Adverse patient events are an inevitable part of an anesthesiologist’s work. When such incidents occur, they may lead to significant emotional and psychological distress in healthcare providers—a phenomenon known as the Second Victim Phenomenon (SVP). While international evidence of SVP exists, data from German anesthesiologists remain scarce. This study aimed to determine the prevalence, symptom severity, recovery time, and available support structures for second victims among German anesthesiologists and to identify individual and workplace-related risk and protective factors. A cross-sectional survey was conducted using the validated SeViD questionnaire. The survey assessed five domains: demographics, SVP experience and symptoms, support structures, and personality traits (Big Five Inventory-10). Data were collected both online and on paper at three national anesthesiology symposia in Germany. Of the 408 respondents (mean age: 50.8 years), 76.9% identified as second victims, with 27% having experienced a related incident in the previous 12 months. Common triggers included patient harm or death, near misses, and critical events. The most frequently reported symptoms were self-doubt (69%), feelings of guilt (66%), reliving the event (59%), and sleep disturbances (59%). 16% of the respondents had not recovered at the time of the survey, and 14% had not recovered even after more than a year. Legal consultation, debriefing, and preventive feedback mechanisms were rated as the most helpful support strategies. A lack of support was significantly associated with increased symptom burden and prolonged recovery. A higher level of neuroticism and a lower level of openness were associated with increased symptom load. SVP is highly prevalent among German anesthesiologists, with a significant psychological burden in many cases. These findings highlight the urgent need for systematic interventions, including peer support and organizational frameworks, to address and mitigate the effects of SVP in clinical practice.

Background: Ventilator-associated pneumonia (VAP) remains a significant complication in patients undergoing mechanical ventilation. It is particularly prevalent in neurosurgical patients, contributing to high morbidity and healthcare costs. Early diagnosis and timely treatment are crucial for preventing the progression of VAP. However, diagnosing VAP remains challenging because no diagnostic tool or biomarker can reliably confirm the condition. Nevertheless, biomarkers remain the most frequently used surrogates for VAP. Therefore, this study aimed to evaluate the predictive value of interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) and look at relevant clinical markers for the early detection of VAP. Additionally, the impact of the use of IL-6 or PCT/CRP on clinical decision-making in the diagnosis and management of VAP in neurosurgical patients was explored. Methods: In this retrospective single-center study, we screened 1,817 neurosurgical intensive care patients between January 2020 and December 2023. In the first step, the ability of IL-6, PCT, and CRP to predict VAP was tested. We distinguished microbiologically confirmed VAP (mcVAP), suspected VAP (suspVAP ), and non-VAP. In the second step, two cohorts were compared: patients monitored with IL-6 alone and those monitored with PCT and CRP. Here, we compared the relevance of these markers for treatment decisions, antibiotic usage, and clinical parameters. Results: A total of 240 neurosurgical patients fulfilled the eligibility criteria: 155 in the IL-6 group and 85 in the PCT/CRP group. The IL-6 level on the day of mcVAP and suspVAP was 106 pg/mL (IQR: 58.3-259.0) and 112 pg/mL (IQR: 58.3-259), respectively, whereas it was 33.55 ng/L (IQR: 19.6-59.2) in non-VAP patients (p<0.001; η² = 0.14, AUC 0.82 and 0.81, respectively). PCT also showed significant differences, although with a small effect size (η² = 0.008, p = 0.010). For CRP, no significant differences were observed (p = 0.317). In the IL-6 group, the start of treatment did not differ from that in the PCT/CRP group. The duration of antibiotic administration was slightly shorter in the IL-6 group than in the control group, although the differences were not statistically significant (6.25 (±3.73) and 5.9 (±2.23) days versus 7.37 (±4.95) and 7.67 (±2.65) days; p = 0.339 and p = 0.214, respectively). Conclusion: While PCT has diagnostic value, IL-6 has superior predictive value for VAP, which is reflected in its high effect size and shorter duration of antibiotic treatment, although the difference was not significant. This study suggests that incorporating IL-6 as a routine biomarker may improve the early recognition of VAP, potentially optimizing treatment strategies in the neurosurgical ICU setting. However, the major limitation lies in the study’s retrospective design, which limits its generalizability.

Background: Point-of-care ultrasound (POCUS) is increasingly being used in prehospital emergency medicine. While physician-performed prehospital ultrasound is well established, evidence regarding the feasibility and diagnostic accuracy of paramedic-performed POCUS in real-world settings remains limited. Methods: We conducted a retrospective observational cohort study evaluating paramedic-performed POCUS following a structured, multimodal training program. Twenty-one certified paramedics performed handheld ultrasound examinations in prehospital emergencies using standardized protocols with an observation period of 24 months, starting from March 2023. Feasibility, utilization patterns, diagnostic accuracy, and perceived clinical impact were assessed using standardized documentation. Hospital diagnoses served as the reference standard, based on radiological, sonographic, and/or clinical documentation. Results: A total of 169 ultrasound examinations were performed on 144 patients. The overall diagnostic performance achieved a sensitivity of 87.9% and specificity of 92.7%. Diagnostic accuracy, defined as the concordance between prehospital POCUS-based working diagnoses and final in-hospital diagnoses, was particularly strong for lung ultrasound (pneumothorax, pulmonary edema, pneumonia and pleural effusion; sensitivity 91.7%, specificity 100%) and eFAST (sensitivity 100%, specificity 96.5%), while for the abdominal ultrasound examinations, the specificity was 70% and sensitivity was 71.43%. Ultrasound findings influenced logistical and clinical decision-making in a substantial proportion of missions, including changes in transport urgency (36.1%) and hospital destination (18.1%), whereas emergency room prealerts were avoided in 9.7% of cases. Training resulted in significantly more positive attitudes regarding feasibility, clinical relevance, and image of paramedic-performed ultrasound. Concerns regarding time delay and workload were markedly reduced. Conclusions: Paramedic-performed prehospital POCUS is feasible after structured training and can be integrated into routine prehospital care. Prospective studies should further assess the diagnostic accuracy, reliability, and clinical impact of paramedic-performed POCUS in the prehospital setting.

The second victim phenomenon describes the psychological, cognitive and physical reactions of healthcare professionals who are directly or indirectly involved in adverse patient events or errors and are themselves impaired as a result. Common symptoms include anxiety, guilt, grief, depression and burn-out, which can significantly restrict their ability to work. Surveys in German-speaking countries show that the prevalence of the second victim phenomenon is as high as 89% across all healthcare professions. This paper aims to synthesise learning objectives pertaining to the second victim phenomenon from the current literature and thus provide a basis for training medical students. Design: Qualitative synthesis of relevant categories using “best fit” framework synthesis based on the European Researchers’ Network Working on Second Victims. Data collection: Literature search in PubMedCentral, MEDLINE, Cochrane and CINAHL based on the categories. Data analysis: Qualitative document analysis according to Mayring with synthesis of the learning objectives and definition of the depths of competency: According to the depths of competency in knowledge, practical knowledge, and practical skills, based on the taxonomy of the National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). The analysis resulted in the definition of a framework catalogue with four subcategories: I: Basic concepts and definition of the second victim phenomenon, II: Symptoms of the second victim phenomenon and need for support, III: Intervention options, and IV: Contextualisation of the second victim phenomenon in the broader context of employee welfare. These categories were assigned to seven areas of knowledge and, based on this, seven learning objectives with their respective depths of competence were defined. In this study, seven evidence-based learning objectives concerning the second victim phenomenon were defined for medical students and systematically integrated into the NKLM’s taxonomy. The results provide a structured basis for anchoring this topic into the curriculum in order to impart knowledge about the second victim phenomenon early on and minimise long-term, negative consequences for healthcare professionals.

Background: Healthcare-associated ventriculitis (HAV) is a serious complication following neurosurgical procedures, especially in patients with external ventricular drains. Diagnosis remains challenging due to nonspecific clinical features, limited physical examination options, and the low sensitivity of microbiological methods. While cerebrospinal fluid (CSF)-derived biomarkers are linked to a higher infection rate, serum biomarkers have a low predictive value. However, they are still part of our daily routine monitoring for infections. In addition, the predefined criteria catalog (Centers for Disease Control [CDC]/Infectious Diseases Society of America [IDSA]) may be promising, but also underestimate the burden of the disease. This study aims to explore, with a matched case-control design, whether systemic markers (interleukin-6 [IL-6], C-reactive protein [CRP], and procalcitonin [PCT]) and their albumin ratios are associated with the clinical decision to initiate antibiotic therapy for HAV and how their performance compares to that of routine CSF markers. Furthermore, differences between microbiologically confirmed and unconfirmed HAV are explored. Finally, we reflect on our treatment decision with reference to the CDC and IDSA criteria. Methods: Adult neurosurgical intensive care patients with and without HAV treated between 2020 and 2023 were included. Patients with microbiologically confirmed and suspected ventriculitis (mcHAV and suspHAV) were both characterized by the initiation of targeted empirical antibiotic therapy and had positive and negative CSF cultures, respectively. Serum and CSF parameters were analyzed from day −4 to day 0 (initiation of therapy). Group comparisons, logistic regression, and area under the receiver operating characteristic curve (AUROC) analyses were performed to evaluate diagnostic accuracy. Results: Of the 1,817 screened neurosurgical Intensive Care Unit patients, 196 met the inclusion criteria, and after matching, 33 treated patients (16 mcHAV and 17 suspHAV) and 33 matched controls were included. Neither serum levels of IL-6, CRP, and PCT nor their albumin ratios differed between the mcHAV/suspHAV group and the control group and were not associated with treatment initiation. In contrast, CSF markers showed strong discriminatory ability: CSF white blood cell count (WBC) (AUROC 0.828), the CSF/blood WBC ratio (0.797), CSF glucose (0.754), and the CSF/blood glucose ratio (0.768) were significantly associated with ventriculitis. No significant correlations were detected between CSF and serum biomarkers. According to the CDC and IDSA criteria, 50% of treated patients met the definition for definitive HAV and 97% for probable HAV, whereas only 2.9% of controls were culture positive. Conclusion: In this exploratory matched case–control study, in contrast to serum infection markers, higher routine CSF markers were associated with a greater likelihood of treatment despite imperfect microbiological confirmation, highlighting the need for improved bedside techniques and innovative CSF sampling methods to reduce diagnostic uncertainty in HAV.

Background: Healthcare professionals in intensive care units face substantial psychological stress, yet structured educational approaches to promote mental health during early training remain underdeveloped. While current recommendations advocate early integration of psychosocial support into onboarding, they have not been translated into competency-based educational frameworks aligned with modern health professions education. Objective: To develop a competency-based educational framework for ICU onboarding that integrates mental health promotion into structured learning objectives across knowledge, reflection, and action domains. Methods: A mixed-methods design was applied, combining a structured consensus process with competency-based curricular mapping. Guiding questions were iteratively refined using a two-stage rapid consensus process involving a multidisciplinary panel of clinicians, educators, and external experts in psychology and occupational health. Consensus was defined as the absence of substantial disagreement. The resulting content was mapped to competency dimensions informed by competency-based medical education principles and aligned with Miller’s Pyramid, a hierarchical model of clinical competence ranging from knowledge to action. Results: The process resulted in a competency-based framework comprising eight educational domains: relevance of mental health, ICU-specific stressors, conceptual understanding of stress, resilience and coping, the second victim phenomenon (the psychological impact on healthcare professionals following adverse events), structural support systems, professional self-reflection, and shared responsibility. Each domain was operationalized into competency levels (knowledge to evaluation), enabling constructive alignment between learning objectives, teaching formats, and potential assessment strategies. The framework integrates individual, team, and organizational perspectives and provides a structured basis for embedding psychosocial competencies into onboarding curricula. Conclusion: This study may contribute to advancing health professions education and supports constructive alignment among learning objectives, teaching formats, and assessment strategies. It operationalizes existing recommendations into actionable educational components and supports constructive alignment in curriculum design. Implementation and evaluation studies are warranted to assess its impact on learning outcomes, behavioral change, and clinical practice.