[Artificial intelligence and smartphone program applications (Apps) : Relevance for dermatological practice]. / Künstliche Intelligenz und Smartphone-Programm-Applikationen (Apps) : Bedeutung für die dermatologische Praxis.

ADVANTAGES OF ARTIFICIAL INTELLIGENCE (AI): With responsible, safe and successful use of artificial intelligence (AI), possible advantages in the field of dermato-oncology include the following: (1) medical work can focus on skin cancer patients, (2) patients can be more quickly and effectively treated despite the increasing incidence of skin cancer and the decreasing number of actively working dermatologists and (3) users can learn from the AI results. POTENTIAL DISADVANTAGES AND RISKS OF AI USE: (1) Lack of mutual trust can develop due to the decreased patient-physician contact, (2) additional time effort will be necessary to promptly evaluate the AI-classified benign lesions, (3) lack of adequate medical experience to recognize misclassified AI decisions and (4) recontacting a patient in due time in the case of incorrect AI classifications. Still problematic in the use of AI are the medicolegal situation and remuneration. Apps using AI currently cannot provide sufficient assistance based on clinical images of skin cancer. REQUIREMENTS AND POSSIBLE USE OF SMARTPHONE PROGRAM APPLICATIONS: Smartphone program applications (apps) can be implemented responsibly when the image quality is good, the patient's history can be entered easily, transmission of the image and results are assured and medicolegal aspects as well as remuneration are clarified. Apps can be used for disease-specific information material and can optimize patient care by using teledermatology.

Role of the health professional in ending the tobacco pandemic: clinic, classroom, and community.

Physicians and other health professionals have become complacent about the tobacco pandemic, because there is a mistaken belief that the war on smoking has been won. In reality, the survival from lung cancer is little better than it was 30 years ago, and cigarettes have become the most advertised and promoted product in society. The prevalence of overall smoking in the United States has declined by only 0.5%/y during the past decade. Among certain US minority populations, the decline has been far less or nonexistent. Traditional efforts to control the tobacco pandemic have been reactive and static, whereby government agencies, schools, and health professionals provide the public with generic information about the adverse health effects of smoking. As a result of these efforts, it is assumed that individuals will act to change their behavior. In contrast, the tobacco industry is proactive and dynamic, changing its brand-name strategies through advertising and promotion. To more effectively combat tobacco use, health officials need to move beyond patient education and adopt a more active model that includes clinic-based, school-based, and community-based tobacco-control strategies. Use of humorous, satirical images as part of paid counteradvertising campaigns and proactive health education curricula should be part of a concerted effort to end the tobacco pandemic and limit the promotional influence of tobacco companies.

Depressive symptoms and health service utilization among the community elderly.

The relationship between depression and complaints of physical disease in the elderly is often discussed but has received little documentation. The authors administered questionnaires to 88 elderly volunteers to assess two common psychologic diagnoses, affective disorders and organic brain syndrome, and three common cardiovascular symptoms, pain or numbness in the jaw or arm, pressure in the chest, and difficulty in breathing. Data on utilization of health care professionals and demographic information were also obtained. A significant correlation between reports of depression and complaints of cardiovascular symptoms was seen. While the volunteers with depressive symptoms also visited their physicians more often than did the other volunteers, they did not seek the help of mental health professionals. This raises the larger issue that elderly persons who have mild to moderate depression present to our health care system.

Paid counter-advertising: proven strategy to combat tobacco use and promotion.

This article discusses the effectiveness of paid counter-advertising in combating tobacco use and promotion, the impact of the Fairness Doctrine, which mandated anticigarette television advertisements in the late 1960s, and reasons why the media today are reluctant to run antismoking advertisements. Although counter-advertisements can work very well, they should be image-based, rather than fact-based. Currently, tobacco companies promote a positive image of cigarette smoking and brand awareness. Most antismoking ads, however, tend to focus on the tobacco itself and its adverse effects on the smoker, rather than combating the images the cigarette ads promote. Urging counter-advertising to focus on the product, rather than to try to produce guilt in smokers, this article provides examples of paid counter-advertising strategies employed by Doctors Ought to Care to illustrate an image-based approach. Overall, the antismoking movement must guard against complacency and measure its success according to tobacco companies' declining revenues, rather than the number of public service advertisements in the media.

[Helicobacter pylori infection and ulcer]. / Helicobacter-pylori-Infektion und Ulcuskrankheit.

Our understanding of ulcer pathogenesis has dramatically changed since the discovery of Heliobacter pylori. Peptic ulcer is now recognized as a chronic gastric infectious disease. H. pylori can be considered the pacemaker, with other known risk factors ultimately contributing to the ulcer formation. Treatment of H. pylori in peptic ulcer disease cures the acute lesion and prevents relapse and complications. In clinical management a positive diagnosis of H. pylori is required and other potential causes for ulcer formation must be excluded before starting treatment. The standard treatment in H. pylori positive ulcer consists of PPI in standard dose and two antibiotics either clarithromycin 2 x 500 mg and amoxycillin 2 x 1 g or metronidazole 2 x 400 mg and clarithromycin 2 x 250 mg (or 500 mg) for 7 days. The simultaneous presence of H. pylori and NSAID intake requires distinct management. Following bleeding complication a PPI needs to be given beyond 7 days until ulcer healing is endoscopically confirmed.

[Prevention of recurrence of ulcer disease: indications and choice of procedure]. / Rezidivprophylaxe der Ulkuskrankheit: Indikation und Verfahrenswahl.

In this contribution we discuss the relapse prophylaxis of ulcers by nonmedicamentous measures, by long-term drug therapy and, in particular, with inhibitors of secretion, by eradication therapy of Helicobacter pylori and by surgical therapy. Besides secondary prophylaxis (prevention of ulcer relapses), primary prophylaxis (prevention of the first episode) is also briefly treated.

The family physician and health promotion: do-gooding or really doing well?

Conventional health promotion efforts, whether attempted by the individual physician or by community-wide health charities, suffer from a lack of creativity, timeliness, and an awareness of the principles of effective advertising. The difference between do-gooding and really doing well lies in carefully identifying the promoters of adverse health behavior (such as cigaret advertisers), studying their success, and-on an individual and community-wide basis-counteracting their influence by investing time and money in individualized, positive health strategies.

[Objectives in the therapy of ulcers]. / Ziele bei der therapie der Ulkuskrankheit.

The six aims of ulcer treatment are acceleration of healing, improvement of pain, prevention of complications and recurrences, avoidance of side effects of medical treatment, and reduction of the costs of treatment. The most important aims are prevention of recurrences and late complications. During acute exacerbation of the ulcer a favorable effect on ulcer symptoms is more important than acceleration of healing. It is now accepted practice that drugs with side effects should not be used in the treatment of ulcer. The costs of treatment are best reduced by the reduction of recurrences, irrespective of the actual cost of the drug used for this purpose

[Taking responsibility for one's own health. Possibilities and limits using the example of malignant melanoma]. / Gesundheitliche Eigenverantwortung. Möglichkeiten und Grenzen am Beispiel des malignen Melanoms.

Because of the persistent shortage of health care resources, scientists and politicians are discussing ways to increase the patients' personal responsibility for their own health. Based on a philosophical analysis of the concept of responsibility, this article tries to assess strengths and limits of a personal responsibility for health, illustrated by the prevention of cutaneous melanoma. On the one hand, individuals bear prospective responsibility for their health status by adopting a healthy lifestyle and participating in prevention programs. On the other hand, individuals can--retrospectively--be held responsible for those conditions that result from the voluntary choice of health risks. Considering the tremendous practical and ethical problems associated with retrospective responsibility, prevention and public health policies should emphasize prospective personal responsibility for health.

Snuffing tobacco out of sport.

Use of oral snuff has risen sharply among baseball players following a tobacco industry marketing campaign that linked smokeless tobacco with athletic performance and virility. Millions of adolescents have copied these professional role models and, today, are at risk of developing oral cancer and other mouth disorders. New policies and programs are needed to break the powerful grip that the tobacco industry has on professional sport. Health agencies, including the National Cancer Institute and the National Institute for Dental Research, have teamed up with major league baseball to help players quit and reduce public use of oral tobacco. If these efforts are successful, our national pastime will once again become America's classroom for teaching health and fitness, not nicotine addiction.

Application of argon plasma coagulation in skin surgery.

BACKGROUND: Argon plasma coagulation (APC) is a noncontact electrosurgical technique which has been used in open surgery for about 20 years and in endoscopy for about 5 years. OBJECTIVE: The aim of the present study was to provide preliminary results on the effect of this method in skin surgery. METHODS: The effects of variations in gas flow, output power and coagulation times on the extent of the resulting skin coagulation zone were tested in a pig skin model. Furthermore, preliminary results were obtained from 48 patients. RESULTS: The depth of the coagulation zone, which depends on the output power of the high-frequency (HF) generator and the application time, was examined clinically and histologically in 150 different pig skin coagulations. The maximum depth of the coagulation zone was 4 mm. Coagulation zones below 4 mm can be maintained by controlling the output power of the HF generator and/or the duration of application. Variations of argon flow did not influence the depth of the coagulation zone significantly. In preliminary clinical tests, 48 patients with common warts, senile hemangiomas and actinic keratoses were treated with APC. In all cases, APC was highly effective and easy to perform. No severe problems or complications were observed. The skin lesions were destroyed with minimal or no scarring and without damaging the surrounding tissue. CONCLUSION: In the present preliminary study, APC proved to be an effective treatment with well-controlled tissue destruction. Further clinical studies are required to evaluate the suitability and the indications of this method in the treatment of cutaneous lesions.

[Diagnosis and differential diagnosis of chronic pancreatitis (author's transl)]. / Diagnose und Differentialdiagnose der chronischen Pankreatitis

The large number of pancreas tests recommended today shows that no single method is satisfactory. In general, the rule holds that invasive methods are relatively conclusive and non-invasive are unreliable. In this report it is shown that by a rational combination of simple tests, a reliable procedure for pancreatic diagnosis in about 75% of cases is possible for the general practitioner. The methods described in recent years, such as scintigraphy, ultrasonography, angiography and retrograde pancreaticography are complicated and require great experience. In combination, they raise the accuracy to about 95%. Individual investigators can specialize in only one or a few of these methods. Diagnosis of pancreatic conditions which exceed the facilities of the doctor in practice is only possible in large centers or through co-operation of several specialists.