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This perspective discusses the important aspects of the design of molecular gear systems based on triptycene. Molecular systems are categorized into three classes according to the orientation of the gear axes: i) bent (bevel gears), ii) linear, and ii) parallel (spur gears). To date, no examples of molecular gears in which the axes of rotation lie in parallel have been reported; correspondingly, the bulk of this report focuses on the factors one must evaluate to construct such systems.

Objective: Day centres for people with mental disabilities are widespread. Nevertheless, there are only a few studies on their utilisation and effectiveness. This study examines what an ideal day centre should look like from the perspective of the users., Methods: Six guided focus groups were conducted with 4-8 users each. The discussions were transcribed verbatim and analysed using qualitative content analysis., Results: 36 participants (67% women, aged 20-62 years). The day centres fulfilled 5 functions: Improving mental health, experiencing community, maintaining daily structure, meaningful occupation and building up workability. The results revealed important aspects of organisation, current and desired activities and support., Conclusion: Day centres are seen as an elementary component of intermediate mental health care. Users have clear ideas about how day centres can support their social and occupational rehabilitation., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aim: Inpatient-Equivalent Home Treatment (IEHT) for mental health is new in Germany and therefore requires quality development. A best practice model (BPM) for IEHT is being developed from a service user perspective., Methods: 1. Collection and organization of evidence (literature review; n=55 interviews with service users), 2. qualitative analysis and formulation of criteria; 3. consensus and grouping of criteria (Delphi process)., Results: 58 Best practice criteria were developed in 8 groups: 1. Information, access and crisis management; 2. Treatment framework, end of treatment and continuity; 3. Scheduling, organization of contacts and flexibility; 4. Practical support and activation; 5. Treatment and therapy services; 6. Treatment team and staff; 7. Relatives, caregivers and community; and 8. Privacy and behavior in the home environment., Conclusion: The BPM provides initial guidance for a user-centered assessment of the implementation of IEHT., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Depression is a common and often very debilitating disease causing a high number of years lost to disability worldwide. Mortality rates are high due to suicide and depression-associated somatic disorders, which seem to have a bidirectional connection. Depression is considered to be stress associated. Adverse life events such as losses, interpersonal conflicts, financial issues, unemployment, and loneliness are often found in the patient history. Also childhood maltreatment is a known risk factor. Chronic stress can cause maladaptive changes in different neurobiological systems and may contribute to the development of depression. Relevant changes have been described in the stress-response and immune systems of persons with depression and those with childhood trauma or abuse. Psychotherapy and antidepressants are both effective, and current treatment guidelines recommend their combination in severe depressive episodes., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

If dependency makes vulnerable: Nursing home residents' claims for dignity-conserving nursing care - A narrative literature review Abstract. Introduction: Due to an increase in the very old population, it is important to know what is needed in order to support older people's needs regarding dignity-conserving nursing care when living in a nursing home. Aim: The aim of this article is to gather information on how nursing home residents feel respected and protected in regards of their dignity. Methods: A narrative literature review was conducted in the databases CINAHL Complete and PubMed. Six qualitative studies met the inclusion criteria and were compared regarding similarities. Results: The protection of dignity is jeopardized not only by the residents' dependency, but also by nurses, social environment, and society. To protect their own dignity, residents wanted to be perceived as individuals and be treated with respect. Additionally, they wanted to be as independent as possible and take part in meaningful activities. Discussion: Facilitation of staff members as well as flat, peripheral leadership structures are important in order to protect the residents' dignity. The residents' needs regarding social and societal participation has been additionally challenged due to the Covid-19 pandemic. At the same time, the pandemic enforced innovations that may help protect nursing home residents' dignity. Conclusions: These findings can help nurses to protect the dignity of nursing home residents in their daily lives and in the implementation of care measures.

Introduction: In view of the limited capacities in intensive care units and the increasing economic burden, identification of risk factors could allow better and more efficient planning. Therefore, the aim of this study was to assess independent risk factors for the duration of intensive care unit stay after pancreatoduodenectomy (PD)., Methods: 147 patients who underwent pancreatoduodenectomy in the time period from 2013 to 2015 were identified from a prospective database and a retrospective analysis was performed. The primary endpoint was length of time spent in the ICU. A retrograde analysis was performed using univariate and multivariate regression analysis. All pre-, intra- and postoperative parameters were considered in the analysis., Results: The median time spent in the intensive care unit (ICU) is one day. The univariate analysis demonstrated increased pack years, cerebrovascular events, anticoagulation, elevated creatinine and CA 19-9 as preoperative risk factors. In multivariate analysis, antihypertensive medication (AHT; OR 2.46; 95% CI 1.57 - 3.87; p = 0.05), operation time (OR 1.01; 95% CI 1.00 - 1.01; p = 0.03), extended LAD (OR 5.46; 95% CI 2.77 - 10.75; p = 0.01) and severe PPH (OR 4.01; 95% CI 2.07 - 7.76; p = 0.04) are significant risk factors for longer ICU stay., Discussion: Patients with cardiovascular risk factors and elevated preoperative creatinine level are at greater risk for a prolonged ICU stay. Risk and benefit of an extended LAD should be weighed during the operation. Median duration on ICU/IMC after PD is one day or less for patients without risk factors. Whether routine monitoring in the ICU/IMC after PD is necessary must be clarified in further studies., Competing Interests: The authors declare that they have no conflict of interest./Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

During occupational therapeutic treatment of clients with mental disorders, perception and mindfulness-based techniques are used. However, little is known regarding relevant outcomes. Aim of the present study is to describe the results of a perception and mindfulness-based occupational therapeutic intervention (self-control techniques using perception-based methods (SELWA®) by S. Thielen) regarding the outcomes occupational performance and satisfaction in self-care, productivity and leisure, as well as concentration. The data of 28 clients (22 ♀, 6 ♂; mean age = 42.8 (±SD 14.7) years) with mental disorders, that were collected before and after prescribed occupational therapeutic treatment, were analyzed. The outcomes were quantified using the Canadian Occupational Performance Measure (COPM) and the revision test, respectively. Significance of changes after the intervention was tested using the Wilcoxon-Signed Rank Test (p < 0.05). Effect sizes Cohen's d z and r were determined to evaluate the meaningfulness of changes. The occupational performance as well as the satisfaction in the COPM improved significantly after the therapeutic intervention (p < 0.001; d z  = 2.37, r = 0.77 and d z  = 2.24, r = 0.75). Moreover, the clients improved significantly in the revision test after the therapeutic intervention (p < 0.001; d z  = 0.65, r = 0.31). Clients with mental disorders seem to benefit meaningfully from the SELWA®-treatment by S. Thielen regarding occupational performance and satisfaction in self-care, productivity and leisure. Furthermore, a moderate improvement of concentration seems to occur after the therapeutic intervention., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Pancreatic carcinoma in the body and on the left side of the mesentericoportal axis is often only detected in late stages owing to unspecific or even missing clinical symptoms. In approximately 20% of the cases, there is already infiltration of the tumour into the surrounding arteries or veins. Despite locally advanced growth, 30% of patients do not have distant metastases and would potentially qualify for local resection. Arterial resections and vascular reconstruction are associated with an almost 9-fold increase in postoperative mortality compared with resections without vascular reconstruction. The Appleby procedure is a complex surgical technique originally developed for advanced gastric cancer. The technique has been further developed for patients with advanced pancreatic body and tail tumours with infiltration of the coeliac trunk (modified Appleby procedure). The advantage of the procedure is that technically, no reconstruction of the resected arteries is required. This is because a natural internal anastomosis in the pancreatic head between the A. mesenterica superior and the A. hepatica via branches of the A. gastroduodenalis is used to maintain liver perfusion and gastric blood flow. However, the surgical procedure is also associated with high morbidity and mortality, with comparably poor oncological results (R0 rates of approximately 60%). Therefore, the procedure was not recommended until a few years ago, and patients were considered inoperable. With developments in neoadjuvant therapy for pancreatic carcinoma, the Appleby procedure is being performed more frequently, with the goal of improving oncological outcomes in the context of multimodal treatment. With developments in robotics in visceral surgery, the previous limitations of minimally invasive pancreatic surgery can be overcome, and significantly more patients may benefit from the advantages of this minimally invasive surgery, such as faster convalescence. The use of robotic surgical techniques allows the extension of minimally invasive techniques into the field of complex vessel resection and reconstruction. In this video contribution, we describe a robot-assisted modified Appleby procedure using the Da Vinci Xi Surgical System in a patient with advanced pancreatic carcinoma of the pancreatic body, after neoadjuvant therapy., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Minimally invasive pancreatic surgery lags behind the development of other fields of application of minimally invasive surgery. After a very slow development over the last two decades minimally invasive pancreatic surgery has currently gained wider acceptance especially in centers. This is due if nothing else, to the increasing availability of robotic assistance systems, which provide maneuverable instruments as well as a 3‑dimensional and enlarged view. Meanwhile, the technical feasibility for even complex pancreatic resections has been shown. This gives rise to the question whether laparoscopic or robotic techniques can generate equal or better results (evidence) with respect to perioperative morbidity, survival after oncological resection and the quality of life. As with all innovative techniques, which are implemented in surgery, the transferability to a wider audience, teaching methods and cost-effectiveness have to be evaluated. This article presents the current scientific evidence for laparoscopic and robotic pancreatic head and left-sided pancreatic surgery.

Background: The digital transformation of healthcare is changing the medical profession. Augmented/Virtual Reality (AR/VR) and robotics are being increasingly used in different clinical contexts and require supporting education and training, which must begin within the medical school. There is currently a large discrepancy between the high demand and the number of scientifically proven concepts. The aim of this thesis was the conceptual design and structured evaluation of a newly developed learning/teaching concept for the digital transformation of medicine, with a special focus on the influence of surgical teaching., Methods: Thirty-five students participated in three courses of the blended learning curriculum "Medicine in the digital age". The 4th module of this course deals with virtual reality, augmented reality and robotics in surgery. It is divided into the following course parts: (1) immersive surgery simulation of a laparoscopic cholecystectomy, (2) liver surgery planning using AR/VR, (3) basic skills on the VR simulator for robotic surgery, (4) collaborative surgery planning in virtual space and (5) expert discussion. After completing the overall curriculum, a qualitative and quantitative evaluation of the course concept was carried out by means of semi-structured interviews and standardised pre-/post-evaluation questionnaires., Results: In the qualitative evaluation procedure of the interviews, 79 text statements were assigned to four main categories. The largest share (35%) was taken up by statements on the "expert discussion", which the students consider to be an elementary part of the course concept. In addition, the students perceived the course as a horizon-widening "learning experience" (29% of the statements) with high "practical relevance" (27%). The quantitative student evaluation shows a positive development in the three sub-competences knowledge, skills and attitude., Conclusion: Surgical teaching can be profitably used to develop digital skills. The speed of the change process of digital transformation in the surgical specialty must be considered. Curricular adaptation should be anchored in the course concept., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Psychogenic non-epileptic seizures (PNES) occur in the context of various diseases. Therefore, PNES patients represent a heterogeneous group with different causative disorders. The etiology is still poorly understood. Previous concepts assume an increased rate of trauma disorders in PNES, which has been proven several times by previous studies 1 2. The clinical picture is threatening, which means that those affected often receive intensive care measures without benefiting from them 3. PNES patients accumulate especially in epilepsy centers, since a diagnostic differentiation from epileptic seizures is possible at those specialized centers. Often, the transition from making the diagnosis in epilepsy centers to follow-up treatment in psychosomatic/psychiatric settings is difficult. A reason could be that patients and practitioners are often involved in somatic disease concepts, which might be caused by the threatening clinical picture of PNES 28. Due to this difficulties, a special outpatient clinic was set up at the Charité Berlin for people with dissociative seizures, which settles in the transition from neurology to psychosomatics and works as a cooperation project 27. Out of the ambulance, a group treatment program (CORDIS) was developed, which aims at a better care of PNES patients at the interface between neurology and psychosomatic medicine. This modularized 10-week treatment program will be presented in this article and is the subject of a currently ongoing randomized, controlled evaluation study. The pilot data from the ongoing RCT study presented here showed significant effects in the effectiveness of the program, in particular the primary and secondary outcome measures., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The clinical relevance of the drug interaction between valproic acid and dipyrone is presented in the context of a gerontopsychiatric case. It is assumed that dipyrone at a dose of 4 g/d has a relevant influence on the valproate level and the associated clinical outcome. This may be due to a possible induction of CYP2B6 and increased valproate metabolism. In the case of a treatment of valproate combined with dipyrone, a close monitoring of the valproate level is recommended., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose:  The example of university radiology/neuroradiology illustrates how high-tech angiography simulators can be used meaningfully in teaching, clinical training and research., Materials and Methods/technical Basics:  A VIST LAB simulator (Mentice, Gothenburg, Sweden), which has been continuously developed both in terms of software and hardware, has been in use since 2013. Recently, the simulator has been integrated into the angiography suite Azurion (Philips, Amsterdam, Netherlands)., Results/areas of Application:  In student education there is the possibility for intensive examination of cerebrovascular diseases and their therapy in small group lessons. The training of beginners in diagnostic and interventional angiography begins mandatorily on the simulator. Research questions are the proof of validity and the training effect, but also the influence on patient safety and the possible cost reduction of an intervention., Conclusion:  As a result of continuous further development in recent years, simulators are now very well suited for both student teaching and beginner medical training. In the future, even experienced interventionalists could benefit from further technical advances, which should also be driven by academic research. Possible effects would be the reduction of examination times, complications and costs., Key Points:   · Angiography simulators are useful in teaching students, medical training and research.. · Linking a simulator to an angiography suite increases the degree of reality even further.. · Real patient cases can be practiced and thus patient safety can be increased.. · Future developments should also increase the benefit for experienced interventionalists.. · Integration of simulators into certification programs (e. g. DEGIR) is to be targeted in the future.., Citation Format: · Kreiser K, Gehling K, Zimmer C. Simulation in Angiography - Experiences from 5 Years Teaching, Training, and Research. Fortschr Röntgenstr 2019; 191: 547 - 552., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Apophyseal avulsion fractures of the ischial tuberosity are rare injuries and therefore often not diagnosed in a timely manner. Healing may then result in massive hypertrophic ischial tuberosity. This can cause ischiofemoral impingement symptoms. Due to the low incidence and scarce literature, the optimal treatment and surgery is unclear., Materials and Methods: A literature search was carried out using the online medical database "PubMed". The findings of the literature were then applied to a clinical case of delayed diagnosis of the apophyseal avulsion fracture of the ischial tuberosity., Results: There is no gold standard in the literature for the treatment of avulsion fractures on the ischial tuberosity. Nearly 90% are treated conservatively and a fragment dislocation of more than 2 cm is often the indication for surgical care. However, the surgical procedures described are very diverse. An ischiofemoral impingement symptom may result from excessive ossification of the ischial tuberosity, bringing the ischiofemoral distance to the critical limit of 2 cm., Conclusions: The timely correct diagnosis and initiation of a therapy is crucial for the later outcome of the patient. Ischiofemoral impingement symptoms may be the indication of bony displacement of the ischial tuberosity as a result of injury. Therapy is then surgical with partial resection of the ischial tuberosity and plate osteosynthesis., Competing Interests: The authors declare no conflict of interest with regard to this study. There was no guarantee of any grants or any financial advantages for the authors. The data and results presented in this article have not been published earlier. The written consent of the patient to the use of the photographic material was obtained./Die Autoren schließen jegliche Interessenkonflikte in Bezug auf diese Studie aus. Es bestand keine Gewährleistung von Zuschüssen oder finanziellen Vorteilen gegenüber den Autoren. Auch wurden die hier verwendeten Daten und Ergebnisse bisher nicht veröffentlicht. Die schriftliche Einwilligung des Patienten zur Verwendung des Bildmaterials liegt vor., (Georg Thieme Verlag KG Stuttgart · New York.)

This pilot study investigates the implementation of a practical program for pupils including psychoeducation aimed to educate them about professions in psychiatry. 29 persons aged between 16-21 years were included in the program for vocational orientation at the Department of Psychiatry and Psychotherapy, University of Munich, from 2013-2016. The 1-2-week program provides information about job descriptions of psychologists and physicians. On average the pupils performed at M=2.75, SD=0.64 and they were motivated. At the end of their practical course, they reported that their fear of contact with inpatients decreased. Their knowledge in psychiatry and psychotherapy increased. 59 % of the participants reported that they plan to study medicine or psychology. All young adolescents reported that they satisfied with the program. Enhancing contact with patients and their caretakers may serve to decrease anxiety and prejudices as well as to increase interest and knowledge in this area., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

As an effort to reduce the treatment time in dental implantology, immediate loading has received increasing attention during the past years. The success of early and immediate loading of implants in the interforaminal region is well documented in the dental literature. However, early loading of implants still bears an increased risk. Therefore, strict patient selection is needed. In this case report the rehabilitation of a patient with an immediately loaded implant-supported cantilever fixed partial denture in the mandible is presented. The occurrence of complications few weeks after loading lead to the explantation of two of the five implants. As a consequence, the patient was restored with an implant-retained overdenture.

Twenty-one patients with congenital deformities of the petrous bones were examined by high resolution computed tomography. This allows an accurate description of the extent of the malformation in all parts of the cochlear and vestibular organs; only localised changes in the auditory ossicles, such as fixation of the stapes and changes in the soft tissue portions of the labyrinth, cannot be shown. Improved demonstration of soft tissues while using less radiation makes high resolution CT preferable to conventional polytomography. It is also easier to perform and provides axial projections which are essential for the elucidation of malformations of the middle and inner ear.