Background:In Germany, approximately 1,100 beds are allocated to early neurological-neurosurgical rehabilitation (ENNR) for patients with severe neurological illness requiring weaning from mechanical ventilation. Specialized ENNR institutions play a major role in maintaining ICU capacity in acute care hospitals and in reducing the number of patients dependent on home intensive care. However, nationwide structural data on ENNR weaning centers-together with detailed patient characteristics-remain unavailable. This lack of information poses significant challenges for healthcare planning, resource allocation, and understanding the national weaning capacity. Methods:In June 2022, an online survey was conducted to collect structural data on institutions and wards, as well as cross-sectional clinical data from mechanically ventilated neurological patients. The survey was sent to the members of the weaning commission of the German Society for Neurological Rehabilitation (DGNR), to participants of a preceding study, and also to institutions recruited through personal communication. Findings:Data were collected from 24 institutions, including 46 wards and 182 patients. Institutions showed considerable variability in diagnostic and therapeutic resources; however, most relied on multidisciplinary teams and intensive monitoring, indicating high medical complexity of the patient population. The most frequent primary diagnoses included ischemic stroke (n = 27, 15%), intracerebral hemorrhage (n = 21, 12%), hypoxic-ischemic encephalopathy (n = 12, 7%), and subarachnoid hemorrhage (n = 12, 7%). The most frequent comorbidities were coronary heart disease (n = 40, 22%), left ventricular failure (37, 20%), and COPD (37, 20%). Mechanical ventilation was predominantly invasive (n = 180, 99%). The median number of days on mechanical ventilation during the stay in ENNR was 22 (IQR 9-41) days, and the median duration of ventilation was 18 (IQR 10-24) h during the last 24 h before data collection. Fourteen (8%) patients needed renal replacement therapy. Palliative therapy limitations were implemented in 22 (12%) patients. Interpretation:Institutions providing weaning in ENNR commonly treat older, medically complex patients who have undergone pretreatment in acute intensive care units. These patients typically present with severe neurological illness accompanied with cardiopulmonary comorbidities. In order to meet their needs, multidisciplinary teams deliver rehabilitation, intensive care, and palliative care.
Congenital Cytomegalovirus (cCMV) infection is the leading non-genetic cause of sensorineural hearing loss in newborns. Systematic nationwide screening programmes are lacking. Antiviral valganciclovir therapy could improve auditory outcomes if initiated within the first 30 days of life, making timely diagnosis crucial. To address this, we investigated whether a hearing screening-based protocol is suitable. Between 2015 and 2019, newborns, aged ≤21 days, with repeated abnormal newborn hearing screening (NHS) were prospectively enrolled at University Hospital Frankfurt. Oral mucosal swabs were tested for CMV DNA by real-time PCR, with confirmatory urine and blood diagnostics in positive cases. Of 2741 infants presenting for repeat NHS, 2059 (75.1%) showed normal bilateral findings. Of the 682 (24.9%) with abnormal results, 575 (84.3%) were aged >21 days and thus ineligible. A total of 107 infants (3.9%) met both criteria-abnormal NHS and aged ≤21 days-of whom 100 entered per-protocol analysis. Two (2%) were confirmed as cCMV-positive and received valganciclovir. Among the 48 infants who additionally underwent DBS testing, diagnostic sensitivity and specificity were 100%. The presented NHS-driven cCMV protocol reliably identified cCMV-infected newborns to offer timely antiviral therapy. In the absence of universal cCMV screening, this targeted approach offers a challenging but WHO screening-criteria-compliant strategy to enable timely antiviral intervention.
Zusammenfassung Bahnbrechende technische Fortschritte in der plastischen und orthopädischen Chirurgie haben in den vergangenen Jahrzehnten maßgeblich zur signifikanten Erhöhung der Rate an Extremitätenerhalt beigetragen. Die adäquate Rekonstruktion komplexer Gewebedefekte unterschiedlicher Ätiologie – einschließlich traumatischer, onkologischer, ischämischer und infektiöser Ursachen – ist durch den Einsatz fortschrittlicher rekonstruktiver Techniken heute in hohem Maße realisierbar und trägt wesentlich zur funktionellen Erhaltung der betroffenen Extremität sowie zur signifikanten Verbesserung der Lebensqualität bei. Der Erfolg solcher komplexen rekonstruktiven Therapien setzt ein multidisziplinäres Team voraus, das nicht nur die jeweilige chirurgische Expertise – wie knöcherne Fixation, Weichteildeckung oder Revaskularisierung – mitbringt, sondern auch im Sinne eines kohärenten, fächerübergreifenden Behandlungskonzepts zusammenarbeitet. Die orthoplastische Chirurgie basiert auf der engen Kooperation zwischen orthopädischen und plastisch-rekonstruktiven Mikrochirurgen, deren komplementäre Expertise sowohl die operative Rekonstruktion komplexer Defekte als auch die fundierte Beurteilung der Erfolgsaussichten eines Extremitätenerhalts ermöglicht. Dieser Artikel bietet einen Überblick über die Rolle von Orthopäden und plastisch-rekonstruktiven Chirurgen als zentrale Säulen eines orthoplastischen Behandlungsteams und veranschaulicht, wie dieses interdisziplinäre Konzept zur Lösung komplexer Herausforderungen in der Extremitätenrekonstruktion beitragen kann.
Groundbreaking technological advances in plastic and orthopedic surgery have contributed to substantially increasing the overall limb-salvage rates over recent decades. Adequate reconstruction of complex tissue defects of diverse etiologies - including traumatic, oncologic, ischemic, and infectious causes - has become highly feasible through the application of advanced reconstructive techniques and plays a pivotal role in preserving limb function and markedly improving patients' quality of life. The success of such complex reconstructive strategies requires a multidisciplinary team capable of integrating diverse surgical competencies - such as skeletal stabilization, soft-tissue coverage, and vascular reconstruction - into a coherent treatment pathway. Orthoplastic surgery is founded on the close collaboration between orthopedic surgeons and plastic-reconstructive microsurgeons, whose complementary expertise facilitates both the execution of intricate reconstructions and a well-founded assessment of limb-salvage potential. This article outlines the roles of orthopedic and plastic-reconstructive surgeons as core pillars of an orthoplastic care model and illustrates how this interdisciplinary approach can address the multifaceted challenges in limb reconstruction.
Introduction:The increasing prevalence of life-threatening neurological diseases raises the need for neuropalliative care. Setting up neurological palliative outpatient clinics is one way of addressing this need. This study aims to describe the patient clientele of a neurological palliative outpatient clinic and the spectrum of necessary treatments and interventions. Methods:In this longitudinal analysis, clinical routine data from a single centre were collected retrospectively from adult patients. The patient characteristics related to disease and treatment were evaluated descriptively. Factors influencing the need for ventilation were modelled in a logistic regression. The required treatment effort was modelled with a zero-inflated Beta regression. Results were reported as odds ratios with 95% confidence intervals (CIs). Results:Two hundred and thirty-two patients were included in the study. Ninety-one patients were women, 141 were men, and the mean age was 55.42 years. Neuropalliative patients represented diagnoses such as amyotrophic lateral sclerosis (ALS) (n = 81), ischemic stroke (n = 15), intracerebral haemorrhage (n = 15), Duchenne muscular dystrophy (n = 12), or craniocerebral trauma (n = 10). Palliative care counselling was the most common intervention for patients (n = 203), their close relatives (n = 177), and their nursing services (n = 75). Respiratory therapy (n = 188), speech and language therapy (n = 145), and physiotherapy (n = 143) were also frequently applied interventions. Sixty patients received botulinum toxin A treatment for hypersalivation, and 32 for spasticity. The odds of needing invasive ventilation increased by 3.7 (CI 1.7-7.8), and the need for mechanical insufflation-exsufflation increased by 2.2 (CI 1.1-4.3) in patients previously discharged from early neurological-neurosurgical rehabilitation. Prior intensive care treatment increased the odds of invasive ventilation by 5.1 (CI 2.2-11.5) and the use of mechanical insufflation-exsufflation by 2.3 (CI 1.1-4.8). Conclusion:Neuropalliative outpatient clinics demand a wide range of diagnostic measures and interventions as well as a multidisciplinary approach. Further research is necessary to investigate the relation between diagnosis and treatment needs. Clinical trial registration:https://drks.de/search/en/trial/DRKS00030778, identifier DRKS00030778.
