Medical Library

[Hospital hygiene - clothing in hospitals: protection for staff and patients]

Hospital clothing worn by medical personnel in German hospitals can be divided into two groups, work clothing and protective clothing. Work clothing is not changed between patient visits and hence is no measure of infection control. Its function is to protect private clothing and to identify medical personnel. Protective clothing on the other hand should protect staff and patients from nosocomial infections. It has to be changed between patient visits and is especially recommended with invasive procedures and immunocompromised patients.

Kerwat K, Wulf H.

Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Giessen und Marburg, Standort Marburg.

[Anesthesia in pulmonary diseases. Prevention of postoperativ pulmonary complications]

Postoperative pulmonary complications (PPC) are considered a main factor increasing postoperative morbidity and mortality. Medical history and clinical examination are highly predictive for the development of PPC. Extended evaluation is indicated in the presence of pulmonary symptoms. Prophylaxis of PPC includes cessation of smoking, antiinfectious measures, optimization of bronchodilator therapy and improvement of cardiac performance. Regional anesthesia is favorable in the presence of bronchial hyperreactivity and for postoperative pain therapy. Postoperative course includes early extubation besides positioning, relief of intrabdominal pressure and physiotherapy.

Pappert D, Thomaschewski S.

Zentrums für Anaesthesiologie, operative Intensivmedizin und OP-Management am Klinikum. dpappert@klinikumevb.de

[Prehospital management of geriatric patients]

The prehospital management of geriatric patients involves an understanding of the physiology of aging and necessitates the special acknowledgement of diagnosis and treatment of emergencies in the elderly. It is essential to keep in mind the prevention of an underestimation of the severity of disease and the necessity of an adequate therapy. The prehospital management of moribund patients gains special importance.

Schmidbauer W, Hasper D, Kerner T.

Bundeswehrkrankenhaus Berlin,Abt. XB/Notfallmedizin. willischmidbauer@bundeswehr.org

[Neurological diseases in pregnancy: implications for anesthesia care - part 2]

In the parturient as well as in the pregnant patient with neurological disease, surgery is necessary more frequently than in healthy pregnants. Most pregnancies of these patients will result in a slightly increased rate for cesarean section. The focus of anesthesia care is mostly to avoid damage to the fetus, in some pathologies to protect the mother. Pregnancy itself may change the course of pre-existent chronic neurological diseases such as epileptic seizure, multiple sclerosis, or myasthenia gravis. Other diseases will have their onset predominantly in pregnancy such as back pain, nerve compression syndromes, some brain tumors or cerebrovascular events. Subarachnoidal hemorrhage and intracranial bleeding contribute to 65 % of maternal mortality. Finally, pregnancy induced conditions such as eclampsia and HELLP syndrome and its management are reviewed where the concerns for the nervous system have high relevance for anesthesiological management. Anesthesia care for the pregnant and the parturient presenting with a neurological disease requires 1.) expertise with neuroanesthesia and obstetric anesthesia care, 2.) accurate physical examination of the neurological system preoperatively, 3.) safe choice and conductance of the anesthesia technique (mostly regional anesthesia) 4.) avoidance of unfavorable drug effects for the fetus and the nervous system of the mother and 5.) intraoperative neuromonitoring together with the control of the fetal heart rate.

Griebe A, Aniset L, Jámbor C, Frietsch T.

Klinik für Anästhesiologieund Operative Intensivmedizin,Universitätsklinikum Mannheim. annette.griebe@anaes.ma.uni-heidelberg.de

[Case report: tachyarrhythmia in the sports stadium - differential diagnosis and therapy]

Preclinical occuring tachyarrhythmias could represent a life-threatening situation. Signs of haemodynamically instability like systolic blood pressure <90mmHg, heart rate >150/min, chest pain, heart failure, and reduced conscious level should rapidly be recognized. Immediately treatment using electrical cardioversion is then indicated. A therapeutic option in patients with haemodynamically stable tachycardia is the application of an antiarrhythmic drug. The following case describes the preclinical treatment of a patient with a haemodynamically unstable reentry-tachycardia. In the after-care clinic an electrophysiological evaluation reveals the existence of a reentry-tachycardia induction and clarifies the pathophysiology. In symptomatic tachycardias, catheter ablation is the method of choice.

Steinmann D, Faber T, Heringhaus C.

Restlessness and psychomotor agitation after kidney transplantation: Their impact on perceived health status.

Restlessness and psychomotor agitation are among the causes of morbidity and mortality in different diseases. They are known problems in end-stage renal disease patients but no study has ever evaluated their presence and effects in kidney recipients. This study aimed to explore the presence of restlessness and psychomotor agitation and their relation with morbidity of patients after renal transplantation. Sixty-one subjects were randomly selected from kidney transplant recipients being followed in Baqiyatallah Hospital, Tehran, Iran. Restlessness and psychomotor agitation were determined by Hospital Anxiety and Depression Scale (HADS). The correlation of these scores with demographic data, clinical data, sexual function, marital adjustment, quality of life, sleep quality and medical comorbidity of patients was evaluated. The scores of restlessness and psychomotor agitation were significantly correlated with the age at transplantation (r = .269, p = .04 and r = .324, p = .01, respectively), the total score of medical comorbidity (r = .273, p = .02 and r = .257, p = .04, respectively), role limitation due to emotional problems (r = -.26, p = .03 and r = -.25, p = .04, respectively) and mental health (r = -.277, p = .02 and r = -.252, p = .04 respectively). There was no correlation between these symptoms and the gender, marital status, and sexual relationship score of the patients (p > .05). Restlessness and psychomotor agitation are frequent and can impose high degrees of morbidity on renal transplant recipients. Proper management of these problems seems to improve the different aspects of quality of life in these patients.

Noohi S, Tavallaii SA, Bazzaz A, Khoddami-Vishte HR, Saadat SH.

Behavioral Sciences Research Center, Health Research Center & Clinical Research Unit, Baqiyatallah Sciences Medical University, Tehran, Islamic Republic of Iran.

Functional outcome following liver transplantation - A pilot study.

Background/aims: We have previously shown that prior to liver transplantation, patients exhibit impairment in memory and psychomotor speed. Despite significant improvement following transplantation, recovery remained incomplete at 1 year post-transplant. This study aimed to investigate the effects of liver transplantation on a wider range of cognitive abilities, and to assess the impact of any impairment upon day-to-day functioning, particularly driving ability. Methods: This study was a between-group design involving three groups of participants: liver transplant candidates, liver transplant recipients and healthy controls. All participants completed measures of affective status, functional capacity, quality of life, neuropsychological status and driving ability. Results: For the majority of measures, healthy controls performed best, followed by liver transplant recipients and then liver transplant candidates, respectively. This pattern was most pronounced with respect to functional limitations, language and attention. No significant difference between the three groups was observed for simulated driving ability. Conclusions: The results suggest that while significant recovery occurs in many areas of psychosocial functioning following liver transplantation, this recovery may be incomplete, that is, many patients do not recover to their full pre-illness status. The measure we employed to assess driving ability was not a sensitive or discriminating measure in this study.

O\’Carroll RE, Turner F, Flatley K, McGregor LM, Hayes PC.

Psychology, Stirling University, Stirling, UK.

Health-related quality of life in chronic fatigue syndrome: Predictors of physical functioning and psychological distress.

This study investigated health-related quality of life (HRQoL; physical functioning and psychological distress) in an Australian chronic fatigue syndrome (CFS) population. The aims of the study were to compare HRQoL in those with CFS to the normal population, and to investigate the extent to which sociodemographic (age, gender, partner status, education), illness-related (illness duration, symptom frequency), and fatigue severity (physical, mental) variables predicted HRQoL. A total of 139 people meeting CFS criteria completed questionnaires. HRQoL was assessed using standardised measures of distress and physical functioning. Compared with norms, those with CFS obtained significantly lower scores on all physical functioning areas, whereas 63% of participants reported clinically significant psychological distress. Hierarchical regression analyses indicated that physical fatigue severity and symptom frequency were the strongest predictors of deficits in physical domain HRQoL. Physical HRQoL outcomes were also predicted by mental fatigue severity, older age, and female gender. All predictors were unrelated to psychological distress apart from weak positive associations with physical fatigue and symptom frequency. Results identify a potent set of predictors of HRQoL and show that CFS has a pervasive negative impact on quality of life, particularly physical and psychological functioning.

Lowry TJ, Pakenham KI.

School of Psychology, University of Queensland.

Confirming preferences or collecting data? Information search strategies and romantic partner selection.

This article investigates two kinds of information search strategies in the context of selecting romantic partners. Confirmatory searching occurs when people ask for more information about a romantic partner in order to validate or confirm their assessment. Balanced searches are characterized by a search for risk information for partners rated as attractive and for attractiveness information about partners rated as risky in order to attain a more complete evaluation. A factorial survey computer program randomly constructed five types of partner descriptions and college-age respondents evaluated nine descriptions in terms of both health risk and romantic attractiveness outcomes. The results show little evidence of balanced search strategies: for all vignette types the respondents searched for attractiveness information. Regression analysis of the search outcomes showed no difference between males and females in the desire for attractiveness or risk information, the amount of additional information desired, or the proportion of descriptions for which more information was desired. However, an attractive physical appearance did increase the amount of additional information desired and the proportion of vignettes for which more information was desired. The results were generally inconsistent with a balanced search hypothesis; a better characterization of the respondents\’ strategy might be \”confirmatory bias.\”

Hennessy MH, Fishbein M, Curtis B, Barrett D.

Public Policy Center, Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Unrealistic optimism and event threat.

Individuals typically exhibit \”unrealistic optimism\” (UO), the belief that they are less likely than the average person to experience a negative event. This may be because, fearing the event, they try to reassure themselves by distorting their reasoning to conclude that they are at comparatively little risk. If this is so, the greater the \”event threat\” (i.e., the more serious the event\’s consequences and/or the greater the likelihood that those consequences will be experienced), the more reassurance should be required, and the greater the UO that should be observed. This prediction was tested in a study in which students (N = 148) were informed about a type of heart disease that could develop in later life due to inadequate diet when young. The risk attributable to diet was stated to be either slight (low-threat condition) or great (high-threat condition). Participants were asked to rate their own risk and that of the average student of developing the disease; question order was counterbalanced. The effects of event threat and question order were found to interact: event threat affected UO in the predicted way, but only when the question about own risk came first. The results are explained in motivational terms. Implications for health education are discussed.

Gold RS.

Deakin University, Victoria, Australia.