المؤلفون: M. Misailovski, D. Koller, S. Blaschke, M. Berens, A.M. Köster, R. Strobl, R. Berner, P. Boor, M. Eisenmann, S. von Stillfried, D. Krefting, M. Krone, J. Liese, P. Meybohm, G. Ulrich- Merzenich, S. Zenker, S. Scheithauer, E. Grill

المصدر: Infection Prevention in Practice, Vol 6, Iss 3, Pp 100371- (2024)

مصطلحات موضوعية: Incidental SARS-CoV-2, COVID-19, Hospitalization rate, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270

الوصف: Summary: Purpose: Until now, the Hospitalization Rate (HR) served as an indicator (among others) for the COVID-19 associated healthcare burden. To ensure that the HR accomplishes its full potential, hospitalizations caused by COVID-19 (primary cases) and hospitalizations of patients with incidental positive SARS-CoV-2 test results (incidental cases) must be differentiated. The aim of this study was to synthesize the existing evidence on differentiation criteria between hospitalizations of primary cases and incidental cases. Methods: An online survey of the members of the German Network University Medicine (NUM) was conducted. Additionally, senior clinicians with expertise in COVID-19 care were invited for qualitative, semi-structured interviews. Furthermore, a rapid literature review was undertaken on publications between 03/2020 and 12/2022. Results: In the online survey (n=30, response rate 56%), pneumonia and acute upper respiratory tract infections were the most indicative diagnoses for a primary case. In contrast, malignant neoplasms and acute myocardial infarctions were most likely to be associated with incidental cases. According to the experts (n=6), the diagnosis, ward, and type of admission (emergency or elective), low oxygen saturation, need for supplemental oxygen, and initiation of COVID-19 therapy point to a primary case. The literature review found that respiratory syndromes and symptoms, oxygen support, and elevated levels of inflammatory markers were associated with primary cases. Conclusion: There are parameters for the differentiation of primary from incidental cases to improve the objective of the HR. Ultimately, an updated HR has the potential to serve as a more accurate indicator of the COVID-19 associated healthcare burden.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2590088924000350Test; https://doaj.org/toc/2590-0889Test

الوصول الحر: https://doaj.org/article/43b32d1731164ad6a1b95248d8b33fc0Test

المؤلفون: K. Hoppe, E. Khan, P. Meybohm, T. Riese

المصدر: Critical Care, Vol 27, Iss 1, Pp 1-9 (2023)

مصطلحات موضوعية: ARDS, Ventilation, ECMO indication, Mechanical power, Driving pressure, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

الوصف: Abstract The current ARDS guidelines highly recommend lung protective ventilation which include plateau pressure (P plat 5 cm H2O) and tidal volume (V t of 6 ml/kg) of predicted body weight. In contrast, the ELSO guidelines suggest the evaluation of an indication of veno-venous extracorporeal membrane oxygenation (ECMO) due to hypoxemic or hypercapnic respiratory failure or as bridge to lung transplantation. Finally, these recommendations remain a wide range of scope of interpretation. However, particularly patients with moderate-severe to severe ARDS might benefit from strict adherence to lung protective ventilation strategies. Subsequently, we discuss whether extended physiological ventilation parameter analysis might be relevant for indication of ECMO support and can be implemented during the daily routine evaluation of ARDS patients. Particularly, this viewpoint focus on driving pressure and mechanical power.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1364-8535Test

الوصول الحر: https://doaj.org/article/2a3f9a90055d4bdc869b53c09caae155Test

المؤلفون: T. Grundgeiger, F. Hahn, T. Wurmb, P. Meybohm, O. Happel

المصدر: Resuscitation Plus, Vol 7, Iss , Pp 100152- (2021)

مصطلحات موضوعية: Cardiopulmonary resuscitation, Checklists, Crisis management, Information technology, Medical emergency team, Simulation, Specialties of internal medicine, RC581-951

الوصف: Aim: Cardiac arrests require fast, well-timed, and well-coordinated interventions delivered by several staff members. We evaluated a cognitive aid that works as an attentional aid to support specifically the timing and coordination of these interventions. We report the results of an experimental, simulation-based evaluation of the tablet-based cognitive aid in performing guideline-conforming cardiopulmonary resuscitation. Methods: In a parallel group design, emergency teams (one qualified emergency physician as team leader and one qualified nurse) were randomly assigned to the cognitive aid application (CA App) group or the no application (No App) group and then participated in a simulated scenario of a cardiac arrest. The primary outcome was a cardiopulmonary resuscitation performance score ranging from zero to two for each team based on the videotaped scenarios in relation to twelve performance variables derived from the European Resuscitation Guidelines. As a secondary outcome, we measured the participants’ subjective workload. Results: A total of 67 teams participated. The CA App group (n = 32 teams) showed significantly better cardiopulmonary resuscitation performance than the No App group (n = 31 teams; mean difference = 0.23, 95 %CI = 0.08 to 0.38, p = 0.002, d = 0.83). The CA App group team leaders indicated significantly less mental and physical demand and less effort to achieve their performance compared to the No App group team leaders. Conclusions: Among well-trained in-hospital emergency teams, the cognitive aid could improve cardiopulmonary resuscitation coordination performance and decrease mental workload.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2666520421000771Test; https://doaj.org/toc/2666-5204Test

الوصول الحر: https://doaj.org/article/9f1366d69bb2472bb5392bea5ca08303Test

المؤلفون: V. Neef, S. Koenig, D. Monden, M.W. Ronellenfitsch, P.N. Harter, C. Senft, P. Meybohm, E. Hattingen, K. Zacharowski, V. Seifert, P. Baumgarten

المصدر: Brain and Spine, Vol 1, Iss , Pp 100568- (2021)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2772529421005683Test; https://doaj.org/toc/2772-5294Test

الوصول الحر: https://doaj.org/article/81e75b12042f4a26bfbe40277a95a2feTest

المؤلفون: Beierle, Felix, Schobel, Johannes, Vogel, Carsten, Allgaier, Johannes, Mulansky, Lena, Haug, Fabian, Haug, Julian, Schlee, Winfried, Holfelder, Marc, Stach, Michael, Schickler, Marc, Baumeister, Harald, Cohrdes, Caroline, Deckert, Jürgen, Deserno, Lorenz, Edler, Johanna-Sophie, Eichner, Felizitas A., Greger, Helmut, Hein, Grit, Heuschmann, Peter, John, Dennis, Kestler, Hans A., Krefting, Dagmar, Langguth, Berthold, Meybohm, Patrick, Probst, Thomas, Reichert, Manfred, Romanos, Marcel, Störk, Stefan, Terhorst, Yannik, Weiß, Martin, Pryss, Rüdiger

مصطلحات موضوعية: Computer Science - Computers and Society

الوصف: Physical and mental well-being during the COVID-19 pandemic is typically assessed via surveys, which might make it difficult to conduct longitudinal studies and might lead to data suffering from recall bias. Ecological momentary assessment (EMA) driven smartphone apps can help alleviate such issues, allowing for in situ recordings. Implementing such an app is not trivial, necessitates strict regulatory and legal requirements, and requires short development cycles to appropriately react to abrupt changes in the pandemic. Based on an existing app framework, we developed Corona Health, an app that serves as a platform for deploying questionnaire-based studies in combination with recordings of mobile sensors. In this paper, we present the technical details of Corona Health and provide first insights into the collected data. Through collaborative efforts from experts from public health, medicine, psychology, and computer science, we released Corona Health publicly on Google Play and the Apple App Store (in July, 2020) in 8 languages and attracted 7,290 installations so far. Currently, five studies related to physical and mental well-being are deployed and 17,241 questionnaires have been filled out. Corona Health proves to be a viable tool for conducting research related to the COVID-19 pandemic and can serve as a blueprint for future EMA-based studies. The data we collected will substantially improve our knowledge on mental and physical health states, traits and trajectories as well as its risk and protective factors over the course of the COVID-19 pandemic and its diverse prevention measures.

الوصول الحر: http://arxiv.org/abs/2106.03386Test

المؤلفون: Johannes Menger, Zheng-Yii Lee, Quirin Notz, Julia Wallqvist, M. Shahnaz Hasan, Gunnar Elke, Martin Dworschak, Patrick Meybohm, Daren K. Heyland, Christian Stoppe

المصدر: Critical Care, Vol 26, Iss 1, Pp 1-12 (2022)

مصطلحات موضوعية: Vitamin D, Critically ill, Nutrition, Meta-analysis, Mortality, Mechanical ventilator weaning, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

الوصف: Abstract Background The clinical significance of vitamin D administration in critically ill patients remains inconclusive. The purpose of this systematic review with meta-analysis was to investigate the effect of vitamin D and its metabolites on major clinical outcomes in critically ill patients, including a subgroup analysis based on vitamin D status and route of vitamin D administration. Methods Major databases were searched through February 9, 2022. Randomized controlled trials of adult critically ill patients with an intervention group receiving vitamin D or its metabolites were included. Random-effect meta-analyses were performed to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Risk of bias assessment included the Cochrane tool for assessing risk of bias in randomized trials. Results Sixteen randomized clinical trials with 2449 patients were included. Vitamin D administration was associated with lower overall mortality (16 studies: risk ratio 0.78, 95% confidence interval 0.62–0.97, p = 0.03; I 2 = 30%), reduced intensive care unit length of stay (12 studies: mean difference − 3.13 days, 95% CI − 5.36 to − 0.89, n = 1250, p = 0.006; I 2 = 70%), and shorter duration of mechanical ventilation (9 studies: mean difference − 5.07 days, 95% CI − 7.42 to − 2.73, n = 572, p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1364-8535Test

الوصول الحر: https://doaj.org/article/761ebf9f1be946ca914a4816261fdda5Test

المؤلفون: Maximilian Kippnich, Maximilian Duempert, Nora Schorscher, Martin C. Jordan, Andreas S. Kunz, Patrick Meybohm, Thomas Wurmb

المصدر: Scientific Reports, Vol 12, Iss 1, Pp 1-8 (2022)

مصطلحات موضوعية: Medicine, Science

الوصف: Abstract The trauma center of the University Hospital Wuerzburg has developed an advanced trauma pathway based on a dual-room trauma suite with an integrated movable sliding gantry CT-system. This enables simultaneous CT-diagnostics and treatment of two trauma patients. The focus of this study was to investigate the quality of the concept based on defined outcome criteria in this specific setting (time from arrival to initiation of CT scan: tCT; time from arrival to initiation of emergency surgery: tES). We analyzed all trauma patients admitted to the hospital’s trauma suite from 1st May 2019 through 29th April 2020. Two subgroups were defined: trauma patients, who were treated without a second trauma patient present (group 1) and patients, who were treated simultaneously with another trauma patient (group 2). Simultaneous treatment was defined as parallel arrival within a period of 20 min. Of 423 included trauma patients, 46 patients (10.9%) were treated simultaneously. Car accidents were the predominant trauma mechanism in this group (19.6% vs. 47.8%, p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2045-2322Test

الوصول الحر: https://doaj.org/article/e0adefcad0ec49a192dbdc2af1f81b8bTest

المؤلفون: Samantha Hackenbroich, Peter Kranke, Patrick Meybohm, Stephanie Weibel

المصدر: Systematic Reviews, Vol 11, Iss 1, Pp 1-10 (2022)

مصطلحات موضوعية: Randomized controlled trial, Conference abstract, Systematic review, Reporting quality, CONSORT, Postoperative nausea and vomiting, Medicine

الوصف: Abstract Background Systematic reviews attempt to gather all available evidence. Controversy exists regarding effort and benefit of including study results presented at conferences only. We recently published a Cochrane network meta-analysis (NMA) including 585 randomized controlled trials comparing drugs for prevention of postoperative nausea and vomiting (PONV). Studies published as conference abstracts only were excluded. This study aimed to include all eligible studies published as abstracts only, assessing their added value regarding reporting quality and effect on the review’s interpretation. Methods Conference abstracts were searched in the review’s excluded studies and conference proceedings of anaesthesiologic societies. We assessed their reporting quality regarding review’s eligibility criteria, Cochrane ‘risk of bias’ assessment tool 1.0, and adherence to CONSORT (Consolidated Standards of Reporting Trials) for abstracts. Abstracts were included in sensitivity NMA, and impact on the NMA structure was investigated. Results We identified 90 abstracts. A total of 14% (13/90) were eligible. A total of 86% (77/90) are awaiting classification due to insufficient reporting of review’s eligibility criteria. In abstracts awaiting classification, sufficient information was missing on standardization of anaesthesia in 71% (55/77), age of participants in 56% (43/77), and outcome details in 46% (36/77). A total of 73% (66/90) of abstracts lacked sufficient information on 15/25 data extraction items. Reported study characteristics of abstracts were comparable to included studies of the review. A total of 62% (56/90) of abstract trials were assessed as overall high risk of bias due to poor reporting. Median adherence to CONSORT for abstracts was 24% (IQR, 18 to 29%). Six of the 13 eligible abstracts reported relevant outcome data in sufficient detail for NMA on seven outcomes of the Cochrane review. Inclusion of abstracts did not substantially change the network structure, network effect estimates, ranking of treatments, or the conclusion. Certainty of evidence for headache on palonosetron use was upgraded from very low to low. Conclusions Most conference abstracts on PONV were insufficiently reported regarding review’s narrow inclusion criteria and could not be included in NMA. The resource-intensive search and evaluation of abstracts did not substantially extent the full-text evidence base of the review, given the few adequately reported abstracts. Conferences should oblige authors to adhere to CONSORT for abstracts.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2046-4053Test

الوصول الحر: https://doaj.org/article/03da47b2b9bf4dbd8ca3456aa9ad72f5Test

المؤلفون: Tim Rahmel, Felix Kraft, Helge Haberl, Ute Achtzehn, Timo Brandenburger, Holger Neb, Dominik Jarczak, Maximilian Dietrich, Harry Magunia, Frieda Zimmer, Jale Basten, Claudia Landgraf, Thea Koch, Kai Zacharowski, Markus A. Weigand, Peter Rosenberger, Roman Ullrich, Patrick Meybohm, Axel Nierhaus, Detlef Kindgen-Milles, Nina Timmesfeld, Michael Adamzik

المصدر: Critical Care, Vol 26, Iss 1, Pp 1-11 (2022)

مصطلحات موضوعية: Immunoglobulins, Immunoglobulin M, COVID-19, Coronavirus disease, SARS-CoV-2, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

الوصف: Abstract Background A profound inflammation-mediated lung injury with long-term acute respiratory distress and high mortality is one of the major complications of critical COVID-19. Immunoglobulin M (IgM)-enriched immunoglobulins seem especially capable of mitigating the inflicted inflammatory harm. However, the efficacy of intravenous IgM-enriched preparations in critically ill patients with COVID-19 is largely unclear. Methods In this retrospective multicentric cohort study, 316 patients with laboratory-confirmed critical COVID-19 were treated in ten German and Austrian ICUs between May 2020 and April 2021. The primary outcome was 30-day mortality. Analysis was performed by Cox regression models. Covariate adjustment was performed by propensity score weighting using machine learning-based SuperLearner to overcome the selection bias due to missing randomization. In addition, a subgroup analysis focusing on different treatment regimens and patient characteristics was performed. Results Of the 316 ICU patients, 146 received IgM-enriched immunoglobulins and 170 cases did not, which served as controls. There was no survival difference between the two groups in terms of mortality at 30 days in the overall cohort (HRadj: 0.83; 95% CI: 0.55 to 1.25; p = 0.374). An improved 30-day survival in patients without mechanical ventilation at the time of the immunoglobulin treatment did not reach statistical significance (HRadj: 0.23; 95% CI: 0.05 to 1.08; p = 0.063). Also, no statistically significant difference was observed in the subgroup when a daily dose of ≥ 15 g and a duration of ≥ 3 days of IgM-enriched immunoglobulins were applied (HRadj: 0.65; 95% CI: 0.41 to 1.03; p = 0.068). Conclusions Although we cannot prove a statistically reliable effect of intravenous IgM-enriched immunoglobulins, the confidence intervals may suggest a clinically relevant effect in certain subgroups. Here, an early administration (i.e. in critically ill but not yet mechanically ventilated COVID-19 patients) and a dose of ≥ 15 g for at least 3 days may confer beneficial effects without concerning safety issues. However, these findings need to be validated in upcoming randomized clinical trials. Trial registration DRKS00025794 , German Clinical Trials Register, https://www.drks.deTest . Registered 6 July 2021.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1364-8535Test

الوصول الحر: https://doaj.org/article/99b78e3709e747369739ec981b3a519eTest

المؤلفون: Waltraud Pfeilschifter, Edelgard Lindhoff-Last, Ali Alhashim, Barbara Zydek, Simone Lindau, Stavros Konstantinides, Oliver Grottke, Ulrike Nowak-Göttl, Christian von Heymann, Ingvild Birschmann, Jan Beyer-Westendorf, Patrick Meybohm, Andreas Greinacher, Eva Herrmann, the RADOA-Registry Investigators (Reversal Agent use in patients treated with Direct Oral Anticoagulants or vitamin K antagonists Registry)

المصدر: Neurological Research and Practice, Vol 4, Iss 1, Pp 1-7 (2022)

مصطلحات موضوعية: Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Neurology. Diseases of the nervous system, RC346-429

الوصف: Abstract Background and purpose The use of direct oral anticoagulants (DOAC) has increased sharply and DOAC are the oral anticoagulant therapy (OAT) of choice for the majority of patients with newly-diagnosed atrial fibrillation. Intracranial hemorrhage is the most severe adverse event of OAT. Systematic data on the course of intracranial hemorrhage under DOAC compared to vitamin K antagonists (VKA) are warranted to enable shared decision making in AF patients needing OAT. Methods This is a secondary analysis of the patients with intracranial bleedings from the prospective multicenter emergency department-based RADOA registry, which collected data on patients admitted with major bleeding while taking VKA or DOAC. The primary endpoint was in-hospital mortality until day 30. We evaluated hematoma volume and short-term clinical outcomes in relation to the extent of active OAT according to coagulation parameters and OAT plasma levels measured by UPLC-MS/MS. Results Of 193 patients with major bleeding, 109 (56.5%) had intracranial hemorrhage [52.3% intracerebral (ICH), 33.9% subdural (SDH), 11.0% subarachnoidal (SAH)]. 64 (58.7%) were on VKA and 45 (41.2%) were on DOAC. On admission, we could confirm active anticoagulation in 97.7% of VKA-treated patients based on either INR > 1.3 or phenprocoumon levels and in 75.8% of DOAC-treated patients based on DOAC levels. Patients suffering an intracranial hemorrhage under VKA showed significantly larger hematoma volumes and a higher in-hospital mortality. Especially in intracerebral hemorrhage, we observed a higher initial severity and numerically greater proportion of early changes towards palliative therapy under VKA, which coincided with a numerically higher case fatality. Conclusions We show significantly smaller hematoma volumes for ICH and SDH under DOAC in comparison to VKA and a significantly lower 30-day in-hospital mortality rate of DOAC-ICH, even before the introduction of specific antidotes. These data strongly support the use of DOAC whenever possible in patients requiring OAT. Trial Registration: http://www.clinicaltrials.govTest ; Unique identifier: NCT01722786.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2524-3489Test

الوصول الحر: https://doaj.org/article/e2692267b3564bf7aed7eb40465da227Test