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Ausgehend von einer differenten Definition und diffusen Methodenvielfalt der Osteopathie sowie einer teilweise inkorrekten Auflistung von Prinzipien wurde in dieser Untersuchung der Versuch unternommen, aus den 4 Werken von A.T. Still, des Begründers der Osteopathie, essenzielle Paradigmata einer ursprünglichen Osteopathie zu extrahieren. Um den Interpretationsspielraum zu minimieren, wurden der genaue Wortlaut und die Beschreibungen des Autors im historischen und soziokulturellen Kontext überwiegend beibehalten. Als Ergebnis konnten 6 Leitideen gefunden werden, welche trotz des chronologischen Unterschiedes auch heute noch als wissenschaftskonform gelten können. Dies ermöglicht es einer auf den Paradigmata der ursprünglichen von A.T. Still aufbauenden Osteopathie, ein integraler Bestandteil aktueller geistes- und naturwissenschaftlicher Fachbereiche zu werden. Based on a different definition and diffuse variety of methods of osteopathy as well as a partially incorrect listing of principles, this study attempted to extract essential paradigms of an original osteopathy from the four works of A.T. Still, the founder of osteopathy. In order to minimise the scope for interpretation, the exact wording and the author's descriptions in the historical and socio-cultural context were predominantly adhered to. As a result, six guiding ideas were found which, despite the chronological difference, can still be considered to be consistent with science today. This enables osteopathy, which is based on the paradigms of the original A.T. Still, to become an integral part of current humanities and natural science disciplines. [ABSTRACT FROM AUTHOR]

Copyright of Sozial Extra 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 Public Health Forum is the property of De Gruyter 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: Molecular profiling is currently not yet widespread in Germany and its potential for personalized treatment of solitary thyroid nodules is not exhausted. Method: Narrative assessment of the available options and their evidence based on the current international literature as well as discussion of the options in the German context from the perspective of a thyroid surgeon and a thyroid pathologist. Results: The commercial tests available, especially in the USA, for molecular profiling of thyroid nodules offer good rule-in and somewhat poorer rule-out options, as many differentiated thyroid carcinomas do not display genetic alterations. The costs of these tests and molecular pathology for nodule assessment are still high and the individual mutations have not yet been clearly characterized. Conclusion: It can be assumed that molecular profiling will become more important in the coming years and find its way into the clinical routine. At this point in time, however, there is not yet sufficient evidence of the clinical significance of most mutations in thyroid carcinomas to derive therapeutic consequences from them. [ABSTRACT FROM AUTHOR]

Robotic operations as a further development of conventional laparoscopic surgery have been introduced for nearly all interventions in visceral surgery during the last decade. They also currently have a high importance and acceptance in pancreatic surgery despite a relevant learning curve and high associated costs. Standard procedures, such as robotic distal pancreatectomy (RDP) and partial pancreatoduodenectomy (RPD) are most frequently performed, whereas extended resections, e.g., vascular reconstructions of the portal vein, are still limited to a small number of centers worldwide. Potential advantages of robotic pancreatic surgery compared to open surgery include, in particular, less blood loss and a faster postoperative recovery of the patients leading to a shorter hospital stay. Compared to conventional laparoscopic surgery, robotic approaches offer advantages with respect to better visualization and three-dimensional dexterity of the instruments; however, the currently published literature comprises only retrospective or prospective observational studies and randomized controlled results are not yet available but first study results in this respect are expected within the next 2–3 years. [ABSTRACT FROM AUTHOR]

Basierend auf den Vorgaben des SGB V bildet Evidenzbasierte Medizin (EbM) die Grundlage für die Arbeit des Gemeinsamen Bundesausschusses (G-BA) sowie des Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) bei deren medizinischen Bewertungen und Entscheidungen zur Konkretisierung von Versorgungsinhalten wie z. B. den Disease-Management-Programmen (DMP) sowie der von der Gesetzlichen Krankenversicherung (GKV) zu finanzierenden Leistungen. Die Bewertung vorliegender Evidenz ist somit direkt mit Preisbildung, Erstattung, aber auch mit Versorgungssteuerung verknüpft. Eine höhere Flexibilität im Umgang mit den Evidenzanforderungen wurde in der Vergangenheit zwar ausgeübt, allerdings ohne Konsistenz und durchaus auch dann, wenn eine Absenkung des Anforderungsniveaus zu einem finanziellen Vorteil für die Gesetzliche Krankenversicherung (GKV) führte. Zugleich existieren auch Beispiele, bei denen die klinische Relevanz einer Intervention so offensichtlich war, dass der G-BA Handlungsspielräume im Sinne der Versorgung nutzte.

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.)

Depending on the fracture pattern and soft tissue mantle involvement, clavicle fractures can be treated surgically or non-operatively. Historically, displaced fractures of the clavicle shaft in adults have been treated non-operatively. However, the nonunion rate after non-operative therapy seems to be higher than reported in the past. Additionally, publications reporting better functional outcomes after surgical therapy are accumulating. The current literature suggests that primary surgical stabilization, especially of displaced fractures, provides more rapid functional exercise treatment and thus earlier physical recovery than nonoperative therapy. Individualized treatment is suggested, with careful consideration of the advantages and disadvantages of each therapeutic approach and patient preferences. [ABSTRACT FROM AUTHOR]

Over the past 5 years both media and scientific interest has surged regarding the disorder myalgic encephalomyelitis and chronic fatigue syndrome (ME/CFS), not least because of the clinically similar manifestation in long COVID or post-COVID. In this review we discuss the process of clinical diagnosis and randomized controlled therapeutic studies on ME/CFS, and the similarities or differences to long COVID and post-COVID. So far, neither clear pathophysiologically causal nor therapeutic evidence-based results on ME/CFS have been identified in the many years of scientific research. Given the evident psychiatric comorbidity rates in patients with a diagnosis of ME/CFS, a psychosomatic etiology of this syndrome should be considered. Furthermore, a precise and reliable diagnostic classification based on stricter criteria would benefit both pathophysiological and therapeutic research. [ABSTRACT FROM AUTHOR]

Copyright of Public Health Forum is the property of De Gruyter 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 Unterrichtswissenschaft (Springer Science & Business Media B.V.) 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.)

Computer-assisted procedures are becoming increasingly more relevant in orthopedics and trauma surgery. The data situation on these systems has improved in recent years but still has a low level of evidence. In particular, data on short-term or medium-term results on the use of these procedures are currently available. These could show that improved precision and reproducibility of the surgical procedures can be achieved by the use of computer-assisted procedures. Nevertheless, there is still no recommendation in the current guidelines for routine use. [ABSTRACT FROM AUTHOR]

The article "Off-Label Use of Medicines in Children" deals with the application of medicines outside their approved range in children. Due to the lack of approved alternatives, off-label use in children is often necessary and represents the "state of the art". The contribution discusses the background and significance of off-label use in children, as well as the legal framework regarding permissibility, standard of care, informed consent, and reimbursement. It is pointed out that despite regulatory initiatives to promote drug development for children, many medicines still have to be used off-label due to a lack of approved drugs and data for the youngest age groups. [Extracted from the article]

Abstract: Objective: Germany´s federal government has decided to legalize the non-medical use and supply of cannabis, and presented core elements of the proposed regulation framework. Select core regulatory details are being assessed and commented on from a viewpoint of international scientific evidence and experiences in regard to cannabis legalization, with a principal focus on efforts and objectives of public health. Methods: Select summary and policy-analytical application of scientific evidence. Results: A substantial proportion of cannabis-related health problems is associated with the use of high-potency (THC) products; however, categorical THC-limits for legally available cannabis would overall be unlikely to reduce the total of these adverse outcomes, but rather retain many high-risk users involved in illegal supply systems. The minimum legal age of 18 years for legal cannabis appears to primarily reflect political considerations, and does not necessarily reflect optimal health or social protection efforts for young users; notwithstanding, cannabis use among youth will likely remain high. A cross-substance, public-health-oriented integration of regulatory restrictions with those for other substances (e. g., alcohol) would make sense. Driving under cannabis impairment is relatively common, and increases the risk for related injury and death, and consequentially results in substantial burden of disease; its control requires targeted education and deterrence measures. Cannabis legalization is generally difficult to reconcile with seminal international (e. g., UN) conventions; rather, it should be used as impetus to advocate for fundamental reforms of these treaties on the basis of public health principles and their protection. Conclusions: There are no golden recipes for the regulations for cannabis legalization in Germany; some of its core objectives will only be achievable by way of compromise approaches, which may need to be adjusted depending on outcomes experienced. Once implemented, Germany will be able to offer valuable data on cannabis legalization as a policy option, for which systematic and comprehensive process and outcome monitoring will need to be conducted. [ABSTRACT FROM AUTHOR]

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In diesem Kapitel des Themenheftes „Lehrkräfte forschen“ werden die Befunde der Aufsätze des Heftes zusammengeführt und mit Blick auf die Wirksamkeit des Seminarkonzeptes diskutiert. Dies geschieht auch unter Einbezug der studentischen Seminarevaluation sowie unter Berücksichtigung von Forschungsergebnissen zur Entwicklung der selbst eingeschätzten Forschungskompetenz im Seminar. In der Gesamtschau lässt sich festhalten, dass die angestrebten Ziele nur zum Teil erreicht wurden und ein tatsächlicher Zuwachs an forschungsbezogenen Fähigkeiten bei den Studierenden nur bedingt attestiert werden kann. Gründe hierfür werden diskutiert.

Der Beitrag führt in das Themenheft ein, in dem ein Seminarkonzept vorgestellt wird, das den Aufbau und die Förderung von Forschungskompetenz Lehramtsstudierender zum Ziel hat. Es wird der Hintergrund der Überlegungen zum Seminar dargestellt und ein Überblick über die Beiträge des Themenheftes gegeben.

Die Nutzung von Evidenz ist eine Herausforderung für die Lehrkräftebildung. Studien und konzeptionelle Überlegungen zu diesem Thema zeichnen sich durch unterschiedliche Zugriffe auf Evidenz aus. Im vorliegenden Beitrag werden diese Zugriffe anhand von vier Fragen diskutiert: (1) Was ist Evidenz? (2) Wozu kann diese genutzt werden? (3) Wo ist Evidenz zu finden? (4) Wie kann Evidenz kommuniziert werden? Abschließend schlagen wir eine Taxonomie der Nutzung von Evidenz vor und diskutieren mögliche Implikationen für die Lehrkräftebildung.

Numerous reports in recent years have focused on the influence of environmental factors on rheumatoid arthritis. This article provides an overview of the current study situation on the influence of modifiable environmental factors on the development and course of rheumatoid arthritis. Lifestyle factors, such as cigarette smoking, diet, exercise and body weight can be individually influenced. Factors such as air pollution and socioeconomic status can be influenced by environmental and sociopolitical measures at a public level. Epidemiological studies have identified nicotine abuse, an unhealthy diet and obesity as well as a low level of education and social status as risk factors for the development of rheumatoid arthritis. Numerous factors are also associated with a poorer response to treatment and a worse prognosis. As randomized interventional studies on most environmental factors are hardly feasible, the causal relationship of the individual factors to the incidence and progression of rheumatoid arthritis is difficult to quantify. Nevertheless, the current evidence already enables the provision of appropriate counselling to patients with rheumatoid arthritis with respect to a healthy lifestyle including abstaining from cigarette smoking, maintaining a healthy diet, physical activity and avoiding obesity., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Lesions of the extracranial carotid artery are the cause of 10–15 % of all cases of cerebral ischemia. The aims of the updated S3 guidelines are evidence-based and consensus-based recommendations for action on comprehensive care of patients with extracranial carotid stenosis in Germany and Austria. Methods: A systematic literature search (1990–2019) and methodical assessment of existing guidelines and systematic reviews were carried out. Consensus answers to 37 key questions with evidence-based recommendations. Results: The prevalence of extracranial carotid stenosis is approximately 4% and increases after the age of 65 years. The most important examination method is duplex sonography. Randomized controlled studies (RCT) have shown that carotid endarterectomy (CEA) of an asymptomatic 60–99% carotid artery stenosis reduces the absolute risk of stroke (absolute risk reduction, ARR) within 5 years in comparison to drug treatment alone by 4.1%. Due to an improved pharmaceutical prevention of arteriosclerosis, the S3 guidelines recommend a prophylactic CEA of a 60–99% stenosis only for patients without an increased surgical risk. Additionally, one or more clinical or imaging results should be present, which indicate an increased risk of carotid-related stroke in the follow-up. For medium-grade (50–69 %) and high-grade (70–99 %) symptomatic stenoses the ARRs after 5 years are 4.6% and 15.6%, respectively. Systematic reviews of RCTs have shown that CEA is associated with a ca. 50% lower periprocedural risk of stroke compared to carotid artery stenting (CAS). There are no differences in the long-term course. The CEA is recommended for high-grade asymptomatic, medium-grade and high-grade symptomatic carotid stenosis as a standard procedure, alternatively CAS can be considered. For both procedures the periprocedural stroke rate/mortality during hospitalization should be a maximum of 2% (asymptomatic stenosis) or 4% (symptomatic stenosis). Conclusion: Both CEA and CAS necessitate a critical evaluation of the indications and strict quality criteria. Future studies should evaluate even better selection criteria for an individual, optimal, conservative, operative or endovascular treatment. [ABSTRACT FROM AUTHOR]

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The scientifically founded surgical specialist discussion regarding the legal requirements for minimum volume numbers for diverse organ systems and selected surgical procedures as the basis of quality assurance and optimization of treatment is not new. Comprehensive and also reliable data from national and international studies are available for colorectal surgery, pancreatic surgery, esophageal surgery, liver surgery and gastric surgery. Recently, the raising of the minimum volume for complex esophageal interventions by the Federal Joint Committee (G-BA) in Germany from 10 up to 26 procedures per hospital and year, reignited the debate on this topic as well as the debate on centralization in the healthcare system in general. This decision seems to be scientifically well-justified from the perspective of political bodies and realizable in the practical implementation; however, from the perspective of physicians routinely involved in the corresponding highly complex procedures, there is a very much broader basis for discussion, which is only partially covered by a report of the Institute for Quality and Efficiency in the Healthcare System (IQWiG) as the foundation of the decision of the G‑BA. For the scientifically oriented surgical specialist society, in the first instance priority is given to the scientific evidence as the guiding principle. Nevertheless, aspects of the treatment reality cannot and should not be ignored. Therefore, the recommendations of the specialist society must be oriented not only to the quality of results but also to the realistic options for successful implementation in practice. Furthermore, questions of further education, the right of the patient to freedom of choice of the physician and preservation of the attractiveness of the occupational profile of surgeons are immanent topics for the surgical specialist society. [ABSTRACT FROM AUTHOR]

Retroperitoneal soft tissue sarcomas represent extreme challenges for interdisciplinary treatment teams. The sarcoma-specific experience of surgeons has the greatest impact on the survival of patients; however, too many patients still die despite optimal local treatment. The role of chemotherapy is undisputed only for patients with highly malignant bone sarcomas or rhabdomyosarcomas. For soft tissue sarcomas in adult patients, especially liposarcomas and leiomyosarcomas, the evidence situation is very unsatisfactory. This overview article discusses the complex data situation and controversial aspects that are relevant for current treatment decisions in interdisciplinary treatment teams. [ABSTRACT FROM AUTHOR]

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Copyright of NTM Zeitschrift für Geschichte der Wissenschaften, Technik und Medizin 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.)