First results of a refeeding program in a psychiatric intensive care unit for patients with extreme anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) is associated with a high mortality rate. This study describes a compulsory re-feeding program established in Munich for extremely underweight patients. METHODS: The contract between the patient and the therapeutic team included mandatory inpatient status, establishment of guardianship and compulsory re-feeding with a percutaneous gastric feeding tube, as indicated. The predefined target was a body mass index (BMI) of 17 kg/m(2). Data on the first 68 patients with AN are presented. RESULTS: 65 (95.6%) patients were female and mean age at admission was 26.5 ± 8.5 years. BMI increased from 12.3 ± 1.4 kg/m(2) at admission to 16.7 ± 1.7 kg/m(2) at discharge. Thirty-two (47.1%) patients had the restrictive subtype (ANR) and 36 (52.9%) had the binging and purging subtype (ANBP). Duration of illness before admission (p = .004), days of treatment until discharge (p = .001) and weight increase (p = .02) were significantly different between subgroups in favor of patients with ANR. Also, seasonal differences could be found. Comparison of feeding methods showed that percutaneous tube feeding was superior. Almost half of the patients were treated with psychotropic medication. To date, however, the number of patients included in this program is too small to assess rare complications of this acute treatment program and long term outcomes of AN. CONCLUSIONS: An intensive care program for severely ill AN patients has been successfully established. Besides averting physical harm in the short term, this program was designed to enable these patients to participate in more sophisticated psychotherapeutic programs afterwards. To our knowledge, this is the first such program that regularly uses percutaneous feeding tubes.

S2k-Guideline Developmental Dysplasia of the Hip in the Neonate. / S2k-Leitlinie Hüftdysplasie Teil Säugling.

Hip developmental disorders are the most common musculoskeletal disease in newborns in Central Europe. The definition of hip developmental disorder includes both dysplastic and dislocated joints. In a dysplastic joint, shearing forces induce a growing disorder in the acetabulum. If this growing disorder persists, the femoral head first displaces the acetabular cartilage cranially and finally the femoral head dislocates posteriorly into the gluteal fossa - progressively losing contact to the acetabulum. Therefore nowadays there is general support for the concept of a developmental instead of a congenital dislocation of the hip. From the first day of life, the different stages of hip developmental disorder be exactly classified by an ultrasound examination of the infant hip joint according to Graf. Therefore the Graf hip ultrasound examination has been an integral part of the paediatric guidelines in Germany since 1996. All newborns must receive Graf hip ultrasound screening examination, ideally at the age of 4-5 (maximal 8) weeks as part of the U3 screening examination. Newborns with historical or clinical risk factors must receive an ultrasound examination in the first week of life, additionally to the clinical examination of the hip joints of all newborns according to the second screening examination U2. In the case of pathological results, therapy should be initiated according to measured hip type within one week. Dislocated joints need reduction and as soon as the contact between the femoral head and the acetabulum has been restored, the head should be retained securely within the acetabulum. This phase of retention is followed by the maturation phase for dislocated joints, which is also sufficient therapy for dysplastic joints. In order to avoid femoral head necrosis as an early complication or as a new hip developmental disorder in the course of further growth, the femoral head during the retention phase and the maturation phase should be placed deeply into the socket. This can be achieved by retaining hip flexion of 100-110° with simultaneous hip abduction of 50° to a maximum of 60°.

Compiling video cases to support PD facilitators in noticing productive teacher learning.

BACKGROUND: Research studies on facilitating professional development describe the knowledge and skills facilitators need to effectively attend to teachers' learning processes. In this context, some studies gave rise to the question how to design learning opportunities to prepare facilitators to support teachers' learning during professional development. The approaches share putting mathematics specialized content knowledge, pedagogical content knowledge on the professional development level and facilitation moves in the center. Research findings also highlight the role of video-based learning opportunities to qualify facilitators respectively. In particular, structured approaches that guide facilitators noticing toward advancing teacher learning have to be proven effective. Although research highlights using video-based material as a training tool for facilitators, what exactly the learning opportunities should consist of is up for discussion. In this article, we report on a validation study concerned with designing video cases, taken from a videotaped teacher professional development. We explored how eight experienced facilitators perceived the representativeness and the quality of the video cases for using them in facilitator professional development with respect to specialized content knowledge, pedagogical content knowledge on the professional development level, and facilitation moves. Additionally, we investigated what facilitation moves are noticeable in the video cases, and what noticing prompts can enhance these learning opportunities. RESULTS: Our results indicate that all video cases present vital opportunities to discuss how to support teacher learning in terms of specialized content knowledge, pedagogical content knowledge on the professional development level and facilitation moves. Our analyses provide insights into facilitators thinking processes, thus enriching their ratings by ideas and concerns considering the final implementation of the video cases in facilitator professional development. On the basis of our validation study, we were able to carefully check the learning opportunities that the chosen video cases can provide for facilitator professional development. CONCLUSIONS: This paper provides information on how to design video-based learning opportunities for facilitator professional development. Although our results are of course bound to the six video cases we selected, our approach can be transferred to other contexts. The procedure of compiling the video cases and validating them takes up the most prominent research findings on designing facilitator professional development and pays careful attention to experiences facilitators thinking. We exemplarily show how the empirical evidence can be used to prepare facilitator PD.

High prevalence of amyloid in 150 surgically removed heart valves--a comparison of histological and clinical data reveals a correlation to atheroinflammatory conditions.

INTRODUCTION: The prevalence, pathophysiology, and clinical indicators of valvular amyloid deposition have not been clarified yet. METHODS: One hundred fifty surgically resected heart valve specimens [67.4+/-1.0 years; aortic stenosis (AS), n=100; aortic regurgitation, n=19; mitral stenosis, n=7; mitral regurgitation, n=24] were qualitatively, semiquantitatively, and immunohistochemically analyzed and correlated with clinical data. RESULTS: Amyloid was found in 83/150 specimens with highest prevalence in AS (74/100), intermediate prevalence in mitral stenosis (2/7) and regurgitation (7/24), and lowest prevalence in aortic regurgitation (2/19). Severe and polymorphic amyloid deposits were almost exclusively found in AS (35/100). Filamentous cloudy amyloid patterns occurred with the same frequency in AS (29/100). A combination of both was found only in AS (n=7/100). By immunohistochemistry, none of the most common amyloid proteins was identified except for a weak staining by the apolipoprotein AI antibody, but more intense adjacent to amyloid deposits. Amyloid correlated with valvular thickening (P<.05), hyperlipidemia (P=.07), coronary artery disease (P=.084), and obesity (P=.082). CONCLUSIONS: Localized valvular amyloid is predominantly found in stenotic aortic valves. It appears to depend on atheroinflammatory conditions and high shear-stress hemodynamics. Further studies are needed to identify the underlying protein.