Deutsches Arzteblatt international最新文献

{"title":"The Differential Diagnosis of Leg Ulcers.","authors":"Joachim Dissemond, Jan-Malte Placke, Maurice Moelleken, Knut Kröger","doi":"10.3238/arztebl.m2024.0133","DOIUrl":"10.3238/arztebl.m2024.0133","url":null,"abstract":"<p><strong>Background: </strong>Chronic wounds on the leg (below the knee) are called leg ulcers. They have many causes, and thus patients with leg ulcers are treated by many different kinds of medical specialist. Appproximately 80% of sufferers have chronic venous insufficiency (CVI) and/ or peripheral arterial occlusive disease (PAOD). Knowledge of the relevant differential diagnoses is important for appropriate treatment, particularly for patients with atypical findings or an intractable course.</p><p><strong>Methods: </strong>This article is based on publications retrieved by a selective search in PubMed, including current guidelines and expert recommendations.</p><p><strong>Results: </strong>The diagnostic evaluation of a leg ulcer can be structured according to the ABCDE rule. This involves individualized, targeted history-taking (anamnesis); bacteriological testing; clinical exami - nation; ancillary testing, particularly for perfusion (defective vascular system); and extras, such as biopsies. Specifically, we present in this article the main aspects of the complex diagnostic evaluation of venous leg ulcers, arterial leg ulcers, vasculitis, vasculopathy, calciphylaxis, pyoderma gangrenosum, necrobiosis lipoidica, ecthyma, and squamous cell carcinoma. There remain many unsolved problems, including interactions between the various areas of clinical treatment and the relative paucity of relevant highquality research.</p><p><strong>Conclusion: </strong>A timely differential-diagnostic evaluation for the many diseases that can cause leg ulcers, which require treatment from representatives of many different medical specialties and health professions, is a prerequisite for their effective individualized treatment.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"733-739"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901278","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":"Sometimes Less Is More.","authors":"Nicolaus Dahlmann, Dietrich Klingmüller","doi":"10.3238/arztebl.m2024.0140","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0140","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"754"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001868","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 Caseload Requirement for Renal Transplantation—An Analysis of German Hospital Quality Assurance Data from 2013–2021.","authors":"Philipp Reimold, Cem Aksoy, Jonas Beckmann, Aristeidis Zacharis, Christer Groeben, Philipp Karschuck, Nicole Eisenmenger, Josef Geks, Rainer Koch, Luka Flegar, Johannes Huber","doi":"10.3238/arztebl.m2024.0139","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0139","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"746-747"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001869","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":"In Reply.","authors":"Susanne Singer","doi":"10.3238/arztebl.m2024.0085","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0085","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"752-753"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001862","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":"Not Enough Information.","authors":"Stephan Knipping","doi":"10.3238/arztebl.m2024.0198","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0198","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 22","pages":"756"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001867","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":"Emphysema Following Dissection of the Glottic Synechia in Concealed Anterior Laryngeal Cleft.","authors":"Philipp P Caffier, Dirk Mürbe, Tadeus Nawka","doi":"10.3238/arztebl.m2024.0076","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0076","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 21","pages":"695"},"PeriodicalIF":6.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001853","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 Cystic Fibrosis—a Comparison of Patient Registry Data and Billing Data Within the German Statutory Health Insurance System.","authors":"Lutz Naehrlich, Christian Gallowitz, Manuel Burkhart, Diana Kurch-Bek","doi":"10.3238/arztebl.m2024.0126","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0126","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 21","pages":"712-713"},"PeriodicalIF":6.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001858","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":"Irritant (Toxic) Contact Dermatitis Following Topical Use of Dimethylsulfoxide.","authors":"Chiara L Blomen, Lina Hildebrandt, Stefan W Schneider","doi":"10.3238/arztebl.m2024.0091","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0091","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 21","pages":"714"},"PeriodicalIF":6.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001855","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 Use of Single-Use Medical Gloves in Doctors' Practices and Hospitals.","authors":"Tobias Siegfried Kramer, Annika Brodzinski, Marco Paul, Hans Drexler, Simone Scheithauer, Christine Geffers","doi":"10.3238/arztebl.m2024.0159","DOIUrl":"10.3238/arztebl.m2024.0159","url":null,"abstract":"<p><strong>Background: </strong>Single-use medical gloves achieve their purpose only when properly used. Proper use also helps avoid undesired consequences such as excessive waste and CO2 emissions, as well as inadequate hand hygiene.</p><p><strong>Methods: </strong>In this selective review of the primary scientific literature, we summarize the current state of knowledge on the use of singleuse medical gloves in the health-care sector. We also provide further information from national recommendations, guidelines, and regulatory provisions.</p><p><strong>Results: </strong>Single-use medical gloves mainly serve to protect the health-care professional and are only rarely meant to promote patient safety. For reasons of occupational safety and self-protection, hand hygiene should be performed after single-use medical gloves are removed. In a study of opened glove boxes, human pathogenic bacteria were detected on around 13% of single-use medical gloves. A meta-analysis found that wearing single-use medical gloves can lower the risk of nosocomial infection (incidence rate ratio, IRR: 0.77 [0.67; 0.89]. In a randomized controlled trial, adherence for putting on single-use medical gloves without prior hand disinfection was 87%. On the other hand, where hand disinfection was expected to be performed before putting on gloves, adherence was 41%. Proper use can lower the rate of occupational skin diseases and improve adherence to hand hygiene for the five moments in which it is recommended (before and after patient contact, before aseptic procedures, after contact with potentially infectious material, and after contact with the immediate patient environment).</p><p><strong>Conclusion: </strong>Limiting the use of single-use medical gloves to its proper indications promotes the safety of health-care professionals and patients and has beneficial ecological and economic effects as well.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"715-724"},"PeriodicalIF":6.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281916","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":"Evaluation of an Automated Decision Aid for the Further Referral of Emergency Room Patients—A Prospective Cohort Study.","authors":"Anna Slagman, Anne Bremicker, Martin Möckel, Larissa Eienbröker, Antje Fischer-Rosinský, André Gries","doi":"10.3238/arztebl.m2024.0191","DOIUrl":"10.3238/arztebl.m2024.0191","url":null,"abstract":"<p><strong>Background: </strong>Instruments for the initial evaluation of emergency room patients as an aid to their onward referral to ambulatory care structures are a matter of current interest. In this study, we assess the safety of the software application SmED-Kontakt+ for this purpose. SmED is an abbreviation for Strukuturierte Medizinische Ersteinschätzung Deutschland, \"structured initial medical evaluation in Germany.\"</p><p><strong>Methods: </strong>In this prospective cohort study, we compared the recommendations of SmED-Kontakt+ concerning the time and place of further care with those of the treating physicians. The subjects were adult patients who were able to walk and had presented themselves to the emergency room. Whenever SmED-Kontakt+ assessed the situation less critically than the physicians, and in 5% of the remaining cases, the potential endangerment of patient safety was assessed by an expert panel (expected value <1%).</p><p><strong>Results: </strong>In a total of 1840 cases, SmED-Kontakt+ agreed with the physicians' assessment in 353 (19%). The assessment of SmEDKontakt+ was more critical in 1221 cases (66%) and less critical in 266 (15%; potential undertriage). There was potential endangerment in 49 cases (2.7%; 95% confidence interval [2.0; 3.5]). Potential endangerment was less common among patients in the more urgent recommendation categories [0.1; 2.6] and more common in the categories of a recommended outpatient phy - sician visit or telephone consultation within or beyond 24 hours [2.4; 17.2].</p><p><strong>Conclusion: </strong>SmED-Kontakt+ generally assessed these patients' needs for further care as more urgent than the treating physicians did. Nevertheless, the percentage of potentially endangered patients was higher than expected. We conclude that further care should be provided in timely fashion with an obligatory appointment. The sites of further ambulatory care should be immediately accessible and properly equipped. Patients should not be referred for further care at later times on the basis of an SmEDKontakt+ assessment.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"703-709"},"PeriodicalIF":6.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142343496","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}