Die Spezialambulanz für Borderline-Störungen an der Universitätsklinik für Psychoanalyse und Psychotherapie

Psychotherapie Forum - In dem Beitrag wird einleitend die Geschichte der Entstehung der Spezialambulanz für Borderline-Störungen an der Universitätsklinik für Psychoanalyse und...     

From clock to functional pacemaker

In mammals, the central pacemaker that coordinates 24‐hr rhythms is located in the suprachiasmatic nucleus (SCN). Individual neurons of the SCN have a molecular basis for rhythm generation and hence, they function as cell autonomous oscillators. Communication and synchronization among these neurons are crucial for obtaining a coherent rhythm at the population level, that can serve as a pace making signal for brain and body. Hence, the ability of single SCN neurons to produce circadian rhythms is equally important as the ability of these neurons to synchronize one another, to obtain a bona fide pacemaker at the SCN tissue level. In this chapter we will discuss the mechanisms underlying synchronization, and plasticity herein, which allows adaptation to changes in day length. Furthermore, we will discuss deterioration in synchronization among SCN neurons in aging, and gain in synchronization by voluntary physical activity or exercise.     

Medical marijuana and workers' compensation claiming

We study the effect of state medical marijuana laws (MMLs) on workers' compensation (WC) claiming among adults. Medical marijuana is plausibly related to WC claiming by allowing improved symptom management, and thus reduced need for the benefit, among injured or ill workers. We use data on claiming drawn from the Annual Social and Economic supplement to the Current Population Survey over the period 1989 to 2012, coupled with a differences‐in‐differences design to provide the first evidence on this relationship. Our estimates show that, post MML, WC claiming declines, both the propensity to claim and the level of income from WC. These findings suggest that medical marijuana can allow workers to better manage symptoms associated with workplace injuries and illnesses and, in turn, reduce need for WC. However, the reductions in WC claiming post MML are very modest in size.     

Low-dose hydrocortisone in patients with COVID-19 and severe hypoxia (COVID STEROID) trial—Protocol and statistical analysis plan

Introduction

Severe acute respiratory syndrome coronavirus-2 has caused a pandemic of coronavirus disease (COVID-19) with many patients developing hypoxic respiratory failure. Corticosteroids reduce the time on mechanical ventilation, length of stay in the intensive care unit and potentially also mortality in similar patient populations. However, corticosteroids have undesirable effects, including longer time to viral clearance. Clinical equipoise on the use of corticosteroids for COVID-19 exists.

Methods

The COVID STEROID trial is an international, randomised, stratified, blinded clinical trial. We will allocate 1000 adult patients with COVID-19 receiving ≥10 L/min of oxygen or on mechanical ventilation to intravenous hydrocortisone 200 mg daily vs placebo (0.9% saline) for 7 days. The primary outcome is days alive without life support (ie mechanical ventilation, circulatory support, and renal replacement therapy) at day 28. Secondary outcomes are serious adverse reactions at day 14; days alive without life support at day 90; days alive and out of hospital at day 90; all-cause mortality at day 28, day 90, and 1 year; and health-related quality of life at 1 year. We will conduct the statistical analyses according to this protocol, including interim analyses for every 250 patients followed for 28 days. The primary outcome will be compared using the Kryger Jensen and Lange test in the intention to treat population and reported as differences in means and medians with 95% confidence intervals.

Discussion

The COVID STEROID trial will provide important evidence to guide the use of corticosteroids in COVID-19 and severe hypoxia.

     

Case Reports of Fatal or Metastasizing Melanoma in Children and Adolescents: A Systematic Analysis of the Literature

Childhood melanoma (ChM) is rare, with clinical and epidemiologic characteristics that differ from those of adult melanomas. The objective of the current study was to systematically identify and analyze case reports and case series of fatal and metastasizing ChM in the medical literature. ChM case reports with a fatal outcome or metastases were identified using a Medline search and subdivided into ChM developing in the absence of a congenital melanocytic nevus (ChM without CMN) and ChM associated with a CMN (ChM with CMN); 258 cases of ChM without CMN (206 cutaneous, 52 noncutaneous) were identified. In cutaneous ChM without CMN with a fatal outcome (n = 155), the mean age at diagnosis was 13.1 years (median 14 yrs). The mean Breslow index in this group was 8.5 mm for children ages 0 to 10 years and 3.7 mm for children ages 11 to 18 years. In ChM with CMN (n = 178; 112 cutaneous, 66 central nervous system [CNS]), the mean age at diagnosis was 5.8 years for cutaneous melanoma (median 3 yrs) and 5.5 years for CMN‐associated CNS melanoma (median 3 yrs). The majority of CMN‐associated cutaneous melanomas developed in small and giant CMN (vs medium and large); 53.9% of CNS melanomas developed in patients with multiple medium CMN. This study represents the largest and most complete synopsis of ChM case reports in the medical literature. Our analysis supports the view that cutaneous ChM without CMN (or associated with smaller CMN) differs in several important aspects from ChM associated with large or giant CMN.     

Identifying a context-effective school hearing screening test: An emic/etic framework

Objective: To identify a context-effective hearing screening test for primary schools in the Western Cape, South Africa using an emic-etic framework for test selection. Design: A sequential mixed methods design was used to: (1) Identify test properties needed to successfully screen hearing in primary school children in the Western Cape, (2) select the hearing screening test most likely to succeed in this context, and (3) assess the use of the test in context. Study sample: Three nurses, two nursing assistants, two paediatric audiologists, and 100 grade-one children participated. Results: Distortion product otoacoustic emissions (DPOAEs) were identified as the test most likely to succeed as a hearing screening test in primary school children in the Western Cape. While school nurses were able to successfully apply OAE testing in this context, its sensitivity to hearing loss in these children was 57.14%. Conclusions: The sensitivity would need to be improved before OAE testing could be used as a context-effective screening test for primary school children in the Western Cape. The study demonstrated the value of collaborative program planning using an emic-etic framework to ensure that screening tests are contextually appropriate.