There is currently a gap in the follow-up care of patients with post-traumatic stress disorder (PTSD) after intensive care. Long-term care is mainly provided within the setting of general practice. A conversation-based brief intervention carried out by general practitioners improved the symptoms of mild to moderate post-traumatic stress disorder sustainably. The aim of this study is to assess the subjective effectiveness and feasibility of short-term, primary care-based narrative exposure intervention from the perspective of participating general practitioners. Process-accompanying follow-up calls were made to all general practitioners in the intervention group to check the feasibility of the intervention and to reinforce the initial training. The survey was conducted by telephone between the second and third intervention sessions using an open-response questionnaire. The data analysis was carried out using the structuring qualitative content analysis according to Kuckartz. A total of N = 93 protocols from 87 general practitioners were analyzed. The intervention was assessed as useful and effective by most general practitioners. Nearly half of respondents considered permanent implementation in everyday practice, another third with certain limitations. The good learnability and practicability of the intervention as well as the patient's need were cited as beneficial factors. The greatest barriers to feasibility were seen in the high time expenditure and the lack of remuneration in standard care. Given the shortage of follow-up care for post-ICU PTSD symptoms and the substantial waiting times for trauma-focused psychotherapy, this low-threshold intervention delivered by general practitioners appears both feasible and well-positioned to help bridge a critical gap in care. Since the general practitioners surveyed emphasized the advantage of a quick and low-threshold treatment option for the care of patients with symptoms of PTSD after a stay on an intensive care unit, it seems sensible to ensure that general practitioners have access to training opportunities in the future. Additionally, diagnostics for Post-Intensive Care Syndrome should be implemented after intensive care.

Introduction In light of the growing workload in general practices, a redistribution of medical tasks between general practitioners (GPs) and medical assistants (MAs) is being discussed. Methods The delegation of medical tasks to MAs and the division of tasks within the practice team were discussed in six focus groups that were held 12 years apart and involved 21 MAs and 19 practicing GPs. The contributions were simultaneously visualized by a co-moderator using knowledge mapping and validated in consultation with the participants. The Focus Group Illustration maps generated in this way were then analysed comparatively. Results The delegation of various tasks to MAs was an integral part of everyday practice for general practitioners at both points in time, with high variance in type and scope and a slight tendency to expand over time. By the time of the second data collection, the MAs’ self-image and willingness to take on tasks, as well as their openness to delegation by GPs, increased. However, both professional groups rejected a fundamental redistribution of core medical areas such as diagnostic and therapeutic decisions. Both groups would like to hand over administrative tasks to administrative staff and consider standardized, high-quality MA training as necessary. Discussion A general transfer of core medical duties was not a consideration for either profession. The desire to delegate administrative activities was increasingly addressed at the second data collection period of the study. At the same time, the job profile of the practice manager became more established. In both professional groups, willingness and acceptance of delegation have increased over time, facilitating a new distribution of tasks in general practice in the future. Conclusion From the perspective of focus group participants, an expanded and standardised qualification for MAs appear to play a key role: training standards and legal frameworks need to be developed further in order to expand the role of MAs in general practice.

Abstract Survivors of critical illness frequently experience persistent impairments in health-related quality of life (HRQoL), with psychological symptoms contributing substantially to this burden. The relative contribution of co-occurring depression, anxiety, and post traumatic stress symptoms remains insufficiently understood. To address this gap, we conducted a cross-sectional analysis of pre-randomization data from the PICTURE randomized controlled trial, a multicenter study of a brief primary care–based psychological intervention for post-traumatic stress disorder symptoms following critical illness, including 319 intensive care unit survivors. Clinical, demographic, and mental health assessments were obtained after ICU discharge. Latent profile analysis, random forest modeling, and quantile regression were applied to identify determinants of HRQoL measured by the EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS). The mean EQ-5D-5L index was 0.71 (SD 0.27; median 0.81) and the mean EQ VAS score was 60.7 (SD 19.4; median 60.0), indicating considerable overall impairment. Depression, anxiety, and post-traumatic stress symptoms showed substantial overlap and formed four distinct symptom profiles associated with specific functional impairments. Screening positive for depression on the 2-item Patient Health Questionnaire (PHQ-2) with ≥ 3 points was associated with a median reduction of -0.13 (95% CI -0.19 to -0.07) on the EQ-5D-5L index and -12.45 points (95% CI -17.93 to -6.96) on the EQ VAS, exceeding clinical and demographic predictors. These findings indicate that depressive symptoms are a major determinant of impaired health related quality of life among intensive care survivors with psychological distress and support routine brief depression screening in post-intensive care follow up. Trial registration: ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register: DRKS-ID: DRKS00012589 (Registration date: 2017-10-17).

BACKGROUND:Survivors of critical illness often experience persistent functional disability alongside psychological distress. We examined baseline determinants and domain-specific patterns of disability, and the longitudinal effects of a brief primary care intervention for post-traumatic stress disorder (PTSD). METHODS:In the PICTURE randomized controlled trial, 319 adults aged 18-85 years with PTSD symptoms at least 3 months after intensive care unit (ICU) discharge were randomized to three general practitioner (GP)-led narrative exposure consultations or to improved usual care based on PTSD guidelines. Disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) at baseline, 6, and 12 months. Baseline determinants, disability profiles, and longitudinal changes in disability were evaluated using descriptive analyses and adjusted linear regression models. RESULTS:Depressive and anxiety symptoms were the strongest correlates of baseline disability, exceeding associations with ICU-related factors. Disability showed distinct domain-specific patterns, with emotional difficulties predominating at lower disability levels and progressively broader impairments at higher levels. No meaningful between-group difference was observed at 6 months, whereas disability showed a greater decline in the intervention group by 12 months (adjusted β = -4.31, 95% CI -8.25 to -0.37). Exploratory item-level analyses suggested the greatest improvements in emotional distress, friendships, and work-related activities. CONCLUSIONS:During the later stages of post-ICU recovery in primary care, psychological symptoms appear to become stronger determinants of functional disability than characteristics of the preceding critical illness. Functional benefits following brief trauma-focused care may emerge gradually, suggesting that psychological recovery translates into broader gains over time.

INTRODUCTION:In light of the growing workload in general practices, a redistribution of medical tasks between general practitioners (GPs) and medical assistants (MAs) is being discussed. METHODS:The delegation of medical tasks to MAs and the division of tasks within the practice team were discussed in six focus groups that were held 12 years apart and involved 21 MAs and 19 practicing GPs. The contributions were simultaneously visualized by a co-moderator using knowledge mapping and validated in consultation with the participants. The Focus Group Illustration maps generated in this way were then analysed comparatively. RESULTS:The delegation of various tasks to MAs was an integral part of everyday practice for general practitioners at both points in time, with high variance in type and scope and a slight tendency to expand over time. By the time of the second data collection, the MAs' self-image and willingness to take on tasks, as well as their openness to delegation by GPs, increased. However, both professional groups rejected a fundamental redistribution of core medical areas such as diagnostic and therapeutic decisions. Both groups would like to hand over administrative tasks to administrative staff and consider standardized, high-quality MA training as necessary. DISCUSSION:A general transfer of core medical duties was not a consideration for either profession. The desire to delegate administrative activities was increasingly addressed at the second data collection period of the study. At the same time, the job profile of the practice manager became more established. In both professional groups, willingness and acceptance of delegation have increased over time, facilitating a new distribution of tasks in general practice in the future. CONCLUSION:From the perspective of focus group participants, an expanded and standardised qualification for MAs appear to play a key role: training standards and legal frameworks need to be developed further in order to expand the role of MAs in general practice.

BACKGROUND:Intensive care unit (ICU) survivors frequently experience symptoms of post-traumatic stress disorder (PTSD) and reduced health-related quality of life (HRQoL), yet evidence for effective post-ICU interventions in primary care remains limited. This secondary analysis of the PICTURE randomised controlled trial provides an in-depth evaluation of HRQoL trajectories and potential treatment mechanisms. METHODS:The analysis included 319 adult ICU survivors with at least moderate PTSD symptoms, randomised to a brief general practitioner (GP)-delivered narrative exposure intervention or enhanced usual care. Longitudinal mixed-effects models estimated treatment-by-time effects on HRQoL, based on EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS), with mediation via PTSD symptom change assessed using structural equation modelling. RESULTS:The mean baseline EQ index was 0.71 ± 0.27 and EQ VAS was 60.7 ± 19.4. Mixed-effects models showed a transient improvement in EQ VAS at 6 months in the intervention group (ß = 5.85; 95% CI 0.84-10.87), followed by a delayed improvement in the EQ index at 12 months (ß = 0.075; 95% CI 0.014-0.136). About one quarter of the 12-month EQ index effect was mediated by PTSD symptom reduction at 6 months. Domain-level analyses indicated greater improvement in anxiety/depression and mobility. CONCLUSIONS:In ICU survivors with PTSD symptoms, a brief GP-delivered psychological intervention was associated with clinically meaningful improvements in health-related quality of life over 12 months, with effects emerging over time and only partly explained by PTSD symptom reduction. TRIAL REGISTRATION:ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register (DRKS): DRKS00012589 (Registration date: 2017-10-17).

Emergency department (ED) crowding is a global challenge, presumably aggravated by low-acuity utilization. Various patient streaming interventions have been implemented in EDs to reduce potentially unnecessary utilization and improve care coordination and patient throughput. This systematic review examined the effectiveness and safety of ED-based streaming for low-acuity patients. A search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was conducted up to December 2, 2025. Screening and data extraction were performed in duplicate. RCTs, non-randomized controlled trials, interrupted time series, and before-after studies on general practitioner (GP) streaming, ED streaming, and urgent care (UC) streaming for low-acuity utilizers were eligible. We assessed outcomes related to care effectiveness, patient safety, and cost-effectiveness. Random-effects meta-analyses were performed. Risk of bias was assessed by the Effective Public Health Practice Project tool. We included 137 publications reporting on 119 research projects. Meta-analyses showed higher proportions of cases managed in alternative tracks for GP streaming (0.32; CI 0.17;0.51) compared to ED streaming (0.25; CI 0.15;0.37). Both GP and ED streaming demonstrated reductions in length of stay, particularly for low-acuity patients (GP: SMD − 0.85; CI -1.37;-0.33; ED: SMD − 0.39; CI -0.56;-0.22). Safety outcomes, including leaving without being seen and unplanned ED reattendances, generally improved or were unchanged. The impact on ED utilization and cost-effectiveness remained inconclusive due to inconsistent evidence. There was high variability across outcomes, likely due to diverse context factors and multifaceted interventions. This review provides a comprehensive synthesis of various ED-based streaming interventions for low-acuity patients, with effect estimation by meta-analyses. Results suggest that GP and ED streaming improve care without compromising safety, with indications of a greater potential for alternative care with GP streaming. The predominance of observational studies with potential biases and unexplained heterogeneity, however, results in very low overall certainty of the evidence. PROSPERO CRD42022355935.

Background & objective:The objective of the study is to explore and to evaluate existing patient navigation models between emergency departments (ED) and alternative outpatient emergency care providers. Therefore, three different patient navigation models in emergency care in Berlin, Germany will be evaluated regarding their efficiency, quality of care, patient safety, patient satisfaction, costs and cost-effectiveness: (1) a hospital-owned separate outpatient care model within the ED premises or on the hospital grounds, (2) an urgent care practice of the Regional Association of Statutory Health Insurance (SHI) Physicians at the ED location, and (3) a standard care ED with prospective assessment of patient-care and urgency levels by ED doctors. Methods:In a convergent, parallel, mixed-methods, multi-center study design, patients' and health care providers' perspectives assessed by qualitative methods will be triangulated with the results of a quantitative prospective cohort study at six EDs in Berlin, Germany. This study includes four working modules: (1) a systematic literature review; (2) qualitative semi-structured interviews with patients (n∼15-20), as well as four focus group interviews with health care providers (n∼5); (3) a prospective multi-centre cohort study in adult, self-referred emergency patients at two time points (t0: n = 1,031; t1: n = 344), primary endpoint: proportion of patients treated other than standard emergency care, secondary endpoints: secondary efficiency, patient-reported outcome measures (PROMs), patient safety, quality of care, clinical outcomes, and cost-effectiveness; participant observation of patients' treatment trajectories and organizational processes at three different patient navigation models (n∼10-15), an online provider survey; and (4) data triangulation and recommendations for practice and policy. Discussion:This is the first study to compare different patient navigation and cooperation models to standard ED care in Germany and evaluate their effectiveness. Results will provide deep insights into the efficiency, patient satisfaction, quality of care, patient safety and cost-effectiveness. This will help providers and policymakers organise future emergency care in Germany. The study is expected to contribute to health services and systems research. Trial registration:DRKS00030398.

Abstract Background Approximately 20–25% of patients who survive medical treatment at an intensive care unit (ICU) develop post-traumatic stress symptoms. There is currently a gap in follow-up care for them. As part of the PICTURE study, general practitioners (GPs) carried out a brief interview-based intervention. The aim of this sub-study is to record the most distressing memories of ICU treatment from the patient’s perspective and their evaluation of a GP-based brief psychological intervention. Methods Participants were recruited from the intervention group of the main PICTURE study using selective sampling. All of them had experienced an ICU stay with mechanical ventilation and severe organ failure in the previous two years. They were interviewed about their experience of psychological stress during their ICU stay and their retrospective evaluation of the intervention. Semi-structured, guideline-based telephone interviews were conducted for this purpose, processed, and analyzed using the structuring qualitative content analysis based on Mayring. Findings When asked N = 8 patients about the most stressful memory of their stay at ICU, the main themes were helplessness, pain, fixation, inability to communicate and sleep disturbances. The question of amnesia regarding the stay in the ICU was answered affirmatively by half of the interviewees but was not experienced as stressful. The brief trauma-focused intervention carried out by their GPs was well received by all respondents. Conclusions The interviewees confirm that aversive traumatizing experiences are often associated with intensive care treatment and reinforce each other. These are due to the treatment setting but should be reduced wherever possible. In view of chronification and the lack of specific follow-up treatment options for these patients and the long waiting times for psychotherapy, the implementation of low-threshold treatment options by GPs appears to be ideally suited to closing this gap in care, particularly for patients with mild to moderate symptoms of a post-traumatic stress disorder. Trial registration The main trial was registered at ClinTrials gov (NCT03315390) and at the German Register of Clinical Trials (DRKS, DRKS00012589) on 17/10/2017.

Background Symptom checker apps (SCAs) are layperson-facing tools that advise on whether and where to seek care, or possible diagnoses. Previous research has primarily focused on evaluating the accuracy, safety, and usability of their recommendations. However, studies examining SCAs’ impact on clinical care, including the patient-physician interaction and satisfaction with care, remain scarce. Objective This study aims to evaluate the effects of an SCA on satisfaction with the patient-physician interaction in acute care settings. Additionally, we examined its influence on patients’ anxiety and trust in the treating physician. Methods This parallel-group, randomized controlled trial was conducted at 2 emergency departments of an academic medical center and an emergency practice in Berlin, Germany. Low-acuity patients seeking care at these sites were randomly assigned to either self-assess their health complaints using a widely available commercial SCA (Ada Health) before their first encounter with the treating physician or receive usual care. The primary endpoint was patients’ satisfaction with the patient-physician interaction, measured by the Patient Satisfaction Questionnaire (PSQ). The secondary outcomes were patients’ satisfaction with care, their anxiety levels, and physicians’ satisfaction with the patient-physician interaction. We used linear mixed models to assess the statistical significance of primary and secondary outcomes. Exploratory descriptive analyses examined patients’ and physicians’ perceptions of the SCA’s utility and the frequency of patients questioning their physician’s authority. Results Between April 11, 2022, and January 25, 2023, we approached 665 patients. A total of 363 patients were included in the intention-to-treat analysis of the primary outcome (intervention: n=173, control: n=190). PSQ scores in the intervention group were similar to those in the control group (mean 78.5, SD 20.0 vs mean 80.8, SD 19.6; estimated difference –2.4, 95% CI –6.3 to 1.1, P=.24). Secondary outcomes, including patients’ and physicians’ satisfaction with care and patient anxiety, showed no significant group differences (all P>.05). Patients in the intervention group were more likely to report that the SCA had a beneficial (66/164, 40.2%) rather than a detrimental (3/164, 1.8%) impact on the patient-physician interaction, with most reporting no effect (95/164, 57.9%). Similar patterns were observed regarding the SCA’s perceived effect on care. In both groups, physicians rarely reported that their authority had been questioned by a patient (intervention: 2/188, 1.1%; control: 4/184, 2.2%). While physicians more often found the SCA helpful rather than unhelpful, the majority indicated it was neither helpful nor unhelpful for the encounter. Conclusions We found no evidence that the SCA improved satisfaction with the patient-physician interaction or care in an acute care setting. By contrast, both patients and their treating physicians predominantly described the SCA’s impact as beneficial. Our study did not identify negative effects of SCA use commonly reported in the literature, such as increased anxiety or diminished trust in health care professionals. Trial Registration German Clinical Trial Register DRKS00028598; https://drks.de/search/en/trial/DRKS00028598/entails International Registered Report Identifier (IRRID) RR2-10.1186/s13063-022-06688-w

BACKGROUND:In Germany, the alternative care of patients with ambulatory treatment needs has been discussed for years as a way to relieve emergency departments. This study provides insights into currently implemented models of patient streaming and integrated acute and emergency care. METHODS:Between July 2023 and July 2024 emergency department physicians were surveyed online. One section targeted management personnel and gathered information on care structures and case numbers. Based on this, the potential for relieving emergency departments was calculated. The analysis was descriptive. RESULTS:Of the 370 participants 28% (n = 105) held management positions in the emergency department and 50% (n = 45) of those with alternative structures reported collaborations with the Association of Statutory Health Insurance Physicians. Standardized patient streaming was implemented in 43% (n = 24), often based on triage. The median indicated relief potential was 21%. DISCUSSION:The findings reveal a heterogeneous care landscape with varying patient streaming approaches and relevant potential to relieve emergency departments. Due to the small number of cases and a convenience sample, the results should be interpreted as exploratory. Further research could support the evidence-based development of acute and emergency care.

Despite therapeutic advances, sepsis remains a global burden. Shortcomings within the healthcare system that inflate morbidity and mortality rates are instructive in this regard. This review aims to provide a qualitative synthesis of literature related to healthcare providers’ perspectives on sepsis care, emphasizing perceived factors that impact the adequate care of septic patients and sepsis survivors. In February 2023, we conducted a systematized search approach using the PubMed database. Of 114 articles found in the PubMed database, 37 were included. A further 13 articles were identified by manual search. Healthcare providers highlighted a variety of dysfunctional and functional processes with an impact on sepsis care. Six domains were identified, related to the underlying disease, the patient, the provider, the guidelines, the healthcare system, and the collaboration among providers. Of note, providers’ level of knowledge and a lack of communication between disciplines and/or sectors were reported as shortcomings in each phase of the care pathway (prevention, recognition, treatment, transitions of care, and aftercare). This review suggests that, without limitation, interventions that provide continuous provider education as well as standard communication channels between interdisciplinary and intersectoral providers have great potential to improve structural deficiencies in sepsis care.

Zusammenfassung Hintergrund Zur Entlastung der Notaufnahmen wird in Deutschland seit Jahren über die alternative Versorgung von Patient:innen mit ambulantem Behandlungsbedarf diskutiert. Dieser Beitrag gibt Einblick in aktuell praktizierte Modelle der Steuerung und integrierten Akut- und Notfallversorgung in Deutschland. Methode Zwischen Juli 2023 und Juli 2024 wurde ärztliches Notaufnahmepersonal mittels eines Onlinesurveys befragt. Ein Teil richtete sich an Leitungspersonal und erhob Versorgungsstrukturen und Fallzahlen. Daraus wurden Entlastungspotenziale berechnet. Die Auswertung erfolgte deskriptiv. Ergebnisse Von 370 Teilnehmenden waren 28 % ( n = 105) leitendes Notaufnahmepersonal. 50 % ( n = 45) derjenigen mit alternativen Strukturen berichteten über Kooperationen mit der Kassenärztlichen Vereinigung. In 43 % ( n = 24) erfolgte eine standardisierte Steuerung, oft triagebasiert. Das angegebene Entlastungspotenzial lag im Median bei 21 %. Diskussion Die Ergebnisse zeigen eine heterogene Versorgungslandschaft mit unterschiedlichen Steuerungsansätzen und relevanten Entlastungspotenzialen. Aufgrund geringer Fallzahlen und eines konvenienten Samples sind die Ergebnisse als explorativ zu interpretieren. Weitere Forschung kann zur evidenzbasierten Weiterentwicklung der Akut- und Notfallversorgung beitragen.

Background/Objectives: Despite recent decades’ rapid advances in the management of patients with sepsis and septic shock, global sepsis mortality and post-acute sepsis morbidity rates remain high. Our aim was, therefore, to provide a first overview of sepsis care pathways as well as barriers and supportive conditions for optimal pre-clinical, clinical, and post-acute sepsis care in Germany. Methods: Between May and September 2023, we conducted semi-structured, video-based, one-to-one pilot expert interviews with healthcare professionals representing pre-hospital, clinical, and post-acute care settings. The interviews were audio-recorded, transcribed verbatim, and analyzed according to the principles of Mayring’s content analysis. Results: The eight interviewed professionals identified perceived critical success factors along the entire care pathway with regard to early detection (e.g., disease awareness), early acute treatment (e.g., unknown origin of infection), rehabilitation/aftercare (e.g., availability of primary care actors), and patient transitions within and between sectors (e.g., advance notice of patient arrival). These critical factors comprised: (1) the characteristics of the staff providing care (e.g., available experience), (2) the aids/utilities used (e.g., SOPs), (3) the presentation of the disease (e.g., clear symptoms), (4) the workplace (e.g., high workload), and (5) the cooperation between the staff caring for the patient (e.g., announced and standardized handovers). Conclusions: Apart from the specific recommendations that can be derived from the individual factors presented, it can be summarized that all levels of care seem only to be purposeful if providers collaborate and communicate efficiently (i.e., correct triage, multiple-eye principle, transfer management, provision of content-rich medical/discharge letters).

Background Post-traumatic stress has been identified as a frequent long-term complication in survivors of critical illnesses after sepsis. Little is known about long-term trajectories of post-traumatic stress and potentially modifiable risk factors following the ICU stay. Study objective was to explore and compare different clinical trajectories of post-traumatic stress symptoms in sepsis survivors up to two years after discharge from ICU. Methods Data on post-traumatic stress symptoms by means of the Post-traumatic Symptom Scale (PTSS-10) were collected in sepsis survivors at one, six, 12 and 24 months after discharge from ICU. Data on chronic psychiatric diagnoses prior ICU were derived from the primary care provider’s health records, and data on intensive care treatment from ICU documentation. Trajectories of post-traumatic symptoms were identified ex post, discriminating patterns of change and k-means clustering. Assignment to the trajectories was predicted in multinomial log-linear models. Results At 24 months, all follow-up measurements of the PTSS-10 were completed in N = 175 patients. Three clusters could be identified regarding clinical trajectories of PTSS levels: stable low symptoms ( N = 104 patients [59%]), increasing symptoms ( N = 45 patients [26%]), and recovering from symptoms ( N = 26 patients [15%]). Patients with initially high post-traumatic symptoms were more likely to show a decrease (OR with 95% CI: 1.1 [1.05, 1.16]). Females (OR = 2.45 [1.11, 5.41]) and patients reporting early traumatic memories of the ICU (OR = 4.04 [1.63, 10]) were at higher risk for increasing PTSS levels. Conclusion Post-traumatic stress is a relevant long-term burden for sepsis patients after ICU stay. Identification of three different trajectories within two years after ICU discharge highlights the importance of long-term observation, as a quarter of patients reports few symptoms at discharge yet an increase in symptoms in the two years following. Regular screening of ICU survivors on post-traumatic stress should be considered even in patients with few symptoms and in particular in females and patients reporting traumatic memories of the ICU.

Zusammenfassung Hintergrund Intensivmedizinische Aufenthalte führen bei vorbelasteten Menschen häufig zu Symptomen einer posttraumatischen Belastungsstörung (Post-ICU-PTBS). In der Nachsorge spielen HausärztInnen eine wichtige Rolle. Falldarstellung Eine 58-jährige Patientin entwickelt nach erlebter Sepsis eine Post-ICU-PTBS. Sie erhält durch ihre Hausärztin eine Kurzform der Narrativen Expositionstherapie (NET) und erfährt eine deutliche Symptombesserung. Schlussfolgerung Die angewandte Kurzform der NET kann für die Behandlung von leicht- bis mittelgradigen Symptomen einer Post-ICU-PTBS geeignet sein.

Background Sepsis is associated with about 20% of deaths worldwide. It often presents with non-specific initial symptoms, making its emergency treatment an interdisciplinary and cross-sectoral challenge. Three in four sepsis survivors suffers from new cognitive, psychological, or physical sequelae for which specific treatment concepts are scarce. The AVENIR project aims to improve the understanding of patient pathways, and subjective care experiences and needs along the entire healthcare pathway before, with and after sepsis. Based on this, concrete recommendations for the organization of care and patient information materials will be developed with close patient participation. Methods Mixed-methods study including (1) analysis of anonymized nationwide health claims data from Germany, (2) linkage of health claims data with patient care reports (PCR) of emergency medical services from study regions in two federal states within Germany, and (3) qualitative exploration of the patient, relative, and care provider perspective on sepsis care. In (1), we analyze inpatient and outpatient health care utilization until 30 days pre-sepsis; clinical sepsis care including intra- and inter-hospital transfers; and rehabilitation, inpatient and outpatient aftercare of sepsis survivors as well as costs for health care utilization until 24 months post-sepsis. We attempt to identify survivor classes with similar health care utilization by Latent Class Analyses. In (2), PCR are linked with health claims data to establish a comprehensive database outlining care pathways for sepsis patients from pre-hospital to follow-up. We investigate e.g., whether correct initial assessment is associated with acute (e.g., same-day lethality) and long-term (e.g., new need for care, long-term mortality) outcomes of patients. We compare the performance of sepsis-specific screening tools such as qSOFA, NEWS-2 or PRESEP in the pre-clinical setting. In (3), semi-structured interviews as well as synchronous and asynchronous online focus groups are conducted and analyzed using qualitative content analyses techniques. Discussion The results of the AVENIR study will contribute to a deeper understanding of sepsis care pathways in Germany. They may serve as a base for improvements and innovations in sepsis care, that in the long-term can contribute to reduce the personal, medical, and societal burden of sepsis and its sepsis sequelae. Trial registration Registered at German Clinical Trial Register (ID: DRKS00031302, date of registration: 5th May 2023).

Background: The use of mobile health applications is increasingly common among the general public. More recently, healthcare systems incorporate such tools in their service workflows, be it as guidance to the most appropriate care setting or as prescription digital therapeutics. With such apps percolating into the classic healthcare sector, the necessity of sound and standardized evaluation grows. The mHealth App Usability Questionnaire (MAUQ) provides a novel and custom-tailored psychometrically validated instrument to capture users’ perception of the usefulness and usability of an mHealth application. So far, this questionnaire is only available in English, Malay and Chinese.Objective: The aim of this study was to translate and validate a German version of the MAUQ (G-MAUQ). Further, we developed a short scale with 6 items (G-MAUQ-S) in German. Methods: We used the Translation, Review, Adjudication, Pretest and Documentation (TRAPD) method to translate the MAUQ. Subsequently, we assessed content validity with 15 expert ratings and face validity with 15 German speaking mHealth users. To further validate the questionnaire, we used data from 148 participants of an RCT examining symptom checkers in the Emergency Department to assess convergent validity by correlating the G-MAUQ with the German version of the System Usability Scale and discriminant validity by correlating the G-MAUQ with other unrelated questionnaires. Lastly, we developed a short version by assessing item discrimination, factor loadings, correlation with the full scale and construct validity.Results: All but one item showed sufficient content validity with item-level content validity index values between CVI-I = 0.8 and 1.0. Face validity was excellent with item-level face validity index values ranging from FVI-I = 0.87 to 1. Convergent validity was sufficient with r = 0.769, and discriminant validity was sufficient with values between r = -0.014 and r = 0.220. An internal consistency of Cronbach’s α = 0.93 demonstrated high reliability. The short scale showed sufficient convergent validity (r = 0.762) and discriminant validity (r between –0.012 and 0.201). Conclusions: A validated and reliable G-MAUQ can be used by researchers and practitioners to assess the usability of mHealth interventions. We also provide the German mHealth App Usability Questionnaire – Short Version (G-MAUQ-S) with six questions to quickly assess the usability of an intervention.