Invasive Medical Interventions Research Articles

Laser to laser power conversion with remote signaling.

We demonstrate laser power conversion using an edge-coupled waveguide configuration. A laser with an emission energy of 0.87 eV (1427 nm) optically pumps a second with an emission energy of 0.80 eV (1540 nm), achieving the maximum possible open circuit voltage of 0.83 V due to optically pumped lasing. A fiber to device power conversion efficiency of 33% is achieved with internal power conversion efficiency ranging from 57% to 51%. The voltage at maximum power is 0.6 V, which is a record for the wavelength range. The same optically pumped device is used for effectively power-free 500 Mbps upstream data transmission, enabling compact powering and signaling for emerging applications in minimally invasive medical interventions and remote photonics.

Effects of Hospice Care for Terminal Head and Neck Cancer Patients: A Nationwide Population-Based Matched Cohort Study

Background: Head and neck cancer was the fourth-most common cause of cancer death among Taiwanese men in 2018. Hospice care has been proven to reduce the use of invasive medical interventions and expenditures in caring for cancer patients. Aim: This study examined the effects of hospice care for terminal head and neck cancer patients. Design: A matched cohort study was used to compare the use of invasive interventions and expenditures among hospice care and nonhospice care patients. Setting/Participants: The investigated patients consisted of patients who died of head and neck cancer in Taiwan from 2004 to 2013 and were included in the Registry for Catastrophic Illness Patients in Taiwan and the Taiwan National Health Research Insurance Database. Results: A total of 45,948 terminal head and neck cancer patients were identified, and 9883 patients remained in each group after matching for comorbidities. After that matching, the rates of intensive care unit admission (23.9% vs. 38.94%, p < 0.0001), endotracheal intubation (10.05% vs. 31.32%, p < 0.0001), cardiopulmonary resuscitation (2.93% vs. 20.18%, p < 0.0001), defibrillation (0.51% vs. 4.36%. p < 0.0001), ventilator use (21.92% vs. 46.47%, p < 0.0001), blood transfusion (71.25% vs. 73.45%, p = 0.006), and hemodialysis (1.06% vs. 3.26%. p < 0.0001) were significantly lower in the hospice group than the nonhospice group, although the rates of parenteral nutrition for the two groups were similar (7.74% vs. 7.97%, p = 0.5432). The mean medical expenditure per person in the six months before death was 460,531 New Taiwan Dollar (NTD) for the nonhospice group and 389,079 NTD for those provided hospice care for more than three months, which was the lowest amount among various hospice enrollment durations. Conclusions: Hospice care can effectively reduce the use of invasive medical interventions in caring for terminal head and neck cancer patients and may improve their quality of death. Moreover, hospice care enrollment for more than three months can save on unnecessary medical expenditures for terminal head and neck cancer patients.

Determinants of mortality and intensive care requirement in pediatric thoracoabdominal injuries.

Thoracoabdominal injuries (TAI) are an important cause of trauma-related morbidity in children. Early and correct intervention is essential to reduce mortality. We aimed to determine factors associated with mortality and the need for intensive care in TAI. The children admitted to the pediatric emergency department of a tertiary care hospital with TAI in a 6-year-period were enrolled. Demographic data; mechanism of injuries; clinical, laboratory and imaging findings; length of hospital and intensive care unit (ICU) stay; invasive procedures and medical treatments; surgical interventions; and survival outcomes were recorded. The median age of the 136 children was 9 (IQR: 5-14) years and 72.8% were male. The vast majority of injuries were caused by blunt trauma (92.7%). Pulmonary contusion, pneumothorax, splenic, and liver injuries were the most common diagnoses. Motor vehicle accidents were seen in more than half of the cases (52.2%). The median length of hospital stay was 5 (IQR: 2-8) days; 21 patients were hospitalized in the ICU (15.4%). The need for intensive care was higher in patients with lower Glasgow Coma Scale (GCS) scores and lower Pediatric Trauma Scores (PTSs), in the presence of multiple injuries, pulmonary contusion, and pneumothorax (p<0.001). Mortality was seen in nine patients, eight of whom had multiple injuries. The mortality rate was higher in patients with pulmonary contusion and pneumothorax (p=0.002 and p=0.003, respectively). The PTS and GCS were found to be lower in patients who died in hospital (p<0.001). Prolongation of coagulation parameters and hyperglycemia was more common in the non-survivor group (p=0.005 and p=0.004, respectively). Although thoracoabdominal trauma is not common in childhood, it is an important part of trauma-associated mortality. Multiple injuries, pulmonary contusion, pneumothorax, lower GCS, and PTSs can be a sign of serious injuries to which physicians must be alert.

Locomotion of Miniature Soft Robots.

Miniature soft robots are mobile devices, which are made of smart materials that can be actuated by external stimuli to realize their desired functionalities. Here, the key advancements and challenges of the locomotion producible by miniature soft robots in micro- to centimeter length scales are highlighted. It is highly desirable to endow these small machines with dexterous locomotive gaits as it enables them to easily access highly confined and enclosed spaces via a noninvasive manner. If miniature soft robots are able to capitalize this unique ability, they will have the potential to transform a vast range of applications, including but not limited to, minimally invasive medical treatments, lab-on-chip applications, and search-and-rescue missions. The gaits of miniature soft robots are categorized into terrestrial, aquatic, and aerial locomotion. Except for the centimeter-scale robots that can perform aerial locomotion, the discussions in this report are centered around soft robots that are in the micro- to millimeter length scales. Under each category of locomotion, prospective methods and strategies that can improve their gait performances are also discussed. This report provides critical analyses and discussions that can inspire future strategies to make miniature soft robots significantly more agile.

Play Effects on Hospitalized Children With Acute Respiratory Infection: An Experimental Design Study.

Acute respiratory infection is a major health issue and a primary cause of morbidity and mortality among preschool-aged children worldwide. Disease and hospitalization are chief stressors for children during their development. Therapeutic play has been used in pediatric care processes and has been demonstrated to be effective by most studies that have targeted children undergoing surgeries or invasive medical treatments. Currently, few published studies have focused on children receiving acute inpatient care. Additionally, not all types of therapeutic play produce significant results, and few studies have elaborated on the purposes, principles, and concrete measures of therapeutic play. Therefore, this study aimed to design therapeutic play that would reduce the stress responses of preschool-aged children hospitalized with acute respiratory infection. An experimental design with a pretest/posttest was conducted with 105 preschool children recruited from a regional teaching hospital in southern Taiwan. The children in the experimental group received the therapeutic play, while those in the control group received routine nursing care. Children in the experimental group showed significantly greater reductions in their physiological, psychological, and behavioral stress responses than those in the control group. Future studies could apply therapeutic play to children from different age groups with diverse health issues before recommending it be used in pediatric health settings.

The role of public health versus invasive coronary interventions in the decline of coronary heart disease mortality

Purpose: There has been considerable debate on the extent to which the decline in coronary heart disease (CHD) mortality has been caused by better control of coronary risk factors in the general population or is the result of invasive coronary interventions in symptomatic individuals. MethodsUsing the Myocardial Infarction Data Acquisition System, a statewide database of all cardiovascular hospital admissions in New Jersey, we examined time trends in incidence of death from CHD in the Years 2000–2014 in persons with a history of hospitalization for CHD in the previous 10 years and those without such a history. ResultsOver the 10-year study period, there was a marked decline in CHD-related mortality in both persons with a history of CHD and persons without a history of CHD. The decline occurred across all gender, racial, and age groups and was higher in those without a prior history of CHD. ConclusionsThis adds more evidence that the decline in CHD was not only because of advanced invasive medical and surgical treatments but also equally because of improved lifestyle, pharmacologic treatment of risk factors for CHD, and public health interventions.

Paleomedicine and the Evolutionary Context of Medicinal Plant Use.

Modern human need for medicines is so extensive that it is thought to be a deep evolutionary behavior. There is abundant evidence from our Paleolithic and later prehistoric past, of survival after periodontal disease, traumas, and invasive medical treatments including trepanations and amputations, suggesting a detailed, applied knowledge of medicinal plant secondary compounds. Direct archeological evidence for use of plants in the Paleolithic is rare, but evidence is growing. An evolutionary context for early human use of medicinal plants is provided by the broad evidence for animal self-medication, in particular, of non-human primates. During the later Paleolithic, there is evidence for the use of poisonous and psychotropic plants, suggesting that Paleolithic humans built on and expanded their knowledge and use of plant secondary compounds.Graphical

A perfect storm of intervention? Lesbian and cisgender queer women conceiving through Australian fertility clinics

ABSTRACT Amendments to various state laws have made it easier for cisgendered lesbian, bisexual and queer (LBQ) women to access Australian fertility clinics. When women conceive through clinics, they generally use intrauterine insemination (IUI) or in vitro fertilisation (IVF). IUI is cheaper and requires less invasive medical intervention than IVF. A recent survey found that almost 60% of Australian cisgendered LBQ women who conceived with clinical assistance did so using IVF, despite most presenting to clinics without a diagnosis of infertility and seeking donor sperm only. In this paper, based on 20 interviews with Australian clinicians who treat LBQ patients seeking pregnancy, we explore potential explanations for why over half of LBQ women using Australian fertility clinics to conceive used IVF rather than IUI. A ‘perfect storm’ of factors appears to converge in this tendency. Although some LBQ women are purposefully choosing IVF to achieve biological relatedness for two mothers, other pressures toward high intervention conceptions include the distinction between ‘social’ and ‘clinical’ infertility by Medicare (the Australian national health insurance scheme), the relative profitability of IVF procedures and issues with the supply and quality of donor sperm. Accessing sperm from clinics appears to set some Australian women without male partners on a potentially unnecessary path to a high intervention and costly conception.

Special Issue on MEMS for Robotics and Mechatronics

MEMS (Micro Electro Mechanical Systems) is a technology that is used to incorporate sensors, actuators, microstructures, and circuits on chips by using a combination of various technologies with semiconductor process. MEMS are also used in robotics and mechatronics since they can provide compact, low-cost functional components that play crucial roles in their respective systems. We would like to elaborate on the history of MEMS technology, whose initial development started around 1970. In 1960s, Dr. Isemi Igarashi of Toyota Central R&amp;D Labs., Inc. in Japan developed a semiconductor pressure sensor of piezo-resistance type. In 1980s, the pressure sensors were used to control automobile engines to clear exhaust gas regulations and thus contributed to solving environmental issues. In 1990s, semiconductor acceleration sensors were used for passive safety technologies to detect collision of automobiles and activate air bags, which resulted in decrease in traffic fatalities. In 2000s, an active safety system with gyro sensors was developed to detect and control spinning of a vehicle. In future, space recognition sensors with optical scanners to measure light propagation time and detect distance to an object will be used for autonomous driving. For smartphones, a microphone, an acceleration sensor, and a gyro sensor are used in user interface, and a film bulk acoustic wave resonator (FBAR) is used in a wireless communication filter. For projectors, the built-in circuit of a mirror array system is used to move mirrors placed in an array. After the development of projectors, films have not been used in movie theaters. MEMS are also widely used in medical and biological fields, such as blood pressure measurement. Esashi began research on a semiconductor ion sensor ISFET (ion sensitive field effect transistor) in 1971. ISFET detects ion concentration in electrolyte by exposing the insulating film of an insulated gate transistor to the liquid. He set up a prototyping facility when he was a graduate student and wrote only one paper on this research, although the prototyping facility was used afterwards. The ion sensor was certified under the Pharmaceutical Affairs Law after a 12-year application process and was used as catheter-type pH sensor to diagnose reflux esophagitis. MEMS are widely used for minimally invasive medical treatment, which causes minimum damage to human body. Moreover, MEMS are used as disposable sensors to prevent infection or as implanted devices. In addition, MEMS are used for production inspection and scientific instrument, including scanning probe microscopes (SPMs), which observe atoms using extremely small nano-probes, and probe cards that simultaneously test several integrated circuits on a wafer using aligned probes. When he was an associate professor, Esashi improved the prototyping facility that he made when he was a student and made a large scale integrated circuit (LSI). After he became a professor, he accepted researchers from more than 130 companies and developed MEMS using the prototyping facility to develop a product through the academia-industry collaboration. He realized integrated MEMS by combining LSI and MEMS. This includes a system of many tactile sensors attached on the body surface of a safe robot for real-time detection of contact through packet communication. After he retired from the university, he developed a “prototype coin laundry,” which enables companies to do develop without having their own prototyping facility. The prototype coin laundry is a system where engineers can use the prototyping facility to develop devices, and the system has been managed by successors. Unlike integrated circuits for which standardization is easy, standardization of MEMS is challenging because of difficulty in development. It is necessary to access various knowledge for the development of MEMS, and he has made efforts to provide the knowledge. Finally, we would like to thank authors who submitted papers to this Special Issue on MEMS for Robotics and Mechatronics as well as those who were involved in editing and reviewing the papers. We sincerely hope for further development in this field of research.

Vitamin D plus epigallocatechin gallate: a novel promising approach for uterine myomas.

Uterine myomas are the most common benign tumors in females. Most myomas are asymptomatic and require no intervention or further investigations; however, almost a third of women with myomas will require a therapy. Treatment options include pharmacological approaches or surgery, and depend on symptomatology, size, number and desire for future pregnancy. Minimally invasive procedures or alternative medical treatments for handling myomas are preferred, when possible, to the radical abdominal surgery. Vitamin D and epigallocatechin gallate (EGCG) recently proved effective in the management of these benign tumors. Our aim was to verify the effect of combined oral vitamin D and EGCG supplementation in symptomatic women with myomas. Symptomatic women with myomas were enrolled in this pilot study and divided in two groups: one group treated daily with two tablets of 25 μg vitamin D + 150 mg EGCG + 5 mg vitamin B6, for 4 months; the other group received no treatment (control), for the same period. Volume, number of myomas as well as severity of symptoms (SS) and quality of life (QoL) were analyzed. The total myoma volume significantly decreased by 34.7% in the treated group, whereas it increased by 6.9% in the control group. An improvement in the QoL of women treated with vitamin D, EGCG and vitamin B6 was reported along with a reduction of the SS. The combined supplementation of vitamin D and EGCG seems to be an optimal approach for the management of myomas and correlated symptoms. For the first time, we showed the cooperative effectiveness as a promising and novel treatment for myomas.

Acoustically powered surface-slipping mobile microrobots

Untethered synthetic microrobots have significant potential to revolutionize minimally invasive medical interventions in the future. However, their relatively slow speed and low controllability near surfaces typically are some of the barriers standing in the way of their medical applications. Here, we introduce acoustically powered microrobots with a fast, unidirectional surface-slipping locomotion on both flat and curved surfaces. The proposed three-dimensionally printed, bullet-shaped microrobot contains a spherical air bubble trapped inside its internal body cavity, where the bubble is resonated using acoustic waves. The net fluidic flow due to the bubble oscillation orients the microrobot's axisymmetric axis perpendicular to the wall and then propels it laterally at very high speeds (up to 90 body lengths per second with a body length of 25 µm) while inducing an attractive force toward the wall. To achieve unidirectional locomotion, a small fin is added to the microrobot's cylindrical body surface, which biases the propulsion direction. For motion direction control, the microrobots are coated anisotropically with a soft magnetic nanofilm layer, allowing steering under a uniform magnetic field. Finally, surface locomotion capability of the microrobots is demonstrated inside a three-dimensional circular cross-sectional microchannel under acoustic actuation. Overall, the combination of acoustic powering and magnetic steering can be effectively utilized to actuate and navigate these microrobots in confined and hard-to-reach body location areas in a minimally invasive fashion.

A novel approach in managing an arteriovenous malformation of head and neck region using sclerotherapy

Arteriovenous malformations are unusual fast-flow lesions that arise as a result of dysplastic arterial and venous development, with the lack of a normal intervening capillary bed. Treatment options for small and peripheral vascular lesions are numerous in the form of conventional surgical excision, laser therapy, cryotherapy, selective embolization, and sclerotherapy. Less invasive medical treatment in the form of beta-blocker or steroid is also used. We report a patient who was diagnosed with arteriovenous malformation managed with a sclerosing agent in the form of sodium tetradecyl sulfate.

Knowledge and Confidence of Junior Medical Doctors in Discussing and Documenting Resuscitation Plans: A Cross-Sectional Survey

Background: A Resuscitation Plan is a medically authorised order to use or withhold resuscitation interventions. Absence of appropriate resuscitation orders exposes patients to the risk of invasive medical interventions that may be of questionable benefit depending on individual circumstances. Aims: To describe among junior doctors: (1) self‐reported confidence discussing and completing resuscitation plans; (2) knowledge of resuscitation policy including whether resuscitation plans are legally enforceable and key triggers for completion; and (3) the factors associated with higher knowledge of triggers for completing resuscitation plans. Methods: A cross‐sectional survey was conducted at five hospitals. Junior doctors on clinical rotation were approached at scheduled training sessions, before or after ward rounds, or at change of rotation orientation days and provided with a pen‐and‐paper survey. Results: A total of 118 junior doctors participated. Most felt confident discussing (79%, n = 92) and documenting (87%, n = 102) resuscitation plans with patients. However, only 45% of doctors (n = 52) correctly identified that resuscitation plans are legally enforceable medical orders. On average, doctors correctly identified 6.8 (SD = 1.8) out of 10 triggers for completing a resuscitation plan. Doctors aged >30 years were four times more likely to have high knowledge of triggers for completing resuscitation plans (OR 4.28 (95% CI 1.54 to 11.89), p = 0.0053). Conclusion: Most junior doctors feel confident discussing and documenting resuscitation plans. There is a need to improve knowledge about legal obligations to follow completed resuscitation plans, and about when resuscitation plans should be completed to ensure they are completed with patients who are most at risk.

ETHICO-MEDIKOLEGAL EMERGENCY SERVICE

Emergency Room (ER) is specific department in the hospital with specific problem too. A true emergency is any condition clinically determined to require immediate medical care. Government has regulation if every health facility must give health care without money deposit and every invasive medical treatment need informed consent.Together, this condition sometimes made unsatisfaction for patient and his family. How applied informed consent, if unconscious patient came without his/her family ? Who must make decision for treatment ?

A Radial Clutch Needle for Facile and Safe Tissue Compartment Access.

Efficient and safe access to targeted therapeutic sites is a universal challenge in minimally invasive medical intervention. Percutaneous and transluminal needle insertion is often performed blindly and requires significant user skill and experience to avoid complications associated with the damage of underlying tissues or organs. Here, we report on the advancement of a safer needle with a radial mechanical clutch, which is designed to prevent overshoot injuries through the automatic stopping of the needle once a target cavity is reached. The stylet-mounted clutch system is inexpensive to manufacture and compatible with standard hypodermic or endoscopic needles, and therefore can be adapted to achieve safe access in a myriad of minimally invasive procedures, including targeted drug delivery, at-home and in-hospital intravenous access, laparoscopic and endo- and trans-luminal interventions. Here, we demonstrate the clutch needle design optimization and illustrate its potential for rapid and safe minimally invasive cannulation.

Retrospective Evaluation of the Seropositivity Rate of Toxoplasmosis and Clinical Results in Pregnant Women That were Admitted to a Tertiary Health Institution Between 2012 and 2017 in Turkey

The aim of this study was to determine the frequency of toxoplasmosis in pregnant women who were admitted to our hospital in their first trimester and to contribute to screening and management strategies by evaluating clinical outcomes. In this retrospective study, women in their first trimester of pregnancy who were aged between 15-49 years, admitted to the Mersin University Medical Faculty Gynecology and Obstetrics outpatient clinic between 2012-2017, and screened for Toxoplasma gondii immunoglobulin M (IgM) antibodies were included. The data was obtained from the hospital’s digital records. First, the high-risk patients were identified who had anti-T. gondii IgM seropositivity and subsequently underwent anti-T. gondii immunoglobulin G (IgG) and anti-T. gondii IgG avidity tests. Next, the invasive procedures and medical treatments performed for diagnosis and treatment, as well as the clinical course and results for each patient were evaluated. Cases were then analyzed according to the admittance year and patient’s age. Anti-T. gondii IgM positivity was found in 266 (7.66%) of 3474 pregnant women meeting the study’s criteria. The frequency of the Toxoplasma IgM seropositivity was the highest in the 15-25 age group and this frequency decreased gradually as the age of the patients increased. Congenital toxoplasmosis was detected in 1 of 61 patients who had a positive polymerase chain reaction for T. gondii performed in the amniotic fluid. In our province, the prevalence of anti-T. gondii IgM was found to be 7.66% in pregnant women who were admitted to a tertiary health institution in their first trimester of pregnancy. This rate is much higher than the average in Turkey; therefore, we suggest that routine screening of pregnant women for T. gondii may be recommended in this region.

Adjunctive Strategies for Benign Maxillofacial Pathology.

Benign cysts and neoplasms of the maxillofacial region can vary in behavior, with some growing rapidly and resulting in destruction of surrounding structures. Despite their benign histology, many require often-morbid treatment to prevent recurrence of these lesions. Several less invasive and adjunctive medical treatments have been developed to lessen the morbidity of surgical treatment. As the molecular and genomic pathogenesis of these lesions is better understood, more directed treatments may lessen the burden for patients.

Craniofacial abnormalities in a murine model of Saethre-Chotzen Syndrome

BackgroundSaethre-Chotzen Syndrome (SCS) is an autosomal dominant syndrome that occurs due to a mutation or deletion of the Twist1 gene at chromosome 7p21. Our aim was to conduct a morphometric analysis of the craniofacial features in the mouse associated with a Twist1+/− mutation. MethodsMicro-computed imaging was conducted for the skulls of forty skeletally mature mice, equally distributed by sex (male and female) and two genotypes (Twist1+/− or murine model of SCS; and Twist1+/+ or wild-type). A morphometric analysis was carried out for eight parameters for the maxillary-zygomatico-temporal region, 10 parameters for the mandible and three parameters for teeth from three-dimensional reconstructions. ResultsCompared with wild-type, the murine model of SCS showed these trends: (1) maxillary-zygomatico-temporal region, significantly shorter length and width posteriorly (p<0.05), (2) mandible, significantly reduced height and width (p<0.05), and (3) teeth, significantly shorter height, shorter mesio-distal width but longer bucco-lingual width (p<0.05). In the murine model of SCS, the key morphological variations included incomplete ossification of the temporal bone and zygomatic arch, twisting and/or incomplete ossification of the palatal process of the maxilla, premaxilla and the ventral nasal concha, as well as bifid coronoid processes. ConclusionsThe skeletal and dental alterations in the height, length and width provide a foundation for large-scale phenomics studies, which will improve existing knowledge of the Twist1 signalling cascade. This is relevant given the predicted shift towards minimally invasive molecular medical treatment for craniosynostosis.

Discordant susceptibility of inbred C57BL/6 versus outbred CD1 mice to experimental fungal sepsis.

Individual susceptibility differences to fungal infection following invasive and/or immunosuppressive medical interventions are an important clinical issue. In order to explore immune response-related factors that may be linked to fungal infection susceptibility, we have compared the response of inbred C57BL/6J and outbred CD1 mouse strains to different experimental models of fungal sepsis. The challenge of animals with the zymosan-induced generalised inflammation model revealed poorer survival rates in C57BL/6J, consistent with lower Th1 cytokine interferon (IFN)-γ serum levels, compared with CD1 mice. Likewise, ex vivo exposure of C57BL/6J splenocytes to zymosan but also bacterial lipopolisaccharide or lipoteichoic acid, resulted in lower IFN-γ secretion compared with CD1 mice. C57BL/6J susceptibility could be reverted by rescue infusion of relative low IFN-γ doses (0.2μg/kg) either alone or in combination with the ß-glucan-binding CD5 protein (0.7mg/kg) leading to improved post zymosan-induced generalised inflammation survival. Similarly, low survival rates to systemic Candida albicans infection (2.86×104 CFU/gr) were ameliorated by low-dose IFN-γ infusion in C57BL/6J but not CD1 mice. Our results highlight the importance of strain choice in experimental fungal infection models and provide a susceptibility rationale for more specific antifungal immunotherapy designs.

Control of hospital acquired infections and antimicrobial resistance in Europe: the way to go.

SummaryOne of the major challenges for modern medicine is our ageing society and an increased level of immunocompromised hosts. More invasive and intensive medical interventions will increase the number of healthcare-associated infections (HCAI), which means infection that occur because of or in concomitance, but in any case, during or after healthcare interventions. Such infections are caused usually endogenously from microbial components of the patient’s own microbiome. Usually, the microorganisms of the microbiome show a natural resistance against a few antibiotics. Due to selection processes and epidemic transmission of specific clones, microorganisms that have become resistant to multiple antibiotics become part of the patient’s microbiome and can subsequently cause infections that are difficult or even impossible to treat. The kind of infections that will occur depends on diverse factors. Already today, according to Cassini et al., 2,609,911 new cases of HCAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 disability-adjusted life years (DALYs) per 100,000 general population each year in the EU/EEA. In a recent publication, 426,277 healthcare-associated infections caused by antimicrobial resistant microorganisms were calculated to occur in the EU every year. Attributable deaths in the EU due to antimicrobial resistant microorganisms were estimated to be 33,110 per year. We know that we cannot prevent all HCAI. Because medical innovations will allow for an increased number of novel treatments that will comprise abiotic materials, microorganisms will adapt to this environment and enhance the risk for new HCAI. The challenge for the future will not be to try to prevent all infections, as some of them will remain unavoidable, but to prevent the occurrence of non-treatable microorganisms that would make unavoidable infections additionally untreatable. That means that we need to reflect on how we organize infection prevention, diagnostics and control. While patients with classical infectious diseases present with infectious diseases (ID)-specific symptoms, patients with HCAI present usually with another underlying disease. HCAI are therefore perceived as a secondary damage not following classical clinical and epidemiological rules. However, more recently we have to consider how we should react to HCAI and antimicrobial resistance (AMR) as they are quite different in epidemiology and transmission behavior than classical infectious diseases. Today, the prevalence of AMR is rising all over Europe. Although good success has been seen in many countries, methicillin-resistant Staphylococcus aureus (MRSA) remains an important challenge for many countries. In addition to MRSA, multidrug-resistant Escherichia coli and carbapenem-resistant Enterobacteriaceae are becoming a problem of public health importance. Furthermore, we need to focus more on implementation of known infection prevention measures than trying to solve the problem by observing and describing it. However, in addition to medical factors such as antibiotic use, hand hygiene etc., we tend to forget that there are factors behind these factors that have a major influence and are found in the structures of our different healthcare systems. We need to look more at the context before we try to implement prevention measures and need to learn from each other. A common goal to tackle carbapenem-resistant Enterobacteriaceae (CRE) by 2030 would be an important step to foster collaboration across Europe. As the current funding and remmuneration system does not sufficiently support prevention of HCAI and AMR, it is time for the development of a less production- but more prevention-economic financing system for clinical microbiology and infection control.