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Pancreatic cystic lesions represent a challenging heterogeneous entity with a potential risk of malignant transformation. The diagnostics include in particular medical history taking with collection of relevant clinical information and high-resolution imaging, preferably using magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) and/or endoscopic ultrasonography. A differentiation between different cystic entities and identification of risk factors are crucial for making appropriate treatment decisions. Only a small proportion of pancreatic cystic neoplasms require surgery. Pancreatic cystic lesions with a relevant risk of malignancy, such as main duct intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN) and general cystic pancreatic lesions with risk factors regardless of the entity, should be resected, whereas an individualized approach is required for branch duct IPMN and serous cystic neoplasms (SCN) and dysontogenetic cysts require no treatment. Parenchyma-sparing and minimally invasive resection techniques should be preferred whenever possible for resecting pancreatic cystic tumors. Approximately 10% of patients develop recurrences over time. [ABSTRACT FROM AUTHOR]

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Copyright of Forensische Psychiatrie, Psychologie, Kriminologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Background: With an estimated prevalence of 1 to 2 per 100 people, Fetal Alcohol Spectrum Disorders (FASD) are common in Europe and are associated with a high burden for people with FASD, their relatives and the society. They are complex disorders with limitations at various levels, including behavior, performance and independence. An S3 guideline is available for the diagnosis of FASD in children and adolescents. Aim: We present an author consensus on the diagnosis of FASD in adults. Conclusions: In addition to the weaker evidence for adulthood, a major problem is that only a few locations offer appropriate services. The result is an inadequate diagnostic and care structure in Germany. The following four approaches can be taken to improve the situation: (1) More consistent use of available screening tools in general medical, psychiatric and psychotherapeutic care; (2) Establishment of additional specialized diagnostic centers; (3) Establishment of additional specialized treatment and residential facilities; and (4) Promotion of research on FASD across the lifespan. These steps will lead to an improvement in the treatment and care of people with FASD. [ABSTRACT FROM AUTHOR]

Background: Clinical cancer registries are intended to reflect the reality of care through differentiated data analysis and, if necessary, to offer approaches for improving care. Methods: For the years 2000–2018, the data of the Clinical Epidemiological Cancer Registry Brandenburg-Berlin were examined separately for adenocarcinoma and squamous cell carcinoma with respect to epidemiology and health care reality. Results: Between 2000 and 2018 a total of 3207 esophageal cancers were documented in the cancer registry, of which 2182 were squamous cell carcinomas (ESCC), 843 adenocarcinomas (EAC) and 182 various others or missing histology. During the observation period there was a clear dominance of ESCC but with a significant increase in EAC in both sexes. Overall, the rate of new cases was 5 times higher for men than for women. The relative 5‑year survival probability of all esophageal cancers was 17.4% in men and 22.5% in women. Patients with EAC survived significantly longer than those with ESCC. Radiotherapy and chemotherapy, individually or in combination, were mainly used as treatment methods. Surgery was performed on 19% of ESCC and 42% of EAC. Conclusion: The proportion of ESCC in Brandenburg is still significantly higher than EAC, with a significant increase for the latter, especially in men. Although locally advanced tumors have been significantly more common, modern neoadjuvant concepts have rarely been documented, and although the quality of the surgery is comparable to the international standard, surgery is carried out in relatively few patients. [ABSTRACT FROM AUTHOR]

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Background: Consumption of stimulant drugs, a heterogeneous group of addictive substances, has significantly increased in recent years with rising numbers of stimulant-associated intoxication and deaths. Objective: To provide an overview of recent scientific evidence of the diagnosis and treatment of stimulant use disorders. Material and methods: A literature review of the neuropathology, clinical presentation, diagnostic criteria and evidence-based treatment for stimulant use disorders. Results: The chronic use of stimulant drugs is associated with significant physical (e.g., hypertension, tachycardia and dyspnoea) and psychological harm (e.g., dependence, psychotic disorders and affective disorders). Despite major advances in the research of the neuropathology of stimulant use disorder and the refinement of diagnostic criteria, the disorder still presents a challenge, not least because of the lack of effective treatments. There are currently no approved pharmacotherapeutic interventions for stimulant use disorder and meta-analyses show that the efficacy of behavioural interventions is low to moderate, similar to cognitive behavioural treatment. Conclusion: Despite growing insights into the neuropathology associated with stimulant use disorder, treatment remains a challenge. The lack of effective interventions makes it difficult to give clear recommendations for the clinical practice. Further scientific research is thus warranted. [ABSTRACT FROM AUTHOR]

Back pain is, according to the World Health Organization, a widespread disease and is associated with a high disease burden. The aim of this study was to examine the effects of 50 units of rehabilitation sport (once/week) after a 3-week rehabilitation measure for patients with chronic back pain. 130 patients (75.38% female, mean age of 52,02 ± 7,44 years) were included in a prospective observational study, of which 54 (41.54%) performed rehabilitation sports in the 1.5 years between the initial measure and a 1-week refresher (rehabilitation sport group, intervention group) and 76 patients did not do sports (control group). Assessments of one's own ability to work (Work Ability Index, WAI), limitations due to back pain (Oswestry Disability Index), fear avoidance behavior (Fear Avoidance Believe) and one's own quality of life (Short Form - 36 questionnaire) were evaluated. There were no statistically significant differences in the items queried between the intervention group and the control group. The lack of significant differences between the two groups should be taken as an implication for further studies. It seems sensible to stick to general measures of rehabilitation sport until measures are designed that are effective beyond doubt. Rückenschmerzen sind laut Weltgesundheitsorganisation eine Volkskrankheit und mit einer hohen Krankheitslast verbunden. Ziel dieser Studie war es, die Wirkung von 50 Einheiten Rehabilitationssport (1x/Woche) nach einer 3-wöchigen Rehabilitationsmaßnahme bei Patienten mit chronischen Rückenschmerzen zu untersuchen. 130 Patienten (75,38% weiblich, Durchschnittsalter 52,02 ± 7,44 Jahre) wurden in eine prospektive Beobachtungsstudie eingeschlossen, von denen 54 (41,54%) in den 1,5 Jahren zwischen der Erstmaßnahme und einwöchiger Auffrischung 50 Einheiten Rehabilitationssport durchführten (Interventionsgruppe), 76 Patienten machten keinen Sport (Kontrollgruppe). Ausgewertet wurden Einschätzungen zur eigenen Arbeitsfähigkeit (Work Ability Index, WAI), zu Einschränkungen durch Rückenschmerzen (Oswestry Disability Index), zum Angstvermeidungsverhalten (Fear Vermeidung Believe) und zur eigenen Lebensqualität (Short Form – 36 Fragebogen). Es gab keine statistisch signifikanten Unterschiede in den abgefragten Items zwischen der Interventionsgruppe und der Kontrollgruppe. Das Fehlen signifikanter Unterschiede zwischen den beiden Gruppen sollte als Implikation für weitere Studien gewertet werden. Es erscheint sinnvoll, mit dem Rehabilitationssport in der derzeitigen Form fortzufahren, bis wirksamere Maßnahmen entwickelt werden. [ABSTRACT FROM AUTHOR]

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In Deutschland ist der aktuelle Stand der Nutzung von Patient-Reported Outcome Measures (PROM) und Patient-Reported Experience Measures (PREM) ausbaufähig. Derzeit erfolgt hierzulande die Anwendung dieser Instrumente eher noch in einem fragmentierten und unkoordinierten Rahmen (1). Der Grund: Es fehlt an einer flächendeckenden und systematischen Implementierung, die auf der Metaebene zu einer stärkeren Ergebnisorientierung im deutschen Gesundheitswesen (2) beitragen könnte oder auf der Systemebene in der Lage wäre, realistischere und evidenzbasierte Endpunkte zum Beispiel in „besonderen Therapiesituationen“ zu generieren. Der 13. Fachkongress von „Monitor Versorgungsforschung“ widmet sich diesem Themenkomplex unter dem Titel „Mit PROM und PREM zu Patient Centered Care“: Startpunkt eines möglichen Umdenkens.

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Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Rheumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Rheumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Assistance following acute violence was previously regulated by the Victim Compensation Act (OEG). At the beginning of the current year it was replaced by the Social Code XIV (SGB XIV). The SGB XIV defines new groups of beneficiaries, outpatient trauma clinics must be provided nationwide and binding criteria for the quality of care were established. The aim of this study was to map the current status of care in outpatient trauma clinics in accordance with the requirements of the new SGB XIV. With respect to new beneficiaries, the status of services for victims of human trafficking was recorded as an example. Methods: Outpatient clinics that provide rapid assistance under the OEG or SGB XIV were surveyed on structural and content-related aspects of their work. An online survey consisting of 10 thematic modules was used. Data were obtained from a total of N = 110 outpatient clinics (response rate 50%). Results: The participating outpatient clinics reported a wide range in terms of the number of staff and the number of people seeking counselling. Some of the outpatient clinics reported deficits with respect to structural aspects, such as the waiting time for the initial consultation and specific training in trauma treatment for staff. The majority of outpatient clinics were uncertain about how to deal with victims of human trafficking. Discussion: Outpatient trauma clinics appear to reach their target population and provide appropriate services for their care; however, a significant number of outpatient clinics need to make improvements in order to fulfil the quality criteria of SGB XIV and provide adequate care to new groups of beneficiaries. [ABSTRACT FROM AUTHOR]

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Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rheuma Plus is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Adverse childhood experiences (ACEs) are well-known risk factors for poor physical and mental health outcomes. The purpose of this study was to explore the relationship between ACEs and self-report measures of emotional regulation and interpersonal functioning among a sample of individuals provincially incarcerated for sexual offending. In total, 112 males participating in an in-custody sexual offender treatment program completed the study measures. Two-stage hierarchical linear regression was used to examine the association between cumulative ACE scores and each self-report measure. Individual ACE item impacts were also explored using two-stage hierarchical regression. Higher cumulative ACE scores were associated with greater emotional dysregulation and multiple indices of interpersonal dysfunction. Several ACE items were consistently associated with greater emotional and interpersonal difficulties. The findings have clinical implications for sexual offender assessment, treatment, and prevention. Specifically, the findings support a growing movement towards trauma-informed practice, incorporating attachment theory and intimacy-based interventions, and promoting empirically supported interventions for cultivating emotional self-regulation. [ABSTRACT FROM AUTHOR]

Background and Objective: Myofascial pain syndrome (MPS) is a chronic musculoskeletal disorder characterized by the presence of trigger points. Among the treatment options, botulinum toxin injections have been investigated. The aim of this paper was to provide a synthesis of the evidence on intramuscular botulinum toxin injections for upper back MPS. Databases and Data Treatment: A systematic review of the literature was performed on the PubMed, Scopus and Cochrane Library, using the following formula: ("botulinum") AND ("musculoskeletal") AND ("upper back pain") OR ("myofascial pain"). Results: Ten studies involving 651 patients were included. Patients in the control groups received placebo (saline solution) injections, anaesthetic injections + dry needling or anaesthetic injections. The analysis of the trials revealed modest methodological quality: one "Good quality" study, one "Fair" and the other "Poor". No major complications or serious adverse events were reported. Results provided conflicting evidence and did not demonstrate the superiority of botulinum toxin over comparators. Most of the included trials were characterized by a small sample size, weak power analysis, different clinical scores used and non-comparable follow-up periods. Even if there is no conclusive evidence, the favourable safety profile and the positive results of some secondary endpoints suggest a potentially beneficial action in pain control and quality of life. Conclusion: The currently available studies show conflicting results. Their overall low methodological quality does not allow for solid evidence of superiority over other comparison treatments. Further insights are needed to properly profile patients who could benefit more from this peculiar injective approach. Significance: The randomized controlled trials included in this review compared using botulinum toxin to treat upper back MPS with placebo or active treatments (e.g., dry needling or anaesthetics) showing mixed results overall. Despite the lack of clear evidence of superiority, our study suggests that the use of botulinum toxin should not be discouraged. Its safety profile and encouraging results in pain control, motor recovery and disability reduction make it an interesting treatment, particularly in the subset of patients with moderate to severe chronic pain and active trigger points. To support the safety and efficacy of botulinum toxin, further high-quality studies are needed. [ABSTRACT FROM AUTHOR]

Vaskulitiden bilden eine sehr heterogene Gruppe im Rahmen der systemisch-rheumatologischen Grunderkrankungen. Ihnen gemeinsam ist eine Entzündung der Gefäße, wobei sämtliche Gefäße betroffen sein können. Die Symptome können je nach befallenen Gefäßen zum Teil stark variieren. Gefäßentzündungen können mit einem schweren Verlauf einhergehen, weshalb eine zügige Diagnose essenziell ist. [ABSTRACT FROM AUTHOR]

177Lu-PSMA is a novel therapy in patients with metastatic castration-resistant prostate carcinoma (mCRPC). The radiolabeled drug is administered intravenously, usually in 4–6 cycles, in which β‑radiation induces intracellular DNA damage and cell death of PSMA-expressing prostate cancer cells. The γ‑decay of the radionuclide can be used for imaging and dosimetry. An international phase III study showed that end stage mCRPC patients that received 177Lu-PSMA had a survival benefit (15.3 vs. 11.3 months; p < 0.001). Moreover, several studies suggest that ~25% of these heavily pre-treated patients respond better and likely have a longer survival benefit. The most important side effects are: grade I–II fatigue (~40%) and xerostomia (~40%), which are mostly transient. Grade III–IV CTCAE hematologic toxicity (thrombocytopenia, leukopenia) was seen in ~8% of patients. Recently, the American Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved the drug for patients with end stage prostate cancer. Currently, there are several studies investigating if patients in an earlier stage of the disease, metastatic hormone-sensitive or hormone-naïf, can also benefit from therapy with 177Lu-PSMA. [ABSTRACT FROM AUTHOR]

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Copyright of Innere Medizin (2731-7080) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Health literacy (HL) describes people’s knowledge, motivation, and competences to access, understand, appraise, and apply health information. Limited health literacy can clearly negatively impact health outcomes and therapeutic professionals are potentially important contact persons for patients and their relatives to address health literacy.

The «Recommendations for the Diagnosis and Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)» were developed in parallel with the Swiss National Dementia Strategy 2014-2019 under the auspices of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP) and mark the beginning of a series of recommendations for geriatric psychiatric disorders. They depict the evidence-based state of knowledge about diagnostics and therapy, based on the clinical experience of the experts, and are designed for interprofessional and interdisciplinary use. The non-pharmacological intervention options and pharmacotherapy are discussed in detail. This paper is the revised version of the 2014 publication and compiles the development in this area for everyday clinical practice. [ABSTRACT FROM AUTHOR]

Although coccygodynia was already first described in 1859, it remains a controversially discussed clinical picture to this day. Typical for patients with tailbone pain is a long deal with many preliminary examinations without a real diagnosis. The deep-seated pain directly above the tip of the tailbone, usually only when sitting or changing position, can be seen as a leading symptom. Women are affected more often than men and trauma is only remembered in around 50 % of the cases. From the author's point of view, the dynamic, lateral x-rays of the coccyx are the most informative imaging methods. After diagnosis, conservative measures such as oral NSAID intake and discharge through a donut cushion should be tried. In addition, local infiltrations can be carried out directly on the tailbone with local anaesthetic and a glucocorticoid. Physiotherapy (pelvic floor) and osteopathy can also have a positive influence on the symptoms. Coccygectomy should be considered for treatment-resistant symptoms over 6 months with a good short-term response to conservative treatment. With the correct selection of patients, the removal of the coccyx is a safe method with a success rate of over 80-90 % according to the literature. [ABSTRACT FROM AUTHOR]

Osteoporotic pelvic ring fractures show a continuously increasing incidence. In addition to the fracture morphology, the clinical situation of the patients is also crucial for therapy. The osteoporotic fracture working group of the spine section of the German Society for Orthopaedics and Trauma Surgery (DGOU) has developed a score for the treatment decision that is based on the OF-Pelvis classification and on essential clinical parameters. The score includes the clinical parameters of mobilization ability, pain situation, fracture-related neurological deficits and risk factors for an increased surgical complication rate. In addition, the fracture morphology is determined according to the OF-Pelvis classification including the fracture modifiers. For each parameter, points are awarded or deducted depending on the characteristics and the total is then calculated. If a parameter cannot be determined, no point are awarded. A score below 8 means a recommendation for conservative therapy, while a score above 8 means a recommendation for surgical therapy. If there are exactly 8 points, conservative or surgical treatment is possible. The OF-Pelvis score was evaluated retrospectively in 5 trauma centers based on records and imaging in 107 patients and compared with the therapy actually carried out. There was an overall agreement of 91 % between the therapy recommendation of the OF-Pelvis score and the therapy actually carried out (conservative versus surgical). Collecting the score took about 5 minutes. The OF-Pelvis score is an easy-to-use decision-making aid for determining the indication for conservative or surgical treatment of osteoporotic pelvic ring fractures. [ABSTRACT FROM AUTHOR]