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Reinhard Strametz,1,* Hannah Roesner,1,2,* Thomas Neusius,1,* Isabell Wiesenhuetter,1 Stefan Bushuven,3,4 José Joaquín Mira,2,5 Dominik Hinzmann,6 Susanne Heininger7 1Wiesbaden Institute for Healthcare Economics and Patient Safety, RheinMain UAS, Wiesbaden, Germany; 2Miguel Hernández University of Elche, Elche, Spain; 3Training Center for Emergency Medicine (NOTIS e.V), Engen, 78234, Germany; 4Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany; 5Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain; 6Department Clinical Medicine, Department of Anesthesiology and Intensive Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany; 7Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany*These authors contributed equally to this workCorrespondence: Reinhard Strametz, Wiesbaden Institute for Healthcare Economics and Patient Safety, RheinMain UAS, Bleichstr. 3, Wiesbaden, 65183, Germany, Email reinhard.strametz@hs-rm.dePurpose: The objective of this study is to evaluate whether the nationwide establishment and institutionalization of a peer-support program, is economically justified given the potential positive effects on the Second Victim Phenomenon (SVP) among healthcare professionals in Germany.Methods: A comprehensive methodological approach was employed, using data from the SeViD studies to assess the prevalence and duration of SVP among physicians and nurses in Germany. Economic impact assessments were conducted to estimate the potential cost savings associated with implementing a peer-support program.Results: The economic analysis reveals significant annual costs associated with SVP-induced absenteeism: approximately 1.56 billion euros for physicians and 1.87 billion euros for nurses. Implementing comprehensive peer-support programs could reduce these costs to approximately 0.85 billion (physicians) and 1.02 billion euros (nurses), respectively, demonstrating substantial potential economic benefits.Conclusion: Investing in a structured peer-support program could yield annual savings exceeding 1.55 billion euros while enhancing workforce resilience and improving patient care. This underscores the economic rationale for scaling up peer support initiatives in healthcare settings.Keywords: peer support program, economic impact, second victim phenomenon, healthcare professionals

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Introduction/aims: In preparation for clinical trials, it is important to better understand how disease burden changes over time in facioscapulohumeral muscular dystrophy (FSHD) and to assess the capability of select metrics to detect these changes. This study aims to evaluate FSHD disease progression over 1 year and to examine the sensitivity of several outcome measures in detecting changes during this interval., Methods: We conducted a 12-month prospective observational study of 41 participants with FSHD. Participants were evaluated at baseline, 6 months, and 12 months with serial strength testing (manual muscle testing or MMT and maximum voluntary isometric contraction testing or MVICT), functional testing (FSHD-Composite Outcome Measure or FSHD-COM, FSHD Clinical Severity Score or CSS, and FSHD Evaluation Score or FES), sleep and fatigue assessments, lean body mass measurements, respiratory testing, and the FSHD-Health Index patient-reported outcome. Changes in these outcome measures were assessed over the 12-month period. Associations between changes in outcome measures and both age and sex were also examined., Results: In a 12-month period, FSHD participant function remained largely stable with a mild worsening of strength, measured by MMT and standardized MVICT scores, and a mild loss in lean body mass., Discussion: The abilities and disease burden of adults with FSHD are largely static over a 12-month period with participants demonstrating a mild average reduction in some measures of strength. Selection of patients, outcome measures, and trial duration should be carefully considered during the design and implementation of future clinical studies involving FSHD patients., (© 2024 Wiley Periodicals LLC.)

Background: Inflammatory demyelinating diseases of the central nervous system, such as multiple sclerosis, are significant sources of morbidity in young adults despite therapeutic advances. Current murine models of remyelination have limited applicability due to the low white matter content of their brains, which restricts the spatial resolution of diagnostic imaging. Large animal models might be more suitable but pose significant technological, ethical and logistical challenges., Methods: We induced targeted cerebral demyelinating lesions by serially repeated injections of lysophosphatidylcholine in the minipig brain. Lesions were amenable to follow-up using the same clinical imaging modalities (3T magnetic resonance imaging, 11 C-PIB positron emission tomography) and standard histopathology protocols as for human diagnostics (myelin, glia and neuronal cell markers), as well as electron microscopy (EM), to compare against biopsy data from two patients., Findings: We demonstrate controlled, clinically unapparent, reversible and multimodally trackable brain white matter demyelination in a large animal model. De-/remyelination dynamics were slower than reported for rodent models and paralleled by a degree of secondary axonal pathology. Regression modelling of ultrastructural parameters (g-ratio, axon thickness) predicted EM features of cerebral de- and remyelination in human data., Interpretation: We validated our minipig model of demyelinating brain diseases by employing human diagnostic tools and comparing it with biopsy data from patients with cerebral demyelination., Funding: This work was supported by the DFG under Germany's Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy, ID 390857198) and TRR 274/1 2020, 408885537 (projects B03 and Z01)., Competing Interests: Declaration of interests CS, SH, BL, EL and TL are part of Ergosurg GmbH, which developed and manufactured the navigation system, the trackable instruments and the robotic system. VMB has received consulting fees from Brainlab. IY has received grants from the German Federal Ministry of Education and Research (BMBF) and the German Research Foundation (DFG), consulting fees from ABX-CRO, Blue Earth Diagnostics and Pentixapharm, honoraria from Piramal, support for attending meeting from the Society of Nuclear Medicine and Molecular Imaging, the European Association of Nuclear Medicine, the Slovenian Neuroscience Association (SiNAPSA) and the International Brain Research Organization, and is a member of the Neuroimaging Committee, European Association of Nuclear Medicine, the Board of Directors, Brain Imaging Council, Society of Nuclear Medicine and Molecular Imaging as well as the Molecular Connectivity Working Group. JK has received consulting fees from Novartis, possesses stock options at Bonescreen GmbH and was supported by the European Research Council, the DFG and the BMBF. TM has received speaker fees from Novartis and Roche as well as travel support from Novartis. BH has received consulting fees from GLG Consulting, Sandoz and Polpharma, possesses issued patents for detection of antibodies against KIR4.1 in a subpopulation of patients with multiple sclerosis, as well as genetic determinants of neutralizing antibodies to interferon, and has participated on Data Safety Monitoring and Advisory Boards for Novartis, Sandoz, Polpharma, Allergycare, TG Therapeutics and Biocon., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Professional identity formation (PIF) is a life-long process, starting even before professional education. High levels of motivation for medical school are essential for effective learning and academic success. Both are key factors in future physicians' professional and personal development, and according to self-determination theory, professional identity (PI) and students' levels of motivation could be closely linked. Therefore, we sought to investigate whether PI and strength of motivation for medical school are associated in new medical students., Methods: In a cross-sectional survey, all new medical students in Munich, Germany, were asked to complete the Macleod Clark Professional Identity Scale (MCPIS-9) and the Strength of Motivation for Medical School-Revised questionnaire (SMMS-R) as well as to provide information about age, gender, and waiting time before starting medical school., Results: Eight hundred eleven out of 918 new medical students participated in the survey. A positive correlation between the MCPIS-9 and the SMMS-R ( p  < 0.001) was found. Female students showed higher scores in the SMMS-R ( p  < 0.05) and the SMMS-R-subscale Readiness to Start ( p  < 0.001) . The amount of waiting semesters showed a positive correlation with the total SMMS-R score ( p  < 0.01) as well as with the subscales Readiness to Start and Persistence (both p  < 0.001)., Discussion: We found an association between PI and strength of motivation for medical school in a large cohort of new medical students. Female gender and more waiting semesters were associated with higher levels of self-perceived motivation and higher scores on the SMMS-R-subscale Readiness to Start . More research is needed to better understand this topic to further improve medical education., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2023.)

Objectives: Crohn's disease (CD) is a multifactorial disease, characterized by oxidant-induced tissue injury with a possible activation of poly(ADP-ribose) polymerase (PARP)-1. MicroRNAs (miRs) can offer a potential link between the genetic susceptibility, environmental and immunologic factors in the pathogenesis of CD. Previously, PARP-1 was identified as a direct target gene of miR-223 in an epithelial cell line. Our aim was to examine PARP activation and miR-223 expression in colonic biopsies of pediatric CD. To support our in vivo findings, the effect of lipopolysaccharide (LPS) on same parameters was examined in HT-29 colonic epithelial cell line., Methods: Colonic biopsies were taken from patients with macroscopically inflamed and intact mucosa with CD and controls. LPS treated HT-29 cells served as our in vitro model. To analyze the PARP-1 expression real-time PCR, Western blot and immunohistochemical analyses were used. PARP-1 enzymatic activity was assessed on the basis of poly(ADP-ribosyl)ated proteins. Expression of miR-223 was examined by real-time PCR., Results: PARP-1 mRNA and miR-223 expression was significantly elevated, however, the amount of PARP-1 protein and poly(ADP-ribose) was reduced in pediatric CD compared to controls. LPS incubation did not affect the expression of PARP-1 mRNA, however, decreased miR-223 expression, and enhanced PARP-1 activity., Conclusions: In our study, we showed that the expression of miR-223 is up-regulated and poly(ADP-ribosyl)ation is reduced in pediatric patients with CD. Moreover, we confirmed their opposite change in LPS treated epithelial cells, too. These data suggest that the hypofunctionality of PARP-1 may play a potential role in the pathomechanism of CD.

Introduction: We developed an evaluator-administered functional facioscapulohumeral muscular dystrophy composite outcome measure (FSHD-COM) comprising patient-identified areas of functional burden for future clinical trials., Methods: We performed a prospective observational study of 41 patients with FSHD at 2 sites. The FSHD-COM includes functional assessment of the legs, shoulders and arms, trunk, hands, and balance/mobility. We determined the test-retest reliability and convergent validity compared to established FSHD disease metrics., Results: The FSHD-COM demonstrated excellent test-retest reliability (intraclass correlation coefficient [ICC] 0.96; subscale ICC range, 0.90-0.94). Cross-sectional associations between the FSHD-COM and disease duration, clinical severity, and strength were moderate to strong (Pearson correlation coefficient range |0.51-0.92|)., Discussion: The FSHD-COM is a disease-relevant, functional composite outcome measure suitable for future FSHD clinical trials that shows excellent test-retest reliability and cross-sectional associations to disease measures. Future directions include determining multisite reliability, sensitivity to change, and the minimal clinically important change in the FSHD-COM. Muscle Nerve, 2018., (© 2018 Wiley Periodicals, Inc.)

Introduction: In preparation for future clinical trials, we determined the reliability, relationship to measures of disease severity, and consistency across sites of the 6 Minute Walk Test (6MWT) in patients with facioscapulohumeral muscular dystrophy (FSHD)., Methods: Genetically defined and clinically affected FSHD participants at 2 sites performed the 6MWT, the Timed Up and Go, and the 30 foot Go/Timed 10 meter test as measures of mobility using standard procedures., Results: Eight-six participants representing the full range of severity performed the 6MWT. The mean 6MWT distance was 404.3 meters (SD 123.9), with no difference between sites. The 6MWT was reliable (n = 25; intraclass correlation coefficient = 0.99) and demonstrated moderate to strong correlations with lower extremity strength, functional outcomes, and FSHD Clinical Score., Conclusions: The 6MWT is reliable and is associated with other measures of FSHD disease severity. Future directions include assessing its sensitivity to disease progression. Muscle Nerve 55: 333-337, 2017., (© 2016 Wiley Periodicals, Inc.)

This article describes a new interaction device for surgical navigation systems--the so-called navigation mouse system. The idea is to use a tracked instrument of a surgical navigation system like a pointer to control the software. The new interaction system extends existing navigation systems with a microcontroller-unit. The microcontroller-unit uses the existing communication line to extract the needed 3D-information of an instrument to calculate positions analogous to the PC mouse cursor and click events. These positions and events are used to manipulate the navigation system. In an experimental setup the reachable accuracy with the new mouse system is shown.

In order to prevent nerve injuries during ear-nose-throat (ENT) and skull base surgery, the method Navigated Control Functional is presented. Thereby, the power of active instruments is controlled based on position information, provided by a surgical navigation system, and nerve activity information, provided by a neurophysiologic monitoring system. Electrical stimulation is usually required for the extraction of distance information from neurophysiologic signals (e.g., Electromyography (EMG)). However, this article presents an experiment to investigate a possible relationship between EMG signals and the nerve-instrument distance without additional electrical stimulation. The EMG signals and position information were recorded intra-operatively during ear surgery. An off-line statistical analysis with Spearman's rank correlation coefficient was accomplished. The results show that there is occasionally some correlation at a statistically significant level of 5%. They highly depend on time range, the selected threshold value and time window. Moreover, all the observed correlations are positive against an expected negative correlation.