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Hundreds of thousands of individuals who experience lasting sequelae after sepsis and infections in Germany do not receive optimal care. In this White Paper we present measures for improvement, which were developed by a multidisciplinary expect panel as part of the SEPFROK project. Improved care rests on four pillars: 1. cross-sectoral assessment of sequelae and a structured discharge and transition management, 2. interdisciplinary rehabilitation and aftercare with structural support, 3. strengthening the specific health literacy of patients and families, and 4. increased research into causes, prevention and treatment of sequelae. To achieve this, appropriate cross-sectoral care structures and legal frameworks must be created., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The number of patients who survive sepsis is growing. However, two of three sepsis survivors suffer from new physical or mental sequelae. Cognitive deficits, depression or limitations of the activities of daily living can seriously impair quality of life and working ability. Sepsis sequelae cover a range of lesions; current rehabilitation therapies appear unsuited because they are focused on only one organ system. An interdisciplinary approach is necessary to evaluate and treat sepsis sequelae. Survivors and their relatives should be informed about sepsis and possible sequelae as early as possible. Further studies are needed to improve the understanding of pathomechanisms and effectivity of treatment interventions for sepsis sequelae., Competing Interests: Christiane Hartog gibt Förderungen durch das Bundesministerium für Bildung und Forschung (BMBF), den Innovationsfonds des Gemeinsamen Bundesausschusses (G-BA) und die European Society of Intensive Care Medicine an. Carolin Fleischmann-Struzek erhält Förderungen durch das BMBF und den Innovationsfonds des G-BA und gibt eine Beratertätigkeit bei der WHO an. Björn Weiss gibt Honorare für Beratertätigkeiten bzw. Vorträge von Orion Pharma Ltd. bzw. Dr. F. Köhler Chemie an. Konrad Reinhart erhält Förderung durch das BMBF, den Innovationsfonds des G-BA und die Stiftung Charité. Claudia Denke und Ulf Bodechtel geben an, dass keine Interessenkonflikte vorliegen., (© Georg Thieme Verlag KG Stuttgart · New York.)

Family-centered care in the ICU is a quality criterion of modern intensive care. Relatives are not just visitors, caregivers and involved stakeholders, but also partners for the medical team, especially when eliciting patient preferences and during shared decisionmaking. The move towards family-centered care signifies that traditional roles are changing; family-centered care is becoming a critical component of optimizing patient outcomes in the ICU., Competing Interests: Interessenkonflikt: C.S. Hartog gibt an, teilweise durch die Mitteldeutsche Sepsiskohorte (MSC) gefördert zu sein. Die MSC ist ein Projekt des Center for Sepsis Control and Care, das vom BMBF gefördert wird (FKZ No. 01EO1502) sowie von der Rudolf Presl GmbH. U. Bodechtel gibt keinen Interessenkonflikt an. Funding: Dieser Artikel wurde ohne externe Mittel verfasst., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Post-stroke care programs based on a standardized treatment pathway supported by case management may prevent secondary stroke and minimize risk factors., Objectives: We aimed to determine the feasibility of a standardized treatment pathway and its impact on risk factor control, life-style changes and adherence to secondary prevention medication., Methods: We conducted a prospective pilot study in consecutive stroke patients. The 12-month post-stroke care program included regular perosnal and phone contact with a certified case manager. Target values for vascular risk factors following current recommendations of stroke guidelines were monitored and treated if necessary. In the case of deviations from the treatment pathway the case manager intervened. Patients were screened for recurrent stroke at the end of the program after 12 months., Results: We enrolled 101 patients: 57.4 % were male, the median age was 72 (IQR, 62-80) years, median baseline NIHSS score was 2(IQR, 1-5), 79.2 % had an ischemic stroke, 3 % a hemorrhagic stroke, and 17.8 % a transient ischemic attack (TIA). Eighty-six (85.1 %) patients completed the program, 12 (11.9 %) withdrew from the program and 3 died of malignant diseases. In total, 628 personal (6.2/patient) and 2,683 phone contacts (26.6/patient) were conducted by the case manager. Three hundred-seventy-nine specific interventions were necessary mostly because of missing medication, non-compliance, and social needs. After 12 months, target goals for blood pressure, body mass index, nicotine use, and cholesterol were more frequently (p < 0.05) achieved than at baseline. No recurrent stroke occurred during the program., Conclusions: Our pilot data demonstrate that case management-based post-stroke care is feasible and may contribute to effective secondary prevention of stroke.

Whereas statins and acetylsalicylic acid (ASA) are considered gold standard for secondary prevention following myocardial infarction or atherotrombotic stroke, there are inconsistent data on the use of these drugs for primary prevention in patients with increased cardiovascular risk. Some meta-analyses indicated that the use of statins and ASA for primary prevention of cardiovascular disease can reduce the risk of cardiovascular events such as ischemic stroke or myocardial infarction. However, the effects of primary prevention with statins and ASA on mortality varied in the data included in these meta-analyses. Therefore the guidelines of the German College of General Practitioners and Family Physicians recommend primary prevention with statins and ASA only in those patients who have a 10-year risk of cardiovascular events which exceeds 20 %. Divergently, primary prevention with ASA is not recommended by the European Society of Cardiology. Observational studies suggested that treatment success of primary prevention with statins and ASA depends on various factors such as adherence to medication and prescription behavior of physicians. This review summarizes the current literature on primary prevention of cardiovascular events with ASA and statins., (© Georg Thieme Verlag KG Stuttgart · New York.)