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Blood gas analysis at or near the patient’s bedside is a common practice in acute medicine and plays a crucial role in the diagnosis and management of patient’s respiratory status, metabolites, electrolytes, co-oximetry and acid–base balance. Pre-analytical quality aspects of the specimens are getting more and more attention, including the presence of potential interferences. Central laboratories have implemented technologies to detect interferences such as hemolysis, lipidemia or hyperbilirubinemia in blood samples to ensure the highest possible quality in results provided to routine care. However, systematic detection for interference due to hemolysis is currently not in place for blood gas analysis at the point-of-care (POC). To apply hemolysis detection solutions at the central laboratory, but not at the POC for blood gas analysis, is a clear contradiction when novel hemolysis detecting technologies are available. The introduction of a system that systematically detects hemolysis in connection to POC blood gas analysis would be imperative to patient safety and costs associated with potential clinical malpractice (leading to wrong, missing and/or delayed treatment) and would also ensure better compliance to CLSI guidelines and ISO standards, and be beneficial for patient and staff.

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Introduction: For an interoperable Intelligent Tutoring System (ITS), we used resources from Fast Healthcare Interoperability Resources (FHIR) and mapped learning content with Unified Medical Language System (UMLS) codes to enhance healthcare education. This study addresses the need to enhance the interoperability and effectiveness of ITS in healthcare education. State of the art: The current state of the art in ITS involves advanced personalized learning and adaptability techniques, integrating technologies such as machine learning to personalize the learning experience and to create systems that dynamically respond to individual learner needs. However, existing ITS architectures face challenges related to interoperability and integration with healthcare systems. Concept: Our system maps learning content with UMLS codes, each scored for similarity, ensuring consistency and extensibility. FHIR is used to standardize the exchange of medical information and learning content. Implementation: Implemented as a microservice architecture, the system uses a recommender to request FHIR resources, provide questions, and measure learner progress. Lessons learned: Using international standards, our ITS ensures reproducibility and extensibility, enhancing interoperability and integration with existing platforms. [ABSTRACT FROM AUTHOR]

Copyright of Herz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The turn-around-time (TAT) of diagnostic and screening measures such as testing for SARS-CoV-2 can affect a patient's length of stay (LOS) in the hospital as well as the emergency department (ED). This, in turn, can affect clinical outcomes. Therefore, a reliable and time-efficient SARS-CoV-2 testing strategy is necessary, especially in the ED. In this randomised controlled trial, n = 598 ED patients presenting to one of three university hospital EDs in Berlin, Germany, and needing hospitalisation were randomly assigned to two intervention groups and one control group. Accordingly, different SARS-CoV-2 testing strategies were implemented: rapid antigen and point-of-care (POC) reverse transcription polymerase chain reaction (rtPCR) testing with the Roche cobas® Liat® (LIAT) (group one n = 198), POC rtPCR testing with the LIAT (group two n = 197), and central laboratory rtPCR testing (group three, control group n = 203). The median LOS in the hospital as an inpatient across the groups was 7 days. Patients' LOS in the ED of more than seven hours did not differ significantly, and furthermore, no significant differences were observed regarding clinical outcomes such as intensive care unit stay or death. The rapid and POC test strategies had a significantly (p < 0.01) shorter median TAT (group one 00:48 h, group two 00:21 h) than the regular central laboratory rtPCR test (group three 06:26 h). However, fast SARS-CoV-2 testing strategies did not reduce ED or inpatient LOS significantly in less urgent ED admissions. Testing strategies should be adjusted to the current circumstances including crowding, SARS-CoV-2 incidences, and patient cohort. This trial is registered with DRKS00023117. [ABSTRACT FROM AUTHOR]

Piwi‐interacting RNAs (piRNAs) direct PIWI proteins to transposons to silence them, thereby preserving genome integrity and fertility. The piRNA population can be expanded in the ping‐pong amplification loop. Within this process, piRNA‐associated PIWI proteins (piRISC) enter a membraneless organelle called nuage to cleave their target RNA, which is stimulated by Gtsf proteins. The resulting cleavage product gets loaded into an empty PIWI protein to form a new piRISC complex. However, for piRNA amplification to occur, the new RNA substrates, Gtsf‐piRISC, and empty PIWI proteins have to be in physical proximity. In this study, we show that in silkworm cells, the Gtsf1 homolog BmGtsf1L binds to piRNA‐loaded BmAgo3 and localizes to granules positive for BmAgo3 and BmVreteno. Biochemical assays further revealed that conserved residues within the unstructured tail of BmGtsf1L directly interact with BmVreteno. Using a combination of AlphaFold modeling, atomistic molecular dynamics simulations, and in vitro assays, we identified a novel binding interface on the BmVreteno‐eTudor domain, which is required for BmGtsf1L binding. Our study reveals that a single eTudor domain within BmVreteno provides two binding interfaces and thereby interconnects piRNA‐loaded BmAgo3 and BmGtsf1L. Synopsis: In the silkworm Bombyx mori, piRNA amplification requires BmVreteno, which enhances re‐loading of the empty Siwi protein after piRNA‐target cleavage. Here, a single eTudor domain within BmVreteno is shown to interconnect piRISC‐BmAgo3 with BmGtsf1L, a protein known to enhance BmAgo3 activity, to ensure efficient piRNA amplification. BmGtsf1L associates with piRNA‐loaded BmAgo3 and resides in BmAgo3 bodies.BmVreteno stimulates the interaction between BmGtsf1L and BmAgo3‐containing piRISC.The C‐terminal tail of BmGtsf1L directly interacts with the eTD1 domain of BmVreteno via a newly identified hydrophobic pocket.BmGtsf1L and BmAgo3 bind to the same eTudor domain of BmVreteno. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Heart failure remains a major global burden regarding patients' morbidity and mortality and health system organization, logistics, and costs. Despite continual advances in pharmacological and resynchronization device therapy, it is currently well accepted that heart transplantation and mechanical circulatory support represent a cornerstone in the management of advanced forms of this disease, with the latter becoming an increasingly accepted treatment modality due to the ongoing shortage of available donor hearts in an ever-increasing pool of patients. Mechanical circulatory support strategies have seen tremendous advances in recent years, especially in terms of pump technology improvements, indication for use, surgical techniques for device implantation, exchange and explantation, and postoperative patient management, but not in the field of treatment of critically ill patients and those undergoing cardiac arrest. This contemporary review aims to summarize the collected knowledge of this topic with an emphasis on complications in patients with left ventricular assist devices, their treatment, and establishing a clear-cut algorithm and the latest recommendations regarding out-of-hospital or emergency department management of cardiac arrest in this patient population. [ABSTRACT FROM AUTHOR]

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: It has not yet been possible to ascertain the exact proportion, characterization or impact of low-acuity emergency department (ED) attendances on the German Health Care System since valid and robust definitions to be applied in German ED routine data are missing. Methods: Internationally used methods and parameters to identify low-acuity ED attendances were identified, analyzed and then applied to routine ED data from two EDs of the tertiary care hospitals Charité—Universitätsmedizin Berlin, Campus Mitte (CCM) and Campus Virchow (CVK). Results: Based on the three routinely available parameters 'disposition´, 'transport to the ED´ and 'triage´ 33.2% (n = 30 676) out of 92 477 presentations to the two EDs of Charité—Universitätsmedizin Berlin (CVK, CCM) in 2016 could be classified as low-acuity presentations. Conclusion: This study provides a reliable and replicable means of retrospective identification and quantification of low-acuity attendances in German ED routine data. This enables both intra-national and international comparisons of figures across future studies and health care monitoring. [ABSTRACT FROM AUTHOR]