Epilepsie und dissoziative Anfälle: Kommunikative Besonderheiten und ihre Implikationen für Diagnostik und Therapie

In unserem narrativen Review beschreiben wir die Besonderheiten der Interaktion von Patient:innen mit dissoziativen Anfällen. Wir zeigen, welches Potenzial in der Kenntnis dieser Besonderheiten liegt sowohl für die Differenzialdiagnose von epileptischen und dissoziativen Anfällen als auch für den klinischen Gebrauch. Patient:innen mit epileptischen Anfällen wollen das Gespräch mit der Ärztin/dem Arzt nutzen, um möglichst viel von dem nachvollziehbar zu machen, was mit ihnen im Anfall passiert und wie sie versuchen mit den Anfällen sinnvoll umzugehen. Wir berichten davon, wie sich nach unserer Erfahrung die Kommunikation unterscheidet, wenn wir mit Patient:innen mit dissoziativen Anfällen sprechen: Sie berichten eher ohne Details und ohne das subjektive Erleben des Anfalls zu schildern. In ihren Beschreibungen wird meist deutlich, wie stark sie dem Geschehen ausgeliefert sind. Sie sind eher irritiert von den Nachfragen zum Erleben im Anfall und lenken das Gespräch in andere Richtungen. Damit die Gespräche mit Patient:innen, die von dissoziativen Anfällen betroffen sind, nicht ins Leere laufen, ist es wichtig, diese kommunikativen Besonderheiten zu kennen und Einsicht in ihre Bedeutung für Diagnose und Therapie zu haben. Wir machen konkrete Vorschläge, wie Gesprächsführende mit der eigenen Irritation und mit den Aussagen der Patient:innen so umgehen, dass beide Seiten zu einem tieferen Verständnis der Situation kommen. So kann schon das Erstgespräch den Beginn der therapeutischen Arbeit einleiten. Wenn Kinder und Jugendliche zur Abklärung von Anfallsereignissen vorgestellt werden, so treten die Unterschiede in der Darstellung meist noch deutlicher zutage, da sie weniger Erzählroutine haben und eine meist deutlich kürzere Krankengeschichte

British Society for Immunology & United Kingdom Primary Immunodeficiency Network (UKPIN) consensus guideline for the management of immunoglobulin replacement therapy

Currently there is no guideline to support the use of immunoglobulin replacement therapy (IgRT) in primary and secondary immunodeficiency disorders in UK. The UK Primary Immunodeficiency Network (UK-PIN) and the British Society of Immunology (BSI) joined forces to address this need. Given the paucity of evidence a modified Delphi approach was employed covering statements for the initiation, monitoring, discontinuation of IgRT as well as home therapy programme. A group of 6 consultant immunologists and 3 nurse specialists created the statements, reviewed responses and feedback and agreed on final recommendations. This guideline includes 22 statements for initiation, 22 statements for monitoring, 11 statement for home therapy and 19 statements for discontinuation of IgRT. Further areas of research are proposed to improve future delivery of care

A National Survey of Hereditary Angioedema and Acquired C1 Inhibitor Deficiency in the United Kingdom

Background: Detailed demographic data on people with hereditary angioedema (HAE) and acquired C1 inhibitor deficiency in the United Kingdom are relatively limited. Better demographic data would be beneficial in planning service provision, identifying areas of improvement, and improving care./ Objective: To obtain more accurate data on the demographics of HAE and acquired C1 inhibitor deficiency in the United Kingdom, including treatment modalities and services available to patients./ Methods: A survey was distributed to all centers in the United Kingdom that look after patients with HAE and acquired C1 inhibitor deficiency to collect these data./ Results: The survey identified 1152 patients with HAE-1/2 (58% female and 92% type 1), 22 patients with HAE with normal C1 inhibitor, and 91 patients with acquired C1 inhibitor deficiency. Data were provided by 37 centers across the United Kingdom. This gives a minimum prevalence of 1:59,000 for HAE-1/2 and 1:734,000 for acquired C1 inhibitor deficiency in the United Kingdom. A total of 45% of patients with HAE were on long-term prophylaxis (LTP) with the most used medication being danazol (55% of all patients on LTP). Eighty-two percent of patients with HAE had a home supply of acute treatment with C1 inhibitor or icatibant. A total of 45% of patients had a supply of icatibant and 56% had a supply of C1 inhibitor at home./ Conclusions: Data obtained from the survey provide useful information about the demographics and treatment modalities used in HAE and acquired C1 inhibitor deficiency in the United Kingdom. These data are useful for planning service provision and improving services for these patients

Simultaneous energy and mass calibration of large-radius jets with the ATLAS detector using a deep neural network

The energy and mass measurements of jets are crucial tasks for the Large Hadron Collider experiments. This paper presents a new calibration method to simultaneously calibrate these quantities for large-radius jets measured with the ATLAS detector using a deep neural network (DNN). To address the specificities of the calibration problem, special loss functions and training procedures are employed, and a complex network architecture, which includes feature annotation and residual connection layers, is used. The DNN-based calibration is compared to the standard numerical approach in an extensive series of tests. The DNN approach is found to perform significantly better in almost all of the tests and over most of the relevant kinematic phase space. In particular, it consistently improves the energy and mass resolutions, with a 30% better energy resolution obtained for transverse momenta pT > 500 GeV

Studies of new Higgs boson interactions through nonresonant HH production in the b¯bγγ fnal state in pp collisions at √s = 13 TeV with the ATLAS detector

A search for nonresonant Higgs boson pair production in the b ¯bγγ fnal state is performed using 140 fb−1 of proton-proton collisions at a centre-of-mass energy of 13 TeV recorded by the ATLAS detector at the CERN Large Hadron Collider. This analysis supersedes and expands upon the previous nonresonant ATLAS results in this fnal state based on the same data sample. The analysis strategy is optimised to probe anomalous values not only of the Higgs (H) boson self-coupling modifer κλ but also of the quartic HHV V (V = W, Z) coupling modifer κ2V . No signifcant excess above the expected background from Standard Model processes is observed. An observed upper limit µHH < 4.0 is set at 95% confdence level on the Higgs boson pair production cross-section normalised to its Standard Model prediction. The 95% confdence intervals for the coupling modifers are −1.4 < κλ < 6.9 and −0.5 < κ2V < 2.7, assuming all other Higgs boson couplings except the one under study are fxed to the Standard Model predictions. The results are interpreted in the Standard Model efective feld theory and Higgs efective feld theory frameworks in terms of constraints on the couplings of anomalous Higgs boson (self-)interactions