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In a general sense, entrepreneurial thinking and action relates to all those in employment, as an attitude to work and working behaviour, and it is accordingly becoming a key factor in competence. For independent entrepreneurs it is also, in a more specific sense, a fundamental precondition for successfully establishing and operating an enterprise. This applies above all to small and medium-sized enterprises, whose contributions to employment, training, gross value added, turnover, innovation, competitiveness and social-policy objectives make them the mainstay of the European economy. Entrepreneurial thinking and action is not a single competence--it combines a bundle of (key) abilities, such as initiative, creativity and single-mindedness. The leading organisations of German trade and industry have developed a plan for promoting entrepreneurial thinking and action, which systematically takes account of these abilities in general secondary education; they are then developed during training into an entrepreneurial attitude to work. Specific skills going as far as management and setting up in business are to be offered in continuing education/training and in higher education. Various coordinated measures are required in the individual phases, in order to put in place sustainable entrepreneurship education. (Contains 2 figures and 42 footnotes.)

Synthetic cannabinoids become increasingly popular as a supposedly safe and legal alternative to cannabis. In order to circumvent the German New Psychoactive Substances Law, producers of so-called herbal mixtures rapidly design new substances with structural alterations that are not covered by the law. Acting as full agonists not only at the cannabinoid receptors 1 and 2, synthetic cannabinoids might have not only desired mental but also serious physical adverse effects. However, knowledge of adverse effects of specific substances is sparse and incomplete. This also accounts for 5F-Cumyl-PEGACLONE, a synthetic cannabinoid, which has been detected regularly in Germany in recent years. By using an animal model, the isolated perfused Langendorff heart, the study at hand aimed on finding out more about possible cardiovascular adverse effects of 5F-Cumyl-PEGACLONE. Hearts of male Wistar rats, which were excised postmortem, were exposed to two different concentrations of 5F-Cumyl-PEGACLONE: 13 hearts were exposed to 50 ng/ml and 12 hearts were exposed to 100 ng/ml. Thirteen control hearts were merely exposed to an additional amount of buffer solution. Functional parameters heart rate, minimal and maximum left ventricular pressure and coronary flow were documented at pre-defined time points during and after the administration of 5F-Cumyl-PEGACLONE/additional buffer solution. Electrocardiograms (ECGs) were documented throughout the experiments and evaluated afterwards. Kruskal–Wallis analysis was performed for each functional parameter as well as for the duration of the QRS complexes and the duration of RR intervals as derived from the ECGs. Furthermore, a multivariate analysis, comprising all functional and ECG parameters, was performed. Kruskal–Wallis analysis revealed only single significant p-values for QRS duration and minimum left ventricular pressure that did not pass a Bonferroni test. The results of the multivariate approach were also comparably homogeneous, but still the model correctly recognized hearts exposed to 100 ng/ml of 5F-Cumyl-PEGACLONE more often than hearts exposed to the low concentration of 5F-Cumyl-PEGACLONE or additional buffer solution. Evaluation of the ECGs presented single cases of ST depression and QT prolongation. Though certainly not unambiguous, these findings support the assumption that 5F-Cumyl-PEGACLONE can cause severe, if not lethal, cardiac adverse effects like arrhythmias or myocardial infarctions especially if it is consumed in combination with other drugs like alcohol or if the consumer suffers from pre-existing heart diseases. [ABSTRACT FROM AUTHOR]

Background: Knowledge, attitudes and substitution laws of biosimilars are not consistent across countries. Biosimilar acceptance among patients and healthcare professionals may be suffering from gaps in knowledge and understanding about biosimilars and their regulatory approval process. Pharmacists' roles and responsibilities changed considerably during the COVID-19 pandemic. Thus, they might have gained new skills and self-confidence in counseling and substitution of biosimilars. Aims: To examine and compare the knowledge, perceptions and information needs of German and Swiss pharmacists regarding original biologicals and biosimilars in 2020 and 2022. Methods: We conducted an online survey among Swiss and German community pharmacies in February 2020 (before) and August 2022 (after the COVID-19 pandemic). Descriptive statistics were calculated and the Chi-Square test was used for comparisons among categorical variables. Results: A total of 764 pharmacists took part in the survey (390 in 2020 and 374 in 2022) with comparable demographics. The frequency of dispensing biologicals remained similar between German and Swiss pharmacists in 2020 and 2022, but the Swiss dispensation of biosimilars increased significantly in 2022 compared to 2020. Concerning the understanding of the term biosimilars, knowledge remained moderate in both countries in both years. Participants were equally familiar with the term and most felt sufficiently informed. In both countries, substitution with a biosimilar showed the least confidence of all attitudes. A third of the participants indicated correct substitution rules in their country. In both years, around 85% of the participants were highly interested in additional training on this topic. Discussion/Conclusion: The results indicate that similarities and differences between Germany and Switzerland regarding knowledge and attitudes towards biologicals and biosimilars remained unchanged before and after the COVID-19 pandemic. An influence of the pandemic is unlikely. There is still a clear lack of knowledge among community pharmacists on biosimilars, especially regarding the substitution rules. Due to a rising market with many benefits but also big challenges to overcome, the topic of biosimilars should receive more attention in the future. This requires additional training for pharmacists. Key points: Overall, the similarities and differences between both countries regarding knowledge and attitudes towards biologicals and biosimilars remained unchanged before and after the COVID-19 pandemic. There is still a clear lack of knowledge among community pharmacists on biosimilars, especially regarding the substitution rules. This shows the need for additional training for pharmacists on this topic. [ABSTRACT FROM AUTHOR]

Purpose: A medication list (ML) is a document listing the patient's entire medication, instructions for use, and indications. In Germany, a national standard was established in 2016 by law. However, data on patients' use of this standardized ML are scarce. We investigated (i) patients' practical use of the ML, (ii) patients' understanding of the ML, (iii) completeness and correctness of the current ML version, and (iv) reasons why patients did not adhere to their ML.Patients and Methods: Community pharmacists recruited patients possessing a standardized ML with ≥ 5 medications. Information sources to evaluate the ML were: (a) brown bag analysis, (b) practical demonstration, (c) patient interview, and (d) patient file. Data were analyzed using qualitative and quantitative methods.Results: Two hundred and eighty-eight patients (median age: 76 years, range: 27– 95) were enrolled. (i) 38.5% of the patients used their ML regularly to prepare their medication and 73.3% to inform their physician. (ii) Overall, patients' understanding of the ML was good, with > 80% of the patients being able to identify all relevant information. (iii) While n = 2779 medications were actually taken, n = 2539 were documented on the ML. No ML was fully correct and complete. Regarding particularly relevant items, ie, active ingredient, strength, dosage, medication missing or listed but not taken, 79.2% of ML were incorrect or incomplete. Handwritten modifications on the ML were frequent. (iv) Almost 60% of all patients did not follow their ML with "fear of adverse drug reactions" being the most frequently (n = 50) mentioned reason.Conclusion: Completeness and correctness of the current ML version was poor with handwritten modifications being frequent. Additionally, most of the patients did not adhere to their ML. This indicates that measures that lead to correct and up-to-date ML and improvements in patient counseling about their medication should be developed and implemented into routine practice. [ABSTRACT FROM AUTHOR]

The number of co-hosted sports events has significantly increased in recent years. In view of society's changing expectations for more sustainability, greater consideration of social concerns and an increasingly critical analysis of sports events, this research paper explores the social value of co-hosted sports events. A mixed-method design was employed. For exploratory study one, 23 semi-structured, in-depth interviews were conducted with senior managers involved in seven different co-hosted sports events. To test findings from study one, 561 spectators of the Men's Handball World Championship in Denmark and Germany were surveyed. Structural equation modelling was used to test the hypotheses derived from study one. Co-hosted sports events provide great opportunities for generating different kinds of social value. However, the event organisers are not fully aware of this potential and have no strategy in place to take advantage of it. One of the preconditions for leveraging a co-hosted sports event for (social) value is that people perceive the event as one event. This significantly increases the perceived event benefits as well as consumer support for the event. This study extends the knowledge of the management of co-hosted sports events and identifies specific features for delivering (social) value through co-hosted sports events. It is strongly recommended that event organisers develop and implement a social leveraging plan and pay attention to a common and uniform presentation of the event. Policymakers should reconsider the promotion of and subsidies for co-hosted sports events. [ABSTRACT FROM AUTHOR]

Perceiving someone else's gaze shift toward an object can influence how this object will be manipulated by the observer, suggesting a modulatory effect of a gaze-based social context on action control. High-functioning autism (HFA) is characterized by impairments of social interaction, which may be associated with an inability to automatically integrate socially relevant nonverbal cues when generating actions. To explore these hypotheses, we made use of a stimulus-response compatibility paradigm in which a comparison group and patients with HFA were asked to generate spatially congruent or incongruent motor responses to changes in a face, a face-like and an object stimulus. Results demonstrate that while in the comparison group being looked at by a virtual other leads to a reduction of reaction time costs associated with generating a spatially incongruent response, this effect is not present in the HFA group. We suggest that this modulatory effect of social gaze on action control might play an important role in direct social interactions by helping to coordinate one's actions with those of someone else. Future research should focus on these implicit mechanisms of interpersonal alignment ("online" social cognition), which might be at the very heart of the difficulties individuals with autism experience in everyday social encounters. (Contains 2 tables and 2 figures.)

Background: Interprofessional medication management in primary care is a recognized strategy for improving medication safety, but it is poorly implemented in Germany. As a pilot project, ARMIN [Arzneimittelinitiative Sachsen-Thüringen] was initiated in 2014 to establish better interprofessional medication management between general practitioners and community pharmacists. Aim: The aim of this study was to explore the views of non-participating general practitioners and community pharmacists towards interprofessional medication management within ARMIN and to identify barriers to participation. Method: This was an interview study comprising a series of semi-structured telephone interviews. In total, 36 general practitioners and 15 community pharmacists were interviewed in the period between March and June 2020. Data were analyzed using thematic analysis as an inductive approach and the consolidated framework for implementation research as a deductive approach. Results: Many general practitioners and community pharmacists had a generally positive attitude towards interprofessional medication management. However, various barriers were identified and categorized into five major themes: (I) collaboration between general practitioners and community pharmacists, e.g. concerning general practitioners' professional sovereignty and pharmacists' fear of jeopardizing their relationship with general practitioners when interfering in therapy; (II) eligibility for participation, e.g., the fact that patients had to be insured with a specific statutory health insurance fund; (III) local circumstances, e.g. many pharmacists could not find a collaborating general practitioner (and vice versa). Moreover, patient demand was low, probably because patients were not aware of the program; (IV) information technology, e.g. concerning the lack of available software and data security concerns; and (V) cost–benefit ratio, e.g. the fact that potential benefits were outweighed by program-associated costs. Conclusion: The perceived discrepancy between positive attitudes and multiple prevalent barriers indicates considerable potential for further interprofessional collaboration between general practitioners and community pharmacists. [ABSTRACT FROM AUTHOR]

Abundance and diversity of pollinating insects are decreasing. Intensification of agricultural bioenergy production is presumed to accelerate the decline of pollinators. Sorghum (Sorghum bicolor L. Moench) is a promising bioenergy crop. Enhanced dual‐purpose type cultivars have been developed and tested for suitability for bioenergy cropping in Germany. Sorghum is assumed to be a nutritional resource for pollen‐collecting insects. To evaluate this assumption, we studied the foraging strategy of A. mellifera colonies, which were migrated to sorghum fields in Germany. The bee hives were equipped with bottom fixed pollen traps. The pollen loads of the colonies contained variable shares of sorghum pollen ranging between approx. 10% and 50% (weight/weight). Sorghum pollen occurred frequently in more than 50% of all pollen samples. Experimental mini colonies were placed in plots which were grown with two varieties of sorghum, phacelia (Phacelia tanacetifolia), maize (Zea mays) and a control plot without any vegetation. All plots were encased with flight tents. Significant effects of the crop were found for the productivity parameters brood rearing and pollen collection. The sorghum and maize variants performed significantly better than the controls but significantly poorer than phacelia (p < 0.05). The parameters number of dead bees and colony sizes were not affected by the crops (p < 0.05). Pollen of sorghum is a valuable food for bees which supports nursing of bee brood, but its availability proved to be inferior to phacelia as the pollen shedding of sorghum lasted a considerably shorter time. Pollen collection by honeybees did not negatively affect seed yield of sorghum in any case. Under unfavourable weather conditions, flower visiting bees enhanced seed yield of sorghum. [ABSTRACT FROM AUTHOR]

Germany is the highest populated country in Europe with a population of 82.3 million in 2019. As in many other developed countries, it has an aging population. Approximately 10% of the gross domestic product is spent on healthcare. The healthcare system is characterized by its accessibility. Patients are generally free to choose their primary care physicians, both family doctors and specialists, pharmacy, dentist, or emergency service. Up to a certain income, health insurance is mandatory with the statutory health insurance (SHI) system, covering 88% of the population. Major challenges are the lack of cooperation and integration between the different sectors and healthcare providers. This is expected to change with the introduction of a telematic infrastructure that is currently being implemented. It will not only connect all providers in primary and secondary care in a secure network but will also enable access to patients' electronic record/medical data and at the same time switch from paper to electronic prescriptions. Approximately 52,000 of the 67,000 pharmacists are working in approximately 19,000 community pharmacies. These pharmacies are owner-operated by a pharmacist. Pharmacists may own up to three subsidiaries nearby to their main pharmacy. Community pharmacy practice mainly consists of dispensing drugs, counselling patients on drug therapy and safety, and giving advice on lifestyle and healthy living. Many cognitive pharmaceutical services have been developed and evaluated in the past 20 years. Discussions within the profession and with stakeholders on the national level on the roles and responsibilities of pharmacists have resulted in nationally agreed guidelines, curricula, and services. However, cognitive services remunerated by the SHI funds on the national level remain to be negotiated and sustainably implemented. A law passed in November 2020 by parliament will regulate the remuneration of pharmaceutical services by the SHI funds with an annual budget of EUR 150 million. The type of services and their remuneration remain to be negotiated in 2021. The profession has to continue on all levels to advocate for a change in pharmacy practice by introducing pharmacy services into routine care. [ABSTRACT FROM AUTHOR]

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Purpose: A standardized medication plan for patients has been developed and recently enacted into German law depicting all medicines taken. It can only increase medication safety if patients use and understand it. We evaluated patients' comprehensibility of the medication plan and analyzed potential variables influencing patients' understanding. Methods: The medication plan template v2.0 was first tested in N = 40 patients, and the 'Evaluation Tool to test the handling of the Medication Plan' (ET-MP) was developed, rating patients' understanding from 0 to 100 %. The cut-off, distinguishing if patients understand the medication plan, was set at 90 %. The ET-MP was then applied to an amended medication plan questioning N = 40 general internal medicine (GIM) and N = 50 patients with chronic heart failure (CHF). Results: The mean (± standard deviation (SD)) age of the study cohort was 69 ± 13 years, 47 % female. Patients took 8 ± 3 drugs chronically. The CHF patients had a lower level of education compared to the GIM group ( p = 0.004). The overall ET-MP score was 82 ± 21 % (GIM 86 ± 19 %, CHF 78 ± 23 %; p = 0.16). Forty-three percent achieved a score >90 %. A moderate correlation was found between the ET-MP score and the level of education ( r = 0.45) and age ( r = −0.46), respectively (both p < 0.001). Cognitively impaired CHF patients ( p = 0.03) and patients with advanced CHF ( p = 0.006) achieved a lower ET-MP score. In the CHF cohort, signs of depression or a lower level of self-care behaviour were not associated with a lower ET-MP score. Conclusion: The ET-MP is suitable to explore patients' understanding of a medication plan. Less than 50 % of the patients reached a score above 90 %. Higher age and lower level of education but not the diagnosis of CHF seem to correlate with impaired understanding of the standardized medication plan. In addition to a medication plan, a significant number of patients are in need of further and continuous care to improve medication safety. [ABSTRACT FROM AUTHOR]

Purpose: The Action Plan for Medication Safety by the German Federal Ministry of Health introduced a standardized medication plan (MP), a printable document for the patient. The practical handling needs to be tested before the nationwide implementation in Germany. Therefore, the aims of our study were 1) to develop an instrument to evaluate the usage of the standardized MP, 2) to assess if patients can locate, and 3) understand important information. Moreover, we explored patients' opinion and suggestions regarding the standardized MP template. Patients and methods: We conducted a cross-sectional study to evaluate the practical handling of the standardized MP. We interviewed 40 adult patients in seven community pharmacies in Germany, who took at least five medicines regularly and gave their written informed consent. The interview consisted of questions regarding finding and understanding information provided on a mock-up MP, patients' opinion and the execution of the information on the MP by filling pill boxes. We eventually developed a new evaluation method to quantify the practical handling of the MP by rating the pill boxes filled by the patients. Results: Overall, the participants rated the MP positively. Thirty-nine (98%) participants found important information on a mock-up standardized MP. Patients were questioned to identify if they understood information on medical intake as it relates to meals. In particular, they were questioned about medicine intake "1 hour before a meal", which 98% (n=39) interpreted correctly, and "during a meal", which 100% (n=40) interpreted correctly. The less precise advice of "before a meal" was interpreted correctly by 73% (n=29), and only 15% (n=6) correctly interpreted the term "after the meal". The evaluation of the filled pill boxes resulted in the "Evaluation Tool to test the handling of the Medication Plan" (ET-MP) - a weighted scoring system. Conclusion: The standardized MP is clearly arranged, and patients are able to find important information. The findings of this study resulted in minor but important revisions of the standardized MP template. The developed evaluation tool ET-MP may serve as an objective instrument to assess patients' ability to transfer written information on the MP into practical handling of medicines. [ABSTRACT FROM AUTHOR]

At the Heavy Ion Research Institute GSI in Darmstadt an experimental cancer treatment program with a five years duration has been developed. A new method for cancer treatment with ions is applied, using rasterscan method in addition to an active pulse to pulse variation of ion beam properties, including the energy, intensity and focusing. An overview of this Cancer Therapy Project is presented, that covers both accelerator aspects to provide the required beam variations within a short time and the installations at the treatment place for rasterscan control. In addition to a description of the technical design (control-hard- and software) experimental results will be shown, containing the achieved beam properties and measurements of rasterscan performance. [ABSTRACT FROM AUTHOR]

Background Drug-related problems (DRPs) can have an important impact on the effectiveness and safety of pharmacotherapy. In Germany, the frequency of DRPs in prescribed medicines in ambulatory care is not yet known. Objective To quantify DRPs in prescribed medicines identified by community pharmacists (CPs) at the time the medicine is dispensed. Setting German CPs in four different regions. Method We invited CPs to document one hundred consecutive patients presenting prescriptions using a standardized documentation form. For each patient, person- and medication-related as well as identified DRP-related data were documented. Data were transcribed electronically, coded if necessary, checked for validity, and analyzed. Main outcome measure Nature and frequency of DRPs. Results In total, 143 CPs documented 14,231 patients with 24,422 prescribed drugs and identified DRPs in 2,556 patients (18.0 %). Analyses resulted in 0.23 DRPs per patient and 0.13 DRPs per prescribed medicine. Four DRPs were responsible for almost 70 % of all DRPs: Potential drug-drug interaction (22.9 %), dose not known to patient (21.7 %), patient insecure due to generic substitution (13.5 %), and insufficient patient knowledge of correct drug use (10.9 %). If a patient's drug file was kept in the pharmacy, specific types of DRPs were detected more frequently e.g., drug-drug interactions ( p < 0.001). Interventions primarily comprised counselling, monitoring, and changing drug or instructions for use. The prescribing physician was contacted in 28 % of DRPs resulting in a change of these prescriptions in 50 % of the cases. Overall and according to the pharmacists, more than 90 % of the DRPs detected were partially (10.4 %) or completely (85.4 %) solved. Conclusion We quantified DRPs in prescribed medicines in daily ambulatory care practice in Germany. When filling a prescription, in nearly 20 % of the patients relevant DRPs were revealed. According to the pharmacists, the majority could be partially or completely solved during the encounter at the pharmacy. Keeping a patient's drug file including patient specific data may facilitate the detection of DRPs and shall, therefore, be offered to patients more often. [ABSTRACT FROM AUTHOR]

What is known and Objective: Identifying, preventing and resolving drug-related problems (DRP) is an important issue in the pharmaceutical care process. Because DRPs have been detected in a more systematic way, the need for a classification system to document, classify and evaluate the collected data has become necessary. The objective was to develop a classification system for DRPs within the hospital setting, to evaluate the practicality and to assess the inter-rater reliability. Methods: All DRPs defined in PI-Doc and PCNE, which are relevant in the hospital setting, were included. Further relevant DRPs identified in other projects in a hospital setting as well as DRPs from the daily work on the ward were collected, and a short description of each DRP was written. A prospective study was conducted at Klinikum Fulda, Germany, in both a non-surgical and a surgical setting to explore whether the new classification system is suitable to classify DRPs in clinics with different specifications. For assessing the inter-rater reliability, 24 standardized case reports were provided. All participants classified them independently. The inter-rater reliability was analysed using Kappa coefficient. Results and Discussion: A classification system for DRPs in the hospital setting (APS-Doc) was established with 10 main categories and 48 subcategories. Practicality was assessed in 250 patients in a non-surgical ward as well as in 100 patients in a surgical ward. The inter-rater agreement was 0·68 (95% CI, 0·66-0·69) for main categories, which comprises substantial agreement. Moderate agreement (κ = 0·58; 95% CI, 0·58-0·59) was demonstrated for the subcategories. What is new and Conclusion: A new hierarchical classification system for DRPs in the hospital setting has been developed. APS-Doc seems suitable for various parts of the medication process such as medication reconciliation and drug therapy within both non-surgical and surgical wards. Inter-rater reliability was found to be substantial in the main categories and moderate in the subcategories. [ABSTRACT FROM AUTHOR]

Background and aim: Surgical site infections (SSIs) are associated with a high morbidity, mortality and healthcare costs. The prevention of SSIs is based on a combination of preoperative preparation, surgical techniques, perioperative antibiotic prophylaxis (PAP) and postoperative wound care. Despite an abundance of evidence demonstrating the effectiveness of antimicrobials to prevent SSIs, the use of antimicrobial prophylaxis in this clinical setting is associated with inappropriate timing and selection and excessive duration of administration. To date, pharmacy interns (PIs) have not been involved in this process. The aim of this study was to evaluate feasibility of involving PIs in monitoring adherence to the guidelines for antibiotic prophylaxis in surgery patients. Methods: The study was conducted in seven hospitals in Germany within the framework of the project 'Pharmacy interns on the ward' (P-STAT2). Twenty-seven PIs participated, either from either May to October 2008 or from November 2008 to April 2009. Each patient admitted to the participating wards was consecutively monitored. PIs documented the antibiotic prophylaxis and checked the adherence with the hospital ward's PAP guidelines taking both the choice of antibiotic drug and the duration of PAP into account. The costs of antibiotics, personnel and material were calculated in cases of non-adherence with guidelines. Results: This is the first time that PIs were involved in monitoring antibiotic prophylaxis guidelines. A total of 6,167 patients were enrolled (mean age 58.3 ± 19.6 years; 47.1% male); of these, 5,064 patients underwent surgery and were ultimately available for evaluation. Guidelines for antibiotic prophylaxis were followed in 70.7% of the cases. Conclusions: The study revealed that many patients do not receive the appropriate antibiotic prophylaxis despite the fact that guidelines are in place. Based on these results, we conclude that PIs may play an important role in antibiotic prophylaxis management. [ABSTRACT FROM AUTHOR]

The article offers information on a study conducted to investigate effects of noradrenergic stimulation on the cortical motor system in patients of hemiparetic stroke. It states that eleven first-ever stroke patients were recruited from Department of Neurology, University of Cologne in Germany who were given single oral dose of reboxetine (RBX). It mentions that the study show that improvement in motor function under RBX is due to rearrangement of cortical interactions.

To investigate a new method for evaluating counselling performance of staff in community pharmacies and to assess the quality of patient counselling.Trained pseudo customers, instructed to play their role according to two different self-medication scenarios, visited voluntarily participating community pharmacies in Berlin. After documenting the counselling process, immediately after each visit, outside the pharmacy on an assessment form, the pseudo customer re-entered the pharmacy and gave detailed performance feedback to the counsellor and the pharmacist in charge in order to provide support for improving counselling skills and practice behaviour, when appropriate. This was followed with a written summary of the general performance of all participating pharmacies and additional individual feedback and suggestions for improvement. Educational needs were identified for subsequent performance-based educational strategies such as group-workshops, team-training and on-site team-coaching.Forty-nine community pharmacies in Berlin volunteered to participate in this pilot study. Ninety-eight per cent of the participating pharmacies offered advice. However, in 36% of the cases, advice was only given on request. The different types of scenarios– presentation of a symptom or request for a specific product– made a great difference to the spontaneity of questions and advice. At least one question to check on accuracy of self-diagnosis was asked in 95% of the cases of symptom presentation but in only 47% of the cases of specific product request. Information on appropriate self-medication was provided on at least one item in 74% of pseudo customer visits, but most of the time the information was not sufficient. Communication skills (nonverbal elements, comprehensibility etc.) were very good or good in 54% of the visits. Potential for improvement was mainly in relation to the use of open-ended questions to gain more information and on counselling about appropriate self-medication. Direct feedback was given in 96% of the pharmacies (one person refused to accept feedback and one feedback had to be postponed because of time shortage). All of the participants regarded counselling as an important subject in pharmacy practice.The pseudo customer method was successfully used in this study of German community pharmacies. It was shown that pseudo customer visits and performance feedback following the counselling process, were feasible in daily practice and well accepted by the participants. A training program, focussing on areas in most need of improvement, has been developed. The promising results have led to the Federal Chamber of Pharmacists in Germany adopting this method as part of a continuous quality improvement program in community pharmacies. [ABSTRACT FROM AUTHOR]

Between 1977 and 1981 hamstring release (n = 27) and posterior capsulotomy (n = 22) were performed on 27 haemophilic patients. The follow-up of 19 patients is documented for at least 5 years after the operation. The mean age was 30 years (15–40 years), the mean follow-up period was 12.5 years (5–20 years). Postoperatively 16 of 19 knee joints achieved immediate full extension, three patients showed 10° extension deficiency. In the long run the original good result could be demonstrated in just 11 patients. Using the Orthopedic Advisory Committee of the World Federation of Hemophilia (OAC) Scores there were three good, 12 satisfactory and four poor results. In minor forms of arthropathy a hamstring release with posterior capsulotomy is the only recommended operation. In severe forms we would actually recommend a combination with other procedures such as arthroscopic synovectomy or joint replacement. [ABSTRACT FROM AUTHOR]

The article presents the author's views on how he gained knowledge about airborne diseases from various works of epidemiologist Alexander D. Langmuir. It includes development of the Epidemic Intelligence Service, studies conducted during the Second World War and conventional epidemiology theory. It also offers information on the Global Eradication Program, a program that aimed at analyzing the spreading of smallpox in Meschede, Germany.

Background: After a first episode in schizophrenia guidelines recommend antipsychotic maintenance treatment (MT) for at least 1year. Recent RCTs on subsequent targeted intermittent treatment (IT) after stepwise drug discontinuation yielded noticeably higher relapse rates than during MT also in first-episode patients. Nevertheless, about 50% of patients remain stable under IT. Given the potential adverse effects of antipsychotics and the preference of many patients to discontinue drugs, valid predictors for the feasibility of IT are urgently needed to support decision making.Methods: Based on a one-year RCT phase comparing MT with IT in first-episode patients after 1year of MT, conducted within the German Research Network on Schizophrenia (GRNS), predictors for deterioration under IT in 19 feasible patients were identified by logistic regression analysis.Results: Deterioration occurred in 10 patients (52.6%). Univariate analyses indicated a lower PANSS positive score after acute treatment as well as after one year of MT as significant predictors; in multivariate logistic regression, in addition to the lower PANSS positive score after acute treatment, reaching enduring remission and having had a deterioration both during MT evolved as significant predictors and indicate a higher risk for deterioration.Conclusions: Although limited by the small sample size, our findings suggest that patients who show a favorable response and full and enduring symptom remission during antipsychotic treatment, as well as those with marked deterioration despite MT should rather be recommended to remain on treatment because they are at higher risk for symptom re-exacerbation after (stepwise) drug discontinuation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Full and sustained symptom remission is a major treatment objective after a first-episode in schizophrenia. Findings regarding differences in remission between first- and second-generation antipsychotics are inconclusive. This study aimed to provide rates and predictors of remission in first-episode schizophrenia and to identify symptoms that prevent remission. Methods: Prevalence rates of “symptomatic remission” (symptom criteria only) and “enduring remission” (symptom and 6-month time criteria), defined according to Andreasen et al. (2005), were determined in first-episode patients participating in a RCT by the German Research Network on Schizophrenia (GRNS) that compared post-acute, 1-year maintenance treatment with risperidone or haloperidol. Respective predictors at baseline were identified by logistic and Cox regression analysis. Results: Prevalence rates were 91.5% for symptomatic remission (n=152/166 eligible patients) and 58.6% for enduring remission (n=65 of 111 patients who continued for at least 6months; 39.2% of all 166 patients included), with no significant differences between risperidone and haloperidol in either type of remission. Enduring remission often was not reached because of negative symptoms: After 6months, 40.5% of the patients had at least 1 negative symptom, whereas only 10.8% of the patients had “persisting” positive symptoms. Of the different predictors identified in univariate analyses, (lower) negative symptoms and participating in standardized psychological treatment remained significant in multivariate (stepwise forward) analyses for enduring remission. Conclusions: By far most of the first-episode patients reached a temporary state of full symptomatic remission within 1year of antipsychotic treatment. However, only about 50% achieved sustained, enduring remission. Negative symptoms are still a major treatment obstacle to enduring remission in schizophrenia. [Copyright &y& Elsevier]

Abstract: The Institute of Space Systems at the University of Stuttgart has a small satellite programme consisting of currently four missions. The first of these missions is the Flying Laptop, the purpose of which are technology evaluation, Earth observation and scientific measurement. Since the budget for a University satellite programme is obviously limited, engineering models of the entire spacecraft are to be avoided. In order to keep technical risks at a low level, a simulation based development approach was selected instead which already has been applied as proven technology in industry. The Institute of Space Systems applies the system simulation infrastructure Model-based Development and Verification Environment (MDVE) developed by Astrium as real-time simulator which is commanded via a SCOS-2000 mission control system. Easy commanding of such an entire simulated S/C, respectively, later the hardware in AIT phase, is mandatory especially for students only working with the equipment for a typical 6 months thesis period. Therefore the infrastructure setup was completed by the test procedure editor and execution engine Manufacturing and Operations Information System (MOIS) which for the first time provides a complete command/execution/control chain in the programme. [Copyright &y& Elsevier]

Climate protection, ecology and CO 2 neutrality have been discussed intensively and increasingly in society for years. This is also becoming increasingly important in hospitals and other medical facilities. The health care sector is responsible for 5.6% of all CO 2 emissions in Germany, particularly due to high energy consumption and a daily waste production of 6kg per patient. The following article summarizes the options for endoscopy to contribute to ecological sustainability, with a special focus on measures that can be easily implemented today., Competing Interests: Ambu Medical, Pentax, ERBE, (Thieme. All rights reserved.)

Background: As life expectancy is increasing the incidence and therefore the number of elderly female patients with bladder cancer is also increasing. The aim of this study was to assess long-term clinical, functional and oncological outcome in elderly women (≥70 years) who were treated by radical cystectomy and ileal neobladder reconstruction for invasive bladder cancer., Material and Methods: A total of 121 women with clinically organ-confined invasive urothelial carcinoma underwent radical cystecomy with an orthotopic ileal neobladder in Ulm between 1995 and 2010. The clinical course, functional, pathological, and oncological outcome of these women were analyzed retrospectively and compared between patients ≥70 (n=24) and <70 years of age (n=97). All complications which occurred during the first 90 days after surgery were analyzed in detail, defined and classified according to the modified Clavien system., Results: The overall 90 day complication rates were 66.7 % and 62.5 % for patients ≥70 and <70 years, respectively. Of these 54.2% and 44.8% were minor complications and 12.5 % and 17.7 % were major complications, respectively. Infections were the most frequent cause of complications with 36.7 %. Univariate analyses revealed that neither age nor comorbidity (ASA score) were significant predictors of perioperative complications. The daytime continence rates were comparable in both age groups (71% versus 82%, p=0.64); however, younger patients showed significantly higher night time urinary continence rates (43% versus 89%, p=0.013). Neither univariable nor multivariable analyses indicated that age ≥70 years had a significant impact on tumor-specific survival., Conclusions: Chronological age per se does not seem to be a contraindication for the creation of an orthotopic ileal neobladder; however, the risk of postoperative incontinence seems to increase with age.

Primary prevention of cancer still only finds limited acceptance in the general population, therefore, secondary prevention plays an important role in order to avoid the high costs necessary for the treatment of advanced forms of cancer. Breast cancer, prostate cancer and colorectal carcinoma (CRC) are the most common forms of cancer with high mortality and a high socio-economic impact. Screening tests for these diseases are effective and simple to carry out. The measures for secondary prevention are well known but are only implemented to approximately 30-40%. For persons over 55 years old routine screening at 10-year intervals by ileocoloscopy is now established for CRC, or alternatively an annual examination for occult blood in faeces (FOBT) over 50 years of age. Screening mammography for women aged between 50 and 69 years old is firmly established in the guidelines of the Gemeinsamer Bundesausschuss since 2004 for early recognition of cancer. It is anticipated that the establishment of the screening programme in Germany will be completed in all Federal States by the end of March 2008. All men over 45 years of age who are compulsory insured are entitled to have an annual examination of the external genital organs and a digital rectal examination of the prostate under the compulsory cancer early recognition programme. PSA testing within the framework of preventive examinations is, however, not yet part of the catalogue of available tests.

Background and Objective: The analysis of risk factors in acute variceal bleeding may help to optimize patient management. The influence of hyperglycemia, which has been demonstrated for different diseases in the intensive care unit, has not been investigated for acute variceal bleeding., Patients and Methods: We reviewed a consecutive series of 99 patients with acute variceal bleeding treated in our clinic between 1996 and 2005. Possible risk factors leading to death during the hospital stay were analysed., Results: The in-hospital mortality was increased in patients with a raised Child-Pugh index of cirrhosis, active bleeding during emergency endoscopy and an elevated creatinine concentration. The baseline blood glucose value was of no prognostic value., Conclusion: Even in the current management of variceal bleeding the Child-Pugh index for cirrhosis as well as and active bleeding during emergency endoscopy remain decisive factors in the short-term prognosis. In contrast to other diseases occurring in the intensive care unit, hyperglycemia or insulin resistance plays no significant role.

Background: Malignant dysphagia due to esophagogastric cancer is associated with poor overall prognosis. Placements of self-expandable metal stents or plastic tubes are established methods as palliative treatment options. As an alternative and/or complementary therapy, radiologic techniques (external beam radiation/brachytherapy) and locally endoscopic techniques (laser, APC-beamer, PDT) are often used. STUDY AND GOALS: Retrospective trial of 153 patients treated in our department between 1993 and 2001. Forty-five patients received a plastic tube (Group A) and 108 patients were treated with metal stents (Group B). Both groups were compared for improvement of dysphagia score, survival, recurrent dysphagia and complications., Results: Stent placement was successful in 41 of 45 (93%) patients of Group A and 107 of 108 (99%) of Group B. The median dysphagia score improved significantly in Group A (from 3.03 to 1.55, P = 0.010) and Group B (from 2.77 to 1.44, P = 0.009). Recurrent dysphagia was noted in 12 of 45 (27%) patients of Group A and 27 of 108 (25%) patients of Group B. Median survival time after stent insertion was 78 days (Group A) and 113 days (Group B). Overall complications occurred in 15 of 45 (33%) patients of Group A and 28 of 108 (26%) patients of Group B. However, significantly (P = 0.05) more major complications were seen in Group A than in Group B (22% vs. 9%)., Conclusions: Our results indicate a marginal clinical benefit for metal stents versus plastic tubes in malignant dysphagia in the long run. However, metal stents seem to be safer and associated with a prolonged improvement of dysphagia score.

The endoscopic examination of the large intestine can be considered today a routine examination in internal medicine. Since the introduction of flexible videoendoscopy, evaluating diseases in the distal colon using rectoscopy has become less important. Anoproctoscopy is an obligatory component for a complete colon diagnostic after a flexible ileo-colonoscopy has been performed. Colonoscopy has improved significantly the diagnosis and therapy of diseases in the large intestine since it has been introduced more than 30 years ago. By introducing modern videocolonoscopy in addition to other instruments, there is today a broad spectrum of diagnostic and therapeutic indications available. Specifically, due to its frequency and prognostic relevance, colonoscopy has become the most powerful and important procedure in the early detection and prevention of colon cancer.