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Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.

Background In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure. Methods Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50). Results A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was - 14% [CI (- 11)-(- 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [- 16%; CI (- 13)-(- 19)], less urgent [- 18%; CI (- 12)-(- 22)] and non-admitted cases [- 17%; CI (- 13)-(- 20)] in particular during the second wave. During the entire observation period admissions for chest pain [- 13%; CI (- 21)-2], myocardial infarction [- 2%; CI (- 9)-11] and heart failure [- 2%; CI (- 10)-6] were less affected and remained comparable to the previous year. Conclusions ED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies. [GRAPHICS] .

Im vorliegenden Beitrag geht es um die Rekonstruktion der Prozesse der Einführung und Umsetzung der Frauenquote in zwei österreichischen Gewerkschaften: einer ArbeiterInnengewerkschaft des privaten Dienstleistungssektors und einer Angestelltengewerkschaft. Zur Bearbeitung der Fragestellung wurden 41 leitfadengestützte Interviews geführt. In beiden Gewerkschaften erschweren die geschlechtsspezifische innerfamiliale Arbeitsteilung, eine männlich geprägte Organisationskultur und männlicher Widerstand die Implementation der Quotenregelung. In der ArbeiterInnengewerkschaft läuft die Umsetzung weniger gut als in der Angestelltengewerkschaft; vor allem ist es schwieriger, Frauen für die Ausübung von Funktionen zu gewinnen, und es gibt weniger Unterstützung durch männliche Gewerkschafter. Die Einführung der Quote ohne grundlegende Diskussion und die geringere Dichte an Betriebsratskörperschaften in den relevanten Branchen des privaten Dienstleistungsbereichs können als wichtige Ursachen für die Probleme in der ArbeiterInnengewerkschaft identifiziert werden., This article deals with the reconstruction of the processes of introduction and implementation of women’s quotas in two Austrian trade unions: a private services blue-collar union and a white-collar union. For investigating this issue 41 guided interviews were conducted. In both unions the gendered division of labour in the family, the male organizational culture and male resistance make the implementation of the quota rule difficult. In the blue-collar union the implementation works less well than in the white-collar union; in particular it is more difficult to find women for exercising the mandates and there is less support from male unionists. The introduction of the women’s quota without fundamental discussion and the lower density of works councils in the relevant private services industries can be identified as important reasons for implementation problems in the blue-collar union.

Background: Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. Methods: The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI. Results: Minicare cTnI correlated with Architect hs-cTnI (r(2) = 0.85, p < 0.0001) and I-Stat cTnI (r(2) = 0.93, p < 0.0001). Areas under the receiver operating characteristics curves were 0.87-0.91 at admission (p = ns) and 0.96-0.97 3 h after admission (p = ns). The negative predictive values (NPV) at admission were 95% ((92-97%, 95% CI) for Minicare cTnI and increased to 99% (97-100%) at 2-4 h, and similar to Architect hs-cTnI (98%, 96-100%), but higher than I-Stat cTnI (95%, 92-97%; p < 0.01). Negative likelihood ratios (LR) after 2-4 h were 0.06 (0.02-0.17, 95% CI) for Minicare cTnI, 0.11 (0.05-0.24) for Architect hs-cTnI (p = 0.02) and 0.28 (0.18-0.43) for I-Stat cTnI (p < 0.0001). The clinical concordances between Minicare cTnI and Architect hs-cTnI were 92% (admission) and 95% (2-4 h), with lower concordances between Minicare cTnI and I-Stat cTnI (83% and 78%, respectively; p = 0.007). Conclusions: The Minicare cTnI POC assay may become useful for prompt and safe ruling-out of AMI in ED patients with suspected AMI using a guideline supported 0/3 h sampling protocol.

Background: Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. Methods: The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI. Results: Minicare cTnI correlated with Architect hs-cTnI (r(2) = 0.85, p < 0.0001) and I-Stat cTnI (r(2) = 0.93, p < 0.0001). Areas under the receiver operating characteristics curves were 0.87-0.91 at admission (p = ns) and 0.96-0.97 3 h after admission (p = ns). The negative predictive values (NPV) at admission were 95% ((92-97%, 95% CI) for Minicare cTnI and increased to 99% (97-100%) at 2-4 h, and similar to Architect hs-cTnI (98%, 96-100%), but higher than I-Stat cTnI (95%, 92-97%; p < 0.01). Negative likelihood ratios (LR) after 2-4 h were 0.06 (0.02-0.17, 95% CI) for Minicare cTnI, 0.11 (0.05-0.24) for Architect hs-cTnI (p = 0.02) and 0.28 (0.18-0.43) for I-Stat cTnI (p < 0.0001). The clinical concordances between Minicare cTnI and Architect hs-cTnI were 92% (admission) and 95% (2-4 h), with lower concordances between Minicare cTnI and I-Stat cTnI (83% and 78%, respectively; p = 0.007). Conclusions: The Minicare cTnI POC assay may become useful for prompt and safe ruling-out of AMI in ED patients with suspected AMI using a guideline supported 0/3 h sampling protocol.

Background: Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. Methods: The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI. Results: Minicare cTnI correlated with Architect hs-cTnI (r(2) = 0.85, p < 0.0001) and I-Stat cTnI (r(2) = 0.93, p < 0.0001). Areas under the receiver operating characteristics curves were 0.87-0.91 at admission (p = ns) and 0.96-0.97 3 h after admission (p = ns). The negative predictive values (NPV) at admission were 95% ((92-97%, 95% CI) for Minicare cTnI and increased to 99% (97-100%) at 2-4 h, and similar to Architect hs-cTnI (98%, 96-100%), but higher than I-Stat cTnI (95%, 92-97%; p < 0.01). Negative likelihood ratios (LR) after 2-4 h were 0.06 (0.02-0.17, 95% CI) for Minicare cTnI, 0.11 (0.05-0.24) for Architect hs-cTnI (p = 0.02) and 0.28 (0.18-0.43) for I-Stat cTnI (p < 0.0001). The clinical concordances between Minicare cTnI and Architect hs-cTnI were 92% (admission) and 95% (2-4 h), with lower concordances between Minicare cTnI and I-Stat cTnI (83% and 78%, respectively; p = 0.007). Conclusions: The Minicare cTnI POC assay may become useful for prompt and safe ruling-out of AMI in ED patients with suspected AMI using a guideline supported 0/3 h sampling protocol.

Background: Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. Methods: The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI. Results: Minicare cTnI correlated with Architect hs-cTnI (r(2) = 0.85, p < 0.0001) and I-Stat cTnI (r(2) = 0.93, p < 0.0001). Areas under the receiver operating characteristics curves were 0.87-0.91 at admission (p = ns) and 0.96-0.97 3 h after admission (p = ns). The negative predictive values (NPV) at admission were 95% ((92-97%, 95% CI) for Minicare cTnI and increased to 99% (97-100%) at 2-4 h, and similar to Architect hs-cTnI (98%, 96-100%), but higher than I-Stat cTnI (95%, 92-97%; p < 0.01). Negative likelihood ratios (LR) after 2-4 h were 0.06 (0.02-0.17, 95% CI) for Minicare cTnI, 0.11 (0.05-0.24) for Architect hs-cTnI (p = 0.02) and 0.28 (0.18-0.43) for I-Stat cTnI (p < 0.0001). The clinical concordances between Minicare cTnI and Architect hs-cTnI were 92% (admission) and 95% (2-4 h), with lower concordances between Minicare cTnI and I-Stat cTnI (83% and 78%, respectively; p = 0.007). Conclusions: The Minicare cTnI POC assay may become useful for prompt and safe ruling-out of AMI in ED patients with suspected AMI using a guideline supported 0/3 h sampling protocol.

Background: Efficient rule-out of acute myocardial infarction (MI) facilitates early disposition of chest pain patients in emergency departments (ED). Point-of-care (POC) cardiac troponin (cTn) may improve patient throughput. We compared the diagnostic accuracy of a novel cTnI test (Minicare cTnI, Philips), with current POC cTnI (I-Stat, Abbott) and high-sensitivity central laboratory cTnI (hs-cTnI; Architect, Abbott) assays. Methods: The clinical performance of the assays were compared in samples from 450 patients from a previous clinical evaluation of Minicare cTnI. Results: Minicare cTnI correlated with Architect hs-cTnI (r(2) = 0.85, p < 0.0001) and I-Stat cTnI (r(2) = 0.93, p < 0.0001). Areas under the receiver operating characteristics curves were 0.87-0.91 at admission (p = ns) and 0.96-0.97 3 h after admission (p = ns). The negative predictive values (NPV) at admission were 95% ((92-97%, 95% CI) for Minicare cTnI and increased to 99% (97-100%) at 2-4 h, and similar to Architect hs-cTnI (98%, 96-100%), but higher than I-Stat cTnI (95%, 92-97%; p < 0.01). Negative likelihood ratios (LR) after 2-4 h were 0.06 (0.02-0.17, 95% CI) for Minicare cTnI, 0.11 (0.05-0.24) for Architect hs-cTnI (p = 0.02) and 0.28 (0.18-0.43) for I-Stat cTnI (p < 0.0001). The clinical concordances between Minicare cTnI and Architect hs-cTnI were 92% (admission) and 95% (2-4 h), with lower concordances between Minicare cTnI and I-Stat cTnI (83% and 78%, respectively; p = 0.007). Conclusions: The Minicare cTnI POC assay may become useful for prompt and safe ruling-out of AMI in ED patients with suspected AMI using a guideline supported 0/3 h sampling protocol.

"Der vorliegende Beitrag beschäftigt sich mit der seit mehreren Jahren laufenden Reorganisation der Gewerkschaftsbewegung in Österreich. Im Zuge dieser Reorganisation hat als Folge von Fusionen der Anteil der Industriegewerkschaften ab- und der Anteil der Multibranchengewerkschaften zugenommen. Nach einer Erörterung der Abgrenzung von Industrie- und Multibranchengewerkschaften diskutiert der Beitrag die Anwendbarkeit des von Müller (2001) entwickelten Kategorienschemas auf die österreichischen Multibranchengewerkschaften. Es zeigt sich, dass dieses Schema erweitert werden muss, damit die in Österreich entstandenen Multibranchengewerkschaften einzuordnen sind. Im weiteren wird auf die Hintergründe der Fusionen zu Multibranchengewerkschaften eingegangen. Die bisher vollzogenen Fusionen waren primär von den defensiven Motiven finanzschwacher Gewerkschaften getrieben und von administrativer Rationalität geleitet. In der geplanten Großfusion von fünf Gewerkschaften sind nun konsolidierende Motive von größerer Bedeutung und der politischen Rationalität kommt ein höheres Gewicht zu. Als Folge der Fusionen, insbesondere der geplanten Großfusion, werden sich auch Rolle und Funktion des Dachverbands verändern." (Autorenreferat), "This paper discusses trade union restructuring in Austria, a process that has been going on for several years. In its course, as a consequence of mergers, the share of industrial unions has declined and the share of conglomerate unions increased. After a discussion of the distinction between industrial and conglomerate unions, the paper considers how well the typology developed by Müller (2001) can be applied to conglomerate unions in Austria. It is shown that this framework must be extended in order to classify the conglomerate unions that have emerged in Austria. Then the focus lies on the background of the mergers which led to conglomerate unions. So far, mergers were primarily driven by the defensive motives of financially weak trade unions and led by administrative rationality. In the planned mega- merger of five trade unions consolidation now assumes greater importance and political rationality has a stronger weight. As a consequence of the mergers, in particular the planned five-union merger, role and function of the peak association will not remain unchanged." (author's abstract)

"Die in den meisten europäischen Gewerkschaften konstatierbaren Mitgliederrückgänge und Finanzprobleme haben zu unterschiedlich ausgeprägten Revitalisierungsbemühungen beigetragen. Die machtpolitische Stellung der österreichischen und deutschen Gewerkschaften baut vielfach immer noch auf ihre institutionelle Einbettung in das System der nationalen Arbeitsbeziehungen auf. Etablierte Institutionen bilden hier wesentliche strukturelle Macht- und Legitimationsressourcen, die allerdings zunehmend brüchig werden. Diese Entwicklungen haben zwar nicht zu einer umfassenden Neuorientierung der Gewerkschaften geführt, die Öffnung ihrer Vertretungsdomänen für Solo-Selbstständige wird allerdings als eine strategische Option gesehen, um den Veränderungen der Arbeitsgesellschaft Rechung zu tragen. In dem Beitrag fragen die Verfasser nach der Organisierungsfähigkeit und den Organisationsproblemen der Gewerkschaften in Bezug auf diese Gruppe. Das gewählte Forschungsdesign zielt darauf ab, die strukturellen und institutionellen Rahmenbedingungen zu kontrollieren und die Unterschiede der strategischen Entscheidungen deutscher und österreichischer Gewerkschaften herauszuarbeiten." (Autorenreferat), "Most European unions have faced a substantial decline in membership rates in recent years. These developments in turn have triggered an extensive debate on strategies to revitalize national labour organisations. Austrian and German unions still rely largely on their institutional embeddedness. Established institutions provide structural power resources and legitimacy to unions irrespective of their membership rates. However, institutions have increasingly ceased to provide support to unions. These developments have not led to a fundamental reorientation. However, the inclusion of the formerly excluded group of self-employed workers is perceived as a particular means to address changes in the labour market. The author's paper focuses on the organisational capabilities of, and problems faced by, unions with regard to self-employed workers. The study's research design seeks to control for structural and institutional differences, and the paper examines whether and how the strategic responses to these problems by the two unions differ." (author's abstract)

"Das Buch behandelt die Entstehung und Ausgestaltung von gewerkschaftlichen Strukturelementen für die weiblichen Mitglieder, die Repräsentation von Frauen in den gewerkschaftlichen Entscheidungsstrukturen und die Vertretung von Fraueninteressen in der Gewerkschaftspolitik. Neben der deskriptiven Darstellung der Situation in den einzelnen österreichischen und deutschen Gewerkschaften verfolgt die Arbeit das Ziel, systematische Unterschiede zwischen den Gewerkschaften aufzuspüren. Theoretischer Ausgangspunkt ist die Annahme, dass langfristig stabile Organisationseigenschaften (Organisationsbedingungen einschließlich Charakteristika der Mitglieder) und Umweltbedingungen die Strukturen und Merkmale einer Organisation beeinflussen. In der vergleichenden Untersuchung der Gewerkschaften wird der Frage nachgegangen, wie Umwelt- und Organisationsbedingungen Unterschiede in der Situation von Frauen in Gewerkschaften erklären können. Die Ergebnisse zeigen auf, welche Faktoren die Ausgestaltung von Strukturelementen für die weiblichen Mitglieder, die Teilhabe von Frauen an gewerkschaftlichen Entscheidungsprozessen und eine Vertretung ihrer Interessen begünstigen bzw. behindern." (Autorenreferat)

Background The current COVID-19 pandemic, despite the availability of rapid tests and the start of the vaccination campaign, continues to pose major challenges to emergency departments (ED). Structured collection of demographic, clinical, as well as treatment-related data provides the basis for establishing evidence-based processes and treatment concepts. Aim of the work To present the systematic collection of clinical parameters in patients with suspected COVID-19 in the Registry for COVID-19 in the Emergency Room (ReCovER) and descriptive presentation of the first 1000 patients. Materials and methods Data from patients with suspected COVID-19, regardless of evidence of SARS-CoV-2 infection, are continuously entered into a web-based, anonymized registry in ED at six university hospitals. Results Between 19 May 2020 and 13 January 2021, 1000 patients were entered into the registry, of whom 594 patients (59.4%) were in the SARS-CoV-2 positive group (PG) and 406 patients (40.6%) were in the negative group (NG). Patients of the PG had significantly fewer pre-existing conditions and a significantly longer latency between symptom onset and presentation to the ED (median 5 vs. 3 days), were more likely to suffer from cough, myalgia, fatigue, and loss of smell/taste and had significantly higher oxygen requirements than NG patients. The rate of severe disease progression was significantly higher in the PG, and persistent symptoms were more common after discharge (11.1 vs. 4.6%). Conclusions The multicenter collection of comprehensive clinical data on COVID-19 suspected cases in the ED allows analysis of aspects specific to the situation in Germany in particular. This is essential for a targeted review and adaptation of internationally published strategies.

Background The current COVID-19 pandemic, despite the availability of rapid tests and the start of the vaccination campaign, continues to pose major challenges to emergency departments (ED). Structured collection of demographic, clinical, as well as treatment-related data provides the basis for establishing evidence-based processes and treatment concepts. Aim of the work To present the systematic collection of clinical parameters in patients with suspected COVID-19 in the Registry for COVID-19 in the Emergency Room (ReCovER) and descriptive presentation of the first 1000 patients. Materials and methods Data from patients with suspected COVID-19, regardless of evidence of SARS-CoV-2 infection, are continuously entered into a web-based, anonymized registry in ED at six university hospitals. Results Between 19 May 2020 and 13 January 2021, 1000 patients were entered into the registry, of whom 594 patients (59.4%) were in the SARS-CoV-2 positive group (PG) and 406 patients (40.6%) were in the negative group (NG). Patients of the PG had significantly fewer pre-existing conditions and a significantly longer latency between symptom onset and presentation to the ED (median 5 vs. 3 days), were more likely to suffer from cough, myalgia, fatigue, and loss of smell/taste and had significantly higher oxygen requirements than NG patients. The rate of severe disease progression was significantly higher in the PG, and persistent symptoms were more common after discharge (11.1 vs. 4.6%). Conclusions The multicenter collection of comprehensive clinical data on COVID-19 suspected cases in the ED allows analysis of aspects specific to the situation in Germany in particular. This is essential for a targeted review and adaptation of internationally published strategies.