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Background Structured reporting allows a high grade of standardization and thus a safe and unequivocal report communication. In the past years, the radiological societies have started several initiatives to base radiological reports on structured reporting rather than free text reporting. Methods Upon invitation of the working group for Cardiovascular Imaging of the German Society of Radiology, in 2018 an interdisciplinary group of Radiologists, Cardiologists, Pediatric Cardiologists and Cardiothoracic surgeons -all experts on the field of cardiovascular MR and CT imaging- met for interdisciplinary consensus meetings at the University Hospital Cologne. The aim of these meetings was to develop and consent templates for structured reporting in cardiac MR and CT of various cardiovascular diseases. Results Two templates for structured reporting of CMR in ischemia imaging and vitality imaging and two templates for structured reporting of CT imaging for planning Transcatheter Aortic Valve Implantation (TAVI; pre-TAVI-CT) and coronary CT were discussed, consented and transferred to a HTML 5/IHR MRRT compatible format. The templates were made available for free use on the website www.befundung.drg.de. Conclusion This paper suggests consented templates in German language for the structured reporting of cross-sectional CMR imaging of ischemia and vitality as well as reporting of CT imaging pre-TAVI and coronary CT. The implementation of these templates is aimed at providing a constant level of high reporting quality and increasing the efficiency of report generation as well as a clinically based communication of imaging results. Key points: Zitierweise

Zusammenfassung Ziel Unsere Studie untersuchte den Effekt dauerhafter gesundheitlicher Beeinträchtigungen auf das arbeitsbezogene Inklusionserleben. Methodik Über einen Online-Fragenbogen erfassten wir dazu das Inklusionserleben Arbeitnehmender (1807 mit und 540 ohne Beeinträchtigungen) und identifizierten durch Propensity-Score-Matching passende Paare. Ergebnisse Arbeitnehmende mit Beeinträchtigungen gaben ein geringeres Inklusionserleben an als ihre gematchten Paare ohne Beeinträchtigungen, jedoch nur dann, wenn sie ihre Arbeitstätigkeit als stark eingeschränkt oder ihre Beeinträchtigung als stark stigmatisiert erlebten. Einschränkungen und Stigmata erwiesen sich dabei als voneinander unabhängige negative Prädiktoren für das Inklusionserleben. Schlussfolgerung Unsere Ergebnisse legen einen Bedarf an Maßnahmen zur Verbesserung des arbeitsbezogenen Inklusionserlebens von Menschen mit dauerhaften gesundheitlichen Beeinträchtigungen nahe. Solche Maßnahmen sollten sowohl auf die Optimierung von Arbeitsplatzanpassungen als auch auf die Änderung leistungsbezogener sozialer Normen in Organisationen und stereotyper Vorannahmen über Arbeitnehmende mit dauerhaften gesundheitlichen Beeinträchtigungen abzielen.

Objective The rising incidence of infective endocarditis (IE) accompanied by the de-escalation of antibiotic prophylaxis and the complexity of surgical treatment makes IE a daunting foe. We reviewed all patients who underwent cardiac surgery for IE at our institution with a focus on causative organisms and infective foci. Methods A review of 3,952 consecutive patients who underwent cardiac surgery at our institution between January 2013 and December 2017 revealed 160 patients (4%) who were operated for IE. Results The predominantly affected valves were the aortic (30%) and mitral valve (26.9%) as well as a combination of both (8.8%). A total of 28.8% of patients suffered from prosthetic valve endocarditis (PVE). The most frequently identified causative organisms were Staphylococcus (45.7%), Streptococcus (27.5%), and Enterococcus species (16.7%), which was predominantly associated with PVE (p = 0.050). In 13.1% of patients, a causative organism has not been detected. The most frequent infective foci were dental (15%), soft-tissue infections (15%), spondylodiscitis (10%), and infected intravascular implants (8.8%). Relevant predisposing factors were immunosuppression (9.4%) and intravenous drug abuse (4.4%). Septic cerebral infarctions were diagnosed in 28.8% of patients. Postoperative mortality was 22.5%. Conclusions As the bacterial spectrum and the infective foci are still the “old acquaintances,” and with regard to the increasing incidence of IE, current risk–benefit evaluations concerning antibiotic prophylaxis may need to be revisited.

Little is known about why neonatology fellows pick the fellowship program they do. Understanding why fellows choose neonatology and rank their programs would be of benefit to program leadership and to other applicants. This was a survey study sent to current neonatology fellows in the United States between September 2020 and October 2020, and were asked to rank their choices on a Likert scale. Respondents were also able to give free text responses to open-ended questions. The most important factor fellows state for choosing their program was location, with multiple reasons given. There were significant differences in how certain subgroups ranked programs. Location of the fellowship program is the most important factor for fellows. There are differences within subgroups of fellows on how they rank their fellowship program. Fellowship directors can use this information to better inform selections on who to interview and how to rank fellows.· Patient population appears to be the most important reason why fellows choose neonatology.. · Program location is the most important reason why fellows choose their specific training program.. · Fellowships can continue to highlight fellow camaraderie, scholarship, and clinical opportunities..

Zusammenfassung Ziel der Studie Die Schwerbehindertenvertretung hat eine Schlüsselrolle bei der Verwirklichung behinderungsgerechter und inklusiver Arbeitsbedingungen. Durch das Bundesteilhabegesetz wurde dem Rechnung getragen und die Rechte der Schwerbehindertenvertretung wurden ausgebaut. Ziel der vorliegenden explorativen Analyse ist es, die veränderte Rechtsstellung aus Perspektive der Schwerbehindertenvertretung zu beleuchten und Herausforderungen in der praktischen Anwendung der gesetzlichen Neuerungen sowie nicht berücksichtigte Bedarfe aufzudecken. Vor dem Hintergrund, dass Forschung zur Implementation und Evaluation der Sozialgesetzgebung Kernelemente der Rehabilitationsforschung sind, soll eine Lücke zwischen der rechtlichen Implementation und der praktischen Anwendung geschlossen und der Prozess einer lernenden Gesetzgebung vorangebracht werden. Methodik Deutschlandweit wurden 1552 Schwerbehindertenvertretungen schriftlich mittels Online-Survey befragt. Für die vorliegende Analyse wurden vorrangig die Antworten zu Herausforderungen für die Schwerbehindertenvertretung mit Hilfe der inhaltlich strukturierenden qualitativen Inhaltsanalyse nach Kuckartz ausgewertet und anhand der gesetzlichen Änderungen durch das Bundesteilhabegesetz analysiert. Ergebnisse Das Bundesteilhabegesetz wird aus Sicht der Schwerbehindertenvertretungen kritisch gewürdigt. Die Umfragedaten verdeutlichen, dass die Schwerbehindertenvertretungen die gesetzlichen Änderungen in Teilen als nicht umfassend genug bewerten. Einzelne Regelungen, wie die Heranziehung von Stellvertretern und -vertreterinnen und die Absenkung der Freistellungsgrenze, sind nicht weitreichend genug und betreffen nur die Teilgruppe der Vertretungen in großen Betrieben. Bei anderen Rechten wie dem Informations- und Anhörungsrecht fehlen Sanktionsmöglichkeiten bei Nicht-Anwendung der Gesetze durch den Arbeitgeber. Die Einführung der Unwirksamkeitsklausel in Bezug auf Kündigungen wird als nicht ausreichend bewertet. Schlussfolgerung Zwar werden die Rechte der Schwerbehindertenvertretung durch das Bundesteilhabegesetz ausgebaut, doch gibt es noch Herausforderungen bei der Umsetzung, der Präzisierung und der Verbindlichkeit der einzelnen Neuerungen, die es im Sinne einer lernenden Gesetzgebung zu beachten und weiter zu diskutieren gilt. Auf Grundlage der vorliegenden Ergebnisse bedarf es eines weiteren Einbezugs der Schwerbehindertenvertretungen, um Ansätze zur zielgerichteten Optimierung in der Anwendung sowie der Ausgestaltung der gesetzlichen Neuerungen ableiten zu können.

As our previous studies have shown, cosmetic surgery has a positive correlation with postoperative well-being. The aim of this study was to prospectively examine the postoperative changes in quality of life (QoL) after a rhinoplasty. Thirty-four patients who underwent septorhinoplasty performed by a single surgeon from July 2015 to October 2018 reported in indication-specific self-developed and different validated questionnaires (FLZM or Fragen zur Lebenszufriedenheit Module, Freiburg Personality Inventor, Rosenberg self-esteem scale, Functional Rhinoplasty Outcome Inventory 17 [FROI-17], and Glasgow Benefit Inventory [GBI]) on the status of their QoL preoperatively (T0) and 6 months' follow-up (T1). Our goal was to assess the difference in psyche and self-esteem and to get objective insights into the effect of the operation. Significant improvements in QoL in terms of general module, health, and appearance were noted. The general part of the FLZM showed increasing T1 values in the sum scores (p = 0.005). With regard to the item “health,” T1 was better than the norm data (p = 0.003). The statistically significant improvement for the item nose appearance (p

Objective Bronchopulmonary dysplasia (BPD) is a major cause of morbidity in neonates and can be associated with long hospitalization and high health care utilization. This extremely stressful situation can be difficult for many families and caregivers. The high-risk situation combined with increased medical complexity can result in involvement of Department of Child Services (DCS) and even foster care placement. This study seeks to define risk factors for DCS involvement and foster care placement in children with BPD. Study Design A retrospective study of children born at less than 32 weeks of gestation born between 2010 and 2016, on oxygen at 28 days of life and discharged home from a tertiary care center. Results A total of 246 patients were identified. DCS was involved in 49 patients with 13 requiring foster care placement. The most common correlated risk factors that were identified for DCS involvement were maternal THC (tetrahydrocannabinol) positivity, hospital policy violations, maternal mental health diagnosis, and home insecurity. Home insecurity (p Conclusion There are numerous risk factors for both DCS and foster care placement. The identification of these risk factors is important to help establish services to help families and identify potential biases to avoid. Key Points

Objective While previous studies regarding neonatal home feeding regimens have demonstrated a more favorable prognosis for nasogastric (NG) versus gastrostomy tubes (GT), institutional practices of discharge on NG feeds are varied, particularly for infants with bronchopulmonary dysplasia (BPD). Little is known regarding the risk factors for patients treated with GT postdischarge in premature infants with BPD. Our objective was to identify frequency and risk factors for treating premature infants with BPD discharged on NG feeds with GT. Study Design In this retrospective study, we included infants born at 30 weeks’ gestational age with BPD transitioning from a tertiary care center to home on NG feeds from 2010 to 2016. Results Of the 86 infants included in this study, 25 (29%) underwent GT placement at a median age of 264 days postdischarge. Fourteen (56%) were able to remove the GT at a median age of 979.5 days. Infants not requiring GT placement postdischarge were found to have a significantly higher ccipitofrontal circumference (p = 0.0089) and length (p = 0.0166) at discharge compared with infants with GT. Conclusion NG feeding for infants with BPD appears to be a viable treatment with fewer patients (29%) requiring GT placement. Gestational age and abnormal magnetic resonance imaging results were found to have a significant association with GT placement postdischarge.

Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scientific Expert Group RehaFutur had been commissioned to elaborate cornerstones for the medium- and long-term development of vocational rehabilitation of adults with disabilities (re-integration). Initial questions inter alia were as follows: Which function should vocational rehabilitation have in a service- and knowledge-oriented working world that will increasingly be affected by demographic change? How can disabled persons' right to occupational participation by way of vocational rehabilitation, a right stipulated both under the German constitution and in German law, be realized as needed also in the future? Various fields of action have been derived on the basis, for one, of an investigation of the factors, social law, social and education policy as well as European, influencing vocational rehabilitation and, for the other, of an evaluation of current labour market and demographic developments. Dealt with in the fields of action Outlined are the aspects: equitable opportunities of access, developmental and needs orientation, closeness to the real occupational and working world, as well as the role of self-determination and self-responsibility. The fields of action are to be understood as framework concept for shaping a cross-actor innovation process. Sustainable vocational rehabilitation is characterized in particular by the fact that it is specifically targeted at promoting disabled persons' self-determination and self-responsibility actively using these in the process and that it strengthens an independent lifestyle, ensures social participation by inclusive structures; also, it facilitates continued participation in working life by ongoing education involving holistic development of professional and personal competencies oriented towards the individual's resources and potentials, safeguarding it by systematic networking with companies. The concept presented for vocational rehabilitation of adults with disabilities encompasses a change of paradigms which service carriers and providers will have to face jointly and including the service users, the rehabilitants.

Surgical aortic valve replacement is still considered the first-line treatment for patients suffering from severe aortic valve stenosis. In recent years, transcatheter aortic valve implantation (TAVI) has emerged as an alternative for selected high-risk patients. According to the latest results of the German external quality assurance program, mandatory by law, the initially very high mortality and procedural morbidity have now decreased to approximately 6 and 12%, respectively. Especially in Germany, the number of patients treated by TAVI has increased exponentially. In 2013, a total of 10.602 TAVI procedures were performed. TAVI is claimed to be minimally invasive. This is true concerning the access, but it does not describe the genuine complexity of the procedure, defined by the close neighborhood of the aortic valve to delicate intracardiac structures. Hence, significant numbers of life-threatening complications may occur and have been reported. Owing to the complexity of TAVI, there is a unanimous concordance between cardiologists and cardiac surgeons in the Western world demanding a close heart team approach for patient selection, intervention, handling of complications, and pre- as well as postprocedural care, respectively. The prerequisite is that TAVI should not be performed in centers with no cardiac surgery on site. This is emphasized in all international joint guidelines and expert consensus statements. Today, a small number of patients undergo TAVI procedures in German hospitals without a department of cardiac surgery on site. To be noted, most of these hospitals perform less than 20 cases per year. Recently, the German Cardiac Society (DGK) published a position paper supporting this practice pattern. Contrary to this statement and concerned about the safety of patients treated this way, the German Society for Thoracic and Cardiovascular Surgery (DGTHG) still fully endorses the European (ESC/EACTS) and other actual international guidelines and consensus statements. Only the concomitance of departments for cardiac surgery and cardiology on site can provide optimal TAVI care. This commentary by the DGTHG delineates the data and resources upon which its opinion is based.

Ziel der Studie: Begleitende Hilfen am Arbeitsplatz sind ein wichtiger Faktor fur die Teilhabe von Menschen mit einer Horschadigung am Arbeitsleben. Im folgenden Beitrag werden die Ergebnisse aus der GINKO-Studie (Gesetzeswirkungen bei der beruflichen Integration schwerhoriger, ertaubter und gehorloser Menschen durch Kommunikation und Organisation; Projektforderung: BMAS) vor dem Hintergrund eines Gutachtens der Universitat zu Koln (Auftraggeber: MAIS) reflektiert, um so einen umfassenden Blick auf die berufliche Lage von Menschen mit einer Horschadigung in NRW zu erhalten. Im Mittelpunkt steht bei der Zusammenfuhrung der beiden Studien die Frage, wie die Ergebnisse der GINKO-Studie fur NRW durch das Gutachten der Universitat zu Koln erklart werden konnen. Methodik: In der in Kooperation mit dem Deutschen Schwerhorigenbund e.V. und dem Deutschen Gehorlosen Bund e.V. durchgefuhrten GINKO-Studie wurden erwerbstatige Betroffene mit einem standardisierten Fragebogen, der auch online mit Gebardensprachfilmen zur Verfugung stand, schriftlich zu ihrer Situation am Arbeitsplatz befragt. In der NRW-Studie wurde partizipativ die Versorgungslage schwerhoriger, gehorloser und taubblinder Menschen uber Interviews bewertet und die Versorgungssituation uber amtliche Statistiken analysiert. Ergebnisse: Die Ergebnisse der bundesweiten GINKO-Studie zeigen, dass die befragten horgeschadigten Menschen in NRW tendenziell die gesetzlich vorgesehenen begleitenden Hilfen im Arbeitsleben haufiger in Anspruch nehmen als horgeschadigte Menschen im restlichen Deutschland. Statistisch lassen sich Unterschiede fur die Bereiche „Erhaltung und Erweiterung der beruflichen Kenntnisse und Fertigkeiten“ und „Psychosoziale Hilfen bei behinderungsbedingt auftretenden Konflikten“ nachweisen. Schlussfolgerung: Eine Ursache fur die tendenziell positivere Bewertung der Befragten in NRW konnte durch die besondere Angebotsstruktur begrundet sein. Diese Ergebnisse in NRW durfen aber nicht daruber hinwegtauschen, dass auch in vielen Bereichen in NRW die horgeschadigtengerechte Gestaltung des Arbeitsplatzes fur einen Grosteil der Befragten (noch) nicht realisiert ist und auch begleitende Hilfen offensichtlich noch nicht alle Betroffenen erreicht haben.