1,721,021 research outputs found
Neue Ansätze zur sektoren- und grenzübergreifenden Versorgung von Patient*innen in der prähospitalen Notfallmedizin
No full textBackground: Prehospital emergency medical services (EMS) are increasingly under pressure, in Germany, but also at Euregional level. Reasons include the shortage of both resources and staff as well as steadily increasing numbers of EMS missions. The corona pandemic challenged the health care system and all its sectors and showed how essential innovative approaches are to ensure efficient use of scarce resources. Methods: 1) In a qualitative study about cross-border collaboration in the Euregio Meuse-Rhine (EMR: between Germany, Belgium and The Netherlands), 22 semi-structured interviews were carried out with experts in the field of prehospital EMS (including EMS management dispatch center staff, EMS medical directors, politicians, crisis management experts and intensive medicine staff). All interviews were transcribed, anonymized and if necessary, translated into English or German. Thematic coding and analysis took place afterwards. The results were structured into the two domains: direct EMS care and interhospital-transports (IHT). 2) Within a retrospective mixed-methods cross-sectional study, focus group interviews were undertaken with community paramedics [in German “Gemeindenotfallsanitäter” (G-NFS)] from the four regional groups (City of Oldenburg and districts of Vechta, Cloppenburg and Ammerland). After the interviews, a short anonymous survey was conducted with the same participants. Both the interviews and the survey had the goal of discussing the personal experiences of the G-NFS before and during the corona pandemic. The interview results were analyzed via thematic coding. Results: 1) Cross-border collaboration in the EMR has been identified by the participants as important and valuable. In the past cross-border collaboration took place regularly in EMS and IHT. However, with the onset of the corona pandemic, the local cross-border collaboration was hampered by national procedures leading to patients being transported to hospitals far outside the border regions. To function well, cross-border collaboration needs regular personal contact across working groups, the exchange of information and best-practices as well as formalized agreements, which need to be recognized at both national and international level. 2) Introducing G-NFS as a new resource in EMS leads to a useful relief for the overall EMS system. G-NFS can care for non-urgent patients adequately and with sufficient time. Moreover, intersectoral care can be ensured by the G-NFS and therefore, unnecessary transports of patients to the hospital are prevented. G-NFS could be dispatched to triage patients during the corona pandemic peaks. This would allow other EMS vehicles, such as emergency ambulances, to be more available and to cover genuine emergency cases. Discussion: Both studies show that an efficient and more needs-based use of resources within emergency care is essential for adequate and high-quality care of patients in today’s health care system. Although cross-border collaboration in the EMR has high potential for effective Euregional support, this has been inhibited by national guidelines, especially at the beginning of the pandemic. Consequently, the available resources in the border region were not being taken advantage of. On the other hand, the availability of G-NFS as a local care provision resource ensures patients are forwarded to the correct sector of care. Both the enhancement of intersectoral and cross-border care are necessary to relieve the burden on the overall system of emergency medical services and care
Unterschiede zwischen alkoholisierten und nicht alkoholisierten polytraumatisierten Patienten : Eine retrospektive Studie zur Untersuchung des Einflusses von Alkohol auf Polytraumata
No full textDreifachsedierung aus Propofol, Midazolam und Fentanyl bei flexiblen Bronchoskopien : Komplikationsraten und Möglichkeit einer Dosisreduktion der einzelnen Sedativa
No full textImpact of chest trauma and overweight on mortality and outcome in severely injured patients
No full textBiomechanische Auswirkungen der additiven Zementaugmentation von Wirbelkörperendplatten nach Cageimplantation bei osteoporotischen Wirbelkörperfrakturen
No full textAnalyse extrazellulärer Vesikel in Zusammenhang mit der ARDS-Induktion im Polytrauma-Großtiermodell
No full textAnalysis of extracellular vesicles in relation to ARDS induction in a multiple trauma large animal model background: In Germany, more than 30,000 patients suffer from multiple trauma per year. Due to diverse complex and still not fully understood immunological correlations, these patients are predisposed to the development of primary or secondary Acute Respiratory Distress Syndrome (ARDS), which is associated with high lethality. In recent years, extracellular vesicles (EV) have gained increasing attention as a means of intercellular transport and communication. In particular, their effect on alveolar macrophages (AM) represents an interesting new approach in the study of the pathogenesis and resulting potential therapeutic options of ARDS. Material & Methods: Polytrauma was induced in a porcine large animal model (thoracic trauma, hemorrhagic shock (MAP 35 ±5 mmHg), tibial fracture, liver laceration), which was treated strictly analogous to clinical reality. Plasma samples were collected 72 hours after trauma, from which exosomes and microvesicles (MV) were isolated via sequential centrifugation. These were then characterized in terms of their sizes and concentrations using nanoparticle tracking analysis (NTA). The endogenous potential of MV was investigated in cell experiments using a porcine AM cell line (3D4/31, ATCC, USA). For this purpose, interleukin-6, -8, -10 and NF-κ-B concentrations in the cell lysate were measured at different time points by ELISA. Results: Application of multiple trauma resulted in a dysbalance of cellular homeostasis, with no significant differences in EV size or concentration between trauma and sham groups. In addition, MV from the Sham group were shown to have the endogenous potential to induce an anti-inflammatory cytokine profile with elevated IL-10 levels in AM. In contrast, incubation of AM with MV from the trauma group resulted in elevated IL-6 as well as NF-κ-B levels, thus mediating a pro-inflammatory effect. Conclusion: Systemic MV are a possible translational mechanism between the systemic inflammatory stimulus of multiple trauma and pulmonary injury in the setting of ARDS, as they have the potential to influence AM with respect to their functionality, esp. their activation. A future therapeutic application is conceivable
Die Anwendung des vTAC-Verfahrens auf kapilläre Blutgasanalysen als mögliche Erweiterung des Einsatzbereichs
No full textPrädiktion des klinischen Verlaufes polytraumatisierter Patienten durch die computertomographische Analyse unterschiedlicher Körperkompartimente
No full textBackground: Body mass composition (BC) was shown to correlate with outcome in patients after surgery and minor trauma. As BC is assessed using computed tomography (CT) and routinely applied in multiple trauma (MT), this study will help to analyze whether BC variables also correlate with outcome in trauma patients. Materials and Methods: Inclusion criteria were MT (Injury Severity Score (ISS) > 15) and whole-body CT (WBCT) scan on admission. Muscle and fat tissue were assessed at the level of the fourth thoracic vertebra (T4) and the third lumbar vertebra (L3) using Slice-O-matic software, version 5.0 (Tomovision, Montreal, QC, Canada). Univariate and multivariate regression models were used with regard to outcome parameters such as duration of ventilation, hospital stay, local (i.e., pneumonia, wound infection) and systemic (i.e., MODS, SIRS) complications, and mortality. Results: 297 patients were included. BC correlated with both the development and severity of complications. Skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) at both T4 and L3 correlated positively with the occurrence of systemic infections. Local infections positively correlated with SMI at T4. Low muscle mass and high visceral adipose tissue (VAT) predicted the severity of systemic and local complications. Muscle tissue markers at both T4 and L3 predicted the severity of complications in roughly the same way. Moreover, higher muscle mass at the L3 level was significantly associated with higher overall survival, while SATI at the T4 level correlated positively with hospital stay, length of stay in the ICU, and duration of ventilation. Conclusions: A lower muscle mass and a high adipose tissue index are associated with a poor outcome in MT. For the first time, it was shown that BC at the fourth thoracic vertebra is associated with comparable results to those found at the third lumbar level
Vorhersagewahrscheinlichkeit von Massentransfusionen bei polytraumatisierten Patienten anhand des modifizierten TICCS (mTICCS)
No full textThe influence of macrophage activating lipopeptide 2 on local and systemic inflammatory response in a murine two-hit model of hemorrhagic shock and the subsequent sepsis
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