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Background: The lack of standardized pre-hospital treatment is a weak link in the care of acute stroke patients., Methods: Selective review of the literature on acute stroke, with consideration of current guidelines in Germany and other countries (DGN, ESO, AHA/ASA)., Results: The mandatory, immediate transfer of acute stroke patients to a specialized stroke unit is supported by high-level evidence. Simple, sensitive screening tests for the diagnosis of stroke are available that can be performed in the field by trained non-physician emergency medical personnel. With regard to pre-hospital treatment, adequate scientific evidence supports cardiopulmonary stabilization, as well as oxygen supplementation if there are signs of hypoxemia. The patient's neurological findings, time of onset of symptoms, current medications, and past medical and surgical history must all be precisely and thoroughly documented. The receiving hospital must be informed of the patient's impending arrival as early as possible, particularly in cases where recanalizing procedures are still a therapeutic option. Treatment with aspirin or heparin must not be started in situ, i.e. without prior cerebral imaging., Conclusion: In the pre-hospital phase of stroke care delivery, the goal of a high capture rate can best be achieved through the use of appropriate diagnostic tests with maximal sensitivity. Patients with suspected acute stroke should be given the highest priority for transfer to a specialized stroke unit. Optimal pre-hospital care requires the smoothly functioning cooperation of all professionals involved, from the triaging and nursing personnel to the paramedics, dispatchers, emergency physicians in the field, and admitting physicians in the hospital.

Objective: 1. The transfer rate of mature newborns will be presented as a new quality indicator. 2. Another objective of this study was to adjust the transfer rate of mature newborns of different hospitals according to their "risk" profile of patients by multivariate analysis., Method: The perinatal database of 118,416 newborns of the Saxonian quality surveillance from 2001 to 2004 was analysed. Based on 17 clinical and 3 structural factors, a logistic regression model was used to develop a specific "risk" predictor for the quality indicator "transfer rate"., Results: For care level III (basic care) a "risk" predictor for the transfer rate was developed, which consists of 15 factors. The AUC(ROC)-value of this quality indicator was 78.6%, which is sufficient. The hospital ranking based on the adjusted risk assessment was different from the hospital ranking prior to this adjustment. The average correction of ranking position was 10.4 for 43 clinics., Conclusion: 1. The new quality indicator "transfer rate of mature newborns" can be recommended. 2. The application of the risk adjustment method proposed here allows for a more objective comparison of the quality indicator "transfer rate" among different hospitals., (Copyright © 2011. Published by Elsevier GmbH.)

Background: Primary percutaneous coronary intervention (PCI) is the recommended revascularization strategy for patients presenting with acute ST-elevation myocardial infarction (STEMI). In most hospitals, transfer of patients with STEMI is organized from the emergency site via emergency room (medical and cardiologic evaluation) and then to the catheterization laboratory., Hypothesis: In this prospective study, we sought to evaluate the effect of a logistic modification in this treatment process., Methods: Local emergency ambulance teams were instructed to identify and evaluate patients with STEMI eligible for direct PCI and to transport them directly to the cardiac catheterization laboratory for immediate percutaneous coronary intervention ("ER bypass"). This study prospectively included 74 consecutive patients with acute coronary syndromes (STEMI) and compared them with a matched historic control group ("ER evaluation"). Primary endpoint was the reduction in door-to-balloon time; secondary endpoint was quality of preclinical emergency diagnosis., Results: Median door-to-balloon time was reduced by 27 min. Primary interventional success was achieved in 92% of patients. Preclinical emergency diagnoses were correct in 95% of patients., Conclusion: The preclinical emergency diagnosis of STEMI was reliable. Direct transport of patients with STEMI to the cardiac catheterization laboratory and early preclinical alert by the interventional PCI team significantly reduces door-to-balloon-times compared with established standard processes-of-care for patients considered for primary PCI.

Background and Objectives: Transferring adolescent patients with endocrine disorders from paediatric to adult care units depends on regional facilities with varying efficiency. A nationwide system of transition clinics in Germany is actually not available, despite demands by physicians and patients., Patients and Methods: We conducted a survey for the 36 German university hospitals to examine the regional existence and characteristics of actual transition methods. In a second questionnaire patients were asked to report their individual transition periods., Results: Despite physician's demand in the majority of hospitals, there are only eight transition clinics nationwide. On average 56 patients attended these clinics yearly. Most patients suffered from disorders of pituitary, thyroid or adrenal gland (each 76 %) and diabetes mellitus type 1 (82 %). The perception of teamwork between the paediatric and adult care units was better in hospitals with transition clinics. Moreover, there was more scientific cooperation in those hospitals. Attendance to medical care and patient's compliance was enhanced by establishing transition clinics in 82 % and 70 %, respectively. Questioning affected patients we found attendance to the paediatric team up to the age of twenty with substantial difficulties finding an adequate adult care unit. Patients were more contend with paediatric than adult quality of physicians care (mark 1.6 versus 2.4). 82 % of patients judged establishing transition clinics as "urgently needed"., Conclusion: In conclusion there are transition clinics in one quarter of German university hospitals. A more widespread installation of transition clinics is medical reasonable and is demanded by patients.