Greifswald University Hospital (German: Universitätsmedizin Greifswald) in Greifswald, Germany is a teaching hospital for the University of Greifswald's medical school. Greifswald University Hospital is owned and operated by a non-profit Anstalt des öffentlichen Rechts in cooperation with the university and serves as one of the primary hospitals in the state of Mecklenburg-Vorpommern. It also fills the function of a tertiary referral hospital for the health care region..
Zusammenfassung Hintergrund Die Bestimmung des prozentualen Hörverlusts (pHV) aus dem Tonaudiogramm nach Röser 1973 oder aus dem Sprachaudiogramm nach Boenninghaus und Röser 1973 sind weithin eingesetzte Methoden zur quantitativen Bemessung des Hörvermögens. Die Bestimmung von pHV aus ton- und sprachaudiometrischen Befunden im Rahmen der postoperativen Evaluation von Hörsystemen ist bisher nicht üblich. Bei Durchführung aller empfohlenen audiologischen Leistungen nach der Indikation für ein Cochleaimplantat (CI) liegen alle nötigen Messwerte zur Bestimmung des pHV aus der Hörfeldskalierung (pHV KLS ) und aus dem Sprachaudiogramm (pHV FB ) vor. Ziel der Arbeit Die Parameter pHV KLS and pVH FB sollen vorgestellt und anhand von Daten aus der klinischen Routine berechnet werden. Dadurch soll die prinzipielle Verwendbarkeit für die Bewertung des Ergebnisses einer CI-Versorgung evaluiert werden. Material und Methoden Retrospektive Auswertung der Daten von 66 CI-Versorgungen an einer Universitätsklinik. Kalkulation des prozentualen Hörverlusts pHV aus dem numerischen Skalenwert 5 CU der kategorialen Lautskalierung (pHV KLS ) bzw. aus dem Freiburger Sprachtest im freien Schallfeld mit CI (pHV FB ). Ergebnisse Während die Werte des pHV KLS eine geringe Streuung aufweisen, zeigt pHV FB eine größere, aber über der Zeit abnehmende Streuung. Außerdem zeigt sich eine Konvergenz der mittleren pHV ab dem Zeitpunkt der CI-Erstanpassung. Die Differenz aus pHV FB und pHV KLS ergibt mit statistischer Signifikanz positive Werte. Schlussfolgerung Die Bestimmung des pHV aus der kategorialen Lautheitsskalierung bzw. aus dem Freiburger Sprachtest ist in der klinischen Routine möglich. Eine Korrelation der Differenz aus pHV FB und pHV KLS mit dem Erfolg der CI-Versorgung erscheint plausibel.
PURPOSE:Routine augmentation of pedicle screws in standard clinical practice is performed using polymethylmethacrylate (PMMA) cement. However, owing to its high compressive strength and high Young's modulus, this material acts more as a stiffener in the spine than as a suitable replacement for compressed cancellous bone. Adjacent fractures caused by this represent a common clinical problem. A new experimental magnesium phosphate cement seems more suitable for this purpose, as it shows promising biomechanical properties and has been proven to be injectable via long cannulated systems. However, the application of this material has not yet been explored or quantified. METHODS:Fenestrated pedicle screws were inserted into polyurethane bone blocks of different densities and augmented with experimental magnesium phosphate cement. This was followed by biomechanical testing in a realistic loading scenario. In addition, the injection force required for augmentation was quantified depending on the syringe type. RESULTS:Cement augmentation was possible in all bone blocks used and consistently had a positive effect on the biomechanical stability of fenestrated pedicle screws. The size of this effect varied depending on the density of the bone blocks used. No cutoff value could be identified at which augmentation should be performed. CONCLUSION:The novel experimental ready-to-use formulation of magnesium phosphate cement reliably enabled cement augmentation of fenestrated pedicle screws and consistently resulted in improved biomechanical stability. These findings suggest that a biocompatible and degradable bone cement with suitable biomechanical properties may represent a future alternative for spinal augmentation.
Multiple sclerosis (MS) care in Germany has entered a phase in which therapeutic progress is increasingly constrained by delivery capacity. Earlier diagnosis, broader access to high-efficacy disease-modifying therapies (DMTs), and more refined monitoring strategies have improved the potential for favourable long-term outcomes. At the same time, these advances have increased the need for specialised expertise, infusion and monitoring infrastructure, rapid imaging access, structured safety procedures, and cross-sector coordination. Real-world evidence from Germany indicates a shift towards early high-efficacy treatment but also shows regional variation in treatment initiation, therapy intensity, and the proportion of people with MS who remain DMT-untreated. This expert-informed narrative review combines a non-systematic literature review with selected regional implementation examples from German MS care. This review synthesises key delivery challenges in German MS care and maps regional models whose underlying organisational principles may be transferable across healthcare settings, while their specific implementation depends on the local regulatory and reimbursement context. The central argument is that high-quality MS care should be understood not only as a therapeutic decision but as a system property: evidence-based treatment must be embedded in reliable pathways for diagnosis, monitoring, escalation, de-escalation, rehabilitation, and long-term support. Regional models such as ambulatory specialist care structures, hub-and-spoke networks, Germany´s inpatient MS complex treatment programme, delegated task models, telemedical consultation pathways, and digital monitoring infrastructures provide practical building blocks. Implementation at scale will require measurable quality indicators, financing of coordination work, formalised skill-mix models, digital interoperability, and explicit strategies for ageing and multimorbid MS populations. For neurological practice, the challenge is therefore not whether modern MS care is possible, but how to make it reproducible, safe, and equitable across regions.
