Search

Goals for health and health care are an indispensable basic requirement for a functioning health care system. The dilemma of the German health care system is that it has not been designed in a planned way, but that it has grown historically. In recent years, it has developed through the free play of forces into what it is today. The OECD characterizes the current state as follows: The costs of the German health system do not correspond to the often only average health outcomes for the population. To meet the legal requirements (especially SGB V §§ 12, 27 and 70), health care/the health system in Germany needs concrete goals. An orientation towards health care goals entails measures on all levels of health care: on the macro level (overall system/total population), on the meso level (subdivided according to regions, specific population groups, etc.) as well as on the micro level (patients and health care providers). Based on national and international experiences, this position paper of the DNVF e.V. (German Network for health services research) shows the potential of how operationalised health care targets can ensure effective, affordable and high-quality health care. The coalition agreement of the current government propagates a reorientation with patient-related health care goals. Now it is important to derive concrete and realisable goals from this declaration of intent and to involve all important groups in the process. In addition, values and ethical standards for implementation shall be agreed upon in this process. The Health Ministry (BMG) should facilitate and promote the process of societal will-building for the definition of national health care goals. This requires a clear political will. As a result, the National Health Care Goals are available at the end of the process, which are published and maintained together with evidence-based facts as well as valid and resilient data in a Manual "National Health Care Goals". The operational responsibility for implementation could lie with the newly to be founded Federal Institute of Public Health, as already announced in the agreement of the governing coalition. The DNVF is willing to actively participate in the development of health care targets.Gesundheits- und Versorgungsziele sind eine unverzichtbare Grundvoraussetzung für ein funktionierendes Gesundheitssystem. Das Dilemma des deutschen Gesundheitssystems ist, dass es nicht planvoll weiter entwickelt wurde, sondern dass es historisch gewachsen ist. In den letzten Jahren hat es sich im freien Spiel der Kräfte zu dem entwickelt, was es heute ist. Den aktuellen Zustand beschreibt die OECD so: Die Kosten des deutschen Gesundheitssystems entsprechen nicht den oft nur durchschnittlichen Gesundheitsergebnissen für die Bevölkerung. Zur Erfüllung der gesetzlichen Anforderungen (vor allem SGB V §§ 12, 27 und 70) braucht die Gesundheitsversorgung/das Gesundheitssystem in Deutschland konkrete Ziele. Eine Orientierung an Versorgungszielen zieht Maßnahmen auf allen Ebenen der Versorgung nach sich: auf der Makroebene (Gesamtsystem/gesamte Bevölkerung), auf der Mesoebene (unterteilt nach Regionen, spezifischen Bevölkerungsgruppen etc.) sowie auf der Mikroebene ( Patient:innen und Leistungserbringer) Ausgehend von nationalen und internationalen Erfahrungen zeigt das vorliegende Positionspapier des DNVF e.V. (Deutsches Netzwerk Versorgungsforschung) das Potenzial, wie operationalisierte Versorgungsziele eine effektive, finanzierbare und qualitativ hochwertige Gesundheitsversorgung gewährleisten können. Der Koalitionsvertrag der Ampelregierung propagiert eine Neuausrichtung mit Patient:innen bezogenen Versorgungszielen. Jetzt gilt es, aus dieser Absichtserklärung konkrete und umsetzbare Ziele abzuleiten und dabei alle wesentlichen Gruppen zu beteiligen. Ergänzend werden in diesem Prozess Werte und ethische Normen für die Umsetzung vereinbart. Das BMG (Bundesministerium für Gesundheit) sollte den Prozess der gesellschaftlichen Willensbildung zur Definition von Nationalen Versorgungszielen ermöglichen und fördern. Dazu bedarf es einer klaren politischen Willensbildung. Als Ergebnis liegen am Ende des Prozesses die Nationalen Versorgungsziele vor, die zusammen mit evidenzbasierten Fakten sowie mit validen und belastbaren Daten in einem Handbuch „Nationale Versorgungsziele“ veröffentlicht und gepflegt werden. Die operative Verantwortung für die Umsetzung könnte bei dem neu zu gründenden Bundesinstitut für öffentliche Gesundheit liegen, wie es bereits im Koalitionsvertrag der Ampelkoalition angekündigt wurde. Das DNVF ist bereit, an der Entwicklung von Versorgungszielen aktiv mitzuwirken.

Hundreds of thousands of individuals who experience lasting sequelae after sepsis and infections in Germany do not receive optimal care. In this White Paper we present measures for improvement, which were developed by a multidisciplinary expect panel as part of the SEPFROK project. Improved care rests on four pillars: 1. cross-sectoral assessment of sequelae and a structured discharge and transition management, 2. interdisciplinary rehabilitation and aftercare with structural support, 3. strengthening the specific health literacy of patients and families, and 4. increased research into causes, prevention and treatment of sequelae. To achieve this, appropriate cross-sectoral care structures and legal frameworks must be created.Hunderttausende Menschen mit Sepsis- und Infektionsfolgen werden derzeit in Deutschland nicht optimal versorgt. Dieses White Paper stellt Maßnahmen zur Verbesserung der Versorgung vor, die von einer multidisziplinären Expertengruppe im Rahmen des Innovationsfonds-Projektes SEPFROK erarbeitet wurden. Eine optimale Versorgung beruht auf 4 Säulen: 1. der sektorenübergreifenden Erfassung der Folgen und einem strukturierten Entlass- und Überleitungsmanagement, 2. einem gezielten Angebot von interdisziplinärer Rehabilitation- und Nachsorge mit struktureller Unterstützung, 3. der Stärkung der spezifischen Gesundheitskompetenz von Betroffenen und Angehörigen und 4. der Intensivierung der Forschung zu Ursachen, Prävention und Therapie der Folgen. Hierfür müssen entsprechende sektorenübergreifende Versorgungsstrukturen und sozialrechtliche Rahmenbedingungen geschaffen werden.

The inpatient care of children after ENT surgery is organized heterogeneously across Germany. In this statement, the working group on Pediatric ENT comments a national survey on the status quo of child care after ENT interventions in German hospitals. The statement should serve as a basis for further interdisciplinary discussion.Die stationäre Betreuung von Kindern nach Operationen im HNO-Bereich ist deutschlandweit heterogen organisiert. In dieser Stellungnahme kommentiert die Arbeitsgemeinschaft Pädiatrische HNO-Heilkunde eine nationale Umfrage zum Status quo der Kinderversorgung nach HNO-Eingriffen in deutschen Kliniken. Diese dient als Grundlage für die weitere interdisziplinäre Diskussion.

Irrespective of the great impact stroke exerts on the society as a whole and far-reaching advances in acute treatment and rehabilitation of stroke, so far outpatient services for post-stroke care have not been established on a national level in Germany.Against the background of this contemporary lack of care, in May 2020 the German Stroke Society (DSG) established the stroke aftercare commission. This position paper discusses structural models of future services addressing outpatient post-stroke care.The specialized care by a neurologist should be central to a multidisciplinary, interprofessional and transsectoral treatment. Structural concepts of post-stroke care must take regional differences but also effective strategies for quality control into account. Certification processes and appropriate financing of follow-up registries at state and federal levels may pave the way for improvement over the medium term. Structured outpatient post-stroke care services should be open to all subgroups of stroke patients. Additionally, innovative technologies can make an important contribution to post-stroke care; however, the implementation of specialized services demands adequate funding as well as separate financial incentives for the providers. The solution must carefully balance the advantages and disadvantages of the specific care and financing models. Currently the discussion of new models of post-stroke care is gaining new momentum, which opens up perspectives for the advancement of the otherwise still insufficient contemporary care structures.HINTERGRUND: Ungeachtet der großen gesamtgesellschaftlichen Bedeutung des Schlaganfalls sowie der Fortschritte in der Akutversorgung und Rehabilitation konnten bisher keine flächendeckenden Versorgungsstrukturen zur strukturierten ambulanten Nachsorge in Deutschland etabliert werden.Vor dem Hintergrund der bestehenden Versorgungslücken wurde im Mai 2020 die Kommission Schlaganfallnachsorge der Deutschen Schlaganfall-Gesellschaft (DSG) gegründet. Das Positionspapier diskutiert strukturelle Konzepte für zukünftige Versorgungsformen der Schlaganfallnachsorge.Eine neurologische Betreuung sollte zentraler Bestandteil einer multidisziplinären, interprofessionellen und sektorenübergreifenden Behandlungsplanung sein. Strukturelle Konzepte zur Schlaganfallnachsorge müssen sowohl regionale Strukturunterschiede als auch den Aspekt der Qualitätssicherung berücksichtigen. Zertifizierungsprozesse und die angemessene Finanzierung von Nachsorgeregistern auf Landes- und Bundesebene können den Weg hierhin mittelfristig ebnen. Das Angebot zur strukturierten Schlaganfallnachsorge sollte allen Subgruppen von Schlaganfallpatienten offenstehen. Auch innovative Technologien können einen wichtigen Beitrag zur Schlaganfallnachsorge leisten. Die Einführung und Umsetzung einer strukturierten Schlaganfallnachsorge bedarf in jedem Fall einer ausreichenden Finanzierung und eigener finanzieller Anreize für die Leistungsträger. Die Vor- und Nachteile der spezifischen Versorgungs- und Finanzierungsmodelle müssen dabei kritisch gegeneinander abgewogen werden. Die Diskussion neuer Versorgungsformen zur Schlaganfallnachsorge erfährt gegenwärtig ein neues Momentum und eröffnet Perspektiven für eine Verbesserung der aktuell noch unzureichenden Versorgungslösung.

Research in mental health services in Germany is of increasing relevance. To this end, the recently founded "Mental Health Working Group" as part of the German Network of Health Services Research (DNVF) has written a discussion paper presenting key specifics, challenges, and goals of health service research in the field of mental health. Some research-relevant specifics in the area of mental health care, pragmatic challenges of research organization, ethical problems, and particular research topics in this field are presented and discussed critically.Versorgungsforschung im Feld der seelischen Gesundheit ist von zunehmender Bedeutung. Angesichts dieser Entwicklung hat die im Oktober 2017 gegründete DNVF Fachgruppe „Seelische Gesundheit“ ein Diskussionspapier verfasst, welches zentrale Besonderheiten, Herausforderungen und Ziele der Versorgungsforschung im Bereich der seelischen Gesundheit zusammenfasst. Im Einzelnen werden forschungsrelevante Besonderheiten des Versorgungsfeldes, pragmatische Probleme bei der Forschungsorganisation, ethische Herausforderungen und für dieses Feld besondere Themenstellungen vorgestellt und diskutiert.

The National Action Plan for People with Rare Diseases contains 52 concrete actions, including in the fields of care, research, diagnosis, and information management. With the aim of improving the quality and interoperability of national registries in the long term, action 28 proposed the establishment of a "Rare Diseases Registry" strategy group. The strategy group began its work in 2016. In this report, the group takes into account developments at the national and international level in order to develop recommendations for national initiatives.In addition to this, the group reports on consent and implementation as well as on the adaptation of a minimal dataset for use in rare disease registries and mapping the used data elements and schemata in a metadata repository. This position paper was created by the strategy group together with additional authors. The paper reached a consensus within the strategy group and can be seen as a concept paper of the Rare Diseases Registry strategy group.Der Nationale Aktionsplan für Menschen mit Seltenen Erkrankungen (SE) enthält 52 konkrete Maßnahmen, u. a. in den Handlungsfeldern Versorgung, Forschung, Diagnose und Informationsmanagement. Mit dem Ziel, langfristig die Qualität und Interoperabilität von nationalen Registern zu erhöhen, sieht Maßnahmenvorschlag 28 die Etablierung einer Strategiegruppe „Register für Seltene Erkrankungen“ vor. Diese Strategiegruppe hat 2016 ihre Arbeit aufgenommen. Sie berichtet hier über Entwicklungen auf nationaler und internationaler Ebene, um Empfehlungen für nationale Initiativen daraus abzuleiten.Zusätzlich werden die Konsentierung und Implementierung sowie mit der Zeit ggf. die Anpassung eines Minimaldatensatzes zur Verwendung in Registern für Seltene Erkrankungen erläutert. Zusätzlich werden die verwendeten Datenelemente bzw. -schemata in einem sog. Metadata Repository abgebildet. Dieses Positionspapier wurde durch die Strategiegruppe sowie weitere Autoren erarbeitet und innerhalb der Gruppe konsentiert. Es wird als Konzeptpapier zum Aufbau und Betrieb von Registern der Strategiegruppe „Register“ veröffentlicht.

Digitalization in the healthcare system is a great challenge for rheumatology as for other medical disciplines. The German Society for Rheumatology (DGRh) wants to actively participate in this process and benefit from it. By founding the commission on digital rheumatology, the DGRh has created a committee that deals with the associated tasks, advises the DGRh on questions and positions associated with digital health. For the DGRh, this affects the most diverse areas of digitalization in medicine and rheumatology. This position paper presents the topics and developments currently handled by the commission and the tasks identified.

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.Die Auswirkungen psychischer Erkrankungen auf die Arbeits- und Erwerbssituation können erheblich sein. Sie sind eine der Hauptursachen für Arbeitsunfähigkeit sowie Erwerbsminderung. Vor diesem Hintergrund stellt sich die Frage nach geeigneten beruflichen Wiedereingliederungsmaßnahmen für Menschen mit schweren psychischen Erkrankungen, wobei sich in den letzten Jahren international das Prinzip des Supported Employment als zunehmend erfolgreich erwiesen hat. Hierbei werden psychisch erkrankte Menschen mit beruflichem Rehabilitationsbedarf primär auf einem Arbeitsplatz des ersten Arbeitsmarktes platziert und vor Ort durch einen Jobcoach unterstützt. Dieses Konzept ist inklusiv, individuell, nachhaltig und evidenzbasiert. Trotz erwiesener Wirksamkeit ist es im deutschsprachigen Raum bislang noch wenig umgesetzt. Es wird zukünftig darauf ankommen, stärker als bislang den individuellen Hilfebedarf psychisch erkrankter Menschen aufzunehmen und mit funktional, im besten Fall multiprofessionell und mobil aufgestellten Angeboten zu begegnen.

Increased awareness of the rising antimicrobial resistance problem and impending loss of suitable treatment options for infectious diseases have changed patient care. Antimicrobial/antibiotic stewardship (ABS) activities aiming to optimize antimicrobial treatment were specified in international (WHO, ECDC) and national programmes and evidence-based practice guidelines. In Germany, ABS in hospitals is enshrined in the Infection Protection Act §23 and in a national guideline. The position paper presents the goals and tasks of ABS as well as the necessary organisational and staff requirements.Qualified training and education, mandates and support from hospital directors, and the provision of sufficient resources are essential prerequisites for the successful work of the ABS team. The ABS team should work hospital-wide across clinical services. Their main tasks are developing and implementing an ABS programme tailored to local needs and the conditions of the hospital, taking into account anti-infective drug prescribing, the resistance situation and case mix. Their tasks also include drafting and implementing in-house recommendations for diagnosis, prophylaxis and treatment of important infectious diseases. The ABS team should be interdisciplinary and include specially qualified doctors and pharmacists. Doctors commissioned for ABS should support this team and take the department-specific concerns into account. The document specifies a minimum ABS staff of one full-time equivalent (FTE) per 500 beds. Depending on the case mix and specialties, additional staff may be required. It proposes that there should be 0.1 FTE doctors commissioned for ABS per 100 beds.Gesteigertes Bewusstsein für die Problematik zunehmender Antibiotikaresistenzen und drohender Verlust geeigneter Therapieoptionen für Infektionen haben die Rahmenbedingungen in der Patientenversorgung verändert. In internationalen (WHO, ECDC) und nationalen Programmen und evidenzbasierten Leitlinien wurden Maßnahmen und Instrumente von Antibiotic Stewardship (ABS) konkretisiert. In Deutschland ist ABS im Krankenhaus im Infektionsschutzgesetz §23 verankert und Empfehlungen dazu in einer S3-Leitlinie. Das vorliegende Positionspapier stellt Ziele von ABS sowie erforderliche strukturelle und personelle Voraussetzungen für Krankenhäuser dar.Für die erfolgreiche Arbeit des ABS-Teams sind die Sicherung einer qualifizierten Fort- und Weiterbildung, die Mandatierung, die Unterstützung und die Bereitstellung ausreichender Ressourcen durch die Krankenhausleitung unabdingbar. Das ABS-Team soll krankenhausweit und abteilungsübergreifend arbeiten. Aufgaben sind Ausarbeitung und Umsetzung eines auf die lokalen Bedürfnisse und Möglichkeiten des Krankenhauses zugeschnittenen ABS-Programms unter Berücksichtigung von Antiinfektivaeinsatz, Resistenzlage und Patientenschwerpunkten. Dazu kommen Erstellung und Implementierung hausinterner Empfehlungen zur Diagnostik, Prophylaxe und Therapie wichtiger Infektionen. Das ABS-Team soll interdisziplinär arbeiten und als Teammitglieder speziell qualifizierte Ärzte und Apotheker umfassen. ABS-beauftragte Ärzte unterstützen das ABS-Team und berücksichtigen abteilungsspezifische Belange. Es wird von einer Mindestpersonalstärke für das ABS-Team von 1 Vollzeitäquivalent (VZÄ) pro 500 Betten ausgegangen. Je nach Krankenhausschwerpunkten und Anforderungen wird ein Zusatzbedarf gesehen. Die Wochenarbeitszeitstunden für einen ABS-beauftragten Arzt einer mittelgroßen Abteilung wurden auf 0,1 VZÄ pro 100 Betten geschätzt.

Spinal muscular atrophy (SMA) is a severe, life-limiting neurodegenerative disease. A disease-modifying and approved therapy with nusinersen has been available in Germany since July 2017. Gene therapies offer another promising treatment option through a once in a lifetime administration. In May 2019 a gene replacement therapy for the treatment of SMA was approved for the first time by the U.S. Food and Drug Administration (FDA). An application for approval in Europe has been submitted and is currently pending.This consensus paper was compiled at the invitation of the German Society for Muscular Diseases (DGM) with the participation of all potential German neuromuscular treatment centers, the German section of the Society for Pediatric Neurology (GNP) and with the involvement of the medical scientific advisory board of the DGM. The aim was to define and establish the necessary prerequisites for a safe and successful application of the new gene replacement therapy in clinical practice.Gene replacement therapy with onasemnogene abeparvovec has the potential to significantly influence the course of SMA. Long-term data on sustainability of effects and possible adverse effects of gene replacement therapy are not yet available. The application of this innovative therapy must be carried out in specialized and appropriately qualified treatment centers under strict safety conditions. This article makes suggestions for the necessary framework conditions and gives recommendations for a systematic pretreatment and posttreatment assessment schedule under gene therapy. The effectiveness and safety of the therapy should be systematically documented in an industry-independent and disease-specific register.

Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Symptomatic cardiac manifestations are found in less than 10 % of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies.underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.Während 90 % aller Sarkoidosepatienten eine parenchymatöse Beteiligung der Lunge aufweisen, ist die kardiale Sarkoidose (in weniger als 10 % der Fälle klinisch manifest) selten. Generell können alle Strukturen des Herzens von der Granulombildung betroffen sein. Meist jedoch sind das Myokard des linken Ventrikels sowie das Reizleitungssystem beeinträchtigt. Klinisch manifestiert sich die kardiale Sarkoidose als dilatative Kardiomyopathie oder in Form von Herzrhythmusstörungen wie Vorhofflimmern und/oder ventrikulären Tachykardien. Das Spektrum reicht von der benignen, subklinischen Manifestation als Zufallsbefund bis zur lebensbedrohlichen Komplikation, wie akuelle Kohortenstudien zeigen. Diagnostische Schritte und therapeutische Empfehlungen zur kardialen Sarkoidose sollten daher einem einheitlichen Standard unterliegen. Die vorliegende Arbeit ist die Expertenstellungnahme unter dem Schirm der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK). Die nachstehenden Empfehlungen ersetzen jedoch nicht die ärztliche Begutachtung des individuellen Patienten und Anpassung der Diagnostik und Therapie an dessen spezifische Situation.

In Germany, there are currently many voices calling for a reform of hospital planning and reimbursement to correct some aberrations of the last decades and to enable the system to cope with future challenges. Some recent political decisions to change the structures of emergency medical services as well as the introduction of mandatory nurse-to-patient ratios and the exclusion of the cost for nursing from the case-based hospital reimbursement represent first steps of a reform, which also affects intensive care and emergency medicine. In this discussion paper a group of intensivists, emergency physicians, medical controllers, and representatives of nurses suggest more far-reaching changes, which can be summarized in 5 points: (1) General hospitals with intensive care units (ICU) and emergency departments (ED) which are part of the emergency medical system should be considered as an element of public service and be planned accordingly. (2) The planning of the intensive care infrastructure should be based on the three levels of emergency medical services to identify hospitals that are system relevant and to define appropriate criteria for structure and quality measures. (3) Hospital reimbursement should consist of a base amount (covering costs for hospital staff, infrastructure plus investments) and case-based fees (covering material costs). (4) To determine the requirements for nurses, physicians, and other medical staff, adequate tools for ICU and ED should be applied. (5) For these purposes as well as for quality management and optimal medical care, hospitals should be provided with a substantially improved IT-infrastructure.

Currently two intravitreally applied corticosteroids (dexamethasone and fluocinolone) are licensed in Germany for treatment of diabetic macular oedema (DME). The use of DEX implant for DME in daily clinical practice has not been defined in detail. Following a Delphi panel survey, a group of retina experts set out to come up with a consensus for use of the DEX implant in DME.International and national treatment recommendations were identified from the literature. A steering group generated a catalogue of 72 statements on the aetiology and pathogenesis of DME, therapy with DEX implant, use of DEX implant in patients previously treated with VEGF-inhibitors, use of DEX implant in combination therapy, safety of DME therapies as well as patients' burden of treatment. Twenty-two ophthalmologists from private practice and 6 hospital ophthalmologists participated in the Delphi panel via Survey Monkey. Consensus was reached if at least 75% of participants agreed or disagreed with a statement. Statements for which consensus was not reached were discussed once more during the expert consensus meeting and a vote was taken. Based on these results a treatment algorithm for foveal DME was proposed.If a patient does not show sufficient response after 3 - 6 months of anti-VEGF treatment (visual acuity gain of 5 ETDRS letters or reduction of central retinal thickness ≤ 20%), a switch to DEX implant should take place. DEX implant is also suitable in eyes with longer presentation of DME, showing e.g. massive lipid exudates. DEX implant is suitable as first-line therapy especially in pseudophakic patients, patients unwilling or able to comply with tight anti-VEGF injection intervals or patients with known vascular diseases. With fixed control visits every 4 - 8 weeks, use of DEX implant is flexible and individual. Decision parameters for repeated use should be visual acuity, retinal thickness and intraocular pressure. Treatment of both eyes on the same day should not take place.The algorithm presented reflects survey as well as expert discussion results and may differ from recommendations issued by the German professional society. The consensus recommendations for the treatment of DME generated during the survey and meeting of retina experts are intended to guide use of DEX implant in daily practice.In Deutschland sind 2 intravitreal anzuwendende Kortikosteroide (Dexamethason und Fluocinolon) für die Behandlung des diabetischen Makulaödems (DMÖ) zugelassen. Der Einsatz von DEX-Implantat bei DMÖ ist in der täglichen Praxis bisher nicht im Detail definiert. Mithilfe eines Delphi-Panels und einer Runde von Retinaspezialisten sollte ein Konsens für die Anwendung von DEX-Implantat erarbeitet werden.Aus der Literatur wurden internationale und nationale Behandlungsempfehlungen identifiziert. Eine Steuerungsgruppe erarbeitete einen Katalog von 72 Aussagen zur Ätiologie und Pathogenese des DMÖ, Therapie mit dem DEX-Implantat, Einsatz bei mit VEGF-Hemmern vorbehandelten Patienten, Verwendung von DEX-Implantat in der Kombination mit anderen Therapien, Sicherheit von DMÖ-Therapien sowie Therapiebelastung des Patienten. 22 niedergelassene Ophthalmologen und 6 Ophthalmologen aus der Klinik gaben über Survey Monkey ihre Bewertung zu den Aussagen ab. Die Definition des Konsenses zu einer Aussage galt als erfüllt, wenn mehr als 75% der Befragten einer Aussage zustimmten bzw. nicht zustimmten. Über nicht konsensfähige Aussagen wurde nach erneuter Diskussion in der Konsensrunde nochmals abgestimmt. In der Folge sollte auch ein Behandlungsschema für DMÖ mit fovealer Beteiligung vorgeschlagen werden.Sofern ein Patient unter VEGF-Hemmern unzureichend anspricht (Visusgewinn 5 ETDRS-Buchstaben oder Reduktion der zentralen Netzhautdicke ≤ 20%), sollte nach 3 – 6 Monaten auf das DEX-Implantat umgestellt werden. DEX-Implantat ist ebenfalls geeignet für Augen mit länger bestehendem DMÖ, bei denen z. B. massive Lipidexsudate vorhanden sind. DEX-Implantat eignet sich als Ersttherapie insbesondere bei Pseudophaken, Patienten, die nicht willens oder in der Lage sind, enge Injektionsintervalle unter Anti-VEGF-Therapie einzuhalten oder für Patienten mit vaskulären Vorerkrankungen. Bei festgelegten Kontrollintervallen von 4 – 8 Wochen kann die Anwendung des DEX-Implantats flexibel und individuell erfolgen. Als Entscheidungsparameter gelten hierbei neben Visus und Netzhautdicke auch der Augeninnendruck. Eine Behandlung von beiden Augen am selben Tag sollte nicht stattfinden.Der hier vorgestellte Algorithmus entspricht den Ergebnissen des Delphi-Prozesses und weicht u. U. von den Empfehlungen der Fachgesellschaft ab. Die im Rahmen der Befragung und Expertenrunde erarbeiteten Konsensempfehlungen für die Therapie von DMÖ können für den Einsatz des DEX-Implantats in der täglichen Praxis dienen.

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 regulations for ability to drive with cerebrovascular diseases in the German Driving License Regulations (Fahrerlaubnisverordnung, FeV) and German Guidelines for the Evaluation of Driving Ability of the Federal Highway Research Institute (BASt) are not up to date with the current medical knowledge and are not consistent with comparable regulations regarding cardiovascular diseases. This is particularly true for the assessment of future risks for a sudden loss of control during driving. The present position paper of six medical and neuropsychological societies in Germany presents the current conditions for the assessment of driving ability of patients a cerebrovascular diesease and recommends an estimation of the ability to drive founded on the current state of scientific knowledge. It addresses the following: 1. Physical and mental functional limitations and the possibilities for compensation, which if necessary enable a fitness to drive under conditions or within limits, including the importance of behavioral or personality changes and cognitive deficiencies that interfere with safety. 2. The potential danger due to a sudden loss of control as a result of a transient ischemic attack (TIA) new stroke event, or another cardiovascular event while driving. A summary in the form of a table provides physicians and expert assessors with assistance for the most important cerebrovascular diseases.

This position paper describes the legal framework requirements when crediting digital teaching formats towards the teaching load in higher education medical teaching, as exemplified by the Federal State of Bavaria in Germany. It reveals the need for precise rules adapted to the advances in technology, if the process of digitalisation in higher education (HE) is not to come to a halt. If HE institutions are to act as centres of innovation with respect to the implementation of digital teaching and learning formats, then structural and strategic positioning with regard to e- and blended learning above all is called for in addition to financial resources, as well as the distribution and sustainable incorporation of digital offerings in faculties and HE institutions. There is a great deal of insecurity however with respect to the legal framework requirements and how best to count digital teaching towards one’s own teaching load. This results to some extent from the complexity of current laws and regulations partially overtaken by didactic and methodological changes in education, with decentralised educational federalism only adding to the complexity. Bearing in mind teaching and learning formats that are undergoing change or have already been transformed, ways of adapting the (legal) framework to the digital shift need to be found, last but not least in order to offer enthusiastic teaching staff incentives to develop and expand digital formats., Dieses Positionspapier beschreibt die rechtlichen Rahmenbedingungen bei der Anrechnung digitaler Lehrformate auf das Lehrdeputat in der medizinischen Hochschulbildung am Beispiel Bayern. Es zeigt die Notwendigkeit präziser, dem technologischen Fortschritt angepasster Regelungen, wenn der Digitalisierungsprozess in der Hochschullehre nicht ins Stocken geraten soll. Wenn Hochschulen als Orte der Innovation im Einsatz digitaler Lehr- und Lernformate fungieren sollen, bedarf es neben finanzieller Ressourcen vor allem einer strukturellen und strategischen Positionierung im Bereich des E- und Blended-Learnings sowie der Verbreitung und nachhaltigen Verankerung digitaler Angebote innerhalb der Fakultäten und Hochschulen. Hinsichtlich der rechtlichen Rahmenbedingungen und des Umgangs mit digitaler Lehre bei der Anrechnung auf das eigene Lehrdeputat herrscht jedoch große Unsicherheit, was unter anderem an der komplexen, vom didaktisch-methodischen Wandel der Lehre in Teilen überholten Gesetzes- und Verordnungslage liegt, die durch den dezentralen Bildungsföderalismus an Komplexität dazugewinnt. Unter Berücksichtigung veränderter und im Wandel begriffener Lehr- und Lernformate sollen Wege gefunden werden, die (rechtlichen) Rahmenbedingungen dem digitalen Wandel anzupassen, um nicht zuletzt engagierten Lehrenden Anreize zum Ausbau digitaler Formate zu bieten., GMS Journal for Medical Education; 35(3):Doc34

The "Masterplan Medizinstudium 2020" from the German Federal Government should not be underestimated as only one among many announcement. Thus, the Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) comments on the intended measures of the "Masterplan Medizinstudium 2020" and discusses the challenges, consequences and duties arising from the "Masterplan Medizinstudium 2020" for the representatives of the surgical societies and those engaged in surgical undergraduate training.Der „Masterplan Medizinstudium 2020“ der Bundesregierung darf in der Chirurgie keinesfalls als „beiläufiges Werk unter Vielen“ unterschätzt werden. Daher nimmt die chirurgische Arbeitsgemeinschaft Lehre (CAL) der Deutschen Gesellschaft für Chirurgie (DGCH) in ihrem Positionspapier zu den geplanten Maßnahmen im „Masterplan Medizinstudium 2020“ Stellung und diskutiert die Herausforderungen, Konsequenzen und Aufgaben, vor die der „Masterplan Medizinstudium 2020“ die Fachvertreter der chirurgischen Fachgesellschaften und die in der Lehre engagierten Chirurgen stellt.

Demographic changes in Germany means that nursing and medical care is becoming increasingly complex. This is especially true for intensive care. Despite the closure of hospitals in Germany, the number of beds in intensive care units rose between 2002 from 23,113 to 26,162 in 2010. At the same time the number of patients treated in intensive care units increased by 148,989 to 2,049,888. The increasing complexity requires specific education for nurses in intensive care based on a model of advanced nursing practice (ANP). Nursing experts who fulfill an advanced practise nursing are competent to make decisions autonomously and accountably within complex care situations. This includes decisions such as artificial ventilation, weaning, nutrition management and the management of delirium, wounds and pain. Nursing experts are responsible for specific clearly defined areas of care and initiate nurse-led services and practice. Scientific and research based evidence are transferred directly into health care practice and can be implemented directly. The DGF demands a scientific and with it academic development of critical care as advanced nursing practice based on a master level qualification. This also includes the request for expansion of competencies and roles and the assignment of decision making authority within complex health care situations and an orientation on the Competencies for European Critical Care Nurses of the European Federation of Critical Care Nursing Associations (EfCCNa).

The term "digital health" is currently the most comprehensive term that includes all information and communication technologies in healthcare, including e-health, mobile health, telemedicine, big data, health apps and others. Digital health can be seen as a good example of the use of the concept and methodology of health services research in the interaction between complex interventions and complex contexts. The position paper deals with 1) digital health as the subject of health services research; 2) digital health as a methodological and ethical challenge for health services research. The often-postulated benefits of digital health interventions should be demonstrated with good studies. First systematic evaluations of apps for "treatment support" show that risks are higher than benefits. The need for a rigorous proof applies even more to big data-assisted interventions that support decision-making in the treatment process with the support of artificial intelligence. Of course, from the point of view of health services research, it is worth participating as much as possible in data access available through digital health and "big data". However, there is the risk that a noncritical application of digital health and big data will lead to a return to a linear understanding of biomedical research, which, at best, accepts complex conditions assuming multivariate models but does not take complex facts into account. It is not just a matter of scientific ethical requirements in health services care research, for instance, better research instead of unnecessary research ("reducing waste"), but it is primarily a matter of anticipating the social consequences (system level) of scientific analysis and evaluation. This is both a challenge and an attractive option for health services research to present itself as a mature and responsible scientific discipline.Der Begriff Digital Health (digitale Gesundheitsanwendungen) ist zurzeit der umfassendste und schließt alle Informations- und Kommunikationstechnologien aus dem Gesundheitsbereich mit ein, inkl. E-Health, Mobile Health, Telemedizin, Big Data, Gesundheits-Apps und anderen. Digital Health kann als ein Paradebeispiel für den Einsatz des Konzeptes und der Methodik der Versorgungsforschung gelten, wo es um das Zusammenspiel von komplexen Interventionen und komplexem Kontext geht. Das Positionspapier betrachtet 1) Digital Health als Gegenstand der Versorgungsforschung und 2) Digital Health als methodische und wissenschaftsethische Herausforderung für die Versorgungsforschung. Der häufig postulierte Nutzen, der von Digital Health-Interventionen erwartet wird, sollte durch gute Studien nachweisbar sein. Erste systematische Evaluationen von Apps zur „Behandlungsunterstützung“ liefern teilweise Ergebnisse, die eher auf einen Schaden, denn auf einen Nutzen hinweisen. Die Forderung eines Nachweises von Nutzen bzw. Risiken gilt erst recht für Big Data-gestützte Interventionen, die Entscheidungsprozesse im Behandlungsablauf unter Zuhilfenahme von Künstlicher Intelligenz unterstützen. Natürlich ist es aus Sicht der Versorgungsforschung anstrebenswert, möglichst an dem durch Digital Health verfügbaren Datenzugang zu partizipieren und „Big Data“ zu nutzen. Es besteht allerdings die Gefahr, dass es durch eine unkritische Anwendung von Digital Health und Big Data zu einer Rückkehr zum linearen, naturwissenschaftlich-biomedizinischen Forschungsverständnis kommt, der bestenfalls komplizierte Verhältnisse unter der Annahme multivariater Modelle akzeptiert und komplexe Sachverhalte nicht zur Kenntnis nimmt. Es geht für die Versorgungsforschung nicht nur darum, wissenschaftsethischen Anforderungen zu genügen, indem statt unnötiger Forschung („reducing waste“) bessere Forschung gemacht wird, sondern vor allem darum, die gesellschaftlichen Konsequenzen (Systemebene) der wissenschaftlichen Analyse und Evaluation zu antizipieren. Dies birgt für die Versorgungsforschung die anspruchsvolle, gleichseitig aber attraktive Option, sich über die Kompetenz, eine solche Diskussion zu initiieren und zu führen, als reifes und verantwortungsvolles Wissenschaftsgebiet zu präsentieren.

Complex trends in occupancy determined by many influencing factors, clear state-specific differences in imprisonment practices as well as recently implemented statutory alterations to the appropriate paragraphs in criminal law, underline the necessity for qualitative high-grade concomitant research of German forensic commitment; however, neither the structural prerequisites nor an adequate data situation are currently present in order to do justification to this aim. Not even the total number of patients currently accommodated in forensic commitment can be elucidated from the publicized (partial) statistics. This consensus paper, which was formulated by three research institutes active at the state level, describes the limited possibilities for current forensic healthcare research and raises the demand for a nationwide uniform data situation on patients in forensic commitment. Furthermore, how the appropriate elicitation instrument should be organizationally and structurally achieved, is sketched from a scientific perspective. This article aims at initiating a discussion on a sustainable improvement in the prerequisites for healthcare research in German forensic commitment and targets a sensitization of decision makers in politics and administration for this topic.

The introduction of requirements for a minimum intake capacity of trauma patients by the German Trauma Society (DGU) into the so-called white book of treatment of seriously injured patients, is helpful for a sufficient preparation for threats and for dealing with mass casualties for trauma centers as well as for the emergency medical services (EMS). In the hospital information database provided by the Federation of German Medical Directors of Emergency Medical Services, more than 1300 hospitals are currently listed. This information supports the allocation of trauma patients from the field to the appropriate trauma center. Currently, without any coordination requirements, the current 626 trauma centers in Germany are able to immediately handle 6260 patients. This number could be doubled by activating the local hospital action plan, where a priority plan is set up. Additionally, the implementation of a nationwide flexible standardized communication structure between the dispatch center of the ambulance service and the hospitals, would improve daily care as well as the management of threats and mass casualties. It is the obligation of the local medical director of the EMS, to maintain and update the hospital database. Providing the information in the database with the hospital resources and the flexible standard communication structure, is appropriate to improve the daily collaboration and the preparation for mass casualties.

Zusammenfassung Die Behandlung Schwerverletzter ist – wie auch die Verletzungsschwere und -kombination – oftmals hoch komplex und lässt nur wenig Spielraum für Verzögerungen, Dissens oder gar Fehler. Um diese auf ein Minimum zu reduzieren sind – neben optimalen apparativen und strukturellen Voraussetzungen – auch eingespielte Schockraumteams notwendig, die nach festen, allen Teammitgliedern bekannten und auch von allen Teilnehmern konsentierten Algorithmen interdisziplinär zusammenarbeiten. Das Weißbuch „Schwerverletztenversorgung“ der Deutschen Gesellschaft für Unfallchirurgie (DGU) und die kürzlich erschienenen S3-Leitlinie bieten hier evidenzbasierte Vorgaben der strukturellen, apparativen, organisatorischen und personellen Voraussetzungen.

In times of mass tourism, traveler's diarrhea is one of the most common health problems of long-distance travel. Globally, some 40 million cases occur annually. Travellers to risk areas should therefore be comprehensively advised beforehand, as to what action to take in case of an acute traveler's diarrhea and what drugs to add to their first-aid kit. To date none, or hardly any specific studies or valid specific guidelines for the treatment of traveler's diarrhea are available for Germany.Drafting a consensus paper based on results of a specialists' meeting to evaluate therapeutic options in the treatment of acute uncomplicated travelers' diarrhea. The foundation for the present consensus recommendations is current evidence on antidiarrheals available in Germany for symptomatic treatment of gastrointestinal infections, summarized in the S2k guideline for gastrointestinal infections and Whipple's disease. Further taken into account for the present consensus recommendations were Pubmed-listed publications on symptomatic treatment of traveler's diarrhea, practical aspects, and the experts' experience in travel medicine.For the treatment of acute uncomplicated traveler's diarrhea - more than 90 % of all cases - the secretion inhibitor racecadotril is considered first choice, based on our evaluation criteria. The previously usual practice of recommending the antimotility drug loperamide as first choice should be reconsidered, in favor of the recent active ingredient racecadotril. Antibiotics should be used only in complicated cases. A large number of travelers who generally demand antibiotic therapy should be disabused of their expectations. Other therapeutic measures that are currently available for the treatment of acute diarrhea while traveling play a subordinate role.

Point-of-care ultrasound in acute care medicine is a prerequisite for diagnosis and therapy monitoring of critically ill patients. There is currently no uniform education strategy for medical intensive care and emergency medicine. As part of the basic level, the trainee takes theoretical and clinical training covering abdominal and thoracic ultrasonography and focused cardiovascular ultrasound. In a second step, special knowledge and skills can be acquired at an expert level. This two-stage concept is intended to guarantee quality assurance in ultrasound education in medical intensive care and emergency medicine.

In this position paper, the adverse health effects of cannabis are reviewed based on the existing scientific literature; in addition possible symptom-relieving effects on some diseases are depicted. In Germany, cannabis is the most widely used illicit drug. Approximately 600,000 adult persons show abusive or addictive cannabis consumption. In 12 to 17 year old adolescents, cannabis use increased from 2011 to 2014 from 2.8 to 6.4%, and the frequency of regular use from 0.2 to 1.5%. Currently, handling of cannabinoids is much debated in politics as well as in general public. Health aspects have to be incorporated into this debate. Besides analysing mental and neurological side effects, this position paper will mainly focus on the influences on the bronchopulmonary and cardiovascular system. There is strong evidence for the induction of chronic bronchitis. Allergic reactions including asthma are known, too. Associations with other diseases like pulmonary emphysema, lung cancer and pneumonia are not sufficiently proven, however cannot be excluded either. In connection with the use of cannabis cardiovascular events such as coronary syndromes, peripheral vascular diseases and cerebral complications have been noted. Often, the evidence is insufficient due to various reasons; most notably, the overlapping effects of tobacco and cannabis use can frequently not be separated adequately. Empirically, early beginning, high-dosed, long-lasting and regular cannabis consumption increase the risk of various psychological and physical impairments and negatively affect age-based development. Concerns therefore relate especially to children and adolescents. There is only little scientific evidence for medical benefits through cannabis as a remedy; systematic research of good quality, in particular prospective, randomised, placebo-controlled double-blinded studies are rare. The medical societies signing this position paper conclude that cannabis consumption is linked to adverse health effects which have to be taken into consideration in the debate about the social attitude towards cannabinoids. The societies agree that many aspects regarding health effects of cannabis are still uncertain and need clarification, preferably through research provided by controlled studies.

Calls are increasing for the legalization of cannabis. Some legal experts, various politicians, political parties and associations are demanding a change in drug policy. The legalization debate is lively and receiving wide coverage in the media. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) comments on the most important questions from a medical scientific perspective: can cannabis consumption trigger mental illnesses, what consequences would legalization have for the healthcare system and where is more research needed?

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 third and final discussion paper of the German Network of Health Services Research's (DNVF) "Qualitative Methods Working Group" demonstrates methods for the evaluation and quality of qualitative research in health services research. In this paper we discuss approaches described in evaluating qualitative studies, including: an orientation to the general principles of empirical research, an approach-specific course of action, as well as procedures based on the research-process and criteria-oriented approaches. Divided into general and specific aspects to be considered in a qualitative study quality evaluation, the central focus of the discussion paper undertakes an extensive examination of the process and criteria-oriented approaches. The general aspects include the participation of relevant groups in the research process as well as ethical aspects of the research and data protection issues. The more specific aspects in evaluating the quality of qualitative research include considerations about the research interest, research questions, and the selection of data collection methods and types of analyses. The formulated questions are intended to guide reviewers and researchers to evaluate and to develop qualitative research projects appropriately. The intention of this discussion paper is to ensure a transparent research culture, and to reflect on and discuss the methodological and research approach of qualitative studies in health services research. With this paper we aim to initiate a discussion on high quality evaluation of qualitative health services research.

In this paper the German Society for Medical Intensive Care Medicine and Emergency Medicine (DGIIN) provides statements regarding the importance and advancement of Medical Intensive Care Medicine within the structures of Internal Medicine in Germany. Of pivotal importance are the training of medical intensivists, the cooperation with intensivists from other disciplines and the collaboration with emergency departments. In order to fulfil the various and challenging tasks in patient care, training, research and medical education competently and on an international level, more intensivists in leading positions especially in academic institutions are essential.

From the perspective of patients with rheumatic diseases, the reduction of inflammatory disease activity alone is not a sufficient treatment goal. In addition the functional health and participation also have to be improved. Starting with the first symptoms the empowerment for the self-management of the disease is important for the patients; therefore, the established treat to target-strategy has to be expanded by the functional dimension to treat to participation. The position paper of the German Society for Rheumatology (GSR) summarizes the relevant fields of the multiprofessional action that is frequently necessary. This includes the acquirement of function-related competencies during training, further education and advanced training as well as implementation in the everyday practice of patient care. Furthermore, the GSR acknowledges the need for research related to functional and sociomedical consequences of rheumatic diseases and to individual and combined function-related programs in outpatient and inpatient care in rheumatology.

Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management. In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.

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 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.

Spirometry is a highly standardized method which allows to measure the forced vital capacity (FVC) with high precision and reproducibility. In patients with IPF FVC is directly linked to the disease process which is characterized by scaring of alveoli and shrinkage of the lungs. Consequently, there is ample evidence form clinical studies that the decline of FVC over time is consistently associated with mortality in IPF. As for the first time effective drugs for the treatment of IPF are available it becomes obvious that in studies which could demonstrate that the drug reduces FVC decline, a numerical effect on mortality was also observed, while in one study where a significant effect on FVC decline was missed, there was also no change in mortality. Based on these studies FVC decline is a validated surrogate of mortality in IPF. It is concluded that FVC decline is not only accepted as an endpoint of clinical treatment trials in IPF but is also valid as a patient related outcome parameter which should be considered for the assessment of the efficacy of an IPF drug.

The hospital emergency departments play a central role for the in- and outpatient care of patients with medical emergencies in Germany. In this position paper we point out some general financial and organizational problems of German emergency departments and urge for a higher significance of emergency care in the German health system as an element of public services. The corresponding reform proposals include a change in hospital financing towards a more budget-based system for the emergency departments, an improved structural planning for regional and transregional emergency care, an intensified cooperation with the emergency services of the ambulatory care physicians, a better organizational representation of emergency care within the hospitals and an advancement of emergency medicine in postgraduate medical education.

Antihormonal and cytotoxic therapy options are available for the therapy of metastasized prostate cancer (mPC). Because no comparative studies are available, especially for castration-resistant prostate cancer (mCRCP), it remains unclear which patients will profit best from which therapy.Previous data on the sequence of the various therapy options show that correct selection of the first line therapy for mCRPC can have an influence on the prognosis of the patient. In this position paper the various therapy options are critically illustrated and the clinical and pathohistological criteria for selection of the first line therapy of mCRPC are discussed.Molecular markers are an important aid for future patient selection and individualized therapy for optimal use of the available forms of therapy.