STUDY AIMS: To determine the incidence of mechanical restraint in the emergency department (ED) of the University Hospital of Bern, Switzerland; To assess differences in restraint frequency and practice across patient groups (sex, age, alcohol involvement); To characterise triggers of aggression or agitation and restraint-related interventions including medication use; To examine temporal patterns, particularly the impact of the COVID-19 lockdown and pandemic. METHODS: We included patients presenting at our institution between 1 January 2018 and 30 September 2022 who were subjected to mechanical restraint. Patients were identified through a keyword search followed by a comprehensive full-text review of the hospital database. Demographic and consultation characteristics, data about restraining circumstances and characteristics, as well as referral or discharge procedure were collected. Group comparisons were performed using the Wilcoxon rank-sum test or Kruskal–Wallis test, as appropriate. Categorical variables were compared using the chi-squared test. Incidence rate ratios across the three COVID-19 mitigation phases (pre, during, post) were estimated using Poisson regression. RESULTS: We identified 285 patients who were subjected to mechanical restraint, corresponding to an incidence of 1.22 (95% CI: 1.08–1.37) per 1000 ED consultations during the study period. Men were overrepresented with 67.4% and the median age was 30 years (IQR: 23–41). Alcohol intoxication was the primary trigger of aggression in 35.4% of cases, with mixed intoxication present in 24.2%. The largest subgroup consisted of young men (≤40 years) under the influence of alcohol (31.6%). Compared to men, women were generally younger (28 vs 32 years, p <0.001) and had a higher prevalence of psychiatric comorbidities (43.0% vs 20.3%, p <0.001). Older patients were more likely to be intoxicated with alcohol (52.8% vs 29.6%, p <0.001), whereas younger patients had a higher rate of mixed intoxication (28.2% vs 12.5%, p = 0.007) and psychiatric disorders (31.9% vs 15.3%, p = 0.006). Mechanical restraint involving alcohol was more common in men (74.7%, p = 0.001), associated with risk of harm to others (69.8%, p <0.001) and addiction problems (76.4%, p <0.001). Pharmacological coercive measures were primarily administered using benzodiazepines (78.2%, typically intravenous and/or nasal application) and haloperidol (47.4% intravenous and/or intramuscular). The median duration of mechanical restraint was 258 minutes (IQR: 160–400). Alcohol-involved presentations were significantly associated with young men, non-Swiss nationality, acute risk of harm to others, night shift, addiction and longer restraint times (all p ≤0.001). The number of mechanical restraints increased until mid-2020, stabilising during the COVID-19 mitigation period, with a higher incidence of mechanical restraints during the pandemic (1.43 vs 1.02 per 1000 consultations pre-pandemic, p = 0.008). CONCLUSION: The incidence of mechanical restraint was low (1.22 per 1000 visits). Predominantly, young, intoxicated men, presenting with risk of harm to others, were subject to mechanical restraint. Psychiatric comorbidities were more common in women, who were therefore more likely to pose a risk of self-harm. During the COVID-19 mitigation period, the incidence of mechanical restraint increased; however, the causal factors underlying this trend remain unclear.

Introduction Cardiac arrest (CA) remains a major health burden with poor survival and poor neurological outcomes despite decades of advances in resuscitation science. Although high-quality cardiopulmonary resuscitation is essential, it provides only limited cerebral and coronary perfusion, and current strategies relying on high-dose epinephrine may adversely affect cerebral microcirculation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a potential adjunct to improve coronary and cerebral perfusion without compromising microvascular blood flow. Although animal studies and small human case series suggest physiological and clinical benefits of REBOA in CA, randomised clinical trials are lacking.Methods and analysis This prospective, randomised controlled, single-centre clinical trial investigates the effect of REBOA during the treatment of CA. The planned study duration is 36 months, with a total of 98 patients to be randomised to either standard advanced life support (ALS) or ALS plus REBOA. Adult patients with an in-hospital CA, successful placement of a femoral artery introducer sheath and any electrical cardiac activity in the initial rhythm analysis are eligible for inclusion. Exclusion criteria comprise traumatic CA, asystole as the initial rhythm, pregnancy and CA occurring on intensive care units, in the operating room or in cardiac catheter laboratory. The primary outcome is sustained return of spontaneous circulation lasting for at least 20 min. Secondary and exploratory outcomes include survival, neurological outcome, changes in aortic blood pressure, end-tidal CO₂ and near-infrared spectroscopy values as well as causes of death and vascular complications related to the intervention. Statistical analyses will be performed on a modified intention-to-treat basis.Ethics and dissemination The study protocol (Version 2.1, 11.02.2026) was approved by the Cantonal Ethics Committee of Cantone Bern (2025-D0108). Study results will be disseminated through peer-reviewed journals.Trial registration number NCT07434726.

Abstract Background Vertigo, dizziness and balance disorders affect over half of adults aged 65 and older. The MobilE-PHY2 study, conducted in Germany, evaluated the effectiveness of an evidence-based, multidisciplinary care pathway for this population. From a health economic perspective, the intervention was expected to increase outpatient and physiotherapy costs while reducing resource utilisation in other healthcare areas and improving patient-relevant outcomes. Objective This health economic evaluation examined the cost-effectiveness of the care pathway compared to optimised routine care. Incremental costs were related to incremental changes in both quality-adjusted life years (QALYs) and the Dizziness Handicap Inventory (DHI) as a disease-specific outcome; expressed as incremental cost-effectiveness ratios (ICER). Methods The study was a multicentre, cluster-randomised controlled trial with six -month follow-up. The health economic evaluation was conducted from a societal perspective. Cost-effectiveness was determined via incremental cost-utility ratios (ICURs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using cost-effectiveness acceptability and net-monetary-benefit curves. Missing data were handled using Multiple Imputation by Chained Equations. Sensitivity analyses excluded informal care costs and focused on a subgroup with reduced imputation uncertainty. Results The ICER was 81,246.85€ per additional patient achieving a clinically relevant DHI improvement. Indicating that if the willingness-to-pay threshold were €50,000 per additional patient achieving a clinically relevant DHI improvement, the intervention would be cost-effective with 71% probability. The ICUR was negative (-121,847.54€/QALY), meaning optimised routine care dominated the intervention. From a payer perspective, the intervention was less costly, though with lower QALYs. Findings were robust in sensitivity analyses. Conclusion The care pathway shows potential for cost-effectiveness among patients achieving DHI improvements, supporting cautious, targeted implementation in routine care. Future research should address the economic burden on informal caregivers. Trial registration DRKS00028524 retrospectively registered on March 24, 2022.

Diagnostic errors are a major care health concern but remain difficult to study because their identification often requires resource-intensive chart reviews. We aimed to validate a previously proposed automated method for detecting discrepancies between an initial and a later, more definitive diagnosis as a screening tool for potential diagnostic errors in a large, prospective cohort of emergency department (ED) patients. This secondary analysis included 1,204 patients enrolled in the DDxBRO randomized trial, which evaluated the effect of a diagnostic decision support tool on diagnostic quality in four Swiss emergency departments. For each patient, the ED diagnosis was extracted from the ED discharge letter, and the follow-up diagnosis at 14 days was obtained from hospital discharge letters, or general practitioner notes. All diagnoses were coded using ICD-10 and manually classified for discrepancies by two blinded ED physicians according to a predefined scheme. The automated method calculated the “similarity” between ICD-10 codes for ED and follow-up diagnoses. Discriminative performance of this method to distinguish between cases with and without diagnostic error was evaluated using receiver operating characteristic (ROC) curves, and sensitivity, specificity, and predictive values were assessed across multiple cutoffs. The automated method showed high and consistent discriminative performance across all algorithms tested, with areas under the ROC curve (AUCs) ranging from 0.94 to 0.95. Using the most sensitive cutoff in the simplest algorithm, all true discrepancies were detected, but 162 cases (15

Rising patient volumes, the increasing use of computed tomography (CT) imaging in emergency departments and the resulting prolonged waiting times highlight the urgent need for efficient and accurate diagnostic tools, especially given that the number of experienced healthcare professionals is not increasing at the same pace. Artificial intelligence (AI) has emerged as a promising tool to support fracture detection on CT scans, with the potential to streamline diagnostic workflows in emergency care. However, concerns exist regarding dataset bias, limited external testing, and methodological variability. This systematic review and diagnostic test accuracy (DTA) meta-analysis aimed to comprehensively assess the diagnostic accuracy of AI-driven fracture detection solutions, with a particular focus on the effect of the testing strategy, cohort composition and commercial availability on diagnostic accuracy. The Cochrane Handbook for Systematic Reviews of DTA and reported according to PRISMA-DTA guidelines were followed. We systematically searched Embase, MEDLINE, Cochrane Library, Web of Science, and Google Scholar for studies published from January 2010 onward, complemented by citation chasing and manual searches for commercial AI fracture detection solutions (CAAI-FDS). Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using a modified QUADAS-2 tool. Statistical analysis was conducted using STATA 18.1 and the –metadta– command. Primary analyses evaluated diagnostic accuracy (sensitivity and specificity) of stand-alone AI based on (1) cohort type (selected vs. unselected), (2) test dataset origin (internal vs. external), and (3) level of analysis (patient-wise, vertebra-wise, rib-wise). Secondary analyses explored accuracy differences according to (1) CAAI-FDS, (2) anatomical region and (3) reader type (stand-alone AI, human unaided, human aided by AI). Forest plots visualized results, and heterogeneity was measured using generalized I2 statistics. Out of 7683 identified articles, 44 studies were included for meta-analysis. 14 CAAI-FDS were identified. Primary analyses of stand-alone AI showed moderate sensitivity (0.85, 95

PurposeInternal carotid artery dissection (ICA-D) is an important cause of stroke in adults. The styloid process (SP) may be associated with ICA-D due to potential (micro)trauma resulting from its close anatomical proximity to the internal carotid artery (ICA). The aim of this systematic review with meta-analysis is to investigate the association between SP characteristics –particularly SP-ICA distance – and ICA-D.MethodsA systematic review was conducted across six databases to identify observational studies comparing ICA-D patients to controls. The primary outcome of interest was the association between SP-ICA distance and ICA-D. Secondary outcomes included associations between ICA-D and the SP length or angulation. A random-effects meta-analysis was performed, including a subgroup analysis of moderate/high-quality studies. Effect sizes were expressed as standardized mean differences (SMD, Hedges' g).ResultsSix studies were included in the systematic review, of which five were eligible in the meta-analysis. The pooled analysis of all five case-control studies (270 ICA-D patients and 377 controls) showed no significant difference in SP-ICA distance (SMD = −0.92, p = 0.143); with a high degree of heterogeneity (I2 = 98%). Subgroup analysis of moderate/high-quality studies evaluating the SP-ICA distance ipsilateral to the ICA-D (4 studies) yielded a negative pooled SMD (−0.29, p = 0.047; moderate heterogeneity: I2 = 64%), consistent with a shorter SP-ICA distance in ICA-D cases. Meta-analysis of the SP length (3 studies) found no significant association (SMD 0.24, p = 0.139) and two studies also found no significant relationship between ICA-D and SP angulation.ConclusionA shorter SP–ICA distance was associated with ICA-D, whereas no significant associations were observed for SP length or angulation. However, the available evidence remains limited and heterogeneous.Systematic Review RegistrationCRD42024582594

INTRODUCTION:Optimising cardiopulmonary resuscitation (CPR) management is crucial for out-of-hospital cardiac arrest (OHCA) survival but requires a clear understanding of the entire chain of survival. However, detailed OHCA management data from Swiss emergency centres (EC) are limited. METHODS: A nationwide cross-sectional survey was conducted among Level 1 and 2 ECs affiliated with the Swiss Society of Emergency and Rescue Medicine (SGNOR). The questionnaire covered key aspects of CPR management, including EC characteristics, team composition, resuscitation protocols and challenges pertaining to the year 2022. Analyses were performed using descriptive methods. RESULTS: Response rates were 94% (15/16) from Level 1 and 28% (10/36) from Level 2 ECs. CPR training is widely implemented with 90% of centres conducting emergency bay simulations. ACLS certification is mandated in 73% of Level 1 but only 20% of Level 2 centres. Team composition and debriefing practices vary with a structured debriefing absent in 67%/60% of Level 1/2 ECs. Mechanical chest compression devices are used in 80%/30% of ECs, while extracorporeal membrane oxygenation is available in 73%/10% ECs. Standard operating procedures are widely implemented, but 40%/60% of ECs lack structured OHCA databases. Challenges differ by Level, with Level 1 centres reporting variability in expertise due to frequently rotating staff and Level 2 centres highlighting staff shortages especially during night shifts. Decision-making challenges include termination of resuscitation, interdisciplinary coordination and post-resuscitation care. Research engagement is limited to 20% of Level 1 centres, but 93% of Level 1 and 50% of Level 2 ECs report willingness to engage in research projects under specific conditions, such as minimal time commitment. CONCLUSION: Significant variability in CPR management, training and data collection exists across Swiss ECs. Standardised protocols, structured training and improved interdisciplinarity coordination are needed. Enhancing data registration and aligning practices with international guidelines could optimise patient outcomes, emphasising the need for further research and national standardisation efforts.

INTRODUCTION:The complex intervention PECAN (Participation Enabling CAre in Nursing) was developed to promote activities and participation among nursing home residents with joint contractures at organisational and resident levels. It was implemented by trained facilitators and nursing staff. In a cluster RCT, PECAN showed no effect on the primary endpoint. The cluster-wide process evaluation identified leadership behaviour and differences in the degree of implementation as possible influencing factors. This case study examines a nursing home with protocol-compliant implementation but no observed effectiveness to analyse possible causes. METHODS:A qualitative secondary data analysis was conducted as an in-depth case study based on a focus group with nursing home staff (n = 5) and an individual interview with a facilitator. Data were analysed using structured qualitative content analysis according to Kuckartz along the dimensions of context, setting, and implementation. In addition, documentation forms from ten consultation sessions related to the implementation component 'consultation of facilitators by the research team' were analysed using a deductive-descriptive approach. RESULTS:This analysis identified additional influencing factors that were not apparent in the cluster-wide process evaluation, including socio-cultural expectations, spatial conditions, nursing staff workload, and organisational upheavals, particularly changes in leadership. These factors seem to play a relevant role in the limited changes observed in nursing care practice. DISCUSSION:Organisational upheavals led to discontinuities and hindered implementation. It remains unclear what intervention dose is required to achieve measurable effects. CONCLUSION:Early and systematic consideration of organisational conditions appears to be crucial for implementing complex interventions at the resident level. Furthermore, the effective intervention dose has yet to be determined.

Background: Indoor climbing is a rapidly growing sport; however, data on injury patterns and clinical outcomes remain limited. This study aimed to evaluate the injury severity, characteristics, and clinical outcomes of indoor climbing-related injuries and explore the clinical applicability of the UIAA MedCom Score. Methods: We conducted a 10-year retrospective analysis (2012–2021) of patients aged ≥16 years presenting with indoor climbing-related injuries to a Swiss level 1 emergency department. Cases were identified using predefined keywords in the E-care and Qualicare databases. Demographics, injury mechanisms and patterns, Injury Severity Score (ISS), UIAA MedCom Score, treatment strategies, and clinical outcomes were analysed. A multivariable logistic regression model was applied to explore factors associated with higher injury severity. Results: A total of 98 patients were included, with 50% aged 26–35 years. Injuries occurred with a similar frequency during climbing and bouldering (51.0% vs. 49.0%). The predominant mechanism was ground fall (68.4%). Lower-extremity injuries were most common, particularly affecting the ankle and foot (43%). Most injuries were of mild-to-moderate severity, with 46.9% classified as UIAA grade 2. Conservative treatment was sufficient in 83.7% of cases, while 16.3% required surgical intervention, and one fatality (1.0%) was recorded. Injury severity was significantly associated with clinical outcomes, including hospitalisation and resource utilisation. In addition, in a multivariable model, higher Injury Severity Score (ISS) was significantly associated with longer hospital length of stay. A strong association between the UIAA MedCom Score and ISS was observed (p < 0.001). Conclusions: The indoor climbing injuries of individuals presenting to the emergency department were predominantly mild to moderate and were generally associated with favourable short-term outcomes. These findings are supported by model-based analysis demonstrating an independent association between injury severity and hospital length of stay. These findings are based on a single-centre emergency department cohort and do not capture injuries managed outside the hospital setting. Therefore, conclusions regarding overall injury risk should be interpreted with caution. The observed association between the UIAA MedCom Score and ISS suggests that the UIAA classification may serve as a complementary tool for injury assessment, although further validation is required.

The elderly population of developing countries is increasing rapidly. Complicating this demographic development, elderly patients are at high risk for injuries that result in polytrauma and tend to experience worse outcomes when such injuries occur. The purpose of the present study was to evaluate and identify risk factors for polytrauma in the elderly population (≥ 65 years). The following case-control study used the Trauma Registry Database of the University Hospital Bern to extract the case group, consisting of elderly polytrauma patients (ISS ≥ 16). The control group, representing an average elderly population in Switzerland, included relatives (≥ 65 years) accompanying patients admitted to the emergency department (ED) of Bern University Hospital. The two groups were compared according to potential risk factors for polytrauma (demographics, civil status, pre-existing conditions, medication use, and care-dependency in daily life). Adjusted odds ratios (OR) were obtained with multivariable regression analyses to identify independent risk factors associated with polytrauma in the elderly people. The study population comprised 400 individuals, including 200 elderly polytrauma patients and 200 age- and sex-matched controls. In univariable conditional logistic regression analysis being married (OR: 0.27, 95

Hintergrund Die komplexe Intervention PECAN (Participation Enabling CAre in Nursing) wurde entwickelt, um Aktivitäten und Teilhabe von Pflegeheimbewohner*innen mit Gelenkkontrakturen durch Maßnahmen auf der Ebene der Organisation und der Bewohner*innen zu fördern. Die Umsetzung erfolgte über geschulte Multiplikator*innen und Pflegefachpersonen. In einer Cluster-RCT hatte PECAN keinen Effekt auf den primären Endpunkt. Die clusterübergreifende Prozessevaluation identifizierte u.a. Führungsverhalten und Unterschiede im Implementierungsgrad als mögliche Einflussfaktoren. Die vorliegende Einzelfallstudie untersucht ein Pflegeheim mit protokollgerechter Implementierung bei gleichzeitig ausbleibender Wirksamkeit, um mögliche Ursachen vertieft zu analysieren. Methode Es wurde eine qualitative Sekundärdatenanalyse im Sinne einer vertiefenden Einzelfallstudie auf Basis einer Fokusgruppe mit Pflegeheimmitarbeitenden (n = 5) und eines Einzelinterviews mit einer Multiplikatorin durchgeführt. Die Auswertung erfolgte mittels inhaltlich strukturierender qualitativer Inhaltsanalyse nach Kuckartz entlang der Dimensionen Kontext, Setting und Implementierung. Ergänzend wurde die Dokumentation von zehn Beratungsgesprächen zur Implementierungskomponente „Beratung der Multiplikator*innen durch das Forschungsteam“ deduktiv-deskriptiv analysiert. Ergebnisse Die Analyse identifizierte zusätzliche Einflussfaktoren, die in der clusterübergreifenden Prozessevaluation nicht sichtbar waren. Dazu zählen soziokulturelle Erwartungen, räumliche Rahmenbedingungen, Arbeitsbelastungen des Pflegepersonals sowie organisationale Umbrüche, insbesondere Leitungswechsel. Diese Faktoren weisen auf eine relevante Rolle für die begrenzte Veränderung der Versorgungspraxis hin. Diskussion Organisationale Umbrüche führten zu Diskontinuität und erschwerten die Implementierung der Intervention. Unklar bleibt, welche Dosis der Intervention notwendig wäre, um messbare Effekte zu erzielen. Schlussfolgerung Eine frühzeitige und systematische Berücksichtigung organisationaler Rahmenbedingungen erscheint zentral für die Umsetzung komplexer Interventionen auf der Ebene der Bewohner*innen. Zudem bleibt die wirksame Interventionsdosis zu bestimmen.

Point-of-care ultrasound (POCUS) has become an increasingly used diagnostic tool in adult emergency departments (ED). Although numerous diagnostic test accuracy systematic reviews (DTA-SR) evaluating various POCUS applications are available, clinicians often face uncertainty due to ungraded accuracy estimates and inconsistent evidence. We conducted an umbrella review to (i) summarize diagnostic accuracy evidence for POCUS across adult non-traumatic emergency medicine-relevant conditions, (ii) provide GRADE-based ratings of pooled sensitivity and specificity, and (iii) synthesize findings when multiple DTA-SR addressed the same condition. We systematically searched PubMed and Embase from database inception to April 2026 for DTA-SR with meta-analysis evaluating the diagnostic performance of POCUS in adult ED populations for non-traumatic emergency medicine-relevant conditions. DTA-SR were included if they reported pooled sensitivity and specificity against accepted reference standards. The methodological quality was assessed using a DTA-adapted AMSTAR 2 tool. Sensitivity and specificity estimates were graded using the GRADE approach. Results were synthesized using a predefined hierarchical decision framework to account for overlap between primary studies. A total of 197 DTA-SR were included, most focusing on cardiovascular, gastrointestinal, respiratory, or musculoskeletal conditions. About half were conducted in ED; the rest examined emergency medicine-relevant conditions in specialist settings. Methodological quality was mostly low or moderate. Diagnostic utility varied substantially across conditions. Among 91 evaluated conditions, 12 fulfilled predefined criteria for combined rule-in/rule-out supportive applications, 17 for primarily rule-in supportive applications, and 6 for primarily rule-out supportive applications (defined as pooled sensitivity or specificity ≥ 90

To assess the effect of scan length, partial humeral head inclusion, and body mass index (BMI) on radiation dose of CTs of the medial clavicular epiphysis (MCE) performed with elevated arms (arms-up). Ninety consecutive MCE CTs acquired in an arms-up position for forensic age estimation were retrospectively analysed. Scans were grouped by scan length (short: ≤4 cm; long: >4 cm, rounded to the nearest cm) and by arm position (arms-out: humeral heads excluded; arms-in: humeral heads partially included). Dose-relevant parameters (effective tube current, volume CT dose index, CT dose length product, and effective dose) were compared. Adjusted geometric mean ratios (aGMRs) were calculated to quantify the association between radiation doses and scan length, arm inclusion, and BMI. Population: 88 males, 2 females; median (IQR) weight 62.0 kg (57.5–67.9), height 172 cm (168–178), BMI 21.1 kg/m² (19.5–22.4). Effective dose was lowest in short scans with arms-out (0.38 mSv, 0.32–0.43), highest in long scans with arms-in (0.49 mSv, 0.39–0.62), and equal in short scans with arms-in and long scans with arms-out (0.41 mSv, 0.36–0.46 and 0.34–0.46, respectively). Each additional centimetre of scan length increased dose by 8.3

Prehospital tracheal intubation intends to provide respiratory support and protect the airway from possible pulmonary aspiration. Trauma guidelines recommend tracheal intubation in patients with a Glasgow Coma Scale (GCS) score of <9. We hypothesised that in clinical practice, GCS scores before prehospital tracheal intubation are lower in trauma and medical patients. Retrospective observational cohort study Swiss anaesthetist-staffed helicopter emergency medical system between 07 September 2020 and 11 December 2023. Intubated trauma and nontrauma patients ≥18 years and nonintubated patients with GCS <9 admitted to three tertiary referral Swiss hospitals. Prehospital tracheal intubation GCS score before prehospital tracheal intubation. Association of GCS score before prehospital tracheal intubation with length of ventilator days, intensive care unit stay, hospitalisation, and 28-day survival. We screened 35 021 missions, of which 401 (335 intubated vs. 66 nonintubated) met inclusion criteria. The median GCS before prehospital tracheal intubation was 4 [IQR 3 to 6] for nontrauma and 6 [3 to 8] for trauma patients. Trauma patients with burns had a GCS score of 14 [13 to 15] before prehospital tracheal intubation. In the trauma cohort, women had a median GCS score of 5 [3 to 7] compared to men with 6 [3 to 8] ( P = 0.043). The GCS before prehospital tracheal intubation was associated with length of intensive care unit stay ( P = 0.042) and survival ( P = 0.036) but not with length of ventilation and hospital stay. Overall median GCS score before prehospital tracheal intubation was lower than 8. Our data suggests that the GCS score is not suitable as the sole indicator for prehospital tracheal intubation. Further randomised controlled trials should investigate more robust intubation criteria to be included in the guidelines for trauma and nontrauma patients. Finally, a patient-centred approach should be emphasised, especially in patients with burns.

Nursing science as an academic discipline in Germany is still developing and has not yet been sufficiently integrated into acute hospital care. The aim of this paper is to analyze the key challenges of nursing research in acute hospital care and to develop strategic solutions to strengthen the development of nursing science in Germany. The results of a two-day scoping workshop with national and international experts indicate that the lack of structural integration of nursing science into clinical care, the low number of academically qualified nursing professionals, and insufficient research funding are major obstacles to further development. Based on a SWOT analysis, six priority action areas were identified: (1) development and implementation of qualification and career programs, (2) promotion of clinician scientists, (3) strengthening visibility and communication, (4) effective political participation, (5) increase of research funding, and (6) improvement of networks and collaborations. The implementation of these strategies will contribute to establishing nursing science as an independent discipline, increasing its societal relevance, and promoting evidence-based nursing practice in inpatient acute care. Close collaboration among academia, policymakers, and practitioners is essential for achieving these goal.

Vasospasms are common in patients presenting with non-traumatic subarachnoid haemorrhage (SAH) and are the main contributor to long-term disability or death in these patients. The key immediate management of vasospasms is the improvement of brain perfusion by the administration of intravenous fluid and vasopressors if needed. Yet, there is no clear recommendation regarding the choice of fluid in this particular patient population. Data suggests a survival benefit using normal saline in patients with TBI; however, its impact on outcomes in patients with SAH is lacking. Thus, the aim of this study is to evaluate whether the use of normal saline reduces clinically relevant vasospasms compared to Ringer’s lactate in patients with SAH. Patients presenting with non-traumatic SAH will be randomised 1:1 to normal saline or Ringer’s lactate group. Blinded study fluid will be used exclusively for resuscitation and maintenance until ICU/IMC discharge or a maximum of 14 days, whichever occurs first. Management of vasospasms and general management of the SAH patient will be according to the clinic standard of care. Primary endpoint is the occurrence of clinically relevant vasospasms. Key secondary outcomes include mortality, severity and treatment of vasospasms, and neurological outcomes at 90 days. The proposed randomised controlled trial offers a safe, non-invasive way to gain insights about crystalloid fluid choice in SAH patients, with potential to improve outcomes in this critically ill patient group. This study could establish a new gold standard in fluid therapy for neuro-critical care. The trial is registered on ClinicalTrials.gov (date of registration 18 June 2021) and on the Swiss National Clinical Trials Portal, SNCTP000004575.

The COVID-19 pandemic led to profound changes in healthcare, requiring hospitals to implement extensive structural adaptations for infection control. This study investigates the effects of COVID-19-related measures on older, non-COVID-19 patients, their caregivers, and healthcare professionals. Using real-time qualitative data from the TRADE project, collected during the pandemic's peak, this secondary analysis identifies seven key themes: (1) structural changes: (2) altered tasks and care practices: (3) ward and occupancy adjustments: (4) shifts in staffing situation: (5) revised visitation policies: (6) changes in communication: and (7) reduced social contact post-discharge. While essential for safety, COVID-19-related changes in hospital care posed challenges to direct patient care, increased staff burden, and limited social interaction. The study findings emphasize the need for clear, flexible, and well-communicated visitation policies and the integration of technology to maintain patient-family connections, promoting resilience and preparedness for future healthcare crises.

BACKGROUND:Virtual reality (VR) is increasingly used in healthcare education, offering immersive training experiences that are as effective as conventional methods, with benefits like cost-effectiveness, replicating complex scenarios, and reduced need for physical resources. However, the use of VR as an assessment tool is still emerging, particularly in nursing and medical education. The aim of this systematic review was to examine how immersive VR is used as an assessment tool for nursing and medical students. METHODS:Embase, PubMed, PsycINFO, Cochrane, CINAHL, and ERIC were searched for articles that assessed nursing and/or medical students using immersive/HMD VR. The data was extracted, and content analysis was performed. RESULTS:Twenty-six studies met the inclusion criteria, investigating VR assessments in various settings mostly emergencies. Assessments focused on core competencies Patient Care such as first triage, Interpersonal and Communication Skills (e.g., interprofessional communication), and Medical Knowledge (e.g., about coma), utilizing a range of assessment methods from knowledge to performance levels. VR was used either as an automated or supporting assessment tool. Practical considerations in VR implementation were also examined, such as hardware and software. CONCLUSION:The use of VR in medical education assessment shows promise, particularly for emergency scenarios and performance-based tasks related to core competencies such as Patient Care, Interpersonal and Communication Skills, and Medical Knowledge. While this technology offers opportunities to automate assessments and reduce examiner workload, challenges related to software, costs, and feasibility must be addressed. Additionally, aligning learning objectives, teaching methods, and VR assessments through constructive alignment is essential to ensure effective implementation as both a teaching and evaluation tool.

BACKGROUND:Prehospital tracheal intubation intends to provide respiratory support and protect the airway from possible pulmonary aspiration. Trauma guidelines recommend tracheal intubation in patients with a Glasgow Coma Scale (GCS) score of <9. OBJECTIVES:We hypothesised that in clinical practice, GCS scores before prehospital tracheal intubation are lower in trauma and medical patients. DESIGN:Retrospective observational cohort study. SETTING:Swiss anaesthetist-staffed helicopter emergency medical system between 07 September 2020 and 11 December 2023. PATIENTS:Intubated trauma and nontrauma patients ≥18 years and nonintubated patients with GCS <9 admitted to three tertiary referral Swiss hospitals. INTERVENTIONS:Prehospital tracheal intubation. MAIN OUTCOME MEASURES:GCS score before prehospital tracheal intubation. Association of GCS score before prehospital tracheal intubation with length of ventilator days, intensive care unit stay, hospitalisation, and 28-day survival. RESULTS:We screened 35 021 missions, of which 401 (335 intubated vs. 66 nonintubated) met inclusion criteria. The median GCS before prehospital tracheal intubation was 4 [IQR 3 to 6] for nontrauma and 6 [3 to 8] for trauma patients. Trauma patients with burns had a GCS score of 14 [13 to 15] before prehospital tracheal intubation. In the trauma cohort, women had a median GCS score of 5 [3 to 7] compared to men with 6 [3 to 8] ( P  = 0.043). The GCS before prehospital tracheal intubation was associated with length of intensive care unit stay ( P  = 0.042) and survival ( P  = 0.036) but not with length of ventilation and hospital stay. CONCLUSIONS:Overall median GCS score before prehospital tracheal intubation was lower than 8. Our data suggests that the GCS score is not suitable as the sole indicator for prehospital tracheal intubation. Further randomised controlled trials should investigate more robust intubation criteria to be included in the guidelines for trauma and nontrauma patients. Finally, a patient-centred approach should be emphasised, especially in patients with burns.