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Background: Currently, no data are available, which reflect the situation of medical doctors specializing in neurology in German hospitals. In order to secure the high standard of neurological patient care it is essential to evaluate the working conditions and the specialty training in neurology., Objective: This nationwide survey was conducted throughout Germany with the aim to address problems and to give suggestions for improvements in neurological training curricula., Material and Methods: The survey was online from February to May 2017 and 953 neurologists undergoing further training participated., Results: More than half of the young neurologists were satisfied with their medical training. One of the main problems that complicates clinical training is the workload. In addition, organizational obstacles within the clinic, such as poor structure of education or a lack of mentors, lead to dissatisfaction among participants. The size or type of the department, as well as the prevailing service system, exert only a minor influence on the quality of specialist training, although there were differences especially in the self-assessment of the participants in connection with the type of department (university hospital versus public or private hospital)., Conclusion: Specialist training in neurology can be improved by simple arrangements, e. g., the introduction of a binding rotation scheme, internal mentoring and structured feedback. In addition, it will be necessary to relieve medical staff of administrative duties in order to create time for training and the learning of competencies.

Background: The purpose of this study is to evaluate whether wrapping of the pedicled falciform ligamentum flap around the gastroduodenal artery (GDA) stump/hepatic artery can significantly decrease the incidence of erosion hemorrhage after pancreatoduodenectomy (PD)., Methods/design: This is a randomized controlled multicenter trial involving 400 patients undergoing PD. Patients will be randomized into two groups. The intervention group consists of 200 patients with a prophylactic wrapping of the GDA stump using the pedicled falciform ligament. The control group consists of 200 patients without the wrap. The primary endpoint is the rate of postoperative erosion hemorrhage of the GDA stump or hepatic artery within 3 months. The secondary endpoints are postpancreatectomy hemorrhage stratified according to the texture of the pancreas, postoperative pancreatic fistula (POPF), postoperative rate of therapeutic interventions, morbidity, and mortality., Discussion: Only few retrospective studies investigated the effectiveness of a falciform ligament wrap around the GDA for prevention of erosion hemorrhage. Erosion hemorrhage occurs in up to 6-9% of cases after PD and is most frequently evoked by a POPF. Erosion hemorrhage is associated with a remarkable mortality of over 30%. The rate of hemorrhage after performing the wrap is reported to be low. However, there exist no prospectively controlled data to support its general use. Therefore, the presented randomized controlled trial will provide clinically relevant evidence of the effectiveness of the wrap with statistical significance., Trial Registration: clinicaltrials.gov, NCT02588066 ; Registered on 27 October 2015.

Objectives: To evaluate the ability of general practitioners (GPs) in Germany to estimate the risk of patients with diabetes developing complications., Methods: An interview study using a structured questionnaire to estimate risks of four case vignettes having diabetes-specific complications within the next 10 years, risk reduction and life expectancy potential. A representative random sample of 584 GPs has been drawn, of which 150 could be interviewed. We compared GPs' estimates among each other (intraclass correlation coefficient (ICC) and Cohen's (multirater-) kappa) and with risks for long-term complications generated by the multifactor disease model "Mellibase", which is a knowledge-based support system for medical decision management., Results: The risk estimates by GPs varied widely (ICC 0.21 95% CI (0.13 to 0.36)). The average level of potential risk reduction was between 47% and 70%. Compared with Mellibase values, on average, the GPs overestimated the risk threefold. Mean estimates of potential prolongation of life expectancy were close to 10 years for each patient, whereas the Mellibase calculations ranged from 3 to 10 years., Conclusions: Overestimation could lead to unnecessary care and waste of resources.

The idea of family doctor-based health care corresponds to a social necessity for economical health care and a basic requirement for family doctors. However, this request is turned into the opposite by the legal description of a "particularly qualified family doctor". Economic interests dominate, dissect the family doctor level and influence long-standing family doctor-patient relationships and put the performance of social goals into question. Against that, the Family Doctor Association is setting the concept for family doctor-based integrated care, which also places quality demands, but does not exclude physicians basically or by selection of the compulsory health insurance fund.

We assess the diagnostic value of the recombinant antigens E1/E2 (heterodimer) and E2 for the screening of blood donors. For this purpose an ELISA assay was developed which used these recombinant glycoproteins as solid antigens on the microtiter plates. The anti-E1/E2 assay was able to detect 80% of the positive samples by Matrix and 87% of the PCR-positive samples. Anti-E2 was less sensitive. Fifteen percent of the indeterminate samples were anti-E1/E2 and 8% anti-E2 positive. In the case of the indeterminate samples there was no coincidence of results between these assays and the PCR. Fifty percent of seroconverters showed an anti-E1/E2-positive result with a previous indeterminate donation. We conclude that the recombinant envelope proteins, mainly anti-E1/E2, might be used in future in the diagnostics of HCV infection to increase the sensitivity of the currently used assays.