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The author talks about the use of biologic and traditional systemic treatments for atopic dermatitis (AD). topics discussed include the use of medications such as methotrexate, cyclosporine, and azathioprine to treat AD, the use of medication event-monitoring system, the effectiveness of targeting adherence, and advancements in targeted therapeutics for AD.

Background: Developing a safe and immunogenic vaccine against Zika virus remains an unmet medical need. We did two phase 1 studies that evaluated the safety and immunogenicity of two mRNA-based Zika virus vaccines (mRNA-1325 and mRNA-1893) in adults., Methods: Two randomised, placebo-controlled, dose-ranging, multicentre, phase 1 trials, one of mRNA-1325 (mRNA-1325 trial) and one of mRNA-1893 (mRNA-1893 trial), were done. For both studies, eligible participants were healthy adults (aged 18-49 years) who were flavivirus seronegative or flavivirus seropositive at baseline. Participants in the mRNA-1325 trial, which was done at three centres in the USA, were randomly assigned centrally (1:4), using a randomisation table, to the placebo group or one of three mRNA-1325 dose groups (10, 25, or 100 μg). All participants received two doses. The mRNA-1325 vaccine encoded the premembrane and envelope E structural proteins (prME) from a Micronesia 2007 Zika virus isolate. Participants in the mRNA-1893 trial, which was done at three centres in the USA and one centre in Puerto Rico, were randomly assigned (1:4) to the placebo group or one of four mRNA-1893 dose groups (10, 30, 100, or 250 μg) using centralised interactive response technology. All participants in the mRNA-1893 trial received dose one on day 1 and then dose two on day 29. The mRNA-1893 vaccine encoded the prME from the RIO-U1 Zika virus isolate. Safety was the primary outcome of each study, which was evaluated in the respective safety populations (mRNA-1325 trial: participants who received at least one dose and provided safety data; mRNA-1893 trial: participants who received at least one dose) and the solicited safety population (mRNA-1893 trial only: received at least 1 dose and contributed solicited adverse reaction data). Endpoints in both trials included solicited adverse reactions within 7 days after vaccination and unsolicited adverse events within 28 days after vaccination. The secondary outcome of both trials was immunogenicity assessed by Zika virus-specific neutralising antibodies (nAbs) in the per-protocol populations in either trial (participants with no major protocol deviations received full dose[s] of assigned dose level within the acceptable time window, had samples drawn within acceptable time window, and had prevaccination and corresponding post-vaccination serum samples for testing). These were descriptive studies, with no formal hypothesis testing in either trial. Both trials are registered with ClinicalTrials.gov, NCT03014089 (mRNA-1325 trial) and NCT04064905 (mRNA-1893 trial)., Findings: The mRNA-1325 trial was done from Dec 14, 2016, to Aug 16, 2018. 90 participants were enrolled: 53 (59%) participants were women and 37 (41%) were men; 84 (93%) were White; and 74 (82%) were not Hispanic or Latino. All three dose levels of mRNA-1325 (10, 25, and 100 μg) were generally well tolerated, but the vaccine elicited poor Zika virus-specific nAb responses. At 28 days after dose two, geometric mean titres (GMTs) were highest for mRNA-1325 10 μg (10·3 [95% CI 5·9-18·2]). The mRNA-1893 trial was done from July 23, 2019, to March 22, 2021. 120 participants (70 [58%] women and 50 [42%] men) were enrolled, most participants were White (89 [74%]), and not Hispanic or Latino (91 [76%]). In the mRNA-1893 trial, solicited adverse reactions in participants who received a vaccine were mostly grade 1 or 2 and occurred more frequently at higher dose levels and after dose two. No participants withdrew due to an unsolicited treatment-emergent adverse event and most of these events were not treatment related. On day 57, all evaluated mRNA-1893 dose levels induced robust Zika virus-specific nAb responses, independent of flavivirus serostatus, that persisted until month 13. At day 57 in participants who were flavivirus seronegative, plaque reduction neutralisation titre test nAb GMTs were highest for mRNA-1893 100 μg (454·2 [330·0-619·6]); in participants who were flavivirus seropositive, GMTs were highest for mRNA-1893 10 μg (224·1 [43·5-1153·5]) and mRNA-1893 100 μg (190·5 [19·2-1887·2])., Interpretation: These findings support the continued development of mRNA-1893 against Zika virus, which was well tolerated at all evaluated dose levels and induced strong Zika virus-specific serum nAb responses after two doses, regardless of baseline flavivirus serostatus., Funding: Biomedical Advanced Research and Development Authority and Moderna., Competing Interests: Declaration of interests HB, VF, RP, YDP, BB, SW, JD, SK, and BL are employees of and shareholders in Moderna. NLC is an independent consultant for Moderna. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Human metapneumovirus (hMPV) and parainfluenza virus type 3 (PIV3) cause respiratory tract illness in children and the elderly. No licensed vaccines are available., Methods: In this phase 1, randomized, dose-ranging, first-in-human study, the safety, reactogenicity, and humoral immunogenicity of an investigational mRNA-based hMPV and PIV3 combination vaccine, mRNA-1653, were evaluated in healthy adults aged 18-49 years. Sentinel participants (n = 20) received 2 doses of mRNA-1653 (25, 75, 150, or 300 μg) in the dose escalation phase, and participants (n = 104) received 2 doses of mRNA-1653 (75, 150, or 300 μg) or placebo in the dose selection phase; injections were 28 days apart., Results: The most common solicited reactogenicity events were injection site pain, headache, fatigue, and myalgia, the majority of which were grade 1 or 2. A single mRNA-1653 dose increased neutralization titers against hMPV and PIV3 1 month after vaccination compared with baseline. No notable increases in neutralizing antibody titers were observed with escalating dose levels after mRNA-1653, although no statistical inferences were made; a second mRNA-1653 dose had little observable impact on antibody titers. Neutralizing titers through 1 year remained above baseline for hMPV and returned to baseline for PIV3., Conclusions: mRNA-1653 was well tolerated, with an acceptable safety profile and increased hMPV and PIV3 neutralization titers in healthy adults., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Objective: Within the scope of a prospective study, the assessment reports completed in Otorhinolaryngology between March 1, 2011 and December 31, 2018 by the Health Advisory Boards in the German federal states of Lower Saxony and Bremen were analyzed regarding the primary and secondary misallocation in the G-DRG system., Methods: The assessment reports were documented using a standardized database system, which was developed on the basis of the electronic data interchange (EDI) by the Health Advisory Board in Lower Saxony. In addition, the documentation of medical assessment reports according to the G-DRG system was used for data analysis., Results: During the period from March 1, 2011 and December 31, 2018, a total of 42,126 cases of inpatient assessments of DRGs according to the G-DRG system were collected in the field of Otorhinolaryngology. In 1,946 cases, a primary and in 14,044 cases a secondary misallocation was detected. In 26,136 cases, neither a primary nor a secondary misallocation could be identified; thus, the rate of primary and secondary misallocations observed over the entire period was 5 % and 33 %, respectively., Conclusions: Primary and secondary misallocations were most frequently found with treatments that included outpatient interventions in the catalog according to para. 115b of the German Social Code Fifth Book (SGB V). With secondary misallocations, exceeding the lower limit to length of stay (uGVD) therefore prevailed. In order to improve the demarcation between outpatient and (short-term) inpatient treatment in Otorhinolaryngology, in addition to the special consideration of the here presented "hit list" of Otorhinolaryngology departments, a more intensive cooperation between hospitals and the Health Advisory Boards of the federal states should be encouraged., (Copyright © 2021. Published by Elsevier GmbH.)

Background: In 2010, the ICF working group of Faculty II "Applied Social Medicine and Rehabilitation" of the German Society for Social Medicine and Prevention, DGSMP proposed a classification of personal factors (PF) for the German-speaking area. Meanwhile, the International Classification of Functioning, Disability and Health (ICF) and WHO's bio-psycho-social model were increasingly integrated into the German Social Code (Book IX for Rehabilitation and Participation). It was a legislative decision that the needs assessment for the rehabilitation process must be "comprehensive"., Aim: This publication aims to present an updated classification of PF to support the socio-medical assessment. For this purpose other published papers proposing a classification of PF were analyzed, especially the publication of Geyh et al. METHODS: The multiprofessional working group re-examined the basic structure, consistency and selection of factors of the 2010 classification using a qualitative approach and modified them if meaningful and necessary. The principles for the selection of factors were the same as in the 2010 publication (comprehensive, manageable, universal, impartial, relevant, unambiguous, focusing on finality, not regarding causality and non-discriminatory)., Results: A fundamental revision was not necessary; the basic structure remained primarily unchanged. Some items were included, excluded, summarized, shifted and editorially or content-related altered. Legal expertise shows that the classification of PF and their individual use for the socio-medical assessment, if necessary for the individual rehabilitation allocation, incur no problems with regard to data-protection regulations., Perspectives: The revised classification is ready to support users to describe and document relevant influences of the life background of individuals in a structured manner. Thus, influences on functioning and participation can be described comprehensively and transparently based on the bio-psycho-social model. A justiciable allocation of benefits for persons with disabilities is facilitated., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Prospective analysis of assessment reports in otorhinolaryngology for the period 01-03-2011 to 31-03-2017 by the Health Advisory Boards in Lower Saxony and Bremen, Germany in relation to coding in the G-DRG-System., Material and Methods: The assessment reports were documented using a standardized database system developed on the basis of the electronic data exchange (DTA) by the Health Advisory Board in Lower Saxony. In addition, the documentation of the assessment reports according to the G-DRG system was used for assessment. Furthermore, the assessment of a case was evaluated once again on the basis of the present assessment documents and presented as an example in detail., Results: During the period from 01-03-2011 to 31-03-2017, a total of 27,424 cases of inpatient assessments of DRGs according to the G-DRG system were collected in the field of otorhinolaryngology. In 7,259 cases, the DRG was changed, and in 20,175 cases, the suspicion of a DRG-relevant coding error was not justified in the review; thus, a DRG change rate of 26% of the assessments was identified over the time period investigated., Conclusions: There were different kinds of coding errors. In order to improve the coding quality in otorhinolaryngology, in addition to the special consideration of the presented "hit list" by the otorhinolaryngology departments, there should be more intensive cooperation between hospitals and the Health Advisory Boards of the federal states., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Rehabilitative health care is paying increasing attention to multimorbid people with 2 and more coexistent chronic diseases of sociomedical relevance., Methods: Terms, requirements, design, configuration, challenges and supply of sociomedical rehabilitation were described in part I. A project group of the Medical Advisory Board of the Federal Rehabilitation Council describes manifold fields of actions to be taken in the rehabilitation of persons with multimorbidity., Results: The actions proposed range from reviewing existing forms of management to identifying rehabilitative needs and initiating accurately fitting interventions, sensitizing and enlarging competences of involved personnel, considering multimorbidity in guidelines and further research on questions still open., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Rehabilitative health care is increasingly focusing its attention on multimorbid people with 2 and more coexistent chronic diseases of sociomedical relevance., Methods: After defining the term "multimorbidity" in the context of rehabilitative health care, an exploratory overview of the prevalence and clinical implication of this condition as reported in the literature was drafted. Based on a case history, special attention was paid to general as well as special challenges regarding design, configuration and supply of sociomedical rehabilitative care. Consensus was achieved with the Health Advisory Board of the German Federal Rehabilitation Council., Results: The proposed actions necessary for the healthcare of persons with multimorbidity include specific function-oriented individual assessment of needs via the distinctive allocation, selection and performance of rehabilitative procedures as well as post-rehabilitative care until the patient's reintegration into his social environment., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: In a retrospective study the cases of possibly false medical treatment investigated by the Health Advisory Boards (MDK) in Lower Saxony and Bremen, Germany, in the years from 2012 to 2015 were analyzed. Material and Methods: All relevant data - especially diagnoses and procedures - were recorded in accordance to a standardized data entry form and were evaluated. In addition, relevant case studies are presented. Results: Altogether 206 cases of possibly false medical treatment were recorded for the investigated period. Among them there were 24 cases (12%), in which a false medical treatment was detected. The relevant case studies showed on the one hand, that relevant false medical treatment does occur in the field of ENT-surgery and on the other hand that it is sometimes very difficult do get the right decision even on a high-skilled background. Conclusions: In the field of Otorhinolaryngology there is a constant number of cases for examination in possibly false medical treatment, although the number of detection of false medical treatment is rather lower than in other disciplines. Analysis of possible false medical treatment cases produces the chance of preventing false medical treatment in future., (© Georg Thieme Verlag KG Stuttgart · New York.)

Avian infectious bronchitis (IB), caused by a gammacoronavirus, is an OIE-listed (List B) disease and characterized by respiratory and renal involvements, causing high mortality, and economic loss in both layers and broilers. In comparison with other diagnostic methods, real-time polymerase chain reaction (RT-PCR) and conventional RT-PCR are potent, more sensitive and faster techniques for infectious bronchitis virus (IBV) detection. This research was conducted to detect IBV using specific primers of IB in three governorates (Basra, Thi-Qar and Muthana) in the south of Iraq. Tracheal specimens were collected from 46 IB suspected commercial broiler flocks. XCE2+ and XCE2- Primers, which amplify all IBV serotypes, were used. Primers MCE1+, BCE1+ and DCE1+ were used to amplify the specific nucleotide sequences of Massachusetts, 793/B and D274 genotypes, respectively. The results of real-time RT-PCR of this study showed that 34 (74.00%) out of 46 infected flocks were positive to IBV. The results of nested PCR showed that 50.00% and 5.89% of positive samples were belonged to genotypes 793/B and Massachusetts, respectively, and the remaining positive (44.11%) were unknown. The results indicate presence of Massachusetts and 793/B IBV strains in commercial broilers in southern Iraq.

Infectious bronchitis virus (IBV) is one of the most critical pathogens in the poultry industry, causing serious economic losses in all countries including Iraq. IBV has many genotypes that do not confer any cross-protection. This virus has been genotyped by sequence analysis of the S1 glycoprotein gene. A total of 100 tracheal and kidney tissue specimens from different commercial broiler flocks in the middle and south of Iraq were collected from September 2013 to September 2014. Thirty-two IBV-positive samples were selected from among the total and were further characterized by nested PCR. Phylogenetic analysis revealed that isolates belong to four groups (group I, variant 2 [IS/1494-like]; group II, 793/B-like; group III, QX-like; group IV, DY12-2-like). Sequence analysis revealed nucleotide sequence identities within groups I, II, and III of 99.68 %-100 %, 99.36 %-100 %, and 96.42 %-100 %, respectively. Group I (variant 2) was the dominant IBV genotype. One Chinese-like recombinant virus (DY12-2-like) that had not been reported in the Middle East was detected. In addition, the presence of QX on broiler chicken farms in the area studied was confirmed. This is the first comprehensive study on the genotyping of IBV in Iraq with useful information regarding the molecular epidemiology of IBV. The phylogenetic relationship of the strains with respect to different time sequences and geographical regions displayed complexity and diversity. Further studies are needed and should include the isolation and full-length molecular characterization of IBV in this region.

Medical experts who practice social medicine have a strong ethical approach for their professional positions. Their reports must reflect an objective, independent, high-quality assessment of interactions between health status and the disability of individuals. However, they must simultaneously consider the societal involvement of these individuals when determining the framework of the Statutory Health Insurance and Social Security Systems. Their task is to recommend sociomedical benefits that are tailored to suit personal needs and that respect the individual life situations of the persons involved, thus complementing the efforts of healthcare professionals in clinical settings. The editorial describes the self-conception of this medical specialty on behalf of the German Society of Social Medicine and Prevention (DGSMP). Policy makers in social insurances and social security systems generally must respect independent sociomedical recommendations as a crucial point for further realistic development activities.

We describe the results of a survey of claim forms that are used when starting rehabilitation following inpatient treatment and of an evaluation of a claim form developed on the basis of the results. The survey of different existing forms shows a high overlapping in content, suggesting the possibility of unification to one claim form that can be accepted by all insurers. In analogy to the Delphi method criteria for evaluation were consented and applied by the author group to assess the relevance of the claim forms content items for the process of initiating rehabilitation. A group of further experts added their evaluations. We prioritised the results and extracted the essential contents to conceive a unified claim form eligible for all types of rehabilitation. The claim form was discussed in 3 focus groups, revised accordingly and tested in the Hannover Medical School. Test results show that all relevant information is asked for and that the form is well manageable. The users' request for an IT-based solution and further ideas for improvement were integrated into the revised and validated version of the claim form. It is now available for all stake holders, in particular for insurers, as a means to improve quality of care and efficiency by standardisation of rehabilitation claim forms., (© Georg Thieme Verlag KG Stuttgart · New York.)

The process of "clinical reasoning" is exemplified as supportive to the complaint management of the Statutory Medical Health Advisory Board in Lower Saxony, Germany, within the operational division for long-term care insurance. A model case from real life illustrates in detail the hypothetical-deductive approach by Beusheusen and Klemme/Siegmann. Because of the potential area of conflicts between human concern in the case of a long-term care burden and legal requirements, the process was analysed in terms of a pragmatic reasoning. Human resources of the claimant and persons in charge at customer's service were demonstrated as well as political, statutory and institutional determining factors. Concluding self-perception validates the process in the context of evidence-based practice., (© Georg Thieme Verlag KG Stuttgart · New York.)