[Social media-Chances and risks for rheumatology]. / Social Media ­ Chancen und Risiken für die Rheumatologie.

The use of social media and social networks has increased significantly in recent years. They are becoming progressively more important as information channels in private and professional contexts. Also, in medicine, social media are already being used in a variety of ways. For example, professional societies and patient interest groups are being increasingly represented in social networks. The broad use and wide audience of these networks offer new opportunities for the field of rheumatology. This review article provides an overview of the characteristics of some major social media platforms and systematically analyses the existing publications in the context of rheumatology. Furthermore, advantages, but also potential risks that may arise due to social media use are being addressed.

[Impact of COVID-19 on rheumatological care : A national survey in April 2020]. / Auswirkungen von COVID-19 auf die rheumatologische Versorgung : Eine nationale Umfrage im April 2020.

BACKGROUND: The preparations of healthcare systems to accommodate the large numbers of severely ill COVID-19 patients in March/April 2020 also had a substantial impact on rheumatological patient care. OBJECTIVE: The aim of this online survey was to assess the changes and current status of rheumatology departments and practices in Germany. MATERIAL AND METHODS: A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient operations. Questions addressed the following issues: characteristics of the department, impact on patient care, application of recommendations, personal protective equipment (PPE), and organizational adaptations to the new framework conditions. The survey was available for 14 days and closed on 3 May 2020. RESULTS: A total of 66 complete answers were recorded and evaluated. In the first 4 weeks of the COVID-19 crisis the proportion of outpatients in the institutions decreased on average by -40.6%. The number of outpatients receiving infusions decreased by -25.6%. Of the inpatient facilities 81% reported an average decrease of hospitalized patients of -54.9% and 52% of the participants complained of a lack of PPE. Organizational adjustments are reported. CONCLUSION: The rheumatological services were significantly reduced 4 weeks after the SARS-CoV­2 pandemic had reached Germany on a large scale. The study showed that in this phase there were decisive turning points in patient care and implicated substantial organizational and ultimately also economic effects on the healthcare system, both in hospitals and private practices. As the survey cannot adapt to the daily dynamic changes in priorities it serves as a first snapshot, which requires follow-up studies.

[A patient with inflammatory arthralgia, paraesthesia and atrial fibrillation]. / Ein Patient mit entzündlichen Arthralgien, Parästhesien und Vorhofflimmern.

A 61-year-old male patient had suffered from inflammatory arthralgia since 2014 and had been taking a proton pump inhibitor (PPI) for many years. Additionally, the patient was prescribed apixaban for atrial fibrillation. The blood tests on admission showed a marked hypomagnesemia with secondary hypocalcemia and hypokalemia. After discontinuation of the PPI and through substitution of magnesium, the blood results normalized completely and the patient was finally symptom-free. This case report underlines the important role of magnesium in rheumatology and presents the various mechanisms of action of magnesium.

[Specialist training quo vadis?] / Facharztweiterbildung quo vadis?

BACKGROUND: In May 2018 a revision of the training regulations for German doctors (MWBO) was passed which will significantly impact the medical training for German rheumatologists. The goal of this paper was to create an overview of the status quo in advanced medical training in this field. METHODS: A quantitative and qualitative analysis was conducted to identify the strengths and weaknesses of the current continuous education in the field of rheumatology in Germany. The number of newly trained specialists in rheumatology in the years 2015 to 2017 was determined from the regional medical associations. Furthermore, an online survey assessing the training conditions of assistant physicians was conducted. 71 physicians participated in the nationwide survey. RESULTS: In 2015 (53 specialists), in 2016 (43 specialists) and in 2017 (43 specialists) completed their training in the field of rheumatology. The online survey of assistant physicians found that the medical training was graded 3.1 on a scale of 1 to 6 (SD ± 1.1). 19.4% of respondents reported that they had regular mentoring, and 41.7% had on-the-job evaluations. Deficits were evident concerning practical diagnostic skills: 22.8% of the physicians were not practicing joint ultrasonography and another 20% performed it only once a month. As points of criticism 46.6% mentioned a missing structure in training programme and 33.3% noted a lack of supervision. The majority of respondents wanted more training options, supervision and better practical training in ultrasound diagnostics. CONCLUSION: The nationwide number of newly acquired specialist qualifications (between 2015 and 2017) showed a decreasing trend. It is to be feared that the numbers will continue to stagnate, which increases the importance to invest further in medical education. The online survey also showed that the current medical training in Germany has deficits. Here, the new MWBO could create better guidelines for a structured training, which should be guided by the principle of "Teach to Target".

[Use of medical apps and online platforms among German rheumatologists : Results of the 2016 and 2018 DGRh conference surveys and research conducted by rheumadocs]. / Nutzung von Medizin-Apps und Online-Plattformen unter deutschen Rheumatologen : Ergebnisse der rheumadocs-Recherche und DGRh-Kongress-Umfragen von 2016 und 2018.

BACKGROUND: Apps and online platforms play an ever increasing role in the daily work routine of physicians. The aim of this study was to investigate which medical apps and online platforms are used by German rheumatologists for certain tasks and to identify usage trends. METHODS: Data were collected via a SurveyMonkey survey conducted by members of rheumadocs (Young German Rheumatology Association) at the 2016 and 2018 German Society for Rheumatology (DGRh) conferences. RESULTS: In 2016 and 2018 the survey was completed by 75 and 84 assistant and specialist rheumatologists, respectively. In 2016, 37% of rheumatologists were using medical apps in routine care which changed to 49% in 2018. In 2016, 47% compared to 68% in 2018, planned to integrate medical apps into routine care. In total, 20 different medical apps were recommended for colleagues to use; however only 2 of these apps were specific for rheumatology. In contrast to 52 app recommendations for colleagues, only 8 app recommendations for patients were recorded. Most recommendations to physicians received the app "Arznei aktuell" (21%). "Embryotox" was the app, most recommended to patients (38%). In 2016 the online database PubMed was most popular and 97% of participants were familiar with it. Use of other online platforms showed great age dependency in 2016: Amboss (a digital learning platform) was used by 31% of the age group 21-30 years and was not used at all by the age group 51-60 years. DISCUSSION: Use of medical apps and planned integration of medical apps into routine care is increasing among German rheumatologists. On the other hand, recommendable rheumatological apps for rheumatologists and especially for patients are currently largely unknown to rheumatologists.

A quantitative approach to evaluate image quality of whole slide imaging scanners.

CONTEXT: The quality of images produced by whole slide imaging (WSI) scanners has a direct influence on the readers' performance and reliability of the clinical diagnosis. Therefore, WSI scanners should produce not only high quality but also consistent quality images. AIM: We aim to evaluate reproducibility of WSI scanners based on the quality of images produced over time and among multiple scanners. The evaluation is independent of content or context of test specimen. METHODS: The ultimate judge of image quality is a pathologist, however, subjective evaluations are heavily influenced by the complexity of a case and subtle variations introduced by a scanner can be easily overlooked. Therefore, we employed a quantitative image quality assessment method based on clinically relevant parameters, such as sharpness and brightness, acquired in a survey of pathologists. The acceptable level of quality per parameter was determined in a subjective study. The evaluation of scanner reproducibility was conducted with Philips Ultra-Fast Scanners. A set of 36 HercepTest™ slides were used in three sub-studies addressing variations due to systems and time, producing 8640 test images for evaluation. RESULTS: The results showed that the majority of images in all the sub-studies are within the acceptable quality level; however, some scanners produce higher quality images more often than others. The results are independent of case types, and they match our perception of quality. CONCLUSION: The quantitative image quality assessment method was successfully applied in the HercepTest™ slides to evaluate WSI scanner reproducibility. The proposed method is generic and applicable to any other types of slide stains and scanners.

Automated, semi-automated, and manual analyses of anti-cardiolipin and anti-ß2-glycoprotein I antibodies in women with a history of miscarriage.

INTRODUCTION: Anti-cardiolipin and ß2-glycoprotein I antibodies represent important diagnostic parameters in routine hematology. In this study, five different automated, semi-automated, and manual immunoassays detecting IgG/IgM anti-cardiolipin and anti-ß2 -glycoprotein I antibodies were tested. METHODS: A total of 162 samples from women with a history of miscarriage were recruited from 110 different G&O outpatient centers in Germany. RESULTS: For both anti-cardiolipin and anti-ß2 -glycoprotein I antibodies, considerable differences in the percentage of positive results were seen between all five methods, and itemization of all positive test results revealed a poor accordance. These findings were confirmed by Cohen's kappa coefficients. CONCLUSION: Our study revealed a moderate to poor accordance between five different test systems for anti-cardiolipin and anti-ß2 -glycoprotein I antibodies. Such deviations may result in clinical misinterpretation of data and may lead to wrong therapeutic consequences. Therefore, further standardization of all tests for anti-phospholipid antibodies should be achieved.