University Hospital in Halle

Handheld ultrasound (HHUS) devices are increasingly used in clinical practice due to their portability and cost-effectiveness. However, HHUS image quality remains variable, and a standardized expert-based evaluation protocol is lacking. This study compares the image quality of B-mode recordings of five HHUS models with a high-end reference system (HEUS) using a blinded assessment to identify differences, covariates, offering a standardized evaluation framework.In this blinded, multi-center study, video sequences of the liver, pancreas, and sigmoid colon were recorded in ten volunteers using 5 HHUS devices - Vscan Air, Butterfly iQ+, Philips Lumify, Clarius C3, and Clarius C3 HD3 - and one HEUS (GE Logiq E10). Twenty-two physicians with many years of abdominal ultrasound experience rated blinded clips for 5 image quality parameters.The HEUS consistently received the highest ratings. Image quality differed significantly between HHUS devices. Clarius systems showed the smallest deviation from the reference, followed by Vscan Air and Philips Lumify. All image parameters significantly correlated with the overall impression, without a single dominant factor. The patients' BMI had no relevant influence. Examiner experience was less impactful than device familiarity and personal preference.The image quality of HEUS remained superior to all tested HHUS devices. Further subdivision of image quality aspects did not provide additional information. Furthermore, we could not identify significant covariates in our setup. These findings could justify simplified setups with reduced questionnaires and requirements for examiners.

The updated version of the German S3 guideline for bladder cancer introduces several changes in the areas of diagnostics, perioperative systemic therapy, and rehabilitation, as well as psycho-oncological and palliative care for bladder cancer patients. In urinary diagnostics, the Paris system, including aquality algorithm, has been introduced to improve the comparability of cytological findings. Imaging diagnostics now recommends multiparametric magnetic resonance imaging (MRI) with Vesical Imaging-Reporting and Data System (VI-RADS) reporting as an alternative or complement to computed tomography (CT) scans. CT urography remains the gold standard for the upper urinary tract, while intravenous pyelography (IVP) is no longer recommended. In perioperative systemic therapy, the importance of multidisciplinary case conferences for muscle-invasive bladder cancer (MIBC) is emphasized to enable as many patients as possible to receive perioperative systemic therapy. Rehabilitation now follows quality criteria (multiprofessional teams, long-term concepts) and includes an expanded assessment of physical and psychological burdens. Particularly relevant is the treatment of sexual dysfunction in women after cystectomy. In psycho-oncology and palliative medicine, early integration of the S3 guidelines is required, including advanced care planning (ACP) starting from the diagnosis of advanced tumors. These changes aim for higher diagnostic accuracy, better treatment planning, and holistic patient care.

The S2K guideline, organized by the German Respiratory Society, is aimed at physicians in Germany, Switzerland, and Austria who perform outpatient or inpatient diagnostic flexible bronchoscopy in adult patients. Its goal is to standardize the procedure, minimize complications, and improve diagnostic safety. The guideline specifically addresses specialists in pulmonology, thoracic surgery, and hospital hygiene, as well as nursing and technical staff. It provides evidence- and consensus-based recommendations on indications, preparation, execution, hygiene measures, and aftercare. Additionally, it serves as an information resource for physicians from other specialties, payers, professional societies, and can support quality management. It applies to medical care in Germany, Austria, and Switzerland and incorporates the latest scientific findings up to the date of publication.

This study compared the clinical outcomes of the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations for the management of acute midsubstance Achilles tendon ruptures (AMATR). A retrospective analysis was conducted on 63 AMATR patients (54 men and 9 women, with a mean age of 39.84 ± 10.40 years (range, 21-62 years). All patients underwent Achilles tendon repair using the modified Bunnell suture configuration using the all-inside endoscopic repair (n = 31) or a minimally invasive repair (n = 32). The primary endpoint was postoperative functional outcome, assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS) at 6, 12, and 24 months. Secondary endpoints included perioperative and short-term recovery parameters, including operative time, incision length, postoperative pain assessed by the Visual Analog Scale (VAS) on postoperative days 1 and 3, wound complications, and time to return to work and sports activities. There were no intraoperative complications, and all patients in the endoscopic group achieved primary wound healing. At the 6-, 12-, and 24-month follow-up, both groups demonstrated significant improvement in AOFAS and ATRS scores over time, with no significant differences between groups. Regarding secondary endpoints, the all-inside endoscopic group had a significantly longer operative time but a significantly shorter incision length compared with the minimally invasive group (p < 0.05). VAS pain scores on postoperative days 1 and 3 were significantly lower in the endoscopic group (p < 0.05). No wound infections occurred in the endoscopic group, whereas three superficial infections were observed in the minimally invasive group; however, the difference was not statistically significant. Patients in the endoscopic group returned to work one week earlier (p < 0.05), while the time to return to sports was comparable between groups. Both the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations provide reliable repair for AMATR and support a successful return to occupational and athletic activity. While the all-inside endoscopic procedure was associated with a longer operative time, it offered advantages in terms of reduced early postoperative pain, smaller incisions, and earlier return to work, without compromising functional recovery at the 2-year follow-up.

Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses. Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword 'orthopaedic'. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates. Larger author teams were associated with higher citation rates (β = 0.108 citations/year per additional author, 95% confidence interval [CI] 0.103-0.114, p < 0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p = 0.001). Title length in characters correlated positively with citation rate (β = 0.023 per character, p < 0.001), whereas title length in words showed a negative association (β = -0.183 per word, p < 0.001). The presence of a colon (+0.314 citations/year, p < 0.001) or dash (+0.187, p = 0.001) increased citation performance, while question marks (-0.476, p < 0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p < 0.0001). In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more critical than citation metrics.

Aufbauend auf den Erfahrungen aus nunmehr 40 Jahren mit Cochlea-Implantaten (CI) haben sich auch die Indikationskriterien für eine CI-Versorgung immer weiter von einer Gehörlosigkeit in Richtung hochgradiger Schwerhörigkeiten verschoben. Damit stellen CIs für das betroffene Klientel [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Appraisal for self-care agency (ASAS) is central to cardiovascular disease (CVD) management, yet the influence of loneliness as a social stressor remains under-characterized. In patients with CVD (N = 80), cross-sectional predictors for ASAS were assessed via ordinary least squares (OLS) and quantile regression; robust methods are supplemented to buffer the sample size. Interaction effects on ASAS were tested between loneliness and physical activity, and loneliness and self-efficacy. The diminishing effect of loneliness explained 10% of ASAS variance and remained significant when controlling for covariates (ß = -1.05, p = 0.031). Self-efficacy (β = 2.97, p = 0.009) and physical activity (β = 5.13, p = 0.001) were positively associated with ASAS, although quantile models indicated heterogeneity: loneliness exerts its effect at low ASAS (τ = 0.25; ß = -1.95, p < 0.001) whereas physical activity is influential at high ASAS (τ = 0.75; ß = 5.21, p < 0.001) and self-efficacy across all levels. Interactions showed a buffering of loneliness' negative influence on ASAS via physical activity (ß = 3.29, p = 0.044). Self-efficacy is crucial for self-care agency in CVD. While loneliness exerts its strongest detriment at lower self-care levels, physical activity may attenuate loneliness-related vulnerability. These findings support interventions enhancing self-efficacy, promoting activity, and targeting loneliness to improve self-care.

BackgroundElder abuse (EA) is a serious health issue in older adults. The risk of EA may be increased by ear or hearing diseases (EHD), which are prevalent in this population and can lead to dependence on caregivers. The objective of the study was to determine the association between EHD and EA in older adults.MethodsData were derived from 2,817 individuals aged 80 years or older from the Old Age in Germany (D80+) study. EA was measured using the Elder Abuse and Emotional Consequences Scale (EACS) and its subscales: intimidation, shaming and blaming, paternalism, neglect, financial exploitation, and physical behavior. Elastic net regressions and multivariate analyses of covariance (MANCOVA) were performed to examine the link between EHD and EA subscales.ResultsIndividuals had a mean age of 84.4 ± 3.9 years. Of these, 52.4% were male and 47.6% female. The prevalence of EA was higher in individuals with EHD (84.2%) compared to those without (79.4%, p < .001). In addition to depressive symptoms (coefficient = 0.101, p < .001), EHD was also significantly associated with EA (coefficient = 0.052, p = .003). MANCOVA results showed a multivariate effect of EHD on EA subscales (Wilks’ λ = 0.987, F(6, 2653) = 5.696, p < .001, partial η² = 0.013). The strongest effects were observed on the intimidation (F = 22.364, p < .001, η² = 0.008) and neglect subscales (F = 21.151, p < .001, η² = 0.008).ConclusionsThe study identified an association between EHD and EA. This emphasizes the importance of addressing hearing impairments in EA prevention strategies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-026-07222-2.