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In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lacking regarding indications, contraindications, limitations and management of ECMO/ECLS patients. Therefore in 2015, the German Society of Thoracic and Cardiovascular Surgery (GSTCVS) registered the multidisciplinary S3 guideline "Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure" to develop evidence-based recommendations for ECMO/ECLS systems according to the requirements of the Association of the Scientific Medical Societies in Germany (AWMF). Although the clinical application of ECMO/ECLS represents the main focus, the presented guideline also addresses structural and economic issues. Experts from 17 German, Austrian and Swiss scientific societies and a patients' organization, guided by the GSTCVS, completed the project in February 2021. In this report, we present a summary of the methodological concept and tables displaying the recommendations for each chapter of the guideline., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: Older employees are often thought to be vulnerable to negative effects of information and communication technology (ICT). Our study aims to examine associations between work-related ICT exposure (i.e. ICT use or digital work intensification), physical health, mental health and work ability (WA). We examine whether these associations are modified by socio-economic position (SEP)., Methods: We analysed cross-sectional data from 3180 participants (born in 1959 and 1965) in wave 3 of the representative German lidA cohort study. We performed hierarchical multiple regression to assess the distinct associations of ICT use and digital work intensification with mental and physical health and WA. We stratified analyses by SEP and controlled for age, sex, and digital affinity., Results: 92% of participants reported ICT use at work. Almost 20% reported high levels of digital work intensification, while a similar proportion did not experience digital work intensification. In bivariate analyses, ICT use by itself was not significantly associated with mental health or WA in the total sample or when stratified. Digital work intensification displayed negative associations with mental health and WA. In hierarchical multiple regressions, digital work intensification showed consistently negative associations with mental health and work ability of similar strength across SEP., Conclusion: Our results suggest that ICT use, per se, does not negatively impact older workers. Digital work intensification may be associated with worse mental health and work ability. Research on health and social implications of work-related ICT should differentiate patterns of ICT exposure and assess modifications by SEP to better gauge the ambiguous effects of ICT.

Purpose: This study aimed to find out more about factors that hinder physicians' careers, especially with regard to gender differences, and which future working conditions they would prefer., Methods: In an online survey, members of the professional societies of Hematology and Oncology in Germany, Austria and Switzerland were asked to rate factors that might hinder or facilitate their professional career. Data analysis included χ 2 -tests, t tests and analyses of variance., Results: 469 physicians participated (61% female, response rate 9.1%). 40% of the participants experience a lack of compatibility between family life and career. Female physicians with children living in their household especially feel restricted in their professional development. The most preferred conditions for improving compatibility were flexible working hours (72%), opportunities to work in home office (71%), better opportunities for specialist training (51%) and enabling managerial activities on a part-time basis (73%). Both female and male physicians would like fathers to be encouraged to take parental leave to the same extent as mothers (50%). They would, e.g., like to see more flexible drop-off and pickup times for children (71%) and more childcare options offered by their employer (61%)., Conclusion: Results suggest various options for promoting compatibility of family life and work, e.g., by family-friendly working time models and part-time offers breaking with traditional role models. Managerial positions might be offered on a regular part-time basis. Structured qualification programs could enable the compatibility of clinical work, research and family life. Childcare services should preferably be provided in line with existing needs., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

As the German population is continually aging and the majority of older adults still wish to 'age in place', the need for informal care provided by family and friends will correspondingly continue to increase. In addition, while the need for formal (professional) care services is also likely to increase, the supply already does not meet the demand in Germany today. The aim of our study is the elicitation of people's willingness to provide informal care by means of a discrete choice experiment. The self-complete postal survey was disseminated to a random sample of the German general population in Lower Saxony. Data cleansing resulted in a final sample size of 280 participants. A conditional logit and a latent class model were estimated. All attributes were judged as highly relevant by the respondents. The results revealed that an increase in the care hours per day had the greatest negative impact overall on the willingness to provide informal care in our sample. The marginal willingness-to-accept for 1 h of informal care was €14.54 when having to provide informal care for 8 h in reference to 2 h per day. This value is considerably higher than the national minimum wage of €9.82. A three-class latent class model revealed preference heterogeneity. While a monetary compensation is often discussed to increase the willingness and availability of informal care in a country, our results show that this statement could not be generalized within our entire sample., (© 2022. The Author(s).)

Purpose: The International Abstract(s) of Surgery (IAS) was a monthly supplement to Surgery, Gynecology & Obstetrics (SG&O, later Journal of the American College of Surgeons) from 1913-1994, approximately equal in size to the journal itself. It followed the example of the Zentralblatt für Chirurgie (ZblCh), which had been compiling abstracts of the current world surgical literature since 1874 (but in the German language). This article seeks to review the relationships of these surgical abstract journals in historical context., Methods: Citations in the IAS were systematically sampled for 1913-1990, and in the ZblCh and other American and German surgical publications for 1905-1940. Changes in the proportions of citations by language category were tabulated over time and related to concurrent international events and the publication histories of the sampled journals., Results: German-language citations were most frequent until the First World War, even in America. They subsequently became less frequent in America, but remained dominant in Germany. Articles in French or other languages were occasionally cited by Americans, but in German publications, they were cited as frequently as those in English. Contemporary observations from this time confirm that the American literature was being disregarded by most German surgeons. Since the Second World War, surgical publications have become predominantly English-language, even in Germany, and printed abstract compilations have become irrelevant., Conclusions: The history of the IAS and ZblCh reflects world events of the early twentieth century, the isolation and decline of German scientific leadership, the rise of American surgery, and the transition from a multilingual print-based era to one where scientific communication is primarily electronic and in English., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Gastrointestinal infections are among the most frequent imported diseases diagnosed in Germany in travelers or migrants from the tropics. Acute traveler's diarrhea is the most frequent illness in long-distance travelers and in high-risk areas (e.g. India, Mexico) around one third of all travelers suffer from diarrhea. Chronic diarrhea plays a role especially after longer stays abroad (> 4 weeks) and in migrants and is often caused by protozoa. Helminths are less frequently the causative agent of gastrointestinal complaints (diarrhea, nausea, abdominal pain). A worm infestation of the large and small intestines is often present but helminths can also affect the liver or lead to generalized symptoms of illness when larvae migrate. In principle, in the case of gastrointestinal complaints after exposure to the tropics, the possibility of an imported tropical endemic infectious disease must be considered and appropriate diagnostics initiated. For travelers returning from tropical countries other, sometimes life-threatening diseases, such as malaria, typhoid fever, rickettsiosis and viral hemorrhagic fever (VHF) can present with gastrointestinal symptoms and should never be overlooked., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: Due to recent trends such as globalization and digitalization, more and more employees tend to have flexible working time arrangements, including boundaryless working hours. The aim of this study was to investigate the relationships of various aspects of boundaryless working hours (overtime, Sunday work, and extended work availability) with employees' state of recovery. Besides, we examined the mediating and moderating role of recovery experiences (psychological detachment, relaxation, mastery, and control) in these relationships., Methods: We used data from 8586 employees (48% women; average age of 48 years) who took part in the 2017 BAuA-Working Time Survey, a representative study of the German working population. Regression analyses were conducted to test main effects as well as mediation and moderation., Results: Overtime work, Sunday work, and extended work availability were negatively related to state of recovery. Psychological detachment mediated these relationships. Furthermore, we found that relaxation and control mediated the association between extended work availability and state of recovery. However, no relevant moderating effects were found., Conclusions: Altogether, our findings indicate that various aspects of boundaryless working hours pose a risk to employees' state of recovery and that especially psychological detachment is a potential mechanism in these relationships. In addition, the results suggest that a high level of recovery experiences cannot attenuate these negative relationships in leisure time. Therefore, employers and employees alike should try to avoid or minimize boundaryless working hours., (© 2021. The Author(s).)

Background: Survey by the commission for cross-sectoral ophthalmology, as a joint commission of the German Ophthalmological Society (DOG) and the Professional Association of German Ophthalmologists (BVA) on the effects of the SARS-CoV‑2 pandemic on ophthalmological patient care in Germany., Methods: Online-based survey., Results: A total of 1190 questionnaires were (partly) answered. With respect to outpatient care and consultations from 15 March to 15 April 2020, a total of 69 (5.8%) participants indicated unlimited, 756 (63.5%) reduced and 330 (27.7%) emergency care only, independent of the type of institution. Outpatient surgery was restricted to emergency surgery in 68% of clinics, 42.0% of inpatient wards, 45.0% of surgical medical care centers and group practices and 33.0% of private practices. Inpatient procedures were limited to emergency care in 75.0% of inpatient wards and in 71.0% of clinics. With the exception of endophthalmitis (+8.2%), the number of urgent indications and emergencies declined: retinal detachment (-34.8%), perforating eyeball injuries (-7.3%), acute glaucoma (-17.8%), central retinal artery occlusion and anterior ischemic optic neuropathy (-31.0%), others (-30.9%), penetrating keratoplasty and amniotic membrane transplantation (-59.1%). Institutional or professional policy requirements (76.0%) and appointment cancellation by patients (84.0%) were the most common reasons for limitations in ophthalmic patient care., Conclusion: The initial phase of the pandemic was characterized by a massive reduction in non-urgent conservative and surgical treatment that affected all areas of ophthalmology. Due to intensive care capacities required for COVID-19 patients, inpatient treatment was largely restricted to emergencies. Treatment of ophthalmological patients, including ocular emergencies and urgent treatment, was maintained across all sectors with a (considerable) decrease in the number of cases even in these groups., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: Neck dissection (ND) is a surgical procedure addressing cervical lymph nodes and metastases in patients with oral squamous cell carcinoma (OSCC). The aim of this study was to analyze clinical decisions regarding indications and variations of ND in Oral and Maxillofacial Surgery (OMFS) in Germany., Material and Methods: A nationwide survey of the German Association of Oral and Maxillofacial Surgery was performed using dynamic online questionnaires including 38 questions. Data about oncological centers, case numbers, and staging procedures were collected. Relevant aspects, such as inclusion of level IIb and levels IV and V to ND, uni- vs. bilateral ND, and the influence of extra-nodal extension (ENE) of metastases on extension of ND were evaluated., Results: Eighty-four OMFS of university and non-university hospitals participated in the study (responding rate 21.4%). Sixty-six (78.57%) stated to work at certified cancer centers and 53.57% of the hospitals treated between 50 and 100 OSCC cases per year. CT and/or MRI of the head and neck was performed in most of the staging procedures. Level IIb was included by 71 (93.42%) of the participants in selective ND. Levels IV and V were included by 53 (69.74%) in node-positive neck. In solitary ipsilateral metastases (ENE-), 49 participants (62.82%) stated to perform exclusively an ipsilateral ND and 40 (51.95%) stated to perform only an ipsilateral ND in ENE+., Conclusion: This study demonstrated a high rate of certified cancer centers in Germany showing differences regarding staging procedures, indications, and extension of ND, especially in increasingly complex cases., Clinical Relevance: Clinical decisions regarding ND are dependent on case-individual aspects and must be decided individually.

Purpose: The evidence-based (S3) guideline "Adult Soft Tissue Sarcomas" (AWMF Registry No. 032/044OL) published by the German Guideline Program in Oncology (GGPO) covers all aspects of sarcoma treatment with 229 recommendations. Representatives of all medical specialties involved in sarcoma treatment contributed to the guideline. This paper compiles the most important recommendations for surgeons selected by delegates from the surgical societies., Methods: A Delphi process was used. Delegates from the surgical societies involved in guideline process selected the 15 recommendations that were most important to them. Votes for similar recommendations were tallied. From the resulting ranked list, the 10 most frequently voted recommendations were selected and confirmed by consensus in the next step., Results: The statement "Resection of primary soft tissue sarcomas of the extremities should be performed as a wide resection. The goal is an R0 resection" was selected as the most important term. The next highest ranked recommendations were the need for a preoperative biopsy, performing preoperative MRI imaging with contrast, and discussing all cases before surgery in a multidisciplinary sarcoma committee., Conclusion: The evidence-based guideline "Adult Soft Tissue Sarcomas" is a milestone to improve the care of sarcoma patients in Germany. The selection of the top ten recommendations by surgeons for surgeons has the potential to improve the dissemination and acceptance of the guideline and thus improve the overall outcome of sarcoma patients., (© 2023. The Author(s).)

When healthcare interventions prolong life, people consume medical and non-medical goods during the years of life they gain. It has been argued that the costs for medical consumption should be included in cost-effectiveness analyses from both a healthcare and societal perspective, and the costs for non-medical consumption should additionally be included when a societal perspective is applied. Standardized estimates of these so-called future costs are available in only a few countries and the impact of inclusion of these costs is likely to differ between countries. In this paper we present and compare future costs for five European countries and estimate the impact of including these costs on the cost-effectiveness of life-prolonging interventions. As countries differ in the availability of data, we illustrate how both individual- and aggregate-level data sources can be used to construct standardized estimates of future costs. Results show a large variation in costs between countries. The medical costs for the Netherlands, Germany, and the United Kingdom are large compared to Spain and Greece. Non-medical costs are higher in Germany, Spain, and the United Kingdom than in Greece. The impact of including future costs on the ICER similarly varied between countries, ranging from €1000 to €35,000 per QALY gained. The variation between countries in impact on the ICER is largest when considering medical costs and indicate differences in both structure and level of healthcare financing in these countries. Case study analyses were performed in which we highlight the large impact of including future costs on ICER relative to willingness-to-pay thresholds., (© 2022. The Author(s).)

Background: Chronic pain, with a prevalence of at least 17%, is a costly health problem associated with a high burden of disease. Musculoskeletal chronic pain is particulary common, which in many cases is treated with physiotherapy., Aim: The aim of this paper is to provide an overview of innovative, promising physiotherapy interventions in pain management, to present their effectiveness and to discuss their implementation in healthcare., Methods: A narrative review was conducted. The Cochrane, Medline (via PubMed) and PEDro databases were searched using the search terms chronic pain, physiotherapy, prevention, pain education, behavioural intervention, eHealth, and systematic review as well as chronic pain, guideline and relevant synonyms., Results: One guideline review, two guidelines and ten systematic reviews were included. Chronic pain prevention, digital health apps, lifestyle interventions and behavioural approaches were identified as promising and effective interventions for people with chronic pain, showing the potential to meaningfully complement pain physiotherapy and improve quality of care., Conclusions: Despite the predominantly positive results from systematic reviews, implementation in everyday care is difficult due to conditions of care and the contemporary education system for physiotherapists in Germany. Health services research can play an important role in accelerating the transfer of innovations into practice., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

This paper contributes to the discussion of whether non-indicated ultrasound examinations of the thyroid gland contribute to overtreatment and excess health care expenditures. Using two sources of claims data from Germany, we analyzed data from patients who underwent a TSH blood test which is the initial diagnostic measure to check for possible presence of thyroid dysfunction. In a matching analysis, we compared health costs of two groups of patients. One consisted of patients who underwent an early thyroid ultrasound that according to medical guidelines-at this point-was probably not indicated. The other group consisted of patients, who underwent no ultrasound examination at all or later in the course of the disease, making probable a correct indication. Both groups were made comparable by the means of a matching procedure. Average thyroid-specific health costs were substantially higher for the first group in the quarter in which the ultrasound examination took place. Some deviation in these specific costs persisted over a substantial period of time, with drug expenditures exhibiting the biggest difference. If, however, total health costs were considered, difference in costs was only found in the initial quarter. We conclude that non-indicated ultrasound examination of the thyroid gland may have some moderate effects on thyroid-specific costs. Yet the data do not suggest that long-lasting overtreatment and excess health expenditures are initiated by non-indicated ultrasound in Germany., (© 2021. The Author(s).)

When Adolf Hitler annexed Austria to the German Reich in 1938, the famous Jewish oral pathologist Bernhard Gottlieb was in great distress. The Viennese university teacher immediately lost his employment and teaching authority and was forced to emigrate.While Gottlieb's exceptional scientific position in oral pathology is well documented, the complex implications of his deprivation of rights and forced emigration in the Third Reich have so far received little attention. Against this background, the present contribution poses the question of the concrete effects of this drastic event on Gottlieb's life and work.In order to clarify this question, Gottlieb's career status, his scientific success up to 1938, the concrete background of his forced emigration, as well as the further course of his life and career in the USA (his immigration country) are scrutinized. In addition, the paper analyzes the extent to which Gottlieb was able to build on his professional career after 1945 and posthumously. The work is based on a thorough analysis of Gottlieb's academic career using archival sources and a re-analysis of the relevant research literature.The study concludes that Gottlieb suffered a severe setback after his emigration. Several reasons played a role. In particular, cultural and age-related adjustment problems, difficult local conditions, and scarce financial resources hampered the seamless continuation of Gottlieb's career in the USA. Only in the last two decades have efforts been made, particularly in the environment of the University of Vienna, to bring Bernhard Gottlieb and his scientific achievements back into collective memory., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Herbert Siegmund (1892-1954) was undoubtedly one of the most influential German pathologists of the 20th century. He received numerous high honors both during the Third Reich and after 1945. He was, among other things, rector of the University of Münster (1943-1945), holder of the Goethe Medal awarded by Hitler (1944), honorary doctor of the University of Cologne (1949), recipient of the Paracelsus Medal (1953), and president of the German Society for Pathology (DGP, 1954). The almost seamless post-war career was possible above all because Siegmund was counted among the politically uninvolved university physicians after 1945. It was not until after the turn of the millennium that this picture cracked., Material and Methods: The article is based on primary sources from the State Archives of Schleswig-Holstein and North Rhine-Westphalia, the University Archives of Münster, the Federal Archives of Berlin, the University Archives of Cologne, and the City Archives of Stuttgart, some of which were evaluated for the first time. Two questions are at the center of this article: (1) To what extent can it be proven that Siegmund benefited from the Nazi state in terms of his career after 1933? (2) Are there indications that he served the Nazi regime and its networks? In addition, we will discuss how Siegmund himself described his role in the Third Reich and whether his statements stand up to critical scrutiny., Results: The paper concludes that Siegmund contributed to valorizing the Nazi system. After 1945, he did not position himself at a critical distance from his activities in the Third Reich; rather, he drew of himself - largely unopposed - the image of a politically blameless scholar., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Like many OECD countries, Germany is currently facing a shortage of long-term care (LTC) workers. This situation is concerning in the context of the ageing of the German population. A potential reason why Germany fails to recruit and retain LTC workers is that LTC jobs are particularly demanding (physical and psychological strain) which may be harmful to health. However, there is a lack of empirical evidence demonstrating this effect. This article fills the gap in the literature by exploring to what extent LTC jobs reduce workers' health over time. We estimate a dynamic panel data model on the German Socio-Economic Panel (v.35; 1984-2018), which allows adressing selection issues into occupations. Our paper provides innovative findings on the impact of LTC occupations on workers' health. We confirm that LTC jobs have a negative impact on self-reported health. Our results have strong policy implications: we emphasize the need to provide sufficient assistance to LTC workers, who are at risk of facing more health issues than other workers. This issue is key to increase the attractiveness of LTC jobs and reduce turnover in the LTC workforce.

Objective: Studies examining what renders workplace interventions to sustain and promote work ability of older workers successful have largely neglected older workers´ perspective. This paper outlines the results of a study with regard to older workers´ experiences and expectations of a workplace intervention. Based on these findings, some reflections on how to improve the design and the implementation of workplace interventions for older workers are provided., Methods: Semi-structured interviews were conducted with older workers (N = 8) participating in a workplace intervention undertaken at one production site of a large manufacturing company in Baden-Wurttemberg/Germany. The interview guide included questions on participants´ experiences with and expectations of the intervention. The interviews were recorded, transcribed verbatim and analyzed using qualitative content analysis according to Mayring (2014)., Results: Older workers´ reported some challenges they face due to their participation in the workplace intervention. These resulted from the work environment (physical challenges), the work process design (new long work cycle), the work organization (tight time allowances, little job rotation, change of teams, age stereotypes) and the management of the workplace intervention (bad information, feeling of occupational insecurity and lack of being valued)., Conclusions: The study shows that challenges arising for older workers from their participation in the workplace intervention may have counteracted the promotion of work ability. As findings suggest, some of these challenges might have been avoided either by considering workers´ perspective during design and implementation of an intervention or by referring to evidence on aging and work ability.

Background: Endometriosis is one of the most common diseases in women of reproductive age. Despite characteristic symptoms such as dysmenorrhea, chronic abdominal pain, dysuria, dyschezia and dyspareunia, the average latency until diagnosis is around 10 years. In addition to the individual limitations, the disease also has economic and health policy relevance. The complaints are followed by reductions in working hours, cyclically recurring short-term sick leave or presenteeism with reduced performance., Objective: An overview of the main recommendations of the S2k guideline on the diagnosis and treatment of endometriosis., Material and Methods: For the S2k guideline "Diagnostics and therapy of endometriosis", a systematic literature search was conducted in PubMed and Cochrane according to a defined algorithm and over a period of more than 5 years, from 01.01.2014 to 31.12.2018. For the evaluation, 322 publications, including systematic reviews, meta-analyses and randomized controlled trials were considered and these were assessed by 41 mandate holders and representatives from 25 Association of the Scientific Medical Societies in Germany (AWMF) and non-AWMF professional societies, organizations, associations and working groups of the German Society for Gynecology and Obstetrics (DGGG), as well as two patient target groups., Results: In a structured consensus process, 48 recommendations and 27 statements were formulated, which are presented in extracts in this paper., Discussion: Interdisciplinary cooperation is essential in the treatment of patients with (suspected) endometriosis. This team should include all necessary disciplines in a cross-sectoral network. This is most likely to be achieved in a certified structure.

Background: In recent decades, a number of institutions have been established to address the development, application, and dissemination of evidence-based medicine (EBM) in Germany., Objectives: The aim of the paper is to give an overview of important EBM institutions in Germany and to determine their tasks and goals., Materials and Methods: Internet research was conducted to identify important German EBM institutions., Results: EBM institutions in Germany can be divided into institutions of self-administration and independent institutions in the health care system. Common tasks and goals are mainly the improvement of health care, the dissemination of evidence-based knowledge and the further development and teaching of EBM methods., Conclusions: Both self-governing institutions and independent institutions have taken up EBM. They ensure that EBM becomes an integral part of everyday medical practice.