[Acceptance of and factors influencing attitudes towards post-mortem organ donation in Germany : Analysis of representative cross-sectional studies between 2010 and 2016]. / Entwicklung der Akzeptanz der postmortalen Organspende und ihre Einflussfaktoren in Deutschland : Eine Auswertung von repräsentativen Querschnittstudien zwischen 2010 und 2016.

The German post-mortem organ donation rate has been low, since transplantation scandals attracted media attention in 2012. Therefore, the objective of this article is to address the willingness to document attitudes (e.g., organ donor card) towards organ donation, factors influencing the willingness to document the individual will and knowledge of organ donation among the German public. Data of surveys on attitudes towards organ and tissue donation in Germany conducted between 2010 and 2016 by the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung) were analysed. Using binary logistic regression, factors influencing the method for documenting the individual will were identified. In the 2016 survey, 35.7% of all respondents had documented their will in the form of an organ donor card or an advance health care directive. Female gender, younger age, higher level of education, discussion of organ donation with next-of-kin/friends, grasping the concept of death and knowledge of organ donation increase the likelihood of possessing an organ donor card. Being male increases the likelihood of documenting the individual will using an electronic health insurance card. Older respondents or respondents with lower level of education lack knowledge about organ donation. Persons with extensive knowledge are more likely to possess an organ donor card and to consent to donate organs of next-of-kin. Further measures to increase knowledge of organ donation among the general public should be discussed. The influence of gender on the willingness to use different methods to document attitudes needs to be evaluated.

Attitudes and knowledge about post-mortem organ donation among medical students, trainee nurses and students of health sciences in Germany : A cross-sectional study.

OBJECTIVE: In 2018 Germany had the lowest rate of post-mortem organ donation in the Eurotransplant network. Healthcare trainees and students will be important advisors on organ donation for patients in the future. This study aimed to examine 1) attitudes and knowledge about post-mortem organ donation, 2) how past transplantation scandals have affected those attitudes and 3) how satisfied respondents were with the knowledge provided on the courses. METHODS: A cross-sectional study was conducted between 20 March and 8 July 2019 at a university hospital and nursing schools in Berlin and Potsdam, Germany. Study participants were 209 medical students, 106 health sciences students and 67 trainee nurses. RESULTS: Of the respondents 29.3 and 50.8% knew the tasks of the German Organ Transplantation Foundation and Eurotransplant, respectively. All brain death questions were correctly answered by 56.3% of the medical students, 25.7% of the health sciences students and 50.9% of the trainee nurses (Fisher's exact test p < 0.001, Cramer's V = 0.242). Transplantation scandals had damaged attitudes towards organ donation for 20.7% of the medical students, 33.3% of the health sciences students and 13.6% of the trainee nurses (χ2-test p = 0.001, Cramer's V = 0.164). Asked whether post-mortem organ donation was sufficiently addressed in their courses, 39.5% of the medical students, 60.4% of the health sciences students and 51.9% of the trainee nurses said this was not or tended not to be the case (Kruskal-Wallis H-test p < 0.001, Spearman's rho r = -0.112). CONCLUSION: Given the knowledge gaps identified and the respondents' dissatisfaction with the knowledge they received, organ donation should be better integrated into curricula and training programs.

Health-related quality of life in adult heart-transplant recipients-a systematic review.

BACKGROUND: Health-related quality of life is a multidimensional concept to assess the impact of medical interventions from an individual perspective. This concept is important to evaluate benefits of heart transplantation. This systematic review was conducted to determine (1) posttransplant health-related quality of life in heart transplantation patients and (2) influencing factors of health-related quality of life. METHODS: A systematic review of cross-sectional, prospective and mixed methods studies published from November 2007 to November 2017 was conducted on PsycINFO, PSYNDEX and PubMed using a combination of the keywords heart transplantation, heart transplantation patient, quality of life, and health-related quality of life. RESULTS: A total of 14 studies with a cross-sectional design, 6 studies with a prospective design and 2 mixed-methods studies were identified. The stability of health-related quality of life up to 10 years after transplantation has been reported. Most often generic scales, such as SF-36 (8) and WHOQoL-BREF (7) were used for data collection. Demoralization, depression, pain, gastrointestinal symptoms, sexual dysfunction, and poor oral health influence health-related quality of life negatively, whereas social and family support have a positive impact. CONCLUSION: Although health-related quality of life is positively influenced by transplantation, further research regarding gender differences is needed. Disease-specific scales were rarely used.

Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK : A systematic review.

BACKGROUND: German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation. METHODS: A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy. RESULTS: Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns. CONCLUSION: Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.

Lobe-wise assessment of lung volume and density distribution in lung transplant patients and value for early detection of bronchiolitis obliterans syndrome.

PURPOSE: To evaluate quantitative computed tomography (CT) measurements of the lung parenchyma in lung transplant (LTx) patients for early detection of the bronchiolitis obliterans syndrome (BOS). MATERIALS AND METHODS: 359 CT scans of 122 lung transplant patients were evaluated. Measurements of lung volume and density were performed for the whole lung and separately for each lobe. For longitudinal analysis the difference between the baseline at 6 months after LTx and follow-up examinations was calculated. Patients with and without BOS (matched 1:2) were compared at two different time points, the last examination before the BOS onset and the first examination within one year after BOS onset. RESULTS: 30 patients developed BOS during the follow-up period. Longitudinal changes in the lung volume and lung density measured on CT differed significantly between those patients with and without early BOS, in particular the difference of the inspiratory and expiratory lung volume (p < 0.001), the ratio of the expiratory and inspiratory lung volume (p < 0.001-p = 0.001) and MLD (p < 0.001-p = 0.001), the volume on expiration (p < 0.001-p = 0.007), the MLD on expiration (p < 0.001-p = 0.007), and the percentiles on expiration (p < 0.001-p = 0.002) with an increase of lung volume and a decrease of lung density. Changes were pronounced in the lower lobes. Before BOS onset, patients with and without future development of BOS showed no significant differences. CONCLUSION: Longitudinal changes of lung volume and lung density measured on CT start markedly at BOS onset with increased lung volume and decreased lung density indicating increased inflation levels. Even though this method may help to diagnose BOS at onset it is not useful as a predictor for BOS before disease onset.

[Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study]. / Akzeptanz der postmortalen Organspende in Deutschland : Repräsentative Querschnittsstudie.

BACKGROUND: The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. A voluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. METHODS: Binary logistic regression of data from the 2014 survey by the Federal Centre for Health Education on attitudes towards organ and tissue donation in Germany was conducted, aiming to identify influencing factors on the likelihood of organ donor card possession. Additionally, data of the German Organ Transplantation Foundation on post-mortem organ donations in Germany in 2014 were studied to highlight reasons for approval and objections by next of kin of potential and explanted post-mortem organ donors. Methods of documentation of the deceased's will according to data of the German Organ Transplantation Foundation were analyzed. RESULTS: Male gender and lack of knowledge about organ donation decrease the likelihood of having an organ donor card. Of the respondents in the survey of the Federal Centre for Health Education 71.0% would donate their own organs, whereas only one third possess an organ donor card. Health insurances and physicians are the most important providers of organ donor cards in Germany. An increase in the percentage of organ donor card possession following the amendment of the transplantation law could not be observed by 2016. Fear of organ trade and unjust organ allocation are the main reasons for rejecting organ donation among the general public. Previous transplantation scandals are a primary reason for a negative change in attitudes. Main reasons for objection among the next of kin of potential organ donors are known objections of the deceased and the lack of knowledge about the will of the deceased. In addition, only 58.1% of all explanted organ donors documented their will in written or verbal form. CONCLUSION: Education on organ donation can be a means to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany.

Phenotyping Chronic Lung Allograft Dysfunction Using Body Plethysmography and Computed Tomography.

Restrictive subtype of chronic lung allograft dysfunction (CLAD) was recently described after lung transplantation. This study compares different definitions of a restrictive phenotype in CLAD patients and impact on survival. Eighty-nine CLAD patients out of 1191 screened patients (September 1987 to July 2012) were included as complete longitudinal lung volume measurements and chest computed tomography (CT) after CLAD onset was available. CT findings and lung volumes were quantified and survival was calculated for distinctive groups and predictive factors for worse survival were investigated. Graft survival in patients with total lung capacity (TLC) between 90% and 81% of baseline (BL) (n = 13, 15%) in CLAD course was similar to those with TLC >90% BL (n = 64, 56%; log-rank test p = 0.9). Twelve patients (13%) developed a TLC ≤80% BL and 10 (11%) had significant parenchymal changes on CT, of whom 6 (46%) also had TLC ≤80% BL. CT changes correlated with TLC ≤80% BL (Φ-coefficient = 0.48, p = 0.001). Patients with either TLC ≤80% or significant CT changes (n = 16, 18%) had a significantly reduced survival (log-rank p < 0.001). Forced vital capacity loss at CLAD onset was associated with poorer survival but did not correlate with the TLC or CT changes. A restrictive subtype of CLAD may be defined by either TLC ≤80% BL or severe parenchymal changes on chest CT.

[Minimally invasive chest surgery. Is palpation control still necessary with modern computed tomography?]. / Minimal-invasive Thoraxchirurgie. Macht die moderne Computertomographie die Palpationskontrolle verzichtbar?

BACKGROUND: A fundamental argument against minimally invasive oncological chest surgery is the risk of overlooking pulmonary nodules due to a lack of intraoperative palpation. In the literature this risk in the treatment of primary lung cancer is given as up to 8.4 % and as more than 15 % in the surgical treatment of pulmonary metastases. OBJECTIVE: The aim of this study was to evaluate if modern computed tomography (CT) is sensitive enough to replace intraoperative palpation and justify a minimally invasive approach. PATIENTS AND METHODS: The medical records from 92 patients who underwent 95 open lung resections due to pulmonary malignancies from April 2010 through September 2011 at the Medical School Hannover were retrospectively analysed. A comparison was carried out between the lesions detected preoperatively by CT and those removed during surgery and histologically confirmed as being malignant. Patients with more than five nodules suspected of being malignant in the preoperative CT scan were excluded. RESULTS: According to the final histopathological examination 125 malignant nodules were resected and 2 of these were not detected in the preoperative CT scan, which were performed in external hospitals with a slice thickness of 5 mm and 8 mm, respectively. This represents a sensitivity of 98 % for all CT scans in terms of detection of pulmonary nodules. With thin slice CT (slice thickness up to 1.5 mm) a sensitivity of 100 % was even achieved. CONCLUSION: The results demonstrate that a high sensitivity of thin slice CT for detection of lung nodules can be achieved. Based on these results the categorical reservation with respect to thoracoscopic resection of pulmonary metastases should be reconsidered in suitable patients where a minimally invasive resection is possible. The extent of lymph node dissection is not influenced by these data. Further studies with larger sample sizes are warranted to confirm these results.

Integrative teaching in radiology - a survey.

PURPOSE: To survey integrative teaching in radiology at German universities. MATERIALS AND METHODS: A questionnaire about radiological education was sent electronically to all 37 chairpersons of university radiology departments in Germany. The questions included the course type, teaching methods, concept, perception, and advantages and disadvantages of integrative teaching. Statistical analysis was performed with nonparametric statistics and chi-square test. RESULTS: The survey was considered representative with a return rate of 68 %. Integrative teaching is established at 4/5 of all departments. Integrative teaching is well accepted with an acceptance rate that is significantly higher in so-called "Modellstudiengängen" [model courses of study] (100 %) compared to conventional courses of study (72 %). The advantages of integrative teaching include linking of content (92 %) and preparation for interdisciplinary work (76 %). The disadvantages include high effort (75 %) and time (67 %) for organization. Furthermore, there is a risk that basic radiological facts and knowledge cannot be conveyed and that the visibility of radiology as an independent discipline is lost. Conventional radiological teaching has a similarly high acceptance (84 %) compared to integrative courses (76 %). CONCLUSION: Integrative teaching has a high acceptance among chairpersons in radiology in Germany despite the greater effort. A good interdisciplinary collaboration is essential for integrative teaching and at the same time this can be conveyed to the students. However, the visibility of radiology as a discipline and the possibility to cover basic radiological content must be ensured. Therefore, both conventional courses and integrative teaching seems reasonable, especially in cross-disciplinary subjects such as radiology. KEY POINTS: Both integrative teaching and conventional radiological teaching are highly accepted. The advantages include the linking of multidisciplinary content and the preparation for interdisciplinary cooperation. The disadvantages include more time and effort for organization and reduced visibility of cross-disciplinary subjects.

[Diseases of the airways]. / Erkrankungen der Atemwege.

Diseases of the airways are common symptomatic patterns with a steadily increasing prevalence. Bronchial pathologies are often encountered in the daily routine and also often as secondary findings, e.g. in cancerous diseases in the form of (chronic) bronchitis, emphysema and bronchiolitis. Characteristic methodological techniques in imaging of the airways are computed tomography (CT) acquisition in expiration for occlusive diseases of the airways and the possibility of quantitative CT image analysis by measuring the thickness of the parenchyma and the bronchial wall. In general a differentiation is made between diseases of the large and small airways. In diseases of the large airways, which include bronchitis, pulmonary cystic fibrosis and allergic bronchopulmonary aspergillosis, the predominant pattern is the occurrence of bronchial wall thickening, bronchiectasis and mucus impaction. Examples of diseases of the small airways are emphysema, bronchial asthma, exogenous allergic alveolitis and the various forms of bronchiolitis. The predominant morphological patterns are the tree-in-bud pattern and air trapping. Even though the morphological pattern of findings is unspecific, together with the distribution and clinical findings it can often be decisive for the diagnostics.

Radiological anatomy - evaluation of integrative education in radiology.

PURPOSE: Evaluation and analysis of the integrative course "Radiological Anatomy" established since 2007 at the Medical School Hannover (MHH) in comparison with conventional education. MATERIALS AND METHODS: Anatomy and radiology are usually taught separately with a considerable time lag. Interdisciplinary teaching of these associated subjects seems logical for several reasons. Therefore, the integrative course "Radiological Anatomy" was established in the second year of medical education, combining these two closely related subjects. This interdisciplinary course was retrospectively evaluated by consideration of a student questionnaire and staff observations. The advantages and disadvantages of integrative teaching in medical education are discussed. RESULTS: The course ratings were excellent (median 1; mean 1.3 on a scale of 1 to 6). This is significantly (p < 0.001) better than the average of all evaluated courses in the respective term (grade 2.8). The course improved the anatomical comprehension (90 %) and the students stated that the topics were relevant for their future medical education (90 %). Furthermore, interest in the subject's anatomy and radiology increased during the course (88 %). According to the students' suggestions the course was enhanced by a visitation in the Department of Radiology and the additional topic central nervous system. CONCLUSION: Integrative teaching of anatomy and radiology was well received by the students. Both, anatomical and radiological comprehension and the motivation to learn were improved. However, it should be considered, that the amount of work and time required by the teaching staff is considerably increased compared to traditional teaching.

Bronchial wall thickness measurement in computed tomography: effect of intravenous contrast agent and reconstruction kernel.

Bronchial wall thickness measurements in computed tomography (CT) has become a useful tool for assessment of the severity of diseaseand the response to treatment in a large number of pulmonary diseases. However, there are only few reports evaluating its dependence on different scan protocols. The effect of intravenous contrast medium has not been analyzed. The aim of this study was to evaluate the influence of intravenous contrast medium application, the contrast phase (arterial and venous) and different reconstruction kernels on bronchial wall measurements of a newly developed algorithm. The bronchial wall thickness was analyzed in 630 bronchial sections of 56 CT examinations with dedicated software (MEVIS Airway Examiner, Fraunhofer MEVIS Bremen, Germany). Application of i.v. contrast agent significantly increased bronchial wall thickness (paired t-test, p<0.001). Comparing arterial and venous phase, bronchial wall thickness was significant higher in the arterial phase (paired t-test, p=0.045). Bronchial wall thickness also increased (ANOVA with Bonferroni correction, p<0.001) when using a softer reconstruction kernel. The absolute differences in bronchial wall thickness were independent of bronchial size and generation.

MRI-based breast volumetry-evaluation of three different software solutions.

As lipofilling of the female breast is becoming more popular in plastic surgery, the use of MRI to assess breast volume has been employed to control postoperative results. Therefore, we sought to evaluate the accuracy of magnetic resonance imaging (MRI)-based breast volumetry software tools by comparing the measurements of silicone implant augmented breasts with the actual implant volume specified by the manufacturer. MRI-based volume analysis was performed in eight bilaterally augmented patients (46 ± 9 years) with three different software programs (Brainlab© I plan 2.6 neuronavigation software; mass analysis, version 5.3, Medis©; and OsiriX© v.3.0.2. 32-bit). The implant volumes analysed by the BrainLab© software had a mean deviation of 2.2 ± 1.7% (r = 0.99) relative to the implanted prosthesis. OsiriX© software analysis resulted in a mean deviation of 2.8 ± 3.0% (r = 0.99) and the Medis© software had a mean deviation of 3.1 ± 3.0% (r = 0.99). Overall, the volumes of all analysed breast implants correlated very well with the real implant volumes. Processing time was 10 min per breast with each system and 30 s (OsiriX©) to 5 min (BrainLab© and Medis©) per silicone implant. MRI-based volumetry is a powerful tool to calculate both native breast and silicone implant volume in situ. All software solutions performed well and the measurements were close to the actual implant sizes. The use of MRI breast volumetry may be helpful in: (1) planning reconstructive and aesthetic surgery of asymmetric breasts, (2) calculating implant size in patients with missing documentation of a previously implanted device and (3) assessing post-operative results objectively.

Observation of phase fluctuations in elongated Bose-Einstein condensates.

The occurrence of phase fluctuations due to thermal excitations in Bose-Einstein condensates (BECs) is studied for a variety of temperatures and trap geometries. We observe the statistical nature of the appearance of phase fluctuations and characterize the dependence of their average value on temperature, number of particles, and the trapping potential. We find pronounced phase fluctuations for condensates in very elongated traps in a broad temperature range. The results are of great importance for the realization of BEC in quasi-1D geometries, for matter wave interferometry with BECs, as well as for coherence properties of guided atom laser beams.

[Assessment of the diagnostic yield of cerebral CT in children]. / Udbyttevurdering ved CT af cerebrum hos børn.

In order to show if an excessive use of cerebral computed tomography of children (aged 0 to 15 years) existed, scans from 157 patients from a single X-ray-department was examined. The clinical information which was presented on referral of the patients was also investigated. No excessive use was proven, as 26.1% of the patients showed pathological changes on the scans. But the investigation also showed that the percentage could probably be higher if more (if not all) patients was examined by a neurologist before referral to the X-ray-department.