Desire to Receive More Pain Treatment: A Relevant Patient-Reported Outcome Measure to Assess Quality of Post-Operative Pain Management? Results From 79,996 Patients Enrolled in the Pain Registry QUIPS from 2016 to 2019

Acute postoperative pain is frequently evaluated by pain intensity scores. However, interpretation of the results is difficult and thresholds requiring treatment are notwell defined. Additional patientreported outcome measures (PROMs) might be helpful to better understand individual pain experience and quality of pain management after surgery.We used data from the QUIPS pain registry for a cross-sectional study in order to investigate associations between the desire to receive more pain treatment (D2RMPT) with pain intensity ratings and other PROMs. Responses from 79,996 patientswere analyzed, of whom 10.7% reported D2RMPT. A generalized estimating equation Poisson model showed that women had a lower risk ratio (RR) to answer this question with “yes” (RR: .92, P < .001). Factors that increased the risk most were “maximal pain intensity ≥ 6/10 on a numerical rating scale” (RR: 2.48, P < .001) and “any pain interference” (RR: 2.48, P < .001). The largest reduction in risk was observed if patients were “allowed to participate in pain treatment decisions” (RR: .41, P < .001) and if they felt that they “received sufficient treatment information” (RR: .58, P < .001). Our results indicate that the (easily assessed) question D2RMPT gives additional information to other PROMs like pain intensity. The small proportion of patients with D2RMPT (even for high pain scores) opens the discussion about clinicians’ understanding of over- und under-treatment and questions the exclusive use of pain intensity as quality indicator. Future studies need to investigatewhether asking about D2RMPT in clinical routine can improve postoperative pain outcome. Perspective: This article presents characteristics of the patient-reported outcome measure “Desire to receive more pain treatment.” This measure could be used to apply pain treatment in a more individualized way and lead to improved treatment strategies and quality

A co-simulation of flexibility market based congestion management in Northern Germany

This paper analyses a flexibility market based approach to prevent grid congestions and reduce costs for feed in management. A method and implementation are presented to simulate this local flexibility market for the district Brunsbüttel in Northern Germany. The analysed approach introduces a regional auction to trade energy in a way that day-ahead forecasted congestions are minimised by coordinating the flexibility potential of the area. To quantify the potential of the mechanism a cosimulation was set up, using the OpSim co-simulation framework. The results show that the mechanism solves 100 % of congestions at the cost of 74 % of conventional feed-in management. Local flexibility assets, excluding curtailed wind farms, manage to prevent 21 % of congestions. The concept seems particularly attractive for large combined heat and power plants and electrolysis. Additional 62 MW flexibility would be required in order to completely avoid curtailment, corresponding to a ratio of 0.5 MW flexibility per megawatt installed wind capacity

Design and evaluation of a last-minute electricity market considering local grid limitations

Schedule deviations have become a major issue in Germany's power system in recent years. This paper introduces a fast local intraday market design to address this problem. It shows the concept of a market clearing process for the 15- minute frame between the closing time of the intraday market and the time of delivery. This fast local intraday market shall reduce the schedule deviation of renewable energies and increase system stability. It also introduces a concept of considering grid limitations in the market process. Hence the grid sensitivities of the trading partners on the power grid are considered in the matching process. Therefore, a co-simulation which includes renewable energy providers, the system operator, the market component and flexibility providers is implemented. The results of the simulation show the predicted deviations in a 2025 scenario, the potential for flexibility, the reduction of the deviations and the expected costs.Bundesministerium für Wirtschaft und Energi

Risk Factors for Severe Pain and Impairment of Daily Life Activities after Cesarean Section—A Prospective Multi-Center Study of 11,932 Patients

Cesarean section (CS) is the most widely performed and one of the most painful surgeries. This study investigated postoperative pain after CS using patient-related outcomes (PROs) to identify risk factors for severe pain. The secondary outcome was to evaluate the influence of surgery indication (primary CS (PCS) vs. urgent CS (UCS)). This multi-center, prospective cohort study included data submitted to the pain registry “quality improvement in postoperative pain treatment” (QUIPS) between 2010 and 2020. In total, 11,932 patients were evaluated. Median of maximal pain was 7.0 (numeric rating scale (NRS) 0 to 10); 53.9% suffered from severe pain (NRS ≥ 7), this being related to impairment of mood, ambulation, deep breathing and sleep, as well as more vertigo, nausea and tiredness (p p p p p < 0.05). Severe pain has a major effect on daily-life activities and recovery after CS, and depends on modifiable factors. More effort is needed to improve the quality of care after CS

A multistress responsive type I toxin-antitoxin system: <i>bsrE</i>/SR5 from the <i>B. subtilis</i> chromosome

<p><i>bsrE</i>/SR5 is a type I TA system from prophage-like element P6 of the <i>B. subtilis</i> chromosome. The 256 nt <i>bsrE</i> RNA encodes a 30 aa toxin. The antitoxin SR5 is a 163 nt antisense RNA. Both genes overlap at their 3′ ends. Overexpression of <i>bsrE</i> causes cell lysis on agar plates, which can be neutralized by <i>sr5</i> overexpression, whereas deletion of the chromosomal <i>sr5</i> copy has no effect. SR5 is short-lived with a half-life of ≈7 min, whereas <i>bsrE</i> RNA is stable with a half-life of >80 min. The <i>sr5</i> promoter is 10-fold stronger than the <i>bsrE</i> promoter. SR5 interacts with the 3′ UTR of <i>bsrE</i> RNA, thereby promoting its degradation by recruiting RNase III. RNase J1 is the main RNase responsible for SR5 and <i>bsrE</i> RNA degradation, and PnpA processes an SR5 precursor to the mature RNA. Hfq stabilizes SR5, but is not required for its inhibitory function. While <i>bsrE</i> RNA is affected by temperature shock and alkaline stress, the amount of SR5 is significantly influenced by various stresses, among them pH, anoxia and iron limitation. Only the latter one is dependent on <i>sigB</i>. Both RNAs are extremely unstable upon ethanol stress due to rapid degradation by RNase Y.</p

Management von COVID-19 Verdachtsfällen im Krankenhaus

Im aufgeführten Algorithmus wird das interhospitale Management von COVID-19 Verdachtsfälle beschrieben. Es dient der Identifikation, Abklärung und Isolation bzw. Kohortierung von entsprechenden Fällen im Krankenhaus inklusive der Quarantäne-Bedingungen und Vorraussetzung für die Beendigung der Quarantäne. Der Algorithmus wurde in Kooperation der Krankenhaushygiene, Intensivmedizin, Infektiologie und Virologie erstellt