BACKGROUND:Functional abdominal pain (FAP) is a severely debilitating condition affecting approximately 11.7% of children and adolescents worldwide, often persisting into adulthood and significantly restricting daily life. Health literacy is essential for treatment success. To improve knowledge about the biopsychosocial factors influencing FAP and support its management, we developed an educational multimedia website (https://meine-bauchstelle.com). METHODS:In a multicenter randomised controlled trial (RCT), patients with FAP (N = 166, age 5-17 years, M = 10.8, SD = 3.31; 53.6% female) and their parents were randomly assigned to an intervention group (IG: access to the website before the first measurement) or a control group (CG: no access to the website during data collection). The primary outcome was health literacy (knowledge and health behaviour) and secondary outcomes were abdominal pain symptoms and the physician-patient/parent interactions. Group differences were analysed using t-tests and multilevel models. RESULTS:Patients in the IG who visited the website demonstrated significantly higher initial knowledge scores compared to the CG. Moreover, they reported significantly less pain-related disability across three assessments over 3 months. Parents who visited the website rated the physician-parent interaction significantly more positively than those in the CG. CONCLUSIONS:The educational website efficiently increased patient knowledge about FAP and improved certain pain-related behaviours. It serves as an effective tool in conveying information about FAP in clinical practice. Future applications could extend to preventive measures in schools and other settings. SIGNIFICANCE STATEMENT:The educational website about functional abdominal pain is effective in transferring knowledge, reducing pain-related disability, and improving physician-parent interactions. It can support physicians in day-to-day clinical practice by referring patients to the website for further information and might be extended as a preventive measure in schools.
In the case of acute perforated cholecystitis, rapid control of the infection site is important for patient outcomes. For free perforation with generalized peritonitis, emergency laparoscopic cholecystectomy remains the gold standard therapy. Percutaneous transhepatic cholecystostomy (PTC) is an alternative damage-control option, particularly for frail, septic, or profoundly comorbid patients, either as a bridge to (early or interval) cholecystectomy or, in truly inoperable patients, as definitive palliation. Gallbladder perforations are categorized on the basis of the Niemeier classification. The therapeutic modality depends on the type of perforation. In this editorial, we present the actual guidelines and the findings from trials related to this issue. Moreover, we propose a pragmatic pathway that is based on clinical evidence. The following research gaps are identified: Randomized controlled trials aiming to compare emergency laparoscopic cholecystectomy with PTC as a bridge in cases of Niemeier I and Niemeier II disease are lacking; there are no standardized criteria for the use of PTC as a definitive therapy, such as frailty, sarcopenia or other markers; and there are no comparative studies of endoscopic ultrasound-guided gallbladder drainage vs PTC in cases of perforation.
BACKGROUND:Atopic diseases-including atopic dermatitis (AD), food allergy (FA), allergic rhinitis (AR), and asthma-are the most common chronic conditions in childhood and adolescence, affecting up to 30% of the global population. In Germany alone, more than 2.1 million children and adolescents are affected. These conditions frequently coexist and share common genetic, environmental, dietary, and microbial risk factors. METHODS:A comprehensive literature review was conducted, and a multidisciplinary Task Force of the German Society for Pediatric Allergology and Environmental Medicine (GPA) and the German Society for Allergology and Clinical Immunology (DGAKI) developed consensus-based algorithms for early risk assessment and recognition of allergies in children in already existing preventive medical check-ups. The approach emphasizes stepwise risk assessment, including family history, environmental exposures, and early clinical signs such as recurrent wheezing. RESULTS:For children identified as at risk for or with early clinical signs of atopy, targeted diagnostic steps are recommended that follow the national/international guidelines for the management of the suspected atopic disease. This may include general and specific recommendations for nutrition, measurement of specific sensitization and selected biomarkers, if indicated and recommended by the guidelines. Routine allergy testing in asymptomatic children is not recommended. The algorithms are designed to be embedded into routine pediatric check-ups, enabling systematic and early identification of children at increased risk or with early clinical signs of atopic diseases. Early recognition and management can reduce disease severity, improve quality of life, and decrease healthcare costs. CONCLUSION:Structured programs for early risk assessment and recognition of allergies in children are currently lacking but can provide substantial clinical and economic benefits. Integration into routine pediatric preventive examinations, supported by standardization, interdisciplinary collaboration, and sustainable funding, offers a promising strategy to improve long-term outcomes for affected children and their families.
Device-based rhythm therapy has fundamentally evolved in recent years. Conventional implants consisting of a generator and transvenous leads have largely been optimized and are now characterized by miniaturization, extended battery life and magnetic resonance imaging (MRI) compatibility. To circumvent specific lead-related complications, novel technologies, such as leadless pacemakers and subcutaneous implantable cardioverter defibrillators (ICD) are gaining prominence. In the realm of physiological pacing methods conduction system pacing (CSP), particularly left bundle branch pacing (LBB pacing), is increasingly complementing traditional cardiac resynchronization therapy. Furthermore, innovative approaches such as artificial intelligence (AI)-assisted diagnostics, wearables and biological pacemakers offer promising prospects but require careful clinical evaluation.
