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The Intrauterine Treatment of Open Spinal Dysraphism. 开放式脊柱发育障碍的宫内治疗。
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2025-01-24 DOI: 10.3238/arztebl.m2024.0239
Corinna Keil, Benjamin Sass, Maximilian Schulze, Siegmund Köhler, Roland Axt-Fliedner, Ivonne Bedei
{"title":"The Intrauterine Treatment of Open Spinal Dysraphism.","authors":"Corinna Keil, Benjamin Sass, Maximilian Schulze, Siegmund Köhler, Roland Axt-Fliedner, Ivonne Bedei","doi":"10.3238/arztebl.m2024.0239","DOIUrl":"10.3238/arztebl.m2024.0239","url":null,"abstract":"<p><strong>Background: </strong>Open spinal dysraphism is a congenital malformation that causes major morbidity. Its consequences include sensory and motor impairment as well as bladder- and bowel dysfunction. It is often also associated with prenatal ventriculomegaly, which, in turn, necessitates postnatal treatment with a ventriculoperitoneal shunt in approximately 80% of cases. Prenatal therapy with coverage of neural tube defect can reduce the shunt rate and preserve motor function. In this review, we describe the different surgical procedures and their outcomes.</p><p><strong>Methods: </strong>This review is based on publications that were retrieved by a selective literature search in the MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane databases, employing pertinent keywords. Studies of all types (except case reports) that were published in English or German in the period 2010-2024 were included.</p><p><strong>Results: </strong>The randomized, controlled MOMS trial showed that intrauterine surgery for defect closure resulted in less progressive neural tissue damage than postnatal surgery and reduced the need for shunting by approximately half (40% vs. 82%). Since the publication of these results, various prenatal surgical procedures have been established, including hysterotomy-assisted, percutaneous fetoscopic, and laparotomy-assisted fetoscopic closure. The individual surgical methods yield comparable results in terms of motor function and shunt rate. A problem with these procedures is that they increase the likelihood of preterm birth, to an extent that varies from one type of procedure to another.</p><p><strong>Conclusion: </strong>Prenatal surgery improves motor function and reduces the shunt rate but long-term outcomes beyond adolescence are still lacking. Transparent and interdisciplinary counseling is essential in prenatal communication to inform parents not only about the potential benefits of this treatment, but also about its limitations and risks.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Practice Guideline: The Diagnosis and Treatment of Osteoporosis. 临床实践指南:骨质疏松症的诊断与治疗。
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2025-01-10 DOI: 10.3238/arztebl.m2024.0222
Friederike Thomasius, Andreas Kurth, Erika Baum, Michael Drey, Uwe Maus, Ralf Schmidmaier
{"title":"Clinical Practice Guideline: The Diagnosis and Treatment of Osteoporosis.","authors":"Friederike Thomasius, Andreas Kurth, Erika Baum, Michael Drey, Uwe Maus, Ralf Schmidmaier","doi":"10.3238/arztebl.m2024.0222","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0222","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis is a common disease that affects approximately 6 million people in Germany alone. Osteoporotic fractures impair the quality of life and may make independent living impossible. Recommendations on the diagnosis and treatment of osteoporosis are indispensable for the effective care of this large group of patients.</p><p><strong>Methods: </strong>For a thorough updating of the German clinical practice guideline (an evidence-based guideline with recommendations for clinical practice) on osteoporosis, a comprehensive, systematic search for relevant publications was carried out, including guidelines from other countries. The retrieved literature was assessed with standardized (Oxford) criteria, and clinically relevant key questions were answered according to the PICO scheme (\"population, intervention, comparison, outcomes\").</p><p><strong>Results: </strong>The assessment of clinical risk factors for osteoporosis is the basis of osteoporosis diagnostics, which should be carried out quickly after a fracture. If risk factors are present in a postmenopausal woman or a man aged 50 or above, bone densitometry testing with dual-energy x-ray absorptiometry (DXA) is recommended. The further diagnostic evaluation should proceed in stepwise fashion depending on the clinical symptoms, the fracture status, and the degree of bone density reduction. Pharmacotherapy should be adapted to the fracture risk. Osteoanabolic treatment is recommended with high priority if the patient is judged to have a very high risk of fracture (10% or more in the next three years). The further course and duration of treatment should be determined individually, depending on the evolution of the patient's clinical state.</p><p><strong>Conclusion: </strong>Prerequisites for the optimal treatment of patients with osteoporosis include a correct diagnosis and interdisciplinary and interprofessional collaboration to determine and provide the proper treatment. 71% of persons with osteoporosis in Germany are still untreated, and this gap must be closed.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
"Rice-Body" Arthritis Due to Periprosthetic Infection 2 Years After Hip Replacement Surgery.
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0227
Ines Severloh, Wilfried Ehlers-Henning, Ann-Kathrin Oehus
{"title":"\"Rice-Body\" Arthritis Due to Periprosthetic Infection 2 Years After Hip Replacement Surgery.","authors":"Ines Severloh, Wilfried Ehlers-Henning, Ann-Kathrin Oehus","doi":"10.3238/arztebl.m2024.0227","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0227","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 26","pages":"890"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psilocybin as a Disease-Modifying Drug—A Salutogenic Approach in Psychiatry. 裸盖菇素作为一种疾病改善药物——精神病学的有益健康途径。
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0224
Moritz Spangemacher, Lea J Mertens, Luca V Färber, Andrea Jungaberle, Henrik Jungaberle, Gerhard Gründer
{"title":"Psilocybin as a Disease-Modifying Drug—A Salutogenic Approach in Psychiatry.","authors":"Moritz Spangemacher, Lea J Mertens, Luca V Färber, Andrea Jungaberle, Henrik Jungaberle, Gerhard Gründer","doi":"10.3238/arztebl.m2024.0224","DOIUrl":"10.3238/arztebl.m2024.0224","url":null,"abstract":"<p><strong>Background: </strong>Treatment with so-called psychedelic drugs, including psilocybin, lysergic acid diethylamide (LSD), and others, is among the most promising recent developments in psychiatry. This review focuses on psilocybin, a substance found in all mushrooms of the genus Psilocybe, because the largest amount of available evidence relates to this drug.</p><p><strong>Methods: </strong>This review is based on pertinent publications (since 1969) that were retrieved by a selective search carried out in August 2024 in the PubMed and ScienceDirect databases employing the keywords \"psilocybin\" AND \"long-term effects\" AND \"mental disorders\", with an emphasis on randomized, controlled clinical trials (RCTs).</p><p><strong>Results: </strong>The available RCTs document the efficacy of psilocybin mainly against depression, including otherwise medically refratory depression. Most of the trials revealed a strong effect, with Cohen's d ranging from 0.67 to 2.6; they used a variety of depression scales and follow-up intervals. Evidence was also found for the efficacy of psilocybin against substance use disorders (alcohol in particular) and symptoms of anxiety accompanying life-threatening somatic illnesses, such as cancer. Initial uncontrolled studies have also shown significant improvement after the administration of psilocybin for other indications.</p><p><strong>Conclusion: </strong>Treatment with psilocybin differs fundamentally from classic psychopharmacotherapy. Its potentially transdiagnostic, rapid, and sustainable efficacy and its positive effect on further dimensions of mental health beyond the patient's symptoms and psychopathology imply that it may have diseasemodifying and salutogenic mechanisms of action. Psychotherapy accompanied by the administration of psychedelic drugs may turn out to be the first disease-modifying treatment in the history of psychiatry.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"868-874"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Performance of Artificial Intelligence on a National Medical Licensing Examination—The Answers of Large Language Models to Text Questions.
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0231
Mark Enrik Geissler, Merle Goeben, Kira A Glasmacher, Jean-Paul Bereuter, Rona Berit Geissler, Isabella C Wiest, Fiona R Kolbinger, Jakob Nikolas Kather
{"title":"The Performance of Artificial Intelligence on a National Medical Licensing Examination—The Answers of Large Language Models to Text Questions.","authors":"Mark Enrik Geissler, Merle Goeben, Kira A Glasmacher, Jean-Paul Bereuter, Rona Berit Geissler, Isabella C Wiest, Fiona R Kolbinger, Jakob Nikolas Kather","doi":"10.3238/arztebl.m2024.0231","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0231","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 26","pages":"888-889"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Shoulder Arthroplasty—An Analysis of Data From the German Federal Statistical Office, 2010–2021.
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0154
Matthias Aurich, Daniel P Berthold, Jan Theopold, Bernd Bittersohl, Milad Farkhondeh Fal, Felix Krane, Jörn Kircher
{"title":"Shoulder Arthroplasty—An Analysis of Data From the German Federal Statistical Office, 2010–2021.","authors":"Matthias Aurich, Daniel P Berthold, Jan Theopold, Bernd Bittersohl, Milad Farkhondeh Fal, Felix Krane, Jörn Kircher","doi":"10.3238/arztebl.m2024.0154","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0154","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 26","pages":"882-883"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Partial Pressure of Oxygen Under Long-Term Oxygen Therapy With Various Types of Face Masks.
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0153
Arno Mohr, Maria M Mercado, Nina M Sicker, Stefanie Zahn, Michael Pfeifer, Maximilian V Malfertheiner, Bernd Salzberger, Florian Hitzenbichler, Florian Geismann
{"title":"The Partial Pressure of Oxygen Under Long-Term Oxygen Therapy With Various Types of Face Masks.","authors":"Arno Mohr, Maria M Mercado, Nina M Sicker, Stefanie Zahn, Michael Pfeifer, Maximilian V Malfertheiner, Bernd Salzberger, Florian Hitzenbichler, Florian Geismann","doi":"10.3238/arztebl.m2024.0153","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0153","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 26","pages":"884-885"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Heidelberg Decision Aid for Patients With Lung Cancer (HELP)—Findings of a Randomized Controlled Trial. 肺癌患者的海德堡决策辅助(HELP) -一项随机对照试验的发现。
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0228
Matthias Villalobos, Laura Unsöld, Nicole Deis, Rouven Behnisch, Anja Siegle, Michael Thomas
{"title":"The Heidelberg Decision Aid for Patients With Lung Cancer (HELP)—Findings of a Randomized Controlled Trial.","authors":"Matthias Villalobos, Laura Unsöld, Nicole Deis, Rouven Behnisch, Anja Siegle, Michael Thomas","doi":"10.3238/arztebl.m2024.0228","DOIUrl":"10.3238/arztebl.m2024.0228","url":null,"abstract":"<p><strong>Background: </strong>Advanced lung cancer typifies the challenges of shared decision-making in oncology. With a limited prognosis for survival, the increasingly numerous and complex treatment options must continually be weighed against issues of fragility, quality of life, and the end of life.</p><p><strong>Methods: </strong>This randomized, controlled trial, carried out on 138 patients, concerned the use of a decision aid combined with decision coaching, versus standard care. The primary endpoint was clarity of the patient's personal attitude, as assessed on the Decisional Conflict Scale. The secondary endpoints were self-efficacy, decisional conflict, perceived preparedness and participation in decision-making, and anxiety/depression. The data were analyzed with descriptive statistics and intergroup comparisons. The trial was entered into the German registry of clinical trials (DRKS00028023).</p><p><strong>Results: </strong>No statistically significant difference with regard to the primary endpoint (clarity of the patient's personal attitude concerning the decision) was found in a comparison between the intervention group and the control group (IG: median/IQR: 41.67/47.92; CG: median/IQR: 33.33/43.75; p = 0.35). The descriptive statistics revealed a high level of decisional conflict in the overall group of study participants: 57.6% had a very high level of decisional conflict, composed in particular of the dimensions of feeling inadequately informed (64.4%) and of uncertainty (58.9%). Most participants judged the intervention to be helpful in preparing them to make a decision.</p><p><strong>Conclusion: </strong>Even though the intervention was perceived as helpful preparation for decision-making, it did not bring about any improvement in the high level of decisional conflict. With the continual development of new treatments and the associated increase in prognostic uncertainty, there is an important role for individualized patient information and the training of physicians in how to deal with uncertainty.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"861-867"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Retrospective, Single-Center Analysis of the Time of Diagnosis of Congenital Cataract Requiring Surgical Treatment.
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0131
Hanna Faber, Martin S Spitzer, Vasyl Druchkiv, Frank Schüttauf, Diana Bittersohl
{"title":"A Retrospective, Single-Center Analysis of the Time of Diagnosis of Congenital Cataract Requiring Surgical Treatment.","authors":"Hanna Faber, Martin S Spitzer, Vasyl Druchkiv, Frank Schüttauf, Diana Bittersohl","doi":"10.3238/arztebl.m2024.0131","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0131","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 26","pages":"886-887"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Loss of Head Voice Function in Long-Standing Hashimoto's Thyroiditis.
IF 6.5 2区 医学
Deutsches Arzteblatt international Pub Date : 2024-12-27 DOI: 10.3238/arztebl.m2024.0202
Martin J P Kampmann, Thomas Steinmüller, Philipp P Caffier
{"title":"Loss of Head Voice Function in Long-Standing Hashimoto's Thyroiditis.","authors":"Martin J P Kampmann, Thomas Steinmüller, Philipp P Caffier","doi":"10.3238/arztebl.m2024.0202","DOIUrl":"10.3238/arztebl.m2024.0202","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 26","pages":"881"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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