Sylvia Siebig

Clinical impact of a commercially available multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis

BackgroundTimely identification of pathogens is crucial to minimize mortality in patients with severe infections. Detection of bacterial and fungal pathogens in blood by nucleic acid amplification promises to yield results faster than blood cultures (BC). We analyzed the clinical impact of a commercially available multiplex PCR system in patients with suspected sepsis.MethodsBlood samples from patients with presumed sepsis were cultured with the Bactec 9240™ system (Becton Dickinson, Heidelberg, Germany) and aliquots subjected to analysis with the LightCycler® SeptiFast® (SF) Test (Roche Diagnostics, Mannheim, Germany) at a tertiary care centre. For samples with PCR-detected pathogens, the actual impact on clinical management was determined by chart review. Furthermore a comparison between the time to a positive blood culture result and the SF result, based on a fictive assumption that it was done either on a once or twice daily basis, was made.ResultsOf 101 blood samples from 77 patients, 63 (62%) yielded concordant negative results, 14 (13%) concordant positive and 9 (9%) were BC positive only. In 14 (13%) samples pathogens were detected by SF only, resulting in adjustment of antibiotic therapy in 5 patients (7,7% of patients). In 3 samples a treatment adjustment would have been made earlier resulting in a total of 8 adjustments in all 101 samples (8%).ConclusionThe addition of multiplex PCR to conventional blood cultures had a relevant impact on clinical management for a subset of patients with presumed sepsis.

Intensive care unit alarms--how many do we need?

Objective: To validate cardiovascular alarms in critically ill patients in an experimental setting by generating a database of physiologic data and clinical alarm annotations, and report the current rate of alarms and their clinical validity. Currently, monitoring of physiologic parameters in critically ill patients is performed by alarm systems with high sensitivity, but low specificity. As a consequence, a multitude of alarms with potentially negative impact on the quality of care is generated. Design: Prospective, observational, clinical study. Setting: Medical intensive care unit of a university hospital. Data Source: Data from different medical intensive care unit patients were collected between January 2006 and May 2007. Measurements and Main Results: Physiologic data at 1-sec intervals, monitor alarms, and alarm settings were extracted from the surveillance network. Video recordings were annotated with respect to alarm relevance and technical validity by an experienced physician. During 982 hrs of observation, 5934 alarms were annotated, corresponding to six alarms per hour. About 40% of all alarms did not correctly describe the patient condition and were classified as technically false; 68% of those were caused by manipulation. Only 885 (15%) of all alarms were considered clinically relevant. Most of the generated alarms were threshold alarms (70%) and were related to arterial blood pressure (45%). Conclusion: This study used a new approach of off-line, video-based physician annotations, showing that even with modern monitoring systems most alarms are not clinically relevant. As the majority of alarms are simple threshold alarms, statistical methods may be suitable to help reduce the number of false-positive alarms. Our study is also intended to develop a reference database of annotated monitoring alarms for further application to alarm algorithm research.

Reducing False Alarms of Intensive Care Online-Monitoring Systems: An Evaluation of Two Signal Extraction Algorithms

Online-monitoring systems in intensive care are affected by a high rate of false threshold alarms. These are caused by irrelevant noise and outliers in the measured time series data. The high false alarm rates can be lowered by separating relevant signals from noise and outliers online, in such a way that signal estimations, instead of raw measurements, are compared to the alarm limits. This paper presents a clinical validation study for two recently developed online signal filters. The filters are based on robust repeated median regression in moving windows of varying width. Validation is done offline using a large annotated reference database. The performance criteria are sensitivity and the proportion of false alarms suppressed by the signal filters.

Cardiac Arrest: Composition of Resuscitation Teams and Training Techniques: Results of a Hospital Survey in German-Speaking Countries

BACKGROUND The long-term outcome of patients requiring cardiopulmonary resuscitation depends heavily on swift and appropriate care. The aim of this study was to obtain data on the composition and training of resuscitation teams in specialist departments for internal medicine and anesthesiology. METHODS Between October 2006 and February 2007, 440 questionnaires were sent to departments for anesthesiology and internal medicine in Germany (hospitals with more than 300 beds) and to university hospitals in Switzerland and Austria. RESULTS The response rate was 38%. Of 166 participating hospitals, 152 have an emergency team. Resuscitation training (RT) takes place in 111 hospitals. Ninety-two hospitals (55%) hold a course more than once a year. Of those hospitals with RT, 86% use a simulation dummy, 77% conduct theoretical tutorials, and 65% follow a fixed algorithm. CONCLUSION The majority of hospitals that participated in this survey have an emergency team in place and organize resuscitation training for their medical personnel. The training varies greatly, however, in frequency, size of group, and qualification of the trainer. Implementation of standardized training for and management of in-hospital resuscitation measures might further hone staff skills and therefore improve the long-term outcome for the patients concerned.

Noise in intensive care units. Do the alarms for subspecialties differ

INTRODUCTION Cardiovascular monitoring alarms are frequent in intensive care units (ICUs) and lead to noise levels often exceeding 80 dB. The aim of this study was to evaluate if there are relevant differences between ICUs with different subspecialties in the frequency and distribution of alarm signals, their occurrence during the day, the types of alarms and the underlying vital parameters. METHODS All alarm signals of the cardiovascular monitoring systems from randomly chosen patients at five different ICUs of the university hospital of Regensburg were evaluated. RESULTS No significant differences between the ICUs regarding the frequency of alarm signals and only slight differences in the time distribution could be recognized (p=0.02). The most frequent alarm signals were from threshold alarms (61%) followed by technical alarms. The majority of alarms generated were related to invasive arterial blood pressure measurement. CONCLUSIONS The frequency and distribution of ICU alarm signals seem to be comparable on different ICUs. Therefore, implementation of universal concepts for alarm reduction seems to be applicable regardless of the subspecialty of the ICU.

[Congress of the German Society of Internal Medicine 2009: evaluation of the poster exhibition].

BACKGROUND AND PURPOSE The presentation of scientific posters gives young scientists the opportunity to present their data in the setting of a medical congress. In preparation of the organization of the 116th Congress of the German Society of Internal Medicine (DGIM) 2010, the authors evaluated the poster rounds at the 115th Congress of the DGIM 2009 by using a questionnaire that was given to poster presenters, poster chairmen, and visitors. The authors sought to receive an instructive criticism for the organization in 2010. METHODS Distribution of questionnaires containing ten questions with preformulated response options and an additional field for further comments to all presenters, chairmen, and visitors of the poster rounds during the 115th Congress of the DGIM (April 2009). RESULTS 159 questionnaires were returned and evaluated. Almost all respondents quoted the poster presentation as being important for their scientific work (98%). In general, they were satisfied with the discussion at the poster rounds (83%). The amount of posters within one round was criticized by 41%, as was the inadequate adherence to time constraints and time frame and room conditions themselves. CONCLUSION The poster exhibition of the 115th Congress of the DGIM 2009 was evaluated positively by most of the respondents to the survey. Nevertheless, helpful hints were retrieved as how to further improve poster rounds. They should be respected when planning the exhibition at the congress in 2010.ZusammenfassungHintergrund und Ziel:Die Präsentation von Postern bietet insbesondere jungen Wissenschaftlern die Möglichkeit, ihre Forschungsergebnisse auf einem medizinischen Kongress vorzustellen. Im Rahmen der eigenen Arbeit als Mitorganisatoren des 116. Kongresses der Deutschen Gesellschaft für Innere Medizin (DGIM) 2010 suchten die Autoren mit Hilfe einer Fragebogenerhebung die Zufriedenheit sowohl der Posterpräsentierenden, der Besucher als auch der Vorsitzenden der Posterdiskussionen des 115. Kongresses der DGIM 2009 zu evaluieren, um entsprechend den geäußerten Kritikpunkten Impulse für die Gestaltung im Jahr 2010 zu erlangen.Methodik:Verteilung von Fragebögen mit zehn geschlossenen Fragen bzw. der Möglichkeit zur Kritikäußerung in Form von Freitexten an alle Posterpräsentierenden, Besucher sowie Vorsitzenden der Posterdiskussion während des 115. Kongresses der DGIM (April 2009).Ergebnisse:159 Fragebögen wurden abgegeben und entsprechend ausgewertet. Nahezu alle Teilnehmer der Umfrage empfanden die Präsentation von Postern auf dem Kongress der DGIM als wichtig für ihre wissenschaftliche Arbeit (98%) und zeigten sich zufrieden mit der Posterdiskussion (83%). Kritik wurde insbesondere an der Quantität der Poster pro Diskussionsrunde (41%) und in Form von Freitexten an der Zeitüberschreitung der Begehung sowie der räumlichen und zeitlichen Organisation geäußert.Schlussfolgerung:Die Posterausstellung im Rahmen des 115. Kongresses der DGIM 2009 wurde von den meisten Teilnehmern der Fragebogenerhebung positiv bewertet, so dass hilfreiche Impulse für ihre weitere wissenschaftliche Arbeit geschöpft werden konnten. Kritikpunkte an der Ausstellung sollten in der Planung des Kongresses 2010 entsprechend berücksichtigt werden.AbstractBackground and Purpose:The presentation of scientific posters gives young scientists the opportunity to present their data in the setting of a medical congress. In preparation of the organization of the 116th Congress of the German Society of Internal Medicine (DGIM) 2010, the authors evaluated the poster rounds at the 115th Congress of the DGIM 2009 by using a questionnaire that was given to poster presenters, poster chairmen, and visitors. The authors sought to receive an instructive criticism for the organization in 2010.Methods:Distribution of questionnaires containing ten questions with preformulated response options and an additional field for further comments to all presenters, chairmen, and visitors of the poster rounds during the 115th Congress of the DGIM (April 2009).Results:159 questionnaires were returned and evaluated. Almost all respondents quoted the poster presentation as being important for their scientific work (98%). In general, they were satisfied with the discussion at the poster rounds (83%). The amount of posters within one round was criticized by 41%, as was the inadequate adherence to time constraints and time frame and room conditions themselves.Conclusion:The poster exhibition of the 115th Congress of the DGIM 2009 was evaluated positively by most of the respondents to the survey. Nevertheless, helpful hints were retrieved as how to further improve poster rounds. They should be respected when planning the exhibition at the congress in 2010.

Lärm auf der Intensivstation

INTRODUCTION Cardiovascular monitoring alarms are frequent in intensive care units (ICUs) and lead to noise levels often exceeding 80 dB. The aim of this study was to evaluate if there are relevant differences between ICUs with different subspecialties in the frequency and distribution of alarm signals, their occurrence during the day, the types of alarms and the underlying vital parameters. METHODS All alarm signals of the cardiovascular monitoring systems from randomly chosen patients at five different ICUs of the university hospital of Regensburg were evaluated. RESULTS No significant differences between the ICUs regarding the frequency of alarm signals and only slight differences in the time distribution could be recognized (p=0.02). The most frequent alarm signals were from threshold alarms (61%) followed by technical alarms. The majority of alarms generated were related to invasive arterial blood pressure measurement. CONCLUSIONS The frequency and distribution of ICU alarm signals seem to be comparable on different ICUs. Therefore, implementation of universal concepts for alarm reduction seems to be applicable regardless of the subspecialty of the ICU.

Qualitätsmanagement: Implementierung des In-Hospital -Notfallprotokolls in die klinische Praxis

ZusammenfassungHintergrund und Ziel:Die Überlebensrate nach einer stattgehabten Reanimation im Krankenhaus liegt nach wie vor bei nur 14–17%. Die Dokumentation dieser „In-Hospital“-Notfallsituation (IHN) erscheint dabei gerade im deutschsprachigen Raum lückenhaft und inhomogen. Eine Optimierung der IHN-Aufzeichnung könnte neben der Komplettierung der Informationen für die Patientenweiterversorgung auch helfen, mögliche organisatorische und strukturelle Probleme zu erkennen, um so ein verbessertes Patientenoutcome zu ermöglichen. Zielsetzung dieser Erhebung war es, nach Implementierung eines von den Autoren in enger Anlehnung an das DIVI-Notarztprotokoll (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) entwickelten IHN-Protokoll alle Einsätze des internistischen Notfallteams (NT) über einen Zeitraum von 40 Monaten auszuwerten. Dabei sollte geklärt werden, inwieweit diese Dokumentationsform die notwendigen Fakten der IHN adäquat widerspiegelt, wie die Akzeptanz dieser zusätzlichen Dokumentation ist und inwiefern eine Qualitätsverbesserung der IHN-Dokumentation verzeichnet werden kann.Methodik:Analyse aller verfügbaren Protokolle der NT-Einsätze zur IHN zwischen August 2004 und Dezember 2007 (n = 65) sowie Auswertung der Entlassarztbriefe (EB) der jeweiligen Patienten.Ergebnisse:In 65% aller NT-Einsätze fand eine Dokumentation mit Hilfe des IHN-Protokolls statt. Im Mittel wurden 80% der vorgegebenen Protokollinhalte dokumentiert, wobei die Medikamente, deren Dosierung und der Zusammenhang der Applikation im zeitlichen Verlauf der IHN nur unzureichend dokumentiert wurden (77% lückenhafte Angaben). 25% der EB enthielten keinerlei Angaben über die IHN.Schlussfolgerung:Der Einsatz des IHN-Protokolls erscheint geeignet, um die aus medizinischer und forensischer Sicht erforderlichen Daten der IHN adäquat zu dokumentieren. In Anbetracht der Tatsache, dass die IHN im EB eines Patienten teilweise gar nicht erwähnt wurde, verbesserten sich die hausinterne Qualität und Vollständigkeit der Dokumentation durch die Einführung des IHN-Protokolls deutlich. Das „Vorfinden“ eines solchen Protokolls in der Patientenakte sollte zukünftig zur vermehrten Erwähnung der IHN in der Entlassungsdokumentation führen.AbstractBackground and Purpose:Outcome after in-hospital resuscitation with survival rates between 14–17% still remains poor. Structured documentation of in-hospital cardiac arrest especially in Germany is rare and inhomogeneous. Documentation of in-hospital emergency situations (I-ES) may help to develop organizational structures, to collect information of treatment after resuscitation and therefore, improve patient’s outcome. The aim of this study was to evaluate the documentation quality and user’s acceptance after the implementation of an in-house emergency (IHE) protocol used by the authors’ internal medicine emergency team (ET).Methods:Analysis of IHE protocols and discharge letters of 65 patients between August 2004 and December 2007 at a university medical center.Results:The IHE protocol was used in 65% of all emergency calls with a completion rate of 80% of all available documentation categories. Especially documentation of drugs given, their dosage and the general course of action was incomplete. In 25% the discharge letters did not contain information about the I-ES.Conclusion:Implementation of the authors’ IHE protocol, designed in close accordance with the DIVI (German Interdisciplinary Association of Intensive Care and Emergency Medicine) out-of-hospital emergency protocol, helps to collect important data in I-ES. Usage of the protocol resulted in better documentation of emergency situations in contrast to the information found in discharge letters alone. Nevertheless, documentation of I-ES still needs to be improved, especially concerning the completeness of records.

Kongress der Deutschen Gesellschaft für Innere Medizin 2009: Evaluation der Posterausstellung

BACKGROUND AND PURPOSE The presentation of scientific posters gives young scientists the opportunity to present their data in the setting of a medical congress. In preparation of the organization of the 116th Congress of the German Society of Internal Medicine (DGIM) 2010, the authors evaluated the poster rounds at the 115th Congress of the DGIM 2009 by using a questionnaire that was given to poster presenters, poster chairmen, and visitors. The authors sought to receive an instructive criticism for the organization in 2010. METHODS Distribution of questionnaires containing ten questions with preformulated response options and an additional field for further comments to all presenters, chairmen, and visitors of the poster rounds during the 115th Congress of the DGIM (April 2009). RESULTS 159 questionnaires were returned and evaluated. Almost all respondents quoted the poster presentation as being important for their scientific work (98%). In general, they were satisfied with the discussion at the poster rounds (83%). The amount of posters within one round was criticized by 41%, as was the inadequate adherence to time constraints and time frame and room conditions themselves. CONCLUSION The poster exhibition of the 115th Congress of the DGIM 2009 was evaluated positively by most of the respondents to the survey. Nevertheless, helpful hints were retrieved as how to further improve poster rounds. They should be respected when planning the exhibition at the congress in 2010.ZusammenfassungHintergrund und Ziel:Die Präsentation von Postern bietet insbesondere jungen Wissenschaftlern die Möglichkeit, ihre Forschungsergebnisse auf einem medizinischen Kongress vorzustellen. Im Rahmen der eigenen Arbeit als Mitorganisatoren des 116. Kongresses der Deutschen Gesellschaft für Innere Medizin (DGIM) 2010 suchten die Autoren mit Hilfe einer Fragebogenerhebung die Zufriedenheit sowohl der Posterpräsentierenden, der Besucher als auch der Vorsitzenden der Posterdiskussionen des 115. Kongresses der DGIM 2009 zu evaluieren, um entsprechend den geäußerten Kritikpunkten Impulse für die Gestaltung im Jahr 2010 zu erlangen.Methodik:Verteilung von Fragebögen mit zehn geschlossenen Fragen bzw. der Möglichkeit zur Kritikäußerung in Form von Freitexten an alle Posterpräsentierenden, Besucher sowie Vorsitzenden der Posterdiskussion während des 115. Kongresses der DGIM (April 2009).Ergebnisse:159 Fragebögen wurden abgegeben und entsprechend ausgewertet. Nahezu alle Teilnehmer der Umfrage empfanden die Präsentation von Postern auf dem Kongress der DGIM als wichtig für ihre wissenschaftliche Arbeit (98%) und zeigten sich zufrieden mit der Posterdiskussion (83%). Kritik wurde insbesondere an der Quantität der Poster pro Diskussionsrunde (41%) und in Form von Freitexten an der Zeitüberschreitung der Begehung sowie der räumlichen und zeitlichen Organisation geäußert.Schlussfolgerung:Die Posterausstellung im Rahmen des 115. Kongresses der DGIM 2009 wurde von den meisten Teilnehmern der Fragebogenerhebung positiv bewertet, so dass hilfreiche Impulse für ihre weitere wissenschaftliche Arbeit geschöpft werden konnten. Kritikpunkte an der Ausstellung sollten in der Planung des Kongresses 2010 entsprechend berücksichtigt werden.AbstractBackground and Purpose:The presentation of scientific posters gives young scientists the opportunity to present their data in the setting of a medical congress. In preparation of the organization of the 116th Congress of the German Society of Internal Medicine (DGIM) 2010, the authors evaluated the poster rounds at the 115th Congress of the DGIM 2009 by using a questionnaire that was given to poster presenters, poster chairmen, and visitors. The authors sought to receive an instructive criticism for the organization in 2010.Methods:Distribution of questionnaires containing ten questions with preformulated response options and an additional field for further comments to all presenters, chairmen, and visitors of the poster rounds during the 115th Congress of the DGIM (April 2009).Results:159 questionnaires were returned and evaluated. Almost all respondents quoted the poster presentation as being important for their scientific work (98%). In general, they were satisfied with the discussion at the poster rounds (83%). The amount of posters within one round was criticized by 41%, as was the inadequate adherence to time constraints and time frame and room conditions themselves.Conclusion:The poster exhibition of the 115th Congress of the DGIM 2009 was evaluated positively by most of the respondents to the survey. Nevertheless, helpful hints were retrieved as how to further improve poster rounds. They should be respected when planning the exhibition at the congress in 2010.

Entwicklung einer Eingabemaske für die Erfassung klinischer Annotationen

Im Rahmen des Projektes ?Zeitreihenanalytische Methoden zur Behandlung von Online-Monitoring-Daten aus der Intensivmedizin? im Sonderforschungsbereich 475 wird eine klinische Studie zur Evaluierung und zum Vergleich von Alarm-Algorithmen fur die Patientenuberwachung auf Intensivstationen durchgefuhrt. Die Studie erhebt klinisch annotierte Daten. Die durch ein Monitoringgerat aufgezeichneten Patientendaten fur die Vitalparameter und die aufgetretenen Alarme werden dazu retrospektiv analysiert. Alle Annotationen werden mit Hilfe einer speziell zu diesem Zweck entwickelten Eingabemaske erfasst, die in dieser Arbeit beschrieben wird.