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Introduction: Partly because of a lack of governmental commitment in educational work, tissue donation is largely unknown in the German population, although it has an increasing relevance for patient care. Due to the progress in research, the shortage of donor tissues in Germany is constantly increasing and has to be compensated by imports. In contrast, nations such as the USA are self-sufficient in donor tissue and can even export it. Since not only individual but also institutional factors (e.g., legal framework, allocation principles and the organization of tissue donation) can lead to these national differences in donor rates, the present systematic literature review will investigate how these factors influence the willingness to donate tissue., Methods: Relevant publications were systematically searched in seven databases. The search command consisted of English and German terms for the two search components "tissue donation" and "health care system". Papers published in English or German between 2004 and May 2021 and focusing on the analysis of institutional factors influencing the willingness to donate tissue post-mortem for transplantation were included (inclusion criteria); studies on blood and organ and living donation as well as publications not dealing with institutional factors influencing the willingness to donate tissue were excluded (exclusion criteria). In reporting, we followed the PRISMA 2020 statement., Results: Of 1,398 hits, seven were finally included after screening. Many of the remaining studies focused on organ donation or non-institutional aspects of tissue donation. Only two studies considered the central population perspective. Furthermore, five publications originate from an Australian research group and focus on the international allocation of tissues. The results highlight the inadequate state of research and at the same time suggest that both tissue bank organization and allocation principles may influence the willingness to donate tissue. At the same time, the publications indicate that tissue donors are often not informed about a potential commercial use or an international allocation of tissues, which represents an ethical-legal conflict., Conclusion: The results indicate that institutional factors may influence people's willingness to donate. In particular, the lack of societal awareness of the issue results in various areas of tension for which recommendations for action have been developed. In order to prevent a slump in tissue donations because of socially unacceptable practices, further population-based studies should explore the institutional framework conditions that society demands for tissue donation., (Copyright © 2023. Published by Elsevier GmbH.)

Background: Although psychotherapy is an important pillar in the treatment of bipolar disorders, alongside pharmacotherapy, non-drug and complementary procedures, there is no up to date evidence synthesis for inpatient psychotherapeutic treatment and work with caregivers., Objective: To review and evaluate the current study situation on evidence-based inpatient psychotherapy for bipolar disorders., Material and Methods: 1.Summary of the evidence for inpatient psychotherapy in adolescents and adults with bipolar disorders from current review articles and guidelines (German S3 guidelines, Australian, Canadian, and British NICE guidelines). 2. Systematic literature search (PRISMA) in Cochrane trials and Medline (via PubMed). 2a. Identification of original articles using the following search term: "bipolar fft" OR "bipolar ipsrt" OR "bipolar cbt" OR "bipolar cognitive remediation" OR "bipolar psychotherapy inpatient". 2b. Screening of n = 942 publications on the following inclusion criteria: randomized controlled efficacy trials, inpatient treatment/recruitment in the inpatient setting, adolescent or adult patients with bipolar disorder or caregivers., Results: The guidelines recommend a combination of pharmacotherapy and psychotherapy for the treatment of patients with bipolar disorders (so far no evidence-based presentation of inpatient psychotherapy). The results from reviews and original papers are heterogeneous. Recently described evidence-based psychotherapeutic approaches for inpatient treatment are family focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT) and psychoeducation., Conclusion: Although the current evidence is heterogeneous and further systematic studies are necessary, the results indicate that psychotherapy should be started or initiated in the inpatient setting with inclusion of caregivers., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Commercial weight loss programs offer support to overweight and obese patients to reduce excess bodyweight. Many patients seek advice for weight loss from their general practitioners., Patients and Methods: In the framework of a randomized controlled 1-year trial the effectiveness and safety of a commercial weight loss program was compared with a primary care intervention. At the end of the trial the participating general practitioners and study participants were asked to answer specific questions about their offered weight loss management. This paper relates to the German study part (268 participants, 40 general practitioners)., Results: More than half of the general practitioners reported to offer a dietary concept which varied strongly across general practitioners. About one third of the general practitioners considered commercial weight loss programs as an alternative to support weight reduction. Participants reported that they considered weight loss advice by their general practitioners as helpful. But patients in the commercial weight loss program assessed the advice as more positive and achieved twice as much weight loss as patients in the primary care intervention., Conclusion: Evaluated commercial weight loss programs can be effective and safe alternatives for general practitioners to achieve weight loss in overweight and obese patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: This paper analyses schemes to promote the authorisation of and reimbursement for orphan drugs., Methods: 8 countries - Australia, Canada, Germany, Great Britain, France, Netherlands, Switzerland, USA - were studied to compare specific regulations for orphan drugs regarding drug admission, health technology assessment (HTA), decision-making for reimbursement, and off-label and compassionate use. Information was obtained by reviewing published and grey literature. Expert interviews were also conducted., Results: The comparison of orphan drug legislation reveals that the EU and the USA offer the greatest incentives for the development of orphan drugs, whereas there is a tendency for Australia and Switzerland to profit from incentives in other countries. Although not explicitly stated, economic evaluation of orphan drugs takes the special circumstances for orphan drugs into account. In addition to common reimbursement practices, special schemes or programmes for the reimbursement of high-priced orphan drugs exist in all countries that were analysed. Therefore access to orphan drugs seems to be warranted. However, due to co-payments of 5%, the USA may form an exception., Conclusion: On the one hand, the use of special criteria for drug admission, HTA, and reimbursement promotes R&D for orphan drugs. On the other hand, high opportunity costs arise, because huge efforts are made for a minority of patients. A solution for this moral dilemma may be the application of "rule of rescue" or of "no cure, no pay" programmes., (© Georg Thieme Verlag KG Stuttgart · New York.)

The growing burden of chronic disease and the current nature of healthcare systems which are structurally ill-equipped to cater to the complex needs of patients with chronic conditions has led to governments and healthcare providers seeking alternative ways to improve patients own capacity to actively self-manage their chronic condition. In Australia, there has been a focus on patient education and self-management programs within the healthcare system to achieve this. These programs aim to empower patients through providing information and teaching skills and techniques to improve self-care and doctor-patient interaction with the ultimate goal of improving quality of life. Patient education and self-management programs have been supported through several national government initiatives and implemented within the healthcare setting. This paper describes the current position of patient education and self-management within the Australian healthcare system. It further describes a new collaboration project between an Australian and a German research team which aims at translating an assessment questionnaire used in Australia for the evaluation of self-management programs, the "Health Education Impact Questionnaire" ("heiQ"); this instrument is expected to be of significant use in the German rehabilitative system.