[Triage, screening, and assessment of geriatric patients in the emergency department]. / Triage, Screening und Assessment des alten Menschen in der Notaufnahme.

BACKGROUND: Geriatric patients are increasingly dominating the daily routine in German emergency departments (ED). With their typical characteristics multimorbidity, polypharmacy, vulnerability, frailty and cognitive impairment, especially delirium, they are a special challenge for the processes in the ED. Though some emergency physician might consider "the old patient" as not exciting, there is a broad consensus that pragmatic geriatric screening tools are required. This consensus exists not only among the medical societies but also within the German Society for Emergency Medicine itself. In this article the characteristics of the geriatric patient, the pitfalls of triage systems and the difficulties to screen geriatric patients in a sensible manner are described. DISCUSSION: The common triage systems and the screening tools that have been developed for geriatric emergency patients have disadvantages. In Manchester Triage System (MTS) and Emergency Severity Index (ESI) geriatric patients are at risk of incorrect triage, though both systems, e.g., name acute cognitive impairment as a high-risk factor. The ESI has been validated for geriatric patients. The correct use of the triage algorithms is crucial, but for a triage nurse, acute cognitive impairment, e.g., might be difficult to identify. One reason for that is that many of the existing screening tools are not applicable in the ED or are without immediate benefit for the patient. More practical tools will have to be developed in the future.

[Workload in emergency departments : A Problem for personnel and patients?] / Arbeitsbelastung in der Notaufnahme : Ein Problem für Personal und Patienten?

Apart from operating theaters, intensive care units and diagnostic services, the central emergency department is one of the areas of any hospital with a high workload, which is very susceptible to risk. The following aspects of routine daily work can lead to a great strain on the personnel working in the central emergency department: the need for quick, targeted decisions, especially for patients with life-threatening disorders, a high number of patients with insufficient available resources, dissatisfaction of patients with low treatment priority and longer waiting times and delayed inpatient admissions with long stays. Interruptions in the individual work process during activities are not uncommon but represent additional disruptive factors for employees and can lead to treatment errors. Furthermore, a workload that is permanently perceived as too high leads to psychological and physical disturbances for the team members. Suitable structural, organizational and personnel prerequisites as well as solution strategies for the central emergency department are necessary to avoid corresponding treatment errors and also as a duty of care for employees.

Easy access to triazolinedione-endcapped peptides for chemical ligation.

An efficient and easy route towards triazolinedione (TAD) endcapped peptides is described, in which a TAD-precursor was coupled to N-terminal amines on a solid support. Modified peptides readily reacted with diene end-functionalized poly(ε-caprolactone) of different molecular weights. The ligation proved to be orthogonal to a variety of functional groups present in natural amino acids.

[Emergency departments--2016 update]. / Zentrale Notaufnahme--Update 2016.

Acute medical care in hospital emergency departments has experienced rapid development in recent years and gained increasing importance not only from a professional medical point of view but also from an economic and health policy perspective. The present article therefore provides an update on the situation of emergency departments in Germany. Care in emergency departments is provided with an increasing tendency to patients of all ages presenting with varying primary symptoms, complaints, illnesses and injury patterns. In the process, patients reach the emergency department by various routes and structural provision. Cross-sectional communication and cooperation, prioritization and organization of emergency management and especially medical staff qualifications increasingly play a decisive role in this process. The range of necessary knowledge and skills far exceeds the scope of prehospital medical emergency care and the working environment differs substantially. In addition to existing structural and economic problems, the latest developments, as well as future proposals for the design of in-hospital emergency medical care in interdisciplinary emergency departments are described.

[Pain therapy in emergency medicine. Focus on emergency admissions]. / Schmerztherapie in der Notfallmedizin. Fokus Notaufnahme.

With a prevalence of 50-80 % pain is one of the main symptoms of emergency admission patients worldwide; however, study results demonstrate that only 30-50 % of patients receive adequate analgesia. Therefore, in the USA quality indicators have been established by the Centers for Medicare & Medicaid Services (CMS) since 2010 within the framework of quality assurance of emergency admissions, e.g. the time window until the start of pain therapy. Despite the prescribed pain evaluation as part of many existing triage systems, e.g. the Manchester triage system (MTS), emergency severity index (ESI), Australasian triage scale (ATS), Canadian triage and acuity scale (CATS), in most emergency rooms there is no standardized, documented pain assessment and pain intensity is documented by using the appropriate pain scales in only 30 % of cases. Lack of knowledge and training and lack of awareness by the nursing and medical staff regarding pain perception and management represent the main causal factors. Studies on the situation of pain therapy in German emergency departments are not currently available. Due to the increasing number of central emergency departments and interdisciplinary teams of physicians and nurses, it seems sensible to introduce interdisciplinary standards of treatment to achieve the greatest possible safety in the use of analgesics in the emergency room. It is important to incorporate the experiences of the various clinical departments in the standards. This article aims to provide an overview of the situation in pain management in emergency departments and to serve as a basis for recommendations for pain therapy in German emergency departments. This article particularly discusses the possibilities of pain evaluation, treatment options with various medications and under specific conditions, e.g. for children, pregnant women or the elderly or alternative ways of pain management.

Recruiting African Americans into research on cognitive aging.

A total of 218 adults with an average age of seventy-eight years participated in a study of memory performance in community elders. A computer-generated random zip code list of adults > or = 70 years of age was purchased and a four-phase telephone-screening plan was adopted. During the second year, the sampling plan had to be changed, with a convenience-sampling plan being adopted to recruit adequate numbers of African-American subjects. Fifty-seven percent of the African-American subjects (N = 55) and 68% of the White subjects (N = 83) were recruited from random sampling methods. As compared to the random sample, the convenience sample was significantly older (80 vs 76), had more depression (12 vs 9), had lower physical functioning (46 vs 65), and less vitality (48 vs 60). On meta-memory, the convenience sample scored higher than the random sample on achievement (3.84 vs 3.69), and lower on task (3.75 vs 3.85). The convenience sample scored significantly lower than the random sample on memory performance (15 vs 18), and memory self-efficacy (26 vs 33). More research is needed to document normative measures for cognitive function and to facilitate accurate comparisons between African-American elderly and other elderly.

Effect of different bedding materials on the reproductive performance of mice.

Vermiculite, pine shavings and unbleached eucalyptus pulp contact-bedding were compared using the number of litters and individuals born and weaned, mortality rates at different stages of the lactation period, and the weight increase of pups as evaluation indices for bedding quality. These bedding materials exerted different effects on the reproductive performance of the same mouse strain. The same is true for the effect of a specific bedding material on different mouse strains. These effects are most pronounced during the first 4 days of life. As a whole, the results demonstrated that eucalyptus pulp was the better bedding type, followed by pine shavings and vermiculite. The latter material had a detrimental effect on the mating success of AKR mice.

The in vivo effect of different bedding materials on the antioxidant levels of rat heart, lung and liver tissue.

Several experimental effects due to wood-derived bedding have been reported. Female Sprague Dawley rats were kept on pine shavings, eucalyptus pulp, vermiculite and in wire-bottomed cages without bedding for 14 days whereafter normal values for the antioxidants ascorbic acid and reduced glutathione (G-SH) in rat heart lung and liver tissue were determined and compared. Statistically significant differences were observed for lung G-SH between pine shavings and eucalyptus pulp (p < 0.0183), and heart G-SH between vermiculite and eucalyptus pulp (p < 0.0948). The highest levels of liver G-SH were obtained using pine shavings compared to vermiculite (p < 0.0001), eucalyptus pulp (p < 0.0002) and wire floor (p < 0.0001). Statistically significant differences in ascorbic acid concentrations could only be described between the wire-bottomed cages and eucalyptus pulp (p < 0.0333) for lung tissue and between pine shavings and eucalyptus pulp for liver tissue (p < 0.042). Although no statistically significant differences were observed in heart ascorbic acid levels between the different bedding applications, the concentration obtained using vermiculite was approximately 50% higher than that observed with the other materials. Pine shavings, eucalyptus pulp and wire floors demonstrated virtually the same heart tissue ascorbic acid levels. It was thus demonstrated that bedding material can alter the tissue antioxidant concentration of laboratory animals, limiting the comparison of this type of result between institutions to those using identical environmental conditions.

The dust content, dust generation, ammonia production, and absorption properties of three different rodent bedding types.

Vermiculite, pine shavings and unbleached eucalyptus pulp contact bedding were compared for dust content, dust production (as a result of animal activity), moisture absorption properties and ammonia production. The percentage of dust particles <300 microm found in pine shavings and vermiculite was 18 and 8 times greater respectively than was found in eucalyptus pulp. The lowest ammonia levels (<1-1 ppm), measured on day 7, were obtained using eucalyptus pulp. Although the ammonia levels obtained for vermiculite compared very well with those of pulp, high levels of dust, up to 5 times more than pulp, were experienced with vermiculite. Pine shavings were associated with the highest ammonia concentration (1-3 ppm), but produced approximately 50% less dust than vermiculite. The water absorption properties obtained for pulp were between 35% and 76% higher than those obtained for vermiculite and pine shavings respectively.

The in vitro enzyme-inducing and cytotoxic properties of South African laboratory animal contact bedding and nesting materials.

Enzyme-inducing and cytotoxic effects of South African bedding materials were investigated using a mouse hepatoma cell line, Hepa-1, cell culture system. This cell culture system is a convenient and sensitive method for the screening of bedding materials for the presence of compounds that could be potentially harmful to animals and thus the experimental outcome. Cells were exposed to acetone extracts of the different materials or their components. Corn cobs displayed very little or no CYP1A1-inducing or cytotoxic effects, whilst vermiculite and unbleached pulp from pine and eucalyptus showed greater induction and cytotoxic properties. The latter properties were lower than those produced by the different recycled paper extracts. Pine shavings (Pinus elliottii) and the different wood components making up industrial sawdust expressed the highest cytotoxic and CYP1A1-inducing properties.

Laboratory animal bedding and nesting materials for rodents and lagomorphs: the South African situation.

The different bedding and nesting materials used for small laboratory animals (mice, rats, hamsters, guinea pigs, and rabbits) by different institutions (n = 27) in South Africa were investigated by making use of questionnaires. A response of 81.5% was obtained. Twenty-two per cent of the respondents made exclusive use of direct (contact) bedding materials, whilst the rest used both direct (breeding) and indirect (nonbreeding) bedding methods. Three institutions did not use bedding materials for indirect bedding applications. Ten different bedding and nesting materials were identified. Non-sterile materials were used by 57% (indirect bedding), 44% (direct bedding), and 42% (nesting material) of the respondents. Between 7 and 22% of the respondents did however use both sterile and non-sterile materials for the different applications.

Laboratory animal bedding: a review of specifications and requirements.

The literature is reviewed regarding existing specifications and requirements for laboratory animal bedding. The lack of comprehensive specifications in the guidelines of laboratory animal governing bodies, and the introduction of external variables by unsuitable bedding into experimental design, are discussed on the basis of examples from the literature.

Enzymatic formation of nitrogen oxides from L-arginine in bovine brain cytosol.

In dialyzed bovine brain cytosol, the enzymatic formation of nitrogen oxides was directly determined. The basal formation of nitrite and nitrate was concentration-dependently enhanced by L-arginine (EC50 about 3.10(-5) M). Both the basal and L-arginine induced formations were inhibited by NG-monomethyl-L-arginine (EC50 about 2.10(-4) M). In the presence of L-arginine, a concomitant formation of citrulline was detected. L-Arginine methyl ester also served as a substrate, but neither D-arginine, D-arginine methyl ester nor N alpha-benzoyl-L-arginine ethyl ester did so. The formation of nitrite and nitrate was time-dependent, increased linearly with the protein concentration of the cytosol and was not observed when the cytosolic proteins were heat-denaturated. Exogenous NADPH (or NADP+) concentration-dependently enhanced the formation of nitrite and nitrate, whereas NADH, NAD+, FAD, Ca2+, Mg2+ and calmodulin were ineffective. These results indicate that bovine brain contains a cytosolic enzyme which uses NADPH or NADP+ as cofactors to form nitrogen oxides from both an endogenous non-dialyzable substrate and from L-arginine.

Net utilization of roughage and concentrate diets by sheep.

1. Two diets, an all-roughage diet and a high-concentrate diet, were fed at two levels, a low level of estimated 1-5 times maintenance energy requirement and a higher level of estimated two times maintenance energy requirement, to South African Mutton Merino castrated male sheep, aged 13 months and in fairly lean condition at the start of the 93 d experimental period. 2. Body composition and energy retention were determined using the comparative slaughter technique and two series of digestibility and balance studies were done during the course of the experiment. Metabolizability of each diet was estimated and corrected for fermentation heat using the fermentation balance approach. 3. Although there were significantly different rates of energy gain on different diets and feeding levels, fat energy gained (% total energy gained) was similar for the four groups, i.e. 78-80. 4. Regression of energy gain v. corrected metabolizable energy (ME) intake indicated that the maintenance energy requirements of sheep used in this experiment were 310-2 and 302-3 kJ ME/kg body-weight0-75 per d and the values for net utilization of ME for body energy gain were 0-411 and 0-479 with the roughage and concentrate diets respectively. 5. It was concluded that the estimated maintenance energy requirements of sheep obtained in this study are realistic values and that the efficiency of utilization of surplus ME for the two diets did not differ significantly.