Orale Mukositis bei Patienten unter Tumortherapie

Zusammenfassung: Zu den unerwünschten Nebenwirkungen bestimmter Chemo- und Radiotherapien gehört die orale Mukositis, eine Entzündung der Mundschleimhaut. Da sie die Lebensqualität der Patienten in hohem Maße beeinträchtigen kann, sollten Pflegende der Mundhygiene einen besonders hohen Stellenwert beimessen. In der täglichen Praxis wird die orale Mukositis oft kontrovers diskutiert. In diesem Artikel werden aktuelle theoriebasierte und erfahrungsbasierte Grundlagen und Anleitungen für die Pflege und Behandlung vorgestell

The TASTE Toolset: turning human designed heterogeneous systems into computer built homogeneous software

International audienceThe TASTE tool-set results from spin-off studies of the ASSERT project, which started in 2004 with the objective to propose innovative and pragmatic solutions to develop real-time software. One of the primary targets was satellite flight software, but it appeared quickly that their characteristics were shared among various embedded systems. The solutions that we developed now comprise a process and several tools ; the development process is based on the idea that real-time, embedded systems are heterogeneous by nature and that a unique UML-like language was not helping neither their construction, nor their validation. Rather than inventing yet another "ultimate" language, TASTE makes the link between existing and mature technologies such as Simulink, SDL, ASN.1, C, Ada, and generates complete, homogeneous software-based systems that one can straightforwardly download and execute on a physical target. Our current prototype is moving toward a marketed product, and sequel studies are already in place to support, among others, FPGA systems

Identification et localisation des impacts par analyse inverse - Poutre et plaque

L’estimation des forces d’impact par des mesures directes, pour des structures qui sont dans des conditions réelles d’utilisation, est en pratique très difficile voire même impossible. Pour répondre à ce besoin il est souvent fait recours aux méthodes inverses, qui correspondent à la démarche inverse du problème direct : des réponses mesurées sur une structure donnée sont exploitées pour tenter d’en identifier les causes, qui en sont à l’origine. L'approche conduit à créer des fonctions de transfert entre les points d'impact et de mesure sur la structure que ce soit expérimentalement ou numériquement, à mesurer les réponses, et à reconstruire l’effort par déconvolution du signal. Il est connu que ce type de problème est souvent mal posé, et que les solutions trouvées peuvent ne pas être représentatives du problème réel, du fait de bruits de mesures. Pour obtenir une solution stable avec un sens physique, nous utilisons l’une des méthodes classiques de régularisation, tels que Tikhonov qui semble la plus appropriée. Le problème de caractérisation de l'impact devient plus complexe lorsque le point d’impact est inconnu, par conséquent, nous devons créer les fonctions de transfert entre plusieurs points d'impact et de mesure, et minimiser la fonctionnelle permettant dans un premier temps de localiser l’impact, et dans un second temps d’identifier la force d’impact

Subjective Cognitive Decline in Older Adults: An Overview of Self-Report Measures Used Across 19 International Research Studies

Research increasingly suggests that subjective cognitive decline (SCD) in older adults, in the absence of objective cognitive dysfunction or depression, may be a harbinger of non-normative cognitive decline and eventual progression to dementia. Little is known, however, about the key features of self-report measures currently used to assess SCD. The Subjective Cognitive Decline Initiative (SCD-I) Working Group is an international consortium established to develop a conceptual framework and research criteria for SCD (Jessen et al., 2014, Alzheimers Dement 10, 844-852). In the current study we systematically compared cognitive self-report items used by 19 SCD-I Working Group studies, representing 8 countries and 5 languages. We identified 34 self-report measures comprising 640 cognitive self-report items. There was little overlap among measures- approximately 75% of measures were used by only one study. Wide variation existed in response options and item content. Items pertaining to the memory domain predominated, accounting for about 60% of items surveyed, followed by executive function and attention, with 16% and 11% of the items, respectively. Items relating to memory for the names of people and the placement of common objects were represented on the greatest percentage of measures (56% each). Working group members reported that instrument selection decisions were often based on practical considerations beyond the study of SCD specifically, such as availability and brevity of measures. Results document the heterogeneity of approaches across studies to the emerging construct of SCD. We offer preliminary recommendations for instrument selection and future research directions including identifying items and measure formats associated with important clinical outcome

Hypoglycaemia: A little known effect of Venlafaxine overdose

We report the case of a 39-year-old woman who presented with serotonin syndrome and hypoglycaemia likely due to intoxication with a very high dose of venlafaxine. This case of venlafaxine-associated hypoglycaemia was treated first by glucose perfusion, but despite large doses, hypoglycaemia recurred. Blood glucose normalized after injection of octreotide, eliminating the need for hypertonic glucose. Octreotide has been shown to decrease glucose requirements and the number of hypoglycaemic episodes in patients with sulfonylurea-induced hypoglycaemia but, to our knowledge, its ability to resolve hypoglycaemic episodes due to massive venlafaxine overdose has not yet been described

Balloon catheters versus vaginal prostaglandins for labour induction (CPI Collaborative): an individual participant data meta-analysis of randomised controlled trials

Background: Induction of labour is one of the most common obstetric interventions globally. Balloon catheters and vaginal prostaglandins are widely used to ripen the cervix in labour induction. We aimed to compare the effectiveness and safety profiles of these two induction methods. Methods: We did an individual participant data meta-analysis comparing balloon catheters and vaginal prostaglandins for cervical ripening before labour induction. We systematically identified published and unpublished randomised controlled trials that completed data collection between March 19, 2019, and May 1, 2021, by searching the Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and PubMed. Further trials done before March 19, 2019, were identified through a recent Cochrane review. Data relating to the combined use of the two methods were not included, only data from women with a viable, singleton pregnancy were analysed, and no exclusion was made based on parity or membrane status. We contacted authors of individuals trials and participant-level data were harmonised and recoded according to predefined definitions of variables. Risk of bias was assessed with the ROB2 tool. The primary outcomes were caesarean delivery, indication for caesarean delivery, a composite adverse perinatal outcome, and a composite adverse maternal outcome. We followed the intention-to-treat principle for the main analysis. The primary meta-analysis used two-stage random-effects models and the sensitivity analysis used one-stage mixed models. All models were adjusted for maternal age and parity. This meta-analysis is registered with PROSPERO (CRD42020179924). Findings: Individual participant data were available from 12 studies with a total of 5460 participants. Balloon catheters, compared with vaginal prostaglandins, did not lead to a significantly different rate of caesarean delivery (12 trials, 5414 women; crude incidence 27·0%; adjusted OR [aOR] 1·09, 95% CI 0·95–1·24; I2=0%), caesarean delivery for failure to progress (11 trials, 4601 women; aOR 1·20, 95% CI 0·91–1·58; I2=39%), or caesarean delivery for fetal distress (10 trials, 4441 women; aOR 0·86, 95% CI 0·71–1·04; I2=0%). The composite adverse perinatal outcome was lower in women who were allocated to balloon catheters than in those allocated to vaginal prostaglandins (ten trials, 4452 neonates, crude incidence 13·6%; aOR 0·80, 95% CI 0·70–0·92; I2=0%). There was no significant difference in the composite adverse maternal outcome (ten trials, 4326 women, crude incidence 22·7%; aOR 1·02, 95% CI 0·89–1·18; I2=0%). Interpretation: In induction of labour, balloon catheters and vaginal prostaglandins have comparable caesarean delivery rates and maternal safety profiles, but balloon catheters lead to fewer adverse perinatal events. Funding: Australian National Health and Medical Research Council and Monash Health Emerging Researcher Fellowship

Hippocampal morphology and cognitive functions in community-dwelling older people:the Lothian Birth Cohort 1936

Structural measures of the hippocampus have been linked to a variety of memory processes and also to broader cognitive abilities. Gross volumetry has been widely used, yet the hippocampus has a complex formation, comprising distinct subfields which may be differentially sensitive to the deleterious effects of age, and to different aspects of cognitive performance. However, a comprehensive analysis of multidomain cognitive associations with hippocampal deformations among a large group of cognitively normal older adults is currently lacking. In 654 participants of the Lothian Birth Cohort 1936 (mean age = 72.5, SD = 0.71 years), we examined associations between the morphology of the hippocampus and a variety of memory tests (spatial span, letter-number sequencing, verbal recall, and digit backwards), as well as broader cognitive domains (latent measures of speed, fluid intelligence, and memory). Following correction for age, sex, and vascular risk factors, analysis of memory subtests revealed that only right hippocampal associations in relation to spatial memory survived type 1 error correction in subiculum and in CA1 at the head (β = 0.201, p = 5.843 × 10(−4), outward), and in the ventral tail section of CA1 (β = −0.272, p = 1.347 × 10(−5), inward). With respect to latent measures of cognitive domains, only deformations associated with processing speed survived type 1 error correction in bilateral subiculum (β(absolute) ≤ 0.247, p < 1.369 × 10(−4), outward), bilaterally in the ventral tail section of CA1 (β(absolute) ≤ 0.242, p < 3.451 × 10(−6), inward), and a cluster at the left anterior-to-dorsal region of the head (β = 0.199, p = 5.220 × 10(−6), outward). Overall, our results indicate that a complex pattern of both inward and outward hippocampal deformations are associated with better processing speed and spatial memory in older age, suggesting that complex shape-based hippocampal analyses may provide valuable information beyond gross volumetry