[Social pediatric care situation and needs during the COVID-19 pandemic from 2020 to 2022. What is needed now?] / Sozialpädiatrische Versorgungssituation und -bedarfe in Zeiten der COVID-19-Pandemie 2020 bis 2022. Was wird jetzt gebraucht?

BACKGROUND: Children and adolescents with social pediatric care needs represent a group with special challenges. The aim of this qualitative study was to describe social pediatric care during the pandemic from the perspective of experts. From this, conclusions were to be drawn for any social pediatric care needs that may have arisen. METHODS: Between May and November 2022, 25 experts from the field of social pediatrics were interviewed using guided interviews on the following topics: deviations in care, utilization behavior of families, individual burdens and resources, and sustainable needs. The interviews were analyzed by two research assistants. RESULTS: Overall, the social pediatric care offer was temporarily clearly limited. While families who were already well connected before the pandemic could be adequately cared for with the help of telephone/video contacts, an unreported number of at-risk groups, were described, for example, those with low competence to act, who did not make use of services or did so with delays. It was observed that there was a need for care for newly developed mental disorders and regression in therapy due to limited opportunities for support, as well as a need to catch up on missed opportunities for early support in the case of developmental disorders. DISCUSSION: To meet the needs that have arisen, underserved families should be identified and cared for promptly, taking individual characteristics into account. To this end, for example, more outreach services should be established that reach affected families unbureaucratically.

The Role of Urine and Washing Cytology in Primary Transurethral Resection of Bladder Tumours.

INTRODUCTION: Urine cytology (UC) is a recommended tool for the diagnosis of urothelial malignancies. Thus far, no specific recommendations regarding the role of washing cytology (WC) have been included in the guidelines. The goal of our study was to analyse the relationship between the histology of transurethrally (transurethral resection of the bladder [TURBT]) resected bladder tumours (BCa) and intraoperative UC or WC findings. MATERIALS AND METHODS: Five hundred consecutive primary TURBT cases conducted between November 2010 and 2015 at our department of the University Hospital Luebeck were retrospectively analysed. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of UC and WC were evaluated to detect BCa. Multivariate logistic regression models were fit to further examine associations between patient- and tumour-related factors and a bladder UC or WC positive for BCa. RESULTS: UC was performed in 297 patients, WC in 294 patients, and both in 261 patients. Sensitivity was 50.7% in UC, 58.1% in WC, and 62.1% for both tests combined. Specificity was 97.8% for UC, 98.0% for WC, and 96.4% for the combined tests. PPV was 98.0% for UC, 98.1% for WC, and 97.2% for combined tests. NPV was 47.8% for UC, 54.5% for WC, and 55.9% for the combined tests. The multivariate analyses revealed no association between positive UC or WC results and subsequent radical cystectomy (UC OR 1.35, 95% CI: 0.3-5.7; WC OR 2.0, 95% CI: 0.4-11.4). Neither UC nor WC was significantly correlated with local recurrence. CONCLUSIONS: Cytologic testing is an important diagnostic tool in BCa detection, showing acceptable sensitivity of around 60% and excellent specificity of over 90%. UC and WC present similar sensitivity. Our results advocate, however, against cytologic testing during primary TURBT, especially with regard to the lack of value in assessing the risk of recurrence. The clinical benefit of taking both types of samples at once is minimal. Furthermore, intraoperative WC collection does not reliably predict subsequent cystectomies.

Impact of COVID-19 crisis on medical care of patients with metastasized uro-oncologic disease under systemic cancer therapy: a multicenter study in German university hospitals.

PURPOSE: To date, over 4.2 million Germans and over 235 million people worldwide have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Uro-oncology (UO) patients are particularly vulnerable but in urgent need of life-saving systemic treatments. Our multicentric study examined the impact of the COVID-19 crisis on the medical care of UO patients in German university hospitals receiving ongoing systemic anti-cancer treatment and to detect the delay of medical care, defined as deferred medical treatment or deviation of the pre-defined follow-up assessment. METHODS: Data of 162 UO patients with metastatic disease undergoing systemic cancer treatment at five university hospitals in Germany were included in our analyses. The focus of interest was any delay or change in treatment between February 2020 and May 2020 (first wave of the COVID-19 crisis in Germany). Statistical analysis of contingency tables were performed using Pearson's chi-squared and Fisher's exact tests, respectively. Effect size was determined using Cramér's V (V). RESULTS: Twenty-four of the 162 patients (14.8%) experienced a delay in systemic treatment of more than 2 weeks. Most of these received immuno-oncologic (IO) treatments (13/24, 54.2%, p = 0.746). Blood tests were delayed or canceled significantly more often in IO patients but with a small effect size (21.1%, p = 0.042, V = 0.230). Treatment of patients with renal cell carcinoma (12/73, 16.4%) and urothelial carcinoma (7/32, 21.9%) was affected the most. CONCLUSIONS: Our data show that the COVID-19 pandemic impacted the medical care of UO patients, but deferment remained modest. There was a tendency towards delays in IO and ADT treatments in particular.

Prediction of chronic lymphocytic leukaemia incidence in Germany and of patients ineligible for standard chemotherapy.

Chronic lymphocytic leukaemia (CLL) patients often remain asymptomatic for several years after diagnosis. When the disease becomes symptomatic or progressive, chemotherapy with fludarabine in combination with an anti-CD20 antibody (FCR) is recommended as standard therapy, except for patients with relevant comorbidity or with del(17p13) oder TP53 mutation. We predict the number of prevalent CLL patients in 2011-2020 who need first-line therapy but are ineligible for FCR treatment. The input parameters of the Markov model are the estimated total CLL incidence (based on German cancer registry data) and clinical data on disease progression and patient characteristics (obtained by a systematic literature research). Plausibility ranges for the estimation of the total CLL incidence are given by the following: (1) inclusion of small lymphocytic lymphoma and (2) an alternative handling of death-certificate-only cases. The number of patients ineligible for FCR treatment increases from approximately 1200 in 2011 to approximately 1450 in 2020. The inclusion of small lymphocytic lymphoma cases results in 10% higher estimates, the alternative handling of death-certificate-only cases in 8% lower estimates. Recently, several new and targeted agents have been approved for CLL patients ineligible for standard treatment. Estimation of patient numbers is a prerequisite for planning of health care and for calculating the costs of treatment. Copyright © 2015 John Wiley & Sons, Ltd.

The ProCaSP study: quality of life outcomes of prostate cancer patients after radiotherapy or radical prostatectomy in a cohort study.

BACKGROUND: This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer. METHODS: The prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups' baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data. RESULTS: The typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values. CONCLUSIONS: Findings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients' health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient.

Incidence trends of nonmelanoma skin cancer in Germany from 1998 to 2010.

BACKGROUND AND OBJECTIVES: Nonmelanoma skin cancer (NMSC) is the most common malignant neoplasm in Germany. However, little is known about incidence trends of NMSC and its main subtypes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in Germany. MATERIAL AND METHODS: Cancer registry data from fourteen German federal states was used to estimate age-standardized incidence rates by histologic subtype. Annual percentage changes (APC) were estimated in joinpoint regression models, in order to assess trend shifts in the years from 1998 to 2010. RESULTS: In Germany, incidence rates of NMSC showed a significant increase from 43.1 cases/100 000 in 1998 to 105.2 cases/100 000 in 2010. Incidence rates and incidence increases revealed large regional variations. Basal cell carcinoma was the most common tumor followed by SCC. Men were more frequently affected than women, but incidence increases were steeper in women. CONCLUSIONS: Results are consistent with national and international observations. The heterogeneity of incidence rates and their changes among federal states indicate that incidence changes are most likely related to improved case registration practices in German cancer registries.

[Non-pharmaceutical therapy of candidates for geriatric rehabilitation: Non-pharmaceutical therapy prescribed by SHI-accredited doctors after application for outpatient geriatric rehabilitative care]. / Heilmittelversorgung geriatrischer Rehabilitationskandidaten in Schleswig-Holstein: Vertragsärztlich verordnete Heilmitteltherapie nach Beantragung ambulanter geriatrischer rehabilitativer Versorgung.

BACKGROUND: The rejection of an application for ambulant geriatric rehabilitation (AGRV) is usually justified by the argument that non-pharmaceutical therapy prescribed by doctors accredited by social housing institutions (SHI) would suffice. The reality in healthcare during the 6 months following an application is unknown. METHODS: In this study 203 patients who had made an application for AGRV in the second half of 2010 in Flensburg, Lübeck or Ratzeburg were interviewed by telephone. RESULTS: The survey revealed that 25.7% of the applications for AGRV had been rejected. The majority of these patients received no ambulant non-pharmaceutical therapy (e.g. physical therapy, physiotherapy, occupational therapy, speech therapy or psychological therapy), less than 20% received more than 12 therapy sessions and in most cases exclusively physiotherapy. The 141 successful AGRV applicants received additional ambulant therapies of a similar magnitude. CONCLUSION: The difference between the intensified interdisciplinary therapy offered in the AGRV and additionally and the offer to rejected applicants is substantial.

[Timed up and go test for fingers in the form of the 20 cents test. Psychometric criteria of a simple performance test of fine motor skills]. / "Timed up and go" für die Finger in Form des 20-Cents-Tests. Psychometrische Gütekriterien eines einfachen Feinmotorik-Performance-Tests.

BACKGROUND: Although many activities depend on intact fine motor skills no standardized assessment has been broadly established. The 20 cents test (20-C-T) was developed in 2009 and takes less than 5 mins. The quality criteria were investigated within the framework of this study. PATIENTS AND METHODS: A total of 300 geriatric patients participated in the study. The classification of occupational therapists based on standardized anamnesis and clinical examination served as the gold standard. Physiotherapists blinded to the study particulars applied the 20-C-T. RESULTS: Every fourth patient suffered from deficits in fine motor skills relevant to everyday life. The 20-C-T correlated with the clinical severity level and was also feasible for patients with intermediate impairment of cognition or vision. Handedness, age and sex were without significant influence. Intrarater and interrater reliability were good. CONCLUSION: Standardized testing of fine motor skills should be included in geriatric screening and basic assessment. The quality criteria of the 20-C-T show that it can be used for this purpose. Further diagnostic steps are recommended whenever a geriatric patient needs more than 40 s for the task.

Transition to endemic: 2-year SARS-CoV-2 surveillance follow-up of the ELISA cohort.

The 2-year SARS-CoV-2 surveillance follow-up of the ELISA cohort shows the successful transition from COVID-19 pandemic to endemic, confirms occupational risk factors in healthcare and identifies household risk factors in a high-incidence period https://bit.ly/43x8q6i.

General and health-related life satisfaction of patients with community-acquired pneumonia.

When assessing the quality of care, patients' characteristics such as general and health-related life satisfaction, are of major significance. Our study examined the general and health-related life satisfaction of patients with community-acquired pneumonia (CAP). To quantify the general and health-related life satisfaction, we used the validated instrument Questions on Life Satisfaction(Modules) by Henrich and Herschbach. CAP cases included in the German competence network on CAP (CAPNETZ) were asked to answer questions on their personal satisfaction with aspects of their life and health and on the individual importance of each addressed aspect. Data were compared with a normal population sample. In addition, several subgroup analyses were conducted. One thousand eight hundred ninety-nine (50.5%) CAP patients returned the questionnaire within a median time of 3 days. The mean age of the study sample was 55.1 +/- 17.1 years, 47.0% were female. The CAP patients reported not only a lower satisfaction with health (52.1 +/- 42.6 vs. 74.4 +/- 41.5, p < 0.001), but also a lower general life satisfaction (55.0 +/- 35.2 vs. 60.5 +/- 37.3, p < 0.001) than the normative German sample. Subgroup analyses revealed a significantly impaired general life satisfaction in patients with comorbidities (52.2 +/- 34.7) compared with patients without any underlying disease (58.1 +/- 35.4, p = 0.001). A non-significant lower general life satisfaction (53.3 +/- 35.1 vs. 57.0 5 +/- 35.2, p = 0.052) as well as a lower health-related life satisfaction (49.25 +/- 42.0 vs. 55.3 +/- 43.0, p = 0.602) could be observed in men compared with those in women. Patients aged 65 years and older and patients with a severe CAP reported a lower health-related life satisfaction, but a higher general life satisfaction than younger patients or patients with mild CAP. The lower general life satisfaction observed in patients with CAP was found to reflect comorbidity rather than the effects of the pneumonia itself.

Longitudinal measurement of airway inflammation over one year in children and adults with intermittent asthma.

BACKGROUND: Asthma is an inflammatory disease of the airways, but in clinical practice inflammation is rarely monitored. The aim of this study was to assess the level of airway inflammation in steroid naïve adult and pediatric patients with intermittent asthma over one year. METHODS: 54 children and 50 adults with intermittent asthma (GINA step 1) were included. On up to 6 visits lung function, airway hyperresponsiveness to methacholine (PC20FEV1), sputum eosinophils and exhaled nitric oxide (FeNO) were assessed. RESULTS: 36 pediatric and 34 adult patients were able to produce at least three adequate sputum samples over the study period and were included into the analysis.In 8 children (22%) the percentage of sputum eosinophils was always below 2.5%. A higher level of eosinophils (>2.5%) was found on at least one visit in 16 (44%) and always >2.5% in 12 children (33%). In the adult group the respective numbers were 14 patients (41%) with always low (<2.5%), 17 (50%) with at least once over 2.5% and three patients (9%) were always above the threshold of 2.5% sputum eosinophils. CONCLUSION: These results demonstrate that a substantial number of children and adults with intermittent asthma under ß-agonist treatment only, have variable or persistently high levels of eosinophilic airway inflammation. Long-term studies are needed to observe the progression of asthma severity in such patient populations.

Approaches to estimate the population-based incidence of community acquired pneumonia.

OBJECTIVES: In Germany the estimation of a population based annual incidence of community acquired pneumonia (CAP) in adults has been referred to the denominator problem. To estimate a population based annual incidence of CAP in an urban German area we compared the incidence estimated on four different approaches. METHODS: We estimated the annual incidence on the basis of the covered population of sentinel practices from Luebeck participating in the German competence network CAPNETZ. We estimated the incidence on the basis of a population based survey, on the basis of the mortality and lethality in Luebeck, and on the basis of data of the regional Association of Statutory Health Insurance Physicians ("Kassenärztliche Vereinigung (KV) Schleswig-Holstein"). RESULTS: The annual incidence of CAP in Luebeck was 3.7/1000 inhabitants (95% confidence interval (CI) 2.4-5.5), 6.0/1000 inhabitants, 8.7/1000 inhabitants (95% CI 8.2-9.1), or 10.1/1000 inhabitants (95% CI 9.6-10.5) depending on the approach of estimation. According to this, in Germany we would expect 400,000-680,000 new CAP cases per year. CONCLUSIONS: The true incidence of CAP in Luebeck might range between 3.7 and 10 per 1000 inhabitants. Comparisons with the rates in the literature are difficult due to the differences in the applied methods.

Bicaval versus standard technique in orthotopic heart transplantation: a systematic review and meta-analysis.

OBJECTIVE: We aimed to evaluate and compare the efficacy of the bicaval and the biatrial standard techniques in orthotopic heart transplantation. METHODS: A systematic review with meta-analysis was performed. As data sources, we used the electronic databases EMBASE and Medline (1966-August 2006), hand searching in 4 journals, expert consultation, and reference lists of reviews. Observational and randomized and prospective and retrospective controlled trials that reported outcomes on the 2 techniques of heart transplantation were considered. RESULTS: A total of 23 retrospective and 18 prospective studies were included. Meta-analyses of prospective trials including between 228 and 472 patients revealed significant superiority of the bicaval technique in comparison with the biatrial procedure for early atrial pressure (weighted mean difference, -3.95; 95% confidence interval, -6.50 to -1.40), perioperative mortality (odds ratio, 0.41; 95% confidence interval, 0.17 to 0.98), tricuspid valve regurgitation (odds ratio, 0.23; 95% confidence interval, 0.15 to 0.36), and sinus rhythm (odds ratio, 7.01; 95% confidence interval, 2.57 to 19.13). The latter also showed a significant difference in the analysis of retrospective studies (odds ratio, 2.69; 95% confidence interval, 1.55 to 4.66). CONCLUSION: In summary, this systematic review and meta-analysis provides evidence of clinically relevant beneficial effects of the bicaval technique in comparison with those of the standard technique. Nevertheless, the longer-term beneficial effects of the bicaval technique remain to be evaluated.