AktivMobil – ein betriebliches Gesundheitsprogramm

Background

Workplace health promotion programs (WHPP) are becoming increasingly important. AktivMobil is a behavioral preventive WHPP that was developed for an occupational group with increased work-related strain. This study aimed to elucidate the impact of the program, consisting of a check-up session and a subsequent 20-week virtual and 6?hour personal coaching, on health-related quality of life and physical activity.

Methods

Health-related quality of life and physical activity were quantified by the Short-Form Health Survey (SF-36) and the International Physical Activity Questionnaire (IPAQ) in a quasi-experimental, controlled trial. In all, 28 employees took part in the intervention and were compared to 20 employees without intervention.

Results

The physical component summary score, physical functioning, physical role functioning, pain, general health, vitality, social functioning, mental health and health transition improved significantly in the treatment group after 20 weeks. However, no significant effects were observed for total physical activity and leisure time physical activity. In addition, there was no significant difference between treatment and control subjects at the second evaluation point.

Conclusions

The findings speak for the effectiveness of AktivMobil on promoting health-related quality of life, which is also an indicator of absenteeism. However, the combination with work-related strategies should not be ignored.

     

Krankenheimtransport bei gynäkologischen Problemen und Schwangerschaftskomplikationen auf Reisen

The German Automobile Club (ADAC) offers car and health insurance for domestic and foreign travel and is thus confronted with a myriad of cases within Germany and abroad involving gynecology and obstetrics. Many of these acute problems arising during vacation or travel entail a hospital stay abroad or sometimes rather expensive transfer back to Germany for inpatient treatment. Depending on the severity of the illness and the clinical picture, complex problems often appear during transport, which require application of all medical possibilities extending even to intensive emergency care. Rapid return home is always aspired in cases of less than adequate treatment. When, however, the quality of care meets German standards, the risks involved for the patients during transportation should be weighed carefully. Many of the problems occurring during travel can already be solved and minimized by the local gynecologist.     

Design considerations for PET scanners.

In 2-D PET scanners employing septa, scattered radiation is reduced by the septa, placing less importance on good energy resolution. Additionally, the reduced sensitivity in 2-D limits the maximum countrates encountered in clinical FDG studies. In contrast, 3-D PET scanners rely on good energy resolution to reduce the scattered radiation and also must deal with countrates, which are typically 5 times higher than in 2-D mode. To achieve good energy resolution, 3 factors must be considered: 1) choice of a scintillator with good intrinsic energy resolution, 2) choice of a crystal dimension which transmits a uniform amount of light to the PMT in order to avoid light loss along the length of the crystal and 3) choice of a crystal-to-PMT coupling which collects a uniform amount of light from all crystals. As PET scanners are being designed using new, faster scintillators for 3-D imaging, the appropriate trade-off between energy resolution and countrate capability must be found to give the best overall system performance. An example of a fully 3-D PET scanner is the Allegro (ADAC Laboratories), which uses GSO as the detector material. Given the right choice of material and design parameters, good quality, high contrast images can be obtained in 3-D in a relatively short time.     

Geschichte der Notfallmedizin im Osten Deutschlands

As early as 1908 Dr. Paul Streffer, a physician from Leipzig, expressed his opinions at the International Congress for Rescue Services in Frankfurt/Main on medical assistance at the scene of accidents as well as the medical management of transport of patients to hospital. However, the development of civil emergency medical services was delayed by World War II. Afterwards physicians in a divided Germany tried to establish an on-site emergency care system and a system of transport of the injured to hospital. In the German Democratic Republic (GDR) the system practiced up to then was for the most part continued through regulations made in 1953. From 1967 onwards the system of emergency services was established through regulations made by the Ministry of Health of the GDR. Emergency medical care involving a system with emergency physicians was initially organized in densely populated industrial areas and later extended to other areas. At the 15th Conference of Health Ministers of the COMECON states in 1974 in Budapest, the “medical emergency” was generally defined and corresponding structures were established for all forms of medical requests for assistance ranging from urgent house visits to life-threatening emergencies. The structure of Rapid Medical Assistance with the elements of management, sections for medical assistance, for urgent house visits, for emergency pediatric assistance and transport of sick and injured by the Red Cross was rapidly established in the 1970s. In addition to the establishment of the emergency telephone number 115, there were unified fully equipped medical vehicles and a unified medical documentation system. After the reunification of Germany these features have only been partially incorporated into the total German concept.     

Luftgebundene Intensivverlegung in Bauchlage bei COVID-19-ARDS

Notfall + Rettungsmedizin - Ein ITH wird für einen Transport einer Patientin mit COVID-19-ARDS disponiert. Im abgebenden Krankenhaus wird die Patientin allerdings in Bauchlagerung vorgefunden....     

Sieben Punkte für sieben Minuten – Sieben-Punkte-Checkliste für ein medizinisches Briefing in der Luftrettung (7-4-7-Checkliste)

Notfall + Rettungsmedizin - Anfang September 2019 wurde ein neuer Dual-use-RTH/ITH-Standort in der Westpfalz etabliert. Während der Einarbeitung der medizinischen Crew entstand bei den Autoren...     

Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study

Background  

For patients' safety reasons, current American Heart Association and European Resuscitation Council guidelines recommend intraosseous (IO) vascular access as an alternative in cases of emergency, if prompt venous catheterization is impossible. The purpose of this study was to compare the IO access as a bridging procedure versus central venous catheterization (CVC) for in-hospital adult emergency patients under resuscitation with impossible peripheral intravenous (IV) access. We hypothesised, that CVC is faster and more efficacious compared to IO access.     

Vasopressin zur Therapie eines therapierefraktären traumatisch-hämorrhagischen Schocks

While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs. saline placebo IV (up to 3 injections at least 5 min apart) in patients with prehospital traumatic hemorrhagic shock that persists despite standard shock treatment. The study will be carried out by helicopter emergency medical service teams in Austria, Germany, Czech Republic, Portugal, the Netherlands and Switzerland. Inclusion criteria are adult trauma patients with presumed traumatic hemorrhagic shock (systolic arterial blood pressure <90 mmHg) that does not respond to the first 10 min of standard shock treatment (endotracheal intubation, fluid resuscitation and use of vasopressors) after arrival of the first emergency physician at the scene. The time window for randomization will close after 30 min of shock treatment. Exclusion criteria are terminal illness, no intravenous access, age <18 years, injury >60 min before randomization, cardiac arrest before randomization, presence of a do-not-resuscitate order, untreated tension pneumothorax, untreated cardiac tamponade, or known pregnancy. Primary study end-point is the hospital admission rate, secondary end-points are hemodynamic variables, fluid resuscitation requirements and hospital discharge rate.     

Requirements for a treatment planning system for radioimmunotherapy

Cancer-seeking antibodies carrying radionuclides can, in theory, be very powerful agents for the radiotherapy of cancer. However, as with all radiotherapy, the undesired dose to critical normal organs is the limiting factor that determines success or failure. The distribution of radiation dose in cancer and noncancer tissue is highly dependent on choices the therapist can make: choices of the antigens to be targeted, choices of the antibodies or antibody fragments to be used, choices of radionuclides, of amounts, of timing, and other electives. New technologies, especially of monoclonal antibody production, make the options myriad. Optimization of this therapy depends on a foreknowledge of the radiation dose distributions to be expected. The necessary data can be acquired by established tracer techniques, in individual patients, for particular treatment selections. These tracer techniques can now be implemented by advanced equipment for quantitative, tomographic radionuclide imaging and strengthened by dynamic modeling of the physiological parameters which govern radionuclide distribution, and hence radiation dose distribution.