OPUS THD (Technischen Hochschule Deggendorf)
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How preventive emergency medical services can address the challenges of the future in Germany
No full textHintergrund
Der Rettungsdienst in Deutschland sieht sich mit wachsenden Herausforderungen und einem veränderten Einsatzspektrum konfrontiert; hieraus ergeben sich strukturelle Anpassungsbedarfe hin zu einem vorbeugenden Rettungsdienst. International wird dieses Konzept vielerorts bereits erfolgreich angewendet, und auch in Deutschland zeigen erste Pilotprojekte großes Potenzial für diese neue Versorgungsform.
Methodik
Im Rahmen des 2. Regensburger Expertenforum vorbeugender Rettungsdienst 2025 diskutierten 29 Fachleute in 3 Workshops die Bedeutung des proaktiven Handelns für den vorbeugenden Rettungsdienst sowie die damit einhergehenden strukturellen Voraussetzungen und Kompetenzen und konsentierten die hier vorgestellten Kernaussagen.
Ergebnisse
Die Bedeutung des proaktiven Handelns wurde unterstrichen und die rechtliche und strukturelle Verankerung – u. a. im SGB V und in den Landesrettungsdienstgesetzen – als Voraussetzung für diesen neuen Leistungsbereich herausgearbeitet. Weiterhin wurden die zukünftig erweiterten Rollen der Rettungsleitstellen beleuchtet und ein breites Kompetenzspektrum beschrieben. Zudem wurden die Implikationen für eine passgenaue Qualitätssicherung diskutiert.
Schlussfolgerungen
Sektorenübergreifende Vernetzung und proaktives, selbstständiges Aufsuchen ohne vorherige Alarmierung setzen eine Verankerung innerhalb von bestehenden Hilfeleistungssystemen voraus und leitet den Wandel des Rettungsdienstes zu einem proaktiv agierenden System ein.Background
The emergency medical services (EMS) in Germany are facing growing challenges and a changing spectrum of calls resulting in a need for structural adjustments towards community paramedicine. This concept is already being successfully applied internationally in many areas and initial pilot projects in Germany also show huge potential for this new approach to care.
Methodology
At the 2nd Regensburg Expert Forum on Preventive Emergency Medical Services 2025, 29 experts discussed the importance of proactive action for preventive emergency medical services and the associated structural requirements and competencies in three workshops and agreed on the key statements presented here.
Results
The importance of proactive intervention was highlighted and the legal and structural anchoring, including in the Social Security Code V (SGB V) and in the state emergency medical services laws, was identified as a prerequisite for this new type of service. Furthermore, the broadening roles of emergency dispatch centers were examined and a wide range of competencies were described. Additionally, the implications for tailored quality management were discussed.
Conclusion
Cross-sectoral networking and proactive independent outreaching without prior alerting requires anchoring within existing support structures and initiates the transformation of emergency medical services into a proactively reacting system
Applications of 3D models in cholangiocarcinoma
No full textThe prognosis for patients diagnosed with cholangiocarcinoma (CCA) is dismal, with an overall 5-year-mortality rate of 80%. Therapeutic approaches for this cancer are very limited and the only curative treatment is total surgical resection despite recent advancements in CCA research. However, only a minority of patients are eligible for surgery due to late-stage diagnosis. Therefore, there is an urgent need to gain a deeper understanding of CCA and to discover new treatments, which can be achieved by utilization and optimization of 3D tumor models. Traditional 2D cell culture is still undeniably important in cancer research, especially for the discovery of biomarkers and drug screening. However, classical 2D tumor models do not represent the tumor biology in its full complexity as they lack the vital interactions between cancer cells, angiogenesis, and tumor microenvironment. In recent years, 3D models, including spheroids, 3D co-culture systems, organoids, tumors-on-a-chip, and the in vivo chorioallantoic membrane (CAM) model, have been used for CCA research. These models enable the study of the tumor microenvironment, investigation of metastases, drug development and testing, cholangiocarcinogenesis and personalized therapy. This review summarizes the applications of the different 3D tumor models that have been used for the investigation of CCA. Moreover, the advantages and disadvantages of the different 3D tumor models are discussed, and suggestions for future research possibilities are described. By optimizing 3D models, the gap between basic research findings and clinical applications can be bridged, enabling the discovery of more effective therapies for CCA and other cancers
Frank, hands-on and collaborative. Seven Years of the Bavarian RDM Competence Pool – A Retrospective
No full textDer Beitrag behandelt die Entstehung, Entwicklung und strukturelle Verankerung des FDM-Kompetenzpools im Bibliotheksverbund Bayern (BVB) als praxisorientiertes Austauschformat für das Forschungsdatenmanagement (FDM). Gegründet im Jahr 2018 auf Initiative der Kommission Virtuelle Bibliothek (KVB), etablierte sich der Pool rasch als Plattform für kollegialen FDM-Wissenstransfer und thematische Vernetzung in Bayern. Im Gegensatz zu zentral gesteuerten FDM-Landesinitiativen verfolgt der bayerische Weg einen dezentralen, informellen und kollegial organisierten Ansatz. Der Kompetenzpool fördert den Austausch über Tools, Schulungsmaterialien und Best Practices und dient als Vorbild für agile Fokusgruppen innerhalb des BVB. Trotz struktureller Veränderungen im Laufe der Jahre bleibt der Pool ein bewährtes Forum für FDM-Praktiker:innen – geprägt von Offenheit, Praxisnähe und gegenseitiger Unterstützung.This article explores the origin, development, and structural integration of the Research Data Management (RDM) Competence Pool within the Bavarian Library Network (in German Bibliotheksverbund Bayern, BVB) as a practice-oriented exchange format. Established in 2018 through an initiative of the Virtual Library Commission (in German Kommission Virtuelle Bibliothek, KVB), the pool quickly became a well-established platform for collegial RDM knowledge sharing and thematic networking in Bavaria. In contrast to centrally managed federal state RDM initiatives, the Bavarian approach emphasizes decentralized, informal, and collegially organized collaboration. The pool promotes the exchange of tools, training materials, and best practices, serving as a model for agile focus groups within the BVB. Despite structural changes over the years, the pool remains a trusted forum for RDM practitioners—characterized by openness, practical relevance, and mutual support
The Complexity of eHealth Architecture: Lessons Learned from Application Use Cases
No full textThe rapid evolution of eHealth technologies has revolutionized healthcare, enabling data-driven decision-making and personalized care. Central to this transformation is interoperability , which ensures seamless communication among heterogeneous systems. This paper explores the critical role of interoperability, data management processes, and the use of international standards in enabling integrated healthcare solutions. We present an overview of interoperability dimensions—technical, semantic, and organizational—and align them with data management phases in a concise eHealth architecture. Furthermore, we examine two practical European use cases to demonstrate the extend of the proposed eHealth architecture, involving patients, environments, third parties, and healthcare providers
Patient-derived xenografts from circulating cancer stem cells as a preclinical model for personalized pancreatic cancer research
No full textPatient-derived xenografts (PDXs) provide biologically relevant models and potential platforms for the development of treatment strategies for precision medicine in pancreatic cancer. Furthermore, circulating epithelial tumor cells (CETCs/CTCs) are released into the bloodstream by solid tumors and a rare subpopulation—circulating cancer stem cells (cCSCs) – is considered to be responsible for recurrence and plays a key role in metastasis. For the identification of cCSCs, an innovative in vitro assay to generate tumorspheres was established in this study. The number of tumorspheres and CETCs/CTCs was analyzed perioperatively in 25 pancreatic cancer patients. Additionally, an individual in vivo chorioallantoic membrane (CAM) culture system was used to generate PDXs from these tumorspheres. While overall correlations of CETCs/CTCs with clinicopathological parameters did not reach statistical significance, a significant difference in the number of tumorspheres was observed between patient subgroups with lower and higher UICC stages. This finding underscores their potential as biomarkers, providing valuable insights into clinical decision-making and tumor progression. The application of tumorspheres on the CAM successfully established PDXs within 7 days. These xenografts closely resembled the histological features of the primary tumor. Hence, this model represents a novel and fast option for individualized testing of new therapies for PDAC
Virtual team training with Mixed Reality and Virtual Reality – benefits and limitations illustrated on the example of two paramedic classes
No full textIn the field of medical case simulations, strong technologization has been observed for years, for example through Extended Reality. This study examined the impact of Virtual and Mixed Reality (VR, resp. MR) on the team training of paramedic trainees. In the quasi-experimental cross-sectional controlled comparison study, participants were assigned to an experimental group (= EG, mixed reality with manikin) and a comparison group (= CG, virtual reality without manikin). After a virtual case simulation, “VR sickness”, sense of presence, motivation, and sociodemographic variables were elicited. Parametric tests were used for mean comparison and correlation analysis. A total of 20 participants were evaluated in the EG and 16 in the CG. In both groups, high intrinsic motivation (mean 5.32/7), an acceptable sense of spatial presence (mean 4.24/6), and advanced usability (mean 68.54/100), were observed. VR sickness symptoms were present (SSQ total score: 11.43). In both groups, correlation was found between Identified Regulation and Usability (EG: r = .74, p < .001, CG: r = .76, p < .001). The same pattern could be observed for Intrinsic Motivation and Usability (EG: r = .83, p < .001, CG: r = .70, p = .003). Spatial Presence and Usability were also correlated in both groups (EG: r = .71, p < .001, CG: r = .61, p = .01). A significant mean score difference (p = .021) was found for Amotivation between the EG (Mean = 1.92/6) and the CG (Mean = 1.56/6). VR and MR are potential learning methods if they are implemented in a planned manner by competent faculty. Our recommendation is to use setup checklists, but also a competence-oriented approach, considering fiction contract and structured debriefing. The use of wireless head-mounted displays and "data gloves" is also recommended
Second victim: translation of the international consensus-based definition using the Delphi method
No full textZusammenfassung
Einleitung
Der Begriff „Second Victim“ erfuhr seit seiner Prägung im Jahr 2000 bedeutende inhaltliche Erweiterungen und wurde kürzlich international neu konsentiert. Bislang existiert keine einheitliche deutsche Definition des Begriffs „Second Victim“. Um eine Basis für ein flächendeckendes Verständnis des Phänomens zu schaffen und die Vergleichbarkeit durchgeführter Forschung zum Thema zu erleichtern, zielt diese Studie darauf ab, eine konsensbasierte Übersetzung der aktuellen englischen Definition des Begriffs Second Victim zu erarbeiten.
Methode
Die konsensbasierte Übersetzung wurde mittels der Delphi-Methode durchgeführt. Es wurden 11 deutschsprachige Expertinnen und Experten aus Deutschland, Österreich und der Schweiz mit einschlägigen Publikationen eingeladen und 3 Delphi-Runden geplant.
Ergebnisse
An der Studie beteiligten sich 9 von 11 eingeladenen Expertinnen und Experten. Die Übersetzung der internationalen Definition eines Second Victim wurde nach drei Delphi-Runden mit einer Zustimmungsrate von 90 % konsentiert. Ein Second Victim wird damit definiert als: „Jede Fachkraft im Gesundheitswesen, die direkt oder indirekt an einem unerwarteten unerwünschten Patientenereignis, einem unbeabsichtigten Fehler in der Gesundheitsversorgung oder einer Patientenschädigung beteiligt ist und die zur betroffenen Person wird, indem sie ebenfalls beeinträchtigt ist.“
Diskussion
Mit der vorliegenden Delphi-Studie wurde erstmals eine deutschsprachige, evidenzbasierte Definition des Begriffs „Second Victim“ formal durch anerkannte Fachexpertinnen und Fachexperten konsentiert. Damit ist auch in Deutschland eine Grundlage für ein klares Verständnis des Begriffs geschaffen und ein Beitrag zu einer gemeinsamen Basis für die Diskussion und Erforschung des Second-Victim-Phänomens im deutschsprachigen Raum geleistet worden.Abstract
Introduction
Since its inception in 2000 the notion of the second victim has undergone significant expansions and was recently internationally reconceptualized. So far there is no unified German definition of the term second victim. This study aims to establish a consensus-based German translation of the current English definition of the term second victim to lay the groundwork for a widespread understanding and to facilitate comparability of research conducted on the subject.
Method
The consensus-based translation was carried out using the Delphi method. A total of 11 German-speaking experts from Germany, Austria and Switzerland with relevant publications were invited and 3 Delphi rounds were planned.
Results
Out of the 11 invited experts 9 participated in the study. The translation of the international definition of a second victim was achieved through 3 Delphi rounds with a consensus rate of 90%. A second victim is thus defined as: “Jede Fachkraft im Gesundheitswesen, die direkt oder indirekt an einem unerwarteten unerwünschten Patientenereignis, einem unbeabsichtigten Fehler in der Gesundheitsversorgung oder einer Patientenschädigung beteiligt ist und die zur betroffenen Person wird, indem sie ebenfalls beeinträchtigt ist”.
Discussion
With the present Delphi study, for the first time a German language evidence-based definition of the term second victim was formally agreed upon by recognized experts in the field. This establishes a foundation for a clear understanding of the term in Germany and contributes to a common basis for the discussion and exploration of the second victim phenomenon in the German-speaking region
LoDEI: a robust and sensitive tool to detect transcriptome-wide differential A-to-I editing in RNA-seq data
No full textRNA editing is a highly conserved process. Adenosine deaminase acting on RNA (ADAR) mediated deamination of adenosine (A-to-I editing) is associated with human disease and immune checkpoint control. Functional implications of A-to-I editing are currently of broad interest to academic and industrial research as underscored by the fast-growing number of clinical studies applying base editors as therapeutic tools. Analyzing the dynamics of A-to-I editing, in a biological or therapeutic context, requires the sensitive detection of differential A-to-I editing, a currently unmet need. We introduce thelocaldifferentialeditingindex (LoDEI) to detect differential A-to-I editing in RNA-seq datasets using a sliding-window approach coupled with an empirical q value calculation that detects more A-to-I editing sites at the same false-discovery rate compared to existing methods. LoDEI is validated on known and novel datasets revealing that the oncogene MYCN increases and that a specific small non-coding RNA reduces A-to-I editing
Predictors of weaning failure in ventilated intensive care patients: a systematic evidence map
No full textBackground
Ventilator weaning is of great importance for intensive care patients in order to avoid complications caused by prolonged ventilation. However, not all patients succeed in weaning immediately. Their spontaneous breathing may be insufficient, resulting in extubation failure and the subsequent need for reintubation. To identify patients at high risk for weaning failure, a variety of potential predictors has already been examined in individual studies and meta-analyses over the last decades. However, an overview of all the predictors investigated is missing.
Aim
To provide an overview of empirically investigated predictors for weaning failure.
Methods
A systematic evidence map was developed. To this end, we conducted a systematic search in the Medline, Cochrane, and CINAHL databases in December 2023 and added a citation search and a manual search in June 2024. Studies on predictors for weaning failure in adults ventilated in the intensive care unit were included. Studies on children, outpatients, non-invasive ventilation, or explanatory factors of weaning failure were excluded. Two reviewers performed the screening and data extraction independently. Data synthesis followed an inductive approach in which the predictors were thematically analyzed, sorted, and clustered.
Results
Of the 1388 records obtained, 140 studies were included in the analysis. The 112 prospective and 28 retrospective studies investigated a total of 145 predictors. These were assigned to the four central clusters ‘Imaging procedures’ (n = 22), ‘Physiological parameters’ (n = 61), ‘Scores and indices’ (n = 53), and ‘Machine learning models’ (n = 9). The most frequently investigated predictors are the rapid shallow breathing index, the diaphragm thickening fraction, the respiratory rate, the P/F ratio, and the diaphragm excursion.
Conclusion
Predictors for weaning failure are widely researched. To date, 145 predictors have been investigated with varying intensity in 140 studies that are in line with the current weaning definition. It is no longer just individual predictors that are investigated, but more comprehensive assessments, indices and machine learning models in the last decade. Future research should be conducted in line with international weaning definitions and further investigate poorly researched predictors.
Registration, Protocol: https://doi.org/10.17605/OSF.IO/2KDY
When Mechanical Stress Matters: Generation of Polyploid Giant Cancer Cells in Tumor‐Like Microcapsules
No full textBiofabrication techniques enable the performance of bioinspired three‐dimensional (3D) matrices resembling primary tumors. To validate their reliability, embedded cells may express complex biophysical responses. Among others, the emergence of tumor heterogeneity and the generation of Polyploid Giant Cancer Cells (PGCC), as a result of the mechanical stress, are two of the most challenging hallmarks to resemble in vitro. Here, these phenomena are studied in cells cultured on two‐dimensional (2D) flasks, in 3D spheroids, or immobilized within 3D polymer‐based tumor‐like microcapsules. These results show that cells cultured in 3D microcapsules exhibited an enhanced biomechanical heterogeneity, a higher number of PGCC, and an increased exertion of cell‐matrix attachment forces with respect to the other two experimental conditions. Additionally, cells isolated from tumor‐like microcapsules redistribute and align the cytoplasmatic protein Caveolin‐1, and upregulate markers involved in cell proliferation (i.e., Ki67), metastasis (i.e., TGF‐β1, TGF‐β‐R2), and epithelial to mesenchymal transition, to name a few. These hallmarks are barely described in the past as a result of the confinement and mechanical stress. Thus, in this work it is demonstrated that both the mechanical stress and confinement are required to stimulate cell polyploidy and biomechanical heterogeneity, which can be easily addressed by immobilizing breast cancer cells in tumor‐like microcapsules