Advances in respiratory medicine have presented a clear need for the continuous training and accreditation of health professionals, as well as of institutions providing and delivering care to respiratory patients. EBAP holds a central overarching position across Europe and overseas as an independent accreditor of training centres and educational activities with transferable and recognised CME/CPD points across countries https://bit.ly/3uZb5WT

Demografischer Wandel, rascher medizinischer Fortschritt, zunehmende Prozesse der Ökonomisierung und Digitalisierung im Gesundheitswesen sowie die Veränderung gesellschaftlicher Normen in Bezug auf die Arbeitsplatzgestaltung und das Verhältnis von Beruf und Familie bzw. Freizeit wirken sich in unterschiedlicher Weise auf die Arbeits- und Weiterbildungsbedingungen des ärztlichen Nachwuchses aus. Dem Wesen nach ist „der ärztliche Beruf (...) kein Gewerbe; er ist (...) ein freier Beruf“ [1]. Diese Definition lässt sich im zweiten Satz der Bundesärzteordnung nachlesen, in der durch den Bundesgesetzgeber der rechtliche Rahmen für die Ausübung des Arztberufs geregelt wird. Als freier Beruf verwaltet sich die Ärzteschaft selbst. Nach abgeschlossener ärztlicher Ausbildung, für die die medizinischen Fakultäten verantwortlich sind, wird die ärztliche Weiterbildung in der jeweils angestrebten Fachdisziplin durch die Weiterbildungsordnung (WBO) der zuständigen Landesärztekammern geregelt und findet zumindest in den ersten Berufsjahren überwiegend noch im Krankenhaus statt. Van den Bussche et al. [2] beschreiben 2018 grundlegende konzeptionelle Probleme, die aus einer scharfen Trennung von Aus- und Weiterbildung resultieren und sich im Wesentlichen in einem „Learning by doing“ oder „Training on the job“ zeigen. Noch zu Beginn des 20. Jahrhunderts galt die ärztliche Qualifizierung mit Erlangen der Approbation als abgeschlossen. Über die Jahrzehnte hat sich das medizinische Wissen und erforderliche Können immens vermehrt und damit zu einer immer stärkeren Spezialisierung geführt mit der Folge, dass eine adäquate Patientenversorgung ohne entsprechenden Facharztstandard nicht mehr garantiert werden kann. Vor dem Gesetz ist der Facharzt aber kein besonderer Beruf im Sinne der Artikels 12 des Grundgesetzes, sondern wird weiterhin als eine besondere Form der Berufsausübung gesehen. Dies hat Konsequenzen für die eher lose und „theorieferne“ Ausgestaltung der Weiterbildung. Häufig wird ein Mangel an Struktur und Schwierigkeiten bezüglich der Umsetzung der Weiterbildungsinhalte sowohl auf der Seite der in Weiterbildung befindlichen Ärzte*innen als auch auf der Seite der Weiterbilder*innen wahrgenommen.

Die meisten Ärzte und Pflegefachkräfte sehen die Sputumgewinnung als selbsterklärend an und überlassen sie fast regelhaft den Patienten ohne vorherige Anweisungen, wodurch häufig Fehler passieren. Diese schränken Sputumqualität und Aussagekraft der Ergebnisse stark ein. Um klinisch verwertbare Befunde zu erhalten, werden an die Sputumgewinnung und -verarbeitung im Labor hohe Anforderungen gestellt, die in dieser Übersicht näher erläutert werden sollen.

Palliative care should be part of respiratory medicine for two reasons: first, many respiratory diseases--besides thoracic tumours--need palliative care in the late stages of the disease. Second, dyspnoea is a common symptom in advanced, primary extrapulmonary diseases and the knowledge of respiratory specialists can be beneficial in the treatment of this symptom. In this paper we describe frequent symptoms of advanced pulmonary diseases and their treatment. Moreover, we focus on the structure of palliative care in Germany.

Four respiratory medicine disease categories appear in the global top 10 causes of mortality [1], resulting in 600 000 people dying from respiratory disease in Europe each year. The economic burden of respiratory diseases in Europe exceeds 380 billion euros. In a fast-developing environment, new clinical challenges have arisen for pulmonary specialists; techniques and procedures have evolved and become more complex.

n All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least 3 weaning attempts (i.e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 - 20% of patients.Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft fur Pneumologie und Beatmungsmedizin e.V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care. This short version summarises recommendations on prolonged weaning from the German guideline.

Young physicians in Germany often criticize the advanced training programme, especially the lack of structure and the insufficient rotations. The Medical Association in each Bundesland/federal state require to include a proposal for advanced training and rotation in a trainer's aplication for an educational license. However, there is no systematic scrutiny of these concepts and therefore the criteria stated outcomes are often only incompletely met. Trainers engage too little in training methods and medical didactics. They rarely evaluate learning outcomes, and structured assessments based on workplace are exceptions. The reasons are deeply rooted in Germany's education system: Resources for specialist training are not provided, and there is no funding for a commitment in continued medical education. In addition, teaching is not assigned a quantifiable value. However, during the last decade awareness has arisen that good training programmes are an important part of quality assurance and the validation of a hospital. Better planning, structuring and evaluation of training programmes is necessary. New learning methods should be incorporated in training programmes. The German Respiratory Society (DGP) wishes to contribute to the improvement of advanced training: for example with "train the trainer" seminars for teachers, with a structured educational course programme for the trainees, with assessments such as the HERMES (Harmonized Education in Respiratory Medicine for European Specialists) exam and with support for the accreditation as a Respiratory Training Centre of the ERS (European Respiratory Society) and EBAP (European Board for Accreditation in Pneumology).

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Zusammenfassung Die nicht-invasive Beatmung (NIV) ist in der klinischen Medizin weit verbreitet und hat mittlerweile einen hohen Stellenwert im klinischen Alltag erlangt. Der Einsatz der NIV reduziert die Intensiv- und Krankenhausaufenthaltsdauer sowie die Mortalitat von Patienten mit akutem hyperkapnischen Atemversagen. Patienten mit akuter respiratorischer Insuffizienz im Rahmen eines Lungenodems sollten neben den notwendigen kardiologischen Interventionen mit CPAP oder NIV behandelt werden. Bei anderen Formen des akuten hypoxamischen Atemversagens wird empfohlen, den Einsatz der NIV auf lediglich mildes ARDS zu begrenzen, da eine NIV bei schweren Formen mit hoheren Raten von Therapieversagen und Mortalitat assoziiert ist. Im Weaning von invasiver Beatmung reduziert die NIV die Reintubationsraten im Wesentlichen bei hyperkapnischen Patienten. Eine verzogerte Intubation bei Auftreten eines NIV-Versagens fuhrt zu einem Anstieg der Mortalitat und sollte deshalb vermieden werden. Bei entsprechendem Monitoring auf der Intensivstation kann die NIV auch bei padiatrischen Patienten mit akuter respiratorischer Insuffizienz erfolgreich eingesetzt werden. Weiterhin kann im Rahmen der Palliativmedizin die NIV hilfreich bei der Reduktion von Dyspnoe und Verbesserung von Lebensqualitat sein. Ziel des Updates dieser Leitlinie ist es, unter Berucksichtigung der zunehmenden aktuellen wissenschaftlichen Evidenz, sowohl die Vorteile als auch die Limitationen der NIV in der Behandlung der akuten respiratorischen Insuffizienz in der taglichen klinischen Praxis und bei verschiedenen Indikationen aufzuzeigen.Abstract The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.

All mechanically ventilated patients must be weaned from the ventilator at some stage. According to an International Consensus Conference the criteria for "prolonged weaning" are fulfilled if patients fail at least 3 weaning attempts (i. e. spontaneous breathing trial, SBT) or require more than 7 days of weaning after the first SBT. This occurs in about 15 - 20 % of patients.Because of the growing number of patients requiring prolonged weaning a German guideline on prolonged weaning has been developed. It is an initiative of the German Respiratory Society (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., DGP) in cooperation with other societies (see acknowledgement) engaged in the field chaired by the Association of Scientific and Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).This guideline deals with the definition, epidemiology, weaning categories, underlying pathophysiology, therapeutic strategies, the weaning unit, transition to out-of-hospital ventilation and therapeutic recommendations for end of life care. This short version summarises recommendations on prolonged weaning from the German guideline.

Background Evidence is weak for the ability of long-term non-invasive positive pressure ventilation (NPPV) to improve survival in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). Previous prospective studies did not target a reduction in hypercapnia when adjusting ventilator settings. This study investigated the effect of long-term NPPV, targeted to markedly reduce hypercapnia, on survival in patients with advanced, stable hypercapnic COPD.Methods This investigator-initiated, prospective, multicentre, randomised, controlled clinical trial enrolled patients with stable GOLD stage IV COPD and a partial carbon dioxide pressure (PaCO2) of 7 kPa (51.9 mm Hg) or higher and pH higher than 7-35. NPPV was targeted to reduce baseline PaCO2 by at least 20% or to achieve PaCO2 values lower than 6.5 kPa (48.1 mm Hg). Patients were randomly assigned (in a 1:1 ratio) via a computer-generated randomisation sequence with a block size of four, to continue optimised standard treatment (control group) or to receive additional NPPV for at least 12 months (intervention group). The primary outcome was 1-year all-cause mortality. Analysis was by intention to treat. The intervention was unblinded, but outcome assessment was blinded to treatment assignment. This study is registered with ClinicalTrials.gov, number NCT00710541.Findings Patients were recruited from 36 respiratory units in Germany and Austria, starting on Oct 29, 2004, and terminated with a record of the vital status on July 31, 2011. 195 patients were randomly assigned to the NPPV group (n=102) or to the control group (n=93). All patients from the control group and the NPPV group were included in the primary analysis. 1-year mortality was 12% (12 of 102 patients) in the intervention group and 33% (31 of 93 patients) in the control group; hazard ratio 0.24 (95% CI 0.11-0.49; p=0.0004). 14 (14%) patients reported facial skin rash, which could be managed by changing the type of the mask. No other intervention-related adverse events were reported.Interpretation The addition of long-term NPPV to standard treatment improves survival of patients with hypercapnic, stable COPD when NPPV is targeted to greatly reduce hypercapnia.

OBJECTIVE:The aim of this trial was to assess the acceptance of a telemonitoring device (Health Buddy®) by patients with chronic obstructive pulmonary disease (COPD). The device makes it possible to monitor vital parameters and to ask questions about symptoms, behavior and disease-specific knowledge. METHOD:A single-arm non-randomized clinical study was performed for three months in 43 patients with severe/very severe COPD. The primary intent was to determine the patients' compliance with the device. In addition the patients were questioned about their general acceptance of the telemonitoring intervention, their quality of life and the overall use of resources. RESULTS:36 patients (25 men, 11 women, mean age 67,9 ± 6,9; range 54 - 81 years) completed the protocol. All 43 patients were using the device (Health Buddy®) on two thirds of all possible working days (this had been predefined as full compliance). Especially the questions on technical functioning of the device, trust in the technique and data security, as well as the confidentiality of communication with the physician via telemedicine were very positively answered. Health-related quality of life did not change and no rise of autonomy was noted. However, the objective of early detecting of acute exacerbations by daily measurements of vital parameters and assessment of symptoms was difficult to achieve because of inadequate definition of the parameters. CONCLUSION:This cohort of patients with advanced COPD was highly compliant in the use of the telemonitoring device. But clinical efficacy and economic effectiveness remain to be investigated.