Although intermittent catheterisation (IC) has been established as the standard method of bladder emptying in cases of neurogenic bladder dysfunction since the 1960s, there are still many uncertainties in everyday nursing practice regarding the specific implementation of IC. It, therefore, seemed necessary to standardise the IC procedure and develop specific recommendations for performing IC based on an interprofessional, interdisciplinary consensus process. In 2014, an interprofessional, interdisciplinary working group developed initial Clinical Practice Guidelines (CPG) in accordance with the rules of the Association of the Scientific Medical Societies in Germany (AWMF) based on the evidence level of a structured consensus process. The methods used to develop the CPG and the professional associations involved are described in detail. These CPG have been consistently refined and have been available as update 3.0 since 2026. The CPG describes in detail the topics of indications for IC, definitions, detailed descriptions of the various catheter characteristics, specific implementation of IC including disinfection of hands and meatus urethrae, management of complications such as urinary tract infections (UTIs) or autonomic dysreflexia, and options for UTI prophylaxis, and provides specific recommendations for action. This CPG, based on consensus-based evidence, has proven itself in clinical and everyday use for over 10 years. Due to the regular further development of the CPG, the guideline will also be able to meet future challenges such as changing demographic conditions of our patients with an increase in older patients with complex medical situations and increased use of permanent urinary catheter drainage or increased cost pressure in the healthcare system, even in developed countries. Consensus-based CPGs are an important component of evidence-based medicine, especially in situations where there are few randomised-controlled trials and none are expected in the future. Such CPGs can also address aspects that are likely to become even more important in the future, such as sustainability and environmental issues.
Statistische Fragilität beschreibt, wie stabil oder instabil die Ergebnisse klinischer Studien gegenüber kleinen Änderungen einzelner Datenpunkte sind. Gerade in der Arthroskopie und Gelenkchirurgie, in der viele Studien auf kleinen Stichproben und seltenen Ereignissen basieren, kann bereits der Wechsel weniger Patient:innenergebnisse dazu führen, dass statistische Signifikanz verloren geht. Der Fragility-Index sowie seine Weiterentwicklungen für kontinuierliche und nichtsignifikante Endpunkte erlauben eine intuitive Einschätzung dieser Robustheit und ergänzen klassische Kennzahlen wie p-Wert und Konfidenzintervalle. In diesem Übersichtsartikel werden die Konzepte der statistischen Fragilität, ihre Berechnung für binäre und kontinuierliche Variablen sowie ihre Bedeutung für die Interpretation gelenkchirurgischer Studien dargestellt.
Ein 48-jähriger Patient stellte sich ein Jahr nach konservativ therapierter Ruptur des hinteren Kreuzbandes (HKB) mit vorderem Knieschmerz, subjektivem Instabilitätsgefühl und Bewegungseinschränkung vor. Die Schmerzintensität auf der visuellen Analogskala (VAS) betrug 7/10 unter Belastung und 3/10 in Ruhe, der Bewegungsumfang lag bei 0°–5°–120° (Extension/Flexion). Die gehaltenen Röntgenaufnahmen zeigten eine fixierte hintere Schublade. Es erfolgte eine arthroskopische Arthrolyse mit Lösung narbiger Adhäsionen zwischen vorderem und hinterem Kreuzband, die Resektion des Septums zwischen posteromedialem und posterolateralem Rezessus sowie die Entfernung fibrotischer Adhäsionen im posterioren Kompartiment. Postoperativ zeigte sich eine deutliche Schmerzreduktion (VAS 1/10 unter Belastung, 0/10 in Ruhe) sowie ein freies Bewegungsausmaß (5–0°–140°, Extension/Flexion). Eine subjektive und objektive posterolaterale Rotationsinstabilität persistierte, sodass eine HKB-Rekonstruktion mit zusätzlicher posterolateraler Rekonstruktion geplant ist.
Background: Management of tracheobronchial secretions is an integral part of clinical work in many specialist areas, contributing to respiratory stability and survival of the patients. This study aimed at recording the practice of secretion management among doctors, respiratory therapists, specialist nurses and other health professions in German-speaking countries and to derive measures from the results to improve patient care. Methods: An online survey with 15 closed and two open-ended questions was designed to collect information regarding the profession and working environment of the respondents as well as the practice of secretion management in their primary working environment. The survey was distributed to members of the German Interdisciplinary Society for Out-of-Hospital Ventilation and Intensive Care e.V. (DIGAB), the German Society for Neurorehabilitation e.V. (DGNR), the German Society for Respiratory Therapy e.V. (DGA) and the German Society for Pulmonology and Mechanical Ventilation e.V. (DGP). Findings: The invitation to participate in the survey was distributed to 1695 members of the DIGAB, DGNR, DGA and DGP. Two-hundred fifty-eight health professionals including doctors, respiratory therapists, nurses, pediatric nurses, speech and language therapists and physiotherapists mostly working in Germany (97 %) completed the survey. One-Hundred eighty-eight (73 %) worked in hospitals or rehabilitation facilities and seventy (27 %) in an in-community setting. The spectrum of diagnostic and therapeutic methods used for management of tracheobronchial secretions on a daily or routine basis differed between hospitals or rehabilitation facilities and the in-community setting, between ICUs, weaning units and wards with specialization in ENNR, between in-community intensive care in the home of the patients and in residential communities, and between respondents treating only children, both children and adults, and only adults. Interpretation: A consensus on proceedings for the management of tracheobronchial secretions is required, which again requires further research into the differences regarding the practice of secretion management observed in this study. Standardized proceedings for the management of tracheobronchial secretions should be implemented by national treatment guidelines or local standard operating procedures.
