Asklepios Klinikum Harburg

Attention-deficit/hyperactivity disorder (ADHD) often continues into adulthood and affects several million adults in Germany. Many do not receive timely, evidence-based treatment because of long waiting times and limited access to care. Digital health applications offer a low-threshold option to provide guideline-based support. A pilot study of the present app-based program showed encouraging improvements in quality of life and reductions in ADHD symptom severity.This randomized controlled trial (RCT) aims to confirm and extend the pilot findings. The primary objective is to examine whether the digital intervention improves quality of life in adults with ADHD. Further outcomes include changes in ADHD symptoms, functional impairment, depressive and anxiety symptoms, substance use, general health, health literacy, medication adherence, and user satisfaction.A total of 380 adults with verified ADHD will be recruited online and via a university hospital. After informed consent and baseline assessment, participants will be randomized 1:1 to immediate access to a 12-week digital unguided program or to care as usual (CAU). Self-report assessments will take place at baseline, 6 weeks, and 12 weeks. Mixed models for repeated measures will be used for the primary analyses, complemented by intention-to-treat and complete-case approaches.The trial will test the robustness of the previous pilot results and provide evidence on the clinical value of a scalable digital intervention for adult ADHD.

Zusammenfassung Das Zertifizierungssystem „Zertifiziertes Gefäßzentrum“, das seit 2003 eine externe Überprüfung der Struktur‑, Prozess- und Ergebnisqualität anbietet, besitzt heute eine hohe Akzeptanz und Außenwirkung. Ziel der Arbeit ist eine Darstellung der Entwicklung des interdisziplinären Zertifizierungssystems in den Anfangsjahren und der Anpassungen im Verlauf und nun im Besonderen in Hinblick auf die Krankenhausreform in Deutschland. Derzeit sind 117 Zentren zertifiziert, und es wurden auch Zentren in Österreich, der Schweiz und Luxemburg erfolgreich begutachtet. Neben einer Verbesserung der Struktur- und Prozessqualität konnten wissenschaftliche Arbeiten aus der Versorgungsforschung nachweisen, dass die Ergebnisqualität der Versorgung von Patienten mit Bauchaortenaneurysmen, mit peripherer arterieller Verschlusserkrankung oder einer Carotisstenose durch die Zertifizierung signifikant verbessert werden konnten. Das Zertifizierungssystem wurde weiterentwickelt und durch die Digitalisierung des Antragswesens beschleunigt. Weiterhin wurde ein Gefäßzentrumssignet entwickelt, um die Außenwirkung des Zertifikates klarer darzustellen. Man bemühte sich, eine Zentrumsvergütung über die Gemeinsamer Bundesausschuss (G‑BA)-Zentrumsregelung zu erreichen. Eine Kooperation mit der Weissen Liste führte zu einer verbesserten Außendarstellung und als eines der wenigen Zertifizierungssysteme zu einer Erstaufnahme in den Bundes-Klinik-Atlas. Die Überprüfung des Zertifizierungssystems im Rahmen der Krankenhausreform durch das Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG) führte zu einer Weiterentwicklung der Zertifizierungskriterien mit Erstellung und Veröffentlichung eines Statuts und der Evidenzbasis des Zertifikates. Diese Optimierungen und der zu erwartende Strukturwandel im Rahmen der Krankenhausreform mit Fokus auf eine Zentralisierung werden zu einer weiteren positiven Entwicklung des Zertifizierungssystems und der Marke „Zertifiziertes Gefäßzentrum“ führen.

Extracorporeal Life Support (ECLS) has evolved into an established treatment for severe cardiogenic shock. As most patients have residual antegrade left ventricular output toward the descending aorta that meets the retrograde blood flow from the arterial ECLS cannula, they may develop differential hypoxemia. The location of the mixing cloud is critical for coronary and brain oxygenation. We analyzed the effects of the development of differential hypoxemia on morbidity and mortality of ECLS patients. Moreover, we analyzed the impact of two different treatment options for this phenomenon, including the administration of beta-blockers and the provision of a supplementary arterial cannula, on survival. We performed a retrospective review of patient demographics, outcomes, laboratory, and respiratory parameters during and after ECLS support for 76 ECLS patients treated at our institution. Overall, 38 ECLS patients developed differential hypoxemia. Treatment of this phenomenon included either the administration of beta-blockers (n = 18) or the introduction of a second arterial ECLS cannula (n = 20). There were no significant differences in median SOFA-Scores (Sequential Organ Failure Assessment Scores) between groups (p = 0.072; ECLS vs. ECLS with differential hypoxemia patients). Under all respiratory and laboratory values analyzed, only bilirubin levels were significantly different (p = 0.020). Development of differential hypoxemia was associated with significantly decreased survival rates (p = 0.05). Moreover, insertion of a second arterial ECLS cannula was a risk factor for mortality (OR: 3.68, 95% CI 1.18-11.47, p = 0.025). Development of differential hypoxemia is associated with significantly increased mortality rates among ECLS patients and should therefore be prevented as far as possible. Non-invasive administration of beta-blockers seems to be the more effective treatment option for differential hypoxemia, as the introduction of a second arterial ECLS cannula was a risk factor for mortality.

Currently, there is an intensive discussion about enhancing and expanding outpatient rhinosurgical procedures. Many questions about how to stratify into out- and inpatient procedures are still not sufficiently clarified. Particularly, the use of nasal packing materials is not adequately discussed. We performed a Germany-wide survey among otorhinolaryngologists regarding the use of nasal packing materials in sinonasal surgery. Additionally, we asked for any complication in relation to nasal packing. In 85,6% nasal packing was used for septal and turbinate surgery at least occasionally, in 44,2% always. In sinus surgery these numbers are 94,1% and 49%, respectively. Non-resorbable nasal packing materials were predominantly used.Most frequent complications were bleeding with nasal packing in situ (> 50% of respondents) and posterior dislocation (24% of respondents), requiring emergency treatment. Death was listed in 5 patients. One patient suffered from permanent brain damage due to hypoxia. Application of non-resorbable nasal packing materials with occlusion of the nasal cavity carry a substantial risk of complications, which necessitate emergency treatment, thus requiring inpatient care.

Surgical atrial ablation is evaluated by surgeons in relation to the estimated surgical risk. We analyze whether high-risk patients (HRPs) experience risk escalation by ablation procedures.The CASE-Atrial Fibrillation (AF) registry is a prospective, multicenter, all-comers registry of atrial ablation in cardiac surgery. We analyzed the 1-year outcome regarding survival and rhythm endpoints of 1,000 consecutive patients according to the operative risk classification (EuroSCORE II ≤ 2 vs. >2).Higher NYHA (New York Heart Association) score, ischemic heart failure, status poststroke, renal insufficiency, chronic obstructive pulmonary disease, and diabetes mellitus were strongly represented in HRPs. HRPs exhibit more left ventricular ejection fraction < 40% (19.2 vs. 8.8%; p < 0.001) but identical left atrial diameter and left ventricular end-diastolic diameter compared with low-risk patients (LRPs). CHA2DS-Vasc-score (2.4 ± 1 vs. 3.6 ± 1.5; p < 0.001), sternotomies, combination surgeries, coronary artery bypass graft, and mitral valve procedures were increased in HRPs. LRPs underwent stand-alone ablations as well. Ablation energy did not differ. Left atrial appendage closure was performed in up to 86.1% (mainly cut-and-sew procedures). Mortality corresponded to the original risk class without an escalation that may be related to ablation, stroke rate, or myocardial infarction. A total of 60.6% of HRPs versus 75.1% of LRPs were discharged in sinus rhythm. Long-term EHRA (European Heart Rhythm Association) score symptoms were lower in HRPs. Repeated rhythm therapies were rare. Additional antiarrhythmics received a minority without group dependency. A total of 1.6 versus 4.1% of HRPs (p = 0.042) underwent long-term stroke; excess mortality was not observed. Anticoagulation remained common in HRPs.Surgical risk and long-term mortality are determined by the underlying disease. In HRPs, freedom from AF and symptom relief can be achieved. Preoperative risk scores should not lead to withholding an ablation procedure.

Einleitung Das Pleuramesotheliom gehört zu den Asbest-verursachten Krebserkrankungen. Obwohl Mesotheliome eher selten sind, gehören sie hierzulande zu den häufigsten beruflich verurs. Krebserkrankungen. Maligne Pleuramesotheliome wachsen meist lokal infiltrativ-destruktiv. Fernmetastasen treten selten auf u. befallen v.a. Lunge/Knochen/Leber/Niere.