Klinikum Region Hannover

Despite agrowing proportion of women in surgery, there is asignificant underrepresentation in clinical and academic leadership positions. The mechanisms are still poorly understood. The German Congress of Visceral Medicine, as the largest interdisciplinary medical congress in German-speaking countries, provides asuitable platform for investigating gender-specific representation patterns. The aim of this study was to analyze the gender distribution in various congress functions between 2013 and 2024 in order to identify potential structural inequalities. The gender distribution of speakers and chairs at the German Congress of Visceral Medicine from 2013 to 2024 was analyzed based on the official congress programs. After excluding gastroenterological, endoscopic and interdisciplinary sessions, the visceral surgery sessions were analyzed in the categories of abstract sessions, plenary sessions and industry symposia. The analysis revealed asignificant increase in the number of female speakers (r2 = 0.585; p = 0.006) and chairs (r2 = 0.777; p < 0.001). The proportion of female speakers significantly increased in both plenary sessions (r2 = 0.600, p = 0.005) and abstract sessions (r2 = 0.445, p = 0.025). An increase in the number of female chairs was also observed for plenary sessions (r2 = 0.796; p < 0.001) and abstract sessions (r2 = 0.678; p = 0.002). Parity could not be achieved except for chairs of abstract sessions. At industry symposia, speakers were male in 88-100%, and chairs were male in 100% of all cases. The congress presidency was held by men in 10out of 11years (92%). The Walter Kausch Medal and the Rudolf Pichlmayr Medal went exclusively to men (100%). The analysis reveals apersistent underrepresentation of female surgeons in prestigious conference roles. Women were predominantly represented in less visible formats, indicating structural barriers. Following the introduction of transparent selection procedures and gender parity requirements, asignificant increase in female participation was observed. These results suggest that targeted institutional measures are suitable for promoting the representation of women in academic surgery and reducing existing imbalances.

Die drucklose Messung der akustischen Immittanz (PLAI) ist eine neuartige Technologie, die frequenzbereichsbezogene, drucklose Messungen im offenen äußeren Gehörgang ermöglicht. Sie erfasst mehrere Parameter, darunter die Resonanzfrequenz und den Peak der Admittanz. Ziel: Ziel [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Zusammenfassung Die Einführung des Pflegebudgets markiert einen grundlegenden Paradigmenwechsel in der Krankenhausfinanzierung. Während das DRG-System pflegerische Leistungen lange Zeit unterbewertete und der Pflegekomplexmaßnahmen-Score (PKMS) nur begrenzte Wirkung entfalten konnte, führte die Ausgliederung der Pflegepersonalkosten ab 2020 zu einer eigenständigen, zweckgebundenen Finanzierungsgrundlage. Dies stärkte die Pflege ökonomisch und trug zu einer Renaissance des examinierten Pflegeberufs bei. Gleichzeitig entstanden neue Konfliktlinien zwischen Krankenhäusern und Kostenträgern, insbesondere bei der Abgrenzung „Pflege am Bett“ und der Bewertung pflegeentlastender Maßnahmen. Die Umsetzung erwies sich als normativ komplex und bürokratisch belastend, verstärkt durch die COVID-19-Pandemie. Insgesamt zeigt sich: Das Pflegebudget hat die Pflege gestärkt, zugleich aber erhebliche Herausforderungen für die Selbstverwaltung und die strategische Krankenhausorganisation geschaffen.

Recent evidence-based guidelines recommend adjuvant therapy following surgery for most patients with WHO grade 2 and 3 gliomas. However, deviations from these recommendations are frequently observed in clinical practice. This study aimed to evaluate patterns of postoperative management across Germany, using multicentre registry data from certified neuro-oncology centres. We analysed data from the ongoing multicentre registry study, which prospectively collects adult patients with IDH-mutant WHO grade 2 and 3 diffuse gliomas. Patients treated at 14 certified neuro-oncology centres were included. Multivariate logistic regression was used to identify factors associated with observation, chemotherapy, or radiotherapy. We assessed concordance between guideline recommendations and actual treatment during the first year after surgery. A total of 217 patients with astrocytoma or oligodendroglioma were included, of whom 169 (78%) had WHO grade 2 tumours. Observation alone was selected in 90 (53%) patients with grade 2 tumours. Gross total resection was independently associated with observation (OR 0.10; 95% CI, 0.04–0.22; p < 0.001). In patients aged ≥ 40 years, adjuvant treatment decisions deviated from current guidelines (OR 3.15; 95% CI, 1.70–5.95; p = 0.001), although age itself was not an independent predictor of treatment choice in multivariate models. The presence of residual tumour after surgery was the principal determinant of postoperative management in patients with WHO grade 2 gliomas. Age ≥ 40 years did not independently influence clinical decision-making. These findings highlight a gap between guidelines and real-world practice and underscore the need for more flexible, individualised treatment frameworks.

Zusammenfassung Die Studie untersucht den strukturellen Bestand und Bedarf an Hospizarbeit und Palliativversorgung in der Region Hannover. Im Zeitraum 06–08/2024 wurden Strukturen der Hospizarbeit und Palliativversorgung über eine Online-Recherche erfasst und 16 Interviews mit Expert:innen in Leitungsfunktionen geführt und inhaltsanalytisch ausgewertet. In der Region Hannover (1,18 Mio. Einw.) existieren 3 Palliativstationen (23 Betten), 1 stationärer Palliativdienst, 5 Hospize (48 Betten), 1 Tageshospiz (6 Plätze), 5 SAPV-Teams und 17 ambulante Hospizdienste. Die hospizlichen Versorgungsstrukturen werden von den Expert:innen als ausreichend, die spezialisierte stationäre Palliativversorgung als unzureichend wahrgenommen. Aufgebaute Kooperationen der Versorger ermöglichen eine effizientere Patientenüberleitung, aber eine engere Zusammenarbeit wird gewünscht. Die Anzahl an Palliativstationen, Palliativdiensten und SAPV-Teams liegen unterhalb der Empfehlungen der europäischen Fachgesellschaft für Palliative Care (EAPC). Dieses Defizit lässt sich nur zum Teil durch eine enge Kooperation zwischen den bestehenden Hospiz- und Palliativversorgen auffangen.

Along with early administration and the selection of the right drug, it is important to consider pharmacokinetic and pharmacodynamic principles, especially in life-threatening infections. Therefore, successful antibiotic therapy requires aclear understanding of the relationship between microbiology, pharmacology, and intensive care medicine. Open and transparent communication among professionals is essential for improving the quality of care. This article discusses current concepts and controversies by presenting arelevant case study of community-acquired pneumonia. It aims to help clinicians select the right drug for each patient, including the correct dose, the appropriate administration, and the right duration of treatment.

Abstract Background Inflammatory Bowel Diseases (IBD), including Crohn's Disease (CD) and Ulcerative Colitis (UC), are marked by dysregulated immune responses and significant T cell infiltration, leading to chronic intestinal inflammation. The global burden of IBD is increasing, yet its pathogenesis remains only partly understood. Our study aims to gain deeper insights into the immunological responsiveness of diseased tissue using ex vivo primary human intestinal tissue slices (Precision Cut Intestinal Slices; PCIS). PCIS are ultrathin tissue slices of the intestine of human donors that remain viable in culture, preserve intestinal architecture, and maintain all relevant intestinal cells including tissue-resident immune cells. Here, we specifically investigated the effects of the JAK1 inhibitor filgotinib and the calcineurin inhibitor pimecrolimus on tissue-resident immune cell responses in PCIS ex vivo. Methods PCIS from ileum and colon resections of Crohn’s disease (CD) and non-CD patients were stimulated ex vivo with Concanavalin A, anti-CD3/CD28 antibodies and IL-1β. Induced responses were modulated with anti-inflammatory treatments such as pimecrolimus and filgotinib for 24h. We evaluated tissue viability (LDH-assay), cytokine release (multiplex ELISA), and PCIS morphology (H&amp;E-staining and Immune fluorescence). Results CD and non-CD intestinal tissue slices maintained viability and intestinal morphology, including disease-specific features in ex vivo culture such as immune cell infiltrates and higher abundance of CD4+ and CD8+ T cells. Ex vivo treatment with various immune stimulations revealed distinct disease-specific cytokine release patterns, with a primary focus on Th1 and Th17 responses, but also including other Th cell, innate and epithelial responses. Filgotinib (1-100 μM) dose-dependently inhibited the secretion of general proinflammatory and T cell-specific cytokines (maximal decrease e.g. IL-8: 8-fold, IL-6: 50-fold, IL-17A: 27-fold). Pimecrolimus (25 µM) specifically decreased T cell-specific cytokines (maximal decrease e.g. IL-2: 13-fold, IL-17A: 22-fold, IL-17F: 27-fold or IFNγ: 7-fold) while the release of general proinflammatory mediators like IL-8 was less affected. Conclusion Our data show the anti-inflammatory effects of filgotinib and pimecrolimus in primary intestinal tissue slices ex vivo. These effects include modulation of various T cell-associated cytokines and other molecules involved in the calcineurin and JAK-STAT pathways. Notably, the different treatments showed distinct effects on cytokine release profiles. This study underscores the potential of PCIS to elucidate the mechanisms of JAK1 inhibitors, advancing IBD treatment strategies and providing a test platform for new drugs in a complex human tissue system.