Research question:Germany's longstanding separation of healthcare sectors - most prominently between outpatient and inpatient care - creates risks of fragmented service delivery, disrupted information flows, and ultimately suboptimal outcomes for patients. This position paper examines how cross-sectoral and integrated strategies can effectively mitigate or overcome this fragmentation. Methods:During a Berlin Forum of the Association of the Scientific Medical Societies in Germany (AWMF) (6 December 2024), experts presented best-practice models and discussed legal, structural, financial, and regional dimensions of integrated care. The insights from these discussions were synthesized into AWMF's recommendations. Results:Integrated care represents a critical lever for improving the efficiency and quality of the German healthcare system. Promising examples exist across surgical, medical, psychiatric, and regionalized care settings. Key recommendations address the following topics: harmonized financing and remuneration system, regional population-based healthcare networks, interoperable information exchange across healthcare sectors, shared decision-making on care options. Health services research - and especially implementation research - plays an indispensable role in guiding and evaluating these reforms. The AWMF further emphasizes the need for integrated education and postgraduate training, particularly within structured residency networks, and offers AWMF as an important interdisciplinary and interprofessional platform for promoting cross-sectoral care. Conclusions:Broad implementation of integrated care, combined with robust and evidence-based monitoring of implementation, is essential for meeting the challenges posed by demographic change and increasing demands on healthcare delivery.
Tumor lysis syndrome (TLS) is a rare but life-threatening complication in solid tumors such as colorectal cancer (CRC). We report a 61-year-old male with metastatic CRC and extensive liver metastases who developed acute TLS within 48 hours of initiating FOLFOX chemotherapy. He presented with acute kidney injury (AKI), hyperuricemia, hyperphosphatemia, hypocalcemia, and elevated liver enzymes. Prompt treatment with intravenous fluids, rasburicase, and febuxostat led to rapid resolution of TLS. Despite recovery, the patient died two weeks later from complications of advanced metastatic disease. This case highlights the need for early TLS recognition in high-risk CRC patients.
Urinary tract infections (UTIs) are becoming increasingly challenging to treat owing to the emergence of multidrug-resistant (MDR) strains, including uropathogenic Escherichia coli (UPEC). Clove (Syzygium aromaticum L.) has antimicrobial activity that can alter UPEC morphology and exhibit inhibitory effects. However, the mechanisms underlying the inhibition of specific small molecules remain largely unknown. This study aimed to explore the potential of small molecules in clove flower extract as anti-MDR UPEC agents using in vitro and in silico approaches. Extraction was performed using ethanol and n-hexane, yielding 27.44% and 9.9%, respectively. The ethanol extract exhibited inhibitory activity against MDR-UPEC, forming clear zones ranging from 11.07±0.32 (250 mg/mL) to 16.77±1.36 (1,000 mg/mL) in a disk diffusion assay. However, the combination of ethanol extract and ciprofloxacin resulted in antagonistic effects. GC-MS analysis of the ethanol extract identified 29 small molecules, which were subsequently analyzed using PASS Online, Lipinski's Rule of Five, and molecular docking against target proteins PBP2 and AcrB. Three small molecules showed the potential to inhibit PBP2, and ten small molecules targeted AcrB. Spesifically, 8,14-Seco-3,19-epoxyandrostane-8,14-dione, 17-acetoxy-3β-methoxy-4,4-dimethyl-, Ethyl iso-allocholate and Estra-1,3,5(10)-trien-17β-ol show binding affinities of -7.9; -7.6; dan -8.0 kcal/mol to PBP2, and -9.3; -8.5; dan -8.6 kcal/mol to AcrB, respectively. These three small molecules are promising candidates for developing plant-based antibacterial agents against MDR UPEC.
Background: In Mecklenburg-Western Pomerania, multidisciplinary round tables bring together stakeholders from the healthcare sector to jointly develop and advance solutions for regional care challenges on a semi-annual basis. In a sparsely populated state with distinct structural and service-related difficulties, these collaborative formats play a key role in improving discharge management. Against this backdrop, the present study explores the main fields of action required to enhance discharge processes in rural areas of Mecklenburg-Western Pomerania. It aims to prioritise the key challenges, objectives, and measures that can contribute to a more efficient and patient-centred continuum of care following hospital discharge. Methods: Guideline-based group discussions were conducted at the round tables in Demmin, Pasewalk, Parchim and Ueckermünde and analysed using qualitative content analysis. To prioritise key topics and measures, a dialogue-based structural mapping method (Strukturlegetechnik) was applied. This approach enables the reconstruction of participants’ subjective theories through consensus-oriented discussions and visual mapping of conceptual relationships. Results: In four focus group discussions involving a total of 30 participants, three main areas for action were emphasised: the expansion of networks and binding coordination structures, the use of digital tools such as online platforms and telemedicine, and the development of tailored support services for vulnerable groups. In addition, prevention, health education, citizen participation and public relations were highlighted as essential cross-cutting tasks. Discussion & conclusion: To ensure sustainable healthcare provision in rural areas, it is essential to establish stable networks that meet on a regular basis and have reliable funding. The targeted expansion of telemedicine, digital communication platforms and capacity monitoring systems should be pursued to strengthen cross-sector collaboration and reduce gaps in service delivery.
Background:Idiopathic intracranial hypertension is a neurological disorder of unclear etiology that primarily affects young adults. Although several therapeutic options are available, many patients continue to experience persistent visual impairment and headaches, suggesting that key disease mechanisms remain poorly understood. Emerging evidence implicates dysfunction of the glial neurovascular unit (gNVU) in the pathogenesis of IIH. Objective:To systematically evaluate the association between alterations of gNVU-related proteins, specifically aquaporin-4, glial fibrillary acidic protein, fibrinogen, and neurofilament light chain, with the risk of IIH. Methods:A comprehensive literature search of PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted through August 2025. Studies comparing patients with IIH to control participants and reporting gNVU-related biomarkers in cerebrospinal fluid, plasma, serum, or brain tissue were included. Data extraction and quality assessment were performed independently using the Newcastle-Ottawa Scale. Pooled standardized mean differences with 95% confidence intervals were calculated using random-effects models. Results:Ten studies comprising 327 patients with IIH and 216 controls met the inclusion criteria, with seven studies contributing to quantitative synthesis. Levels of CSF Nf-L and plasma fibrinogen were significantly higher in IIH patients, indicating neuroaxonal injury and a hypercoagulable state (Nf-L: SMD=0.78, 95% CI 0.51-1.05; fibrinogen: SMD=0.66, 95% CI 0.08-1.23). Findings for AQP4 and GFAP were inconsistent across studies. Higher BMI was also associated with an increased risk of IIH (SMD=0.80, 95% CI 0.17-1.44). Study quality did not significantly influence effect estimates.
Systematic reviews (SRs) and meta-analyses are regarded as the pinnacle of evidence-based medicine, synthesizing fragmented research to guide clinical decision-making. However, the exponential increase in their publication has raised concerns regarding redundancy, methodological flaws, and misleading conclusions. Many SRs lack preregistration, employ inconsistent methodologies, and fail to account for clinical heterogeneity. Additionally, the integration of artificial intelligence (AI) in research poses new challenges, including data fabrication, plagiarism, and AI-induced biases. While AI offers efficiency in processing vast amounts of data, its unregulated use may compromise research integrity. Furthermore, current review processes often overlook critical clinical insights, leading to misinterpretations. To improve SR quality, a rigorous, stepwise approach is necessary, including preregistration, comprehensive literature searches, unbiased data abstraction, and meticulous assessment of confounding factors. AI-generated content must be scrutinized through human oversight to ensure accuracy and reliability. Ultimately, the overreliance on statistical aggregation without critical clinical evaluation may lead to flawed conclusions. Clinicians must actively engage in assessing SRs beyond methodological frameworks, integrating human judgment to enhance the credibility and applicability of findings. Addressing these challenges is crucial for maintaining the integrity of evidence-based medicine.
Purpose:Financial pressure on the German healthcare system is rising, and physicians face high pressure in balancing patient care and research. Into this environment comes an ethics approval process for retrospective studies that is becoming more complex and requires a greater volume of documentation. The objective of this study was to first describe and calculate the costs incurred by the ethics approval process. Methods:Using ChatGPT and Gemini, the required times for preparation, creation, and submission, as well as the time required for the ethics committee to process and vote on ethics approval, were estimated. Costs were calculated based on the newest version of the collective agreement for physicians at German university hospitals (Tarifvertrag für Ärzte an Universitätskliniken). Results:Time required for submitting adds up to approximately 4-10 hours, and 4.5-8.5 hours for submission control and voting, respectively. Summing up, this amounts to 161.7-388.1 € for submission and 241.6-456.3 € for the ethics committee, respectively. In total, 8.5-18.5 hours are required for ethics approval for a retrospective study, resulting in a total of 403.3-844.4 €. Conclusion:Ethics approval is of major relevance to ensure good ethical practice and shall therefore not be omitted. Nevertheless, processes can be tightened to facilitate clinical research, free up resources, and save costs.
Background:Waist-to-height ratio (WHtR) is a superior indicator of central obesity and cardiometabolic risk compared with body mass index (BMI). However, its use in clinical practice is limited because waist circumference is often not measured or may be collected inconsistently. This study aimed to develop and validate SMRT, a simple anthropometric model that estimates WHtR using only height and weight. Methods:Four NHANES cycles (2015-2016, 2017-2018, partial 2017-March 2020, and 2021-2023) were pooled to obtain a nationally representative sample of adults aged ≥18 years with complete anthropometric data (n=22,109). Linear regression was used to derive a height-weight model for estimating WHtR. Model performance was evaluated using Pearson correlation (r), root mean square error (RMSE), mean absolute error (MAE), and agreement across WHtR risk categories, and was compared directly with BMI. Results:The SMRT model was: WHtR_est = 1.271 + 0.00470 × weight (kg) - 0.634 × height (m). SMRT showed a very strong correlation with measured WHtR (r=0.92504), outperforming BMI (r=0.9133). SMRT demonstrated the lowest prediction error (RMSE=0.03899; MAE=0.0291). It correctly classified 78.2% of participants across WHtR risk categories, compared with 64.4% using BMI. Sensitivity for detecting WHtR≥0.50 was markedly higher for SMRT (90.3%) than for BMI (78.1%). Conclusions:SMRT is a simple, robust, and clinically practical model for estimating WHtR using only height and weight. Developed using more than 22,000 adults from multiple NHANES cycles, SMRT provides a valuable screening tool when waist circumference is unavailable and may improve assessment of central adiposity and cardiometabolic risk.
Objective: This study investigates the current integration of eHealth content into the medical curriculum at the University of Luebeck. The aim is to explore how students and alumni remember e-health teaching content und to assess their knowledge, confidence and preparedness for using digital applications in clinical practice. The results can help with the further development of the curriculum. Methods: A cross-sectional online survey was conducted among current medical students and alumni (graduation within the last five years) of the University of Luebeck. The questionnaire assessed participants’ attitudes toward eHealth, their self-assessed knowledge and confidence, and the eHealth content taught during their studies. Data were analyzed descriptively, and associations between key variables were examined using Spearman’s rank correlation and Mann-Whitney U test. Results: A total of 131 responses were analyzed (students: n=76, alumni: n=54). While students reported more frequent exposure to eHealth content (70%) than alumni (19%), overall, 51% indicated that no eHealth instruction had been part of their curriculum. The most common taught topics included the electronic patient record (ePA), ePrescriptions, and communication platforms like Communication in healthcare (KIM) and Telematics messenger (TIM). Self-assessed knowledge of eHealth showed strong correlations with perceived confidence and preparedness. Confidence in using eHealth applications strongly predicted perceived preparedness. Gender and age were also found to be relevant factors: male participants reported higher knowledge levels, and younger participants more frequently encountered eHealth content. Conclusions: The findings highlight substantial variability in the perception of eHealth teaching and reveal significant associations between perceived knowledge, confidence, and readiness for professional application. Participants expressed a clear need for broader and more structured digital health education. Core topics identified for future curricular integration include digital documentation systems, telemedicine, data protection, and the use of AI in healthcare. Comprehensive, longitudinal integration of eHealth across core and elective curricula is essential to adequately prepare future physicians for an increasingly digitalized healthcare system.
Background:To curb SARS-CoV-2 transmission, citizens were urged to get vaccinated and adhere to hygiene recommendations (keeping distance, washing hands, wearing face masks), as well as informing contacts if infected. Studies confirm the effectiveness of these measures in reducing virus spread. Understanding factors influencing nonadherence is vital for enhancing the efficacy of future pandemic education campaigns. Methods:An online survey assessed nonadherence to SARS-CoV-2 containment recommendations among 30,000 randomly selected Cologne residents aged 18 or older. Invitations were sent on December 7, 2022, with the survey open until January 7, 2023. Logistic regression analyzed associations between participants' sociodemographic, health, and virus-related characteristics and reported nonadherence to recommended behaviors. Results:Out of 30,000 invited Cologne residents, 4,486 (15%) responded, with 10% reporting not having received recommended SARS-CoV-2 vaccination. Nonadherence correlated significantly with older age, male gender, low income, living alone, migrant background, and chronic lung disease. 80% reported not adhering to current hygiene recommendations, linked to younger age, absence of certain pre-existing conditions, and prior SARS-CoV-2 infection. Additionally, 16% reported hesitancy in informing all contacts upon testing positive, associated with male gender, absence of certain pre-existing conditions, and fewer booster doses. Conclusion:The results presented here point to which sociodemographic, health, and virus-related factors are associated with nonadherence to recommended individual behaviors to mitigate the SARS-CoV-2 pandemic. However, issues related to the representativeness of the sample for the general population limit the validity of the results.Trial registration: DRKS.de, German Clinical Trials Register (DRKS), identifier: DRKS00024046, registered on 25 February 2021.
Background:In rural areas, discharge management presents a significant challenge. Despite its relevance, there is limited research on implementation strategies and the preferences of the involved parties. In Mecklenburg-Western Pomerania, four round tables have been established with the goal of promoting sustainable local healthcare. These regional networks involve multidisciplinary stakeholders working together on acute care and follow-up care for patients. This paper examines the implementation strategies of discharge management in rural areas of Mecklenburg-Western Pomerania, analyses associated challenges, and identifies stakeholder preferences. Methodology:Semi-structured group discussions were conducted at the round tables in Demmin, Pasewalk, and Ueckermünde. The data was analysed using qualitative content analysis, with a focus on structuring the content. Results:Three group discussions with a total of 30 participants were held. Key challenges in rural areas include securing day care services, the lack of sufficient and locally accessible short-term care, long-term inpatient care, and rehabilitation placements. As a result, patients often remain hospitalized longer than necessary or must transfer to distant follow-up facilities. Discussion and conclusion:A key aspect is questioning traditional approaches, such as the strict separation of responsibilities, and focusing more on shared accountability. The goal is to create synergies and enable more efficient care delivery.
The German healthcare system faces considerable challenges, particularly due to a shortage of physicians in rural areas and increasing demands from an aging and multimorbid population. Physician assistants (PAs) represent a promising solution to address these challenges. As academically trained healthcare professionals, they take on delegable tasks such as medical histories, routine examinations, documentation, and the care of chronically ill patients. This relieves physicians and allows for more intensive patient care. This paper examines the advantages of integrating physician assistants (PAs) into outpatient care. It shows that PAs can significantly improve the efficiency and quality of care through their work. In particular, PAs play a crucial role in disease management programs (DMPs) for the long-term care of chronically ill patients. Their involvement leads to a reduction in complications and an increase in patient satisfaction. From an economic perspective, PAs optimize the use of resources and help stabilize practices, especially in underserved regions. Despite these potentials, there are significant challenges. There is a lack of uniform national legal regulations clearly defining the competencies and fields of activity of PAs. In addition, there are uncertainties regarding the refinancing of PA services, as well as issues of acceptance among physicians and patients. Competition with existing healthcare professions such as medical assistants (MFAs) or specialized roles like VERAHs necessitates clear delineation of responsibilities. This paper concludes by presenting strategies for the successful integration of physician assistants (PAs). In addition to creating clear legal frameworks and refinancing models, promoting interdisciplinary collaboration is essential. Regular continuing education and the use of digital technologies such as telemedicine can further expand the competencies of PAs. The findings underline that PAs can play a crucial role in ensuring sustainable and patient-centered healthcare - especially in regions affected by physician shortages.
Objectives:Invasive ductal carcinoma (IDC), the most prevalent subtype of breast cancer, is characterized by significant genomic heterogeneity. Tumor mutation burden (TMB) has emerged as a predictive biomarker for immunotherapy response, yet its estimation via whole-exome sequencing remains complex and costly. This study aimed to evaluate whether total somatic mutation count can serve as a practical surrogate for TMB and assess its association with progesterone receptor (PR) status in PIK3CA-mutated IDC patients. Methods:This retrospective observational study utilized publicly available data from a previously published breast cancer sequencing study. A total of 164 female IDC patients with confirmed PIK3CA mutations and documented PR status were included. Relevant genomic and demographic parameters - TMB, mutation count, and age - were extracted and analyzed. Statistical analyses included correlation, intergroup comparisons by PR status, and binary logistic regression. Predictive performance was assessed using area under the receiver operating characteristic (AUROC) curves. Results:Patients with PR-negative status exhibited significantly higher TMB and mutation count than PR-positive patients (p-value<0.001 for both). TMB and mutation count were positively correlated (r=0.61, p-value<0.001), indicating overlapping representation of genomic instability. Logistic regression showed that mutation count was a significant predictor of PR status (p-value=0.01). Mutation count demonstrated a slightly superior predictive performance (AUROC=0.738) compared to TMB (AUROC=0.737). Conclusion:Total mutation count shows strong potential as a surrogate biomarker for TMB and a predictive marker for PR status in PIK3CA-mutated IDC, offering a cost-effective genomic tool in personalized breast cancer stratification.
Objective:The doctor-patient interaction is essential for successfull dental treatment. Although it is possible to consider social skills during student selection, these are rarely taken into account. The described project aims to identify and evaluate the social skills deemed necessary by various stakeholders and to assess whether these skills can be effectively measured using a Situational Judgment Test (SJT). Methods:The project involved conducting interviews with stakeholders (lecturers, students, patients, practicing dentists) to identify relevant social skills. This was followed by a Delphi survey to evaluate the importance of these skills. Additionally, the SJT was examined for its suitability in the context of dental medicine, and various methods for reliably measuring the identified skills were assessed. Results:Dental lecturers and students consider emotional resilience, particularly stress management, to be especially important during dental studies, while patient-related behaviors are of lesser priority - possibly due to the constraints of the academic environment. In contrast, patients and dentists emphasize the importance of helpfulness and caring conduct during treatment. Conclusion:Our research highlights the need to strengthen social skills in dental education. Although the SJT from general medicine is also suitable for dental studies, Multiple Mini Interviews (MMIs) are a more effective method for capturing complex skills, such as behavioral flexibility.
The current S2k guideline "kutane Borreliose" has been updated in accordance with the methodological standards of the "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.". It has received consensus from 18 AWMF member societies, the Robert Koch Institute, the "Paul-Ehrlich-Gesellschaft für Infektionstherapie e.V.", "Instand e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien", the "Deutsche Borreliose-Gesellschaft" and the two German patient organisations "Borreliose und FSME Bund Deutschland" and "Aktionsbündnis gegen zeckenübertragene Infektionen Deutschland e.V.". This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis and is directed at physicians in private practices and clinics who treat Lyme borreliosis. Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis and recommendations for the treatment of the different manifestations erythema migrans, multiple erythemata migrantia, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. The current update of the guideline incorporates the international literature on cutaneous manifestations of Lyme borreliosis up to 2022. There have been no significant changes in diagnosis and treatment. The Cochrane network analysis on the treatment of erythema migrans has only shown that, in addition to doxycycline and amoxicillin, oral penicillin V is equally effective. A Slovenian analysis of patients with acrodermatitis chronica atrophicans over the past 30 years has shown a decrease in the incidence of constitutional symptoms and atrophy, likely due to improved early detection. In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline.
Objective:Breast cancer is the most commonly diagnosed malignancy worldwide. Insulin resistance (IR) plays a key role in its progression by activating oncogenic signaling pathways. The triglyceride-glucose (TyG) index is a validated, cost-effective surrogate marker for IR. This study aims to evaluate the prevalence of IR in female breast cancer patients using the TyG index and to identify lipid parameters associated with increased IR, thereby supporting strategies for secondary prevention. Methods:A cross-sectional study was conducted among non-diabetic, histopathologically confirmed female breast cancer patients. Demographic data, lipid profiles, and fasting glucose levels were collected. Participants were stratified into high-risk (TyG≥8.87) and low-risk (TyG<8.87) groups based on their TyG index. Logistic regression analysis was performed to identify significant predictors of elevated TyG index. Results:Among 122 patients, 44.3% demonstrated elevated insulin resistance. Triglycerides (TG), total cholesterol (TC), very low-density lipoprotein cholesterol (VLDL-C), and the TC/high-density lipoprotein-cholesterol (HDL-C) ratio were significantly higher in the high-risk group. Logistic regression identified TC, TC/HDL-C ratio, and low-density lipoprotein cholesterol (LDL-C) as significant predictors of elevated IR (p<0.05). The model is represented as: Logit(P)=-13.941+0.145X1+1.558X2-0.178X3, where X1, X2, and X3 correspond to TC, TC/HDL-C ratio, and LDL-C, respectively. The predictive model achieved 90.2% accuracy with an area under the receiver operating characteristic (ROC) curve (AUROC) of 0.927. Conclusion:Monitoring lipid parameters and managing insulin resistance are crucial for enhancing breast cancer prognosis and potentially reducing progression.
The reliability of laboratory tests is ensured in particular by the interaction of regulated market access and certification of diagnostics, scientific evidence through guidelines, the guideline of the German Medical Association on quality assurance of laboratory medical examinations mentioned in § 9 of the German Medizinproduktebetreiberverordnung, as well as standardisation and accreditation. The Webinar 2024 of the Association of Scientific Medical Societies in Germany's (AWMF) Ad-hoc Commission on In-vitro Diagnostics on 9 October 2024 highlighted this thematic network in four presentations from the perspective of the Federal Ministry of Health, the AWMF Institute for Medical Knowledge Management (IMWi), the German Accreditation Body (DAkkS) and the German Medical Association.
Postgraduate training varies significantly both between countries and among medical specialties within a nation, due to differences in medical education and health care systems. We aim to provide detailed information about postgraduate training in general practice. This narrative review is based on a selective literature review, supplemented by legal texts and information from official institutions. Postgraduate training is strongly influenced by Germany’s federal governmental structure, funding regulations and lack of structured programmes attached to academic bodies. This system allows for freedom in career choice, and the organisation of education and training after medical school. However, it presents significant challenges for workforce planning. Additionally, it places a heavy organisational burden on the individual trainee, who is responsible for organising their own rotations and ensuring that all necessary skills are acquired during training. In response to an increasing shortage in general practitioners, recent years have seen new developments such as the establishment of competence centres and coordination offices. Nevertheless, further improvements are necessary to guarantee up-to-date training, so that future general practitioners can meet the growing challenges of medical care.
Objective: The study aims to identify critical predictors of mortality and evaluate the performance of different artificial intelligence (AI) models among patients with colorectal cancer (CRC). Furthermore, the study also sought to enhance our comprehension of survival outcomes by identifying key predictors and evaluating the accuracy of AI-driven prediction methods for patients with CRC. Methods: The study employed a retrospective-predictive design, using data from the electronic health records of patients with colorectal cancer (CRC) admitted between 2016 and 2023. Among the eight AI models created by the SPSS Modeler version 18.0, the Bayesian network model was the most effective of the eight models in this study. Results: The researchers identified the most relevant variables associated with mortality among patients with CRC through data visualization. The study analysed 1,159 colorectal cancer patients, with 45.7% living up to six years and 54.3% living between seven and 16 years post-diagnosis. The Bayesian network AI model identified stage, age, recurrence, sex, marital status, and smoking status as key predictors. Conclusion: This study model’s structure emphasizes these predictors’ interconnectedness because parent nodes directly connect to child nodes. The model shows how age, smoking status, marital status, cancer stage, and recurrence affect patient survival. The model clarifies these variables’ interactions.
The explantation of medical devices is a common procedure. However, the legal regulations and the resulting obligations of treating physicians and institutions regarding the handling of explanted medical devices are not always well known. The present recommendations aim to summarize the essential legal and practical aspects involved in the process following the explantation of medical devices.
