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Introduction Telemedical concepts in emergency medical services (EMS) lead to improved process times and patient outcomes, but their technical performance has thus far been insufficient; nevertheless, the concept was transferred into EMS routine care in Aachen, Germany. This study evaluated the system's technical performance and compared it to a precursor system. Methods The telemedicine system was implemented on seven ambulances and a teleconsultation centre staffed with experienced EMS physicians was established in April 2014. Telemedical applications included mobile vital data, 12-lead, picture transmission and video streaming from inside the ambulances. The tele-EMS physician filled in a questionnaire regarding the technical performance of the applications, background noise and assessed clinical values of the transmitted pictures and videos after each mission between 15 May 2014-15 October 2014. Results Teleconsultation was established during 539 emergency cases. In 83% of the cases ( n = 447), only the paramedics and the tele-EMS physician were involved. Transmission success rates ranged from 98% (audio connection) to 93% (12-lead electrocardiogram (ECG) transmission). All functionalities, except video transmission, were significantly better than the pilot project ( p < 0.05). Severe background noise was detected to a lesser extent ( p = 0.0004) and the clinical value of the pictures and videos were considered significantly more valuable. Discussion The multifunctional system is now sufficient for routine use and is the most reliable mobile emergency telemedicine system compared to other published projects. Dropouts were due to user errors and network coverage problems. These findings enable widespread use of this system in the future, reducing the critical time intervals until medical therapy is started. [ABSTRACT FROM AUTHOR]

Background: Quantifying patients' preferences for health outcomes associated with atrial fibrillation (AF) and its treatments offers a replicable approach to considering the patient perspective in regulatory decision-making., Objective: The authors conducted a preference survey to estimate the relative importance of AF-related events for use in clinical trial analyses to estimate net health benefits with anticoagulants., Methods: The survey included nontechnical descriptions of three severities of stroke, systemic embolism, myocardial infarction (MI) with or without subsequent heart failure (HF), major bleeding, clinically relevant nonmajor bleeding, and death. A best-worst scaling question format was used in which patients were shown 10 sets of four events and asked to select what they considered to be most and least serious., Results: One thousand twenty-eight patients, mean age 69.2 years, 40.4% female, completed the survey. Best-worst scaling importance weights were significantly different across all events except between major bleeding and MI with HF. Death was considered the most serious (reweighted to 1), followed by severe disabling stroke (0.83), then major bleeding (0.53) or MI with HF (0.50), moderate-severity stroke (0.28) and systemic embolism (0.13). Clinically relevant nonmajor bleeding, MI without HF, and minor stroke (0.10, 0.06, and 0.04, respectively) were considered least serious. Events ordered by importance were consistent across age, sex, and race, but relative weights across events varied by sex and race., Conclusions: Patients expressed relatively high levels of concern about major bleeding compared to moderate-severity stroke or systemic embolism, endpoints frequently used in AF trials. Estimated weights could be used in patient-centered net-benefit determinations for AF therapies., Competing Interests: This study was supported through an investigator-initiated research contract agreement between Bayer AG and Duke University. Drs Reed, Gonzalez, and Patel report research funding and external relationships at https://scholars.duke.edu/. Drs Viethen and Mundl were employees of Bayer AG when the study was conducted. Dr Tamm is employee of Bayer AG. Drs Xiao and Coppolecchia are employee of Bayer U.S. LLC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

It has been shown that the metabolism of long chain fatty acids is involved in colorectal carcinogenesis. Acyl-CoA synthetases (ACSL) activate free fatty acids by synthesis of acyl-CoA thioesters. ACSL isoform 5 (ACSL5) is involved in enterocytic differentiation and maturation by regulating both pro-apoptotic and anti-proliferative effects. Whilst impaired expression of ACSL5 has been associated with sporadic colorectal carcinogenesis, little is known about ACSL5 as a prognostic factor. Aim of this retrospective study was to characterize the prognostic impact of ACSL5 expression levels in sporadic colorectal adenocarcinomas. A total of 72 patients with a median follow-up of 54 months was included. Using a standardized immunohistochemical approach, colorectal adenocarcinomas with low (n=41; group 1) or high (n=31; group 2) ACSL5 levels were identified. In a one-year follow-up, tumour recurrence was significantly increased in group 1 (p=0.0279). The finding was independent of the TNM- and UICC-stage in the surgical resections. Frequency of lymph node metastasis and mortality was not different between the groups. In a long-time follow-up no differences were found between the ACSL5 groups. The data indicate that ACSL5 could be an independent prognostic factor for early recurrence of sporadic colorectal adenocarcinoma., (Copyright © 2016 Elsevier GmbH. All rights reserved.)