Deutsches Arzteblatt international最新文献_第5页

Pulmonary Angiothrombotic Granulomatosis. 肺血管血栓性肉芽肿病。

IF 7.1 2区医学

Deutsches Arzteblatt international Pub Date : 2025-07-11 DOI: 10.3238/arztebl.m2025.0064

Julia Krüger, Oliver Peschel, Andreas G Nerlich

引用次数: 0

Cardiovascular Arrest Due to Tension Enterothorax During Pregnancy. 妊娠期肠胸张力引起的心血管骤停。

IF 7.1 2区医学

Deutsches Arzteblatt international Pub Date : 2025-07-05 DOI: 10.3238/arztebl.m2025.0085

Alexander Buia, Michael Schütz, Annette Dürr

引用次数: 0

Prostate Cancer: Early Detection, Diagnostic Evaluation, and Individualized Treatment Decisions. 前列腺癌：早期发现、诊断评估和个体化治疗决策。

IF 7.1 2区医学

Deutsches Arzteblatt international Pub Date : 2025-07-05 DOI: 10.3238/arztebl.m2025.0112

Marc-Oliver Grimm

引用次数: 0

The Probability of Remaining Under Active Surveillance for Localized Prostate Cancer: An Analysis of Young Patients in the Framework of the Multicenter ProjuMa Registry Study. 局部前列腺癌保持积极监测的可能性：多中心ProjuMa注册研究框架下对年轻患者的分析

IF 7.1 2区医学

Deutsches Arzteblatt international Pub Date : 2025-07-05 DOI: 10.3238/arztebl.m2025.0081

Kevin Claassen, Christina Justenhoven, Silke Hermann, Jana Brandhorst, Jale Lakes, Dominique Werner, Hiltraud Kajüter, Madeleine Karpinski, Volker Arndt, Andreas Stang, Peter Albers

{"title":"The Probability of Remaining Under Active Surveillance for Localized Prostate Cancer: An Analysis of Young Patients in the Framework of the Multicenter ProjuMa Registry Study.","authors":"Kevin Claassen, Christina Justenhoven, Silke Hermann, Jana Brandhorst, Jale Lakes, Dominique Werner, Hiltraud Kajüter, Madeleine Karpinski, Volker Arndt, Andreas Stang, Peter Albers","doi":"10.3238/arztebl.m2025.0081","DOIUrl":"10.3238/arztebl.m2025.0081","url":null,"abstract":"Background: After a diagnosis of prostate cancer, the 15-year cancer-specific survival probability is high; in suitable patients, active surveillance lessens the side effects of curative treatment. Limited evidence is available on the continuation of active surveillance in young prostate cancer patients in Germany.Methods: Using data that were reported, as required by law, to the population-based cancer registries of the German federal states of North Rhine-Westphalia, Baden-Württemberg, and Rhineland- - Palatinate, we studied the course of 732 patients under 60 years of age who were under active surveillance after receiving a diagnosis of low-risk localized prostate cancer (ISUP grade 1 or 2) in the years 2016-2021.Results: The median duration of follow-up was 28 months. 64% [61%; 68%] of the patients were still under active surveillance at two years; this was true for 66% [62%; 70%] of those with ISUP grade 1 disease, 46% [37%; 58%] of those with ISUP grade 2 disease, and 72% [63%; 83%] of those for whom no Gleason grading was available. 62% of discontinuations occurred without any documented progression and without a documented patient-initiated decision.Conclusion: The two-year probability of young prostate cancer patients remaining under active surveillance was lower in Germany than in other countries. The cancer registries mostly received no information concerning the clinical rationale for the discontin uations. The potentially incomplete reporting of reasons for discontinuing active surveillance suggests that clinical reporting practices should be improved.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"401-405"},"PeriodicalIF":7.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265609","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}

引用次数: 0

The Early Detection, Diagnostic Evaluation, and Local Treatment of Prostate Cancer: A Paradigm Shift. 前列腺癌的早期发现、诊断评估和局部治疗：一种范式转变。

IF 7.1 2区医学

Deutsches Arzteblatt international Pub Date : 2025-07-05 DOI: 10.3238/arztebl.m2025.0099

Peter Albers, Tobias Franiel, Thomas Kötter, Glen Kristiansen, Ken Herrmann, Thomas Wiegel

{"title":"The Early Detection, Diagnostic Evaluation, and Local Treatment of Prostate Cancer: A Paradigm Shift.","authors":"Peter Albers, Tobias Franiel, Thomas Kötter, Glen Kristiansen, Ken Herrmann, Thomas Wiegel","doi":"10.3238/arztebl.m2025.0099","DOIUrl":"10.3238/arztebl.m2025.0099","url":null,"abstract":"Background: Approximately 75 000 men receive a diagnosis of prostate cancer in Germany each year. New data on the early detection, diagnostic evaluation, and treatment of prostate cancer provide the basis for a paradigm shift in the management of locally confined prostate cancer.Methods: This narrative review is based on the systematic literature search that was carried out for the 2025 update of the German clinical practice guideline on prostate cancer.Results: Risk-adapted early detection is now recommended. This involves the measurement of a baseline PSA value at age 45 whose magnitude determines the interval of follow-up testing: once every 5 years for baseline values below 1.5 ng/mL, and once every two years for baseline values between 1.5 and 3 ng/mL. Patients with PSA levels above 3 ng/mL should undergo a repeat PSA test and, if these levels are confirmed, receive a urological risk assessment including prostatic volume, family history, and past medical history. High risk patients should undergo magnetic resonance imaging (MRI) and, if necessary, prostate biopsy. This new PSA-MRI algorithm increases accuracy in detecting clinically significant prostate cancers, enabling the previously recommended annual testing and digital rectal examination to be avoided. Another novelty is that the indication for an active surveillance strategy for men with low-risk prostate cancer has been expanded to ISUP grade group 1 and 2 cancers with favorable risk.Conclusion: The need for high-quality diagnostic testing, including MRI, with broad geographic coverage will be a major challenge to the health care system, especially with regard to accessibility. Patients can be expected to benefit greatly from the new PSA-MRI algorithm, as it eliminates unnecessary diagnostic testing and treatment while enabling necessary treatment to be initiated earlier and therefore with fewer side effects.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"420-426"},"PeriodicalIF":7.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324709","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}

引用次数: 0

The Treatment of Older Patients with Parkinson's Disease. 老年帕金森病患者的治疗

IF 7.1 2区医学

Deutsches Arzteblatt international Pub Date : 2025-07-05 DOI: 10.3238/arztebl.m2025.0083

Marija Djukic, Elisabeth Yoshida-Stiksrud, Roland Nau

{"title":"The Treatment of Older Patients with Parkinson's Disease.","authors":"Marija Djukic, Elisabeth Yoshida-Stiksrud, Roland Nau","doi":"10.3238/arztebl.m2025.0083","DOIUrl":"10.3238/arztebl.m2025.0083","url":null,"abstract":"Background: There are approximately 150 000 persons over age 80 in Germany who suffer from Parkinson's disease. Eighty percent of patients develop dementia during the course of this disease. Older patients with Parkinson's disease often suffer from the multimorbidity typically seen in this age group. Comorbidities affect the options for treating Parkinson's disease. Older patients are markedly underrepresented in most trials of antiparkinsonian drugs.Methods: In this narrative review, we propose practical ways to simplify the treatment regimen of older patients with Parkinson's disease to lessen side effects and make treatment more manageable for these patients and the persons caring for them.Results: The mainstay of treatment is levodopa in combination with a dopa decarboxylase inhibitor, taken during the day as a standardrelease or dispersible formulation and at night in extended-release form; along with a catechol-O-methyltransferase inhibitor if neces - sary. Antiparkinsonian drugs with other mechanisms of action should be used sparingly, if at all. Treatment options for patients with severe fluctuations in efficacy and long \"off\" (akinetic) phases include a jejunal levodopa pump and the subcutaneous administration of foslevodopa. Parkinson's disease dementia should be treated with rivastigmine, a cholinergic anti-dementia drug (approved in capsule form for this indication). Otherwise intractable psychosis should be treated with quetiapine (off-label) or clozapine (evidence-based; weekly blood tests required). Other neuroleptic drugs should not be given to patients with Parkinson's disease. Physiotherapy and speech therapy are evidencebased components of therapy with proven efficacy in every stage of the disease.Conclusion: Further randomized controlled trials tailored to this patient population are needed to provide a better evidence base for the treatment of older patients with Parkinson's disease.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"412-418"},"PeriodicalIF":7.1,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215237","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}

引用次数: 0

Thyroid Nodules: Diagnosis and Treatment in Primary Care. 甲状腺结节：初级保健的诊断和治疗。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2025-06-27 DOI: 10.3238/arztebl.m2025.0067

Jeannine Schübel, Alexander Stahl, Joachim Feldkamp, Felix Werner, Til Uebel, Karen Voigt

{"title":"Thyroid Nodules: Diagnosis and Treatment in Primary Care.","authors":"Jeannine Schübel, Alexander Stahl, Joachim Feldkamp, Felix Werner, Til Uebel, Karen Voigt","doi":"10.3238/arztebl.m2025.0067","DOIUrl":"10.3238/arztebl.m2025.0067","url":null,"abstract":"Background: Thyroid nodules are very common, with a prevalence of more than 75% among persons over age 60 in Germany, yet more than 80% of them remain asymptomatic and undetected. Only a small fraction of thyroid nodules pose a relevant risk to health; these include carcinomas of the thyroid gland (prevalence 0.027%) and functionally autonomous adenomas (clinically relevant prevalence 0.34%).Methods: Systematic literature searches based on the PICO scheme or exploratory key questions were carried out during the development of an S3-level clinical practice guideline for the management of patients with thyroid nodules in primary care. The quality of the pertinent guidelines and studies was assessed with standardized instruments. Selected findings are described in this article.Results: Most thyroid nodules are discovered incidentally. Further diagnostic evaluation by the primary care physician is generally only indicated if the patient is symptomatic, has a family history of thyroid cancer, or has a low TSH (thyroid-stimulating hormone) level. Ultrasonography should be performed in targeted and standardized fashion (TIRADS classifications) and cascading diagnostic studies should be avoided. If the nodule is considered potentially malignant, the patient should be referred to a specialist. The indications for treatment include symptoms due to compression, esthetic impairment, or functionally relevant autonomous adenomas. Pharmacotherapy with the goal of shrinking the nodule(s) is now obsolete, and other measures can only be carried out after specialized referral.Conclusion: Rational, patient-centered approaches are needed in primary care so that overdiagnosis and overtreatment can be avoided and appropriate care provided as efficiently as possible. The diagnostic evaluation is focused on the meticulous selection of patients who must be referred to a specialist. For most thyroid nodules, no treatment is indicated.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"341-347"},"PeriodicalIF":6.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962508","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}

引用次数: 0

Communication on Rounds: The Role of Rounds Culture and Communication in Patient Care and Teaching. 查房交流：查房文化和交流在病人护理和教学中的作用。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2025-06-27 DOI: 10.3238/arztebl.m2025.0080

Flavio Gössi, Christoph Becker, Sebastian Gross, Armon Arpagaus, Stefano Bassetti, Sabina Hunziker

{"title":"Communication on Rounds: The Role of Rounds Culture and Communication in Patient Care and Teaching.","authors":"Flavio Gössi, Christoph Becker, Sebastian Gross, Armon Arpagaus, Stefano Bassetti, Sabina Hunziker","doi":"10.3238/arztebl.m2025.0080","DOIUrl":"10.3238/arztebl.m2025.0080","url":null,"abstract":"Background: The daily visit by the treating doctor or medical team at the bedside of the hospitalized patient («rounds») is essential for patient-centered care and interprofessional exchange.Methods: This narrative review is based on pertinent publications (up to December 2024) that were retrieved by a selective search in the PubMed/Medline database.Results: Bedside rounds are used to fulfill multiple tasks: medical, communicative, and educational. Complex social interactions, in particular, require precise and empathetic communication. 71% of patients say they primarily expect clear information about their medical situation. Information exchange can nonetheless be difficult, particularly with older and frail patients. So-called teach-back techniques improve patients' understanding of medications and behavioral instructions (OR 1.84 [1.09; 3.12] and 1.83 [1.07; 3.13], respectively). Although many patients would like to take active part in discussions on rounds, the physicians explicitly encouraged them to do so in only 54% of cases. If the team discusses the patient outside the room before entering, the patient's understanding of their condition is no different, but they are less likely to be confused by medical technology (21.3 versus 13.7); team satisfaction is higher (78.0 versus 68.3), and there is more opportunity to discuss sensitive topics (84.3 versus 59.3, each on a visual analog scale VAS 1-100).Conclusion: Interprofessional discussion of the patient and suitable communication on rounds can improve patient care and are essential for undergraduate, postgraduate, and continuing medical education.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"362-370"},"PeriodicalIF":6.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157394","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}

引用次数: 0

Prevalence of Fractures in the Adult Population of Germany: An Evaluation of Inpatient and Outpatient Cases. 骨折的患病率在德国的成人人口：住院和门诊病例的评估。

IF 7.1 2区医学

Deutsches Arzteblatt international Pub Date : 2025-06-27 DOI: 10.3238/arztebl.m2025.0070

Nike Walter, Dominik Szymski, Susanne Bärtl, Christoph Biehl, Gero Knapp, Siegmund Lang, Volker Alt, Christian Heiß, Markus Rupp

{"title":"Prevalence of Fractures in the Adult Population of Germany: An Evaluation of Inpatient and Outpatient Cases.","authors":"Nike Walter, Dominik Szymski, Susanne Bärtl, Christoph Biehl, Gero Knapp, Siegmund Lang, Volker Alt, Christian Heiß, Markus Rupp","doi":"10.3238/arztebl.m2025.0070","DOIUrl":"10.3238/arztebl.m2025.0070","url":null,"abstract":"Background: Fractures are a major public health problem, especially in older people. A better understanding of epidemiological trends and risk factors is essential for the development of prevention strategies.Methods: We analyzed ICD-10 data provided by the German Federal Statistical Office and the Central Institute for Health Care (Zi) on inpatient and outpatient treatments for fracture in the year 2022. The frequency and distribution of fractures were examined according to anatomical site, sex, and age. The prevalence of inpatient cases was standardized to the German population and compared with figures from 2019.Results: In 2022, there were 683 185 recorded fracture treatments in the inpatient setting, 1% fewer than in 2019. 63% of fractures were in women, and 71% in persons over age 65. The most common types were femoral neck fractures (129 per 100 000 population), pertrochanteric femur fractures (115/100 000), and distal radius fractures (106/100 000). Compared to 2019, there were more fractures of the femoral neck (+8%), femoral shaft (+7%), and distal humerus (+7%), and fewer fractures of the scaphoid bone (-31%), carpal and metacarpal bones (-30%), and ribs (-29%). 2 400 606 fractures were treated in the outpatient setting in 2022, corresponding to a prevalence of 2845.71/100 000. The most common types were distal radius fractures (210.76/100 000), finger fractures (186.1/100 000), and rib fractures (156.51/100 000 population).Conclusion: Although the overall fracture prevalence declined slightly between 2019 and 2022, certain fracture types remained prevalent or even increased in frequency. This highlights the continued need for targeted preventive strategies, particularly for older adults.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"355-359"},"PeriodicalIF":7.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157397","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}

引用次数: 0

Mycoplasma-Related Acute Hemorrhagic Leukoencephalomyelitis. 支原体相关急性出血性白质脑脊髓炎。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2025-06-27 DOI: 10.3238/arztebl.m2024.0237

Mathias Fousse, Jakob Stögbauer, Michael Kettner

引用次数: 0