Jessica Breuing

Introduction: Sports pre‐participation evaluations (PPEs) aim to identify people at increased risk of acute adverse events during physical activity. Little is known about their acceptability and feasibility among physicians and participants (‘interest holders’). During the development of a consensus‐based PPE guideline in Germany targeted at healthy adults who plan to take up or resume intense physical activity, we used surveys to assess interest holder perceptions of the acceptability and feasibility of the PPE, and to obtain their feedback on draft guideline recommendations. Methods: Cross‐sectional online surveys were conducted separately in two interest holder groups. Acceptability was evaluated among adults (≥ 18 years) in Germany (‘consumers’), the target population of the PPE guideline. Feasibility was investigated among potential guideline users, which included sports medicine specialists and general practitioners practising in Germany (‘sports physicians’). Agreement with nine acceptability and feasibility statements was analysed descriptively. Comments on draft recommendations were collected and grouped thematically. Results: A total of 144 consumers and 204 physicians (186 with certification in sports medicine) completed the survey. Among the consumers, 82% would consider making use of a PPE, 8% were neutral, and 10% would not. Only 1% had ‘concerns or reservations’. The main barrier was a potential non‐reimbursement of the PPE by their health insurance (61%). Of the 186 certified sports physicians, 83% would offer or already offer a PPE, 12% were neutral, and 5% would not offer a PPE. Potential barriers were non‐reimbursement by health insurers (20%), the required time and effort (13%), and qualification issues (14%). About half of the draft recommendations (11/23, 48%) were modified based on interest holder feedback. Discussion: Conducting consumer and end‐user surveys as part of the guideline development process increased awareness of the main acceptability and feasibility issues, provided relevant suggestions to the draft recommendations, and identified considerations for guideline implementation.

Purpose: Our aim was to update evidence-based and consensus-based recommendations for the initial surgical management of urogenital injuries in patients with polytrauma and/or severe injuries based on current evidence. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Polytrauma and/or Severe Injuries. Methods: MEDLINE and Embase were systematically searched to June 2021. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared surgical and/or therapeutic interventions for urogenital injuries in the hospital setting. We considered patient-relevant clinical outcomes such as mortality and bleeding control, or coagulation parameters as surrogate outcomes. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Results: Two new studies were identified. The topics covered were the comparison of outcomes after surgical and nonsurgical management as well as the use of surgical repair versus catheter drainage in patients with extraperitoneal bladder injuries. Three recommendations were modified, one of which for editorial reasons. All achieved strong consensus. Conclusion: The following key recommendations are made. 1. Renal artery injuries can be managed using an endovascular approach. 2. Depending on the type and severity of the injury and concomitant injuries, renal injuries should be managed with the intent to preserve the organ. 3. Extraperitoneal bladder ruptures without involvement of the bladder neck should be conservatively treated with catheterisation.

Background: Pre-participation evaluation (PPE) aims to support safe participation in sports. The goal of this systematic review was to aggregate evidence- and consensus-based recommendations for the PPE of recreational or competitive athletes as preparation for developing a German guideline on this subject. Methods: Five databases, including MEDLINE, were searched in August 2022, complemented by searches on the websites of relevant guideline organisations and specialty medical associations and citation screening. We included guidelines/consensus statements with recommendations for PPE of adult recreational athletes or competitive athletes of any age, excluding those with certain chronic illnesses. We extracted and synthesised data in a structured manner and appraised quality using selected domains of the AGREE-II tool. Results: From the 6611 records found, we included 35 documents. Overall, the quality of the included documents was low. Seven documents (20%) made recommendations on the entire PPE process, while the remainder focussed on cardiovascular screening (16/35, 45.7%) or other topics. We extracted 305 recommendations. Of these, 11.8% (36/305) applied to recreational athletes and 88.2% (269/305) applied to athletes in organised or competitive sports. A total of 12.8% (39/305) of recommendations were directly linked to evidence from primary studies. Conclusion: Many recommendations exist for PPE, but only a few are evidence based. The lack of primary studies evaluating the effects of screening on health outcomes may have led to this lack of evidence-based guidelines and contributed to poor rigour in guideline development. Future guidelines/consensus statements require a more robust evidence base, and reporting should improve. Registration: PROSPERO CRD42022355112.

Introduction: Clinical practice guidelines (CPGs) provide recommendations and are a fundamental part of clinical practice. Many guideline organisations also produce patient versions of CPGs (PVGs). To explore the up‐to‐dateness of German PVGs, potential methodological influence factors and experts' perspectives, we applied a convergent mixed‐methods design.Methods: First, a literature search to identify PVGs was performed between October 2022 and January 2023. We searched the websites of German guideline organisations, Google and the reference lists of included PVGs. We screened the title, downloaded the documents if relevant and retrieved the underlying CPGs and methods reports of CPGs. We aggregated the literature search dates of CPGs and calculated the time between the CPG literature search and PVG publication. Second, interviews with experts in the PVG development were conducted and analysed using qualitative content analysis (Mayring) with MAXQDA.Results: 49 PVGs were included and analysed. A median of 36 months elapsed between the literature search of CPGs and the publication of PVGs. A median of 25 months passed between the literature search and publication of CPGs, and a median of 7.5 months elapsed between the CPG and PVG publication. Six interviews were conducted and interviewees mostly perceived PVGs as up‐to‐date. However, they identified exceptions in the up‐to‐dateness depending on the topic or thematic chapters of PVGs. Interviewees mentioned different influencing factors such as the scientific progress and the editorial process of PVGs.Discussion: Our findings underline potential issues with the up‐to‐dateness of PVGs. In the context of a fast‐moving evidence basis, it seems doubtful whether PVGs actually reflect the current state of knowledge, especially in fields with high research activity. However, some factors may not be modifiable because they essentially contribute to the quality assurance of PVGs. Further research is desirable to investigate possible measures to improve the up‐to‐dateness of PVGs.

Introduction: Patient involvement (PI) is a key element of clinical practice guidelines (CPGs). However, PI in CPGs often falls short of quality standards. For evidence‐ and consensus‐based CPGs in Germany, a study in 2018 showed that a mere 58% had included a patient (participation), 56% with voting right. We aimed to provide an update on whether and how patients were involved in CPGs (participation and consultation), on the availability of patient versions (PVGs) (communication) and to investigate whether CPGs in Germany adhere to the RIGHT checklist.Methods: An electronic search on the Register of the Association of Scientific Medical Societies was performed. Eligibility criteria were defined a priori. We included evidence‐ and consensus‐based CPGs valid on 31 March 2023. A data extraction form including 35 items was designed and piloted. Five researchers independently extracted data from CPGs, methodology reports and PVGs. Data were analysed descriptively.Results: The search identified 135 CPGs meeting the eligibility criteria. Participation has increased to 79% (107/135 CPGs), in 73% of CPGs (98/135) with voting right. Participation was more common in CPGs for chronic than acute conditions (76/86 CPGs, 88% chronic vs. 23/38 CPGs, 61% acute). Consultation was scarcely employed (3/135 CPGs, 2%). Communication, operationalised as PVGs being available on the internet, increased from 33% (35/105) in 2018 to 43% (58/135) in 2023. 26% of CPGs (28/107) with participation reported on patients' selection as required by the RIGHT checklist.Discussion: PI has improved, although around 20% of CPGs were still developed without participation. This applies in particular to CPGs on acute conditions where PI should be strengthened. At the same time, innovative and efficient methods for consultation and for evaluating patients' impact are required. Moreover, communication should be expanded. To further improve transparency in CPGs, guideline development groups should specifically report on patients' recruitment and selection.

Purpose Our aim was to update evidence-based and consensus-based recommendations for the initial surgical management of spinal (cord) injuries in patients with multiple and/or severe injuries based on current evidence. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. Methods MEDLINE and Embase were systematically searched to May 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions and the timing of interventions for the initial surgical management of spinal (cord) injuries in patients with polytrauma and/or severe injuries. We considered patient-relevant clinical outcomes such as mortality, complication rates, and lengths of stay. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Results Seven new studies were identified. All studies compared different moments for the initial surgical management of spinal injuries. Three recommendations were modified, and three additional recommendations were developed. All achieved strong consensus. Conclusion The following key recommendations are made. (1) Patients with spinal injuries or deformities with confirmed or assumed neurological deficits which can be treated operatively should undergo surgery as soon as possible (ideally on day 1) if their other medical conditions permit. (2) If suggested by fracture morphology with spinal canal compression or translational injury and if spinal neurological damage cannot be ruled out, assume the presence of spinal neurological damage until it can be ruled out. (3) In the absence of neurological signs and/or symptoms, unstable spinal injuries should be treated by early surgical stabilization based on the patient’s overall condition. (4) Depending on the injury, an anterior and/or posterior approach or, in exceptional cases, a halo fixation device can be used to stabilize the cervical spine. (5) Posterior internal fixation should be used as the primary surgical technique for stabilizing injuries to the thoracic and lumbar spine.

Purpose: Our aim was to review and update the existing evidence-based and consensus-based recommendations for the management of chest injuries in patients with multiple and/or severe injuries in the prehospital setting. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. Methods: MEDLINE and Embase were systematically searched to May 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, cross-sectional studies, and comparative registry studies were included if they compared interventions for the detection and management of chest injuries in severely injured patients in the prehospital setting. We considered patient-relevant clinical outcomes such as mortality and diagnostic test accuracy. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Results: Two new studies were identified, both investigating the accuracy of in-flight ultrasound in the detection of pneumothorax. Two new recommendations were developed, one recommendation was modified. One of the two new recommendations and the modified recommendation address the use of ultrasound for detecting traumatic pneumothorax. One new good (clinical) practice point (GPP) recommends the use of an appropriate vented dressing in the management of open pneumothorax. Eleven recommendations were confirmed as unchanged because no new high-level evidence was found to support a change. Conclusion: Some evidence suggests that ultrasound should be considered to identify pneumothorax in the prehospital setting. Otherwise, the recommendations from 2016 remained unchanged.

Clinical practice guidelines include recommendations to optimize patient care. As patients are "experts by experience" for their medical conditions, their involvement in the development of clinical practice guidelines is essential. Accordingly, many organizations worldwide require patient involvement in the development of clinical practice guidelines. However, in 2018 a German study found that patient involvement in the development of German clinical practice guidelines still lagged significantly behind international requirements. This meta research-study is an update on the status of patient involvement in German clinical practice guidelines. It examines whether and how patients have been involved in the development of currently valid German clinical practice guidelines as well as the current status of patient versions of German clinical practice guidelines. Furthermore, this meta-research study investigates in how far German clinical practice guidelines follow the RIGHT Checklist with respect to the reporting of patient involvement. To this aim the German clinical practice guidelines register will be searched for currently valid S3 clinical practice guidelines which will be screened by two independent reviewers. Relevant data on patient involvement will be extracted and analyzed descriptively. The results will be compared to the previous German study.

Background: Obesity is a worldwide problem with different treatment options. Bariatric surgery is an effective treatment for severe obesity; however, it leads to drastic changes (e.g., changes in everyday life and eating behavior) for patients, which may lead to information needs. Our aim was to identify the information needs of patients undergoing bariatric surgery and to explore the information provision within the healthcare process of bariatric surgery in Germany. Methods: We conducted a qualitative study (n = 14 single, semi-structured telephone interviews) between April 2018 and April 2019. The interview guide was designed prior to the interviews and consisted of four main sections (demographic information, pre-/postoperative healthcare provision, information needs). The interviews were transcribed verbatim and analyzed using qualitative content analysis with MAXQDA software. Results: There were unmet information needs with two factors (time: pre/postoperative and categories of information: general/specific) to be considered. Due to the patients’ description of information, we categorized information into general (different surgical procedures, general nutritional information) and specific (occurring simultaneously with a problem) information. Most patients felt well informed concerning general information. However, it was pointed out that it was not possible to provide complete information preoperatively, as the need for information only arises when there are postoperative (specific) problems. In addition, there seems to be a high demand for specific postoperative information regarding nutrition and nutrition-related problems. However, patients stated that postoperative nutritional counseling is not reimbursed by health insurance funds. The information conveyed in support groups and the exchange of experiences are highly valued by patients. However, some patients describe the information provided within the support groups as unfiltered, frightening or exaggerated. Conclusion: Overall, there were unmet information needs. Reimbursement by health insurance funds could increase the use of postoperative nutritional counseling and thus serve existing information needs. Support groups enable an exchange of experiences and therefore offer low-barrier access to information. Cooperation between support groups and healthcare professionals in information provision could be an approach to improving existing information needs or to avoiding the development of information gaps. Furthermore, the development and implementation of a digital solution for (postoperative) information dissemination could be helpful.