Deutsches Arzteblatt international最新文献

{"title":"Inflammatory Skin Diseases: The Importance of Immunological Signatures.","authors":"Natalie Garzorz-Stark, Stephan Weidinger, Michael Sticherling, Kamran Ghoreschi, Alexander Enk, Kilian Eyerich","doi":"10.3238/arztebl.m2025.0045","DOIUrl":"https://doi.org/10.3238/arztebl.m2025.0045","url":null,"abstract":"<p><strong>Background: </strong>The understanding and classification of inflammatory skin diseases is shifting from a historical-descriptive perspective to a molecular-pathophysiological one based on immune response patterns. These are derived from a few key immunological mediators, each of which induces its own characteristic clinical, histopathological, and molecular patterns in the skin.</p><p><strong>Methods: </strong>This discussion of the definition of the immune response patterns of inflammatory skin diseases is based on information from pertinent publications retrieved by a selective literature search. A systematic literature search was also conducted on the response of inflammatory skin diseases to treatment with specific biologic agents.</p><p><strong>Results: </strong>The described immune response patterns are: autoinflammation; type 1, cytotoxic; type 2a, eczematous; type 2b, blistering; type 3, psoriasiform; type 4a, fibrosing; and type 4b, granulomatous. Each signature can usually be treated in a targeted manner. In general, each therapeutic target structure is associated with an adequate treatment response if and only if the skin disease under treatment has the relevant signature type. Hardly any biomarkers are currently available for the determination of immune response patterns in routine clinical practice.</p><p><strong>Conclusion: </strong>The classification of inflammatory skin diseases by their immune response patterns opens up the prospect of specifically targeted immunotherapy for each immune response pattern regardless of the historical-descriptive disease entity. Targeting is intended to improve response rates. Initial findings suggest that this strategy is likely to succeed.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973694","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}

{"title":"The Effectiveness of a Physician-Led Web Portal on Back Pain: A Cluster Randomized Controlled Trial.","authors":"Christian Schlett, Piet van der Keylen, Andrea C Schöpf-Lazzarino, Nicole Röttele, Mirjam Körner, Andy Maun, Joerg J Meerpohl, Lukas M Horstmeier, Klaus Kaier, Erik Farin-Glattacker, Sebastian Voigt-Radloff","doi":"10.3238/arztebl.m2025.0015","DOIUrl":"10.3238/arztebl.m2025.0015","url":null,"abstract":"<p><strong>Background: </strong>It is important for patients with back pain to be well-informed. The well-informed patient is better prepared for selfmanagement and for joint decision-making with the physician. This is why we developed tala-med, a web portal providing up-to-date, evidence-based, independent information on back pain. Primary care physicians can use it in their practices and make it accessible to their patients.</p><p><strong>Methods: </strong>A cluster randomized controlled trial (registration number DRKS00014279) was carried out in which the primary care physicians (PCPs) in the intervention group (IG: 33 physicians) were directed to use the tala-med web portal in their consultations with patients who had back pain (180 patients). The PCPs in the control group (CG: 12 physicians) were not given access to talamed and treated their patients with back pain (136 patients) as they had done before. The patients' informedness about back pain was the primary endpoint: it was assessed by the patients themselves in terms of their subjective degree of knowledge and subjective state of informedness about back pain. Pain intensity, the second endpoint, was assessed with a visual analog scale.</p><p><strong>Results: </strong>Intention-to-treat analyses revealed that the patients' subjective degree of knowledge about back pain increased to a greater extent in the intervention group than in the control group (B = 0.25, 95% confidence interval [0.07; 0.43]), as did their subjective state of informedness about back pain (B = 0.51 [0.13; 0.89]). Patients in the intervention group also reported a larger reduction of pain intensity compared to patients in the control group (B = -10.46 [-18.52; -2.38]).</p><p><strong>Conclusion: </strong>Use of the tala-med web portal by primary care physicians and their patients made patients better informed about back pain and lessened the intensity of their pain. These improvements, although statistically significant, were not large enough to be clinically important.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"203-209"},"PeriodicalIF":6.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729300","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}

{"title":"New Bladder Preservation Strategies in Urothelial Carcinoma of the Bladder.","authors":"Axel Heidenreich, Dirk Böhmer, Christian Bolenz, Angelika Borkowetz, Constantin Rieger, Maria De Santis","doi":"10.3238/arztebl.m2025.0014","DOIUrl":"10.3238/arztebl.m2025.0014","url":null,"abstract":"<p><strong>Background: </strong>17 500 persons receive a new diagnosis of urothelial carcinoma of the bladder in Germany each year. Radical cystectomy is performed for muscle-invasive and for non-muscle-invasive, recurrent, high-risk tumors. Because this procedure carries a perioperative complication rate of 30-40% and impairs the patients' quality of life, options have been developed for intravesical and systemic bladder-preserving treatment.</p><p><strong>Methods: </strong>This review is based on pertinent publications (up to July 2024) on bladder-preserving treatment methods that were retrieved by a selective search in the PubMed, Web of Science, and Cochrane Library databases.</p><p><strong>Results: </strong>Multiple clinical phase II-III trials and observational studies are available. Carefully selected patients with recurrent, non-muscle-invasive, high-risk urothelial carcinoma received bladder-preserving treatment of the following kinds: intravesical chemotherapy with or without hyperthermia (52-65% progressionfree at 2-3 years); drug-coated carrier systems (complete remission, 50-83%); viral gene therapy (complete remission, 53%); systemic immunotherapy with checkpoint inhibitors (19-44% recurrence-free at 1 year). The rate of bladder preservation was 49-100%. No worsening of overall survival was observed. Treatments for muscle-invasive urothelial carcinoma included neoadjuvant chemotherapy followed by frequent follow-up, radical transurethral tumor resection, partial cystectomy, and trimodal radiochemotherapy (TMRT). Only TMRT yielded comparable long-term oncological results to those of cystectomy, with a 74% rate of freedom from metastases and an overall survival rate of 73%. Any type of bladder-preserving treatment requires meticulous long-term urooncological follow-up, with repeated cystoscopies, bladder biopsies, urine cytologies, and multiparametric bladder MRI.</p><p><strong>Conclusion: </strong>Bladder-preserving treatments should be considered part of the therapeutic armamentarium and should be critically discussed in an interdisciplinary setting.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"211-218"},"PeriodicalIF":6.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440098","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}

{"title":"Clinical Practice Guideline: The Diagnosis and Treatment of AcuteSpinal Cord Injury.","authors":"Nora Cryns, Sandra Himmelhaus, Sophie Irrgang, Moritz Ernst, Norbert Weidner, Anke Scheel-Sailer","doi":"10.3238/arztebl.m2025.0034","DOIUrl":"10.3238/arztebl.m2025.0034","url":null,"abstract":"<p><strong>Background: </strong>In Germany, the incidence of traumatic spinal cord injury is approximately 16 per million inhabitants per year. This article aims to present evidence-based diagnostic and therapeutic measures for the first 14 days after injury to minimize neural damage, prevent complications, and preserve functioning as much as possible.</p><p><strong>Methods: </strong>After the formulation of key questions, systematic literature searches were carried out on multiple topics. The findings were evaluated for methodological quality, and recommendations were agreed upon by consensus.</p><p><strong>Results: </strong>Spinal cord injury may be due to traumatic (e.g., a fall) or non-traumatic causes (e.g., ischemia). The evidence presented here on the diagnosis and treatment of spinal cord injury is mainly based on observational studies. 15 evidence-based and 43 consensus-based recommendations were formulated. The patients' neurological course should be monitored by clinical neurological examination according to the International Standards for Neurological Classification of Spinal Cord Injury (strength of recommendation [SOR]: strong). If traumatic spinal cord injury is suspected, the patient should be transported as rapidly as possible to a tertiarycare trauma center (SOR: strong). Spine decompression surgery should be performed within 24 hours (SOR: weak). Corticosteroids should not be given in the acute phase of traumatic spinal cord injury (SOR: strong) but are indicated if the spinal cord is compressed by a tumor (SOR: strong). The mean arterial pressure should be between 70 and 90 mmHg for the first 2-3 (maximum 7) days (SOR: weak). Pharmacotherapy with heparin should be started early to prevent thromboembolism, with due attention to the risk of hemorrhagic complications (SOR: strong).</p><p><strong>Conclusion: </strong>This (S3 level) clinical practice guideline aims to standardize clinical care. Early interdisciplinary management is essential to protect at-risk neural tissue and to prevent complications, and constitutes a key prerequisite for long term neurological and functional recovery. No neuroprotective or neuroregenerative treatments are available to date.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"219-224"},"PeriodicalIF":6.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613929","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}

{"title":"Eosinophilic Esophagitis: Prevalence, Diagnosis, and Treatment in Childhood and Adulthood.","authors":"André Hoerning, Jens-Oliver Steiß, Ahmed Madisch, Jan de Laffolie","doi":"10.3238/arztebl.m2025.0042","DOIUrl":"10.3238/arztebl.m2025.0042","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis is a chronic, Th2 immune-mediated disease of the esophagus characterized by eso - phageal dysfunction and predominant eosinophilic inflammation. Its prevalence and incidence have risen in recent years and now stand at 16.1 per 100 000 persons and 1.7 per 100 000 persons per year.</p><p><strong>Methods: </strong>This review is based on selected publications retrieved by a search in PubMed, Medline, and Google Scholar for clinical trials, reviews, and guidelines that were published between 2011 and 2024 in either English or German (search term, \"eosinophilic esophagitis\").</p><p><strong>Results: </strong>Eosinophilic esophagitis markedly impairs patients' quality of life; its diagnosis is often delayed. It can be treated with an appropriately altered diet, pharmacotherapy, and/or endoscopic intervention (\"diet, drugs, dilatation\"). Elimination diets with the omission of 2, 4, or 6 food groups lead to histological remission in 43%, 60%, and 79% of patients, respectively. An entirely amino acid-based diet leads to histological remission in over 90% of patients, but can only be performed for a limited time. Topical corticosteroids lead to histological remission in 60-87% of cases, proton-pump inhibitors in 30-50%, and dupilumab (anti-IL- 4Rα/IL-13Rα1) in 60-86%. These treatments differ widely in their side-effect profiles and in the restrictions they impose in everyday life, and their use must be considered individually for each patient. Because eosinophilic esophagitis is a chronic disease, remission maintenance therapy is needed over the long term.</p><p><strong>Conclusion: </strong>Eosinophilic esophagitis was first described three decades ago. Effective treatments are available, but questions remain concerning the longterm course of the disease, remission maintenance therapy, and non-invasive markers of disease activity, among others. Delays in diagnosis should be avoided. The appropriate treatment and long-term care of the affected patients are needed to assure them an optimal quality of life.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"195-202"},"PeriodicalIF":6.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656356","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}

{"title":"The Prognosis After Cardiac Arrest: Evidence on the Short- and Long-Term Course.","authors":"Samuel K Zumbrunn, René Blatter, Benjamin Bissmann, Simon A Amacher, Raoul Sutter, Sabina Hunziker","doi":"10.3238/arztebl.m2025.0006","DOIUrl":"10.3238/arztebl.m2025.0006","url":null,"abstract":"<p><strong>Background: </strong>Each year, approximately 84 out of 100 000 individuals in Europe sustain a cardiac arrest; many die or suffer long-term neurological injury. Early prognostication can be of assistance for treatment planning and for the holding of evidencebased discussions with these patients' families to make decisions about treatment.</p><p><strong>Methods: </strong>This narrative review is based on pertinent guidelines and on publications retrieved by a selective search in Medline/ PubMed.</p><p><strong>Results: </strong>The survival rate of in-hospital cardiac arrest (IHCA) is 15-34%, that of out-of-hospital cardiac arrest (OHCA) approximately 10%. Survivors have an elevated risk of severe neurological injury: 22.9% (IHCA) and 67.7% (OHCA) go on to die in an intensive care unit of severe brain damage. Among those who are still alive one year after cardiac arrest, 83.3% have a good neurological outcome (cerebral performance category [CPC] score, 1-2), although many suffer from post-intensive care syndrome. Early prognostication is generally difficult, and an initial assessment can often only be made 72 hours or more after the event, on the basis of multimodal diagnostic testing. Risk models and biomarkers are available as aids to early prognostication but have not yet come into broad use.</p><p><strong>Conclusion: </strong>Many successfully resuscitated patients die shortly thereafter. Those who survive for one year generally have good neurological function. Early prognostication is of fundamental importance for decision-making about continuing treatment or whether resuscitation should be attempted again in the case of a second arrest. Physicians communicating with the affected patients and their families should also be mindful of the commonly associated emotional stress.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"173-179"},"PeriodicalIF":6.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457252","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}

{"title":"Time-Limited Trials in Intensive Care Medicine: A Tool for Avoiding Inappropriate Treatment.","authors":"Martin Russwurm","doi":"10.3238/arztebl.m2025.0016","DOIUrl":"10.3238/arztebl.m2025.0016","url":null,"abstract":"<p><strong>Background: </strong>Approximately 16% of patients treated in intensive care units do not outlive the treatment. Among patients in intensive care units who undergo mechanical ventilation or dialysis, only half survive longer than six months. Prognostication is unreliable in the individual case. Time-limited trials (TLT) may help prevent inappropriate treatment, particularly for older and chronically ill patients.</p><p><strong>Methods: </strong>This review is based on pertinent publications that were retrieved by a selective search in the PubMed and Scopus databases and the Google Scholar searching service.</p><p><strong>Results: </strong>19 empirical studies and 15 medical-ethical analyses on time-limited trials were identified, as well as expert opinions, guidelines, and review articles. If the prognosis of a patient in intensive care is poor or unclear, the patient or representative can agree with the treating team on a trial of predefined treatment, for a limited period of time, to attain objectifiable, individual therapeutic goals. These goals are set and assessed with the aid of scores used in intensive care medicine, along with the patient's individual values and resources. TLTs enable more accurate prognostication based on the observed effect of treatment in the individual patient, so that a joint decision can be taken on whether to provide further treatment with curative intent or to switch to palliative care. In this way, inappropriate treatment can be avoided-both over- and undertreatment. Initial findings suggest that TLT can identify patients who will not benefit from continued intensive treatment.</p><p><strong>Conclusion: </strong>TLTs are well founded in medical ethics and address a central problem in intensive care medicine, namely, the question of individual benefit. Only sparse empirical data on TLTs are available to date. TLTs should be standardized and evaluated in prospective studies to determine whether their expected benefit can truly be achieved in the complex real world of intensive care medicine.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"180-185"},"PeriodicalIF":6.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656385","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}

{"title":"Physical Activity, Genetic Susceptibility, and Risk of Colorectal Cancer in Type 2 Diabetes: A Large Population-Based Cohort Study.","authors":"Yanjun Wu, Meijun Meng, Yufeng Liu, Ruijie Zeng, Jing Feng, Qizhou Lian, Yuying Ma, Lijun Zhang, Wentao Huang, Felix W Leung, Chongyang Duan, Weihong Sha, Hao Chen","doi":"10.3238/arztebl.m2025.0013","DOIUrl":"10.3238/arztebl.m2025.0013","url":null,"abstract":"<p><strong>Background: </strong>It is crucial to identify modifiable preventive measures to mitigate the risk of colorectal cancer (CRC) among patients with type 2 diabetes (T2D), a high-risk group for CRC. We conducted a study to investigate the potential association between various levels of physical activity (PA) and the incidence of CRC, taking account of genetic susceptibility, in a T2D population cohort.</p><p><strong>Methods: </strong>The study was based on UK Biobank (UKB) data on persons diagnosed with T2D; the participants were tracked until 2022. Hazard ratios (HR) and 95% confidence intervals (95% CI) for CRC were calculated using Cox regression models.</p><p><strong>Results: </strong>The 33 733 patients with T2D were followed up for a median of 13.62 years. During this time, 551 patients were diagnosed with CRC. Compared with low PA, the multivariable adjusted HR for CRC among T2D patients was 0.81, 95% CI [0.66; 0.98] and 0.74 [0.58; 0.94] in the groups with moderate and high PA, respectively. In right colon cancer, moderate and high levels of PA were associated with 31% (HR 0.69; 95% CI [0.51; 0.93]) and 42% (HR 0.58; 95% CI [0.40: 0.85]) reductions in the risk of CRC. High PA (HR 0.54; 95% CI [0.35; 0.84] was associated with a lower risk of CRC even in patients with a high polygenic risk score (PRS). Persons with low PRS and high PA had the lowest risk of CRC.</p><p><strong>Conclusion: </strong>Our study suggests that moderate to high PA helps to reduce the risk of CRC in T2D patients and that joint consideration of PA level and PRS could provide valuable insights for personalized strategies to prevent CRC.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"186-192"},"PeriodicalIF":6.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398246","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}

{"title":"The Potential for Providing Treatment on an Outpatient Rather Than Inpatient Basis: A Nationwide Analysis of Hospital Discharge Data in Germany for the Year 2022.","authors":"Carolina Pioch, Reinhard Busse, Thomas Mansky, Ulrike Nimptsch","doi":"10.3238/arztebl.m2025.0012","DOIUrl":"10.3238/arztebl.m2025.0012","url":null,"abstract":"<p><strong>Background: </strong>In an expert analysis by the IGES Institute, it was examined which inpatient hospital treatments could also be carried out on an outpatient basis. A method of determining the feasibility of performing any particular treatment in the outpatient setting based on routine documentation was proposed in the report. A new version of the German catalogue of operations that can be per - formed on an outpatient basis and other outpatient procedures (the AOP catalogue) was issued accordingly. In addition, sector-blind (hybrid DRG) reimbursement of selected treatments was introduced, i.e., the amount of the reimbursement is now the same regardless of whether the treatment is provided on an inpatient or outpatient basis.</p><p><strong>Methods: </strong>The present analysis is based on German nationwide hospital discharge data from 2022. It was calculated how many inpatient treatments could have been carried out on an outpatient basis according to the criteria of the IGES report and the AOP catalogue, and how many cases would fall under hybrid DRGs.</p><p><strong>Results: </strong>Of 14.8 million inpatient treatment cases (excluding deliveries and neonates), 7.2% were identified that might have been provided on an outpatient basis according to both models, and a total of 17.3% and 21.8%, respectively, according to the IGES model or the AOP catalogue. The estimated number of potential hybrid DRG cases was 153 000, or 1.0%.</p><p><strong>Conclusion: </strong>Both the IGES model and the AOP catalogue identified a relevant potential for providing treatment on an outpatient rather than inpatient basis. However, the overlap between the two approaches is small. Further development of the AOP catalogue appears necessary for the more accurate identification of treatment cases that can be provided in the outpatient setting. The extent to which the new AOP catalogue and hybrid DRG remuneration can promote the provision of outpatient rather than inpatient care will need to be determined in future analyses.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"151-155"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254728","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}

{"title":"The Accuracy of Physicians' Quantitative Estimates.","authors":"Lisa Margarete Knipps, Igor Fischer, Thomas Klenzner","doi":"10.3238/arztebl.m2025.0010","DOIUrl":"10.3238/arztebl.m2025.0010","url":null,"abstract":"<p><strong>Background: </strong>Doctors often describe sizes by comparison with everyday objects, e.g., a pinhead-sized tympanic defect or a dehiscence the size of a penny. But do they really know how big a pinhead is? We used an internet-based questionnaire to study whether quantities are accurately estimated and whether comparisons with everyday objects improve accuracy.</p><p><strong>Methods: </strong>In a prospective, single-center study conducted by internet-based questionnaire, physicians estimated the size of everyday objects, such as a pea or a one-euro coin, and SI units as they appeared on a computer screen and then estimated their own accuracy of estimation.</p><p><strong>Results: </strong>On average, the sizes of everyday objects and SI units were underestimated by 15% (95% confidence interval, [-17; -13]). The physicians' self-assessment was not correlated with their actual degree of accuracy. Board-certified specialists considered themselves better estimators than others; however, no difference in accuracy was found between specialists and resident physicians. Nor did the particular specialty have any effect on the accuracy of estimation, even though the participating radiologists and neurosurgeons considered themselves especially good estimators. The frequent use of aids such as rulers in clinical practice was not associated with a better accuracy of estimation.</p><p><strong>Conclusion: </strong>Underestimates of size, such as were frequently observed in this study, can cause inaccurate descriptions and faulty decision-making in clinical practice. We therefore recommend that quantities should be measured with the appropriate instruments, and that physicians should refrain from making eyeball estimates wherever possible, regardless of their medical specialty or degree of clinical experience.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"145-150"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566301","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}