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Background
There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care.
Methods
We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal.
Results
We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)).
Conclusions
We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS.
Background
A pre-existing neurocognitive disorder (NCD) is a relevant factor for the outcome of surgical patients. To improve understanding of these conditions, we investigated the association between parameters of the cholinergic system and NCD.
Method
This investigation is part of the BioCog project (www.biocog.eu), which is a prospective multicenter observational study including patients aged 65 years and older scheduled for elective surgery. Patients with a Mini-Mental State Examination (MMSE) score ≤23 points were excluded. Neurocognitive disorder was assessed according to the fifth Diagnostic and Statistical Manual of Mental Disorders criteria. The basal forebrain cholinergic system volume (BFCSV) was assessed with magnetic resonance imaging, the peripheral cholinesterase (ChE) activities with point-of-care measurements, and anticholinergic load by analyzing the long-term medication with anticholinergic scales (Anticholinergic Drug Scale [ADS], Anticholinergic Risk Scale [ARS], Anticholinergic Cognitive Burden Scale [ACBS]). The associations of BFCSV, ChE activities, and anticholinergic scales with NCD were studied with logistic regression analysis, adjusting for confounding factors.
Results
A total of 797 participants (mean age 72 years, 42% females) were included. One hundred and eleven patients (13.9%) fulfilled criteria for mild NCD and 82 patients (10.3%) for major NCD criteria. We found that AcetylChE activity was associated with major NCD (odds ratio [95% confidence interval]: [U/gHB] 1.061 [1.010, 1.115]), as well as ADS score ([points] 1.353 [1.063, 1.723]) or ARS score, respectively ([points] 1.623 [1.100, 2.397]) with major NCD. However, we found no association between BFCSV or ButyrylChE activity with mild or major NCD.
Conclusions
AcetylChE activity and anticholinergic load were associated with major NCD. Future research should focus on the association of the cholinergic system and the development of postoperative delirium and postoperative NCD.
The effect of pulsed electric field (PEF) and ultrasound (US) on the frying behavior of potato chips was investigated. For this purpose, a special fryer with a window was designed to enable the investigation of water evaporation by the characterization of bubble formation during frying. The number of water vapor bubbles and the bubble volume distribution were analyzed in order to gain an insight into heat and mass transfer affected by PEF and US treatment. Quality parameters of the potato chips such as moisture, fat and acrylamide content were measured. Overall, the results of this study show for the first time impacting effects on the frying process that can be achieved by combining PEF as a volumetric cell disintegration technology and ultrasound as a mean to affect interface phenomena. The obtained results can be used to further optimize frying processes used for the production of chips and other products.
Chlorophyllfluoreszenz als Werkzeug für die DCA-Lagerung von Äpfeln (Malus x domestica BORKH.)
(2024)
Äpfel besitzen mehrere Allergene, die beim Essen innerhalb von 5–10 min zu Symptomen im Mundbereich führen – und deshalb von Apfelallergikern nicht gegessen werden können. In Deutschland haben rund 7,5 Mio. Menschen spezifische Antikörper gegen das Hauptallergen (Mal d 1) in Äpfeln entwickelt und sind damit sensibilisiert. Mindestens 3,5 Mio. von ihnen entwickeln die teilweise erheblichen allergischen Symptome als Ausdruck eines Oralen Allergie-Syndroms. Es gibt bisher keine medikamentöse Therapie gegen diese Allergie.
Apfelallergiker können daher nur auf Äpfel ganz verzichten, oder vorher erhitzte Äpfel essen oder Sorten suchen, die wenig Allergene enthalten und deshalb als allergikerfreundliche Apfelsorten bezeichnet werden können.
Alleinige Bestimmungen von Allergenen im Labor können nicht voraussagen, ob ein Apfel ohne allergische Symptome von Apfelallergikern gegessen werden kann; dazu bedarf es klinischer Prüfungen.
Wir beschreiben eine standardisierte klinische, orale Provokationstestung, die zur Charakterisierung eines allergenarmen, allergikerfreundlichen Apfels bzw. Apfelsorte benutzt werden kann.. Die Ergebnisse solcher mindestens dreijährigen Tests können zur Verleihung des ECARF-Siegels für allergikerfreundliche Produkte genutzt werden.
Currently, only non-imaging chlorophyll fluorescence measurements are used to identify the Lower Oxygen Limit (LOL) in Dynamic Controlled Atmosphere - Chlorophyll Fluorescence (DCA-CF) storage. The disadvantage of non-imaging fluorescence is that no statement can be made about the spatial heterogeneity of the sample. In contrast, chlorophyll fluorescence imaging can detect spatial heterogeneity of photosynthetic activity and has been established in research for some decades because the information benefit is higher. In this study, the chlorophyll fluorescence (Fo, Fm, Fv, Fv/Fm) of apples (Malus x domestica, BORKH.) was measured with a fluorescence imaging system in situ during storage. Intact apples of ‘Braeburn’ and ‘Golden Delicious’ were stored under low-oxygen stress conditions (< 1 kPa). The metabolic shift from aerobic to fermentative metabolism was made visible with the chlorophyll fluorescence imaging and was spatially localized on the sample. Furthermore, a method was developed to identify the LOL based on the chlorophyll fluorescence imaging combined with the histogram division method. This method considers the heterogeneity of the fluorescence and bundles the measured Fo data as histograms. Our results showed that the fluorescence imaging combined with the histogram division method can be a powerful tool for identifying the LOL.
BACKGROUND:
Intraoperative electroencephalography (EEG) signatures related to the development of postoperative delirium (POD) in older patients are frequently studied. However, a broad analysis of the EEG dynamics including preoperative, postinduction, intraoperative and postoperative scenarios and its correlation to POD development is still lacking. We explored the relationship between perioperative EEG spectra-derived parameters and POD development, aiming to ascertain the diagnostic utility of these parameters to detect patients developing POD.
METHODS:
Patients aged ≥65 years undergoing elective surgeries that were expected to last more than 60 minutes were included in this prospective, observational single center study (Biomarker Development for Postoperative Cognitive Impairment [BioCog] study). Frontal EEGs were recorded, starting before induction of anesthesia and lasting until recovery of consciousness. EEG data were analyzed based on raw EEG files and downloaded excel data files. We performed multitaper spectral analyses of relevant EEG epochs and further used multitaper spectral estimate to calculate a corresponding spectral parameter. POD assessments were performed twice daily up to the seventh postoperative day. Our primary aim was to analyze the relation between the perioperative spectral edge frequency (SEF) and the development of POD.
RESULTS:
Of the 237 included patients, 41 (17%) patients developed POD. The preoperative EEG in POD patients was associated with lower values in both SEF (POD 13.1 ± 4.6 Hz versus no postoperative delirium [NoPOD] 17.4 ± 6.9 Hz; P = .002) and corresponding γ-band power (POD −24.33 ± 2.8 dB versus NoPOD −17.9 ± 4.81 dB), as well as reduced postinduction absolute α-band power (POD −7.37 ± 4.52 dB versus NoPOD −5 ± 5.03 dB). The ratio of SEF from the preoperative to postinduction state (SEF ratio) was ~1 in POD patients, whereas NoPOD patients showed a SEF ratio >1, thus indicating a slowing of EEG with loss of unconscious. Preoperative SEF, preoperative γ-band power, and SEF ratio were independently associated with POD (P = .025; odds ratio [OR] = 0.892, 95% confidence interval [CI], 0.808–0.986; P = .029; OR = 0.568, 95% CI, 0.342–0.944; and P = .009; OR = 0.108, 95% CI, 0.021–0.568, respectively).
CONCLUSIONS:
Lower preoperative SEF, absence of slowing in EEG while transitioning from preoperative state to unconscious state, and lower EEG power in relevant frequency bands in both these states are related to POD development. These findings may suggest an underlying pathophysiology and might be used as EEG-based marker for early identification of patients at risk to develop POD.
Durch die Auswirkungen des Klimawandels – besonders durch Hitze – geraten viele indigene Baumarten innerhalb der nächsten 75 Jahre voraussichtlich an den Rand ihrer Existenz. Der Stadtstandort stellt eine zusätzliche Herausforderung dar, der durch menschliche Aktivitäten negativ, aber auch positiv beeinflusst werden kann. Besonders die Wasserverfügbarkeit kann durch geeignete vegetationstechnische Maßnahmen und intelligente Profilierung von Oberflächen befördert werden. Die Vegetation wird sich verändern. Mit gebietseinheimischen Genotypen und natürlicher Migration hitzeverträglicher Arten alleine lassen sich unsere Probleme nicht lösen. Wir brauchen Bäume in der Stadt, die beschatten und verdunsten.
Lösungsansätze sind die vielfältige Anpflanzung hitzeresistenter Genotypen indigener Arten, neuer, submediterraner Arten aus Süd- und Südosteuropa (assisted migration) sowie klimatoleranter Arten anderer Kontinente. Es ist allerdings davon auszugehen, dass sich diese Arten dann bei uns auch etablieren werden. Und das ist bei der durch die Eiszeiten verarmten Gehölzflora Mitteleuropas und für lebenswerte Städte auch gut so!
Aufgrund vermuteter, negativer Folgen, welche von der Etablierung und Ausbreitung gebietsfremder Art ausgehen können, ist um die Verwendung von Zukunftsbäumen im städtischen Raum eine Diskussion entstanden. Im Rahmen einer Forschungsarbeit an der Hochschule Osnabrück wurde daher untersucht, wie die Ausbreitungstendenz einzelner Arten von Mitarbeiter*innen in Grünflächenämtern und Botanischen Garten eingeschätzt wird.
Background: New ischaemic brain lesions on magnetic resonance imaging (MRI) are reported in up to 86% of patients after transcatheter edge-to-edge repair of the mitral valve (TEER-MV). Knowledge of the exact procedural step(s) that carry the highest risk for cerebral embolisation may help to further improve the procedure.
Aims: The aim of this study was to identify the procedural step(s) that are associated with an increased risk of cerebral embolisation during TEER-MV with the MitraClip system. Furthermore, the risk of overt stroke and silent brain ischaemia after TEER-MV was assessed.
Methods: In this prospective, pre-specified observational study, all patients underwent continuous transcranial Doppler examination during TEER-MV to detect microembolic signals (MES). MES were assigned to specific procedural steps: (1) transseptal puncture and placement of the guide, (2) advancing and adjustment of the clip in the left atrium, (3) device interaction with the MV, and (4) removal of the clip delivery system and the guide. Neurological examination using the National Institutes of Health Stroke Scale (NIHSS) and cerebral MRI were performed before and after TEER-MV.
Results: Fifty-four patients were included. The number of MES differed significantly between the procedural steps with the highest numbers observed during device interaction with the MV. Mild neurological deterioration (NIHSS ≤3) occurred in 9/54 patients. New ischaemic lesions were detected in 21/24 patients who underwent MRI. Larger infarct volume was significantly associated with neurological deterioration.
Conclusions: Cerebral embolisation is immanent to TEER-MV and predominantly occurs during device interaction with the MV. Improvements to the procedure may focus on this procedural step.
BACKGROUND: Postoperative delirium (POD) is an acute and common complication after surgery that can increase morbidity and mortality. Few previous studies with inconsistent findings have examined the association of preoperative pain and POD. Our purpose is to investigate the association of preoperative chronic pain and POD.
METHODS: This prospective observational cohort study included 200 patients ≥ 18 years scheduled for elective surgery under general anaesthesia in a tertiary care hospital. POD was defined as meeting diagnostic criteria during the study visits (according to delirium screening tests and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), or by diagnosis of the responsible physicians. Chronic pain was defined as pain lasting six months or longer. Features of chronic pain were assessed with the German Pain Questionnaire, including the Depression Anxiety and Stress Scale-21 (DASS-21). Associations with POD were assessed using logistic regression analysis adjusting for confounding factors.
RESULTS: Thirty-nine (22%) out of 176 patients developed POD. Chronic pain was not associated with POD after adjustment for ASA physical status, duration of anesthesia and DASS-21 Anxiety score (Odds ratio [OR], 95%-Confidence Interval [CI], 2.216 [0.968;5.070], P=0.060). A subgroup analysis of chronic pain patients revealed that current pain intensity was higher in patients with POD.
CONCLUSIONS: Preoperative chronic pain was no independent predictor for POD. Current pain intensity was higher in chronic pain patients with POD. This indicates that certain features of pain might be influential. Further research is needed to examine different forms of preoperative pain and their possible influence on POD.
Trotz wachsender Bedeutung von Talent Management (TM) in Unternehmen gelingt es nicht, der Talentknappheit zu begegnen. Die Corona-Pandemie verschärft die Situation. Denn der bislang nicht ausgeschöpfte Anteil qualifizierter Frauen auf dem Arbeitsmarkt wächst u. a., weil sich anteilig mehr Frauen als Männer zur Erfüllung von Sorgeaufgaben vom Arbeitsmarkt zurückziehen. Gleichzeitig werden Maßnahmen zur Vereinbarung von Berufs- und Privatleben bislang bei der Rekrutierung und Bindung von Talenten nicht oder unzureichend thematisiert. Auf der Basis der wissenschaftlichen Diskussion wird daher die Frage untersucht, inwiefern sich Vereinbarkeitsangebote von Talenten karriereunschädlich nutzen lassen.