Fliedner Fachhochschule Düsseldorf

For carefully selected patients with peritoneal surface malignancies (PSMs), secondary cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide similar oncological results as primary CRS/HIPEC. However, the mortality rate and the incidence of reoperations due to perioperative complications after secondary CRS/HIPEC remain understudied. A retrospective analysis was conducted using the StuDoQ|HIPEC registry, a prospectively maintained national German CRS/HIPEC database, to compare reoperation rates and 30-day mortality between patients undergoing primary and secondary CRS/HIPEC. The analysis included patients treated at 83 centers between 2011 and 2024. Propensity-score matching was performed to adjust for confounding factors prior to comparing outcomes between the matched cohorts. A comprehensive analysis of 5011 primary CRS/HIPEC cases and 236 secondary CRS/HIPEC cases showed no significant differences in reoperation rates (15% vs. 12%, p=0.192) or 30-day mortality (2% vs. 1%, p=0.240). After propensity-score matching to control for confounding factors, outcomes remained comparable, with identical reoperation rates of 12% in both groups (p=1.000) and similar 30-day mortality (2% vs. 1%, p=0.685). Within the secondary CRS/HIPEC group, the male-to-female ratio was 1:3, and the median age was 55 years. The majority of these patients underwent secondary CRS/HIPEC primarily for appendiceal cancer (27%), pseudomyxoma peritonei (21%), or colorectal cancer (20%), mesothelioma (12%) and ovarian cancer (10%). Secondary CRS/HIPEC can be performed safely in selected patients with PSMs, comparable to primary CRS/HIPEC. Reoperation rates and 30-day mortality rates were similar between groups, even after adjusting for confounding factors.

The most prevalent conditions affecting the pelvic floor include fecal incontinence (FI) and urinary incontinence (UI), both of which are particularly common among women with obesity. Although the effect of metabolic bariatric surgery (MBS) on FI remains a topic of ongoing discussion, the present study seeks to assess the impact of effective bariatric surgery on UI and FI in women with obesity. An observational prospective study was conducted at the Tours University Hospital, involving 212 women who underwent MBS. Participants completed pre-operative and post-operative questionnaires to evaluate UI and FI one-year after surgery. Additionally, urinary symptom profile (USP) and Wexner score (WS) were utilized for the assessment of UI and FI, respectively. Of the 212 patients, 148 achieved a weight loss of more than 20% of their weight one-year after surgery, and of these 40 (27.0%) completed all questionnaires. The median pre-surgical BMI was found to be 41.8 kg/m², which reduced to 29.1 kg/m² one-year post-surgery. A significant improvement was observed in stress urinary incontinence (SUI), which decreased from 32.5% pre-operatively to 22.5% post-operatively (p < 0.0001). FI showed slight exacerbation, with an increase in moderate FI (from 5.0% to 10.0%), frequency of liquid stool per week (from 2.5% to 5.0%), and gas-related symptoms (from 0 to 2.5%). The findings of this study indicate that MBS significantly improves SUI in women with obesity, yet has minimal impact on FI one-year postoperatively. Further studies are required to more accurately assess the impact of metabolic bariatric surgery on postoperative FI.

Patients, as central actors in healthcare, should be enabled to actively participate in health services research processes. In addition, other stakeholders, such as professionals from healthcare practice, are also essential for a comprehensive participatory approach. This DNVF memorandum focuses on participatory approaches in the context of health services research. It begins by outlining the key characteristics of participatory health services research and describing its current development and institutionalization in Germany. The DNVF memorandum also highlights the potential and benefits of participatory research. Finally, it addresses two cross-cutting topics that are particularly relevant for further development in this field: the theoretical and conceptual foundations, and the investigation of effects and effectiveness of participatory approaches.

ABSTRACT The article explores how social workers are engaged in the making of public space in local communities. Based on a case study which the authors conducted in a German municipality the analysis show that Social Work acts in different spheres in reaction to a certain ‘local’ problem: A conflict that arose between established user and new user groups at a skate park leads to interventions of social workers not just on the site of the park itself as well as local politics and community planning. Despite using different professional sets of action, the social workers involved all deploy a strategy which might be called ‘zoning’: By defining and reserving distinct segments of the public space for different user groups the children and young people in the community receive designated places for their leisure activities. But at the same time, they are exclusively allocated to these places and thus excluded from the wider public space with their sports activities and youth cultures. In reference to the more recent concept of the Commons as well as to earlier traditions of community work the article concludes by suggesting an alternative understanding of space for Social Work practice.

During low anterior rectal resection for rectal cancer, a protective ileostomy (PI) is routinely created to reduce the severity of anastomotic complications. The aim of this study was to investigate the side-effects of PI during adjuvant chemotherapy. A retrospective cohort of patients was operated on for non-metastatic rectal cancer with a PI during 2005-2022. Patients treated with adjuvant chemotherapy (AC) were compared with those not receiving AC. A subgroup analysis compared patients with early PI closure (<10 weeks) and those with a PI in place during chemotherapy. A total of 242 patients were included: 178 (73.6%) without adjuvant chemotherapy and 64 (26.4%) with. History, tumour location, neoadjuvant treatment and postoperative follow-up were similar for both groups. Patients treated with AC had a greater risk of renal failure (37.5% vs. 14.6%, p=0.0002), ionic disorders (45.3% vs. 26.9% p=0.008), malnutrition (23.4% vs. 5.6%, p=0.0002) and rehospitalization (35.9% vs. 18.5% p=0.007). Patients treated with AC needed significant dose adjustments of oxaliplatin in 40.6% of cases, this adjustment being higher in patients with a PI compared to patients with early closure (47.1 vs. 9.1%, p=0.021). Presence of a PI during chemotherapy predisposes to increased episodes of renal failure, and requires major adaptation of chemotherapy doses, especially of oxaliplatin.

ObjectivesEmotional and psychological safety is important during the use of digital technologies in healthcare. We aimed to gain comprehensive insight into needs, influencing factors and outcomes in the context of perceived safety and digital technologies in healthcare.MethodsWe employed a participatory, design ethnographic research approach with 16 participants in 10 use cases. The methods included in an iterative process were, think-aloud, guideline-based interviews, process mapping, storyboard creation, and photo documentation. A qualitative, primarily inductive data analysis and synthesis was performed.ResultsPerceived safety is influenced by various factors and unmet needs. Increased perceived safety can positively support the use of digital technologies, whereas low perceived safety can limit or even hinder its use.ConclusionThe needs of the different target groups should be considered throughout the entire process of digital technology development and healthcare provision to support their implementation. These findings support further research by providing specific aspects of emotional and psychological safety regarding target groups, settings, and ages and those with different levels of affinity for digital technologies.