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Background One of the most common complications of hip arthroplasty is excessive blood loss that could necessitate allogenic blood transfusion, which is further associated with other complications, such as infections, transfusion reactions or immunomodulation. In gynecology, 4DryField®PH, an absorbable polysaccharide-based formulation, is used for hemostasis and adhesion prophylaxis. In this study, we evaluated its hemostatic effect in patients undergoing hip bipolar hemiarthroplasty following intracapsular femoral neck fracture. Methods We studied 40 patients with intracapsular femoral neck fractures (Garden III or IV) admitted at our institution between July 2016 and November 2017. We included patients above 60 years with simple fracture and without pathologic fractures. Patients were randomized into intervention and control groups. The intervention group received 5 g of 4DryField® PH (subfascially and subcutaneously) during wound closure. Three drainages were inserted in a standardized manner (submuscular, subfascial, and subcutaneous) and drainage volume was measured immediately before extraction. Total blood loss was calculated using Mercuriali’s formula and standard hemograms upon admission and five days after surgery. Volume of postoperative hematoma was measured using point-of-care ultrasound seven days after surgery. Results Volume of the postoperative hematoma was reduced by 43.0 mL. However, significant reduction of total blood loss and drainage volume was not observed. Conclusions We observed that 4DryField® PH had a local hemostatic effect, thereby reducing volume of the postoperative hematoma. However, this reduction was small and had no effect on the total blood loss. Further studies are warranted to improve the application algorithm. Trial registration DRKS, DRKS00017452, Registered 11 June 2019 – Retrospectively registered.

Purpose Early detection of bleeding is important for managing trauma cases in the emergency department (ED). Several trauma suites are equipped with computed tomography (CT) scanners to reduce the time to CT. In the last decade, sliding gantry CT has been implemented in trauma suites, highlighting conventional techniques' advantages. We investigated the change in the time to CT and the challenges faced during the implementation. Methods Trauma suite treatments with a conventional CT scanner between January and December 2016 formed the control group. From January to April 2017, trauma suites were modified, and treatment was outsourced to an interim trauma suite. By May 2017, trauma suites were equipped with a sliding gantry CT scanner. Treatments from May to July 2017 formed the transition group, and those from August to December 2017 formed the routine use group. We evaluated the time to CT in all groups and considered the reasons for the delays in the transition and routine use groups. Results On sliding gantry CT implementation, although time to CT remained unaffected in the transition group, it significantly reduced in the routine use group, independent of injury severity score. The incidence of cable management problems was significantly higher in the latter group. Conclusions We have demonstrated a decrease in the time to CT with the implementation of a sliding gantry CT. However, due to a higher number of cable management problems in the routine use group, we recommend regular refresher team training with routine use.

Background We retrospectively evaluated the mid-term results of surgery for talar process fractures (lateral and posterior processes) and exploratively analyzed parameters that potentially impact treatment outcomes. Methods Fifteen patients who underwent internal fixation (January 2000 to December 2015) were examined for radiological and clinical functional outcomes. The independent parameters evaluated were age, sex, extent of general injury, soft-tissue damage, surgical latency, and fracture type. Results All fractures healed completely. Three patients developed osteoarthritis. The American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Scale score was 79.5 ± 18.6, the Functional Foot Index score was 31.1 ± 31.4, and the physical and mental component summary scores of the Short Form 36, version 2, were 46.6 ± 11.8 and 50.3 ± 9.1, respectively. No influence on the above scores was determined. Conclusions The clinical outcomes of internal fixation of talar process fractures were good. Delayed surgical treatment (≥14 days) did not significantly lead to poorer outcomes in our patients.

Purpose To improve quality of trauma room management, intra- and inter-hospital benchmarking are important tools. However, primary data quality is crucial for benchmarking reliability. In this study, we analyzed the effect of a medical documentation assistant on documentation completeness in trauma room management in comparison to documentation by physicians involved in direct patient treatment. Methods We included all patients treated in the trauma room from 2016/01/01 to 2016/12/31 that were documented with the trauma module of the German Emergency Department Medical Record V2015.1. We divided the data into documentation by medical documentation assistant (DA, 07:00 to 17:00), physician in daytime (PD, 07:00 to 17:00), and physician at night (PN, 17:00 to 07:00). Data were analyzed for completeness (primary outcome parameter) as well as diagnostic intervals. Results There was a significant increase in complete recorded data for DA (74.5%; IQR 14.5%) compared to PD (26.9%; IQR 18.7%; p p p = 0.007) or PN (24.5 min; IQR 10.0; p = 0.001). Conclusion In presence of a qualified medical documentation assistant, data completeness and time to WBCT improved significantly. Therefore, utilizing a professional DA in the trauma room appears beneficial for data quality and time management.

In der Akutversorgung stellen sich Patienten vor, die durch fremde Personen geschadigt wurden. Trotz der medizinischen Behandlungsnotwendigkeit sollen auch juristische Konsequenzen berucksichtigt werden. Ziel dieser Arbeit war die Analyse der Konsilanforderungen an das Institut fur Rechtsmedizin des Universitatsklinikums Halle (Saale) und der Vergleich mit der Opferstatistik des Landeskriminalamtes (LKA) Sachsen-Anhalt. Die Konsilanforderungen der Jahre 2012–2015 wurden hinsichtlich der Alters- und Geschlechtsverteilung, den Vorstellungsgrunden und der Latenz bis zur Konsilanforderung ausgewertet. Anschliesend erfolgte ein prozentualer Vergleich mit den Opferstatistiken des LKA Sachsen-Anhalt 2014–2015. Es konnten 536 Falle mit 55,6 % mannlichen und 44,4 % weiblichen Patienten ausgewertet werden. 62,1 % der Patienten waren

In recent years, increases in the number of patients in emergency departments (ED) have led to continuous work intensification. To handle this problem, the treatment effectiveness has to be maximized. One strategy that may help to optimize workflow is the use of standard operating procedures (SOPs). We investigated the existence of SOPs and subjective effects on treatment in German EDs.We performed an online survey from February 2015 until June 2016. We collected data regarding the existence of SOPs, health care level, medical field, work experience, and education. All professional groups participating in the treatment of patients were requested to take part in the survey.Seventy-five percent of the 589 participants in the survey confirmed the existence of SOPs in their EDs. SOPs were more frequently available in hospitals with higher health care levels. Participants working in EDs without SOPs felt less confident regarding treatment of patients. More than 85% of these participants were in favor of having SOPs. The absence of SOPs was associated with a subjective delay in patient treatment.Most of the EDs had available SOPs. In departments without SOPs, most physicians wanted them to be implemented. SOPs seemed adequate in terms of supporting workflow and satisfaction with patients' treatment.HINTERGRUND: Die in den letzten Jahren steigende Zahl an Patienten in den Notaufnahmen führte zu einer zunehmenden Arbeitsverdichtung. Um dieses Problem zu adressieren, muss u. a. die Behandlungseffektivität gesteigert werden. Eine Strategie ist die Optimierung des Workflows durch die Nutzung von Standard Operating Procedures (SOP). Wir untersuchten die Häufigkeit von SOP und deren subjektive Effekte auf die Patientenbehandlung in deutschen Notaufnahmen.Wir führten von Februar 2015 bis Juni 2016 eine Onlineumfrage in deutschen Notaufnahmen durch. Dazu wurden Daten zum Vorliegen von SOP, dem Versorgungslevel des Krankenhauses sowie dem medizinischen Hintergrund, der Arbeitserfahrung und der Ausbildung des Befragten erhoben. Dabei wurden alle Professionen eingeschlossen, die an der unmittelbaren Patientenbehandlung beteiligt sind.Von den insgesamt 589 Teilnehmern gaben 75 % an, über SOP in der Notaufnahme zu verfügen. Dabei waren SOP häufiger in Krankenhäusern mit höherem Versorgungslevel zu finden. Teilnehmer, die über keine SOP in der Notaufnahme verfügten, fühlten sich unsicherer in der Patientenbehandlung. Mehr als 85 % dieser Befragten wünschten sich SOP. Das Fehlen der SOP war weiterhin mit einer subjektiven Verzögerung der Patientenbehandlung verbunden.Die meisten Notaufnahmen verfügen über SOP. Beim Fehlen von SOP wünschten sich die meisten dort arbeitenden Ärzte deren Implementierung. In diesem Hinblick scheinen SOP ein geeigneter Weg zu sein, den Workflow zu unterstützen und die Zufriedenheit mit der Patientenbehandlung zu verbessern.

Hintergrund Opfer von Gewalttaten bedurfen bei der Behandlung in einer Notaufnahme einer moglichst genauen Dokumentation, die vor Gericht Bestand hat. Dabei kann es vorkommen, dass die Dokumentation durch den Kliniker zunachst selbst erfolgen muss, falls kein Rechtsmediziner vor Ort ist.

Background Some of the advantages of implementing electronic emergency department information systems (EDIS) are improvements in data availability and simplification of statistical evaluations of emergency department (ED) treatments. However, for multi-center evaluations, standardized documentation is necessary. The AKTIN project (“National Emergency Department Register: Improvement of Health Services Research in Acute Medicine in Germany”) has used the “German Emergency Department Medical Record” (GEDMR) published by the German Interdisciplinary Association of Intensive and Emergency Care as the documentation standard for its national data registry. Methods Until March 2016 the documentation standard in ED was the pen-and-paper version of the GEDMR. In April 2016 we implemented the GEDMR in a timeline-based EDIS. Related to this, we compared the availability of structured treatment information of traumatological patients between pen-and-paper-based and electronic documentation, with special focus on the treatment time. Results All 796 data fields of the 6 modules (basic data, severe trauma, patient surveillance, anesthesia, council, neurology) were adapted for use with the existing EDIS configuration by a physician working regularly in the ED. Electronic implementation increased availability of structured anamnesis and treatment information. However, treatment time was increased in electronic documentation both immediately (2:12 ± 0:04 h; n = 2907) and 6 months after implementation (2:18 ± 0:03 h; n = 4778) compared to the pen-and-paper group (1:43 ± 0:02 h; n = 2523; p

Die primare Diagnostik schwerverletzter Patienten im Schockraum ist im Rahmen des „primary survey“ zunachst klinisch gepragt. In der S3-Leitlinie fur die Behandlung polytraumatisierter Patienten werden hierzu Schlusselempfehlungen gegeben. Wie verlasslich sind sogenannte klinische Leitsymptome bzw. „red flags“, die im Schockraum erhoben werden und dazu veranlassen, weitere diagnostische bzw. therapeutische Masnahmen einzuleiten? Es erfolgt eine Bewertung der Leitsymptome als Synopsis aus wissenschaftlicher Literatur unter besonderer Berucksichtigung der Aspekte der Wahrscheinlichkeitsrechnung und arztlichen Erfahrung. Die Erhebung von Leitsymptomen im Rahmen der klinischen Untersuchung darf aufgrund der unzureichenden Sicherheit nicht alleinige Grundlage fur die weitere Diagnostik und Therapie sein. Somit wird letztlich auch die Sinnhaftigkeit des stringenten Vorgehens nach dem Advanced-Trauma-Life-Support(ATLS)-Algorithmus bestatigt. „Red flags“ konnen als Warnhinweise aber bereits fruhzeitig den Blick fur relevante Verletzungsmuster scharfen. Eine rationale bildgebende Diagnostik muss sich anschliesen.

No clinical standard procedure has yet been defined to quantify the vascular pattern of vocal folds. Subjective classification trials have shown a lot of promise. Narrow band imaging (NBI) as an endoscopic imaging tool is useful, because it shows the vascular structure clearer than white light endoscopy (WL) alone. Endoscopic images of 74 human vocal folds (NBI and WL) were semi-automatically evaluated after image processing with respect to pixels of vessels and mucosa by the software MeVisLab. The ratios of vessel/mucosa pixels were compared. Using NBI, more vocal fold vessels are visible compared with WL alone (p = 0.000). There may be a difference between the right and left vocal folds due to the handedness of the examiner (p = 0.033) without any interaction between the method (NBI/WL) and the side (right/left) (p = 0.467). MeVisLab is a suitable tool for the objective quantification of the vessel/mucosa ratio for NBI and WL endoscopic images. NBI is an appropriate endoscopic tool for examination of diseases of vocal folds with changes in the vascular pattern. There is evidence that the handedness of the examiner may have an influence on the quality of the examination between the right and left vocal folds.

Demographic changes resulting in an aging population are major factors for an increase of fall-related injuries. Especially in situations where dual tasks such as walking whilst talking have to be performed simultaneously the risk of a fall-related injury increases. It is well known that some types of martial art (e.g. Tai Chi) can reduce the risk of a fall. It is unknown if the same is true for karate. In this randomized, controlled study 68 people with a mean age of 69 years underwent 5-month karate training, 5-month fitness training or were part of a control group. Before and after the time of intervention a gait analysis with normal walk, a cognitive dual task and a motor dual task were performed. The gait parameter step frequency, walking speed, single-step time and single-step length were investigated. It could be seen that all groups improved their gait parameters after a 5-month period, even the control group. A sporty intervention seems to affect mainly the temporal gait parameters positively. This effect was especially demonstrated for normal walk and cognitive dual task. An improvement of the human walk seems to be possible through karate and fitness training, even under dual-task conditions. A prolonged intervention time with multiple repetitions of gait analysis could give better evidence if karate is a useful tool to increase fall prevention.