1.000.000 Fußballfans in einer Stadt mit 120.000 Einwohnern - ein notfallmedizinischer Albtraum?: Die Euro 2008 und das "Oranje-Wunder von Bern"

Zusammenfassung: Die Fußballeuropameisterschaft 2008 war die größte je in der Schweiz organisierte Sportveranstaltung. Eine Million Fußballfans besuchten in diesem Zeitraum Bern, und der lokale Flughafen Bern/Belp verzeichnete 261 zusätzliche Flüge. Pro Fußballspiel waren 33.000 Zuschauer im Stadion und 100.000 schauten in den Public-viewing-Zonen zu. Der Rettungsdienst und das Notfallzentrum des Inselspitals am Universitätsklinikum Bern waren für die medizinische Grundversorgung und die Notfallversorgung zuständig. Verletzungen und Krankheiten wurden mit einem standardisierten Score (NACA-Score, NACA National Advisory Committee of Aeronautics) analysiert. Details zu den Vorbereitungen, Kosten und Patientenzahlen werden im vorliegenden Artikel dargestellt. Insgesamt waren 30 zusätzlich Ambulanzfahrzeuge im Einsatz, 4723 zusätzliche Arbeitstage (1/3 davon durch medizinische Fachkräfte) wurden geleistet, 662 Ambulanzrufe gingen ein, 240 Personen benötigten eine medizinische Versorgung (62% Schweizer, 28% Niederländer, 10% anderer Nationalität). Von diesen wurden 51 Personen in einem der 4 städtischen Krankenhäuser behandelt. Es kamen keine Verletzungen der Grade NACAVI und VII vor (NACAI 4, NACAII 17, NACAIII 16, NACAIV 10, NACAV 4Patienten). Die Stadt Bern erstattete dem Inselspital 112.603EUR für die medizinische Versorgung. Die größten Anteile daran hatten die Sicherheitsmaßnahmen (50.300EUR) und die Kosten für medizinisches Personal (22.600EUR für Ärzte, 29.000EUR für Pflegefachkräfte). Aufgrund des schlechten Wetters und des vorbildlichen Verhaltens der Fans nahmen die Ereignisse einen eher friedlichen Verlau

Effects of self-generated electric and magnetic fields in laser-generated fast electron propagation in solid materials: Electric inhibition and beam pinching

We present some experimental results which demonstrate the presence of electric inhibition in the propagation of relativistic electrons generated by intense laser pulses, depending on target conductivity. The use of transparent targets and shadowgraphic techniques has made it possible to evidence electron jets moving at the speed of light, an indication of the presence of self-generated strong magnetic fields

Fast electron transport and heating in solid-density matter

Two experiments have been performed to investigate heating by high-intensity laser-generated electrons, in the context of studies of the fast ignitor approach to inertial confinement fusion (ICF). A new spectrometer and layered targets have been used to detect Kα emission from aluminum heated by a fast electron beam. Results show that a temperature of about 40 eV is reached in solid density aluminum up to a depth of about 100 μm

Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey

Background In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre. Objectives To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk Methods We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland. Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees. Results Retrospective survey A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. Case-control survey 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury. Conclusions Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index

Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department

BACKGROUND Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. METHODS All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen's d was calculated as effect size for all statistically significant tests. RESULTS Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (d z  = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). DISCUSSION Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. CONCLUSION An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED

Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broadspectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians' awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with communityacquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1-5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients' group's broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group's antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update

Transcrestal Sinus Floor Elevation with Coral-Derived Hydroxyapatite: pilot study.

Objective: The purpose of this pilot study is to set a mini-invasive surgical protocol for the rehabilitation of edentulous posterior maxilla, consisting of the positioning of short or standard implants in combination with sinus lifting, with the adjunct of coral-derived hydroxyapatite (Duravit Crestal Sinus Lift & Novocore Plus by B&B Dental Implant Company S.r.l.,Bologna, Italy). Method: 12 patients with residual bone height <4mm were included in this pilot study. After the elevation of a full-thickness flap, the cortical bone has been perfored with a pilot drill. The guide path has expanded with a compactor-expander 2mm wide, then 3mm wide and then, depending from the bone thickness, 4mm wide compactor was used. All these compactor were used 1mm inside the sinus. Coral-derived hydroxyapatite was placed by injector into the surgical cavity and the pushed into the sinus to elevate the membrane. Finally the implant was placed. All implant site were underprepared to achieve implant primary stability. After implant placement, the flap was repositioned and sutured with 4.0 non-adsorbable sutures. All patients received a standard post-surgical and maintenance protocol. Periapical radiographs were taken immediately after implant placement, at the prosthetic phase, and at each follow-up visit. Patients were left healing for 4 months before prosthetic phase. 12 implants have been inserted. All implants supports a screw-retained single-crown prosthesis. Result: All 12 implant placed achieved osseintegretion. Overall implant success and survival rates were 100% and average marginal bone loss was 0.60±0.2mm at 1 year follow-up visit. All prosthetic rehabilitations were successful and in function. Conclusion: Within the limits of this pilot study the proposed treatment protocol for mini invasive sinus floor elevation seems to be a viable option for rehabilitation of edentulous posterior atrophic maxilla