Klinik Niederrhein

ABSTRACT Mechanical regeneration of desublimator heat‐exchanger surfaces is proposed as an energy‐ and cost‐efficient alternative to steam defrosting in industrial freeze dryers. A pilot‐scale mechanically regenerated desublimator (MRD) was designed, built, and tested under food‐drying conditions. Continuous scraping keeps the overall heat‐transfer coefficient at the clean‐surface level and avoids warm‐up/cool‐down cycles. Compared with a thermally regenerated desublimator (TRD), the specific energy for desublimating 1 kg H 2 O decreased from 923 to 820 Wh kg −1 (−11.2%). The required energy for scraping was 35 Wh kg −1 of frost, which is approximately three times lower than the minimum latent heat input required for thermal defrosting. One MRD can replace two TRDs operating in an alternating cycle, reducing investment costs and enabling continuous freeze‐drying.

Modern cardiovascular medicine and surgery enable the treatment of complex cardiovascular disease, even in elderly and multimorbid patients, through increasingly sophisticated procedures. Nevertheless, there are situations in which surgical intervention appears medically inappropriate or is explicitly declined by the patient. Similarly, it may become necessary in the postoperative course to revise the original therapeutic goals-particularly when continued survival depends upon prolonged intensive care unit treatment, or when the anticipated quality of life, from the patient's perspective, appears inadequate. While established guidelines and position papers-most notably from the German Interdisciplinary Association for Intensive and Emergency Medicine-are already available in the field of intensive care medicine, a discipline-specific framework for cardiac surgery has been lacking thus far. This inaugural position paper issued by the German Society for Thoracic and Cardiovascular Surgery seeks to contribute to the definition of clinical and ethical standards in the context of therapeutic restraint (Section A) and to the redefinition of therapeutic goals (Section B) within our specialty. The aim is to promote a structured and multiprofessional approach that transparently integrates the core pillars of goal setting in therapy-namely, medical indication and patient autonomy-into a comprehensible decision-making framework. Achieving this objective requires close collaboration among physicians and nursing staff in cardiac surgery, cardiology, intensive care, anesthesiology, ethics consultation, and palliative care. The present recommendations are intended to serve as a foundation for patient-centered, appropriate, and transparent decision-making-always with the overarching aim of preserving the dignity and self-determination of the patients concerned.

Return to work (RTW) is a goal of many patients with colorectal cancer (PwCRC) attending inpatient rehabilitation. In German rehabilitation clinics, physicians conduct the socio-medical assessment of work capacity (SMWC) with the aim of assessing the current ability to work. We tested how well it also predicts the actual RTW of PwCRC. This study combined a nationwide physician survey (n = 38) with longitudinal data from a cohort study of PwCRC (n = 172) aged 65 or younger who were employed prior to CRC diagnosis. Physicians were asked about their use of validated tools for the SMWC and their attitudes toward a standardized assessment checklist. PwCRC completed baseline and 9-month follow-up questionnaires about their employment status. SMWC results of the cohort study's participants were extracted from rehabilitation discharge reports. While 97% of PwCRC were predicted to be capable of working ≥ 6h/day, only 70% actually returned to work 9months after rehabilitation. The SMWC showed high sensitivity (98%) but low specificity (6%) for predicting RTW, with a positive predictive value (PPV) of about 70%. Most physicians (73%) at least partly saw the need for an evidence-based structured checklist for an improved SMWC, and almost all (95%) would use it if it did not take more than 10min to apply it. The SMWC for PwCRC in German rehabilitation clinics is not standardized and overestimates the return-to-work rate. There is a need for a standardized checklist, and most physicians would be willing to use it.

Simple Summary In Germany, physicians assess the work ability of colorectal cancer patients at the end of a usually 3-week stay in a rehabilitation clinic. This study evaluated the diagnostic accuracy of this assessment for return to work and the open-mindedness of physicians towards changing their current assessment practice. We conducted an online survey with physicians and followed up colorectal cancer patients for 9 months after rehabilitation. Although 97% of the patients were judged to be able to work by their physicians, only 70% actually did 9 months after rehabilitation. The majority of physicians at least partly agreed that a standardized checklist is needed to help them with the work ability assessment (73%), and almost all (95%) said that they would use it. The diagnostic accuracy of the current work ability assessment for colorectal cancer patients in Germany is limited, and a checklist could help physicians in their judgments. Background/Objectives Return to work (RTW) is a goal of many patients with colorectal cancer (PwCRC) attending inpatient rehabilitation. In German rehabilitation clinics, physicians conduct the socio-medical assessment of work capacity (SMWC) with the aim of assessing the current ability to work. We tested how well it also predicts the actual RTW of PwCRC. Methods This study combined a nationwide physician survey (N = 38) with longitudinal data from a cohort study of PwCRC (N = 172) aged 65 or younger who were employed prior to CRC diagnosis. Physicians were asked about their use of validated tools for the SMWC and their attitudes towards a standardized assessment checklist. PwCRC completed baseline and 9-month follow-up questionnaires about their employment status. SMWC results of the cohort study’s participants were extracted from rehabilitation discharge reports. Results While 97% of PwCRC were predicted to be capable of working ≥ 6 hours/day, only 70% actually returned to work 9 months after rehabilitation. The SMWC showed high sensitivity (98%) but low specificity (6%) for predicting RTW, with a positive predictive value (PPV) of about 70%. Most physicians (73%) at least partly saw the need for an evidence-based structured checklist for an improved SMWC, and almost all (95%) would use it if it did not take more than 10 minutes to apply it. Conclusions The SMWC for PwCRC in German rehabilitation clinics is not standardized and overestimates the return-to-work rate. There is a need for a standardized checklist, and most physicians would be willing to use it.

This study aimed to assess the sex-specific prevalence and patterns of complementary and alternative medicine (CAM) use in patients undergoing radiotherapy, using the standardized questionnaire developed as part of the S3 Guideline on Complementary Medicine in Oncology. Between August and December 2022, 112 out of 697 eligible cancer patients receiving radiotherapy were prospectively enrolled and completed a structured questionnaire assessing CAM use. The questionnaire included 38 CAM methods classified according to their potential for interactions. Female participants generally used more CAM methods than male participants (median methods: 3 vs. 1, p<0.001). The most frequently used CAM methods were vitamin D (46.4%), sports/exercise (33%) and vitamin A/C/E or beta-carotene (25%). At least one of the listed CAM methods was used by 79.5%. At least three of the listed CAM methods were used by 52 (46.4%) patients. Thirty-six (32.1%) and 54 (48.2%) patients used CAM methods with known or potential interactions, while 76 (67.9%) used methods with no known interactions. In addition, a higher number of female patients used uncertain methods or medications compared to males (p=0.022). The desire for counseling was very similar between both sexes, with no significant difference (p=0.973). The high rate of CAM utility before radiotherapy, especially among females, and the use of uncertain methods, highlights the need for standardized questionnaires to identify potential interactions. This would help enhance patient safety through structured screening and counseling.

Background/Objective: Previous studies have indicated a higher incidence of complications associated with dual-lead devices compared to single-lead devices. This retrospective study aimed to investigate the effect of lead count and other factors on peri/postoperative complications for new pacemaker (PM) or implantable cardioverter-defibrillator (ICD) implantations in a representative German cohort. Methods: In accordance with quality assurance (QS) requirements, all hospitals in Germany collect patient-specific data on cardiac device implantation. We utilized the QS database from North Rhine-Westphalia to analyze data from 169,547 patients who underwent PM (n = 137,208) or ICD (n = 32,339) implantation between 2010 and 2014. The primary endpoint was the incidence of perioperative complications in the PM and ICD groups, analyzed separately for single- and dual-lead systems. Regression analysis was performed to identify specific risk factors and the effect of lead number on complications. Results: In the PM group, patients with dual-lead devices experienced significantly more complications than those with single-lead devices (3.27% vs. 2.85%, p < 0.001), largely driven by lead dislocations. In the ICD group, no significant difference in complication rates was observed between single-lead and dual-lead devices (1.39% vs. 1.46%, p = 0.635). The risk of complications was over twice as high for PM implantation compared to ICD implantation (3.17% vs. 1.42%). Patients with intrahospital complications faced a significantly higher risk of mortality than those without complications (PM: 4.5% vs. 1.6%; ICD: 3.9% vs. 0.5%). Independent risk factors for complications and mortality were identified in both groups, with a notable increase in the risk of intrahospital mortality associated with complications. Conclusions: Complications of dual-lead PM implantations are higher than single-lead procedures, mostly due to lead dislocations. Such a difference, though, was not observed in ICD implantations. Our findings may help optimize procedural strategies to improve patient safety, especially in PM implantations.

Patients with lung cancer under treatment have been associated with a high risk of COVID-19 infection and potentially worse outcome, but real-world data on patient-reported outcomes (PROs) are rare. We assess patients' characteristics and PROs before and during the COVID-19 pandemic in an advanced non-small cell lung cancer (NSCLC) cohort in Germany. Patients with locally advanced or metastatic NSCLC from the prospective, multicentre, observational CRISP Registry (NCT02622581) were categorised as pre-pandemic (March 2019 to Feb 2020, n = 1621) and pandemic (March 2020 to Feb 2021, n = 1317). From baseline to month 15, patients' health-related quality of life (HRQoL) was assessed by FACT-L, anxiety and depression by PHQ-4. Association of pandemic status with time to deterioration (TTD) in QoL scales adjusted for potential covariates was estimated using Cox modelling. PROs were documented for 1166 patients (72%) in the pre-pandemic, 979 (74%) in the pandemic group. Almost 60% of patients were male, median age was 66 years, comorbidities occurred in 85%. Regarding HRQoL, mean-change-from-baseline plots hardly differed between both samples. Approximately 15%-21% of patients reported anxiety, about 19%-27% signs of depression. For the pandemic group, TTD was slightly, but statistically significantly, worse for the physical well-being-FACT-G subscale (HR 1.15 [95%CI 1.02-1.30]) and the anxiety-GAD-2 subscale (HR 1.14 [95%CI 1.01-1.29]). These prospectively collected real-world data provide valuable insights into PROs before and during the COVID-19 pandemic in advanced NSCLC. For the patients, the pandemic seemed to be less of a burden than the disease itself, as there was a considerable proportion of patients with anxiety and depression in both groups.