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The principles of suicide prevention and easy access to assisted suicide are not compatible. Although suicide prevention does not aim to prevent suicide at all costs, it is fundamentally geared towards supporting people in existential crises and emergency situations in developing options for a successful life. Based on empirical facts on suicide and suicidal ideation in old age as well as clinical psychodynamic theories on the understanding of suicide, the corresponding foundations of assisted suicide are presented. After a brief introduction to the basic principles of suicide prevention, the relationship between suicide prevention and assisted suicide is explained and described. Based on the empirical knowledge of specific emergencies that can lead to a request for assisted suicide, possibilities of universal, selective and indicated suicide prevention are derived for this field., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: R. Lindner gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Aim: This study sought to quantify the healthcare costs of multivessel disease (MVD) and determine the prevalence and incidence of recurrent major adverse cardiovascular events (MACE) in high-risk patients diagnosed with MVD following an acute myocardial infarction (MI)., Methods: This retrospective study utilized German claims data (AOK PLUS), between 01/01/2010 and 31/12/2020. Patients were included if they (1) had an inpatient diagnosis of an MI between 01/01/2012 and 31/12/2019 (index date), (2) were ≥ 18 years of age at date of MI diagnosis, and (3) had diabetes or met two of the following criteria: ≥ 65 years old, prior MI, peripheral arterial disease. MACE was defined as (1) MI, (2) stroke, or (3) death with a cardiovascular diagnosis within 30 days prior. To measure the burden of MVD, patients were identified during the index hospitalization by presence of MVD. Healthcare resource use and costs were compared after adjustment based on propensity score matching (PSM)., Results: A total of 5158 patients with evidence for MVD were included in the main analysis. 31.17% experienced a MACE within 365 days following the incident MI. After PSM adjustment, 33.22% of the MVD cohort experienced a MACE versus 36.48% of non-MVD patients. MVD patients had a higher rate of recurrent MI (14.22% vs. 9.81%). Additionally, public healthcare costs were about €4 million higher in the total MVD cohort than in the non-MVD cohort in the first year after an MI (€47,896,012.32 vs. €43,718,713.75, respectively), reflecting the MVD cohort's higher use of the public healthcare system. More MVD patients were prescribed guideline-recommended medication (61.4% vs. 46.0%)., Conclusion: This study found that presence of MVD contributed to higher rates of recurrent MI. Patients with MVD experienced higher rates of recurrent MI despite a higher proportion of patients receiving guideline-directed medication therapy compared to non-MVD patients. Conversely, there was a higher mortality rate observed in the non-MVD cohort., Competing Interests: Declarations. Funding: The study was funded by CSL Behring, 1020 First Ave, King of Prussia, PA, USA. Conflict of Interest: The following are the conflicts of interest for each respective author: Alexandra Starry and Nils Picker participated in this study as staff members of Cytel; the work of Cytel in this study was financed by CSL Behring, 1020 First Ave, King of Prussia, PA, USA. Axel Dittmar has no other conflicts of interest to declare than the ones related to the affiliation. Ulf Maywald has no other conflicts of interest to declare than the ones related to the affiliation. Stefan G. Spitzer received honoraria for lectures from Medtronic, Abbott, Daiichi Sankyo, Edwards, AstraZeneca, Bayer Vital, Bristol Myer Squibb/Pfizer, Boehringer Ingelheim, Biotronik, and Amgen; received honoraria for advisory board activities from Ingress health; and participated in clinical trials with Abbott, Medtronic, and Ablacon. Jonathan Galduf is an employee of CSL Behring. Availability of Data and Material: The primary data source for this study was claims data obtained from AOK PLUS. Due to privacy, contractual obligations, and local data protection laws, both the raw claims data and anonymized derived datasets cannot be publicly shared. However, we are committed to data transparency and have taken steps to ensure the reproducibility of our findings by providing detailed methodology, including statistical models and analytical techniques within the text and supplemental material. Ethics Approval: This study used the data under the formal agreement and legal basis of §75, Tenth Book of the Social Code and in accordance with the World Medical Association's Declaration of Helsinki [1]. Therefore, informed consent and ethics approval from an institutional review board were not required for this retrospective study because the secondary dataset was anonymized, non-identifiable, and non-interventional, ensuring participant privacy and upholding the ethical principles outlined in the Declaration. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Code Availability: The code is generally considered proprietary and may not be publicly shared. However, upon request, Cytel may be able to provide access to specific components of the code. Author Contributions: A.S. and S.S. designed the study and protocol, and U.M. provided constructive feedback and comments from a technical perspective. A.S. and A.D. conducted the data analysis. N.P. provided scientific support on the methodology. All other authors assisted in interpreting the findings. A.S. took the lead in writing the manuscript, with the guidance of N.P. All authors provided critical feedback and helped shape the research, analysis, and manuscript., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

While policy interest and research on recreational ecosystem services (RES) has increased substantially, insights into the actual flows of benefits to people have remained scarce, especially at levels beyond local communities. This paper aims to model RES Flows and Benefits for Germany in monetary and non-monetary terms. We use Germany as a case study due its diversity of landscapes and availability of relevant spatial and empirical data. We develop and apply an assessment approach that considers RES Demand and Supply based on user preferences. Our results show distinct demand-supply matches and mismatches, for example in southwest Germany, and highest flows near population centres. Monetary benefits are highest in counties with high RES Supply that are close to densely populated areas. Our results can usefully inform planning and decision-making, for example to improve and further justify destination management, landscape development, and investments in RES at local, regional, and national levels., (© 2024. The Author(s).)

Background: Clinical experiences using a psychosomatic-oriented multimodal treatment approach in patients with post-COVID are promising. We established a half-day multimodal treatment program for post-COVID patients at the Department of Psychosomatic Medicine at General Hospital Nuremberg, Paracelsus Medical University, Germany., Methods: This observational study between January 2022 and March 2023 comprised baseline documentation of Patient Health Questionnaire (PHQD), ICD-10 Symptom Rating (ISR), Fatigue Scale (FS) and Health Status Questionnaire (SF-12) at admission and discharge of 65 patients suffering from post-COVID. Multimodal psychosomatic treatment was scheduled for 3-4 weeks., Results: At admission, PHQ and FS showed a high level of somatic symptom burden (PHQ-15: M = 16.0, SD = 5.6) and fatigue symptoms (FS: M = 27.1, SD = 4.4). Depressive (PHQ-9: M = 14.0, SD = 5.3) and anxiety symptoms (GAD-7: M = 9.6, SD = 5.6) were moderately and mildly pronounced, respectively. Compared to patients from our standard clinical settings post-COVID patients had a comparably high or even higher mental symptom burden (e.g. PHQ-15: p < .001, d = 0.79; PHQ-9: p = .009, d = 0.39). Compared to admission, symptomatology of post-COVID patients at discharge was improved (e.g. PHQ-15: p = .004, d = 0.26; FS: p = .009, d = 0.32)., Conclusions: Despite the short duration of treatment, the patients showed a significant reduction in symptoms between admission and discharge. Further data including a control group and extending the duration of treatment will show whether the changes in symptoms are of the multimodal psychosomatic treatment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

This review examines the issue of overtreatment and overdiagnosis in the context of intensive care and emergency medicine and its relationship to sustainability. It shows that the intensive use of resources, both human and technology, is often associated with risks of overuse, especially in critical medical situations. More diagnostic and therapeutic measures are often taken than necessary, leading to both stress for the patient and a high consumption of resources. One of the main problems is the often difficult distinction between necessary and excessive treatment. Uncertainty in acute care, coupled with legal concerns, often leads to defensive medicine. This means that, for safety reasons, physicians initiate more diagnostic tests and treatments than are clinically necessary. There are also economic disincentives in the healthcare system that encourage overtreatment. The paper also discusses the role of guidelines, particularly with respect to patient preferences. These can help to avoid unnecessary admissions to the intensive care unit and thus contribute to sustainability. The discussion shows that sustainability should not be at odds with high-quality patient care. Rather, treatment options should also be considered in terms of their contribution to sustainability, without neglecting the individual needs of patients., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: M. Kochanek, M. Berek, U. Janssens, V. Kitz und F.M. Wilkens geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Green and biowaste, processed within large facilities into compost, is a key fertilizer for agricultural and horticultural soils. However, due to improper waste disposal of plastic, its residues often remain or even lead to the formation ofmicroplastics (1 µm - 5 mm, MiPs) in the final compost product. To better understand the processes, we first quantified 'macroplastics' (> 20 mm, MaPs) input via biowaste collection into an industrial composting plant, and, then determined MiP concentrations at five stages during the composting process (before and after shredding and screening processes), and in the water used for irrigation. The total concentrations of MaPs in the biowaste collected from four different German districts ranged from 0.36 to 1.95 kg ton -1 biowaste, with polyethylene (PE) and polypropylene (PP) representing the most abundant types. The "non-foil" and "foil" plastics occurred in similar amounts (0.51 ± 0.1 kg ton -1 biowaste), with an average load of 0.08 ± 0.01 items kg -1 and 0.05 ± 0.01 items kg -1 , respectively. Only 0.3 ± 0.1 kg MaP t -1 biowaste was biodegradable plastic. Compost treatment by shredding tripled the total number of MaPs and MiPs to 33 items kg -1 , indicating an enrichment of particles during the process and potential fragmentation. Noticeably, a substantial amount of small MiPs (up to 22,714 ± 2,975 particles L -1 ) were found in the rainwater used for compost moistening, being thus an additional, generally overlooked plastic source for compost. Our results highlight that reducing plastic input via biowaste is key for minimizing MiP contamination of compost., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: We conducted a cluster-randomized-controlled trial (cRCT) in 18 German nursing homes (NH) to evaluate the cost-effectiveness of reinstruction and remotivation of nursing staff by dental assistants (DAs) over 13 months., Methods: In the intervention arm, dentists examined NH residents, identified oral health conditions, and prescribed individualized oral care interventions. Nursing staff delivered these interventions, with regular follow-up support from DAs (reinstruction and remotivation). In the control group, similar interventions were prescribed via a standardized form, without reinstruction and remotivation (standard of care). The primary outcome was Oral-Health-related Quality-of-Life (OHrQoL) using the Geriatric/General Oral Health Assessment Index (ADD-GOHAI). Secondary outcomes included Health-related Quality-of-Life (HrQoL) using the EQ-5D summary index and caries experience (DMFT index). Costs, including those for staff, materials, and travel, were assessed in Euro 2022. Cost-effectiveness ratios and bootstrapping simulations assessed cost-effectiveness-acceptability at different willingness-to-pay thresholds., Results: Of 358 recruited participants, 68 and 63 in the intervention and control group completed the study. No significant differences existed between groups in demographics or baseline health measures. After 13 months, changes in ADD-GOHAI and DMFT scores were minimal and non-significant, while EQ-5D scores decreased in the intervention group (p < 0.001). Total costs were higher in the intervention arm (median 121.10 Euro) versus the control (median 0 Euro, p < 0.001), mainly due to travel expenses. The intervention increased dental service use but demonstrated lower cost-effectiveness acceptability., Conclusions: DA-led reinstruction did not improve OHrQoL, negatively impacted HrQoL, and increased costs. Notably, our study was suffering from significant attrition, impacting on statistical power., Clinical Significance: Reinstruction and remotivation by dental assistants did not improve OHrQoL, but generated significant costs, mainly due to an uptake of dental services., Trial Registration: ClinicalTrials.gov (Trial registration number NCT04140929)., Competing Interests: Declaration of competing interest The authors have no conflicting interests to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Clinical Issue: Acute ischemic stroke remains one of the most common causes of death in Germany and affects around 16,000 people every year. With the begin of using of i.v. lysis therapy in the mid-1990s and endovascular thrombectomy (after publication of randomized studies) in 2015, these two procedures represent the two most important pillars in acute therapy. In the absence of neuroradiology centers with endovascular treatment options, there are two principles for triaging of stroke patients-the drip-and-ship or mothership model. The question repeatedly arises as to whether and exactly when bridging i.v. lysis therapy should be used., Results: The S2 guideline for the treatment of acute stroke offers an evidence-based treatment decision for treating physicians and has been extended until 2026, with the exception of a few updates, due to its proven effectiveness., Conclusion: Every stroke patient should receive i.v. lysis therapy, taking into account the onset of neurological symptoms and possible contraindications, regardless of the planned triaging principle., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: A. Haußmann gibt an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: Fibromyalgia syndrome (FMS) is a complex condition that is often refractory to therapy and is associated with impaired quality of life. In some studies, multimodal rheumatological treatment has been shown to be an effective therapy option for patients with systemic-inflammatory and degenerative rheumatic diseases. However, the effects of this therapeutic approach have not been sufficiently investigated in patients with FMS. Therefore, the aim of this study was to examine the effect of a concise 9‑ to 10-day inpatient multimodal fibromyalgia treatment (MFT) using patient-reported outcomes in a German cohort., Methods: The effects of MFT were assessed using visual analog scales (VAS) for pain (P) and subjective disease activity (DA), questionnaires measuring everyday functional capacity (Health Assessment Questionnaire [HAQ], Funktions-Fragebogen-Hannover [FFbH, Hannover Functional Ability Questionnaire]), and pharmacotherapy at three time points (Visit 1: beginning of multimodal therapy, Visit 2: end of MFT, and Visit 3: 3 months after Visit 2)., Results: Sixty-one patients were enrolled in the study at the Rhineland-Palatinate Acute Rheumatology Center. Under MFT, a significant improvement in VAS (P) and VAS (DA) was observed between the start and end of treatment (Visit 2 versus Visit 1: median decrease from 7 to 5, p < 0.001, for both VAS [P] and VAS [DA]). Additionally, comparison of the other two assessment points showed a change in VAS (P) (Visit 3 versus Visit 1: median decrease from 7 to 6, p = 0.041, and Visit 3 versus Visit 2: median increase from 5 to 6, p = 0.004). However, there were no significant differences in FFbH and HAQ parameters among the three visits. Examination of the subgroup of patients whose medication therapy was not intensified during hospitalization also showed significant improvements in VAS (P) and VAS (DA) between the start and end of MFB (Visit 2 versus Visit 1: median decrease from 7 to 4, p < 0.001, for VAS [P] and median decrease from 6.25 to 4, p = 0.002, for VAS [DA])., Conclusion: These findings indicate a demonstrable benefit to patients of MFT regarding both pain and subjective disease activity. Furthermore, pain relief was even observed 3 months after the end of therapy. This shows the high value of this therapeutic approach to treating patients with FMS., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: K. Triantafyllias, V. Balaklytska, C. Sauer, M. Dreher und A. Schwarting geben an, dass kein Interessenkonflikt besteht. Alle PatientInnen wurden vor Einschluss in die Studie entsprechend der Deklaration von Helsinki sorgfältig aufgeklärt. Nach Rücksprache mit der Ethikkommission der Landesärztekammer Rheinland-Pfalz war keine gesonderte Stellungnahme erforderlich., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Understanding how land use affects temporal stability is crucial to preserve biodiversity and ecosystem functions. Yet, the mechanistic links between land-use intensity and stability-driving mechanisms remain unclear, with functional traits likely playing a key role. Using 13 years of data from 300 sites in Germany, we tested whether and how trait-based community features mediate the effect of land-use intensity on acknowledged stability drivers (compensatory dynamics, portfolio effect, and dominant species variability), within and across plant and arthropod communities. Trait-based plant features, especially the prevalence of acquisitive strategies along the leaf-economics spectrum, were the main land-use intensity mediators within and across taxonomic and trophic levels, consistently influencing dominant species variability. Functional diversity also mediated land-use intensity effects but played a lesser role. Our analysis discloses trait-based community features as key mediators of land-use effects on stability drivers, emphasizing the need to consider multi-trophic functional interactions to better understand complex ecosystem dynamics.

Background: Little is known about mortality from four disorder combinations: fully attributable to alcohol or tobacco, partly attributable to both alcohol and tobacco, to tobacco only, to alcohol only., Aim: To analyze whether residents who had disclosed risky alcohol drinking or daily tobacco smoking had a shorter time to death than non-risky drinkers and never daily smokers twenty years later according to the disorder combinations., Methods: A random adult general population sample (4,075 study participants) of a northern German area had been interviewed in the years 1996-1997. Vital status and death certificate data were gathered 2017-2018. The data analysis included estimates of alcohol- or tobacco-attributable mortality using all conditions given in the death certificate and alternatively the underlying cause of death only., Results: Among 573 deaths, 71.9-94.1% had any alcohol- or tobacco-attributable disorder depending on the estimate. Risky alcohol consumption and daily tobacco smoking at baseline were related to disorders in the death certificate according to the combinations. Deaths with an alcohol- and tobacco-attributable disorder were related to risky alcohol consumption (subhazard ratio 1.57; 95% confidence interval 1.25-1.98) and to daily tobacco smoking at baseline (subhazard ratio 1.85; 95% confidence interval 1.42-2.41)., Conclusion: First, more than 70% of the deceased persons had one or more alcohol- or tobacco-attributable disorders. This finding suggests that total mortality seems to be the suitable outcome if potential effects of alcohol or tobacco consumption in a general population are to be estimated. Second, the relations of risky alcohol consumption and tobacco smoking with time to death speak in favor of the validity of alcohol- and of tobacco-attributable disorders in death certificates and of considering both alcohol consumption and tobacco smoking if attributable deaths are to be estimated., Competing Interests: Declarations. Ethics approval and consent to participate: The research of this study complies with the ethical standards of the relevant institutional committees on human experimentation and with the Helsinki declaration of 1975, as revised in 2008. The ethics committee of the University of Greifswald approved the study (BB 044/13). Consent for publication: Consent for publication was part of informed consent. All study participants gave informed consent to participate in the study and had been informed to be free to withdraw the consent at any time. It was safeguarded that no individual study participant could be identified in published material. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Number of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface., Methods: We performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings., Results: Ten health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention., Conclusions: Further studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows., Trial Registration: https://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval of this study was obtained by the Ethics Committee of the Hamburg Medical Association (number: PV5754). The project was conducted in accordance with the Declaration of Helsinki. All participants gave written informed consent and received additional verbal information about the rational, content, and use of the interview material. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Shifting tasks from General practitioners (GPs) to practice nurses (PNs) could help address the shortage of GPs in Europe. Internationally, PN-led care (PNLC) is feasible and offers similar health outcomes to usual care. However, PN-led consultations (PN-cons) or as PN-led dosage changes for permanent medication (PN-DCPM) are uncommon in German general practice offices (GPO)., Objective: To explore GPs' and PNs' views on the feasibility and acceptability of PN-cons and PN-DCPM in GPOs., Methods: In this exploratory, qualitative online focus group study, we recruited GPs, GP trainees, PNs and specialized PNs (APN) currently working in German GPO using a qualitative sampling plan. We used a semi-structured self-developed interview guide. Separate focus groups (FGs) were performed for each profession, with audio and video recordings, and the transcripts were analysed using thematic analysis., Results: Two FGs comprising 15 GPs and three FGs with 26 PNs revealed four major themes: (i) Attitudes towards PN-cons and PN-DCPM, revealing that participants were generally open towards a PN-cons, but were more reserved towards PN-DCPM. (ii) Acceptable reasons for encounters for PN-cons, e.g. diabetes or hypertension, and acceptable medications for PN-DCPM, e.g. antidiabetics, antihypertensive drugs. (iii) Conditions mentioned for implementing PN-led care were e.g. adequate qualification and supervision concepts. (iv) Perceived chances were e.g. time savings and increased quality of care and perceived risks were e.g. fear of treatment errors., Conclusion: Participants showed openness towards PN-cons and were more reserved towards PN-DCPM in German GPO. Further quantitative studies should assess how acceptance and rejection of PN-led care are distributed among patients, GPs, and PNs., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Many risk factors for dementia have been identified, but the timing of risk is less well understood. Here, we analyzed risk factors in a case-control study covering 10 years before an incident dementia diagnosis., Methods: We designed a case-control study using insurance claims of outpatient consultations of patients with German statutory health insurance between January 1, 2012, and December 31, 2022. We included patients with an incident diagnosis of dementia and controls without a diagnosis of dementia matched 1:2 for age, sex, region, and earliest year of outpatient encounter. We selected exposures based on previous systematic reviews, case-control and cohort studies reporting on risk factors, comorbidities, and prodromal features of dementia. We calculated the prevalence of risk factors in cases and controls and odds ratios for each year before the index date, along with Bonferroni-corrected confidence intervals, using conditional logistic regression., Results: We identified a total of 1,686,759 patients with incident dementia (mean (SD) age, 82.15 (6.90) years; 61.70% female) and 3,373,518 matched controls (mean (SD) age, 82.15 (6.90) years; 61.70% female). Study participants were followed up for a mean (SD) of 6.6 (2.3) years. Of the 63 risk factors and prodromal features examined, 56 were associated with an increased risk of dementia in all years during the 10th and the 1st year before the index date. These included established risk factors, such as depression, hypertension, hearing impairment, nicotine and alcohol abuse, obesity, hypercholesterolaemia, traumatic brain injury, and diabetes. The greatest risk, with odds ratios greater than 2.5, was conferred by delirium, memory impairment, mental retardation, personality and behavioral disorders, sensory disorders, schizophrenia, and psychosis. Cancer was associated with a reduced risk of dementia., Conclusions: This large case-control study confirmed established risk factors of dementia. In addition, the study identified non-specific diagnoses that showed a steep increase in risk close to the index date, such as psychosis, conduct disorder, and other sensory disorders. Consideration of these diagnoses, which may represent prodromal features rather than risk factors for dementia, may help to identify people with dementia in routine care., Competing Interests: Declarations. Ethics approval and consent to participate: The use of claims data for scientific research in Germany is regulated by the Code of Social Law (Sozialgesetzbuch, SGB V). Ethical approval and informed consent are not required for routinely collected pseudonymized data. Consent for publication: Not applicable. Competing interests: ST was serving on advisory boards of Lilly, Eisai, and Biogen. He is member of the Independent Data Safety and Monitoring Board of the study ENVISION (Biogen). JH, JB, SRH, BM, and MA have nothing to disclose., (© 2025. The Author(s).)

Purpose: Our aim was to generate evidence- and consensus-based recommendations for the management of mass casualty incidents (MCIs) based on current evidence. This guideline topic is part of the 2022 update of the German guideline on the treatment of patients with severe/multiple injuries., Methods: MEDLINE and Embase were systematically searched to August 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, cross-sectional studies, prospective cohort studies, and comparative registry studies were included if they compared triage algorithms, interventions for MCI training, logistics or transport, decontamination, diagnosis or therapy during MCIs in the prehospital and hospital settings. We considered patient-relevant clinical outcomes such as mortality, diagnostic outcomes including sensitivity and specificity, rates of undertriage and overtriage as well as resource use. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Population, intervention, comparison, and outcome (PICO) questions from clinical questions were developed by clinical experts and guideline methodologists., Results: We screened 321 records in the original guideline version and 4225 during this update. Twenty-five studies were included, all of them from the updated search from 2009 to 2021. Twenty-five new studies were identified. Interventions covered were triage training (n = 7 studies), prehospital triage (n = 6), secondary triage (n = 2), transport/logistics (n = 3), decontamination (n = 5), and therapy (n = 2) during MCIs. Three new recommendations were developed. All achieved strong consensus., Conclusion: Due to unsatisfactory evidence, recommendations could only be made on training for improving triage quality and regular exercises for testing a hospital's emergency response plan. No triage algorithm can be scientifically proven to be superior in all aspects. The key recommendation is the following: To improve triage quality, exercises or (virtual) training should be conducted in-house using verified triage systems and algorithms., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

One group of elements attracting more and more attention are so-called technology-critical elements (TCEs). In comparison with legacy pollutants, the anthropogenic impact of TCEs on the environment might still be minor, but various applications introduce them to the most remote places in the world including the marine environment. One area prone to pollution is the Baltic Sea, partly due to the lack of water exchange with the North Sea. In this study, a sediment core from the German Baltic Sea was used to analyze a total of 42 elemental mass fractions. Based on radiometric dating of 210 Pb and 137 Cs, results were classified in a recent (2020-2000) and a past period (< 1920), calculating background concentrations based on the Median + 2 Median Absolute Deviation (M2MAD) and the Tukey Inner Fence (TIF). Six legacy pollutants (Ni, Cu, Zn, As, Cd, Pb) and six TCEs (Ga, Ge, Nb, La, Gd, Ta) are discussed in detail. Anthropogenic impacts of both groups were assessed, and local enrichment factors were calculated showing an increase for the legacy pollutants (past period (≤ 0.8); recent period (≥ 1.2)), but also a minor increase for Ga, Ge and Nb (past period (0.9); recent period (1.1)). Values ≥ 1.5, indicating anthropogenic impact, were found for Cu, Zn, Cd and Pb, but also for Ge. Proposed background values may be considered as baseline for future studies., Competing Interests: Declarations. Conflict of interest: The authors have no competing interests to declare., (© 2025. The Author(s).)

Background: The urban environment can influence mental health. However, research on neighbourhood influences on mental health of parents with young children is sparse. This study aimed to analyse the association between neighbourhood socioeconomic status (SES) and mental health outcomes in urban parents in the first years after birth., Methods: We included 4707 parents of young children who participated in the SKKIPPI cohort study in Berlin. Data on mental health outcomes (symptoms of depression, anxiety, or both, measured via PHQ- 4) and individual risk factors stemmed from an online questionnaire and were matched with neighbourhood level data from the Berlin Senate Department for Urban Development and Housing. Neighbourhood status (exposure) was categorized in 4 SES categories: high, medium, low, and very low. We use propensity scores to estimate the probability to live in each neighbourhood category to reduce the risk of bias due to neighbourhood self-selection. Binominal generalised linear mixed models with propensity score adjustment were used to estimate the association between neighbourhood SES and symptoms of depression, anxiety, or both., Results: Overall, 9.3% of parents showed depressive, 10.3% anxiety, and 5.3% both symptoms. The occurrence of mental health problems was lowest in neighbourhoods with high SES and highest in neighbourhoods with low/very low SES. The association between neighbourhood SES and mental health outcomes seen in unadjusted regression models disappeared when models were adjusted for individual risk factors/neighbourhood self-selection using propensity scores., Conclusion: We found no association between neighbourhood SES and mental health outcomes in parents in the first years after birth after adjusting for neighbourhood selection. Nevertheless, the unadjusted findings suggest that the occurrence of individual risk factors and mental health problems was highest in neighbourhoods with low/very low SES, which should be focus for social and preventive health measures., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024. Published by Elsevier Ltd.)

A significant number of prostate cancer patients are long-term survivors after primary definitive therapy, and the occurrence of late side effects, such as second primary cancers, has gained interest. The aim of this editorial is to discuss the most current evidence on second primary cancers based on six retrospective studies published in 2021-2024 using large data repositories not accounting for all possible confounding factors, such as smoking or pre-existing comorbidities. Overall, prostate cancer patients treated with curative radiotherapy have an increased risk (0.7-1%) of the development of second primary cancers compared to patients treated with surgery up to 25 years after treatment. However, current evidence suggests that the implementation of intensity modulated radiation therapy is not increasing the risk of second primary cancers compared to conformal 3D-planned radiotherapy. Furthermore, increasing evidence indicates that highly conformal radiotherapy techniques may not increase the probability of second primary cancers compared to radical prostatectomy. Consequently, future studies should consider the radiotherapy technique and other confounding factors to provide a more accurate estimation of the occurrence of second primary cancers., Competing Interests: Conflict of interest: C. Zamboglou, D. M. Aebersold, C. Albrecht, D. Boehmer, U. Ganswindt, N.-S. Schmidt-Hegemann, S. Hoecht, T. Hölscher, S. A. Koerber, A.-C. Mueller, P. Niehoff, J.C. Peeken, M. Pinkawa, B. Polat, S.K.B. Spohn, F. Wolf, D. Zips and T. Wiegel declare that they have no competing interests., (© 2024. The Author(s).)

Background: Descriptions of long-term histories of alcohol dependence provide insight into the etiology, prevention and care., Objective: Report of empirical findings about the development into and remission from alcohol dependence., Method: Narrative literature review, analysis of findings from cohort studies in the general population., Results: Risk factors provide the opportunity to estimate increased probabilities of developing an alcohol dependence. Adolescents disclosed symptoms of alcohol dependence within 8 years after the first alcohol consumption. Alcohol dependence is related to a life expectancy 17.6 years fewer than in the general population. Data of a general population sample revealed a risk of early death 2.8 times higher than among people without mental disorders. The severity of alcohol dependence was shown to be a predictor of premature death. Nicotine dependence can add to the shortening of life in addition to alcohol dependence. Among the alcohol dependent residents in a general population sample, 90.2% did not have utilized detoxification treatment that included motivational treatment and 78.4% did not have utilized standard detoxification treatment in a psychiatric treatment facility. Remission without formal help has been proven. It is the main route of remission., Conclusion: To reduce unfavorable courses of alcohol dependence, prevention and treatment should be focused more on the needs in the general population. In psychiatric and other medical routine care, screening and an appropriate brief intervention should be carried out., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: U. John, H.-J. Rumpf, S. Hoffmann, C. Meyer und F. Kiefer geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

The question of the need for generalists and specialists in trauma surgery is controversially discussed concerning the challenges in the healthcare system, the interdisciplinary nature of the discipline, and the consequences of increasing specialization. The hospital reform as well as the availability of personnel and financing are discussed as central points. For high-quality patient care it is essential that the balancing act between generalists and specialists is successful. Effective interdisciplinary collaboration and holistic thinking are crucial to overcome the challenges in the healthcare system and to fulfil the needs of patients., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: M. Samland und Junges Forum O und U geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

University teaching is undergoing radical changes. Rising student numbers and the progressive digitalization of routine daily life are also leading to the testing of various new teaching and learning formats. This article provides an overview of the reasons for and approaches used to effectively and efficiently organize teaching of anatomy using digital learning methods and to fulfil the expectations of students., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: E.C. Maier, V. Ödemis und A.U. Bräuer geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden keine eigenen Studien an Menschen oder Tieren durchgeführt. Für die zitierten Studien gelten die angegebenen ethischen Richtlinien. Erkennbare Personen gaben ihr Einverständnis zur Publikation., (© 2025. The Author(s).)

Background: The increasing congestion in emergency departments of all specialties is one of the most pressing challenges of our time., Objective: The aim of this study is to make a well-founded contribution to the development of emergency case numbers in the tertiary sector (specialist clinics) of German ophthalmology. From this, the need to develop new control and triage mechanisms for ophthalmology can be derived., Material and Methods: Retrospectively, > 140,000 emergency treatment cases at the University Eye Hospital Tübingen in the period from 1 January 2010 to 31 December 2023 were analyzed. Sub-analyses were conducted to quantify the impact of the COVID-19 pandemic and differences between weekend and weekday visits. In addition, a questionnaire survey on the referral status of emergency consultations at off-peak times and at weekends was conducted in 2022., Results: The number of emergency consultations more than doubled between 2010 and 2023 and more than tripled at weekends. The peak load, which is relevant for guaranteeing treatment, has increased to the same extent. In the long term, a shift in emergency treatment from core to off-peak times can be observed, particularly at weekends. The majority of consultations (up to 87%) take place without a referral from a doctor. In 2023, the treatment figures returned to the level before the start of the COVID-19 pandemic., Discussion: The emergency outpatient clinic at the University Eye Hospital is increasingly exposed to a double burden: providing treatment for emergency cases with specialist referrals and at the same time acting as a catchment basin for general emergencies. New control and triage mechanisms are urgently needed to ensure good care in the long term., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: I.P. Seitz, M. Zarzo Vargas, T. Strasser, E. Nasyrov und K.U. Bartz-Schmidt geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

At least in Western Europe, competitive social health insurance systems have implemented systems of morbidity-based risk adjustment to establish a level playing field for insurers. However, insured persons with specific socio-economic characteristics are still underfunded, leaving incentives for risk selection. In Germany, there is an ongoing debate about (re)implementing socio-economic variables to reduce this undercompensation. This study analyses whether the following four socio-economic groups are systematically under- or over-compensated under the present risk equalization system in Germany: insured persons with co-payment exemption (1), recipients of basic income support for unemployment (2), of benefits of social long-term care-insurance (3) and insured persons with reduced earning capacity (4). On this basis, several attempts of incorporating these variables into the German risk adjustment system, allowing a better fit for the socio-economically disadvantaged groups, are examined. With a data set of about 9.2 million insured persons, the performance of the modifications is demonstrated for the German system. The disparate outcomes of the various models in different dimensions necessitate the consideration of trade-offs and their incorporation into the implementation of a model designed to mitigate the undercompensation of the affected insured groups., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Background: Survivors of a major trauma experience a range of difficulties in relation to the reduction in physical, psychosocial, and cognitive functions, which can result in a reduced health-related quality of life. This study aims to explore lived experiences of major trauma survivors in the German healthcare system., Methods: Semi-structured exploratory interviews were performed with nine major trauma survivors (18-55 years; Injury Severity Score ≥16). For exploratory analyses, an artificial intelligence-based coding software was used. Further, results were clustered by using the International Classification of Functioning, Disability and Health framework (ICF)., Results: Communication was one of the major topics concerning amongst others diverting opinions between different healthcare disciplines and a general lack of information. The participants showed a high demand for a contact person. Furthermore, social support was essential during recovery for those interviewed. Social network was not only important as emotional and physical support but also for overcoming of gaps in the healthcare system. The support by employers and colleagues seemed to be beneficial for our participants in relation to returning to work. Further, psychological consequences of trauma, and that mobility is a key factor for quality of life, self-efficacy and return to work were discussed., Discussion: The qualitative analyses highlight several topics such as communication, burden of sickness, support systems that the participants mentioned as important along their journey through the German healthcare system during recovery. Through the ICF model the interplay of certain components that influenced the outcome of the major trauma survivors was visualized., Implications: These results might offer a deepened understanding of modifiable components of a patient pathway in recovery process such as improvements of patient communication, provision of a contact person and others., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This position paper is based on the authors' many years of clinical experience and basic science research on the diagnosis and treatment of children and adolescents with a presymptomatic early stage of type 1 diabetes. The benefits as well as potential disadvantages of early detection of type 1 diabetes by islet autoantibody screening are critically discussed. In addition, the perspectives of delaying the onset of the clinical metabolic disease through treatment with teplizumab are addressed. Today, we see the chance for a relevant improvement in therapeutic options and life perspectives of affected children and adolescents. Important next steps for the implementation of islet autoantibody screening in Germany are the training of pediatricians who should inform families about the screening, establishment of a few transregional laboratories that carry out the test, and expansion of regional capacities for the training and care of children with an early stage of type 1 diabetes., Competing Interests: A.G.Z. ist Mitglied im Data Monitoring Committee (DMC) der Protect-Studie und der Petite-Studie (Teplizumab). O.K. ist National-Principle Investigator für Deutschland in der PROTECT-Studie (Teplizumab). R.B. ist Principle Investigator in der Protect-Studie (Teplizumab). Die weiteren 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/).)

In Germany, Trichinella spp. are mainly detected in the sylvatic cycle. Here, the affected animal species are wild boar, fox, badger, raccoon dog, wolf, raccoon and golden jackal. The predominantly detected species are T. spiralis, followed by T. pseudospiralis and T. britovi. Due to legal requirements in Germany, all hunted wild boars and other susceptible animals must be examined for Trichinella spp. if their meat is intended for human consumption. In recent years, an increase in the number of Trichinella-positive wild boar shot in Germany has been registered and the prevalence of positive wild boar scaled up from 0.002 % to 0.005 % between 2013 and 2023. Regarding regional distribution, most Trichinella findings in wild boar have been registered in the North-Eastern part of Germany. Here, the federal states Western-Pomerania, Brandenburg and Saxony that are bordering to Poland are particularly affected. The increase in positive wild boar may be associated with the spread of raccoon dogs and wolves in these regions. Thus, measures are required to prevent the spread of Trichinella among wild animals and to follow the systematic meat inspection in susceptible wild animals intended for food especially wild boar., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The COVID-19 pandemic has had a drastic impact on healthcare systems. They had to react, adapt and innovate in order to build resilience, that is maintain healthcare access and health equity. For example, access to abortion services during the pandemic was increasingly facilitated through "Telehealth for Early Medical Abortion" (TEMA).This narrative review article compares Germany, France and Great Britain in terms of abortion numbers, methods and settings from 2018 to 2023. Changes in the availability of services and legislation during the pandemic are presented, and the differences between the countries, as well as various innovation factors, are discussed. We used national statistics and conducted a literature and online search (Rapid Review).In the three countries, there are differences in abortion rates, the share of medical abortions and the impact of the pandemic. In France and Great Britain, where medical abortion is the main method of abortion and where abortion care was more accessible before the pandemic than in Germany, a series of innovations were officially introduced to facilitate access during the pandemic. They included teleconsultations and the mailing of abortion medication. Most changes have been sustained since then, contributing to addressing historic and systemic health inequities in terms of access. In Germany, innovations during the pandemic have been crafted mainly by civil society organisations, offering for the first time teleabortion services.The COVID-19 pandemic provoked or accelerated innovation in terms of abortion care in France, Germany and Great Britain. The sustainability and scaling-up of those innovations remain fragile, especially in Germany, where the disruptive approach of civil society organisations has not yet found its way into mainstream healthcare services., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: C. Miani und J. Niemann geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

Successful invasive species increase their spreading success by trading-off nutritional and metabolic resources allocated to reproduction and range expansion with other costly body functions. One proposed mechanism for the reallocation of resources is a trade-off with the immune function and the regulation of oxidative status. Relying on a panel of blood-based markers of immune function and oxidative status quantified in an invasive species (Egyptian goose) and two native competing species (mallard and mute swan) in Germany, we tested the hypothesis that the invasive species would have (i) lower investment in immune function, (ii) lower levels of oxidative damage, and (iii) no higher antioxidant defences compared to the native species. We found lower levels of adaptive immune markers (lymphocytes and immunoglobulin Y), in the invasive species compared to the two native species. Innate immune profile was generally similar between Egyptian geese and mallards. By contrast, mute swans showed higher levels of heterophils and lysozymes, and lower levels of bacteria killing ability compared to both Egyptian geese and mallards. Mute swans also showed higher levels of haemolysis and haemagglutination, but lower levels of monocytes and haematocrit compared to Egyptian geese. Reactive oxygen metabolites, a marker of oxidative damage, were higher in mallards and lower in Egyptian geese compared to the other waterfowl species, while levels of antioxidants were generally similar among the three species. Our results point to a reduced investment in adaptive immune function in the invasive species as a possible resources-saving immunological strategy due to the loss of co-evolved parasites in the new colonised habitats, as observed in a previous study. A lower investment in immune function may benefit other energy-demanding activities, such as reproduction, dispersal, and territoriality, while maintaining relatively higher innate immunity is beneficial since invasive species mainly encounter novel pathogens. Results pointed out also other important species-specific differences in baseline immune status, supporting previous findings on the relationship between species' body mass and immune profile., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Ministry of Health to provide support for the further development of the S2k guideline on first-trimester abortion into an S3 guideline. To this end, the responsible guideline group formulated research questions that were answered in IQWiG evidence reports. One of the questions to be addressed was the evidence regarding the psychological consequences of an abortion in the first trimester compared to no abortion in the first trimester in pregnant women who wish to have an abortion. A systematic search identified one relevant prospective comparative cohort study that reported results on the outcomes of clinically diagnosed depression and clinically diagnosed anxiety disorders. The evidence was evaluated in accordance with the methodological requirements of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group, as specified by the IQWiG methods. No significant differences were observed between the study groups with regard to the outcomes mentioned. The certainty of the evidence was rated as very low and downgraded due to study limitations and imprecision of the effects. Prospective comparative cohort studies that approach the research question under investigation should, inter alia, have adequate control for relevant confounders, a sufficient number of participants, and a carefully planned collection of data on relevant outcomes., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: D. Endres, J. Gowik und A. Tasar geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

The works of Julius Hirschberg (1843-1925), especially his "History of ophthalmology" are even now still worth reading and indispensable for those who are interested in the history of the discipline ophthalmology. In addition to his scientific achievements in the field of ophthalmology, he was particularly concerned with international understanding and is therefore more current than ever before., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: Gemäß den Richtlinien des Springer Medizin Verlags werden Autoren und Wissenschaftliche Leitung im Rahmen der Manuskripterstellung und Manuskriptfreigabe aufgefordert, eine vollständige Erklärung zu ihren finanziellen und nichtfinanziellen Interessen abzugeben. Autoren: J.M. Rohrbach: A. Finanzielle Interessen: Aktien: Bayer, CureVac, Alcon, Siemens Healthineers, Carl Zeiss, Sanofi, Immatics, Novartis, Takeda. – B. Nichtfinanzielle Interessen: Ruheständler mit 40 % Tätigkeit an der Augenklinik des Universitäts-Klinikums Tübingen | Mitgliedschaften: Deutsche Ophthalmologische Gesellschaft, Julius-Hirschberg-Gesellschaft (für Geschichte der Augenheilkunde). Wissenschaftliche Leitung: Die vollständige Erklärung zum Interessenkonflikt der Wissenschaftlichen Leitung finden Sie am Kurs der zertifizierten Fortbildung auf www.springermedizin.de/cme . Der Verlag: erklärt, dass für die Publikation dieser CME-Fortbildung keine Sponsorengelder an den Verlag fließen. Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

Background: Mental health consequences of the COVID-19 pandemic have been a major research focus since its beginning. A specific vulnerability of patients with borderline personality disorder (BPD) following social distancing measures has been reported, however there is a lack of adequately sized studies that provide evidence of this vulnerability. Suicide attempts may reflect mental health effects of the COVID-19 pandemic in psychiatric settings., Methods: Retrospective follow-up analysis of clinical documentation in a psychiatric emergency department (pED) of a major academic psychiatric hospital in Berlin, Germany. Observation periods include the first- (3/2/2020-5/24/2020) and second-wave (9/15/2020-3/1/2021) of the COVID-19 pandemic in Germany and respective periods one year earlier as control-periods. Poisson-regression was used for statistical modelling of individual counts of pED presentations after a suicide attempt., Results: N = 4110 patients attended the pED during the four observation periods. BPD patients were associated with elevated risk of pED presentation after a suicide attempt during COVID-periods (RR = 3.4; p = .014). Schizophrenia and psychotic disorders showed lower risk of pED presentation after a suicide attempt during COVID-periods (RR = 0.4; p = .048). Other diagnostic groups did not show significant interaction effects with COVID-periods. The first-wave was a risk factor for pED presentation after a suicide attempt affecting the sample across all diagnostic groups (RR = 3.1; p = .006)., Conclusions: BPD patients seem to be particularly vulnerable during the COVID-19 pandemic showing increased rates of suicide attempts during both COVID-periods. This should be addressed in future health crises by ensuring availability of psychosocial help. There is a need for further research regarding BPD patients in public health crisis situations., Competing Interests: Declarations. Ethics approval and consent to participate: This retrospective study was approved by the local ethics committee ​(Ethikkommission der Charité – Universitätsmedizin Berlin; number of approval: EA 110/20). As only retrospective and pseudonymised routinely assessed data was concerned, informed consent was waived by the ethics committee of Charité – Universitätsmedizin Berlin (Ethikkommission der Charité – Universitätsmedizin Berlin; number of approval: EA 110/20). The study was conducted following the declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Zoonotic diseases are partly associated with pets. However, data is sparse on pet owners' compliance with preventive recommendations. Also, research focuses on self-reports, which are subject to overestimation biases, i.e., assessing one's actual performance to be better than it is. One reason is task difficulty: people tend to overestimate their performance on hard tasks. Regarding handwashing, compliance after touching animals should be harder for pet vs. non-pet owners due to the number of opportunities. This study tests for differences in self-reported handwashing between pet and non-pet owners, and explores reasons for non-compliance. Thus, it aims to provide insights on how to improve self-report behavioral assessment methods in public health and One Health research., Methods: Data from cross-sectional computer-assisted telephone surveys of the general population in Germany aged 16-85 years in 2012, 2014, 2017 and 2019 were analyzed (N = 15,559; response rate: 45.9%). Handwashing frequency was operationalized for nine indications using the item "How often do you wash your hands in each of the following situations: 'never/almost never', 'seldom', 'mostly', 'always/almost always'?", with the latter defining compliance. In 2017 and 2019, those reporting to 'never/almost never' or 'rarely' wash hands were questioned regarding possible reasons. Chi²-tests, Cohen's d's and multiple logistic regressions were used., Results: Pet and non-pet owners differed in self-reported handwashing compliance primarily in the indication "After touching animals" (35.5% vs. 55.7%, effect size: d = 0.45). For other indications (e.g., "After using the toilet"), differences were insignificant (≤|3.6%|, d ≤ 0.11). Additionally, 79% of pet owners who rarely or almost never washed their hands after touching animals felt it is not necessary (non-pet owners: 67.1%; d = 0.34). Reporting to not have an appropriate washing facility available was rarer among pet owners (44.5% vs. 63%, d = 0.41). Differences regarding other reasons were trivial (d ≤ 0.16), including "It takes too long" (16.9 vs. 13.3%; p = .138 in multiple regression)., Conclusions: Study limitations include that due to unknown true compliance, over- and underestimations have to be inferred. Yet, that the only substantial difference between pet and non-pet owners pertained to "After touching animals" suggests such effects. While pet owners obviously adjust for task difficulty, the likely residual overestimation should be reduced by measures using script-based covert recall or survey items with response categories constructed to better resemble subjective compliance ratios., Competing Interests: Declarations. Ethics approval and consent to participate: The data in this study were gathered in telephone surveys commissioned by the German Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA), a specialist authority within the portfolio of the German Federal Ministry of Health. The surveys were administered by the Forsa Institute for Social Research and Statistical Analysis [23, 34–36] on behalf of the BZgA. Data sets from 2012 to 2014 are publicly available online at the Data Archive for the Social Sciences of the GESIS Leibniz Institute for the Social Sciences [40, 41], and those for 2017 and 2019 were provided by the BZgA upon our request (Dr. Andrea Rückle, personal communication, August 23, 2023). Participation in the surveys was voluntary and ensured anonymity. Respondents were informed that they were taking part in a scientific study and were able to refuse or withdraw their participation at any time, thus obtaining their consent. All data records are available in anonymized form. Deemed unnecessary according to national regulations for telephone surveys by the BZgA, the need for ethics approval was waived for all surveys by the German Federal Ministry of Health as its institutional review board. The study adhered to the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Effective healthcare delivery in today's diverse society necessitates healthcare providers' adeptness in navigating cultural and religious nuances in patient care. However, the integration of cultural competence training into medical education remains inadequate, particularly concerning the care of Muslim patients. In response, we introduce a novel educational intervention aimed at enhancing intercultural proficiency among medical students, emphasizing care for Muslim patients., Methods: The intervention comprised interactive seminars and simulated patient sessions. With a bespoke and the Cross-Cultural Competence of Healthcare Professionals (CCCHP-27) questionnaire the pre- and post-course intercultural competencies of n = 31 medical students of the Medical Faculty of Jena University were assessed. Additionally, there was a control group consisting of 34 students. Statistical analyses including descriptive statistics, paired samples t-tests, Wilcoxon tests, correlation analysis, Mann-Whitney U-tests, and multiple regression analysis were employed for data analysis., Results: Results of the bespoke questionnaire reveal significant improvements in intercultural knowledge (median pre 1.0 (0.6 - 1.6), median post 2.2 (2.4-2.8), p < 0.001) and in knowledge regarding Muslim patients (median pre 1.0 (0.5 - 1.5), median post 2.5 (2-3), p < 0.001) following the course. Regarding the CCCHP-27, students demonstrated a significant improvement in their skills, with pre-assessment score of 4.10 (± 0.47) and post-assessment score of 4.38 (± 0.40), p = 0.001. Female participants and those with limited prior experience demonstrated greater gains (p = 0.005 and p = 0.053). Notably, the incorporation of a session with a simulated patient garnered favorable feedback, affirming the efficacy of practical application in consolidating learning outcomes., Discussion: Our study emphasizes the importance of integrating intercultural competencies training into medical education and our findings underscore the efficacy of targeted educational interventions in enhancing intercultural competencies among medical students. For the assessment of intercultural competence, our bespoke questionnaire serves as a valuable addition to the German healthcare system., Conclusion: Implementation of similar interventions into medical curricula nationwide is imperative to address the needs of diverse patient populations effectively., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. This study was conducted with approval from the local ethics committee of the University Hospital Jena, registered under the reference number 2022–2857-Bef. Informed consent was obtained from all participants. Consent for publication: The participants consented to the publication of data. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: Splenectomy is regularly performed in total and distal pancreatectomy due to technical reasons, lymph node dissection and radicality of the operation. However, the spleen serves as an important organ for competent immune function, and its removal is associated with an increased incidence of cancer and a worse outcome in some cancer entities (Haematologica 99:392-398, 2014; Dis Colon Rectum 51:213-217, 2008; Dis Esophagus 21:334-339, 2008). The impact of splenectomy in pancreatic cancer is not fully resolved (J Am Coll Surg 188:516-521, 1999; J Surg Oncol 119:784-793, 2019)., Methods: We therefore compared the outcome of 193 pancreatic cancer patients who underwent total or distal pancreatectomy with (Sp) or without splenectomy (NoSp) between 2015 and 2021 using the StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery. In addition, we integrated our data into the existing literature in a meta-analysis of studies on splenectomy in pancreatic cancer patients., Results: There was no difference between the Sp and NoSp groups regarding histopathological parameters, number of examined or affected lymph nodes, residual tumor status, or postoperative morbidity and mortality. We observed a significantly prolonged survival in pancreatic cancer patients who underwent total pancreatectomy, when a spleen-preserving operation was performed (median survival: 9.6 vs. 17.3 months, p = 0.03). In this group, splenectomy was identified as an independent risk factor for shorter overall survival [HR (95%CI): 2.38 (1.03 - 6.8)]. In a meta-analysis of the existing literature in combination with our data, we confirmed splenectomy as a risk factor for a shorter overall survival in pancreatic cancer patients undergoing total pancreatectomy, distal pancreatectomy, or pancreatic head resection [HR (95%CI): 1.53 (1.11 - 1.95)]., Conclusion: Here, we report on a strong correlations between removal of the spleen and the survival of pancreatic cancer patients undergoing total pancreatectomy. This should encourage pancreatic surgeons to critically assess the role of splenectomy in total pancreatectomy and give rise to further investigations., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Studies investigating notions of a 'good death' tend to focus on specific medical conditions and specific groups of people. Therefore, their results are often poorly comparable, making it difficult to anticipate potential points of conflict in practice. Consequently, the study explores how to achieve a good death from the perspective and experience of physicians, nursing staff, and seniors. The aim of this study is to identify comparable notions of a good death among the participants and to determine factors that may promote or prevent a good death, including those that may lead to futile care., Methods: The study used a qualitative design with a total of 16 focus group discussions, 5 each with physicians and nursing staff, and 6 with seniors at least 75 years old. The group size ranged between 3 and 9 participants. Analysis was carried out using Qualitative Content Analysis., Results: Three major aspects affect the quality of death: (1) good communication and successful cooperation, (2) avoidance of death, and (3) acceptance of death. While successful communication and acceptance of death reinforce each other, successful communication counters avoidance of death and vice versa. Acceptance and avoidance of death are in constant tension. Additionally, the role of family and loved ones has been shown to be crucial in the organization of dying (e.g. communicating the patient's wishes to health care professionals)., Conclusions: Communication and cooperation between patients and all involved caretakers determines quality of death. However, communication depends on several individual and organizational factors such as the personal level of acceptance or avoidance of death and the availability of institutionalized communication channels crossing professional and organizational boundaries. Furthermore, treatment cultures and organizational structures in hospitals and nursing homes often default towards life prolongation. This carries significant potential for problems, particularly because physicians emphasized the need to prevent hospital admissions when no further life-sustaining treatment is desired. In contrast, nurses and seniors were less aware that hospitals may not be the most suitable place for end-of-life care. This, along with the ambivalent role of nursing homes as places of death, holds potential for conflict., Trial Registration: German Clinical Trials Register: DRKS00027076, 05/11/2021., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and with the principles of good research practice. It has been approved by the Medical Ethics Committee of the University Medical Center Göttingen (Ethics Approval No. 16/9/21). Written informed consent to participate has been obtained from all participants. A small honorarium was offered to all participants. Consent for publication: All authors revised and approved the final manuscript. By signing the consent forms, all participants gave their consent that quotes from the focus group discussions may be published after the data were pseudonymized. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: The increasing survival rates of oncology patients have led to a corresponding increase in long-time survivors living with chronic cancer-related pain. Data is scarce on the care situation for this distinct clinical entity and on specific therapy requirements, such as interdisciplinary, multimodal pain therapy (IMPT). Our cross-sectional study aimed to assess the current care situation, distinct chronification factors, and optimization potential. This survey addresses this need in Germany, but also provides results with international implications., Methods: Via an online survey, German Pain Society members involved in the treatment of long-time survivors with chronic cancer-related pain assessed the current care situation, chronification factors, specific treatment needs, and the required practitioner's expertise. The German Pain Society's Cancer Pain Working Group created the non-validated questionnaire using the Delphi method., Results: One hundred fifty-nine Pain Society members across 70% of Germany's postal regions answered our survey. Respondents (primarily physicians, and 75% with + 6 years of experience) assessed the care situation as worse for chronic cancer-related pain compared to acute pain. Only 10% of the sites provided specific therapy for chronic cancer-related pain (mostly via outpatient treatment). Compared to non-cancer-related pain, additional, cancer-specific chronification factors were assumed, especially at psychological levels, and these need incorporating into therapies. A majority of practitioners recommended cancer-specific IMPT and specific pain expertise for this distinct clinical entity., Conclusions: Members from the German Pain Society assume that there are relevant deficits in the care of long-term survivors with chronic cancer-related pain. The situation may be assessed differently by other groups, e.g., oncologists, and the data relates to Germany. Nevertheless, considering the raising survival rates, it can be supposed that there is reason to be concerned about an increasing care deficit. Thus, besides expanding the range of available treatment and raising awareness, IMPT with specially trained personnel should be developed to address the care needs of cancer survivors experiencing chronic cancer-related pain., Competing Interests: Declarations. Competing interests: Hofbauer H Financial interests: HH received speaker honoraria from Grunenthal GmbH and Roche AG Non-financial interests: 2nd chair Cancer Pain Working Group, Germany Pain Society; Kieselbach K Financial interests: KK has received research funding from the State of Baden-Württemberg Ministry of Social Affairs, Health, and Integration and study funding from the Federal Joint Committee (Gemeinsamer Bundesausschuss)/ Innovation Fund; further funding from the “Kirstin’s Way” Foundation to support cancer medicine (Verein zur Förderung der Krebsmedizin e.V. „Kirstins Weg“, Neuwied, Germany); author’s and editor’s fees from Kohlhammer publishers, Stuttgart. The mentioned fundings and fees, however, will not be affected by publication of this manuscript. There are no further financial interests. Non-financial interests: KK is Speaker of the Ad-hoc Commission “Pain Centers / Funding”, German Pain Society (Deutsche Schmerzgesellschaft e.V.), Deputy Head of the Ethics Committee of the University Freiburg and Chair of the Federal Advisory Board for Pain Health Care of the Ministry of Social Affairs, Baden-Wuerttemberg, Germany. Wirz S Financial interests: WS received speaker honoraria from Grunenthal GmbH, Besins Healthcare Germany, Kyowa Kirin, Novartis / Hexal, Riemser WS received consultation fees from Dr. Pfleger, Cannaflos Non-financial interests: Advisory Board German Pain Society; 1st chair Cancer Pain Working Group, Germany Pain Society; Past Chair Special Interest Group Cancer Pain IASP; Bundscherer A Financial interests: None affecting the publication of this manuscript. Funding by the Bavarian Health and Food Safety Authority (Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL)) for a post-COVID19 care project, funding started after finishing data collection for this study (Dec 2023) Non-financial interests: None Stamer UM Financial interests: none Non-financial interests: 2020-2023 chair person of the subforum Acute and chronic pain and palliative care of the Eu-ropean Society of Anaesthesiology and Intensive Care (ESAIC); Chair of the Acute pain working group of the German Pain Society. Rapp F Financial interests: RF received speaker honorarium from Grunenthal GmbH Non-financial interests: None, (© 2024. The Author(s).)

In contemporary healthcare, effective risk stratification in the general population is vital amidst rising chronic disease rates and an ageing demographic. Deceleration Capacity of the heart rate (DC), derived from 24-hour Holter electrocardiograms, holds promise in risk stratification for cardiac patients. However, the potential of short-term electrocardiograms of five minutes duration for population screening has not been fully explored. Our study aims to investigate the utility of Deceleration Capacity derived from short-term electrocardiograms as a scalable, fully-automated screening tool for predicting long-term mortality risk in the general population. Within a cohort of a representative population-based survey in Germany (KORA-KMC-study), 823 participants with sinus rhythm aged 27 to 76 years at enrollment (females 47.4%) were followed for a median of 13.4 years (IQR 13.1-13.6). All-cause mortality was defined as the primary endpoint and observed in 159 participants. Deceleration Capacity was calculated from 5-minute 12-lead electrocardiograms by a fully automated approach. Participants were divided into three predefined risk categories: DC category0 - low-risk (> 4.5ms); DC category1 - intermediate-risk (2.5-4.5ms); and DC category2 - high-risk (≤ 2.5ms). More than two-thirds of the participants (n = 564, 68.5%) fell into DC category0 , about one-fifth (n = 168, 20.4%) into DC category1 , and about one-tenth (n = 91, 11.1%) into DC category2 . Estimated 13-years mortality in the risk groups was 16.7%, 23.5%, and 49.1%, respectively (p < 0.001). Adjusting for age, life-style-related risk factors, and comorbidities, increased mortality risk was observed for DC category2 (HR 2.34, 95%-CI 1.56-3.50). Deceleration Capacity, derived automatically from brief 5-minute electrocardiogram recordings, emerges as a robust, feasible, and independent predictor of long-term mortality risk in the general population., Competing Interests: Declarations. Competing interests: GS owns patent on Deceleration Capacity. All other authors have nothing to disclose., (© 2024. The Author(s).)

Background: Farm-specific management practices greatly impact calf mortality rates. This cross-sectional study aimed to analyse the association between calf mortality and management practices in large dairy farms. A total of 93 dairy farms were voluntarily included in the study. All farms reared their own youngstock, and all but one kept more than 100 dairy cows. From March 2017 to March 2018, calf management practices were monitored during a farm visit, and farm managers were surveyed regarding calving procedures, neonate management, and environmental factors. Data were collated and analysed in conjunction with the 2017 calf mortality rate, as determined for each farm by using data from the German database of animal origin and movement (HI-Tier). All variables from the topics of colostrum supply, calf feeding, housing, health related information and calving preparation of the cows that resulted in P ≤ 0.1 in the analysis of variance were assumed to be associated with the calf mortality rate and were considered for a general linear mixed regression model., Results: According to the data from the HI-Tier database of the 93 study herds from 2017, 54,474 calves were born alive and 3,790 calves died within the first six months of life. The calf mortality rate was lower on farms where calves were immediately provided with dam-sourced colostrum. Farm managers perceiving dust as the primary factor precipitating respiratory disease on the farm was positively associated with calf mortality. Regularly replacing bucket teats correlated with lower calf mortality rates compared to replacing them only upon detection of abrasion., Conclusions: The study findings suggest that feeding calves with dam-sourced colostrum can potentially reduce overall calf mortality within the herd. This management practice holds comparable importance to ensuring successful passive transfer through timely and adequate colostrum feeding. Moreover, maintaining a low dust environment for the calves and consistently replacing bucket teats play significant roles in promoting better overall calf health., Competing Interests: Declarations. Ethics approval: Not applicable. Consent for publication: Not applicable. Prior publication: The data present herein have not been previously published. Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

The climate crisis seriously threatens Central European forests and their ecosystem functions. There are indications that old-growth forests are relatively resilient and efficient in micro-climatic regulation during extreme climatic conditions. This study evaluates five well-protected old beech forests in Germany, part of a UNESCO World Heritage Site. We examined temperature dynamics and vitality in core, buffer, and border zones during hot days from 2017 to 2023, using Landsat 8 and 9 imageries to assess Land Surface Temperature (LST) and Normalized Difference Vegetation Index (NDVI), alongside on-site Air Temperature (AT) measurements. Our findings reveal that all five forests were impacted by recent extreme heat events, with core zones remaining cooler and more vital, followed by buffer zones. Temperature-regulating patterns varied with landscape characteristics and the surrounding matrixes. We observed a site-dependent cooling effect of the forest interior that increased with higher LST. Our study highlights the value of old-growth forests and recommends increasing effective protection around mature forests, establishing corridors between isolated patches, and creating mosaics in managed landscapes that include unmanaged areas capable of developing into old-growth ecosystems., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Helicopter hoist operations (HHO) are an important option for rescue operations in rugged and challenging terrain. German mid-range mountains are characterized by the versatility of ground conditions, few urban structures, and frequent use for local leisure activities, including the practice of more or less high-risk outdoor sports. This retrospective analysis aims to investigate the incidence of rescue missions in German mid-range mountains requiring HHO. The contributing air rescue bases' operational tactics and the underlying medical characteristics, such as injury patterns and the provided medical care, are also reported., Methods: This study is a retrospective analysis of the documentation of HHO missions carried out at the air rescue bases in Freiburg, Nuremberg, and Bautzen staffed by emergency physicians between 01/2020 and 07/2022. Data was extracted from the German Air Rescue database. To assess the topics of interest, we conducted basic descriptive statistics., Results: Data selection retrieved 410 HHO-associated rescue missions. A total of 304 datasets, including HHO, were suitable for further statistical processing. Air rescue base Freiburg contributed 152, Nuremberg 63, and Bautzen 89 missions. HHO missions showed an increased frequency in the summer season and from Friday to Sunday. In this collective, 75% of the underlying diagnoses were trauma-associated; in 33% of all patients, traumatic injury of the pelvis or lower limb occurred. 28% of the patients were in a potential or actual life-threatening condition and were scored NACA 4 or higher. The rates of invasive medical treatment, such as endotracheal intubation (5%) or venous access (79%), were considerably higher than in overall emergency missions. In terms of mission tactics and cooperation with mountain rescue services, different approaches of the three air bases resulted in differences regarding first-on-scene rates and time spans., Conclusion: The results show a relevant year-round need to deploy emergency medical expertise to inaccessible terrain in the three regions examined. Detailed analysis showed relevant differences in operational tactics between the three bases and potential for optimization. Simultaneous alerting of the hoist helicopter and reliable and precise coordination with other rescue organizations involved, especially the local mountain rescue service and the rescue coordination center, can help to shorten both the treatment-free interval and the prehospital time for patients in inaccessible terrain., Trial Registration: The study is registered at DRKS (DRKS00033493)., Competing Interests: Declarations. Ethical approval and consent to participate: Ethics approval was given by the ethics committee of the University Freiburg (24–1063). Consent for publication: Not applicable. Competing interests: None., (© 2024. The Author(s).)

Background: Demographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care., Methods: In this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. A second control group with n=300 will provide self-reported measures. The study is planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology., Discussion: Demographic change results in a larger older people population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home - Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies., Trial Registration: German Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered): https://drks.de/search/de/trial/DRKS00034260 and https://who.int/clinical-trials-registry-platform/network/who-data-set ., Competing Interests: Declarations. Ethics approval and consent to participate: The study received approval by the Ethics Committee of the Charité – Universitätsmedizin Berlin (ethics approval EA4/168/23). All participants in relation to the intervention group (intervention group patients, GPs, care givers) give written informed consent. The study has been set up according to the Consort SPIRIT-Outcomes 2022 Checklist (for combined completion of SPIRIT 2013 and SPIRIT-Outcomes 2022 items). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The introduction of hybrid diagnosis-related groups (DRG) presents new challenges for healthcare providers and health insurances. The same applied in 2023 to the institute designated by the Federal Ministry of Health (BMG) to extract medical procedures and calculate remuneration levels for the first hybrid DRGs. A responsible calculation methodology and a realistic data basis are required as the result of the calculation can lead to controversy, even to a splitting among specialist groups and constructs. There is also the threat of mismanagement with subsequent supply problems. In this context, a loss of quality can occur due to the use of simple surgical procedures that are less complex and not expensive with respect to material costs and are economical but not state of the art and thus directly worsen the medical care of patients in the statutory health insurance (GKV). Furthermore, it is already becoming apparent that procedures that are uneconomical due to the miscalculation are partially no longer being comprehensively rendered by healthcare providers due to adjustment of the service portfolio. An appropriate compensation of procedures is only possible based on a remuneration that adequately covers the costs. In this respect, this article is not intended to be understood as a "solution to the problem of the internal distribution of the remuneration in hybrid DRGs" but more to offer suggestions for solutions for the required further development of the hybrid DRG compensation level calculation to prevent a threat to the treatment of GKV patients due to mismanagement. As required in § 115f of the Sozialgesetzbuch V (SGB V), the recalculation of an economic remuneration must be carried out urgently and promptly using an empirical calculation basis and methodology and this must be regularly adapted., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: T. Kisch, R. Müller-Rath, S. Gregor, R. Lorenz, A. Neumann, S. Dittrich, M. Müller, R. Lippert, J. Henniger, B. Lembeck, E.-M. Baur, J. Karst, F. Vescia und R. Schmitz geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Medical data registers are a key instrument of medical care research and a valuable tool for medical quality assurance. The structured plausibility tested documentation of large case numbers on a longitudinally oriented time axis with different points in time of data acquisition enables statements to be made on numerous relevant outcomes, not only the mortality of patients. For incidents outside the daily routine care in trauma surgery, such as natural disasters, accidents with multiple casualties and nonmilitary treatment of the domestic population in defence situations, such registers can provide data-based recommendations for action. These data, mainly obtained from routine traumatological treatment, enable a targeted resource management in the abovenamed incidents, which are associated with mass casualties. Due to the utilization of registers from the military field or from international registers, the perspective is additionally extended with respect to treatment strategies and injury patterns. Whether data can also be generated in a suitable manner for the abovenamed registers in specific disaster situations and can provide a direct gain of knowledge from the incident, must be critically discussed. The maintenance of the register datasets is time-consuming and has been subjected to a more stringent regulation at least since May 2018, when the European Union General Data Protection Regulation (EU-GDPR) came into force. The future Register Act in Germany will hopefully achieve greater simplification in the documentation of routine data., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: S. Imach ist der Sprecher des Arbeitskreises TraumaRegister der Sektion Notfallmedizin, Intensivmedizin und Schwerverletztenversorgung der Deutschen Gesellschaft für Unfallchirurgie. R. Lefering ist der leitende Statistiker des TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie. D. Bieler ist der 1. Vorsitzende der Sektion Notfallmedizin, Intensivmedizin und Schwerverletztenversorgung der Deutschen Gesellschaft für Unfallchirurgie. B. Kölbel, M. Wolf und L. Hackenberg geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: While laparoscopic cholecystectomy has largely been performed in an outpatient setting in some countries for years, in Germany it is still generally performed on an inpatient basis; however, with the progressive ambitions for more outpatient treatment within the German healthcare system, laparoscopic cholecystectomy will (have to) increasingly be performed on an outpatient basis in the upcoming years., Aim of the Work: Presentation of the current framework conditions and the potential for outpatient performance of laparoscopic cholecystectomy in Germany. Presentation and discussion on the current state of knowledge regarding patient selection, treatment pathways and safety of outpatient laparoscopic cholecystectomy., Results: The potential for outpatient management of laparoscopic cholecystectomy in Germany is high. Based on the current literature, there are no safety concerns regarding outpatient performance of laparoscopic cholecystectomy in selected patients., Conclusion: Outpatient management of laparoscopic cholecystectomy is inevitably heading our way in the next years. The key to successful change will be comprehensive patient information, patient selection and structured outpatient treatment pathways., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: I. Photiadis, D. Eckhardt, E. Loch, F.J. Hüttner, M.K. Diener und P. Heger geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Sexualized harassment, discrimination and violence (SHDV) in the workplace, during training and studies can affect people regardless of their gender. The Equality team at the University Medicine Greifswald (UMG) conducted a survey to determine the current status of such experiences within the company and to derive targeted preventive measures., Method: Over a period of four months, employees from various professional groups and students were asked online about their experiences and knowledge of sexualized harassment, discrimination and violence, as well as their need for support options., Results: The overall response rate was 11.9%. Of the total number of people surveyed, the responses of 766 were analysed, with 44.6% of these respondents stating that they had experienced SHDV in a professional context in the course of their lives. Women (48.6%) were affected more frequently than men (34.8% p < 0.001). Physical boundary violations were mainly reported by women (21.6% vs. 11.0%). 68.5% of respondents were aware of the Equality team as a contact point. Nevertheless, only 2.2% of those affected turned to this institution. Merely 4.4% stated that they had received formal training on sexualized harassment and protection options, although more than half of the respondents expressed interest in such training., Conclusion: Based on the results, formal training should now be offered to UMG employees, trainees and students in order to prevent sexualized harassment, discrimination and violence in order to strengthen the handling of these issues., Competing Interests: Interessenkonflikt. Die Autorinnen geben an, dass kein Interessenkonflikt vorliegt., (© 2024. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Outpatient visceral surgery is still in its infancy in Germany. While hernia repair that can be performed on an outpatient basis is still being discussed in this country, larger visceral surgery procedures such as thyroidectomy, fundoplication, bariatric procedures and colorectal resection are increasingly being performed abroad on an outpatient basis or in a short inpatient setting (< 24 h). The USA is the pioneer of outpatient care. Due to the private sector character of the American health insurance system, structures were created that ensure seamless care for patients. Overall, a look abroad shows that outpatient surgical procedures are a promising development that can also be further promoted in Germany through appropriate measures and strategies., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: F. Peters und J.-P. Ritz geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Renal cell carcinoma (RCC) accounts for about 13.5% of all urological tumors. Healthcare research analyzes whether treatment recommendations from controlled studies or guidelines are being implemented in routine care. A prerequisite for the assessment and scientific study of the quality of care in the treatment of urological tumors is standardized documentation., Objectives: This article illustrates healthcare research in RCC by presenting current data from the prospective of the VERSUS study (VERSorgUngsStudie) by d‑uo (Deutsche Uro-Onkologen)., Materials and Methods: The VERSUS study is a noninterventional, prospective, multicentric study for the documentation and descriptive statistical analysis of the diagnosis, treatment, and aftercare of uro-oncological patients., Results: Of 25,065 patients currently included in the VERSUS study, 1976 have a diagnosis of RCC. Data regarding stage distribution, reason leading to initial diagnosis, distribution of symptomatic vs. asymptomatic patients as well as surgical margins from surgical treatment of RCC are presented., Conclusions: Despite providing interesting results, the VERSUS study remains limited with regard to the depth of the data, since it relies on the same dataset as the German cancer registry. In order to provide more comprehensive healthcare research, organ-related cancer registries like the Urothelial Cancer National Registry (UroNAT) and the Prostate Cancer National Registry (ProNAT) by d‑uo are necessary. These national cancer registries by d‑uo are unique in that they comprise all tumor stages. The Renal Cancer National Registry (ReNAT) by d‑uo is in preparation and will be a valuable contribution to quality assurance of oncological care in Germany., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: M. Johannsen, R. Eichenauer, J. Klier, F. König, R. Schönfelder, J. Schröder, E. Hempel und C. Doehn geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Structures of palliative care, cross-sectoral transitions and care pathways of patients with palliative care needs were investigated at two sites. The systematic comparison of similarities and differences using the topic of 'pain' as an example is intended to provide information on the extent to which these are related to site-specific palliative care concepts (integrated and cooperative)., Methods: The study follows a mixed-methods design. In addition to a document analysis of anonymised patient records (n = 774), expert interviews (n = 20), as well as interviews with patients, relatives (n = 60) and focus groups (n = 12), were conducted., Results: The systematic comparative analysis provides evidence for concept-independent commonalities (e.g. sociodemographic distribution, aggravated pain treatment) as well as concept-dependent differences (e.g. care pathways, facilitated continuous symptom control through integrated care structures) in the context of integrated or cooperative palliative care., Discussion: Commonalities and differences with regard to the topic of pain, as focused on here, and its organisational management become tangible as effects of the respective organisational structure (= concept-dependent) as well as concept-independent external influencing factors., Competing Interests: Einhaltung ethischer Richtlinien Interessenkonflikt S. Peuten, B. Jaspers, I. Hainsch-Müller, C. Aulmann, W. Schneider, L. Radbruch und G. Ateş geben an, dass kein Interessenkonflikt besteht.Nach positivem Votum des Ethikrats des Universitätsklinikums Bonn (Lfd. Nr. 238/17) wurden nach Studieninformationsgesprächen und unterschriebenen Einwilligungserklärungen qualitative und quantitative Erhebungen durchgeführt., (© 2023. The Author(s).)

Background: Sepsis is defined as "being evoked as a life-threatening organ dysfunction caused by an inadequate host response to infection". The most recent German S3 guidelines were published in 2018 and the Surviving Sepsis Campaign (SSC) last published the current recommendations for the treatment of sepsis and septic shock in 2021., Objective: This article explores and discusses which evidence in the treatment of sepsis and septic shock has been confirmed., Material and Methods: Discussion of the 2018 German S3 guidelines, supplementation of the content of the 2021 international guidelines and recent research results since 2021., Results: The primary objective for managing sepsis and septic shock still includes rapid identification, early initiation of anti-infective treatment, and focus cleansing when feasible. In addition, the focus is on hemodynamic stabilization, including the early use of vasopressors for prevention of hypervolemia and, if necessary, the use of organ support procedures. Supportive treatment, such as the administration of corticosteroids and the use of apheresis, can be advantageous in specific scenarios. The focus is increasingly shifting towards post-intensive care unit (ICU) follow-up care, improving the quality of life after surviving sepsis and the close involvement of relatives of the patient., Conclusion: Despite the fact that considerable progress has been made in understanding the pathophysiology and treatment of sepsis, the early administration of anti-infective agents, focus control, nuanced volume therapy and the use of catecholamines continue to be fundamental to sepsis management. New recommendations emphasize the early use of vasopressors (primarily norepinephrine) and the administration of corticosteroids, especially in cases of septic shock and pneumonia., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: U. Hillebrand, N. Rex, B. Seeliger, K. Stahl und H. Schenk geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)