Marien Hospital Witten

BackgroundEndotracheal intubation is the gold standard for airway management in out-of-hospital cardiopulmonary resuscitation (CPR) but requires practice, especially in difficult conditions. To facilitate this, video laryngoscopy (VL) is increasingly used. The extent to which it is actually used in practice by paramedics or emergency physicians (EPs) and its effectiveness remain unclear. This prospective observational study investigates these aspects.MethodsFrom January 2020 to June 2024, we surveyed emergency physicians and paramedics in a German county about out-of-hospital resuscitations. The questionnaire covered qualifications, airway devices, attempts, and complications. Data was analyzed descriptively and statistically. The significance level was set at alpha ≤ 0.05.Results301 questionnaires were analyzed, with an overall first pass success (FPS) rate of 62.8%. No significant difference was found between direct laryngoscopy (DL) and video laryngoscopy (VL), though VL with McGrath performed worse than DL and VL with C-Mac. FPS rates did not differ significantly between emergency physicians and paramedics. Both achieved better results with their regularly used device. Paramedics used laryngeal masks more frequently (34% vs. 1.5%, p < 0.001). Among emergency physicians, anesthetists had the lowest FPS using DL (p < 0.001).InterpretationThe FPS rate did not differ between DL and VL but was low overall. This low rate, as well as the fact that emergency physicians and paramedics achieved comparable results in intubation, might indicate an increased need for training and further education in the area of airway management for emergency personnel. However, it can also be questioned to what extent ETI can be recommended at all, with supraglottic devices being an alternative. A possible benefit of more training can be seen in the higher success rates with the more frequently used devices in both professions. An uncertainty of paramedics regarding endotracheal intubation is also reflected in an more frequent use of laryngeal masks. The fact that internists who used VL more frequently had better FPS rates than anesthetists who intubated conventionally more often shows the potential of VL, especially under difficult out-of-hospital intubation conditions.Trial registrationThe study was registered in the German Clinical Trials Register (DRKS ID: DRKS00021821, 12.06.2020).

Introduction: Deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, is approved in multiple countries for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy. PSORIATYK SCALP, an ongoing, 52-week, phase 3b/4, multicenter, randomized, double-blinded, placebo-controlled trial, evaluated deucravacitinib efficacy/safety in patients with moderate to severe scalp psoriasis, including those with more limited overall psoriasis. Methods: Adults with moderate to severe scalp psoriasis defined by more focused and objective inclusion criteria (ss-PGA ≥3, scalp surface area involvement ≥20%, and PSSI ≥12 at baseline) and BSA involvement ≥3% were randomized 1:2 to oral placebo or deucravacitinib 6 mg once daily through Week 16. The primary efficacy outcome was ss-PGA 0/1; key secondary outcomes were PSSI 90, change from baseline in scalp-specific itch numeric rating scale (NRS), and sPGA 0/1 at Week 16. Efficacy outcomes were evaluated at Week 16 for the overall population and the subpopulation with global sPGA ≥3. Nonresponder imputation and modified baseline observation carried forward were used for patients who discontinued or had missing data for binary and continuous outcomes, respectively. Results: 154 patients were randomized (placebo, n=51; deucravacitinib, n=103). Baseline characteristics were similar in each group (placebo: mean BSA 10.0%, PASI 9.4, PSSI 32.2; deucravacitinib: mean BSA 10.5%, PASI 10.2, PSSI 33.5). In the overall population, a higher proportion of patients receiving deucravacitinib versus placebo achieved ss-PGA 0/1 at Week 16 (48.5% vs 13.7%; P&lt;0.0001). Deucravacitinib was superior to placebo for PSSI 90 (38.8% vs 2.0%; P&lt;0.0001) and mean change from baseline in scalp-specific itch NRS (−3.2 vs −0.7; P&lt;0.0001). In the subpopulation (sPGA ≥3), a greater proportion achieved sPGA 0/1 with deucravacitinib versus placebo (51.0% vs 4.3%; P&lt;0.0001). The most common adverse events (AEs) in the deucravacitinib group (≥5%) were nasopharyngitis (14.6%), upper respiratory tract infection (11.7%), acne (9.7%), headache (7.8%), COVID-19 (5.8%), and pustular acne (5.8%). Two serious AEs were reported (1/group); neither was considered treatment related or led to discontinuation. Conclusion: Deucravacitinib was efficacious and well tolerated in patients with moderate to severe scalp psoriasis, including those with less extensive overall psoriasis (BSA ≥3%). The overall psoriasis response rate (sPGA 0/1) was consistent with POETYK trial results, despite including patients with more limited BSA involvement. Safety findings were consistent with the known deucravacitinib safety profile.

Der M. Perthes ist die häufigste

359 Background: Peritoneal relapse is seen in 60-70% of patients with diffuse type gastric cancer (gc), compared to 20-30% with intestinal type according to Laurens`s classification. Hyperthermic intraperitoneal chemoperfusion (HIPEC) is an increasingly used therapy method for patients (pts) with peritoneal metastases. The preventive use of HIPEC could represent an approach for diffuse type cell gc pts before macroscopic peritoneal seeding has evolved, since pts with operable disease are fit and may have potential risk of microscopic involvement, thus having a theoretical chance of cure with HIPEC even without the need for cytoreduction. Methods: This is a multicenter, randomized, controlled, open-label phase III study including a total of 200 pts with localized and locally advanced diffuse type cell adenocarcinoma of the stomach and type II/III gastroesophageal junction (i.e. ≥cT3 any N or any T N positive). A negative diagnostic laparoscopy before treatment and 3-6 pre-operative cycles of FLOT are a prerequisite for enrollment (Docetaxel 50 mg/m2; Oxaliplatin 85 mg/m2; Leucovorin 200 mg/m2; 5-FU 2600 mg/m2, q2wk). Pts were randomized 1:1 to receive surgery only and postoperative FLOT (Arm A-control arm) or surgery + intraoperative HIPEC (cisplatin 75mg/m2 solution at 42°C for 90 min) and postoperative FLOT (Arm B-experimental arm). Surgery is carried out as subtotal, total gastrectomy or transhiatal extended gastrectomy. The scope of the trial is to evaluate the efficacy as well as the safety and tolerability of the combination of perioperative chemotherapy combined with an intraoperative prophylactic HIPEC. Here, we show safety results from the pre-specified safety analysis after 20 pts had undergone surgical resection plus HIPEC and the corresponding 20 pts in the control arm. Results: Treatment arms were balanced regarding age, ECOG and tumor parameters like localization of the primary, of lymph nodes or cTN stage. Most pts in both arms received a subtotal or total gastrectomy. In 15 out of 20 arm B pts the HIPEC was 6 pts (30%) in Arm A and 7 pts (35%) in Arm B were seen with at least one SAE. Perioperative complications resulted in overall 7 SAEs in Arm A and in 4 SAEs in Arm B. One postoperative mortality (grade 5) was documented in Arm B due to septic complication. 11 pts showed no complications in both arms according to Clavien-Dindo-Classification. 6 pts in Arm A and 2 in Arm B showed grade 3. No patient was grade 4. Conclusions: The incidence of perioperative morbidity with surgical and/or medical complications were nearly equal in both treatment groups. The safety data showed no abnormalities or evidence increase in toxicity-rates including postoperative complications or increased severity of documented events within the experimental HIPEC arm. Clinical trial information: NCT04447352 .

Das Buch orientiert sich an den Weiterbildungsinhalten der Bundesärztekammer für die Zusatz-Weiterbildung Palliativmedizin.

In diesem Buch wird Marc Richirs Projekt einer Neugründung der Phänomenologie des Leibes und der Leiblichkeit untersucht. Dies ist ein Open-Access-Buch.