OptiScreen – ein Schulungskonzept für Pflegekräfte zur Durchführung des psychosozialen Distress-Screenings

Hintergrund

Eine angemessene, bedarfsgerechte psychoonkologische Versorgung reduziert Depressivität und Ängste von Krebserkrankten sowie ihren Angehörigen und erhöht die Lebensqualität. Psychisch belastete Krebserkrankte werden jedoch nicht flächendeckend identifiziert, um ihnen psychoonkologische Unterstützung anzubieten. Screeningfragebögen haben sich zur Identifikation bewährt, allerdings bestehen bei der Anwendung im klinischen Alltag Hürden. Pflegekräfte haben durch ihren kontinuierlichen Kontakt zu Patient_innen, die vielfältigen klinischen Eindrücke und ihre Verbindung zu anderen Berufsgruppen eine Schlüsselrolle.

Ziele

Die OptiScreen-Schulung soll Pflegekräfte in der Onkologie zur Durchführung des Distress-Screenings befähigen, entsprechendes Expert_innenwissen vermitteln und Hürden sowie Unsicherheiten im Screeningprozess abbauen, um somit belastete Erkrankte zielgerichtet identifizieren und einer psychoonkologischen Versorgung zuführen zu können.

Das Training

Die OptiScreen-Schulung gliedert sich in drei Module à 1,5–2 h zu den Themen psychische Störungen bei Krebs, psychoonkologische Versorgung, psychische Belastung, Distress-Screening, Kommunikation im Screeningprozess und Psychohygiene (vermittelt durch Vorträge, Videos, Rollenspiele, Übungen).

Ergebnisse und Diskussion

Erste praktische Erfahrungen weisen auf eine erfolgreiche Umsetzung des Schulungskonzepts hin. Weitere Ziele sind es, den Wissenszuwachs und die zunehmende Sicherheit der Pflegekräfte im Screeningprozess zu stärken sowie die Effekte langfristig aufrechtzuerhalten. Zusätzlich soll die Schulung in verschiedenen Settings etabliert und die Auswirkungen der Schulung in Bezug auf die Informiertheit und Zufriedenheit der Patient_innen mit dem Screeningprozess untersucht werden.

[Removal of a bent femoral nail : Case report: treatment strategy of a complex femoral deformity with a bent femoral nail in situ since 36 years]

To remove a bent femoral nail is always a challenging task for a surgeon. In the last 20 years several case reports and descriptions of techniques are to be found in literature, the goal being to weaken the nail at the apex and then straightening it in situ in most cases. Those reports all have one parameter in common: the necessity to remove the nail relates to a refracture of the femur.We report the case of a patient who presented with the explicit wish to have a bent femoral nail removed and a femoral angulation corrected because of pain in the ipsilateral hip. A femoral fracture had been treated by a Küntscher nail in 1982. A refracture with severe bending of the nail had occurred a short time later, which was treated conservatively without a second surgical procedure.We can show that a planned removal of a bent and well-osseointegrated Küntscher nail can be achieved without complications and that thereby a multiplane angulation in the femur can be corrected, paving the way for a future arthroplasty in this specific case.

[Movember health care initiative 2019: prostate cancer screening at the University Hospital Frankfurt]

Hintergrund

Männer in Deutschland sterben früher als Frauen und nehmen weniger häufig Krebsvorsorgeuntersuchungen wahr.

Fragestellung

Ziel war die prospektive Evaluation einer „Movember-Gesundheitsinitiative“ am Universitätsklinikum Frankfurt (UKF) im November 2019.

Methoden

Im Rahmen der „Movember-Gesundheitsinitiative“ wurde allen männlichen Mitarbeitern des UKF ab dem 45. Lebensjahr und bei erstgradiger familiärer Vorbelastung eines Prostatakarzinoms ab dem 40. Lebensjahr im November 2019 gemäß S3-Leitlinien der Deutschen Gesellschaft für Urologie (DGU) eine Prostatakarzinom-Vorsorgeuntersuchung angeboten.

Ergebnisse

Insgesamt nahmen 14,4 % der Mitarbeiter teil. Eine familiäre Vorbelastung gaben insgesamt 14,0 % Teilnehmer an. Das mediane Alter betrug 54 Jahre. Der mediane PSA(prostataspezifisches Antigen)-Wert lag bei 0,9 ng/ml, der mediane PSA-Quotient bei 30 %. Bei 5 % (n = 6) zeigte sich ein suspekter Tastbefund in der DRU (digital-rektale Untersuchung). Nach Altersstratifizierung (≤ 50 vs. > 50 Lebensjahre) zeigten sich signifikante Unterschiede im medianen PSA-Wert (0,7 ng/ml vs. 1,0 ng/ml, p < 0,01) und der bereits zuvor durchgeführten urologischen Vorsorge (12,1 vs. 42,0 %, p < 0,01). Vier Teilnehmer (3,3 %) zeigten erhöhte Gesamt-PSA-Werte. Bei 32,2 % der Teilnehmer zeigte sich mindestens ein kontrollbedürftiger Befund. Insgesamt wurden 6 Prostatabiopsien durchgeführt. Hierbei zeigte sich in einem Fall ein intermediate-risk Prostatakarzinom (Gleason 3 + 4, pT3a, pPn1, pNx, R0).

Schlussfolgerungung

Im Rahmen der UKF-Movember-Gesundheitsinitiative 2019 konnten durch ein Vorsorgeangebot 121 Männer für eine Prostatakrebs-Vorsorge inklusive PSA-Testung gewonnen werden. Auffällige/kontrollbedürftige Befunde zeigten sich bei 32,2 %. Bei einem Mitarbeiter wurde ein therapiebedürftiges Prostatakarzinom entdeckt und therapiert.

MED13L-related intellectual disability: involvement of missense variants and delineation of the phenotype

Molecular anomalies in MED13L, leading to haploinsufficiency, have been reported in patients with moderate to severe intellectual disability (ID) and distinct facial features, with or without congenital heart defects. Phenotype of the patients was referred to "MED13L haploinsufficiency syndrome." Missense variants in MED13L were already previously described to cause the MED13L-related syndrome, but only in a limited number of patients. Here we report 36 patients with MED13L molecular anomaly, recruited through an international collaboration between centers of expertise for developmental anomalies. All patients presented with intellectual disability and severe language impairment. Hypotonia, ataxia, and recognizable facial gestalt were frequent findings, but not congenital heart defects. We identified seven de novo missense variations, in addition to protein-truncating variants and intragenic deletions. Missense variants clustered in two mutation hot-spots, i.e., exons 15-17 and 25-31. We found that patients carrying missense mutations had more frequently epilepsy and showed a more severe phenotype. This study ascertains missense variations in MED13L as a cause for MED13L-related intellectual disability and improves the clinical delineation of the condition.

Social Discrimination and Tolerance in Intergroup Relations: Reactions to Intergroup Difference

In this article, we present a theoretical approach to social discrimination on the one hand and intergroup relations characterized by tolerance and plurality on the other hand. Central to the analysis is the question of how members deal with intergroup difference. If the outgroup's difference is judged to be nonnormative and inferior, devaluation, discrimination, and hostility are likely responses toward the outgroup. Judging the outgroup's difference to be normative or positive leads to acceptance and appreciation of this group. Following self-categorization theory, the criteria—being norms and values for judging intergroup differences—are derived from the superordinate category that is perceived to include both groups. More specifically, they are derived from the prototype, or representation, of this inclusive category. Social discrimination results from the generalization of ingroup attributes to the inclusive category, which then become criteria for judging the outgroup. Tolerance, on the other hand, is conceptualized as either a lack of inclusion of both groups in a higher order category or as the representation of the inclusive category in such a way as to also include the other group and designate it as normative.

Exciton dynamics in perturbed vibronic molecular aggregates

A site specific perturbation of a photo-excited molecular aggregate can lead to a localization of excitonic energy. We investigate this localization dynamics for laser-prepared excited states. Changing the parameters of the electric field significantly influences the exciton localization which offers the possibility for a selective control of this process. This is demonstrated for aggregates possessing a single vibrational degree of freedom per monomer unit. It is shown that the effects identified for the molecular dimer can be generalized to larger aggregates with a high density of vibronic states.

[Trabeculotomy Combined with Cataract Surgery in Glaucoma: Outcome in a Rural Setting]

Purpose: Intensive postoperative care is essential for the outcome of trabeculectomy. However, in a rural setting, repeated visits to the operating theatre are often not requested or possible. The objective of this study was to examine the outcome of trabeculotomy combined with cataract surgery in patients with glaucoma. Patients and Methods: 142 patients with glaucoma and cataract were included in a retrospective clinical study. All patients were operated on from November 2005 to December 2008 by a single surgeon and with a minimum follow-up of 2 months. Intraocular pressure (IOP), number of antiglaucomatous medications and surgical success rate were assessed at 2 months and at the longest follow-up (at least 1 year). Results: IOP was significantly reduced from 24.1 ± 8.3 mmHg preoperatively to 14.9 ± 3.3 mmHg at 2 months (p < 0.0001) and to 15.1 ± 3 mmHg at the longest follow-up (3.71 ± 1.5 years). The number of IOP-lowering medications was lowered from 1.35 ± 1 preoperatively to 0.73 ± 1 at the longest follow-up. Complete surgical success (no IOP-lowering medications, longest follow-up) was achieved in 51.3 % (IOP < 22 mmHg) and 47.5 % (IOP < 19 mmHg) of patients, respectively. Conclusions: Trabeculotomy combined with cataract surgery is a safe and effective surgical option to treat combined cataract and glaucoma without the need of intensified postoperative treatment.

Toward anticancer gold-based compounds targeting PARP-1: a new case study

A new gold(iii) complex bearing a 2-((2,2′-bipyridin)-5-yl)-1H-benzimidazol-4-carboxamide ligand has been synthesized and characterized for its biological properties in vitro.

Which colours are seen by the patient during cataract surgery? Results of an intraoperative interview

PURPOSE

To discover what cataract patients see during phacoemulsification and if these light phenomena influence their anxiety levels during surgery.

METHODS

In all, 200 patients were interviewed intraoperatively at the Eye Hospital, Petrisberg, Trier, Germany. The quality of the visual experiences was described and if these were pleasant, neutral or unpleasant. Systemic sedation was noted.

RESULTS

Among 200 patients (209 eyes): 88 were men (91 eyes; 44%) and 112 were women (118 eyes; 56%). Median age (years): men (71), women (70). Mean operating time was 8 min. 49/209 (23%) were not anxious before and during surgery. 110/209 (52%) were more anxious before than during surgery, 50/209 (24%) were still anxious during surgery, 27/209 (13%) got sedation with midazolam (1-5 mg). Colours in descending order seen: blue, red, pink, yellow, green, purple, turquois, and orange. The most dominant colour combination was red/blue. Structures were seen by 162/209 (78%). Most (61%) intraoperative visual experiences were pleasant, 38% were neutral, and 1% found them transiently unpleasant. Three patients felt blinded by the light of the operating microscope.

CONCLUSIONS

The experience of colours and other light phenomena was pleasant for most patients during phacoemulsification under topical anaesthesia. They occur spontaneously when the patient is fixating on the operating light. They are not dependent on the individual or environment. Sedation only in 13%. Direct questioning for visual sensations by the operating surgeon may lead to less need for sedation and lead to less side effects for elderly and multimorbidity people postoperatively. The surgeon can use this knowledge to reassure patients during surgery.

Emergence of Chaotic Scattering in Ultracold Er and Dy

We show that for ultracold magnetic lanthanide atoms chaotic scattering emerges due to a combination of anisotropic interaction potentials and Zeeman coupling under an external magnetic field. This scattering is studied in a collaborative experimental and theoretical effort for both dysprosium and erbium. We present extensive atom-loss measurements of their dense magnetic Feshbach-resonance spectra, analyze their statistical properties, and compare to predictions from a random-matrix-theory-inspired model. Furthermore, theoretical coupled-channels simulations of the anisotropic molecular Hamiltonian at zero magnetic field show that weakly bound, near threshold diatomic levels form overlapping, uncoupled chaotic series that when combined are randomly distributed. The Zeeman interaction shifts and couples these levels, leading to a Feshbach spectrum of zero-energy bound states with nearest-neighbor spacings that changes from randomly to chaotically distributed for increasing magnetic field. Finally, we show that the extreme temperature sensitivity of a small, but sizable fraction of the resonances in the Dy and Er atom-loss spectra is due to resonant nonzero partial-wave collisions. Our threshold analysis for these resonances indicates a large collision-energy dependence of the three-body recombination rate.

[The Influence of Intravitreal Injections on Outpatient Cataract Operations in Germany]

PURPOSE

The number of outpatient operations in Germany is not registered in a centralised manner. To estimate the development of the outpatient intraocular surgery especially since the implementation of the intravitreal injections, surveys among ophthalmic surgeons were analysed.

METHODS

Between 2006 and 2013 surveys were done among ophthalmic surgeons in Germany using questionnaires. An average of 318 completed questionnaires were sent back. The mean participation ratio was 37 %.

RESULTS

Between 2006 and 2013 an extrapolated mean of 347 564 cataract operations and 139 946 intravitreal injections were reported. Whereas the number of cataract operations was constant in the observation period, the number of injections increased considerably from 35 135 in 2006 to 274 714 in 2013.

CONCLUSION

A saturation in the development of the numbers of the intravitreal injections could not yet be observed. Other outpatient operations, especially cataract procedures were not replaced by the increase of the injections in the recent years.

[Systematic analysis of the annual quality reports of the Federal Joint Committee with regard to cataract surgery]

BACKGROUND

Cataract is one of the most common diseases in ophthalmology. Up to now the only way to estimate the total number of carried out surgeries in Germany were the surveys done by DOG, BVA, DGII and BDOC or reports of the federal statistical office.

OBJECTIVES

Objective of this paper is to evaluate the annual quality reports of the Federal Joint Committee with a view to how the hospitals are participating in the nationwide comprehensive coverage concerning cataract surgery and if there is a continuing trend to more outpatient cataract surgeries in German eye hospitals.

MATERIAL AND METHODS

The number of outpatient and inpatient cataract surgeries included in the annual quality reports of 2006, 2008 and 2010 were put into relation with population density for every provincial state.

RESULTS

In 2006, 2008 and 2010 a total of 765,179 cataract surgeries were recorded. Median number of cataract surgeries per 1000 inhabitants showed an only slight increase (2006: 2.8; 2008 and 2010: 3.0; p = 0.82). The ratio of outpatient to inpatient surgeries showed only a slight increase from 0.84 (2006) to 0.86 (2010).

CONCLUSIONS

Lack of spatial and temporal variations imply that hospitals take a part in supplying the population with cataract surgery. There is no trend to more outpatient cataract surgeries at the moment. This implies that there might be a stable patient population that is not suitable for outpatient care.

[Visual experiences during cataract surgery under topical anesthesia]

BACKGROUND

Cataract patients observe structures, colors and movements during surgery. Is there any pattern to their visual experiences?

METHODS

From 2005 to 2011 a total of 20,000 phacoemulsification procedures were performed using topical anesthesia. From these patients we received 45 pictures which had been painted to reflect intraoperative their visual impressions so that approximately 1 out of 500 of the patients painted a picture. A further 98 patients were questioned postoperatively about their intraoperative visual impressions and were shown the 45 pictures. They described their own visual experiences and any similarities with the 45 pictures were documented.

RESULTS

All patients were awake and cooperative during surgery. Afterwards they described their visual experiences whereby 36 patients saw mainly blue, 32 red/pink and 27 saw yellow colors. Out of the 45 pictures 30 (67%) were identified as being similar to their own visual images and 10 patients could not describe any postoperative visual phenomena.

CONCLUSION

Patients notice optical phenomena during cataract surgery under topical anesthesia with eye drops. Visual images are often similar among patients. The surgeon can use this knowledge to explain these experiences while talking to the patient intraoperatively. This may reassure patients during surgery.

Stabilität des Ferricinium-Kations und seine cytostatische Wirkung / Stability of Ferricinium and its Cytostatic Effect

The relative stabilities of different ferricinium cations were studied in buffer or serum-containing solution and in vivo and compared with their cytostatic effects in cultures of Yoshida ascites tumor cells.

Although the ferricinium cation itself was the most unstable cation compared with the dimethyl-ferricinium cation and the deuterated ferricinium derivatives it showed the highest cytostatic effect.

Markierung kohleadsorbierter Verbindungen mit Tritium nach Wilzbach bei 20°C und —196°C

Bei der Markierung nach Wilzbach lassen sich die spezifischen Aktivitäten der 3H-markierten Verbindungen erhöhen, wenn man Tritium auf aktivkohle-adsorbierte Verbindungen einwirken läßt. Arbeitet man bei Temperaturen um - 200 °C, so wird auch das Tritium quantitativ an die Kohle adsorbiert und die spezifischen Aktivitäten werden dadurch abermals erhöht. Gleichzeitig wird bei den adsorbierten Verbindungen der Anteil an radioaktiven Nebenprodukten oft erniedrigt und damit die Reinigung der markierten Verbindungen erleichtert.

Toxizität und cytostatische Wirkung von PtCl2(NH3)2 nach i. v. und intratumoraler Injektion / Toxicity and Cytostatic Effect of PtCl2(NH3)2 after i. v. and i. t. Injection

oxizität und cytostatisch e W irkung von PtCl2(NH3)2 nach i. v. und intratumoraler Injektion Toxicity and Cytostatic Effect of PtCl2(NH3)2 after i. v. and i. t. Injection In tumor bearing mice intratumoral injection of PtCl2(NH3)2-solution increases the cytostatic effect while decreasing its toxicity in comparison to i. v. injection. In­ tratumoral injections of water-in-oil emulsions of the platin-compound are less cytostatic but have a consider­ ably lower toxicity.

Biochemie der Metallocene, II Organ-Verteilung und Thymus-Anreicherung von [103Ru]Cinnamoyl-ruthenocen / Biochemistry of Metallocenes, II. Organ-Distribution and Thymus Affinity of Cinnamoyl-[103Ru] Ruthenocene

Metallocenes, labelled with 103Ru, are potential radiopharmaceuticals for use in nuclear medicine diagnosis. Ruthenocene derivatives with oxopropene side-chains were administered to mice and rats to study their biochemical properties. Excretion rates and organ distributions of 103RuCl3 and Cinnamoyl-[103Ru] ruthenocene were very different. While 103RuCl3 was relatively evenly distributed in the body, the metallocene derivative was concentrated in liver, lungs and spleen after intravenous (i.v.) injection. After i.p. injection however a high thymus affinity was observed and autoradiography proved that the site of 103Ru accumulation was in thymocytes. The thymus affinity can be diminished by corticoid pretreatment and raised by inhibition of phagocytosis (BeSO4). The mechanism of accumulation in the thymus and a possible clinical application are discussed.

Der protektive Effekt von D2O bei Bakterien (E. coli) / he Protective Effect of Heavy Water (D2O) on Bacteria (E. coli)

E. coli suspended in D2O showed a better survival than in H2O when the bacteria were treated with various damaging agents like UV , heat and freezing. On the contrary E. coli grown in D2O - containing media - therefore being fully deuterated - were more sensitive than normally grown bacteria.

Einbauhemmung 14C-markierter Nucleoside in DNS und RNS von Ascites-Tumorzellen durch D-und L-Glycerinaldehyd

D-Glycerinaldehyd [10-2-m.] hemmt den Einbau von 14C-Thymidin in DNS von Asciteszellen unter aeroben und anaeroben Bedingungen um 80 bis 90 Prozent. Der Einbau von 14C-Uridin in RNS wird durch D-Glycerinaldehyd kaum gehemmt. L-Glycerinaldehyd [10-2-m.] hemmt den Thymidineinbau in DNS und den Uridineinbau in RNS und DNS unter aeroben Bedingungen nur schwach, bei Anaerobiose dagegen um zwei Zehnerpotenzen. Die Wirkung des D-Aldehyds auf den Thymidineinbau in DNS wird durch Auswaschen des Glycerinaldehyds kaum abgeschwächt.

Verfolgung der in vivo-Oxydation von 17-Hydroxy- zu 17-Ketosteroiden durch Messen der Tritium-Aktivität im Körperwasser

Östradiol-17 α-T wird durch die 17-Hydroxy-Steroid-Dehydrogenase, mit DPN oder TPN als Coenzym, zu Östron oxydiert. Dabei entstehen DPN-T bzw. TPN-T, die das Tritium in die Atmungskette einschleusen. Das gebildete Tritiumwasser erscheint im Harn und in der Atemluft und wird bei Kleintieren (Ratte, Maus) unmittelbar gemessen. Der Gehalt an Tritium in der Atemluft bzw. im Harn ist somit ein Maß für die Reaktionsgeschwindigkeit Östradiol-17 α-T → Östron.

Es wurde gefunden, daß Rattenweibchen, ohne und nach Progesterongabe, Tritium gleich schnell aus dem Östradiol-17 α-T umsetzen und nach 7—9 Stdn. etwa 80% ins Körperwasser überführen.

Östradiol-6.7-T gibt dagegen kein Tritium ins Körperwasser ab.

[Characteristics of several humidifiers for CPAP-therapy, invasive and non-invasive ventilation and oxygen therapy under standardised climatic conditions in a climatic chamber]

INTRODUCTION

Patients receiving mechanical ventilation and oxygen therapy frequently complain about the dryness of their airways. Humidifiers increase air humidity by generating water vapour and thus preventing the mucosa from desiccation. In this bench study, we compared the efficiency of several humidifiers.

METHODS

Two identical humidifiers of each type (HC 602, HumiCare 200, Humid Aire 2i, minni-Max, MR 730 AGM, REMstar, Sirius, Somnia2, Somno Comfort2, VENTIclick, VIVO 30) were measured at three different heating intensities (low, medium, high) and three different flow rates (20, 55 and 90 l/min). The relative humidity at the exit of the tube and the temperature of the water in the heating chamber were registered. Additionally, we measured the humidity of the oxygen humidifier Respiflo at 1 - 5 l/min, the Respiflo was filled with either NaCl 0.9% or Aqua dest. Measurements were taken in a climatic chamber at 20 degrees C and 50% relative humidity. The atmospheric pressure was taken into consideration.

RESULTS

The MR 730 AGM and Humicare 200 generated a constant relative humidity of 100%. Among the remaining humidifiers, only the HC 602, HumidAire 2i and REMstar reached a humidity of about 95% at high flow rates. The Minni-Max, Somnia2 and VIVO 30 generated a humidity of 95% still at a flow rate of 55 l/min. The Sirius, Somno Comfort2 and the VENTIclick generated this amount of humidity only at low flow rates of 20 l/min. The three humidifiers mentioned last generated a relative humidity of only 68 - 76 at high flow rates of 90 l/min. The Respiflo generates a humidity of about 90% at each flow rate (1 - 5 l/min.), independent of being filled with NaCl 0.9% or Aqua dest.

CONCLUSION

Factors determinating the efficacy of humidifiers are the velocity of the airstream, the temperature of the water, the contact surface of the air and water compartments and the turbulence of the airstream. In vivo the amount of leakage is a very important determinant for the velocity of the airstream. In the care of mechanically ventilated patients one should have an approximate idea of the magnitude of the applied air flows. The limitations of some humidifiers should be known. The simple presence of a humidifier in combination with a respirator does not mean that the problem of dryness of the airway mucosa is eliminated.

Telemetric implantable pressure sensor for short- and long-term monitoring of intracranial pressure

Patients with hydrocephalus, idiopathic intracranial hypertension and head injury frequently require monitoring of intracranial pressure (ICP) and may need repeated episodes of monitoring months or years apart. The gold standard for measurement of ICP remains the external ventricular catheter. This is a fluid-filled catheter transducer system that allows regular recalibration and correction of zero drift by its position relative to a fixed anatomical reference. It also allows drainage of cerebrospinal fluid (CSF), providing a means of lowering the ICP. Several catheter tip transducer systems are currently in clinical use, including using strain gauges or fiber-optical pressure sensing techniques. In these devices, zero drift and calibration cannot be checked in vivo. All the ICP monitoring devices in current clinical use require a physical connection between the brain and the external environment. This is a source of infection and limits the duration of monitoring. A number of telemetric monitoring devices, in which data is in some way transmitted transcutaneously, have been developed over the last twenty years, but significant technical problems have precluded their use in routine clinical practice. All current ICP monitors are temporary percutaneous implanted devices. Placement of these devices carries significant morbidity, particularly infection. Patients undergoing repeated monitoring require multiple surgical procedures. Apart from decreasing the risk of infection in patients with severe head injury, the clinical value of an accurate telemetric ICP monitoring system which maintains its reliability over a long period of implantation is high.

[Expiratory pressure reduction (C-Flex Method) versus fix CPAP in the therapy for obstructive sleep apnoea]

INTRODUCTION

The REM star C-Flex (Fa. Respironics) was introduced in 2003. In contrast to the conventionel fix CPAP mode, the C-Flex mode is characterised by a pressure reduction at the beginning of expiration. In a randomised cross-over design, we investigated if this C-Flex-mode has advantages compared to the fix CPAP mode in terms of treatment quality and patient satisfaction.

METHODS

In this prospective randomised single-blinded cross-over study we investigated 20 patients with obstructive sleep apnoea treated with fix CPAP versus treatment with the C-Flex mode (level 2) for 6 weeks, respectively. We compared the polysomnographically measured quality of treatment and the subjective satisfaction of either form of therapy. Additionally, we measured long-term compliance of the C-Flex therapy in a 3-year follow-up with the integrated counter of the C-Flex devices.

RESULTS

The mean levels of pressure of the fix CPAP and the C-Flex therapies were 8.4 +/- 2.9 mbar in both groups. There was an identical quality of treatment in terms of respiratory events, arousal index, slow wave sleep and Epworth sleepiness scale. The compliance of nocturnal use of the C-Flex and the fix CPAP was identical (6.0 +/- 0.67 C-Flex use vs. 5.8 +/- 0.98 CPAP use [h/night]). The subjective satisfaction was higher in the C-Flex mode at the end of the study since 18 of 20 patients (90%) subjectively prefered the C-Flex mode because of the easier expiration. 19 patients received a C-Flex device for long-term therapy. The 3-year-follow-up showed a regular utilisation of the C-Flex by 16 of 19 (84.2%) of these patients (mean nocturnal use 6.0 +/- 0.9 h/night). 3 of the 19 patients (15.8%) did not use their C-Flex regulary. None of the patients has terminated therapy completely.

CONCLUSION

C-Flex mode and the conventional fix CPAP therapies show an equivalent treatment quality according to polysomnographic data. The expiratory pressure reduction compared to conventional CPAP was felt to be more comfortable by 90% of patients. The long-term-compliance as measured by regular use of the C-Flex device was 84.2% (16 out of 19 patients) after 3 years, these numbers are higher than published data on compliance with conventional CPAP therapy.