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Background: The healthcare sector is responsible for 5.2% of CO2 emissions in Germany. The prescribing of medicines is a significant contributor. Among the prescribed medicines, metered dose inhalers (MDIs) play a decisive role due to the propellant gases they contain. A relevant reduction in emissions is possible by switching to dry powder inhalation systems (DPI). Aim: The guideline "Climate-conscious prescribing of inhalants" is intended to provide assistance in the prescribing of inhaled medicines by summarising the available evidence on the decision between DPI and MDI and explicitly addressing the aspect of climate damage caused by propellants. It addresses everyone involved in prescribing and counselling those affected. Materials and methods: The S2k guideline was drawn up under the joint leadership of DEGAM (German College of General Practitioners and Family Physicians) and the German Society for Pneumology and Respiratory Medicine (DGP) under moderation of the AWMF (Association of the Scientific Medical Societies in Germany). The main contents from a practical perspective are presented in this paper. Results: Overall, MDIs account for a high proportion of inhaler prescriptions in Germany. The aspects of climate damage should be considered when prescribing MDIs. In order to facilitate implementation in practice, several decision aids were developed. Conclusion: The guideline is the first to address the importance of prescribing a group of medicines in relation to climate change. The degree of implementation of the guideline recommendations can be determined by future analyses of prescription data. A planned practical test is required to check the acceptance of the decision aids. [ABSTRACT FROM AUTHOR]

In 2017, patients aged 0-18 years accounted for about 10million medical consultations in German general practitioners' (GPs') practices compared to 26.7 million in pediatric practices. Despite this high demand in GP practices, few federal statemedical boards require a mandatory pediatric component in GP training. The aim of this paper is to outline the main reasons for children and adolescents consulting a GP, discuss the basic skills needed for physical examinations and the appropriate investigations which should be provided and to consider which symptoms should alert the GP as "red flags" requiring immediate action (e.g., dehydration, severe bacterial infections, failure to thrive). In Germany, GPs are indispensable for the primary care of children and adolescents. Thus, appropriate training in pediatricmedicine is essential to enable German GPs to be true "family doctors" caring for all ages. This article is seen as part of continuing medical education for general practitionerswho treat children and adolescents. [ABSTRACT FROM AUTHOR]

Background In 2017, the agreement on an intermediate level of outpatient palliative care (BQKPMV) emerged. It is unclear what role BQKPMV plays in healthcare practice and what experiences family physicians have with the implementation. Methods In September 2021, all 5012 family physicians in Lower Saxony were invited to participate in an online or paper-based questionnaire survey on the implementation of BQKPMV. Data were analysed using descriptive statistics and frequency analyses. Results With 665 responses, a participation rate of 13 % was achieved. Data from 642 family physicians were included in the analysis. 13 % of the respondents (n = 84) are aware of BQKPMV. 71% of the participants with knowledge of BQKPMV (n = 58) have decided not to participate in the agreement. Thirty-eight of these family physicians justify this by saying that they consider the existing forms of outpatient palliative care to be sufficient. More than half of the participants see difficulties in the practical implementation. Conclusions The results of the survey of family physicians in Lower Saxony indicate that BQKPMV is rarely used in the clinical practice of the participants. Respondents see limitations in the feasibility of BQKPMV. Due to the rather low response rate and the regional connection, reliable nationwide conclusions about the reality of care can only be drawn to a limited extent. It is conceivable that, in addition to providing all family physicians with low-threshold information about BQKPMV, the framework conditions of BQKPMV need to be adjusted, e.g. in the areas of qualification requirements, remuneration and the distribution of tasks. Recommendations for optimising BQKPMV are developed in the overall project and enable a comprehensive evaluation of the implementation of this form of care. [ABSTRACT FROM AUTHOR]

Background This paper explores the role of providing structure for students within a new blended-learning family medicine curriculum at Saarland University. This study intends to clarify the role of different structural elements for different learning approaches (deep vs. structured vs. surface learning). Methods This study is based on a mixed-methods approach. Fifth year medical students' (n = 84) learning approaches, measured by a shortened version of the ASSIST questionnaire, were correlated with students' academic performance in state exams and the family medicine exam. Based on learning approaches and age, participants were purposefully sampled into two semi-structured group interviews with seven participants each. Results Although surface approach learning weakly correlated with lower performance in the first state exam (rho = 0.231), surface approach learning did not correlate with lower performance in the family medicine assessment. Based on qualitative results, the structural design of the curriculum seemed to have a high impact on students' satisfaction and motivation to learn. The reduction of extraneous cognitive load was identified as effective in motivating students to study. Deep-learning students highlighted the positive effects of curriculum activities that foster germane cognitive load through schema- based learning. Conclusions Especially for surface approach learners it may be important to provide structured guidance and provide a clear alignment of course content in a blended-learning curriculum, even in higher education. Deep and structured approach learners also benefit from a clear course structure that keeps extraneous cognitive load low and fosters schema acquisition. [ABSTRACT FROM AUTHOR]