RESUMEN
BACKGROUND: Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. Annually, sepsis leads to approx. 90.000 deaths in Germany. Risk factors include amongst others older age (>60), innate or acquired dysfunction of the immune system, and underlying chronic diseases of the lung, heart, liver, or kidneys. The manifestation of sepsis is a medical emergency, and patient outcomes depend on timely diagnosis and immediate treatment. In addition, vaccinations e.g., against pneumococci or influenza virus, are a highly effective public health tool to prevent the most common underlying infections that may lead to sepsis. However, a lack of public awareness for the relevance of vaccination and detecting sepsis as an emergency underlines the need for public health interventions that address these issues. SepWiss aims to evaluate the effects of a multimodal information campaign designed to address this lack of awareness among the risk population in Germany. METHODS: SepWiss is an intervention at state level, consisting of a multimodal information campaign targeting risk groups in the German federal states of Berlin and Brandenburg (intervention region). Based on available evidence, various information formats were developed and implemented by outdoor advertising, social media, educational formats and through stakeholders' platforms, starting in August 2021. The control region comprises of the remaining 14 German federal states. We will analyze vaccination coverage (primary outcome), and sepsis knowledge, the ability to detect sepsis as an emergency, and attitude towards vaccination (secondary outcomes) amongst the risk population in a controlled before-after comparison. The implementation is accompanied by a mixed-method process evaluation. DISCUSSION: SepWiss is the first project of its kind to evaluate a complex multi-faceted evidence-based information campaign with regards to the topics of vaccination coverage, and the importance of sepsis detection and prevention for the most vulnerable populations in Germany. Results will be valuable for informing further nationwide campaigns. TRIAL REGISTRATION: German Registry for Clinical Trials: DRKS00024475. Registered February 24th, 2021.
Asunto(s)
Diagnóstico Precoz , Sepsis , Humanos , Sepsis/diagnóstico , Sepsis/prevención & control , Alemania/epidemiología , Factores de Riesgo , Vacunación , Adulto , Masculino , Persona de Mediana Edad , Femenino , Conocimientos, Actitudes y Práctica en Salud , AncianoRESUMEN
BACKGROUND: Sepsis is a life-threatening and relatively common emergency which is often recognized too late or not at all. Therefore, the "SepsisWissen" (SepsisKnowledge) project aimed to bring about changes in health care professionals' behavior in the area of sepsis prevention and early detection. It addressed the health care professionals themselves (e. g., their own vaccination, hygiene and early detection behavior) and their patient counseling behavior. To promote this behavior, the SepsisWissen campaign included offers such as trainings or print products. The subsequent core question is: From the health professionals' perspective, which barriers and facilitators affect their own application of sepsis competence and their promotion of their patients' sepsis competence? METHODS: This paper was based on a cross-sectional mixed-methods study part of "SepsisWissen" withPart a) was analyzed using qualitative oriented content analysis based on Mayring, part b) was analyzed descriptively. The interviewees included physicians, nurses, pharmacists, assistants to physicians and pharmacists and, additionally, one paramedic in the quantitative sample. Some of them had attended "SepsisWissen" trainings. RESULTS: The qualitative data analysis identified 41 conducive and hindering factors, which can be assigned to the following eight major topics: 1) syndrome sepsis; 2) predisposing factors for health professionals' own acquisition and application of sepsis competence; 3) enabling factors for health professionals themselves; 4) behavior and lifestyle of patients; 5) reinforcing factors for patients; 6) public health education; 7) political, administrative, and organizational context; 8) environmental factors. In the qualitative and quantitative surveys, the suggestion to improve the sepsis competence of the population and to reduce misinformation, respectively, through public education (e.g., via schools or the media). DISCUSSION: Sepsis training for health professionals was considered as a facilitating factor for taking potential sepsis symptoms and patients' respective statements more seriously. Future training formats should convey more explicitly how health professionals can better communicate their own sepsis knowledge to their patients. They request instruments to support their communication, such as checklists for lay persons. According to the interviews, health workers themselves need recurring external reminders for the topic of sepsis. Organizational and political conditions should be improved. From the health professionals' point of view, it is essential to offer better reimbursement for prevention and counseling services and to allocate adequate time resources for both. CONCLUSION: Health professionals could increase their potential to apply and promote sepsis competence if general conditions were optimized. From their perspective, it is most important to relieve them of some of their patient counselling burden by initiating more public education.
RESUMEN
BACKGROUND: Sepsis is a medical emergency with potentially life-threatening consequences. Patients play a crucial role in preventing and recognizing sepsis at an early stage. The understanding of risk groups' sepsis knowledge and their ability to use this knowledge to recognize sepsis as an emergency is incomplete. METHODS: We conducted a cross-sectional survey in Germany and included a sample of 740 persons stratified by age (< 60 years, ≥ 60 years), specific chronic diseases (e.g. diabetes, chronic diseases, cancer), and region (Berlin/Brandenburg vs. other federal states of Germany). Standardized questionnaires were administered by a market research institute through online, telephone, or face-to-face methods. We assessed sepsis knowledge through a series of questions and the ability to recognize sepsis as an emergency through five case vignettes. To identify predictors of sepsis knowledge and the ability to recognize sepsis as a medical emergency, we conducted multiple linear regressions. RESULTS: Of the 36 items on sepsis knowledge, participants answered less than 50 per cent correctly (mean 44.1%; standard deviation (SD) 20.1). Most patients knew that sepsis is a defensive host response to infection (75.9%), but only 30.8% knew that vaccination can prevent infections that lead to sepsis. Across the five vignettes, participants identified sepsis as an emergency in only 1.33 of all cases on average (SD = 1.27). Sepsis knowledge was higher among participants who were older, female, and more highly educated and who reported more extensive health information seeking behaviour. The ability to recognize sepsis as an emergency was higher among younger participants, participants without chronic diseases, and participants with higher health literacy, but it was not significantly associated with sepsis knowledge. CONCLUSIONS: Risk groups showed low levels of knowledge regarding the preventive importance of vaccination and a low ability to recognize sepsis as a medical emergency. Higher levels of sepsis knowledge alone were not sufficient to improve the ability to identify sepsis as a medical emergency. It is crucial to develop effective educational strategies-especially for persons with lower education levels and infrequent health information seeking behaviour-that not only transfer but also facilitate the choice of appropriate actions, such as seeking timely emergency care. TRIAL REGISTRATION: DRKS00024561. Registered 9 March 2021.
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Sepsis , Humanos , Femenino , Persona de Mediana Edad , Estudios Transversales , Encuestas y Cuestionarios , Morbilidad , Sepsis/diagnóstico , Enfermedad CrónicaRESUMEN
Cleft palate repair comprises the surgical creation of a congenitally nonexistent normal anatomy, to establish physiological function by moving tissues into their normal anatomical positions. In patients with isolated incomplete (IICP) or submucous (SMCP) cleft palate, the vomer is usually not completely attached to the palatal plate in the midline. This condition, which is visible through surgical access radiologically or via endoscope, is often disregarded during hard palate repair. This can lead to "hypernasality" despite a well-functioning velopharyngeal mechanism. The general practice of hard palate repair by suturing merely the nasal layers together separates the oral and nasal cavities. However, without incorporation of the vomer, it is impossible to build two separate nasal floors on the left and right sides. We consider that achieving normal speech and separation of the nasal cavities are mutually dependent and have to be considered equally. METHODS: We described hard palate repair involving the vomer for construction of both nasal floors. We presented the occlusal relationship, hypernasality, and fistula rates in 37 patients operated on between January 1, 2017 and June 30, 2018. RESULTS: One child presented minimal hypernasality; all others had normal resonance/voice. Fistula rate was zero, and no cross bites were observed. CONCLUSIONS: The implicit connection between the inner nose, resonance/voice, and prevention of fistulae has not yet been acknowledged. The correct usage of vomer flaps in IICP and SMCP creating separate nasal floors supports the velopharyngeal competency, avoids fistula formation, and should be incorporated regularly, like in other cleft forms.
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Servicios Médicos de Urgencia/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/terapia , Distribución por Edad , Niño , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Heridas y Lesiones/diagnósticoRESUMEN
Invasive monitoring is rarely used in children undergoing routine anaesthesia. Therefore the management of fluid therapy and its maintenance depends often on the experience of the anaesthetist. In situations of high volume uptake and during critical surgical procedures haemodynamic state can easily be underestimated and hypovolaemic episodes remain undetected. This article summarises recent developments of less invasive and continuous monitoring techniques available for paediatric use which probably represent a useful addition in optimising the perioperative haemodynamic performance.