Peripartale Blutungen,Diagnostik und Therapie

Die Anaesthesiologie - Anhand einer fiktiven Kasuistik wird die aktuelle Leitlinie „Peripartale Blutungen, Diagnostik und Therapie“ mit einem Schwerpunkt auf die anästhesiologische...     

Challenges of adopting the role of care manager when implementing the collaborative care model for people with common mental illnesses: A scoping review

This review aimed to identify the main factors influencing the adoption of the role of care manager (CM) by nurses when implementing the collaborative care model (CCM) for common mental illnesses in primary care settings. A total of 19 studies met the inclusion criteria, reporting on 14 distinct interventions implemented between 2000 and 2017 in five countries. Two categories of factors were identified and described as follows: (i) strategies for the CCM implementation (e.g. initial care management training and supervision by a mental health specialist) and (ii) context‐specific factors (e.g. organizational factors, collaboration with team members, nurses’ care management competency). Identified implementation strategies were mainly aimed towards improving the nurse's care management competency, but their efficacy in developing the set of competencies needed to fulfil a CM role was not well demonstrated. There is a need to better understand the relationship between the nurses’ competencies, the care management activities, the strategies used to implement the CCM and the context‐specific factors. Strategies to optimize the adoption of the CM role should not be solely oriented towards the individual's competency in care management, but also consider other context‐specific factors. The CM also needs a favourable context in order to perform his or her activities with competency.     

Electromagnetic interference caused by common surgical energy-based devices on an implanted cardiac defibrillator

Background

Surgical energy-based devices emit energy, which can interfere with other electronic devices (eg, implanted cardiac pacemakers and/or defibrillators). The purpose of this study was to quantify the amount of unintentional energy (electromagnetic interference [EMI]) transferred to an implanted cardiac defibrillator by common surgical energy-based devices.

Methods

A transvenous cardiac defibrillator was implanted in an anesthetized pig. The primary outcome measure was the average maximum EMI occurring on the implanted cardiac device during activations of multiple different surgical energy-based devices.

Results

The EMI transferred to the implanted cardiac device is as follows: traditional bipolar 30 W .01 ± .004 mV, advanced bipolar .004 ± .003 mV, ultrasonic shears .01 ± .004 mV, monopolar Bovie 30 W coagulation .50 ± .20 mV, monopolar Bovie 30 W blend .92 ± .63 mV, monopolar instrument without dispersive electrode .21 ± .07 mV, plasma energy 3.48 ± .78 mV, and argon beam coagulator 2.58 ± .34 mV.

Conclusion

Surgeons can minimize EMI on implanted cardiac defibrillators by preferentially utilizing bipolar and ultrasonic devices.     

Calcium Influx,But Not Intracellular Calcium Release,Supports PACAP-Mediated ERK Activation in HEK PAC1 Receptor Cells

In HEK cells expressing GFP-tagged PAC1Hop1 receptors, PACAP augments ERK phosphorylation through two parallel pathways: one through PACAP/PAC1 receptor internalization/endosome MEK/ERK signaling and the other through PLC/DAG/PKC activation. We examined whether elevation of intracellular calcium ([Ca²⁺]_i) was required for either of the PACAP/PAC1 receptor-mediated ERK activation mechanisms. The PACAP (25 nM)-induced elevation of [Ca²⁺]_i was greater with cells maintained in Ca²⁺-containing than in Ca²⁺-deficient solution, suggesting that both calcium release from internal stores and calcium influx contributed to the rise in [Ca²⁺]_i. A thapsigargin-induced increase in [Ca²⁺]_i also was greater with calcium in the external solution. OAG, the cell permeable analogue of DAG, increased [Ca²⁺]_i, but only in Ca²⁺-containing solution. Decreasing external calcium or depleting internal calcium stores did not block PACAP-induced PAC1 receptor internalization. Omission of calcium from the external solution, but not thapsigargin pretreatment, significantly blunted PACAP-stimulated ERK phosphorylation. The PKC inhibitor BimI decreased PACAP-mediated ERK activation in both Ca²⁺-containing or Ca²⁺-deficient solutions. In contrast, following Pitstop 2 pretreatment to block endocytic mechanisms, PACAP activated ERK only when calcium was present in the external solution. We conclude that the endosome signaling pathway is largely calcium-independent whereas calcium influx appears necessary for the PLC/DAG/PKC component of PACAP-induced ERK activation.