Erste Erfahrungen und Ergebnisse mit der Einführung eines Patientenüberleitungsbogens

Es wird ein studentisches Forschungsprojekt in Zusammenarbeit zwischen dem Institut für Gesundheits- und Pflegewissenschaft und den BG-Kliniken Bergmannstrost, Halle, Saale, beschrieben, das sich mit der Einführung eines Patientenüberleitungsbogens (PüB) mit dem Ziel der Entwicklung eines Dokumentationsinstruments zur kontinuierlichen Informationsweitergabe an die Pflegenden und andere, an der nachstation?ren Versorgung beteiligten Berufsgruppen unter den Pr?missen eines integrativen, Berufsgruppen übergreifenden Ansatzes befasste. Zugleich sollte mehr Transparenz für Patienten und deren Angeh?rige geschaffen werden. Das methodische Vorgehen war prozessorientiert: in der Identifikationsphase wurden die Ziele des Projekts untersucht, die Konzeptionsphase diente der überprüfung der Praxisrelevanz, des Iststands der Entlassungsmodalit?ten und einer Dokumentenanalyse und daran anschlie?end der Entwicklung eines überleitungsbogens und dessen überarbeitung nach der überprüfung durch Experten. Die Pretestphase beinhaltete 35 unfallchirurgisch versorgten Patienten, die zum Zeitpunkt der Untersuchung ?lter als 64 Jahre waren. Diese wurden telefonisch mittels Interviewleitfaden zur Weitergabe des überleitungsbogens durch die Patienten entsprechend der Zielstellung nachbefragt. Die Ergebnisse beziehen sich neben dem Resultat der Dokumentenanalsye und der Beschreibung der Stichprobe auf die Verwirklichung der definierten Ziele, den integrativen Ansatz, die patientenseitige Akzeptanz im Sinn von Selbstbestimmung, die Qualit?t der Dokumentation und die Einsch?tzung des PüB aus der Sicht der station?r Pflegenden. In dem Patientenüberleitungsbogen ist ein praktikables Instrument zur Informationsweitergabe in der Versorgungskette unter Einbeziehung des Patienten zu sehen; neben der Verbesserung einiger methodischer Aspekte sollten zukünftig Barrieren für die Integration der Berufsgruppen übergreifenden Information analysiert und minimiert werden. Für die spezifischen Vorgaben der gesetzlichen Unfallversicherung in Bezug zu den Behandlungszielen und zur Bemessung des Pflegegelds kann der Bogen nach spezifischer Adaption ein aussagef?higes, spezifisches Dokumentationsinstrument sein.      

Greater variety of fruit served in a four-course snack increases fruit consumption

Greater variety of energy-dense foods increases intake in meals composed of several courses. Little research has examined the effect of variety in low-energy-dense foods (i.e., fruits and vegetables). This study examined the effect of fruit variety on fruit intake during a four-course snack. Twenty unrestrained eaters (50% female, 100% White and Non-Hispanic, aged 26.5±8.1years, with a body mass index [BMI] of 22.9±3.0kg/m) completed two, counter-balanced sessions, VARIETY and NON-VARIETY. In VARIETY, participants received four highly-liked fruits over 4, 7-min courses, while in NON-VARIETY participants received their most highly-liked fruit (fruit 1) for each of the four courses, to consume ad libitum. Intake, grams and energy, in each course was measured. Changes in pleasantness for each of the four fruits, with measures taken prior to course 1 and at the completion of course 4, were calculated. Greater intake (grams and energy) occurred in course 4 in VARIETY as compared to NON-VARIETY. Changes in pleasantness for fruit 1 were significantly different between the sessions, with NON-VARIETY decreasing more so than VARIETY. These results indicate that greater fruit variety increased fruit consumption in the last course, which may be due to differential changes in fruit pleasantness.     

Influence of residual alveolar bone height on osseointegration of implants in the maxilla: a pilot study

Aims/Background: For sinus floor augmentation and simultaneous implant placement, a minimum of 5 mm of residual bone height has been recommended empirically. This study was designed to test this assumption in an experimental animal trial. Material and methods: In eight mini pigs, three premolars and two molars were removed on one side of the maxilla. Three months later, the animals were assigned to four groups of two animals each. A cavity was created at the base of the alveolar process so that the residual bone height was reduced to 2, 4, 6 and 8 mm, respectively. Six implants were installed and an inlay augmentation procedure was carried out using a particulated iliac bone graft. Implants were loaded with fixed provisional restorations after a healing period of 6 months. The animals were sacrificed after 6 months of functional loading. Histologic specimens were prepared and histomorphometric analysis was performed [bone‐to‐implant contact (BIC) ratio, interthread bone area, peri‐implant bone area, crestal bone resorption (CBR)]. Results: Two implants were lost during follow‐up and fibrous encapsulation was detected in one additional implant. All failures occurred in one animal with a residual alveolar height of 2 mm. On the buccal aspect, BIC turned out to be significantly higher for 6 mm when compared with 2/4 mm (75.8 ± 26.1 vs. 58 ± 23.2/53.9 ± 22.8; P<0.05), while on the palatal aspect, BIC was significantly higher for 6/8 mm when compared with 2/4 mm (80 ± 17.8/78.9 ± 10.3 vs. 55.8 ± 26.5/55.6 ± 21.3; P<0.05). For an alveolar height of 8 mm, CBR tended to be significantly lower than for bone heights of 2/4 mm (3.8 ± 2.3 vs. 5.3 ± 2.6/5.8 ± 3.9; P<0.05). Correlation analysis revealed a significant association of BIC and interthread bone area as well as a negative association to CBR on the palatal aspect. Conclusion: The results of the present study show that the combination of maxillary inlay grafting and simultaneous implant placement does not hinder osseous integration even though the alveolar crest has been reduced to a residual height of 4 mm and below. However, according to histomorphometry, the highest predictability is gained in sites with residual bone heights of 6 and 8 mm.     

Prognostic Impact of HIF-1α Expression in Patients with Definitive Radiotherapy for Cervical Cancer

PURPOSE: To investigate the relationship between the hypoxia-inducible factor-(HIF-)1alpha expression in tumor tissue, tumor oxygenation and hemoglobin levels in patients with advanced cervical cancers prior to radiotherapy and the effect on clinical outcome. PATIENTS AND METHODS: The investigation included 44 patients who underwent definitive radiotherapy for advanced cervical cancers between May 1995 and March 1999. Tumor biopsies were taken prior to treatment, and HIF-1alpha expression was determined by immunohistochemistry. In the same tumor area, tumor tissue oxygenation (pO2) was measured using the Eppendorf device. RESULTS: The 5-year cancer-specific survival of all patients was 60%. Twelve of 44 tumor specimens were HIF-1alpha-negative with a significantly better 5-year survival (92 +/- 8%) versus 32 patients who were HIF-1alpha-positive (45 +/- 10%; p < 0.02). There was no correlation between HIF-1alpha expression and tumor oxygenation (p = 0.57 both for pO2 median and hypoxic fraction < 5 mmHg vs. HIF-1alpha expression). However, patients with hemoglobin levels < 11 g/dl showed elevated HIF-1alpha expression compared to patients with hemoglobin levels > 12.5 g/dl (p = 0.04). Furthermore, HIF-1alpha correlated with vascular endothelial growth factor expression (p = 0.002). In a multivariate Cox regression model, HIF-1alpha expression (relative risk [RR] = 7.5; p = 0.05) revealed an increased risk of tumor-related death. CONCLUSION: The study indicates, that endogenous tumor markers such as HIF-1alpha may serve as prognostic markers of clinical outcome concerning cervical cancer after primary radiotherapy.     

Urologic aspects of kidney-pancreas transplantation.

The population of pancreas transplant recipients is growing steadily, and urologists most likely will be confronted with their unique anatomy and metabolic complications. The principles of diagnosis and management of these patients can be applied to other transplant recipients (e.g., heart, lung, and liver) who also are maintained on life-long immunosuppression and in whom urologic pathology develops commensurate with the incidence in the general population.     

Is conceptual priming for environmental sounds obligatory?

Conceptual priming for environmental sounds was examined in two tasks using pairs of a visually presented word (prime stimulus) and an environmental sound (probe stimulus). In the first task (physical task) participants had to indicate to which ear the sound was presented. In the second task (semantic task) participants judged whether word and sound of a pair fitted together. Participants switched between the two tasks randomly, with the color of the word indicating each trial which task was to be performed. An N400-effect for unrelated compared to related sounds was observed in both tasks, although reaction times did not reveal a statistically reliable priming effect. The results show that environmental sounds are processed conceptually even if the task does not require analysis of stimulus meaning.