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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.)

Objective: Accurate psychodiagnostics is crucial for diagnosing and ensuring quality treatment for individuals with mental health disorders. However, there is limited understanding of psychodiagnostic practices within Psychosocial Centers (PSZ) when dealing with refugees, particularly in the presence of language and cultural barriers and resource constraints. This study aims to evaluate the current status and potential pathways for enhancing culturally sensitive diagnostics in this context., Methods: We conducted an online survey using a self-developed questionnaire with representatives from 32 PSZ to examine psychodiagnostic practices, barriers, and perceived development potentials, and analyzed the data descriptively., Results: Most centers prefer individual case assessments over standardized diagnostics. Key barriers to using standardized questionnaires and interviews include communication difficulties (unfamiliarity with question formats, reading and writing difficulties) and resource limitations (time, translation). When conducting diagnostics, time constraints and prioritizing complex cases are the primary challenges. Additional assessments are needed for several disorders and languages. Employees are interested in receiving training in the field of culturally sensitive diagnostics., Discussion: Diagnostic practice in the PSZs is characterized by numerous challenges that differ from the challenges in standard care. In order to ensure appropriate standardized diagnostics and care for mentally distressed people with a refugee or migrant background, further expansion of the linguistic and cultural adaptation of established diagnostic instruments is essential., Conclusion: In the care of psychologically distressed refugees, culturally sensitive standardized diagnostics offer critical benefits for both practitioners and affected individuals. Existing resources are being referred to., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

A dynamic tracheal collapse caused by multiple rib fractures in a neonatal wagyu calf was diagnosed by radiography, endoscopy and computed tomography. Conservative treatment, consisting of the medical treatment of respiratory inflammation and the reduction of environmental and social stress was initiated. The respiratory signs improved significantly, and the calf was discharged. The condition deteriorated after several weeks without treatment, most likely due to of excessive callus formation of the fractured ribs causing increased reduction in tracheal diameter., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht.Dieser Artikel ist Herrn Prof. Karl Nuss gewidmet, anlässlich seines Ausscheidens aus dem Universitätsdienst., (Thieme. All rights reserved.)

Objective: Teachers are subject to exceptionally high vocal stress throughout their lives and have an increased prevalence of voice disorders. The aim of this study was to evaluate the long-term efficiency of voice training in student teachers during their lifelong career as a teacher. In addition, we investigated the relationship between vocal aptitude tests and teachers' vocal health., Methods: In a multicentre case-control study, 202 teachers (median age: 48 years, 165 women, 37 men) were examined. The examination consisted of a standardised anamnesis, analysis of the voice, laryngostroboscopy and audiometry. Subjects were attributed to the case group if at least two of the following criteria were met: pathological videolaryngostroboscopic findings, pathological analysis of the voice, subjective vocal complaints., Results: 65/202 teachers were categorised as cases. Comparing the groups, cases were older (p=0.001), worked more often in primary schools (p=0.008) and had more problems with reflux (p=0.002). 63.8% of the controls had completed a vocal aptitude test before starting their studies, compared to 47.6% of the cases (p=0.031). A multivariate analysis showed an OR of 1.6 for developing dysphonia if neither voice training nor a vocal aptitude test has taken place during the course of study., Conclusion: Many risk factors associated with dysphonia in teachers are often difficult or impossible to change. Vocal aptitude tests and voice training during the studies represent a primary prevention of occupational dysphonia in the teaching profession., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

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

Objective: Aim of the study was to report evidence on mental health needs and access to mental health and psychosocial support for Leipzig citizens of Afghan and Iraqi citizenship in the presence of mental stress and, above all, to identify barriers to access to care., Methods: All adults in Leipzig with Iraqi or Afghan citizenship, who were not born in Germany were contacted. Various instruments (PHQ-9, GAD-7, SSS-8, PCL-5/LEC-5) to screen for symptoms of depression, anxiety, somatization disorder or PTSD and one item for self-reported emotional problems were used. Questions on health care utilization and barriers to care followed., Results: 51.4% screened positive in at least one of the tests and self-reported emotional problems. 38.2% of those in need of treatment did not seek help. Frequent reasons for not seeking help were, that the people wanted to solve the problem on their own or that the problem did not bother them very much. A lack of trust and understanding regarding the healthcare system and fear of discrimination and stigmatisation were also perceived as additional barriers to care., Discussion: The study revealed a high percentage of mental health needs. This could be due to the high number of traumatic events and post-migration stressors. A longer period of residence in Germany and easier access to the public health system through the health insurance card could have encouraged the health care utilization. The treatment gap was caused by barriers to care such as a lack of knowledge or trust of the German health care system and fear of stigmatisation and discrimination., Conclusion: More information about access to care structures and more low-threshold services need to be implemented. These should be organised on an interdisciplinary basis and focus on culturally and racially sensitive care. Mental health awareness should be strengthened and under no circumstances should the access to care be restricted any further., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The criteria-oriented assessment of the population with a migration background that is common in Germany is currently being criticized from a social science and methodological perspective, among others. In particular, its usefulness as an indicator of perceived discrimination against the population with a migration background can be critically questioned based on the current state of research METHOD: Based on a population-representative data set (N=1,989) for the city of Berlin, the subjective perception of a migration background based on self-attribution and anticipated external attribution of a migration background was recorded in addition to the objective assessment of a migration background. Furthermore, socio-demographic and migration-specific characteristics as well as perceived discrimination were assessed. Using descriptive and inferential statistical methods, differences between the objective and subjective assessment of a migration background and their relationship with perceived discrimination were analyzed., Results: Less than half (38%, 154/400) of the respondents identified as having a migrant background using the criterion-oriented approach reported describing themselves as migrants. 36% (144/405) reported that they believed that others in Germany described them as a person with a migrantion background. Respondents with a migration background are significantly more likely to experience discrimination on grounds of skin color, religion or country of origin compared to respondents without a migration background. Furthermore, it was found that both the self-attribution and the anticipated attribution by others as a migrant are positively associated with experiences of discrimination and racism., Discussion: The results suggest that migration-sensitive research should not simply differentiate between people with and without a migration background according to official criteria. Rather, the subjective perceptions of one's own attribution as a migrant seem more suitable as indicators of discrimination and should be taken into account in future research or surveys on experiences of discrimination., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: The aim of this retrospective study was to analyze the clinical signs, confirmed or suspected toxicants, treatments and outcomes of poisoning cases in dogs presented over a 5-year period to the emergency service of a small animal referral center., Material and Methods: Medical records of 634 dogs were evaluated for a history of confirmed or presumed poisoning, suspected toxicant, clinical signs, treatment, and patient outcome. The probability of poisoning was graded based on the patient history, clinical findings, toxicologic examination and - in some cases - investigation of gastrointestinal contents., Results: Most dogs were hospitalized (77%) due to poisoning with mostly unknown toxicants (33%), food residues (18%), rodenticides (10%), tremorgenic mycotoxins (8%), medications (7%) and various plants (7%), followed by recreational drugs (5%), chemicals (4%), molluscicides (3%), antiparasitics (2%), feces (2%), nuts (2%), or toxins of animal origin (1%). Patients were presented predominantly showing neurologic signs (56%), reduced general condition (39%), and cardiovascular or hydration status abnormalities (26%). The survival rate was 97%. Most dogs were clinically unremarkable at the time of hospital discharge (70%). An additional 18% of the survivors had no apparent complications by the time of discharge. Toxicant-related complications (20.5%) included hemorrhage (4%), hepatic (4%), renal (4%), respiratory (3%), gastrointestinal (3%), cardiovascular (3%), and/or central nervous system (3%) complications, or clinically relevant hypoglycemia (0.3%)., Conclusion and Clinical Relevance: In the present study, poisoning in dogs was mostly associated with the ingestion of food residues, but the causative toxicant remained unidentified in many cases. Neurological signs were the major clinical presentation. The survival rate (97%) in this study was higher compared to those reported by other investigators., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In 2023, no new active pharmaceutical ingredients were released on the German market for horses and food-producing animals. Two established veterinary active pharmaceutical ingredients became available for additional species: The phosphorus compound butafosfan was also approved for horses, dogs, and cats and the mineral sodium chloride as an isotonic sodium chloride solution was also approved for rabbits and guinea pigs. In addition, for small animals, there were new releases of an agent (pergolidmesilate) in a novel pharmaceutical formulation and a lower content of the active ingredient, one drug (fluralaner) in a smaller package size as well as one drug (oxalic acid dehydrate) with a new route of administration. Furthermore, one combination of active ingredients (diprophylline+heptaminol) is available on the market for horses and food producing animals again., Competing Interests: Die Autorin bestätigt, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In 2023, 2 novel pharmaceutical agents for small animals were released on the German market: the structural but non-functional analog of the inhibitory neurotransmitter gamma-aminobutyric acid pregabalin with an anxiolytic active component and the dopamine agonist ropinirole in form of eye drops to induce vomiting. Two established active veterinary pharmaceutical ingredients became available for additional species: The phosphorus compound butafosfan was additionally approved for horses, dogs and cats and the mineral sodium chloride as an isotonic sodium chloride solution was also approved for rabbits and guinea pigs. In addition, for small animals, there were new releases of an agent (dexamethasone) in a novel pharmaceutical formulation, one drug with a new route of administration (hydrocortisone aceponate), one drug with a new content of the active ingredient (firocoxib) as well as one veterinary drug with a new combination of active ingredients in a novel pharmaceutical formulation (gentamicin+mometasone+posaconazole). Furthermore, one combination of active ingredients (diprophylline+heptaminol) is available on the market for small animals again., Competing Interests: Die Autorin bestätigt, dass kein Interessenskonflikt besteht., (Thieme. All rights reserved.)

Aim of the Study: The aim of this study was to investigate acceptance and intention to use teledermatological application by means of a survey of general practitioners and dermatologists in Saxony (Germany). Considering the demographic development in Saxony and the low regional density of medical specialists, this federal state is particularly well suited for conducting a survey dealing with telemedicine., Methods: Based on a stratified random selection, 108 physicians were interviewed via self-administered postal or online questionnaire (60 general practitioners and 48 dermatologists, response rate: 23.5%). The theory of acceptance and use of technology (UTAUT) was applied to teledermatology. Four central hypotheses were deduced and tested with logistic regressions., Results: The tested hypotheses postulating relationships between performance expectancy, effort expectancy, social influence and facilitating conditions and the intention to use teledermatology were partly confirmed. In addition, teledermatology was shown to have potential among Saxon general practitioners, as 9.5% of their patients came to the medical office for treatment of skin diseases; 78% of general practitioners offered skin cancer screenings., Conclusion: The population structure and the low density of medical specialists in Saxony would be favourable prerequisites for the implementation of teledermatology. Survey results failed to show any reservations of general practitioners and dermatologists towards teledermatology., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

There are different initial situations in the treatment of local or locoregional recurrences, secondary carcinomas or residual squamous cell carcinomas of the head and neck region after primary therapy. The majority of patients with locoregional recurrences have had prior treatment consisting of surgery and/or postoperative radiotherapy or radiochemotherapy or primary radiotherapy or radiochemotherapy. In any case, it is a matter of new tumor growth in a previously treated area, which must be taken into account for the therapy decision. The biological backgrounds are diverse and are described in more detail and clinically classified in the present work., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: Odontogenic cysts may be of developmental or inflammatory origin. They are frequently observed in brachycephalic dogs. Due to their expansive growth, cysts in the maxilla may extend into the nasal cavity, obstruct the nasal airway and cause nasal discharge. Epithelial cysts may lead to a comparable clinical picture. A new endonasal endoscopic intervention for the removal of these cysts is described., Material and Methods: Four brachycephalic dogs (Boxer, Chihuahua, French bulldog, Pug) with unilateral cysts obstructing the nasal cavity were included in the study. The animals underwent clinical examination, computed tomography (CT) imaging and rhinoscopy examination. Histopathologic evaluation of the cyst wall was performed. In addition to dental surgery and conventional extraction of the involved tooth, the cyst wall was removed by endoscopic intervention via the physiologic nasal opening. Clinical course following treatment was assessed by rhinoscopy and CT., Results: The main clinical signs were unilateral or bilateral serous to hemorrhagic nasal discharge. Nasal airflow was restricted in all patients. Removal of the cysts and involved teeth did not lead to any intra- and postoperative complications. No recurrence of the cysts was observed. Histologic diagnosis consisted of an epidermoid cyst, a follicular cyst, a radicular cyst, and a canine odontogenic parakeratinized cyst (COPC). Neoplastic transformation was excluded in all cases., Conclusions: Removal of the cyst wall may be performed by means of minimally invasive endoscopic intervention via the physiologic nasal entrance. The procedure is curative and carries the risk of only few complications. In cases in which treatment is restricted to extraction of the affected tooth, the nasal airway may remain obstructed due to a calcified cyst wall., Clinical Relevance: In brachycephalic dogs, oronasal defects due to dental pathology are the most common reason for chronic nasal discharge, whereas in normocephalic dogs nasal neoplasia are. Odontogenic cysts carry importance as differential diagnosis of nasal discharge., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: During inhalation anesthesia with nitrous oxide in oxygen the pressure in the cuff of the endotracheal tube may increase due to diffusion of nitrous oxide into the cuff. The aim of the study was to investigate the development of cuff pressure during nitrous oxide anesthesia under clinical conditions in feline patients and to identify possible influencing factors such as tube size and gas flow rate., Material and Methods: The prospective study included cats scheduled for inhalation anesthesia with nitrous oxide for a minimum duration of 60 minutes at the Department for Small Animals of the University of Leipzig. Cuff pressure was adjusted with a cuff manometer and its development was recorded., Results: In total, the cuff pressure values of 24 cats were recorded. Animals were allocated into groups by tube size (ID 4.0 mm and ID 4.5 mm) and by fresh gas flow rate: low flow rate (0.6 l/min) and high flow rate (3 l/min). During anesthesia, cuff pressure increased over time, with statistical significance occurring from 45 minutes onwards in comparison to the initial cuff pressure (p=0.005). After 60 minutes, there was a mean cuff pressure increase of 3 cmH 2 O. Despite this moderate mean increase, highly variable pressure values up to 48 cmH 2 O in individual animals were recorded. No cat reached the termination criterion of 60 cmH 2 O cuff pressure. Effects of tube size (p=0.63) and flow rate (p=0.334) on the cuff pressure were not evident., Conclusion: After a period of 45 minutes of nitrous oxide administration, a significant increase in cuff pressure occurs in the cat. However, tube size and total gas flow rate do not seem to influence the cuff pressure development., Clinical Relevance: When using nitrous oxide during inhalation anesthesia, regular cuff pressure evaluation and correction are necessary and hence recommended in feline patients. As individual pressure changes may be highly variable, no fixed recommendations for optimal management are possible., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Subject and Aim: The aim of the study was to clarify to what extent the sonographic representation of the stomach changes depending on its filling state., Material and Methods: In a prospective controlled study, warmblood horses presented for gastroscopy were assessed sonographically. The examinations took place when the horses were fed normally (measurement 1), after 12 hours of food deprivation (measurement 2), after insufflation of air during gastroscopy (measurement 3) and after removal of air from the stomach at the end of the gastroscopy (measurement 4). The following objective parameters were recorded: Number of intercostal spaces (craniocaudal extension) and determination in which intercostal spaces the stomach could be visualized sonographically, maximum dorsal extension of the stomach, distance between skin and stomach wall., Results: The median number of intercostal spaces in which the stomach could be visualized sonographically was 7.5 (IQR 3.75), 1.0 (IQR 1.0), 7.0 (IQR 2.0) and 2.0 (IQR 1.0) for measurements 1, 2, 3 (n=32) and 4 (n=15), respectively. The differences were significant between measurements 1 and 2 and between measurements 2 and 3. There was no significant difference between measurements 1 and 3. After 12 hours of food deprivation, the stomach size measured by the number of intercostal spaces visualizing the stomach was reduced by 75%. The maximum dorsal expansion of the stomach for measurements 1, 2, 3 (n=32) and 4 (n=15) was a median of 38 cm (IQR 15.25), 13 cm (IQR 6.75), 43 cm (IQR 7.00) and 21 cm (IQR 8.00), respectively. The differences were significant between measurements 1 and 2 and between 2 and 3. Concerning the distance between skin and stomach wall, the following medians were determined for measurements 1, 2, 3 (n=32) and 4 (n=15): 5.8 cm (IQR 2.27), 4.05 cm (IQR 3.05), 4.8 cm (IQR 1.48) and 5.9 cm (IQR 2.90). The only statistically significant difference was observed between measurements 1 and 3., Conclusions and Clinical Relevance: The sonographic appearance of the stomach changes according to the state of filling. Parameters that are readily determined sonographically are the craniocaudal and maximum dorsal extension as well as the distance between the skin and the stomach wall., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Primary malignant melanoma of the urinary tract is a rare entity with less than 50 cases reported worldwide. The following case concerns a 64-year-old woman whom we first saw in our emergency room due to gross haematuria. As part of the subsequent diagnostic investigation, we detected a primary malignant melanoma of the bladder and the urethra. The patient was treated with radical urethrocystectomy including pelvic lymphadenectomy and an ileum conduit. This was followed by a year of adjuvant therapy using checkpoint inhibitors., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Diagnostic imaging represents an important part during modern pregnancy management of the dog. Ultrasound has become the modality of choice for an early pregnancy diagnosis, enabling a verification as early as 17-20 days after LH surge. Furthermore an evaluation of fetal viability and development is possible as well as the depiction of malformations and an early assessment of fetal stress. Doppler imaging may also be of supporting value in this context . Using fetal maturity as well as measurements of fetal and extrafetal structures, a calculation of the gestational age and therefore the time of parturition is achievable. Radiographs of the caudal abdomen enable pregnancy diagnosis from the 43 rd day after LH surge onward. In addition, an assessment of fetal size as well as litter size is possible. Both modalities allow for complementary statements concerning possible labor complications and possess supporting value concerning the decision of necessary obstetric intervention and further management in patients with dystocia., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht.Mit Prof. Dr. Dr. h.c. mult. H. Bostedt verbindet die Autoren eine langjährige Zusammenarbeit. Prof. Bostedt präsentierte wie kaum eine Lehrkraft das Bild eines Professors alter Gangart. Seine fachliche und wissenschaftliche Kompetenz konnten wir als Studenten natürlich nicht beurteilen, wohl aber seine Fähigkeiten als Hochschullehrer Wissen zu vermitteln. Er war einer der wenigen Hochschullehrer, der nicht nur fachliche Kompetenz, sondern auch mit seinem Allgemeinwissen und seinem Interesse an vielen Dingen beeindruckt hat. Seine Weihnachtsvorlesungen, welche stets den Hörsaal gefüllt haben, sind 30 Jahre später immer noch in Erinnerung. Wenn er sich jetzt aus dem akademischen Leben zurückzieht, so verliert die Tiermedizin einen fachlichen und menschlichen Leuchtturm. Wir wünschen ihm alles Gute und noch viele schöne Jahre. Ingmar Kiefer, (Thieme. All rights reserved.)

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

Einleitung: In Hinblick auf den immer größer werdenden Ärztemangel und gleichzeitig steigenden Versorgungsbedarf in der Allgemeinbevölkerung war das Ziel der vorliegenden Untersuchung, ein detailliertes Bild über Renteneintrittswünsche der aktiven Hausärztinnen und Hausärzte (N=143) zu erfassen., Methode: Die Daten wurden im Rahmen einer Baseline-Befragung einer Langzeitstudie erhoben (repräsentative Ärztebefragung). Es wurde untersucht, inwiefern soziodemographische als auch berufsbezogene Variablen mit einem vorzeitigen bzw. späteren Renteneintritt in Zusammenhang gebracht werden können und welche Gründe für eine ärztliche Tätigkeit über das Rentenalter hinaus sprechen., Ergebnisse: Die Ergebnisse zeigen, dass die Hälfte der Befragten zwischen 29 und 66 Jahren vorzeitig in den Ruhestand gehen möchte und diese Entscheidung vor allem von Familienstand, aber auch von Arbeitszufriedenheit und Arbeitsbelastung abhängig ist. Zu den Gründen, die für einen späteren Eintritt sprechen, zählen "Freude an der Arbeit", "sich nützlich und gebraucht fühlen" und ein allgemein "berufliches Interesse"., Schlussfolgerung: Renteneintrittswünsche sollten bei der zukünftigen Planung der Versorgung berücksichtigt werden, um Maßnahmen zu ergreifen, die einem ungewollten oder vorzeitigen Ausstieg der Mediziner aus der Versorgung entgegenwirken., Background: There is a steadily increasing shortage of doctors and simultaneously an increasing need for health care of the general population. The aim of the present survey was to investigate retirement planning by family doctors (n=143)., Method: Data was collected as part of a baseline survey (longitudinal design, representative sample of physicians). Possible association between socio-demographic and occupation-related variables with early or later retirement was investigated and also why some physicians may consider continuing in their profession beyond retirement age., Results: The results showed that half of the respondents between 29 and 66 of age would like to retire early and that this decision depended primarily on marital status, but also on job satisfaction and workload. Reasons for late retirement were "enjoying work", "feeling useful and needed" and general "professional interest"., Conclusion: The results indicate that retirement wishes of GPs must be taken into account in the future planning of health care and that measures should be taken to counteract their early retirement from professional activity., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: Assessing the experience with and the attitudes towards exercise therapy in persons with severe mental illness (SMI). Furthermore, potential variables of high preference towards exercise therapy are investigated., Methods: Cross-sectional observational study of SMI patients aged between 18 and 65 years (n=385). Patients were interviewed by trained staff using standardised instruments. Potential variables were analysed using a hierarchic binary logistic regression model., Results: 84,4% of SMI patients had a high preference for exercise therapy; of these, 44,1% exercised regularly. Among patients with severe mental illness especially a higher value in the GAF-assessment (p=0,041) and living in a metropolitan area (p=0,011) predict a high preference for exercise therapy., Conclusion: Most of the patients with severe mental illness interviewed in this study place a surprisingly high value on sports and exercise therapy. Due to the increasing evidence with regard to positive effects of these therapies, it may be an excellent starting point to expand sports and exercise therapy as part of a comprehensive treatment plan. At the same time, strategies for everyday transfer need to be implemented more rigorously., Competing Interests: Alkomiet Hasan ist Herausgeber der AWMF S3-Leitlinie Schizophrenie. Er erhielt Vortragshonorare von Janssen, Otsuka, Lundbeck und Recordati und war Mitglied in Advisory Boards dieser Firmen und bei Rovi. Karel Frasch hat Kongressreiseunterstützungen von Janssen erhalten. Er ist außerdem Mitglied des Geschäftsführenden Ausschusses von ackpa. Stephan Heres hat in den zurückliegenden drei Jahren Vortragshonorare der Firmen Johnson & Johnson und Otsuka/Lundbeck erhalten, ferner Honorare für wissenschaftliche Beratertätigkeit in klinischen Studien der Firmen TEVA, ROVI und KYE., (Thieme. All rights reserved.)

In the discussion of medical history of psychiatry in the GDR, little attention has been paid to the subfield of forensic psychiatry. In the following literature-based overview, essential aspects of this specific topic are therefore presented. The content-related discussion in this field took place in particular in the area of forensic psychiatric expertise in criminal law, to which, among others, the most well-known forensic psychiatrist of the GDR, Hans Szewczyk, made important contributions. After the introduction of the Criminal Code in 1968 and the accompanying legal changes regarding reduced or abolished criminal responsibility of delinquents, a discourse took place until the beginning of the 1980s on various questions on the improvement of the quality of expert opinions and further development of their work. The focus was on the assessment of criminal responsibility rather than on the assessment of prognosis, which probably resulted from the abolition of the "Maßregelvollzug" in 1968. Only a few sources refer to the placement and treatment of forensic psychiatric patients. Mentally ill offenders were hardly ever accommodated in specific departments, which were apparently established in a few clinics from the mid-1970s onwards. There was also a lack of specially developed structural treatment concepts specifically for forensic psychiatric patients. Especially for mentally ill lawbreakers with a high level of delinquency, inpatient placement was apparently hardly possible due to a new legislation after 1968. In the area of civil law, only a few sources indicate that the topics of incapacitation and guardianship were addressed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In 2022, one novel pharmaceutical agent was released on the German market for horses or food-producing animals: An injection suspension for horses containing tenogenic primed equine allogeneic peripheral blood-derived mesenchymal stem cells as the active ingredient (RenuTend ® ) is now available. The authorization of one established veterinary active ingredient was extended to an additional species: The synthetic prostaglandin F 2α -analogue cloprostenol (Syncroprost ® ) received approval for goats. Additionally, for 2 active ingredients (paracetamol, suxibuzone), drugs with a higher content of the active ingredient were launched on the market for horses and food-producing animals., Competing Interests: Die Autorin bestätigt, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In 2022, 3 novel pharmaceutical A: gents for small animals were released on the German market: the peripheral selective α 2 -adrenoceptor antagonist vatinoxan in combination with medetomidine (Zenalpha ® ), mesenchymal stem cells from the umbilical cord of horses (DogStem ® ) and the ectoparasitic agent tigolaner in combination with emodepside and praziquantel (Felpreva ® ). No active substance received an animal species extension. In addition, for small animals, there were new releases of four active ingredients in a novel pharmaceutical formulation (acetylcysteine, clindamycin, metoclopramide, oclacitinib maleate), one drug with a new content of the active ingredient (firocoxib) and one veterinary drug with a new combination of active ingredients in a novel pharmaceutical formulation (ketoconazole+marbofloxacin+prednisolone)., Competing Interests: Die Autorin bestätigt, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim of the Study: Since 2011, non-vitamin-K-dependent oral anticoagulants (NOAC) have extended the spectrum of anticoagulation therapy. Initially, the approval of NOAC was limited to the prophylaxis of postoperative thrombosis, but in the course of time the spectrum was extended to the therapy of thrombosis and embolism as well as anticoagulation in non-valvular atrial fibrillation. The study was designed to examine how the approval of NOAC had affected the prescribing behaviour of general practitioners in the first years of their approval., Methods: In a retrospective longitudinal study, the prescriptions of anticoagulants between 2012 and 2017 were analysed in 3 general practitioners' practices in the Bonn area. The study included all patients for whom at least one prescription from a NOAC or a vitamin K antagonist (VKA) was documented in the administrative system of the practices during this period., Results: A total of n=579 patient files were evaluated (47% female; median age 75 years). Of these, 47% received a VKA, and 40% a NOAC (59% rivaroxaban, 29% apixaban, 9% dabigatran and 3% edoxaban). During the period under examination, the share of VKA prescriptions decreased from 45% to 14% and the share of NOAC increased from 28% to 87%. Anti-coagulation was changed in 12%. The most frequent change was from a VKA to a NOAC (70%)., Conclusion: After marketing approval, the use of NOAC in the initial prescriptions increased steadily. This trend can also be seen in other European studies. VKA are mainly prescribed to patients with stable oral anticoagulation. As recommended in the guidelines, anticoagulation is changed mainly when problems occur during therapy. If the trend in the prescription of anticoagulants continues, in the medium term, VKA will only be prescribed for patients who have been stable for many years and for patients with artificial heart valves., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Clinical signs, additional diagnostic procedures, treatment, and outcome of a clinically diagnosed posterior scleritis in a male Landseer are reported and discussed in context with the existing literature., Competing Interests: Es besteht kein Interessenkonflikt., (Thieme. All rights reserved.)

From a psychological perspective, male survivors of sexual violence in the context of war and forced displacement represent a highly burdened population. An adequate assessment of traumatic events and trauma related disorders is often hampered by both disclosure barriers from the patient side as well as by lack of awareness on the part of healthcare professionals regarding male victimization. Based on a narrative literature review, relevant characteristics of violence and their relation to the diagnostic process are elaborated on eight dimensions of individual experience of violence (form of violence, frequency and severity, perpetrator-victim context, societal discrimination, subjective evaluation, concept of masculinity, culture-specific norms, and trauma sequelae). The dimensions are delineated in a case study. In order to thoroughly assess sexualized experiences of violence, there is a need for sensitivity on the part of practitioners to the signs of male victimization and regular assessment of sexualized violence in male patients. In this context, certainty about the confidentiality of the information disclosed and recognition of the injustice are of central importance for those affected. In the long term, the development of specialized support services for male victims is needed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

For some years now, the incidence of syphilis and neuroluetic clinical pictures has been increasing. As a result, tabes dorsalis and progressive paralysis are once again gaining relevance in neurology. In the last two decades of the 19th century, there was a heated debate in German neurology about the understanding of the aetiology of these conditions, the so-called 'tabes syphilis controversy'. In 1879, Wilhelm Erb had called on the German neurological community in a much-noticed lecture to finally tackle the problem to unequivocally identify the cause of tabes dorsalis. Mainly on the basis of disease statistics he himself postulated a previous syphilitic infection as of key importance. Answering this question was urgent, because the proportion of patients in psychiatric institutions suffering from progressive paralysis, to which tabes was seen in close parallel, was rapidly increasing. The Berlin neurologists Carl Westphal, Ernst Julius Remak, Martin Bernhardt and Ernst Victor von Leyden regarded Erb's thesis as a gauntlet. They saw the causes of tabes and progressive paralysis in social impoverishment such as damp and cold living conditions, in physically one-sided work overloads or in the hardships of soldiers in the army. They assumed that traumatic tabes was caused by concussions or bruises. The Leipzig neurologist Paul Julius Möbius was the first to state between 1890 and 1897 that the only cause of tabes and progressive paralysis was a previous syphilitic infection. He consistently ruled out all other aetiological theories. Above all, bacteriological and microbiological research in the following years proved Möbius right. Thus 40 years after Erb's lecture, in addition to diagnostic, specific therapeutic approaches could be developed and applied., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Previous navigation systems can determine the position of the "tracked" surgical instrument in CT images in the context of functional endoscopic sinus surgery (FESS), but do not provide any assistance directly in the video endoscopic image of the surgeon. Developing this direct assistance for intraoperative orientation and risk reduction was the goal of the BIOPASS project ( Bi ld O ntologie und p rozessgestütztes Ass istenzsystem). The Project pursues the development of a novel navigation system for FESS without markers. BIOPASS describes a hybrid system that integrates various sensor data and makes it available. The goal is to abandon tracking and exclusively provide navigation information directly in the video image. This paper describes the first step of the development by collecting and structuring the surgical phases (workflows), the video endoscopic landmarks and a first clinical evaluation of the model version. The results provide the important basis and platform for the next step of the project., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

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

Purpose and Aim: The presenting complaints, clinical signs, diagnostic evaluation, therapy, and outcome of 12 horses with clinically apparent West-Nile-Virus (WNV) infection are described., Material and Methods: Case series RESULTS: The adult horses (age 6-18 years, 7 mares, 5 geldings) from Saxony and Saxony-Anhalt were presented with various clinical histories between September 2018 and September 2020. All horses were presented in August or September and no horse was vaccinated against WNV. Fever as the most common general clinical sign was present in 8/12 horses. The most common neurological signs were muscle fasciculations (11/12 horses), ataxia (8/12 horses), hyperesthesia and head tilt (6/12 horses each). Diagnosis of WNV infection was confirmed by demonstrating IgM antibody and neutralizing antibody production in all horses; 2 euthanized horses also tested positive by PCR. Therapy was symptomatic and primarily included non-steroidal anti-inflammatories or dexamethasone as well as fluid therapy. Duration of hospitalization was 7.5 days on average. According to their owners, seven horses recovered completely, while information was missing for 2 horses., Conclusions and Clinical Relevance: In eastern-central Germany, WNV-encephalomyelitis must be considered a differential diagnosis for unvaccinated horses with acute neurologic disease occurring in summer and late summer. The reported clinical signs and the outcome of therapy are mostly congruent with reports from North America and other European countries., Competing Interests: Bei den Autoren liegt kein Interessenkonflikt im Hinblick auf diese Arbeit vor., (Thieme. All rights reserved.)

The study focuses on the life and work of the German-Jewish neurologist Dr. Ernst Jolowicz who was born in 1882. Originally from Poznan in present-day Poland, Jolowicz had gained his initial professional experience in the German Empire before serving as a neurologist at the Western Front during the First World War. After the war, he opened a private psychotherapeutic practice in Leipzig, published numerous scientific papers and was involved in the General Medical Society for Psychotherapy. In his writings, Jolowicz appeared as an undogmatic adherent of suggestive techniques and came up with his own methods for a patient-centered, psychagogic psychotherapy. In addition, he wrote numerous cultural and social scientific essays showing a wide range of interest. Shortly after the seizure of power by the National Socialists, he emigrated to Paris and supported the anti-fascist resistance in a Strasbourg radio station. After the occupation of France, Jolowicz fled to the United States in 1941 and gained a foothold there once more before he died of a heart disease in New York City in 1958., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

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

Background: Photodynamic Diagnosis (PDD) is widely used today for the diagnosis and treatment of superficial bladder cancer. This study aimed to analyse the impact of using this technique on recurrence rate, residual tumour rate and progression-free survival., Materials and Methods: We conducted this study retrospectively in our unit between 10/2014 and 02/2018. We divided our patients into 2 groups: white light group, 49 patients who underwent primary bladder tumour resection with white light transurethral resection of bladder tumour (WL-TURB), and blue light group, 49 patients treated with blue light transurethral resection of bladder tumour (BL-TURB) with PDD. Patients in both groups were followed up for one year. We collected data for tumour recurrence for the first year, 3-month and 1-year relapse-free survival and 1-year progression-free assessment pursuant to the EORTC risk classification by Sylvester 2006. Furthermore, the residual tumour rate was determined by re-TURB., Results: The following results were found independent of age, gender and histological findings: Residual tumour rate: blue light group 13.95 % vs. white light group 32.6 %, (p 0.02, OR 3.8, CI 95 % [1.17 - 12.85]).; 3-month relapse-free survival: blue light group 87.7 % vs. white light group 67.4 % (p 0.02, HR 3.18, CI 95 % [1.20 - 8.42]); 1-year relapse-free survival: blue light group 77.6 % vs. white light group 55.1 % (p 0.015, HR 2.56, CI 95 % [1.20 - 5.45]); 1-year progression-free survival: blue light group 95.9 % vs. white light group 79.6 %, p 0.03, HR 5.23, CI 95 % [1.11 - 24.53]) CONCLUSION:  The use of hexaminolevulinate significantly reduces the risk of residual tumours compared with conventional TURB. The PDD technique significantly improved 3- and 12-month recurrence-free survival, especially in low and medium-risk tumours, and 1-year progression-free survival, especially in high-risk tumours., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The following is a case report of a 54-year-old female who presented with persistent macrohaematuria with bladder tamponade three weeks after percutaneous nephrolithotomy. Angiography revealed an intrarenal aneurysm, which was closed by coiling, resulting in complete cessation of bleeding., 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.

Goals for health and health care are an indispensable basic requirement for a functioning health care system. The dilemma of the German health care system is that it has not been designed in a planned way, but that it has grown historically. In recent years, it has developed through the free play of forces into what it is today. The OECD characterizes the current state as follows: The costs of the German health system do not correspond to the often only average health outcomes for the population. To meet the legal requirements (especially SGB V §§ 12, 27 and 70), health care/the health system in Germany needs concrete goals. An orientation towards health care goals entails measures on all levels of health care: on the macro level (overall system/total population), on the meso level (subdivided according to regions, specific population groups, etc.) as well as on the micro level (patients and health care providers). Based on national and international experiences, this position paper of the DNVF e.V. (German Network for health services research) shows the potential of how operationalised health care targets can ensure effective, affordable and high-quality health care. The coalition agreement of the current government propagates a reorientation with patient-related health care goals. Now it is important to derive concrete and realisable goals from this declaration of intent and to involve all important groups in the process. In addition, values and ethical standards for implementation shall be agreed upon in this process. The Health Ministry (BMG) should facilitate and promote the process of societal will-building for the definition of national health care goals. This requires a clear political will. As a result, the National Health Care Goals are available at the end of the process, which are published and maintained together with evidence-based facts as well as valid and resilient data in a Manual "National Health Care Goals". The operational responsibility for implementation could lie with the newly to be founded Federal Institute of Public Health, as already announced in the agreement of the governing coalition. The DNVF is willing to actively participate in the development of health care targets., 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/).)

Background: Endoscopic surgical procedures have been established as gold standard in sinus surgery. Challenges for surgical training have been addressed by the use of virtual reality (VR) simulators. To date, a number of simulators have been developed. However, previous studies regarding their training effects investigated only medically pretrained subjects or the time course of training outcomes has not been reported., Methods: A computer tomography (CT) dataset was segmented manually. A three-dimensional polygonal surface model was generated and textured using original photographic material. Interaction with the virtual environment was performed using a haptic input device. For the investigation of training outcomes with the simulator, the parameters duration and the number of errors were recorded. Ten subjects completed a training consisting of five runs on ten consecutive days., Results: Within the whole exercise period, four subjects reduced the duration of intervention by more than 60%. Four subjects reduced the number of errors by more than 60%. Eight out of 10 subjects showed an improvement with respect to both parameters. On median, the duration of the procedure was reduced by 46 seconds and the number of errors by 191. The statistical analysis between the two parameters showed a positive correlation., Conclusion: Our data suggests that training on the FESS-simulator considerably improves the performance even in inexperienced subjects, both in terms of duration and accuracy of the procedure., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The aim of this study was to describe how the therapy of anorexia nervosa (AN) and food refusal have been discussed in leading textbooks used in German-speaking academic psychiatry over the past 200 years. For this purpose, 18 textbooks of important school psychiatrists were selected. These were analyzed in a structured way to determine the content of the subject taught at universities in German-speaking countries at a given period. We found that AN was not taught as a distinct disorder until the end of the 20th century, although great attention had been paid to food refusal as a symptom and manifold therapeutic concepts had been developed much earlier. Whereas at the beginning of the 19th century forced feeding using feeding tubes was established, in the following years pharmacotherapies and special diets were developed. It is noteworthy that since the beginnings of academic psychiatry, some early forms of psychotherapy have been developed; for instance, special kinds of behavior were recommended when dealing with the patient, as the therapist was supposed to serve as a role model to encourage patients to eat. Treatment of food refusal by means of structured psychotherapeutic approaches were not established before AN was generally accepted as a distinct disease entity. The understanding of etiological factors that might lead to AN as well as potential psychotherapeutic interventions have changed fundamentally over the past decades., Competing Interests: Alle Autor*innen geben keinen Interessenkonflikt zum Inhalt dieses Beitrags an., (Thieme. All rights reserved.)

The present work discusses soft tissue sarcoma in the head and neck area, due to the new published German S3-Guideline "adult soft tissue sarcoma". The head and neck surgeon plays the central role in the diagnosis and treatment of the vast majority of cases. It is crucial to admit the patients immediately to specialized centers for diagnoses and specific treatment. Regarding correct diagnostic procedures, in contrast to squamous cell carcinoma, a larger accidental excisional biopsy within the tumor tissue is strongly prognostic negative. After confirmation of histology and tumor extension, it is mandatory to discuss the interdisciplinary treatment concept. If possible, introduction of the patient in ongoing clinical studies is key., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: The Leipzig Veterinary Risk-Index - "LeiV-Risk-Index" is a multifactorial risk index developed to enable an improved objective assessment of the anesthetic risk in dogs. The scoring system is based on 10 risk factors affecting perioperative mortality. The aim of this study was to evaluate the applicability of the LeiV-Risk-Index and its risk factors as well as to perform a direct comparison with the ASA-classification., Material and Methods: An online survey was conducted among veterinarians working in small animal medicine throughout Germany. Participants received a questionnaire containing information on 15 selected patients. They were asked to classify the patients according to the LeiV-Risk-Index and ASA-classification and to answer several questions concerning their professional background. The results were statistically analyzed considering the consistency among veterinarians of rating the different patients by using Fleiss'-Kappa. The correlation of LeiV-Risk-Index and ASA-classification was calculated., Results: The consistency of all assigned LeiV-risk classes between participants was moderate (κ = 0.55) and higher than classification by ASA (κ = 0.33). On average, 3 different LeiV-risk classes and 4 different ASA-classes were assigned for one patient. There was a positive correlation between LeiV-risk class and increasing ASA-class. No effect of gender or clinical experience of the veterinarian could be demonstrated on ranking patients. There was also no effect of how confident veterinarians felt in applying the LeiV-Risk-Index., Conclusion Und Clinical Relevance: The LeiV-Risk-Index is the first index available in veterinary medicine for assessing anesthetic risk that is based on objective risk criteria and whose objectivity exceeds that of the ASA classification. Anesthetic patients can thus be evaluated more consistently in veterinary medicine as well. Utility and practicability were positively received by 95 % of the participants. Further revision of individual risk criteria needs to be reconsidered., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

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

Recent studies on the treatment of overweight and obesity in children and adolescents have generally considered single psychological or somatic parameters. The present study examined the efficacy of multimodal obesity treatment in routine care in N=278 children and adolescents (ages 2-17) over 12 months using comprehensive psychological and somatic parameters. The primary endpoint was the objectively measured change of BMI-SDS (Body Mass Index Standard Deviation Score). Secondary objectives included patient-reported health-related quality of life, general and eating disorder psychopathology, weight-related self-stigmatization as well as objectively measured parameters of lipoprotein and glucose metabolism and liver enzymes. At the end of treatment after 12 months, there was significant improvement in BMI-SDS (M=-0.10; SD=0.32) and single liver enzymes in the total sample whereas psychological and other blood parameters showed no significant improvement. Treatment responders showed greater BMI-SDS reductions (M=-0.44; SD=0.22) as well as similar results concerning blood and psychological parameters compared to the total sample. This multimodal obesity treatment in routine care mostly improved patients' BMI-SDS and single somatic parameters, but not psychological parameters. Patients' psychological stressors emphasize the need for psychotherapeutic treatment going beyond reduction of BMI-SDS. Furthermore, these results underline the importance of comprehensive evaluation of psychological and somatic parameters to improve treatment outcome., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The new pharmaceutical regulations for veterinary medicinal products introduced in the course of the EU harmonization also have an impact on pharmacotherapy of honey bee colonies in Germany. In particular, the requirement to use veterinary medicinal products in accordance with the terms of the marketing authorization not only restricts the veterinarians' freedom of therapy, but also marks the end of off-label use of approved varroacides in honey bees not subject to pharmacy requirements by beekeepers. A deviation from the terms of the marketing authorization is only possible in the case of a so-called therapeutic emergency in the reclassification, irrespective of the sales demarcation/limitation. If such a situation exists, however, veterinary medicinal products for honey bees from other member states of the European Union may already be used in the first reclassification level, even if veterinary medicinal products with the same active ingredient are available in Germany. For this reason, the article discusses not only the impact of the required adherence to the marketing authorization, but also additional treatment options for honey bees in consequence to the harmonisation of the internal market., Competing Interests: Die Autorin bestätigt, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany.)

Objective: As a follow-up to a previous study on the incidence, history and clinical findings of tibial neuropathy (TN), the present work aimed at describing the treatment and prognosis of this disease., Materials and Methods: Of 88 German Holstein dairy cows with unilateral (UTN, n = 71) or bilateral (BTN, n = 17) TN, 68 (56 UTN, 12 BTN) with a complete data set were analyzed. They were retrospectively assigned to one of four groups: no treatment - spontaneous healing within 48 h (Spontaneous, 5 UTN), no bandage (0Cast, 8 UTN, 3 BTN) or treatment with anti-inflammatory drugs and support bandage (StV, 3 UTN) or fiberglass cast (Cast, 40 UTN, 9 BTN). Treated cows were re-examined five times (14, 21, 28, 42 and 56 days after the first presentation). The plasma activity of creatine kinase was measured at the last re-examination in 29 cows similar to measurement at day 0., Results: The observed overall success rate of treatment of cows with UTN was considerably higher compared with untreated cows (Cast 98 % and StV 100 % vs. 0Cast 62 %). By comparison, the observed difference between treated and untreated cows with BTN was not so clear (78 % vs. 67 %). Recovering cows exhibited a calculated longer median survival time than cows that did not recover (545 d vs. 100 d). Plasma creatine kinase activities were increased initially and returned within the reference interval (434 U/l and 152 U/L) following treatment., Conclusions: Cows with ETN have an excellent prognosis provided that treatment with anti-inflammatory drugs and stabilizing bandage is administered. In cows with BTN, the prognosis depended on the type and degree of the primary injury. Loss of skin sensitivity indicated a poor prognosis. From an economic standpoint, treatment of TN is indicated provided that the prognosis is good. In cows that had healed clinically, the average survival time extended into the following lactation., Clinical Relevance: This study highlights the advantages of a support bandage for the treatment of cows with TN. Compared with other peripheral neuropathies, muscle damage appears to be of particular importance in TN., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In 2021, one novel pharmaceutical agent for horses or food-producing animals was released on the German market, making the anti-haemorrhagic etamsylate (Hemosilate) available for horses, cattle, pigs, sheep, goats, dogs and cats, for the first time. The authorization of one established veterinary active ingredient was extended to an additional species: The endectocide eprinomectin (Eprecis ® ) from the group of macrocyclic lactones was also approved for sheeps and goats. Additionally, two veterinary formulations with a new active substance content (bromhexine, tiamulin) and one active ingredient in a novel pharmaceutical formulation (indigo carmine stained intramammary suspension with heavy bismuth subnitrate) appeared on the market. Furthermore, one active ingredient (oxytetracycline) is again available for horses on the market for horses and food-producing animals., Competing Interests: Die Autorin bestätigt, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: To evaluate recommendations of an antibiotic stewardship (ABS) team during routine weekly visits and to analyse their implementation and reasons for non-implementation by the ward physicians., Methods: Multiprofessional ABS Rounds (members: infectiology, microbiology, pharmacy and hospital epidemiology) were accompanied by an observer in nine intensive and peripheral wards of a university hospital (1451 beds) for eight weeks. The recommendations of the ABS team were prospectively analysed, and when these were not implemented, ward physicians in charge were asked to give reasons for non-implementation., Results: A total of 262 patients were visited in the course of 359 ABS visits. A median of four physicians and one pharmacist (Q25/Q75: 4/6) participated in the ABS rounds. In 177/359 (49%) of visits, at least one recommendation for anti-infective therapy was given; the total number of recommendations made was 210. The most frequent (38%, 80/210) recommendations were related to the prescribed therapy duration. The more different the professional groups participating in the ABS rounds, the larger was the number of recommendations given (p=0.016; odds ratio=1.018 (1.003-1.033)). 62/210 (30%) of the ABS recommendations were not implemented by the ward physicians in charge. The most frequent reason (32%: 20/62) for this was the deliberate decision by the physicians to deviate from the recommended therapy., Conclusions: The high recommendation rate of 50% demonstrates the need for optimizing therapy by the ABS teams in routine practice. The larger the number of different specialists participating in single visits, the larger was the number of recommendations. Reasons for the lack of implementations need to be critically examined by both the ABS team and the ward physicians in charge., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

In 2021, 8 novel pharmaceutical agents for small animals were released on the German market: The specific monoclonal antibodies bedinvetmab (Librela ® ) and frunevetmab (Solensia ® ), the cyclooxygenase-2 inhibitor enflioxib (Daxocox ® ), the ectoparasitic esafoxolaner (NexGard ® Combo) of the isoxazoline group, the anti-haemorrhagic etamsylate (Hemosilate), the antidepressant mirtazapine (Mirataz ® ), the alpha-selective sympathomimetic tetryzoline for ophthalmic use (Zolicep ® ) and the cytostatic tigilanol tiglate (Stelfonta ® ). No active substance received an animal species extension. In addition, for small animals, there were new releases of two agents in a novel pharmaceutical formulation (cefalexin, gentamicin), five drugs with a new content of the active ingredient (metronidazole, pimobendan, thiamazole, tramadol, trilostane), one veterinary drug with a new combination of active ingredients (lotilaner + milbemycin oxime), one drug with a new route of administration (propofol) and furthermore two temporarily non-available active ingredients for certain animal species were reapproved in new drugs (levothyroxine for cats and oxytetracycline for dogs and cats)., Competing Interests: Die Autorin bestätigt, dass kein Interessenskonflikt besteht., (Thieme. All rights reserved.)

Objective: Complications associated with indwelling intravenous catheters vary from minor to severe. Changes in tissue architecture and vein structure may be detectable prior to clinical alterations. The aim of the study was to characterize and compare changes in a catheterized vein and surrounding tissue by clinical and ultrasonographic examination. Microbiological infestation of catheter specimens was assessed., Material and Methods: In this prospective, observational, clinical study 55 horses with an indwelling intravenous catheter have been included. Subsequent to catheter placement, vein and surrounding tissue were daily examined clinically and by ultrasonographic examination at predetermined localizations. After sterile removal of the catheters, specimens underwent microbiological testing and scanning electron microscopy. Obtained data were analyzed via descriptive statistics. Thickness of the venous wall was compared at predetermined localizations and time points for several parameters with the help of non-parametric tests (level of significance at p < 0.05, post-hoc Bonferroni correction)., Results: Overall, in 41.8 % of the horses transient alterations (swelling) of the surrounding tissue occurred during catheterization. Median catheterization was 69.5 hours (19 hour-10 days). With ultrasonography, venous valves and collateral vessels could be detected reliably. Significant alterations in wall thickness during catheterization were associated with various factors (location site [p ≤ 0.001], season [p = 0.006], anesthesia [p ≤ 0.001]).Microbiological analysis revealed a positive result in 23.5 %, 12 of the 51 samples; raster electron microscopy showed presence of bacteria in 25.0 %, 4 of the 16 investigated catheter samples., Conclusion and Clinical Relevance: Local tissue changes at the insertion site of the catheter are commonly associated with catheterization, and are easily detectable with ultrasonography. Despite the easy performance in a clinical setting, the benefit of routine ultrasonographic monitoring of catheterized veins might be questionable with regard to early identification and prediction of catheter-associated venous disease. Bacteria might be detectable morphologically on the catheter but frequently lack a positive result from standard bacterial cultivation., Competing Interests: Die Autoren bestätigen, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)