GMS German Medical Science最新文献

{"title":"A case for the introduction of the ICD-11 in Germany.","authors":"Jürgen Stausberg, Rolf Bartkowski, Wolfgang Gaebel, Rolf-Detlef Treede","doi":"10.3205/000365","DOIUrl":"10.3205/000365","url":null,"abstract":"<p><p>Since its adoption by the World Health Assembly in 2019, the 11^th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) has been set to replace ICD-10. The old revision is no longer maintained by World Health Organization (WHO). In Germany, a national advisory board (Kuratorium für Fragen der Kodiersysteme im Gesundheitswesen (KKG)) of the Ministry of Health is concerned with ICD-11 since 2013. Members of the KKG Working Group ICD-11 from the Association of the Scientific Medical Societies in Germany (AWMF) describe in this paper the need for a careful, well planned and timely transition from ICD-10 to ICD-11. The transition to ICD-11 ensures a valid representation of medical progress with the coded diagnoses and seizes opportunities of digitization for health care and science. Combining a unique documentation of medical facts with their multiple use for daily health care and research as well as for reimbursement and health policy should be the ultimate goal. This goal demands a one-time coding covering different coding systems in order to bridge a transitional period with parallel support of ICD-10 and ICD-11 on the one hand and to support further policy areas, e.g. with SNOMED CT, on the other hand. In particular, the use of generative artificial intelligence offers a high potential to achieve this goal. Even though estimating the time required is always subject to a high degree of uncertainty given the nature of the German health care system, the transition from ICD-10 to ICD-11 can be carried out in the next 5 years. Then, 13 years without content maintenance through the WHO, the ICD-10 would have lost the connection to the medical State of the Art at the latest.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc12"},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"About the future of GMS German Medical Science.","authors":"Manfred Gogol","doi":"10.3205/000364","DOIUrl":"https://doi.org/10.3205/000364","url":null,"abstract":"","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc11"},"PeriodicalIF":0.0,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting urinary tract infections: Anti-MDR efficacy of Syzygium aromaticum small molecules against uropathogenic Escherichia coli through in vitro and in silico approaches.","authors":"Farhan Kesawa Mukti, Fairuz Fajriani Kusumaningrum, Muhammad Evy Prastiyanto, Daniel Geleta, Abdul Rahman Siregar, Wahyu Aristyaning Putri","doi":"10.3205/000363","DOIUrl":"10.3205/000363","url":null,"abstract":"<p><p>Urinary tract infections (UTIs) are becoming increasingly challenging to treat owing to the emergence of multidrug-resistant (MDR) strains, including uropathogenic <i>Escherichia coli</i> (UPEC). Clove (<i>Syzygium</i> <i>aromaticum</i> L.) has antimicrobial activity that can alter UPEC morphology and exhibit inhibitory effects. However, the mechanisms underlying the inhibition of specific small molecules remain largely unknown. This study aimed to explore the potential of small molecules in clove flower extract as anti-MDR UPEC agents using in vitro and in silico approaches. Extraction was performed using ethanol and n-hexane, yielding 27.44% and 9.9%, respectively. The ethanol extract exhibited inhibitory activity against MDR-UPEC, forming clear zones ranging from 11.07±0.32 (250 mg/mL) to 16.77±1.36 (1,000 mg/mL) in a disk diffusion assay. However, the combination of ethanol extract and ciprofloxacin resulted in antagonistic effects. GC-MS analysis of the ethanol extract identified 29 small molecules, which were subsequently analyzed using PASS Online, Lipinski's Rule of Five, and molecular docking against target proteins PBP2 and AcrB. Three small molecules showed the potential to inhibit PBP2, and ten small molecules targeted AcrB. Spesifically, 8,14-Seco-3,19-epoxyandrostane-8,14-dione, 17-acetoxy-3β-methoxy-4,4-dimethyl-, Ethyl iso-allocholate and Estra-1,3,5(10)-trien-17β-ol show binding affinities of -7.9; -7.6; dan -8.0 kcal/mol to PBP2, and -9.3; -8.5; dan -8.6 kcal/mol to AcrB, respectively. These three small molecules are promising candidates for developing plant-based antibacterial agents against MDR UPEC.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc10"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards an integrated care. A position paper by the Association of the Scientific Medical Societies in Germany (AWMF).","authors":"Steffi G Riedel-Heller, Manfred Gogol, Thomas Schmitz-Rixen, Vera von Dossow, Rolf-Detlef Treede","doi":"10.3205/000362","DOIUrl":"10.3205/000362","url":null,"abstract":"<p><strong>Research question: </strong>Germany's longstanding separation of healthcare sectors - most prominently between outpatient and inpatient care - creates risks of fragmented service delivery, disrupted information flows, and ultimately suboptimal outcomes for patients. This position paper examines how cross-sectoral and integrated strategies can effectively mitigate or overcome this fragmentation.</p><p><strong>Methods: </strong>During a Berlin Forum of the Association of the Scientific Medical Societies in Germany (AWMF) (6 December 2024), experts presented best-practice models and discussed legal, structural, financial, and regional dimensions of integrated care. The insights from these discussions were synthesized into AWMF's recommendations.</p><p><strong>Results: </strong>Integrated care represents a critical lever for improving the efficiency and quality of the German healthcare system. Promising examples exist across surgical, medical, psychiatric, and regionalized care settings. Key recommendations address the following topics: harmonized financing and remuneration system, regional population-based healthcare networks, interoperable information exchange across healthcare sectors, shared decision-making on care options. Health services research - and especially implementation research - plays an indispensable role in guiding and evaluating these reforms. The AWMF further emphasizes the need for integrated education and postgraduate training, particularly within structured residency networks, and offers AWMF as an important interdisciplinary and interprofessional platform for promoting cross-sectoral care.</p><p><strong>Conclusions: </strong>Broad implementation of integrated care, combined with robust and evidence-based monitoring of implementation, is essential for meeting the challenges posed by demographic change and increasing demands on healthcare delivery.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc09"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An uncommon encounter with tumor lysis syndrome in colorectal cancer.","authors":"Ursula M A de Matos, Wan Ying Tan, Moana Divina Da Silva Santiago, Qian Wu, Faripour Forouhar, Ritika Vankina, Pragna Kapadia, Victoria Forbes","doi":"10.3205/000361","DOIUrl":"10.3205/000361","url":null,"abstract":"<p><p>Tumor lysis syndrome (TLS) is a rare but life-threatening complication in solid tumors such as colorectal cancer (CRC). We report a 61-year-old male with metastatic CRC and extensive liver metastases who developed acute TLS within 48 hours of initiating FOLFOX chemotherapy. He presented with acute kidney injury (AKI), hyperuricemia, hyperphosphatemia, hypocalcemia, and elevated liver enzymes. Prompt treatment with intravenous fluids, rasburicase, and febuxostat led to rapid resolution of TLS. Despite recovery, the patient died two weeks later from complications of advanced metastatic disease. This case highlights the need for early TLS recognition in high-risk CRC patients.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc08"},"PeriodicalIF":0.0,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time and costs of the ethics approval process for retrospective studies in Hanover, Germany.","authors":"Max Lukas Linderkamp, Efthymios Papazacharias, Philippe Korn, Nils-Claudius Gellrich, Michael-Tobias Neuhaus","doi":"10.3205/000360","DOIUrl":"10.3205/000360","url":null,"abstract":"<p><strong>Purpose: </strong>Financial pressure on the German healthcare system is rising, and physicians face high pressure in balancing patient care and research. Into this environment comes an ethics approval process for retrospective studies that is becoming more complex and requires a greater volume of documentation. The objective of this study was to first describe and calculate the costs incurred by the ethics approval process.</p><p><strong>Methods: </strong>Using ChatGPT and Gemini, the required times for preparation, creation, and submission, as well as the time required for the ethics committee to process and vote on ethics approval, were estimated. Costs were calculated based on the newest version of the collective agreement for physicians at German university hospitals (Tarifvertrag für Ärzte an Universitätskliniken).</p><p><strong>Results: </strong>Time required for submitting adds up to approximately 4-10 hours, and 4.5-8.5 hours for submission control and voting, respectively. Summing up, this amounts to 161.7-388.1 € for submission and 241.6-456.3 € for the ethics committee, respectively. In total, 8.5-18.5 hours are required for ethics approval for a retrospective study, resulting in a total of 403.3-844.4 €.</p><p><strong>Conclusion: </strong>Ethics approval is of major relevance to ensure good ethical practice and shall therefore not be omitted. Nevertheless, processes can be tightened to facilitate clinical research, free up resources, and save costs.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc07"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into systematic reviews and meta-analyses: Are we judgmental enough?","authors":"Ulas Kumbasar, Ahmet Baris Durukan","doi":"10.3205/000359","DOIUrl":"10.3205/000359","url":null,"abstract":"<p><p>Systematic reviews (SRs) and meta-analyses are regarded as the pinnacle of evidence-based medicine, synthesizing fragmented research to guide clinical decision-making. However, the exponential increase in their publication has raised concerns regarding redundancy, methodological flaws, and misleading conclusions. Many SRs lack preregistration, employ inconsistent methodologies, and fail to account for clinical heterogeneity. Additionally, the integration of artificial intelligence (AI) in research poses new challenges, including data fabrication, plagiarism, and AI-induced biases. While AI offers efficiency in processing vast amounts of data, its unregulated use may compromise research integrity. Furthermore, current review processes often overlook critical clinical insights, leading to misinterpretations. To improve SR quality, a rigorous, stepwise approach is necessary, including preregistration, comprehensive literature searches, unbiased data abstraction, and meticulous assessment of confounding factors. AI-generated content must be scrutinized through human oversight to ensure accuracy and reliability. Ultimately, the overreliance on statistical aggregation without critical clinical evaluation may lead to flawed conclusions. Clinicians must actively engage in assessing SRs beyond methodological frameworks, integrating human judgment to enhance the credibility and applicability of findings. Addressing these challenges is crucial for maintaining the integrity of evidence-based medicine.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc06"},"PeriodicalIF":0.0,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glial neurovascular unit protein dysregulation and risk of idiopathic intracranial hypertension: A systematic review and meta-analysis.","authors":"Bhoomika Arora, Manabesh Nath, Poorvi Tangri, Pradeep Kumar, Rajesh Kumar Singh, Gyaninder Pal Singh, Deepti Vibha, Achal Kumar Srivastava, Divyani Garg, Ayush Agarwal, Divya M R, Vishnu V Y, Awadh Kishor Pandit","doi":"10.3205/000358","DOIUrl":"10.3205/000358","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic intracranial hypertension is a neurological disorder of unclear etiology that primarily affects young adults. Although several therapeutic options are available, many patients continue to experience persistent visual impairment and headaches, suggesting that key disease mechanisms remain poorly understood. Emerging evidence implicates dysfunction of the glial neurovascular unit (gNVU) in the pathogenesis of IIH.</p><p><strong>Objective: </strong>To systematically evaluate the association between alterations of gNVU-related proteins, specifically aquaporin-4, glial fibrillary acidic protein, fibrinogen, and neurofilament light chain, with the risk of IIH.</p><p><strong>Methods: </strong>A comprehensive literature search of PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted through August 2025. Studies comparing patients with IIH to control participants and reporting gNVU-related biomarkers in cerebrospinal fluid, plasma, serum, or brain tissue were included. Data extraction and quality assessment were performed independently using the Newcastle-Ottawa Scale. Pooled standardized mean differences with 95% confidence intervals were calculated using random-effects models.</p><p><strong>Results: </strong>Ten studies comprising 327 patients with IIH and 216 controls met the inclusion criteria, with seven studies contributing to quantitative synthesis. Levels of CSF Nf-L and plasma fibrinogen were significantly higher in IIH patients, indicating neuroaxonal injury and a hypercoagulable state (Nf-L: SMD=0.78, 95% CI 0.51-1.05; fibrinogen: SMD=0.66, 95% CI 0.08-1.23). Findings for AQP4 and GFAP were inconsistent across studies. Higher BMI was also associated with an increased risk of IIH (SMD=0.80, 95% CI 0.17-1.44). Study quality did not significantly influence effect estimates.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc05"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From bottleneck to efficiency: Key areas for improving discharge management in healthcare - a qualitative study.","authors":"Jann Niklas Vogel, Hanna Hilgenhof, Ivonne Honekamp, Chiara Kleinschmidt, Anne Petereit, Valerie Bühler, Stefan Schmidt","doi":"10.3205/000357","DOIUrl":"10.3205/000357","url":null,"abstract":"<p><strong>Background: </strong>In Mecklenburg-Western Pomerania, multidisciplinary round tables bring together stakeholders from the healthcare sector to jointly develop and advance solutions for regional care challenges on a semi-annual basis. In a sparsely populated state with distinct structural and service-related difficulties, these collaborative formats play a key role in improving discharge management. Against this backdrop, the present study explores the main fields of action required to enhance discharge processes in rural areas of Mecklenburg-Western Pomerania. It aims to prioritise the key challenges, objectives, and measures that can contribute to a more efficient and patient-centred continuum of care following hospital discharge.</p><p><strong>Methods: </strong>Guideline-based group discussions were conducted at the round tables in Demmin, Pasewalk, Parchim and Ueckermünde and analysed using qualitative content analysis. To prioritise key topics and measures, a dialogue-based structural mapping method (Strukturlegetechnik) was applied. This approach enables the reconstruction of participants' subjective theories through consensus-oriented discussions and visual mapping of conceptual relationships.</p><p><strong>Results: </strong>In four focus group discussions involving a total of 30 participants, three main areas for action were emphasised: the expansion of networks and binding coordination structures, the use of digital tools such as online platforms and telemedicine, and the development of tailored support services for vulnerable groups. In addition, prevention, health education, citizen participation and public relations were highlighted as essential cross-cutting tasks.</p><p><strong>Discussion & conclusion: </strong>To ensure sustainable healthcare provision in rural areas, it is essential to establish stable networks that meet on a regular basis and have reliable funding. The targeted expansion of telemedicine, digital communication platforms and capacity monitoring systems should be pursued to strengthen cross-sector collaboration and reduce gaps in service delivery.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc04"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender dynamics in diagnostic imaging: Understanding patient preferences and enhancing radiologist preparedness for opposite-gender interactions.","authors":"Kanza Riaz, Noshaba Razaq, Muskan Rasheed","doi":"10.3205/000356","DOIUrl":"10.3205/000356","url":null,"abstract":"<p><strong>Objective: </strong>This study explores gender dynamics in diagnostic imaging by identifying factors influencing patients' refusal of imaging by opposite-gender radiologists and examining radiologists' preparedness in managing such interactions. The goal is to propose targeted training strategies that enhance gender-sensitive, culturally competent radiology practices.</p><p><strong>Method: </strong>A cross-sectional survey was conducted among 120 radiology residents in public and private hospitals of Rawalpindi and Islamabad, Pakistan. A structured, paper-based questionnaire was used, comprising two sections: Section A assessed patient-related factors influencing refusal of imaging by opposite-gender radiologists; Section B explored radiologists' experiences, confidence, and preferences for gender-sensitive training.</p><p><strong>Results: </strong>Among patients, personal modesty (28.3%), religious beliefs (26.7%), and family influence (24.2%) were the primary reasons for refusing imaging by opposite-gender radiologists. Female patients most frequently cited modesty, while male patients emphasized religion and family. Radiologists reported varied comfort and preparedness in cross-gender interactions. Female radiologists showed significantly greater preparedness (p=.029) but encountered more perceived patient discomfort (p=.008). Preferred training areas included gender-sensitive communication (36.2%) and ethical/legal considerations (31.5%).</p><p><strong>Conclusion: </strong>Gender-related factors significantly influence patient decisions and radiologist preparedness in diagnostic imaging, especially in culturally conservative settings. Female radiologists appear more prepared but face distinct challenges. Incorporating structured training in gender-sensitive communication, cultural competence, and ethics can improve patient satisfaction and radiologist confidence.</p>","PeriodicalId":39243,"journal":{"name":"GMS German Medical Science","volume":"24 ","pages":"Doc03"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}