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Background and Objective: Despite the proven effectiveness of organized PSA-based screening in reducing prostate cancer-related mortality, there is currently no program in Germany covered by statutory health insurance. In accordance with the EU Council Decision (2022/0290(NLE)), the German Society of Urology (DGU) has developed a concept for risk-adapted prostate cancer early detection., Materials and Methods: Based on a literature review of current screening studies, an algorithm for PSA-based prostate cancer early detection was developed., Results: Risk-adapted prostate cancer screening involves PSA testing in the age group of 45-70 years, followed by PSA-based individual risk stratification and stepwise expansion of diagnostics through magnetic resonance imaging (MRI) to biopsy. While initially up to 2.6 million men will undergo PSA testing, a reduction in these initial examinations to fewer than 200,000 men per year will occur from year four onwards., Conclusions: The presented algorithm provides clear recommendations for risk-adapted PSA-based early detection for prostate cancer for urologists and patients. The goal is to improve diagnosis of clinically significant prostate cancer, while reducing overdiagnosis and overtreatment., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Extracorporeal life support systems (ECLS) are life-sustaining measures for severe cardiovascular diseases, serving as bridging treatment either until cardiovascular function is restored or alternative treatment, such as heart transplantation or the implantation of permanent ventricular assist devices is performed. Given the insufficient evidence and frequent urgency of implantation without initial patient consent, the ethical challenges and psychological burden for patients, relatives and the interprofessional intensive care team are significant. As with any treatment, an appropriate therapeutic goal for ECLS treatment based on the indications and patient informed consent is mandatory. In order to integrate the necessary ethical considerations into everyday clinical practice, a structured algorithm for handling ECLS is proposed here, which takes ethical aspects into due account. [ABSTRACT FROM AUTHOR]

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Background: Isthmic spondylolysis represents the most common cause of spinal pain in adolescent athletes. This article provides an overview of the classification, diagnosis, and treatment options for these conditions, including conservative and operative measures. It also provides a treatment pathway to how young athletes with spondylolysis should be treated., Diagnostics: Diagnostic imaging techniques are essential for an accurate diagnosis, with CT scans providing additional information for surgical planning., Treatment: Conservative treatment focuses on activity modification and physiotherapy, with a phased approach tailored to individual patient needs. Operative intervention may be considered if conservative measures fail, with minimally invasive techniques such as Buck's screw fixation showing promising results. The decision between conservative and operative management should consider factors of the patients' individual profile. In this paper, we present the first treatment algorithm for the treatment of isthmic spondylolysis. Long-term prognosis varies, with most athletes able to return to sport following treatment., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The increasing digitization of the healthcare system is leading to a growing volume of health data. Leveraging this data beyond its initial collection purpose for secondary use can provide valuable insights into diagnostics, treatment processes, and the quality of care. The Health Data Lab (HDL) will provide infrastructure for this purpose. Both the protection of patient privacy and optimal analytical capabilities are of central importance in this context, and artificial intelligence (AI) provides two opportunities. First, it enables the analysis of large volumes of data with flexible models, which means that hidden correlations and patterns can be discovered. Second, synthetic - that is, artificial - data generated by AI can protect privacy.This paper describes the KI-FDZ project, which aims to investigate innovative technologies that can support the secure provision of health data for secondary research purposes. A multi-layered approach is investigated in which data-level measures can be combined in different ways with processing in secure environments. To this end, anonymization and synthetization methods, among others, are evaluated based on two concrete application examples. Moreover, it is examined how the creation of machine learning pipelines and the execution of AI algorithms can be supported in secure processing environments. Preliminary results indicate that this approach can achieve a high level of protection while maintaining data validity. The approach investigated in the project can be an important building block in the secure secondary use of health data., (© 2024. The Author(s).)

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Big data and artificial intelligence are buzzwords that everyone is talking about and yet always provide a touch of science fiction to the scenery. What is the status of these topics in anesthesia? Are the first robots already rolling through the corridors while doctors are getting bored as all the work has been done? Spoiler alert! We are still far away from achieving this. Initially, paper charts and analogue notes stand in the way of comprehensive digitization. Source systems need to be merged and data standardized, harmonized and validated. Therefore, the friendly android that is rolling towards us, waving and holding a freshly brewed cup of coffee in our thoughts will have to wait; however, a glimpse of the future is already evident in some clinics and the first promising developments are already showing what could be the standard tomorrow. Learning algorithms calculate the length of stay individually for each patient in the intensive care unit (ICU), reducing negative consequences such as readmission and mortality. The field of ultrasound technology for regional anesthesia and closed-loop anesthesia systems is also demonstrating the benefits of artificial intelligence (AI)-assisted technologies in practice. The efforts are diverse and ambitious but they repeatedly collide with privacy challenges and significant capital expenditure, which weigh heavily on an already financially strained healthcare system; however, anyone who listens carefully to the medical staff knows that robots are not what they would expect and the buzzwords big data and artificial intelligence might be less science fiction than initially assumed. [ABSTRACT FROM AUTHOR]

In this paper methods and algorithms are examined for solving one important problem of transport logistics, namely formation of roadmap. The proposed mathematical model is based on the well-known multi-depot heterogeneous vehicle routing problem with time windows algorithm. Modifications of the model provide additional conditions and restrictions. Algorithmic support of information transport system in an enterprise is connected with features of the vehicle routing problem. The suggested solution is based on modified Clarke and Wright Algorithm and Variable Neighborhood Search. The risk on the roads and the cost of toll roads are calculated, too. [ABSTRACT FROM AUTHOR]

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Background: Low back pain is a common problem for primary care providers, outpatient clinics and A&E departments. The predominant symptoms are those of so-called "unspecific back pain", but serious pathologies can be concealed by the clinical signs. Especially less experienced colleagues have problems in treating these patients, as - despite the multitude of recommendations and guidelines - there is no generally accepted algorithm., Methods: After a literature search (Medline/Cochrane), 158 articles were selected from 15,000 papers and classified according to their level of evidence. These were attuned to the clinical guidelines of the orthopaedic and pain-physician associations in Europe, North America and overseas and the experience of specialists at LMU Munich, in order to achieve consistency with literature recommendations, as well as feasibility in everyday clinical work and optimised with practical relevance., Results: An algorithm was formed to provide the crucial differential diagnosis of lumbar back pain according to its clinical relevance and to provide a plan of action offering reasonable diagnostic and therapeutic steps. As a consequence of distinct binary decisions, low back patients should be treated at any given time according to the guidelines, with emergencies detected, unnecessary diagnostic testing and interventions averted and reasonable treatment initiated pursuant to the underlying pathology., Conclusion: In the context of the available evidence, a clinical algorithm has been developed that translates the complex diagnostic testing of acute low back pain into a transparent, structured and systematic guideline., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

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This paper is a practical survey of immune-mediated, inflammatory and hereditary neuropathies along with recommendations for diagnostic procedures. The large group of immune-mediated, inflammatory neuropathies includes the Guillain-Barré syndrome and chronic-inflammatory demyelinating polyradiculoneuropathy and their subtypes, vasculitic, paraneoplastic and paraproteinemic neuropathies as well as neuropathies resulting from connective tissue disorders. Besides clinical features such as time-dependent progression and distribution of sensorimotor deficits, characteristic electroneurographic findings and antibody profiles are considered. Recent studies in hereditary neuropathies reveal a prevalence of 10-28 out of 100 000 persons in Europe. Research into the genetic causes has made significant progress in the last 20 years; up to now more than 80 genes mutated in hereditary neuropathies have been identified. Besides classification into axonal, demyelinating or intermediate neuropathies based on electroneurography, distinguishing between sensorimotor, pure motor and (autonomous) sensory neuropathies as well as consideration of particular clinical features and ethnic origin can be helpful in orientating molecular genetic analysis., Competing Interests: Es liegen keine Interessenkonflikte der beiden Autoren vor., (© Georg Thieme Verlag KG Stuttgart · New York.)

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Artificial Intelligence (AI) has been become a household expression, especially in the past couple of years thanks to Google's AI Computer program AlphaGo defeating a couple of world-class Go masters from Korea and China. In recent years, machines have surpassed humans in the performance of certain specific tasks, such as some aspects of image recognition. Although it is unlikely that machines will exhibit broadly-applicable intelligence comparable to or exceeding that of humans in the near future, experts forecast that rapid progress in the field of specialized AI will continue, with machines reaching and exceeding human performance on an increasing number of tasks. Simultaneous interpreting, being among the most complex of human cognitive/linguistic activities, with all the associated ergonomic elements, has been discussed profusely as one of the most likely to be taken over by AI in a couple of years. Given that so much has to be there simultaneously, i. e. anticipation, restoration of the implicit-explicit balance, and communicative re-packaging ('re-ostension'1) of the discourse, simultaneous interpreting (SI) has yet to be fully explained, not the least the rich pragmatic information guiding the construction of the appropriate contexts and the speaker's underlying intentionalities, which is the centre piece of SI, given the illusive nature of meaning assembly could be quite beyond even the most intelligent robots. This paper discusses what SI is like, how AI has evolved, and concludes that AI is dramatically changing the profession, but given the rulebased nature of AI driven by data and algorithms, human intelligence as possessed by SI practitioners is still irreplaceable. SI practitioners can harness cutting-edge technologies such as AI to do a better job, which bears significance for trainers and would be SIs. [ABSTRACT FROM AUTHOR]

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Clearance monitor systems are used for gross gamma measurements of waste potentially contaminated with radioactivity. These measurements are to make sure that legal requirements, e.g. clearance criteria according to the german radiation protection ordinance, are met. This means that measurement results may overestimate, but must not underestimate the true values. This paper describes a pragmatic way using a calibrated Cs-137 point source to generate a conservative calibration for the clearance monitor system used in the Medizinische Hochschule Hannover (MHH). The most important nuclides used in nuclear medicine are considered. The measurement result reliably overestimates the true value of the activity present in the waste. The calibration is compliant with the demands for conservativity and traceability to national standards., (Copyright © 2014. Published by Elsevier GmbH.)

In ionization chambers, not all released charge is collected due to the recombination of charge carriers. This effect is taken into account by the saturation correction factor kS. A physical description of the correction factor has been established for pulsed radiation. However, it is only accurate when the pulse length is short compared with the collection time of the ionization chamber. In this paper we develop a description of the saturation correction for radiation pulses of arbitrary length. For this, a system of partial differential equations is solved iteratively. The numerical solutions are verified experimentally for a Roos ionization chamber (PTW TM34001) exposed to a pulsed electron beam. The results of this iterative procedure describe the experimental data well. The calculations are also possible for beam structures which are experimentally hard to get and thereby contribute to a better understanding and correct description of the saturation correction at arbitrary pulse length. Among other things the pulse length dependent distributions of the charge carriers in the ionization chamber is calculated, inclusive of the transition to the conditions prevailing in the case of continuous irradiation. Furthermore is shown that the formula for kS established by Hochhäuser and Balk is applicable even at arbitrary pulse length, if pulse duration dependent effective values are used for the parameters a and p. These effective values have been determined for the Roos chamber at pulse lengths up to 300 μs., (Copyright © 2013. Published by Elsevier GmbH.)

Clinical/methodical Issue: Breast cancer is the most common cancer and the leading cause of cancer deaths in women worldwide., Standard Radiological Methods: Mammography is the only imaging technique approved for nationwide breast cancer screening. Digital full field mammography has improved mammographic image quality. Nevertheless, mammography has a low positive predictive value and a low sensitivity especially in mammographically dense breasts. One of the major limitations is the inherently low contrast between healthy breast parenchyma and breast cancer., Methodical Innovations: Phase contrast imaging is based on the phase shift that occurs when X-rays encounter a change in refractive index between different materials., Performance: The improved soft tissue contrast makes the technology particularly promising for breast diagnostics., Achievements: The studies presented here suggest that phase contrast imaging provides additional diagnostic information both using phase contrast mammography and phase contrast computed tomography (CT)., Practical Recommendations: This paper provides an overview of the basic principles of the phase contrast imaging and describes recent developments towards in vivo and ex vivo phase contrast imaging of the breast.

Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Cardiac manifestations are found in up to 10 % of the affected cohort and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis are not only found in patients with rhythmogenic heart disease such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathies. The overall morbidity and mortality caused by cardiac sarcoidois in Germany is unclear and no large prospective international studies are published on this topic. This consensus paper on diagnostic and therapeutic algorithms in cardiac sarcoidosis is based on a current literature search and forms a expert opinion statement under the hospices of the "Deutsche Gesellschaft für Pneumologie" and "Deutsche Gesellschaft für Kardiologie". It is the rationale of this statement to offer algorithms to facilitate clinical decision-making based on the individual case., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introductions: Gynecomastia is a persistent benign uni- or bilateral enlargement of the male breast ranging from small to excessive findings with marked skin redundancy. In this paper we introduce an algorithm to facilitate the selection of the appropriate surgical technique according to the presented morphological aspects., Patients and Methods: The records of 118 patients (217 breasts) with gynecomastia from 01/2009 to 08/2012 were retrospectively reviewed. The authors conducted three different surgical techniques depending on four severity grades. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and the need to re-operate were observed and related to the employed technique., Results: In 167 (77%) breasts with moderate breast enlargement without skin redundancy (Grade I-IIa by Simon's classification) a subcutaneous semicircular periareolar mastectomy was performed in combination with water-jet assisted liposuction. In 40 (18%) breasts with skin redundancy (Grade IIb) a circumferential mastopexy was performed additionally. An inferior pedicled mammaplasty was used in 10 (5%) severe cases (Grade III). Complication rate was 4.1%. Surgical corrections were necessary in 17 breasts (7.8%). The patient survey revealed a high satisfaction level: 88% of the patients rated the aesthetic results as "very good" or "good", nipple sensitivity was rated as "very good" or "good" by 83%., Conclusion: Surgical treatment of gynecomastia should ensure minimal scarring while respecting the aesthetic unit. The selection of the appropriate surgical method depends on the severity grade, the presence of skin redundancy and the volume of the male breast glandular tissue. The presented algorithm rarely leads to complications, is simple to perform and shows a high satisfaction rate and a preservation of the nipple sensitivity., (© Georg Thieme Verlag KG Stuttgart · New York.)

Technical innovations in multislice computed tomography (CT) allow for larger volume coverage in ever shorter scan times. This progress has stimulated the clinical application of dynamic contrast-enhanced (DCE) CT techniques, which offer the possibility to noninvasively characterize tissue microcirculation in terms of well-defined physiological quantities. This educational review imparts to radiologists the essential physiological terms and definitions as well as the basic tracer kinetic concepts required for the analysis of DCE-CT data. In particular, four different approaches are presented and exemplified by the analysis of representative DCE data: the steepest-gradient method, model-free algebraic deconvolution in combination with the indicator-dilution theory, two-compartment modelling and the so-called adiabatic approximation to the homogeneity model. Even though DCE-CT offers substantial methodological and practical advantages as compared to DCE-MRI (magnetic resonance imaging), there are also two serious and interconnected shortcomings: the low contrast enhancement in relation to the noise level and the high exposure of patients to ionizing radiation. These limiting aspects are considered in detail from a radiation hygienic point of view, emphasizing the basic principles of justification and optimization. Clinically established as well as potential future applications of DCE-CT will be presented in a subsequent paper.

Algorithms have become an indispensable part of everyday business life. They not only screen markets within a very short time, but also influence the market behavior of companies. In the age of ChatGPT and “deep learning algorithms”, many intriguing questions arise: Can algorithms be “cartel promoters”, “cartel facilitators” or even “cartel initiators”? Is the antitrust concept of “concurrence of wills” still up-to-date? When can the “conduct” of algorithms be attributed to a company? This practice-oriented article is intended to shed light on problematic constellations on the basis of a number of cases. [ABSTRACT FROM AUTHOR]

Different research traditions have separately developed various theories of causal inference. Three of these approaches are contrasted in this paper. In particular, I will explore differences and similarities of the potential outcomes approach, the generalized causal inference framework of Campbell, and the theory of causal DAGs. Each of the 3 approaches has strengths and weaknesses; however I argue that it is possible to combine them in applied research. The potential outcomes approach offers an exact and formal definition of a causal effect, however it is not very informative as to which covariates need to be selected for adjustment. The Campbell framework lacks a precise mathematical definition of a causal effect, but offers a long list of threats to internal validity that researchers can try to rule out in their studies. Causal DAGs offer applied researchers a tool to find minimally sufficient adjustment sets of covariates that allow an unbiased estimation of a causal effect, given that researchers are willing and able to encode their causal assumptions of all important covariates., (© Georg Thieme Verlag KG Stuttgart · New York.)

Causal graphs such as directed acyclic graphs (DAGs) are a novel approach in epidemiology to conceptualize confounding and other sources of bias. DAGs visually encode the causal relations based on a priori knowledge among the exposure of interest and the outcome while considering several covariates. The application of formal rules on these diagrams enables the identification of the causal and non-causal structures in the DAG. The causal effects are of interest and require no adjustment. Whereas the non-causal effects have to be checked for confounding and for which covariates adjustment is necessary. The identification of the adjustment set depends on the causal relations among the variables. The consideration of these relations is valuable because adjusting for more variables increases the risk of introducing bias. Considering every single path of a DAG allows the systematic identification of the causal structures in the DAG, and the determination of minimally sufficient adjustment sets for estimating the causal effect of the exposure on the outcome based on the underlying DAG. The aim of this paper is to provide an introduction to the basic assumptions as well as the steps for drawing and applying a DAG., (© Georg Thieme Verlag KG Stuttgart · New York.)

Within the framework of restructuring for the certification to a regional trauma centre of the DGU (German Society for Casualty Surgery), a uniform algorithm for multiple trauma was developed in the medical centre of Wolfsburg. The Wolfsburg multiple trauma algorithm is based on ATLS (advanced trauma life support) with integration of FAST (focused assessment with sonography for trauma), as well as the white paper of the DGU and regional-specific features. Thus structural, instrumental, organizational and personnel conditions were created to improve the care of multiply traumatized patients even further. The conditions for transition to a regional trauma centre of the DGU were confirmed by a successful audit.