Patient-Centered Process Optimization in A German Emergency Department With A Particular Focus on Sufficient Pain Management: A Best Practice Model for the Continouus Improvement of Quality and Patient Satisfaction

While pain is the main reason for patients to visit ahospital’s emergency department (ED), it is a hardly exploredphenomenon in this context. Moreover, while effective painmanagement is the most important dimension of patientsatisfaction in EDs, there is a lack of studies in Central Europewhich could be used for optimizing the deficient painmanagement in these units. This study will clarify whether theimplementation of an interdisciplinary structured pain managementimproves the care of patients in the emergency room andwhether its use improves patient satisfaction. Additionally, itinvestigates whether the implementation of such a structuredpain management system will also bring advantages for the workof personnel employed in the emergency room. To this end, amultimethod approach was chosen, in which both the patientstreated in the emergency room and the staff working there wereinterviewed by a written survey during a two-week examinationperiod before and after the implementation. Included were allpatients of the somatic departments who met the ethical criteria,as well as all doctors and nurses. Data analysis and processingwas carried out using Microsoft Excel. It was found that the useof a structured pain management system leads to better, moreeffective pain treatment of the patients in the emergencydepartment and increases their overall satisfaction with theirtreatment. Furthermore, it is easy to use by the staff and reducestheir workload so that they have more time to spend on patient care

Mapping the Knowledge on Coping Processes in Patients with Pancreatic Cancer

Background: Pancreatic cancer is one of the malignant diseases with the highest cancer-specific mortality. At the time of diagnosis, life expectancy is often already very limited, as it is usually discovered late and in an advanced stage. Coping with cancer is a complex process. Coping strategies of patients with pancreatic cancer probably differ from those of other malignancies. Yet to date, there exists no pancreatic cancer-specific coping model. Objective: The objective of this scoping review is to explore and characterize the academic literature related to coping processes in patients with pancreatic cancer. Methods/Design: The JBI's three-step search strategy, combined with the Arksey and O'Malley framework, will be used to identify articles via PubMed/MEDLINE, CINAHL, Cochrane Library, Google Scholar, CAMbase, CareLit, CC Med, Scopus, and PsycARTICLES (Arksey & O'Malley, 2005; Peters et al., 2017). It follows the PRISMA guidelines for scoping reviews (Tricco et al., 2018). Primary and secondary studies and reviews which report on coping with pancreatic cancer (adenocarcinoma) in adults in English or German language will be included in this scoping review, regardless of publication date or study design. Discussion: This scoping review will add new insights on coping with pancreatic cancer by summarizing current knowledge, and identifying research&nbsp

Higher chance of survival in patients with out-of-hospital cardiac arrest attributed to poisoning

Aim of the study: Description and comparison of cohort characteristics and outcome of adult patients with out-of-hospital cardiac arrest (OHCA) attributed to poisoning (P-OHCA) versus patients with OHCA attributed to other medical causes (NP-OHCA). Methods: We included all patients who received cardiopulmonary resuscitation after OHCA between January 2011 and December 2020 from German emergency medical services with good data quality in the German Resuscitation Registry. Exclusion criteria: patients < 18 years of age or OHCA attributed to trauma, drowning, intracranial bleeding or exsanguination. Results: Patients with P-OHCA (n = 574) were significantly younger compared to NP-OHCA (n = 40,146) (median age of 43 (35-54) years vs. 73 (62-82) years; p < 0.001). Cardiac arrest in P-OHCA patients was significantly less often witnessed by bystanders (41.8 % vs. 66.2 %, p < 0.001). Asystole was the predominant initial rhythm in P-OHCA patients (73.5% vs. 53.7%, p < 0.001) while ventricular fibrillation (VF) and pulseless electrical activity (PEA) were less common (9.2% vs. 25.1% and 16.2 % vs. 20.5%, p < 0.001). P-OHCA had a higher chance of survival with good neurological outcome at hospital discharge (15.2 vs. 8.8 % p < 0.001) and poisoning was an independent protective prognostic factor in multivariate analysis (OR 2.47, 95%-CI [1.71-3.57]). P-OHCA patients with initial PEA survival with good neurological outcome was comparable to initial VF (34.3 % vs. 37.7%). Conclusion: Patients in the P-OHCA group had a significantly higher chance of survival with good neurological outcome and PEA as initial rhythm was as favourable as initial VF. Therefore, in P-OHCA patients resuscitation efforts should be extended

Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation

Abstract Aim This work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival. Methods Data from the German Resuscitation Registry (GRR) were used, and we included patients registered between 1st January 2007 and 31st December 2021. We included children aged between > 7 days and 17 years, where cardiopulmonary resuscitation (CPR) was started, and treatment was continued by emergency medical services (EMS). Incidences and descriptive analyses are presented for the overall cohort and each age group. Multivariate binary logistic regression was performed on the whole cohort to determine the influence of (1) CPR with/without ventilation started by bystander, (2) OHCA witnessed status and (3) night-time on the outcome hospital admission with return of spontaneous circulation (ROSC). Results OHCA in children aged  1 year. Bystander-witnessed OHCA and bystander CPR rate were highest in children aged 1–4 years, with 43.9% and 62.3%, respectively. In reference to EMS-started CPR, bystander CPR with ventilation were associated with an increased odds ratio for ROSC at hospital admission after adjusting for age, sex, year of OHCA and location of OHCA. Conclusion This study provides an epidemiological overview of OHCA in children in Germany and identifies bystander CPR with ventilation as one primary factor for survival. Trial registrations German Clinical Trial Register: DRKS00030989, December 28th 2022. Graphical Abstrac

Impact of FAPI-PET/CT on Target Volume Definition in Radiation Therapy of Locally Recurrent Pancreatic Cancer

(1) Background: A new radioactive positron emission tomography (PET) tracer uses inhibitors of fibroblast activation protein (FAPI) to visualize FAP-expressing cancer associated fibroblasts. Significant FAPI-uptake has recently been demonstrated in pancreatic cancer patients. Target volume delineation for radiation therapy still relies on often less precise conventional computed tomography (CT) imaging, especially in locally recurrent pancreatic cancer patients. The need for improvement in precise tumor detection and delineation led us to innovatively use the novel FAPI-PET/CT for radiation treatment planning. (2) Methods: Gross tumor volumes (GTVs) of seven locally recurrent pancreatic cancer cases were contoured by six radiation oncologists. In addition, FAPI-PET/CT was used to automatically delineate tumors. The interobserver variability in target definition was analyzed and FAPI-based automatic GTVs were compared to the manually defined GTVs. (3) Results: Target definition differed significantly between different radiation oncologists with mean dice similarity coefficients (DSCs) between 0.55 and 0.65. There was no significant difference between the volumes of automatic FAPI-GTVs based on the threshold of 2.0 and most of the manually contoured GTVs by radiation oncologists. (4) Conclusion: Due to its high tumor to background contrast, FAPI-PET/CT seems to be a superior imaging modality compared to the current gold standard contrast-enhanced CT in pancreatic cancer. For the first time, we demonstrate how FAPI-PET/CT could facilitate target definition and increases consistency in radiation oncology in pancreatic cancer

Three-year trends in out-of-hospital cardiac arrest across the world : second report from the International Liaison Committee on Resuscitation (ILCOR)

Background The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017. Methods We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data. Results Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0–97.1 individuals per 100,000 population in 2015, 36.4–97.3 in 2016, and 40.8–100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017. Conclusion We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend