Deutsches Arzteblatt international最新文献_第4页

Quality Assurance in Aneurysmal Subarachnoid Hemorrhage. 动脉瘤性蛛网膜下腔出血的质量保证。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-23 DOI: 10.3238/arztebl.m2024.0107

Joachim Berkefeld, Björn Misselwitz, Marco Stein

引用次数: 0

The Treatment of Metastatic Renal Cell Carcinoma. 转移性肾细胞癌的治疗。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-23 DOI: 10.3238/arztebl.m2024.0147

Philipp Ivanyi, Tabea Fröhlich, Viktor Grünwald, Stefanie Zschäbitz, Jens Bedke, Christian Doehn

{"title":"The Treatment of Metastatic Renal Cell Carcinoma.","authors":"Philipp Ivanyi, Tabea Fröhlich, Viktor Grünwald, Stefanie Zschäbitz, Jens Bedke, Christian Doehn","doi":"10.3238/arztebl.m2024.0147","DOIUrl":"10.3238/arztebl.m2024.0147","url":null,"abstract":"Background: Approximately 15 000 people receive a diagnosis of renal cell carcinoma (RCC) in Germany each year; in 20-30% of cases, metastatic RCC (mRCC) is already present at the time of diagnosis. This disease in the metastatic stage is still mainly treated palliatively, yet the multimodal therapeutic landscape has changed markedly over the past 15 years, with the approval of many new treatments for patients with mRCC.Methods: This review is based on prospective studies retrieved by a selective search in PubMed and the ASCO and ESMO databases and on the German and European oncological and urological guidelines for RCC.Results: Drugs are the mainstay of treatment. mRCC can be treated with a combination of two immune checkpoint inhibitors (CPIs), a CPI and a tyrosine-kinase inhibitor (TKI) (evidence level IA), or a TKI as monotherapy (evidence level IIC-IC). With prognosis-based sequential drug treatment, a mean progressionfree survival of 12 to 24 months and an overall survival of approximately 50 months can be achieved from the time of initiation of first-line therapy. Aside from pharmacotherapy, the multidisciplinary tumor board should evaluate the indications for local treatments such as cytoreductive nephrectomy, metastasectomy, and radiotherapy, depending on the individual prognostic constellation and the patient's present condition.Conclusion: Optimal individualized decisions require a high level of expertise and the collabo - ration of a multidisciplinary tumor board. Older prognostic parameters currently play a leading role in decision-making, while predictive parameters and molecular markers are not yet adequately validated.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"576-586"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999574","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}

引用次数: 0

Unanswered Questions Remain. 悬而未决的问题依然存在。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-23 DOI: 10.3238/arztebl.m2024.0143

Peter P Schmittenbecher

引用次数: 0

The Diagnosis and Treatment of Tricuspid Regurgitation. 三尖瓣反流的诊断和治疗。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-23 DOI: 10.3238/arztebl.m2024.0104

Thomas J Stocker, Christian Besler, Hendrik Treede, Jörg Hausleiter

{"title":"The Diagnosis and Treatment of Tricuspid Regurgitation.","authors":"Thomas J Stocker, Christian Besler, Hendrik Treede, Jörg Hausleiter","doi":"10.3238/arztebl.m2024.0104","DOIUrl":"10.3238/arztebl.m2024.0104","url":null,"abstract":"Background: It is estimated that 6% of persons over age 75 have clinically relevant tricuspid regurgitation (TR). This condition carries a high mortality and is of particular interest because of the recent development of new interventional treatments.Methods: This review is based on publications that were retrieved by a selective search in the PubMed database for randomized controlled trials (RCTs), observational studies, registry studies, expert recommendations, and current international guidelines.Results: The evidence reveals that TR is an independent cause of mortality. Mortality is correlated with the severity of TR: approximately 35% of patients with severe TR and right heart failure die within 1 year, and about 60% within 3 years. The clinical course varies depending on the etiology (primary TR, atrial/ventricular secondary TR, association with pacemaker systems). In the outpatient setting, timely diagnosis by transthoracic echocardiography is crucial. The options for pharmacotherapy are essentially limited to diuretic treatment (grade 2a recommendation). Early referral to a specialized heart valve center is essential for the prevention of irreversible damage of the right heart and secondary end-organ damage, including cardiohepatic and cardiorenal syndromes. In the heart valve center, an extended diagnostic evaluation with multimodal imaging is followed by a case discussion by the interdisciplinary cardiac team, with individual evaluation of the treatment options. The first randomized controlled trial of treatment for TR yielded a win ratio of 1.48 (95% confidence interval, [1.06; 2.13]) for interventional treatment (edge-to-edge repair) compared to optimal medical therapy.Conclusion: As the understanding of tricuspid regurgitation improves, strategies for its interventional treatment are undergoing steady development, with the aim of lowering the mortality of this condition.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"551-558"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418279","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}

引用次数: 0

Evaluation of a Digital Decision Aid for Knee Replacement Surgery. 评估膝关节置换手术的数字决策辅助工具：阶梯式楔形分组随机试验

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-23 DOI: 10.3238/arztebl.m2024.0152

Jörg Lützner, Stefanie Deckert, Franziska Beyer, Waldemar Hahn, Jürgen Malzahn, Martin Sedlmayr, Klaus-Peter Günther, Jochen Schmitt, Toni Lange

{"title":"Evaluation of a Digital Decision Aid for Knee Replacement Surgery.","authors":"Jörg Lützner, Stefanie Deckert, Franziska Beyer, Waldemar Hahn, Jürgen Malzahn, Martin Sedlmayr, Klaus-Peter Günther, Jochen Schmitt, Toni Lange","doi":"10.3238/arztebl.m2024.0152","DOIUrl":"10.3238/arztebl.m2024.0152","url":null,"abstract":"Background: We studied whether an individualized digital decision aid can improve decision-making quality for or against knee arthroplasty.Methods: An app-based decision aid (EKIT tool) was developed and studied in a stepped-wedge, cluster-randomized trial. Consecutive patients with knee osteoarthritis who were candidates for knee replacement were included in 10 centers in Germany. All subjects were asked via app on a tablet about their symptoms, prior treatments, and preferences and goals for treatment. For the subjects in the intervention group, the EKIT tool was used in the doctor-patient discussion to visualize the individual disease burden and degree of fulfillment of the indication criteria, and structured information on knee arthroplasty was provided. In the control group, the discussion was conducted without the EKIT tool in accordance with the local standard in each participating center. The primary endpoint was the quality of the patient's decision on the basis of the discussion of indications, as measured with the Hip and Knee Quality Decision Instrument (HK-DQI). (Registration number: ClinicalTrials.gov:NCT04837053).Results: 1092 patients were included, and data from 1055 patients were analyzed (616 in the intervention group and 439 in the control group). Good decision quality, as rated by the HKDQI, was achieved by 86.0% of patients in the intervention group and 67.4% of patients in the control group (relative risk, 1.24; 95 % confidence interval, [1.15; 1.33]).Conclusion: A digital decision aid significantly improved the quality of decision-making for or against knee replacement surgery. The widespread use of this instrument may have an even larger effect, as this trial was conducted mainly in hospitals with high case numbers.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"566-572"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897058","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}

引用次数: 0

VEXAS Syndrome in a Male Patient With Fever and Rash. 一名男性患者的 VEXAS 综合征，伴有发热和皮疹。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-23 DOI: 10.3238/arztebl.m2024.0043

Katharina A Kälber, Jochen Hoffmann, Norbert Blank

引用次数: 0

The Reality of Healthcare Provision. 提供医疗服务的现实情况。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-09 DOI: 10.3238/arztebl.m2024.0028

Patrik Finkenwirth

引用次数: 0

Clinical Practice Guideline: The Treatment of Peripheral Nerve Injuries. 临床实践指南：治疗周围神经损伤。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-09 DOI: 10.3238/arztebl.m2024.0071

Leila Harhaus, Nora F Dengler, Karsten Schwerdtfeger, Annette Stolle

{"title":"Clinical Practice Guideline: The Treatment of Peripheral Nerve Injuries.","authors":"Leila Harhaus, Nora F Dengler, Karsten Schwerdtfeger, Annette Stolle","doi":"10.3238/arztebl.m2024.0071","DOIUrl":"10.3238/arztebl.m2024.0071","url":null,"abstract":"Background: Nerve lesions often heal incompletely, leading to lifelong functional impairment and high costs for the health care system. The updated German clinical practice guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function.Methods: The recommendations are based on an assessment of all the evidence revealed by a systematic search of the literature, as well as on the expertise of the multiprofessional guideline group.Results: Only a few publications contain high-quality evidence. This version of the guideline contains a more detailed discussion of war injuries, iatrogenic injuries, MR neurography, and specific treatments than the previous version. As for the different methods of nerve replacement, a comparison of autologous transplantation versus the use of conduits and tubes revealed no significant difference between these two methods on the mBMRC scale, and minimal superiority of autologous transplantation with respect to two-point discrimination. As for the use of nerve transfers when nerve reconstruction is not feasible or unlikely to succeed, nerve transfer yielded slightly better results than proximal reconstruction for elbow flexion, but the difference did not reach statistical significance (mBMRC ≥ 3: RR 1.16, 95% confidence interval [1.02; 1.32]). The treatment of neuromas with targeted muscle reinnervation was superior to the classic approach in decreasing both stump pain (MD 2.0 +/- 2.8) and phantom limb pain (MD 3.4 +/- 4.03).Conclusion: The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"534-538"},"PeriodicalIF":6.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237559","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}

引用次数: 0

Severely Affected Persons Are Still Left Behind. 受严重影响的人仍然落在后面。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-09 DOI: 10.3238/arztebl.m2024.0022

Wolfgang Freund, Klaus Gehring

引用次数: 0

Target Corridor for Older People not Justified. 老年人目标走廊不成立。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-08-09 DOI: 10.3238/arztebl.m2024.0019

Armin Mainz

引用次数: 0