The findings suggest that the necessity for the high number of physician-staffed emergency missions should be verified, especially in the context of strained emergency healthcare resources. The basis of an optimized use of resources could be a better inclusion of alternative, especially ambulant, healthcare structures and the implementation of a structured emergency call questionnaire accompanied by a more efficient disposition of the operating resources, not least in view of the economic aspects. Taking the concentrated patient allocation to level 1 hospitals into consideration, there is a need for optimized patient distribution strategies to minimize the overload of individual institutions and thereby improve the general quality of care at the interface between preclinical and clinical emergency medicine.

No abstract

The aim of this study was to detect pathological changes of the complex autonomous regulation of ecg, blood pressure and respiration (synchronously recordings of 30 minutes) in patients with cardiac diseases. We investigated the cardiovascular and cardiorespiratory linear and nonlinear interactions in 10 patients with dilative cardiomyopathy (dcm) and in 10 patients after myocardial infarction (mi). We compared results from the classical linear correlation function analysis with results from the mutual information method (transinformation) for analysis of nonlinear and linear interactions. Both methods yield high significant parameters (p < 0.01). Thus, we found both linear and nonlinear interactions with partly different specificity in patients with dcm and mi compared to healthy subjects (ref).

The prognosis of acute myocardial infarction depends on the development of left-ventricular dilatation and chronic heart failure. Serial echocardiography was performed on admission and on days 2, 4 and 6, to discover the temporal course of any early myocardial adaptation. There were 78 patients (20 women, 58 men; mean age 59 [49-69] years) with acute myocardial infarction and systemic thrombolysis, first studied up to 4 hours after onset of symptoms. The patients were divided into two groups according to infarct size as measured by creatine kinase ("area under the curve"--AUC); group 1: CK AUC < 12 IU/ml.h; group 2: CK AUC > 12 IU/ml.h. While there was no difference between the two groups on admission and on day 2, filling patterns differed significantly at the end of the first postinfarction week in that maximal early diastolic flow velocity (E) in group 1 was 0.65 m/s, but 0.73 m/s in group 2 (P < 0.05); maximal late diastolic flow velocity (A), group 1: 0.71, group 2: 0.58 m/s (P < 0.01); E/A ratio: 0.89 vs 1.22 (P < 0.001); integrated E/A ratio 1.37 vs 1.77 (P < 0.001), and the atrial component of left-ventricular filling 42 vs 36% (P < 0.001). It is concluded that the serial measurement of left-ventricular filling by Doppler echocardiography in the first post-infarction week can identify patients with impaired left-ventricular function through differences in flow pattern. Drug or interventional treatment can then be started early to prevent further left-ventricular dilatation and in this way improve prognosis.

The objective of this study was to develop an analysis method for the automatic detection of intracoronary microemboli triggered high intensity signals (HITS) during percutaneous coronary interventions (PCI). The recorded ultrasonic Doppler velocity spectra from an intracoronary ultrasonic guide-wire were decomposed into 13 wavelet scales applying the continuous wavelet transform. From 7 wavelet scales which were most suitable for a differentiation between HITS and pulsatile flow, envelopes were calculated and combined to improve the HITS-to-background noise ratio. For different intensity thresholds the resulting number of HITS was automatically counted and compared with the number estimated by experienced observers. In a first validation trial HITS were detected within a simplified in vitro model with a sensitivity of 89.2% and a positive predictive value of 87.6%. In a following clinical study 211 HITS from 18 patients during PCI were counted manually by the observers. With the developed wavelet-based method 189 HITS were correctly detected (sensitivity of 89.6%, positive predictive value of 85.5%). The introduced new method automatically detects intracoronary HITS for the first time with a reliable accuracy. This may support further studies evaluating the incidence and consequences of coronary microembolization during coronary interventions.