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Digital learning resources are in increasing demand, especially in the light of the planned reform of the medical licensing regulations for 2028. In a pilot project, we digitised and evaluated a logbook for students in their practical year (PJ).The aim of this study is to evaluate the digital and non-digital PJ logbooks.Based on a printed PJ logbook, a digital PJ logbook was developed as a web app. The implementation was performed using the commercial enterprise knowledge management system Confluence (Atlassian Corporation, Sydney, Australia), which allows responsive design, integration with the university's user directory, and incorporation of corporate design. Student satisfaction (n = 34) was assessed using questionnaires and a 5-level Likert scale. Additionally, students self-assessed their skills at the beginning and end of the rotation before (n = 49) and after (n = 34) the introduction of the digital logbook by grade points.The majority of students found the digital logbook to be an intuitive and a valuable addition. In the stationary setting, the introduction of the digital logbook led to a significant improvement in self-assessed skills by 0.73 grade points at the beginning (p < 0.001) and 0.78 grade points at the end of the rotation (p < 0.001). In the operating theatre, there was only a significant improvement of 0.47 grade points at the beginning of the rotation (p = 0.027).The evaluation demonstrates that the digital PJ logbook is well-received by students and significantly improves their self-assessed skills. The observed increase in self-assessed skills could be attributed to the introduction of the digital logbook and its contents, although other factors, such as the engagement of the instructors, cannot be excluded. Future modifications are planned to make the logbook more appealing., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

With the Network of University Medicine (NUM) and the Medical Informatics Initiative (MII), the BMBF is funding two pioneering, structure-building research measures that are now being merged. The data integration centers (DIZ) of the MII are to be consolidated in the NUM. The aim is to establish a standardized research infrastructure within which the existing data from the clinical routine care of the 36 German university hospitals, from clinical cohorts and clinical-epidemiological studies can be used for various research questions upon request and via coordinated processes. The legal basis for this was the MII's "Informed Broad Consent", which had been agreed upon with ethics committees and data protection authorities and implemented in all NUM locations, with a so-called "health insurance module" that allows the collection and linking of routine medical data from statutory health insurance funds (GKV) and private health insurers (PKV) as a category of care-related data (VeDa). Linking this routine data with data from hospital information systems offers particularly high potential, as no single data source provides a complete picture of medical care and the two data sources complement each other optimally. The aim now is to integrate this routine data into the NUM's secure, transparent and participatory research infrastructure in a strategic partnership with statutory health insurance funds and private health insurance companies. This promotes Germany in its role as a research location and makes a decisive contribution to improving the quality and safety of healthcare in Germany in an evidence-based manner., 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/).)

Objective of the Study: To investigate the importance of individual topics in outpatient care services and the preferences for their design from the perspective of young adults with cancer (AYA="adolescents and young adults") in Germany., Methodology: A total of 514 AYAs aged 18-39 years were surveyed twice over a 12-month period (t1=immediately after acute treatment, t2=12 months post-treatment) regarding the importance and satisfaction with topics such as anxiety, the impact of the illness on partnerships/family and social environment, future perspectives, personal coping strategies, sexuality, and desire for children/fertility, as well as the types of care services. The subjective importance and satisfaction with the care topics and services were analyzed using variance and moderator analyses., Results: The most important topics for care services were future career prospects (M=3.22, SD=1.56), social impact (M=3.19, SD=1.54), and personal coping strategies (M=3.52, SD=1.46). The greatest dissatisfaction was noted in the areas of sexuality (M=2.01, SD=1.59) and desire for children/fertility (M=2.08, SD=1.72). At time t2, relaxation techniques (M=3.46, SD=1.36) and psychological counseling (M=3.43, SD=1.46) were the most desired care services. Female AYAs rated psychological counseling (F[1.199)=9.21, p=0.003), social counseling (F[1.221]=6.60, p=0.011), creative therapy options (F[1.219]=21.74, p<0.001), support groups (F[1.215]=4.29, p=0.040), patient education (F[1.210]=6.96, p=0.009), and relaxation techniques (F[1.194]=23.68, p<0.001) significantly more important than male AYAs., Conclusions: The study highlighted several areas of dissatisfaction with the current outpatient care services for AYAs. The results demonstrate the need to incorporate cross-sex and gender-specific care preferences of AYAs to improve outpatient psychosocial care. A specific set of AYA-care services should be designed and implemented to address the aforementioned psychosocial topics, which include sexuality and the desire for children/fertility. It is also crucial for outpatient practice to raise awareness among the involved professional groups. Further research is required to gain a deeper understanding of sex differences., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The present article describes the special features of an evaluation of research in mental health services in Germany. The experiences of the evaluation of flexible and integrated treatment options with a global treatment budget in psychiatric hospitals based on routine data of more than 70 statutory health insurance (SHI) funds (EVA64 study) are systematically presented. Using the EVA64 study as an example, recommendations for the use of claims data in the field of mental health services research and in general are derived. (1) First, the study and its use of claims data is described and classified. (2) The individual outcomes of the study are presented and evaluated in order to (3) derive criteria, identify strengths and suggest potential uses of claims data. (4) Finally, recommendations for the further development of claims data from SHI funds as a basis for evaluation are described., Competing Interests: ZEGV, WIG2 und ISMG wurden im Rahmen der EVA64-Studie, der Bundesweit einheitlichen Wissenschaftlichen Evaluation von Modellprojekten nach § 64b SGB V, finanziert. Die Förderung dieser Studie erfolgt von einem Konsortium bestehend aus mehr als 70 GKVen., (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/).)

Introduction: Pirfenidone was the first anti-fibrotic drug approved in Europe in 2011 for the treatment of mild-to-moderate idiopathic pulmonary fibrosis., Objectives: To investigate the clinical course of mild-to-moderate idiopathic pulmonary fibrosis in pirfenidone-treated patients in a real-world setting., Methods: The non-interventional study was conducted at 18 sites in Germany from 6/2014-12/2016. Adult patients with mild-to-moderate idiopathic pulmonary fibrosis were treated with pirfenidone (escalated from 3×1 to 3×3 capsules of 267 mg/day within 3 weeks) for 12 months. The observation period comprised 4 follow-up visits at months 3, 6, 9 and 12. Disease progression was defined as decrease of ≥10% in vital capacity or ≥15% in diffusing capacity of the lung for carbon monoxide (DL CO ) and/or ≥50m in 6-minute walking distance vs. baseline, or "lack of response/progression" as reason for therapy discontinuation., Results: A total of 51 patients (80.4% male, mean age 70.6 years) were included in the full analysis set. Disease progression at any visit was reported for 23 (67.6%) of 34 patients with available data. Over the course of the study, lung function parameters, physical resilience, impact of cough severity on quality of life, and the mean Gender, Age and Physiology Index (stage II) remained stable. In total, 29 patients (56.9%) experienced at least one adverse drug reaction (11 patients discontinued due to adverse drug reactions); serious adverse reactions were reported in 12 patients (23.5%)., Conclusions: The results of this study are in line with the established benefit-risk profile of pirfenidone. Therefore, pirfenidone can be considered a valuable treatment option to slow disease progression in mild-to-moderate idiopathic pulmonary fibrosis. NCT02622477., Competing Interests: JS: grants, personal fees and research support from Roche, during the conduct of the study; WS: Research grants, investigator fees, honoraria, speakers fees from Lilly, Merck, AstraZeneca, Roche, Boehringer Ingelheim; WK: The author has no conflicts of interest to declare; BS: Speakers fees from Boehringer Ingelheim, Berlin Chemie, Roche, GSK; DK: consultancy or speaker fees from AstraZeneca, Boehringer Ingelheim, Grifols, Novartis, Roche/Intermune, Sanofi-Aventis and Teva; KN: Employee of Roche; CG: Boehringer Ingelheim, Novartis, Merck Sharp & Dome, Takeda, Boehringer Ingelheim, Roche. CG is editor-in-chief for the journal “Pneumologie”., (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/).)

Purpose: To utilize 4 D flow MRI to acquire normal values of "conventional 2 D flow MRI parameters" in healthy volunteers in order to replace multiple single 2 D flow measurements with a single 4 D flow acquisition., Materials and Methods: A kt-GRAPPA accelerated 4 D flow sequence was used. Flow volumes were assessed by forward (FFV), backward (BFV), and net flow volumes (NFV) [ml/heartbeat] and flow velocities by axial (VAX) and absolute velocity (VABS) [m/s] in 116 volunteers (58 females, 43 ± 13 years). The aortic regurgitant fraction (RF) was calculated., Results: The sex-neutral mean FFV, BFV, NFV, and RF in the ascending aorta were 93.5 ± 14.8, 3.6 ± 2.8, 89.9 ± 0.6 ml/heartbeat, and 3.9 ± 2.9 %, respectively. Significantly higher values were seen in males regarding FFV, BFV, NFV and RF, but there was no sex dependency regarding VAX and VABS. The mean maximum VAX was lower (1.01 ± 0.31 m/s) than VABS (1.23 ± 0.35 m/s). We were able to determine normal ranges for all intended parameters., Conclusion: This study provides quantitative 4 D flow-derived thoracic aortic normal values of 2 D flow parameters in healthy volunteers. FFV, BFV, NFV, and VAX did not differ significantly from single 2 D flow acquisitions and could therefore replace time-consuming multiple single 2 D flow acquisitions. VABS should not be used interchangeably., Key Points: · 4 D flow MRI can be used to replace 2 D flow MRI measurements.. · The parameter absolute velocities can be assessed by 4 D flow MRI.. · There are sex-dependent differences regarding forward, backward, net aortic blood flow and the aortic valve regurgitant fraction.., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

The article deals with the question of how Long Covid has become a disease. Of interest are the pathways and imprints, how the problem has established itself as a disease and materialized, or how society has come to the realization of its problems. Far-reaching institutionalization of Long Covid as a disease belies existing interpretive struggles in and around Long-Covid. How meaning is produced and how it becomes effective might be the starting point of a praxeological cultural analysis as proposed here., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Ultrasound-guided ablation techniques have been increasingly introduced into routine treatment of thyroid lesions as a complement to existing surgical therapies and radioiodine treatment. In cystic or predominantly cystic lesions instillation therapy (ethanol/polidocanol ablation) has yielded good results. Novel thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high intensity focused ultrasound (HIFU), induce irreversible cellular effects by locally applying temperatures ≥ 60 °C to the targeted thyroid region. Lesions causing local symptoms or focal hyperfunctionality can thus be selectively treated under continuous sonographic monitoring. While a considerable body of evidence supports the efficacy and safety of various local ablative techniques, future challenges lie in initiating comparative prospective trials and in standardizing clinical practice, training and continuous quality assessment on a regional and superregional level. In the future, it shall be indicated to include local ablative techniques - so far not known to all patients in Germany - into the informed decision-making process as a suitable alternative or supplement to existing therapies., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Sporadic cerebral small vessel disease determines age- and vascular-risk-factor-related processes of the small brain vasculature. The underlying pathology develops in a stage-dependent manner - probably over decades - often already starting in midlife. Endothelial and pericyte activation precedes blood-brain barrier leaks, extracellular matrix remodeling and neuroinflammation, which ultimately result in bleeds, synaptic and neural dysfunction. Hemodynamic compromise of the small vessel walls promotes perivascular drainage failure and accumulation of neurotoxic waste products in the brain. Clinical diagnosis is mainly based on magnetic resonance imaging according to the Standards for Reporting Vascular Changes on Neuroimaging 2. Cerebral amyloid angiopathy is particularly stratified according to the Boston v2.0 criteria. Small vessel disease of the brain could be clinically silent, or manifested through a heterogeneous spectrum of diseases, where cognitive decline and stroke-related symptoms are the most common ones. Prevention and therapy are centered around vascular risk factor control, physically and cognitively enriched life style and, presumably, maintenance of a good sleep quality, which promotes sufficient perivascular drainage. Prevention of ischemic stroke through anticoagulation that carries at the same time an increased risk for large brain hemorrhages - particularly in the presence of disseminated cortical superficial siderosis - remains one of the main challenges. The cerebral small vessel disease field is rapidly evolving, focusing on the establishment of early disease stage imaging and biofluid biomarkers of neurovascular unit remodeling and the compromise of perivascular drainage. New prevention and therapy strategies will correspondingly center around the dedicated targeting of, e. g., cellular small vessel wall and perivascular tissue structures. Growing knowledge about brain microvasculature bridging neuroimmunological, neurovascular and neurodegenerative fields might lead to a rethink about apparently separate disease entities and the development of overarching concepts for a common line of prevention and treatment for several diseases., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: The aim of this study was to give an overview of the content, procedure and diagnostic methods used for the school entrance examination (SEE) in Germany. The focus was on the general implementation of the SEE and the developmental screening methods in the individual federal states of Germany., Method: A total of 183 employees from the public health authorities from 15 different states took part in an online survey., Results: The results showed a very heterogeneous picture with regard to the SEE, with the information provided by the employees varying both between and within most states. However, most frequently the SEE was carried out by physicians from the public health service within one examination (single stage), took 46 to 60 minutes per child, and administered not earlier than 12 months before school entrance. In terms of content, the focus was on the physical and cognitive development of the children. Most employees of the health authorities reported that they had specific requirements from the state or municipality for the implementation of the SEE. The Social Pediatric Screening of Developmental Status for School Entry (SOPESS) was the screening instrument used most often. In addition, it was reported that the majority of screenings lasted between 16 to 30 minutes, were executed completely and carried out in the same order. In around 50-60% of the cases, it was assumed that the screenings used met the scientific quality criteria., Conclusions: The present study offers an opportunity to compare the different approaches to the implementation of the SEE and to suggest further developments., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The School Entrance Examination (SEE) provides important information about the educational needs of pre-school children and for health reporting. The SEE should reflect the latest scientific knowledge and generate high-quality data. To do this, it must meet scientific quality criteria and be continuously evaluated and further developed. Regarding the high relevance of the data and the enormous resources needed to test all pre-school children, the SEE must face a scientific and public debate with regard to its usefulness, content and structure. This requires a transparent communication and publication practice. The aim of this overview article was to summarize the publicly available information on the developmental screening incorporated in the SEE in the different federal states of Germany and to evaluate it in terms of transparency, completeness and scientific quality. While the assessed abilities were very similar, there were major differences in the timing of the SEE, whether a one- or multi-stage procedure was used and the extent to which all children were examined by physicians from the public health service. SOPESS is the most frequently used developmental screening method in Germany, for which sufficient quality criteria have been identified. For some of the other widely used methods, validation and standardization were found to be lacking. Overall, there is little publicly available information or scientific publications on the SEE. The heterogeneity of the procedures used in Germany can be seen as an opportunity for the further development and improvement of the SEE. Continuous communication between public health authorities and users as well as thorough scientific monitoring and public debate would be desirable in this context., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Recently, the Tetrafecta score has been published as the first instrument for assessing the quality of primary surgical treatment for penile cancer (PECa). An external scientific discussion about the defining criteria is still pending and forms the study objective., Material and Methods: An international working group consisting of 12 urologists and an oncologist with clinical and academic-scientific expertise in penile cancer was established. In a modified four-stage Delphi process, a total of 13 criteria for PECa patients in clinical AJCC stages 1-4 (T1-3N0-3, but M0) were defined, incorporating the Tetrafecta criteria. Each expert had to select five of these criteria in a secret ballot to generate an individual Pentafecta score. Subsequently, the experts' ratings were aggregated and a final Pentafecta score was formed., Results: None of the original Tetrafecta criteria were included in the final Pentafecta score, which consisted of the following criteria: 1) organ preservation, if possible (≤T2), but always with negative surgical margins, 2) bilateral inguinal lymph node dissection (ILND) from ≥pT1G2N0, 3) perioperative chemotherapy if indicated by guidelines, 4) ILND, if indicated, within a maximum of three months after primary tumour resection, and 5) the treating clinic should perform at least 15 primary surgical treatments in PECa patients. Only in seven out of the 13 experts (54%), a strong correlation was found between individual Pentafecta scores and the final Pentafecta score (r sp >0.60)., Conclusion: Based on a moderated voting process among international PECa experts, a Pentafecta score was developed as a quality assurance instrument for primary surgical treatment, which now needs to be validated using patient-relevant and patient-reported endpoints., Competing Interests: Benjamin Ayres: Member of the EAU & ASCO penile cancer guidelines panel and a Trustee to Orchid Male Cancer charity., (Thieme. All rights reserved.)

In Germany, thoracic surgery is mainly represented at non-university thoracic surgery clinics. It is only established clinically as an independent department or clinic and scientifically as a W2 or W3 professorship at relatively few university hospitals. As a result, it is significantly more difficult to recruit junior specialists and to generate academically active thoracic surgeons as contact persons for researchers from the various fields of life and engineering sciences and for the further development of the field of thoracic surgery, than it is for other surgical specialities. In medical faculties, teaching, research and patient care are on an equal footing. For thoracic surgeons to take on these tasks, concepts are needed to expand and promote academic thoracic surgery in German university medicine. A structured curriculum for academic thoracic surgery can support an academic career in thoracic surgery in addition to mentoring programs, funding opportunities and additional freedom for research or teaching., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The German Society of Uro-Oncologists ("Deutsche Uro-Onkologen e.V.", d-uo) provides a national registry for urothelial cancer (UroNat) and a national registry for prostate cancer (ProNAT). These registries aim to evaluate the standard of care for urothelial cancer of the bladder and the upper urinary tract as well as prostate cancer by office-based urologists, oncologists and outpatient hospital departments in Germany. This includes, but is not limited to, adherence to guidelines during the treatment of patients with urothelial cancer and prostate cancer. The registries aim to capture and analyse scientifically how patients with these two most frequent urological tumours are treated and how quality assurance is implemented to improve the quality of their outpatient treatment in Germany. Both registries may share basic patient data supplied by the non-interventional, prospective, multicentre VERSUS registry by d-uo, which has been ongoing since 2018 and today includes more than 15,000 patients with different urological malignancies. In the UroNAT and ProNAT registries, additional items and parameters are included to allow for more detailed analyses of outcomes of outpatient treatments in Germany, which have so far been unavailable from the German Cancer Registry. By documenting the current treatment landscape of urothelial and prostate cancer in the outpatient setting, the registries intend to identify potential improvements of patient care and to initiate their implementation into clinical practice. These non-interventional prospective registries only document daily routine diagnostics, clinical courses and procedures., Competing Interests: Manfred Johannsen: Vortrags- und/oder Beratertätigkeit: AstraZeneca, Astellas, Bayer HealthCare, Bristol Myers Squibb, Janssen, Pfizer, medac, Merck Serono, MSD. Jörg Klier: Vortrags- und/oder Beratertätigkeit: Amgen, Astellas, AstraZeneca, Bayer HealthCare, BMS, Eisai, Janssen, Lilly, medac, MSD. Frank König: Vortrags- und/oder Beratertätigkeit: Amgen, Apogepha, Astra Zeneca, Bayer HealthCare, Janssen. Robert Schönfelder: Vortrags- und/oder Beratertätigkeit: Amgen, Apogepha, Astellas, AstraZeneca, Bayer Vital, Bristol Myers Squibb, Hexal, Janssen, medac, MSD, Roche, Takeda. Christian Doehn: Vortrags- und/oder Beratertätigkeit: Apogepha, BMS, Eisai, EUSA Pharm, Ipsen, Merck Serono, MSD, Novartis, Pfizer, Roche. Jörg Schröder und Elke Hempel: keine Interessenkonflikte. Rolf Eichenauer: Vortrags- und/oder Beratertätigkeit: Anwerina, Astellas, AstraZeneca, Bayer HealthCare, Bristol Myers Squibb, Ferring, Ipsen, Janssen-Cilag, medac, MSD, Novartis, Pierre Fabre, Pfizer, Sanofi-Aventis, Takeda, Teva., (Thieme. All rights reserved.)

At the beginning of 2017, the German Society of Uro-Oncologists (d-uo) had the idea of designing a documentation platform that would enable d-uo members to report cancer cases to the cancer registry and transfer data to d-uo's own database - without a double effort. The cancer registry reimburses the first notification of a tumour with €18. As the only provider, d-uo reimburses its members for the documentation effort associated with the additional notification to d-uo with a further €18. In addition to the basic oncological data set, further parameters were defined by d-uo. This data is collected, evaluated and interpreted as part of the VERSUS study. At the end of 2022, 14,834 patients with a newly diagnosed urological tumour were included in the VERSUS study. Almost two thirds of all patients had prostate cancer. About half of all patients with prostate cancer were diagnosed as part of an early detection measure. These patients then also had more favourable tumour stages. Overall, almost every eighth patient already had metastases at the time of initial diagnosis. Data from the VERSUS study are available for 2,167 operations on prostate cancer with tumour category T2 or T3. There were 1,360 operations in patients with a T2 tumour (62.8%) and 807 operations in patients with T3 tumours (37.2%). A positive margin was present in 25.5% of all operated-on patients. In relation to tumour categories T2 and T3, the proportion of a positive resection margin was 14.3% and 44.2%, respectively. The VERSUS study will continue to provide answers to many questions from the uro-oncological field with reference to the "real world" situation in Germany., Competing Interests: Jörg Klier: Vortrags- und/oder Beratertätigkeit: Amgen, Astellas, AstraZeneca, Bayer HealthCare, BMS, Eisai, Janssen, Lilly, medac, MSD. Rolf Eichenauer: Vortrags- und/oder Beratertätigkeit: Anwerina, Astellas, AstraZeneca, Bayer HealthCare, Bristol Myers Squibb, Ferring, Ipsen, Janssen-Cilag, medac, MSD, Novartis, Pierre Fabre, Pfizer, Sanofi-Aventis, Takeda, Teva. Manfred Johannsen: Vortrags- und/oder Beratertätigkeit: AstraZeneca, Astellas, Bayer HealthCare, Bristol Myers Squibb, Janssen, Pfizer, medac, Merck Serono, MSD. Frank König: Vortrags- und/oder Beratertätigkeit: Amgen, Apogepha, Astra Zeneca, Bayer HealthCare, Janssen., (Thieme. All rights reserved.)

The current cancer registry notification, which was introduced in Germany as a mandatory institution in 2015, has its starting point in the National Cancer Plan of 2008. Other milestones include the Federal Cancer Registry Data Act (2009), the Cancer Early Detection and Registry Act (2013), the Uniform Oncological Basic Data Set (2014/2021) with its modules (e.g. the module prostate carcinoma 2017) as well as the Cancer Registry Data Merger Act (2021). At the beginning of 2017, the German Society of Uro-Oncologists (d-uo) had the idea of designing a documentation platform that would enable d-uo members to report to the cancer registry and transfer data to d-uo's own database - without a double effort. The cancer registry reimburses the first notification of a tumour with € 18. As the only provider, d-uo reimburses its members for the documentation effort associated with the additional notification to d-uo with a further € 18. In addition to the basic oncological data set, further parameters were defined by d-uo. This data is collected, evaluated and interpreted as part of the VERSUS study. The realisation that the parameters of the basic data set are limited in their informative value led d-uo to establish the two national registries for urothelial carcinoma (UroNAT) and prostate carcinoma (ProNAT). This underscores d-uo's leading position in uro-oncological healthcare research in Germany., Competing Interests: Christian Doehn: Vortrags- und/oder Beratertätigkeit: Apogepha, BMS, Eisai, EUSA Pharm, Ipsen, Merck Serono, MSD, Novartis, Pfizer, Roche. Manfred Johannsen: Vortrags- und/oder Beratertätigkeit: AstraZeneca, Astellas, Bayer HealthCare, Bristol Myers Squibb, Janssen, Pfizer, medac, Merck Serono, MSD. Rolf Eichenauer: Vortrags- und/oder Beratertätigkeit: Anwerina, Astellas, AstraZeneca, Bayer HealthCare, Bristol Myers Squibb, Ferring, Ipsen, Janssen-Cilag, medac, MSD, Novartis, Pierre Fabre, Pfizer, Sanofi-Aventis, Takeda, Teva. Jörg Klier: Vortrags- und/oder Beratertätigkeit: Amgen, Astellas, AstraZeneca, Bayer HealthCare, BMS, Eisai, Janssen, Lilly, medac, MSD. Frank König: Vortrags- und/oder Beratertätigkeit: Amgen, Apogepha, Astra Zeneca, Bayer HealthCare, Janssen. Jörg Schröder und Elke Hempel: keine Interessenkonflikte. Robert Schönfelder: Vortrags- und/oder Beratertätigkeit: Amgen, Apogepha, Astellas, AstraZeneca, Bayer Vital, Bristol Myers Squibb, Hexal, Janssen, medac, MSD, Roche, Takeda., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

The German research data center for health will provide claims data of statutory health insurances. The data center was set up at the medical regulatory body BfArM pursuant to the German data transparency regulation (DaTraV). The data provided by the center will cover about 90% of the German population, supporting research on healthcare issues, including questions of care supply, demand and the (mis-)match of both. These data support the development of recommendations for evidence-based healthcare. The legal framework for the center (including §§ 303a-f of Book V of the Social Security Code and two subsequent ordinances) leaves a considerable degree of freedom when it comes to organisational and procedural aspects of the center's operation. The present paper addresses these degrees of freedom. From the point of view of researchers, ten statements show the potential of the data center and provide ideas for its further and sustainable development., Competing Interests: Stefanie March, Falk Hoffmann, Holger Gothe, Ingo Meier, Sebastian Claudius Semler, Christoph Stallmann, Enno Swart und Peter Ihle erklären, dass Sie innerhalb der vergangenen 3 Jahre Gutachtertätigkeit für das Bundesministerium für Gesundheit ausgeübt haben, und einzelne Autor*innen am begleitenden Arbeitskreis zum Forschungsdatenzentrum Gesundheit beim BfArM beteiligt sind., (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/).)

Surgery is associated with numerous health hazards for the staff.The aim of this article is to show the risks to the health and ability to work of surgical staff and the possibilities for improving occupational health and safety in terms of behavioural and situational prevention, as well as secondary and tertiary prevention, especially with regard to cooperation with the occupational physician.The brief narrative overview is based on the author's own occupational medicine, surgery and interdisciplinary experience from daily practice and selective references from the current medical-scientific literature, using the example of the operating theatre work area.The possible activity-related health hazards and the risks to the working ability of medical staff as well as the possibilities for occupational health and safety in the sense of behavioural and situational prevention are an important matter in the interdisciplinary status of surgery that should not be underestimated (since it is also partly determined by law). Above all, this discipline must responsibly dedicate itself to the points of contact with occupational medicine (in addition to acquiring its own knowledge from the surgical side)., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Thoracic trauma is a frequent injury pattern with high patient morbidity and mortality. Preclinical and clinical emergency treatment is consented in a national S3-guideline. Following emergency therapy one third of patients may develop lung lacerations, pleural fistulation and persisting pneumothorax. An interdisciplinary working group of the German Society for Thoracic Surgery and the German Society for Traumatology reviewed the published medical literature on treatment of those injuries and assessed the existing evidence according to consensus recommendations. An inconsistent classification of those subsequent lung injuries was found. Evidence for diagnostic and therapeutic recommendations is small., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The management of occult and retained haemothorax is challenging for all involved in the care of polytrauma patients in terms of diagnosis and treatment. The focus of decision making is preventing sequelae such as pleural empyema and avoiding a trapped lung. An interdisciplinary task force of the German Society for Thoracic Surgery (DGT) and the German Trauma Society (DGU) on thoracic trauma offers recommendations for post-trauma care of patients with occult and/or retained haemothorax, as based on a comprehensive literature review., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The Covid-19 pandemic, officially declared in March 2020 by the WHO, poses major challenges to public, private, and occupational life. CoronaCare is an ethnographic research project that investigates the everyday life of people during the Covid-19 pandemic in Germany with a particular focus on social health. The aim of the project was to develop recommendations for pandemic preparedness planning focusing on expanding social health care. Through a series of workshops conducted between June and November 2021 with stakeholders from the fields of science, health and social administration drawn from both local and state levels, care institutions and social associations, the research team developed specific recommendations for pandemic preparedness and response on the basis of empirically substantiated vignettes demonstrating key tensions in caring practices. These tensions illustrate that pandemic management must be understood as a so-called wicked problem in which there are only relational rather than clear-cut, ultimate solutions. As such, the recommendations developed in the workshops point to the imperative to 1. recognize the irresolvable tension between measures to contain the pandemic in planning pandemic management and the human desire to care and be cared for; 2. understand and manage pandemics at the community level; 3. aim for close collaboration between actors at the local health, social, and family level; and 4. create spaces for ethical reflection on good care during a pandemic and develop context-specific strategies for action. For pandemic preparedness and management as a 'wicked problem', this means that measures should be disseminated as recommendations rather than regulations in order to have some leeway that enables care to be tailored to individual needs. They should be accompanied by stable guidance for action as well as regular training for staff. The workshop formats can be understood as an example of multidimensional knowledge transfer in a socially challenging situation., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

During phase III study ERA-223, patients under combination therapy with radium-223 and abiraterone showed an increased risk of bone fractures and a possible higher risk of death. This observation led to a change in the German therapeutic guidelines in 2018. Radium-223 is now only allowed as a third-line monotherapy (besides ADT) in patients with metastatic castration resistant prostate cancer (mCRPC) with symptomatic bone lesions without known visceral metastases or for patients with mCRPC, for whom no other available systematic therapy is suitable. Since almost no data on practice-related care research on the use of radium-223 exist, we consulted members of d-uo (German Uro-Oncologists) over their therapy algorithms. This study analysed data of patients treated with radium-223 between 2014 and 2019. It could be shown that 50% of mCRPC-patients had received radium-223 in the past as third-line therapy. Half of these were treated in combination with new androgen receptor targeted therapies (ARTA) and no increase in bone fractures was observed. This was most likely due to the additional use of bone protecting agents. Despite the late cancer stage, treatment response was seen in almost half of the patients., Competing Interests: Die Autoren R. Schönfelder, J. Klier, M. Johannsen und F. König erhielten in der Vergangenheit von der Firma BAYER Unterstützungen für Kongressreisen sowie Honorare für die Teilnahme an Advisory Boards und für das Halten von Vorträgen., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Due to the optimisation of conservative treatment, the improvement of imaging methods and the continuous development of surgical techniques, the borders of resectability in liver surgery have changed significantly in recent decades.Thanks to numerous technical developments, in particular three-dimensional segmentation, preoperative planning and orientation during the operation itself, can now be facilitated, especially in complex procedures.New technologies such as 3D printing as well as virtual and augmented reality offer additional display options for the patients' individual anatomy. Various intraoperative navigation options are intended to make preoperative planning available in the operating room in order to increase patient safety.This review article is intended to provide an overview of the current state of available technologies and an outlook into the operating theatre of the future., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: In the light of the increasing importance of cardiovascular cross-sectional imaging in current guidelines, the goal of this study is to provide a comprehensive overview of cardiovascular imaging (CVI) offered by radiological institutions across Germany., Materials and Methods: Data were extracted from the national certification program database of the German Roentgen Society (DRG) from 2015-2021. A nationwide online survey among radiology institutes (university hospitals, non-university hospitals, and private practices) was conducted for 2019, and data was extracted from the European Society of Cardiovascular Radiology (ESCR) registry. The data collection's key points included the number of centers and individuals certified for CVI, the number of cardiac CT and MRI examinations performed, the reporting habits, and the participation in the ESCR registry., Results: 71 centers and 1278 persons, both with a substantial increase since 2015, were registered and certified by the DRG to perform CVI. According to the survey, a total of 69,286 CT and 64,281 MRI examinations were performed annually. Data from the survey and the ESCR registry indicated that reporting was mostly done solely by radiologists or, to a lesser degree, in joint consensus meetings with non-radiologists. The overall participation rate in the ESCR registry was 48 % among the survey's participants., Conclusion: This comprehensive analysis demonstrates that high-quality CVI by radiologists is available nationwide. The current challenges are to provide the best medical and technical quality of CVI by radiology for patient care and to ensure economic sustainability in the German health care system to accommodate the predicted substantial need for CVI in the future., Key Points: · High-quality advanced CVI service by radiologists is available nationwide.. · Highly qualified specialist knowledge is widely represented from university to private practices.. · Certification programs successfully contribute to the dissemination & deepening of CVI expertise.. · The ESCR registry is an established international tool for the documentation of CVI.., Citation Format: · Sieren M, Maintz D, Gutberlet M et al. Current Status of Cardiovascular Imaging in Germany: Structured Data from the National Certification Program, ESCR Registry, and Survey among Radiologists. Fortschr Röntgenstr 2022; 194: 181 - 191., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background:  The Onkonet database has been developed and coordinated by the Berliner Tumorzentrum e. V. (http://www.prostata-ca.net) and contains data on pre-, peri- and postoperative parameters of radical prostatectomy documented since January 2005. With its user-friendly interface and its integrated benchmarking tool, the main goal of Onkonet was to outline and improve the surgical care of prostate cancer patients in Germany. This study aimed to analyse all Onkonet data documented from the beginning of the project until June 2018. We focused on the completeness and plausibility of data to investigate and define the possibilities and limits of further analyses., Patients and Methods:  All patients who underwent radical prostatectomy in one of the urological clinics participating in this project until June 2018 were included in this retrospective study. The completeness of all documented patient data was analysed using Excel 2013. The statistical analysis was descriptive., Results:  A total of 21 474 patients were documented in Onkonet. 58,6 % (12 591) of them had a complete dataset including date of birth, date of surgery, dates of hospitalisation and discharge, initial PSA value, Gleason score of the biopsy, clinical T stage, pathological T stage, pathological Gleason score, as well as information on the surgical technique. Mean completeness of pre-operative parameters was 26,8 %, of hospitalisation parameters 64,5 %, and of pathological parameters 58,1 %. Amongst these, the documentation of the pathological T stage was complete in 80,1 %, documentation of N stage in 78,8 %, of M stage in 74,8 %, of pathological Gleason Score in 78,7 %, and of R1 status in 78,7 %. Completeness of follow-up data was 8,1 %, with PSA data being available in 27,2 %, continence data in 23,0 %, and potency data in 13,9 %., Conclusions:  Comprising 21 474 documented patients and over 200 parameters, Onkonet is one of the most comprehensive clinical registers for the documentation of prostate cancer patients in Germany. The data analysis showed that the limitations of such a database are mainly due to the high number of parameters and the high susceptibility to errors due to manual data submission., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Data are both material and product for health services research. As a "substrate" or starting point for health-related analyses, they have gained immense importance in recent decades. Data are an essential raw material for the assessment of services in the health care system, for its control and development. In everyday scientific life and in research work that uses this raw material, the meaning of the term "data" - especially "secondary data" - is often neglected. This article aims to shed more light on the context of meaning of the two terms and to attempt to classify the term "secondary data" terminologically., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Based on sections 303a to 303f social code book V, the course is currently being set for an innovative and high-performance national information and data platform. This requires short-term provision of current and relevant data on the health care system, especially process data on statutory health insurance and other social insurance carriers, using established methodological standards as well as taking into account data protection regulations. From the point of view of future users, expectations regarding an "ideal" research health data centre are formulated in ten recommendations. The present article is an offer from health services researchers intended to support decision-makers in the field of politics and self-administration in the German health system in their task of establishing and further development of a research health data centre., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: In Germany, Emergency Medical Services (EMS) were involved in a total of 7.3 million emergency cases in 2016/2017. Information on prehospital care is stored in several secondary data sources, yet combined analysis of these data at the level of individual patients or EMS cases happens rarely. Research is needed on which methods and variables are suitable for the linkage of these data sources., Methods: We linked EMS records from five Bavarian emergency service districts to health claims data belonging to ten statutory health insurers (data from 2016). Two linkage approaches at the level of individual patient's EMS case/reimbursement case were demonstrated. First, a deterministic linkage was conducted based on the patient's unique identifying health insurance number. The second linkage was probabilistic. As linkage variables, it comprised the only partially available health insurance number plus several non-unique key variables, the latter being a patient's health insurance provider, sex, year of birth and distance travelled. In order to verify the deterministic and the probabilistic linkages' quality, rates of accordance of several variables present in both data sources were calculated., Results: The starting point for our data linkage were 106,371 EMS records (independent of certain health insurance companies) and 432,693 EMS services reimbursed by health insurers (independent of specific EMS providers). 4,327 EMS records could be linked to health claims data - out of 5,921 EMS records that coded a health insurance company contributing claims data to Inno&#95;RD. With a probabilistic linkage, it was possible to increase this number to a total of 5,379 linked EMS records. All checks carried out indicated a high linkage quality for both the deterministic and the probabilistic approach., Conclusion: A linkage of EMS records with health claims data is possible. In Inno&#95;RD, a probabilistic approach has proven a valuable alternative to deterministic linkage via health insurance number since EMS records can be linked meaningfully even if the health insurance number is unavailable or where a minority of non-unique key variables show non-accordance or missing values., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Seven new antimycotics are presented that are at different points of development or approval. These substances are mainly first-in-class drugs. They are primarily developed for systemic administration. However, with the support of a pharmacist, the intravenous formulation may be used as eyedrops. In this short review, the activities of the substances against various fungal infections are described. After unsuccessful conventional therapy of fungal eye infections, one of these new substances might be suitable to cure the mycosis., Competing Interests: The author declares that he has no conflict of interest./Der Autor gibt an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

BACKGROUND : With low influenza vaccination rates among the chronically ill, approaches to increase these rates among risk patients with chronic obstructive pulmonary disease (COPD) are to be uncovered. METHODS : 120 COPD patients from Magdeburg filled out a questionnaire and were analyzed regarding the influenza vaccination status 2015/2016 or 2016/2017. Vaccinated and unvaccinated were compared in socio-epidemiological factors, the health belief model (HBM), self-efficacy (GESIS-ASKU), anxiety/depression (HADS-D) and disease processing (FKV-LIS). RESULTS : 62.5 % (n = 75) were vaccinated, 31.7 % (n = 38) unvaccinated, 5.8 % (n = 7) made no statement. In over or equal to 60-year-olds 76 % were vaccinated, in under 60-year-olds 42 % were vaccinated. 60 % (n = 72) knew to belong to a risk group. Unvaccinated indicated greater concern about side effects of the vaccination (p = .004) and drew a worse benefit-expense balance (p = .001). Unvaccinated were more often uncertain about the vaccination protection and the severity of influenza (p ≤ .001). Vaccinated were highly motivated to think about vaccination themselves and more often had a positive vaccination history (p = .001). COPD patients showed a lower self-efficacy than the reference group of the German general population (p = .000), vaccinated and unvaccinated did not differ (p = .418). No difference between vaccinated and unvaccinated was found in the processing of the disease and in depression and anxiety, but unvaccinated tended to give higher anxiety values. CONCLUSION : Measures should particularly target COPD patients under 60 years of age with a negative vaccination history and sensitize them as risk patients. Widespread uncertainties about the severity of influenza and vaccination protection should be addressed. It should be communicated that influenza vaccination does not lead to exacerbation. The vaccination recommendation should increasingly be made by pulmonologists., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Kindergarten teachers are exposed to a variety of stresses that can lead to psychological impairments and illnesses. A balance between stress and resources is necessary for performance and well-being. The aim of the study was to examine correlations between the risk of burnout and human resources in order to derive approaches for preventive measures. A total of 200 teachers from Magdeburg and the surrounding area took part in the study (age: 43.6±12.6 years). The MBI-GS inventory was used to determine the burnout risk. Stress processing strategies as personal resources were recorded using the stress processing form (SVF). A risk of burnout was found in nine (4.5%) teachers, 68 (34%) suffered from at least some burnout symptoms. There were significantly more negative stress processing strategies among educators at risk of burnout. As a preventive measure, a resource-oriented approach should be strengthened in order to maintain the health of the teachers and to prevent development of burnout syndrome., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The evaluation of intervention effects is an important domain of health services research. The ad hoc commission for the use of routine practice data of the German Network for Health Services Research (DNVF) therefore provides this second part of its manual focusing on the use of routine practice data for the evaluation of intervention effects. First, we discuss definition issues and the importance of contextual factors. Subsequently, general requirements for planning, data collection and analysis as well as concrete examples for the evaluation of intervention effects for the 3 fields of application regarding pharmacotherapy, nonpharmaceutical interventions as well as complex interventions are elaborated. We consider scenarios in which no information from randomized controlled trials (RCTs) comparing the two groups directly is yet available or in which RCTs are already available but an extension of the research question is required. In all examples either with or without randomization, the first and foremost question is always whether the data source is suitable for the specific research question. Most of the examples chosen are from oncology trials, because the necessary data are already available for Germany, at least in some form. Finally, the manual discusses possible challenges for future use of these data., Competing Interests: JS nutzt regelmäßig GKV-Routinedaten für wissenschaftliche Forschungsprojekte und ist Leiter des Deutschen Neurodermitisregisters TREATgermany. Er erhielt institutionelle Unterstützung für wissenschaftliche Forschungsprojekte von Sanofi, Novartis, Pfizer und ALK und war als Berater gegen ein Honorar für Sanofi, Novartis, ALK und Lilly tätig. Die anderen Autoren geben keine Interessenkonflikte an., (Thieme. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

This prospectively registered review characterizes 50 intervention studies from the 1 st wave of the Innovation Fund based on study protocols or original articles, among other sources. The mainly (randomized) controlled intervention studies included predominantly adults/seniors in ambulatory care without a regional focus and analyzed treatment processes, clinical and patient outcomes as outcomes. The substantial lack of study protocols and methodological details (e. g., sample size planning) reveals (avoidable) methodological problems regarding the scientific quality of the funded studies., Competing Interests: CA erhielt institutionelle Fördermittel aus dem Innovationsfonds. Außerhalb dieses Projektes erhielt er institutionelle Fördermittel für selbst initiierte Forschungsprojekte durch die Dr. Wolff Group, sowie von der DFG und dem BMBF. Er erhielt Beratungshonorare von Sanofi, LEOPharma und der Dr. Wolff Group, sowie ein Vortragshonorar von AstraZeneca.DB hat keine Interessenkonflikte.EF hat keine Interessenkonflikte.FW war als wissenschaftlicher Mitarbeiter an der in diesem Review mit untersuchten IMPRESS-Studie beteiligt.HH hat keine Interessenkonflikte.JS erhielt institutionelle Fördermittel aus dem Innovationsfonds und ist Hauptgeschäftsführer des DNVF. Außerhalb des Fokus dieses Projekts erhielt er institutionelle Fördermittel für selbst initiierte Forschungsprojekte von Pfizer, Sanofi, Novartis, ALK, sowie von der DFG, vom BMG und vom BMBF. Er war gegen persönliches Honorar als Berater für Sanofi, Lilly und Novartis tätig.LK hat keine Interessenkonflikte.MG war als Mitglied des Evaluationsteams an der in diesem Review mit untersuchten INTEGRAL-Studie beteiligt.MH erhielt institutionelle Fördermittel aus dem Innovationsfonds und ist Vorstandsmitglied im DNVF. Außerhalb dieses Projektes erhielt er institutionelle Fördermittel für selbst initiierte Forschungsprojekte durch das BMG und das BMBF.TB ist Geschäftsführer des DNVF. Das DNVF hat in der vergangenen Förderwellen beim Innovationsfonds Anträge gestellt, die nicht bewilligt wurden., (Thieme. All rights reserved.)

Aims: During the COVID-19 pandemic, many health-related questions require rapid answers. In the Competence Network Public Health COVID-19, founded by representatives of several scientific societies in March 2020, rapid reviews are often conducted to generate evidence-based answers that are useful for policy makers. The aim of this paper is to reflect on the practical experience with rapid reviews in the context of the Competence Network Public Health. Methods for high-quality and practicable implementation of rapid reviews were developed, which are particularly helpful for rapid evidence generation based on observational studies., Methods: Using the 8-step approach proposed by Tricco et al. [1], we describe the acute challenges that have arisen in the Public Health Competence Network COVID-19 while conducting rapid reviews on public health-related issues related to the COVID-19-pandemic. The 8 steps are: 1. conceptualization of the research question, 2. literature search, 3. title/abstract and full text screening, 4. data extraction, 5. risk of bias assessment, 6. evidence synthesis, 7. dissemination, 8. update. We develop a methodological approach for conducting rapid reviews by expert consensus of the members (n=42 as of 01/28/2021) of the Rapid Reviews Working Group in the Competence Network Public Health COVID-19., Results: A standardized approach is presented that closely follows the approach of the Cochrane Rapid Reviews Methods Group and takes into account the special requirements of etiological - but often also ecological - observational studies on COVID-19., Conclusions: The proposed approach for conducting rapid reviews can form an important basis for evidence-based policy advice - certainly beyond questions related to COVID-19. Flexible and rapid funding concepts should be made available for the short-term realization of methodologically high-quality rapid reviews on emerging questions. Scientific cooperation in conducting rapid reviews needs to be expanded, and more methodologically high-quality approaches such as prospective meta-analyses should be used., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Stress reactions can be a result of occupational and everyday stress, which are perceived individually. The insufficient compensation of stress can lead to various diseases. Personality traits play an important role in this. Stress reactions can lead to health problems and diseases. Therefore it is important to reduce stress. The aim of this study was to examine the role of personality traits in dealing with stress perception and coping., Material and Method: The questionnaire on Differential stress inventory (DSI) differentiated 217 subjects into 5 types of DSI. The survey compared these 5 types along their personality traits via the Freiburg Personality Inventory (FPI-R)., Results: The DSI types showed significant differences in the expression of the personality traits. This applies the everyday stress, professional and private interactions with other people and the existential and future fears. People with pronounced physical disorders in the FPI showed physical and/or emotional-cognitive stress manifestation as well as a sense of helplessness. Life satisfaction is negatively related to stressors, for example through everyday life., Conclusion: The survey revealed the importance of personality traits in coping with job strain. Occupational health diagnostics should be integrated in occupational health care and prevention. The occupational physician or the prevention team appear here to be significant, as they see workers falling through the classic family doctor model. In the prevention team, personality traits can be supplemented by psychologists. Personal resources can be imparted or reinforced to prevent physical disorders., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The prognosis of going blind is very stressful for patients diagnosed with "glaucoma". Worries and fear of losing independence is a constant mental burden, with secondary risks of depression and social isolation. But stress is not only a result of glaucoma but also a possible cause (risk factor). This should not be surprising, given that chronic stress can trigger "psychosomatic" organ dysfunctions anywhere in the body. Why should the organ "eye" be an exception? Indeed, glaucoma patients often suspect that severe emotional stress caused their visual field loss or "foggy vision". The hypothesis that stress is a possible cause of glaucoma is supported by different observations: (i) acute and chronic stress increases intraocular pressure and (ii) long-term stress can lead to vascular dysregulation of the microcirculation in the eye and brain ("Flammer's syndrome"), leading to partial hypoxia and hypoglycaemia (hypo-metabolism). Even if nerve cells do not die, they may then become inactive ("silent" neurons). (iii) Degenerative changes have been reported in the brain of glaucoma patients, affecting not only anterograde or transsynaptic areas of the central visual pathway, but degeneration is also found (iv) in brain areas involved in emotional appraisal and the physiological regulation of stress hormones. There are also psychological hints indicating that stress is a cause of glaucoma: (v) Glaucoma patients with Flammer's syndrome show typical personality traits that are associated with low stress resilience: they often have cold hands or feet, are ambitious (professionally successful), perfectionistic, obsessive, brooding and worrying a lot. (vi) If stress hormone levels and inflammation parameters are reduced in glaucoma patients by relaxation with meditation, this correlates with normalisation of intraocular pressure, and yet another clue is that (vii) visual field improvements after non-invasive current stimulation therapy, that are known to improve circulation and neuronal synchronisation, are much most effective in patients with stress resilient personalities. An appreciation of stress as a "cause" of glaucoma suggests that in addition to standard therapy (i) stress reduction through relaxation techniques should be recommended (e.g. meditation), and (ii) self-medication compliance should not be induced by kindling anxiety and worries with negative communication ("You will go blind!"), but communication should be positive ("The prognosis is optimistic")., Competing Interests: B. Sabel is shareholder of an outpatient clinic (SAVIR-Center), where patients are treated with the procedures described here./B. Sabel ist Anteilseigner einer medizinischen Ambulanz (SAVIR-Center), in der die vorgestellten Behandlungsverfahren eingesetzt werden., (Thieme. All rights reserved.)

Nerve ultrasound is a fairly new non-invasive method to visualise peripheral nerves and to detect peripheral nerve lesions. This technique can depict nerve compression syndromes and their aetiologies as well as fascicular torsions. It is also suitable for sonographically guided nerve interventions and for intraoperative navigation. The main advantage of nerve ultrasound is its capability for early diagnosis of severe traumatic nerve lesions that require immediate surgery. Neurologists further use this method to aid the diagnosis of different kinds of polyneuropathies. Within this review we introduce nerve ultrasound to surgeons from a neurological perspective. We focus on different peripheral nerve disorders that might need surgical interventions. Nerve ultrasound will lay the grounds to bring together different expertise in medicine and thus to establish interdisciplinary excellence centres for the understanding, diagnosis and treatment of diseases of the peripheral nervous system., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The final year is the last part of the study of human medicine and can be regarded as an essential period, during which medical knowledge should be consequently converted into medical expertise. Since the amendment of the medical license policy ("Ärztliche Approbationsordnung" [ÄApprO]) from July 17, 2012, in particular, since April 01, 2013, German universities have been obliged to provide a training schedule such as a "logbook" for this final year, specifically for the mandatory time periods within surgery and internal medicine. In preparation for this innovation, the German Medical School Association ("Medizinischer Fakultätentag") presented basic logbooks as consensus documents in June 2012. The portfolio for each surgery discipline and the Magdeburg Medical School, had been developed on the basis of individual initiatives and used for years, and was revised, specified and further developed into a "logbook of the medical study's final year" - specific for daily practice and the Magdeburg Medical School, and to the guidelines of the Medical School Association ("Medizinischer Fakultätentag"). The aim of the present commentary is i) to present the Magdeburg Medical School logbook and its clinical planning for cases, diagnoses and (surgical) interventions, as a summary of institutional experience and ii) to describe the mandatory surgical part of the "Magdeburg's final year of the study of human medicine"., Method: Narrative short overview including individual teaching experiences and topic-related references from "PubMed" using terms for literature search such as "surgical logbook", "practical year" and "medical teaching". The background and aims of the document's modifications are explained for each surgical discipline., Results: The "Logbook" is subdivided into 6 chapters: introduction, basics, statement of requirement, selected surgical diseases and interventions as well as information on final year-associated events and courses and instructions for creating the obligatory case report., Conclusion: The presented "Magdeburg Medical School Final Year Logbook of the Surgical Disciplines" has been created according to the requirements of the German Medical School Association ("Medizinischer Fakultätentag") and has been simultaneously adapted to the conditions and established medical teaching at the presenting Medical School. In particular, the medical students are given a document related to daily clinical practice, which allows them, within an overall teaching concept, to acquire indispensable expertise., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background:  The blockade of immune escape mechanisms (e. g. PD1 /PD-L1) using immune checkpoint inhibition (ICI) can significantly prolong survival and induce remission in patients with advanced non-small cell lung cancer (NSCLC). Less is known about neoadjuvant ICI in patients with resectable (UICC stage III) or oligometastatic (UICC stage IVa) NSCLC., Methods:  Tissue biopsies from patients with advanced or oligometastatic NSCLC were screened for PD-L1 expression. In case of PD-L1-expression > 50 %, ECOG status of 0 or 1 and expected operability, patients received ICI. After about four weeks, patients underwent thoracic surgical resection. In all patients, a complete staging, including PET-CT, cMRI, and endobronchial ultrasound, was performed. The tolerability, the radiological and the histopathological tumor response as well as the surgical and oncological outcomes were analyzed., Findings:  Four patients (2 male, 2 female, age 56 - 78 years, n = 3 adenocarcinoma, n = 1 squamous cell carcinoma) with local advanced tumors received ICI before surgical resection. In three cases the mediastinal lymph nodes were positive. One patient had a single cerebral metastasis which was treated with radiotherapy. All four patients underwent therapy with two to six cycles of ICI (3 × pembrolizumab, 1 × atezolizumab) without any complication, and ICI did not delay the time of surgical resection. According to iRECIST, three patients showed partial response (PR), one patient had stable disease (SD). All tumors were completely resected. The thoracic surgical procedures proved to be technically unproblematic despite inflammatory changes. There were neither treatment-related deaths nor perioperative complications. In the resectates, complete pathological response (CPR, regression grade III ) and regression grade IIb were detected twice. The average time of follow-up was 12 (1 - 24) months. Patients with PPR developed distant metastasis after six months or a local recurrence after four months. The CPR patient is relapse free to date., Conclusion:  In selected patients, neoadjuvant therapy with ICI is well tolerated and can induce a complete remission of the tumor. Treatment with ICI has no negative impact on the surgical procedure. Prognosis seems to be promising in CPR and limited in PPR., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)