<b><i>Objectives:</i></b> We developed the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up of germ cell tumours (GCT) of the testes in adult patients. We present the guideline content in 2 separate publications. The present second part summarizes the<b><i></i></b>recommendations for the treatment of advanced disease stages and for the management of follow-up and late effects. <b><i>Materials and Methods:</i></b> An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements. <b><i>Results:</i></b> Here we present the treatment recommendations separately for patients with metastatic seminoma and non-seminomatous GCT (stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex cord/stromal tumours, the management of follow-up and toxicity, quality-of-life aspects, palliative care, and supportive therapy. <b><i>Conclusion:</i></b> Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present guideline. The guideline also comprises quality indicators for measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented in a future publication.
<b><i>Introduction:</i></b> This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic’s background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages. <b><i>Methods:</i></b> An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements. <b><i>Results:</i></b> We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma. <b><i>Conclusion:</i></b> Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.
Digitalization is the future and, simultaneously, a challenge for nursing. In addition, health literacy is increasingly associated with the use of technology. Older adults are greatly underrepresented in the use of digital technology and regarded as a vulnerable group. Consequently, training programs for technological knowledge and improving technological competencies are indispensable to promote equal opportunities and health literacy. The researchers inquire what characterizes nursing informatics as an expanding field in relation to the roles and competencies of nurses in technical appropriation processes of older adults. We conducted a scoping review based on a systematic literature search. We identified 23 relevant studies and developed a modular system to characterize the potential of nursing informatics: nursing informatics as a profession, competencies of nurses and nursing informatics, assessments, and eHealth literacy. Nursing informatics is a new field in some countries, but competence profiles and role descriptions clearly show that nurses act as educators, supporters, advocates, and mediators.
Der Einsatz von vollimmersiven VR-Lernumgebungen fördert bei Lernenden die individuellen Fähigkeiten und ihr Vorwissen. Konkrete Lerneffekte und Integrationskonzepte sind jedoch noch nicht ausreichend untersucht. Im Rahmen eines vom BMBF geförderten Forschungsprojektes soll mit diesem Beitrag deshalb der Frage nachgegangen werden: Welche didaktisch-gestalterischen sowie kommunikativ-interaktiven Unterschiede zeigen vollimmersive virtuelle Lernumgebungen gegenüber dem Einsatz von Videokonferenzsoftware im Kontext der Gruppenarbeit? Das Ziel ist es, den Einsatz von Multiplayer-VR-Szenarien der Nutzung von Videokonferenztools für Gruppenarbeitsprozesse im Rahmen der Fallarbeit gegenüberzustellen und deren Vor- und Nachteile aufzuzeigen. Die Ergebnisse zeigen, dass sich für Gruppenarbeitsprozesse in beiden Formaten Vor- und Nachteile finden lassen. Die Umsetzung des Konzeptes der Fallarbeit fällt jedoch in beiden Formaten positiv aus. Folglich ist der Erfolg einer Gruppenarbeit von der konzeptionellen Einbindung der Methode in den Lehrkontext abhängig, sodass die Form der Umsetzung vorwiegend Einfluss auf die Performanz nimmt. Zukünftig gilt es, konkrete Implementierungskonzepte für den Einsatz von VR-Anwendungen in der Lehre zu entwickeln und zu erproben.
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