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Incontinence-associated dermatitis (IAD) describes damage to the skin caused by repeated and prolonged contact with urine and/or feces. Patients of all ages can be affected; the diagnosis is preferably used in adults and adolescents. The predilection sites are perineal, perianal, the inner thighs and the convex areas of the buttocks. Increased moisture on the skin surface, increased pH, occlusion, feces digestive enzymes and repeated skin cleansing procedures are pathophysiologically relevant factors. Typical clinical signs of IAD are erythema, erosions, excoriations and pain. Diagnosis is often difficult because there are many relevant differential diagnoses, some of which may occur together with an IAD. In particular, pressure ulcer, contact dermatitis and intertrigo need to be differentiated and treated. Effective strategies of prevention and therapy of IAD are continence management, the use of efficient, absorbent products as well as consistent skin protection and care. IAD is a skin disease that is often not or incorrectly diagnosed. It should be treated as early as possible, together with the causative factors such a fecal and/or urinary incontinence, as otherwise it can lead to an unnecessarily long duration and severity of the symptoms.

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder with an increasing prevalence. Affected individuals suffer from a repetitive partial or complete occlusion of the pharyngeal airway despite continued respiratory efforts leading to sleep fragmentation, abnormal gas exchange and significant cardiovascular and metabolic morbidity. Surgical patients with OSA, which in the majority of cases has not been diagnosed prior to surgery, have an increased risk of developing a variety of pulmonary, cardiovascular and other complications throughout the perioperative period. Certain actions may contribute to increase the safety of patients with OSA during this time. Among them are preoperatively, a timely recognition and assessment of OSA and potentially co-existing diseases, intraoperatively, the selection of an appropriate anaesthesia and monitoring technique, and postoperatively, the continuation of monitoring for an adequate period of time with the option of intensive care treatment. The actual clinical approach should follow the risk profile of the individual patient which is determined by OSA severity, invasiveness of the surgical procedure and requirement for postoperative opioids as well as the incidence of critical events in the early postoperative period. Initiated and mandated by the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, and conceived on the basis of the available literature and existing guidelines, the following paper provides recommendations for the perioperative management of adult patients with OSA in ENT surgery.

Position Paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology - Current State of Clinical and Endoscopic Diagnostics, Evaluation, and Therapy of Swallowing Disorders in Children and AdultsSwallowing disorders are frequent. The main concern is mortality due to aspiration induced pneumonia and malnutrition. On the other hand quality of life is severely affected. The demographic trend indicates an increase of dysphagia in the future. Neurodegenerative diseases, tumors of the digestive tract and sequelae of tumor treatment in the head and neck region are the main pathologic entities.Predominantly ENT physicians and phoniatrists, are asked for diagnostics and therapy who will coordinate the interdisciplinary treatment according to the endoscopic findings.A differentiated approach in history, diagnostics, and symptom oriented treatment is necessary for the mostly complex disorders. The integration of non-medical personnel such as logopeds (speech language pathologists), physiotherapists, and occupational therapists in planning and executing an effective therapy expands and completes the patient-oriented care. Conservative treatment by these therapists is an important pillar in the treatment. Parts of the specific diagnostics can be taken over by them in close cooperation.In particular an interdisciplinary cooperation with the staff from intensive care medicine is indispensable.The diagnostic procedures of specific endoscopy as described in this position paper are part of the primary and fundamental tasks of ENT specialists and phoniatrists.Endoscopy is a medical service that is basically not delegable. Consequently substitution of the physician is precluded.Schluckstörungen sind häufig. Sie können zu erhöhter Mortalität durch aspirationsbedingte Lungenkomplikationen und Mangelernährung einerseits sowie einer erheblichen Beeinträchtigung der Lebensqualität andererseits führen. Die demografische Entwicklung in Deutschland lässt einen kontinuierlichen Anstieg der Dysphagie in den kommenden Jahren erwarten. Schwerpunkte sind dabei neurodegenerative Erkrankungen, die Tumoren im Verlauf der Schluckstraße und die Folgen der Tumorbehandlung im oberen Aerodigestivtrakt.Vorrangig sind die Ärzte aus dem HNO-Bereich und der Phoniatrie als kompetente Fachgruppen zentrale Ansprechpartner für die Diagnostik und Therapieplanung der Dysphagie.Die meist komplexen Störungen verlangen eine differenzierte Anamnese, Diagnostik und eine symptomorientierte Behandlung.Das Einbeziehen auch von nicht-ärztlichen Fachgruppen wie Logopäden, Physiotherapeuten und Ergotherapeuten in die Planung einer effizienten Therapie erweitert und komplettiert die kompetente patientenzentrierte Betreuung. Die konservative Dysphagietherapie durch Logopäden und ähnliche Fachgruppen ist, auch längerfristig, ein wichtiges Standbein der Behandlung. Zudem können Anteile der spezifischen Diagnostik in enger Kooperation übernommen werden.Eine interdisziplinäre Zusammenarbeit insbesondere mit den intensivmedizinischen neurologischen und internistischen Fachgruppen ist erforderlich.Die in diesem Positionspapier beschriebenen Verfahren der speziellen Endoskopie gehören zu den originären ärztlichen Leistungen, vornehmlich der Fachärzte für Hals-, Nasen-, und Ohrenheilkunde bzw. für Sprach-, Stimm- und kindliche Hörstörungen (Phoniatrie und Pädaudiologie).Die Endoskopie ist eine ärztliche Leistung, die grundsätzlich nicht delegierbar ist „In keinem Fall delegierbar sind Leistungen der Endoskopie (außer Kapselendoskopien, die durch speziell ausgebildete nichtärztliche Mitarbeiter geführt werden können) und der Sonografie“ siehe 278. Entsprechend ist eine Substitution des Arztes ausgeschlossen.

This study examined the degree and manner of involving parents in the treatment of dyslexic children. The study also identified therapeutic variables predicting the extent of parent involvement and the reasons for any instances of failed involvement.A sample of 53 out of 120 randomly selected German dyslexia therapists (response rate: 44 %) filled out a paper-pencil questionnaire assessing the degree and manner of parent involvement in the treatment of dyslexic children. Furthermore, therapists' attitudes toward parent involvement and their subjective competence when working with parents were assessed.The most common forms of parent involvement occurred during anamnesis and when drawing up recommendations for home exercises. The therapists' attitudes toward working with parents predicted the extent of parent involvement (β = .58). There was a significant correlation between working with parents and the subjective competence of the therapist (r = .28), which was mediated by therapists' attitudes toward parent involvement. Disinterest on the part of parents and therapists' lack of time proved to be reasons for less parent involvement.Despite declared positive attitudes toward working with parents, the involvement of parents in the therapeutic process by therapists was limited.Fragestellung: Ziel vorliegender Studie war eine erste Erhebung der derzeitigen Praxis der Zusammenarbeit mit Eltern im Rahmen von außerschulischen Übungsbehandlungen lese- und rechtschreibschwacher Schüler. Formen und Bedingungsfaktoren geleisteter Elternarbeit sowie mögliche Gründe für das Scheitern einer Zusammenarbeit sollten identifiziert werden. Methodik: Ein Paper-Pencil-Fragebogen diente der Erhebung von Ausmaß und Form praktizierter Elternarbeit. Zudem wurden die Einstellung der Therapeuten zur Elternpartizipation und deren subjektive Kompetenz hinsichtlich der Zusammenarbeit mit Eltern erfasst. Die Fragebögen wurden bundesweit an eine Zufallsstichprobe von 120 LRS-Therapeuten versandt (Rücklaufquote: 44 %). Ergebnisse: Die häufigsten genannten Formen der Elternpartizipation waren der Einbezug der Eltern in die Erhebung der Anamnese und das Geben von Hinweisen für das Üben zu Hause. Die Einstellung der Therapeuten gegenüber Elternarbeit prädizierte bedeutsam das Ausmaß der Elternpartizipation (β = .58). Es bestand ein signifikanter Zusammenhang zwischen Elternarbeit und subjektiver Kompetenz der Therapeuten (r = .28), welcher über die Einstellung der Therapeuten mediiert wurde. Ein Desinteresse der Eltern sowie ein Zeitmangel seitens der Fachpersonen sind aus Sicht der Therapeuten Gründe für das geringe Durchführen von Elternarbeit. Diskussion: Im Gegensatz zu der insgesamt positiven Einstellung der Therapeuten zu Elternarbeit werden die verschiedenen Möglichkeiten der Elternpartizipation in der Praxis relativ selten und einseitig genutzt.

The use of ECMO to stabilize critically ill patients with severely depressed cardiac function and hemodynamics increased in the last years due to broader availability, better performance and easier implantation of the devices. The present guidelines of the Austrian Society of Cardiology focus on the use of ECMO in adult non-operated patients with cardiac diseases. Not only indications and contraindications are highlighted, but also the equally important issues of monitoring, complication management, measures during implantation and operation, and weaning of the devices are treated in detail. Thereby the present guidelines aim to optimize the use of ECMO in the individual centers, and aim to help current non-ECMO centers in developing a local ECMO-program or to contact ECMO-centers for discussion of individual patients.

The use of botulinum neurotoxin (BoNT-A) for suppression of neurogenic detrusor overactivity was first reported in 2000. Since that time, this method has gained widespread use. A number of recommendations and consensus statements have already been published. The current practice-oriented consensus paper takes into account recent developments and the over 10-year experience of most members of the Working Group Neuro-Urology of the German-speaking Medical Society for Paraplegia (DMGP) with a focus on the use of BoNT-A in paraplegic patients and in patients with multiple sclerosis.

In this study a computer-assisted cognitive training programme (CAT) was compared to a paper-pencil-cognitive training and evaluated in psychiatric patients for its effects on neuropsychological parameters, mood and dysfunctional cognitions.A total of 29 subjects were randomized either to the computer group or the paper-pencil group. Both groups underwent 20 sessions cognitive training. At the beginning and at the end of the training, both groups were given neuropsychological tests (memory, attention, concentration and information processing speed) and also questionnaires to assess depressive mood, thoughts, negative self communication and locus of control.At the start of the study, both the groups were comparable in demographic, diagnostic, neuropsychological and almost cognitive parameters. Compared to the baseline values, only the computer group improves significantly in mood and increases its positive self-verbalisation. In both groups no remarkable changes were found in the neuropsychological parameters.According to these results a computer-assisted cognitive training programme might primarily have a positive influence on mood than in parameters of performance and thus could be a very interesting therapeutic tool in the treatment of psychiatric patients.

The most common morphological changes in 485 of our ambulatory patients were found on external examination of the anal region (46%). These changes included erosions, fissur and eczema. Regarding the symptoms the predominant complaints were itching and burning in 42.1%. Anal hygiene after defaecation was most commonly done with dry toilet-paper (55%). A change in anal hygiene after defaecation relieves symptoms: By changing from water to moist toilet paper in 9%, from dry toilet paper to moist toilet paper in 30%, from moist toilet paper to water in 32%, an from dry toilet paper to water in 60%. These results confirm known facts regarding the influences of conserving agents an printing materials in dry (often recycled) and moist toilet papers on the skin. These side-effects to be even more pronounced in the compromised skin and suggest that anal hygiene should be done with water only.

The advent of anti-TNF alpha antibodies has clearly improved the outcome of patients with Crohn's disease. With adalimumab, the first fully human, monoclonal anti-TNF alpha antibody, which can be administered subcutaneously by means of a pen, became available in 2007. In Europe adalimumab is approved for the treatment of severe, active Crohn's disease, in patients who have not responded despite a full and adequate course of therapy with a corticosteroid and/or an immunosuppressant; or who are intolerant to or have medical contraindications for such therapies. Adalimumab is clinically efficacious both in patients with Crohn's disease naïve to previous exposure to anti-TNF alpha antibodies and in those previously exposed with a rapid onset of action and a confirmed maintenance performance over 3 years. A reduction in the rate of hospitalisation and an improvement of health-related quality of life are associated with this treatment. The safety profile of adalimumab is comparable to those of other TNF alpha inhibitors. Due to low immunogenicity, allergic reactions are rare. A careful screening of patients before and during treatment with adalimumab is of key importance. The presented therapy guidelines based on existing evidence are aimed to assist in the efficient and safe use of adalimumab in the treatment of Crohn's disease.

In Germany, 45 min of continuing medical education (CME) are awarded 1 credit point. It was the aim of this study to assess the time amount needed to read a CME article in a wide variety of specialist journals.All CME articles in 18 specialist journals presented in 2004 were analyzed, which had all used the same evaluation form provided by the Chamber of Physicians North Rhine (65,393 evaluation forms of 12,587 participants).There was only a weak linear relationship between the time needed to read an article and the number of characters as a measure of length of the text. Duration of reading was more closely related to the amount of new data presented and was inversely related to duration of professional activity and clinical experience, but, on the other hand, age was positively related to very long reading times. Reading times also increased with the number of articles read, up to the fourth article. Day of the week and hour of the day revealed no influence on reading time.The time amount needed to read a CME article is mainly determined by factors which are relevant in terms of clinical experience, while the length of the article is only of minor importance. Thus, the number of credit points awarded for reading CME articles should be based on direct assessment of reading time.

This report investigates the equivalence of the computerized version of the WILDE intelligence test (WIT) and its paper-and-pencil analog in a group of occupationally reorienting adults at the Leipzig Vocational Retraining Centre (Berufsförderungswerk Leipzig). In particular, the normative as well as the structural equivalence of the two test formats (paper-and-pencil vs. computer) were examined. The results indicate that both test formats are measuring the same construct, i. e., the two tests are structurally equivalent. Significant differences in mean for the total scores of most of the WIT subtests favour separate standardization of the computerized test format.

Until the end of the 1990's it was thought that hormone therapy has a lot of positive health effects and should be prescribed for nearly all women. Recently conducted studies have shown that menopausal hormone therapy has a higher health risk especially for breast cancer and cardiovascular disease. In this study we investigated to what extent hormone therapy changes could be identified during the past years. We therefore analysed data of a German health insurance (Gmünder ErsatzKasse=GEK) from 2001-2005. It was shown, that studies and recommendations, as well as statements of different German institutions, which were published during this period lead to an important decrease in respect of hormone therapy prevalence. It seems that the most important impact of this topic came from the results of the Women's Health Initiative study (WHI) and the followed controversial discussion in Germany. In respect of the individual five years age groups the changes were very different and for the older women especially there were no decreases detectable. It must be expected that frequently the diagnoses of Osteoporosis results in a treatment of hormone therapy over a long period and that the recommendations and statements (as mentioned above) are not implemented sufficiently. Therefore, it is necessary to conduct an evidence based hormone therapy treatment in the practitioners daily work, to keep health risks low. Furthermore, physicians should be more engaged to show their patients alternatives instead of hormone therapy. They should also advise and support their treated patients how to quit hormone therapy.

The influence of demographic parameter, the number of different drugs or the frequency of the single doses on the reliability of compliance was subject in different studies. The goal of this investigation was to examine the influence of the drug package information paper on the compliance of neurological-psychiatric patients. 951 patients of one quarter of a neurological-psychiatric practice were given a questionnaire, which examined the income behavior and the estimate of the meaning of the drug package information paper. 352 patients answered the questionnaires. Only 15.6 % refused it to answer the questionnaire. The remaining were not able to answer because of different reasons (dementia, aphasia, acute psychiatric disorders, foreign language origin, immobility, etc.). 98.1 % considered the drug package information paper to be important. Older patients and patients with lower education degree judged the drug package information paper to be too extensive. Only few patients (11.5 %) let the physician explain the drug package information paper. 86.3 % of the patients assumed the medication prescribed by the physician to be correct. 58.1 % of the patients however were not satisfied with the information by the physician. Patients with neuroses were particularly dissatisfied over the clearing-up by the physician (77.3 %). 73.3 % of the patients were deterred from taking in their medicines occasionally or frequently by the side effects described in the drug package information paper. 59.9 % of the patients would take the medicine, if the physician insisted on it. Independently of the influence of the drug package information paper 57.5 % of the patients forgot to take their medicines occasionally or frequently. Patients with epilepsies and M. Parkinson were most compliant. In summary the investigation showed that the clearing-up only by the drug package information paper in contrast to the clearing-up by the physician leads to more non-compliance.

The ontogenesis of moods and the process that establishes them is addressed. Moods arise out of normal developmental processes at both a macro- and micro-developmental level. Moods are part of normal development as well as a component of pathological processes and they are a ubiquitous presence that gives meaning to experience in infant and adult during daily life and therapy. In this first part of a two-part paper I will address the normal development of moods; in the second part I will to address issues related to psychopathology and therapy, especially depression and the intergenerational transfer of mood. I argue that moods are dyadic phenomena--something that develops out of the chronic co-creative interactions of two individuals--rather than solely being an intrapsychic process. I will also argue, especially when one considers the development of moods in infants, that moods make sense of the world as components of states of consciousness that give unique meaning to the individual's engagement with the world and further that moods function to bring the past into the present.

Three facts made new guidelines for tuberkulin skin-testing in Austria necessary: the low incidence of tuberculosis, the stop of routinously performed BCG-vaccination in neonates and the increasing importance of infections with atypical mycobacterials. According to analogous guidelines in Germany, Switzerland, the USA, and other countries and related to the Austrian specifities in tuberculosis situation the authors present guidelines thought as a consensus-paper of the Austrian Societies for Lung Diseases and Tuberculosis and for Pediatrics. The most essential guideline include that tuberkulin skin testing as a screening method with multiple puncture tests cannot further be recommended, and that the Mendel-Mantoux-test is the gold standard test. Only this test is sensitive and specific enough for case-finding and for giving indication to start a preventive or curative chemotherapy. The cut-off size of reactive areas for positive Mendel-Mantoux tuberculin-reaction are presented in this paper and also the consequences what is to decide in relationship to the test result.

The use of cotton swabs is well known as a cause of a traumatic membrane perforation. More reasons are known. A detailed description of the aetiology and therapy in Germany does not exist. The treatment consist of a readaptation of the perforation an splinting of the tympanic membrane with paper sheets or silicon foils.238 patients with an acute tympanic membrane perforation were included in this retrospective study. They were treated between 2005 and 2010.The mean causes of a traumatic tympanic membrane perforation were slaps with the open hand (37.4%), the use of a cotton swab (19.3%) and high diving (13.0%). The perforations have been splinted with paper sheets or silicon foils. The rate of complete wound closure after splinting with different materials are comparable (71.9% and 81.8%). The side effects are low.This is the first study about the aetiology of traumatic tympanic membrane perforations in Germany. There is no statistic difference between the 2 materials for tympanic membrane splinting. A traumatic tympanic membrane perforation should be treatet at least to improve the air conduction threshold.

HINTERGRUND: Der temporÄre Einsatz eines Magenballons zur Behandlung der Adipositas Grad1 und 2 nimmt weltweit zu; bei der Adipositas Grad 3 wird der Magenballon als adjuvantes Hilfsmittel zur prÄoperativen Gewichtsreduktion implantiert. Ziel dieser retrospektiven Kohorten analyse ist, die Wirksamkeit des Magenballons auf Gewichtsreduzierung und das Risikoprofil der Methode zu evaluieren. METHODEN: Retrospektive Kohortenanalysen aus 4 Adipositas-Zentren, in denen der Magenballon seit 2001 regelmÄßig implantiert wurde. ERGEBNISSE: Von Februar2001 bis April 2008 wurde bei 634 Patienten ein Magenballon implantiert (BIBTM Intragastric Balloon System; Allergan Medical, Irvine, CA, USA). Die Geschlechterverteilung war 31,5% MÄnnerzu 68,5% Frauen; das Durchschnittsalter betrug 41,5 Jahre. Das durchschnittliche Ausgangsgewicht lag bei 126 kg. Der initiale BMI bei Implantation des Magenballons war 42,5 kg/m(2). Die Implantation der Prothese war in allen FÄllen unkompliziert. Der durchschnittliche Gewichtsverlust lag bei 20,75 kg bzw. 7,05 BMI-Punkten. SUMMARY: The Gastric Balloon — a Retrospective Cohort Analysis with 634 Patients BACKGROUND: The temporary use of a gastric balloon for the treatment of obesity grade 1 and 2 is increasing worldwide, whereas in grade 3 obesity, it is implanted as a tool for preoperative adjuvant weight loss. The aim of this retrospective cohort analysis is to evaluate the effectiveness of weight reduction and to describe the risk profile of the method. METHODS: Retrospective cohort analysis of 4 obesity centers where gastric balloons had been regularly implanted since 2001. RESULTS: Between February 2001 and April 2008, the gastric balloon (BIBTM Intragastric Balloon System; Allergan Medical, Irvine, CA, USA) was implanted in 634 patients. The gender ratio was 31.5% males to 68.5% females; the average age was 41.5 years. The average initial weight was 126 kg. The initial BMI at implantation of the gastric balloon was 42.5 kg/m2. The implantation of the prosthesis was uncomplicated in all cases. Average weight loss was 20.75 kg or 7.05 BMI points, respectively.

Die Adipositaschirurgie bei Kindern und Jugendlichen findet in Deutschland bisher keine breite Akzeptanz, obwohl es auch bei uns zahlreiche Patienten gibt, die ihr Gewicht trotz intensiver Therapien nicht dauerhaft reduzieren kÖnnen. Wie auch bei Erwachsenen weisen viele dieser Kinder und Jugendlichen bereits eine oder mehrere metabolische und/oder kardiovaskulÄre VerÄnderungen des metabolischen Syndroms auf. Der folgende Artikel vergleicht die nationalen mit den internationalen Erfahrungen hinsichtlich der Leitlinien, Operationstechniken und Ergebnisse. Dabei zeigt sich, dass es in Deutschland bisher weder eine einheitliche Leitlinie noch ein zentrales Register fÜr Adipositaschirurgie bei Kindern und Jugendlichen gibt. Internationalgelten die Empfehlungen der Bariatric Scientific Collaborative Group (BSCG) auch fÜr Kinder als Standard. Operativ finden sich in der Literatur im Wesentlichen der Roux-Y-Magenbypass und das Magenband, in letzter Zeit auch die Schlauchmagenbildung (sleeve gastrectomy). Diese werden insbesondere in den USA in designierten pÄdiatrischen Zentren durchgefÜhrt. Deren Erfolgs- und Komplikationsraten scheinen Ähnlich wie bei Erwachsenen zu sein. Allerdings bleibt dabei vÖllig offen, wie diese Ergebnisse angesichts der sehr viel lÄngeren Lebenserwartung zu beurteilen sein werden. Als Konsequenz ergibt sich, dass fÜr Kinder und Jugendliche mit morbider Adipositas a) spezielle Zentren mit dem gesamten Behandlungsspektrum etabliert werden sollten, b) Leitlinien fÜr diese Adipositaschirurgie definiert werden mÜssen und c)eine langfristige Nachsorge aller Patienten im Rahmen einerzentralen Studie gewÄhrleistet sein mÜsste, um Erfahrungen fÜr die Zukunft zu generieren. Bariatric Surgery for Morbid Obesity in Childhood and Adolescence: Where Do We Stand in 2008? Bariatric surgery for children and adolescents with morbid obesity has not gained broad acceptance in Germany yet. Nevertheless, these children often fail to reduce weight despite intensive weight loss programmes and suffer from an associate metabolic syndrome, just like adults. Thus, bariatric surgery may be a favourable option. The present article compares national and international experiences concerning guidelines, surgical procedures, and results. It becomes obvious that Germany has neither specific guidelines for children and adolescents nor a central registry. Internationally, the recommendation from the Bariatric Scientific Collaborative Group (BSCG) should be taken as the standard. As in adults, most surgeons performRoux-Y gastric bypass or gastric banding. Additionally, sleeve gastrectomy is gaining some popularity. These procedures are performed in designated pediatric centres especially in the US. Their success and complication rates are similar to those found in adults. The overall long-term consequences, however, remain unclear. Thus, for bariatric surgery in children and adolescents it may be concluded that a) these patients should be treated in designated centres that offer the full range of therapeutic options, b) specific guidelines should be established, especially in Germany, and c) a long-term postoperative study of all patients is necessary to collect all data and refine the techniques used.

Knee joint injury statistics are dominated by ruptures of the capsular ligament structures. Post-traumatic deficits in dynamic movement patterns are assessed quantitatively as well as qualitatively. The aim of this review was to compile tools that are used to assess the quality of movement after knee ligament injuries in adults.A systematic search for original papers was carried out in the following primary sources: Ovid, PubMed, Scopus and Web of Science. Both conservative and surgical treatment options were considered. PROSPERO registration of the study protocol: CRD42020175359.A total of 1153 papers were identified. Eleven original papers from four different working groups were included in this work. All papers assessed the quality of movement in adults after anterior cruciate ligament (ACL) injury. A total of 348 (70 deficient, 278 reconstructed) patients after an ACL injury and 119 adults with an intact ACL were examined in the studies included.It is possible to assess movement quality after a knee ligament injury with a low temporal and technical effort. The changes recorded result in a functional valgus, which, based on the study results, may be further differentiated into isolated knee valgus, medial collapse or postural collapse.Rupturen der kapsuloligamentären Strukturen dominieren die Verletzungsstatistik am Kniegelenk. Die Beurteilung posttraumatischer Defizite oder Dysfunktionen bei dynamischen Bewegungsmustern erfolgt sowohl quantitativ als auch qualitativ. Ziel dieser Übersichtsarbeit war es, Werkzeuge, die zur Bewertung der Bewegungsqualität nach einer Kniebandverletzung bei Erwachsenen eingesetzt werden, zusammenzutragen.In folgenden Primärquellen wurde eine systematische Suche nach Originalarbeiten durchgeführt: Ovid, PubMed, Scopus, Web of Science. Sowohl die konservativen als auch die operativen Therapieoptionen wurden berücksichtigt. PROSPERO Registrierung des Studienprotokolls: CRD42020175359.Insgesamt wurden 1153 Arbeiten identifiziert. In diese Arbeit wurden 11 Originalarbeiten aus 4 verschiedenen Arbeitsgruppen eingeschlossen. In allen Arbeiten wurde die Bewegungsqualität bei Erwachsenen nach einer Ruptur des vorderen Kreuzbandes beurteilt. Insgesamt wurden in den eingeschlossenen Studien 348 (70 nicht operiert, 278 rekonstruiert) Patienten nach einer Verletzung des vorderen Kreuzbandes und 119 Erwachsene mit intaktem vorderem Kreuzband untersucht.In der Praxis ist es möglich, die Bewegungsqualität nach einer Kniebandverletzung mit geringem zeitlichem und technischem Aufwand zu erfassen. Die erfassten Veränderungen resultieren in einem funktionellen Valgus, dessen Ausmaß basierend auf den Ergebnissen der einzelnen Arbeiten in einen isolierten Knievalgus, in einen medialen Kollaps oder einen posturalen Kollaps weiter differenziert werden kann.

KurzfassungHintergrund: Asthma bronchiale ist eine der häufigsten chronischen Krankheiten weltweit, welche ein hohes Maß an Selbstmanagementfähigkeiten erfordert, um eine gute Lebensqualität zu erreichen. Angesichts begrenzter klinischer Ressourcen stellen empfohlene regelmäßige Konsultationen und Schulungseinheiten ein Problem dar. Diverse Telehealth-Interventionen können hier als gute Alternative eingesetzt werden, um den Zu-gang zur Behandlung zu gewährleisten und den Betroffenen eine gute gesundheitsbezogene Lebensqualität ermöglichen.Forschungsziel: Ziel dieser Arbeit ist es, diverse Telehealth-Interventionen zu beschreiben und aufzuzeigen, wie sich diese auf die Lebensqualität von erwachsenen Personen mit Asthma bronchiale auswirken.Methode: Es wurde eine strukturierte Literaturrecherche in den Datenbanken PubMed, CINAHL und Cochrane sowie in Referenzlisten und Google Scholar im Zeitraum von Oktober 2021 bis Februar 2022 durchgeführt und eine Übersichtsarbeit erstellt. Ergebnis: Von den anfänglich 233 erzielten Treffern konnten sechs Studien in die Arbeit inkludiert werden. Die in den Studien untersuchte Lebensqualität wurde mit dem Mini Asthma Quality of Life Questionnaire von Juniper et al. (1999) gemessen und konnte nicht in jeder Studie statistisch signifikant verbessert werden. Die diversen Telehealth-Interventionen können dennoch als klinisch relevant angesehen werden. Schlussfolgerung: Telehealth-Maßnahmen stellen eine gute Alternative zu persönlichen Interventionen dar und haben das Potential, die Lebensqualität von Asthmapatienten/Asthmapatientinnen zu verbessern. Background: Bronchial asthma is one of the most common chronic diseases worldwide, which requires a high level of self-management skills to achieve a good quality of life. Given limited clinical resources, recommended regular consultations and educational sessions pose a problem. Various telehealth interventions can therefore be used as a good alternative to ensure access to treatment and enable affected people to achieve a good health-related quality of life.Research question: The aim of this paper is to describe various telehealth interventions and to show how they affect the quality of life of adults with bronchial asthma.Method: A structured literature search was conducted using the electronic databases PubMed, CINAHL and Cochrane as well as reference lists and Google Scholar. Then, a structured literature review was created.Results: 233 results were obtained, of which six studies could be included in this paper. The quality of life investigated in the studies was measured with the Mini Asthma Quality of Life Questionnaire by Juniper et al. (1999) and could not be statistically significantly improved in each study. Nevertheless, the various telehealth interventions can be consid-ered as clinically relevant.Conclusion: Telehealth interventions represent a good alternative to face-to-face inter-ventions and have the potential to improve the quality of life of asthma patients. Nicole Pfeifenberger Abweichender Titel laut Übersetzung der Verfasserin/des Verfassers Bachelorarbeit FH JOANNEUM 2022

The term "ergophthalmology", coined on the occasion of the 20th International Congress of Ophthalmology in Munich in 1966, denotes a subject, which is concerned with vision and work, and which comprises four main areas: (1) eye damage caused at work by occupational diseases and industrial accidents; (2) medical opinion on the consequences of damage, for various purposes; (3) assessment of the fitness of the visually handicapped subject for work, with regard to rehabilitation; (4) analysis of demands made on visual performance and on conditions at workplaces. The problems we are confronted with in the individual area overlap one another. However, cooperation with many related disciplines is often indispensable. These can include not only a variety of medical disciplines, but also technical and scientific disciplines, as well as the humanities, economics and jurisprudence; and last not least, education and medical training. The ophthalmologist's first responsibility is to treat eye damage and subsequently to insure rehabilitation; but he should also cooperate in the prevention of damage and the vocational rehabilitation of people, who have suffered eye damage. Moreover, as far as visual functions are concerned, his opinion regarding the suitability of an individual for certain occupation and activities is of major importance. Occupations involving work at display units are an example of immediate interest. The ophthalmologist's advice may often be very useful with regard to the design and furnishing of workplaces and workrooms. Finally, in giving a medical opinion, questions of relationships and the extent of the damage have to be dealt with; these are largely a question of ophthalmological experience and knowledge.

Reference values for screening parameters, evaluating the shape of flow-volume-curves on forced expiration, were calculated from measurements in 1127 healthy subjects aged between 13 and 72 years. The following parameters were determined by means of the electronic spirometer pneumo-test: 1. the peak flow value Vmax, 2. the whole time constant tauges of the flow volume diagram and its components tau1 and tau2 from the upper and the lower part of the flow volume curve, 3. the most frequent time constant taumax in the distribution function of time constants. In relation to age Vmax-values show a maximum at 35 years and a significant decrease in younger and older subjects. Values in women are significant smaller than in men throughout the range of age. The time constants tauges and tau1 decrease significantly with increase in age. Differences between females and males are not statistically significant for these parameters. The time constants tau2 and taumax are age-independent. Their mean values are identical in all age decades and in women significantly smaller than in man.

FMD, whether in the stage of a fibrous cortical defect or a non-ossifying fibroma, possesses very characteristic radiological appearances which rarely make it necessary to resort to biopsy. In order to avoid mistakes, it is necessary to observe strictly the known radiological features: metaphyseal position, clearcut relationships to the cortex, well defined margins, maximal size 6 to 7 cm., presence during growth, rarely observed in the upper extremity. The differential diagnosis, which needs to be considered only rarely, is discussed.

Hintergrund: Angst gehört grundsätzlich wie viele andere Emotionen zum normalen Gefühlsspektrum von Menschen. Wenn die Symptome jedoch die eigene Handlungsfähigkeit massiv einschränken, spricht man von Angststörungen, welche zu einem enormen Leidensdruck der Betroffenen führen. Es dauert leider meist sehr lange, bis Personen mit Angststörungen eine passende Therapie erhalten. Da es in der Ergotherapie viele verschiedene Ansätze in der Behandlung dieser psychischen Krankheit gibt, wird der Einfluss kreativer, achtsamer und sensorischer Interventionen beleuchtet. Ziel: Das Ziel dieser Arbeit ist es, den Einfluss verschiedener ergotherapeutischer Interventionen auf die Angstsymptomatik von Erwachsenen zu untersuchen und bestenfalls einen Anstoß für zukünftig erfolgreiche Therapien zu geben. Methodik: Die Literaturrecherche und Selektion wurde in fünf Datenbanken und zusätzlicher Handrecherche durchgeführt. Dabei wurden sechs qualitative Studien in den Ergebnisteil eingeschlossen. Diese wurden systematisch beschrieben und kritisch bewertet. Im Anschluss wurden die Ergebnisse in verschiedenen Bereichen miteinander verglichen. Ergebnisse: In allen Studien kann die Wirksamkeit der ergotherapeutischen Interventionen auf die Reduzierung der Angstsymptomatik bewiesen werden. Jedoch unterscheiden sich die Angststörungen der Teilnehmer*innen in den verschiedenen Studien und die Evidenzlevel waren im Durchschnitt nicht sehr hoch. Conclusio: Der positive Einfluss von kreativen, achtsamen und sensorischen ergotherapeutischen Interventionen bei Erwachsenen mit Angststörungen konnte nachgewiesen werden. Weitere Forschungen mit höheren Evidenzlevel sind erforderlich. Zudem können die Ergebnisse nicht auf alle Arten von Angststörungen übertragen werden, weshalb die Anwendung in der Praxis sehr individuell gestaltet werden muss. Background: In principle, anxiety – like many other emotions – is part of the normal range of human feelings. However, if the symptoms massively restrict one's own ability to live and act, one speaks of anxiety disorders which lead to great suffering for those affected. Unfortunately, it usually takes a long time for people with anxiety disorders to receive appropriate therapy. Since there are many different approaches in occupational therapy in the treatment of this mental illness, the influence of creative, mindful, and sensory interventions will be highlighted. Aim: The purpose of this paper is to shed light on the influence of various occupational therapy interventions on adult anxiety and, at best, provide an impulse for future successful therapies. Methods: The literature research and selection was conducted in five databases and additional hand search. Six qualitative studies were included in the results section. These were systematically described and critically evaluated. Subsequently, the results were compared in different areas. Results: In all studies, the effectiveness of occupational therapy interventions on reducing anxiety can be proven. However, the participants’ anxiety disorders differed in the various studies and the evidence levels were on average not very high. Conclusion: The positive impact of creative, mindful, and sensory occupational therapy interventions on adults with anxiety disorders was proven. Further research with higher levels of evidence is needed. Furthermore, the results cannot be reproduced for all types of anxiety disorders, so the application in practice has to be adapted to the individual.

The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children ( 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).Die Versorgung von Patienten mit einer hochgradigen Schwerhörigkeit oder Taubheit mit einem Cochlea-Implantat (CI) stellt heute in Deutschland einen Standard dar. Umso überraschender ist es, dass kaum Daten zur aktuellen Anzahl der CI-versorgenden Einrichtungen (CI-Kliniken) und zu deren geografischer Verteilung existieren. Der Selbsthilfeverband Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V. und die Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie (DGHNO-KHC) haben daher eine Umfrage zur Erfassung der regionalen Verteilung, des Leistungsspektrums, der Berücksichtigung existierender Qualitätsstandards sowie der Zusammenarbeit mit Patientenselbsthilfe-Organisationen der einzelnen CI-versorgenden Einrichtungen initiiert.Hierfür wurden insgesamt 170 Kliniken für Hals-Nasen-Ohrenheilkunde bzw. deren ärztliche Leiter (37 Lehrstuhlinhaber und 133 Chefärzte) per E-Mail kontaktiert und mittels Fragebogens befragt. Die Befragung erfolgte von Oktober 2019 bis Februar 2020.Von den 170 kontaktierten Kliniken nahmen 71 (41,8 %) an der Umfrage teil. Hiervon bestätigten 70 Kliniken (98,6 %), CI-Operationen durchzuführen. Damit gaben 41,8 % aller kontaktierten Kliniken an, CI-Operationen durchzuführen (70 von 170 Kliniken), während diese Information von 99 Kliniken nicht verfügbar war. Alle 70 CI-versorgenden Einrichtungen (100 %) gaben an, CI-Operationen an Erwachsenen, 60 Kliniken (85,7 %) ebenfalls bei Kindern ( 18 Jahre) durchzuführen. 36 Kliniken (51,4 %) berichteten, dass die Gesamtanzahl der CI-Operationen an ihrer Einrichtung im Jahr 2018 mehr als 50 betrug. In 64 Kliniken (91,4 %) werden, nach den erhobenen Daten, die Empfehlungen der DGHNO-KHC zur CI-Versorgung (gemäß Weißbuch CI-Versorgung, Stand 2018) berücksichtigt. Eine Zusammenarbeit der Klinik mit der CI-Selbsthilfe wurde von 67 Kliniken (95,7 %) angegeben. Die geografische Verteilung der CI-versorgenden Einrichtungen, die an der Umfrage teilgenommen haben, zeigte ein heterogenes Verteilungsmuster zwischen den einzelnen Bundesländern und auch innerhalb der jeweiligen Bundesländer.Die hier präsentierte Arbeit ist eine erste Standortbestimmung im Hinblick auf die regionale Verteilung der CI-versorgenden Einrichtungen in Deutschland. Auffällig ist eine Clusterbildung der CI-Kliniken in Ballungsräumen, teils mit mehreren Einrichtungen in einer Stadt. Erfreulich ist die weit überwiegende Beachtung qualitätsbezogener Aspekte, wie die Berücksichtigung des CI-Weißbuchs der DGHNO-KHC und die Zusammenarbeit mit der Patientenselbsthilfe. Limitationen der Studie ergeben sich aus der begrenzten Teilnahme an der Umfrage (41,8 % der kontaktierten Kliniken).

To assess digital patient briefing as an alternative to conventional paper documentation. 502 patients with a planned computed tomography (CT) examination were selected for digital patient briefing using the E-ConsentPro software from Thieme Compliance on an iPad by Apple (Cupertino, California, USA). For the analysis, three age groups were formed. The time required for the patient briefing, the number of open questions as well as the time needed for discussion with physicians were determined. Student's t-test was performed to assess statistical significance. There was no significant difference between patient age and briefing time which was about 20 minutes on average. The number of open or unclear questions increased with patient age. While patients younger than 30 years of age had about 2 open questions, patients over 30 and 60 years had about 4 and 5 questions, respectively. The total time needed for discussion with physicians was less than 2 minutes on average. A significant difference in the time required for discussion with physicians could not be observed between the individual age groups. Tablet-based digital briefing allows the storage of patient documents with reasonable time and effort. Furthermore, it minimizes the risk of data loss. · Tablet-based digital patient briefing in computed tomography can be performed with reasonable time and effort.. · The time required for tablet-based patient briefing is independent of patient age.. · The cost-benefit analysis presents a significant improvement in digital patient briefing compared to the paper-based process..· Alikhani B, Hensen B, Grosser A et al. Initial Experience with Digital Patient Briefing in Computed Tomography. Fortschr Röntgenstr 2019; 191: 540 - 546.ZIEL: Die Möglichkeit der digitalen Aufklärung von Patienten wurde im Rahmen eines Pilotprojekts evaluiert. Für die vorliegende Arbeit wurden 502 konsekutive Patienten ausgewählt, die in der Computertomografie (CT) untersucht werden sollten. Die digitale Aufklärung erfolgte mit der Software E-ConsentPro der Firma Thieme Compliance auf einem iPad. Die Patienten wurden in 3 Altersgruppen unterteilt. Die Auswertung beschränkte sich auf die Ermittlung der Gesamtdauer der Patientenaufklärung, der offenen oder unklaren Fragen sowie des Zeitaufwands für ein Aufklärungsgespräch mit dem Arzt. Zur Prüfung von signifikanten Unterschieden wurde der t-Test durchgeführt. Unabhängig vom Alter bearbeiteten die Patienten den digitalen Aufklärungsbogen im Mittel ca. 20 Minuten. Die Anzahl der offenen oder unklaren, noch mit dem aufklärenden Arzt zu besprechenden Fragen nahm nicht signifikant mit dem Patientenalter zu. Während Patienten unter 30 Jahren vor dem Arztgespräch ca. 2 offene Fragen hatten, hatten Patienten über 60 Jahre ca. 5 offene Fragen. Patienten zwischen 30 und 60 Jahren hatten noch ca. 4 Fragen, die mit dem Arzt besprochen werden sollten. Die Gesamtdauer eines Aufklärungsgesprächs mit dem Arzt betrug im Mittel unter 2 Minuten. Signifikante Unterschiede im Zeitaufwand für das ärztliche Aufklärungsgespräch konnten zwischen den einzelnen Altersgruppen nicht festgestellt werden. Die Tablet-basierte digitale Aufklärung ermöglicht unabhängig vom Patientenalter und der Anzahl der offenen Fragen vor dem Arztgespräch eine mit vertretbarem Zeit- und Arbeitsaufwand zu realisierende rechtssichere Ablage der Dokumente, bei der das Risiko des Datenverlusts durch die Logistik und Archivierung von Patientenunterlagen reduziert werden kann. · Die digitale, Tablet-basierte Patientenaufklärung kann mit vertretbarem Zeit- und Arbeitsaufwand durchgeführt werden.. · Die Tablet-basierte Aufklärungsdauer ist vom Alter der Patienten unabhängig.. · Die digitale Aufklärung leistet einen wesentlichen Beitrag zur Verbesserung der Arbeitsabläufe in der Radiologie..· Alikhani B, Hensen B, Grosser A et al. Initial Experience with Digital Patient Briefing in Computed Tomography. Fortschr Röntgenstr 2019; 191: 540 – 546.

This paper examines the distribution of attachment representations among social work professionals using the Adult Attachment Projective Picture System (AAP; George, West, Pettem, 1997). In this sample, the influence of attachment on the occurrence of burnout syndrome is investigated, as this is considered as a trigger for further mental and physical illnesses. For this purpose, 79 social pedagogical professionals from the German-speaking part of Switzerland were examined over four time points using the Burnout Screening Scales - BOSS. The following distribution of attachment representations was found using the AAP: 25.3 % secure, 38.0 % insecure dismissing, 27.8 % insecure preoccupied, and 8.9 % unresolved trauma. This distribution differs significantly from other samples of non-clinical adults and psychotherapists. Interestingly, no general associations emerged between insecure attachment representations and burnout. A significant positive correlation was shown between "unresolved trauma" and the suspected diagnosis of "burnout occupation". The so far few but contradictory empirical findings on attachment representations among professionals require further research activities as well as an intensive sensitization with regard to attachment theory in basic and further training courses and a further establishment of self-awareness and supervision components in all psychosocial fields of work.Zusammenfassung In der vorliegenden Arbeit wird die Verteilung der Bindungsrepräsentationen unter sozialpädagogischen Fachpersonen anhand des Adult Attachment Projective Picture System (AAP; George, West, Pettem, 1997) untersucht. In dieser Stichprobe wird zudem der Einfluss von Bindung auf das Auftreten des Burnout-Syndroms beleuchtet, da dieses als Auslöser weiterer psychischer und physischer Krankheiten diskutiert wird. Hierzu wurden 79 sozialpädagogische Fachpersonen der deutschsprachigen Schweiz über vier Zeitpunkte hinweg anhand der Burnout-Screening-Skalen – BOSS untersucht. Folgende Verteilung der Bindungsrepräsentationen wurden mit dem AAP gefunden: 25,3 % sicher gebunden, 38,0 % unsicher-distanziert, 27,8 % unsicher-verstrickt und 8,9 % unverarbeitetes Trauma, was sich signifikant von anderen Stichproben nicht-klinischer Erwachsener und Psychotherapeuten unterscheidet. Interessanterweise ergaben sich keine generellen Zusammenhänge zwischen unsicheren Bindungsrepräsentationen und Burnout. Ein signifikanter positiver Zusammenhang zeigte sich zwischen einem „unverarbeiteten Trauma“ und der Verdachtsdiagnose „Burnout Beruf“. Die bisher wenigen aber widersprüchlichen empirischen Befunde zu Bindungsrepräsentationen bei Fachpersonen erfordern weitere Forschungstätigkeiten sowie eine intensive Sensibilisierung bezüglich der Bindungstheorie in Grund- und Weiterbildungen sowie eine weitere Etablierung von Selbsterfahrungs- und Supervisionsanteilen in allen psychosozialen Arbeitsfeldern.