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The objective of this medical chart review (MCR) was to describe the clinical characteristics of elderly patients with community-acquired invasive Escherichia coli disease (IED), as well as their treatment, clinical outcomes, and the associated medical resource use in Germany. This retrospective MCR study utilized data documented from 11 hospitals across Germany. Hospitals searched their in-house electronic medical record system to identify IED cases (E. coli mono-infection, age ≥60) hospitalized between January 2018 and February 2020. Two mutually exclusive groups were identified through a clinical case definition (CCD): E. coli in blood or other sterile sites (Group B) or E. coli in urine, with the presence of urosepsis and without identifiable other sources of infection (Group U). Cases were subsequently excluded if the infection was hospital-acquired or if they did not meet the CCD. Of 221 documented IED cases, 134 (60.60%) were ultimately eligible (mean age: 77.98 ± 8.52, females: 47.01%). Of these, 107 (79.85%) were in group B and 27 (20.15%) in group U. Across both groups, the average length of hospitalization was 13.07 ± 11.37 days, and most patients were admitted as emergencies (91.79%). The most common encoded main diagnoses were sepsis due to E. coli (ICD-10: A41.51; 38.06%) and unspecified urinary tract infection (ICD-10: N39.0; 11.94%). The patients' average sepsis-related organ failure assessment score was 3.21 ± 2.43 at admission; 8.96% of patients had a septic shock, and 29.85% were in the intensive care unit during their hospitalization. In total, 10.45% of the patients died during their index hospitalization; of the surviving patients, 18.33% had at least one readmission within 90-days after discharge. In elderly patients (age ≥60) with IED, severe courses associated with increased health care resource utilization and sometimes fatal outcomes were observed. Therefore, advances in recognition and treatment seem to be necessary. [ABSTRACT FROM AUTHOR]

Background: During coronavirus disease of 2019 pandemic a standard usage of personal protective equipment (PPE) in healthcare was mandatory, while actually the usage of PPE is currently decreasing. This raises the question about the further use of PPE in the clinical setting because healthcare workers (HCW) are at greater risk of being infected with SARS-CoV-2 than the general population. The primary objective of this study is to determine the proportion of shock room team members approving the further use of PPE including a FFP2 respirator in simulation training and reality. The secondary objectives are to describe the expertise and difficulties faced while using PPE in the shock room care., Methods: Fifty-four HCW participated in a shock room simulation training at a large urban tertiary care hospital in Germany, utilizing a PPE comprising an FFP2 mask, gloves, goggles, and gown. Subsequently, participants completed an online questionnaire featuring 15 questions presented on a 5-point Likert scale or as multiple-choice questions with predefined answers., Results: Sixty-eight point five percent of our participants voted for an established standard PPE in shock room care. The largest fraction of our participants (40.7%) favors a standard PPE consisting of FFP2 mask, gown, and gloves. Less HCW (31.5%) want to wear PPE in shock room simulation training. Except for goggles we could not detect relevant difficulties faced while using PPE in the shock room environment. Incorrect use of PPE was observed in 14.8%., Conclusion: A majority of our participants favored a standard PPE including a FFP2 respirator in shock room care. In addition, we recommend the use of PPE in shock room simulation training, while further awareness of and training in proper use of PPE seems to be necessary to reduce risk of infectious diseases for HCW., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Remote ischemic preconditioning (RIPC) has been suggested to protect against certain forms of organ injury after cardiac surgery. Previously, we reported the main results of RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study, a multicenter trial randomizing 1403 cardiac surgery patients receiving either RIPC or sham-RIPC., Methods and Results: In this follow-up paper, we present 1-year follow-up of the composite primary end point and its individual components (all-cause mortality, myocardial infarction, stroke and acute renal failure), in a sub-group of patients, intraoperative myocardial dysfunction assessed by transesophageal echocardiography and the incidence of postoperative neurocognitive dysfunction 5 to 7 days and 3 months after surgery. RIPC neither showed any beneficial effect on the 1-year composite primary end point (RIPC versus sham-RIPC 16.4% versus 16.9%) and its individual components (all-cause mortality [3.4% versus 2.5%], myocardial infarction [7.0% versus 9.4%], stroke [2.2% versus 3.1%], acute renal failure [7.0% versus 5.7%]) nor improved intraoperative myocardial dysfunction or incidence of postoperative neurocognitive dysfunction 5 to 7 days (67 [47.5%] versus 71 [53.8%] patients) and 3 months after surgery (17 [27.9%] versus 18 [27.7%] patients), respectively., Conclusions: Similar to our main study, RIPC had no effect on intraoperative myocardial dysfunction, neurocognitive function and long-term outcome in cardiac surgery patients undergoing propofol anesthesia., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01067703., (© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)

The benefits of interdisciplinary approaches in patient care, research and education are quite obvious and set the trend for more interdisciplinary structures. In order to achieve sustained success, however, there are numerous risks of interdisciplinary collaboration that have to be considered. Interdisciplinarity leads to an increasing degree of specialization and consequently to a greater experience of specialists in highly specific procedures. Nevertheless, this is accompanied by a loss of experience of those who do not perform these procedures anymore. Not least, due to the high specialization, the surgeon's profession is changing from generalist to specialist. Hence, the education of young physicians, students and researchers has to be adapted to this reality. It remains unanswered if these changes contribute to the decline in the number of applicants in surgery. In conclusion, the risks of the contradictory contexts of interdisciplinarity can be counteracted with simple principles of fair and cooperative partnership.

Unlabelled: Increasingly complex techniques in cardiovascular medicine lead to a competitive partnership between cardiology and cardiac surgery. Common challenges will arise in the fields of coronary heart disease, heart valves, heart failure and rhythm therapy. For instance, coronary revascularization in acute myocardial infarction is no longer considered to exclusively be an interventional option. In comparison, the implantation of heart valves is increasingly carried out by cardiologists using interventional techniques. The latest designs of sutureless valves try to combine the benefits of conventional and transcatheter heart valves. Heart failure is the most common reason for hospital admission and thus an important therapeutic target for cardiology and cardiac surgery. New approaches in diagnostics, heart assist devices and cellular therapy meet this challenge., Conclusion: In the future only a sensitive and transparent collaboration across transsectoral borders will offer optimal therapy in cardiovascular medicine.

Cardiology and cardiothoracic surgery are closely related so that collaboration and communication are required to offer optimal therapy for patients. During the last decades many innovations have reduced the borders between cardiology and cardiothoracic surgery. Today, cardiologists may perform coronary interventions with good results that would have previously been the domain of coronary bypass surgery. In addition new valvular interventions have been developed, such as transfemoral or transapical aortic valve implantation and endovascular mitral valve reconstruction. New developments in cardiothoracic surgery have led to less invasive procedures and many surgical procedures can now be performed with minimally invasive techniques and without a cardiopulmonary bypass. To enable optimal therapy for patients, closer collaboration between cardiologists and cardiothoracic surgeons is required setting the stage for individualized therapy in the future.

Translation of basic research results into routine patient care is delayed in parts by lack of institutionalization in clinical research. In this article the research structure and organization of our Department of Cardiac, Thoracic, Transplantation and Vascular Surgery are described.Basic research, separately directed, is accomplished in the Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO) and within the scope of the Excellence cluster "REBIRTH--from Regenerative Biology to Reconstructive Therapy".Clinical research is directed by heads of the subdepartments of our institution (valve and coronary surgery, aortic surgery, surgical electrophysiology, vascular surgery, thoracic surgery, cardiac assist systems, thoracic transplantation, intensive care and pediatric heart surgery).A separate subdepartment for clinical research is responsible for study coordination and accompanies clinical studies from study design and patient screening to publication. This subdepartment also serves as a constant contact to sponsors and superordinated research organizations within the Hannover Medical School.

From a care provider's view quality of care should, of course, be the major focus. But should results such as employer quality, quality of cooperation, and the economic outcome not be treated as equally important aims since they interact mutually? By analyzing impacts on the quality of care, we found direct factors like the quality of applied procedures or clinical pathways influenced by secondary factors like quality assurance and research, for instance. As expected, all of these factors are essentially involved by the human factor. In order to sustainably improve results in health care, the human factor requires a new attendance and should be addressed in dimensions of results that are as important as quality of care itself. Optimizing the human factor in health care is a prerequisite to sustainably improve quality and requires an advanced point of view on dimensions of results that mutually interact with the quality of care: Focus on the patient. In order to achieve this goal, we have to primarily focus on the organization hospital., (Georg Thieme Verlag KG Stuttgart, New York.)

Background and Objective: An amendment to the German medical curriculum in April 2002 will place basic practical skills at the centre of medical training. We report here on the implementation and evaluation of an obligatory, tutor-guided, and integrated skills laboratory concept in the field of internal medicine., Methods: To test the effectiveness of a skills laboratory training on OSCE performance a pilot study was carried out. The experimental group, of 77 students, participated in seven sessions of communication training, skills laboratory training, and bedside teaching, each lasting one and a half hours. The control group of 66 students had as many sessions but was only offered bedside-teaching. The evaluation of acceptance of skills' training as well as the related increase in individual competence is on-going (summer term 2004: n = 176 students)., Results: The integrated skills laboratory concept was rated at 3.5 (SD = 1.2) on a 5-point scale and was acknowledged as practice-oriented (M = 4.2; SD = 1.0) and relevant for doctors' everyday lives (M = 3.6; SD = 1.1). Increased levels of competence according to individual self-evaluations proved to be highly significant (p<.001), and results of the pilot study showed that the experimental group had a significantly better OSCE performance than the control group (p<.001)., Conclusion: This pilot study shows that curriculum changes promoting basic clinical skills are effective and lead to an improved practical education of tomorrow's physicians. The integrated skills laboratory concept is well accepted and leads to a relevant increase in competence in the practice of internal medical. The presented skills laboratory concept in internal medicine is proving to be a viable and efficient learning tool.

Hypoparathyroidism is a rare disease with hypocalcemia as the leading symptom. In adults, hypocalcemia is mainly due to postoperative hypoparathyroidism. Hypoparathyroidism requires lifelong therapy with vitamin D or metabolites. Genuine vitamin D3 (Vigantol) is the most economic treatment of hypoparathyroidism; however, vitamin D3 has a very long biologic half life with the subsequent danger of chronic vitamin D intoxication. Dihydrotachysterol (A.T.10), an analogue of vitamin D, acts similarly and can be used alternatively. 1,25-dihydroxyvitamin D3 (Rocaltrol), the biologically active metabolite of vitamin D3, is very potent, but bears the danger of causing acute intoxication; it has a short half life and is more expensive than vitamin D3. A further metabolite, 1-hydroxy-vitamin D3 (alfacalcidol, Doss, EinsAlpha) is available for therapeutic use. Clinical intervention trials concerning the best therapy and management of hypoparathyroidism are lacking. We therefore surveyed German physicians treating hypoparathyroidism. Furthermore, we carried out a retrospective study of 45 patients treated in our endocrinology department during the last 8 years and examined whether measurement of 25(OH)-vitamin D3 is helpful in managing hypoparathyroidism. The data from 59 children and 270 adults could be completed in the survey. 1,25-dihydroxyvitamin D3 was the only vitamin D agent that was administered in the treatment of children, whereas in adults 52% were treated with dihydrotachysterol, 28% with genuine vitamin D3, and 20% with 1,25-dihydroxyvitamin D3. There was a positive correlation between serum 25(OH)-vitamin D3 levels and administered vitamin D3 doses. In patients treated with vitamin D3, serum calcium levels correlated significantly with serum 25(OH)-vitamin D3 levels whereas they did not correlate with administered calcium doses. Thus: (1) in Germany dihydrotachysterol is preferred for therapy of hypoparathyroidism in adults and (2) measurement of serum 25(OH)-vitamin D3 may be helpful in assessing efficacy of therapy and compliance in patients treated with vitamin D3.

NK 611 is a new podophyllotoxin derivative in which a dimethyl amino group replaces a hydroxyl group at the sugar moiety of etoposide. This results in profound physico-chemical differences: NK 611 is much less hydrophobic than etoposide. Preclinical studies have shown that NK 611 is advantageous in terms of bioavailability and of the potency of its anticancer activity. A clinical phase I study was performed in cancer patients within the framework of the AIO. Additionally, its pharmacokinetics and pharmacodynamics were investigated. NK 611 was given to 26 patients at doses ranging from 60 to 140 mg/m2 [maximum tolerated dose (MTD) 120 mg/m2] in a 30-min infusion. Plasma and urine samples were collected from 25 patients and analyzed using a validated high-performance liquid chromatography (HPLC) assay procedure. The concentration versus time curve of total NK 611 in plasma samples was best described by a three-compartment model. The overall median pharmacokinetic values were as follows (ranges are given in parentheses): mean residence time (MRT) 16.5 (5.4-42.3)h, terminal half-life 14.0 (8.2-30.5)h, volume of distribution at steady state (V(ss)) 11.4 (7.9-18.1) l/m2 and plasma clearance (Cl(p)) 15.1 (3.6-36.4) ml min-1 m-2. The total systemic drug exposure, represented by the area under the curve (AUC), varied between 53.4 and 532.0 micrograms ml-1 h. The mean AUC (+/- SD) increased with the dose from 78.7 +/- 3.7 micrograms ml-1 h at 60 mg/m2 up to 202.8 +/- 157.2 micrograms ml-1 h at 120 mg/m2. The mean urinary excretion (UE) fraction of unchanged drug at 48 h after the end of the infusion varied between 3.0% and 25.8% of the total dose delivered. Analysis of ultrafiltrate samples showed a protein binding of approx.. 99%. The percentage reduction in white blood cells (WBC) and neutrophils (ANC) correlated with the dose, AUC, and AUC(free). The best relationship between the percentage of reduction in ANC and a pharmacokinetic parameter (AUC) took a nonlinear Hill-type form. The laboratory parameter for kidney or liver function did not correlate with the AUC. The variation of pharmacokinetic parameters within each dose level was profound. The reason for this pharmacological behavior remains unclear and should be investigated in further studies.