolved issues of particle physics. These include the nature of electroweak symmetry breaking, the origin of mass, the possible constituent of cold dark matter, new sources of CP violation needed to explain the baryon excess in the universe, the possible existence of extra gauge groups and extra matter, and importantly the path Nature chooses to resolve the hierarchy problem - is it supersymmetry or extra dimensions. Many models of new physics beyond the standard model contain a hidden sector which can be probed at the LHC. Additionally, the LHC will be a top factory and accurate measurements of the properties of the top and its rare decays will provide a window to new physics. Further, the LHC could shed light on the origin of neutralino masses if the new physics associated with their generation lies in the TeV region. Finally, the LHC is also a laboratory to test the hypothesis of TeV scale strings and D-brane models. An overview of these possibilities is presented in the spirit that it will serve as a companion to the Technical Design Reports (TDRs) by the particle detector groups ATLAS and CMS to facilitate the test of the new theoretical ideas at the LHC. Which of these ideas stands the test of the LHC data will govern the course of particle physics in the subsequent decades

Building connectomes using diffusion MRI: why, how and but

Why has diffusion MRI become a principal modality for mapping connectomes in vivo? How do different image acquisition parameters, fiber tracking algorithms and other methodological choices affect connectome estimation? What are the main factors that dictate the success and failure of connectome reconstruction? These are some of the key questions that we aim to address in this review. We provide an overview of the key methods that can be used to estimate the nodes and edges of macroscale connectomes, and we discuss open problems and inherent limitations. We argue that diffusion MRI-based connectome mapping methods are still in their infancy and caution against blind application of deep white matter tractography due to the challenges inherent to connectome reconstruction. We review a number of studies that provide evidence of useful microstructural and network properties that can be extracted in various independent and biologically-relevant contexts. Finally, we highlight some of the key deficiencies of current macroscale connectome mapping methodologies and motivate future developments

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Bedeutung von Octenidol®, Glandomed® und Chlorhexidin-Mundspüllösung in der Prävention von Mukositis und der Reduktion der oropharyngealen Flora: Ergebnisse einer doppelt-verblindeten randomisiert-kontrollierten Studie

Aim: The oropharyngeal flora is of importance for the development of oral mucositis, which is a frequent complication in oncologic practice. It also plays a role in the pathogenesis of ventilator-associated pneumonia. Mucositis is associated with significantly worse clinical and economic outcomes. The aim of our study was to assess the efficacy of Octenidol®, Glandomed® and chlorhexidine mouthwash in the prevention of mucositis and reduction of the oropharyngeal flora.Methods: A prospective, double-blinded RCT including two strata was conducted between October 2008 and November 2010. Stratum i consisted of ventilated cardiothoracic surgical patients. Stratum ii consisted of medical patients with haemato-oncological malignancies requiring stem cell transplantation. The primary outcome measures were development of mucositis regarding to OMAS/WHO score and reduction of the oropharyngeal flora. Results: Both strata showed low OMAS/WHO scores which did not differ significantly between the groups. The overall mean reduction of colony forming units was significantly higher in the Octenidol® group compared to the chlorhexidine and the Glandomed® groups.Conclusions: No significant differences in the development of mucositis were found, thus all solutions proved successful in the prevention of mucositis. However, Octenidol® was superior in the reduction of the oropharyngeal flora. Hence, the preventive effect on nosocomial infections might be higher in patients using Octenidol® rather than chlorhexidine or Glandomed®.Ziel: Die oropharyngeale Flora ist in der Pathogenese der oralen Mukositis und der Beatmungs-assoziierten Pneumonie von großer Wichtigkeit. Die Mukositis als häufige Komplikation bei hämato-onkologischen Patienten, ist assoziiert mit signifikant verschlechtertem klinischen und ökonomischen Outcome. Das Ziel unserer Studie war die Überprüfung der Wirksamkeit von Octenidol®, Glandomed® und Chlorhexidin-Mundspüllösung in Bezug auf die Prävention von Mukositis und die Reduktion der oropharyngealen Flora.Methoden: Eine prospektive, doppelt-verblindete randomisierte Studie von Oktober 2008 bis November 2010 mit zwei Studienarmen. Arm i bestand aus beatmeten kardiochirurgischen Patienten. Arm ii bestand aus hämato-onkologischen Patienten, die eine Stammzelltransplantation erhielten. Primäre Endpunkte waren die Entwicklung von Mukositis nach dem OMAD/WHO Score sowie die Reduktion der oropharyngealen Flora.Ergebnisse: Beide Studienarme zeigten niedrige OMAS/WHO Werte, die sich nicht signifikant unterschieden. Die gemittelte Gesamtreduktion von koloniebildenden Einheiten war signifikant größer in der Octenidol®-Gruppe im Vergleich zur Chlorhexidin- und Glandomed®-Gruppe.Fazit: Es zeigten sich keine signifikanten Unterschiede in Bezug auf die Entwicklung von Mukositis in beiden Studienarmen. Alle Lösungen stellten eine erfolgreiche Präventionsmaßnahme in Bezug auf die Pathogenese von Mukositis dar. Octenidol® zeigte im Vergleich zu Chlorhexidin oder Glandomed® eine stärkere Reduktion der oropharyngealen Flora und könnte sich daher als effektiver in der Prävention nosokomialer Infektionen erweisen

Erhebung des Wissensstands zur bionischen Prothetik der oberen Extremität an deutschen Krankenhäusern - eine multizentrische und multidisziplinäre Untersuchung

Purpose: The development of upper extremity prosthetic replacement has progressed rapidly. These technological advances in bionics provide a reason to reconsider extensive upper limb reconstructive surgery. The purpose was to determine the level of knowledge and awareness among clinicians about important advances in bionic limb replacement. Methods: A multicenter and multi-discipline cross-sectional inquiry was designed to survey clinicians at German university hospitals regarding their knowledge of modern bionic prosthesis. Anonymous questionnaires were collected by email, telephone interview, and from submission within the hospital. The questionnaire was divided into 10 parts consisting of 40 questions. Seven parts queried factual knowledge and three parts queried self-perception of knowledge and awareness of surgical reconstruction for severe hand injuries and outcome of plexus brachialis lesions. Anonymous surveys were circulated to a representative sample of institutional specialists, residents and students in departments for plastic/hand surgery, plastic surgery only, orthopedics and trauma/hand surgery.Results: 105 questionnaires were returned by 30 specialists, 35 residents and 40 students. Specialists in plastic and reconstructive surgery departments with an additional hand surgery focus attained the highest accurate response rate (mean value=67% ± SD 13%). Specialists in other departments as well as residents and students attained lower scores. Additionally, the perception of the outcome of severe hand injuries and plexus brachialis lesions seems not to be satisfying and suggests a need to improve outcomes. Most survey responses indicated an insufficient ability to consult and supervise on patients for supply with bionic prosthesis.Conclusion: Survey findings indicate room for improving the state of knowledge and awareness regarding modern bionic prosthesis, especially among residents and students. In general, there is a perception of insufficient information regarding bionic prosthetic supply after severe hand injuries and unsuccessful reconstruction of plexus brachialis lesions. Modern bionic replacement options could significantly lower financial and social burdens of hand trauma compared to traditional surgeries. The lack of knowledge regarding this option may prevent or slow its implementation at hospitals. It is important to integrate bionic prosthetic supply at specialized centers after exact definition of surgical indication.Einleitung: Die Entwicklung der bionischen Prothetik für die obere Extremität ist in einer stetigen Entwicklung. Diese technologischen Fortschritte sollten neben der chirurgischen Rekonstruktion auch für die Wiederherstellung einer Extremität in Erwägung gezogen werden. Zielsetzung der folgenden Arbeit war es, den Kenntnisstand der Kliniker für wichtige Fortschritte im Bereich der bionischen Prothetik zu ermitteln.Methodik: Im Rahmen einer multizentrischen und interdisziplinären Querschnittsuntersuchung wurden Kliniker an deutschen Universitätskliniken hinsichtlich ihrer Kenntnisse zu moderner bionischer Prothesenversorgung befragt.Eine anonyme Datenerhebung erfolgte mittels Fragebögen per E-Mail, Telefoninterview und innerhalb des Krankenhauses. Der Fragebogen bestand aus 10 Teilen mit insgesamt 40 Fragen. Neben dem Fachwissen im Bereich der bionischen Prothetik wurde die Selbstwahrnehmung des Outcomes nach chirurgischer Rekonstruktion von schweren Handtraumata und nach Läsionen des Plexus brachialis erhoben. Anonyme Befragungen einer repräsentativen Stichprobe von Oberärzten/Fachärzten, Assistenzärzten und Studenten in Abteilungen für Plastische/Handchirurgie, Plastische Chirurgie ohne handchirurgischen Fokus, Orthopädie und Unfallchirurgie/Handchirurgie wurden durchgeführt.Ergebnisse: Wir werteten insgesamt 105 Fragebögen von 30 Oberärzten/Fachärzten, 35 Assistenzärzten und 40 Studenten aus. Fachärzte für Plastische und Ästhetische Chirurgie mit einem zusätzlichen Fokus auf Handchirurgie erreichten die höchste Rate an korrekten Antworten (Mittelwert =67% ± SD 13%). Spezialisten in anderen Abteilungen sowie Assistenzärzte und Studenten erreichten niedrigere Werte. Darüber hinaus scheint die Wahrnehmung des Outcomes von schweren Handverletzungen und Läsionen des Plexus brachialis nicht befriedigend zu sein. Die meisten Umfrageergebnisse deuteten auf eine unzureichende Fähigkeit hin, Patienten zur Versorgung mit bionischen Prothesen zu beraten und zu begleiten.Schlussfolgerung: Die Umfrageergebnisse zeigten, dass es Raum für die Verbesserung des Wissensstandes zu modernen bionischen Prothesen insbesondere bei Assistenzärzten und Studenten gibt. Im Allgemeinen ist der Wissensstand zur Versorgung mit bionischen Prothesen nach schweren Handverletzungen und erfolgloser Rekonstruktion von Läsionen des Plexus brachialis als eher unzureichend einzustufen. Moderne bionische Prothesen könnten in der Zukunft eine Ergänzung oder Alternative zu der herkömmlichen chirurgischen Rekonstruktion sein. Der Mangel an Wissen über diese Option kann die Implementierung in Krankenhäusern verhindern oder verlangsamen. Es ist daher wichtig, die bionische prothetische Versorgung in spezialisierte Zentren zu integrieren