Even minor creatinine increases not meeting acute kidney injury criteria were associated with an increased risk of death and hospital length of stay, and this risk was more pronounced in noncardiac compared with cardiac surgical patients. Supplemental Digital Content is available in the text. Background: Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods: The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results: The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P < 0.001) and a longer HLOS of 5 days (P < 0.001) after adjusting for age, sex, comorbidities, congestive heart failure, preoperative hemoglobin, preoperative creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but < 0.3 mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of death (OR, 1.7; 95% CI, 1.3 to 2.4; P < 0.001) and 2 days longer HLOS (P < 0.001). This was more pronounced in noncardiac surgery patients. Patients with minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P < 0.05) and a 3-day longer HLOS (P < 0.01) when undergoing noncardiac surgery. Conclusions: Even minor postoperative increases in creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes.

HINTERGRUND: Das postoperative Delir stellt sowohl im Aufwachraum als auch auf der Intensivstation die häufigste psychiatrische Erkrankung dar. Die Prävalenz des postoperativen Delirs wird in der Literatur zwischen 15 % und 50 % angegeben, wobei intensivpflichtige, beatmete Patienten in bis zu 80 % der Fälle ein Delir entwickeln. Das Delir korreliert mit der Länge der Krankenhausverweildauer und führt zu einer dreifachen Erhöhung der 6–Monats–Mortalität. Gaudreau et al. entwickelten mit der Nu–DESC ein schnell durchführbares, pflegebasiertes und damit in den Arbeitsalltag gut integrierbares Messinstrument zur Delirdiagnostik. Ziel dieser Studie war die Übersetzung der Nu–DESC aus dem Englischen als Voraussetzung für die Nutzung in klinischer Forschung und Routine. MATERIAL UND METHODEN: Der Übersetzungsprozess erfolgte nach den international anerkannten Richtlinien der Translation and Cultural Adaptation of Patient Reported Outcomes Measures – Principles of Good Practice (PGP). Aus 3 unabhängig voneinander entstandenen Versionen der Vorwärtsübersetzung wurde eine vorläufige deutsche Fassung erarbeitet, die dann durch einen diplomierten, staatlich anerkannten Dolmetscher rückübersetzt wurde. Die rückübersetzte Version wurde dem Originalautor zur Bewertung vorgelegt. ERGEBNISSE: Die Rückübersetzung der deutschen Vorwärtsübersetzung wurde durch den Originalautor genehmigt. Aufgrund der durchweg sehr guten bis guten Ergebnisse des kognitiven Debriefings konnte der Übersetzungsprozess abgeschlossen und die finale deutsche Version der Nu–DESC durch das Expertenteam verabschiedet werden. Hinsichtlich der Einschätzung der Durchführbarkeit der deutschen Nu–DESC zeigten sich signifikante Unterschiede zwischen Ärzten und Pflegepersonal. FAZIT: Mit der deutschen Version der Nu–DESC steht nun ein Instrument für die Delir–Evaluation im Bereich der klinischen Routine und Forschung zur Verfügung. BACKGROUND: Both in the recovery room as well as in the intensive care unit post–operative delirium is the most common psychiatric disease. The post–operative delirium is stated in literature to occur in 15 % to 50 % of patients, whereby up to 80 % of patients requiring intensive care with artificial respiration develop a delirium. The delirium correlates with the length of hospital stay and leads to a tripple rate of the six–month–mortality. Nu–DESC, developed by Gaudreau et al. is a measuring instrument for the clinical diagnostics of deliriums which is quickly operable, care–based and which can thus be easily integrated in everyday routine. The aim of this study was the translation of Nu–DESC from English as basis for the use in clinical research and routine. MATERIALS UND METHODS: The translation process was conducted in accordance with the internationally acknowledged guidelines of Translation and Cultural Adaptation of Patient Reported Outcomes Measures – Principles of Good Practice (PGP). An interim German version was developed from 3 independently devised translations, a back–translation of which was then conducted by a registered state–approved translator. The back–translation was then presented to the author of the original for evaluation. RESULTS: The back–translation of the German translation was authorised by the author of the original. On the basis of the cognitive debriefing results which were consistently very good to good, the translation process could be finalised and the final German version of Nu–DESC could be passed by the expert team. An evaluation of the German Nu–DESC regarding its practicability showed significant differences between doctors and nursing staff. CONCLUSION: The German version of Nu–DESC provides an instrument for evaluating the delirium in the area of clinical routine and research.

Although Delirium is the most common psychiatric disease in ICU settings, it is recognized late or not at all in up to 84 % of all cases. Translation of the ICDSC, in accordance with ISPOR guidelines and validation by conducting a screening of 68 ICU patients. The translation process was authorized by the original author. The final German translation of the ICDSC showed a sensitivity and specificity of 89 % and 57 % respectively. The ICDSC is suitable for delirium screening by nurses even on ventilated patients. Besides a high sensitivity another advantage is the possibility to screen for a subsyndromal delirium.

Background: As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany. Objective: We sought to assess the utilization, safety, and technical performance of this telemedical emergency service. Methods: We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations. Results: The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations. Conclusions: The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.

One in five patients in the perioperative setting has a alcohol use disorder (AUD), one in three patients has a nicotine use disorder (NUD) and one in 10 patients has a drug use disorder (DUD) with a high risk of dependency. Patients with dependencies challenge physicians with various complications within the perioperative setting. Adequate treatment of alcohol, nicotine and drug dependency during the perioperative and intraoperative course requires established screening tools in order to evaluate patients' susceptibility to developing complications. Particularly in these patients, secondary prevention and early treatment is warranted. Alcohol, nicotine and drug dependency are very treatable. Numerous effective therapeutic options are available and should be offered to patients. Intensive care treatment can be shortened or even avoided by initiating preventive measures. A multimodal approach includes implementation of screening tools, motivational interviewing, preoperative abstinence, individual anaesthesiological treatment, stress reduction preventing delirium and postoperative infection, prevention and treatment of withdrawal syndrome, replacement therapies and provision of preoperative or postoperative detoxification. The implementation rate is very low and urgently requires strategies for improvement.