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Introduction SSC-CIP (secondary sclerosing cholangitis in critically ill patients) is characterized by biliary tract destruction after long intensive care treatment. Hypotension and vasopressor therapy are main risk factors. Increased prevalence of SSC-CIP occurred in patients with COVID-19 ARDS that were treated by endoscopic retrograde cholangiography (ERC). Aims The aim of the study was to analyze clinical, laboratory, microbiological and endoscopic fndings of patients with SSC-CIP with COVID-19 ARDS. Methods Data of 17 patients with SSC-CIP with COVID-19 ARDS between February 2020 and August 2022 were analyzed retrospectively. The focus was on endoscopic fndings, laboratory and microbiological values and on clinical parameters and potential risk factors during COVID-19 ARDS. Results 14 male and 3 female patients were included. The mean age was 60 years (range 40-76). All patients were mechanically ventilated, 11 patients were treated with ECMO. All patients required catecholamine therapy but only low dosed when compared with other septic conditions. On average 2.6 ERCs were performed. Biliary casts were found in 94 % of the patients and rarefcation of the intrahepatic bile ducts in 50 %. Bile duct stenosis was detected in 3 patients. Casts were extracted and stenoses were dilated. 13 patients died, 4 patients are in follow-up with repeated endoscopic intervention and re-evaluation in regard to liver transplantation. Discussion Mortality rate in patients with SSC-CIP with COVID-19 ARDS is high. Vasopressor therapy and hypotension was not prominent in this cohort. Endo-scopic treatment may improve liver function, however these patients must be evaluated for liver transplantation.
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COVID-19 is a systemic disease afecting the liver to a crucial extent. This study investigates the impact of COVID-19 on the liver and possible early prognostic markers for the development of secondary sclerosing cholangitis (SSC). This rising complication in critically ill patients, also occurs after a severe COVID-19 infection. Early prediction for SSC has not been sufciently investigated yet. 258 patients at intensive care unit (ICU) at the University Hospital of Regensburg were divided into groups depending on their medical history of preexisting liver diseases. Collected laboratory parameters during ICU comprised both baseline values, and worst values developed during hospitalization and were used to assess the rate of mortality between the different groups of patients. Development of SSC was evaluated against the baseline values. Preexisting liver disease increased mortality rate from 39.3 % to 52.6 %. In both groups, mortality correlated signifcantly with an increase in liver values during ICU stay. High baseline values of Bilirubin (P = .002) or INR (P = .018) also correlated with mortality independently of preexisting liver diseases. The risk of developing SSC increased with high liver enzymes and correlated signifcantly (P = .004) with high AP levels at admission. This study shows the high impact of COVID-19 on the liver and biliary system and possible complications in patients with and without preexisting liver diseases. Bilirubin and INR can be used as predictive factors regarding mortality. AP can be considered as an early predictor for development of SSC in patients with COVID-19 and could hint to optimized treatment strategies regarding ventilation and sedation.
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Background and Aims Since 2015, the medical intensive care unit (ICU) with a focus on hepatology of the Department of Internal Medicine 1 at the University Hospital Regensburg, Germany, has a particular emphasis on interprofessional collaboration with staf nurses and hospital pharmacists. Furthermore, there is a joint training and teaching of medical, nursing and pharmacy students within the intensive care training ward Regensburg (I'M A-STAR project). The study aims to investigate to what extent the newly introduced structural changes afect clinical and economic outcomes. Method We examined clinical performance data and consumption fgures for antibiotics and other drugs over a 10-year period from 2011 to 2021. An electronic platform was developed specifically to improve documentation. The years 2020 and 2021 were considered separately due to the COVID-19 pandemic and the care of numerous COVID-19 patients in the ICU. Results It could be shown that the pharmacist's recommendations regarding drug administration were mainly related to indication (43.6 %), dosage (27.6 %), interactions (9.4 %), and side effects (4.1 %). Antibiotic consumption was reduced by 12.2 % from 2015 to 2019. Encouragingly, this included a 23.4 % reduction in carbapenem use. Antibiotic spending was reduced by 24.9 % overall. In another analysis, antibiotic spending per case-mix point was calculated. While spending was EUR 60.22 per case-mix point in 2015, this could be reduced by 42.9 % to EUR 34.37 per case-mix point by 2019. Conclusion Through close interprofessional collaboration between physicians, staf nurses, and pharmacists, the consumption of antibiotics and other drugs was signifcantly reduced, thus improving patient care.
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Most psychological studies focused on how people reason about generative causation, in which a cause produces an effect. We here study the prevention of effects both on the general and singular level. A general prevention query might ask how strongly a vaccine is expected to reduce the risk of contracting COVID-19, whereas a singular prevention query might ask whether the absence of COVID-19 in a specific vaccinated person actually resulted from this person’s vaccination. We propose a computational model answering how knowledge about the general strength of a preventive cause can be used to assess whether a preventive link is instantiated in a singular case. We also discuss how psychological models of causal strength learning relate to mathematical models of vaccination efficacy used in medical research. The results of an experiment suggest that many, but not all people differentiate between preventive strength and singular prevention queries, in line with the formal model. © Cognitive Science Society: Comparative Cognition: Animal Minds, CogSci 2021.All rights reserved.
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Background and aims: Since 2015, the medical intensive care unit (ICU) with a focus on hepatology of the Department of Internal Medicine 1 at the University Hospital Regensburg, Germany, has a particular emphasis on interprofessional collaboration with staff nurses and hospital pharmacists. The hospital pharmacists have access to the hospital information system and the electronic charting program. Consultations take place on daily basis. Furthermore, weekly joint rounds within the antibiotic stewardship program are performed. Furthermore, there is a joint training and teaching of medical, nursing and pharmacy students within the intensive care training ward Regensburg (I’M A-STAR project). The study aims to investigate to what extent the newly introduced structural changes affect clinical and economic outcomes. Method: We examined clinical performance data and consumption figures for antibiotics and other drugs over a 10-year period from 2011 to 2021. Data from the hospital pharmacy, hospital administration, electronic charting, and hospital information systems were included in the analyses. An electronic platform was developed specifically to improve documentation. The years 2020 and 2021 were considered separately due to the COVID-19 pandemic and the care of numerous COVID-19 patients in the ICU. Results: It could be shown that the pharmacist’s recommendations regarding drug administration were mainly related to indication (43.6%), dosage (27.6%), interactions (9.4%), and side effects (4.1%). Antibiotic consumption was reduced by 12.2% from 2015 to 2019. Encouragingly, this included a 23.4% reduction in carbapenem use. Antibiotic spending was reduced by 24.9% overall. An analysis of the intensive care G-DRGs showed that the case-mix points increased significantly by 31.6% during the period under review. Similarly, patient severity of illness as measured by the SAPS II score increased by 21.4%. The proportion of mechanically ventilated patients exceeded 50%. In another analysis, antibiotic spending per case-mix point was calculated. While spending was EUR 60.22 per case-mix point in 2015, this could be reduced by 42.9% to EUR 34.37 per case-mix point by 2019. Conclusion: Through close interprofessional collaboration between physicians, staff nurses, and pharmacists, the consumption of antibiotics and other drugs (e.g., albumin) was significantly reduced, thus improving patient care. There was also a positive economic effect-with a simultaneous increase in case-mix points, expenditure on antibiotics was significantly reduced. Responsible use of resources and high-performance medicine are not contradictory. In our view, a close interprofessional collaboration between physicians, staff nurses, and pharmacists will be of outstanding importance in the future, particularly in intensive care medicine.
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OBJECTIVES: The novel severe acute respiratory syndrome coronavirus 2 pandemic continues to spread globally without an effective treatment. In search of the cure, convalescent plasma (CP) containing protective antibodies from survivors of coronavirus disease 2019 (COVID-19) infection has shown potential benefit in a non-intensive care unit setting. We sought to evaluate the effectiveness of CP therapy for patients with COVID-19 on mechanical ventilation (MV) and/or acute respiratory distress syndrome (ARDS). METHODS: We conducted an open-label trial in a single center, Royal Hospital, in Oman. The study was conducted from 17 April to 20 June 2020. The trial included 94 participants with laboratory-confirmed COVID-19. The primary outcomes included extubation rates, discharges from the hospital and overall mortality, while secondary outcomes were the length of stay and improvement in respiratory and laboratory parameters. Analyses were performed using univariate statistics. RESULTS: The overall mean age of the cohort was 50.0±15.0 years, and 90.4% (n = 85) were males. A total of 77.7% (n = 73) of patients received CP. Those on CP were associated with a higher extubation rate (35.6% vs. 76.2%; p < 0.001), higher extubation/home discharges rate (64.4% vs. 23.8%; p =0.001), and tendency towards lower overall mortality (19.2% vs. 28.6%; p =0.354; study power = 11.0%) when compared to COVID-19 patients that did not receive CP. CONCLUSIONS: CP was associated with higher extubation/home discharges and a tendency towards lower overall mortality when compared to those that did not receive CP in COVID-19 patients on MV or in those with ARDS. Further studies are warranted to corroborate our findings.