Bus Riding as Amplification Mechanism for SARS-CoV-2 Transmission, Germany, 20211

To examine the risk associated with bus riding and identify transmission chains, we investigated a COVID-19 outbreak in Germany in 2021 that involved index case-patients among bus-riding students. We used routine surveillance data, performed laboratory analyses, interviewed case-patients, and conducted a cohort study. We identified 191 case-patients, 65 (34%) of whom were elementary schoolchildren. A phylogenetically unique strain and epidemiologic analyses provided a link between air travelers and cases among bus company staff, schoolchildren, other bus passengers, and their respective household members. The attack rate among bus-riding children at 1 school was ≈4 times higher than among children not taking a bus to that school. The outbreak exemplifies how an airborne agent may be transmitted effectively through (multiple) short (<20 minutes) public transport journeys and may rapidly affect many persons.

[Intraosseous foreign body or osteoma : Challenging differential diagnosis after open radius fracture]

Vorstellung eines 16-jährigen Patienten nach Fahrradsturz beim Mountainbiken 14 Tage nach primärer Versorgung nach offener Epiphysenverletzung. Metaphysär intraossär liegende Steine wurden bei anatomischer Reposition der Fraktur als nebenbefundliches Osteom fehlinterpretiert.

Healthcare experiences of patients with chronic heart failure in Germany: a scoping review

OBJECTIVES

To review systematically the past 10 years of research activity into the healthcare experiences (HCX) of patients with chronic heart failure (CHF) in Germany, in order to identify research foci and gaps and make recommendations for future research.

DESIGN

In this scoping review, six databases and grey literature sources were systematically searched for articles reporting HCX of patients with CHF in Germany that were published between 2008 and 2018. Extracted results were summarised using quantitative and qualitative descriptive analysis.

RESULTS

Of the 18 studies (100%) that met the inclusion criteria, most were observational studies (60%) that evaluated findings quantitatively (60%). HCX were often concerned with patient information, global satisfaction as well as relationships and communication between patients and providers and generally covered ambulatory care, hospital care and rehabilitation services. Overall, the considerable heterogeneity of the included studies' outcomes only permitted relatively trivial levels of synthesis.

CONCLUSION

In Germany, research on HCX of patients with CHF is characterised by missing, inadequate and insufficient information. Future research would benefit from qualitative analyses, evidence syntheses, longitudinal analyses that investigate HCX throughout the disease trajectory, and better reporting of sociodemographic data. Furthermore, research should include studies that are based on digital data, reports of experiences gained in under-investigated yet patient-relevant healthcare settings and include more female subjects.

Written patient information materials used in general practices fail to meet acceptable quality standards

BACKGROUND

Patient information materials and decision aids are essential tools for helping patients make informed decisions and share in decision-making. The aim of this study was to investigate the quality of the written patient information materials available at general practices in Styria, Austria.

METHODS

We asked general practitioners to send in all patient information materials available in their practices and to answer a short questionnaire. We evaluated the materials using the Ensuring Quality Information for Patients (EQIP-36) instrument.

RESULTS

A total of 387 different patient information materials were available for quality assessment. These materials achieved an average score of 39 out of 100. The score was below 50 for 78% of all materials. There was a significant lack of information on the evidence base of recommendations. Only 9 % of the materials provided full disclosure of their evidence sources. We also found that, despite the poor quality of the materials, 89% of general practitioners regularly make active use of them during consultations with patients.

CONCLUSION

Based on international standards, the quality of patient information materials available at general practices in Styria is poor. The vast majority of the materials are not suitable as a basis for informed decisions by patients. However, most Styrian general practitioners use written patient information materials on a regular basis in their daily clinical practice. Thus, these materials not only fail to help raise the health literacy of the general population, but may actually undermine efforts to enable patients to make shared informed decisions. To increase health literacy, it is necessary to make high quality, evidence-based and easy-to-understand information material available to patients and the public. For this, it may be necessary to set up a centralized and independent clearinghouse.

Chronic heart failure patients' experiences of German healthcare services: a protocol for a scoping review

INTRODUCTION

Chronic heart failure (CHF) is a heterogeneous condition requiring complex treatment from diverse healthcare services. An increasingly holistic understanding of healthcare has resulted in contextual factors such as perceived quality of care, as well as patients' acceptance, preferences and subjective expectations of health services, all gaining in importance. How patients with CHF experience the use of healthcare services has not been studied within the scope of a systematic review in a German healthcare context. The aim of this scoping review is therefore to review systematically the experiences of patients affected by CHF with healthcare services in Germany in the literature and to map the research foci. Further objectives are to identify gaps in evidence, develop further research questions and to inform decision makers concerned with improving healthcare of patients living with CHF.

METHODS AND ANALYSIS

This scoping review will be based on a broad search strategy involving systematic and comprehensive electronic database searches in MEDLINE, EMBASE, PsycINFO, PSYNDEX, CINAHL and Cochrane's Database of Systematic Reviews, grey literature searches, as well as hand searches through reference lists and non-indexed key journals. The methodological procedure will be based on an established six-stage framework for conducting scoping reviews that includes two independent reviewers. Data will be systematically extracted, qualitatively and quantitatively analysed and summarised both narratively and visually. To ensure the research questions and extracted information are meaningful, a patient representative will be involved.

ETHICS AND DISSEMINATION

Ethical approval will not be required to conduct this review. Results will be disseminated through a clearly illustrated report that will be part of a wider research project. Furthermore, it is intended that the review's findings should be made available to relevant stakeholders through conference presentations and publication in peer-reviewed journals (knowledge transfer). Protocol registration in PROSPERO is not applicable for scoping reviews.

Colorectal cancer stage at diagnosis in migrants and non-migrants: a cross-sectional analysis of the KoMigra Study in Germany

BACKGROUND

 Colorectal cancer is one leading cause of cancer-related morbidity and mortality. Its prognosis depends largely on tumour stage at diagnosis. Migration status was associated with late stage at diagnosis in some studies, yet results are inconsistent.

METHODS

 The cross-sectional study "The Diagnostics of Colorectal Carcinoma in Migrants and Non-Migrants in Germany" (KoMigra) investigated the association between migration background and tumour stage of colorectal cancer at diagnosis in a large German urban area. Patient variables were collected via a survey translated into nine languages. Data on tumour stage were extracted from medical records.

RESULTS

 437 patients could be recruited for analysis. Explorative logistic regression yielded no significant difference for tumour stage "I" versus "II-IV" according to the tumour classification "Union Internationale Contre le Cancer" (UICC) between migrants and non-migrants. Although the odds of a higher tumour stage were consistently higher in migrants than non-migrants, the effect estimates had wide confidence intervals. In descriptive analyses, migrants reported symptoms more often and for longer time than non-migrants. This was especially true for patients with poor proficiency of German.

CONCLUSIONS

 Migration background was not significantly associated with advanced tumour stage at diagnosis. However, the effect of poor language proficiency should be explored further.

Wer sollte zur Darmkrebsfrüherkennung bei familiärem Risiko informieren? – Die Sicht der Betroffenen

Hintergrund Bei familiärem Risiko für Darmkrebs wird eine Früherkennungskoloskopie bereits vor dem Alter von 55 Jahren empfohlen. Ziel der Untersuchung war die Befragung von Betroffenen im Alter von 40 bis 54 Jahren, ob sie sich bereits zur Früherkennung informiert haben und durch welche Institutionen oder Medien sie informiert werden möchten.

Methode Analyse von Daten aus einer Querschnittstudie: Personen mit familiärem Risiko für Darmkrebs wurden hinsichtlich der genannten Fragestellungen schriftlich im hausärztlichen Setting befragt.

Ergebnisse In der Studie nahmen 191 Personen mit familiärem Risiko für Darmkrebs teil: 59,6% hatten sich bereits zur Früherkennung von Darmkrebs informiert, davon 67,0% über die ärztliche Versorgung. Die Mehrzahl wünscht sich Informationen zur Darmkrebsfrüherkennung vom Hausarzt (98,9% trifft vollständig zu/trifft eher zu) sowie von der Krankenversicherung (74,5% trifft vollständig zu/trifft eher zu). Eher keine Informationen wünschen sich Teilnehmer von öffentlichen Einrichtungen wie dem Gesundheitsamt (69,5% trifft nicht zu/trifft eher nicht zu) und privaten Organisationen wie Selbsthilfegruppen (80,9% trifft nicht zu/trifft eher nicht zu). Etwa die Hälfte bevorzugt Informationen über das Fernsehen. Männer wünschen sich häufiger als Frauen Informationen über das Internet (trifft vollständig zu/trifft eher zu: 66,7 vs. 43,8%) oder Zeitungen und Zeitschriften (trifft vollständig zu/trifft eher zu: 53,6 vs. 41,8%).

Schlussfolgerung Eine im hausärztlichen Setting durchgeführte Befragung ergab, dass sich bereits mehr als die Hälfte der betroffenen Personen zur Früherkennung von Darmkrebs informiert hatten. Das Setting der Befragung kann dazu beigetragen haben, dass der Hausarzt bei den bevorzugten Informationsquellen an erster Stelle genannt wurde. Weiterhin zeigen diese Ergebnisse einer deutschlandweit einzigartigen Kohorte im Alter von 40 bis 54 Jahren mit familiärem Risiko für Darmkrebs, dass das bisherige Informationsverhalten nicht überdurchschnittlich ausgeprägt war und dass Männer und Frauen durchaus auf unterschiedlichen Wegen angesprochen werden können.

Screening interval recommendations following a normal colonoscopy in individuals with a familial risk of colorectal cancer

BACKGROUND

In view of the increased risk of developing colorectal cancer (CRC) in individuals with affected first-degree relatives (FDRs), the German evidence-based S3 guideline recommends having the first screening colonoscopy early and then, following a normal examination, repeating it at least every 10 years. The aim of this analysis was to explore colonoscopy interval recommendations in clinical practice among individuals aged < 55 years with a familial risk of CRC.

METHODS

We analyzed data from the FRIDA.Frankfurt study. Patients aged 40 - 54 years with at least 1 reported FDR with CRC (excluding suspected/known hereditary cancer syndromes) and a normal colonoscopy result (no findings) were included. Data on colonoscopist recommendations for intervals between subsequent colonoscopies were extracted from colonoscopy reports.

RESULTS

Of 63 reports of normal colonoscopies, 20 (32 %) did not include a recommendation on when to undergo a further colonoscopy. Of 43 reports with recommendations, 40 (93 %) suggested an interval that was shorter than the recommended maximum interval in the guideline: 1 (2 %) was for a 3-year interval, 37 (86 %) were for 5-year intervals, and 2 (5 %) were for 8-year intervals.

CONCLUSIONS

Although the low number of cases limits generalizability, the results indicate that recommended intervals in clinical practice are considerably shorter than the recommended maximum interval in the guideline.

Frequency of a positive family history of colorectal cancer in general practice: a cross-sectional study

BACKGROUND

Evidence on the frequency of a positive family history of colorectal cancer (CRC) among individuals aged <55 years is lacking. General practice setting might be well suited for the identification of individuals in this above-average risk group.

OBJECTIVE

To determine the frequency of a reported positive family history of CRC among patients aged 40 to 54 years in a general practice setting.

METHODS

We conducted a cross-sectional study in 21 general practices in Germany. Patients aged 40 to 54 years were identified by means of the practice software and interviewed by health care assistants using a standardized four-item questionnaire. Outcome was occurrence of a positive family history of CRC, defined as at least one first-degree relative (FDR: parents, siblings, or children) with CRC. Further measurements were FDRs with CRC / colorectal polyps (adenomas) diagnosed before the age of 50 and occurrence of three or more relatives with colorectal, stomach, cervical, ovarian, urethel or renal pelvic cancer.

RESULTS

Out of 6723 participants, 7.2% (95% confidence interval [CI] 6.6% to 7.8%) reported at least one FDR with CRC and 1.2% (95% CI 0.9% to 1.5%) reported FDRs with CRC diagnosed before the age of 50. A further 2.6% (95% CI 2.3% to 3.0%) reported colorectal polyps in FDRs diagnosed before the age of 50 and 2.1% (95% CI 1.8% to 2.5%) reported three or more relatives with entities mentioned above.

CONCLUSION

One in 14 patients reported at least one FDR with CRC. General practice should be considered when defining requirements of risk-adapted CRC screening.

Validierung eines 4-Item-Fragebogens zum familiären und hereditären Darmkrebsrisiko in der Hausarztpraxis

Ziel der Studie: Zur Identifikation eines familiären oder hereditären Darmkrebsrisikos wurde vom „Netzwerk gegen Darmkrebs e. V.“ ein 4-Item-Fragebogen entwickelt. Ziel dieser Studie war die Überprüfung der Validität beim Einsatz bei 40- bis 54-jährigen Personen im hausärztlichen Setting.

Methodik: In vier hausärztlichen Praxen des „Forschungsnetzwerks Allgemeinmedizin Frankfurt“ wurden mittels Praxissoftware 100 Indexpatienten ausgewählt, bei denen alle Angehörigen ersten Grades in der Praxis bekannt waren. Es wurden Stammbäume erstellt, die einen Abgleich mit den vier Items des Fragebogens vom „Netzwerk gegen Darmkrebs e. V.“ ermöglichten. Daran anschließend wurden die Indexpatienten durch die medizinischen Fachangestellten anhand des 4-Item-Fragebogens befragt. Die Übereinstimmung zwischen den Antworten der Patienten und den Angaben der Hausärzte wurde anhand von Cohens Kappa-Koeffizient ermittelt.

Ergebnisse: Zur Frage zum Vorkommen von Kolorektalen Karzinomen bei Angehörigen ersten Grades (Frage 1) fand sich eine fast vollkommene Übereinstimmung der Antworten mit Kappa-Koeffizient 0,82 (KI:0,58–1,10). Die Frage nach einem Kolorektalen Karzinom bei einem Angehörigen vor dem Alter von 50 Jahren (Frage 2) wurde von den Hausärzten für keinen Patienten positiv beantwortet, von einem Patienten hingegen bejaht. Eine Interpretation der Übereinstimmung anhand des Kappa-Koeffizienten erschien hier nicht sinnvoll. Die Frage nach kolorektalen Polypen vor dem Alter von 50 Jahren (Frage 3) konnte von den Hausärzten aufgrund fehlender Befunde in der Regel nicht beantwortet werden. Ebenso war eine Erhebung der Tumorerkrankungen für Angehörige zweiten Grades auf Grundlage der Praxisdokumentation nicht möglich (Frage 4). Insgesamt 18,8% der Patienten (15/80) bejahte eine oder mehrere Fragen, die auf ein erbliches Darmkrebsrisiko hinweisen können.

Schlussfolgerung: Die Frage nach einem Angehörigen ersten Grades mit Darmkrebs (Frage 1) eignet sich gut zur Identifikation von 40- bis 54-jährigen Hausarztpatienten mit familiärem Darmkrebsrisiko. Die Fragen 2 bis 4 des Fragebogens des „Netzwerk gegen Darmkrebs e. V.“ konnten mit der von uns gewählten Methodik nicht validiert werden. Die valide Beantwortung von Frage eins durch 40- bis 54-Jährige ermöglicht diesbezüglich allerdings eine Vorselektion. In dieser Gruppe kann dann eine weiterführende Anamnese erfolgen.

Positive family history of colorectal cancer in a general practice setting [FRIDA.Frankfurt]: study protocol of a of a cross-sectional study

Background

Although the risk of developing colorectal cancer (CRC) is 2-4 times higher in case of a positive family history, risk-adapted screening programs for family members related to CRC- patients do not exist in the German health care system. CRC screening recommendations for persons under 55 years of age that have a family predisposition have been published in several guidelines.

The primary aim of this study is to determine the frequency of positive family history of CRC (1^st degree relatives with CRC) among 40–54 year old persons in a general practitioner (GP) setting in Germany. Secondary aims are to detect the frequency of occurrence of colorectal neoplasms (CRC and advanced adenomas) in 1^st degree relatives of CRC patients and to identify the variables (e.g. demographic, genetic, epigenetic and proteomic characteristics) that are associated with it. This study also explores whether evidence-based information contributes to informed decisions and how screening participation correlates with anxiety and (anticipated) regret.

Methods/Design

Prior to the beginning of the study, the GP team (GP and one health care assistant) in around 50 practices will be trained, and about 8,750 persons that are registered with them will be asked to complete the “Network against colorectal cancer” questionnaire. The 10 % who are expected to have a positive family history will then be invited to give their informed consent to participate in the study. All individuals with positive family history will be provided with evidence-based information and prevention strategies. We plan to examine each participant’s family history of CRC in detail and to collect information on further variables (e.g. demographics) associated with increased risk. Additional stool and blood samples will be collected from study-participants who decide to undergo a colonoscopy (n ~ 350) and then analyzed at the German Cancer Research Center (DKFZ) Heidelberg to see whether further relevant variables are associated with an increased risk of CRC. One screening list and four questionnaires will be used to collect the data, and a detailed statistical analysis plan will be provided before the database is closed (expected to be June 30, 2015).

Discussion

It is anticipated that when persons with a family history of colorectal cancer have been provided with professional advice by the practice team, there will be an increase in the availability of valid information on the frequency of affected individuals and an increase in the number of persons making informed decisions. We also expect to identify further variables that are associated with colorectal cancer. This study therefore has translational relevance from lab to practice.

Trial registration

German Clinical Trials Register DRKS00006277

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-015-1600-7) contains supplementary material, which is available to authorized users.

The 5-year survival following the marginal resection of a primary leiomyosarcoma of the distal femur and a stump fracture

In this case, we present a 5-year follow-up of a 3-fault-affected primary leiomyosarcoma of the distal femur (spontaneous fracture treated by osteosynthesis; marginal resection; stump fracture after adequate trauma) with an extended local recurrence but without metastasis.

Loosening pattern in a cementless custom-made hip stem: X-ray analysis, finite-elements and photoelasticity measurements

Thirty-three X-press cementless stems (Depuy) manufactured according to standardized X-rays were inserted from 1992 to 1994. The patients' mean age was 49 (range 15-79) years with a mean follow-up of 32 (+/-6) months. A characteristic radiographic pattern of aseptic loosening with erosion of the medial cortex by the tip of the stem occurred in 28 patients and a valgus shift of the implant in 14 cases. A radiolucent line with increased sclerosis below the tip (zone Gruen 4) was observed in 17 cases. Four stems were revised due to histologically confirmed aseptic loosening. Biomechanical investigation of one of the revised stems with the typical pattern of valgus angulation and medial cortex erosion included photoelasticity and finite-element analysis. The intertrochanteric fit and fill obviously resulted in an unfavorable distribution of contact areas, including peaks of high stress on the medial tip of the stem. These experimental findings are even evident for a postulated rotational stability. The clinical and radiographic results of the cementless X-press stems do not seem to support the fixation concept of intertrochanteric fit and fill of femoral components.

Necrotizing skin lesions induced by low-molecular-weight heparin after total knee arthroplasty

We report the unusual complication of focal necrotizing skin lesions accompanied by moderate thrombocytopenia in a female patient undergoing thromboprophylaxis with low-molecular-weight heparin after total knee arthroplasty. Heparin-induced thrombocytopenia was suspected and confirmed using the heparin-induced platelet activation assay. The skin lesions improved gradually after the discontinuation of heparin application. In addition to the description of this exceptionally rare adverse effect of low-molecular-weight heparin, a brief discussion of previously reported cases is provided.

[Determination of skeletal age using the Oxford Score in children with epiphyseolysis of the femur head]

Pelvis radiographs of 47 children with slipped capital femoral epiphyses (SCFE) and 24 without a hip disorder were reviewed in a retrospective study by four readers to determine the skeletal age by the Oxford method. 72% of the children suffering from SCFE had a body weight above the standard level but a normal body height at the time of diagnosis. The mean chronologic age was 3 years higher than the skeletal age determined by the Oxford-score. The linear regression analyses showed that children with SCFE have had a skeletal maturation delay in comparison with the normal group at the beginning of the age period in question. This deficiency became greater as chronologic age increased. All children with the SCFE disease showed a nearly uniform skeletal age clearly below the bone age standard irrespective of their chronologic age. These results, in connection with obesity in most cases, support the idea of hormonal disorders with delayed skeletal maturation development in the aetiology of SCFE disease.