Klinikum Itzehoe

Penicillin allergy (PA) delabeling optimizes antibiotic prescribing and is a recognized antimicrobial stewardship (AMS) tool. We aimed to characterize current practices and knowledge of PA delabeling in German non-allergist healthcare professionals to define barriers and facilitators for a wider implementation of delabeling strategies. A nationwide web-based, anonymous survey was distributed to physicians and hospital pharmacists. It covered four domains: demographics, access to AMS, allergy assessment and attitude towards PA delabeling. Responses were analysed using descriptive and inferential statistics. A total of 504 responses (249 physicians, 255 pharmacists) were analysed. While 86% of respondents were familiar with the concept of delabeling, only 32% had ever performed it, mostly fewer than 6 times in the past year. 12% of physicians regularly took extended allergy histories, and just 2% always used a standardized method. Only ~ 30% of respondents had onsite access to allergy services. Barriers included lack of time, experience and guidance. Pharmacists frequently cited PA management as outside their role. Despite limited experience, 88% of physicians and 71% of pharmacists expressed interest in delabeling if supported by clear algorithms and institutional support. PA delabeling by non-allergists is of great relevance to physicians and pharmacists in Germany but not routinely integrated in clinical pathways, due to missing guidelines, limited resources and unclear role definitions. However, the results of this study highlight the considerable strong potential for implementing structured delabeling strategies-if they are supported by adequate training, clear protocols and sufficiently resourced antimicrobial stewardship teams.

<bold>Rationale:</bold> Small airway dysfunction (SAD) is a key COPD feature and may occur in tobacco-exposed adults with normal spirometry. <bold>Objective:</bold> To investigate the prevalence of oscillometry-defined SAD and its associations with airway structure, QoL, and comorbidities in tobacco-exposed adults. <bold>Methods:</bold> In a sub-cohort (n=1,628) nested within a lung cancer screening trial, we assessed airway disease using preBD-spirometry, oscillometry, and AI-powered CT. Impaired airflow included airflow obstruction (AFO) and PRISm. Subjects with preserved airflow (PA), defined as FEV1 and FEV1/FVC > LLN, were further stratified as PA with SAD (PA-SAD) or normal lung function. SAD was defined as R5-19 or AX > ULN. CT biomarkers included airway wall thickness (AWT-Pi10), lumen diameter, branch count, and emphysema. QoL was measured using EQ-5D-5L. <bold>Results:</bold> The overall prevalence of SAD was 39%. SAD was present in 26% of subjects with PA and in 60% of those with impaired airflow. The frequency of AFO, PRISm, and PA-SAD was 21%, 15%, and 16%, respectively. PA-SAD subjects had lower EQ-5D-5L, greater AWT-Pi10, narrower lumen, fewer branches, and higher metabolic and CVD rates than those with normal lung function (all p <0.01). However, they had minimal emphysema and higher branch count than AFO. SAD in AFO or PRISm was linked to greater structural changes and more frequent CVD. SAD was associated with CVD (OR: 1.91, 95% CI: 1.55-2.36), even after adjusting for confounders and metabolic disease. <bold>Conclusion:</bold> SAD is common in tobacco-exposed adults and associated with airway remodeling, impaired QoL, and increased CVD risk, even in PA. PA-SAD is a distinct from AFO by preserved airway count and minimal emphysema.

Abstract Importance Numerous studies indicate that the traditional categorical classification of severe mental disorders (SMD), such as schizophrenia, bipolar disorders, and major depressive disorders, does not align with the underlying biology of those disorders as they frequently overlap in terms of symptoms and risk factors. Objective This study aimed to identify transdiagnostic patient clusters based on disease severity and explore the underlying biological mechanisms independently of the traditional categorical classification. Design We utilized data from 443 participants diagnosed with SMD of the PsyCourse Study, a longitudinal study with deep phenotyping across up to four visits. We performed longitudinal clustering to group patients based on symptom trajectories and cognitive performance. The resulting clusters were compared on cross-sectional variables, including independent measures of severity as well as polygenic risk scores, serum protein quantification, miRNA expression, and DNA methylation. Results We identified two distinct clusters of patients that exhibited marked differences in illness severity but did not differ significantly in age, sex, or diagnostic proportions. We found 19 serum proteins significantly dysregulated between the two clusters. Functional enrichment pointed to a convergence of immune system dysregulation and neurodevelopmental processes. Conclusion The observed differences in serum protein expression suggest that disease severity is associated with the convergence of immune system dysregulation and neurodevelopmental alterations, particularly involving pathways related to inflammation and brain plasticity. The identification of pro-inflammatory proteins among the differentially expressed markers underscores the potential role of systemic inflammation in the pathophysiology of SMD. These results highlight the importance of considering illness severity as a core dimension in psychiatric research and clinical practice and suggest that targeting immune-related mechanisms may offer promising new therapeutic avenues for patients with SMD. Key points Question Can analyzing symptom trajectories and cognitive profiles across diagnostic categories reveal clinically relevant subgroups in severe mental disorders? Findings In this longitudinal study of 443 individuals with severe mental disorders, two distinct clusters emerged, differing significantly in illness severity, with the more severe group displaying elevated pro-inflammatory serum proteins, suggesting an association between disease severity and inflammation. Meaning These findings suggest that transdiagnostic clustering clarifies shared mechanisms, underscores the importance of inflammation in severe mental disorders, and highlights a promising avenue for novel therapeutic approaches.

IntroductionData on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory to conservative management is restorative neurostimulation. The efficacy of restorative neurostimulation has been demonstrated in multiple prospective studies, with published follow-up over 4 years, showing a consistent durable effect.MethodsTo further examine the effect of restorative neurostimulation in an older demographic, data from three clinical studies were aggregated: ReActiv8-B prospectively followed 204 patients, ReActiv8-C study prospectively followed 87 patients and ReActiv8-PMCF prospectively followed 42 patients.Two hundred and sixty-one patients were identified with complete 2-year follow-up and divided into cohorts of equal size based of age quartiles.At 2 years from device activation, patients in either cohort were classified by change in disability (Oswestry Disability Index (ODI)) or change in pain score(NRS/VAS) and assessed as proportion of patients per group at each time point. Additionally, health-related quality of life (HRQoL) (EQ5D-5L) was longitudinally compared with baseline. Differences in proportions were assessed using χ2 and continuous variables by repeated measures analysis of variance.ResultsThe oldest quartile (n=65) had a median age of 60 (56–82) years compared with the entire population (n=261) who had a median age of 49 (22–82) years. The completer analysis on patients with 2 years of continuous data showed improvement of a 50% in pain was achieved by 62% and 65% and a 15-point ODI improvement in 48% and 60% in the oldest quartile and entire population, respectively. HRQoL (EuroQol 5-Dimension) improved from baselines of 0.568 and 0.544 to 0.763 and 0.769 in the oldest quartile and entire population respectively. All age quartiles improved statistically and clinically over baseline.ConclusionsThis aggregate analysis of three independent studies provides insight into the performance of restorative neurostimulation in an older population. Patients derived significant and clinically meaningful benefit in disability, pain and HRQoL. When compared with a similarly indicated cohort of younger patients, there were no statistically or clinically significant differences.

Pelvic ring and acetabular fractures are among the most complicated and severe injury patterns in orthopaedic trauma surgery. Inpatient treatment is not only costly but also very time-consuming. The aim of this study is to identify predictors leading to a prolonged length of hospital stay. This study is a retrospective review of data of 211 patients admitted to a Level-1 trauma centre. In this cohort a surgical treatment of pelvic ring and acetabular fractures between 2010 and 2020 was performed. Preclinical data and clinical parameters were analysed. Injury severity was the most important factor for a prolonged stay. High-energy trauma resulted in significantly longer hospital stays. Multiple injury had a significant effect. Low haemoglobin levels measured on admission and an increased shock index, as indicators of the severe trauma, could be identified as good predictors of a longer intensive care period and a long total length of stay. Except for the number of surgical procedures to treat the pelvic fracture, surgical approach and technique showed no predictive value. Age and gender do not play a role. Increased patient age does not result in a longer hospital stay or longer intensive care times. Pelvic fractures demonstrate a prolonged hospital stay. It depends on the severity of the injury. There are good predictors of a long length of stay at admission. These include the presence of multiple injury, the complexity of the fractures, haemoglobin levels, and the shock index.

With advances in industrial data communication technologies, MW-scale PV parks increasingly depend on communication-based coordination among Power Electronic Converters (PECs) to ensure precise voltage regulation and stability, especially during grid fault events. However, Communication Delay (CD) can degrade voltage control, leading to sustained oscillations and Transient Overvoltage (TOV) during post-fault recovery. This paper analyzes the impact of such delays on PV park stability under a centralized secondary voltage controller (SecVC) and proposes a local control strategy to enhance coordination robustness to CDs. A nonlinear model of a PV park is built and used for small-signal stability analysis, incorporating Monte-Carlo Simulations (MCS) to assess the impact of stochastic delays, alongside time-domain simulations to evaluate dynamic responses. The proposed approach is validated through Hardware-in-the-Loop (HIL) testing, using two HIL devices interfaced via a communication network emulator (CNE) with the Modbus-TCP protocol.

Emerging or re-emerging viral diseases have apandemic potential and threaten global health. Vaccination is of crucial importance in the prevention of emerging and re-emerging viral diseases. Description of the current status of vaccine development against Filoviridae, highly pathogenic coronaviruses, smallpox viruses, influenza viruses and arboviruses. Focused literature search. The World Health Organization (WHO) regularly publishes alist of infectious diseases that are expected to pose amajor threat to humanity as they are could potentially trigger new pandemics; however, in addition to these human-to-human transmissible diseases, some arboviruses also have pandemic potential. In recent years numerous new vaccines, some of which are highly effective, have been licensed against new and re-emerging viral diseases and other promising vaccine candidates are currently in development. There are still gaps in the development of vaccines in the area of Filoviridae and highly pathogenic coronaviruses. Vaccinations against smallpox viruses have been available for a long time. Developing influenza vaccines against novel strains in atimely manner is achallenge and universal influenza vaccines could be apossible solution. Modern vaccines are available against the arboviruses dengue and Chikungunya fever.

Abstract Wie ist es möglich, die Mobilität zu Wasser, zu Lande und in der Luft nachhaltig zu verändern? Das in Itzehoe, Tübingen und Detroit ansässige Unternehmen CustomCells meint: Mit maßgeschneiderter Batterietechnologie und einer konsequenten Innovationskultur. Aber wie gestaltet sich diese Kultur und welche Perspektiven sind dabei am wichtigsten? Jan Diekmann, Vice President im Bereich Innovation bei CustomCells, erläutert die Strategie des Zellherstellers im Interview.

BackgroundNon-communicable diseases (NCDs) are responsible for many deaths. They are associated with several modifiable and metabolic risk factors and are therefore prone to significant regional variations on different scales. However, only few intra-urban studies examined spatial variation in NCDs and its association with social circumstances, especially in Germany. Thus, the present study aimed to identify associations of personal risk factors and local social conditions with NCDs in a large German city.MethodsThis study is based on a population-based cohort of the Hamburg City Health Study including 10,000 probands. Six NCDs were analyzed (chronic obstructive pulmonary disease [COPD], coronary heart disease [CHD], diabetes mellitus, heart failure, depression, and hypertension) in 68 city district clusters. As risk factors, we considered socio-demographic variables (age, sex, education) and risk behaviour variables (smoking, alcohol consumption). Logistic regression analyses identified associations between the district clusters and the prevalence rates for each NCD. Regional variation was detected by Gini coefficients and spatial cluster analyses. Local social condition indexes were correlated with prevalence rates of NCDs on city district level and hot-spot analyses were performed for significant high or low values.ResultsThe analyses included 7,308 participants with a mean age of 63.1 years (51.5% female). The prevalence of hypertension (67.6%) was the highest. Risk factor associations were identified between smoking, alcohol consumption and education and the prevalence of NCDs (hypertension, diabetes, and COPD). Significant regional variations were detected and persisted after adjusting for personal risk factors. Correlations for prevalence rates with the local social conditions were significant for hypertension (r = 0.294, p < 0.02), diabetes (r = 0.259, p = 0.03), and COPD (r = 0.360, p < 0.01).ConclusionsThe study shows that regional differences in NCD prevalence persist even after adjusting for personal risk factors. This highlights the central role of both personal socio-economic status and behaviors such as alcohol and tobacco consumption. It also highlights the importance of other potential regional factors (e.g. the environment) in shaping NCD prevalence. This knowledge helps policy- and decision-makers to develop intervention strategies.