搜索结果：German economic review

Artificial intelligence (AI) has made a significant contribution to dentistry, particularly in improving screening and diagnostic accuracy. This systematic review assessed the cost-effectiveness and broader economic implications of incorporating AI into oral disease screening. We included studies that conducted economic analyses and/or cost-effectiveness evaluations of AI-driven tools compared with conventional techniques for detecting oral diseases. We searched Cochrane Library, CINAHL, Embase, PubMed, Scopus, and Web of Science. The search strategy combined terms related to economic evaluation, artificial intelligence, and oral diseases. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42024548039). Articles published up to January 12, 2025, were included. Of 334 records identified, four studies met the inclusion criteria - all these studies dealt with dental economic evaluations, and were conducted in the German dental care settings. All four evaluated AI-assisted detection of dental or proximal caries on bitewing radiographs. Across studies, AI generally improved diagnostic performance, particularly sensitivity. In one modelling study, a U-Net-based system achieved higher accuracy than dentists (0.80 vs. 0.71). Three model-based economic evaluations reported lower costs and greater tooth-retention outcomes with AI than with conventional assessment. Costs ranged from €298 to €378 for AI and from €322 to €419 for conventional care. Tooth retention ranged from 62.4 to 64.0 years with AI and from 60.4 to 62.0 years with conventional care. In contrast, the randomized trial found that AI-supported assessment increased sensitivity but was associated with more invasive treatment decisions. This resulted in similar costs (€330 vs. €330) and identical mean tooth retention (49 years) compared with standard assessment. Overall, the evidence suggests a potential economic benefit of AI in caries detection, but uncertainty remains under real-world treatment conditions. AI-assisted screening may offer economic value in dental caries detection, particularly when improved lesion detection is linked to appropriate downstream management. These findings are relevant for clinicians, payers, and health-system decision-makers considering the integration of AI into diagnostic pathways. Future multicentre, real-world economic evaluations are needed to guide reimbursement, implementation, and equitable adoption across diverse settings. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024548039, PROSPERO: CRD42024548039.

To map and characterise economic evaluations (EEs) and provider-level cost/resource reporting related to direct posterior restorative alternatives following the European Union (EU) dental amalgam phase-out. Scoping review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. PubMed, Embase, Web of Science, CINAHL and LIVIVO (ZB MED search portal for life sciences (Germany)). Peer-reviewed studies (English/German; 1 January 2021-22 February 2026) reporting EEs or cost/resource-use components for direct posterior restorations in permanent teeth. Data were charted using a predefined extraction framework focusing on analytic perspective, time horizon, modelling approach and granularity of provider-level resource components. Two reviewers independently screened records and charted data; disagreements were resolved by discussion and, if needed, by consultation with a third reviewer. Six studies met the inclusion criteria (four model-based or trial-based EEs; two cross-sectional surveys). Most analyses adopted payer, societal or mixed perspectives and used decision-analytic models with medium- to long-term horizons. Outcomes included cost per complication-free month, cost per tooth-year retained and lifetime cost projections. Detailed provider-level reporting (eg, chair time, personnel allocation, overheads or warranty-related retreatment burden) was limited, and survey evidence relied on self-reported estimates. Heterogeneity in methods and metrics precluded quantitative synthesis. Economic evidence regarding direct posterior restorative alternatives after the EU amalgam phase-out is sparse and primarily based on modelled or reimbursement-derived inputs from payer, societal or mixed perspectives, rather than explicitly measured provider-level microcosting. Greater transparency in analytic perspective and microcosting components may support evidence-informed adaptation to restorative material substitution policies.

Headache disorders impose a substantial economic burden. Health economic evaluations are vital for informing healthcare decisions by assessing the costs and benefits of interventions, including physiotherapy. Evaluating the cost-benefit impact of integrating physiotherapy into headache management is therefore essential. To map studies including economic evaluations of physiotherapy interventions for headache management, defined as systematic comparisons of alternative treatments in terms of costs and outcomes. Scoping review (PCC framework) conducted in PubMed, Embase, Web of Science, Scopus, INHTA databases (April 2026). Adults with headache receiving physiotherapy were included. Economic evaluations and cost measures were extracted. Studies were screened in two stages and synthesised descriptively. Reviews, trials, cohort, case report, case-control studies in English, Dutch, German were considered (Open Science Framework, https://doi.org/10.17605/OSF.IO/FVHXA ). Physiotherapy, as monodisciplinary, part of an interdisciplinary or multidisciplinary approach, was only included in eight out of 1271 studies. Interventions varied by setting (inpatient/outpatient) and delivery (individual/group). Three studies conducted cost-effectiveness analyses. A multimodal, interdisciplinary or multidisciplinary approach reduced medication-use, consultations, inpatient admissions (direct), and improved work status (indirect). However, evidence is insufficient to conclude that incorporating physiotherapy reduces healthcare costs. A significant gap exists regarding the cost-reducing potential of physiotherapy in headache management. Rigorous economic analyses are needed to determine its clinical and economic value. Greater transparency and consensus on cost variables are recommended, along with investigation of which physiotherapy components yield optimal cost savings without compromising individual benefits. Not applicable.

Aim: Metabolic dysfunction-associated steatohepatitis (MASH) is a progressive form of metabolic dysfunction-associated steatotic liver disease, linked to hepatic and extra-hepatic complications and substantial healthcare costs. Despite its clinical and economic impact, real-world evidence on disease progression and costs in Germany is limited. Materials & methods: We conducted a retrospective cohort study using statutory health insurance claims from the InGef database (2016-2023), covering 4.7% of the German population. Patients with MASH were identified using ICD-10-GM code K75.8, in absence of the more specific code in the German coding system. Baseline characteristics and comorbidities were assessed over 2 years prior to index diagnosis. Progression was defined by transitions through end-stage liver disease (ESLD) stages: compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma and liver transplantation. Healthcare costs were analyzed descriptively and via regression models. Results: Among 4710 patients with MASH (prevalence: 0.15%), 39.4% had documented ESLD during follow-up (mean follow-up in days 1530). Disease progression to ESLD occurred in 26.0% of patients without baseline ESLD (n = 922/3490), whereas 4.0% of patients with baseline ESLD (n = 48/1188) progressed to a more severe ESLD stage during follow-up, with a mean time to first progression of approximately 25.3 months. Patients with ESLD incurred annual costs of €12,737 versus €4928 for those without ESLD. Progression to hepatocellular carcinoma and liver transplantation resulted in predicted costs of €12,948 and €75,719 per patient-year, respectively. Mortality was significantly higher among patients with ESLD (incidence rate ratio: 4.65; 95% CI: 3.76-5.79). Discussion: Over a quarter of identified patients with MASH already had advanced liver disease at baseline, suggesting potential underdiagnosis or late recognition in routine clinical practice. Early detection, proactive management and targeted therapies are essential to reduce progression and economic burden. What is this article about? This article looks at how metabolic dysfunction-associated steatohepatitis (MASH), a serious form of fatty liver disease, affects people in Germany. Using German health insurance claims data from 2016 to 2023, the study examined how often people with MASH developed advanced liver disease, what other health problems they had, and how much their healthcare cost. What were the results? Among 4710 identified patients with MASH, many already had advanced liver disease or developed it during follow-up. Patients with end-stage liver disease had much higher healthcare costs than those without it. Costs increased further in more severe stages such as liver cancer or liver transplantation. Patients with advanced liver disease also had a much higher risk of death and major cardiovascular events. What do the results mean? The findings show that MASH places a substantial burden on patients and the healthcare system in Germany, especially when the disease progresses to advanced liver stages. Earlier detection and better management may help reduce complications, improve outcomes and lower costs. The results also suggest that MASH may often be diagnosed late in routine care.

Medical adherence is traditionally defined as the extent to which a person's behavior corresponds with agreed-upon recommendations from a health care provider. The rapid diffusion of patient-facing digital health applications (DHAs) challenges the direct applicability of this framework to software-mediated interventions. Unlike pharmacological treatments, DHAs automatically generate detailed usage data but lack a broadly accepted standard for determining which specific data points and usage patterns actually constitute "adequate" use across a broad variety of medical indications and population groups. In parallel, DHAs are becoming increasingly embedded in formal regulatory and reimbursement pathways. A notable example is Germany, where recent reforms plan to link at least 20% of reimbursement for Digitale Gesundheitsanwendungen-formally regulated and reimbursed DHAs-to performance-related indicators that implicitly operationalize adherence as a determinant of reimbursable performance. Despite this growing policy relevance, adherence in patient-facing DHAs remains conceptually fragmented and methodologically heterogeneous. This scoping review aims to map how adherence is conceptualized, operationalized, and measured in the context of patient-facing DHAs, and to explore whether these approaches differ between applications embedded within formal regulatory and/or reimbursement frameworks and those operating outside such settings. This scoping review follows the Joanna Briggs Institute methodology and will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed (MEDLINE), Scopus, and Web of Science will be searched for scientific literature published between 2020 and 2025, inclusive. Machine learning-assisted title and abstract screening will be performed using ASReview, following a sampling-based stopping criterion. Three independent reviewers will conduct screening and data extraction. Relevant gray literature will be identified through targeted searches. Database searches identified 15,403 records (5469 from PubMed/MEDLINE, 6198 from Scopus, and 3736 from Web of Science), which were reduced to 7052 unique records after automated deduplication using Zotero (Corporation for Digital Scholarship). The full results are intended to be submitted to a peer-reviewed journal by the end of 2026. Conducted as part of the DEKODE (Digital Health Adhärenz: Konzept und datenbasierte Evidenz) project funded by the German Federal Joint Committee's Innovation Fund, this review contributes to the development of a conceptual and empirical adherence framework for patient-facing DHAs. Although DEKODE is primarily oriented toward the German Digitale Gesundheitsanwendungen context, this review applies no geographical restrictions, reflecting the value of establishing a broad evidence base before narrowing the focus to country-specific settings and rendering findings relevant for understanding DHA adherence in all geographies. By clarifying how adherence is currently conceptualized, operationalized, and measured, the review will promote more consistent and context-specific generation and interpretation of adherence-related evidence and support evidence-based policy discussions, international harmonization of evidence standards for DHAs, and health economic evaluations in digital health.

Oral diseases are among the most common health problems worldwide, and they are heavily influenced by social inequalities. Routine and secondary dental data can provide valuable insights into care provision and help identify gaps in care and risk factors. This work aims to analyze the current state of routine and secondary data use in the field, highlight research gaps, and develop implications. This scoping review was conducted according to the method developed by Arksey and O'Malley, which was partially refined by Levac, Colquhoun, and O'Brien. Several databases were searched, including PubMed/MEDLINE, SCOPUS, and PubPsych. A total of 5,823 articles were identified, and 38 publications met the inclusion criteria. Three experienced reviewers evaluated the studies using criterion-guided codebooks. Most publications (n=29; 76.3%) are international and were published within the last ten years (n=33; 86.8%). Most publications (n=34; 89.5%) focused on a single data source. Only four publications linked different data sets (data linkage). Most publications (n=15; 39.5%) dealt with cost-benefit analyses and economic aspects. Thirteen publications used routine and secondary data to describe utilization behavior and specific risk factors of vulnerable groups, with four focusing on children and adolescents. Routine and secondary data analyses in dentistry offer great potential for identifying gaps in care, pinpointing specific needs, and determining risk factors. There appears to be a three-way division in the content-related objectives of routine and secondary data analysis in dentistry: 1) clinical questions, 2) economic efficiency, and 3) description or identification of vulnerable groups. The latter focuses on people with comorbid somatic diseases, older adults, people with disabilities, and children and adolescents in international discourse. To improve dental care, routine and secondary dental data in Germany must be made more accessible and usable. Orale Erkrankungen zählen zu den häufigsten Gesundheitsproblemen weltweit und sind stark durch soziale Ungleichheiten beeinflusst. Zahnmedizinische Routine- und Sekundärdaten können wertvolle Einblicke in die Versorgung liefern, um Versorgungslücken und Risikofaktoren zu identifizieren. Ziel dieser Arbeit ist die Analyse des aktuellen Stands zur wissenschaftlichen Routine- und Sekundärdatennutzung, das Aufzeigen von Forschungslücken und die Entwicklung von Implikationen für das Fachgebiet.Scoping Review gemäß dem Konzept von Arksey und O’Malley und partieller Weiterentwicklung von Levac, Colqhoun & O’Brien. Hierbei wurden mehrere Datenbanken (PubMed/MEDLINE, SCOPUS, PubPsych) durchsucht. Insgesamt konnten 5.823 Artikel identifiziert werden, von denen 38 Publikationen die Einschlusskriterien erfüllten. Drei erfahrene Reviewer bewerteten die Studien mithilfe kriteriengeleiteter Codebooks.Der Großteil der Publikationen (n=29; 76,3%) ist international und in den letzten zehn Jahren (n=33; 86,8%) publiziert worden. Die Mehrheit der Veröffentlichungen (n=34; 89,5%) konzentrierte sich auf eine einzige Datenquelle, lediglich vier Publikationen verknüpften verschiedene Datensätze (Data Linkage). Die meisten Publikationen beschäftigten sich mit Kosten-Nutzen-Analysen und wirtschaftlichen Aspekten (n=15; 39,5%). 13 Publikationen nutzten Routine- und Sekundärdaten zur Beschreibung des Inanspruchnahmeverhaltens und spezifischer Risikofaktoren von vulnerablen Gruppen, wovon mit vier Publikationen die meisten auf die Gruppe der Kinder und Jugendliche entfielen.Routine- und Sekundärdatenanalysen in der Zahnmedizin bieten ein großes Potenzial, Versorgungslücken aufzudecken sowie spezifische Bedürfnisse und Risikofaktoren zu identifizieren. Es konnte aufgezeigt werden, dass es eine grobe Dreiteilung in der inhaltlichen Zielsetzung der zahnmedizinischen Routine- und Sekundärdatenanalyse zu geben scheint, welche sich in 1. Klinische Fragestellungen, 2. Wirtschaftlichkeit und 3. Beschreibung bzw. Identifikation von vulnerablen Personengruppen gliedert. Letzteres fokussiert sich auch im internationalen Diskurs auf Menschen mit komorbiden somatischen Erkrankungen, im höheren Lebensalter, mit Behinderungen oder Kinder und Jugendliche. Um die zahnmedizinische Versorgungsforschung zu stärken, müssen zahnmedizinische Routine- und Sekundärdaten in Deutschland besser zugänglich und nutzbar gemacht werden.

Digital tools continue to evolve and have the potential to improve health care delivery. However, they are associated with challenges, including accessibility issues and health misinformation. Individuals need eHealth literacy (eHL) to reliably use these tools, and providers require appropriate eHL measurement approaches to offer targeted solutions. For around 2 decades, researchers have been operationalizing and measuring eHL. This paper aims to provide an up-to-date overview of how eHL has been assessed in recent years in the European Economic Area, Switzerland, and the United Kingdom and which methodological limitations need to be considered. A scoping review was conducted. Records were searched via CINAHL, PubMed, and Google Scholar on January 31, 2025, and January 28, 2026. Peer-reviewed empirical papers published in German or English since 2020 that measured eHL in the European Economic Area, Switzerland, or the United Kingdom were included. The synthesis covered the publication trend, eHL measurement approaches and associated limitations reported in the included papers, eHL measurement frequency, countries and languages, and samples. In the final analysis, 132 papers published between 2020 and 2025 were included. The number of publications per year showed an overall upward trend (2020: 11/132, 8.33%; 2025: 35/132, 26.52%). Nine self-report eHL measurement instruments were used, the eHealth Literacy Scale being the most frequent (94/132, 71.21%). All included papers (132/132, 100%) reported data collection via surveys, and digital surveys were common (71/132, 53.79%). Reported limitations included potential self-report biases (37/132, 28.03%), selection biases due to the data collection modes (26/132, 19.70%), and limitations specific to 5 eHL measurement instruments (18/132, 13.64%). Most included papers (121/132, 91.67%) reported eHL results from a single measurement per participant. Data were collected in 22 countries within the target regions. The distribution of eHL measurement instruments varied considerably between countries. Data were collected in 22 languages within the target regions. Patients or individuals with health problems were a frequent target group (64/132, 48.48%). Most papers (104/132, 78.79%) described studies covering broad adult age ranges. Sample sizes ranged from ≤50 (7/132, 5.30%) to >2000 participants (8/132, 6.06%). To our knowledge, this is the first scoping review synthesizing eHL measurement limitations reported in empirical papers from the European Economic Area, Switzerland, and the United Kingdom. The identified limitations reported in the included papers potentially lead to biased results. Therefore, health care providers and researchers should take various factors into account when selecting eHL measurement approaches, such as eHL measurement purpose, target population, and data collection setting. Future research should address these constraints by adapting and developing new or revised eHL measurement instruments, including translated and culturally adapted versions. Policymakers should encourage health care providers to conduct methodologically well-founded eHL measurements as a basis for targeted solutions.

Flexible hydropower is essential for integrating variable renewables, yet its short-term flow fluctuations (hydropeaking) can result in negative ecological impacts and, when mitigated, financial losses for operators. As balancing these impacts with energy system flexibility represents a key policy challenge for sustainable energy transitions, we conduct a systematic review of the economic dimensions of hydropeaking mitigation using the PRISMA methodology. We identify 35 studies and find that operational mitigation measures (e.g., ramping restrictions, minimum flows) can be effective in reducing ecological stress but may also reduce revenue by 1-8%, depending on market conditions and the perceived severity of the constraints. Structural mitigation measures, such as re-regulation reservoirs and compensation basins, lead to better ecological effectiveness by buffering flow variability, while also maintaining long-term economic feasibility, particularly when designed for multipurpose use. Emerging new hybrid mitigation measures, especially hydro-battery energy storage systems, exhibit potential to balance ecological objectives with system flexibility and market profitability. While some mitigation measures reduce hydropower revenues, several studies indicate that the associated environmental improvements can generate broader economic benefits for society, potentially resulting in net welfare gains. Additionally, the review highlights recent methodological advances used to assess economic trade-offs in hydropeaking mitigation contexts. Overall, environmental externalities associated with hydropeaking are often not fully internalized in market outcomes, with implications for hydropower regulation and market design. Policy frameworks such as environmental flow regulations, compensation mechanisms, and targeted support for mitigation infrastructure may help internalize environmental externalities and incentivize hydropower operation that balances system flexibility with river ecosystem protection.

Physician assistants (PAs) are increasingly considered for physician-led ambulatory care teams in Germany, but activity, satisfaction, or direct labor cost alone cannot establish safe integration. This structured narrative review searched PubMed/MEDLINE in seven focused PA-specific blocks and supplemented the search with two documented Google Scholar sensitivity searches. After deduplication, all 1,508 unique records were screened for evidence concerning safety, diagnostic processes, supervision, role transparency, implementation, workload, and German transferability. Sources used in the synthesis were appraised for design, setting, case mix, supervision ascertainment, outcome validity, and directness. The evidence supports feasibility and positive patient or physician experience in selected, supervised, and often protocolized pathways, but it remains heterogeneous and does not establish equivalence across undifferentiated ambulatory case mix. Case complexity, physician supervision time, escalation performance, role understanding, and downstream utilization are frequently unmeasured. An evidence-informed framework is therefore proposed with nine domains: patient and diagnostic safety, diagnostic process quality, escalation and red-flag handling, supervision burden and hidden physician work, role transparency and patient understanding, patient experience, workflow and productivity, economic and resource impact, and implementation, governance, team effects, and sustainability. Tier 1 contains mandatory safety and implementation indicators, whereas Tier 2 contains extended service and economic outcomes. Every report should stratify results by setting, diagnostic stage, case complexity, supervision model, and PA experience. The framework is an author-proposed starting structure, not a validated core outcome set. German multi-stakeholder consensus, prospective feasibility testing, and validation are required before it can support benchmarking or policy thresholds.

Environmental emergencies and conflicts are major drivers of human and animal displacements, increasing the spread of communicable diseases. In such contexts, livestock keepers are among the most vulnerable communities. As a matter of fact, when animals are moved, tensions between groups may escalate and disease spread can intensify. In contrast, when livestock are left behind, households face severe economic decline and increased poverty. This article explores the phenomenon of forced displacements at the human-animal interface, potential gaps and opportunities. This narrative review is based on a search of PubMed and grey literature. Peer-reviewed literature published from 2015 to March 2025 and reports and documents from governmental institutions, non-governmental organizations (NGOs) and press websites in English, French, German, Hindi, Italian, Portuguese and Spanish were considered eligible for analysis. Thirty-four peer-reviewed papers met the inclusion criteria. The majority of the studies were based in the African Continent on the main migration routes, addressing mainly vector-borne diseases, capacity-building needs and a lack of research. Grey literature was incorporated alongside peer-reviewed papers as governments, intergovernmental organizations, NGOs and the press represent relevant actors in implementing coping strategies and raising awareness on forced animal displacements. This narrative review highlights the need for primary data collection and interdisciplinary collaboration adopting a route-based and equity-oriented One Health approach.

The World Health Organization (WHO) has ranked antibiotic resistance as one of the 10 biggest global threats, leading to significant morbidity, mortality, and economic burden. In Germany the developing resistance situation is critical. The resistance data of the most relevant drug-bug combinations are calculated with data from the German Antibiotic Resistance Surveillance (ARS) system. For four of these drug-bug combinations, incidence reduction targets for 2030 (bloodstream infections per 100,000 inhabitants) have been outlined in the German Antimicrobial Resistance Strategy (DART 2030) action plan. The incidence for the gram-positive vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are currently within the target range. However, this is not the case for Escherichia coli with resistance to third generation Cephalosporins and Carbapenem-resistant Klebsiella pneumoniae, both of which are increasing in incidence. In an EU comparison, the incidence of AMR in Germany ranks in the middle.In addition to the resistance data and incidence, the Measuring Infectious Causes and Resistance Outcomes for Burden Estimation (MICROBE) project presents the absolute numbers of mortalities from infections with antimicrobial-resistant pathogens. In Germany, 40,000 deaths per year are associated with antibiotic-resistant infections, and in almost 10,000 of these cases the death was attributable to the antibiotic-resistant pathogen. This means that more people in Germany are dying from antibiotic-resistant infections than other infectious diseases.The effects on the healthcare system are substantial; the increasing antibiotic resistance in particular leads to greater burden of disease in haemato-oncological diseases and poses challenges to effective perioperative antibiotic prophylaxis. Die Weltgesundheitsorganisation (WHO) stuft Antibiotikaresistenz (AMR) als eine der 10 größten globalen Bedrohungen ein, die zu erheblicher Morbidität, Mortalität und wirtschaftlicher Belastung führt. Auch in Deutschland sind die Entwicklungen der Resistenzsituation teilweise kritisch. Die Resistenzanteile der wichtigsten Erreger-Wirkstoff-Kombinationen werden mithilfe von Daten der Antibiotika-Resistenz-Surveillance (ARS) berechnet. Für 4 Erreger-Wirkstoff-Kombinationen wurden im Aktionsplan der Deutschen Antibiotika-Resistenzstrategie (DART 2030) Reduktionsziele für Inzidenzen (Blutstrominfektionen pro 100.000 Einwohnende) für das Jahr 2030 festgelegt. Während für die grampositiven Erreger Vancomycin-resistente Enterococcus faecium (VRE) und Methicillin-resistente Staphylococcus aureus (MRSA) die Inzidenzen bereits im Zielbereich liegen, ist dies für Escherichia coli mit Resistenz gegen Cephalosporine der 3. Generation und Klebsiella pneumoniae mit Resistenz gegen Carbapeneme nicht der Fall und die Inzidenzen steigen an. Im EU-Vergleich liegt Deutschland bei den Inzidenzen im Mittelfeld.Neben Resistenzanteilen und Inzidenzen gibt das MICROBE-Projekt (Measuring Infectious Causes and Resistance Outcomes for Burden Estimation) absolute Anzahlen von Todesfällen durch Krankheitsepisoden mit resistenten Erregern an. Es sterben pro Jahr über 40.000 Menschen in Deutschland an Infektionen mit antibiotikaresistenten Erregern, bei fast 10.000 dieser Fälle ist die Resistenz der Erreger die Ursache. Damit sterben an solchen Infektionen deutlich mehr Menschen in Deutschland als an anderen Infektionskrankheiten.Die Auswirkungen auf das Gesundheitssystem sind erheblich, so führt die zunehmende Antibiotikaresistenz unter anderem zu einer erhöhten Krankheitslast bei hämatoonkologischen Krankheiten und Herausforderungen bei der perioperativen Antibiotikaprophylaxe.

Intraoperative ureteral injury (IUI) is a serious complication that can result in substantial clinical and economic burdens. This retrospective study evaluated incidence, healthcare resource utilization (HRU), and associated costs among patients with and without IUIs in Germany. This descriptive, comparative, longitudinal study included anonymized claims data from the German WIG2 Benchmark Database. Patients aged&#x2009;&#x2265;&#x2009;18&#xa0;years who underwent abdominopelvic surgery with a risk of IUI from 1 January 2014 to 31 December 2021 were included. IUI incidence proportions were calculated overall and by surgery type (gastrointestinal [GI], gynecological [GYN], and other abdominopelvic surgeries). HRU associated with inpatient stays for index hospitalizations and all-cause costs were summarized during the 1-year follow-up. Among 159,&#xa0;581 patients, 217&#xa0;had IUIs, with an overall incidence proportion of 0.14%. GI procedures accounted for 43.8% of IUIs (incidence proportion 0.10%), GYN for 42.4% (0.16%), and other abdominopelvic procedures for 13.8% (0.28%). Proctectomy (1.03%) and hysterectomy with removal of other structures (0.74%) had the highest IUI incidence proportions. Patients with IUIs had significantly longer mean inpatient stays vs. those without IUIs (19.1 vs. 9.4&#xa0;days; mean difference 9.6&#xa0;days; P&#x2009;<&#x2009;0.001). During the 1-year follow-up, patients with IUIs incurred substantially higher total healthcare costs vs. patients without IUIs (mean &#x20ac;67,041 vs. &#x20ac;38,177; mean difference &#x20ac;28,864; P&#x2009;=&#x2009;0.001). More patients with IUIs experienced postsurgical inpatient admissions (81.5% vs. 41.2%; P&#x2009;<&#x2009;0.001) and emergency visits (39.8% vs. 20.8%; P&#x2009;<&#x2009;0.001) vs. those without IUIs. The increased costs were mainly due to inpatient hospital stays (mean &#x20ac;26,046 vs. &#x20ac;13,600 for patients with vs. without IUIs, respectively; mean difference &#x20ac;12,445; P&#x2009;<&#x2009;0.001). Although relatively rare, patients who experienced IUIs had significantly higher HRU and costs vs. patients without IUIs. Targeted strategies are crucial for reducing IUIs and improving clinical and economic outcomes among at-risk patients.

Global increases in armed conflict, forced displacement, pandemics and economic instability have contributed to rising levels of psychological distress worldwide, placing relevant segments of the population at increased risk of developing mental health conditions. This burden is particularly pronounced in humanitarian and low-resource settings where access to specialist mental health services is limited. Scalable, low-intensity, evidence-based psychological interventions are therefore urgently needed. In response, the WHO has developed transdiagnostic programmes, including Self-Help Plus (SH+) and Doing What Matters in Times of Stress (DWMS). Although these interventions are increasingly implemented across humanitarian and public health contexts, evidence for their effectiveness and implementation has not yet been systematically synthesised. This preregistered systematic review and meta-analysis will be conducted in accordance with Cochrane Collaboration standards and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will include randomised controlled trials evaluating the effectiveness of SH+ or DWMS, alongside qualitative and mixed-methods studies examining their implementation among stressor-exposed individuals of any age. Outcomes will include symptoms of depression and anxiety, general distress and post-traumatic stress symptoms. Moreover, we will examine effects on well-being, psychosocial functioning, adverse events and implementation outcomes (eg, acceptability, feasibility, fidelity). We will search Cochrane CENTRAL, APA PsycNet, Web of Science Core Collection, Embase and Scopus for records published from 2016 onwards. Searches will be supplemented by hand-searching preprint repositories and citation tracking. Risk of bias will be assessed using the Revised Cochrane Risk of Bias Tool and a customised appraisal tool for studies on implementation. Quantitative data will be synthesised using random-effects multilevel meta-analyses, with meta-regression models applied to examine moderators. Bayesian meta-analyses will be conducted where appropriate as sensitivity analyses to assess the robustness of the findings. Certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Ethical approval is not required. Findings will be disseminated through an open-access peer-reviewed publication, a plain-language summary, and the Open Science Framework, where all materials will be made publicly available. CRD420251168521.

Quinoa (Chenopodium quinoa Willd.) is an Andean grain crop introduced as a novel crop to many parts of the world in recent years. Recognized for nutritious seeds and high abiotic stress tolerance, it has been promoted as an element of climate-resilient agriculture, particularly in marginal environments. Successfully introducing new crops to sustainably increase and diversify agricultural production in such settings depends on environmental, economic and social factors of the agricultural context. This review critically assesses the potential and challenges of introducing quinoa as an alternative crop, focusing on marginal lands in Central Asia. We highlight quinoas broad genetic base to abiotic stresses such as drought, salinity and temperature extremes and discuss how it can be leveraged by breeding for marginal environments. Environmental effects, economic aspects and initial experiences with quinoa cultivation in Central Asia are discussed. Furthermore, we discuss broader socioeconomic implications, including land tenure and migration in marginal regions. We conclude that quinoa holds potential for improving sustainable agriculture in marginal environments, when integrated policies and long-term support enable its benefits for sustainable agricultural development. &#xa9; 2026 The Author(s). Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Gender-based discrimination (GBD) has pervasive effects on women's health outcomes. Measurement of GBD is essential in order both to understand and monitor progress against GBD and to study its relationship with health. We aimed to provide an overview of definitions and measures of GBD used in the literature on health in low- and middle-income countries (LMICs). We conducted a mixed-method scoping review following Arksey and O'Malley's methodological framework. We searched PubMed, Web of Science, CINAHL and EconLit and included studies from 1985 to 2025 if they had an explicit focus on GBD and health, were based in LMICs and if the measure of GBD was described. We excluded reviews and studies focusing on specific health conditions or subpopulations. We extracted information on study characteristics, definitions and measures of GBD (their content and their operationalisation). We synthesised data by identifying groups of similar GBD themes and summarising definitions and measures of GBD. We included 228 studies. Most studies (n=200) were quantitative or included a quantitative element (n=8, mixed-methods studies). Only 20 studies were qualitative. We identified 11 themes around GBD, namely healthcare behaviours, health state, son preference at birth, disrespect and abuse during childbirth, self-declared discrimination, cultural and legal practices, gender roles, access to economic resources, decision-making, education and violence against women. Most studies (n=148) used only an individual indicator measure to operationalise GBD, while 65 studies used one or more composite indicators. Only 30 studies provided a definition of GBD and these varied considerably. This is the first review providing an overview of how GBD has been conceptualised and measured in LMICs in the literature on health. Results have several implications: (1) future studies should clearly define GBD when aiming to measure it; (2) a consensus should be reached about what GBD encompasses and (3) a comprehensive measurement tool is needed to capture discrimination with regard to the multiple manifestations of GBD.

Surgical site infections (SSIs) impose a significant clinical and economic burden on the healthcare systems. To date, traditional preventive strategies have frequently failed to demonstrate definitive efficacy. Hypochlorous acid (HOCl) has emerged as a compelling antimicrobial alternative, characterised by potent microbicidal properties and excellent biocompatibility. Hypoclates:Peritonitis investigates the clinical impact of an HOCl-based lavage strategy in patients undergoing surgical treatment for secondary peritonitis. The trial evaluates the primary endpoint of postoperative SSI incidence up to day 10 (&#xb1;2 days), hypothesising that the antimicrobial and biocompatible properties of HOCl significantly lower infection rates compared with standard isotonic lavage. Using a sequential, quasi-experimental design, this mono-centric study assesses the clinical impact of adopting an intensified, multi-day HOCl-lavage protocol (Granudacyn) for patients with secondary peritonitis. We will compare a prospective intervention group (n&#x2248;100) against a preceding cohort of equal size that received standard isotonic irrigation. The primary endpoint is defined as the frequency of SSIs-inclusive of superficial, deep and organ/space infections according to Centers for Disease Control and Prevention criteria-monitored through hospital discharge or up to postoperative day 10 (&#xb1;2 days). Secondary evaluative measures include the length of intensive care unit and total hospital stay, the duration of postoperative antibiotic therapy and the cumulative morbidity burden as calculated by the Comprehensive Complication Index. Ethical clearance for this trial was provided by the Institutional Review Board of the Medical Faculty of Heidelberg University (S-523/2025). To facilitate knowledge transfer and evidence-based practice, the study results will be presented at international scientific meetings and published in peer-reviewed journals, thereby contributing to the refinement of SSI prevention protocols in emergency visceral surgery. German Clinical Trials Register (DRKS), DRKS00038630.

Digital health technologies are increasingly used across oncology services, but the available evidence remains concentrated on patient-facing and clinical applications. Organisational perspectives and the involvement of non-clinical professionals remain poorly represented. This scoping review mapped digital health technologies used in adult oncology care, examined their functions for healthcare professionals (HCPs), and assessed the extent and nature of evidence involving non-clinical professionals (NCPs). A scoping review was conducted to identify studies reporting the use of digital health technologies in adult cancer care. PubMed, Embase, CINAHL, and Web of Science were searched for studies published between 2015 and June 2025, and reference lists were hand-searched. Qualitative, quantitative, mixed-methods, pilot, feasibility, and implementation studies were eligible. Findings were synthesised narratively according to the primary function of each technology and the professional groups involved. Forty-one studies were included. The most frequently reported technologies were electronic patient-reported outcome systems, telehealth and telemonitoring platforms, mobile applications, and decision-support or AI-enabled systems. These technologies were used mainly for symptom monitoring, communication, follow-up, survivorship support, clinical decision support, and care coordination. Reported benefits included earlier symptom detection, improved communication, greater patient reassurance, and more structured clinical workflows. Common barriers included limited digital literacy, declining engagement over time, alert burden, workflow misalignment, poor interoperability, and inadequate technical infrastructure. Only three studies explicitly included non-clinical professionals, indicating that organisational and managerial applications remain substantially under-researched. Interoperability and workflow integration emerged as the most consistently supported implementation priorities. Equity, scalability, sustainability, and economic impact require further evaluation. Because evidence involving non-clinical professionals and AI-enabled implementation remains limited, recommendations concerning organisational adoption, AI governance, and workforce preparation should be treated as priorities for implementation research rather than established policy requirements.

Friedreich's ataxia (FA) is a rare neurodegenerative disease with multisystemic symptoms that requires multidisciplinary care. This systematic review summarizes available pharmacological and nonpharmacological interventions, their outcomes, and alignment with patient-centered care domains, as well as their impact on these domains. The publication search was conducted in three databases (PubMed, Embase, Cochrane Library) from 2010 to 2025 for human studies. Studies were included if they met predefined eligibility criteria (FA population/pharmacological or nonpharmacological interventions/use of comparator/any outcomes, especially patient reported). All study designs were included. Risk of bias assessment was performed by two reviewers using Cochrane RoB-2 for randomized controlled trials and JBI Critical Appraisal Tools for case reports, case series, and quasi-experimental studies. Results were synthesized narratively. Ninety studies (69 FA only, 21 mixed ataxia) were included. FA-only studies included randomized controlled trials (32%), quasi-experimental studies (35%), and case reports (33%), mostly with small samples (<100) and low-to-moderate bias. Pharmacological interventions (66.7%), mainly disease modifying (93.5%), were more common than nonpharmacological interventions, with the most effective interventions being omaveloxolone (pharmacological), as well as rehabilitation and heart interventions (nonpharmacological). Pharmacological studies often showed biological improvements without clear clinical benefit, whereas nonpharmacological therapies yielded more consistent patient-relevant gains, although evidence was limited. Physical health was the most frequently addressed domain (42.3%), whereas mental health and caregiver aspects were rarely studied (1.8% and 1.4%). No study investigated caregiver burden or economic outcomes. More holistic studies are needed, integrating patient- and caregiver-reported outcomes and combining multiple treatment approaches in larger cohorts. &#xa9; 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

The recently published 2024 revisions of the McDonald criteria unified and expanded the diagnosis of MS towards a&#xa0;"biological diagnosis" and incorporated new MR imaging (bio)markers. Most prominently, they now incorporate imaging of the optic nerve as the fifth topography for dissemination in space (DIS), as well as the central vein sign (CVS) and paramagnetic rim lesions (PRLs), to facilitate an earlier diagnosis of MS. In addition, certain new MRI measures, such as slowly expanding lesions (SELs) and particularly PRLs, are increasingly used in clinical trials and may enter routine clinical practice in the near future. These developments, along with the 2024 MAGNIMS-NAIMS-CMSC consensus recommendations, suggest a&#xa0;different role for MRI in managing patients with MS and expansion of the MRI acquisition protocols, reading, and interpretation. Here, an imaging expert panel of the German Society of Neuroradiology (DGNR) established consensus recommendations on the role of MRI in the management of patients with suspected or definite MS, endorsed by the German Society of Neurology (DGN). These recommendations incorporate these new developments into the context of the German healthcare system. We suggest minor modifications to the acquisition protocol outlined in the 2024 McDonald criteria and the MAGNIMS-NAIMS-CMSC consensus recommendations. For patients with inconclusive imaging findings and in specific diagnostic situations, we recommend changes to MRI acquisition protocols that incorporate susceptibility-weighted imaging (SWI) sequences to demonstrate CVS and PRLs, as well as optic nerve imaging. Additionally, we provide recommendations on the use of MRI for treatment monitoring, including progressive MS patients.