Acqua Klinik

This release brings to you a whole new Zettlr experience – we have fixed so many things the changelog will keep you scrolling for quite some time! This also means that Zettlr 1.8 demarcates a quantum jump from the 1.7 series, so make sure to check it out! At a glance, here's the most important improvements: Introducing the Typewriter mode macOS builds are now resource-friendly – always Windows and Linux now feature completely reworked application menus The sidebar now features a Table of Contents The Quicklook windows have received a paint job You can now change the levels of your headings at the press of a button Citations are now rendered if you copy text as HTML The contents of table cells are now pre-rendered Code blocks are now autocompleteable … and much, much more! Make sure to check out our blogpost and also read the changelog below to get to know all the changes we've implemented! Do you enjoy Zettlr? We would like to encourage you to support our development over at Patreon or PayPal to cover hardware and software expenses as well as the occational coffee. Even a symbolic dollar per month will keep Zettlr free for everyone. &lt;a href="https://www.patreon.com/bePatron?u=18115838" data-patreon-widget-type="become-patron-button"&gt;&lt;img width="300" src="https://c5.patreon.com/external/logo/become_a_patron_button@2x.png" alt="Become a Patron"&gt;&lt;/a&gt; Changeloog Breaking Changes Renamed the <strong>sidebar</strong> to <strong>file manager</strong>. We finally decided on better terminology for distinguishing the right from the left sidebar. This means: The left sidebar, formerly known only as "sidebar," is now the "file manager." The right sidebar, formerly known as "attachment sidebar," is now "the" sidebar. This change was introduced to reduce user confusion and provide a better user experience. The shortcut for opening the developer tools on Windows and Linux is now <code>Ctrl+Alt+I</code> (was: <code>Ctrl+Shift+I</code>) to resolve a conflict with the shortcut <code>Ctrl+Shift+I</code> (insert images). Renamed <strong>Root Directories</strong> to <strong>Workspaces</strong>. The term "root" is rather technical, and for most people, it makes most sense to think of those roots as workspaces, albeit other than being opened at the root level of the application, they have no difference to regular directories. The shortcut <code>Cmd/Ctrl+O</code>, which previously would let you open <em>workspaces</em>, now opens files. To open a workspace, use <code>Cmd/Ctrl+Shift+O</code>. This is now in line with many other programs. GUI and Functionality <strong>New Feature</strong>: Typewriter mode. By pressing <code>Cmd/Ctrl+Alt+T</code>, you can activate the typewriter mode, which will keep the current line in the editor always centered so that you have to move your eyes less while editing a text. This also works in combination with the distraction free mode so that you can fully focus on what you're editing right at the moment. <strong>New Feature</strong>: The sidebar (formerly attachment sidebar) is now tabbified. That means you have three distinct tabs to choose from with regard to displaying important information: the non-markdown files in your currently selected directory, the references in the current file, and the table of contents of the current file. <strong>New Feature</strong>: When hovering over links, they now appear in a separate tooltip to click them without holding down Ctrl/Cmd. <strong>New Feature</strong>: The QuickLook windows now share the main editor including its appearance. The same options apply for Quicklook windows as they are set in the global preferences (e.g. if you turned off image previewing, images would also not be displayed in the Quicklooks, etc). <strong>New Feature</strong>: Now you have an additional option in the "Advanced" preferences to choose between a "native" appearance of all Zettlr Windows (that is, a frameless window with inset traffic lights on macOS, and standard window decorations on Windows and Linux) or a custom built-in appearance (that is, for all platforms a frameless window with custom drawn menu and window control buttons, which mimick the Windows 10 design). <strong>New Feature</strong>: The heading tag elements (those <code>h1</code> to <code>h6</code>-tags replacing the Markdown heading characters) finally serve a purpose: Clicking on them reveals a small menu which lets you quickly choose a different heading level. <strong>New Feature</strong>: Improvement in the citation rendering capabilities: Both when copying Markdown as HTML, and when viewing footnote tooltips, any citation will be correctly rendered by the citeproc provider. <strong>New Feature</strong>: The TableEditor now pre-renders table cells so that it looks more like it will when you export it! <strong>New Feature</strong>: A selection of notifications will now be displayed using your operating system's notification service (if available), for instance export messages, errors, and updates. All notifications will still be displayed in the main window, so if you do not like this behaviour, you can turn notifications off for Zettlr within your operating system settings. <strong>New Feature</strong>: Whenever you begin a code block (<code>\</code>```), Zettlr now offers you to autocomplete the syntax highlighting language. Added syntax highlighting modes (with keywords): <strong>diff</strong>: <code>diff</code> <strong>Dockerfile</strong>: <code>docker</code>/<code>dockerfile</code> <strong>TOML</strong>: <code>toml</code>/<code>ini</code> Fixed the fold-gutter being too close to the text. The editor link autocompletion now respects the setting to use headings level 1 instead of YAML frontmatter titles where possible. The paste image dialog now also provides the original image size as a default value, so that you simply can use the arrow buttons on the field to adjust the image size. Fixed a rare bug where changes would be discarded if you renamed the modified file quickly enough. HTML export should now centre both figures and figure captions. Sorting files by name now takes into account possible settings such as using headings of level 1 or YAML frontmatter titles so that sorted files now correspond to their display again. You can now select rendered references from the right sidebar. The file tabs now have their own, dedicated menu, containing a new "Close all tabs" command to close all open file tabs (thanks to @anoopengineer for implementing). The file info now displays the selection information, if there is any. The popup that opens when you click the counter then lists all selections within your document. When you initiate a keyword search from the tag cloud by clicking on a tag, it'll be automatically enclosed in quotes, enabling searches for keywords with spaces in them. The image paste dialog now shows you the resolved path of the directory into which the image you are about to paste will be saved to. Fixed a missing translatable string from the paste image dialog. Fixed the width of the word counter in order to make the toolbar more "stiff." Enabled Dart syntax highlighting (thanks to @Kangie for implementing). Reduced the added margins for overflowing dialog windows from 15 % to 2 %, making the visible gap on smaller screens smaller. Remove the intermediary <code>.ztr-project</code>-migration code, which means you should update to Zettlr 1.7.x before updating to 1.8.x, if you still use an older version of Zettlr. Fixed (= monkeypatched) a weird bug that would cause selections on specially indented lines (e.g. wrapped blockquotes, list items, etc.) to be padded by precisely four pixels, making the selection not look like a box. Double clicks on file tabs now make files intransient (if they were transient before). The editor is now in a non-editable mode if no file is open. If the editor is read-only, the Zettlr logo will display in the background to indicate that fact. Empty files, on the other hand, will not yield the feather logo anymore. This should now meet up with users' expectations about file editing better. The last opened file will now reliably open whenever you start the application again. File loading (especially on boot) is now much faster, because the opened tabs won't be switched through during load anymore. Only the relevant, last file will be opened and displayed. Fixed a bug that would prevent you from exporting standalone files. Non-breaking spaces (NBSP) are now considered word delimiters in the spellchecker. Fixed a bug that would not close all tabs when the corresponding entry was selected from the tab context menu. Fixed a bug where checkboxes of tasks would be strangely hidden on undo/redo operations that checked/unchecked those checkboxes. Fixed a bug that would throw errors and not actually remove the file if said file was a root. Fixed broken shortcuts <code>Cmd/Ctrl+Shift+E</code> (focus the editor) and <code>Cmd/Ctrl+Shift+T</code> (focus the file list). Markdown links to local files that are absolute are now attempted to be opened internally, without recurring to external programs. The various rendering methods now only update anything that is within the viewport, thereby increasing the performance vastly. This is especially noticable for large documents. Fixed a bug that led to the exporter ignoring custom templates and always reverting to the default. Fixed the date formatter, as the moment.js locales are not found when compiling using <code>electron-forge</code>. Fixed a bug that would mess up the tag-tooltip on files under certain circumstances. Fixed a bug that would throw errors instead of exporting, if the export-directory is set to the current working directory and a non-root file is being exported. Fixed a bug which would not let you create duplicates of root files. Now, you can and the duplicate is being placed in the currently selected directory. Fixed a rendering edge condition where if you wanted to retain multiple single-line breaks wi

The interscalene brachial plexus block (ISB), a potent option to control pain after shoulder surgery, has notable adverse effects. The anterior suprascapular nerve block (SSNB) might provide comparable analgesia and cause less grip-strength impairment. These characteristics were studied in this randomized controlled patient- and assessor-blinded trial. Outpatients were randomized to single-shot ultrasound-guided SSNB (10 mL ropivacaine 1%) or ISB (20 mL ropivacaine 0.75%) before general anesthesia for arthroscopic shoulder surgery. Pain (Numerical Rating Scale, 0-10), grip strength, degree of satisfaction, and strength of recommendation were assessed. We randomized 168 patients to each group and analyzed 164 in the SSNB group and 165 in the ISB group. Nerve blocks were successful in 98% of the patients from each group. Both procedures provided good postoperative analgesia, and the mean pain level for SSNB was slightly but significantly lower by 0.32 units (95% confidence interval, 0.18-0.46; P < 0.001) and noninferior given a margin of 1.1 units; P < 0.001. Within the first 24 hours, 162 (99%) of SSNB patients had unimpaired grip strength compared to 81 (49%) of ISB patients (P < 0.001). The multiple primary outcome, superior unimpaired grip strength, and noninferior pain control was significant; P < 0.001. Compared to ISB patients (n = 130 [79%]), significantly more SSNB patients (n = 150 [91%]) were satisfied/highly satisfied. Patients in the SSNB group were more likely to recommend the procedure highly. For outpatients undergoing arthroscopic shoulder surgery under general anesthesia, the SSNB seems preferable to ISB. It provides excellent postoperative analgesia without exposing patients to impaired mobility and to risks of the more potent but also more invasive ISB.

The current trend toward increasingly integrated technological support systems and the rise of streamlined processes in the OR have led to a growing demand for personnel with higher levels of training. Although simulation systems are widely used and accepted in surgical training, they are practically non-existent for perioperative nursing, especially scrub nursing. This paper describes and evaluates an interactive OR environment simulation to help train scrub nurses. A system comprising multiple computers and monitors, including an interactive table and a touchscreen combined with a client-server software solution, was designed to simulate a scrub nurse's workplace. The resulting demonstrator was evaluated under laboratory conditions with a multicenter interview study involving three participating ear, nose, and throat (ENT) departments in Germany and Switzerland. The participant group of 15 scrub nurses had an average of 12.8 years hands-on experience in the OR. A series of 22 questions was used to evaluate various aspects of the demonstrator system and its suitability for training novices. The system received very positive feedback. The participants stated that familiarization with instrument names and learning the instrument table setup were the two most important technical topics for beginners. They found the system useful for acquiring these skills as well as certain non-technical aspects. Interactive training through simulation is a new approach for preparing novice scrub nurses for the challenges at the instrument table in the OR. It can also improve the lifelong training of perioperative personnel. The proposed system is currently unique in its kind. It can be used to train both technical and non-technical skills and, therefore, contributes to patient safety. Moreover, it is not dependent on a specific type of surgical intervention or medical discipline.

Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention.

Lateral parotidectomy is a demanding surgical procedure and requires a large number of instruments with a high frequency (HF) of alternating. Many functions, such as preparing, spreading, coagulating and cutting could be combined by using scissors with an integrated function of bipolar coagulation. This study has targeted an investigation of technical application, influence on surgery time, frequency of HF application and change of instruments. In the period between 01 April 2011 and 30 September 2012 (18 months) 35 procedures of lateral parotidectomy in 35 patients were investigated. In all cases lateral parotidectomy was carried out with a similar technique (modified extracapsular preparation). Workflow data were used from a control group in the period between 01 January 2009 and 31 December 2010 (24 months). The following parameters from both groups were documented and evaluated: incision-suture times (subdivided into nine sections of the procedure), change of instruments, period of application for HF function and early facial nerve function (6 h and 6 days after surgery according to House-Brackmann). Additionally, in the HF+ group a questionnaire that facilitated subjective evaluation of instruments was analyzed. It was possible to perform the surgery in both groups with neither technical nor surgical intraoperative complications. Incision-suture times showed an average reduction of 31.6 min (34.8 %) in the HF+ group. There was a reduction in the change of instruments compared to a conventional group (CONV) by up to 62.7 %. With the deployment of HF scissors there was a clear increase in the use of HF surgery by more than 100 % when comparing incision-suture times. Evaluation of both groups according to House-Brackmann showed a similar postoperative facial nerve function. The surgeons involved were of the opinion that in all 35 surgeries with HF scissors the intervention was easier and more comfortable. The use of HF scissors is appropriate for parotid gland surgery and can be used in all steps of the procedure. Incision-suture time can be reduced and the ergonomics of the intervention can be improved. Up to now no negative effects have been found in the quality of the results.

See also: The Impact of Psychiatric Comorbidity on Quality of Life in Patients Undergoing Herniated Disc SurgeryJ Neurol Surg A Cent Eur Neurosurg 2012; 73(01): 29-37DOI: 10.1055/s-0032-1304502

Welchen Einfluss haben Kontextfaktoren auf den Rehabilitationsprozess/die individuellen Therapieziele?