Background Waiting times of the fast-track of bladder cancer in Sweden are prolonged compared with set lead times.Aim To investigate if stage and grade of tumor affects waiting times.Method Retrospective single center observational study, Örebro University Hospital, Sweden. All patients who underwent resection of tumor or cystoscopy with biopsy via the fast-track between July 1st 2017 and December 31st 2018 were included, n=119.Result The waiting times of muscle invasive tumors were in general longer than for non-invasive tumors. Referral to TURBT - twelve days (p=0.047), referral to information of diagnosis to patient - seven days (p=0.04) and cystoscopy to TURBT - eleven days (p=0.041.Conclusion MIBC had longer waiting times to most steps of the fast-track. There are conflicting results in previous studies regarding whether extended waiting times result in worse outcomes in those with higher stage and grade of tumors or not. It is known that long waiting times results in higher mortality and psychological stress among the patients why reorganizations at the department should take place.

The main drives of development of fast track cardiac anaesthesia are the increase burden of health care cost and the shortage of intensive care beds. Fast track (FT) is multidisciplinary process that leads to rapid patient recovery and discharge without affecting morbidity and mortality. Fast track cardiac anaesthesia (FTCA) was proved to be safe, efficient and economically effective. Leipzig FT protocol was first introduced in November 2005 for elective cardiac surgery patients in the heart center of Leipzig University. It is characterized by using intraoperative remifentanil as main opioid with treating the patients postoperatively in post-anaesthesia care unit (PACU) completely bypassing ICU admission. Remifentanil was unavailable in Germany from February to July 2017, therefore the protocol had to be modified and sufentanil was used instead. The aim of this retrospective study was to compare the effects of remifentanil and sufentanil on the well-established FT concept. The primary end points were ventilation time, LOS in PACU (LOS PACU), the visual analogue score (VAS) and the piritramide consumption on the day of operation. The secondary end points were LOS in intermediate care (LOS IMC), hospital LOS, FT failure (FTF), in-hospital mortality and postoperative complications such as postoperative nausea and vomiting (PONV), delirium and the incidence of reintubation. All cardiac surgery patients consecutively admitted to PACU during the period from February to July 2017 (n=622), received sufentanil (FT-S), were compared to patients (n=679) from the same time period of the previous year treated with continuous remifentanil infusion (FT-R) according to the standard FT protocol. To minimise selection bias and to obtain comparable groups, we used a 1:1 nearest neighbour propensity score matching approach resulted in total 1218 patients divided in 2 equal groups. In FT-R, an uninterrupted continuous infusion of remifentanil (0.2-0.3 µg/kg/min) was used for maintenance of anaesthesia throughout the whole operation. In FT-S, a continuous infusion of sufentanil was used during maintenance of anaesthesia as follows: 1 µg/kg/h until sternotomy, 0.5 µg/kg/h until cardiopulmonary bypass and 0.25 µg/kg/h until chest closure, then the infusion was stopped. Otherwise, the Leipzig FT protocol was used as previously published. Remifentanil was more effective in reducing time to extubation (by 40 minutes) and length of stay in the post anaesthetic care unit during fast track cardiac anaesthesia than sufentanil. There was an increased need of piritramide when remifentanil was used. The hospital length of stay was longer in remifentanil group. There were no differences between both groups regarding postoperative complications. Clinically, a detailed and time-directed weaning protocol is more important than the use of a specific opioid during fast track treatment in cardiac surgery patients.:TABLE OF CONTENTS 1. List of Abbreviations 3 2. Bibliographic description 5 3. Abstract 5 4. Introduction 6 4.1 Fast-track cardiac anaesthesia 6 4.1.1 Definitions 6 4.1.2 Current evidence of FTCA 7 4.1.2.1 The safety of FTCA 7 4.1.2.2 The efficiency of FTCA 7 4.1.2.3 Economic Implications of FTCA 8 4.1.3 Different FTCA pathways 8 4.1.4 Patient selection and optimization 9 4.1.5 Anaesthesia aspects of FT 11 4.1.6 Cardiopulmonary bypass aspects of FT 12 4.2 Leipzig FT Protocol 12 4.3 Opioids 16 4.3.1 Remifentanil 16 4.3.2 Sufentanil 17 5. Objective of the work 19 6. Materials and Methods 19 7. Results 21 8. Discussion 26 9. Publication manuscript: „ A comparison of sufentanil versus remifentanil in fast-track cardiac surgery patients “Anaesthesia 2019, 74, 602–608“. 30 10. Summary 37 11. Bibliography 39 12. Appendix (Anlagen): 43 12.1 Declaration of Independence (Selbstständigkeitserklärung) 43 12.2 Declaration of co-authors’ contribution 44 12.3 Publications 45 12.4 Acknowledgment 46

During the last decades the challenge of sustainability has become more urgent and environmental impacts of different processes in manufacturing industry have received more attention. Life cycle assessment (LCA) has become an important and useful tool to evaluate the environmental impact of products and processes. In this study the environmental impact of two cooling techniques in a turning process has been evaluated using LCA. Turning is used for shaping metal parts by removing material. The compared cooling techniques in this study are dry cutting and Minimum Quantity Lubrication (MQL). The inputs and output in each technique are considered in form of material flows and energy consumption as well as waste flows. The Ecoinvent database has been used in order to quantify, evaluate and compare the environmental impacts of the two cooling techniques. Environmental impact categories considered in this study are Carbon footprint (CO2 kg equivalent), Cumulative Energy Demand (CED), Total eco-cost in Euro and ReCiPe. ReCiPe is a method used to evaluate multiple environmental impact categories and it covers impact categories related to human health, ecotoxicity and material depletion. Calculations and analysis of the results show that MQL has significantly lower environmental impact compared to dry cutting whereas energy consumption is the main contributor in the considered environmental impact categories. / Under de senaste åren har hållbar utveckling blivit mer relevant och miljöpåverkan av olika tillverkningsprocesser i industrin har således fått mer uppmärksamhet. Livscykelanalys (LCA) har blivit ett viktigt och användbart verktyg för att analysera och utvärdera miljöpåverkan av produkter och processer. I det här examensarbetet har miljöpåverkan av två olika kylmetoder vid svarvning utvärderats med hjälp av livscykelanalys (LCA). Svarvning används för att forma metalldelar. De jämförda kylmetoderna är torrskärning (dry cutting) utan kylvätska och minimalsmörjning (Minimum Quantity Lubrication - MQL) där en liten mängd smörjmedel används. Tillfört material, energiförbrukning och avfall vid varje kylmetod har betraktats. Ecoinvent-databasen har använts för att kvantifiera, utvärdera och jämföra miljöpåverkan av de två kylmetoderna. Miljöpåverkanskategorierna som behandlas i denna studie är koldioxidavtryck (CO2 kg ekvivalent), kumulativt energibehov (CED), totala miljökostnader i Euro och ReCiPe. ReCiPe är en metod som används för att utvärdera flera olika miljöpåverkanskategorier inkluderande människors hälsa, miljögifter och förbrukning av naturresurser. Beräkningarna och analysresultaten visar att MQL har betydligt lägre miljöpåverkan än torrskärning och att energiförbrukningen är den mest avgörande faktorn.

BACKGROUND: One of the most recurrent complaints after total joint replacement is difficulty sleeping. Sleep disturbance after major surgery is common. The “stress response” to surgery, personal factors and environmental factors can affect quality and quantity of sleep in the hospital setting. Occupational therapy intervention for individuals that have problems with function as a result of sleep insufficiency is an emerging practice area. However, there are few occupational therapy practitioners who have addressed the important occupation of sleep in acute care settings. There is a need to develop science-driven research and establish evidence to support acute care occupational therapy interventions that address sleep hygiene, a set of behavioral and environmental practices designed to improve both quality and quantity of sleep. In response to this need, the author designed and carried out a non- randomized controlled study to evaluate the effectiveness of a non-pharmacological occupational therapy intervention to improve quality and quantity of clients’ sleep in a fast track joint replacement center. OBJECTIVE: In the author’s study, the aim was to compare sleep quality, sleep quantity, and activities of daily living (ADL) performance before and after fast track total joint replacement surgery for clients who received an occupational therapy intervention targeted at improving sleep hygiene, in addition to conventional acute care occupational therapy, compared to those that received only conventional acute care occupational therapy. The project focused on 1) identifying evidence-based literature to support the benefit of non-pharmacological interventions for joint replacement surgery clients, 2) designing a program that represented best practice while incorporating the holistic and occupation-based theoretical base of occupational therapy, 3) implementing the program, 4) conducting summative program evaluation, and 5) developing a dissemination plan and implementation budget. RESULTS: There were no initial significant differences between the control and experimental groups. The quality of sleep in the experimental group at discharge was significantly better than in the controls and this group reported significantly improved quality of sleep at discharge compared to 2 weeks before surgery. At discharge the experimental group reported significantly longer sleep duration compared to the control group and the increase in duration from 2 weeks before surgery to discharge was significant. CONCLUSION: The results of this study demonstrated that improvement in sleep quality and quantity can be achieved in clients undergoing fast track joint replacement surgery who receive an occupation-based intervention that incorporates implementation of sleep hygiene practices. Moreover the change appears to persist after the client returns home. More research examining the effectiveness of this intervention with other surgical populations and the persistence of learned sleep hygiene practices over time after hospital discharge are warranted. / 2018-11-07T00:00:00Z

Gegenstand der vorliegenden Dissertation bilden persistierende und akute postoperative Schmerzen in der Herzchirurgie nach anterolateraler Thorakotomie und Sternotomie. Kardiochirurgische Eingriffe sind mit einer erwarteten hohen Schmerzintensität verbunden. Eine unzureichende Schmerzkontrolle hat sowohl psychologische als auch physiologische Konsequenzen für alle Körpersysteme, welche die Genesung der Patienten nach einer Operation beeinträchtigen. Dabei stehen mittelstarke und starke postoperative Schmerzen mit dem Auftreten von chronischen postoperativen Schmerzen in Zusammenhang. Als sicher und vorteilhaft haben sich in den meisten chirurgischen Disziplinen Operationstechniken mit einer Reduktion der Größe des Operationsgebietes erwiesen, wo die Minimierung des Gewebetraumas postoperativ zu einer weniger hoch ausgeprägten Schmerzsymptomatik führt. Zu minimalinvasiven Techniken in der Kardiochirurgie gehört unter anderem die anterolaterale Thorakotomie. Die vorliegende Studie wurde in Anbetracht mangelnder Daten zum Vergleich akuter und chronischer postoperativer Schmerzen nach Herzoperationen durch Sternotomie und anterolaterale Thorakotomie durchgeführt. Im Rahmen dieser prospektiven Studie wurden Daten von 202 Patienten analysiert, bei denen ein elektiver, kardiochirurgischer Eingriff minimalinvasiv oder konventionell mit perioperativer Betreuung gemäß dem Fast-TrackKonzept durchgeführt worden ist. Die aufgetretene Schmerzintensität sowie der Schmerzmittelbedarf wurden bis hin zu der Krankenhausentlassung sowie drei, sechs und zwölf Monate nach dem operativen Eingriff verfolgt. Die Studie kommt zu folgenden Ergebnissen: Es konnten keine signifikanten Vorteile des anterolateralen Thorakotomiezugangs im Vergleich zur Sternotomie zur kurz- oder langfristigen Schmerzlinderung unter Anwendung eines standardisierten opioidbasierten perioperativen Schmerzmanagementprotokolls nach dem Fast-Track-Konzept bei elektiven kardiochirurgischen Eingriffen festgestellt werden.:Inhaltsverzeichnis: Abkürzungsverzeichnis: 2 Bibliografische Beschreibung: 3 Einführung: 4 Akuter postoperativer Schmerz 4 1.1. Pathophysiologie 5 1.2. Konsequenzen unzureichender postoperativer Schmerzkontrolle 8 1.3. Schmerzerfassung 9 1.4. Risikofaktoren für das Auftreten starker APP 11 1.4.1. Patientenbezogene Risikofaktoren 11 1.4.2. Prozedurale Risikofaktoren 12 1.5. Therapie 14 2. Persistierender postoperativer Schmerz 17 2.1. Definition 17 2.2. Pathophysiologie 18 2.3. Konsequenzen 18 2.4. Risikofaktoren 19 2.4.1. Nichtmodifizierbare Risikofaktoren: 19 2.4.2. Modifizierbare Risikofaktoren 20 2.5. Therapie 21 3. Fast-track und ERACS Konzepte 23 3.1. Definition und Ziele 23 3.2. Rolle der Schmerzkontrolle 27 3.3. Operativer Zugangsweg als Teil der schmerzminimierenden Strategien 27 4. Die Zielsetzung der Arbeit 29 Publikationsmanuskript 30 Zusammenfassung der Arbeit 40 Literaturverzeichnis 44 Anlagen 54 Spezifizierung des eigenen Beitrags zur Publikation: 54 Erklärung zu den Beiträgen der Mitautorin bei diesem Publikationsmanuskript 55 Erklärung über die eigenständige Abfassung der Arbeit 56 Lebenslauf 57 Publikationen: 58 Mündliche und Poster Präsentationen in internationalen Kongressen: 58 Danksagung 59 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​

Accelerated Bridge Construction, also known as ABC, is a methodology that seeks to improve project development of bridges by reducing the overall project schedule and the impact on the traveling public by implementing innovative technologies and strategies in any phase of project development. However, ABC may incur additional direct costs for the project and some risks are associated because of the accelerated constraints implied in this methodology. On the positive side, the opportunity costs and reductions of traffic disruptions costs may overcome the additional costs associated with ABC. Decision-making methodologies for assessment of ABC as an alternative to traditional construction are of great interest for project developers. The topics of research about ABC are diverse but focus mainly on the means and methods, technical aspects, applications, innovations, and decision-making of ABC. Decision-making is of great concern for project developers, especially government organizations, to sustain project goals of serviceability and to validate the additional expenditures in a project. In addition, project developers improve their decisions and project outcomes by reviewing success and failure cases for completed projects in the past. This study seeks to improve the decision-making processes in ABC by finding a more direct correlation of projects to compare by means of a categorization of these ABC projects. Smaller groups in this categorization will help narrow the scope of the characteristics of the projects to consider and to find more relevant lessons learned from the smaller groups of the categorization. To develop the categorization in this study, the data source used is the completed ABC projects database from the Federal Highway Administration (FHWA). The statistical categorization methodology for this study is the Agglomerate Hierarchy Clustering which developed a determined number of cluster based on the closeness among data parameters with "n" number of dimensions of analysis. The number of dimensions for the analysis in this study was established as 13 parameters collected from the database and these were considered critical decision-making parameters and consequential parameters to reflect project decisions and consequences of those decisions. The results of this study rendered 3 categories, and into these categories, 5 sub-categories were distributed according to the same analysis developed. The sub-categories show similarities between the projects according to the parameters established, so the sub-categories help narrow the scope of projects for project developers. As a complement to the categorization, a project matching tool for external projects was also developed to help decision-makers to test their projects according to the analysis in this study and also help developers narrow their review of cases in search for lessons learned. Uses of this study include the prediction of information of parameters according to the variables and ranges in this categorization, and the narrowing of study cases to review. Stakeholders interested can be government organizations seeking to establish the viability of an ABC project, or to improve their project outcomes at any stage of development. Other stakeholders can be designers and contractors that also need to improve their projects at any stage of development. / Master of Science / Accelerated Bridge Construction (ABC) reduces construction time and diminishes traffic disruption by applying strategies and innovations to the way bridges are designed and constructed. However, it implies additional initial costs that need to be justified. Project developers need to evaluate their projects to make decisions to assure the best execution and outcomes. The review of lessons learned from previous bridge projects has been one of the sources that developers have found to find strategies and tips to implement best practices or to avoid mistakes during planning and construction of new bridge projects. This study relies on the lessons learned compiled on the completed ABC project database from the federal transportation authority, the Federal Highway Administration (FHWA), in order to help developers, narrow the scope of projects to be reviewed and find more relevant cases to compare their projects. This scope includes the development of a categorization or a structured hierarchy of completed ABC projects with the FHWA database by applying a statistical analysis and a validation procedure. The results of this study rendered a categorization with 3 categories and 5 subcategories, each with its definition of parameters, which highlight the similarities among projects in the same groups and the differences among different categories. In addition, a framework was developed to match external projects with the categorization in this study to help project developers narrow the projects to review, or even predict missing information according to the parameters in this study. These results may help decision-makers better inform their decisions and support the research in the field of study.

<p>Text communication is often perceived as lacking some components of communication that are essential in sustaining interaction or conversation. This interaction incoherency tends to make&nbsp / text communication plastic. It is traditionally devoid of intonation, pitch, gesture, facial expression and visual or auditory cues. Nevertheless, Instant Messaging (IM), a form of text communication is on the upward uptake both on PCs and on mobile handhelds. There is a need to rubberise this plastic text messaging to improve co-presence for text communications thereby improving&nbsp / synchronous textual discussion, especially on handheld devices. One element of interaction is gesture, seen as a natural way of conversing. Attaining some level of interaction naturalism&nbsp / requires improving synchronous communication spontaneity, partly achieved by enhancing input mechanisms. To enhance input mechanisms for interactive text-based chat on mobile devices,&nbsp / there is a need to facilitate gesture input. Enhancement is achievable in a number of ways, such as input mechanism redesigning and input offering adaptation. This thesis explores affective gesture mode on interface redesign as an input offering adaptation. This is done without a major physical reconstruction of handheld devices. This thesis presents a text only IM system built on&nbsp / Session Initiation Protocol (SIP) and SIP for Instant Messaging and Presence Leveraging Extensions (SIMPLE). It was developed with a novel user-defined hotkey implemented as a one-click context menu to &ldquo / fast-track&rdquo / text-gestures and emoticons. A hybrid quantitative and qualitative approach was taken to enable data triangulation. Results from experimental trials show that an&nbsp / Affective Gesture (AG)approach improved IM chat spontaneity/response. Feedback from the user trials affirms that AG hotkey improves chat responsiveness, thus enhancing chat spontaneity.</p>

<p>Text communication is often perceived as lacking some components of communication that are essential in sustaining interaction or conversation. This interaction incoherency tends to make&nbsp / text communication plastic. It is traditionally devoid of intonation, pitch, gesture, facial expression and visual or auditory cues. Nevertheless, Instant Messaging (IM), a form of text communication is on the upward uptake both on PCs and on mobile handhelds. There is a need to rubberise this plastic text messaging to improve co-presence for text communications thereby improving&nbsp / synchronous textual discussion, especially on handheld devices. One element of interaction is gesture, seen as a natural way of conversing. Attaining some level of interaction naturalism&nbsp / requires improving synchronous communication spontaneity, partly achieved by enhancing input mechanisms. To enhance input mechanisms for interactive text-based chat on mobile devices,&nbsp / there is a need to facilitate gesture input. Enhancement is achievable in a number of ways, such as input mechanism redesigning and input offering adaptation. This thesis explores affective gesture mode on interface redesign as an input offering adaptation. This is done without a major physical reconstruction of handheld devices. This thesis presents a text only IM system built on&nbsp / Session Initiation Protocol (SIP) and SIP for Instant Messaging and Presence Leveraging Extensions (SIMPLE). It was developed with a novel user-defined hotkey implemented as a one-click context menu to &ldquo / fast-track&rdquo / text-gestures and emoticons. A hybrid quantitative and qualitative approach was taken to enable data triangulation. Results from experimental trials show that an&nbsp / Affective Gesture (AG)approach improved IM chat spontaneity/response. Feedback from the user trials affirms that AG hotkey improves chat responsiveness, thus enhancing chat spontaneity.</p>

MRDV / Institute for Rural Development / Two decades after the “Fast Track” land resettlement in Zimbabwe, little is known about the sustainability of livelihoods of households that benefited from the programme. “Fast Track” refers to the accelerated land resettlement which started in 2000 in Zimbabwe. The government of Zimbabwe argues that it introduced it as an intervention strategy to enhance the livelihoods of marginalised indigenous people. However, the nature of the fast track land resettlement has been met with considerable criticism. An exploratory study that sought to assess the sustainability of livelihoods through obtaining the perspectives of men, women and youth in fast track resettlement areas of Shamva District was carried out. Focus group discussions and semi-structured interview guides were used to obtain the perceptions. The attempt to understand the sustainability of livelihoods involved determining the perceived (a) major features of sustainable livelihoods, (b) criteria for assessing sustainability of livelihoods, and (c) livelihood strategies adopted. Data were coded and analysed using Atlas-it version 7.5 software. Dependability of livelihoods, ability to recover from stress, extent to which livelihoods conserved the environment, ease with which livelihoods were interchanged and ability to close the gap between rich and poor members of society were the perceived features of sustainable livelihoods. Criteria for assessing the sustainability of livelihoods included the ability of livelihoods to contribute to development, provide a stable flow of income, promotion of social development, potential for growth and ability to conserve the environment. Petty trading, agricultural intensification, self-employment and community savings were the main livelihood strategies pursued in the fast track resettlement areas of Shamva District. Inherent challenges that inhibited the sustainability of livelihoods were cited as lack of infrastructure, poor markets for agricultural products and poor communication. The use of participatory research was crucial in co-creation of knowledge with the resettled farmers. The information generated is useful for crafting empowerment strategies in the fast track resettled farming communities. / NRF

In der prospektiven Untersuchung bekommen 50 Patienten ein intraoperativ inseriertes ON-Q® PainBuster® Kathetersystem. Patienten der Verumgruppe erhalten über 72 Stunden postoperativ Ropivacain 0,375 % über das lokale Wundkathetersystem mit einer Flussrate von 5 ml/h, Patienten der Placebogruppe zum Vergleich Natriumchloridlösung 0,9 %. Als Basisanalgesie werden alle Patienten mittels eines oralen Nicht-opioid Analgetikum und intravenösem Piritramid therapiert. Im postoperativen Verlauf von 5 Tagen werden die visuell analoge Schmerzskala bei unterschiedlichen Aktivitäten und der Bedarf von intravenös applizierten Piritramid über die PCA-Pumpe als Ergebnisse evaluiert. Diese Ergebnisse werden mit den aktuellen Analagesieverfahren im Rahmen der Thorax- und Kardiochirurgie verglichen und diskutiert. Mögliche Alternativen werden abschließend aufgezeigt.:BIBLIOGRAPHISCHE BESCHREIBUNG 4 ABKÜRZUNGSVERZEICHNIS 5 1. DIE EINLEITUNG 7 1.1. DAS FAST-TRACK-THERAPIEKONZEPT 7 1.2. DAS POSTOPERATIVES SCHMERZMANAGEMENT 7 1.3. DIE ZIELSETZUNG DER ARBEIT 9 2. DAS MATERIAL UND DIE METHODEN 10 2.1 DAS STUDIENDESIGN 10 2.2 DAS NARKOSEVERFAHREN 10 2.3 DAS ON-Q® PAINBUSTER® KATHETERSYSTEM 13 2.4 DIE LABORANALYSEVERFAHREN 14 2.5 DIE STATISTISCHE AUSWERTUNG 14 3. DIE ERGEBNISSE 15 3.1. DAS PATIENTENKOLLEKTIV 15 3.2. DIE SCHMERZSCORE-ERGEBNISSE 16 3.3. DIE ERGEBNISSE DES PIRITRAMIDBEDARFES 20 3.4. DIE ERGEBNISSE DER ANGEFORDERTEN ZUSATZMEDIKATIONEN 21 3.5. DIE ERGEBNISSE DES ALPHA-1-SAURE-GLYKOPROTEINS UND DER ROPIVACAINSERUMSPIEGEL22 4. DIE DISKUSSION 23 4.1. DIE METHODENKRITIK 23 4.1.1 DAS STUDIENKONZEPT 23 4.1.2 DIE STICHPROBENMENGE UND DIE AUSFALLQUOTEN 23 4.1.3 DIE STATISTISCHE AUSWERTUNG 24 4.1.4 DIE KATHETERLAGE 25 4.1.5 DAS LOKALANÄSTHETIKUM ROPIVACAIN 26 4.1.6 DIE ZUSATZANALGETIKA 26 4.2. DIE ERGEBNISKRITIK 27 4.2.1 URSACHEN FEHLENDER WIRKSAMKEIT 27 4.2.2 DIE ROPIVACAINPLASMAKONZENTRATIONEN 30 4.3. VERGLEICH DER ERGEBNISSE MIT DER LITERATUR 31 4.3.1 DIE FAST-TRACK-KARDIOANÄSTHESIE 31 4.3.2 DAS PERIOPERATIVE SCHMERZMANAGEMENT 32 4.3.2.1 Die rückenmarksnahen Verfahren 33 4.3.2.2 Die peripheren Katheterverfahren 35 4.3.2.2 Die parenterale Opioidapplikation 38 4.3.2.4 Die orale Nicht-Opioidgabe 38 4.4. DIE FALSIFIZIERUNG DER ARBEITSHYPOTHESE 39 4.5. DER AUSBLICK 39 5. DIE ZUSAMMENFASSUNG UND DAS FAZIT 41 3 ANLAGEN 43 LITERATURVERZEICHNIS 44 ABBILDUNGS- UND TABELLENVERZEICHNIS 55 ERKLÄRUNG ÜBER DIE EIGENSTÄNDIGE ABFASSUNG DER ARBEIT 56 LEBENSLAUF 57 DANKSAGUNG 58