Deutsches Arzteblatt international最新文献

{"title":"App-Based Psychotherapy of Panic Disorder With Self-Guided Exposure in Virtual Reality—A Randomized Controlled Trial.","authors":"Josephine Schultz, Anna Baumeister, Stella Schmotz, Lea Schuurmans, Lena Jelinek","doi":"10.3238/arztebl.m2024.0246","DOIUrl":"10.3238/arztebl.m2024.0246","url":null,"abstract":"<p><strong>Background: </strong>Patients with panic disorder often suffer from tempo rary unavailability of care. The smartphone app Invirto (IVT) provides digital treatment for panic disorder comprising self-guided exposure in virtual reality. The aim of this trial was to assess the efficacy of Invirto.</p><p><strong>Methods: </strong>In a randomized, controlled, non-blinded trial, IVT was compared with care as usual (CAU) in patients with panic disorder (preregistration: DRKS00027585). The endpoints were assessed online before treatment (t0) and at 3 months (t1). The primary endpoint was the change in symptoms of anxiety, as measured with the Beck Anxiety Inventory (BAI), between the groups. The secondary endpoints were the patients' scores on the following assessment instruments, all in their German versions: the Panic and Agoraphobia Scale (PAS), the Beck Depression Inventory (BDI-II), a questionnaire on patient satisfaction (Client Satisfaction Questionnaire, CSQ-8), the Acceptance and Action Questionnaire (AAQ-II), and quality of life as a global item in the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF).</p><p><strong>Results: </strong>One hundred twenty-four participants were included. The intention-to-treat analysis revealed greater improvement with IVT than with CAU with respect to both the primary endpoint (BAI, d = -0.46; 95% confidence interval [-0.87; -0.04]) and the secondary endpoints (PAS, d = -0.63 [-1.05; -0.22]; BDI-II, d = -0.44 [-0.86; -0.02]; AAQ-II, d = -0.42 [-0.84; -0.01]), except for WHOQOL-BREF (p = 0.216).</p><p><strong>Conclusion: </strong>A digital treatment with virtual exposure can lessen anxiety, panic, and depressive symptoms and improve mental flexibility. In further studies, IVT should be compared with an active control group.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"1-6"},"PeriodicalIF":6.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767225","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 Prevalence of Lonely Deaths and Suicides in the Home—An Analysis of Death Certificates and Emergency Physician Protocols.","authors":"Burkhard Dasch, Florian Bernhardt, Hans Martin Sudhaus, Philipp Lenz","doi":"10.3238/arztebl.m2024.0157","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0157","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 1","pages":"19-20"},"PeriodicalIF":6.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514702","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 Osteoporosis.","authors":"Friederike Thomasius, Andreas Kurth, Erika Baum, Michael Drey, Uwe Maus, Ralf Schmidmaier","doi":"10.3238/arztebl.m2024.0222","DOIUrl":"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":"12-18"},"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}

{"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}