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Objective: The aim of this study was to analyse accredited study programmes of health services research in Germany at Master's degree level regarding their structural data and content., Methods: Using a descriptive qualitative design, all included plans of study courses, module handbooks and descriptions of the Master's degree programmes were analysed., Results: The Master's degree programmes were similar in their structural elements as well as in their content of education. They aim at enhancing competences related to the areas of health services research to identify health care needs and to develop, initiate, evaluate and critically assess innovative care strategies across disciplines., Discussion: Although the content is similar, the study programmes focus on specific aspects that allow students to choose a certain programme depending on their preferences. A next step can be the development of a core curriculum that takes into consideration further findings and the discourse of different stakeholders., Competing Interests: Prof. Dr. Silke Kuske, Entwicklung und Studiengangsleitung des Masterstudiengangs Versorgungsforschung und Management im Gesundheitswesen M.Sc. an der Fliedner Fachhochschule Düsseldorf. Michel Wensing ist Studiengangsleiter des M.Sc. Programms Versorgungsforschung und Implementierungwissenschaft im Gesundheitswesen an der Universität Heidelberg. Prof. Dr. Bernd Reuschenbach ist Studiengangsleiter des Masterstudiengangs „Angewandte Versorgungsforschung“ an der Katholischen Stiftungshochschule München. Der in der Analyse aufgenommene Studiengang wird an der Katholischen Stiftungshochschule München angeboten. Prof. Dr. Andreas Büscher ist Studiengangsbeauftragter an der Hochschule Osnabrück für den Studiengang HELPP – Versorgungsforschung und -gestaltung. Prof. Dr. Katrin Balzer hat maßgeblich den Masterstudiengang Gesundheits- und Versorgungswissenschaften an der Universität zu Lübeck mitentwickelt und verantwortet den Vertiefungsschwerpunkt Versorgungsentwicklung und -management in diesem Studiengang. Prof. Dr. Sascha Köpke, bis 31.12.2020 Studiengangsleitung des M.Sc. Programms Gesundheits- und Versorgungswissenschaften an der Universität zu Lübeck. Prof. Dr. Holger Pfaff Studiengangsleitung des M.Sc. Programms Versorgungswissenschaft an der Universität zu Köln., (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: Employees of Sanofi-Aventis Deutschland GmbH underwent thyroid screening in 2006 to assess new data about the prevalence of irregular sonomorphological pattern, elevated thyroid peroxidase antibodies (TPO AB) and thyroid function in an unselected adult German population., Participants, Methods: The examination included 700 unselected employees. Blood samples were analyzed for serum TSH and TPO AB, and ultrasound of the thyroid was performed., Results: In 40.7% of the participants (n = 285) an irregular sonomorphological pattern was detected: goiter in 13.7%, nodules in 35.6%, nodular goiter in 8.6% and a hypoechogenic pattern of the thyroid gland in 20.4%. Serum TSH was increased in 3.9% and decreased in 0.6%. Elevated TPO AB values were observed in 13%. Only 1.4% (n = 10) showed elevated TPO AB combined with a TSH increase. Sonomorphological abnormalities were associated with increased TPO AB in 7.1%. Elevated TPO AB was observed significantly more often in combination with sonomorphological pathology (54.9%) than without (45.1%) (p = 0.003)., Conclusions: Sonomorphological disorders are still very common in Germany and our results are comparable with previous screening examinations. Elevated TPO AB correlated significantly with the sonomorphological pattern of nodules and goiter. This may reflect an improved iodine supply or a hypertrophic stage of autoimmune thyroiditis in some cases.

Unlabelled: AIM, METHODS, PATIENTS: In a prospective interdisciplinary study of 468 carotid artery stenoses we compared the ultrasound plaque morphology with the histological diagnosis., Results: For detection of soft plaques and hard plaques by preoperative ultrasound examination we found a sensitivity of 80%. The accuracy for the estimation of the degree of the stenosis was 98%. In case of stroke in progression and completed stroke we found ulcerations by histological examination in 72%. By ultra-sound these ulcerations were detected only in 53%. We found a significant higher figure for TIA and stroke in soft plaque patients than in asymptomatic stage, in which hard plaque formation was seen more often., Consequences: Patients with a soft plaque seem to have a higher risk of a postoperative permanent neurological deficit. However, the dangerous plaque formation with thrombosis or ulceration was not be detected with appropriate accuracy. Therefore the risk of embolisation cannot be predicted sufficiently by means of duplex scanning. This would be extremely important for the indication for stenting in this area. The number of HITS (high intensity transient signals) is 8 to 20 times higher in carotid stenting.

Although operations on varicous veins are regarded as easy and low-risk, severe complications with the involvement of arteries, veins and nerves can occur during the course of such operations and, in reconstruction, demand the whole spectrum of vascular surgery. Therefore, surgeons operating on varicous veins and on out-patients should possess sufficient experience in vascular surgery and be able to admit their patients to a centre of vascular surgery in the case of severe complications without unnecessary loss of time. Beside a perfectly done operation sufficient preoperative diagnostic examinations and postoperative care of the patient have to be claimed. The treatment of varicous veins in a hospital must be possible also in the future. The extent of the procedure is usually greater during stationary treatment and bilateral operations are feasible. Therefore, from the economic point of view, a stationary assignment for a few days does not seem more expensive than several single operations with subsequent outpatient treatment and repeated diagnostic examinations in ambulatory settings.

According to the principles of minimal invasive surgery a reduced operative trauma and complication rate are the main goals of endovascular aneurysm exclusion. From July 1996 to August 1999 we found 75 patients eligible for endovascular aneurysm therapy. The procedure was primarily successful in 95% of the patients. In the first time we had to switch to open surgery in 4 patients. There was 1 procedure related death. Most frequent later complications were graft occlusion (9.7%) and type I, II and III leakages (14.1%), which were partially repaired using endovascular techniques and partially by use of open surgery. In a selected group of patients the middle term results of infrarenal aneurysm therapy by endovascular stent graft implantation are promising.

We report our experience with carotid surgery during the past 11 years and a prospective randomized study on 600 patients with conventional thromb-endarterectomy (TEA) versus eversion-endarterectomy (EEA). First results gave EEA a slight advantage, which could not be proved in the following years. Both methods are equivalent in terms of postoperative and long-term results. Follow-up showed one difference between the two methods: Restenosis occurred more often in the TEA-group (14.7% TEA versus 6.5% EEA). The frequency of symptomatic restenosis was the same in both groups (3.8% TEA versus 3.9% EEA). EEA did not show late restenosis. We attribute this to the avoidance of patch-suture and the introduction of patch material, as was observed by other authors. No ruptures of venous patches occurred in our study after primary implantation, while two venous grafts ruptured after substitution of an infected Dacron patch. Infection rate for the Dacron patch was below 0.2% and is therefore negligible. Duplex-ultrasound is indispensable in evaluating plaque-morphology, although sensitivity is low in the detection of dangerous atherosclerotic lesions (73.4% for the soft plaque, 31.9% for ulcerations). In view of these results and a critical analysis of the current literature, we see slight advantages for EEA over TEA inspite of equivalent operative results. However, EEA is a suitable procedure only in connection with subtile intraoperative control and in the hand of an experienced surgeon.

The simple determination of whole-body retention of the bile acid analogue 75Se-HCAT provides results which are in agreement with those of the established but more difficult measurement of 24-14C-TCA excretion in the feces. Determining whole-body retention of 75Se-HCAT is not only practicable with a whole-body counter but also, with precision, with the more widely used gamma camera. Therefore, the bile acid retention test may be employed wherever there is a gamma camera available.

A West German family with hereditary pancreatitis is described. Four members are definitely known to have had pancreatitis, while three additional members are suspected of having the disease. The mean age of onset of symptoms was 14 years. Known causes of secondary pancreatitis and amino aciduria were ruled out in each case. HLA-segregation was analysed on the A, B, C, and DR loci in all members of the family, but no coupling between distribution of HLA haplotypes and incidence of pancreatitis was detected.

In two randomized prospective trials grafts impregnated with gelatine were compared to those not impregnated. In the first trial a double-velours graft (n = 50) was compared with a graft without velours trimming (n = 50) implanted in the aorto-iliac bifurcation. One half of the grafts in both groups were gelatine-impregnated. In the second trial 24 grafts without velours trimming (Cooley II, Meadox), 24 grafts manufactured by a new warp-knitting procedure without velours trimming (Protegraft 2000, B. Braun AG) and 24 identical grafts of B. Braun AG but with gelatine impregnation were evaluated. Gelatine-impregnated or not the grafts without velours showed no satisfying results. An elevated intraoperative bleeding incidence and a low two-years-patency rate of 64% were noted. On the other hand all double-velours grafts, gelatine-impregnated or not, showed a 100% patency rate two years after implantation. In the second trial a slight reduction in intraoperative blood loss was noted when using the gelatine-impregnated grafts.

Nifedipine (Adalat) was used in managing acute hypertension in 20 patients with coronary heart disease during endarterectomy for carotid stenosis. Nifedipine (Adalat) was given if the cardiac index dropped below 2.5 l/min and the total peripheral resistance increased above 2,500 dyn/sec cm-5. In these patients the systolic blood pressure was 20% higher than the control value. After IV bolus injection of 1 mg nifedipine we noticed a 64% increase of the stroke volume index and a statistically significant 56% decrease of the total peripheral resistance. These values became stable under a maintenance dose. The left ventricular stroke work index increased after IV bolus injection and subsequently, by about 7%. This increase was statistically not significant. To evaluate the myocardial contractility, the heart rate and systolic pulmonary capillary wedge pressure were measured. After greatly raised values in hypertensive emergency, these parameters showed a 27% decrease following IV bolus injection and during the subsequent intraoperative course they stabilised at standard levels. The heart rate increased by about 10%, but this was statistically not significant. In accordance with the increase in heart rate, the coronary perfusion pressure decreased by about 31% (expressed in mm Hg) (mean value) and dropped even lower in some patients. The parameters for preload, central venous pressure and pulmonary capillary wedge pressure did not show any statistically significant changes. The authors conclude that nifedipine (Adalat) can be used with good results in treating hypertensive emergencies associated with low-output syndrome in patients with coronary heart disease during carotid endarterectomy.

During recent years, the risk involved in cerebral angiography has been considerably reduced. However, in our patient group this risk was still almost as high as that involved in operation. Non-invasive examination by means of the ultrasonic Doppler procedure has been improved with a resulting success rate of over 95%. Color coding stored in a computer program with the "Echoflow"-procedure allows for demonstration of the neck vessels giving an indication of the degree of stenosis. By this method, pictures of document quality are provided which can also be obtained by inexperienced examiners and interpreted more easily than curve registrations of the acoustic signals. In comparison with angiography, the Echoflow method was less sensitive than the conventional ultrasonic Doppler procedure especially in cases of low-degree stenosis of the internal carotid artery. Nevertheless, in 2.7% of the cases, a correct Echoflow diagnosis could be confirmed during operation where angiography had not shown the changes correctly. As the Echoflow procedure does not give sufficient information on intracranial pathology, we have so far dropped angiography in emergency cases only when establishing the indication for operation; however, in follow-up examinations this method is used exclusively instead of angiography.