Deutsches Arzteblatt international最新文献

{"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}

{"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}

{"title":"Whole-Body Pain in a Case of a Phosphaturic Tumor.","authors":"Konstantinos Anagnostakos, Ismail Sahan, Winfried Häuser","doi":"10.3238/arztebl.m2024.0149","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0149","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":"143406389","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 Epidemiology and Diagnosis of Measles—Special Aspects Relating to Low Incidence.","authors":"Dorothea Matysiak-Klose, Annette Mankertz, Heidemarie Holzmann","doi":"10.3238/arztebl.m2024.0211","DOIUrl":"10.3238/arztebl.m2024.0211","url":null,"abstract":"<p><strong>Background: </strong>Measles is a highly contagious viral disease (contagion index near 100%) with a complication rate of up to 30%. The worldwide incidence for 2022 was calculated as 29 cases per million people. Measles can be eliminated if 95% of the population is either vaccinated or immune and measures are taken to limit its spread as soon as an initial suspected case is encountered. However, the worldwide immunization rate has fallen since 2020 (from 86% in 2019 to 81% in 2021).</p><p><strong>Methods: </strong>To assess the epidemiological situation and describe the state of scientific knowledge regarding laboratory tests for measles, we analyzed recent epidemiological data from the Robert-Koch Institute (RKI) and reviewed pertinent publications retrieved by a selective literature search.</p><p><strong>Results: </strong>Repeated importations of measles virus have led to a new rise in case numbers in Germany since last year. 79 cases of measles were reported to the RKI in 2023, and 475 in the first eight months of 2024. The latter figure corresponds to the pre-pandemic level. There are still immunization gaps in the population: for instance, by the age of 24 months, 93.7% of children have received their first immunization, and only 80.5% have received the second. Every suspected case must be confirmed by laboratory testing so that targeted measures can be initiated. Serology is no longer considered sufficiently reliable; a reliable diagnosis now requires a poly merase chain reaction (PCR) test. The specimen can be a throat swab or a urine sample. PCR also enables the differentiation of measles virus variants and the tracing of transmission chains.</p><p><strong>Conclusion: </strong>Reliable laboratory testing makes it possible to detect measles cases rapidly, initiate measures to slow the spread of the disease, trace infection chains, and assess the risk exposure for measles in Germany.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"875-881"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142727039","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":"Pretreatment With Unfractionated Heparin in ST-Elevation Myocardial Infarction—A Propensity Score Matching Analysis.","authors":"Sascha Macherey-Meyer, Sebastian Heyne, Max Maria Meertens, Karl Finke, Victor Mauri, Ingo Ahrens, Frank Michael Baer, Frank Eberhardt, Marc Horlitz, Jan-Malte Sinning, Axel Meissner, Benjamin Rosswinkel, Stephan Baldus, Christoph Adler, Samuel Lee","doi":"10.3238/arztebl.m2024.0212","DOIUrl":"10.3238/arztebl.m2024.0212","url":null,"abstract":"<p><strong>Background: </strong>Patients with ST-segment elevation myocardial infarction (STEMI) are often pretreated with unfractionated heparin (UFH) before a primary percutaneous coronary intervention (PPCI). UFH pretreatment is intended to lessen the thrombotic burden, but there have been conflicting study findings on its safety and efficacy. We assessed the risks and benefits of UFH pretreatment with a retrospective analysis of registry data from the STEMI network of a German metropolitan region.</p><p><strong>Methods: </strong>Data from patients with STEMI referred for PPCI from 2005 to 2020 were evaluated with an adjusted outcome analysis, including propensity score matching (PSM). The endpoints included the patency of the infarct-related artery (IRA) after PPCI, in-hospital mortality, access-site bleeding, and the peak creatine kinase (CK) level.</p><p><strong>Results: </strong>We assessed data from 4632 patients with STEMI: 4420 (95.4%) were pretreated with UFH, and 212 (4.6%) were not. After PSM of 511 vs. 187 patients, the adjusted odds ratios for the various endpoints were (pretreatment vs. no pretreatment, with 95% confidence intervals): for impaired flow of the IRA, 1.01 [0.59; 1.74]; for in-hospital mortality, 1.46 [0.88; 2.42]; and for access-site bleeding, 0.59 [0.14; 2.46]. The peak creatine kinase levels were similar in the two groups (median, 1248.0 vs. 1376.5 U/L, estimated difference -134 [-611; 341]).</p><p><strong>Conclusion: </strong>UFH pretreatment was less frequently performed in STEMI patients who had undergone cardiopulmonary resuscitation. UFH pretreatment was not associated with increased access-site bleeding, nor was it found to have significantly higher efficacy with respect to the relevant endpoints. The risks and benefits of UFH pretreatment should be weighed individually in each case, as evidence from high-quality clinical trials is lacking. Data from the existing literature suggest that no pretreatment is an option to be considered, as are certain alternative antithrombotic strategies.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"833-839"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544337","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":"Intraesophageal Malposition of a Subclavian Catheter.","authors":"Andreas Schneider, Sebastian Bergrath, Andreas Kirschniak","doi":"10.3238/arztebl.m2024.0192","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0192","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 25","pages":"839"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398434","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 Health and Medical Care of People Without Regular Health Insurance—An Exploratory Cross-Sectional Study.","authors":"Anke Dickmann, Sabrina Kastaun, Marie-Therese Schmitz, Jacqueline Warth","doi":"10.3238/arztebl.m2024.0169","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0169","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 25","pages":"851-852"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398600","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":"Incidental Pulmonary Nodules: Differential Diagnosis and Clinical Management.","authors":"Philip Baum, Kai Schlamp, Laura V Klotz, Martin E Eichhorn, Felix Herth, Hauke Winter","doi":"10.3238/arztebl.m2024.0177","DOIUrl":"10.3238/arztebl.m2024.0177","url":null,"abstract":"<p><strong>Background: </strong>According to data from the USA, the incidence of incidentally discovered pulmonary nodules is 5.8 per 100 000 person- years for women and 5.2 per 100 000 person-years for men. Their management as recommended in the pertinent guidelines can substantially improve clinical outcomes. More than 95% of all pulmonary nodules revealed by computerized tomography (CT) are benign, but many cases are not managed in conformity with the guidelines. In this article, we summarize the appropriate clinical approach and provide an overview of the pertinent diagnostic studies and when they should be performed.</p><p><strong>Methods: </strong>This review is based on relevant publications retrieved by a selective search in PubMed. The authors examined Englishlanguage recommendations issued since 2010 for the management of pulmonary nodules, supplemented by comments from the German lung cancer guideline.</p><p><strong>Results: </strong>In general, the risk that an incidentally discovered pulmonary nodule is malignant is low but rises markedly with increasing size and the presence of risk factors. When such a nodule is detected, the further recommendation, depending on size, is either for follow-up examinations with chest CT or else for an extended evaluation with positron emission tomography-CT and biopsy for histology. The diagnostic evaluation should include consideration of any earlier imaging studies that may be available as an indication of possible growth over time. Single nodules measuring less than 6 mm, in patients with few or no risk factors, do not require any follow-up. Lung cancer is diagnosed in just under 10% of patients with a nodule measuring more than 8 mm.</p><p><strong>Conclusion: </strong>The recommendations of the guidelines for the management of incidentally discovered pulmonary nodules are intended to prevent both overand undertreatment. If a tumor is suspected, further care should be provided by an interdisciplinary team.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"853-860"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307282","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 Diagnosis and Treatment of Neuropathic Pain.","authors":"Rezvan Ahmadi, Rohini Kuner, Norbert Weidner, Jens Keßler, Martin Bendszus, Sandro Manuel Krieg","doi":"10.3238/arztebl.m2024.0215","DOIUrl":"10.3238/arztebl.m2024.0215","url":null,"abstract":"<p><strong>Background: </strong>The reported prevalence of neuropathic pain in the general population in Germany is from 6.9% to 10%. There are both medical and surgical treatment options.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a selective search in PubMed, with consideration of clinical trials, meta-analyses, and guidelines.</p><p><strong>Results: </strong>Neuropathic pain is diagnosed when pain of the appropriate character is accompanied by further features such as hypesthesia/anesthesia, allodynia, or hyperalgesia. It is generally treated initially with drugs (antidepressant drugs, anticonvulsant drugs, opioids, topical agents, and others); the number needed to treat (NNT) is between 7 and 8 for gabapentin and 3.6 for amitryptiline, as estimated in meta-analyses. For nerve compression and entrapment syndromes, surgical decompression is a treatment directed against the cause of the problem, which can therefore be curative. Microvascular decompression (MVD) is often used to treat supposed compression syndromes of cranial nerves, above all classic trigeminal neuralgia; according to a meta-analysis, MVD brings about a pain-free state in 92.9% [89.1; 96.8] of patients after 5 months to 5 years of follow-up. Ablative surgical procedures are used for symptom control in patients with refractory and/or cancer-related pain. Further symptomdirected treatment options for medically intractable neuropathic pain include neuromodulatory techniques, which involve minimally invasive electrical stimulation of neural structures, and the chronic intrathecal application of drugs such as opioids and ziconotide.</p><p><strong>Conclusion: </strong>The treatment of neuropathic pain can be either cause-directed or symptom-directed, depending on its origin. Multidisciplinary collaboration can facilitate both the diagnostic evaluation and the selection of the optional modality and timing of treatment.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"825-832"},"PeriodicalIF":6.5,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544238","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}