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17 RCTs for 15 digital health applications (DiGA) permanently listed in the state-regulated register were analyzed descriptively for methodological study aspects relevant to evidence analysis. The analysis revealed that several underlying studies had limitations, at least worthy of discussion, in terms of their power concerning sample size, intervention and control group specifications, drop-out rates, and blinding.

Fragestellung: Prospektive Auswertung von 261 adipösen Patienten in der Anwendung des SuperPath Zuganges aus einem Gesamtkollektiv von allen 955 Versorgungen - sind vermehrt Komplikationen, Fehlpositionierungen oder Frühlockerungen im Vergleich zum Gesamtkollektiv aufgetreten? Methodik: [zum vollständigen Text gelangen Sie über die oben angegebene URL]

As the vision of fully autonomous vehicles potentially introduces significant benefits for our society, this work investigates approaches for sequential decision making for high-level actions in highway scenarios. These scenarios are modeled using an markov decision process (MDP) and consider deep reinforcement learning to solve it. Our approach, based on deep Q-networks (DQNs), is able to fully avoid collisions and learns a policy that results in comfortable trajectories compared to baseline policies we developed. One of the main challenges for reinforcement learning are sparse rewards, which we aim to overcome employing reward shaping. Additionally, the necessity of multiple layers of non-liniearities in the DQN algorithm is empirically evaluated using our scenarios. The results support the usage of multiple levels of non-linearities, as a linear variant of the DQN is not capable of learning effective policies in our experiments. Due to a weight initialization with behavioral cloning, an acceleration of the learning procedure is achieved.

Background: Efficient digitization in medicine still is in its infancy but undeniably it entails a great potential for current and future challenges in healthcare. For now, the rollout of medical apps has not resulted in a widespread use of smartphones in the German health sector. 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 the low acceptance of these products. Objective: The current study aims for outlining 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 an usability evaluation test protocol. The results of the usability tests were evaluated by the app development team and the usability test repeated for optimizing backend usability. A priori, 40 criteria to measure ease of app-usage were defined. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, drop-out and test duration. Due to the Covid-19 pandemic, digital conferences (Zoom and QuickTime Player) were applied to complete usability questionnaires. Finally, multiple backend-based apps were developed by healthcare professionals as prototypes. Results: Initial usability testing was conducted with 5 participants (4m/1w, mean age 39.2, SD 5.97 years). All of these were able to complete the given backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, workflow completion time decreased from 5.03 to 3.50 minutes. The basic backend structure was clear to all test users and the handling intuitive to learn. The apps developed, using the aforementioned approach, are in clinical use as a proof of concept. Conclusions: Backends offering operability for medical professionals might pose a great potential for app development in the mHealth sector. A sophisticated and time saving usability represents the critical aspect for the acceptance of medical software. This is illustrated by multiple backend-based apps, developed by medical professionals, that are in clinical use as a proof of concept. Basic interventions are sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible on basis of the usability evaluation test protocol.

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. CA extern

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., 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.

Pole sport is a relatively new athletic sport that is gaining increasing popularity and for which national and international championships are held. It evolved from pole dance and harbours the risk of falls from heights of up to three metres. Currently, no studies on pole sport injuries are available. This is the first description of a small series of five pole sport injuries. A retrospective review of the case histories and radiological findings was performed, and in addition, a follow-up interview was carried out. All the patients were female and had a mean age of 27.2 years. Most injuries were located in the head, neck or spine. The use of proper training equipment like landing mats and grip aids could probably reduce accidents.

Fragestellung: Mit über 755.000 Mitgliedern zählt Handball zu den beliebtesten Sportarten Deutschlands, mit einer Verletzungsquote von über 15% auch zu den verletzungsreichsten (DOSB 2018; Pieper et al. 2007). Abhängig vom Geschlecht differieren die Verletzungshäufigkeiten[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

Fragestellung: Pole Sport ist eine zunehmend populäre Sportart und verbindet Tanz-, Kunstturn- und Akrobatikelemente. Aufgrund unphysiologischer Bewegungsabläufe sowie Sturzhöhen von bis zu drei Metern kommt es regelmäßig zu Sturzereignissen mit akuten Traumafolgen. Untersuchungen[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)