[AKTIN - The German Emergency Department Data Registry - real-time data from emergency medicine : Implementation and first results from 15 emergency departments with focus on Federal Joint Committee's guidelines on acuity assessment]. / Das AKTIN-Notaufnahmeregister ­ kontinuierlich aktuelle Daten aus der Akutmedizin : Ergebnisse des Registeraufbaus und erste Datenauswertungen aus 15 Notaufnahmen unter besonderer Berücksichtigung der Vorgaben des Gemeinsamen Bundesausschusses zur Ersteinschätzung.

BACKGROUND: Emergency care in Germany is in transition. Emergency departments (EDs) treat their patients based on symptoms and acuity. However, this perspective is not reflected in claims data. The aim of the AKTIN project was to establish an Emergency Department Data Registry as a data privacy-compliant infrastructure for the use of routine medical data. METHODS: Data from the respective documentation systems are continuously transmitted to local data warehouses using a standardized interface. They are available for several applications such as internal reports but also multicentre studies, in compliance with data privacy regulations. Based on a 12-months period we evaluate the population with focus on acuity assessment (triage) and vital parameters in combination with presenting complaints. RESULTS: For the period April 2018 to March 2019, 436,149 cases from 15 EDs were available. A triage level is documented in 86.0% of cases, and 70.5% were triaged within 10 min of arrival. Ten EDs collected a presenting complaint regularly (82.3%). The respective documentation of vital signs shows plausible patterns. CONCLUSIONS: The AKTIN registry provides an almost real-time insight into German EDs, regardless of the primary documentation system and health insurance claims data. The Federal Joint Committee's requirements are largely met. Standardized presenting complaints allow for symptom-based analyses as well as health surveillance.

[Even low-acuity patients prefer hospital-based emergency care : A survey of non-urgent patients in an emergency department with unique regional position]. / Der Notfall "geht" ins Krankenhaus : Eine Befragung von Patienten mit niedriger Dringlichkeit in einer Notfallaufnahme mit regionaler Alleinstellung.

BACKGROUND: Besides increasing numbers of cases in German emergency departments (ED), the spectrum of attending patients is also changing. Patients with acute illnesses tend to prefer EDs to ambulatory care as primary contact point. This study examines the motives for use and use behavior of low-urgent ED-patients. METHODS: Anonymous patient survey in the ED of Wolfsburg Hospital between 12/2015 and 03/2016 with descriptive analysis. All patients with low urgency (Manchester-Triage-System (MTS), levels blue and green) were eligible. RESULTS: 81.5% of respondents (729 evaluable out of 7000 questionnaires distributed) attended the ED between 8:00 a. m. and 5:00 p. m., 70.1 % of them were walk-in patients. The motive most frequently cited was that they would receive better care in the ED (48.3 %). Contrary to acuity assessment, 67.8 % of respondents considered themselves a medium to life-threatening emergency. As alternative option, 49.2 % would choose a nearby clinic in the region for their complaints. CONCLUSION: Self-assessed urgency differs with acuity assessment according to MTS. Patients who fear an acute threat to their health do not use services provided in the ambulatory sector such as the emergency practice of the Association of Statutory Health Insurance Physicians in the immediate proximity sufficiently. Previous approaches for patient navigation do not seem to be successful in this setting. Strengthening of EDs as a single 24/7 access point for emergency care with simultaneous abolition of parallel care structures should be discussed.

Dawning of the N=32 Shell Closure Seen through Precision Mass Measurements of Neutron-Rich Titanium Isotopes.

A precision mass investigation of the neutron-rich titanium isotopes ^{51-55}Ti was performed at TRIUMF's Ion Trap for Atomic and Nuclear science (TITAN). The range of the measurements covers the N=32 shell closure, and the overall uncertainties of the ^{52-55}Ti mass values were significantly reduced. Our results conclusively establish the existence of the weak shell effect at N=32, narrowing down the abrupt onset of this shell closure. Our data were compared with state-of-the-art ab initio shell model calculations which, despite very successfully describing where the N=32 shell gap is strong, overpredict its strength and extent in titanium and heavier isotones. These measurements also represent the first scientific results of TITAN using the newly commissioned multiple-reflection time-of-flight mass spectrometer, substantiated by independent measurements from TITAN's Penning trap mass spectrometer.

[Standardized collection of presenting complaints in the emergency room : Integration of coded presenting complaints into the electronic medical record system of an emergency department and their value for health care research]. / Standardisierte Erhebung von Vorstellungsgründen in der Notaufnahme : Implementierung von codierten Vorstellungsgründen in das elektronische Notaufnahmeinformationssystem eines Schwerpunktversorgers und deren Potenzial für die Versorgungsforschung.

BACKGROUND: The point of entry of a patient in emergency care is a symptom or a complaint. To evaluate subsequent processes in an emergency department until a diagnosis is made, this information has to be taken into account. OBJECTIVES: We report the introduction of coded presenting complaints into the electronic medical record system of an emergency department and describe the patients based on these data. METHODS: The CEDIS presenting complaint list was integrated into the emergency department information system of an emergency department (38,000 patients/year). After 8 months, we performed an exploratory analysis of the most common presenting complaints. Furthermore, we identified the most frequent diagnoses for presenting complaint "shortness of breath" and the most frequent presenting complaints for the diagnosis of sepsis. RESULTS: After implementing the presenting complaint list, a presenting complaint code was assigned to each patient. In our sample (26,330 cases), "extremity pain and injury" comprised the largest group of patients (29.5%). "Chest pain-cardiac features" (3.7%) and "extremity weakness/symptoms of cerebrovascular accident" (2.4%) were the main cardiac and neurologic complaints, respectively. They were mostly triaged as urgent (>80%) and hospitalized in critical care units (>50%). The main diagnosis for presenting complaint "shortness of breath" was heart failure (25.1%), while the main presenting complaint for the diagnosis sepsis was "shortness of breath" (18.1%). CONCLUSIONS: Containing 171 presenting complaints, this classification was implemented successfully without providing extensive staff training. The documentation of coded presenting complaints enables symptom-based analysis of the health care provided in emergency departments.

[Collection and processing of personal data to evaluate cancer screening programmes - results of a survey of the German population in light of the bill 'early detection of cancer and cancer registries']. / Erfassung und Verarbeitung von persönlichen Daten zur Evaluation von Krebsfrüherkennungsprogrammen - Ergebnisse einer Bevölkerungsbefragung im Kontext des Krebsfrüherkennungs- und -registergesetzes.

In a representative German sample, 62.1% of participants of cancer screening interventions indicated willingness to provide personal data for data-linkage with cancer registries. An agreement of over 90% is deemed necessary to conduct a meaningful population-based evaluation. The 'early detection of cancer and cancer regis-tries' bill proposed a procedure based on the use of pseudonyms only. This way personal consent is not required but participants are granted the right to object.

Magnetizing a complex plasma without a magnetic field.

We propose and demonstrate a concept that mimics the magnetization of the heavy dust particles in a complex plasma while leaving the properties of the light species practically unaffected. It makes use of the frictional coupling between a complex plasma and the neutral gas, which allows us to transfer angular momentum from a rotating gas column to a well-controlled rotation of the dust cloud. This induces a Coriolis force that acts exactly as the Lorentz force in a magnetic field. Experimental normal mode measurements for a small dust cluster with four particles show excellent agreement with theoretical predictions for a magnetized plasma.

Generation of intermittent turbulent events at the transition from closed to open field lines in a toroidal plasma.

Turbulent transport at the transition from closed to open field lines has been investigated in the stellarator experiment TJ-K. It is found that drift-wave turbulence in the confined region is responsible for the generation of intermittent structures (so-called blobs) in the unconfined region. There the character of turbulence changes and a decoupling of density and potential fluctuations is observed. The poloidal propagation of the intermittent events can be understood in the framework of background flows caused by gradients in the equilibrium plasma pressure and potential profiles.

Baseline computed tomography changes and clinical outcome after thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke.

OBJECTIVE: Intravenous recombinant tissue plasminogen activator (rt-PA) is the only therapy of proven value for patients with acute ischemic stroke (AIS). Controversy exists with regard to the prognostic significance of early computed tomography (CT) changes in patients receiving rt-PA for AIS. The authors retrospectively reviewed all cases of AIS who received intravenous rt-PA for AIS in University of South Alabama hospitals between January 1996 and May 1999. A neuroradiologist, blinded to clinical outcomes, reviewed all baseline CT scans for the presence of the following signs: hyperdense middle cerebral artery (HMCA), loss of gray-white differentiation (LGWD), insular ribbon sign (IRS), parenchymal hypodensity (PH), and sulcal effacement (SE). Modified Rankin Scale (mRS) score was recorded 90 days after thrombolysis, and clinical outcome was dichotomized as favorable (0-1) or unfavorable (2-6). The authors performed both univariate and multivariate analyses to investigate the relationship between early CT signs, baseline clinical variables, and functional outcome as measured by the 90-day mRS scores. Any one early CT finding was detected in 23(64%) patients. The frequency of specific findings were as follows: SE in 13 patients (36%), LGWD in 12 patients (33%), PH in 9 patients (25%), HMCA in 4 patients (11%), and IRS in 3 patients (8%) patients. There was no statistically significant association between the occurrence of these imaging findings and subsequent functional outcome after thrombolysis. The data suggest that the presence of subtle acute CT changes in AIS patients is not predictive of clinical outcome following administration of rt-PA as per National Institute of Neurological Disorders and Stroke protocol.

Migrainous stroke causing thalamic infarction and amnesia during treatment with propranolol.

We report a case of migraine-associated ischemic stroke causing amnesia, wherein treatment with propranolol may have been contributory. The possible mechanisms involved in migrainous stroke occurring in association with use of propranolol are discussed.

Expression of game-related and generic knowledge by dementia patients who retain skill at playing dominoes.

Patients with dementia who remain skilled at musical performance or playing bridge fail explicit memory tests for information related to their skills, suggesting that implicit memory mediates their preserved skills. To reexamine this issue, 23 dementia patients and 15 elderly controls of comparable domino-playing skill were compared on tests of naming, verbal fluency, and domino knowledge. On an explicit test of domino knowledge, the patients scored well below the elderly controls, performing no better than students who were unfamiliar with the game. But when game-like situations were created with real dominoes, both the skilled controls and the patients with dementia chose optimal moves and verbally explained their choices equally well. On naming and fluency tests, the skilled patients showed no advantage over patients of comparable dementia severity who had no retained skill. In dementia, some complex knowledge seems intact but is accessible only in particular contexts.

Interrater agreement of computed tomography infarct measurement.

To determine the reliability of infarct measurements on hard-copy computed tomography (CT) images the in vivo (IV) infarct volumes of 20 CT-detected infarcts were estimated and divided into four size groups with 5 infarcts in each group: Group A, less than 0.5 ml; Group B, 0.5 to 5.0 ml; Group C, 5 to 50 ml; and Group D, more than 50 ml. Seventeen infarcts were measured once and 3 infarcts three times to the nearest 0.5 mm by each of two neurologists and two neuroradiologists using a ruler on hard-copy CT images. The longest diameter (designated AP), the greatest diameter at right angles to AP (designated LAT), and the number of slices showing the infarct were recorded and multiplied by the hard-copy minification factor to give IV dimensions. Volume (VOL) was calculated according to a previously published method. Interrater intraclass correlation coefficients for all infarcts combined were 0.98 (AP), 0.91 (LAT), and 0.97 (VOL). Using all raters' measurements for any single infarct, the difference between the largest and the smallest measurement of AP and LAT was smallest (< 6 mm IV) for Group A and largest (< 31 mm IV) for Group D. This difference was largest relative to the dimension being measured in Groups A and B, where it reached 101% of the mean of the four raters' measurements for the AP dimension being measured in Group B, and 70% of the dimension being measured in Group A. With all raters' measurements for any single infarct, the difference between the largest and smallest measurement of VOL was smallest (< 0.5 ml) for Group A and largest (< 260 ml) for Group D. This difference was largest relative to the mean volume of the infarct being measured in Group B, where it reached 153% of the mean of the four raters' measurements for VOL and reached 115% of the mean of the four raters' measurements for VOL in Group A. The authors conclude that infarcts can be measured on hard-copy images with good interrater agreement. When infarcts with a volume smaller than 5 ml are measured, differences between raters' measurements may exceed the size of the dimensions being measured.

Role of diagnostic imaging in evaluation of the dental implant patient.

Dental implants have become an accepted form of permanent tooth replacement. Nearly all implants currently being placed are of the osseointegrated type. These typically consist of three parts: a fixture, an abutment, and a screw or threaded rod. The fixture, usually composed of titanium, can be placed in either a surgically created site in the alveolar ridge or a fresh extraction socket. Diagnostic imaging can play an important role in evaluating patients with such implants. Useful imaging studies include plain panoramic radiography, computed tomography, and computer-reformatted cross-sectional, panoramic, and three-dimensional imaging. Advanced imaging studies can be used to determine the suitability of implant placement, appropriate sites for implant placement, the size of the implant that can be placed, and the need for preimplantation ridge surgery. Postoperatively, advanced imaging studies can show failure of an endosseous implant to osseointegrate, improper placement of an implant, and violation of important structures.

The incidence of vertebral artery injury after midcervical spine fracture or subluxation.

Twenty-six patients with blunt trauma of the cervical spine, producing a subluxation from a "locked" or "perched" facet, facet destruction with evidence of instability, or a fracture involving the foramen transversarium, underwent preoperative vertebral angiography to determine the incidence of vertebral artery injury. The cervical spine injury in all the patients was deemed unstable and in need of surgical stabilization. Spinal cord injury was present in one-half of the patients studied. Vertebral artery injury was identified angiographically in 12 patients (46%). Occlusion of the vertebral artery near its origin or at the level of the spinal injury was identified in nine patients. An intimal flap, arterial dissection, and a pseudoaneurysm were identified in the remaining three patients. The injury involved the left vertebral artery in all but three patients. In none of the patients did the vertebral artery injury clearly result in neurological dysfunction or other sequelae. After cervical spine fracture or dislocation, vertebral artery injury is more prevalent than commonly believed. The possibility of vertebral artery injury should be considered during the establishment of clinical management schemes for blunt trauma of the cervical spine.