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in English, German Die Übersichtarbeit fasst die aktuellen Erkenntnisse der Auswirkung der COVID-19 Pandemie für die Arbeit der HNO-Ärztin und des HNO-Arztes zusammen. Die aktuell diskutierte Rolle einer Anosmie oder Hyposmie als COVID-19 assoziiertes Symptom wird dargestellt. Wir diskutieren das klinische Management aller HNO-Fälle, aber insbesondere von COVID-19 erkrankten Patienten aus Sicht der HNO-Heilkunde. Ein besonderes Augenmerk gilt den Auswirkungen auf die HNO-Untersuchung und auf HNO-ärztliche Operationen.BACKGROUND Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores. METHODS During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores. RESULTS Overall, total daily EHR usage time (median time [hhmm] [25th, 75th percentile]) was 210 (131, 308). For all hours (8 a.m.-8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric eme Verlag KG Stuttgart · New York.BACKGROUND Sepsis is an uncontrolled inflammatory reaction caused by infection. Clinicians in the pediatric intensive care unit (PICU) developed a paper-based tool to identify patients at risk of sepsis. To improve the utilization of the tool, the PICU team integrated the paper-based tool as a real-time clinical decision support (CDS) intervention in the electronic health record (EHR). OBJECTIVE This study aimed to improve identification of PICU patients with sepsis through an automated EHR-based CDS intervention. METHODS A prospective cohort study of all patients admitted to the PICU from May 2017 to May 2019. A CDS intervention was implemented in May 2018. The CDS intervention screened patients for nonspecific sepsis criteria, temperature dysregulation and a blood culture within 6 hours. Following the screening, an interruptive alert prompted nursing staff to complete a perfusion screen to assess for clinical signs of sepsis. The primary alert performance outcomes included sensitivity, specificity, and positive and negative predictive value. The secondary clinical outcome was completion of sepsis management tasks. RESULTS During the 1-year post implementation period, there were 45.0 sepsis events per 1,000 patient days over 10,805 patient days. The sepsis alert identified 392 of the 436 sepsis episodes accurately with sensitivity of 92.5%, specificity of 95.6%, positive predictive value of 46.0%, and negative predictive value of 99.7%. Examining only patients with severe sepsis confirmed by chart review, test characteristics fell to a sensitivity of 73.3%, a specificity of 92.5%. Prior to the initiation of the alert, 18.6% (13/70) of severe sepsis patients received recommended sepsis interventions. Following the implementation, 34% (27/80) received these interventions in the time recommended, p = 0.04. CONCLUSION An EHR CDS intervention demonstrated strong performance characteristics and improved completion of recommended sepsis interventions. Georg Thieme Verlag KG Stuttgart · New York.OBJECTIVES The objective of this study was to establish the reliability and content validity of the "Modified Naranjo Criteria for Homeopathy-Causal Attribution Inventory" as a tool for attributing a causal relationship between the homeopathic intervention and outcome in clinical case reports. METHODS Purposive sampling was adopted for the selection of information-rich case reports using pre-defined criteria. Eligible case reports had to fulfil a minimum of nine items of the CARE Clinical Case Reporting Guideline checklist and a minimum of three of the homeopathic HOM-CASE CARE extension items. The Modified Naranjo Criteria for Homeopathy Inventory consists of 10 domains. click here Inter-rater agreement in the scoring of these domains was determined by calculating the percentage agreement and kappa (κ) values. A κ greater than 0.4, indicating fair agreement between raters, in conjunction with the absence of concerns regarding the face validity, was taken to indicate the validity of a given domain. Each domain was assia have been proposed for the assessment tool, under the new acronym "MONARCH". Further assessment of two MONARCH domains is required. The Faculty of Homeopathy.in English, German HINTERGRUND Die Schnittführung für den Zugangsweg bei der Versorgung mit Cochlea-Implantaten und aktiven Mittelohrimplantaten wie Vibrant Soundbridge und Bonebridge hat sich in den letzten Jahren in Richtung minimalinvasiver Zugangswege entwickelt.Für das aktive Mittelohrimplantat CARINA wird eine im Vergleich deutlich größere Schnittführung empfohlen, die der der CI-Versorgung vor ca. 2 Jahrzehnten entspricht.Hierdurch sind erhöhte Komplikationsraten durch die exzessive Schnittführung zu erwarten. METHODEN Um die Komplikationsrate bei der CARINA-Versorgung zu minimieren, wurde die Möglichkeit der minimalinvasiven Schnittführung auch für dieses Implantat überdacht und entwickelt. ERGEBNISSE Bisher konnten 4 Patienten mit der minimalinvasiven Schnittführung unter 5 cm Länge erfolgreich und ohne postoperative Komplikationen mit einem CARINA-Implantat versorgt werden. SCHLUSSFOLGERUNGEN Durch eine Optimierung der Fixierung, z. B. durch den Einsatz selbstschneidender Schrauben, kann dieser Zugangsweg als Standard etabliert werden.Derangements in phosphate and calcium homeostasis are common in patients with beta-thalassemia. Fibroblast growth factor 23 (FGF23) is among the main hormones regulating phosphate levels, while several studies underline an interplay between iron (Fe) and FGF23. Herein, we investigated, for the first time, the serum intact molecule (iFGF23) and the carboxyl-terminal fragment (C-FGF23) and Klotho levels simultaneously in patients with beta-thalassemia major receiving iron chelation regimens in comparison to healthy control subjects. We also correlated them with the body iron burden. The observational case-control study included 81 subjects (40 thalassemic patients and 41 healthy controls). Serum iFGF23, C-FGF23 and Κlotho were measured by ELISA. Parathormone, 25-hydroxycholecalciferol, calcium, and phosphorus were measured in blood and/or urine. The degree of hemosiderosis was evaluated by assessing the serum ferritin levels and performing T2* MRI measurements. Serum C-FGF23 levels were significantly lower in patients compared to control subjects (p=0.
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