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1دورية أكاديمية
المؤلفون: Struck, Manuel F., Beilicke, André, Hoffmeister, Albrecht, Gockel, Ines, Gries, André, Wrigge, Hermann, Bernhard, Michael
مرشدي الرسالة: Universität Leipzig, BioMed Central
المصدر: Scandinavian journal of trauma, resuscitation and emergency medicine (2016)24:45 doi: 10.1186/s13049-016-0240-5
مصطلحات موضوعية: info:eu-repo/classification/ddc/610, ddc:610, ätzende Stoffe, Vergiftungen, Notfallmanagement, Atemwege, Endoskopie, caustic ingestion, intoxication, emergency management, airway management, endoscopic management
الوصف: Background: Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures. Methods: We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality. Results: Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3 (21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality. Conclusions: Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.
الإتاحة: https://ul.qucosa.de/id/qucosa%3A14771Test
https://ul.qucosa.de/api/qucosa%3A14771/attachment/ATT-0Test/ -
2دورية أكاديمية
المؤلفون: Struck, Manuel F., Beilicke, André, Hoffmeister, Albrecht, Gockel, Ines, Gries, André, Wrigge, Hermann, Bernhard, Michael
مرشدي الرسالة: Universität Leipzig, Medizinische Fakultät, BioMed Central
المصدر: Scandinavian journal of trauma, resuscitation and emergency medicine (2016)24:45 doi: 10.1186/s13049-016-0240-5
مصطلحات موضوعية: ätzende Stoffe, Vergiftungen, Notfallmanagement, Atemwege, Endoskopie, caustic ingestion, intoxication, emergency management, airway management, endoscopic management, ddc:610
الوصف: Background: Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures. Methods: We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality. Results: Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3 (21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality. Conclusions: Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.
وصف الملف: application/pdf
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4دورية أكاديمية
المؤلفون: Handmann, Eric, Camanor, Sia Wata, Fallah, Mosoka P., Candy, Neima, Parker, Davidetta, Gries, André, Grünewald, Thomas
المساهمون: Universitätsklinikum Leipzig
المصدر: BMC Public Health ; volume 23, issue 1 ; ISSN 1471-2458
مصطلحات موضوعية: Public Health, Environmental and Occupational Health
الوصف: Background Data about the effectiveness of digital contact tracing are based on studies conducted in countries with predominantly high- or middle-income settings. Up to now, little research is done to identify specific problems for the implementation of such technique in low-income countries. Methods A Bluetooth-assisted GPS location-based digital contact tracing (DCT) app was tested by 141 participants during 14 days in a hospital in Monrovia, Liberia in February 2020. The DCT app was compared to a paper-based reference system. Hits between participants and 10 designated infected participants were recorded simultaneously by both methods. Additional data about GPS and Bluetooth adherence were gathered and surveys to estimate battery consumption and app adherence were conducted. DCT apps accuracy was evaluated in different settings. Results GPS coordinates from 101/141 (71.6%) participants were received. The number of hours recorded by the participants during the study period, true Hours Recorded ( tHR ), was 496.3 h (1.1% of maximum Hours recordable) during the study period. With the paper-based method 1075 hits and with the DCT app five hits of designated infected participants with other participants have been listed. Differences between true and maximum recording times were due to failed permission settings (45%), data transmission issues (11.3%), of the participants 10.1% switched off GPS and 32.5% experienced other technical or compliance problems. In buildings, use of Bluetooth increased the accuracy of the DCT app (GPS + BT 22.9 m ± 21.6 SD vs. GPS 60.9 m ± 34.7 SD; p = 0.004). GPS accuracy in public transportation was 10.3 m ± 10.05 SD with a significant ( p = 0.007) correlation between precision and phone brand. GPS resolution outdoors was 10.4 m ± 4.2 SD. Conclusion In our study several limitations of the DCT together with the impairment of GPS accuracy in urban settings impede the solely use of a DCT app. It could be feasible as a supplement to traditional manual contact tracing. DKRS, ...
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5دورية أكاديمية
المؤلفون: Slagman, Anna, Pigorsch, Mareen, Greiner, Felix, Behringer, Wilhelm, Bernhard, Michael, Bienzeisler, Jonas, Blaschke, Sabine, Burst, Volker, Dechant, Katharina, Dommasch, Michael, Ewen, Sebastian, Gries, André, Hans, Felix Patricius, Kanz, Karl-Georg, Klein, Matthias, Kümpers, Philipp, Napp, Matthias, Plata, Christopher, Ramshorn-Zimmer, Alexandra, Risse, Joachim, Röhrig, Rainer, Somasundaram, Rajan, Schunk, Domagoj, Walcher, Felix, Walter, Thomas, Weismann, Dirk, Wolfrum, Sebastian, Wörnle, Markus, Wu, Yves Noel, Möckel, Martin
المساهمون: Charité - Universitätsmedizin Berlin
المصدر: Clinical Research in Cardiology ; volume 111, issue 10, page 1174-1182 ; ISSN 1861-0684 1861-0692
مصطلحات موضوعية: Cardiology and Cardiovascular Medicine, General Medicine
الوصف: Background In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure. Methods Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50). Results A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16%; CI (− 13)–(− 19)], less urgent [− 18%; CI (− 12)–(− 22)] and non-admitted cases [− 17%; CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13%; CI (− 21)–2], myocardial infarction [− 2%; CI (− 9)–11] and heart failure [− 2%; CI (− 10)–6] were less affected and remained comparable to the previous year. Conclusions ED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies. Graphical abstract
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6دورية أكاديمية
العنوان البديل: Adverse drug reactions as cause of nonspecific symptoms in patients in the emergency department. (English)
المؤلفون: Hellinger, Benjamin J., Remane, Yvonne, Bertsche, Thilo, Gries, André
المصدر: Die Anaesthesiologie; Dec2023, Vol. 72 Issue 12, p887-893, 7p
مصطلحات موضوعية: PREVENTION of drug side effects, HOSPITAL emergency services, CLINICAL decision support systems, PHARMACOLOGY, POLYPHARMACY, PATIENTS, DISEASE incidence, MEDICATION therapy management, EMERGENCY medical services, MEDICAL referrals, DRUG side effects, RISK management in business
مصطلحات جغرافية: GERMANY
الملخص (بالإنجليزية): Background: In a large proportion of patients admitted to the emergency department (ED), the initial main symptom is nonspecific. One possible reason for this, especially in older patients, may be adverse drug reactions (ADR) due to their frequent polypharmacy. Aim: To illustrate the incidence of ADRs, the affected patient population including risk factors, and drug classes with ADRs leading to nonspecific symptoms. To provide practice recommendations for the management of ADRs in the ED. Material and methods: Presentation of the pharmacological principles on ADRs, statistics of pharmacovigilance centers as well as original literature including experiences from clinical practice and own projects. Results: In 10% of patients with nonspecific symptoms an ADR is responsible for presentation in the ED. In 60% of cases these ADRs are not correctly identified in the ED setting. A small number of drug classes are responsible for most of these referrals. Databases, risk stratification, clinical pharmacists, or clinical decision support systems are available to improve ADR identification and management. As these options are partly associated with considerable costs or the validation for German EDs is missing, a widespread application does not take place. Conclusion: Correct identification of ADRs in patients with nonspecific symptoms in the ED is necessary to initiate adequate treatment. These ADRs are often overlooked because processes and tools for identification and management are not applied in the ED, leading to a lack of awareness. For high-risk patients in the ED, the focus should be on drug history, ideally considering patient-specific risk factors and specific drug classes. [ABSTRACT FROM AUTHOR]
Abstract (German): Zusammenfassung: Hintergrund: Bei einem großen Anteil der Patienten, die zentralen Notfallaufnahme (ZNA) zugeführt werden, ist das initiale Leitsymptom unspezifisch. Eine mögliche Ursache hierfür können gerade bei älteren Patienten unerwünschte Arzneimittelwirkungen (UAW) der häufig vorhandenen Polypharmazie sein. Ziel der Arbeit: Veranschaulichung von UAW-Inzidenzen, der betroffenen Patientenklientel, inklusive Risikofaktoren, sowie von Arzneimittelklassen, deren UAW zu unspezifischen Symptomen führen können. Empfehlungen für die Praxis zum Management von UAW in der ZNA. Material und Methode: Darstellung der pharmakologischen Grundlagen zu UAW, Statistiken der Pharmakovigilanzzentren sowie Originalliteratur unter Einbezug von Erfahrungen aus der klinischen Praxis und eigenen Projekten. Ergebnisse: Bei 10 % der Patienten mit unspezifischen Symptomen ist eine UAW für die ZNA-Vorstellung verantwortlich. In 60 % der Fälle werden diese nicht korrekt erkannt. Eine geringe Anzahl an Arzneimittelklassen ist für die meisten dieser Zuweisungen verantwortlich. Zur Verbesserung der UAW-Identifikation und des UAW-Managements stehen Datenbanken, Risikostratifizierungen, klinische Pharmazeuten oder „clinical decision support systems" zur Verfügung. Eine flächendeckende Anwendung dieser Möglichkeiten findet in deutschen Notaufnahmen bisher nicht statt. Schlussfolgerungen: Eine korrekte Identifikation von UAW bei Patienten mit unspezifischen Symptomen in der ZNA ist notwendig, um die adäquate Therapie einleiten zu können. Häufig werden die UAW übersehen, da Prozesse und Tools zur Identifizierung und zum Management von UAW in der ZNA nicht angewendet werden. Bei Risikopatienten in der ZNA sollte der Fokus auf die Arzneimittelanamnese gelegt werden, idealerweise unter Berücksichtigung patientenindividueller Risikofaktoren und bestimmter Arzneimittelklassen. [ABSTRACT FROM AUTHOR]
: Copyright of Die Anaesthesiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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7دورية أكاديمية
المؤلفون: Fischer-Rosinský, Antje, Slagman, Anna, King, Ryan, Zimmermann, Grit, Drepper, Johannes, Brammen, Dominik, Lüpkes, Christian, Reinhold, Thomas, Roll, Stephanie, Keil, Thomas, Möckel, Martin, Greiner, Felix, Behringer, Wilhelm, Bernhard, Michael, Blaschke, Sabine, Busch, Hans-Jörg, Erdmann, Bernadett, Flasch, Bernhard, Gries, André, Höger-Schmidt, Heike, Schöpke, Timo, Schwarz, Constanze, Somasundaram, Rajan, Weidmann, Erik, Wolfrum, Sebastian, Wrede, Christian
المصدر: http://lobid.org/resources/99370677014306441Test#!, 117(8):644-653.
مصطلحات موضوعية: Notfallmedizin, Dokumentation, Hospitalization [MeSH], Datenintegration, Humans [MeSH], Documentation, Data integration, Emergency care, Health Services Research [MeSH], Originalien, Secondary data, Emergency Service, Hospital [MeSH], Germany [MeSH], Standardisierung, Emergency Medical Services [MeSH], Sekundärdaten, Standardization
الوصف: Background!#!In Germany there is currently no health reporting on cross-sectoral care patterns in the context of an emergency department care treatment. The INDEED project (Utilization and trans-sectoral patterns of care for patients admitted to emergency departments in Germany) collects routine data from 16 emergency departments, which are later merged with outpatient billing data from 2014 to 2017 on an individual level.!##!Aim!#!The methodological challenges in planning of the internal merging of routine clinical and administrative data from emergency departments in Germany up to the final data extraction are presented together with possible solution approaches.!##!Methods!#!Data were selected in an iterative process according to the research questions, medical relevance, and assumed data availability. After a preparatory phase to clarify formalities (including data protection, ethics), review test data and correct if necessary, the encrypted and pseudonymous data extraction was performed.!##!Results!#!Data from the 16 cooperating emergency departments came mostly from the emergency department and hospital information systems. There was considerable heterogeneity in the data. Not all variables were available in every emergency department because, for example, they were not standardized and digitally available or the extraction effort was judged to be too high.!##!Conclusion!#!Relevant data from emergency departments are stored in different structures and in several IT systems. Thus, the creation of a harmonized data set requires considerable resources on the part of the hospital as well as the data processing unit. This needs to be generously calculated for future projects.
العلاقة: https://repository.publisso.de/resource/frl:6448719Test; https://doi.org/10.1007/s00063-021-00879-0Test; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633500Test/
الإتاحة: https://doi.org/10.1007/s00063-021-00879-0Test
https://repository.publisso.de/resource/frl:6448719Test
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633500Test/ -
8دورية أكاديمية
المؤلفون: Rovas, Alexandros, Paracikoglu, Efe, Michael, Mark, Gries, André, Dziegielewski, Janina, Pavenstädt, Hermann, Bernhard, Michael, Kümpers, Philipp
المصدر: http://lobid.org/resources/99370670818906441Test#!, 29(1):160.
مصطلحات موضوعية: Sepsis [MeSH], Humans [MeSH], Trigger factor, Retrospective Studies [MeSH], Hospital Mortality [MeSH], Resuscitation room, Organ Dysfunction Scores [MeSH], Emergency Service, Hospital [MeSH], ROC Curve [MeSH], Nontrauma patients, Triage [MeSH], Conservative shock room, Original Research, Resuscitation [MeSH], Emergency department
الوصف: Background!#!While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol.!##!Methods!#!All CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]).!##!Results!#!The any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure < 90 mmHg, oxygen saturation < 90%, and Glasgow Coma Scale score < 15 points. This set of triggers identified > 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p < 0.0001 and 2.7 vs. 20.0%, p < 0.012) were significantly lower in trigger factor-negative patients.!##!Conclusion!#!Our simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED.
العلاقة: https://repository.publisso.de/resource/frl:6463919Test; https://doi.org/10.1186/s13049-021-00973-4Test; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590263Test/
الإتاحة: https://doi.org/10.1186/s13049-021-00973-4Test
https://repository.publisso.de/resource/frl:6463919Test
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590263Test/ -
9دورية أكاديمية
المؤلفون: Fischer-Rosinský, Antje, Slagman, Anna, King, Ryan, Zimmermann, Grit, Drepper, Johannes, Brammen, Dominik, Lüpkes, Christian, Reinhold, Thomas, Roll, Stephanie, Keil, Thomas, Möckel, Martin, Greiner, Felix, Behringer, Wilhelm, Bernhard, Michael, Blaschke, Sabine, Busch, Hans-Jörg, Erdmann, Bernadett, Flasch, Bernhard, Gries, André, Höger-Schmidt, Heike, Schöpke, Timo, Schwarz, Constanze, Somasundaram, Rajan, Weidmann, Erik, Wolfrum, Sebastian, Wrede, Christian, INDEED-Projekt
مصطلحات موضوعية: Emergency care, Data integration, Secondary data, Documentation, Standardization, ddc:610
الوصف: Background: In Germany there is currently no health reporting on cross-sectoral care patterns in the context of an emergency department care treatment. The INDEED project (Utilization and trans-sectoral patterns of care for patients admitted to emergency departments in Germany) collects routine data from 16 emergency departments, which are later merged with outpatient billing data from 2014 to 2017 on an individual level. Aim: The methodological challenges in planning of the internal merging of routine clinical and administrative data from emergency departments in Germany up to the final data extraction are presented together with possible solution approaches. Methods: Data were selected in an iterative process according to the research questions, medical relevance, and assumed data availability. After a preparatory phase to clarify formalities (including data protection, ethics), review test data and correct if necessary, the encrypted and pseudonymous data extraction was performed. Results: Data from the 16 cooperating emergency departments came mostly from the emergency department and hospital information systems. There was considerable heterogeneity in the data. Not all variables were available in every emergency department because, for example, they were not standardized and digitally available or the extraction effort was judged to be too high. Conclusion: Relevant data from emergency departments are stored in different structures and in several IT systems. Thus, the creation of a harmonized data set requires considerable resources on the part of the hospital as well as the data processing unit. This needs to be generously calculated for future projects.
وصف الملف: application/pdf
العلاقة: https://refubium.fu-berlin.de/handle/fub188/40261Test; http://dx.doi.org/10.17169/refubium-39981Test
الإتاحة: https://doi.org/10.17169/refubium-39981Test
https://doi.org/10.1007/s00063-021-00879-0Test
https://refubium.fu-berlin.de/handle/fub188/40261Test -
10دورية أكاديمية
المؤلفون: Bernhard, Michael, Döll, Stephanie, Kramer, Andre, Weidhase, Lorenz, Hartwig, Thomas, Petros, Sirak, Gries, André
المصدر: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine ; volume 28, issue 1 ; ISSN 1757-7241
مصطلحات موضوعية: Critical Care and Intensive Care Medicine, Emergency Medicine
الوصف: Background Elevated blood lactate levels were reported as useful predictors of clinical outcome and mortality in critically ill patients. To identify higher-risk patients, this investigation evaluated the relationship between patient mortality and admission lactate levels during the management of non-trauma critically ill patients in the emergency department (ED). Methods In this prospective, single centre observational study in a German university ED, all adult patients who were admitted to the ED resuscitation room were evaluated between September 1, 2014 and August 31, 2015. Blood samples for blood gas analysis, including lactate levels, were obtained immediately at admission. Study endpoint was 30-day mortality. Results During the study period, 532 patients were admitted to the resuscitation room of the ED. The data of 523 patients (98.3%) were available. The overall 30-day mortality was 34.2%. Patients presenting to the resuscitation room with admission lactate levels < 2.0 mmol/l had a 30-day mortality of 22.7%, while admission lactate levels above 8.0 mmol/l were associated with higher mortality (8.0–9.9 mmol/l: OR: 2.83, 95%CI: 1.13–7.11, p = 0.03, and ≥ 10 mmol/l: OR: 7.56, 95%CI: 4.18–13.77, p < 0.001). Conclusion High lactate levels at admission are associated with an increased 24-h and 30-day mortality. These measurements may be used not only to predict mortality, but to help identify patients at risk for becoming critically ill. The breakpoint for mortality may be an ALL ≥8.0 mmol/l.
النص الكامل