Relationship between histopathological lesions and oxidative stress in mice infected with Angiostrongylus costaricensis.

This study describes changes in oxidative stress (OS) parameters in mice experimentally infected with Angiostrongylus costaricensis, which causes abdominal angiostrongyliasis. For this, 28 Swiss mice were used, divided into two groups (G1 and G2), with 14 animals each. Of these, eight were infected with ten infective larvae each, by gavage, and six were used as a control group. Mice from G1 and G2 were euthanized at 14 days and 24 days post-infection, respectively. Tissue samples were used for histopathological analysis and blood (serum) samples were taken to assess the levels of proteins, non-protein thiols (NPTs) and nitric oxide (NO), from centrifugation and subsequent collection of aliquots of the supernatant. Among OS parameters, infected mice in both groups had higher NO levels than the control group, due to the presence of: eosinophil infiltrate in the liver and intestine; pancreatitis; and intestinal granuloma. However, the infected mice of both groups showed a reduction in the levels of NPTs, in relation to the control group, due to the presence of: eosinophilic infiltrate in the liver and intestine; and intestinal granuloma. Our results suggest that A. costaricensis infection has important effects on the intestine, liver and pancreas, and the analyses were performed from the tissue of these organs. The mechanisms for these changes are related to the decrease in the body's main antioxidant defences, as demonstrated by the reduction of NPTs, thus contributing to the development of more severe tissue damage. Thus, the objective of the present study was to evaluate the relationship between histopathological lesions and markers for OS.

[Influence of working conditions and salary on temporary agency work for intermediate care and intensive care units : Partial results of a nationwide survey]. / Einfluss der Arbeitsbedingungen und des Gehalts auf die Leiharbeit für Intermediate-Care- und Intensivstationen : Teilergebnisse einer bundesweiten Umfrage.

BACKGROUND: Agency nursing is used as a form of labour to counter vacant staff positions in hospitals. Stakeholders and nurses might view this critically for different reasons. AIM: The aim of this study was to evaluate what individual net income nurses in German intensive care units and intermediate care units consider "fair and acceptable" for their work. Furthermore, what influence does salary have on the willingness to change to agency nursing or back to a permanent position. METHODS: From September-October 2020, an anonymous online survey was performed among nurses of intermediate care units, intensive care units and special care units in German-speaking countries. The results were evaluated using descriptive statistics. RESULT: Of 1203 participants, 1036 (86%) of those working in Germany could be evaluated. The question about the individual net income was answered by 1032 (99%) participants. The majority of respondents (n = 522) stated that they had an individual net income of 2000-2999 €/month. The higher the level of the net income, the lower the willingness to switch to agency work. The participants in permanent employment only perceive a net income of 3200 €/month (median 3200 €; interquartile range [IQR] 2800-3800 €) as acceptable and fair for their work. In all, 142 agency nurses stated that an individual net income of 3200 €/month (median 3200 €; IQR 3000-3950 €) would be sufficient to move from agency nursing back into permanent employment. CONCLUSION: The intensive care nurses in this survey consider a salary of 3200 €/month as acceptable and fair for their work. The salary level can be a parameter for the decision to go into agency work, but also to move back to permanent employment. Regardless of the salary, better working conditions were indicated as an essential element in terms of job satisfaction for all respondent groups.

Influence of working conditions and salary on agency work for intermediate and intensive care units : Part 2: Partial results of a nationwide survey.

BACKGROUND: Agency work in nursing is used as a form of labor to counter vacant staff positions in hospitals. Both hospital owners and nurses view this critically for different reasons. AIM: The aim of this study was to assess what personal net income nurses in German intensive care units and intermediate care units consider "fair and sufficient" for their work (addressed in Part 1 of the survey) and what influence-aside from the salary-the working conditions have on the willingness to change to temporary work or back to a permanent position. METHODS: From September to October 2020, an anonymous online survey was conducted among nurses of intermediate care units, intensive care units, and special care units in German-speaking countries. Descriptive statistics were used for the analysis. RESULT: Of 1203 participants, 86% (n = 1036) could be evaluated. None of the job satisfaction factors queried received four or five stars (maximum five stars) from those participating in the survey. The most unsatisfied group proved to be regularly employed nurses with an additional part-time job. Key job satisfaction factors differed markedly between the groups, with regular employees favoring consistency and stability. Agency workers prefer gaining experience in a broader range of tasks. Unreliable duty rosters and poor nurse to patient ratios were common points of criticism. CONCLUSION: For job satisfaction, making nurses feel appreciated and respected is essential. This includes a guaranteed nurse to patient ratio and reliable duty rosters that also include tasks outside direct patient care. In order for nurses to leave agency work, it is necessary to take into account the differences in interests in terms of the focus of activity.

[Intensive care of patients with [infarct-related] cardiogenic shock : Abridged version of the S1 guideline]. / Intensivpflegerische Versorgung von Patient:innen mit [infarktbedingtem], kardiogenen Schock : Kurzversion der S1-Leitlinie.

BACKGROUND: Cardiovascular diseases and (infarct-related) cardiogenic shock are among the most frequent causes of death in Germany. Adequate clinical care often poses great challenges for hospitals. The complex care of patients in a multi-professional team places high demands on all those involved in the care process. Since nurses in particular are in close contact with patients and play a decisive role in shaping and controlling therapy, a national (intensive) care guideline is urgently needed. METHODS: Within the framework of the guideline programme of the Association of the Scientific Medical Societies in Germany (AWMF), an S1 guideline was developed with the participation of six professional societies and published in May 2022. The guideline group defined relevant topics, which were processed through a systematic literature search in peer-reviewed journals. Based on the S1 classification, no separate evidence review was conducted. A formal consensus-building process was used to classify the recommendations. RESULTS: The guideline contains 36 recommendations ranging from nursing care in the central emergency department to the cardiac catheterisation laboratory, intensive care unit and follow-up care. In addition, recommendations are made on the necessary qualifications and structural requirements in the respective areas in order to ensure a high-quality (nursing) care process. CONCLUSION: This is the first national intensive care guideline. It is aimed at nurses involved in the care of patients with (infarct-related) cardiogenic shock. The guideline is valid until 30.12.2026.

[Delirium-assessment, prevention and treatment : Task in the interprofessional intensive care unit team]. / Delir ­ Beurteilung, Vorbeugung und Behandlung : Aufgabe im interprofessionellen Team der Intensivstation.

Postoperative delirium is a challenge for patients, relatives, nurses, physicians, and healthcare systems. Delirium is associated with increased mortality, longer hospitalization, reduced quality of life, and higher average treatment costs. Consequently, the most recent version of the German Guideline on Analgesia, Sedation and Delirium Management in Intensive Care Medicine (DAS Guideline 2020) emphasizes the importance of delirium prevention. In particular, nonpharmacological interventions play a special role in this regard for basically all patients receiving intensive care. The DAS Guideline stresses the importance of regular systematic screening with validated instruments to recognize developing delirium early and take the appropriate measures in time, as the duration of delirious conditions influences both mortality and quality of life. If delirium manifests, intervention must be immediate and symptom-oriented.

[Agency work in intensive care : Impact of temporary contract work on patient care in intermediate care and intensive care units]. / Leih- und Zeitarbeit in der Intensivpflege : Auswirkungen auf die Patientenversorgung der Überwachungs- und Intensivstationen.

BACKGROUND: Temporary contract workers are used for the nursing care of intensive care patients, usually by service providers in the sense of temporary employment. If or how temporary contract work has an impact on patient care has scarcely been investigated so far. AIM: The aim of this systematic review is to describe the available research results on the use of temporary workers in nursing care in intensive and intermediate care units and to summarize the prospective effects on patient outcomes. METHOD: Seven databases were systematically searched for English and German language articles using Boolean operators and evaluated according to the PRISMA schema. References of included studies were included in the search and the quality of all included studies was evaluated according to the Hawker criteria. RESULT: From a total of 630 datasets viewed, 1 qualitative and 2 quantitative studies were identified and analyzed. The findings of the quantitative studies indicated that the probability of the occurrence of catheter-associated infections can increase with the use of temporary workers, but is more dependent on the size of the unit: For each additional bed, the probability of VAP increases by 14.8% (95%-CI = 1.032-1.277, p = 0.011). However, trends for a decrease in the sepsis rate as soon as fewer temporary workers (hours/patient) were deployed in the intensive care unit (ICU) could not be confirmed. CONCLUSION: In the few available studies no evidence was found that the use of temporary workers in intensive care units (ICU) and intermediate care units (IMC) has a significant impact on patient outcomes; however, evidence was found that individual qualifications and working conditions have an influence on outcomes. Further studies should consider what ratio of permanent to temporary workers should be considered uncritical, what qualifications temporary workers should have and to what extent these can be checked.

Leukogram and cortisol parameters in Swiss mice experimentally infected with Angiostrongylus costaricensis.

This study describes changes in haematological parameters, cytokine profile, histopathology and cortisol levels in Swiss mice experimentally infected with Angiostrongylus costaricensis. Twenty-eight Swiss mice were divided into two groups (G1 and G2) of 14 animals each. In each group, eight animals were infected orally with ten third-stage larvae of A. costaricensis and six were used as a control group. The mice of groups G1 and G2 were sacrificed 14 and 24 days after infection, respectively. Samples were collected for histopathological and haematological analyses and determination of the cytokine profile and cortisol levels. Granulomatous reaction, eosinophilic infiltrate and vasculitis in the intestinal tract, pancreas, liver and spleen were observed with varying intensity in infected animals. Our results showed that the mice developed normocytic and hypochromic anaemia, and that the histopathological lesions caused by the experimental infection influenced increases in cortisol, neutrophil and monocyte levels. In addition to this, we detected increased interleukin-6 and tumour necrosis factor alpha levels in the infected animals.

[Core curriculum Medical intensive care medicine of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. / Curriculum Internistische Intensivmedizin.

Medical intensive care medicine treats patients with severe, potentially life-threatening diseases covering the complete spectrum of internal medicine. The qualification in medical intensive care medicine requires a broad spectrum of knowledge and skills in medical intensive care medicine, but also in the general field of internal medicine. Both sides of the coin must be taken into account, the treatment with life-sustaining strategies of the acute illness of the patient and also the treatment of patient's underlying chronic diseases. The indispensable foundation of medical intensive care medicine as described in this curriculum includes basic knowledge and skills (level of competence I-III) as well as of behavior and attitudes. This curriculum is primarily dedicated to the internist in advanced training in medical intensive care medicine. However, this curriculum also intends to reach trainers in intensive care medicine and also the German physician chambers with their examiners, showing them which knowledge, skills as well as behavior and attitudes should be taught to trainees according to the education criteria of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).

Abdominal angiostrongyliasis: pathologic findings in Swiss mice infected with different doses of Angiostrongylus costaricensis.

Abdominal angiostrongyliasis is caused by Angiostrongylus costaricensis, the definitive and intermediate hosts of which are wild rodents and terrestrial molluscs, respectively. Humans are accidental hosts and can be infected by ingesting the third-stage (infective) larvae (L3). It remains unclear whether the number of L3 inoculated is related to lesion severity. Our aim was to analyse histopathological alterations in Swiss mice infected with different doses of A. costaricensis. Thirty-two mice were randomly divided into four groups (n = 8/group): uninfected, control mice; mice infected with a low dose (five L3); mice infected with an intermediate dose (15 L3); and mice infected with a high dose (30 L3). The frequency of intestinal thrombi, splenitis, eggs/larvae, hepatic infarction and acute pancreatitis differed among the groups, the last being considered a significant finding. We conclude that different infective doses alter the histopathological aspects of the infection in Swiss mice, those aspects being more pronounced at medium and high doses, with no effect on the development of the disease. This experimental model shows that the parasite life cycle can be maintained in Swiss mice through the inoculation of a low dose (five L3).

[The Early Mobilization Network]. / Netzwerk Frühmobilisierung.

BACKGROUND: Since its foundation in 2011, the German Network for Early Mobilization of mechanically ventilated intensive care patients delivered, among others, more than 90 monthly newsletters, 14 research projects, and 3 national conferences. PURPOSE: The aim of this online survey was to evaluate whether members of the Network perceived a professional benefit for themselves and their intensive cate units (ICU). METHODS: An interprofessional online survey of 303 clinicians of the Network in German speaking countries in July 2019 was undertaken. The survey included questions about newsletters, personal benefits, perceived improvements on their workplaces, and future expectations. RESULTS: The response rate was 48% (n = 145), mainly nurses and physiotherapists. The majority perceived the newsletter as good. Members reported that the network extended their professional knowledge and improved the quality of the ICUs regarding early mobilization, delirium management, and interprofessional goals. Participants expressed a wish for more workshops, case reports, webinars, and other educational possibilities. CONCLUSIONS: Members of the network Early Mobilization perceived a personal and professional benefit. The network supported quality improvements projects in ICUs. The progress of the network may serve as an example for development of other professional networks.

Shedding of Angiostrongylus costaricensis larvae in the faeces of Swiss mice experimentally infected with different infective doses.

Abdominal angiostrongyliasis is an endemic zoonosis in southern Brazil caused by the nematode Angiostrongylus costaricensis, which uses terrestrial molluscs as intermediate hosts and wild rodents as final hosts. Humans can be infected by ingesting infectious A. costaricensis larvae. To date, correlations between shedding of first-stage larvae (L1) and different infective doses of third-stage larvae (L3) have not been elucidated. The aim of this study was to assess L1 faecal shedding levels in Swiss mice experimentally infected with different doses of A. costaricensis L3 and to determine whether infective doses are related to mortality. Thirty-two male Swiss mice were divided evenly into a non-infected control (NI-Con); low-dose infection (LD-Inf); medium-dose infection (MD-Inf) and high-dose infection (HD-Inf) groups infected with 0, 5, 15 and 30 A. costaricensis L3, respectively. Faecal samples were collected from each animal, starting at day 20 post infection. HD-Inf mice had greater faecal L1 shedding levels than LD-Inf mice, but not a significantly shortened survival. In conclusion, infective doses of A. costaricensis L3 affect L1 shedding levels without altering mortality in Swiss mice.

[Reimbursement of intensive care services in the German DRG system : Current problems and possible solutions]. / Vergütung intensivmedizinischer Leistungen im DRG-System : Aktuelle Probleme und Lösungsvorschläge.

The reimbursement of intensive care and nursing services in the German health system is based on the diagnosis-related groups (G-DRG) system. Due to the lack of a central hospital planning, the G­DRG system has become the most important influence on the development of the German health system. Compared to other countries, intensive care in Germany is characterized by a high number of intensive care beds, a low nurse-to-patient ratio, no official definition of the level of care, and a minimal available data set from intensive care units (ICUs). Under the given circumstances, a shortage of qualified intensive care nurses and physicians is currently the largest threat for intensive care in Germany. To address these deficiencies, we suggest the following measures: (1) Integration of ICUs into the levels of care which are currently developed for emergency centers at hospitals. (2) Mandatory collection of structured data sets from all ICUs including quality criteria. (3) A reform of intensive care and nursing reimbursement under consideration of adequate staffing in the individual ICU. (4) Actions to improve ICU staffing and qualification.

[Algorithms for early mobilization in intensive care units]. / Algorithmen zur Frühmobilisierung auf Intensivstationen.

Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.

[Positioning therapy and early mobilization in intensive care units : Findings from the current 2015 guidelines]. / Lagerungstherapie und Frühmobilisation auf der Intensivstation : Erkenntnisse aus der aktuellen Leitlinie 2015.

The 2007 guidelines "Positioning for prophylaxis and therapy of pulmonary disorders" were completely revised in 2015 on behalf of the German Society of Anaesthesiology and Intensive Care Medicine. With regard to practical and scientific relevance, early mobilization of patients in critical care has been included in the guidelines for the first time. Furthermore, the recommendations for prone positioning have been updated, based on current evidence in medicine and nursing. In addition, recommendations regarding unsuitable positions that may actually harm patients were made. As such, the flat supine position should only be used in cases of urgent medical or nursing needs. This underlines the importance of a moderately elevated head of bed position (20(o)-45(o)) in mechanically ventilated patients.

[Early mobilization. Competencies, responsibilities, milestones]. / Frühmobilisierung. Zuständigkeiten, Verantwortungen, Meilensteine.

BACKGROUND: Early mobilization is an evident, interprofessional concept to improve the outcome of intensive care patients. It reduces psychocognitive deficits and delirium and attenuates a general deconditioning, including atrophy of the respiratory pump and skeletal muscles. In this regard the interdisciplinary approach of early mobilization, taking into account different levels of mobilization, appears to be beneficial. The purpose of this study was to explore opinions on collaboration and tasks between different professional groups. METHOD: During the 25th Bremen Conference on Intensive Medicine and Nursing on 20 February 2015, a questionnaire survey was carried out among the 120 participants of the German Early Mobilization Network meeting. RESULTS: In all, 102 questionnaires were analyzed. Most participants reported on the interdisciplinarity of the approach, but none of the tasks and responsibilities concerning early mobilization can be assigned to a single professional group. The practical implementation of mobilizing orally intubated patients may require two registered nurses as well as a physical therapist. Implementation in daily practice seems to be heterogeneous. CONCLUSIONS: There is no consensus regarding collaboration, competencies, and responsibilities with respect to early mobilization of intensive care patients. The approach to date has been characterized by a lack of interprofessional communication, which may lead to an inefficient use of the broad and varied base of knowledge and experienceof the different professions.

[Quality assurance and quality management in intensive care]. / Qualitätssicherung und Qualitätsmanagement in der Intensivpflege.

Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.