Background: To curb SARS-CoV-2 transmission, citizens were urged to get vaccinated and adhere to hygiene recommendations (keeping distance, washing hands, wearing face masks), as well as informing contacts if infected. Studies confirm the effectiveness of these measures in reducing virus spread. Understanding factors influencing nonadherence is vital for enhancing the efficacy of future pandemic education campaigns.Methods: An online survey assessed nonadherence to SARS-CoV-2 containment recommendations among 30,000 randomly selected Cologne residents aged 18 or older. Invitations were sent on December 7, 2022, with the survey open until January 7, 2023. Logistic regression analyzed associations between participants’ sociodemographic, health, and virus-related characteristics and reported nonadherence to recommended behaviors.Results: Out of 30,000 invited Cologne residents, 4,486 (15%) responded, with 10% reporting not having received recommended SARS-CoV-2 vaccination. Nonadherence correlated significantly with older age, male gender, low income, living alone, migrant background, and chronic lung disease. 80% reported not adhering to current hygiene recommendations, linked to younger age, absence of certain pre-existing conditions, and prior SARS-CoV-2 infection. Additionally, 16% reported hesitancy in informing all contacts upon testing positive, associated with male gender, absence of certain pre-existing conditions, and fewer booster doses.Conclusion: The results presented here point to which sociodemographic, health, and virus-related factors are associated with nonadherence to recommended individual behaviors to mitigate the SARS-CoV-2 pandemic. However, issues related to the representativeness of the sample for the general population limit the validity of the results.Trial registration: DRKS.de, German Clinical Trials Register (DRKS), identifier: DRKS00024046, registered on 25 February 2021

Objectives: Invasive ductal carcinoma (IDC), the most prevalent subtype of breast cancer, is characterized by significant genomic heterogeneity. Tumor mutation burden (TMB) has emerged as a predictive biomarker for immunotherapy response, yet its estimation via whole-exome sequencing remains complex and costly. This study aimed to evaluate whether total somatic mutation count can serve as a practical surrogate for TMB and assess its association with progesterone receptor (PR) status in PIK3CA-mutated IDC patients.Methods: This retrospective observational study utilized publicly available data from a previously published breast cancer sequencing study. A total of 164 female IDC patients with confirmed PIK3CA mutations and documented PR status were included. Relevant genomic and demographic parameters – TMB, mutation count, and age – were extracted and analyzed. Statistical analyses included correlation, intergroup comparisons by PR status, and binary logistic regression. Predictive performance was assessed using area under the receiver operating characteristic (AUROC) curves.Results: Patients with PR-negative status exhibited significantly higher TMB and mutation count than PR-positive patients (p-value<0.001 for both). TMB and mutation count were positively correlated (r=0.61, p-value<0.001), indicating overlapping representation of genomic instability. Logistic regression showed that mutation count was a significant predictor of PR status (p-value=0.01). Mutation count demonstrated a slightly superior predictive performance (AUROC=0.738) compared to TMB (AUROC=0.737).Conclusion: Total mutation count shows strong potential as a surrogate biomarker for TMB and a predictive marker for PR status in PIK3CA-mutated IDC, offering a cost-effective genomic tool in personalized breast cancer stratification.

The German healthcare system faces considerable challenges, particularly due to a shortage of physicians in rural areas and increasing demands from an aging and multimorbid population. Physician assistants (PAs) represent a promising solution to address these challenges. As academically trained healthcare professionals, they take on delegable tasks such as medical histories, routine examinations, documentation, and the care of chronically ill patients. This relieves physicians and allows for more intensive patient care. This paper examines the advantages of integrating physician assistants (PAs) into outpatient care. It shows that PAs can significantly improve the efficiency and quality of care through their work. In particular, PAs play a crucial role in disease management programs (DMPs) for the long-term care of chronically ill patients. Their involvement leads to a reduction in complications and an increase in patient satisfaction. From an economic perspective, PAs optimize the use of resources and help stabilize practices, especially in underserved regions. Despite these potentials, there are significant challenges. There is a lack of uniform national legal regulations clearly defining the competencies and fields of activity of PAs. In addition, there are uncertainties regarding the refinancing of PA services, as well as issues of acceptance among physicians and patients. Competition with existing healthcare professions such as medical assistants (MFAs) or specialized roles like VERAHs necessitates clear delineation of responsibilities. This paper concludes by presenting strategies for the successful integration of physician assistants (PAs). In addition to creating clear legal frameworks and refinancing models, promoting interdisciplinary collaboration is essential. Regular continuing education and the use of digital technologies such as telemedicine can further expand the competencies of PAs. The findings underline that PAs can play a crucial role in ensuring sustainable and patient-centered healthcare - especially in regions affected by physician shortages.

Background: In rural areas, discharge management presents a significant challenge. Despite its relevance, there is limited research on implementation strategies and the preferences of the involved parties. In Mecklenburg-Western Pomerania, four round tables have been established with the goal of promoting sustainable local healthcare. These regional networks involve multidisciplinary stakeholders working together on acute care and follow-up care for patients. This paper examines the implementation strategies of discharge management in rural areas of Mecklenburg-Western Pomerania, analyses associated challenges, and identifies stakeholder preferences.Methodology: Semi-structured group discussions were conducted at the round tables in Demmin, Pasewalk, and Ueckermünde. The data was analysed using qualitative content analysis, with a focus on structuring the content.Results: Three group discussions with a total of 30 participants were held. Key challenges in rural areas include securing day care services, the lack of sufficient and locally accessible short-term care, long-term inpatient care, and rehabilitation placements. As a result, patients often remain hospitalized longer than necessary or must transfer to distant follow-up facilities.Discussion and conclusion: A key aspect is questioning traditional approaches, such as the strict separation of responsibilities, and focusing more on shared accountability. The goal is to create synergies and enable more efficient care delivery.

Lyme disease is the most common tick-borne infectious disease in Europe. Neurological manifestations occur in 3-15% of infections and can present as polyradiculitis, meningitis, and rarely as encephalomyelitis. The disease is treatable with antibiotics. The S3 guideline "Neuroborreliosis" has been updated in accordance with the methodological standards of the "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V." (AWMF register number 030/071). Eighteen AWMF member societies, the Robert Koch Institute, the "Paul-Ehrlich-Gesellschaft für Infektionstherapie", the "Schweizerische Neurologische Gesellschaft", the "Österreichische Gesellschaft für Neurologie", the "Deutsche Borreliose-Gesellschaft" and two patient organizations were involved in the update. The guideline aimed at physicians in practice and hospital settings who are involved in the treatment of neuroborreliosis in children and adults. For the first time, there is Class Ia evidence that a 14-day course of antibiotics is therapeutically sufficient in early neuroborreliosis. Additionally, it is now recommended that the administration of steroids alongside antibiotic therapy is not advised in cases of facial palsy within the context of a neuroborreliosis that is probable or confirmed according to diagnostic criteria. The age limit for doxycycline in the treatment of neuroborreliosis in children under 8 years has been removed. There are still no valid study data on the effectiveness of combination antibiotic treatments. A systematic review on the therapy of so-called Post-Treatment Lyme Disease Syndrome (PTLDS) showed that parameters such as quality of life, fatigue, depression, and cognition do not respond to antibiotic therapy.

The current S2k guideline "kutane Borreliose" has been updated in accordance with the methodological standards of the "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.". It has received consensus from 18 AWMF member societies, the Robert Koch Institute, the "Paul-Ehrlich-Gesellschaft für Infektionstherapie e.V.", "Instand e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien", the "Deutsche Borreliose-Gesellschaft" and the two German patient organisations "Borreliose und FSME Bund Deutschland" and "Aktionsbündnis gegen zeckenübertragene Infektionen Deutschland e.V.". This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis and is directed at physicians in private practices and clinics who treat Lyme borreliosis. Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis and recommendations for the treatment of the different manifestations erythema migrans, multiple erythemata migrantia, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. The current update of the guideline incorporates the international literature on cutaneous manifestations of Lyme borreliosis up to 2022. There have been no significant changes in diagnosis and treatment. The Cochrane network analysis on the treatment of erythema migrans has only shown that, in addition to doxycycline and amoxicillin, oral penicillin V is equally effective. A Slovenian analysis of patients with acrodermatitis chronica atrophicans over the past 30 years has shown a decrease in the incidence of constitutional symptoms and atrophy, likely due to improved early detection. In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline.

Objective: Breast cancer is the most commonly diagnosed malignancy worldwide. Insulin resistance (IR) plays a key role in its progression by activating oncogenic signaling pathways. The triglyceride-glucose (TyG) index is a validated, cost-effective surrogate marker for IR. This study aims to evaluate the prevalence of IR in female breast cancer patients using the TyG index and to identify lipid parameters associated with increased IR, thereby supporting strategies for secondary prevention.Methods: A cross-sectional study was conducted among non-diabetic, histopathologically confirmed female breast cancer patients. Demographic data, lipid profiles, and fasting glucose levels were collected. Participants were stratified into high-risk (TyG≥8.87) and low-risk (TyG<8.87) groups based on their TyG index. Logistic regression analysis was performed to identify significant predictors of elevated TyG index.Results: Among 122 patients, 44.3% demonstrated elevated insulin resistance. Triglycerides (TG), total cholesterol (TC), very low-density lipoprotein cholesterol (VLDL-C), and the TC/high-density lipoprotein-cholesterol (HDL-C) ratio were significantly higher in the high-risk group. Logistic regression identified TC, TC/HDL-C ratio, and low-density lipoprotein cholesterol (LDL-C) as significant predictors of elevated IR (p<0.05). The model is represented as: Logit(P)=–13.941+0.145X1+1.558X2–0.178X3, where X1, X2, and X3 correspond to TC, TC/HDL-C ratio, and LDL-C, respectively. The predictive model achieved 90.2% accuracy with an area under the receiver operating characteristic (ROC) curve (AUROC) of 0.927.Conclusion: Monitoring lipid parameters and managing insulin resistance are crucial for enhancing breast cancer prognosis and potentially reducing progression.

Objective: The doctor-patient interaction is essential for successfull dental treatment. Although it is possible to consider social skills during student selection, these are rarely taken into account. The described project aims to identify and evaluate the social skills deemed necessary by various stakeholders and to assess whether these skills can be effectively measured using a Situational Judgment Test (SJT).Methods: The project involved conducting interviews with stakeholders (lecturers, students, patients, practicing dentists) to identify relevant social skills. This was followed by a Delphi survey to evaluate the importance of these skills. Additionally, the SJT was examined for its suitability in the context of dental medicine, and various methods for reliably measuring the identified skills were assessed.Results: Dental lecturers and students consider emotional resilience, particularly stress management, to be especially important during dental studies, while patient-related behaviors are of lesser priority – possibly due to the constraints of the academic environment. In contrast, patients and dentists emphasize the importance of helpfulness and caring conduct during treatment.Conclusion: Our research highlights the need to strengthen social skills in dental education. Although the SJT from general medicine is also suitable for dental studies, Multiple Mini Interviews (MMIs) are a more effective method for capturing complex skills, such as behavioral flexibility.

Objective: The study aims to identify critical predictors of mortality and evaluate the performance of different artificial intelligence (AI) models among patients with colorectal cancer (CRC). Furthermore, the study also sought to enhance our comprehension of survival outcomes by identifying key predictors and evaluating the accuracy of AI-driven prediction methods for patients with CRC.Methods: The study employed a retrospective-predictive design, using data from the electronic health records of patients with colorectal cancer (CRC) admitted between 2016 and 2023. Among the eight AI models created by the SPSS Modeler version 18.0, the Bayesian network model was the most effective of the eight models in this study.Results: The researchers identified the most relevant variables associated with mortality among patients with CRC through data visualization. The study analysed 1,159 colorectal cancer patients, with 45.7% living up to six years and 54.3% living between seven and 16 years post-diagnosis. The Bayesian network AI model identified stage, age, recurrence, sex, marital status, and smoking status as key predictors. Conclusion: This study model’s structure emphasizes these predictors’ interconnectedness because parent nodes directly connect to child nodes. The model shows how age, smoking status, marital status, cancer stage, and recurrence affect patient survival. The model clarifies these variables’ interactions.

Postgraduate training varies significantly both between countries and among medical specialties within a nation, due to differences in medical education and health care systems. We aim to provide detailed information about postgraduate training in general practice. This narrative review is based on a selective literature review, supplemented by legal texts and information from official institutions. Postgraduate training is strongly influenced by Germany's federal governmental structure, funding regulations and lack of structured programmes attached to academic bodies. This system allows for freedom in career choice, and the organisation of education and training after medical school. However, it presents significant challenges for workforce planning. Additionally, it places a heavy organisational burden on the individual trainee, who is responsible for organising their own rotations and ensuring that all necessary skills are acquired during training. In response to an increasing shortage in general practitioners, recent years have seen new developments such as the establishment of competence centres and coordination offices. Nevertheless, further improvements are necessary to guarantee up-to-date training, so that future general practitioners can meet the growing challenges of medical care.