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Background Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector—the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. Objective This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. Methods An end user–operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. Results Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. Conclusions Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol.

BackgroundKnife crime has increased considerably in recent years in Northern Europe. Affected patients often require immediate surgical care due to traumatic organ injury. Yet, little is known about clinically relevant routine laboratory parameters in stab injury patients and how these are associated with intensive care unit (ICU) admission, hospitalization and number of surgeries.MethodsWe retrospectively analyzed 258 stab injury cases between July 2015 and December 2021 at an urban Level I Trauma Center. Annual and seasonal incidences, injury site, injury mechanism, Injury Severity Score (ISS), and surgical management were evaluated. First, correlations between routine laboratory parameters for hematology, coagulation, and serum biochemistry (peak, and Δ (change from admission to peak within 3 days following admission)) and length of hospital stay, ICU stay, and number of surgeries were assessed using Spearman’s rank correlation coefficients. Second, multivariable Least Absolute Shrinkage and Selection Operator (LASSO) regression analyses were conducted to identify parameters predictive of clinical outcomes. Third, longitudinal developments of routine laboratory parameters were assessed during hospital admission.ResultsIn 2021, significantly more stab injuries were recorded compared with previous years and occurred less during winter compared with other seasons. Mean ISS was 8.3 ± 7.3, and ISS was positively correlated with length of hospital and ICU stay (r = 0.5–0.8, p < 0.001). Aspartate transaminase (AST) (Δ) (r = 0.690), peak C-reactive protein (CrP) (r = 0.573), and erythrocyte count (Δ) (r = 0.526) showed the strongest positive correlations for length of ICU stay for penetrating, thoracoabdominal, and organ injuries, respectively. No correlations were observed between routine laboratory parameters and number of surgeries. For patients with penetrating injuries, LASSO-selected predictors of ICU admission included ISS, pH and lactate at admission, and Δ values for activated partial thromboplastin time (aPTT), K+, and erythrocyte count. CrP levels on day 3 were significantly higher in patients with penetrating (p = 0.005), thoracoabdominal (p = 0.041), and organ injuries (p < 0.001) compared with those without.ConclusionOur data demonstrate an increase in stab injury cases in 2021 and an important link between changes in routine laboratory parameters and ICU admission and hospitalization. Monitoring ISS and changes in AST, CrP, erythrocyte count, pH, lactate, aPTT, and K+ may be useful to identify patients at risk and adjust surgical and ICU algorithms early on.

Background Although apps are becoming increasingly relevant in healthcare, there is limited knowledge about how healthcare professionals perceive “quality” in this context and how quality principles that can aid them in assessing health-related apps may be prioritised. The objective was to investigate physicians’ views of predefined (general) quality principles for health apps and to determine whether a ranking algorithm applied to the acquired data can provide stable results against various demographic influences and may thus be appropriate for prioritisation. Methods Participants of an online survey of members of two German professional orthopaedics associations conducted between 02/12/2019 and 02/01/2020 were asked about their perception of a set of quality principles for health apps (i.e., “practicality,” “risk adequacy,” “ethical soundness,” “legal conformity,” “content validity,” “technical adequacy,” “usability,” “resource efficiency,” and “transparency”). Structured as a Kano survey, for each principle, there were questions about its perceived relevance and opinions regarding the presence or absence of corresponding characteristics. The available data were evaluated descriptively, and a newly developed method for prioritisation of the principles was applied overall and to different demographic strata (for validation). Results Three hundred eighty-two datasets from 9503 participants were evaluated. Legal conformity, content validity, and risk adequacy filled ranks one to three, followed by practicability, ethical soundness, and usability (ranks 4 to 6). Technical adequacy, transparency, and resource efficiency ranked last (ranks 7 to 9). The ranking based on the proposed method was relatively stable, irrespective of demographic factors. The principles were seen as essential, with one exception (“resource efficiency”). Only those with little to no interest in digitisation (22/382, 5.8%) rated the nine principles indifferently. Conclusions The specified quality principles and their prioritisation can lay a foundation for future assessments of apps in the medical field. Professional societies build upon this to highlight opportunities for digital transformations in medicine and encourage their members to participate.

Zusammenfassung Hintergrund Im Rahmen der COVID-19-Pandemie hat die Online-Videosprechstunde einen zunehmenden Stellenwert in der Orthopädie und Unfallchirurgie erhalten. In der Literatur werden verschiedene Adaptationsmöglichkeiten für digitale orthopädisch-unfallchirurgische klassische Gelenk- und Funktionsuntersuchungen für eine Online-Videosprechstunde beschrieben. Methodik Es wurde eine systematische Literaturrecherche der wissenschaftlichen Publikationen für passive digitale Gelenk- und Funktionsuntersuchungen auf der Datenbank PubMed (Zeitraum: Januar 2010 bis April 2021) durchgeführt. Die identifizierten Untersuchungstechniken wurden anschließend systematisch nach Körperregion und Pathologie zusammengefasst, detailliert beschrieben und mit reproduzierten Fotografien nachgestellt. Ergebnisse Es konnten 17 Artikel eingeschlossen werden. Die beschriebenen Untersuchungstechniken waren überwiegend an die klassischen orthopädischen Tests angelehnt und so adaptiert, dass sie selbstständig durch den Patienten durchgeführt werden können. Als Hilfsmittel wurden alltägliche Gegenstände beschrieben. In 5 Publikationen wurde die Durchführung der Online-Videosprechstunde mit klassischen orthopädischen Untersuchungen verglichen. Die Funktionsuntersuchungen in der Online-Videosprechstunde zeigte im Vergleich zur Inspektion und ROM-Testung eine schlechtere Übereinstimmung mit der klassischen orthopädischen Untersuchung. Zusammenfassung In der Literatur existiert eine breite Grundlage an bereits publizierten Untersuchungstechniken für die orthopädisch-unfallchirurgische Videosprechstunde. Die beschriebenen Untersuchungen orientieren sich weitgehend an den klassischen orthopädisch-unfallchirurgischen Tests. Die vorgestellten Untersuchungsmöglichkeiten müssen in Zukunft auf ihre Evidenz geprüft, validiert und ggf. weiter angepasst werden.

In the context of the COVID-19 pandemic, video consultations have gained importance in orthopaedic and traumatological departments. In current literature, different adaptations of classic joint and functional examinations have been described for the virtual examination.A systematic review of current literature on adaptations for the virtual joint and functional examination in orthopaedics and trauma surgery was performed over PubMed (January 2010 to April 2021). The identified examination methods were then summarised systematically according to body region and pathology. Each examination was then described in detail and depicted in an exemplary picture.In total 17 articles were identified and included in the analysis. Most of the examinations employed classical examination methods which were adapted so that they could be performed by the patient independently. Everyday items were described as supporting tools. In five publications, orthopaedic examinations performed in video consultations were compared to the classical examination. Results of functional examinations showed less agreement with results of classical orthopaedic examinations when compared to inspection and ROM-testing.Current literature offers a substantial repertoire of examination options that can be used in the orthopaedic and traumatological video consultation. The reported examinations are mostly oriented to classical orthopaedic examinations. In future digital examinations have to be validated and possibly further adapted in future.Im Rahmen der COVID-19-Pandemie hat die Online-Videosprechstunde einen zunehmenden Stellenwert in der Orthopädie und Unfallchirurgie erhalten. In der Literatur werden verschiedene Adaptationsmöglichkeiten für digitale orthopädisch-unfallchirurgische klassische Gelenk- und Funktionsuntersuchungen für eine Online-Videosprechstunde beschrieben.Es wurde eine systematische Literaturrecherche der wissenschaftlichen Publikationen für passive digitale Gelenk- und Funktionsuntersuchungen auf der Datenbank PubMed (Zeitraum: Januar 2010 bis April 2021) durchgeführt. Die identifizierten Untersuchungstechniken wurden anschließend systematisch nach Körperregion und Pathologie zusammengefasst, detailliert beschrieben und mit reproduzierten Fotografien nachgestellt.Es konnten 17 Artikel eingeschlossen werden. Die beschriebenen Untersuchungstechniken waren überwiegend an die klassischen orthopädischen Tests angelehnt und so adaptiert, dass sie selbstständig durch den Patienten durchgeführt werden können. Als Hilfsmittel wurden alltägliche Gegenstände beschrieben. In 5 Publikationen wurde die Durchführung der Online-Videosprechstunde mit klassischen orthopädischen Untersuchungen verglichen. Die Funktionsuntersuchungen in der Online-Videosprechstunde zeigte im Vergleich zur Inspektion und ROM-Testung eine schlechtere Übereinstimmung mit der klassischen orthopädischen Untersuchung.In der Literatur existiert eine breite Grundlage an bereits publizierten Untersuchungstechniken für die orthopädisch-unfallchirurgische Videosprechstunde. Die beschriebenen Untersuchungen orientieren sich weitgehend an den klassischen orthopädisch-unfallchirurgischen Tests. Die vorgestellten Untersuchungsmöglichkeiten müssen in Zukunft auf ihre Evidenz geprüft, validiert und ggf. weiter angepasst werden.

Introduction : The purpose of the present study was to assess orthopedic and orthopedic trauma patients’ willingness to perform hypothetical remote video consultations, possible advantages as well as concerns. Methods : Between June 2019 and November 2019, a survey amongst consecutive regular orthopedic and orthopedic trauma patients at the outpatient clinics from three European level I trauma centers was conducted via paper-based questionnaires, composed of participants` demographics as well as five open and closed questions. Participation was voluntary and anonymity was granted. Results : In total, 780 participants (female 302, 38.7%, male 478, 61.3%) with a mean age of 43.8 years (SD 17.1, range from 14 years to 94 years) were included. The majority of the participants (57,6%) were eager to use a remote consultation. Participants with an age of more than 55 years were significantly less likely to use a remote consultation than their younger counterparts (OR= 0.18, p=0.003. r2=0.141). Among the whole study population, 86.2% stated, that they had a device compatible with an online video consultation. The highest willingness to conduct a video consultation in respect of the participants` occupation was observed in “part-time”-jobs (70.6%), whereas the lowest disposition was seen in retired patients (37.1%) (p= 0.0001). The most stated reason why to conduct a video consultation was “communication of medical findings” (67.8%). The most stated advantage was the “reduction of physical consultations” (66.4%). “No physical examination” was the most frequently stated disadvantage (75.9%). Conclusion : The majority of orthopedic and orthopedic trauma outpatients would use a video consultation, especially because of commuting and time issues and ideally to communicate medical findings, such as x-ray reports or lab values. Elderly patients appear to be less eager in regard to video consultations. These results may change for even better acceptance in view of a current pandemic situation, as experienced since early 2020. We feel that this assumption may warrant further investigation. Level of evidence : IV

Obwohl sich die Digitalisierung im Gesundheitswesen seit Beginn der Corona-Pandemie beschleunigt hat, gibt es noch manche Defizite. An einer weiteren Entwicklung führt jedoch kein Weg vorbei, und es gibt auch schon manche Angebote, die erahnen lassen, was zukünftig möglich sein wird.

ZusammenfassungHintergrund Die Nutzung digitaler Medien ist in nahezu allen Bereich des täglichen Lebens zur Normalität geworden. Ziel dieser Arbeit war es zu analysieren, inwieweit verletzte Sportler Online-Medien nutzen, um Informationen über Sportverletzungen oder deren Prävention zu erhalten.Material und Methoden Zwischen 07/2017 und 12/2019 wurden im Klettersport sowohl Freizeit- als auch Wettkampfsportler nach ihrer Nutzung verschiedener Medien mit Hinblick auf die Bereiche Sportmedizin und Prävention befragt.Ergebnisse 488 Athleten wurden in die Studie eingeschlossen (70,9 % männlich, 29,1 % weiblich, 33,2 ± 10,3 (13–71) Jahre). 69,9 % der Athleten nutzen online verfügbare medizinische Inhalte, wobei die Videoplattform YouTube am häufigsten zur spezifischen Suche verwendet wird (24,4 %). Jüngere Athleten ( 50 Jahre nutzt dieses Medium signifikant seltener (18,8 %; p = 0,013). Wettkampfathleten nutzen signifikant häufiger webbasierte medizinische Inhalte als Freizeitathleten (p = 0,005). Das generelle Interesse an Verletzungsprophylaxe ist groß, wobei Wettkampfathleten häufiger entsprechende Inhalte nutzen. Fast 9 % aller befragten Patienten begaben sich aufgrund ihrer Online-Recherchearbeit in eine entsprechende sportorthopädische Einrichtung.Zusammenfassung Internetbasierte medizinische Informationen werden von 69,9 % der Athleten genutzt, die Videoplattform YouTube wird am häufigsten verwendet. Videoplattformen und sportspezifische Literatur werden von jüngeren Athleten deutlich häufiger als von älteren Athleten genutzt. Webbasierte medizinische Inhalte werden von Wettkampfathleten signifikant häufiger aufgerufen als von Freizeitathleten. Das generelle Interesse an Verletzungsprophylaxe ist groß, wobei Wettkampfathleten häufiger entsprechende Inhalte nutzen bzw. suchen.

BACKGROUND Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector—the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. OBJECTIVE This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. METHODS An end user–operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. RESULTS Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. CONCLUSIONS Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol. CLINICALTRIAL

Contact teaching was prohibited by nationwide lockdowns during the COVID-19 pandemic. The scientific literature contains no concrete figures concerning e‑learning via webinars in the subject of orthopedics and trauma surgery in the context of the COVID-19 pandemic.This research study was established to collect facts and figures about webinars as a representative part of e‑learning in the subject of orthopedics and trauma surgery in the context of the COVID-19 pandemic.German-speaking non-commercial and edited webinars, produced by suppliers from Germany were identified using common search engines. Structured interviews with questionnaires about provider, format, and number of participants in the webinars over time, were offered to the operating companies.The study included four suppliers of webinars (AO Online Campus, BVOU Study Club, OU TO GO and WebDGU). There was approval of all operating companies to participate in the interviews and to disclose facts and figures about their webinars. All suppliers showed an increased supply and demand for webinars during the COVID-19 pandemic.OU TO GO and BVOU Study Club already offered webinars prior to the COVID-19 pandemic. AO online Campus was designed in addition to the existing portfolio. The supply of WebDGU was newly established. Limitations of this study are the exclusion of commercial suppliers, non-German operating companies and all other types of e‑learning except webinars. The increased supply and demand for webinars during the COVID-19 pandemic gives hope for further improvement of e‑learning in the subject of orthopedics and trauma surgery.HINTERGRUND: Im Verlauf der COVID-19-Pandemie haben offizielle Schutzmaßnahmen traditionelle Präsenzfortbildungen zum Erliegen gebracht. Für das Fach Orthopädie und Unfallchirurgie (OU) gibt es bisher bezüglich der Angebots- und Nachfragesituation von E‑Learning per Webinar im Kontext der COVID-19-Pandemie keine belastbaren Zahlen.Das Ziel der vorliegenden Arbeit ist die quantitative Beschreibung von Angebot und Nachfrage deutschsprachiger Online-Fortbildungen mit Webinar-Charakter aus der Orthopädie und Unfallchirurgie (OU) im zeitlichen Zusammenhang mit der COVID-19-Pandemie.Über gängige Suchmaschinen wurden deutschsprachige, nichtkommerzielle, editierte und wissenschaftlich fundierte Fortbildungen in Form von Webinaren im Bereich OU von Anbietern mit Sitz in Deutschland identifiziert und interviewt.Alle 4 eingeschlossenen Anbieter (AO Online Campus, BVOU Study Club, OU TO GO, WebDGU) nahmen an den strukturierten Interviews teil und stimmten einer Offenlegung der Teilnehmerzahlen zu. Das Angebot von Webinaren stieg im zeitlichen Zusammenhang mit der COVID-19-Pandemie an. Ebenfalls erhöhten sich bei allen 4 Anbietern die Teilnehmerzahlen.Während OU TO GO und der BVOU Study Club bereits vor der Pandemie auf E‑Learning-Formate spezialisiert waren, wurde das Kursangebot der AO durch den neu etablierten AO online Campus erweitert und WebDGU ganz neu konzipiert. Eine Limitation der Studie ist die exklusive Ausrichtung auf Webinare und nichtkommerzielle Anbieter. Die Ergebnisse lassen auf positive Entwicklungen in OU im Bereich E‑Learning hoffen.

Facing a shortage of young surgeons, this study aimed to examine the availability of mentoring programs and if this can counteract this lack.Medical mentoring programs have proven to be decisive to influence students' later career decisions. Since their structure may depend on the medical school and the effort of single disciplines, the offers are often very heterogeneous.Anonymous online-questionnaires were developed and distributed among medical students in Germany and the dean for teaching of the medical schools from July 2019 to January 2020 in Germany. Data of the availability of mentoring programs, their structure and the impact of surgery were collected.Forty three medical schools participated, with 65% offering mentoring programs. 18 of medical schools had no additional funding available for this. Surgical subjects participated in these programs in only 30%. Additionally, 1,516 medical students participated in the second survey. A total of 70% had already participated in a mentoring program with a significantly higher proportion of men. Of these, 94% stated that this was helpful and had an impact on their career planning, without any gender differences. 95% would participate in structured surgical mentoring programs and 95% agreed that this could have an impact on their career planning.Mentoring programs may be able to influence career planning, nevertheless participation by surgical specialties has been low. Becoming more active in providing mentoring programs with a special focus on women and offering more surgical content can be a way to counteract the lack of surgical trainees.

Einleitung Das Fortschreiten der Digitalisierung wird neben Vorteilen für Patienten und Ärzte auch ökonomische Implikationen für das Gesundheitswesen in toto weltweit haben. Die Integration digitaler Innovationen ermöglicht es Gesundheitsunternehmen, ihre bisherigen Aktivitäten und Prozesse zu transformieren und eine neue Form der Patientenversorgung zu schaffen. Wichtige ökonomische Themenfelder der Digitalisierung Mithilfe digitaler Anwendungen können eine Prozessoptimierung durch Effizienzsteigerung und damit eine Kostensenkung im Gesundheitswesen erreicht werden. Verbesserte Prozesse können wiederum eine Qualitätssteigerung bei der Behandlung von Patienten erreichen. Gleichzeitig kann durch digitale Schnittstellen eine Doppelung von Untersuchungen vermieden und die Kommunikation unter beteiligten Gesundheitsprofessionen verbessert werden, was eine Ressourcenschonung zur Folge hätte. Letztlich können diese Einflüsse zu einer Präzisierung der Medizin führen, Heilungsabläufe beschleunigen und für alle Beteiligten einen Vorteil darstellen. Ausblick Ökonomische Umverteilungen durch die Digitalisierung der Medizin werden sich erst in der Zukunft klar zeigen. Ethische Überlegungen und auch der Datenschutz werden wichtige Themen sein. Gleichzeitig müssen Investitionen und digitale Innovationen von staatlicher und unternehmerischer Seite gefördert werden. Wissenschaftliche Studien können auch in der Orthopädie und Unfallchirurgie helfen, die nötige Evidenz neuer Methoden für die Praxis zu sichern.

Social media applications on smartphones allow for new avenues of instruction in sports medicine and exercise sciences. This study tested the feasibility of instructing health care personnel through videos of ultrasound vascular measurements distributed by a social media messenger application. After two training sessions with an ultrasound device, voluntary physicians (n=10) and nurses (n=10) received a video for the performance of an ultrasound-guided determination of intima-media-thickness and diameter of the femoral arteries via a social media messenger application. All participants examined the same healthy human subject. There was no significant difference between the groups regarding overall time of performance, measurements of the femoral arteries, or a specifically designed “assessment of mobile imparted arterial ultrasound determination” score. The physicians group achieved significantly higher scores in the established “objective structured assessment of ultrasound skills” score (p=0.019). Approval of the setting was high in both groups. Transmission of videos via social media applications can be used for instructions on the performance of ultrasound-guided vascular examinations in sports medicine, even if investigators’ performances differ depending on their grade of ultrasound experience. In the future, the chosen approach should be tested in practical scientific examination settings.

New communication technologies allow patients to communicate with their physicians from anywhere using computer or smartphone. Adding video to the mere phone call optimizes the personal contact between patient and physicians regardless of distance. Legal and reimbursements requirements must be taken into account, especially only certified software products must be used. In addition, patient consent is needed and confidentiality must be assured. The video patient consultation can be reimbursed by the health insurance companies. As with all new technologies, the introduction of these video consultations faced some challenges. Although patients and physicians have expressed great interest in this technology, it has been rarely used so far. The current COVID crisis increased the need for video consultations resulting in an increasing use of video patient consultation. It can be expected that this demand will still exists after the COVID crisis.

The recently ratified Digital Healthcare Act – DVG – has paved the way, among other issues, for the prescription of health apps. The German DVG creates an entitlement to health apps for the very first time. However, this entitlement is initially limited to low-risk medical devices that have been included in the publicly accessible Register for Digital Health Applications by the German Federal Institute for Drugs and Medical Devices. Listing in the register is granted, if the manufacturer has submitted a health app and verified that it meets basic requirements for medical devices and data security as well as positive health care effects. It is questionable, whether the DVG will lead to sustainable improvements in future patient care. In order to pursue this question and align the DGOUCʼs digitization strategy closely with its basis, an online survey was conducted among the respective members on the DVGʼs content and its associated opportunities and risks. A total of 461 German-speaking, predominantly male, experienced and elderly physicians in leading positions took part in the survey. In this study, it was shown that the majority of the participating German orthopaedic and trauma surgeons is not familiar with the DVGʼs contents. Despite a fundamentally positive attitude towards digitization, scepticism about the use of “apps on prescription” and potential risks still prevails at present. The closing of ranks between medicine, IT and the legislature via interdisciplinary expert groups and the involvement of medical societies might be obligatory.

Background: Due to the Covid-19 pandemic, on-site classroom teaching became limited at most German medical universities. This caused a sudden demand for digital teaching concepts. How the transfer from classroom to digital teaching or digitally assisted teaching was conducted was decided by each university and/or department individually. As a surgical discipline, Orthopaedics and Trauma have a particular focus on hands-on teaching as well as direct contact to patients. Therefore, specific challenges in designing digital teaching concepts were expected to arise. Aim of this study was to evaluate medical teaching at German universities one year into the pandemic as well as to identify potentials and pitfalls in order to develop possible optimization approaches.Methods: A questionnaire with 17 items was designed and sent to the professors in charge of organising the teaching in Orthopaedics and Trauma at each medical university. A differentiation between Orthopaedics and Trauma was not made to allow a general overview. We collected the answers and conducted a qualitative analysis.Results: We received 24 replies. Each university reported a substantial reduction of their classroom teaching and efforts to transfer their teaching to digital formats. Three sites were able to switch to digital teaching concepts completely, whereas others tried to enable classroom and bedside teaching at least for students of higher edcuational levels.The online platforms used varied depending on the university as well as the format it was supposed to support. Conclusion: One year into the pandemic significant differences concerning the proportions of classroom and digital teaching for Orthopaedics and Trauma can be observed. Simultaneously huge differences in concepts used to create digital teaching are present. Since a complete suspense of classroom teaching was never mandatory, several universities developed hygiene concepts to enable hands-on and bedside teaching. Despite these differences, some similarities were observed: the lack of time and personnel to generate adequate teaching material was reported as the leading challenge by all participants of this study.

Introduction Regional health care networks with interfaces between clinics, general practitioners and patients can act faster when utilizing digital measures. This manuscript describes the establishment of an online video consultation service in a clinic and its broad health care region to exemplify challenges and solutions for potential future approaches from a management perspective. Method The underlying pilot project was planned and implemented for follow-up monitoring and consultative presentation of orthopedic and trauma patients within the Bundeswehr Medical Service from 2018 to 2020. With predominantly positive evaluation results regarding quality and acceptance among users, this research investigated organizational and processual aspects including total quality management, strategic control and change management approaches. Results The affected main and subprocesses of patient treatment could be streamlined by the project, as physician recommendations and arrangements could be accelerated and patient travel could be significantly reduced. A SWOT and portfolio analysis showed a high potential for improving existing patient treatment processes for health care enterprises via the use of digital technology. The involved staff should be strategically included at an early stage and continuously involved. By means of a PDCA cycle, the processes of the given project could be exemplarily illustrated with an outlook in the future. Discussion It has proven successful to consciously use management approaches to establish telemedical integrated care structures in a health region. Recommendations for the strategic introduction of an online video consultation for regional network strengthening and care development for a patient-oriented increase in efficiency could be compiled.

Introduction Due to the Covid-19 pandemic, making more use of remote medical solutions has been advertised. The purpose of this study was to assess the willingness of orthopedic trauma patients to conduct an online video consultation (OVC) during the coronavirus pandemic compared to before. Methods A survey amongst orthopedic and trauma outpatients from three European trauma centers was conducted via paper-based questionnaires, composed of participants’ demographics and five open and closed questions between June and November 2019 and between April and July 2020 during Covid-19. The main outcome was the difference between the cohorts regarding the willingness to use an OVC, reasons for and against usage as well as advantages and disadvantages. Sub-analysis was performed for gender, participants’ occupation and three age groups (≤ 30 years; 31–55 years; > 55 years). Results 1400 participants (780 preCovid-19 and 620 Covid-19) were included. There was no difference in willingness to conduct an OVC between the cohorts (57.6% versus 63.9%; p = 0.053). The highest disposition towards an OVC in both cohorts was seen in patients below 30 years of age, followed by 31–55 years and over 55 years. Women were significantly more likely in the Covid-19-group than in the preCovid-19-group to conduct an OVC (p = 0.032). Use of the OVC for “personal questions to the physician” was more often stated in the Covid-19-cohort (p = 0.007). “No danger of an infection” (p = 0.001) and “availability from anywhere” (p = 0.032) as advantages of an OVC were more often stated in the Covid-19-cohort. “No direct contact with the doctor” (p = 0.001) and “relationship to the doctor could change” (p = 0.024) as disadvantages of the OVC were less often stated in the Covid-19-cohort. Conclusion The majority of the assessed outpatients would use an OVC. Fear of infections have increased, and direct physical contact is less important since the Covid-19 pandemic, but have not increased the disposition for an OVC significantly.

Background Video consultations have proven to be an efficient source of support for patient-doctor interactions and have become increasingly used in orthopedics, especially during the COVID-19 pandemic. This study analyzed both patients’ and doctors’ acceptance of an orthopedic telemedical consultation (OTC) and compared the results of OTC examinations to the results of live consultation (LC) to identify discrepancies. Methods The study was carried out in an orthopedic department of a German hospital between 2019 and 2020. After written informed consent was obtained, patients voluntarily presented for follow-up by OTC and LC. The experience with and attitudes toward OTC among both patients and doctors was evaluated (using Likert scale-scored and open questions, 26 to 28 items). The results of the OTC and LC examinations were compared using a 12-item checklist. The data were analyzed by quantitative and qualitative statistics. Results A total of 53 patients were included, each of whom completed an OTC and an LC. The OTC was rated as pleasant, and the experience was rated as very satisfying (average rating on a 5-point Likert scale, with 1 indicating strong agreement: doctors: 1.2; patients: 1.3). Various technical and organizational challenges were identified. Compared to LC, OTC showed no significant differences in patient history or in inspection, palpation, or active range of motion results. Only for the functional or passive joint assessment did LC show significantly higher suitability (p Conclusions Because of the high acceptance and the objective benefits of OTC and the similarity of clinical results with LC, OTC is recommendable for orthopedic follow-up examinations. To better assess joint functionality, meaningful digital alternatives for established examination methods should be further investigated.

Introduction: Telemedical video consultations are a powerful support for patient–doctor interactions. For optimal digital settings, explanatory illustrations may be helpful for patients. This study analyzed patients' the attitude of patients to illustrations preparing for an orthopedic telemedical consultation (OTC).Methods: A leaflet with eight illustrations was designed and their acceptance and estimated necessity was evaluated among patients who had experienced an OTC (EXP-group) and others who had not (NOV-group) with a 12-item-questionnaire.Results: Sixty patients participated (n = 30 each group). All illustrations were evaluated positively. The EXP-group gave significantly higher ratings than the NOV-group for improved understanding by the given keywords of the illustrations (p = 0.046), preference for being informed by illustrations than by merely by a pure text (p = 0.023), better feeling of preparation for an OTC by the illustrations (p = 0.005), and the impression of a simplified process of the OTC by the illustrations (p = 0.012).Discussion: While the illustrations were well-accepted by the participants, significant differences were revealed between the valuation of single aspects by patients, depending on a previous experience with an OTC. Therefore, a leaflet with explanatory illustrations may be helpful in preparing patients for an OTC to support the digital patient–doctor contact.

Einsatz- und Katastrophenszenarien stellen westliche Gesundheitssysteme vor neue Herausforderungen. In der Praxis zeigen sich dabei Parallelen der zivilen Katastrophenmedizin und militarischen Einsatzmedizin, was eine Integration dieser Inhalte bereits in das Medizinstudium sinnvoll erscheinen lasst. Wie ist die Einstellung von Medizinstudierenden zur Ausbildung in der Einsatz- und Katastrophenmedizin (EKM) im Studium, und bestehen hierbei Unterschiede in Abhangigkeit vom Besuch eines fakultativen EKM-Lehrangebots? Im Rahmen einer Vorlesungsreihe zum Thema EKM erfolgte eine anonyme Evaluation unter den Studierenden (Gruppe 1) mit 20 Fragen zu ihrer Einstellung bezuglich der Thematik. Als Vergleichsgruppe (Gruppe 2) dienten Studierende, die die Vorlesungsreihe nicht besucht hatten. Die statistische Auswertung erfolgte deskriptiv sowie mittels Student’s t‑Test. Die Fragebogen wurden von 152 Studierenden vollstandig ausgefullt (Gruppe 1: n = 78, Gruppe 2: n = 74). Nur 10 Studierende aus Gruppe 1 und keiner aus Gruppe 2 fuhlten sich ausreichend in EKM ausgebildet. Medizinstudierende beider Gruppen sahen das Themengebiet EKM als nichtangemessen im Curriculum reprasentiert an (Gruppe 1: 64 %, Gruppe 2: 66 %) und befurworteten eine verstarkte Integration in das Studium (Gruppe 1: 72 %, Gruppe 2: 54 %, p = 0,001) sowie das Erstellen von digitalen Lehrmedien in dem Fach EKM (Gruppe 1: 73 %, Gruppe 2: 72 %). Die Befragten wunschten eine starkere Integration von Inhalten der EKM in das Curriculum. Trotz statistisch signifikanter Unterschiede in den Antworten beider Gruppen zeigten die Teilnehmer gruppenunabhangig ein groses Interesse fur die EKM. Beide Gruppen befurworten zudem E‑Learning-Angebote in der EKM. Dies sollte fur Fakultaten und Fachgesellschaften zum Anlass genommen werden, um die universitare Lehre in diesem Bereich starker zu fordern.

Bei der Behandlung von Schockraumpatienten mussen in komplexen Situationen laufend und unter Zeitdruck zahlreiche kritische Entscheidungen getroffen werden. Auch erfahrene Teams machen hierbei haufig Fehler. Computerassistierte Entscheidungshilfen konnen basierend auf kontinuierlich eingespielten Informationen uber den Zustand des Patienten anhand errechneter Wahrscheinlichkeiten weitere Behandlungsschritte vorschlagen. Die vorliegende Ubersichtsarbeit fasst den aktuellen Stand der Literatur zur computerassistierten Entscheidungsfindung beim Traumapatienten zusammen. Literaturubersicht zu den vorhandenen Konzepten und Anwendungen der computerassistierten Entscheidungsfindung beim Traumapatienten. Narrativer Ubersichtsartikel basierend auf einer Recherche der relevanten deutsch- und englischsprachigen Literatur der letzten 10 Jahre. Es sind bereits einige gut funktionierende computerassistierte Entscheidungshilfen im Bereich der Traumaversorgung implementiert. Diverse Studien konnten zeigen, dass computerbasierte Entscheidungen im praklinischen Setting, im Schockraum und auf der traumatologischen Intensivstation das Behandlungsergebnis verbessern konnen. Zur weiteren Validierung und Implementierung mussen informationstechnische Barrieren behoben, die existierenden Systeme an die Datenschutzgesetze angeglichen und multizentrische Studien zur groseren Datenerhebung generiert werden. Computerassistierte Entscheidungshilfen konnen helfen, die Versorgung von Traumapatienten zu verbessern. Fur eine flachendeckende Anwendung mussen jedoch zuvor technische und legislative Barrieren uberwunden werden.

E-learning is widely used in undergraduate medical education and often in blended learning settings for students learning at home. This study should assess the educative value of e-learning tools in orthopedics and traumatology when used under "field" conditions, in comparison with a controlled laboratory-like setting.Medical students were invited for their voluntary online participation in an uncontrolled study (UCS). They were randomly exposed to digital book chapters or podcasts on four different orthopedic diseases, and then filled in pre-/post-tests and evaluations. Test results indicating insufficient study participation were not included in the subsequent analysis. Results in a gain of knowledge and student's satisfaction were compared to existing data of a randomized controlled trial with the same tools in a laboratory environment (RCT).Among 84 included UCS students and 130 RCT students, podcast learners showed a significantly higher gain of knowledge compared to text learners independent of the learning setting (UCS p0.011; RCT p0.001). There were no significant differences in the gain of knowledge for the two different learning tools when comparing each the UCS and RCT settings. Evaluations showed positive ratings for both tools, while podcasts were on the average rated higher than texts were. Significantly more UCS participants (n=46) compared to the RCT (n=34) showed signs of disengagement with the study (p0.05).The findings suggest that it is possible to achieve a similar gain of knowledge with e-learning tools in uncontrolled settings and in RCTs. The role of e-learning materials in voluntary and formative learning settings is of value and should be explored in future studies.III, case-control study.

Background: Health-related mobile applications (apps) are rapidly increasing in number. There is an urgent need for assessment tools and algorithms that allow the usability and content criteria of these applications to be objectively assessed. The aim of this work was to establish and validate a concept for orthopedic societies to rate health apps to set a quality standard for their safe use. Methods: An objective rating concept was created, consisting of nine quality criteria. A self-declaration sheet for app manufacturers was designed. Manufacturers completed the self-declaration, and the app was examined by independent internal reviewers. The pilot validation and analysis were performed on two independent health applications. An algorithm for orthopedic societies was created based on the experiences in this study flow. Results: “Sprunggelenks-App“ was approved by the reviewers with 45 (98%) fulfilled criteria and one (2%) unfulfilled criterion. “Therapie-App” was approved, with 28 (61%) met criteria, 6 (13%) unfulfilled criteria and 12 (26%) criteria that could not be assessed. The self-declaration completed by the app manufacturer is recommended, followed by a legal and technical rating performed by an external institution. When rated positive, the societies’ internal review using independent raters can be performed. In case of a positive rating, a visual certification can be granted to the manufacturer for a certain time frame. Conclusion: An objective rating algorithm is proposed for the assessment of digital health applications. This can help societies to improve the quality assessment, quality assurance and patient safety of those apps. The proposed concept must be further validated for inter-rater consistency and reliability.

Digital media have found their way into almost all areas of daily life. The aim of this study was to analyse the extent to which injured athletes use online media to gather information on sports injuries or on how to prevent them. Between 07-2017 and 12-2019, both recreational and competitive climbing athletes were surveyed on their use of various media with regard to sports medicine and prevention. 488 athletes were included in the study (70.9 % male, 29.1 % female, 33.2 ± 10.3 (13-71) years of age). 69.9 % of the athletes use web-based medical content, with the video platform YouTube being most frequently used for specific searches (24.4 %). Younger athletes ( 30y) use video platforms significantly more often than older athletes (p = 0.011). Sports-specific literature is most frequently used by the age group 30-50 years (37.4 %). The age group 50 uses this medium significantly less frequently (18.8 %; p = 0.013). Competitive athletes use web-based medical content significantly more often than recreational athletes (p = 0.005). The general interest in injury prevention is high, with competitive athletes using relevant content more often. Almost 9 % of all patients interviewed visited a sports-orthopaedic facility because of their online research work. Internet-based medical information is used by 69.9 % of athletes, with the video platform YouTube being most frequently used. Video platforms and sports-specific literature are used significantly more often by younger athletes than by older athletes. Web-based medical content is accessed significantly more often by professional athletes than by recreational athletes. The general interest in injury prophylaxis is high, with competitive athletes using or browsing medical content more often. Die Nutzung digitaler Medien ist in nahezu allen Bereich des täglichen Lebens zur Normalität geworden. Ziel dieser Arbeit war es zu analysieren, inwieweit verletzte Sportler Online-Medien nutzen, um Informationen über Sportverletzungen oder deren Prävention zu erhalten. Zwischen 07/2017 und 12/2019 wurden im Klettersport sowohl Freizeit- als auch Wettkampfsportler nach ihrer Nutzung verschiedener Medien mit Hinblick auf die Bereiche Sportmedizin und Prävention befragt. 488 Athleten wurden in die Studie eingeschlossen (70,9 % männlich, 29,1 % weiblich, 33,2 ± 10,3 (13–71) Jahre). 69,9 % der Athleten nutzen online verfügbare medizinische Inhalte, wobei die Videoplattform YouTube am häufigsten zur spezifischen Suche verwendet wird (24,4 %). Jüngere Athleten ( 30 Jahre) nutzen Videoplattformen deutlich häufiger als ältere Athleten (p = 0,011). Sportspezifische Literatur wird von der Altersgruppe 30.–50. Lebensjahr am häufigsten verwendet (37,4 %). Die Altersgruppe 50 Jahre nutzt dieses Medium signifikant seltener (18,8 %; p = 0,013). Wettkampfathleten nutzen signifikant häufiger webbasierte medizinische Inhalte als Freizeitathleten (p = 0,005). Das generelle Interesse an Verletzungsprophylaxe ist groß, wobei Wettkampfathleten häufiger entsprechende Inhalte nutzen. Fast 9 % aller befragten Patienten begaben sich aufgrund ihrer Online-Recherchearbeit in eine entsprechende sportorthopädische Einrichtung. Internetbasierte medizinische Informationen werden von 69,9 % der Athleten genutzt, die Videoplattform YouTube wird am häufigsten verwendet. Videoplattformen und sportspezifische Literatur werden von jüngeren Athleten deutlich häufiger als von älteren Athleten genutzt. Webbasierte medizinische Inhalte werden von Wettkampfathleten signifikant häufiger aufgerufen als von Freizeitathleten. Das generelle Interesse an Verletzungsprophylaxe ist groß, wobei Wettkampfathleten häufiger entsprechende Inhalte nutzen bzw. suchen.

Summary Background Changes in demographics and dynamics of our society are affecting the healthcare system, leading to an intensified “war for talents,” especially for surgical departments. Also with regard to the current COVID-19 pandemic, the present work analyzes the potential of digitalization for human resource management of surgical departments in hospitals. Methods PubMed and Google Scholar were searched to identify articles referring to the specific subject of human resource management and its digital support in hospitals and surgical departments in particular. Results The main topics include the digital affinity of young physicians and surgeons in terms of staff recruiting, digital support for everyday working life in surgical departments, and the potential of digital approaches for surgical training. These topics are put into the context of company strategies, and their future potential is identified accordingly. Conclusion Digital programs, digital structures, and digital tools can today be used by human resources departments to advertise the hospital and to make the recruitment of future candidates increasingly attractive. In addition, by making digital tools available, the employees’ satisfaction can be raised with the potential of a strong employer branding. In times of the COVID-19 pandemic, digital personnel strategies and training formats have to be regarded a contemporary offering.

BACKGROUND Support for long-distance research and clinical collaborations is in high demand and has increased owing to COVID-19–related restrictions on travel and social contact. New digital approaches are required for remote scientific exchange. OBJECTIVE This study aims to analyze the options of using an augmented reality device for remote supervision of exercise science examinations. METHODS A mobile ultrasound examination of the diameter and intima-media thickness of the femoral and carotid arteries was remotely supervised using a head-mounted augmented reality device. All participants were provided with a link to a YouTube video of the technique in advance. In part 1, 8 international experts from the fields of engineering and sports science were remotely connected to the study setting. Internet connection speed was noted, and a structured interview was conducted. In part 2, 2 remote supervisors evaluated 8 physicians performing an examination on a healthy human subject. The results were recorded, and an evaluation was conducted using a 25-item questionnaire. RESULTS In part 1, the remote experts were connected over a mean distance of 1587 km to the examination site. Overall transmission quality was good (mean upload speed: 28.7 Mbps, mean download speed: 97.3 Mbps, mean ping: 21.6 milliseconds). In the interview, participants indicated that the main potential benefits would be to the fields of education, movement analysis, and supervision. Challenges regarding internet connection stability and previous training with the devices used were reported. In part 2, physicians’ examinations showed good interrater correlation (interclass correlation coefficient: 0.84). Participants valued the experienced setting as highly positive. CONCLUSIONS The study showed the good feasibility of the chosen design and a highly positive attitude of all participants toward this digital approach. Head-mounted augmented reality devices are generally recommended for collaborative research projects with physical examination–based research questions.

UNSTRUCTURED Owing to an increase in digital technologies in health care, recently leveraged by the COVID-19 pandemic, physicians are required to use these technologies appropriately and to be familiar with their implications on patient care, the health system, and society. Therefore, medical students should be confronted with digital health during their medical education. However, corresponding teaching formats and concepts are still largely lacking in the medical curricula. This study aims to introduce digital health as a curricular module at a German medical school and to identify undergraduate medical competencies in digital health and their suitable teaching methods. We developed a 3-week curricular module on digital health for third-year medical students at a large German medical school, taking place for the first time in January 2020. Semistructured interviews with 5 digital health experts were recorded, transcribed, and analyzed using an abductive approach. We obtained feedback from the participating students and lecturers of the module through a 17-item survey questionnaire. The module received overall positive feedback from both students and lecturers who expressed the need for further digital health education and stated that the field is very important for clinical care and is underrepresented in the current medical curriculum. We extracted a detailed overview of digital health competencies, skills, and knowledge to teach the students from the expert interviews. They also contained suggestions for teaching methods and statements supporting the urgency of the implementation of digital health education in the mandatory curriculum. An elective class seems to be a suitable format for the timely introduction of digital health education. However, a longitudinal implementation in the mandatory curriculum should be the goal. Beyond training future physicians in digital skills and teaching them digital health’s ethical, legal, and social implications, the experience-based development of a critical digital health mindset with openness to innovation and the ability to assess ever-changing health technologies through a broad transdisciplinary approach to translate research into clinical routine seem more important. Therefore, the teaching of digital health should be as practice-based as possible and involve the educational cooperation of different institutions and academic disciplines.

This article deals with the current state mid-2020 in the clinical and practical aspects from the perspective of orthopedics and trauma surgery. The risks, difficulties, potentials and options are discussed in detail. The following topics are specifically debated: infrastructure of telematics, apps and mobile health, online video consultation, electronic medical records and data protection. The advantages and disadvantages and the current state of each topic in the special case of orthopedics and trauma surgery are discussed. Additionally, seven meaningful examples from the field of digital applications are named. A survey of members of the Professional Association of Orthopedic and Trauma Surgeons (BVOU) is described and analyzed. In a concluding perspective the current hurdles and future topics that need clarification are addressed.

Der vorliegende Beitrag behandelt aus Sicht von Orthopädie und Unfallchirurgie den aktuellen Stand Mitte 2020 im klinischen sowie im Praxisumfeld. Es wird auf Risiken, Schwierigkeiten ebenso wie Potenziale und Chancen im Detail eingegangen. Spezifisch werden die folgenden Themenbereiche erörtert: Telematikinfrastruktur, Apps und „mobile health“, Onlinevideosprechstunde, elektronische Patientenakte sowie Datenschutz. Es wird auf die Vor- und Nachteile und den jeweils aktuellen Stand im Spezialfall der Orthopädie und Unfallchirurgie eingegangen. Zudem werden 7 sinnvolle Beispiele aus dem Bereich der digitalen Anwendung genannt. Eine Mitgliederbefragung des Berufsverbandes der Orthopäden und Unfallchirurgen, BVOU, wird beschrieben und analysiert. Im abschließenden Ausblick werden die aktuellen Hürden und künftig zu klärende Themenbereiche adressiert.

In its digital agenda the German Federal Government pursues the ambitious objective to facilitate digital competence and perform research into digital learning and teaching processes. Considerable investments are to be concentrated into the future viability of education, academic research and digitalization. As far as academic teaching and further education are concerned, not only in the field of orthopedics and trauma surgery, three aspects can be identified: digital organization, digital competence and digital tools.New formats, such as the elective subject digital health of the Charité in Berlin, enable digital competences to be mediated in a multimodal and interdisciplinary way. With the help of a newly developed app the University of Essen provides teachers and students with mobile and flexible access to information on lectures in terms of content and organization. Especially because of transparency, high legal compliance and predictability, the digital logbook for the resident training program promises a real innovation for trainees in the further training reformation. Augmented and virtual reality play a crucial role in the imparting of practical skills and interconnect high-tech with classical craftsmanship. Digital training course formats have significantly gained in importance and are meanwhile well-established tools for efficient advanced medical training.If orthopedic and trauma surgeons take an active role in the process of digitalization of teaching, they can take part in decisions, adequately prepare the colleagues of tomorrow, optimize patient care, encourage innovations and altogether improve the discipline even more.

New communication technologies allow patients to communicate with their physicians from anywhere using computer or smartphone. Adding video to the mere phone call optimizes the personal contact between patient and physicians regardless of distance. Legal and reimbursements requirements must be taken into account, especially only certified software products must be used. In addition, patient consent is needed and confidentiality must be assured. The video patient consultation can be reimbursed by the health insurance companies. As with all new technologies, the introduction of these video consultations faced some challenges. Although patients and physicians have expressed great interest in this technology, it has been rarely used so far. The current COVID crisis increased the need for video consultations resulting in an increasing use of video patient consultation. It can be expected that this demand will still exists after the COVID crisis.Ob mit dem Computer oder dem Smartphone – der Patient hat von überall aus die Möglichkeit, mit seinem Arzt oder seiner Ärztin zu kommunizieren. Die Videokomponente verbessert das reine Telefonat in dem Sinne, dass der persönliche Kontakt zum Arzt, trotz großer Distanzen, erhalten bleibt. Für die rechtlich korrekte Durchführung und Vergütung eine Online-Videosprechstunden sind einige Voraussetzungen zu beachten, insbesondere dürfen nur speziell zugelassene Softwareprodukte verwendet werden. Zudem ist bei Durchführung der Videosprechstunden erforderlich, dass der Patient einwilligt und die Videosprechstunde vertraulich und störungsfrei ablaufen kann. Die Videosprechstunde wird von den Kostenträgern vergütet. Die Videosprechstunde hat, wie alle neuen Technologien in der Einführungsphase, mit Akzeptanzproblemen zu kämpfen. Obwohl Erhebungen und Befragungen sowohl bei Ärzten als auch bei Patienten großes Interesse an der Videosprechstunde festgestellt haben, wird sie in der Realität noch viel zu selten als Alternative zum Praxisbesuch angeboten. Dies ändert sich aktuell aufgrund der besonderen Anforderungen, die die Bewältigung der COVID-19-Krise auch an die Orthopädie und Unfallchirurgie stellt. Es ist davon auszugehen, dass auch nach Ende der Krise die Nachfrage nach der Online-Videosprechstunde deutlich gesteigert sein wird.

The recently ratified Digital Healthcare Act - DVG - has paved the way, among other issues, for the prescription of health apps. The German DVG creates an entitlement to health apps for the very first time. However, this entitlement is initially limited to low-risk medical devices that have been included in the publicly accessible Register for Digital Health Applications by the German Federal Institute for Drugs and Medical Devices. Listing in the register is granted, if the manufacturer has submitted a health app and verified that it meets basic requirements for medical devices and data security as well as positive health care effects. It is questionable, whether the DVG will lead to sustainable improvements in future patient care. In order to pursue this question and align the DGOUC's digitization strategy closely with its basis, an online survey was conducted among the respective members on the DVG's content and its associated opportunities and risks. A total of 461 German-speaking, predominantly male, experienced and elderly physicians in leading positions took part in the survey. In this study, it was shown that the majority of the participating German orthopaedic and trauma surgeons is not familiar with the DVG's contents. Despite a fundamentally positive attitude towards digitization, scepticism about the use of "apps on prescription" and potential risks still prevails at present. The closing of ranks between medicine, IT and the legislature via interdisciplinary expert groups and the involvement of medical societies might be obligatory.Mit dem kürzlich ratifizierten Digitale-Versorgung-Gesetz – DVG wurde der Weg geebnet u. a. für die Verschreibung von Gesundheits-Apps auf Rezept. Das DVG schafft erstmalig einen Leistungsanspruch deutscher (gesetzlich) Versicherter auf digitale Gesundheitsanwendungen, beschränkt auf Medizinprodukte niedriger Risikoklassen. Die Aufnahme in das Verzeichnis für digitale Gesundheitsanwendungen erfolgt nach Antragstellung durch den Hersteller und Prüfung, ob die Gesundheits-App grundlegende Anforderungen an Medizinprodukte und Datensicherheit sowie positive Versorgungseffekte aufweist. Um der Fragestellung nachzugehen, ob das DVG künftig eine nachhaltige Verbesserung in der Patientenversorgung bewirken kann und um die Digitalisierungsstrategie der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie und des Berufsverbands für Orthopädie und Unfallchirurgie basisnah ausrichten zu können, wurde unter den entsprechenden Mitgliedern eine Onlineumfrage zur Thematik des DVGs und dessen konsekutiven Chancen und Risiken durchgeführt. An der Umfrage beteiligten sich insgesamt 461 deutschsprachige, überwiegend männliche, erfahrene und ältere Ärzte in Führungspositionen. In dieser Studie konnte gezeigt werden, dass dem Großteil der teilnehmenden deutschen Orthopäden und Unfallchirurgen, trotz eines grundlegenden, positiven Interesses an der Digitalisierung, die Inhalte des DVGs unbekannt sind und derzeit noch eine skeptische Haltung gegenüber der Verschreibung von „Apps auf Rezept“ und möglicher aktuell nicht abschätzbarer Risiken herrscht. Der Schulterschluss von Medizin, IT und Legislative in Form von sektorübergreifenden Expertengruppen und einer Involvierung von medizinischen Fachgesellschaften ist als obligat anzusehen.

Background Support for long-distance research and clinical collaborations is in high demand and has increased owing to COVID-19–related restrictions on travel and social contact. New digital approaches are required for remote scientific exchange. Objective This study aims to analyze the options of using an augmented reality device for remote supervision of exercise science examinations. Methods A mobile ultrasound examination of the diameter and intima-media thickness of the femoral and carotid arteries was remotely supervised using a head-mounted augmented reality device. All participants were provided with a link to a YouTube video of the technique in advance. In part 1, 8 international experts from the fields of engineering and sports science were remotely connected to the study setting. Internet connection speed was noted, and a structured interview was conducted. In part 2, 2 remote supervisors evaluated 8 physicians performing an examination on a healthy human subject. The results were recorded, and an evaluation was conducted using a 25-item questionnaire. Results In part 1, the remote experts were connected over a mean distance of 1587 km to the examination site. Overall transmission quality was good (mean upload speed: 28.7 Mbps, mean download speed: 97.3 Mbps, mean ping: 21.6 milliseconds). In the interview, participants indicated that the main potential benefits would be to the fields of education, movement analysis, and supervision. Challenges regarding internet connection stability and previous training with the devices used were reported. In part 2, physicians’ examinations showed good interrater correlation (interclass correlation coefficient: 0.84). Participants valued the experienced setting as highly positive. Conclusions The study showed the good feasibility of the chosen design and a highly positive attitude of all participants toward this digital approach. Head-mounted augmented reality devices are generally recommended for collaborative research projects with physical examination–based research questions.

Artificial intelligence (AI) is a very relevant topic for the medicine of the future. This article focuses on the field of AI in the context of orthopedics and trauma surgery. The main focus is on the potentials of AI in the analysis of symptoms, radiological images, clinical data sets, use in hospitals and operating theaters as well as for training and education. For the orthopedics and trauma surgery of the future AI is much more than pure fiction; however, there is still a long way to go before the potential of an optimized and individualized patient care can be utilized. Interdisciplinary and international approaches, including personnel, economic, legal and ethical aspects will play a decisive role in this respect.

Digital transformation is becoming increasingly common in modern life and sports medicine, like many other medical disciplines, it is strongly influenced and impacted by this rapidly changing field. This review aims to give a brief overview of the potential that digital technologies can have for health care providers and patients in the clinical practice of sports medicine. We will focus on mobile applications, wearables, smart devices, intelligent machines, telemedicine, artificial intelligence, big data, system interoperability, virtual reality, augmented reality, exergaming, or social networks. While some technologies are already used in current medical practice, others still have undiscovered potential. Due to the diversity and ever changing nature of this field, we will briefly review multiple areas in an attempt to give readers some general exposure to the landscape instead of a thorough, deep review of one topic. Further research will be necessary to show how digitalization applications could best be used for patient treatments., Beteiligte Körperschaft: AG Digitalisierung der Dt. Gesellschaft für Orthopädie und Unfallchirurgie

Mit der digitalen Agenda hat sich die Bundesregierung das ehrgeizige Ziel gesetzt, digitale Kompetenzen zu fordern sowie digitale Lehr- und Lernprozesse zu erforschen. Erhebliche Investitionen sollen auf Zukunftsfahigkeit von Bildung, Hochschulen, Forschung und Digitalisierung konzentriert werden. „Digitalisierung“ in Bezug auf universitare Lehre sowie die Fort- und Weiterbildung nicht nur in der Orthopadie und Unfallchirurgie (O und U) lasst sich in digitale Organisation, digitale Kompetenzen und digitale Werkzeuge gliedern. Mit neuen Formaten wie dem Wahlpflichtfach „Digital Health“ der Charite Berlin lassen sich digitale Kompetenzen multimodal und interdisziplinar vermitteln. An der Universitat Essen konnen Lehrende und Lernende mit einer neuen App sowohl organisatorische als auch inhaltliche Informationen zu Lehrveranstaltungen mobil und flexibel abrufen. Das digitale Logbuch fur die Weiterbildung verspricht insbesondere durch Transparenz, hohere Rechtssicherheit und Planbarkeit fur den Weiterzubildenden eine echte Neuerung in der Weiterbildungsreform. Augmented und Virtual Reality spielen bei der Vermittlung praktischer Fertigkeiten eine immer grosere Rolle und verbinden Hightech mit klassischem Handwerk. Digitale Fortbildungsformate haben zuletzt immens an Bedeutung gewonnen und sind mittlerweile als „Werkzeuge“ fur eine effiziente medizinische Fortbildung gut etabliert. Wenn Orthopaden und Unfallchirurgen eine aktive Rolle im Digitalisierungsprozess der Lehre einnehmen, konnen sie ihn mitgestalten und die Kollegen von morgen vorbereiten, die Patientenversorgung angepasster gestalten, Innovationen fordern und somit das Fachgebiet insgesamt noch besser machen.

BACKGROUND It is undeniable that appropriate smartphone apps offer enormous opportunities for dealing with future challenges in orthopedic surgery and public health, in general. However, it is still unclear how the apps currently available in the two major app stores can be used in daily clinical routine by German orthopedic surgeons. OBJECTIVE This study aimed to gain evidence regarding the quantity and quality of apps available in the two major app stores and their suitability for use by orthopedic surgeons in Germany. METHODS We conducted a systematic, keyword-based app store screening to obtain evidence concerning the quantity and quality of commercially available apps. Apps that met the inclusion criteria were evaluated using the app synopsis–checklist for users and the German Mobile App Rating Scale for secure use, trustworthiness, and quality. RESULTS The investigation revealed serious shortcomings regarding legal and medical aspects. Furthermore, most apps turned out to be useless and unsuitable for the clinical field of application (4242/4249, 99.84%). Finally, 7 trustworthy and high-quality apps (7/4249, 0.16%) offering secure usage in the daily clinical routine of orthopedists were identified. These apps mainly focused on education (5/7). None of them were CE (Conformité Européenne) certified. Moreover, there are no studies providing evidence that these apps have any positive use whatsoever. CONCLUSIONS The data obtained in our study suggest that the number of trustworthy and high-quality apps on offer is extremely low. Nowadays, finding appropriate apps in the fast-moving, complex, dynamic, and rudimentarily controlled app stores is most challenging. Promising approaches, for example, systematic app store screenings, app-rating developments, reviews or app libraries, and the creation of consistent standards have been established. However, further efforts are necessary to ensure that these innovative mobile health apps not only provide the correct information but are also safe to use in daily clinical practice.

Background Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths.

BACKGROUND Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. OBJECTIVE In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. METHODS The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). RESULTS A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). CONCLUSIONS The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths.

In the management of trauma patients in the resuscitation room many time-pressured and critical decisions must continuously be made in complex situations. Even experienced teams frequently make errors in this context. Computer-assisted decision-making systems can predict critical situations based on patient data continuously acquired online. Based on the calculated predictions these systems can suggest the next steps in managing the patient. This review summarizes the current literature on computer-assisted decision-making in the management of trauma patients.A literature review summarizing existing concepts and applications of computer-assisted decision-making support for the management of trauma patients.Narrative review article based on an analysis of literature in the German and English languages from the last 10 years.There exist numerous computer-assisted decision-making systems in the field of trauma care. Several studies could show that computer-assisted decision-making can improve the outcome in the preclinical setting, the resuscitation room and in the intensive care unit. For further validation and implementation of these systems, information technological barriers have to be overcome, existing systems need to be adapted to current data protection regulations and large multicenter studies are necessary.Computer-assisted decision-making can help to improve the management of trauma patients; however, before a ubiquitous implementation a number of technological and legislative barriers have to be overcome.

Background In the course of digitization, smartphones are affecting an increasing number of areas of users’ lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. Objective This study aimed to investigate physicians’ current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. Methods A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants’ app and smartphone usage behavior. Results A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were “intuitive usability” (167/201, 83.1%), “no advertising” (145/201, 72.1%), and “free apps” (92/201, 45.8%). The attributes “transparent app development and app sponsoring” (75/201, 37.3%) and the existence of an “easy-to-understand privacy statement” (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of “medical research” would provide the greatest benefit. The greatest predicted risks were “data misuse” (147/189, 77.8%), “usage of untrustworthy apps” (135/189, 71.4%), and “alienation from patients” (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. Conclusions The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection.

BACKGROUND In the course of digitization, smartphones are affecting an increasing number of areas of users’ lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. OBJECTIVE This study aimed to investigate physicians’ current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. METHODS A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants’ app and smartphone usage behavior. RESULTS A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were “intuitive usability” (167/201, 83.1%), “no advertising” (145/201, 72.1%), and “free apps” (92/201, 45.8%). The attributes “transparent app development and app sponsoring” (75/201, 37.3%) and the existence of an “easy-to-understand privacy statement” (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of “medical research” would provide the greatest benefit. The greatest predicted risks were “data misuse” (147/189, 77.8%), “usage of untrustworthy apps” (135/189, 71.4%), and “alienation from patients” (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. CONCLUSIONS The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection.