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Nowadays, childhood cancer patients survive much more often than they did 40 years ago. Therefore, the cure rates rise over 80%. Approximately 33,000 cured childhood cancer patients are documented by the German Childhood Cancer Registry (GCCR) for long-term follow-up in Germany. But does that mean, they are healthy, too? When compared to the normal population, it can be seen that morbidity and mortality are significantly higher among former childhood cancer patients. In two out of three survivors, the cancer and its treatments can lead to treatment-related late complications 30 years later; in about one-third, these late complications are classified as severe. A structured long-term follow-up is needed to detect and to treat new diseases early. The purpose of this position paper is to update the first position paper from 2007. Current developments are described, how appropriate aftercare structures and aftercare facilities should be planned, taking into account existing structures and increasing needs.Krebskranke Kinder und Jugendliche überleben heute dank Heilungsraten von über 80% viel häufiger ihre Krebserkrankung als vor 40 Jahren. Etwa 33 000 geheilte ehemalige krebskranke Kinder und Jugendliche sind in der Langzeitbeobachtung über das Deutsche Kinderkrebsregister (DKKR) bundesweit erfasst. Heißt geheilt aber auch gesund? Beim Vergleich mit der Normalbevölkerung ist festzustellen, dass die Morbidität und Mortalität bei den ehemaligen Patienten deutlich erhöht ist. Die Krebserkrankungen und deren Behandlungen können bei zwei von drei Überlebenden 30 Jahre später zu therapiebedürftigen Spätfolgen führen, bei etwa einem Drittel werden sie als schwer eingestuft. Mittels einer strukturierten Nachbeobachtung können diese frühzeitig erkannt und bei Bedarf behandelt werden. Ziel dieses Positionspapiers ist eine Aktualisierung des ersten Positionspapiers aus dem Jahre 2007. Hierbei werden die aktuellen Entwicklungen beschrieben und dargestellt, wie geeignete Nachsorgestrukturen und Nachsorgeeinrichtungen – unter Berücksichtigung der bestehenden Strukturen und dem steigenden Bedarf – geplant werden sollten.

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.

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.

After handling plants grown in decomposable pots made of recycling paper, three women working in a big horticulture developed very painful inflammated efflorescences at the finger-tips, followed by scaling off the skin. The pots appeared to be very mouldy. Black masses of conidia of Stachybotrys chartarum and perithecia of Chaetomium globosum were identified on almost every pot. Apart from various other fungal genera, Trichoderma und Acremonium were frequently detected. Considering the observed symptoms, special attention was payed to the mycotoxin producing species St. chartarum. To evaluate the inhalative spore load, air sampling was performed. The detection of St. chartarum in the air was only possible with the spore trap (sampling of particles) but not with the Andersen sampler (detection of colony forming units). Without moving the pots, measurements yielded values of 30-100 St. chartarum conidia per m3 of air. The concentration of air-borne conidia increased drastically by handling the pots, thus attaining up to 7,500 conidia per m3 of air for St. chartarum only. The occurrence of St. chartarum in such amounts is alarming because of possible toxin production. In addition, the allergenic stress by fungal spores has to be emphasized. The results are discussed with regard to general medical-mycological aspects related to the degradation of environmentally-friendly decomposable materials.

In Germany and throughout Europe, medicinal products for adults have been developed and evaluated systematically for decades. Medicinal products for children and adolescents, however, have only been researched for the past ten years. As a result, many medicinal products have been administered to children without systematic clinical trials, for example regarding dosage or pharmaceutical form.EU Regulation 1901/2006 aimes to close the gaps in the medical treatment of children and adolescents. In order to do so, the regulation provides for paediatric use marketing authorisations (PUMA) for previously authorised products no longer covered by intellectual property rights and also grants holders of such PUMA licenses further property rights. However, only two PUMA licenses have been applied for. Thus, the PUMA license instrument is hardly being used despite the fact that many medicinal products have a great potential for closing medical gaps for children and adolescents.In order to improve the situation regarding medicinal products for children and adolescents, this scientific symposium "More Medicines for Minors" intended to promote dialogue among the parties involved and to provide an opportunity to discuss reasons for the reluctance to apply for PUMA licenses. Speakers specialised in paediatric and adolescent medicine as well as those from licensing authorities, the Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA), the pharmaceutical industry and the federal ministries presented problems and possible solutions from their point of view with the aim of making the PUMA license instrument more attractive.

The concept of "participation" and the demand for the use of "participative methods" in human, healthcare, nursing and gerontological research as well as the corresponding fields of practice are in great demand; however, the targets and organization of "participation" are not always sufficiently explicated. The working group on critical gerontology of the German Society of Gerontology and Geriatrics uses this phenomenon as an opportunity for positioning and develops a catalogue of criteria for reflection and assessment of participation of elderly people in science and practice, which can also be considered a stimulus for further discussions.

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.

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 size of a tumor should not be the limiting factor when it comes to the decision for surgical treatment of such entities. Due to modern plastic reconstructive techniques an R0 situaiton should always be attempted, and in the worst case an interdisciplinary palliative resection should be possible and recommendable. As the present case with a tumour that led to immobility clearly indicates, the gain in quality of life undoubtedly is a proof of the necessity and value of the surgical treatment of this entity.

Dementia is an increasing challenge for care providers in nursing homes and hospitals. Since the 1980s, special acute care units in nursing homes have developed rapidly. In Germany, the first unit in a hospital opened in 1990. In 2013, there were 22 units.In the following paper, the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie e. V.") recommends basic standards for these wards.The basic standards for these wards include the following: a maximum of 20 beds, an area physically separated from the geriatric hospital department, their own dayroom and therapy room, a structured daily routine suitable for patients with dementia, the selection of permanent staff on a voluntary basis, specialized training, extended geriatric assessment, and special consideration of the background and social situation of the 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.

The incidence for dysphagia amounts to 44-50% in nursing homes. Dysphagia is one of the main reasons for pneumonia in elderly.Consensus paper.For the advisory board consisting of 2 physicians, 2 pharmacists, a speech therapist, and a respresentative of nursing service it is common understanding that for the ideal maintenance and support of patients with dysphagia an interdisciplinary approach is crucial. Despite high clinical relevance of dysphagia the basic knowledge of this field is often underdeveloped. Specific and validated screening procedures for dysphagia have to be developed and implemented into the relevant guidelines. Specifically in this field an active and discipline spanning risk management should find its way into stationary geriatric care and nursing homes. Just as important is the provision of necessary patient information on the progress of the disease, on therapeutic actions and possible diet forms in a dysphagia pass. Additionally, the mentioned disciplines require an online risk screening (for dysphagia) of the pharmacist concerning the overall medication as well as information of galenic properties like facts regarding the possibility of crushing, portioning or tube feeding of the prescribed medication. In this way health risks due to administration errors concerning the medication can be significantly reduced for this patient group. Adequate oral liquids for adapted application of drugs are missing so far.

Infections due to pneumococci especially in the elderly are vastly underestimated, e.g., because non-invasive infections such as pneumonia may appear with only few symptoms. Sequential vaccination with the pneumococcal conjugate vaccine PCV13, followed by the 23-valent polysaccharide vaccine, is considered as the best preventive measure for individual protection, even though clinical study data demonstrating the efficacy of this sequence are not yet available. Increase of "awareness" by use of computer-based reminder functions may result in a significant improvement of vaccination compliance.

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.

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.

The relevance of endoscopic diagnostic and therapeutic interventions is on a constant rise. However, specific aspects of the treatment of geriatric patients have only been tackled to a rather limited extent so far. The present contribution pinpoints illustratively the status quo on this issue and provides directions for further research which should be conducted in future studies supported by the working group on geriatric gastroenterology.

Since their first marketing, hormonal contraceptives have been used by millions of women, often over many years. There is no consolidated knowledge on late effects of hormonal contraceptives, especially on tumour proliferation. Following a critical review on the available evidence (accompanying paper of C. Giersig) on this issue, further clinical and epidemiological research is deemed necessary in order to elucidate a hypothesised causal relationship between hormonal contraceptives use and breast cancer.

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.

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.

Results obtained with a haemagglutination-inhibition test on dry-blood extracts gave results in 715 female school children which almost completely agreed with those obtained on serum of the same persons. On the other hand, when the specific antibody concentration was low, the haemolysis-in-gel test with dry-blood extracts gave 1% false-negative results and other results which were difficult to interpret.