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Copyright of Wirtschaft und Wettbewerb is the property of Fachmedien Otto Schmidt KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Technisches Messen is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Following recent changes to the German Narcotics Act, this article examines prehospital analgesia by paramedics using piritramide vs. nalbuphine + paracetamol. Material and methods: Prehospital analgesia administered by paramedics from the Fulda (piritramide) and Gütersloh (nalbuphine + paracetamol) emergency services was compared regarding pain intensity at the beginning and end of the mission, measured using the numeric rating scale (NRS). Additionally, an analysis of the resulting complications was carried out. Results: In this study 2429 administrations of analgesia were evaluated (nalbuphine + paracetamol: 1635, 67.3%, initial NRS: 8.0 ± 1.4, end of NRS: 3.7 ± 2.0; piritramide: 794, 32.7%, initial NRS: 8.5 ± 1.1, end of NRS: 4.5 ± 1.6). Factors influencing NRS change were initial NRS (regression coefficient, RC: 0.7075, 95% confidence interval, CI: 0.6503–0.7647, p < 0.001), treatment with nalbuphine + paracetamol (RC: 0.6048, 95% CI: 0.4396–0.7700, p < 0.001). Treatment with nalbuphine + paracetamol (n = 796 (48.7%)) compared to piritramide (n = 190 (23.9%)) increased the odds of achieving NRS < 4 (odds ratio, OR: 2.712, 95% CI: 2.227–3.303, p < 0.001). Complications occurred in n = 44 (5.5%) with piritramide and in n = 35 (2.1%) with nalbuphine + paracetamol. Risk factors for complications were analgesia with piritramide (OR: 2.699, 95% CI: 1.693–4.301, p < 0.001), female sex (OR: 2.372, 95% CI: 1.396–4.029, p = 0.0014), and age (OR: 1.013, 95% CI: 1.002–1.025, p = 0.0232). Conclusion: Compared with piritramide, prehospital analgesia with nalbuphine + paracetamol has favorable effects in terms of analgesic efficacy and complication rates and should therefore be considered in future recommendations for paramedics. [ABSTRACT FROM AUTHOR]

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Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: A small percentage of acute pulmonary thromboembolisms (PTE) persist as chronic fibrin clots, potentially leading to chronic thromboembolic pulmonary hypertension (CTEPH). A scoring system for evaluating the burden of acute PTE based on computed tomography pulmonary angiogram (CTPA) findings was tested for its association with CTEPH within one year. MATERIAL AND METHODS: In this retrospective cohort of 475 patients with a definitive diagnosis of acute PTE, the Qanadli score (QS) was calculated on the initial CTPA. Through regular follow-up over 1 year, symptomatic patients underwent extensive evaluation. RESULTS: Of the 475 patients enrolled in the study [age 58.3 ± 16.6, 195 (41.1%) female, QS: 13.01 ± 7.37/40], 321 patients completed the study. A total of 22 (6.8%) patients were definitively diagnosed with CTEPH. In univariate analysis, the initial QS was significantly higher in patients with subsequent CTEPH than in patients without (17 ± 5.6 vs. 13 ± 7.6, P = .009). QS was directly associated with CTEPH (odds ratio: 1.08, 95% confidence interval: 1.0-1.16, P = .042). The evolution of CTEPH in men could be predicted with a sensitivity of 100% and a specificity of 54% when a cut-off point of 14.5 (43.5%) was set for QS. The area under the receiver operating characteristic curve in this setting was 0.74 with a P-value of .032. Qanadli score failed to predict CTEPH in women. CONCLUSION: Scoring the clot burden in the pulmonary arteries through the Qanadli method can predict the evolution of CTEPH only in men 1 year after acute PTE. Women comprise most of the CTEPH patients. Thus, strict follow-up adherence seems to be even more important in women. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study reports the results of stereotactic radiosurgery and fractionated stereotactic radiosurgery treatment for brain metastasis in non-small cell lung cancer patients treated with modern systemic treatment methods (immunotherapy, targeted agents, and current chemotherapy agents). MATERIAL AND METHODS: This study retrospectively analyzed patients diagnosed with non-small cell lung cancer and brain metastases who underwent stereotactic radio surge ry/fr actio nated stereotactic radiosurgery in the Radiation Oncology Clinic of Ankara Bilkent City Hospital between February 21, 2019, and August 15, 2022. The study's primary endpoint was accepted as the lesions' response status after stereotactic radio surge ry/fr actio nated stereotactic radiosurgery. The secondary endpoint was accepted as the patients' intracranial progression-free survival and overall survival. RESULTS: This study included 85 patients treated for 174 lesions. Their median follow-up was 6.6 (range: 1-42) months. Their median intracranial progression-free survival after radiotherapy was 5.3 (range: 1-33) months, and their median overall survival was 6.6 (range: 1-42) months. Concurrent immunotherapy was administered to 10 (11%) patients and targeted therapy to 8 (9%). Magnetic resonance imaging indicated that 14 (6%) patients had a complete response, 62 (35.6%) had a partial response, 10 (5.7%) had stable disease, and 23 (13.2%) had progressive disease. The complete response rate was significantly higher in patients receiving targeted therapy (P < .001; odds ratio = 0.0025, 95% CI = 0.006-0.109). Intracranial recurrence was observed in 28 (32.9%) patients after stereotactic radio surge ry/fr actio nated stereotactic radiosurgery: 7 (8.2%) were inside the radiotherapy field, 13 (15.3%) were outside the radiotherapy field, and 8 (9.4%) overlapped the radiotherapy field. Intracranial progression-free survival was higher in patients receiving concomitant immunotherapy (P = .028; hazard ratio = 0.107, 95% CI = 0.015-0.783). However, overall survival was higher in patients receiving targeted therapy (P = .035; hazard ratio = 0.217, 95% CI = 0.053-0.897). CONCLUSION: Using current systemic agents with radiotherapy for brain metastasis significantly affected post-radiotherapy intracranial progression-free survival. [ABSTRACT FROM AUTHOR]

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Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In a pilot study involving patients with cutaneous squamous-cell carcinoma, a high percentage of patients had a pathological complete response with the use of two doses of neoadjuvant cemiplimab before surgery. Data from a phase 2 study are needed to confirm these findings. Methods: We conducted a phase 2, confirmatory, multicenter, nonrandomized study to evaluate cemiplimab as neoadjuvant therapy in patients with resectable stage II, III, or IV (M0) cutaneous squamous-cell carcinoma. Patients received cemiplimab, administered at a dose of 350 mg every 3 weeks for up to four doses, before undergoing surgery with curative intent. The primary end point was a pathological complete response (the absence of viable tumor cells in the surgical specimen) on independent review at a central laboratory, with a null hypothesis that a pathological complete response would be observed in 25% of patients. Key secondary end points included a pathological major response (the presence of viable tumor cells that constitute ≤10% of the surgical specimen) on independent review, a pathological complete response and a pathological major response on investigator assessment at a local laboratory, an objective response on imaging, and adverse events. Results: A total of 79 patients were enrolled and received neoadjuvant cemiplimab. On independent review, a pathological complete response was observed in 40 patients (51%; 95% confidence interval [CI], 39 to 62) and a pathological major response in 10 patients (13%; 95% CI, 6 to 22). These results were consistent with the pathological responses determined on investigator assessment. An objective response on imaging was observed in 54 patients (68%; 95% CI, 57 to 78). Adverse events of any grade that occurred during the study period, regardless of whether they were attributed to the study treatment, were observed in 69 patients (87%). Grade 3 or higher adverse events that occurred during the study period were observed in 14 patients (18%). Conclusions: Neoadjuvant therapy with cemiplimab was associated with a pathological complete response in a high percentage of patients with resectable cutaneous squamous-cell carcinoma. [ABSTRACT FROM AUTHOR]

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Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zentralblatt fuer Arbeitsmedizin, Arbeitsschutz und Ergonomie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Time indications for the correlation and calibration of the Rotliegend of Germany are integrated and presented in a new way. The correlations are based on the visual balance of bio- and ecostratigraphic indications and radio-isotopic age determinations (RIA), whereby confidence limits, equivalent to those of the RIA, are applied also for other time indications (conchostracans, aquatic tetrapods, fishes, insects, macroflora, and ecostratigraphic indications). In contrast, terrestrial tetrapods and their tracks, chemo- and sequence stratigraphy, and magnetic susceptibility did not contribute to correlations in the Rotliegend in Central Europe. The Illawarra Reversal of the Earth' magnetic field (≈ 265 Ma) is fundamental for correlation and calibration. In general, however, the Regional Stratigraphic Scale is calibrated using U-Pb CA-ID-TIMS-RIA on zircon, Ar-Ar- and Rb-Sr-based RIA and, in addition, in the Early and Late Rotliegend using orbital-climatically controlled eccentricity cycles (≈ 100 ka, ≈ 400 ka). The boundary ages of the subgroups and of most formations are rounded to 0.5 Ma to avoid overinterpretation. Because of some inconsistent time indications alternative interpretations are also offered. The hitherto differing ages for the global Carboniferous-Permian boundary are the result of different dating methods: The ≈ 296 Ma in the Stratigraphic Tables of Germany 2002 and 2016 A (STG 2002; STG 2016 A) is an integrative age based on RIA from Central Europe, whereas the ≈ 299 Ma in the Global Stratigraphic Scales 2004 ff. and the STG 2016 B is based on a CA-ID-TIMS RIA on zircon from the southern Ural area. The age of ≈ 299 Ma is plausible from the perspective of the current Rotliegend RIA because the Rb-Sr age of 290.7 ± 0.9 Ma for the Donnersberg Formation (Lippolt & Hess 1989) has been replaced by the age of 294.5 ± 2.2 Ma, as recalculated in the present work. The updated time scale developed here will be integrated in the Stratigraphische Tabelle von Deutschland Kompakt 2022 (STDK 2022) and into the Stratigraphic Table of Germany Compact 2022 (STGC 2022). The age of the base of the Rotliegend in the Saar-Nahe Basin (SN, base Remigiusberg Formation and Glan Subgroup) is ≈ 299 Ma (U-Pb CA-ID-TIMS, zircon) resp. ≈ 300 Ma (Ar-Ar); the balanced compromise age of both is ≈ 299.5 Ma. In the Thüringer Wald (TW), the Rotliegend begins with the Ilmenau Formation (Subkommission Perm-Trias 2011) at ≈ 299.5 Ma (U-Pb CA-ID-TIMS). On the Flechtingen Block, at the southern margin of the Central European Basin, the oldest volcanic rock of the Altmark Subgroup is dated at 302 ± 3 Ma (U-Pb SHRIMP data). Accordingly, the Rotliegend in the STG 2002 and STG 2016 A starts at ≈ 302 Ma. However, the mean age calculated in the present work for the SHRIMP data of Breitkreuz & Kennedy (1999) is 298.6 ± 1.9 Ma, so that the base of the Altmark volcanic succession is here re-dated as ≈ 300.5 Ma. Thus, the ages of the present lithostratigraphic lower limits of the Rotliegend in northern Germany (CEB), in the TW and in the SN are, with ≈ 300.5 Ma to ≈ 299.5 Ma, only weakly diachronous if the nominal (face) values, which are both in the latest Carboniferous, are compared without the confidence intervals. For the first time, the Rotliegend of Germany is geochronologically subdivided into Early (≈ 300.5-295.5/294 Ma), Middle (≈ 295.5/294-266 Ma) and Late Rotliegend (≈ 266-257.5 Ma). The very long lasting Middle Rotliegend includes numerous and also extremely long stratigraphic gaps as a result of the amalgamation and the associated immense uplift of Pangaea in the area of Central and Western Europe. A very large stratigraphic gap in the Central European Basin (CEB) of ≈ 15 Ma (≈ 281-266 Ma, here called the Pangaea Gap) is supported by conchostracans, the Illawarra Reversal and the different palaeomagnetic properties of the sediments below and above the gap, which are discussed here for the first time. The Middle Rotliegend (duration of ≈ 29.5/28 Ma) is approx. twice as long as the Early (≈ 5.5/7 Ma) and Late Rotliegend (≈ 8.5 Ma) combined. The latter, however, contain the thickest successions in the Saar-Nahe Basin and the Central European Basin, respectively, which are free of gaps in the basin centre, with 'gaps' being defined in this context as time spans of ≤ 100 ka and ≤ 400 ka, respectively. In the CEB, the Elbe Subgroup is cyclostratigraphically calibrated to 5.6 Ma. A gapless area in the Saar-Nahe Basin is the Glan Subgroup, which covers only 4 Ma and 3 Ma, respectively; correspondingly, its subunits G1 to G10 (Glan 1 to Glan 10), introduced here, last on average 0.4 Ma and 0.3 Ma, respectively. This results in a maximum accumulation rate of 870 Bubnoff (Bub, m/Ma, mm/ka) and of 1150 Bub, respectively, which can be explained by a maximum of tectonic activity along the Hunsrück Southern Border Fault. For the lower Nahe Subgroup (N1 to N5, Nahe 1 to Nahe 5), the maximum accumulation rates are ≈ 450-200 Bub and for the upper Nahe Subgroup (N6-N8), at an estimated duration of 12 Ma ≈ 125 Bub and ≈ 50 Bub at a duration of 30 Ma, respectively. In the Central European Basin the maximum accumulation rates are much lower compared to the Glan Subgroup, with 200 Bub in the Elbe Subgroup and ≈ 360 Bub in the Havel Subgroup (Fig. 27), although here the subsidence rate may have been higher than the accumulation rate, as the basin was ≈ 130 m below sea level at the end of Folge ro4 (Top of the Hannover Formation; this paper). We recommend (1) Bubnoff (Bub) as unit of measure of the accumulation rate and (2) the stratigraphic terminology of the Subkommission Perm-Trias (2011) and the STG 2016 A. We here propose that numerous tuffs of the Glan Subgroup could originate from volcanic centres of the TW, whereas so far only source areas south of the SN were discussed: On the one hand, the tuff-rich time of the upper Jeckenbach Subformation - Odernheim Formation (= Glan units 7 and 8 = G7/G8) seems to correlate with the volcanogenic Oberhof time in the TW and, on the other hand, the tuff-poor time of the Wahnwegen Formation - middle Jeckenbach Subformation (G2/G6) seems to correlate with the upper Ilmenau, Manebach, Goldlauter and lowest Oberhof formations, which are devoid of volcanic rocks in the TW. Should causality exist here, an additional and also precise criterion for correlation would be established. At present there are two variants: On the one hand, volcanism in the Oberhof Formation, according to RIA (U-Pb CA-ID-TIMS on zircon), begins ≈ 1.8 Ma earlier and ends ≈ 0.8 Ma earlier than in the Donnersberg Formation (Ar-Ar, Rb- Sr recalculated). On the other hand, the conchostracan Lioestheria pseudotenella in the TW, if considered equivalent to L. cf. pseudotenella in the SN, the ecostratigraphic and lithofacial indications and the aquatic tetrapod D. pulcherrimus, point to for a similar age of these magmatites. The Sobernheim Lens (SN, Nahe units N4/N5) with its fossils so important for correlations is here assigned to the Jakobsweiler Member (N4, upper Donnersberg Formation), to the Quartzite-Conglomerate (N5, in literature often Wadern) and to the lowermost Standenbühl Formation (N4/N5). The youngest time indication Co13, the conchostracan Lioestheria arroyoensis sp. nov. correlates the upper Standenbühl Formation (N8, Martens 2020, where N8 may be extremely long), roughly with the Arroyo Formation in Texas (≈ early Kungurian). The here favoured age of the Tambach Formation of ≈ 294-292 Ma is significantly higher than the ≈ 286-283 Ma of STG 2016 A and the ≈ 284-281 Ma of STG 2016 B. It is based on RIA R25 (Table 9; lower Rotterode Formation, 295.8 ± 0.4 Ma; Lützner et al. 2021), which is the youngest CA-ID-TIMS RIA in the TW, and the duration estimate of the Rotterode - Tambach gap. In the SN, the youngest RIA R29 (Rb/Sr) is from the Donnersberg Formation (294.5 ± 2.2 Ma, this paper). From here on until ≈ 265 Ma (Illawarra Reversal), the numerical ages of all Rotliegend units and their connection to the Global Stratigraphic Scale (GSS) are uncertain and therefore correlations between Central Europe and the global reference section in the southern Ural area, partly biostratigraphically via North America, vary greatly. In this contect, the „series“ Wolfcampian and Leonardian (standard Permian units of the USA) played an important role. However, these lithostratigraphic units are at least unsuitabel as a reference system for large parts of North America, because they represent very variable time spans from region to region, similar with the "Lower Rotliegend" ("Autun") and "Upper Rotliegend" ("Saxon") of Central and Western Europe and therefore their assignement to the GSS is also very variable. This is due, among other things, to the fact that the Wolfcampian is often still understood as "lower Lower Permian", although considerable parts of it are now placed in the Carboniferous, because as a result of the introduction of the Global Stratigraphic Section and Point (GSSP) for the base of the Asselian Stage (= global base of the Permian in the southern Ural area), the conventional regional Carboniferous-Permian boundaries shifted to an higher stratigraphic level and thus to a younger age in the USA, China and the Donbass (Fig. 14). If the 57 sedimentary cycles in the Ottweiler and Glan subgroups (Königer & Stollhofen 2001: mean duration 245 ka each) in the SN are orbital-climatically induced, these cycles can only be 100 ka cycles (short eccentricity). This is also supported by the 6 cycles in units G7 and G8 that have been described in detail in the literature, which are consistent with the duration of the Glan Subgroup of 3 Ma and (preferred) 4 Ma, respectively. The total duration to be expected from 57 cycles à ≈ 100 ka is ≈ 5.7 Ma in contrast to the duration determined here according to RIA of ≤ 8 Ma. One reason for the difference could be that in the Ottweiler und Glan subgroups there are cycles that have not been recorded so far. The time span of ≤ 8 Ma is also an outcome of the new estimate for the duration of the Cantabrian Gap (early Stephanian) in the Saar-Nahe Basin of ≈ 3.6 Ma that is clearly longer than proposed in the STG 2002 and STG 2016. [ABSTRACT FROM AUTHOR]

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Background: Although patients with chronic obstructive pulmonary disease (COPD) receive poor-quality palliative care, information about the use of palliative sedation (PS) in the last days of life is very scarce. Objectives: To compare the use of PS in hospitalized patients who died from COPD or lung cancer and identify factors correlating with PS application. Methods: In a retrospective observational cohort study, from 1,675 patients died at a teaching hospital between 2013 and 2015, 109 patients who died from COPD and 85 from lung cancer were compared. Sociodemographic data, clinical characteristics, health care resource utilization, application of PS and prescribed drugs were recorded. Results: In the last 6 months of life, patients who died from COPD had more hospital admissions due to respiratory causes and less frequent support by a palliative home care team (PHCT). Meanwhile, during their last hospitalization, patients who died from COPD had fewer do-not-resuscitate orders and were subjected to more intensive care unit admissions and cardiopulmonary resuscitation maneuvers. PS was applied less frequently in patients who died from COPD than in those who died from lung cancer (31 vs. 53%, p = 0.002). Overall, previous use of opioid drugs, support by a PHCT, and a diagnosis of COPD (adjusted odds ratio 0.48, 95% CI: 0.26–0.89, p = 0.020) were retained as factors independently related to PS. In COPD patients, only previous use of opioid drugs was identified as a PS-related factor. Conclusion: During their last days of life, hospitalized COPD patients receive PS less frequently than patients with lung cancer. [ABSTRACT FROM AUTHOR]

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Background: Population-based assessment of long-term survival prospects of cancer patients in Germany have, so far, been mainly based on estimating relative 5-or 10-year survival rates. Alternatively, parametric cure models allow for determining the proportion of patients who although being affected by cancer do not exhibit higher mortality rates compared to the general population. These patients are thus considered as cured from cancer. Internationally, cure models are highly established in the monitoring of longterm survival of cancer patients. Methods: For the present analysis, population-based cancer registry data from patients aged 15 to 79 years (N=453,666) in Germany were used. In order to obtain up-to-date estimates on cure proportions of cancer patients, period analyses with a period window from 2013 to 2014 and a maximal follow-up time of 10 years were conducted. Based on parametric modelling of survival times, sex-specific estimates on cured proportions of cancer patients were calculated for all cancers as well as for the three most common cancer sites among women (breast, colon, lung) and among men (prostate, lung, colon) were calculated. In additional analyses, the extent to which the cured proportion of all cancer patients might have been overestimated due to the exclusion of DCO (Death Certificate Only) cases were quantified. Results: Overall, 64.0%(95°/crconfidence interval; 63.4-64.6) of women and 56.8% (56.3-57.4) of men were considered as statistically cured of their cancer in the sense that their mortality did not differ significantly from that of the general population. Parametric cured models also converged in all site-specific analyses except breast cancer among women. The cure proportions for colon and lung cancer were higher in women than in men (62.3%vs. 56.2%and 18.5%vs. 14.9%). Moreover, the estimated cure proportion of prostate cancer among men was 94.5%. After correctingthe cure fraction of all cancers for the proportion of DCO cases, a maximal drop of 3% was observed among both genders. Conclusions: Based on nation-wide data for the period window 2013-2014, significant sex difference in long-term cancer survival for common cancers can be observed in Germany. Parametric cured models can provide additional insights on remainingor new challenges of cancer care in Germany. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Laboratory Medicine / Laboratoriums Medizin is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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A frequent cause of weaning failure and the resultant long-term artificial ventilation is the generalized weakness syndrome in the sense of critical illness polyneuropathy or polymyopathy. However, hardly any information is presently available regarding the necessary intensity of the diagnostic workup for reaching or excluding a diagnosis with certainty in the neurological examination or regarding the additional diagnostic value of electrophysiological studies in patients receiving long-term acute care suspected of having critical illness polyneuropathy and polymyopathy. Therefore, the goal of this investigation was to address these questions. A total of 280 patients with complicated weaning were included in the study. All patients underwent clinical examination by a specialist in neurology and electrophysiological workup performed by another specialist. Among the patients studied, the greatest possible certainty of the diagnosis (positive predictive value) of the clinical examination was 97.9% [95% confidence interval (CI) 69.4-99.9] and the best certainty of excluding the diagnosis (negative predictive value) was 88.9% (95% CI 82.7-93.0). Thus, in difficult-to-wean patients who were considered to probably have the diagnosis of critical illness polyneuropathy or polymyopathy as assessed by a specialist, little additional information is gained from an electrophysiological study, which is hence dispensable in these cases. [ABSTRACT FROM AUTHOR]

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Background: The data of the German hospital nosocomial infection surveillance system (KISS) were used to investigate the association between the frequency of blood cultures (BC) and central venous catheter associated bloodstream infection (CVC-BSI) rates in intensive care units (ICU). Methods: A questionnaire on the frequency of BCs taken was sent to all ICUs participating in KISS and univariable and multivariable analyses were performed on the results. Results: A total of 223 ICUs provided data. The median number of BC pairs taken in 2006 was 60 with a huge variation from 3.2 to 680 per 1,000 patient days. The mean primary BSI rate was 0.90 per 1,000 patient days and 0.25 BSIs per 1,000 patient days were caused by coagulase negative Staphylococci (CNS). The mean CVC-BSI rate was 1.40 per 1,000 CVC days. In the univariable analysis the blood culture frequency had a significant influence on the CVC-associated BSI rate, considering either all pathogens (p=0.001) or only the subgroup of CNS-related cases (p=0.019). There was also a significant influence of the BC frequency on the CVC-BSI rate considering all pathogens (p=0.004) as well as the subgroup of CNS (p=0.018). Therefore the BC frequency was a significant factor affecting the incidence of BSI and CVC-BSI. According to the multivariable analysis an increase of the BC frequency of 100 BCs per 1,000 patient days leads to a 1.27-fold higher incidence density of CVC-BSI with a 95% confidence interval (95% CI) of 1.01-1.26. A further significant risk factor for CVC-BSI was the length of stay in the ICU with an adjusted incidence rate ratio (IRR) of 1.25 (95% CI 1.15-1.35). To have the status of an interdisciplinary ICU was a significant protective factor (IRR 0.64; 95% CI 0.45-0.92). Conclusions: If an external benchmarking of ICU CVC-BSI rates is intended an adjustment according to the BC frequency is necessary. The BC frequency itself should be established as a quality indicator in intensive care. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to conduct a meta-analysis of the results from randomized controlled trials investigating the relative efficacy of droperidol versus metoclopramide for the prevention of postoperative nausea and vomiting (PONV). Methods: A systematic literature search for randomized controlled trials comparing droperidol and metoclopramide for the prevention of PONV was performed according to the PRISMA recommendations. The incidence of PONV within the early (0-6 h) and cumulative postoperative periods (0-48 h) was collated and the pooled relative risk (RR) with the corresponding 95% confidence interval (CI) was calculated. Results from a subgroup analysis are presented excluding the data of a Japanese group (Fujii et al.) which are given in parentheses. Results: A total of 41 (30) trials with a total number of 3,491 (2,721) patients were included and of these 12 (8) trials with 1,403 (1,083) patients reported data of the early period and 32 (21) studies with 2,656 (1,836) patients comprised data of the cumulative period. A total of 1,797 (1,309) patients were treated with droperidol (0.25-5 mg) and 1,694 (1,412) with metoclopramide (5-50 mg). In the early period the risk for PONV after metoclopramide was 35% (95%-CI: 17-57%) higher than after prophylaxis with droperidol (without Fujii data: 46%; 23-73%). During the cumulative period the risk for PONV after metoclopramide was increased by 20% (95%-CI: 7-37%) compared to droperidol (without Fujii data: 25%; 4-50%). Due to heterogenous dosing of both drugs subgroup analyses with distinct dose intervals were performed with increments of 0.75 mg for droperidol and 7 mg for metoclopramide. Droperidol was superior in 17 (12) out of 19 (14) subgroup analyses. Comparing recommended doses of droperidol (0.75-1.5 mg) with low doses of metoclopramide (7-14 mg) and medium metoclopramide doses (14-21 mg) PONV was increased by 12% (95%-CI: −11% to 42%) and 32% (95%-CI: 4%-66%), respectively when metoclopramide instead of droperidol was used. When higher doses of metoclopramide (>20 mg) were used the superiority of droperidol was less pronounced and did not reach statistical significance due to the limited numbers of trials included in this analysis (3 studies, 662 patients). The risk for PONV after high-dose metoclopramide was increased by 13% (95%-CI: −21% to +61%) for the early period and by 19% (95%-CI: −11% to +57%) for the cumulative observation period. Conclusion: For the prevention of postoperative nausea and vomiting droperidol is significantly superior to metoclopramide doses below 20 mg. There was no obvious positive dose response with respect to increasing doses of metoclopramide. There was also a trend towards higher efficacy of droperidol compared to higher doses of metoclopramide (≥20 mg). However, there were not enough comparative studies to show a statistically significant result in this subgroup analysis. These data support the notion that droperidol in low doses may represent the more effective D-antagonist for a pharmacological armamentarium to cope with PONV. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Laboratory Medicine / Laboratoriums Medizin is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Informative, participatory clinical decision-making needs to combine both skills and expertise as well as current scientific evidence. The flood of digital information makes it difficult in everyday clinical practice to keep up to date with the latest publications. This article provides assistance for coping with this problem. A basic understanding of prior and posterior probabilities as well as systematic error (bias) makes it easier to weigh up the benefits and risks, e.g. of a (surgical) intervention compared to a nonsurgical treatment. Randomized controlled trials (RCT, with all modern modifications) deliver undistorted results but in orthopedic and trauma surgery can lead to a heavily selected nonrepresentative sample and the results must be confirmed or refuted by further, independent RCTs. Large-scale observational data (e.g. from registries) can be modelled in a quasi-experimental manner and accompany RCTs in health technology assessment., (© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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In the journal Nature, under the headline "Retire statistical significance", Amrhein et al. called for the concept of statistical significance to be abolished. This appeal, which was signed by about 800 other researchers, triggered a controversial discussion. One reason for the deliberately provocative call is the scientific practice in which the concept of statistical significance is often applied in an incorrect way for yes/no decisions. The criticism is not new and has been repeatedly expressed over the last 50 years. We refer to current and previously published caveats, give an overview of different applications of the concept of statistical significance as well as possible alternatives. We agree in principle with the criticism of the concept expressed by Amrhein et al. but in the absence of agreed alternatives and insufficient consideration of the many different applications of the concept of statistical significance, we consider the demand for its abolition to be exaggerated. A more pragmatic approach to the problem, supported by targeted instructions for scientists and reviewers, seems to be a more appropriate way forward.