Der Schlaganfall : eine Herausforderung für die klinische Forschung

Hinter dem Begriff "Schlaganfall" verbergen sich verschiedene Krankheitsbilder, die durch gemeinsame Merkmale gekennzeichnet sind: Die Beschwerden treten akut auf, oftmals von einer Sekunde zur anderen. Ein Schlagfall ist darüber hinaus durch das Auftreten von charakteristischen neurologischen Symptomen gekennzeichnet, wie halbseitige Lähmungen, Sprach-, Seh- oder Gefühlsstörungen. Die Ursache hierfür liegt in Veränderungen in den Blutgefäßen des Gehirns, wie die Autoren erläutern

The Impact of Child Welfare Reform on Intake Practice: Social Work by Numbers?

This qualitative study explores the impact of recent changes to child protection in Ontario. The impact of Child Welfare Reform on intake practice was studied via all approach influenced by Grounded Theory. Utilizing interviews of six key informants, this study revealed concern for the implications of the narrow focus on child protection. There seems little faith that these drastic measures that came with Child Welfare Reform will prevent future deaths of children having involvement with a Children's Aid Society. The findings of this study encompass six themes that emerged which support this concern. First, they include the altered context of practice where four supporting components emerged; a political presence, Child Welfare Reform as an unfinished process, a tattered welfare state and a changed institutional psyche. Secondly, the shift in practice theme included components of loss of relationships and the volume of work. Thirdly, a theme regarding social work values included components of the importance of these values and concern for turnover. Fourthly, a theme of strategic organizational playing emerged where a pushing back against bureaucratic expectations was noted. Fifthly, children in care emerged as a theme with components of concern regarding the increase of children in foster care; foster home placement and focus on adoptions. Lastly, a theme regarding service effectiveness emerged where informants could not say with certainty that the changes have resulted in children being better protected. Given that the Child Welfare Reform is built on formulae and benchmarks, this exploratory study concludes that intake practice has changed and that it is largely child protection by numbers with social work happening despite the numbers -- just not to the satisfaction of anyone involved.Master of Social Work (MSW

Meta-analysis of genome-wide association studies from the CHARGE consortium identifies common variants associated with carotid intima media thickness and plaque

Carotid intima media thickness (cIMT) and plaque determined by ultrasonography are established measures of subclinical atherosclerosis that each predicts future cardiovascular disease events. We conducted a meta-analysis of genome-wide association data in 31,211 participants of European ancestry from nine large studies in the setting of the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. We then sought additional evidence to support our findings among 11,273 individuals using data from seven additional studies. In the combined meta-analysis, we identified three genomic regions associated with common carotid intima media thickness and two different regions associated with the presence of carotid plaque (P < 5 × 10 -8). The associated SNPs mapped in or near genes related to cellular signaling, lipid metabolism and blood pressure homeostasis, and two of the regions were associated with coronary artery disease (P < 0.006) in the Coronary Artery Disease Genome-Wide Replication and Meta-Analysis (CARDIoGRAM) consortium. Our findings may provide new insight into pathways leading to subclinical atherosclerosis and subsequent cardiovascular events

Hospital Fall Prevention Using Interactive Patient Care Technology

The impact of patient engagement in hospital fall prevention using interactive patient care technology is not known. The purpose of this investigation was to examine the engagement of hospitalized patients in a computer-based, interactive patient care fall prevention pathway, comprised of a self-assessment of fall risk questionnaire and a fall prevention video, and hospital fall outcomes. The aims were to 1) formulate an interactive patient care technology conceptual framework to guide the study, 2) provide reliability and validity evidence for a patient self-assessment of fall risk questionnaire, and 3) explore the relationship between the fall prevention pathway engagement characteristics and a fall outcome. A conceptual framework for interactive patient care technology was developed and applied to the research investigation. The methodology included a retrospective, cross-sectional design using a convenience sample of 120 subjects to establish preliminary reliability and validity evidence for the patient self- assessment of fall risk questionnaire, and a matched 1:4 case-control design using 73 cases and 292 controls to examine the relationship between the fall prevention pathway engagement characteristics and a fall outcome. Findings indicated the patient self-assessment of fall risk questionnaire is reliable, with a Cronbach\u27s alpha of .73, and valid, with a statistically significant correlation to the nurses fall risk assessment tool, r (118) = .45, p \u3c .001. Using conditional logistic regression, length of stay, number of automatic video prompts, and fall prevention video completion status were significantly associated with a hospital fall. As length of stay increased by one day, the odds of a fall were 11% higher. With each additional automatic video prompt, the odds of a fall increased by a factor of 1.58. Cases were .38 times less likely to complete the fall prevention video than to complete it. Conclusions included an interactive fall prevention pathway promoted engagement and engagement at the empowerment level (video completion) prevented a fall. Limitations of this investigation included the use of secondary data, subject related assumptions, and the inability to generalize due to site, technology, and sample. This investigation contributes new knowledge regarding patient engagement in hospital fall prevention using interactive patient care technology

Sonar as a hybrid technology and its effects on the environment.

3 pages; illustration.Includes bibliographical references

Investigation of protein complexes involved in coenzyme A biosynthesis

Biochemistr

Overview of systematic reviews. Effective home support in dementia care: Components and impacts, Stage 1, psychosocial interventions for dementia.

Aim: To synthesise evidence to identify the components of effective psychosocial interventions in dementia care to inform clinical practice, policy and research. Background: With population ageing dementia represents a significant care challenge with 60% of people with dementia living at home. Design: Overview of systematic reviews with narrative summary. Data sources: Electronic searches of published systematic reviews in English using Cochrane Database of Systematic Reviews, DARE, EPPI-Centre, between September 2013 - April 2014. Review methods: Systematic reviews were appraised against Cochrane Collaboration levels of effectiveness. Components of psychosocial interventions were identified with their theoretical rationale. Findings were explored with a Patient, Public and Carer Involvement group. Results: 36 systematic reviews were included. From interventions, 14 components were identified, nine for people with dementia and five for carers, mostly undertaken in nursing/care homes. For people with dementia, there was evidence of effectiveness for cognitive stimulation and cognitive training; but less evidence for sensory stimulation, reminiscence, staff education, behavioural therapy and ADL training. For carers, there was evidence of effectiveness for education and training, psychotherapy and counselling. Conclusion: There was a lack of definitive evidence of effectiveness for most psychosocial interventions. Further studies with stronger methodology or replication of existing studies would strengthen the evidence base. Few interventions were undertaken with people with dementia and their carers living at home. Further work will investigate the extent to which components identified here are present in models of home support for people with dementia and carers and their effectiveness

Development of a Clinical Reference for Screening and Perioperative Management of Patients With OSA

Obstructive sleep apnea (OSA) is a sleep disorder that affects millions of people in the U.S. with the vast majority of people remaining undiagnosed. Undiagnosed OSA can lead to detrimental health outcomes and significant healthcare costs both in the intraoperative period and beyond. Kaiser Permanente Fontana Medical Center has discovered that intraoperative management of OSA is an area that needs improvement specifically relating to screening and diagnosis of OSA in the perioperative period. The purpose of this project was to develop a clinical reference (CR) based on current evidence and provide education to clinicians on its utilization in practice. The IOWA model was used to carry out this practice improvement project. Due to the COVID-19 pandemic, we were unable to implement and evaluate the project at Kaiser Fontana due to limited resources and the inability to carry out practice change during this time. The plan for implementation, data, analysis, and education pertaining to the OSA CR were established in order to prepare for implementation and evaluation.https://doi.org/10.5281/zenodo.510491