Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献_第10页

[Opportunities and barriers of IPReG for out-of-hospital intensive care : Explorative interview study with payers and health policy stakeholders as part of the PRiVENT study]. [院外重症监护IPReG的机会和障碍：作为PRiVENT研究的一部分，对支付方和卫生政策利益相关者的探索性访谈研究]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-10 DOI: 10.1007/s00063-025-01247-y

Elena Biehler, Thomas Fleischhauer, Gerhard E Fuchs, Johanna Forstner, Aline Weis, Selina von Schumann, Julia D Michels-Zetsche, Franziska C Trudzinski, Felix J F Herth, Joachim Szecsenyi, Michel Wensing

{"title":"[Opportunities and barriers of IPReG for out-of-hospital intensive care : Explorative interview study with payers and health policy stakeholders as part of the PRiVENT study].","authors":"Elena Biehler, Thomas Fleischhauer, Gerhard E Fuchs, Johanna Forstner, Aline Weis, Selina von Schumann, Julia D Michels-Zetsche, Franziska C Trudzinski, Felix J F Herth, Joachim Szecsenyi, Michel Wensing","doi":"10.1007/s00063-025-01247-y","DOIUrl":"https://doi.org/10.1007/s00063-025-01247-y","url":null,"abstract":"Background: The number of long-term ventilated patients in out-of-hospital intensive care (OIC) in Germany has risen sharply in recent years. Due to financial disincentives, structural care deficits and resource bottlenecks, there is an increasing risk of inadequate care. In 2020, the Intensive Care and Rehabilitation Strengthening Act (IPReG) was therefore passed by legislators with the aim of improving OIC. This study examines the opportunities and challenges of the IPReG with regard to the care of long-term ventilated patients in OIC from the perspective of payers and healthcare policy.Materials and methods: A qualitative interview study was conducted as part of the process evaluation of the multicenter study PRiVENT (Prevention of invasive Ventilation). Using semi-structured, guideline-based individual interviews, health policy actors and representatives of statutory health insurers were asked about the IPReG.Results: In all, 11 health policymakers and 12 representatives of statutory health insurance companies took part in the interviews. Both interview groups showed a positive attitude towards the IPReG and expressed the expectation of added value for the outpatient care of long-term ventilated patients. The current remuneration regulations for weaning and the assessment of weaning potential in the OIC were criticized, among other things.Conclusion: The IPReG provides a legal basis for improving OIC, but there is still room for improvement in its current version. The evaluation planned by legislators should be used to identify potential weaknesses and make appropriate adjustments.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Acute management of bleeding complications and coagulation disorders in critically ill patients with liver cirrhosis]. 肝硬化危重患者出血并发症及凝血功能障碍的急性处理

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-10 DOI: 10.1007/s00063-024-01242-9

Philipp Kasper, Frank Tacke, Matthias Kochanek, Guido Michels

{"title":"[Acute management of bleeding complications and coagulation disorders in critically ill patients with liver cirrhosis].","authors":"Philipp Kasper, Frank Tacke, Matthias Kochanek, Guido Michels","doi":"10.1007/s00063-024-01242-9","DOIUrl":"https://doi.org/10.1007/s00063-024-01242-9","url":null,"abstract":"Critically ill patients with liver cirrhosis exhibit complex alterations in coagulation that should be considered in clinical acute management. As routine laboratory tests (e.g., INR, aPTT, platelet count) cannot always adequately reflect the coagulation status of critically ill patients with liver cirrhosis, functional hemostatic tests, such as viscoelastic tests, should also be used to assess coagulation disorders in these patients. If invasive procedures are planned, hemostatic interventions to prevent bleeding and measures to stabilize coagulation disorders should be considered depending on the risk of procedure-associated bleeding, while a prophylactic routine correction of abnormal laboratory coagulation parameters should be avoided. If an acute bleeding complication manifests in critically ill patients with liver cirrhosis, an individualized correction of hemostatic changes is indicated in addition to prompt identification of the source of bleeding. This review article describes the pathophysiological changes underlying the altered hemostatic system in critically ill patients with liver cirrhosis and provides an overview of diagnostic and therapeutic options for hemostatic complications.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Characterization of patients with syncope in the emergency department-secondary diagnoses and laboratory parameters of inpatients versus outpatients]. [急诊科晕厥患者的特征--住院病人与门诊病人的二级诊断和实验室参数对比]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-07 DOI: 10.1007/s00063-024-01241-w

Aaron Becker von Rose, Adrian Patenge, Bernhard Haller, Niel Mehraein, Lisa Schmid, Dominik Pförringer, Michael Dommasch

{"title":"[Characterization of patients with syncope in the emergency department-secondary diagnoses and laboratory parameters of inpatients versus outpatients].","authors":"Aaron Becker von Rose, Adrian Patenge, Bernhard Haller, Niel Mehraein, Lisa Schmid, Dominik Pförringer, Michael Dommasch","doi":"10.1007/s00063-024-01241-w","DOIUrl":"https://doi.org/10.1007/s00063-024-01241-w","url":null,"abstract":"Over 1391 patients presented to the emergency department (ED) of a German university hospital with primary diagnosis of syncope from 2019-2022. This monocentric, retrospective study aims to characterize this cohort regarding secondary diagnoses and blood laboratory parameters. Principal focus lay on the differentiation between inpatients (n = 190; 13.7%) and outpatients (n = 1201; 86.3%). Most common secondary diagnoses comprised head injury (n = 188; 13.5%), infection (n = 126; 9.1%), body injury (n = 124; 8.9%), neurological disease (n = 85; 6.1%), arrhythmogenic heart failure (n = 76; 5.5%), cardiovascular risk factors (n = 75; 5.4%), metabolic/nephrological disease (n = 69; 5.0%), and structural heart disease (n = 68; 4.9%). Surgical interventions were performed using catheter (n = 16; 1.2%), percutaneous coronary interventions (n = 15; 1.1%), and pacemaker/defibrillator/event recorders (n = 12; 0.9%). Inpatients had significantly more secondary diagnoses (3.5 vs. 0.3) and higher incidences of abnormal laboratory parameters compared to outpatients. Secondary diagnoses more common in inpatients included cardiovascular risk factors (37.9 vs. 0.2%), arrhythmogenic heart failure (35.3 vs. 0.7%), infection (57.9 vs. 1.3%), and lung disease (6.3 vs. 0.2%). Abnormal blood laboratory values more frequent in inpatients included elevated levels of highly sensitive (hs) troponin T (58.8 vs. 25.7%), creatinine (36.2 vs. 14.8%), leukocytes (43.4 vs. 36.3%), besides decreased hemoglobin (33.3 vs. 16.0%), potassium (5.3 vs. 1.2%), and sodium (2.1 vs. 0.6%).","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Erratum zu: Psychische Belastung des intensivmedizinischen Personals in Deutschland im Verlauf der COVID-19-Pandemie. Evidenz aus der VOICE-Studie. 在COVID-19大流行期间，德国医院的心理健康状况不佳。声音研究。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-07 DOI: 10.1007/s00063-025-01255-y

Alexander Niecke, Michaela Henning, Martin Hellmich, Yesim Erim, Eva Morawa, Petra Beschoner, Lucia Jerg-Bretzke, Franziska Geiser, Andreas M Baranowski, Kerstin Weidner, Sabine Mogwitz, Christian Albus

引用次数: 0

[Intensive care medicine and sustainability : Contradiction or self-evident?] [重症监护医学与可持续性：矛盾还是不言自明？］

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-01 Epub Date: 2024-11-07 DOI: 10.1007/s00063-024-01204-1

Valery Kitz, Dominik Stark, Victoria König, Nadine Weeverink, Sverrir Möller, David Mager, Carsten Hermes

{"title":"[Intensive care medicine and sustainability : Contradiction or self-evident?]","authors":"Valery Kitz, Dominik Stark, Victoria König, Nadine Weeverink, Sverrir Möller, David Mager, Carsten Hermes","doi":"10.1007/s00063-024-01204-1","DOIUrl":"10.1007/s00063-024-01204-1","url":null,"abstract":"Background: Intensive care medicine is one of the most resource-intensive areas of the hospital. As a result, nurses have a crucial role to play in adapting processes to promote sustainability in the intensive care unit. This represents a significant contribution to creating a more climate-friendly hospital. This paper aims to provide an overview of the opportunities for nurses in the multiprofessional team to exert influence in their daily practice in order to promote sustainability on their ward.Methods: The authors summarize further results of the online survey of the DGIIN (Deutschen Gesellschaft für Internistische Intensiv- und Notfallmedizin) sustainability working group. In addition, a systematic literature search was carried out in the PubMed (U.S. National Library of Medicine, Bethesda, MD, USA) database and in the internet.Results: Nurses are able to identify an influence on the consumption of materials and the possibility of using them according to indication. The willingness to develop strategies and involvement in process changes are essential.Conclusion: The lack of structures that deal exclusively with sustainability and the lack of knowledge on this topic lead to a general lack of knowledge and uncertainty. This situation can be improved by targeted measures of education and training, e.g., by Green Teams.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"30-36"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Action algorithm: management of acute pancreatitis in acute and emergency medicine]. [行动算法：急诊科急性胰腺炎的处理]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-01 Epub Date: 2024-11-19 DOI: 10.1007/s00063-024-01217-w

Philipp Kasper, Guido Michels

引用次数: 0

[Electrical injuries: incidence of delayed cardiac arrhythmias after presentation to the emergency department-a multicenter, retrospective observation study]. [电击伤：急诊科就诊后迟发性心律失常的发生率--一项多中心回顾性观察研究]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-01 Epub Date: 2024-09-28 DOI: 10.1007/s00063-024-01186-0

Hauke Wilcken, Sebastian Casu, Dorothea Sauer

引用次数: 0

[Tympanic temperature measurement in heat illness is (largely) reliable and practicable]. [热病中的耳温测量（基本）可靠可行]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-01 Epub Date: 2024-11-08 DOI: 10.1007/s00063-024-01207-y

Thomas Bein

引用次数: 0

[Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein]. [医生协助医院间转运--来自石勒苏益格-荷尔斯泰因州的分析]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-01 Epub Date: 2024-03-07 DOI: 10.1007/s00063-024-01119-x

Andrea Köser, Christine Eimer, Maximilian Feth, Ulf Lorenzen, Stephan Seewald, Henrik Lehn, Michael Corzillius, Bjarne Schmalbach, Florian Reifferscheid

{"title":"[Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein].","authors":"Andrea Köser, Christine Eimer, Maximilian Feth, Ulf Lorenzen, Stephan Seewald, Henrik Lehn, Michael Corzillius, Bjarne Schmalbach, Florian Reifferscheid","doi":"10.1007/s00063-024-01119-x","DOIUrl":"10.1007/s00063-024-01119-x","url":null,"abstract":"Background: The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles.Objective: To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein.Material and methods: Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022.Results: Of a total of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389 IHT (61.4%) were managed by specialized ambulances, 875 (38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with a higher level of medical care.Conclusion: Emergency physician-assisted IHT are a relevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. A relevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"57-64"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Lessons from the COVID-19-Pandemic : Experiences of critical care nurses during the COVID-19 pandemic: a qualitative explorative study]. [COVID-19大流行的教训：COVID-19大流行期间重症监护护士的经历：定性探索研究]。

IF 1.3 4区医学

Medizinische Klinik-Intensivmedizin Und Notfallmedizin Pub Date : 2025-02-01 Epub Date: 2024-03-08 DOI: 10.1007/s00063-024-01120-4

Elena Camenzind, Luzia Vetter, Matthias Thomas Exl, Marie-Madlen Jeitziner

{"title":"[Lessons from the COVID-19-Pandemic : Experiences of critical care nurses during the COVID-19 pandemic: a qualitative explorative study].","authors":"Elena Camenzind, Luzia Vetter, Matthias Thomas Exl, Marie-Madlen Jeitziner","doi":"10.1007/s00063-024-01120-4","DOIUrl":"10.1007/s00063-024-01120-4","url":null,"abstract":"Background: When the workload for critical care nurses becomes too high, this can have consequences for both personal health as well as patient care. During the COVID-19 pandemic, critical care nurses were confronted with new and dynamic changes.Objective: The aim of this study was to describe the experiences of critical care nurses regarding the ad hoc measures taken and the perceived physical and psychological burden experienced during the coronavirus disease 2019 (COVID-19) pandemic.Methods: This was a cross-sectional study conducted at two hospitals using an online survey. The open questions addressing the challenges faced during the COVID-19 pandemic were subjected to content analysis according to Mayring.Results: A total of 179 critical care nurses participated in the online survey. From the results, the following four categories were developed: \"not meeting one's own quality of care requirements,\" \"uncertainties in everyday professional and private life,\" \"increased responsibility with lack of relief,\" and \"insufficient coping strategies for physical and psychological burden.\"Conclusion: Critical care nurses require structures and processes which support them in situations of high workload. The focus should be on the self-imposed requirements of quality of care as well as potentially relieving measures.","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"65-70"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140066081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0