[The abdominal pain unit as a treatment pathway : Structured care of patients with atraumatic abdominal pain in the emergency department]. / Die Abdominal Pain Unit als Behandlungspfad : Strukturierte Versorgung von Patient*innen mit atraumatischen Bauchschmerzen in der Notaufnahme.

BACKGROUND: Patients with atraumatic abdominal pain are common in the emergency department and have a relatively high hospital mortality, with a very wide spectrum of different causes. Rapid, goal-directed diagnosis is essential in this context. METHODS: In a Delphi process with representatives of different disciplines, a diagnostic treatment pathway was designed, which is called the Abdominal Pain Unit (APU). RESULTS: The treatment pathway was designed as an extended event process chain. Crucial decision points were specified using standard operating procedures. DISCUSSION: The APU treatment pathway establishes a consistent treatment structure for patients with atraumatic abdominal pain. It has the potential to improve the quality of care and reduce intrahospital mortality over the long term.

The Abdominal Pain Unit (APU). Study protocol of a standardized and structured care pathway for patients with atraumatic abdominal pain in the emergency department: A stepped wedged cluster randomized controlled trial.

This study aims to improve emergency department (ED) care for patients suffering from atraumatic abdominal pain. An application-supported pathway for the ED will be implemented, which supports quick, evidence-based, and standardized diagnosis and treatment steps for patients with atraumatic abdominal pain at the ED. A mixed-methods multicentre cluster randomized controlled stepped wedge trial design will be applied. A total of 10 hospitals with EDs (expected n = 2.000 atraumatic abdominal pain patients) will consecutively (every 4 months) be randomized to apply the intervention. Inclusion criteria for patients are a minimum age of 18 years, suffering from atraumatic abdominal pain and being insured with a German statutory health insurance. Primary outcomes: acute pain score at time of discharge from ED, duration of treatment at the ED, patient-reported satisfaction. Secondary endpoints include patient safety and quality of care parameters, process evaluation parameters, and costs and cost-effectiveness parameters. Quantitative data will be gathered from patient-surveys, clinical records, and routine data from hospital information systems as well as from a participating German statutory health insurance. Descriptive and analytic statistical analysis will be performed to provide summaries and associations for primary patient-reported outcomes, process measures, quality measures, and costs. Qualitative data collection consists of participatory patient observations and semi-structured expert interviews, which will be inductively analysed. Findings will be disseminated in publications in peer-reviewed journals, on conferences, as well as via a project website. To ensure data protection, appropriate technical and organisational measures will be taken. Trial registration: DRKS00021052.

Relationship between Discharge and River Plastic Concentrations in a Rural and an Urban Catchment.

Rivers play a major role in the transport of plastic debris from inland sources such as urban areas into the marine environment. The present study examined plastic particle concentrations and loads (>500 µm) upstream and downstream of an urban subcatchment over 15 months and investigated the relationship between river water discharge (Q) and plastic concentration (C). The plastic particle concentration increases by 0.8 g/1000 m3 or 79 n/1000m3 from the rural to the urban subcatchment. In the rural subcatchment, C does not increase with increasing Q (p = 0.57), whereas a positive relationship between C and Q exists downstream of the urban catchment (p = 0.00003). Combined sewer overflows likely contribute additional plastic loads during high flow conditions. Based on the C-Q relationship, we estimate the total plastic export in 2016 from the entire catchment to be 3.0 × 106 n/year or 2.6 × 104 n/(km2 year) and 15 n/(cap year). Because of the positive C-Q relationship, 90% of the plastic load is transported during 20% of the time. The analysis of time-resolved plastic concentration data in rivers provides a data-driven tool to better estimate plastic loads and to better understand the catchment controls of plastic in rivers.