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Background: The survey of Copeia captured early 2022 patient-reported outcomes (PRO) in Germany under cannabis medicinal product (CAM) therapy, with particular attention to symptoms, symptom changes, indications, side effects, dosages, and cost bearers., Goal: This study investigated the question of whether associations emerge from the results that could play a role in the indication and treatment monitoring of CAM in chronically ill patients., Materials and Methods: A standardized questionnaire was administered online nationwide in dialogue form over a 15-week period to collect itemized symptoms and PRO. Recruitment was supported by pharmacies, prescribing physicians, and patient associations. Inclusion criteria included physician-prescribed CAM therapy., Results and Discussion: Of 1582 participants, 1030 data sets (65%) could be completely analyzed. There was a heterogeneous patient population, whose common feature was disease chronicity. The frequency distribution of symptoms showed a homogeneous pattern for the respective indications, in which the most frequent six (pain 71%, sleep disturbance 64%, stress/tension 52%, inner restlessness 52%, depressive mood 44% and muscle tension 43%) seem to have a special significance. According to subjective assessment, quality of life improved significantly in 84% of all participating patients., Conclusion: A symptom matrix (SMX) composed of different symptoms seems to play a special role in CAM therapy to improve the quality of life of chronically ill patients, regardless of the underlying disease. The SMX could contribute to the identification of an indication and to targeted treatment monitoring., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: There are no studies available that have simultaneously assessed the benefits and harms of cannabis-based medicines from the viewpoint of patients and their physicians., Methods: All chronic pain patients at three pain centres in the German federal state of Saarland who had received at least one prescription of cannabis-based medicines (CbMs) in the past from the study centre were included in a cross-sectional study from January 1 to December 31, 2021. Patients and their physicians completed a self-developed questionnaire separately., Results: All 187 contacted patients participated in the study. Since the start of CbM therapy, 44.9% of patients reported to be much or very much, 43.3% to be moderately and 8.0% to be slightly improved overall. A total of 2.7% reported no change and 1.1% a moderate deterioration of overall wellbeing. From the patients' point of view, the symptoms most frequently reported to have substantially improved were sleep problems (36.4%), muscle tension (25.1%) and appetite problems (22.1%). The most frequent bothersome side effects were sweating (6.4%), concentration problems (4.2%) and nausea (4.1%). Physicians noted substantial pain relief in 60.7%, improvement of sleep in 65.7% and of mental well-being in 34.3%. A complete cessation of opioids was achieved in 64.7%, of anticonvulsants in 57.9% and of antidepressants in 60% of patients that had received these medications before the start of CbM therapy., Conclusions: CbMs can contribute to a clinically relevant reduction in pain, sleep problems and muscle tension and can improve daily functioning in carefully selected and supervised patients with chronic pain. CbM can contribute to the reduction or complete cessation of other pain medications (antidepressants, anticonvulsants, opioids)., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lacking regarding indications, contraindications, limitations and management of ECMO/ECLS patients. Therefore in 2015, the German Society of Thoracic and Cardiovascular Surgery (GSTCVS) registered the multidisciplinary S3 guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" to develop evidence-based recommendations for ECMO/ECLS systems according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF). Although the clinical application of ECMO/ECLS represents the main focus, the presented guideline also addresses structural and economic issues. Experts from 17 German, Austrian and Swiss scientific societies and a patients' organization, guided by the GSTCVS, completed the project in February 2021. In this report, we present a summary of the methodological concept and tables displaying the recommendations for each chapter of the guideline., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: This study aimed to find out more about factors that hinder physicians' careers, especially with regard to gender differences, and which future working conditions they would prefer., Methods: In an online survey, members of the professional societies of Hematology and Oncology in Germany, Austria and Switzerland were asked to rate factors that might hinder or facilitate their professional career. Data analysis included χ 2 -tests, t tests and analyses of variance., Results: 469 physicians participated (61% female, response rate 9.1%). 40% of the participants experience a lack of compatibility between family life and career. Female physicians with children living in their household especially feel restricted in their professional development. The most preferred conditions for improving compatibility were flexible working hours (72%), opportunities to work in home office (71%), better opportunities for specialist training (51%) and enabling managerial activities on a part-time basis (73%). Both female and male physicians would like fathers to be encouraged to take parental leave to the same extent as mothers (50%). They would, e.g., like to see more flexible drop-off and pickup times for children (71%) and more childcare options offered by their employer (61%)., Conclusion: Results suggest various options for promoting compatibility of family life and work, e.g., by family-friendly working time models and part-time offers breaking with traditional role models. Managerial positions might be offered on a regular part-time basis. Structured qualification programs could enable the compatibility of clinical work, research and family life. Childcare services should preferably be provided in line with existing needs., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

As the German population is continually aging and the majority of older adults still wish to 'age in place', the need for informal care provided by family and friends will correspondingly continue to increase. In addition, while the need for formal (professional) care services is also likely to increase, the supply already does not meet the demand in Germany today. The aim of our study is the elicitation of people's willingness to provide informal care by means of a discrete choice experiment. The self-complete postal survey was disseminated to a random sample of the German general population in Lower Saxony. Data cleansing resulted in a final sample size of 280 participants. A conditional logit and a latent class model were estimated. All attributes were judged as highly relevant by the respondents. The results revealed that an increase in the care hours per day had the greatest negative impact overall on the willingness to provide informal care in our sample. The marginal willingness-to-accept for 1 h of informal care was €14.54 when having to provide informal care for 8 h in reference to 2 h per day. This value is considerably higher than the national minimum wage of €9.82. A three-class latent class model revealed preference heterogeneity. While a monetary compensation is often discussed to increase the willingness and availability of informal care in a country, our results show that this statement could not be generalized within our entire sample., (© 2022. The Author(s).)

Purpose: The International Abstract(s) of Surgery (IAS) was a monthly supplement to Surgery, Gynecology & Obstetrics (SG&O, later Journal of the American College of Surgeons) from 1913-1994, approximately equal in size to the journal itself. It followed the example of the Zentralblatt für Chirurgie (ZblCh), which had been compiling abstracts of the current world surgical literature since 1874 (but in the German language). This article seeks to review the relationships of these surgical abstract journals in historical context., Methods: Citations in the IAS were systematically sampled for 1913-1990, and in the ZblCh and other American and German surgical publications for 1905-1940. Changes in the proportions of citations by language category were tabulated over time and related to concurrent international events and the publication histories of the sampled journals., Results: German-language citations were most frequent until the First World War, even in America. They subsequently became less frequent in America, but remained dominant in Germany. Articles in French or other languages were occasionally cited by Americans, but in German publications, they were cited as frequently as those in English. Contemporary observations from this time confirm that the American literature was being disregarded by most German surgeons. Since the Second World War, surgical publications have become predominantly English-language, even in Germany, and printed abstract compilations have become irrelevant., Conclusions: The history of the IAS and ZblCh reflects world events of the early twentieth century, the isolation and decline of German scientific leadership, the rise of American surgery, and the transition from a multilingual print-based era to one where scientific communication is primarily electronic and in English., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Gastrointestinal infections are among the most frequent imported diseases diagnosed in Germany in travelers or migrants from the tropics. Acute traveler's diarrhea is the most frequent illness in long-distance travelers and in high-risk areas (e.g. India, Mexico) around one third of all travelers suffer from diarrhea. Chronic diarrhea plays a role especially after longer stays abroad (> 4 weeks) and in migrants and is often caused by protozoa. Helminths are less frequently the causative agent of gastrointestinal complaints (diarrhea, nausea, abdominal pain). A worm infestation of the large and small intestines is often present but helminths can also affect the liver or lead to generalized symptoms of illness when larvae migrate. In principle, in the case of gastrointestinal complaints after exposure to the tropics, the possibility of an imported tropical endemic infectious disease must be considered and appropriate diagnostics initiated. For travelers returning from tropical countries other, sometimes life-threatening diseases, such as malaria, typhoid fever, rickettsiosis and viral hemorrhagic fever (VHF) can present with gastrointestinal symptoms and should never be overlooked., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: Due to recent trends such as globalization and digitalization, more and more employees tend to have flexible working time arrangements, including boundaryless working hours. The aim of this study was to investigate the relationships of various aspects of boundaryless working hours (overtime, Sunday work, and extended work availability) with employees' state of recovery. Besides, we examined the mediating and moderating role of recovery experiences (psychological detachment, relaxation, mastery, and control) in these relationships., Methods: We used data from 8586 employees (48% women; average age of 48 years) who took part in the 2017 BAuA-Working Time Survey, a representative study of the German working population. Regression analyses were conducted to test main effects as well as mediation and moderation., Results: Overtime work, Sunday work, and extended work availability were negatively related to state of recovery. Psychological detachment mediated these relationships. Furthermore, we found that relaxation and control mediated the association between extended work availability and state of recovery. However, no relevant moderating effects were found., Conclusions: Altogether, our findings indicate that various aspects of boundaryless working hours pose a risk to employees' state of recovery and that especially psychological detachment is a potential mechanism in these relationships. In addition, the results suggest that a high level of recovery experiences cannot attenuate these negative relationships in leisure time. Therefore, employers and employees alike should try to avoid or minimize boundaryless working hours., (© 2021. The Author(s).)

Purpose: The healthcare system is responsible for around 5% of CO 2 emissions globally and in Germany. So far, there are no data on the amount of waste from dry eye disease (DED) therapy in ophthalmology. The aim of this project was to evaluate the amount and type of waste from single- and multi-dose units (SDU/MDU) generated by eyedrops used to treat DED in Germany., Methods: The net waste weight (outer/inner packaging, instruction leaflet, empty container) from factory-sealed products was determined using a precision scale. Based on prescription data from PharMaAnalyst, a database of medical prescriptions from over 70 million patients in Germany, the total annual waste volume for 2016-2021 and the net weight of a 30-day treatment were calculated., Results: The total annual waste volume increased significantly (p < 0.0001) from 7.13 tons in 2016 to 20.64 tons in 2021. A 30-day treatment with MDUs (without/with filter) results in a significantly lower mean waste volume (paper: SDU 24.3 ± 18.7 g; MDU 4.8 ± 1.7 g/8.8 g ± 1.7 g; SDU/MDU p = 0.0003, with filter p = 0.0034; plastic: SDU 35.0 ± 4.0, MDU 6.6 ± 0.7 g/ 15.1 g ± 5.8 g, SDU/MDU p < 0.0001, with filter p < 0.0001)., Conclusion: Prescription-based treatment of DED in Germany causes an increasing and substantial waste volume. The use of SDUs is considerably more resource-intensive than MDUs. Due to the large and rising number of patients suffering from DED improvements in packaging could considerably reduce the CO 2 footprint of DED treatment., (© 2024. The Author(s).)

In this paper, we use unique health record data that cover outpatient care and the associated costs to quantify the health care costs of a sizable increase in the retirement age in Germany. For the identification, we exploit a sizable cohort-specific pension reform which abolished an early retirement program for all women born after 1951. Our results show that health care costs significantly increase by about 2.9% in the age group directly affected by the increase in the retirement age (women aged 60-62). We further show that the cost increase is mainly driven by the following specialist groups: Ophthalmologists, general practitioners (GPs), neurology, orthopedics, and radiology. While the effects are significant and meaningful on the individual level, we show that the increase in health care costs is modest relative to the positive fiscal effects of the pension reform. Specifically, we estimate an aggregate increase in the health costs of about 7.7 million euro for women born in 1952 aged 60-62 which amounts to less than 2% of the overall positive fiscal effects of the pension reform., (© 2022. The Author(s).)

Purpose: The evidence-based (S3) guideline "Adult Soft Tissue Sarcomas" (AWMF Registry No. 032/044OL) published by the German Guideline Program in Oncology (GGPO) covers all aspects of sarcoma treatment with 229 recommendations. Representatives of all medical specialties involved in sarcoma treatment contributed to the guideline. This paper compiles the most important recommendations for surgeons selected by delegates from the surgical societies., Methods: A Delphi process was used. Delegates from the surgical societies involved in guideline process selected the 15 recommendations that were most important to them. Votes for similar recommendations were tallied. From the resulting ranked list, the 10 most frequently voted recommendations were selected and confirmed by consensus in the next step., Results: The statement "Resection of primary soft tissue sarcomas of the extremities should be performed as a wide resection. The goal is an R0 resection" was selected as the most important term. The next highest ranked recommendations were the need for a preoperative biopsy, performing preoperative MRI imaging with contrast, and discussing all cases before surgery in a multidisciplinary sarcoma committee., Conclusion: The evidence-based guideline "Adult Soft Tissue Sarcomas" is a milestone to improve the care of sarcoma patients in Germany. The selection of the top ten recommendations by surgeons for surgeons has the potential to improve the dissemination and acceptance of the guideline and thus improve the overall outcome of sarcoma patients., (© 2023. The Author(s).)

When healthcare interventions prolong life, people consume medical and non-medical goods during the years of life they gain. It has been argued that the costs for medical consumption should be included in cost-effectiveness analyses from both a healthcare and societal perspective, and the costs for non-medical consumption should additionally be included when a societal perspective is applied. Standardized estimates of these so-called future costs are available in only a few countries and the impact of inclusion of these costs is likely to differ between countries. In this paper we present and compare future costs for five European countries and estimate the impact of including these costs on the cost-effectiveness of life-prolonging interventions. As countries differ in the availability of data, we illustrate how both individual- and aggregate-level data sources can be used to construct standardized estimates of future costs. Results show a large variation in costs between countries. The medical costs for the Netherlands, Germany, and the United Kingdom are large compared to Spain and Greece. Non-medical costs are higher in Germany, Spain, and the United Kingdom than in Greece. The impact of including future costs on the ICER similarly varied between countries, ranging from €1000 to €35,000 per QALY gained. The variation between countries in impact on the ICER is largest when considering medical costs and indicate differences in both structure and level of healthcare financing in these countries. Case study analyses were performed in which we highlight the large impact of including future costs on ICER relative to willingness-to-pay thresholds., (© 2022. The Author(s).)

Background: Chronic pain, with a prevalence of at least 17%, is a costly health problem associated with a high burden of disease. Musculoskeletal chronic pain is particulary common, which in many cases is treated with physiotherapy., Aim: The aim of this paper is to provide an overview of innovative, promising physiotherapy interventions in pain management, to present their effectiveness and to discuss their implementation in healthcare., Methods: A narrative review was conducted. The Cochrane, Medline (via PubMed) and PEDro databases were searched using the search terms chronic pain, physiotherapy, prevention, pain education, behavioural intervention, eHealth, and systematic review as well as chronic pain, guideline and relevant synonyms., Results: One guideline review, two guidelines and ten systematic reviews were included. Chronic pain prevention, digital health apps, lifestyle interventions and behavioural approaches were identified as promising and effective interventions for people with chronic pain, showing the potential to meaningfully complement pain physiotherapy and improve quality of care., Conclusions: Despite the predominantly positive results from systematic reviews, implementation in everyday care is difficult due to conditions of care and the contemporary education system for physiotherapists in Germany. Health services research can play an important role in accelerating the transfer of innovations into practice., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This paper contributes to the discussion of whether non-indicated ultrasound examinations of the thyroid gland contribute to overtreatment and excess health care expenditures. Using two sources of claims data from Germany, we analyzed data from patients who underwent a TSH blood test which is the initial diagnostic measure to check for possible presence of thyroid dysfunction. In a matching analysis, we compared health costs of two groups of patients. One consisted of patients who underwent an early thyroid ultrasound that according to medical guidelines-at this point-was probably not indicated. The other group consisted of patients, who underwent no ultrasound examination at all or later in the course of the disease, making probable a correct indication. Both groups were made comparable by the means of a matching procedure. Average thyroid-specific health costs were substantially higher for the first group in the quarter in which the ultrasound examination took place. Some deviation in these specific costs persisted over a substantial period of time, with drug expenditures exhibiting the biggest difference. If, however, total health costs were considered, difference in costs was only found in the initial quarter. We conclude that non-indicated ultrasound examination of the thyroid gland may have some moderate effects on thyroid-specific costs. Yet the data do not suggest that long-lasting overtreatment and excess health expenditures are initiated by non-indicated ultrasound in Germany., (© 2021. The Author(s).)

When Adolf Hitler annexed Austria to the German Reich in 1938, the famous Jewish oral pathologist Bernhard Gottlieb was in great distress. The Viennese university teacher immediately lost his employment and teaching authority and was forced to emigrate.While Gottlieb's exceptional scientific position in oral pathology is well documented, the complex implications of his deprivation of rights and forced emigration in the Third Reich have so far received little attention. Against this background, the present contribution poses the question of the concrete effects of this drastic event on Gottlieb's life and work.In order to clarify this question, Gottlieb's career status, his scientific success up to 1938, the concrete background of his forced emigration, as well as the further course of his life and career in the USA (his immigration country) are scrutinized. In addition, the paper analyzes the extent to which Gottlieb was able to build on his professional career after 1945 and posthumously. The work is based on a thorough analysis of Gottlieb's academic career using archival sources and a re-analysis of the relevant research literature.The study concludes that Gottlieb suffered a severe setback after his emigration. Several reasons played a role. In particular, cultural and age-related adjustment problems, difficult local conditions, and scarce financial resources hampered the seamless continuation of Gottlieb's career in the USA. Only in the last two decades have efforts been made, particularly in the environment of the University of Vienna, to bring Bernhard Gottlieb and his scientific achievements back into collective memory., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Herbert Siegmund (1892-1954) was undoubtedly one of the most influential German pathologists of the 20th century. He received numerous high honors both during the Third Reich and after 1945. He was, among other things, rector of the University of Münster (1943-1945), holder of the Goethe Medal awarded by Hitler (1944), honorary doctor of the University of Cologne (1949), recipient of the Paracelsus Medal (1953), and president of the German Society for Pathology (DGP, 1954). The almost seamless post-war career was possible above all because Siegmund was counted among the politically uninvolved university physicians after 1945. It was not until after the turn of the millennium that this picture cracked., Material and Methods: The article is based on primary sources from the State Archives of Schleswig-Holstein and North Rhine-Westphalia, the University Archives of Münster, the Federal Archives of Berlin, the University Archives of Cologne, and the City Archives of Stuttgart, some of which were evaluated for the first time. Two questions are at the center of this article: (1) To what extent can it be proven that Siegmund benefited from the Nazi state in terms of his career after 1933? (2) Are there indications that he served the Nazi regime and its networks? In addition, we will discuss how Siegmund himself described his role in the Third Reich and whether his statements stand up to critical scrutiny., Results: The paper concludes that Siegmund contributed to valorizing the Nazi system. After 1945, he did not position himself at a critical distance from his activities in the Third Reich; rather, he drew of himself - largely unopposed - the image of a politically blameless scholar., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)