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The early initiation of cardiopulmonary resuscitation (CPR) measures by non-professionals before the arrival of Emergency Medical Service (EMS) is known to be crucial for improving outcomes after out-of-hospital cardiac arrest (OHCA). We assessed the impact of deploying CPR-trained volunteers via a smartphone-based alerting system on the outcome of OHCA patients. In a retrospective nonrandomized cohort study, all OHCA cases in the city of Aachen over a six-year period were analysed. We compared patient data, CPR metrics, alerting system data as well as outcome data between the intervention and control groups. From June 2017 to May 2023, 101 out of 852 resuscitations were initiated by volunteers alerted via a smartphone-based alerting system in OHCA events. We found no overall rise in the return of spontaneous circulation (ROSC) rate. An age-dependent subgroup analysis indicated an increased incidence of initially shockable rhythms and an increased ROSC rate for patients younger than 60 years in the intervention group, while implying a lower ROSC rate in patients older than 80 years after mobile responder CPR. Although this study was underpowered to yield statistically significant results, our findings suggest the need for an age-sensitive approach when evaluating the effects of first-responder systems on OHCA cases.

Respiratory distress is a common reason for emergency medical service (EMS) physicians to be prehospitally involved. While the availability of telemedical EMS systems increases continuously, there is a gap in research regarding respiratory emergencies in the context of prehospital telemedicine. The aim of this study is to evaluate the quality of care provided in prehospital respiratory emergencies, managed through a tele-EMS system with a specialized EMS physician. Tele-EMS physician missions from 01/01/2019 to 12/31/2021 in Aachen, Germany, were analyzed. Adult patients presenting with dyspnea, peripheral oxygen saturation < 94%, respiratory rate > 19/min, or any combination of these factors, were included (n = 2234). Data were derived from mission protocols recorded by the attending tele-EMS physicians. Significant changes ( p  < 0.001) in vital parameters towards physiological ranges were observed. For the most common diagnoses, a significant improvement in patient condition was achieved with the use of appropriate medications. In 14 cases (0.63%), an onsite-EMS physician was requested. These cases were confirmed to involve unstable patients who required intervention of an onsite-EMS physician. The tele-EMS physician effectively bridged the time until arrival of the physician. Overall, the study demonstrated that respiratory emergencies were effectively managed using the tele-EMS physician system.

Arrhythmogenic cardiomyopathy (AC) is a heritable, potentially lethal disease without a causal therapy. AC is characterized by focal cardiomyocyte death followed by inflammation and progressive formation of connective tissue. The pathomechanisms leading to structural disease onset and progression, however, are not fully elucidated. Recent studies revealed that dysregulation of autophagy and endoplasmic/sarcoplasmic reticulum (ER/SR) stress plays an important role in cardiac pathophysiology. We therefore examined the temporal and spatial expression patterns of autophagy and ER/SR stress indicators in murine AC models by qRT-PCR, immunohistochemistry, in situ hybridization and electron microscopy. Cardiomyocytes overexpressing the autophagy markers LC3 and SQSTM1/p62 and containing prominent autophagic vacuoles were detected next to regions of inflammation and fibrosis during onset and chronic disease progression. mRNAs of the ER stress markers Chop and sXbp1 were elevated in both ventricles at disease onset. During chronic disease progression Chop mRNA was upregulated in right ventricles. In addition, reduced Ryr2 mRNA expression together with often drastically enlarged ER/SR cisternae further indicated SR dysfunction during this disease phase. Our observations support the hypothesis that locally altered autophagy and enhanced ER/SR stress play a role in AC pathogenesis both at the onset and during chronic progression.

The emergency medical services (EMS) in Germany are facing several challenges in the near future. Due to the increasing number of emergency missions, the availability of EMS physicians is becoming more limited, resulting in longer response times. To maintain the high quality of EMS, telemedical support systems have shown potential as a valuable complement to the existing system for specific diagnoses. Since 2014, a tele-EMS system has been implemented in Aachen as an integrated telemedical solution alongside standard EMS. Accurate prehospital diagnosis plays a crucial role in ensuring appropriate hospital admission and reducing the time to clinical treatment for time-sensitive conditions. The main TEMS study demonstrated the overall non-inferiority of tele-EMS physicians compared to on-site EMS physicians. This sub-analysis focuses on comparing the diagnostic accuracy between these two groups. Up to four prehospital diagnoses were selected, coded according to the ICD-10 system, and compared with all admission and discharge diagnoses. The comparison between diagnoses made by tele-EMS physicians and on-site EMS physicians with admission diagnoses showed no significant difference (  = 0.877). Additionally, no significant differences were found for the diagnoses of stroke (  = 0.385) and epileptic seizure (  = 0.738). However, patients from missions where paramedics decided to consult a tele-EMS physician had significantly longer hospital stays compared to those from missions where an on-site EMS physician was initially dispatched (  < 0.001). This randomized controlled analysis demonstrated that there is no difference in diagnostic accuracy between on-site EMS physicians and remote tele-EMS physicians. The significantly longer hospital stays for patients treated by tele-EMS physicians suggest that EMS physicians may be called too frequently for non-severe cases. clinicaltrials.gov, identifier (NCT02617875).

Jessica Iverson, a spokeswoman for the state Department of Revenue, said agency officials haven 't made a final determination not to tax the federal tax rebates if they 're issued by Congress.

Two days before the new president's inauguration, the Society of Professional Journalists and dozens of other media and government transparency groups sent a letter asking Donald Trump for a meeting to discuss his administration's relationship with the press.[...]we must continue to be vigilant in the face of Trump's tendency to engage in bombast and exaggeration.[...]we must guard against politicians' unwillingness to subject their actions to media scrutiny.

[...]the efforts to restrict the public's access to information have not stopped.