Witten/Herdecke University

Objective: The present study aimed to evaluate patients’ knowledge about their newly prescribed medications, contributing factors, and preferred sources of medication-related information. // Methods: A cross-sectional study using an online survey was conducted among 931 customers of a mail-order pharmacy. Medication-related knowledge was examined using a novel knowledge index (KI) assessing medication dosage, indication, time of administration, and side effects. Patients’ preferred sources of information were assessed. Univariate and multivariate regression analyses were performed to investigate predictors of medication-related knowledge. // Results: The average KI score was 2.97 (SD = 0.73); most participants answered correctly when asked about indication (94.2 %), dosage (90.0 %), and time of administration (92.3 %); however, knowledge of medication-related side effects was limited (23.1 %). KI scores were predicted by greater perceived informedness, younger age, and having received a medication plan (all ps < 0.05). Preferred sources of medication-related information included physicians, written information, and information obtained via secure electronic patient records. // Conclusion: Knowledge gaps were found for medication-related side effects. Insufficient medication-related knowledge is linked to non-adherence and subsequent personal and economic costs. Electronically issued information could provide a cost-effective solution. Practical applications including “OpenNotes” are discussed. // Practice Implications: Issuing medication plans via platforms such as “OpenNotes” can increase patient understanding and participation, and decrease non-adherence. //

Objective In this cluster‐randomized controlled trial, we developed an educational website on tension‐type headache and migraine for children and adolescents and evaluated its effectiveness in a school setting. Background Primary headaches are a widespread issue in children and adolescents, often persisting into adulthood and associated with considerable disabilities, costs, and reduced quality of life. Effective management of primary headaches may prevent chronicity and its associated consequences. Design Guided by a workbook, N = 814 fifth and sixth grade students explored the website during class. Data were collected before the headache education and at three further assessments, each 4 weeks apart, between November 2021 and April 2022. Participants were randomly assigned by class to either the intervention group, which received the website‐based educational intervention after the first data collection, or a control group, which accessed the website after the last data collection. Results The intervention significantly increased children's headache‐related knowledge (time × group interaction: β = 0.35, 95% confidence interval [CI] = [0.30; 0.41], p ≤ 0.001) and resulted in fewer passive pain coping strategies (time × group interaction: β = −0.06, 95% CI = [−0.12; 0.00], p = 0.044). However, the intervention did not significantly reduce the number of days with headaches, use of headache medication, or school absences due to headaches. Conclusion While the website is an effective educational tool for imparting knowledge about headaches, even initiating small behavioral changes, it does not lead to substantial changes in behavior or headache characteristics. Educating children via this website may lay a solid foundation of knowledge, but the intervention should be expanded and supplemented with closer supervision to achieve more significant behavior changes and improved outcomes.

Zusammenfassung Hintergrund Die Nutzung von künstlicher Intelligenz (KI) und Methoden der natürlichen Sprachverarbeitung (NLP) in der Medizin, insbesondere von großen Sprachmodellen (LLM), bietet Möglichkeiten, das Gesundheitssystem und die Patientenversorgung in Deutschland voranzubringen. LLM haben zuletzt an Bedeutung gewonnen, jedoch ist ihre praktische Anwendung in Kliniken und Praxen bisher begrenzt. Erforschung und Implementierung werden durch eine komplexe Rechtslage gehemmt. Es ist essenziell, LLM in klinischen Studien in Deutschland zu erforschen und an den gesetzlichen Rahmen angepasste Anwenderleitlinien zu entwickeln. Ziel der Arbeit Wie können wir Grundlagen für die datenschutzkonforme Nutzung von LLM, insbesondere von Cloud-basierten LLM, im deutschen Gesundheitssystem schaffen? In der vorliegenden Arbeit sollen die datenschutzrechtlichen Aspekte der Nutzung Cloud-basierter LLM in der klinischen Forschung und Patientenversorgung in Deutschland und der Europäischen Union (EU) dargestellt werden; Kernaussagen eines Rechtsgutachtens hierzu werden betrachtet. Soweit die Nutzungsanforderungen in Landesgesetzen geregelt sind, wird auf die Rechtslage in Berlin abgestellt. Material und Methoden Im Rahmen eines Forschungsprojekts wurde ein Rechtsgutachten in Auftrag gegeben, um die datenschutzrechtlichen Aspekte der Verwendung von LLM mit Cloud-basierten Lösungen an der Charité – Universitätsmedizin Berlin zu klären. Ergebnisse Die rechtlichen Rahmenbedingungen variieren je nach Art der Datenverarbeitung und teilweise je Bundesland. Bei anonymen Daten sind datenschutzrechtliche Anforderungen generell nicht einschlägig. Soweit personenbezogene Daten verarbeitet werden, sollten diese nach Möglichkeit pseudonymisiert werden. Im Forschungskontext ist im Regelfall eine Einwilligung der PatientInnen notwendig, um deren personenbezogene Daten zu verarbeiten. Es müssen Auftragsverarbeitungsvereinbarungen mit den Anbietern geschlossen werden. Die von LLM stammenden Empfehlungen müssen stets ärztlich überprüft werden. Schlussfolgerung Die Nutzung Cloud-basierter LLM ist möglich, solange Datenschutzanforderungen beachtet werden. Die rechtlichen Rahmenbedingungen sind komplex und erfordern von Anbietern Transparenz. Zukünftige Entwicklungen könnten das Potenzial von KI und LLM im Speziellen im Klinikalltag erhöhen, jedoch sind klare rechtliche und ethische Vorgaben notwendig.

Purpose To describe the outcomes of a survey on the provision of interventional radiology procedures for the treatment of acute pulmonary embolism (PE) in Europe and beyond. Methods An online survey with 14 structured items was designed by the authors and was sent to 7116 CIRSE members via email. The anonymous online survey collected data for eight weeks; only complete responses were statistically analysed. Results The survey was completed by 373 members (5.24%). Among these, 75.1% worked at centres offering catheter-directed thrombolysis or thrombectomy, in which 89.3% (250) personally perform endovascular treatment techniques for pulmonary embolism and the IR department is primarily responsible for the endovascular treatment techniques of PE in 83.2% of cases. The most frequently used endovascular techniques were (large bore) aspiration thrombectomy (85%) and catheter-directed thrombolysis (58.9%). The most common indications for intervention were sub-massive and massive PE (69.9%) and massive PE only (28%). In 70% of centres offering catheter-directed thrombolysis or thrombectomy, three or more Interventional Radiologists (IRs) are involved in PE treatment. Multidisciplinary rapid response teams for PE were available in 40.8% of centres, and included IRs in 91.4%. Conclusion IRs are heavily involved in the management of patients with massive and sub-massive pulmonary embolism; further research is mandated to address clinical questions including patient selection and the timing for transcatheter therapies of PE provided by IR. Graphical Abstract

Objectives: Facilitating and challenging aspects of a non-linear diagnostic process of dementia were explored in interviews with physicians from outpatient clinics of a major hospital in Turkey. Methods: Semi-structured interviews were conducted with 15 physicians between March and April 2023. Purposive sampling was used to identify clinics that perform dementia diagnostics, including neurology, geriatrics, and psychiatry outpatient clinics. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis. Results: Facilitating and challenging aspects were perceived on three levels: (1) diagnostic procedures and methods, which focus on the assessment of dementia and the aspects that arise in the process; (2) communication, which describes the verbal and nonverbal relationships between health care professionals, patients, and their caregivers, as well as their communication styles; (3) care environment, which describes the various environmental influences on patients, both on a sociocultural and institutional level. Conclusion: The diagnostic process for dementia involves several interrelated aspects, making a flexible, holistic approach essential. In this study, the social and cultural context of the patients and the involvement of the family emerged as crucial elements. By integrating these aspects, along with a mix of informal and formal communication between healthcare providers and families, the diagnostic process can become more patient-centered and effective. To further improve outcomes, raising awareness and providing education about dementia could reduce stigma and encourage earlier recognition and better management of the condition during the diagnostic process.

Die fachärztliche Versorgung wird von krankenhausgebundenen Fachärzten und Fachärzten der vertragsärztlichen Versorgung getragen. Vor allem der vertragsärztliche Strang der sogenannten doppelten Facharztschiene steht in der Kritik. In dieser Arbeit wurde auf Basis von öffentlich zugänglichen Sekundärdatenquellen (Statistisches Bundesamt, Kassenärztliche Bundesvereinigung und Bundesärztekammer) die Relevanz der Stränge zu den Versorgungsparametern Dichte des regionalen (Standorte) und fachlichen (Fachabteilungen und Facharztpraxen) Versorgungsnetzwerks, Verteilung von Fachärzten sowie Fallzahlen quantifiziert und bewertet. Unterschiede nach Fächern und Veränderungen von 2012 zu 2022 wurden nach Verteilung von Fachärzten ermittelt. 2022 dominierte der vertragsärztliche Strang deutlich das Versorgungsnetzwerk in regionaler (vertragsärztlicher Anteil 96 %) und fachbezogener (89 %) Hinsicht. Auf ihn entfielen 86 % aller ambulanten / stationären Fälle und 90 % aller ambulanten Fälle. Etwas weniger als 50 % waren ambulant tätige Fachärzte (nach Köpfen) bzw. entfiel auf vertragsärztliche Vollzeitäquivalente. Fachspezifisch wichen die Verteilungen von Fachärzten stark ab, die relativen Anteile nach Strängen blieben im Vergleich zu 2012 weitgehend konstant. Da die Datenquellen nicht harmonisiert sind, waren für Aufbereitung und Interpretation der parameterspezifischen Daten zum Teil Umrechnungen und Kompromisse notwendig. Im Sinne der Transparenz wurde jedoch auf Hochrechnungen und Gewichtungen (auch im Hinblick auf Unterschiede im Aufwand bei ambulanten und stationären Patienten) verzichtet. Die aus der Verfügbarkeit bzw. dem Handling resultierenden Verzerrungen werden nach Art und Richtung benannt. Sie sind jedoch zu den eindeutig interpretierbaren Daten nachrangig. Die Dimensionen der berichteten Ergebnisse können als robust angesehen werden. Mit Blick auf die deutliche Dominanz der vertragsärztlichen Schiene wäre eine Zentralisierung der fachärztlichen Versorgung im Krankenhaus mit erheblichen Herausforderungen verbunden. Bevor eine Reform gefordert wird, sollte die Kritik an der doppelten Facharztschiene einerseits mit Daten belegt und andererseits deren Vorteile in der wissenschaftlichen Diskussion gewürdigt werden. Specialist care in Germany is provided by hospitals as well as by physicians outside hospitals authorized to provide care in the framework of the Statutory Health Insurance (SHI). This duplicate capacities for specialized care, and in particular the SHI-specialist track is criticized. On the basis of publicly accessible secondary data sources (Federal Statistical Office, National Association of SHI Physicians and German Medical Association), this study analyzes and quantifies the relevance of the two tracks along the parameters density of the regional (number of facilities) and specialist (number of specialized departments and specialist practices) care network, distribution of specialists and case numbers. Differences by specialty and changes between 2012 and 2022 are determined according to the distribution of specialists to tracks. In 2022 the SHI-specialist track dominated in terms of the number of medical facilities (96 % of all were attributed to them) and specialized departments und specialist practices (89 %). 86 % of all outpatient / inpatient cases and 90 % of all outpatient cases were handled by them. Slightly less than 50 % were accounted for by outpatient specialists (by headcount) respectively full-time equivalents of SHI-specialists. The distribution of physicians varied greatly according to specialties, while the relative proportions by tracks compared to 2012 remained largely constant. As the data sources are not harmonized, conversions and compromises were partly necessary for processing and interpretation the parameter specific data. However, in the interests of transparency, extrapolation and weighting (also with regard to differences in workload treating outpatients or inpatients) were avoided. Distortions resulting from availability and handling of the date are named by type and direction. However, they are subordinate compared to the data unambiguously interpretable. The dimensions of the reported results can be regarded as robust. Focusing on the clear dominance of the SHI-specialist track, centralization of specialist care at hospitals would be accompanied by considerable challenges. However, prior to demanding reform, the criticism of the duplicate capacities for specialized care should be substantiated and its potential advantages acknowledged in the scientific discussion.

Zusammenfassung Zement und Estrich enthalten stark alkalische Substanzen, die bei längerer Hautexposition die Hautbarriere zerstören und schwere Hautschäden verursachen können. Der Bericht beschreibt eine 78-jährige demenzkranke Patientin, die nach einem Sturz auf frisch gegossenen Estrich erhebliche Hautnekrosen am Gesäß erlitt. Die Verletzungen entstanden durch irritativ-toxische Reaktionen auf die Zementbestandteile. Dieser Fall verdeutlicht, dass nicht nur Berufstätige, sondern auch Personen mit eingeschränkter Mobilität oder kognitiven Fähigkeiten durch Zementbrand gefährdet sein können.

The aim of the study was to gain insight into the time course of whole-body electromyostimulation (WB-EMS)-induced inflammatory and endocrine factors over 72 h. Twelve healthy individuals (5 men, 7 women; 33.0 ± 12 years) randomly performed a single 20-minute high-intensity WB-EMS and a time- and intensity-matched whole-body circuit training (CT) with a 3-week wash-out period. Blood samples were taken pre- and post-training and at 1.5, 3, 24, 48 and 72 h after exercise to assess creatine kinase (CK), myoglobin, and creatinine, cell populations (red and white blood cells [RBC, WBC], thrombocytes), cytokines (interleukin IL-1Ra, IL-6, IL-10, monocyte chemoattractant protein 1 [MCP-1]), angiogenic factors (IL-8, vascular endothelial growth factor [VEGF], thrombospondin), adipokines (leptin, adiponectin), and hormones (testosterone, cortisol). WB-EMS induced significant CK elevations peaking at 72 h (WB-EMS, 18,358 ± 21,380 vs. CT, 186 ± 129 U/l; time × group, p < .001) and increased MCP-1 after 3 h (time × group, p < .05). Both protocols induced similar effects on WBC, RBC, IL-1Ra, IL-8, leptin, and cortisol (overall time effect, all p < .01). WBC increased at 1.5 and 3 h (p < .001) and RBC decreased over 72 h (p < .05). IL-1Ra peaked at 1.5 h (p < .01) and IL-8 was elevated at 3–72 h (p < .05). The cortisol and leptin decreases lasted up to 48 and 72 h, respectively (p < .05). Despite inducing muscle damage, a single of high-intensity WB-EMS session did not lead to significantly different inflammatory and hormonal signaling compared to an acute aerobic CT session. Prolonged studies are needed to investigate whether regular WB-EMS leads to more pronounced training adaptations despite similar signaling signatures.

Aims This study aimed to evaluate the accuracy and completeness of GPT‐4, a large language model, in answering clinical pharmacological questions related to pain therapy, with a focus on its potential as a tool for delivering patient‐facing medical information. The objective was to assess its reliability in delivering medical information in the context of pain management. Methods A cross‐sectional survey‐based study was conducted with healthcare professionals, including physicians and pharmacists. Participants submitted up to 8 clinical pharmacology questions on pain management, focusing on drug interactions, dosages and contraindications. GPT‐4's responses were evaluated based on comprehensibility, detail, satisfaction, medical–pharmacological accuracy and completeness. Additionally, responses were compared to the German Drug Directory to assess their accuracy. Results The majority of participants (99%) found GPT‐4's responses comprehensible, while 84% considered the information detailed enough. Overall satisfaction was high, with 93% expressing satisfaction, and 96% deemed the responses medically accurate. However, only 63% rated the information as complete, with some identifying gaps in pharmacokinetics and drug interaction data. Usability was evaluated as good to excellent, with a System Usability Scale score of 83.38 (± 10.26). Conclusion GPT‐4 demonstrates potential as a tool for delivering medical information, particularly in pain management. However, limitations such as incomplete pharmacological data and the potential for contextual carryover in follow‐up questions suggest that further refinement is necessary. Developing specialized artificial intelligence tools that integrate real‐time pharmacological databases could improve accuracy and reliability for clinical decision‐making.

Highland populations suffer from significant infant mortality due to chronic ambient hypoxia, which increases the risk of congenital heart disease (CHD) and neonatal pulmonary hypertension. Neither the prevalence of these conditions nor the effectiveness of neonatal cardiac screening to identify CHD or pulmonary hypertension among neonates born at altitudes >4000 m in Bolivia has been reported. In a study of 1033 newborns in El Alto, Bolivia (4510 m), we determined the prevalence of CHD and prolonged postnatal adaptation. We also tested the accuracy of a neonatal cardiac screening tool in identifying infants with/without these conditions. Finally, diagnoses were contrasted between offspring born to parents of lowland versus highland origin. CHD was found in 54 neonates (5.2%), with the most common diagnoses being patent ductus arteriosus and atrial septal defect. Pulmonary hypertension without CHD was observed in 64 neonates (6.8%), with seven cases of persistent pulmonary hypertension of the newborn (PPHN). The neonatal cardiac screening tool showed a sensitivity of 45% and specificity of 99% for CHD, and 35% sensitivity and 92% specificity for prolonged pulmonary adaptation. Offspring of highland‐origin women tended to have increased CHD risk, while those from lower altitudes were predisposed to prolonged postnatal adaptation and PPHN; paternal altitude of origin had no statistic significance but showed same tendency. The high prevalence of relevant CHD and prolonged pulmonary adaptation in neonates born >4000 m in Bolivia likely contributes to the high infant mortality rates observed. The poor sensitivity of the pilot neonatal cardiac screening instrument underscores the need to develop evidence‐based tools optimized for use in low‐resource, high‐altitude settings.

Purpose During fall 2021, children’s hospitals in Germany faced a surge in RSV-related hospitalizations, whereas during fall/winter 2022–2023, RSV and influenza infections both led to increased inpatient admissions. Our study prospectively assessed severe acute respiratory infections, their causative pathogens, and the resulting disease burden on German children's hospitals for the fall/winter 2023–2024 season. Methods From October 3, 2023 through April 16, 2024, children hospitalized with ARI as a primary diagnosis were monitored via a national survey established by the German Society for Pediatric Infectious Diseases (DGPI). Weekly data was collected on total hospital admissions, ARI-related admissions by pathogen (SARS-CoV-2, RSV, influenza, other), ICU admissions with ARI as a primary diagnosis, and respiratory support. Results Overall, 23% of German children's hospitals (77/334 centers) submitted 1234 survey reports. ARI-related hospital admissions surged starting in November 2023 and peaked in late December 2023 (53.4% of all admissions), in parallel with a peak in the average number of newly-admitted patients (aNA) with RSV (2.5 aNA). In comparison to the 2022/2023 season, fewer newborns and infants were admitted for ARI (4.7%, p < 0.001/1.9%, p = 0.05) and fewer required ICU treatment (5.3%, p = 0.02/5.6%, p = 0.001 respectively). In 74.9% of ICU patients, ventilation support was required—9.1% less than in the previous season. Conclusion The clinical burden on pediatric hospitals and ICUs is strongly influenced by the changing, annually circulating pathogens and affected age group. Therefore, a continuous, systematic, dynamic collection of ARI data is critical for assessing the ARI-related morbidity and the associated burden on health care systems.

In many cases, chronic inflammatory dermatoses are accompanied by changes of the nails or periungual region. Sometimes nail changes occur even before the onset of the particular skin disease. In some cases, specific lesions of the nails and the perionychium can contribute to the diagnosis. This review describes the most common nail and periungual changes in chronic inflammatory dermatoses and the corresponding treatment options. Among others, this review deals with nail changes in collagenoses, autoimmune bullous dermatoses, alopecia areata, lichen planus and atopic eczema. Nail psoriasis is not discussed here, as this special edition contains a review devoted entirely to the complex topic of nail psoriasis.

The feeling of being of little worth can trigger suicidal thoughts and behaviors (STBs). In this meta-analysis, we examined the association between self-esteem and STBs based on 114 studies and tested potential moderators of this association. We found moderate to strong negative associations between self-esteem and STBs (ideation: r = −.435, d = −0.805; behavior: r = −.258, d = −0.828; combination of thoughts and behaviors: r = −.405, d = −1.610). In this meta-analysis, we identified evidence gaps, including the need for more studies on the association between suicidal behavior and self-esteem, more research on the second half of life, and more longitudinal studies. Overall, this meta-analysis provides a more nuanced understanding of the relationship between self-esteem and STBs and contributes to the existing literature on suicide prevention.

Background Clinical trials have shown beneficial results from lung volume reduction with endobronchial coils in patients with emphysema, but comprehensive safety data are not yet available for a new coil type, Coil #4. The objective of this study is to generate real-world data (RWD) on the safety and efficacy of endobronchial Coil #2 and Coil #4. Methods This is a cohort study of prospectively collected data from the multicenter German Lung Emphysema Registry e.V. (LE-Registry) for patients with advanced lung emphysema undergoing lung volume reduction. All patients treated with Coil #2 or Coil #4 were evaluated at baseline and at 3 months for pulmonary function tests (FEV1, FVC, RV, DLCO, pCO2), exercise capacity, quality of life (mMRC, CAT, SGRQ), and adverse events. Descriptive statistics were used to analyze response rates and changes in clinical outcomes. Results Data from 73 patients (37 Coil #2, 36 Coil #4) enrolled between 2017 and 2024 were evaluated. At 3 months, outcome data were available for 32 Coil #2 and 26 Coil #4 patients. In the Coil #2 cohort significant improvements in RV and SGRQ were observed. The Coil #4 cohort shows significant improvements in FVC, RV, SGRQ, and CAT. Complications occurred in 37% of Coil #2 and 37% of Coil #4 patients, with 26% of patients treated with Coil #4 experiencing pneumothorax. Conclusions The outcomes observed in this RWD study are consistent with other published coil studies. The higher pneumothorax rate with Coil #4 is surprising and should be minimized by adapting the technique. Trial registration DRKS00021207 registered on 29/05/2020.

Background Simultaneous pancreas-kidney transplantation (SPKT) is the therapy of choice for selected patients with complicated type 1 diabetes mellitus and end-stage renal disease. Pancreas rescue allocation was implemented in Eurotransplant allocation algorithms to increase organ utilization, concurrently facilitating transplantation of supposedly inferior quality organs. The aim of this study was to examine whether outcomes of SPKT after rescue allocation, which can either be recipient-oriented extended allocation or competitive rescue allocation, were as good as after standard allocation. Methods This retrospective multicenter analysis of 1504 SPKT performed from 2013 to 2021 evaluated outcomes by allocation type considering survival of patients, pancreas grafts, and kidney grafts. Multivariable analyses further explored the influence of specific donor-, recipient-, and transplant-related variables on outcomes. Results Multivariable analyses showed no significant differences in SPKT outcome for standard allocation versus either rescue allocation type regarding patient, pancreas graft, and kidney graft survival. Rescue allocation organ donors were older, had higher body mass index, and were more likely to smoke. Rescue allocation had fewer HLA matches. Cold ischemic times of both pancreas and kidneys were longer in competitive rescue allocation but not in recipient-oriented extended allocation. Rescue allocation pancreas recipients had shorter waiting times. Multivariable analyses showed inferior pancreas and kidney graft survival for higher donor age. Higher recipient age correlated with higher mortality despite better pancreas graft survival. Conclusions SPKT outcome after rescue allocation is comparable with standard allocation in both patient and graft survival. Age of both donors and recipients essentially influences the success of SPKT.

Cardiovascular magnetic resonance (CMR) imaging has developed into an established diagnostic tool in cardiovascular medicine providing unique advantages of radiation-free comprehensive morphological, functional and noninvasive tissue quantification analyses. Numerous guideline recommendations already include the implementation of CMR imaging in a variety of clinical pathways while increasing evidence as well as ongoing technological advancements even strengthen and expand the possibilities of its clinical application. At the same time, this requires a certain level of specialized cardiological expertise to ensure an effective utilization of this modality for an optimal patient management in the context of accurate indication assessment, analysis and treatment recommendations. As part of cardiological periprocedural planning, current clinical CMR applications mainly extend to the guidance of coronary interventions, electrophysiological planning as well as management of valvular interventions. This position paper aims to provide an insightful overview of current application possibilities of CMR imaging for periprocedural planning and guidance in interventional cardiology as well as to define recommendations for standardized application and interpretation.

Background: The experience of patients under mechanical ventilation in the intensive care unit is described as complex and multifaceted, but an overarching and in-depth understanding of the experience is still missing. Aim: To provide an in-depth analysis and synthesis of patients’ experience when being mechanically ventilated in intensive care units. Methods: We conducted a meta-synthesis according to the methodological recommendations of Sandelowski and Barroso. Our systematic literature search in Medline, CINAHL, and Cochrane was complemented by hand and citation searches. We included only qualitative studies with a rich description of conscious patients’ experience under mechanical ventilation. Studies on children, step-down units, noninvasive ventilation and non-scientific journal articles were excluded. After the title, abstract and full-text screening by three reviewers, we performed initial, axial and selective coding and in-depth analysis in MAXQDA. The synthesis was supported by multiple discussion rounds. Results: Of the 2,563 records identified, 20 studies were included in our synthesis. This revealed the central phenomenon of patients being observers of their own lives. They are yearning for a stable picture of reality and developing various situation-specific needs. Finally, patients are finding ways to deal with the situation. These concepts are interwoven in time and are experienced repeatedly in different dimensions. Conclusion: Patients under mechanical ventilation are highly perceptive. Healthcare professionals are particularly responsible for patients. They should reflect on their role in intensive care and must be sensitized to patients’ differentiated experience. Registration, Protocol: https://doi.org/10.17605/OSF.IO/G8Q6X

Background Chronic diseases, such as type 2 diabetes, are responsible for a substantial proportion of global deaths and are marked by an increasing number of people that suffer from them. Our objective is to systematically investigate the analytical determination of the drift in prevalence peaks over calendar-time and age, with an emphasis on understanding the intrinsic attributes of temporal displacement. This aims to enhance the understanding of disease dynamics that may contribute to refining medical strategies and to plan future healthcare activities. Methods We present two distinct yet complementary approaches for identifying and estimating drifts in prevalence peaks. First, assuming incidence and mortality rates are known, we employ a partial differential equation that relates prevalence, incidence, and mortality. From this, we derive an ordinary differential equation to mathematically describe the prevalence peak drift. Second, assuming prevalence data (rather than incidence and mortality data) are available, we establish a logistic function approach to estimate the prevalence peak drift. We applied this method to data on the prevalence of type 2 diabetes in Germany. Results The first approach provides an exact mathematical prescription of the trajectory of the prevalence peak drift over time and age, assuming incidence and mortality rates are known. In contrast, the second approach, a practical application based on available prevalence data, demonstrates the prevalence peak dynamics in a real-world scenario. The theoretical model, together with the practical application, effectively substantiates the understanding of prevalence peak dynamics in two different scenarios. Conclusion Our study shows the theoretical derivation and determination of prevalence peak drifts. Our findings underpin the dynamic nature of chronic disease prevalence, highlighting the importance of considering the related age-dependent trends for planning future healthcare activities.