Test-Retest Reliability and Construct Validity of the German Translation of the Gait Outcome Assessment List (GOAL) Questionnaire for Children with Ambulatory Cerebral Palsy.

The Gait Outcome Assessment List (GOAL) is a patient or caregiver-reported assessment of gait-related function across different domains of the International Classification of Functioning, Disability, and Health (ICF) developed for ambulant children with cerebral palsy (CP). So far, the questionnaire is only available in English. The aim of this study was to translate the GOAL into German and to evaluate its reliability and validity by studying the association between GOAL scores and gross motor function as categorized by the gross motor function classification system (GMFCS) in children with cerebral palsy (CP). The GOAL was administered to primary caregivers of n = 91 children and adolescents with CP (n = 32, GMFCS levels I; n = 27, GMFCS level II; and n = 32, GMFCS level III) and n = 15 patients were capable of independently completing the whole questionnaire (GMFCS level I). For assessing test-retest reliability, the questionnaire was completed for a second time 2 weeks after the first by the caregivers of n = 36 patients. Mean total GOAL scores decreased significantly with increasing GMFCS levels with scores of 71 (95% confidence interval [CI]: 66.90-74.77) for GMFCS level I, 56 (95% CI: 50.98-61.86) for GMFCS level II, and 45 (95% CI: 40.58-48.48) for GMFCS level III, respectively. In three out of seven domains, caregivers rated their children significantly lower than children rated themselves. The test-retest reliability was excellent as was internal consistency given the GOAL total score. The German GOAL may serve as a much needed patient-reported outcome measure of gait-related function in ambulant children and adolescents with CP.

[Exacerbation of working conditions due to the economic pressures of hospitals : Mandatory staffing ratios for physicians?] / Verschärfung der Arbeitsbedingungen durch Kostendruck der Krankenhäuser : Verpflichtende Personalschlüssel für Ärzte?

BACKGROUND: In current hospital-based urological care, economic pressure and its influence on urological working and further training conditions are a main point of criticism among young urologists. Against the background of a growing need for young talent in our specialist discipline, there is an urgent need for action. With the introduction of the lower limits for nursing staff, there is now a threat of a reduction in the number of physicians with the aim of reducing costs for business reasons. OBJECTIVE: A mandatory staffing ratio is often mentioned to counteract the downsizing in German clinics. The role of the lower staffing limit is explained in the following article. MATERIALS AND METHODS: We have analyzed the current draft laws of the federal government, as well as position papers and statements from federal political representatives such as the Marburger Bund, Bundesverband Deutscher Urologen and the German Medical Association (Bundesärztekammer) since 2018. RESULTS AND CONCLUSION: The analysis of current developments in nursing policy shows that the first step is a needs-based assessment of personnel and subsequent financing in the clinic setting. With adequate staffing, as in the traffic light scheme of the German Medical Association, not only would clinics position themselves as attractive employers and training centers for large parts of the urological medical profession, but would also significantly improve working conditions, patient care and patient safety. Medical training must remain an essential part of everyday hospital life.

General Movement Assessment from videos of computed 3D infant body models is equally effective compared to conventional RGB video rating.

BACKGROUND: General Movement Assessment (GMA) is a powerful tool to predict Cerebral Palsy (CP). Yet, GMA requires substantial training challenging its broad implementation in clinical routine. This inspired a world-wide quest for automated GMA. AIMS: To test whether a low-cost, marker-less system for three-dimensional motion capture from RGB depth sequences using a whole body infant model may serve as the basis for automated GMA. STUDY DESIGN: Clinical case study at an academic neurodevelopmental outpatient clinic. SUBJECTS: Twenty-nine high risk infants were assessed at their clinical follow-up at 2-4 month corrected age (CA). Their neurodevelopmental outcome was assessed regularly up to 12-31 months CA. OUTCOME MEASURES: GMA according to Hadders-Algra by a masked GMA-expert of conventional and computed 3D body model ("SMIL motion") videos of the same GMs. Agreement between both GMAs was tested using dichotomous and graded scaling with Kappa and intraclass correlations, respectively. Sensitivity and specificity to predict CP at ≥12 months CA were assessed. RESULTS: Agreement of the two GMA ratings was moderate-good for GM-complexity (κ = 0.58; ICC = 0.874 [95%CI 0.730; 0.941]) and substantial-good for fidgety movements (FMs; Kappa = 0.78, ICC = 0.926 [95%CI 0.843; 0.965]). Five children were diagnosed with CP (four bilateral, one unilateral CP). The GMs of the child with unilateral CP were twice rated as mildly abnormal with FMs. GM-complexity and somewhat less FMs, of both conventional and SMIL motion videos predicted bilateral CP comparably to published literature. CONCLUSIONS: Our computed infant 3D full body model is an attractive starting point for automated GMA in infants at risk of CP.

[Delegation yes, substitution no!]. / Delegation ja, Substitution nein!

The aging of society leads on the one hand to increasing case numbers and on the other hand to a reduction in the number of physicians available for patient treatment. The delegation and substitution of medical duties as a tried and tested method is increasingly being recommended in order to compensate for the lack of physicians. The Berufsverband der Deutschen Urologen (BDU, Professional Association of German Urologists) supports the guiding principle of the Bundesärztekammer (Federal Medical Council) of "delegation yes, substitution no" and rejects a substitution of medical duties by non-medical academic health personnel. Against the background of the demographic changes, the increasing need for treatment and the current deficiency of junior physicians, a more extensive inclusion of well-qualified and experienced non-medical personnel by the delegation of medically responsible duties (medical scope of practice) can be an appropriate measure to maintain a good medical service in practices, hospitals and nursing homes.

[Claim and reality of selective contact options : experiences in finalizing selective contracts in urological care]. / Anspruch und Wirklichkeit selektiver Vertragsmöglichkeiten : Erfahrungen beim Abschluss von Selektivverträgen in der urologischen Versorgung.

Selective contracts are an important component in addition to the total healthcare concept in order to introduce process-related innovations into the healthcare system. Since 2011 the Berufsverband der Deutschen Urologen (BDU, Professional Association of German Urologists) has held negotiations with individual health insurance companies and care providers in order to view selective contracts as collective contracts, not only as pilot projects but also as additional forms of care.This article illustrates the experiences of the BDU in the initiation and finalizing of selective contracts as well as existing weak points in the framework conditions.

[Innovative urology needs innovative pharmaceuticals and technology: new cooperation established between BDU and industry]. / Neue Kooperation zwischen BDU und Industrie begründet : Innovative Urologie braucht innovative Arzneimittel und Technologie.

For some time now medical care has been confronted with great challenges. New developments in the healthcare system result in new possibilities for cooperation in which the Professional Association of German Urologists (BDU) must participate. This is also true with respect to the Pharmaceutical Market Revision Act (AMNOG). The Industry Advisory Board aims to continuously observe and analyze the healthcare political and medical care political developments in Germany and Europe. The Professional Association has created room for a transparent cooperation with the Industry Advisory Board. The AMNOG which came into effect in 2011 also opened integrated contracts for businesses in the pharmaceutical industry.

Clinical assessment of indication for ACE-inhibitor treatment early after acute myocardial infarction.

An investigation was conducted to assess whether an algorithm based on simple clinical information would suffice to classify patients with acute myocardial infarction, with respect to indication for angiotensin-converting-enzyme inhibitor treatment. One hundred consecutive patients with myocardial infarction were prospectively studied. Based on clinical, radiological, electrocardiographic and biochemical information, the patients were classified as having (a) significantly depressed left ventricular function (ejection fraction < or = 40%) justifying treatment with angiotensin-converting-enzyme inhibitors (ACEI), (b) preserved ventricular function (ejection fraction > 40%) making ACEI unnecessary, or (c) indeterminate ventricular function, requiring further examination. Using a blinded design, ejection fraction was determined by echocardiography and radionuclide ventriculography. A clinical assumption of reduced left ventricular function had a predictive value of an echocardiographically determined ejection fraction < or = 40% of 83% (n = 23). Clinical criteria of good ventricular function had a predictive value of ejection fraction > 40% of 96% (n = 24). In these two groups clinical misclassification occurred in five patients with ejection fraction within the range of 39-45%. Left ventricular function was found to be clinically indeterminate in 53 of the 100 patients. Ejection fraction values assessed by radionuclide ventriculography (n = 44) were on average 9.3%-points lower than echocardiographic values. The indication for ACEI can apparently be determined on the basis of readily available clinical information in approximately 50% of patients with acute myocardial infarction.

Doppler echocardiographic estimation of the pressure gradient in aortic stenosis. An updated assessment of the technique used in clinical practice in 249 patients.

This study included 249 consecutive patients with suspected significant aortic valve stenosis. Using contemporary ultrasound equipment we reassessed the value of out-patient Doppler-derived maximum pressure gradients for the prediction of peak-to-peak pressure gradients measured later at heart catheterization. It was possible to record the pressure gradient in 97% of the patients by Doppler examination and in 86% at heart catheterization. There was a fair, statistically significant correlation between Doppler and invasive gradients (n = 201, r = 0.80, p < 0.05, SEE = 21 mm Hg), independent of coexistent aortic regurgitation, atrial fibrillation, left ventricular function, number of days between the examinations and other variables analysed. A Doppler gradient > 80 mm Hg was 98% (90-100%) predictive of critical aortic stenosis (gradient > 50 mm Hg as determined by heart catheterization). Similarly, a Doppler gradient of < or = 30 mm Hg was 98% (87-100%) predictive of non-critical stenosis. In the remaining patients (53% of the population) the Doppler gradient did not contribute decisively to clinical management.

[Dentistry: debit and credit; the 1979 rectorial address in Bern]. / Zahnmedizin - Soll und Haben; Rektoratsrede 1979 in Bern.

The importance of the elimination of pain and its refinement by local anesthesia, analgesia and general anesthesia is shown in dental treatment. Preventive measures have gained weight: Teaching patients about plaque and sugar, the importance of fluorides, oral hygiene in school dentistry, changes in nutrition. Economic aspects are shown in the divergence of cost between prevention and therapy. Implants as a last resource are mentioned. Finally, in conclusion, it is emphasized that prevention must rank first in proper dental education into which postgraduate education in a future postgraduate clinic should be integrated.

[Relativity and limits of success yesterday and today]. / Relativität und Endlichkeit des Erfolgs gestern und heute.

A comparing of today's dentistry and the time limits of its success with dental medecine of yesterday, we state an unquestionable advance in the preventive field. Causes of caries and parodontopathies are so well known that proper preventive measures have shown, within the last twenty years, statistically relevant success. Such positive results may be endangered by politics which tend to eliminate personal responsibility and which establish insurance systems by which even the most expensive dental restorations must be paid by the collective community. Thus prophylactic measures become unimportant to the individual. Preventive thinking has various facets: The system of filling gaps and holes must yield to the system of rehabilitation at every level. The basis to this is a high standard of professional ethics. Its realization is easier if dentistry is not subdivided into too many specialties. On the other hand, the dentist must have a large spectrum of knowledge, which is only obtainable through continuous education. The younger generations are profiting most from this development of knowledge, but the old and the handicapped should not be forgotten in the process. It will be one of the noblest tasks of the profession henceforward to care for the treatment of this dentally underpriviledged part of our population.