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Background and Objectives: Weaning from ventilators is not always finished in the primary intensive care unit (ICU) setting. Transfer to other treatment facilities is a sensitive stage in the treatment and rehabilitation of the weaning patient. The aim of the present study was to investigate transition management and interhospital transfer of weaning patients, with special emphasis on documentation quality., Methods: A retrospective data analysis of one year (2018) in two ICUs of a university hospital was performed. All ventilated patients with the following tracer diagnoses were included: chronic obstructive pulmonary disease (COPD), asthma, patients with multiple injuries, pneumonia, sepsis, acute respiratory distress syndrome (ARDS), and cardiac arrest (ventilation > 24 h)., Results: A total of 750 patients were included in the study (median age 64 [IQR 52.8-76]; 32% female). In all, 48 (6.4%) patients were not weaned at the time of transfer (especially sepsis and ARDS). Routine documentation was sufficient for the sections "spontaneous breathing trial", "assessment of readiness to wean" and "presumed weanability" to adequately assess the parameters of the German S2k guideline "prolonged weaning". Predominantly, these patients were transferred with tracheostoma (76%) to rehabilitation units (44%) by specialized physician-assisted patient transport ambulances (75%)., Discussion: The transfer of ventilated patients after initial ICU stay is a relevant issue for interhospital transfer. Routine documentation of a structured weaning process is sufficient in core elements to describe the weaning process. This is of great importance for continuity in the further treatment of these patients., (© 2022. The Author(s).)

Complexity of outpatient intensive care for ventilated people: Cross-mapping into the standardised NNN-taxonomy Abstract. Background: In Germany, free text is the preferred method for recording the nursing process in outpatient intensive care, although classification systems could enable a more precise description. Research question: How is nursing care for people with outpatient ventilation represented by the NNN-taxonomy and what are the recommendations for nursing practice? Methods: A qualitative "multiple case" design was applied. Using deductive content analysis (data sources: nursing documentation and secondary analysis of interviews with affected persons), several cases, both individually and across all cases were linked to the NNN-taxonomy (cross-mapping). Results: In total, the nursing documentation of 16 invasively ventilated persons with a mean age of 58.4 years ( SD = 16.3) was analysed. Seven persons additionally contributed interview data. Documentation was mainly based on the "Strukturmodell" (14/16) with a moderate to high accuracy (D-Catch Score: 16.6; SD = 4.1). Cross-mapping resulted in 4016 codes: 618 nursing diagnoses, 1956 interventions and 1442 outcomes. Documentation was strongly measure-oriented, not very person-centred and with a lack of differentiation between diagnosis and intervention. Conclusions: To improve nursing practice, a person-centred attitude and the ability to differentiate between nursing diagnoses, interventions and outcomes should be promoted.

Background:  The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation., Material and Methods:  In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital., Results:  In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community)., Conclusion:  Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable., Competing Interests: T. Skazel: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .M. Kippnich: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .H. Klingshirn: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .L. Gerken: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .P. Heuschmann: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008), weitere Forschungsförderung außerhalb der Studie: Bundesministerium für Forschung und Bildung; Deutsche Forschungsgemeinschaft; Europäische Union; Charité – Universitätsmedizin Berlin; Ärztekammer Berlin; Deutsche Parkinson-Gesellschaft; Universitätsklinikum Würzburg – Robert-Koch-Institut; Deutsche Herzstiftung; Gemeinsamer Bundesausschuss (G-BA) im Rahmen des Innovationsfonds; Universitätsklinikum Heidelberg (im Rahmen von RASUNOA-prime; gefördert durch eine uneingeschränkte Forschungsförderung an das Universitätsklinikum Heidelberg von Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo); Charité – Universitätsmedizin Berlin (im Rahmen Mondafis; gefördert durch eine uneingeschränkte Forschungsförderung an die Charité von Bayer); Universität Göttingen (im Rahmen FIND-AFrandomised; gefördert durch eine uneingeschränkte Forschungsförderung an die Universität Göttingen von Boehringer-Ingelheim) .K. Haas: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .M. Schutzmeier: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .L. Brandstetter: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008) .J. Ahnert: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008).J. Koch: Keine Interessenkonflikte.B. Seese: Keine Interessenkonflikte.P. Meybohm: bekam für Forschungsvorhaben und für die Durchführung von klinischen Studien Gelder von Bundesministerium für Bildung und Forschung (BMBF; 01KG1815), B. Braun Melsungen AG, CSL Behring GmbH, Deutsche Forschungsgemeinschaft (DFG; ME 3559/1-1, ME 3559/3-1), Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), European Society of Anaesthesiology (ESA), Fresenius Kabi GmbH, International Anesthesia Research Society (IARS), Pfizer Pharma GmbH, ViforPharma GmbH. P. M. erhielt Förderungen oder Reisekostenunterstützung für Beratungen und Vorträge der folgenden Firmen: Abbott GmbH & Co KG, AesculapAkademie GmbH, AstellasPharma GmbH, B. Braun Melsungen AG, Baxter Deutschland GmbH, Biosyn GmbH, Biotest AG, CSL Behring GmbH, Dr. F. KöhlerChemie GmbH, Dräger Medical GmbH, Fresenius Kabi GmbH, HCCM Consulting GmbH, Heinen + Löwenstein GmbH, MSD Sharp&Dohme GmbH, Pulsion Medical Systems S. E., Siemens Healthcare, ViforPharma GmbH.B. Reuschenbach: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008).T. Wurmb: Forschungsförderung des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (OVER-BEAS Förderkennzeichen 01VSF17008)., (Thieme. All rights reserved.)

Background: Outpatient intensive care for people with long-term mechanical ventilation is a rapidly growing area with a wide range of care demands. The aim of this Scoping Review is to present the current state of research on the quality of care for people with home mechanical ventilation in Germany and to identify research gaps., Methods: Based on predefined inclusion criteria, 4 databases were searched for publications dealing with the care of people with home ventilation in Germany. The method of "data driven thematic analysis" led the data extraction and analysis. Distinction was made between research and expert opinion., Results: The search resulted in 493 matches of which 68 publications were included in the this study: two guidelines (3%), 45 (66%) research papers and 21 (31%) expert opinions. The following topics were identified: Organization and control of ventilation (n=43; 63%), nursing (n=23; 34%), medical (n=39; 57%), therapeutic (n=7; 10%) and assistive technologies care (n=24; 35%), as well as the perspective of people with home mechanical ventilation and their relatives (n=33; 49%) and other topics (n=13; 19%)., Conclusion: Although the debate on the quality of care for people living with home mechanical ventilation is conducted broadly, studies focusing on individual care demands, autonomy and participation depending on the living situation or on the role of specific health professionals within the interprofessional team are missing., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenskonflikt besteht. Peter Heuschmann berichtet neben den Zuwendungen des Gemeinsamen Bundesausschusses (G-BA) im Rahmen des Innovationsfonds (welcher im Artikel als offizieller Förderer der Studie genannt ist) über weitere Zuwendungen außerhalb der Studie: – Bundesministerium für Forschung und Bildung– Deutsche Forschungsgemeinschaft– Europäische Union– Charité – Universitätsmedizin Berlin – Ärztekammer Berlin– Deutsche Parkinson-Gesellschaft– Universitätsklinikum Würzburg– Robert-Koch-Institut– Deutsche Herzstiftung– Gemeinsamer Bundesausschuss (G-BA) im Rahmen des Innovationsfonds– Universitätsklinikum Heidelberg (im Rahmen von RASUNOA-prime; gefördert durch ein unbefristetes Forschungsstipendium an das Universitätsklinikum Heidelberg von Bayer, BMS, Boehringer-Ingelheim, Daiichi Sankyo)– Charité – Universitätsmedizin Berlin (innerhalb Mondafis; gefördert durch ein unbefristetes Forschungsstipendium an die Charité von Bayer)– Universität Göttingen (innerhalb FIND-AF randomisiert; gefördert durch ein unbefristetes Forschungsstipendium an die Universität Göttingen von Boehringer-Ingelheim), (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

In Germany various concepts for treating patients with Parkinson's disease (PD) are available, e.g. oral medication with levodopa or deep brain stimulation (DBS), depending on the stage and severity of symptoms and also multidisciplinary management up to intersectoral treatment approaches (e.g. complex PD treatment and integrative care concepts). Nevertheless, in the treatment of patients with PD a comprehensive provision of services and a nationwide standardized collation of treatment quality are so far lacking. This is particularly true for technically complicated procedures, which necessitate a high standard of expertise by the treating physician. Some of these challenges could be overcome by expanding digital approaches (e.g. teleneurological consultation and wearables) and by introducing quality assurance initiatives (e.g. comprehensive registries and certification programs).

Purpose: Systemic anti-VEGF therapy with bevacizumab was effective in neovascular AMD in the SANA study. Intravitreal bevacizumab has the advantage that a high concentration can be achieved in the eye with a low dose. First clinical studies showed a good therapeutic effect., Methods: In a clinical study 93 patients with occult or minimal classic CNV due to neovascular AMD were treated with intravitreal injections of Bevacizumab (1.25 mg). Before, 1, 3 and 6 months after treatment visual acuity, intraocular pressure measurement, angiography and OCT examination were performed. After one day and after one week an eye examination was done and the intraocular pressure was measured., Results: Bevacizumab was well tolerated and we had no complications. Mean visual acuity was 20 / 80 at baseline. Visual acuity was stabilised but not significantly improved after 1, 3 and 6 months (20 / 80). 70 (75 %) patients showed reduced leakage in fluorescein angiography after 6 month. In OCT retinal thickness was reduced significantly after 1, 3 and 6 months (OCT: mean 323 microm at baseline, 260 microm after 1, 290 microm after 3 and 275 microm after 6 months)., Conclusions: Intravitreal therapy with bevacizumab was safe and well tolerated. It is a therapeutic option in treating occult choroidal neovascularisations and minimal classic CNV. Six months after intravitreal administration of bevacizumab mean visual acuity was stabilised. Retinal thickness and leakage were more reduced after 1 month than after 3 and 6 months. According to our results, a monthly injection schedule could give more favourable results.

Purpose: The aim of this study is to discuss the effect and outcome of a combined photodynamic therapy and intravitreal injection of bevacizumab (1.25 mg) in occult and classic choroidal neovascularisation (CNV) due to AMD. Especially cases of occult CNV with pigment epithelium detachment (PED) are not likely to respond positively to standard photodynamic therapy, often ending up in PED enlargement or tearing of the RPE., Methods: In a pilot study involving 23 patients, intravitreal injections of bevacizumab were administered within 12 to 24 hours after standard PDT to reduce the post-PDT increase of proangiogenic and inflammatory factors. Before and at 1, 3 and 6 month after treatment visual acuity and OCT examinations (retinal thickness) were performed., Results: Mean visual acuity was significantly improved compared to baseline. (VA baseline 20/125, after 1 month 20/80, after 3 months 20/80, and 20/80 after 6 months) and an enlargement of the PED in occult CNV was prevented. We found no RPE rip. OCT findings in patients with occult and classic choroidal neovascularisation 1, 3 and 6 months after combination therapy showed a reduced retinal thickness compared to baseline., Conclusions: Photodynamic therapy combined with injection of intravitreal bevacizumab tends to be more effective compared to PDT monotherapy by reducing the post-PDT increase of vascular growth and inflammatory factors. Our short-term results are very promising. Further studies are necessary to show the long-term effect of PDT and anti-VEGF combination therapy.

In addition to the German National Health Interview and Examination Survey, the German Nutrition Survey 1998 (GeNuS) was conducted in a subsample of 4030 participants. Among these persons, a comprehensive dietary interview was performed with use of the software DISHES 98. The proportion of 33-34% energy from fat is considerably less than the 40% energy from fat which was estimated about ten years ago. In general, the supply of most vitamins, minerals and trace elements is sufficient. For a part of the population, the intake of dietary fibre, vitamins D and E, folate, zinc, iodine and, among women, also vitamins B1, B2, B6, iron and phosphorus is on a suboptimal level. Observed differences in dietary habits in the eastern and western part of Germany did not have an obviously more favourable dietary pattern in any part of Germany.

This is a report of a case of cardio-facio-cutaneous (CFC) syndrome in a three-year-old boy. Apart from obvious signs of retardation in his mental and motor development, the child was conspicuous through his short stature, relative macrocephaly, vitium cordis, pendular nystagmus and ptosis and optic atrophy on both sides. The typically dysmorphic facial features that characterize this syndrome such as high forehead, biparietal impression, downward slant of the palpebral fissures, hypoplastic supraorbital ridges, depressed nasal bridge, high palate, and dysplasia of the ears, were particularly marked in this case. The hands and feet were plump, the skin rather thick, and the hair sparse and very curly. A chromosome analysis as well as metabolism tests proved normal. Until now there have been 27 reports of such cases in medical literature.

In the Surgical Department of the Städtisches Krankenhaus München-Harlaching, 7 malformations of the lung in the shape of intralobar or extralobar sequestration were found among 1150 lung resections. Preoperative diagnosis caused no difficulty, even when angiography was dispensed with. In two cases a coincidence with other deformities was demonstrated. Deviations from the usual differentiation between intralobar and extralobar sequestration were found repeatedly with regard to location and vascular supply. All the 7 patients affected were cured by resection therapy.

Rabbits which had been intravenously injected with Vincristine for six weeks showed changes in the outer plexiform layer of the retina after one year, which suggests the destruction of receptor cells, bipolar ganglion cells, and horizontal cells. Compensated cell damage accompanied by loss of microtubuli in the cytoplasma, autolytic vacuoles, granular material deposits, and membrane changes of the ribbon complex were frequently observed. A comparison between axons and dendrites showed a predominance of damaged dendritis over axons. Because short-term studies have not produced the same results, different regeneration capacities, which might have their origin in the endoplasmatic reticulum, are discussed.