Workload reduction through automated documentation in intensive and intermediate care - a monocentric observational study.

OBJECTIVE: The global coronavirus pandemic has placed an unprecedented and enormous burden on health systems worldwide. In addition to a shortage of resources, nurses were also confronted with high levels of sick leave and an increasing exodus from the profession. Automating documentation obligations is an effective way of reducing the burden on the workplace. PATIENTS AND METHODS: The study was conducted at a tertiary university hospital. The time required for the manual documentation of administered medication and dose changes of syringe and infusion pumps was recorded using the patient data management system (PDMS) representing all intensive and intermediate care wards (n = 6). Subsequently, all medication administration - grouped into five classes - was evaluated from January 1st, 2019, until December 31st, 2022. RESULTS: A total of 1,373,340 drug applications were studied, treating 32,499 patients. Data were obtained from ICUs (68%) and IMC wards (32%). This corresponds to an overall time of 2,901 ± 233 hours per year. Based on publicly known national rates for intensive care nurses, an annual financial expenditure of approximately 83,300 € (~ USD 89,300) per year was estimated. CONCLUSIONS: A non-negligible part of the daily working time in the medical sector is spent on documentation duties. This aggravates the high workload, which has increased in recent years. Automated documentation systems can lead to considerable relief and the possibility of focusing primarily on the patient and on other core competencies and activities. This is even more important, as available staff will be a key resource in patient care for the foreseeable future.

[Preoperative iron deficiency with/without anemia-an underestimated risk factor?] / Präoperativer Eisenmangel mit/ohne Anämie ­ ein unterschätzter Risikofaktor?

BACKGROUND: Every third surgical patient already suffers from anemia before surgery. The main cause is iron deficiency. OBJECTIVE: This article describes the perioperative risk of iron deficiency with/without anemia and summarizes potential preventive measures. MATERIAL AND METHODS: Presentation of various current original papers, guidelines and own experiences from the German patient blood management network. RESULTS AND CONCLUSION: Preoperative iron deficiency with/without anemia is an underestimated risk factor for perioperative complications. The implementation of preoperative diagnostics and treatment as part of a comprehensive patient blood management reduces complications and increases patient safety.

[Septic shock in a female patient with miliary tuberculosis]. / Landouzy-Sepsis bei einer Patientin mit Miliartuberkulose.

This article reports the fulminant course of a pneumogenic sepsis with severe ARDS (acute respiratory failure) in a 36-year-old female Indian patient, who died within 14 h after admission to the intensive care unit due to a multiorgan failure. During treatment the diagnosis of a miliary tuberculosis was suspected but was only confirmed by the autopsy. Due to high hygiene standards, miliary tuberculosis as the cause of septic shock is rare in Europe. Only 1-2% of the patients with pulmonary miliary tuberculosis develop an ARDS with a mortality of 60-90%. Based on this case the diagnostics as well as treatment of the patient are described. Furthermore, the management of an open tuberculosis on an intensive care unit is explained.

Establishing PNB-qPCR for quantifying minimal ctDNA concentrations during tumour resection.

The analysis of blood plasma or serum as a non-invasive alternative to tissue biopsies is a much-pursued goal in cancer research. Various methods and approaches have been presented to determine a patient's tumour status, chances of survival, and response to therapy from serum or plasma samples. We established PNB-qPCR (Pooled, Nested, WT-Blocking qPCR), a highly specific nested qPCR with various modifications to detect and quantify minute amounts of circulating tumour DNA (ctDNA) from very limited blood plasma samples. PNB-qPCR is a nested qPCR technique combining ARMS primers, blocking primers, LNA probes, and pooling of multiple first round products for sensitive quantification of the seven most frequent point mutations in KRAS exon 2. Using this approach, we were able to characterize ctDNA and total cell-free DNA (cfDNA) kinetics by selective amplification of KRAS mutated DNA fragments in the blood plasma over the course of tumour resection and the surrounding days. Whereas total cfDNA concentrations increased over the surgical and regenerative process, ctDNA levels showed a different scheme, rising only directly after tumour resection and about three days after the surgery. For the first time, we present insights into the impact of surgery on the release of ctDNA and total cfDNA.

A polymerase chain reaction-based screening method for transgenic Arabidopsis.

A simple and rapid PCR-based method for screening transformed Arabidopsis plants has been developed. Based on the quantity of chlorophyll present in a protoplast suspension, the optimal amount of template is calculated and a fragment of the transgene is amplified.

[Fatal granulocyte function defect in a male infant. Results of in vitro and in vivo stimulation with ascorbic acid as well as in vitro stimulation with levamisol and lithium chloride]. / Letaler Granulocytenfunktionsdefekt bei einem männlichen Säugling. Ergebnisse einer in vitro und in vivo Stimulation mit Ascorbinsäure sowie in vitro Stimulation mit Levamisol und Lithiumchlorid.

We report about a boy who suffered from repeated bacterial infections starting at the age of 4 weeks. A severe defect of chemotactic activity of the neutrophils, and an additional deficient phagocytosis were discovered. The child died at the age of 3 months from septicemia. Chemotactic activity could be stimulated in vitro by ascorbic acid and levamisole but not by lithium chloride. In vivo, however, the effect of ascorbic acid was minimal and treatment with this vitamin could not prevent the lethal end.

[Unusual course of morbus Hodgkin during remission of acute lymphatic leukemia]. / Ungewöhnlicher Verlauf eines Morbus Hodgkin in der Remission einer akuten lymphatischen Leukämie.

6 years after the beginning of acute lymphatic leukemia and 3 years after the end of its therapy M. Hodgkin stage Ia was diagnosed in a then 18-years-old girl. From the same location--left neck--enlarged lymph nodes had been removed already during the maintenance therapy of leukemia. A malignant disease was neither proven nor excluded at that time, when signs of immunodepression were present. The patient is now in complete remission for both diseases.

[Malignant lymphoma of the bone in children (author's transl)]. / Malignes Lymphom des Knochens im Kindesalter.

Two children with primary malignant lymphoma of the bone and the progress of the disease are presented. There was a delayed diagnosis in both children. The tumors were first misinterpreted as being benign (epipiphysiolysis capitis femoris atheroma) and later on as being malignant (Ewing's sarcoma neuroblastoma). The course of the disease in one child (leukemia transformation) confirmed finally the diagnosis of malignant lymphoma.

Interaction of 1,N6-ethenoadenine derivatives of triphosphopyridine and reduced triphosphopyridine nucleotides with dihydrofolate reductase from amethopterin-resistant L1210 cells.

The 1,N6-ethenoadenine derivatives of triphosphopyridine and reduced triphosphopyridine nucleotides (TPN and TPNH) epsilon-TPN and epsilon-TPNH) have been synthesized and used as fluorescent probes to examine the pyridine nucleotide binding site of L1210 dihydrofolate reductase. Epsilon-TPNH (Km = 16.7 muM) was able to replace TPNH (Km = 3.8 muM) in the enzyme-catalyzed reduction of dihyrdofolate, and both epsilon-TPN and epsilon-TPNH formed binary complexes with the enzyme that were stable to polyacrylamide gel electrophoresis. The fluorescence of epsilon-TPN was enhanced and the emission maximum shifted from 415 to 405 nm when the nucleotide was bound to the enzyme. The ethenoadenine moiety in epsilon-TPNH behaved similarily, but the fluorescence changes were complicated by concurrent effects of binding upon the dihydronicotinamide fluorophore. Fluorescence enhancement titrations yielded values of 1.8 and 0.59 muM, respectively, for the dissociation constants of the enzyme-epsilon-TPN and enzyme-epsilon-TPNH complexes. Titration experiments based upon quenching of enzyme fluorescence gave similar values, viz., 2.1 and 0.53 muM for the dissociation constants of these complexes. Fluorimetric titration of the enzyme-TPNH complex with epsilon-TPN (or of the enzyme-TPN complex with epsilon-TPNH) failed to reveal the presence of a second pyridine nucleotide binding site. The fluorescence enhancement of enzyme-bound epsilon-TPN or dihydrofolate was quenched when amethopterin or epsilon-TPN, respectively, was added to form a ternary complex. These results provide information concerning the nature of the pyridine nucleotide binding site and its spatial relationship to the dihydrofolate/amethopterin binding site.

Synthesis of a fluorescent derivative of amethopterin,.

Fluorescein isothiocyanate was treated with excess diaminopentane and the remaining unsubstituted amino group of the product was condensed, via a carbodiimide-promoted reaction, with a carboxyl group of amethopterin. The final product, a fluorescent derivative of amethopterin, was isolated by chromatography on AE-cellulose and preparative electrophoresis on polyacrylamide. It was shown to be homogeneous by analytical polyacrylamide electrophoresis and thin-layer chromatography. Proof of structure was provided by elemental analysis, absorbance spectra (at pH 7.0, lambdamax at 495 nm; fluorescence emission at 520 nm), and 1H NMR measurements. The fluorescent derivative of amethopterin inhibited transport of amethopterin into Lactobacillus casei and L1210 cells. It was also a good inhibitor of the L. casei and L1210 dihydrofolate reductases and could be used to provide a fluorescent label for the enzymes during polyacrylamide electrophoresis.