Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

{"title":"[Frequency and barriers to the patient advanced directive and lasting power of attorney: findings from a prospective observation study in palliative care services].","authors":"Benedict Mathias Breen, Claudia Flohr, Heike Wendt, Katharina Chalk, Ulrike Haase, Christiane Hartog, Sascha Tafelski","doi":"10.1007/s00063-024-01149-5","DOIUrl":"10.1007/s00063-024-01149-5","url":null,"abstract":"<p><strong>Background: </strong>The advance directive and lasting power of attorney are instruments to strengthen patients' autonomy. A hospital-based palliative care consultation service can advise patients and family members about these instruments. This study investigates the need for such consultation among patients with life-limiting illness.</p><p><strong>Methods: </strong>This prospective observational study on intensive and non-intensive care units includes patients with a request for palliative care consultation. Patient-related factors were evaluated for their possible association with the presence or absence of advance directives or power of attorney. In addition, focus group interviews with members of the palliative care consultation team were carried out to identify barriers which prevent patients from drawing up such documents.</p><p><strong>Results: </strong>A total of 241 oncological and 53 non-oncological patients were included with a median age of 67 years; 69 (23%) patients were treated in the intensive care unit (ICU). Overall, 98 (33%) patients had advance directives, and 133 (45%) had determined a legal health care proxy in advance. A total of 52 patients died in hospital (17.7%). Only age and relationship status were associated with directives. In interviews, the following barriers were identified: information deficit, concern regarding discontinuation of treatment, loss of autonomy and wish to avoid a burden for the family.</p><p><strong>Conclusion: </strong>The majority in this severely ill patient population lack advance directives. In order to remove barriers, more effective information and counseling is required about such directives. In particular, guidance should include potential clinical situations in which such directives are potentially beneficial.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"222-229"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140917307","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":"[Treatment algorithm postextubation dysphagia].","authors":"Anemone Neumann-Wagner, Carsten Hermes, Susanne Krotsetis, Lars Krüger, Franziska Thüne, Franziska Wefer, Peter Nydahl","doi":"10.1007/s00063-025-01256-x","DOIUrl":"10.1007/s00063-025-01256-x","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"196-198"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484418","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":"[Recommendations on standard concentrations for continuous infusion of medicinal products in intensive care units].","authors":"L Kreysing, H Hilgarth, M Bodenstein, N Haake, A Kaltwasser, J A Köck, D Meyn, R Riessen, C Waydhas, I Krämer","doi":"10.1007/s00063-025-01264-x","DOIUrl":"10.1007/s00063-025-01264-x","url":null,"abstract":"<p><strong>Background: </strong>Numerous medications are continuously administered to intensive care patients. To minimize medication errors standardized concentrations and dose adjustment by the infusion rate are recommended. This principle is already widely accepted in German intensive care units (ICUs). However, the active ingredients and concentrations used are still heterogeneous throughout the country.</p><p><strong>Aim: </strong>The aim of the ADKA/DIVI (Bundesverband Deutscher Krankenhausapotheker/Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) initiative was to create a nationwide standard for adult continuous intravenous infusions in German ICUs by an expert panel.</p><p><strong>Materials and methods: </strong>A mandated group of experts developed a nationwide standard concentration list for continuous infusion in a two-stage, consensus-based process. In stage 1, the inclusion of active substances was agreed upon, and in stage 2, the standard concentrations to be recommended were decided upon. The decision-making process was based on predefined decision criteria.</p><p><strong>Results: </strong>The continuous infusion standard contains 41 active substances with 49 standard concentrations (37 substances with 1 concentration [conc.], heparin 2 conc., epinephrine and sufentanil 3 conc., norepinephrine 4 conc.), along with the appropriate vehicle solution, and the physicochemical stability over maximum 24 h.</p><p><strong>Conclusion: </strong>The resulting continuous infusion standards are practical and evidence-based and represent a central component for improving medication safety in ICUs. Implementation of the standard list in German ICUs should be facilitated by interdisciplinary teams.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"199-207"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671669","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":"[Developing kinaesthetic competence and team dynamics : A quality improvement project in a stroke unit].","authors":"Jens Wuschke, Alessandra Besomi Thalhammer, Heidrun Gattinger","doi":"10.1007/s00063-024-01211-2","DOIUrl":"10.1007/s00063-024-01211-2","url":null,"abstract":"<p><strong>Background: </strong>Movement training for stroke patients is a crucial component of their treatment. Lack of time and staff are often described as limiting factors for the development of kinaesthetic competence. In contrast, a positive team atmosphere and awareness of kinaesthetics are seen to be beneficial.</p><p><strong>Aim: </strong>The goal of this quality improvement project was to promote the kinaesthetic competence of a stroke unit (SU) nursing team and to investigate its influence on team dynamics.</p><p><strong>Methods: </strong>As a team intervention for the project, a basic course in kinaesthetics in nursing, augmented by practical instructions, was conducted exclusively for the SU nursing team. The Kinaesthetics Competence Observation (KCO) instrument was used to determine competence development. The participants rated team dynamics on a scale of 0-10 points.</p><p><strong>Results: </strong>In all, 88% of the nursing team took part in the quality improvement project and successfully completed the basic course. The kinaesthetic competence improved by 4.2 KCO points and the team dynamics also increased by around 2 points.</p><p><strong>Discussion: </strong>A basic kinaesthetics course with practical instructions improves kinaesthetic competence. Continuous instruction, long-term process implementation and support from nursing managers are required to establish kinaesthetic competence in the long term.</p><p><strong>Conclusion: </strong>The results show that a kinaesthetic training project carried out in this way has a positive influence not only on kinaesthetic competence but also on the dynamics of a care team.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"246-252"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683082","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":"[H5N1 avian influenza: is a new pandemic looming? : Diagnosis, treatment and prognosis].","authors":"Michael Buerke, Priyanka Boettger, Henning Lemm","doi":"10.1007/s00063-024-01221-0","DOIUrl":"10.1007/s00063-024-01221-0","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"192-195"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819676","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":"[OPTINOFA-Intelligent assistance service for structured assessment in the emergency department].","authors":"Elisabeth Nyoungui, Marina V Karg, Marc Wieckenberg, Katrin Esslinger, Michael Schmucker, Andreas Reiswich, Kai L Antweiler, Tim Friede, Martin Haag, Harald Dormann, Sabine Blaschke","doi":"10.1007/s00063-024-01126-y","DOIUrl":"10.1007/s00063-024-01126-y","url":null,"abstract":"<p><strong>Background: </strong>Case numbers in central emergency departments (EDs) have risen during the past decade in Germany, leading to recurrent overcrowding, increased risks in emergency care, and elevated costs. Particularly the fraction of outpatient emergency treatments has increased disproportionately. Within the framework of the Optimization of emergency care by structured triage with intelligent assistant service (OPTINOFA, Förderkennzeichen [FKZ] 01NVF17035) project, an intelligent assistance service was developed.</p><p><strong>Patients and methods: </strong>New triage algorithms were developed for the 20 most frequent leading symptoms on the basis of established triage systems (emergency severity index, ESI; Manchester triage system, MTS) and provided as web-based intelligent assistance services on mobile devices. To evaluate the validity, reliability, and safety of the new OPTINOFA triage instrument, a pilot study was conducted in three EDs after ethics committee approval.</p><p><strong>Results: </strong>In the pilot study, n = 718 ED patients were included (age 59.1 ± 22 years; 349 male, 369 female). With respect to disposition (out-/inpatient), a sensitivity of 91.1% and a specificity of 40.7%, and a good correlation with the OPTINOFA triage levels were detected (Spearman's rank correlation ρ = 0.41). Furthermore, the area under the curve (AUC) for prediction of disposition according to the OPTINOFA triage level was 0.73. The in-hospital mortality rate of OPTINOFA triage levels 4 and 5 was 0%. The association between the length of ED stay and the OPTINOFA triage level was shown to be significant (p < 0.001).</p><p><strong>Conclusion: </strong>The results of the pilot study demonstrate the safety and validity of the new triage system OPTINOFA. By definition of both urgency and emergency care level, new customized perspectives for load reduction in German EDs via a closer cooperation between out- and inpatient sectors of emergency care could be established.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"208-221"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307541","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":"[Extubation failure in a 70-year-old man after implantation of an event recorder].","authors":"Elvin Bairamov, Paul Zimmermann, Martin Braun, Michael Schlicht","doi":"10.1007/s00063-024-01219-8","DOIUrl":"10.1007/s00063-024-01219-8","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"253-255"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802944","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":"[Septic cardiomyopathy-diagnosis and estimation of disease severity].","authors":"Ursula Müller-Werdan, Alexander Vogt, Karl Werdan","doi":"10.1007/s00063-024-01109-z","DOIUrl":"10.1007/s00063-024-01109-z","url":null,"abstract":"<p><strong>Background: </strong>The relevance of septic cardiomyopathy is frequently underestimated due to the complexity of the pattern of cardiac injury and the corresponding difficulties in quantifying the degree of functional impairment.</p><p><strong>Aim: </strong>Account of the methods for diagnosis and severity classification of septic cardiomyopathy.</p><p><strong>Methods: </strong>Literature review and analysis of the main findings.</p><p><strong>Results: </strong>Septic cardiomyopathy is characterized by both systolic and diastolic impairment of not only the left, but also the right ventricle, as well as by sinus-tachycardiomyopathy (≥ 90-95 beats/min) of variable degree. Sepsis-related organ failure assessment (SOFA) score, left ventricular ejection fraction (LVEF), ECG and cardiac biomarkers do not help in grading severity of septic cardiomyopathy. For that purpose either a sophisticated echocardiography diagnosis is mandatory, or the measurement of those global heart function parameters which take into account the dependency of cardiac output on afterload, in view of the pronounced vasodilatation in sepsis and septic shock, is needed. A suitable parameter on the basis of cardiac output measurement is afterload-related cardiac performance (ACP), which gives the percentage of cardiac output in a septic patient related to the cardiac output a healthy heart pumps when challenged by a fall in systemic vascular resistance to the same extent. The calculation of ACP shows that at least one in two septic patients suffers from impaired heart function and that mortality increases as severity increases.</p><p><strong>Conclusion: </strong>Simple parameters like LVEF are not apt for diagnosis nor for disease severity classification of septic cardiomyopathy. For that purpose either sophisticated echocardiography techniques or load-independent parameters-best validated-ACP measurements are appropriate.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":"185-191"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724667","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":"[ST segment elevations and pulmonary edema-\"just\" simple cardiogenic shock caused by ischemia?]","authors":"Maximilian Eichner","doi":"10.1007/s00063-025-01258-9","DOIUrl":"https://doi.org/10.1007/s00063-025-01258-9","url":null,"abstract":"","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721948","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":"The role of shock indexes and RDW/albumin ratio in upper gastrointestinal bleeding : Predicting adverse outcomes.","authors":"Secdegül Coşkun Yaş, Dilber Üçöz Kocaşaban, Sertaç Güler","doi":"10.1007/s00063-025-01267-8","DOIUrl":"https://doi.org/10.1007/s00063-025-01267-8","url":null,"abstract":"<p><strong>Objective: </strong>Upper gastrointestinal bleeding (UGIB) is a common condition in emergency departments (ED). The aim of this study is to evaluate the effectiveness of the red blood cell distribution width (RDW) to albumin ratio and three types of shock index (SI) as predictors of adverse outcomes in patients with UGIB in the ED.</p><p><strong>Methods: </strong>The study was designed as a retrospective, single-center study, and patients were screened using electronic medical records. Glasgow Blatchford, RDW/albumin ratio, SI, modified SI (MSI), and age SI were calculated, and adverse outcomes were defined as ICU admission, red blood cell transfusion, in-hospital mortality, and 30-day mortality. The effectiveness of these parameters in predicting adverse outcomes in UGIB patients admitted to the ED was evaluated.</p><p><strong>Results: </strong>The study enrolled 174 patients, of whom 17.2% required admission to the ICU, 33.9% received red blood cell transfusions, and 10.3% died within 30 days. Patients with adverse outcomes had significantly higher SI, MSI, age SI, and RDW/albumin ratio values. All four indices were statistically significant predictors of adverse outcomes (area under the curve [AUC] SI: 0.676; AUC MSI: 0.706; AUC age SI: 0.778; AUC RDW/albumin: 0.787). Age SI showed significantly higher prognostic performance in predicting adverse outcomes than SI and MSI.</p><p><strong>Conclusion: </strong>The present study suggests that SI, MSI, age SI, and RDW/albumin ratio may be useful in predicting adverse outcomes in patients with UGIB. The RDW/albumin ratio was effective in predicting mortality, while age SI showed a higher predictive ability for adverse outcomes compared to SI and MSI.</p>","PeriodicalId":49019,"journal":{"name":"Medizinische Klinik-Intensivmedizin Und Notfallmedizin","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701972","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}