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Background: Digital health applications (DiGA) can be reimbursed by the statutory health insurance as an „app on prescription" since the Digital Health Care Act (DVG) came into force. Currently, it is unclear how family physicians should be actively involved in the use of DiGAs in order to increase the health literacy of their patients, but at the same time ensure a long-term doctor-patient relationship. The aim of this work was to assess the involvement of GPs in the use of DiGAs based on publicly available information. Methods: We performed a descriptive analysis of cross-sectional data available from the DiGA directory as of 19th of October 2021. We extracted information on the apps, as well as their respective indication and intervention. We also investigated the involvement of family physicians in the use of DiGAs. Results: At the time of the evaluation, 24 DiGAs were included in the register. Available DiGAs offered a wide range of indications with a focus on mental illnesses. The role of the DiGAs were mainly complementary to existing treatment and in the majority of cases designed to be used independently by the patients. Conclusions: DiGAs have the potential to strengthen the resources of patients, but can influence the doctor-patient relationship. Advantages and disadvantages of the different roles of the practitioners should be taken into account when using specific DiGAs in patient care. [ABSTRACT FROM AUTHOR]

Background: Extrahepatic bile duct injuries remain severe complications during cholecystectomies and often require reconstruction by bilioenteric anastomosis (i.e., hepaticojejunostomy), which comes with further long-term complications (e.g., recurring ascending cholangitis, secondary biliary cirrhosis). In the case of inherent extrahepatic biliary atresia or during liver transplant, artificial or engineered bile ducts could allow novel surgical strategies without the need for hepaticojejunostomy. Methods: We present data on the implantation of in vitro-generated neo-bile ducts in 5 domestic pigs. The neo-bile ducts were engineered through decellularization of allogeneic blood vessels and recellularization with autologous cholangiocytes. On postoperative days 0, 1, 7, and 14, blood samples were taken and analyzed (aspartate aminotransferase, alanine aminotransferase, bilirubin, alkaline phosphatase, creatinine, and leukocytes). Magnetic resonance cholangiopancreatography was performed on postoperative day 14 on 1 pig. Fourteen days after implantation, the pigs were sacrificed and the bile ducts were explanted. Results: All pigs survived the complete study period without severe complications. None of the pigs showed signs of biliary leakage or peritonitis. The neo-bile ducts were infiltrated by neutrophils, and neoangiogenesis was observed around and into the implanted tissue. Conclusion: We present a novel strategy for extrahepatic bile duct replacement by implantation of an autologous neo-bile duct generated ex vivo. Whether the presented technique allows the long-term replacement of native bile ducts must be further evaluated. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Emergency departments (EDs) are frequently overcrowded and increasingly used by nonurgent patients. Symptom checkers (SCs) offer on-demand access to disease suggestions and recommended actions, potentially improving overall patient flow. Contrary to the increasing use of SCs, there is a lack of supporting evidence based on direct patient use., Objective: This study aimed to compare the diagnostic accuracy, safety, usability, and acceptance of 2 SCs, Ada and Symptoma., Methods: A randomized, crossover, head-to-head, double-blinded study including consecutive adult patients presenting to the ED at University Hospital Erlangen. Patients completed both SCs, Ada and Symptoma. The primary outcome was the diagnostic accuracy of SCs. In total, 6 blinded independent expert raters classified diagnostic concordance of SC suggestions with the final discharge diagnosis as (1) identical, (2) plausible, or (3) diagnostically different. SC suggestions per patient were additionally classified as safe or potentially life-threatening, and the concordance of Ada's and physician-based triage category was assessed. Secondary outcomes were SC usability (5-point Likert-scale: 1=very easy to use to 5=very difficult to use) and SC acceptance net promoter score (NPS)., Results: A total of 450 patients completed the study between April and November 2021. The most common chief complaint was chest pain (160/437, 37%). The identical diagnosis was ranked first (or within the top 5 diagnoses) by Ada and Symptoma in 14% (59/437; 27%, 117/437) and 4% (16/437; 13%, 55/437) of patients, respectively. An identical or plausible diagnosis was ranked first (or within the top 5 diagnoses) by Ada and Symptoma in 58% (253/437; 75%, 329/437) and 38% (164/437; 64%, 281/437) of patients, respectively. Ada and Symptoma did not suggest potentially life-threatening diagnoses in 13% (56/437) and 14% (61/437) of patients, respectively. Ada correctly triaged, undertriaged, and overtriaged 34% (149/437), 13% (58/437), and 53% (230/437) of patients, respectively. A total of 88% (385/437) and 78% (342/437) of participants rated Ada and Symptoma as very easy or easy to use, respectively. Ada's NPS was -34 (55% [239/437] detractors; 21% [93/437] promoters) and Symptoma's NPS was -47 (63% [275/437] detractors and 16% [70/437]) promoters., Conclusions: Ada demonstrated a higher diagnostic accuracy than Symptoma, and substantially more patients would recommend Ada and assessed Ada as easy to use. The high number of unrecognized potentially life-threatening diagnoses by both SCs and inappropriate triage advice by Ada was alarming. Overall, the trustworthiness of SC recommendations appears questionable. SC authorization should necessitate rigorous clinical evaluation studies to prevent misdiagnoses, fatal triage advice, and misuse of scarce medical resources., Trial Registration: German Register of Clinical Trials DRKS00024830; https://drks.de/search/en/trial/DRKS00024830., (©Johannes Knitza, Ragip Hasanaj, Jonathan Beyer, Franziska Ganzer, Anna Slagman, Myrto Bolanaki, Hendrik Napierala, Malte L Schmieding, Nizam Al-Zaher, Till Orlemann, Felix Muehlensiepen, Julia Greenfield, Nicolas Vuillerme, Sebastian Kuhn, Georg Schett, Stephan Achenbach, Katharina Dechant. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.08.2024.)