Discussion paper: implications for the further development of the successfully in emergency medicine implemented AUD2IT-algorithm

The AUD2IT-algorithm is a tool to structure the data, which is collected during an emergency treatment. The goal is on the one hand to structure the documentation of the data and on the other hand to give a standardised data structure for the report during handover of an emergency patient. AUD2IT-algorithm was developed to provide residents a documentation aid, which helps to structure the medical reports without getting lost in unimportant details or forgetting important information. The sequence of anamnesis, clinical examination, considering a differential diagnosis, technical diagnostics, interpretation and therapy is rather an academic classification than a description of the real workflow. In a real setting, most of these steps take place simultaneously. Therefore, the application of the AUD2IT-algorithm should also be carried out according to the real processes. A big advantage of the AUD2IT-algorithm is that it can be used as a structure for the entire treatment process and also is entirely usable as a handover protocol within this process to make sure, that the existing state of knowledge is ensured at each point of a team-timeout. PR-E-(AUD2IT)-algorithm makes it possible to document a treatment process that, in principle, does not have to be limited to the field of emergency medicine. Also, in the outpatient treatment the PR-E-(AUD2IT)-algorithm could be used and further developed. One example could be the preparation and allocation of needed resources at the general practitioner. The algorithm is a standardised tool that can be used by healthcare professionals of any level of training. It gives the user a sense of security in their daily work.

[Video Consultation Hours in the Statutory Accident Insurance - Application Possibilities and Economic Evaluation]

OBJECTIVES

Video consultations are becoming more and more important for health care providers as they enable new treatment options. Since 2017 video consultations have been used by the public health insurance companies in Germany. However, similar options are lacking in the employer's liability insurance association (BG in Germany) health insurance system. The aim of this article is to present and discuss possible applications of video consultations in the latter system and to evaluate economic advantages.

METHODS

Possible applications of video consultations are discussed in the context of feasibility, potential benefits and the existing scale of fees for physicians (in Germany UV-GOÄ).

RESULTS

Video consultations can be used for follow-up evaluations as well as preparation for initial medical examinations especially in complex cases and for case conferences. Even though video consultations are not included in the reimbursement system, similar CPT codes (current procedural terminology) already do exist.

CONCLUSIONS

Video consultations might help improve the quality and reduce the costs of the public health insurance system. Furthermore, since video consultations can be expected to become more important in the future, they should be included as a standard tool in the employer's liability insurance association insurance system and an adequate reimbursement system be established.

Central nervous system involvement in patients with monoclonal gammopathy and polyneuropathy

BACKGROUND AND PURPOSE

To evaluate clinical presentation of patients with the clinical triad of monoclonal gammopathy, polyneuropathy and signs of CNS involvement.

METHODS

Nineteen patients with monoclonal protein (M-protein, 9 IgM, 10 IgG) were studied. Clinical examination, MRI, cerebrospinal fluid analysis and immune reactivity against myelin-associated glycoprotein and gangliosides in serum were obtained. By immunohistochemistry, different binding patterns of M-proteins to human CNS tissue were investigated.

RESULTS

Nine out of 19 patients (four IgM, five IgG) showed one or more clinical signs of CNS involvement. Clinical features associated with signs of CNS pathology were disease duration and greater concentration of IgM paraprotein. The IgM M-protein of two patients strongly stained the cortex/cerebellar neurons in human brain sections.

CONCLUSION

Our results complement previous reports that some patients with monoclonal gammopathy and polyneuropathy can develop solitary or disseminated signs of CNS involvement. It indicates that pathological effects of M-proteins are not necessarily restricted to the peripheral nervous system. The specificity and affinity of circulating M-protein to antigens in the CNS might be critical for the development of different clinical phenotypes.

The clinical value of therapeutic plasma exchange in multifocal motor neuropathy

OBJECTIVE

Although there is evidence for a pathogenic role of humoral factors in multifocal motor neuropathy (MMN), plasma exchange (PE) is assumed to be an ineffective treatment. We set out to elucidate possible reasons for this apparent contradiction.

METHODS

A retrospective analysis of seven patients with MMN, who underwent 4 to 18 sessions of PE. Clinical response, electrophysiological parameter and anti-ganglioside antibody titers were reviewed.

RESULTS

Two patients, who had anti-ganglioside antibodies, exhibited transient clinical responses to PE, manifested by improved neurological function. Whereas electrophysiological parameters continued to worsen in all patients, anti-ganglioside antibody titers declined during PE, but increased after PE.

CONCLUSION

PE is of limited therapeutic value in patients with MMN, who do not respond to established treatment options. It may only be useful as an adjunctive treatment in a subset of patients. The transient decrease of anti-ganglioside-antibodies titers suggests that pathogenic humoral factors in MMN are only temporarily reduced. Further, PE treatment alone is insufficient to prevent axons from continuing degeneration, which may explain the failure of PE to substantially influence the disease course of patients with MMN.