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Institute
- Fakultät AuL (102) (remove)
Braune Brühe, was tun?
(2022)
Kotwasser beim Pferd
(2022)
Background
The aim of this qualitative study was to identify a practice level model that could explain a sustained change in nutritional behavior.
Methods
The study used three data inputs from four interviewees, one merged input from a married couple, as narrative interviews. The interviews were analyzed using grounded theory.
Results
Coexistence of a certain suffering and a triggering episode lead to the decision to change nutritional life-style by all interviewed. Maintenance of the self-determined newly learned nutritional behavior was supported by subject-related intrinsic motivation, the ability to reflect, and a low expectation of success from the behavioral change. Environment-related factors were identified as support from life-partner and peers. Subjects reported that the sustained nutritional behavior change impacted their holistic health through subject-perceived improved life quality, increase in the number of social contacts, and a change in personal attitudes and perception. The analysis remains limited, and at best hypothesis generating, in that only three data inputs from four interviewees were used.
Conclusion
In this hypothesis-generating narrative interview study of four study subjects, volition, personal decision making, and long-term motivation (though not external determination) seemed to sustain a change in newly learned nutritional behavior.
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.