Klinikum Aschaffenburg

Objective: The objective of this study was to evaluate the association between cervical management strategies, specifically pessary placement, cervical cerclage, or expectant management, and gestational age at delivery in twin pregnancies and to assess the prognostic value of cervical characteristics for early preterm birth (<33 weeks). Methods: We conducted a retrospective cohort study including 120 twin pregnancies managed at a tertiary referral center between 2019 and 2024. Pregnancies with positive vaginal or cervical microbiological cultures or abnormal cervical cytology were excluded. The management strategy was selected based on cervical characteristics and clinical judgment. Gestational age at delivery was compared across intervention groups using descriptive statistics, kernel density plots, boxplots, and Kaplan-Meier survival analysis. Multivariable Cox proportional hazards regression was performed to estimate adjusted hazard ratios (HRs) for early delivery, including intervention type and cervical parameters (length, diameter, and funneling). Results: Overall, 26 of 120 pregnancies (21.6%) resulted in delivery before 33 weeks. Pessary placement was associated with longer gestational duration compared with cerclage or expectant management. Kaplan-Meier analysis demonstrated a clear separation of survival curves by intervention group, with the pessary group maintaining pregnancy to later gestational ages (log-rank p < 0.001). In multivariable Cox regression analysis, pessary use was associated with a significantly lower hazard of early delivery compared with cerclage (HR = 0.088, 95% CI: 0.035-0.220; p < 0.001). Expectant management showed a trend toward an increased risk of early delivery (HR = 2.44; p = 0.067). Cervical length and diameter were not independently associated with early delivery after adjustment for intervention type. Funneling was associated with a lower hazard of early delivery, a finding that warrants cautious interpretation. Conclusions: In this retrospective cohort of twin pregnancies without microbiological evidence of infection, pessary placement was associated with prolonged gestation and a lower hazard of early preterm delivery compared with cerclage or expectant management. These findings support a personalized, risk-adapted approach to cervical intervention selection in twin pregnancies. Prospective, randomized studies incorporating etiologic stratification are needed to confirm these associations and guide clinical practice.

Left panel: Scheme of the XPAG-immune thrombocytopenia trial. The dexamethasone (DEX) arm consisted of DEX 40 mg/day for days 1-4 for one to three cycles every 28 days to a maximum of 12 weeks, cycles 2 + 3 were optional. Patients randomised to eltrombopag (ETB) + DEX received eltrombopag in combination with a short course of high-dose DEX beginning on day 1 (40 mg/day during days 1-4). The starting dose of ETB was 50 mg/day for 2 weeks; thereafter, the ETB dose was increased by 25 mg for all patients who did not achieve the target platelet count of ≥50 × 109/L. The ETB tapering was performed by decreasing the dose by 25 mg every 2 weeks to a minimum dose of 25 mg every other day for all patients. Right upper panel: Clinical outcomes in patients treated with first-line ETB + DEX. Patients displayed a qualitatively longer response duration and qualitatively reduced usage of rescue medication. Right lower panel: The immunological T-cell response was different in treatment responders and non-responders. Patients with sustained response (responders) displayed a high T-cell clonality at baseline. Clones are depicted as bubbles (right side).

BackgroundCardiopulmonary resuscitation (CPR) is vital for improving patient outcomes in medical emergencies. Both laypersons and health care professionals often seek guidance on performing CPR. In today’s digital age, many turn to easily accessible platforms such as YouTube for practical skills.ObjectiveThis study evaluates the didactic and content quality of CPR videos on YouTube using comprehensive checklists and investigates the association between the assigned quality scores and type of publisher, view count, and video rankings.MethodsVideos were included based on defined search terms and exclusion criteria. Two emergency physicians rated each video independently using validated checklists concerning content and didactic quality. Linear regression analysis was performed to assess the relationships between video quality scores and view counts, as well as video rankings.ResultsOf the 250 videos identified, 74 (29.6%) met the inclusion criteria. On the content checklist, videos scored an average of 56.5% (SD 19.2%), and on the didactic checklist, they scored 66.6% (SD 14.3%); none achieved the maximum score. Videos from official medical institutions scored significantly higher in content quality compared to nonofficial sources (P=.04). Video quality scores were not associated with video rankings or view counts.ConclusionsThe study highlights substantial variability in the didactic and content quality of CPR-related videos on YouTube. For medical educators, this underlines the need to curate and recommend reliable online resources or to develop new high-quality content aligned with established checklists. For the general public, the findings caution against relying on popularity metrics as indicators of accuracy and emphasize the importance of guidance from trusted institutions.

Zusammenfassung: Theoretischer Hintergrund: Der Einsatz Digitaler Gesundheitsanwendungen für psychische Erkrankungen (PsyDiGA) wird kontrovers diskutiert. Fragestellung: Für wen und in welchem Behandlungskontext sind PsyDiGA (nicht) geeignet? Methode: Bundesweit niedergelassene Psychotherapeut_innen erhielten einen Fragebogen, der stratifiziert nach Verschreibungserfahrung mit PsyDiGA ausgewertet wurde. Zusätzlich analysierten wir leitfadenbasierte Interviews mittels qualitativer Inhaltsanalyse. Ergebnisse: Es lagen 321 Fragebögen sowie 16 Interviews vor. PsyDiGA seien geeignet für Patient_innen mit eingeschränkter Mobilität und ungeeignet bei Personen älter als 65 Jahre. Die Befragten lehnten PsyDiGA als primäre Behandlungsmethode ab, während dem Einsatz zur Überbrückung von Wartezeiten mehrheitlich zugestimmt wurde. Psychotherapeut_innen mit und ohne Verschreibungserfahrung von PsyDiGA unterschieden sich zum Teil deutlich hinsichtlich ihres Antwortverhaltens. Aus den Interviews ergaben sich die Notwendigkeit von persönlichem Kontakt, die Berücksichtigung psychischer Belastung sowie Technikaffinität als Kriterien für (fehlende) Eignung. Schlussfolgerungen: Die Verschreibung von PsyDiGA scheint abhängig von der therapeutischen Orientierung sowie der Abwägung zwischen Notwendigkeit und Möglichkeiten zu persönlicher Kontaktaufnahme zu sein.

Background: Gastrointestinal leaks and fistulae are serious conditions with the potential to be life-threatening, and they are of significant relevance for both endoscopists and surgeons. These conditions may present in a wide variety of ways in clinical settings. These defects may arise from malignant or inflammatory conditions, or may be iatrogenic, occurring after surgery, endoscopic, or radiation therapy. The therapeutic approach to these conditions is often complex and is associated with a high incidence of morbidity. Consequently, in recent years, advances in interventional endoscopic techniques have earned a pivotal role in the management of gastrointestinal defects, both as a first-line treatment and as a rescue therapy. The advent of clips and luminal stents marked the advent of gastrointestinal defect therapy. However, the advent of innovative endoscopic closure devices and techniques, such as endoscopic internal drainage, suturing systems, and vacuum therapy, has broadened the indications of endoscopy for the management of gastrointestinal wall defects. This is because surgical therapy still tends to be complex and is plagued by high rates of morbidity. Summary: A successful endoscopic management of gastrointestinal leaks and fistulae necessitates a tailored and multidisciplinary approach, based on the aforementioned factors, in addition to local expertise and the availability of devices. Moreover, a standardized evidence-based algorithm for the management of GI defects is still not available. Endotherapy represents a minimally invasive, effective approach with lower morbidity and mortality compared to surgical techniques.

In Germany, economic and financial concepts are characterized by the prevailing Western economic legal system. These are not always in line with the economic and financial concepts in Islam (e.g., prohibition of interests in Islamic law). The more important Islamic financial institutions are in a country, the stronger the impact of Islamic financial principles on the economic and financial knowledge of the population. People who migrated from predominantly Muslim countries were usually family-socialized with concepts of Islamic Economy and Finance and impart this information to their offspring. Young adults who grow up in an environment that is not shaped by Western (cultural) views may be particularly affected. The lack of systematic inclusion of economic and financial content in German general education curricula leads to challenges in understanding these concepts. Here, a two-part qualitative interview procedure was used to investigate possible challenges in the understanding of economic and financial terms and concepts by people with a Muslim background (eight respondents were interviewed in summer 2022). In this article, the findings on the identified barriers are presented and discussed. Subsequently, the implications for economic education are outlined, including the need to raise awareness among (prospective) teachers for migration-specific concepts, the special needs of heterogeneous classes with regard to migration backgrounds and the development of target group-oriented teaching and learning materials in economic and social education.