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Mayer M, Zellmer S, Zenk J, Arens C, Ebigbo A, Muzalyova A, Thoelken R, Jering M, Kahn M, Breitling LP, Messmann H, Deitmer T, Junge-Hülsing B, Römmele C. Status quo after one year of COVID-19 pandemic in otolaryngological hospital-based departments and private practices in Germany. Eur Arch Otorhinolaryngol 2022; 279:1063-1070. [PMID: 34297182 PMCID: PMC8298954 DOI: 10.1007/s00405-021-06992-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/09/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE The COVID-19 pandemic has affected healthcare systems worldwide. Data on the impact on otolaryngological clinics and private practices is sparse. This study aimed to present data on healthcare worker (HCW) screening, status of HCW, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic. METHODS Otolaryngological private practices and hospital-based departments were surveyed nationwide using an online questionnaire. Participating facilities were recruited via the German Society for Oto-Rhino-Laryngology and the German Association for Otolaryngologists in Bavaria. RESULTS 365 private practices (2776 employees) and 65 hospitals (2333 employees) were included. Significantly more hospitals (68.7%) than practices (40.5%) performed pre-interventional testing in their outpatients (p < 0.00). Most inpatients were tested in practices and hospitals (100.0% and 95.0%; p = 0.08). HCW screening was performed in 73.7% of practices and in 77.3% of hospitals (p = 0.54). Significantly more HCW infections were reported in private practices (4.7%) than in hospital (3.6%; p = 0.03). The private or home environment was the most frequent source of infection among HCW in hospitals (44%) and practices (63%). The use of PPE increased over the course of the pandemic. The number of procedures and the revenue decreased in 2020. CONCLUSION The rate of pre-interventional testing among outpatients in otolaryngological practices is low and HCW infections were found to be more frequent in practices than in hospitals. In addition, a high rate of infections in otolaryngological HCW seems to stem from the private or home environment.
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Affiliation(s)
- Marcel Mayer
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Sauerbruchstraße. 6, 86179, Augsburg, Germany.
| | - S Zellmer
- Department for Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - J Zenk
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Sauerbruchstraße. 6, 86179, Augsburg, Germany
| | - C Arens
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Leipziger Straße 44. 6, 39120, Magdeburg, Germany
| | - A Ebigbo
- Department for Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - A Muzalyova
- Department for Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - R Thoelken
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Sauerbruchstraße. 6, 86179, Augsburg, Germany
| | - M Jering
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Augsburg, Sauerbruchstraße. 6, 86179, Augsburg, Germany
| | - M Kahn
- Department for Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - L P Breitling
- Department for Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - H Messmann
- Department for Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - T Deitmer
- German Society for Oto-Rhino-Laryngology, Head and Neck Surgery, Friedrich-Wilhelm Straße 2, 53113, Bonn, Germany
| | - B Junge-Hülsing
- Practice for Otolaryngology, Josef-Jägerhuber-Straße 7, 82319, Starnberg, Germany
| | - C Römmele
- Department for Internal Medicine III-Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Römmele C, Neidel T, Heins J, Heider S, Otten V, Ebigbo A, Weber T, Müller M, Spring O, Braun G, Wittmann M, Schoenfelder J, Heller AR, Messmann H, Brunner JO. [Bed capacity management in times of the COVID-19 pandemic : A simulation-based prognosis of normal and intensive care beds using the descriptive data of the University Hospital Augsburg]. Anaesthesist 2020; 69:717-725. [PMID: 32821955 PMCID: PMC7441598 DOI: 10.1007/s00101-020-00830-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Following the regional outbreak in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, presenting the healthcare systems with huge challenges worldwide. In Germany the coronavirus diseases 2019 (COVID-19) pandemic has resulted in a slowly growing demand for health care with a sudden occurrence of regional hotspots. This leads to an unpredictable situation for many hospitals, leaving the question of how many bed resources are needed to cope with the surge of COVID-19 patients. OBJECTIVE In this study we created a simulation-based prognostic tool that provides the management of the University Hospital of Augsburg and the civil protection services with the necessary information to plan and guide the disaster response to the ongoing pandemic. Especially the number of beds needed on isolation wards and intensive care units (ICU) are the biggest concerns. The focus should lie not only on the confirmed cases as the patients with suspected COVID-19 are in need of the same resources. MATERIAL AND METHODS For the input we used the latest information provided by governmental institutions about the spreading of the disease, with a special focus on the growth rate of the cumulative number of cases. Due to the dynamics of the current situation, these data can be highly variable. To minimize the influence of this variance, we designed distribution functions for the parameters growth rate, length of stay in hospital and the proportion of infected people who need to be hospitalized in our area of responsibility. Using this input, we started a Monte Carlo simulation with 10,000 runs to predict the range of the number of hospital beds needed within the coming days and compared it with the available resources. RESULTS Since 2 February 2020 a total of 306 patients were treated with suspected or confirmed COVID-19 at this university hospital. Of these 84 needed treatment on the ICU. With the help of several simulation-based forecasts, the required ICU and normal bed capacity at Augsburg University Hospital and the Augsburg ambulance service in the period from 28 March 2020 to 8 June 2020 could be predicted with a high degree of reliability. Simulations that were run before the impact of the restrictions in daily life showed that we would have run out of ICU bed capacity within approximately 1 month. CONCLUSION Our simulation-based prognosis of the health care capacities needed helps the management of the hospital and the civil protection service to make reasonable decisions and adapt the disaster response to the realistic needs. At the same time the forecasts create the possibility to plan the strategic response days and weeks in advance. The tool presented in this study is, as far as we know, the only one accounting not only for confirmed COVID-19 cases but also for suspected COVID-19 patients. Additionally, the few input parameters used are easy to access and can be easily adapted to other healthcare systems.
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Affiliation(s)
- C Römmele
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - T Neidel
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - J Heins
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
- Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg (UNIKA-T), Wirtschaftswissenschaftliche Fakultät, Universität Augsburg, Neusässer Straße 47, 86159, Augsburg, Deutschland.
| | - S Heider
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
- Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg (UNIKA-T), Wirtschaftswissenschaftliche Fakultät, Universität Augsburg, Neusässer Straße 47, 86159, Augsburg, Deutschland
| | - V Otten
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - A Ebigbo
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - T Weber
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - M Müller
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - O Spring
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - G Braun
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - M Wittmann
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - J Schoenfelder
- Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg (UNIKA-T), Wirtschaftswissenschaftliche Fakultät, Universität Augsburg, Neusässer Straße 47, 86159, Augsburg, Deutschland
| | - A R Heller
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
- Führungsgruppe Katastrophenschutz, Zweckverband Rettungsdienst und Feuerwehralarmierung Augsburg, 86143, Augsburg, Deutschland
| | - H Messmann
- Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - J O Brunner
- Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg (UNIKA-T), Wirtschaftswissenschaftliche Fakultät, Universität Augsburg, Neusässer Straße 47, 86159, Augsburg, Deutschland
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Ebigbo A, Tziatzios G, Gölder SK, Probst A, Messmann H. Double-endoscope assisted endoscopic submucosal dissection for treating tumors in rectum and distal colon by expert endoscopists: a feasibility study. Tech Coloproctol 2020; 24:1293-1299. [PMID: 32815048 PMCID: PMC7661416 DOI: 10.1007/s10151-020-02308-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022]
Abstract
Background Colorectal endoscopic submucosal dissection (ESD) is an effective but challenging procedure. To facilitate ESD, several methods that apply traction are available; however, the optimal one remains to be established. The aim of this study was to evaluate the feasibility and safety of the double-endoscope assisted ESD (DEA-ESD) by improving traction to treat complex colorectal lesions. Methods Naïve or previously treated lesions in the rectum and sigmoid colon were included. A grasping forceps advanced through a small-caliber endoscope (GIF-XP190N, Olympus Medical Systems, Tokyo, Japan, 5.4 mm outer diameter) was used to apply traction to the mucosal flap. Lesions were deemed complex when they exceeded a total of nine points on the SMSA scoring system (size, morphology, site, and access) and recurrent when they were previously treated with endoscopic mucosal resection (EMR). Outcome measures included procedural success, total procedure time, complications, and recurrence rate at 3-month follow-up. Results Nine patients (mean age 62.3 ± 14.5 years) were included; five had rectal and four had tumors in the sigmoid colon. The median SMSA score was 14 (SMSA Level IV—complex polyp), while three patients were pre-treated with EMR. DEA-ESD was technically feasible in all cases. En bloc resection and R0 resection rates were 100%, respectively, with a mean procedure time of 128.4 ± 54.1 min. No immediate or delayed complications occurred. Conclusions DEA-ESD is a feasible and safe method for treating complex or recurrent tumors in the rectum and distal colon. Electronic supplementary material The online version of this article (10.1007/s10151-020-02308-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - G Tziatzios
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - S K Gölder
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - A Probst
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - H Messmann
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Pimentel-Nunes P, Pioche M, Albéniz E, Berr F, Deprez P, Ebigbo A, Dewint P, Haji A, Panarese A, Weusten BLAM, Dekker E, East JE, Sanders DS, Johnson G, Arvanitakis M, Ponchon T, Dinis-Ribeiro M, Bisschops R. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019; 51:980-992. [PMID: 31470448 DOI: 10.1055/a-0996-0912] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a need for well-organized comprehensive strategies to achieve good training in ESD. In this context, the European Society of Gastrointestinal Endoscopy (ESGE) have developed a European core curriculum for ESD practice across Europe with the aim of high quality ESD training.Advanced endoscopy diagnostic practice is advised before initiating ESD training. Proficiency in endoscopic mucosal resection (EMR) and adverse event management is recommended before starting ESD trainingESGE discourages the starting of initial ESD training in humans. Practice on animal and/or ex vivo models is useful to gain the basic ESD skills. ESGE recommends performing at least 20 ESD procedures in these models before human practice, with the goal of at least eight en bloc complete resections in the last 10 training cases, with no perforation. ESGE recommends observation of experts performing ESD in tertiary referral centers. Performance of ESD in humans should start on carefully selected lesions, ideally small ( < 30 mm), located in the antrum or in the rectum for the first 20 procedures. Beginning human practice in the colon is not recommended. ESGE recommends that at least the first 10 human ESD procedures should be done under the supervision of an ESD-proficient endoscopist.Endoscopists performing ESD should be able to correctly estimate the probability of performing a curative resection based on the characteristics of the lesion and should know the benefit/risk relationship of ESD when compared with other therapeutic alternatives. Endoscopists performing ESD should know how to interpret the histopathology findings of the ESD specimen, namely the criteria for low risk resection ("curative"), local risk resection, and high risk resection ("non-curative"), as well as their implications. ESD should be performed only in a setting where early and delayed complications can be managed adequately, namely with the possibility of admitting patients to a ward, and access to appropriate emergency surgical teams for the organ being treated with ESD.
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Affiliation(s)
- Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for research in health technologies and information systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mathieu Pioche
- Gastroenterology division, Edouard Herriot Hospital, Lyon, France
| | - Eduardo Albéniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain.,Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain
| | - Frieder Berr
- Department of Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Pierre Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - A Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Germany
| | - Pieter Dewint
- Department of Gastroenterology and Hepatology, AZ Maria-Middelares, Ghent, Belgium.,Department of Gastroenterology and Hepatology, UZA, Antwerp, Belgium
| | - Amyn Haji
- King's Institute of Therapeutic Endoscopy, King's College Hospital, Denmark Hill, London, UK
| | - Alba Panarese
- National Research Institute Specialized in Gastroenterology "S. de Bellis" - IRCCS, Castellana Grotte (BA), Italy
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands.,Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | | | | | - Thierry Ponchon
- Gastroenterology division, Edouard Herriot Hospital, Lyon, France
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for research in health technologies and information systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and TARGID, KU Leuven, Belgium
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Vlasenko D, Ebigbo A, Schaller T, Messmann H, Anthuber M. The first case of non-exposed endoscopic wall-inversion surgery (NEWS) for gastric GIST in Germany. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Clostridium difficile infections remain a problem especially for patients in the intensive care unit. The fact that C. difficile infections are strongly associated with antibiotic therapy calls for more caution in the use of antibiotics, especially in patients with a high risk of developing C. difficle infections. Severe infections and recurrent episodes are usually difficult to manage and therapeutic options are often limited. The method of stool transplantation, though not new, has received more attention in recent years, with studies showing stool transplantation to be a promising and easy method which has high clinical cure rates even for recurrent C. difficile infections. However, more randomised and controlled trials are needed to further study the efficacy of stool transplantation in patients with C. difficile infection.
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Affiliation(s)
- A Ebigbo
- III. Medizinische Klinik, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland,
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Sienz M, Zilly M, Ebigbo A, Knipper A, Winzer R, Klinker H, Langmann P. Follow-up measurements of Nevirapine plasma levels over a prolonged period. Eur J Med Res 2004; 9:412-6. [PMID: 15337632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Over a period of more than four years of treatment, 177 Nevirapine plasma levels were taken from 27 patients. The values showed a high inter-patient variability and a lower intra-patient variability. Differences in body weight turned out to be the main reason for inter-patient variability. Treatment over a prolonged period did not result in any change in plasma concentrations. Adjusting dosage by means of therapeutic drug monitoring would appear to be a reasonable way of maximising patient benefit from treatment.
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Affiliation(s)
- M Sienz
- University of Wuerzburg, Division of Infectious Diseases, Medical Policlinic, Josef-Schneider-Str. 2, D-97080 Wuerzburg, Germany
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