Train the Trainer for general practice trainer - a report of the pilot within the programme Verbundweiterbildungplus

Background: Since 2008 the Verbundweiterbildungplus programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training. Within this article we describe the conception and evaluation of the first TTT-workshop within the programme Verbundweiterbildungplus

What Do the First 597 Global Fungal Red List Assessments Tell Us about the Threat Status of Fungi?

Fungal species are not immune to the threats facing animals and plants and are thus also prone to extinction. Yet, until 2015, fungi were nearly absent on the IUCN Red List. Recent efforts to identify fungal species under threat have significantly increased the number of published fungal assessments. The 597 species of fungi published in the 2022-1 IUCN Red List update (21 July 2022) are the basis for the first global review of the extinction risk of fungi and the threats they face. Nearly 50% of the assessed species are threatened, with 10% NT and 9% DD. For regions with a larger number of assessments (i.e., Europe, North America, and South America), subanalyses are provided. Data for lichenized and nonlichenized fungi are also summarized separately. Habitat loss/degradation followed by climate change, invasive species, and pollution are the primary identified threats. Bias in the data is discussed along with knowledge gaps. Suggested actions to address these gaps are provided along with a discussion of the use of assessments to facilitate on-the-ground conservation efforts. A research agenda for conservation mycology to assist in the assessment process and implementation of effective species/habitat management is presented

What Do the First 597 Global Fungal Red List Assessments Tell Us about the Threat Status of Fungi?

Fungal species are not immune to the threats facing animals and plants and are thus also prone to extinction. Yet, until 2015, fungi were nearly absent on the IUCN Red List. Recent efforts to identify fungal species under threat have significantly increased the number of published fungal assessments. The 597 species of fungi published in the 2022-1 IUCN Red List update (21 July 2022) are the basis for the first global review of the extinction risk of fungi and the threats they face. Nearly 50% of the assessed species are threatened, with 10% NT and 9% DD. For regions with a larger number of assessments (i.e., Europe, North America, and South America), subanalyses are provided. Data for lichenized and nonlichenized fungi are also summarized separately. Habitat loss/degradation followed by climate change, invasive species, and pollution are the primary identified threats. Bias in the data is discussed along with knowledge gaps. Suggested actions to address these gaps are provided along with a discussion of the use of assessments to facilitate on-the-ground conservation efforts. A research agenda for conservation mycology to assist in the assessment process and implementation of effective species/habitat management is presented

What Do the First 597 Global Fungal Red List Assessments Tell Us about the Threat Status of Fungi?

Fungal species are not immune to the threats facing animals and plants and are thus also prone to extinction. Yet, until 2015, fungi were nearly absent on the IUCN Red List. Recent efforts to identify fungal species under threat have significantly increased the number of published fungal assessments. The 597 species of fungi published in the 2022-1 IUCN Red List update (21 July 2022) are the basis for the first global review of the extinction risk of fungi and the threats they face. Nearly 50% of the assessed species are threatened, with 10% NT and 9% DD. For regions with a larger number of assessments (i.e., Europe, North America, and South America), subanalyses are provided. Data for lichenized and nonlichenized fungi are also summarized separately. Habitat loss/degradation followed by climate change, invasive species, and pollution are the primary identified threats. Bias in the data is discussed along with knowledge gaps. Suggested actions to address these gaps are provided along with a discussion of the use of assessments to facilitate on-the-ground conservation efforts. A research agenda for conservation mycology to assist in the assessment process and implementation of effective species/habitat management is presented

The MRKH syndrome: Clinic, analysis of misdiagnosis and development of a guideline for differential diagnosis and for avoiding malpractice

Die rechtzeitige und zielsichere Diagnose ist für Frauen mit MRKH-Syndrom von entscheidender Bedeutung für den Umgang mit nachfolgenden psychischen Belastungsfaktoren wie Kohabitationsunfähigkeit und Infertilität, sowie für die Anwendung zeitgemäßer Behandlungsmethoden, die den meist jugendlichen Patientinnen ein weitgehend normales, sexuell aktives Leben ermöglichen. Die vorliegende Untersuchung von 183 Patientinnen zeigt, dass rund 60% initial falsch oder verzögert diagnostiziert wurden, und ein Drittel von ihnen eine falsche Therapie erhielt. Im Schnitt vergingen über acht Monate zwischen dem Zeitpunkt des ersten Frauenarztbesuchs und der Diagnosestellung. Ein Viertel der Patientinnen wurde mit Hormonpräparaten mit dem Ziel der medikamentösen Menarcheinduktion behandelt, bei 9% wurde sogar eine invasive Hymenalinzision bei Verdacht auf Hymenalatresie durchgeführt. Es ist also heute trotz modernster Techniken und ständiger medizinischer Fortbildung notwendig, niedergelassene Ärzte und Kliniker noch mehr für das Krankheitsbild MRKH zu sensibilisieren, und einen standardisierten diagnostischen Ablauf zu implementieren, um den Patientinnen zeitgerecht eine adäquate Therapie zukommen zu lassen. Der in dieser Arbeit dargestellte diagnostische Leitfaden für niedergelassene Ärzte und Kliniker orientiert sich an den „Hauptsymptomen“ des MRKH-Syndroms, „Asymptomatische Amenorrhö bei Aplasie“. Im diagnostischen Prozess fällt besondere Gewichtung auf diejenigen Untersuchungen, die die typischen mit dem Syndrom vergesellschafteten Befunde aufzeigen, häufige assoziierte Fehlbildungen mit einbeziehen, und auf die differenzialdiagnostische Abgrenzung des Syndroms abzielen. Hinsichtlich zusammenhängender Fehlbildungen urogenitaler Organstrukturen, zeigt sich eine relevante seitenbezogene Häufung bestimmter Anomalien. Am häufigsten ist hier eine Nierenagenesie, kombiniert mit einen hochgestellten Ovar, einer hypo- oder aplastischen Tube und teils einer fehlenden Uterusknospe auf der jeweils gleichen – meist linken – Seite nachweisbar. Diese Beobachtungen können zukünftig neue Erkenntnisse hinsichtlich der Pathogenese des MRKH- Syndroms während der Embryonalphase ermöglichen.Timely and accurate clinical diagnostics is crucial for women with MRKH syndrome for dealing with subsequent mental stress factors such as disability to cohabitation and infertility, and for the application of modern treatment methods that allow women to have a sexually active life. This study of 183 patients shows that around 60% of MRKH-patients is initially incorrectly or delayed diagnosed and a third of them receive the wrong treatment. On average, more than eight months passed between the first visit to a gynecologist and diagnosis. A quarter of patients is treated with hormone preparations with the aim of inducing menarche, and at 9% even invasive treatment such as hymen incision is carried out. That is why sensitizing medical education and clinicians more for the MRKH syndrome and a implementing a standardized diagnostic procedure seems fundamental. The diagnostic guide presented in this study is based on the main symptoms of MRKH syndrome, "Asymptomatic Amenorrhea and Aplasia". In diagnostic process, one should focus particularly symptoms and procedures which allow differential diagnosis. With regard to related malformations of urogenital organ structures, this study chows significant relations. The most common combined malformation is renal agenesis, combined with a elevated ovary, a hypo- or aplastic tube and a lack of uterine bud – usually on the left side. These observations could allow new insights into the pathogenesis of MRKH Permit during the embryonic phase

Self-help guidebook improved quality of life for patients with irritable bowel syndrome

<div><p>Background</p><p>The primary aim of our study was to evaluate the impact of a comprehensive self-help guidebook on the disease related quality of life for patients with irritable bowel syndrome (IBS). The secondary aim was to evaluate whether the guidebook is less effective in IBS patients with depression, somatization disorder or panic disorder as a psychiatric comorbidity.</p><p>Methods</p><p>Prospective observational study. At baseline (t1), patients filled in the ´Functional Digestive Disorders Quality of Life´ (FDDQL) questionnaire and received the IBS guidebook together with an explanation of its content and use. Depression, anxiety and somatization were evaluated with the Patient Health Questionnaire (PHQ). Three (t2) and six months (t3) later, the questionnaire was sent by mail to the patients for follow-up evaluation. Data were analyzed with repeated measures ANOVA.</p><p>Results</p><p>71 patients participated (74.6% female). 53 (74.6%) completed the final assessment at t3 after 6 months. The global FDDQL score increased from 49.3 (SD 12.7) at t1 to 64.3 (SD 16.0) at t3 (p < 0.001). There was a significant between-subjects effect on the global FDDQL score related to depression (p = 0.001), anxiety (p = 0.001) and somatization (p = 0.011). Thus, the quality of life of patients with psychosomatic comorbidity was lower at baseline, but showed a similar increase within the following six months.</p><p>Conclusion</p><p>The self-help guidebook significantly improved measured quality of life for IBS patients. The use of screening questionnaires like PHQ might be valuable to identify patients with more complex problems. This might be helpful for them to intensify and adapt therapy. Further research has to evaluate if patients with psychological comorbidity are treated more effectively when they receive psychotherapy or specific medication in addition to the self-management guidebook.</p></div

Quality of life and psychiatric comorbidities (FDDQL and PHQ-D) during the course of the study.

<p>Quality of life and psychiatric comorbidities (FDDQL and PHQ-D) during the course of the study.</p

Sociodemographic gender characteristics for patient sample.

<p>Sociodemographic gender characteristics for patient sample.</p