The 50 most-cited articles in DMW - Deutsche Medizinische Wochenschrift, 2022

Arterial hypertension affects about one third of the German population with a prevalence increasing with age up to 60 %. Globally, more than a quarter gedoppelt of the population are considered hypertensive, resulting in a total of more than one billion people. Not only due to such high prevalence, but also because of its multiple cardiovascular, renal, ocular, and cognitive complications, arterial hypertension is a leading contributor to the global burden of disease and responsible for up to 10 million deaths worldwide. Contrary to the great importance of arterial hypertension resulting from such high prevalence and immense impact on health worldwide, awareness of disease is low in affected people. Less than every second patient knows about his or her disease status and less than 40 % of patients in Europe show adequate blood pressure control with a treatment target of < 140/90 mmHg despite antihypertensive treatment. This overview of arterial hypertension, its etiology, diagnostic tools, and therapeutic options aims to improve the understanding of arterial hypertension and to…

Kidney disease represents an increasing global health problem. Its mitigation requires effective communication between all stakeholders involved in assessment, diagnosis and therapy and individuals affected by kidney disease. However, as of today the nomenclature for kidney function and kidney disease is far from uniform. In 2019, the international non-profit organization Kidney Disease: Improving Global Outcomes (KDIGO) has implemented a consensus process to develop a glossary in English language to standardize the nomenclature for kidney function, kidney structure and kidney disease. Guiding principles for this process were (1) precision, (2) patient-centeredness and (3) consistency with KDIGO guidelines. The current position paper includes a translation of this nomenclature into German that was developed on behalf of the national societies for nephrology in Germany, Austria and Switzerland.

The measurement quality of systems used for determination of glucose concentrations has to be sufficiently high to obtain measurement results that are reliable in a clinical context regarding the intended use (e. g., diabetes diagnosis and monitoring). The "Richtlinie der Bundesärztekammer zur Qualitätssicherung laboratoriumsmedizinischer Untersuchungen" (guideline of the German Medical Association on quality assurance in medical laboratory examinations) includes specifications on the internal and external quality assurance that are legally binding for glucose measurements in healthcare. In the opinion of the authors, however, there is room for improvement, and examples are provided. Systems for self-monitoring of blood glucose by patients do not fall under any legally binding requirements for quality assurance. With systems for continuous glucose monitoring, there are currently no technological means to regularly check measurement quality. Additionally, repeated manufacturer-independent evaluations, which could lead to improved measurement quality, are not available.

Missing information on patients and their medication is a leading cause of medication errors and preventable harm. The TOP Projects uses pharmacy claim data and electronic decision support to improve quality and safety of care on hospital admission. In a survey 100 % of responding hospitals in Germany consider this approach helpful and important to improve availability of necessary information and medication safety and to reduce workload.

The prevalence of post-COVID syndrome (PCS) has not yet been conclusively clarified. The existing definitions primarily reflect temporal aspects, but disregard functional deficits as well as the objectification of symptoms. This leads to diagnostic as well as therapeutic ambiguities. Pubmed was searched for systematic reviews dealing with the impact of SARS-CoV-2 infection. The underlying definitions as well as temporal inclusion criteria were extracted. 16 systematic reviews were included, 11 of which included a definition of PCS. In 58 % of the individual studies analyzed, patients with symptomatology > 12 weeks and thus according to the definition of PCS were included. CONCLUSION:: Further clarification of the definition of PCS is necessary to facilitate diagnosis and multimodal treatment and to use the scarce therapeutic resources accordingly.

Was ist neu? Mit Wirkung zum 1.1.2023 werden Ehegatten kraft Gesetzes (automatisch) zu Stellvertretern in sämtlichen „Angelegenheiten der Gesundheitssorge“, d.h. auch für Therapieentscheidungen nahe dem Lebensende. Einer vorausgehenden Bevollmächtigung ad personam durch den Patienten (soweit er noch geschäftsfähig ist, sog. „Gesundheitsvollmacht“) bedarf es dann nicht mehr. Um möglichem Missbrauch entgegenzuwirken, hat sich der Gesetzgeber jedoch zugleich darum bemüht, Sicherungsvorkehrungen zu etablieren. Insbesondere ist eine zeitliche Befristung und eine generelle Nachrangigkeit der gesetzlichen Stellvertretung gegenüber Vollmacht und gerichtlicher Betreuung vorgesehen, was die neue Vertretungsbefugnis für Ehegatten eher zu einer Maßnahme der Überbrückung in Notlagen macht. Blickt man auf den für Klinikeinrichtungen und Ärzteschaft damit verbundenen bürokratischen Aufwand, wird man allerdings am Sinn des neuen Rechts zweifeln.

Hinter „Post-COVID“ verbergen sich pathobiologisch unterschiedliche Entitäten, von Schädigungen bestimmter Organe bis hin zu neu auftretenden Autoimmun-Erkrankungen. In diesem Beitrag wird es vor allem um die Langzeitverläufe mit den Leitsymptomen Fatigue und Belastungsintoleranz gehen. Sie sind auch von anderen Infektionskrankheiten bekannt und umfassen als schwerwiegendste Entität die Systemerkrankung Myalgische Enzephalomyelitis/Chronisches Fatigue-Syndrom.

Zusammenfassung Einführung Inhalatives Rauchen ist mit erheblicher Morbidität und Mortalität sowie einer signifikanten Belastung der Gesundheitsökonomie verbunden. Der möglichst frühe Rauchstopp ist daher medizinisch und gesundheitsökonomisch von herausragender Bedeutung. Mit dem aktuellen Goldstandard der Tabakentwöhnung, einer kombinierten verhaltenstherapeutischen und medikamentösen Unterstützung, werden bevölkerungsbezogen nur unzureichend viele Raucher erreicht. Leitlinienkonforme, niederschwellige und breit verfügbare digitale Entwöhnungsangebote könnten dagegen die Zahl erfolgreicher Aufhörer signifikant steigern. Mit dem digitalen Entwöhnungsprogramm „Nichtraucherhelden“ (Online-Version und Smartphone-App) steht seit 2016 eine solche leitlinienkonforme und niederschwellige digitale Tabakentwöhnung zur Verfügung. Das Programm besteht aus 2 Vorbereitungs- und 10 Programmtagen und umfasst die Kerninhalte gängiger Tabakentwöhnungskurse. Probanden und Methodik Die vorliegende Studie untersuchte die Programmteilnehmer im Zeitraum von Dez. 2016 bis Nov. 2019 (n = 2491) retrospektiv…

Zusammenfassung Hunderttausende Menschen mit Sepsis- und Infektionsfolgen werden derzeit in Deutschland nicht optimal versorgt. Dieses White Paper stellt Maßnahmen zur Verbesserung der Versorgung vor, die von einer multidisziplinären Expertengruppe im Rahmen des Innovationsfonds-Projektes SEPFROK erarbeitet wurden. Eine optimale Versorgung beruht auf 4 Säulen: 1. der sektorenübergreifenden Erfassung der Folgen und einem strukturierten Entlass- und Überleitungsmanagement, 2. einem gezielten Angebot von interdisziplinärer Rehabilitation- und Nachsorge mit struktureller Unterstützung, 3. der Stärkung der spezifischen Gesundheitskompetenz von Betroffenen und Angehörigen und 4. der Intensivierung der Forschung zu Ursachen, Prävention und Therapie der Folgen. Hierfür müssen entsprechende sektorenübergreifende Versorgungsstrukturen und sozialrechtliche Rahmenbedingungen geschaffen werden.

INTRODUCTION: Chronic kidney failure (CKD) is as common as diabetes or coronary heart disease in a population aged 40 years and older. Although CKD increases the risk of secondary diseases or premature death, patients with CKD are often unaware of their disease. In a recent analysis of German data, unawareness CKD was higher in women than in men. METHODS: Baseline data from 2010 of 3,305 CKD patients from German cohort studies and registries were analyzed. Stage 1-4 CKD was defined by eGFR (estimated glomerular filtration rate) and albumin-creatinine ratio according to the KDIGO-guideline. Patient knowledge of CKD was coded according to self-report. The proportion of patients without knowledge of CKD and the sex-specific proportion difference (each with 95 % confidence interval) were calculated according to CKD stages and additional comorbidities (diabetes, hypertension, anemia, and cardiovascular disease). In addition, the prevalence ratio (PR) for not knowing about CKD was estimated for women compared to men crude and adjusted for age and other risk factors. RESULTS: Women were…

Elevated triglycerides and their lipidological consequences (small, dense LDL, residual particles (remnants), reduced HDL cholesterol) are an important and independent cardiovascular risk factor. Particularly in diabetes mellitus, hypertriglyceridemia is regarded as the main cause of high cardiovascular morbidity and mortality; very high triglyceride levels can cause acute pancreatitis. This article provides an overview of the current scientific status of the pathogenesis and clinical significance of hypertriglyceridemia.

Cancer has become a leading cause of death among patients with metabolic syndrome (MetS). The more components of MetS a patient has, the higher his risk of cancer. MetS is causally associated with colorectal, pancreatic, gallbladder, biliary, hepatocellular, gastric, esophageal, thyroid, breast, endometrial and renal cell cancers. MetS increases cancer mortality up to 2,4-fold. Intentional long-term weight loss reduces the excess cancer risk of obese MetS-patients. Both a low-risk lifestyle and cancer screening are effective and decrease the burden of cancer.

Was ist neu? Disease-Management-Programm für Adipositas Derzeit wird an einem strukturierten Behandlungsprogramm (DMP) für die Adipositas gearbeitet, um eine frühzeitige und leitliniengerechte Behandlung der Adipositas zu ermöglichen und die Entstehung von Folgeerkrankungen zu verhindern. Konservative Therapiestrategien zur Gewichtsreduktion Seit Januar 2022 ist Semaglutid in Deutschland zur Therapie der Adipositas bei Erwachsenen mit einem BMI von ≥ 30 kg/m2 oder ≥ 27 kg/m2 und einer gewichtsbedingten Komorbidität zugelassen. Die Gewichtsreduktion unter dieser Therapie ist teils schon mit bariatrisch-chirurgischer Intervention vergleichbar. Darüber hinaus kann unter der Therapie mit Semaglutid eine Verbesserung in Bezug auf kardiometabolische Risikofaktoren erzielt werden. Zukünftige medikamentöse Therapieoptionen Derzeit werden weitere, insbesondere Inkretin-basierte Therapien und Multiagonisten untersucht, die in der Zukunft eine effektive Behandlungsoption der Adipositas darstellen könnten. Bariatrische Therapieoptionen der Adipositas Die Anzahl der bariatrischen Operationen in…

Contagious diseases and other conditions from the field of internal medicine have always kept the world on its edge. The SARS-CoV-2 pandemic has recently reminded us of this with all its terror. If one looks for a historical equivalent, the Spanish flu impresses with as many similarities as differences. However, many of these aspects are difficult to measure by statistics. How were the waves of infections perceived socially almost 100 years ago? What significance did they have in the lives of the ordinary people? And in what light was medical world showcased? An insightful way to get to the bottom of these questions can be through the historical analysis of the mass medium of film.This paper will therefore systematically analyze the decades surrounding the Spanish Flu, known in film history as the silent era. This venture not only fills a gap in film and medical history research, where the portrayal of the main antagonist of epidemics - the internist - has been missing. Furthermore, such a study helps to put the present events in an adequate context. As a result, it becomes clear…

Lipoprotein(a) - Lp(a) - is an hepatically synthesized lipoprotein, structurally similar to low-density-lipoprotein, and an important marker for cardiovascular risk. Lp(a) plasma concentrations are genetically determined and can hardly be modified by diet, exercise or oral drugs. Lp(a) concentration should be tested at least once per life. The current treatment for high Lp(a) is early intensive risk factor management with optimal lowering of LDL-cholesterol. Potent new RNA-targeting therapies are currently assessed in clinical trials and may be available in a couple of years.

We doctors often have a detached approach to our relationship to patients: we see ourselves as healthy helpers of the sick, needy patients. But some of us are, or have been, patients, and many of us have treated colleagues who were ill. What happens when a doctor becomes seriously ill? In this paper, we describe the change of perspective that resulted from our experience with cancer, and how it has shaped our attitude toward modern medicine.

Was ist neu? Klinik und Therapie Neben den gut bekannten klinischen Symptomen der Hantavirus-Erkrankung (Fieber, Flanken- und abdominelle Schmerzen sowie Arthralgien) geraten zunehmend auch ungewöhnliche neurologische Veränderungen im Rahmen der Infektion in den Fokus. Das Spektrum reicht von passageren Myopien bis zu schweren Paresen im Rahmen eines Guillain-Barré-Syndroms. In Endemiegebieten sind Schnellteste auf IgM-Antikörper zur Ersteinschätzung eine differenzialdiagnostische Hilfe. Therapeutisch stehen weiterhin nur supportive Maßnahmen bis zur passageren Dialyse zur Verfügung. Ausbruchsregionen in Deutschland und regionale Unterscheidung der Virusstämme Durch molekulargenetische Analyse und Vergleich von Hantavirus-Stämmen aus Patienten und Mäusen desselben geografischen Gebietes konnten Viren verschiedener Ausbruchsregionen charakterisiert werden. Inzwischen sind die Puumalaviren der Haupt-Ausbruchsregionen in Deutschland molekular so gut charakterisiert, dass anhand der Nukleotidsequenz des im Patienten nachgewiesenen Virusstammes Rückschlüsse auf die Gegend möglich sind,…

Subclinical hypothyroidism is usually a laboratory diagnosis without significant symptoms and is defined by an elevated thyroid-stimulating hormone (thyrotropin, TSH) with normal thyroid hormone levels. On laboratory checks after two to three months, spontaneous normalization is found in 50 % of all cases in the sense of a transient elevation.With persistently elevated TSH levels, subclinical hypothyroidism is associated with evidence of thyroid-specific antibodies in the sense of autoimmune thyroiditis. Physiologically higher TSH levels are found in old age. It can therefore be assumed that the diagnosis of subclinical hypothyroidism is made and treated too frequently in older people over 70 years of age.Studies have so far failed to show a positive effect of substitution therapy of subclinical hypothyroidism, especially in elderly patients. On the other hand, there is a not inconsiderable risk of overtreatment with the development of subclinical hyperthyroidism. Its negative consequences in the form of atrial fibrillation and osteoporosis impair the quality and duration of life.…

Based on the recent discussion about health impacts of wind turbine noise and infrasound emissions, we present the physical facts and summarize related studies in a narrative review. We are exposed to infrasound emissions from different sources, where wind turbine farms do not cause particularly high infrasound emissions. Epidemiological studies found no association between wind turbine farms and the incidence of diabetes mellitus, heart attacks, strokes and medication with antihypertensive drugs, but a more frequent prescription of sleep medication. In contrast, key indicators of objective sleep outcomes are not impacted by wind turbine noise. Health complaints are more frequently proven, if anti-wind-turbine-groups were active, which is consistent with the psychogenic hypotheses with nocebo effects likely play an important role. Without evidence of health impacts from wind turbine farms, an ongoing slowdown in the urgently needed expansion of renewable energies is not justifiable.

Zusammenfassung Hintergrund Im Rahmen eines Lehrverbesserungsprojekts an der Goethe-Universität, Frankfurt am Main wurde das Praktikum Hygiene und Mikrobiologie für Studierende der Humanmedizin von einem Organsystem-bezogenen auf ein fallbasiertes Unterrichtsmodell umgestellt. Begleitend wurde diese Umstellung im Hinblick auf eine Verbesserung der Lernwahrnehmung und des Lernerfolgs untersucht. Methoden An dem Projekt nahmen 54 Personen teil. In homogenen Fokusgruppen wurden 45 Studierende mit bis zu fünf Personen interviewt. Neun der Teilnehmenden waren Ärztinnen oder Ärzte, die in Einzelinterviews befragt wurden. Die Interviews wurden anhand eines Leitfadens offen durchgeführt, anschließend anonym transkribiert und einer strukturierten qualitativen Inhaltsanalyse unterzogen. Ergebnis Die Ergebnisse belegen, dass sowohl Studierende als auch Ärztinnen und Ärzte im Praktikum Hygiene und Mikrobiologie eine fallbasierte Unterrichtsführung in Kombination mit dem Erwerb praktischer Kompetenzen präferieren. Studierende, die fallorientiert unterrichtet wurden, waren zufriedener und…

TREATMENT GOALS IN DIABETIC NEPHROPATHY: A new classification of patients with diabetes mellitus into so-called clusters can be used to assess the risk of developing diabetic nephropathy. Up to date treatment of patients with diabetic nephropathy includes not only glycemic control, but focuses on a holistic approach with prevention of (progression of) secondary diabetic complications and reduction of the patient's cardiovascular mortality. COMPONENTS OF TREATMENT OF DIABETIC NEPHROPATHY: To achieve this treatment goals, it requires comprehensive management of the patient to implement lifestyle interventions (regarding diet, physical activity, weight loss, smoking cessation) and selection of the medication with the greatest individual benefit. DIETARY RECOMMENDATIONS IN DIABETIC NEPHROPATHY: Part of lifestyle intervention is adherence to a dietary regimen that has again been shown in recent studies to be relevant in inhibiting progression of chronic kidney disease and reducing cardiovascular risk. In particular, this includes protein restriction with preference for plant sources of…

Endocrine disrupting chemicals (EDCs) are universally occurring substances with the potential to interrupt the hormonal system, although the definition of EDCs is not yet standardized. Similar to hormones, EDCs are potentially able to act at very low concentrations, which might be considered save from a toxicological viewpoint. Research over the past years showed that EDCs, even in low doses, might have a relevant impact on human health and the environment as well.The increase of disease burden and disability induced by EDCs causes substantial costs for society. Thus, besides the implications on personal and global health, EDCs affect the economy as well and pose a universal threat to society and environment. Many of the potentially hazardous substances are still inadequately examined and regulated.In this review, we give a brief summary on the previous efforts to classify EDCs and provide a short summary of the current knowledge.

Drug-induced cardiovascular side effects have a significant impact on morbidity and mortality. The demographic change and improved long-term survival particularly in cancer patients have caused an increasing number of affected patients, hence emphasizing the importance of the best possible treatment of such complications. This article gives an overview of classic and modern groups of substances with cardiotoxic effects and summarizes the principles of diagnostics and therapy. After characterizing the common cardiovascular side effects caused by anthracycline chemotherapy, we focus on complications caused by modern forms of immunotherapy, considering its significant impact on oncological therapy in the future due to its growing clinical application. In addition to specific cancer therapies, accompanying measures such as blood transfusions in patients with hematologic diseases can also lead to severe cardiovascular complications. In the last section, we classify important features and therapeutic approaches in cardiac involvement of transfusion-related hemochromatosis. A good…

Thalassemias are a heterogeneous group of genetic diseases based on a quantitative disorder of globin chain synthesis. They are among the most frequent monogenic hereditary diseases worldwide. Migration during recent years led to a profoundly increasing number of patients in countries where the indigenous population has not been affected. The complex treatment of the patients represents a medical and socioeconomic challenge with the need for structured interdisciplinary clinical care and close collaboration among healthcare providers, regulatory authorities, and health care insurance companies. The following article provides an overview of the causes, pathogenesis, clinical presentation, and treatment of alpha- and beta-thalassemias.

BACKGROUND: Serial murder in clinics and care homes have gained attention more than once in recent years. The strong yet quickly fading public outrage has not yet led to well-founded professional and health-political engagement with the topic. With few systematic studies conducted, knowledge about perpetrator-related and environment-related risk factors in the day-to-day context of healthcare is sparse. METHODS: Court cases of serial murder in clinics and care homes in Germany, Austria, and Switzerland that were concluded with a final verdict by February 2022 were investigated. Research materials consisted of court documents and observations made during the trials. The cases were evaluated with regard to the victims, crime scenes, methods of killing, perpetrators, and perpetrator motives. 12 serial murders involving 17 perpetrators were included in this study. RESULTS: Perpetrator-specific early warning signs included a pronounced insecurity in combination with a striving for prestige and power, which were accompanied by a loss of empathy. Reactions of the colleagues and supervisors…

Was ist neu? COVID-19 und Störungen der Wasser- und Natriumhomöostase Eine Dysnatriämie tritt bei hospitalisierten Patient*innen mit COVID-19 gehäuft auf und ist mit einer erhöhten Mortalität und vermehrt septischen Verläufen assoziiert. Insbesondere eine profunde Hyponatriämie kann auch Ausdruck für ein zugrunde liegendes Syndrom der inadäquaten AVP-Sekretion (SIADH) oder einen Cortisolmangel unter COVID-19-Infektion sein. Patient*innen mit bereits bekannten Störungen des AVP-Systems – wie dem SIADH oder Diabetes insipidus – sind einem erhöhten Risiko einer mitunter schwerwiegenden Elektrolyt-Entgleisung unter COVID-19-Infektion ausgesetzt und sollten engmaschig kontrolliert werden. Hyponatriämie unter Immun-Checkpoint-Blockade – nicht immer SIADH Der wachsende Einsatz von Immun-Checkpoint-Inhibitoren (ICI) in der Tumortherapie hat auch zu einem Zuwachs von immunvermittelten endokrinen Nebenwirkungen geführt. Diese können zeitlich sehr variabel, auch noch nach Beendigung einer ICI-Therapie, auftreten und initial eine unspezifische Klinik aufweisen. Als ein einfacher, allgemein…

INTRODUCTION: The use of antibiotics in human medicine is partly responsible for the global increase in antibiotic resistance. Significant reductions in antibiotic prescribing were realised through educational campaigns, communication training and prescribing feedback. Based on data from the cluster-randomised CHANGE-3 trial, the present analysis focuses on the question of patient expectations for an antibiotic in acute respiratory infections. METHODS: 106 of 114 General Practitioner (GP) practices in Baden-Württemberg and Mecklenburg-Western Pomerania took part in the study. 4736 patients who visited the practices with acute respiratory infections from October 2018 to May 2019 filled out a questionnaire after the doctor's consultation. The analysis was descriptive. RESULTS: 16.7 % of patients with acute respiratory infections reported receiving antibiotics from their GP. 13.3 % of patients had hoped for an antibiotic and 5.5 % stated that they had asked their GP for an antibiotic prescription. The lowest prescription rate for antibiotics was reported by patients who had received a…

Current dyslipidemia guidelines emphasize statins as the cornerstone of pharmacological lipid-lowering therapy. The cholesterol absorption inhibitor ezetimibe, PCSK9-antibodies, as well as bempedoic acid and inclisiran are newly available options to further reduce LDL-cholesterol. Since modern lipid-lowering therapy is characterized by an individual, "treat-to-target" approach the aim of this review is to provide a better understanding of cholesterol metabolism to guide decision-making and the rational for using early individualized combination therapies.

The 2021 guidelines of the European Society of Cardiology for the diagnosis and treatment of heart failure recommend the early implementation of all four mortality-lowering drug classes for heart failure with reduced ejection fraction (HFrEF), i. e. angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor II blocker-neprilysin inhibitor (ARNI), betablocker (BB), mineralocorticoid receptor-antagonists (MRA), and sodium-glucose linked transporter-2 inhibitors (SGLT2i). This article aims to give a practical compendium supporting physicians to enable safe and efficacious treatment for patients with HFrEF.

Traveling with babies and children is challenging for parents and the doctor providing travel medicine advice. Especially pediatric VFR (visiting friends and relatives) travelers have a higher risk for infectious diseases due to lower risk perception and higher exposure. Being well prepared helps in exploring the world while staying healthy. Topics to be discussed in pediatric travel consultation are travel vaccinations, mosquito repellents, malaria prophylaxis, thorough sun protection, rehydration for gastroentritis, avoidance of rabies exposure, an agetailored travel pharmacy and more. We provide a guide to the most important topics for pediatric travel consultations.

Next-generation sequencing is a modern diagnostic high-throughput method (multi-gene analysis) that can be used to better diagnose both hereditary cancers (tumor disposition syndromes, germline diagnostics) and somatic mutations in tumors. The broad usage of this technology in daily clinical practice demonstrates the real interindividual genetic variability. This method has great importance for the investigation of heterogeneous genetic diseases (e. g. tumors, neurodegenerative and neuromuscular diseases). Further indications are pharmacogenetics and non-invasive prenatal diagnosis. It can be expected that this diagnostic tool will find wide clinical application. With the rapid increase and complexity of genetic data information, the correct interpretation and transmission of the results in the human genetic counseling (germline diagnostics) is of great importance. The genetic counseling must be realigned and adapted accordingly in daily clinical practice.

Acute gastrointestinal bleeding often leads to admission to the emergency room. Especially in elderly patients and in those with significant comorbidities it is associated with increased morbidity and mortality. Approximately 2 % of the patients with gastrointestinal bleeding present with hemorrhagic shock. This review focusses on the structured preclinical and clinical management of gastrointestinal bleeding in the emergency department.

Geriatric rehabilitation is an interdisciplinary offer of rehabilitation services for elderly persons who often have several impairments and, in some cases, an already existing need for nursing care. It aims at maintaining their self-determined participation in everyday life to the greatest possible extent as well as at avoiding or reducing their needs for nursing care. Characteristic features of geriatric patients are high vulnerability due to an age-related reduction of reserves and often multiple chronic diseases. This is why the geriatric assessment and the multi-professional geriatric team present a correspondingly broad base.As a result of the vulnerability of geriatric patients, early rehabilitation that already starts during acute treatment in hospital is of great importance for their rehabilitative care. Of total German geriatric-rehabilitative care 75 % is inpatient- and 8 % day-care in hospital. These kinds of care are largely provided nationwide. Unfortunately, they often cannot make use of the entire rehabilitation potential of geriatric patients. Independent geriatric…

The positive effects of oncological exercise therapy are sufficiently proven according to scientific studies. International evidence-based guidelines confirm this importance and recommend physical exercise as part of the standard therapy for cancer. The effects of physical activity on cancer-specific deficits are versatile ranging from positive impact on fatigue syndrome, mortality, incontinence, lymphoedema, CIPN, anxiety, depression to reduction of pain. According to current knowledge, sensorimotor training is recommended for the treatment of polyneuropathy. The actual effectiveness of vibration training in reducing symptom burden is undetermined. There are more than 100 randomized, controlled studies with the highest evidence rating for the management of CrF available. In this regard, exercise therapy is more effective than drug therapy in alleviating the symptomatology of CrF. In addition to the movement-therapeutic approach, a coordinated diet is necessary to avoid nutrition shortages.The evidence on physical activity in oncology must be considered not only in theory, but also…

Prevalence and incidence of both urinary and fecal incontinence increase with age. They reduce everyday competence and quality of life in all age groups. It is often not recognized because those affected do not express their complaints, but even if the diagnosis has been made, therapy and care often remains inadequate. The aim of the article is to know types of incontinence and their treatment options for a maximum of continence according to the established continence profiles. In older, especially multimorbid frail people, urinary incontinence is not primarily to be seen as a symptom of a disease, but as a "geriatric syndrome". In the interplay of multimorbidity, environmental factors and other contextual factors that can influence each other, this must be taken into account in diagnostics and therapy. Incontinence itself leads to increased immobility, thus to falls in the elderly and to mental impairments.

Was ist neu? Grundlagen Chronischer Tinnitus ist sehr häufig mit einer Störung des Hörvermögens vergesellschaftet. Die tatsächliche Belastung durch den Tinnitus ist unterschiedlich und hängt wesentlich von psychosomatischen Komorbiditäten, aber auch von der Ausprägung der Schwerhörigkeit ab. Diagnostik Die Therapie des chronischen Tinnitus basiert auf einer fundierten HNO-ärztlichen Basisdiagnostik, einer erweiterten Diagnostik mit Erfassung psychosomatischer Komorbiditäten und anderer Begleiterkrankungen sowie einer Bewertung der Tinnitusbelastung. Therapieempfehlungen In der aktualisierten S3-Leitlinie werden als therapeutische Interventionen ein Counselling (Aufklärung und Beratung), psychotherapeutische Interventionen und hörverbessernde Maßnahmen empfohlen. Nicht empfohlene therapeutische Maßnahmen Wegen unzureichender Evidenz werden eine medikamentöse Behandlung des Tinnitus einschließlich Nahrungsergänzungsmitteln, Sound- und Musiktherapien sowie Neuromodulationen wie die transkranielle Magnetstimulation oder die elektrische Stimulation nicht empfohlen. Erstmalig wurde auf…

BACKGROUND: This study investigates current needs and psychosocial burden of out-patients with cancer during the COVID-19-Pandemic. MATERIAL AND METHODS: Between 11/2020 and 02/2021 122 cancer patients who underwent out-patient treatment at the Comprehensive Cancer Center Munich participated in the study. Based on a standardized, semi-structured interview, participants were asked about their knowledge and informational needs related to COVID-19, risk perception and concerns regarding continuing out-patient treatment, COVID-19 related distress, confidence in the national health system, and their readiness to get vaccinated against COVID-19. Additionally, patients filled out the distress thermometer (DT). RESULTS: More than a third of the patients (34,2 %, n = 41/120) wanted to receive more information about the effects of the coronavirus on their cancer and their treatment. 17,2 % (n = 21/122) had faced changes concerning their current or planned treatment. 42/121 (34,7 %) of the patients were clinically distressed (DT ≥ 5). A possible overload of the health care system was the most…

Congenital disorders of lipid metabolism are characterised by LDL-C concentrations > 190 mg/dl (4.9 mM) and/or triglycerides > 200 mg/dl (2.3 mM) in young individuals after having excluded a secondary hyperlipoproteinemia. Further characteristics of this primary hyperlipoproteinemia are elevated lipid values or premature myocardial infarctions within families or xantelasms, arcus lipoides, xanthomas and abdominal pain. This overview summarises our current knowledge of etiology and pathogenesis of primary hyperlipoproteinemia.

Approximately 50 % of chronic gastrointestinal symptoms in primary care can be attributed to functional gastrointestinal disorders (FGID). The most frequent gastrointestinal disorders are functional dyspepsia and irritable bowel syndrome. FGID are heterogenous with regards to the amount of symptoms and associated patient's impairment as well as to the underlying pathophysiological mechanisms. The biopsychosocial model of FGID assumes that biological, psychological and social factors interact in the predisposition to and in the initiation and course of FGID. The Rome Foundation defines FGID as disorders of the brain-gut interaction.Some physicians are hesitant to diagnose FGID due to the lack of specific biomarkers and/or structural changes in the gastrointestinal tract. In addition, some FGID to not respond well to conventional medications. Some patients are reluctant to accept the diagnosis of a FGID because they are afraid that a serious somatic disease has been missed and/or to be diagnosed as mentally ill.The use of interdisciplinary evidence-based guidelines for diagnosis and…

Zusammenfassung Mit dem Ende des Jahres 2020 entbrannte in Deutschland eine Diskussion darüber, inwieweit das vergangene Jahr durch Übersterblichkeit gekennzeichnet ist. Die gegenteiligen Positionen entstanden in erster Linie durch die Art und Weise der Datenverarbeitung. Um systematische Trends der letzten 2 Jahrzehnte zu bereinigen, wurden in der vorliegenden Arbeit die jährlichen Sterbezahlen für Deutschland als Differenz zu denjenigen des Jahres 2000 berechnet und aufgrund der Nichtlinearität eine polynominale Anpassung 2. Ordnung, jeweils für die Gesamtbevölkerung sowie separat für die Gruppen der unter und ab 80-Jährigen durchgeführt. Es ergaben sich für die Anpassungen hohe Bestimmtheitsmaße mit R2 = 0,965 bzw. R2 = 0,982 und R2 = 0,991. Die Residuen der einzelnen Jahre wurden als Unter- bzw. Übersterblichkeit interpretiert. Für die Gesamtbevölkerung ergaben sich Übersterblichkeiten für die Jahre 2020 und 2021 mit 11 500 bzw. 10 468 Toten, die in der Summe vollständig mit den Übersterblichkeiten der ab 80jährigen, abgedeckt ist. Bei der Altersgruppe unter 80 Jahren…

Advances in basic and clinical research have improved our understanding of the pathomechanisms underlying nephrotic syndrome caused by minimal change disease (MCD) and focal and segmental glomerulosclerosis (FSGS). These advances are reflected in the new 2021 KDIGO-Guidelines, which emphasize the clear distinction between primary, secondary and genetic causes. Proper classification is critical, as it directly affects the therapy of choice. While glucocorticoids still play a central in inducing remission in primary forms, calcineurin inhibitors, mycophenolate mofetil, cyclophosphamide and rituximab (off label) are viable adjuncts/alternatives to reduce or replace glucocorticoids in case of side effects or contraindications. Since SGLT-2-inhibitors have shown renoprotective effects in non-diabetic patients and may help to reduce proteinuria, they should be considered in all (adult) patients with chronic kidney disease, including MCD and FSGS patients. In the near future, Sparsentan, an endothelin type A and angiotensin receptor blocker may be added to the growing arsenal of…

Was Medizin ist und was sie tut, und zwar sowohl in ihrer individuellen Form der ärztlichen Tätigkeit wie in ihrer kollektiven Form als Public Health und Epidemiologie, kann nur verstanden werden, wenn die zugrunde liegende Naturvorstellung verstanden ist. Die wesentliche Unterscheidung ist jene zwischen hervorbringender und hervorgebrachter Natur, zwischen Natura naturans und Natura naturata .

Was ist neu? Morbidität und Mortalität. Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) und Diabetes mellitus stellen eine vulnerable Patientengruppe dar. Sie weisen im Vergleich zu pAVK-Patienten ohne Diabetes eine erhöhte Morbidität und eine gesteigerte Mortalität auf. Diabetes mellitus – ein relevanter Risikofaktor für Amputationen. Das Vorliegen eines Diabetes mellitus stellt bei Menschen mit einer pAVK ein erhebliches Risiko für eine Amputation dar. Die Inzidenz von Major-Amputationen bei Diabetikern ist nach einer aktuellen Studie 10-mal und von Minor-Amputationen 15-mal höher als bei Nichtdiabetikern. Eine Amputation bei Menschen mit Diabetes mellitus hat zudem einen erheblichen Einfluss auf die Morbidität und Mortalität. Optimierung der Patientenversorgung notwendig. Trotz großer Anstrengungen im Gesundheitssystem repräsentiert der Diabetes mellitus weiterhin einen bedeutenden Risikofaktor, auch bei Menschen mit pAVK. Unabhängig vom Vorliegen eines Diabetes mellitus wird eine pAVK wiederum bei betroffenen Menschen oftmals nicht erkannt oder nicht adäquat…

Was ist neu? Epidemiologie und Klinik Die im Rahmen der COVID-19-Pandemie ergriffenen Infektionsschutzmaßnahmen und Reisebeschränkungen haben auch die Übertragung saisonaler Influenzaviren stark eingeschränkt. Es muss jedoch davon ausgegangen werden, dass das Infektionsgeschehen in der kommenden Influenzasaison nach dem Wegfall dieser Maßnahmen wieder zunehmen wird. Koinfektionen von saisonalen Influenzaviren und SARS-CoV-2 sind möglich und gehen gegebenenfalls mit einem erhöhten Risiko für schwere Krankheitsverläufe einher. Influenza-Impfung Die STIKO empfiehlt seit 2021 ab einem Alter von 60 Jahren den Einsatz tetravalenter Hochdosis-Impfstoffe. Diese enthalten im Vergleich zu standarddosierten Impfstoffen die 4-fache Antigenmenge. Impfstoffe, die auf der mRNA-Technologie beruhen, sowie universelle Influenza-Impfstoffe befinden sich in klinischer Prüfung. Es besteht nun auch für Apotheker*innen die Möglichkeit, Grippeimpfungen unter bestimmten Auflagen durchzuführen. Therapie Für Patient*innen mit erhöhtem Risiko für einen schweren Verlauf wird weiterhin eine frühzeitige…

Chimeric antigen receptor T cells (CAR T cells) are genetically modified autologous or allogeneic T lymphocytes that target specific antigens and can be used to combat tumor cells. The approval studies show a high response and remission rate in heavily pretreated patients with aggressive B-cell lymphoma, acute lymphoblastic leukemia or multiple myeloma. The article presents the indications for approval, the clinical implementation and the management of side effects of CAR cell therapy.

The application of chemotherapy against malignant tumors might control the malignant disease but harbours many pitfalls. The chemotherapy type is chosen depending on the entity and stage of the tumor as well as on the patient's characteristics and fitness. Patients under therapy should be informed on the potential side effects and should be closely monitored by physicians, familiar with the common as well as the substance specific side effects of the drugs used. Preventive or timely application of supportive medication can prevent or diminish drug-induced toxicities. The attending physician has to be aware of the potential treatment-related emergency situations during application as well as several days after. One of the most common and dangerous emergencies that requires immediate medical attention is fever in neutropenia.The use of new medical drug classes, targeted molecular and immune therapies has changed and improved disease control in many tumor entities in a revolutionary manner. Overall, combination treatments including targeted drugs, immunotherapy and/or classical…

Early detection and competent treatment of sexually transmitted diseases (STDs) is essential to maintain or restore the sexual health of those affected and to prevent further transmission. In this context, counselling on Sexually transmitted infections (STI) is of particular importance, both in terms of prevention and rapid diagnosis and treatment. STI are not rare in Germany: syphilis, gonococcal and chlamydial infections even occur with increasing frequency, especially among MSM. At-risk populations (MSM, sex workers, people from high-prevalence regions, partners of STI sufferers) should be offered STI screening. If an STI is present, those affected should also be actively screened for other STIs, and furthermore partners should also be examined for STIs and treated if necessary. Syphilis and other STIs also occur with completely unspecific symptoms. Even asymptomatic infections by gonococci, chlamydia, mycoplasma, HPV, HBV, HCV and HPV can lead to serious complications and late consequences. For STI (HIV, HBV, syphilis), highly effective post-exposure prophylaxis (PEP) is…

ANAMNESE: HFrEF (heart failure with reduced ejection fraction) with a left ventricular ejection fraction of 25-30 % was detected in a 79-year-old man. For further treatment, inpatient cardiac rehabilitation war carried out. CLINICAL FINDINGS: At the start of the cardiac rehabilitation, patient complained of shortness of breath with little exertion, corresponding to NYHA III. Drug therapy included empagliflozin 10 mg, sacubitril/valsartan 24/26 mg, edoxaban 60 mg, torasemide 5 mg, verapamil 80 mg and amiodarone 200 mg. INVESTIGATIONS: The daily blood sugar profile showed hypoglycemia with values ​​< 3.7 mmol/l (< 67 mg/dl). After consultation with the patient, these occurred with normal food intake and were symptomatic in form of dizziness during the period of hypoglycaemia. DIAGNOSIS: Symptomatic hypoglycaemia on SGLT2(sodium-glucose linked transporter 2)-inhibitor therapy in a patient with HFrEF without diabetes mellitus. THERAPY AND PROGRESS: The therapy with empaglifozin was stopped and a new daily blood sugar profile was carried out, which no longer showed any hypoglycaemic…

The suspicion of acute myeloid leukemia (AML) is a haematological emergency that requires a rapid diagnostic workup. Symptoms are usually caused by cytopenias of all blood cell lines. The differentiation of acute promyelocytic leukemia (APL) is important because of the early death rate caused by thrombembolic and bleeding events. Rapid immunophenotypic and genetic characterization is necessary for risk stratification and therapy selection. For this purpose, a center with appropriate expertise should be contacted. Therapy has become more complex due to numerous new approvals. For certain patients, the established intensive induction therapy with cytarabine and anthracycline is now combined with targeted agents, like the antibody conjugate Gemtuzumab-Ozogamicin or the FLT3 inhibitor Midostaurin. Patients with secondary AML benefit from the liposomal chemotherapy combination CPX-351. Therapy with the hypomethylating agent Azacitidine and the BCL2-inhibitor Venetoclax (Aza/Ven) represents the standard for patients who are not fit for intensive therapy. Here, it is important to consider…

Was ist neu? Risikofaktoren für eine gastrointestinale Ulkusblutung Die Helicobacter-pylori-Gastritis (H. pylori-Gastritis) und die Therapie mit nicht steroidalen Antirheumatika (NSAR) sind die wichtigsten Risikofaktoren für die Entstehung eines peptischen Ulkus (PUD) und einer Ulkusblutung. Eine Infektion mit H. pylori erhöht das Risiko einer Ulkusblutung bei Patienten mit PUD, die NSAR, Aspirin oder einen anderen Plättchen-Aggregationshemmer einnehmen. H. pylori-positive Patienten unter kombinierter Plättchen-Aggregationshemmung tragen das höchste Blutungsrisiko. Evidenzbasierte interdisziplinäre Behandlungsempfehlungen zur sicheren NSAR-Anwendung aus dem Jahr 2020 berücksichtigen sowohl das kardiovaskuläre als auch das gastrointestinale Risikoprofil der einzelnen Patienten. Für Patienten mit einem moderaten Risiko für die Entstehung eines PUD wird die Therapiekombination aus NSAR und Protonen-Pumpen-Inhibitoren (PPI) oder eine Monotherapie mit selektiven COX-2-Inhibitoren (COX-2: Cyclooxygenase-2) empfohlen. Patienten mit einem hohen Blutungsrisiko dagegen sollten eine…