TY  - THES
A1  - Real, Ruben
T1  - Living with severe motor impairments – from consciousness to quality of life
T1  - Leben mit schweren motorischen Einschränkungen – Bewusstsein und Lebensqualität
N2  - The impact of acquired severe motor impairments is pervasive and may lead to a complete loss of communication and voluntary motor control, rendering the patient behaviourally unresponsive. In routine clinical care it may thus be unclear, whether some of these patients are even conscious. Given that finding a cure is unlikely, care focuses on providing the best possible quality of life (QoL), and knowing its predictors might contribute to that aim. Patients who still can communicate often report a high QoL, and several predictors have been identified. However, many instruments used to assess QoL require at least residual verbal and motor abilities. Thus, a method to assess QoL independent of these requirements is desirable. In addition, many instruments assume QoL to be temporarily stable, and little information is available on predictors of instantaneous QoL, i.e. QoL as it fluctuates from moment to moment throughout the day.
N2  - Die Auswirkungen erworbener motorischer Einschränkungen sind verheerend, und können bis hin zu einem völligen Verlust der Kommunikationsfähigkeit und Willkürmotorik führen. In der klinischen Praxis bedeutet dies, dass bei einigen Patienten unklar ist, ob sie überhaupt bei Bewusstsein sind. Da bei vielen dieser Erkrankungen eine Heilung derzeit unwahrscheinlich ist, steht die Förderung einer möglichst hohen Lebensqualität (LQ) im Fokus der Behandlung. Unabdingbare Voraussetzung hierzu ist eine genaue Kenntnis möglicher Prädiktoren der LQ. Bei Patienten, mit denen noch kommuniziert werden kann, konnten einer Reihe von Prädiktoren der --meist hohen-- LQ identifiziert werden. Alle bislang verwendeten Instrumente erfordern jedoch zumindest residuale motorische und verbale Fähigkeiten, so dass ein Verfahren zur Erfassung der LQ, welches nicht oder kaum auf diese Fähigkeiten angewiesen ist, wünschenswert ist. Des Weiteren unterstellen viele Instrumente zur Erfassung der LQ eine Zeitstabilität der LQ, so dass vergleichsweise weniger Informationen über Prädiktoren der momentanen LQ vorliegen, beispielsweise Fluktuationen der LQ im Tagesverlauf.
KW  - Myatrophische Lateralsklerose
KW  - Lebensqualität
KW  - N400
KW  - P300
KW  - Ereigniskorreliertes Potenzial
KW  - Amyotrophe Lateralsklerose
KW  - Apallisches Syndrom
KW  - Elektroencephalographie
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-138562
ER  - 
TY  - JOUR
A1  - Schmidt, Melanie
A1  - Pfetzer, Nadja
A1  - Schwab, Micheal
A1  - Strauss, Ingrid
A1  - Kaemmerer, Ulrike
T1  - Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot train
N2  - Background: Tumor patients exhibit an increased peripheral demand of fatty acids and protein. Contrarily, tumors utilize glucose as their main source of energy supply. Thus, a diet supplying the cancer patient with sufficient fat and protein for his demands while restricting the carbohydrates (CHO) tumors thrive on, could be a helpful strategy in improving the patients’ situation. A ketogenic diet (KD) fulfills these requirements. Therefore, we performed a pilot study to investigate the feasibility of a KD and its influence on the quality of life of patients with advanced metastatic tumors. Methods: Sixteen patients with advanced metastatic tumors and no conventional therapeutic options participated in the study. The patients were instructed to follow a KD (less than 70 g CHO per day) with normal groceries and were provided with a supply of food additives to mix a protein/fat shake to simplify the 3-month intervention period. Quality of life [assessed by EORTC QLQ-C30 (version 2)], serum and general health parameters were determined at baseline, after every two weeks of follow-up, or after drop out. The effect of dietary change on metabolism was monitored daily by measuring urinary ketone bodies. Results: One patient did not tolerate the diet and dropped out within 3 days. Among those who tolerated the diet, two patients died early, one stopped after 2 weeks due to personal reasons, one felt unable to stick to the diet after 4 weeks, one stopped after 6 and two stopped after 7 and 8 weeks due to progress of the disease, one had to discontinue after 6 weeks to resume chemotherapy and five completed the 3 month intervention period. These five and the one who resumed chemotherapy after 6 weeks report an improved emotional functioning and less insomnia, while several other parameters of quality of life remained stable or worsened, reflecting their very advanced disease. Except for temporary constipation and fatigue, we found no severe adverse side effects, especially no changes in cholesterol or blood lipids. Conclusions: These pilot data suggest that a KD is suitable for even advanced cancer patients. It has no severe side effects and might improve aspects of quality of life and blood parameters in some patients with advanced metastatic tumors.
KW  - Lebensqualität
KW  - Krebskranker
KW  - Ketogenic diet
KW  - cancer patients
KW  - pilot study
KW  - quality of life
Y1  - 2011
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-68871
ER  -