Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Working conditions in German intensive care units-A cross-professional analysis].","authors":"Anna Carola Hertrich, Janika Briegel, Nadine Weeverink, Jan-Hendrik Naendrup, Julian Hoffmann","doi":"10.1007/s00063-025-01302-8","DOIUrl":"10.1007/s00063-025-01302-8","url":null,"abstract":"<p><strong>Background: </strong>Intensive care medicine represents a highly complex and labor-intensive field that entails unique physical, psychological and structural challenges for both physicians and nursing personnel. The aim of this study was to systematically analyze the working conditions in German intensive care units (ICUs), with a particular focus on differences between professional groups, hospital types and individual characteristics, such as gender, professional experience and training level.</p><p><strong>Method: </strong>Using a German language online questionnaire a total of 753 ICU personnel from all professional groups were surveyed regarding working conditions, workload and job satisfaction. Recruitment was conducted via professional societies and social media.</p><p><strong>Results: </strong>The results reveal significant differences in job satisfaction depending on the nurse-to-patient ratio, employment level, professional experience and gender. Nursing personnel with a favorable staffing ratio (1:2) reported higher satisfaction and lower stress levels. Younger and less experienced staff reported insufficient preparation, increased stress and lower satisfaction with training and continuing education. Physicians in training, and especially female staff members, more frequently reported having to perform tasks without adequate preparation. Furthermore, gender-based disparities were observed regarding recognition and assumption of responsibility.</p><p><strong>Conclusion: </strong>The findings highlight the urgent need for structural reformation to improve working conditions in ICUs. Key areas for action include structured onboarding, flexible work schedule models, targeted support for junior staff and gender equity as well as improvements in interprofessional collaboration and staffing levels.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"462-472"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530662","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}

{"title":"[Treatment algorithm: care of the orally placed endotracheal tube in critically ill patients].","authors":"Oliver Rothaug, Franziska Wefer, Peter Nydahl, Daniel Plaß, Richard Schalk, Thomas Mannebach, Tobias Alzen, Pia Kirchhoff, Sarah Köster, Sarah Lohmeier, Anne Oldag, Lars Krüger","doi":"10.1007/s00063-025-01315-3","DOIUrl":"https://doi.org/10.1007/s00063-025-01315-3","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975690","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}

{"title":"[Challenges in neuroprognostication after extracorporeal membrane oxygenation].","authors":"Ewa Anna Gardner, Laura Heine, Alexander Rau, Wolf D Niesen, Kathrin Sacher, Tobias Wengenmayer, Dawid L Staudacher","doi":"10.1007/s00063-024-01232-x","DOIUrl":"10.1007/s00063-024-01232-x","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"515-517"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014767","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}

{"title":"[Do nurses perform sonography in Germany? A survey].","authors":"Lars Krüger, Oliver Rothaug, Rolf Dubb, Peter Nydahl","doi":"10.1007/s00063-025-01269-6","DOIUrl":"10.1007/s00063-025-01269-6","url":null,"abstract":"<p><strong>Background: </strong>Internationally, ultrasounds are carried out by various healthcare professionals and in particular by nurses. It is not yet known whether and in what context this takes place in Germany.</p><p><strong>Aim: </strong>Are ultrasounds performed by nurses in daily nursing care in Germany? Secondary objectives were the context, frequency, qualifications and impact on the nursing care process and teamwork.</p><p><strong>Methods: </strong>Quantitative survey using an online questionnaire with 28 closed and one open question, which was sent out in professional networks.</p><p><strong>Results: </strong>A total of 476 people took part, of whom 98.7% (n = 470) were evaluable. The primary respondents were nurses (80.9%, n = 359) who worked in hospitals (83.0%, n = 390) in the intensive care unit (37.2%, n = 175). A total of 13.2% (n = 62) stated that nurses use sonography in practice. It takes most frequently place for venipuncture or placement of an indwelling cannula (74.2%, n = 46), puncture of an arterial vessel (59.7%, n = 37) and determination of perfusion or peripheral blood sampling (45.2% each, n = 28). Ultrasounds are usually performed several times a week or month (36.4%, n = 12) and the qualification is primarily acquired in the patient's own institution (36.4%, n = 12). A total of 7.0% (n = 33) use ultrasound themselves, which improves work processes (63.6%, n = 21) and communication within the team (48.5%, n = 16) and also leads to greater recognition within the team (42.4%, n = 14).</p><p><strong>Conclusion: </strong>In Germany, only a small proportion of ultrasounds of inpatients are performed by nurses, but the activity improves corresponding workflows, communication within the team and leads to greater recognition.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"508-514"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789216","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}

{"title":"[Forced centralized allocation in the emergency department-what has the COVID-19 pandemic changed?]","authors":"Philipp Zehnder, Viktoria Bogner-Flatz, Michael Zyskowski, Frederik Hartz, Dominik Pförringer, Dominik Hinzmann, Karl-Georg Kanz, Michael Dommasch","doi":"10.1007/s00063-024-01182-4","DOIUrl":"10.1007/s00063-024-01182-4","url":null,"abstract":"<p><strong>Background: </strong>IVENA eHealth (IVENA, interdisziplinärer Versorgungsnachweis, mainis IT-Service GmbH, Offenbach am Main, Germany) supports the coordination of emergency admissions by providing real-time data on treatment options in hospitals. Overload or technical problems can lead to hospitals having to temporarily deregister parts or the entire emergency department, which can lead to acute admissions. The COVID-19 pandemic may have further exacerbated the situation, which was analyzed as part of this study.</p><p><strong>Methods: </strong>This descriptive analysis used the IVENA eHealth information technology (IT) system to examine the occupancy and acute occupancy figures in the Munich ambulance service area from 2016-2022. Particular attention was paid to inpatient (SC II) and shock room + admissions in the specialties of internal medicine, neurology, trauma surgery and urology, as well as the development of acute occupancies, especially after the COVID-19 pandemic.</p><p><strong>Results: </strong>During the COVID-19 pandemic in 2020, the number of patients in the surveyed specialist areas fell by 23.7% (2021: -15% and 2022: -11% compared to 2019). The proportion of acute admissions fell in 2020 compared to 2019 (5.9% acute admissions vs. 6.8%) and rose disproportionately in 2021 (7.7% vs. 6.8%) and 2022 (24.9% vs. 6.8%).</p><p><strong>Conclusion: </strong>There are many reasons for the increase in acute admissions, including the increase in inpatient admissions, the bottleneck in transferring patients (exit block) and the shortage of staff in the healthcare system. The COVID-19 pandemic has exacerbated some of these problems, which could explain the increase in acute admissions. A combination of different solutions is now needed to ensure adequate emergency care.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"500-507"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330668","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}

{"title":"A team without a name: emergency medicine recognition and its impact on working conditions and well-being.","authors":"Megan Gates Kemnitz, Eugenia-Maria Lupan-Muresan, Francis Somville, Bruno Barcella, Noaa Shopen, María de Los Angeles López Hernández, Eric P Heymann","doi":"10.1007/s00063-025-01275-8","DOIUrl":"10.1007/s00063-025-01275-8","url":null,"abstract":"<p><p>Emergency medicine (EM) has evolved significantly over the past 50 years, transitioning from a focus on acute injuries and illnesses to include primary and specialty care, disaster response, and social issues. To date, nearly 60 countries have officially recognized EM as a medical specialty. However, growing patient demands, healthcare staff shortages, and an aging population have strained emergency departments, worsening working conditions for EM professionals and compromising patient care. To address these challenges, formal recognition of EM as a specialty is crucial.As a specialty, EM offers significant benefits. It improves patient outcomes by ensuring structured, standardized training that equips specialists with the skills to manage acute conditions such as trauma, stroke, and myocardial infarction. Countries with recognized EM specialties have reported reduced morbidity and mortality and enhanced healthcare resilience during crises like pandemics and mass casualty events. Additionally, professional recognition aids in recruitment, retention, and reducing burnout among EM practitioners by establishing clear career pathways. Furthermore, it ensures specific paraclinical training in areas such as patient flow, and it strengthens healthcare systems. However, despite these benefits, challenges remain. Resource diversion from primary care, increased healthcare costs, and the initial investment required for training programs are potential drawbacks to EM specialty recognition. Achieving EM recognition will require a strategic collaborative approach, focusing on education, professional support, and collaboration across healthcare sectors.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"481-486"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054812","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}

{"title":"[Antibiotic stewardship-an update : Ongoing development of an initiative].","authors":"Katja Schneider, Stefan Hagel, Jessica Rademacher, Irit Nachtigall, Mathias W Pletz","doi":"10.1007/s00063-025-01290-9","DOIUrl":"10.1007/s00063-025-01290-9","url":null,"abstract":"<p><p>The burden of disease caused by infections with antibiotic-resistant bacteria is increasing worldwide. The reason for this is the inappropriate use of antibiotics. In addition to the development of new antibiotics, their rational use is crucial to slowing down the development of resistance. Antibiotic stewardship makes an important contribution to reducing the use of antibiotics by implementing programs, particularly in hospitals. In addition, \"diagnostic stewardship\" supports the targeted use of infectiological diagnostics to avoid mis- and overdiagnosis, thereby optimizing anti-infective therapy. The critical review of suspected penicillin allergies (\"delabeling\") also promotes the sensible use of antibiotics. Findings from healthcare research on antibiotics and diagnostic stewardship are increasingly being incorporated into infectiology and sector-specific guidelines.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"523-533"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163135","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}

{"title":"[Treatment and Support for Adults at the End of Life in Intensive Care : A Recommendation by the Ethics Section of DIVI and the German Society for Palliative Medicine. Part 1: Key Aspects of End-of-Life Care and Dying in Intensive Care. Part 2: Therapeutic Measures and Support at the End of Life in Intensive Care].","authors":"Urs Münch, Gunnar Duttge, T Johannah Eggardt, Peter Gretenkort, Stefan Kleinschmidt, Stefan Meier, Friedemann Nauck, Gerald Neitzke, Martin Neukirchen, Fred Salomon, Manuela Schallenburger, Anna-Henrikje Seidlein, Sonja Vonderhagen, Claudia Weber, Susanne Jöbges","doi":"10.1007/s00063-025-01327-z","DOIUrl":"https://doi.org/10.1007/s00063-025-01327-z","url":null,"abstract":"<p><p>The primary goal of intensive care medicine is to overcome a critical phase of illness using all available means and to enable patients to survive and return to an independent life without intensive care. However, this therapeutic goal cannot always be achieved. The possibility of death, the need to alleviate suffering, and respect for the end of life make it necessary to integrate palliative approaches into intensive care medicine. Supporting seriously ill and dying patients and their relatives in intensive care units requires an attitude that holistically recognizes and respects their individuality and is shared by the entire team. In addition to recognizing life and death, reliable structures, clear agreements, and palliative care skills among the respective professional groups are necessary. When implementing these approaches, it is important to remain within the framework of legal requirements and to take the wishes of those affected into account. In addition to the relevant professional expertise, the most important tool is respectful and clear communication with all those involved and affected. Help should be available at all times in cases of uncertainty regarding ethical and palliative issues, as well as in cases of psychological stress.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975699","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}

{"title":"[Treatment and support for adults at the end of life in intensive care. A recommendation by the Ethics Section of DIVI and the German Society for Palliative Medicine. : Part 2: Therapeutic measures and support at the end of life in intensive care].","authors":"Kathrin Knochel, Iris Barndt, Gunnar Duttge, Jochen Dutzmann, T Johanna Eggardt, Kristina Fuest, Stefan Meier, Andrej Michalsen, Friedemann Nauck, Martin Neukirchen, Ulrike Olgemöller, Raffael Riegel, Manuela Schallenburger, Alexander Supady, Susanne Jöbges","doi":"10.1007/s00063-025-01330-4","DOIUrl":"https://doi.org/10.1007/s00063-025-01330-4","url":null,"abstract":"<p><p>Life in an intensive care unit (ICU) involves the successful use of life-sustaining treatment and patients dying. In intensive care medicine, allowing a patient to die often means discontinuing life-sustaining measures. Together with the severity of the illness, this has a significant impact on the course of the dying process. End of life treatment and support focus on alleviating symptoms. The interprofessional team's task in the ICU is to anticipate, plan and implement palliative measures. A family-centered approach to palliative care requires providing human resources for psychosocial support and spiritual care for those affected. Implementing internal recommendations for action improves the quality of care. Training in the necessary skills to support people at the end of life is an integral component of education and ongoing professional development. This training includes basic knowledge of palliative care as well as specific knowledge about terminating life-sustaining measures.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975685","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}

{"title":"[Palliative care and dying in emergency medical services-Attitudes, perspectives and knowledge of emergency physicians].","authors":"Susanne Glass, Magdalena Bier, Celina Pötz, Lukas Jäger, Tobias Grübl, Pia von Blanckenburg, Christian Volberg","doi":"10.1007/s00063-025-01313-5","DOIUrl":"https://doi.org/10.1007/s00063-025-01313-5","url":null,"abstract":"<p><strong>Background: </strong>Emergency physicians are confronted with the topic of death and dying almost daily in their work. Demographic changes and the accompanying increase in chronic and incurable diseases at the end of life as well as the frequently expressed wish to die at home, are leading to an increase in emergency situations with palliative patients. To date, there is insufficient data available on how emergency physicians deal with palliative patients.</p><p><strong>Method: </strong>Emergency physicians from two service providers participated in the survey 'Palliative Care and Dying in Emergency Medical Service'. The emergency physicians were asked to complete a paper-and-pencil survey covering several topics in the areas of palliative medicine and descriptions of conflicts in non-emergency medical situations. They were also asked about their personal attitudes towards dying and death, based on established psychometric standards. The survey was conducted anonymously.</p><p><strong>Results: </strong>The response rate was 40% (n = 67). Participants had an average age of 41 years, and 66% (n = 44) were male. The majority of emergency physicians surveyed were anaesthetists and had worked as emergency physicians for more than five years. Only six respondents (9%) had an additional training in palliative medicine. On average, more experienced doctors felt better prepared to deal with dying patients than those with less than five years' professional experience as emergency physicians. The survey showed that many emergency physicians experience a conflict between end-of-life care and saving lives when treating palliative patients. None of the respondents stated that palliative medicine had nothing to do with emergency medicine. The emergency physicians surveyed expressed uncertainty regarding the acute preclinical care of palliative patients.</p><p><strong>Conclusion: </strong>The expertise of emergency physicians in palliative medicine increases with the level of operational experience. Almost all respondents consider this topic to be very important and would like to see it integrated more strongly into training and continuing professional education. A lack of knowledge may result in palliative patients being offered less meaningful therapies, which could lead to hospitalisation. Demographic changes will increase the need for emergency physicians with expertise in palliative medicine. The discrepancy identified must be addressed.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975665","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}