GMS German Medical Science最新文献

Background: Congenital malaria, defined as the presence of malaria parasites in the peripheral smear of newborns within the first seven days of life, remains an underexplored aspect of malaria epidemiology in endemic regions like Nigeria. This study investigated the prevalence and associated risk factors of congenital malaria at the State Specialist Hospital (SSH), Osogbo, Southwestern Nigeria.

Method: This cross-sectional study collected peripheral and cord blood samples from 77 newborns within the first 24 hours of delivery. We examined blood samples for malaria parasites using both light microscopy and malaria rapid diagnostic test (mRDT) kits. A structured research proforma was used to assess various risk factors, including sociodemographic details, gravidity, parity, retroviral status, and malaria prevention measures during pregnancy.

Results: The overall prevalence of congenital malaria was 6.5%, with all infants exhibiting congenital malaria also demonstrating cord blood parasitaemia. Maternal malarial parasitaemia emerged as a strong predictive factor (p<0.05), while factors such as maternal retroviral status, intermittent prophylactic therapy, therapeutic antimalarial use, and bednet usage were not significantly associated with congenital malaria (p>0.05).

Conclusion: Our study observed a low prevalence of congenital malaria in Osogbo and emphasizes the significance of maternal malarial parasitaemia in predicting the condition. However, there is need for additional multicenter studies to comprehensively determine the prevalence of congenital malaria in Osun State and Nigeria, providing a basis for targeted interventions and healthcare strategies.

The explantation of medical devices is a common procedure. However, the legal regulations and the resulting obligations of treating physicians and institutions regarding the handling of explanted medical devices are not always well known. The present recommendations aim to summarize the essential legal and practical aspects involved in the process following the explantation of medical devices.

The reliability of laboratory tests is ensured in particular by the interaction of regulated market access and certification of diagnostics, scientific evidence through guidelines, the guideline of the German Medical Association on quality assurance of laboratory medical examinations mentioned in § 9 of the German Medizinproduktebetreiberverordnung, as well as standardisation and accreditation. The Webinar 2024 of the Association of Scientific Medical Societies in Germany's (AWMF) Ad-hoc Commission on In-vitro Diagnostics on 9 October 2024 highlighted this thematic network in four presentations from the perspective of the Federal Ministry of Health, the AWMF Institute for Medical Knowledge Management (IMWi), the German Accreditation Body (DAkkS) and the German Medical Association.

Objective: Diabetes is associated with lower labour force participation. The proportion of people having diabetes is higher among people with a low socio-economic position. We aimed to describe socio-economic differences in the association between diabetes and labour force participation in Germany.

Methods: Based on repeated cross-sectional data from the German Socio-Economic Panel Study, the probability for participating in labour force was modelled with a logistic regression model including diabetes status, sex, socio-economic position, survey year and age as independent variables. Analyses accounted for the complex survey design of the study and used post-stratification weights. For easier interpretation, we estimated relative risks instead of odds ratios from logistic regression using post-estimation techniques. Relative labour force participation shortfall [%] was calculated as (1 - relative risk) x 100.

Results: Labour force participation among people without diabetes was 82.2% compared to 55.9% among people with diabetes. Labour force participation shortfall was higher for low socio-economic position values and decreased with increasing socio-economic position. Labour force participation shortfall was generally larger among women while the association between labour force participation shortfall and socio-economic position was stronger among men.

Conclusions: Diabetes-associated labour force participation shortfall mainly affects people with low socio-economic position, which indicates that this population subgroup not only carries a higher risk of diabetes, but also might be more strongly affected by its negative impact on productivity. Future studies aiming to quantify diabetes-associated productivity losses should take associations specific to socio-economic position into account.

The guideline is being drawn up as a joint guideline for oropharyngeal and hypopharyngeal carcinoma. Oropharyngeal carcinoma in particular has experienced the greatest increase in incidence among all head and neck carcinomas in the last 20 years and is now the sixth most common cancer in men in Germany. Together with hypopharyngeal carcinoma, these tumors are currently the most common cancer entity in the head and neck region. Due to the association with human papillomavirus type 16 (HPV16), we now distinguish two groups of oropharyngeal carcinomas in Germany: HPV16-positive (approx. 35%) and HPV-negative (approx. 65%). A HPV16 association with hypopharyngeal carcinoma has not been described. The therapy covers the entire spectrum of head and neck surgery, including diversified reconstructive procedures, transoral and external approaches, the options for primary and adjuvant radiotherapy (possibly in combination with chemotherapy) and the current recommendations for drug-based tumor therapy, which range from classic chemotherapy to immuno-oncology. In addition, measures for early detection and prevention are carried out, with particular consideration of the HPV16-associated genesis of oropharyngeal carcinoma, as well as adequate rehabilitation after the primary treatment of oropharyngeal and hypopharyngeal carcinomas. Finally, the treatment options for recurrences or distant metastases that cannot be cured in the further course of the disease are shown and classified.

Introduction: According of the level and severity of the spinal cord injury or disease (SCI/D), and the impairment of motor, sensory, and autonomic functions, individuals with SCI/D recover some standing and walking capabilities. To increase quality of rehabilitation and use newest evidence, the clinical practice guideline (CPG) "S2e-Guideline Rehabilitation of lower extremities, standing and walking function in people with SCI/D" of the German speaking Medical Association for Paraplegiology (DMGP) was updated.

Methods: Following a multi-tiered approach systematic searches were conducted to identify appropriate literature. For this purpose, the Databases PubMed, EMBASE, Cochrane Library and PEDro were searched. Recommendations on assessments were grouped to the categories "activity and participation" or "body functions/body structures". Recommendations on interventions were labeled with outcomes standing, walking, strength, range of motion, pain and muscle tonus.

Results: In total, 9,871 studies were identified during the search. Of these, four systematic reviews and eleven primary studies were utilized in composing the recommendations. A total of 25 recommendations were made, with 20 derived from the literature and 5 based on expert consensus. In total 14 functional assessments and 11 rehabilitation interventions became compiled. The assembled recommendations regarding assessments could be well built on published literature, while overall there is a paucity of literature proofing the evidence of specific interventions used in clinical practice. Therefore, the expertise of the international expert group and input from patient representatives were pivotal.

Conclusion: The method of an evidence-based guideline was sufficient for the recommendation of functional assessments but showed the need scientific clarification in the field of clinically established interventions.

Objective: After over 25 years of developing clinical practice guidelines, the Association of the Scientific Medical Societies in Germany (AWMF) held a symposium to discuss the following topics in order to improve the way evidence is implemented in the delivery of care: expansion of the data pool for guideline development, the regulatory policy framework for this expansion, the transfer of clinical practice guideline statements to medical practice, the associated opportunities and risks resulting from the European legislation.

Methods: The AWMF held its Berlin Forum on 27 April 2022 where experts from scientific medical societies and national institutions in the healthcare sector reported their experiences and perceptions on the topics mentioned. Three writing groups compiled the key statements from these contributions to and discussions made at the Berlin Forum into a position paper.

Results: The AWMF recommends the following:- The creation of a digital infrastructure that serves the quality assurance of clinical practice guidelines and makes their content available at the bedside and during consultations- An increase in the number of industry-independent clinical trials on prevention, diagnostics and therapy with medicinal products, medical devices or other procedures - The funding of registry structures to generate point-of-care healthcare data- The reduction of excessive bureaucratic hurdles at both the national and EU level.

Conclusions: By making concrete recommendations in this position paper, the AWMF maps out the steps required to improve the translation of evidence to the delivery of clinical care.

Institutes for pathology act as operators, users and in-house manufacturers of in vitro diagnostic medical devices and are subject to national and European regulations depending on their function. The entry into force of the EU regulation on medical devices (Regulation (EU) 2017/745, MDR) and the EU regulation on in vitro diagnostic medical devices (Regulation (EU) 2017/746, IVDR) resulted in a need for regulatory adjustments to German medical device law. This has created a new legal framework in which institutes for pathology operate, depending on their function as users, operators or in-house manufacturers of in vitro diagnostic medical devices. This overview of the current legal situation represents a snapshot and provides an up-to-date overview of the landscape of European and German medical device law.

Objective: Common spatial pattern (CSP) is a common filter technique used for pre-processing of electroencephalography (EEG) signals for imaginary movement classification tasks. It is crucial to reduce the amount of features especially in cases where few data is available. Therefore, different approaches to reduce the amount of electrodes used for CSP calculation are tried in this research.

Methods: Freely available EEG datasets are used for the evaluation. To evaluate the approaches a simple classification pipeline consisting mainly of the CSP calculation and linear discriminant analysis for classification is used. A baseline over all electrodes is calculated and compared against the results of the approaches.

Results: The most promising approach is to use the ability of CSP to provide information about the origin of the created filter. An algorithm that extracts the important electrodes from the CSP utilizing these information is proposed.The results show that using subject specific electrode positions has a positive impact on accuracy for the classification task. Further, it is shown that good performing electrode combinations in one session are not necessarily good performing electrodes in another session of the same subject. In addition to the combinations calculated using the developed algorithm, 26 additional electrode combinations are proposed. These can be taken into account when selecting well-performing electrode combinations. In this research we could achieve an accuracy improvement of over 10%.

Conclusions: Carefully selecting the correct electrode combination can improve accuracy for classifying an imaginary movement task.