Deutsches Arzteblatt international最新文献

{"title":"Out-of-Hospital Intensive Care and Mechanical Ventilation after Sepsis: A Population-Based Study of Routine Health Insurance Data.","authors":"Norman Rose, Antje Schwinger, Thomas Ruhnke, Antje Freytag, Sören Matzk, Mathias W Pletz, Carolin Fleischmann-Struzek","doi":"10.3238/arztebl.m2025.0205","DOIUrl":"10.3238/arztebl.m2025.0205","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 3","pages":"78-79"},"PeriodicalIF":7.1,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Intensive Care Syndrome: From Diagnosis To Treatment.","authors":"Claudia Denke, Karin Steinecke, Henning Krampe, Désirée J Boehnke, Björn Weiss, Claudia Spies","doi":"10.3238/arztebl.m2025.0145","DOIUrl":"10.3238/arztebl.m2025.0145","url":null,"abstract":"<p><strong>Background: </strong>Patients who have been treated in intensive care units (ICUs) display a multitude of physical, cognitive, and/or mental impairments that are collectively called post-intensive care syndrome (PICS). People with PICS have difficulty returning to everyday life.</p><p><strong>Methods: </strong>In this narrative review, we present epidemiologic data, risk factors, and approaches to the prevention and treatment of PICS, along with the evidence supporting them. Preliminary findings on the prevalence of PICS and the frequency of treatment for it have been obtained at the PICS outpatient clinic at the Charité-Universitätsmedizin Berlin, where patients are evaluated three months after discharge from an ICU along the three domains of PICS: physical function, cognitive performance, and mental health. These findings yield an overall picture of the everyday reality of post-ICU patient care.</p><p><strong>Results: </strong>Knowledge of the predisposing factors for PICS (sex, old age, pre-existing mental disorders) and of its precipitating factors (stressful experiences in the ICU, severity of illness, delirium), which may change over the course of treatment, enables clinicians to identify patients at risk of PICS and to pursue preventive strategies while they are still being treated in the ICU. Specialized aftercare consists of a wide variety of multidisciplinary treatments whose efficacy remains to be conclusively demonstrated. These include guidance by a physician, patient education, physiotherapy, psychosocial care, and self-help groups. According to the initial findings of the PICS outpatient clinic at the Charité, Campus Virchow Klinikum, 72% (298/417) of patients suffer from impairment in at least one PICS domain three months after discharge from an ICU. The analysis of treatment frequency revealed that half of all patients visited the PICS outpatient clinic in addition to their family physician's practice in at least two three-month periods after their ICU discharge.</p><p><strong>Conclusion: </strong>The specialized, multiprofessional care of patients who have been discharged from an ICU, and of their family members, requires an understanding of the complex pertinent risk factors and courses of illness. It would be desirable for cross-sector care strategies to be established with better integration of rehabilitative services, specialized aftercare facilities, nursing facilities, and primary care practices.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"1-7"},"PeriodicalIF":7.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12951018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Venous Leg Ulcers in Primary Care: The Cluster-Randomized Ulcus Cruris Care Trial.","authors":"Thomas Fleischhauer, Nina Sander, Manuel Feisst, Sinclair Awounvo, Lisa Weller, Regina Poss-Doering, Gunter Laux, Attila Altiner, Uwe Müller-Bühl, Joachim Szecsenyi, Jonas D Senft","doi":"10.3238/arztebl.m2025.0207","DOIUrl":"10.3238/arztebl.m2025.0207","url":null,"abstract":"<p><strong>Background: </strong>Venous leg ulcers (VLUs) markedly restrict patients' everyday activities and impair their quality of life. Compression is the most important treatment measure but is often not consistently implemented in practice. The aim of the Ulcus Cruris Care (UCC) project was to develop a primary care approach for the systematic support of evidence-based, patient-centered treatment.</p><p><strong>Methods: </strong>UCC consists of online training for care teams, software-supported case management, and patient training. Block randomization (1:1) was performed at the level of individual primary care practices. The practices recruited patients with UCV. Each patient was followed up for 12 months. The primary endpoint was wound healing, as confirmed by two independent blinded investigators. The secondary endpoints were guideline-compliant compression, health-related quality of life (EQ-5D-5L), depression (PHQ-9), and case-related treatment costs.</p><p><strong>Results: </strong>59 patients were included. For the primary endpoint of time to wound healing, the intervention yielded a hazard ratio of 2.71 [0.66; 11.06] (p = 0.16). The odds ratio for complete wound healing was 3.60 [0.97; 13.36] (p = 0.049). Guideline-compliant compression was more common in the intervention group (72% versus 33%; p = 0.010). Depression (5.3 ± 6.1 versus 10.0 ± 6.9; p = 0.019) and outpatient treatment costs (€1457 ± 917 versus €3153 ± 1843; p = 0.016) were lower in the intervention group.</p><p><strong>Conclusion: </strong>This multicenter RCT suggests a potential benefit of the UCC intervention but does not confirm its efficacy. The UCC approach can specifically target deficits in outpatient care for chronic wounds at the primary care level.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"9-14"},"PeriodicalIF":7.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12951752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145443955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exposure of Children and Adolescents to Passive Smoking in Cars: A School Survey in 14 German Federal States.","authors":"Reiner Hanewinkel, Julia Hansen","doi":"10.3238/arztebl.m2025.0197","DOIUrl":"10.3238/arztebl.m2025.0197","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 2","pages":"61-62"},"PeriodicalIF":7.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12984980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147527627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hair Loss and Bronze Discoloration of the Skin in Lupus Erythematosus.","authors":"Payam Dibaj, Jutta Gärtner","doi":"10.3238/arztebl.m2025.0188","DOIUrl":"10.3238/arztebl.m2025.0188","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 3","pages":"77"},"PeriodicalIF":7.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric Carcinoma: Diagnosis, Staging, and Treatment.","authors":"Yvonne Huber, Susanne Unverzagt, Petra Lynen Jansen, Thomas Langer, Monika Nothacker, Markus Moehler","doi":"10.3238/arztebl.m2025.0159","DOIUrl":"10.3238/arztebl.m2025.0159","url":null,"abstract":"<p><strong>Background: </strong>Gastric carcinoma ranks tenth in incidence among all cancers in men and women in Germany. 5565 women and 9027 men received a diagnosis of gastric carcinoma in Germany in 2022.</p><p><strong>Methods: </strong>The German clinical practice guideline was comprehensively revised with the interdisciplinary participation of German specialty societies under the leadership of the German Society for Gastroenterology, Digestive and Metabolic Disorders, according to the methodological specifications of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF).</p><p><strong>Results: </strong>The new recommendations promote preventive measures in the presence of risk factors such as hereditary diseases or infection with Helicobacter pylori. Combinations of chemotherapy with immunotherapy, such as nivolumab, pembrolizumab, and tislelizumab, prolong median overall survival compared to chemotherapy alone (e.g., nivolumab plus chemotherapy, 14.4 vs. 11.1 months, HR 0.71) and markedly prolong 5-year survival to 16%. In patients with high claudin18.2 expression, the antibody zolbetuximab, combined with chemotherapy, prolongs median survival to 16.4 vs. 13.4 months (HR 0.77). For patients in good general health, further chemotherapy or biomarker-defined approved second-line (trastuzumab deruxtecan, pembolizumab) or third-line treatment (e.g., trifluridine tipirazole) and advanced molecular-pathological diagnostic testing should be offered at centers for personalized oncology in case of treatment failure. The biomarkers HER2, PD-L1, MSI, and claudin18.2 enable new targeted therapies in palliative situations with long-term improvement in outcome.</p><p><strong>Conclusion: </strong>The diagnostic evaluation of gastric carcinoma should include high-resolution video endoscopy, and its treatment should be stage-adapted and interdisciplinary. Monoclonal antibodies and immune checkpoint inhibitors are increasingly being used for palliative treatment. The new modifications to the clinical practice guideline will promote the use of uniform strategies for perioperative and palliative treatment and supportive measures.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"53-58"},"PeriodicalIF":7.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12996822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Immunotherapy in Oncology.","authors":"Ralf-Dieter Hofheinz, Sylvie Lorenzen, Martin Sebastian, Servet Bölükbas, Stefan Fichtner-Feigl, Sibylle Loibl","doi":"10.3238/arztebl.m2025.0209","DOIUrl":"10.3238/arztebl.m2025.0209","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICI) are in standard use for the treatment of many kinds of metastatic tumor. Their use before surgery to prolong event-free and overall survival (EFS, OS) has been studied in recent years.</p><p><strong>Methods: </strong>This review is based on clinically relevant studies published since 2018 on the preoperative use of ICI for four tumor entities: breast cancer, non-small cell lung cancer (NSCLC), colorectal cancer, and esophagogastric adenocarcinoma. The studies were identified by a selective search in PubMed. In addition, abstracts from international conference presentations were evaluated.</p><p><strong>Results: </strong>The approved, standard perioperative treatment of triple-negative breast cancer of stage IIa and above is with durvalumab (an ICI) combined with chemotherapy for one year. This improved the 5-year EFS by 9% (81.2% vs. 72.2%; HR = 0.65) and the overall survival rate by 5% (86.6% vs. 81.7%; HR = 0.66). In NSCLC, the addition of an ICI to preoperative chemotherapy increased 2-year EFS by approximately 11% in stage II or III (63.3% vs. 52.4%; HR = 0.68), according to the largest trial that has been published to date. The addition of durvalumab to perioperative chemotherapy for stage II or III esophagogastric adenocarcinoma increased the 2-year EFS by 8% (67% vs. 59%; HR = 0.71). Approval for this indication is expected. In colorectal carcinoma with microsatellite instability, neoadjuvant ICI therapy for 1-6 months often led to clinical and/or histological complete remission. In view of the high remission rates (50%-100%), patients with rectal carcinoma may be spared surgery and the particular risks it entails.</p><p><strong>Conclusion: </strong>For some types of tumor, neoadjuvant ICI therapy is standard and/or about to be approved. Special care must be taken in managing ICI toxicity. In view of the adverse effects and cost of ICI, it will be important to identify biomarkers for a higher likelihood of benefit.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"46-52"},"PeriodicalIF":7.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12980815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericardial Rupture Following Deceleration Trauma.","authors":"Philipp Jawny, S Raab, S Reindl","doi":"10.3238/arztebl.m2025.0101","DOIUrl":"10.3238/arztebl.m2025.0101","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 1","pages":"8"},"PeriodicalIF":7.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12951022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147527541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eagle Syndrome as a Rare Cause of Acute Pharyngeal Hemorrhage.","authors":"L Bühning, A Dietz, M Sorge","doi":"10.3238/arztebl.m2025.0176","DOIUrl":"10.3238/arztebl.m2025.0176","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"123 1","pages":"8"},"PeriodicalIF":7.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12951019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147527548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missing Values in Empirical Research: Theory and Practice. Part 39 of a Series on the Evaluation of Scientific Publications.","authors":"Edyta Schaefer, Alexander Lang, Katharina Piedboeuf-Potyka, Oliver Kuss","doi":"10.3238/arztebl.m2025.0213","DOIUrl":"10.3238/arztebl.m2025.0213","url":null,"abstract":"<p><strong>Background: </strong>Values that are missing because of drop-outs and other reasons are a major challenge in clinical and epidemiological studies. If not dealt with appropriately, missing values can impair the validity of study findings, distort effect estimates, and reduce statistical power. In this article, we present statistical methods of dealing with missing values in the assessment of scientific publications and compare their suitability for minimizing distortion and improving the precision of estimates.</p><p><strong>Methods: </strong>A variety of methods of dealing with missing values are presented and discussed on the basis of publications retrieved by a selective search, as well as examples from the authors' personal experience.</p><p><strong>Results: </strong>When reading a scientific article, one should ascertain how missing values are dealt with, what assumptions are made, and what methods are applied. The underlying mechanisms-missing completely at random [MCAR], missing at random [MAR], and missing not at random [MNAR]-determine the choice of suitable analytic methods. The exclusion of incomplete observations causes distortion except in the case of an MCAR mechanism. Simple imputation methods, such as mean or regression imputation, generally lead to an underestimate of variance, because they neglect uncertainties. In contrast, in the case of an MAR mechanism, multiple imputation yields reliable results, as it replaces missing values multiple times and thereby takes proper account of estimation uncertainties.</p><p><strong>Conclusion: </strong>Multiple imputation is an effective method to minimize distortion caused by missing values, but it requires a meticulous examination of the underlying assumptions and of the results.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"71-76"},"PeriodicalIF":7.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13037391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}