Andrea Icks

Purpose: This systematic review investigates how percutaneous screw osteosynthesis for the treatment of intra-articular displaced calcaneus fractures differs from open reduction and internal fixation (ORIF). Methods: Randomized controlled trials and controlled clinical trials investigating adults with closed intra-articular displaced calcaneus fracture (Sanders type II - IV) treated with percutaneous screw osteosynthesis or ORIF were included. Severe vascular and neurological diseases or polytrauma patients were excluded. On January 29, 2024, five databases and two trial registries were searched. The Risk of Bias Tool of Cochrane was used. The protocol was registered on PROSPERO (CRD42021244695). Results: Five studies with 654 participants (682 calcaneus fractures) were included. The risk of bias was moderate to high. None of the single studies found a significant difference regarding severe complications. However, meta-analysis revealed a lower risk for the percutaneous screw osteosynthesis group compared to ORIF (relative risk (RR) 0.40 (95% Confidence Interval [0.17; 0.92]; I² = 0%; p = 0.03). One study showed less pain in the percutaneous screw osteosynthesis group up to 4 weeks postoperatively. No study assessed health-related quality of life. Conclusion: Percutaneous screw osteosynthesis in intra-articular displaced calcaneus fractures might be beneficial to ORIF in terms of minor and severe complications, and pain at four weeks. Percutaneous screw osteosynthesis could be an additional, less invasive treatment option, depending on the complexity of the injury. However, studies with larger sample sizes are needed to confirm these results and explore long-term complications.

Background/Objectives: Pediatric-onset multiple sclerosis (POMS), defined as onset before age 18, is increasingly recognized as a distinct entity, often associated with a more burdensome disease course and earlier disability milestones than adult-onset MS. Although comorbidities may significantly affect disease progression and outcomes, their prevalence, incidence, risk, and characteristics in POMS remain poorly understood. To date, no systematic review has comprehensively evaluated comorbidities in POMS. The primary aim is to systematically identify and synthesize available evidence on the prevalence, incidence, risk, and characteristics of these comorbidities in POMS populations, as well as any reported effects on disease course, treatment outcomes, and overall clinical management. Methods: We will conduct a systematic review and meta-analysis following a hierarchical and pragmatic analytical strategy tailored to the expected heterogeneity and limited evidence base in POMS. MEDLINE (via PubMed) and Embase (produced by Elsevier) will be searched without date restrictions, combining controlled vocabulary terms (MeSH/Emtree) and relevant keywords for POMS and 15 predefined comorbidity categories. Study selection, abstract and full-text screening, and data extraction will be performed independently by two reviewers using predefined criteria and standardized forms. The primary quantitative outcome will be the pooled prevalence of comorbidities. Where study design and reporting permit, incidence rates will be assessed as secondary outcomes, and risk estimates (e.g., odds ratios) will be evaluated only in studies with appropriate comparator groups. Meta-analyses will be conducted using random-effects models when pooling is feasible. Heterogeneity will be assessed using the I² statistic and Cochran’s Q test, with sensitivity and subgroup analyses performed only when sufficient data are available. When quantitative synthesis is not appropriate due to limited data or substantial heterogeneity, findings will be summarized descriptively. Publication bias will be evaluated using funnel plots and, where applicable, Egger’s and Begg’s tests. This protocol adheres to PRISMA and PRISMA-P guidelines. Discussion: A systematic quantification of comorbidity prevalence, incidence (where available), and risk, together with POMS-specific characteristics and any reported impact on clinical outcomes, is anticipated to provide a crucial evidence base for guiding screening, refining management strategies, and informing future research directions. Ultimately, these findings may improve clinical outcomes and quality of life for children and adolescents with MS.

DNVF Memorandum Partizipative Versorgungsforschung (Teil 1) Anna Levke Brütt, Sandra Borgmann, Eva Buchholz et al. Gesundheitswesen; 10.1055/a-2665-0028 Im oben genannten Artikel wurden mehrere Fehler in den Affiliationen 12, 13, 25 und 26 korrigiert. Die korrekten Affiliationen lauten: 12 BRCA-Netzwerk e.V. – Hilfe bei familiären Krebserkrankungen, Bonn, Germany 13 partieval – Vermittlung partizipativer Kompetenzen, Prozessbegleitung und Evaluation im Bereich Gesundheit GmbH, Aachen, Germany 25 Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V., Hannover, Germany 26 MS Forschungs- und Projektentwicklungs-gGmbH, Deutsches MS-Register, Hannover, Germany Die Korrektur wurde in der Online-Version ausgeführt am 18.02.2026. Article published online: 18 February 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background: Although diabetes mellitus is an established risk factor for acute myocardial infarction (AMI), epidemiological studies showed wide variations in the incidence of AMI in people with diabetes and inconsistent time trends. The objectives of the present systematic review were as follows: (i) to analyze the age–sex-adjusted incidence of both non-fatal and fatal AMI in people with diabetes compared to those without diabetes, (ii) to investigate corresponding time trends, and (iii) to identify sex differences. Methods: A systematic literature search was performed in the literature databases MEDLINE, Embase, and LILACS until July 19, 2023, to identify population-based studies reporting the incidence of AMI in people with diabetes compared to those without diabetes according to our predefined inclusion criteria. Results: In total, 28 population-based cohort studies were included in this review. In women with diabetes, the incidence of AMI ranged from 102 to 690 per 100,000 person-years, and in men with diabetes from 206 to 1630. Estimates comparing people with and without diabetes ranged from 1.55 (95% CI 1.44–1.67) to 14.37 (8.43–24.47) in women and from 1.33 (1.18–1.51) to 4.17 (2.72–6.37) in men. Over the past four decades, the incidence of AMI declined in almost all studies in people without diabetes, but only in half of the studies in people with diabetes. There was considerable heterogeneity with regard to the definition of AMI, the population with diabetes, and geographic differences. Conclusion: Incidence of AMI in people with diabetes remained significantly higher than in those without diabetes. A reduction in the incidence of AMI over time was observed in some, but not all reviewed studies in people with diabetes. There was no discernible trend of estimates comparing people with and without diabetes. These findings underscore the necessity for additional initiatives to prevent coronary heart disease in people with diabetes. The observed discrepancy in study results is presumably attributable to variations in the population and regional contexts, as well as to disparate methodological approaches. More standardized studies employing comparable methodologies are therefore required. Systematic review registration: PROSPERO CRD42 02014 5562

Introduction: Shunting of glycolytic intermediates into the pentose phosphate pathway via transketolase activation by benfotiamine has been suggested to protect from hyperglycemia-induced microvascular damage, but the long-term effects of benfotiamine on diabetic sensorimotor polyneuropathy (DSPN) remain unclear. Research design and methods: This 1:1 randomized double-blind, placebo-controlled parallel group monocentric phase II trial compared the efficacy and safety of 1-year treatment with benfotiamine 300 mg two times per day versus placebo over 12 months in participants with type 2 diabetes and mild-to-moderate symptomatic DSPN. The primary endpoint was the change in corneal nerve fiber length (CNFL) assessed by corneal confocal microscopy (CCM) from baseline to 12 months. Secondary endpoints included three other CCM parameters, skin biopsy (four parameters), nerve conduction studies (13 measures), quantitative sensory testing (six parameters), cardiovascular autonomic function tests (17 indices), sudomotor function tests (five parameters), 15 clinical scores and scales for neuropathic symptoms and signs and 13 health-related quality of life and depression instruments. Pharmacokinetics included measurement of six thiamine analytes in blood. Results: A total of 57 participants underwent randomization. The changes from baseline to 12 months in CNFL did not differ between the two groups. The corresponding changes in the secondary morphometric, functional and clinical neuropathic outcomes as well as quality of life were also similar in the two groups. Only the Neuropathy Symptom Score tended to improve after benfotiamine treatment (p=0.098 vs placebo). Benfotiamine treatment increased the concentrations of all six thiamine analytes studied (p≤0.003 vs placebo). Safety analysis showed no relevant differences between the groups in the rates of adverse events. Conclusions: In type 2 diabetes individuals with mild-to-moderate symptomatic DSPN, treatment with benfotiamine for 12 months was well tolerated, but had no significant effects on multiple morphometric, neurophysiological and clinical measures of neuropathy. Trial registration number: European Clinical Trials Database (EudraCT) 2017-003054-16 registered on April 10 ( https://eudract.ema.europa.eu/ ), 2018 and German Register for Clinical Trials DRKS00014832 registered on August 3, 2018 ( https://drks.de/search/de ).

Background: Despite approximately half of the German general population not meeting the physical activity (PA)-guidelines of the World Health Organization with further decreases noted during the pandemic, population-based intervention strategies to tackle this public health problem remain sparse. This study aimed to replicate the successfully delivered “10,000 Steps Ghent” intervention and research trial conducted in Belgium, two research questions were examined: (1) Do individuals located in the city that a complex PA intervention is implemented in (Duesseldorf) engage in more PA compared to individuals located in the control city (Wuppertal) after one year? (2) Is the proportion of those reaching 10,000 steps/day higher in the intervention than in the control city after the intervention? Methods: A nonrandomized controlled intervention trial was conducted among residents of two German cities. The 12-month intervention ‘10,000 Steps Duesseldorf’ was designed as a multicomponent intervention targeting different socioecological levels: at the intrapersonal level, a website allowed participants to self-monitor their steps; at the organizational level, workplaces and community groups were engaged through step count competitions; and at the community and policy levels, a city-wide media campaign to increase awareness regarding PA benefits was rolled out and street signage indicating walking routes were posted in different city district of Duesseldorf. To investigate intervention effects, PA was assessed via pedometers in two representative samples of adults aged 25–75 years from Duesseldorf (intervention) and Wuppertal (control). Measurements were taken at baseline (April 2021-March 2022) and again one year later (May–November 2023) and the same participants recorded their steps over a 7-day period at both time points. Baseline differences in socio-demographic and health-related variables between intervention and control were adjusted for in a propensity score model with matching weights. Results: 627 adults completed baseline and 553 the follow-up assessment (60% female, 60% intervention across both timepoints and cities). The results of the propensity score analyses revealed that intervention participants walked an average of 462 steps per day more (95% confidence interval: -146 to 1070) than controls at follow-up. However, the proportion of residents reaching 10,000 steps/day was comparable between intervention and control (Duesseldorf: 26.4%, Wuppertal: 25.6%) after the intervention (odds ratio 1.04, 95% confidence interval: 0.41 to 2.66). Conclusions: Although the increase in step count detected in our study was promising, further intervention efforts and accompanying research are needed to meet the minimally relevant intervention effect of 1000 steps that was set in the original Ghent study. Trial registration: German Clinical Trials Register DRKS00024873 (Date of registration: April 21st, 2021; URL: https://drks.de/search/de/trial/DRKS00024873 ).

Zusammenfassung: Patient:innen als zentrale Akteur:innen der Gesundheitsversorgung sollen sich aktiv in Versorgungsforschungsprozesse einbringen können. Auch weitere Stakeholder – etwa Fachkräfte aus der Versorgungspraxis – sind für einen umfassenden partizipativen Ansatz von Bedeutung. In diesem DNVF Memorandum stehen partizipative Ansätze im Kontext der Versorgungsforschung im Mittelpunkt. Zunächst werden die Charakteristika partizipativer Versorgungsforschung beschrieben und ihr Entwicklungsstand sowie ihre Institutionalisierung in Deutschland dargestellt. Dabei werden auch das Potenzial und die Vorteile partizipativer Versorgungsforschung beleuchtet. Schließlich widmet sich das DNVF Memorandum zwei Querschnittsthemen, die für die Weiterentwicklung besonders relevant sind: der theoretisch-konzeptionellen Fundierung sowie der Erforschung von Effekten und Wirksamkeit partizipativer Ansätze.

Background: The COVID-19 pandemic has accelerated the adoption of video consultations in mental health care, highlighting the importance of therapeutic alliances for successful treatment outcomes in both face-to-face and web-based settings. Telepresence, the sense of being present with the mental health specialist (MHS) rather than feeling remote, is a critical component of building a strong therapeutic alliance in video consultations. While patients often report high telepresence levels, MHSs express concerns about whether video consultations can replicate the quality of face-to-face interactions. Despite its importance, research on telepresence development in MHSs over time and the dyadic interplay between patients and MHSs remains limited. Objective: This study aimed to evaluate the mutual influence within patient-MHS dyads on telepresence development during video consultations, using data from a randomized controlled trial assessing the feasibility of video consultations for depression and anxiety disorders in primary care. Methods: The study included 22 patient-MHS dyads (22 patients, 4 MHSs). Telepresence was measured using the Telepresence in Videoconference Scale. Dyadic data were analyzed using the actor-partner interdependence model with a distinguishable dyad structural equation model. Actor effects refer to the impact of an individual’s telepresence at time point 1 (T1) on their telepresence at time point 2 (T2), while partner effects represent the influence of one party’s telepresence at T1 on the other’s telepresence at T2. Sensitivity analyses excluded data from individual MHSs to account for their unique effects. Results: A significant actor effect for MHSs (P<.001) indicated a high temporal stability of telepresence between T1 and T2. In contrast, the actor effect for patients was not statistically significant, suggesting a greater variability between T1 and T2. No significant partner effects for both patients and MHSs were observed, suggesting no mutual influence between dyad members. Age was a significant covariate for telepresence in both groups. Conclusions: Consistent with prior findings, MHSs experienced increased telepresence over time, whereas patients reported high telepresence levels from the start of therapy. The lack of dyadic influence highlights the need for further exploration into factors affecting telepresence development, such as age, technical proficiency, and prior treatment experience. Future studies with larger samples and more sessions are necessary to enhance the generalizability of these findings and to optimize the use of video consultations in mental health care.

Health economic methods can support the development and evaluation of new healthcare interventions by generating data on the resources used and relating these to a defined benefit. However, the standard methodology of health economic evaluation that is usually used does not do justice to the high degree of complexity of interventions in healthcare. As a result, there is a lack of decision-relevant information, for example, on the preferences of the target group, on spillover effects on the part of carers, or on implementation costs and the role of different contexts in the implementation of interventions into routine care. The UK Medical Research Council’s (MRC) standard-setting framework for complex interventions therefore emphasises the need to incorporate health economic aspects more strongly into all phases of the development and evaluation of complex interventions. To make this possible, the MRC’s recommendations for expanding and adapting the standard methodology of health economic evaluation must be concretised and supplemented. Building on already established methodological procedures, recommendations should be developed and proposals for necessary further research formulated.