Deutsches Arzteblatt international最新文献_第7页

Conservative Versus Operative Treatment of Proximal Humerus Fractures in Older Individuals. 老年人肱骨近端骨折的保守治疗与手术治疗--保险数据分析。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-07-12 DOI: 10.3238/arztebl.m2024.0059

J Christoph Katthagen, Michael J Raschke, Karen Fischhuber, Janette Iking, Ursula Marschall, Julia Sußiek, Andreas Faldum, Josef Stolberg-Stolberg, Jeanette Köppe

{"title":"Conservative Versus Operative Treatment of Proximal Humerus Fractures in Older Individuals.","authors":"J Christoph Katthagen, Michael J Raschke, Karen Fischhuber, Janette Iking, Ursula Marschall, Julia Sußiek, Andreas Faldum, Josef Stolberg-Stolberg, Jeanette Köppe","doi":"10.3238/arztebl.m2024.0059","DOIUrl":"10.3238/arztebl.m2024.0059","url":null,"abstract":"Background: Little is known about the frequency and results of conservative treatment of proximal humerus fractures (PHF) in older individuals.Methods: Billing data of the BARMER health insurance carrier for all patients of age ≥ 65 for the years 2005-2021 were retrospectively analyzed with multivariable Cox regression models, taking account of the patients' age, sex, and individual comorbidity profiles. The defined primary endpoints were overall survival (OS), major adverse events (MAE), thromboembolic events (TE), and complications of surgery or of trauma. Multivariable p-values for the effect of treatment on all primary endpoints were jointly adjusted using the Bonferroni-Holm method.Results: Of 81 909 patients, 54% were treated conservatively. Conservative treatment was more common in those who received their diagnosis as outpatients (79.5%, vs. 37.2% for inpatients). Operative treatment was associated with significantly longer overall survival (long-term hazard ratio [HR] 0.89, 95% confidence interval [0.86; 0.91]), fewer MAE (0.90 [0.88; 0.92]), and fewer TE (0.89 [0.87; 0.92]), but more complications due to surgery or trauma (1.66 [1,.4; 1.78]; all p < 0.001). By 6 months after diagnosis, 3.1% of the patients who were initially treated conservatively had undergone surgery. Risk factors for failure of conservative treatment were alcohol abuse, obesity, cancer, diabetes mellitus, Parkinson disease, and osteoporosis.Conclusion: The conservative treatment of PHF is associated with a lower overall rate of complications due to surgery or trauma, but also with more MAE, more TE, and higher mortality. These findings underline the need for individualized and risk-adjusted treatment recommendations.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"454-460"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856740","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

Tinnitus as an Indication of Head Injury. 耳鸣是头部受伤的征兆。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-07-12 DOI: 10.3238/arztebl.m2024.0045

Theo Evers, Matthias Tisch

引用次数: 0

Clinical Practice Guideline: Microhematuria in Children and Young Adults. 临床实践指南：儿童和青少年微量血尿--肾脏疾病早期检测评估》。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-07-12 DOI: 10.3238/arztebl.m2024.0070

Kay Latta, Jan Boeckhaus, Ina Weinreich, Angela Borisch, Dominik Müller, Oliver Gross

{"title":"Clinical Practice Guideline: Microhematuria in Children and Young Adults.","authors":"Kay Latta, Jan Boeckhaus, Ina Weinreich, Angela Borisch, Dominik Müller, Oliver Gross","doi":"10.3238/arztebl.m2024.0070","DOIUrl":"10.3238/arztebl.m2024.0070","url":null,"abstract":"Background: Occult blood in the urine, or microhematuria, is a common finding (about 10%) in children and young adults. It is often of brief duration and therefore harmless. In persistent microhematuria, acanthocytes in the urine are a frequently unrecognized early marker of glomerular kidney disease. The purpose of this guideline is to promote the early detection of kidney disease in children and young adults with practical, evidence-based recommendations.Methods: A systematic search for pertinent publications up to January 2023 was conducted in Pubmed, the Cochrane Database, and Livivo. 474 publications were retrieved, summarized in terms of method and content, and classified by Oxford (2011) evidence level.Results: Approximately 1% of children and young adults have undiagnosed chronic kidney disease. Microhematuria is an early warning sign. A timely nephrological evaluation is indicated if microhematuria persists for 3 to 6 months, if ≥ 5% acanthocytes are detectable in the urine, and if there is also proteinuria, hypertension, or impaired renal function. Ultrasonography of the kidneys and urinary tract is the imaging method of choice; cystoscopy should be avoided. For patients with glomerular microhematuria, molecular genetic testing is recommended. Renal biopsy is recommended in case of florid glomerular diseases, after the determination of various laboratory param eters and clinical findings, including molecular genet ic testing especially in children.Conclusion: In the absence of a guideline until now, findings have often been incorrectly assessed, leading either to an inadequate work-up or to excessive diagnostics. As a result, in approximately 30% of young patients, valuable opportunities for early treatment to protect the kidneys have been missed.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"461-466"},"PeriodicalIF":6.5,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141075644","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}

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In Reply. 回复中。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-07-12 DOI: 10.3238/arztebl.m2024.0014

Folgerdiena M de Vries

引用次数: 0

Erratum. 勘误。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-07-12 DOI: 10.3238/arztebl.m2024.9999

引用次数: 0

In Reply. 回复中。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-07-12 DOI: 10.3238/arztebl.m2024.0046

Benno Hartung, Heinz-Lothar Meyer

引用次数: 0

Problematic Consumption of Alcohol, Cannabis and Cigarettes—a German Nationwide Survey on Psychopathology, Stress, Mindfulness, and Quality of Life. 有问题的酒精、大麻和香烟消费--一项关于精神病理学、压力、心态和生活质量的德国全国性调查。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-06-28 DOI: 10.3238/arztebl.m2024.0061

Lutz Wartberg, Matthias Belau, Nicolas Arnaud, Rainer Thomasius

{"title":"Problematic Consumption of Alcohol, Cannabis and Cigarettes—a German Nationwide Survey on Psychopathology, Stress, Mindfulness, and Quality of Life.","authors":"Lutz Wartberg, Matthias Belau, Nicolas Arnaud, Rainer Thomasius","doi":"10.3238/arztebl.m2024.0061","DOIUrl":"10.3238/arztebl.m2024.0061","url":null,"abstract":"Background: Even among minors, the use of psychotropic substances is widespread in Europe. Data on the use of tobacco, alcohol and cannabis are regularly reported in Germany, but data on problematic use are lacking. In the present study, established screening instruments were used to investigate the prevalence of problematic use of cigarettes, alcohol and cannabis among children and adolescents.Methods: A survey that was designed to be representative was conducted across Germany in a sample of 4001 persons aged 12-17. The survey consisted of established screening instruments for problematic consumption patterns and related psychosocial aspects. Prevalences were estimated, and bivariate and multivariate associated characteristics were studied.Results: Among 12- to 17-year-olds in Germany, the prevalence values (with 95% confidence intervals) of problematic use were: for cigarettes, 0.5% [0.3; 0.7]; for alcohol, 11.3% [10.3; 12.3]; and for cannabis, 0.5% [0.3; 0.7]. For the problematic use of cigarettes, alcohol and cannabis, there were both bivariate and multivariate statistically significant associations with greater psychopathology, lower mindfulness, and a lower quality of life. For example, greater psychopathology and stress experience were both associated with an increased risk of problematic cannabis use (odds ratios 1.21 [1.11; 1.31] and 1.59 [1.33; 1.88]).Conclusion: A comparison with the few available previous findings implies that problematic alcohol consumption has become more prevalent. There were both similarities and differences across the three substances studied with respect to patterns of problematic consumption, particularly in relation to the experience of stress.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"422-427"},"PeriodicalIF":6.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855020","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

Lumbar Disc Herniation—the Significance of Symptom Duration for the Indication for Surgery. 腰椎间盘突出症--症状持续时间对手术指征的意义。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-06-28 DOI: 10.3238/arztebl.m2024.0074

Nikolaus Kögl, Ondra Petr, Wolfgang Löscher, Ulf Liljenqvist, Claudius Thomé

{"title":"Lumbar Disc Herniation—the Significance of Symptom Duration for the Indication for Surgery.","authors":"Nikolaus Kögl, Ondra Petr, Wolfgang Löscher, Ulf Liljenqvist, Claudius Thomé","doi":"10.3238/arztebl.m2024.0074","DOIUrl":"10.3238/arztebl.m2024.0074","url":null,"abstract":"Background: Lumbar disc surgery is among the more common spinal procedures. In this paper, we report the current treatment recommendations for patients with symptomatic disc herniation.Methods: This review is based on pertinent publications retrieved by a selective literature search in PubMed using the terms [timing] AND [lumbar disc herniation], supplemented by other relevant articles and guidelines.Results: Symptoms resolve in 60% to 80% of patients with herniated discs in 6-12 weeks, and in 80% to 90% over the long term (≥ 1 year). According to the guidelines, 6-12 weeks of conservative treatment are recommended in the absence of significant neu - rologic deficits. Early surgery is indicated in case of worsening pain or new onset of neurologic deficits. Lumbar disc herniation associated bladder or bowel dysfunction (cauda equina syndrome) is considered an absolute surgical emergency that requires immediate decompression (within 24 to 48 hours). Patients with severe motor deficits (MRC ≤ 3/5) benefit from early intervention and should be offered surgery within three days, if possible, for the best chance of recovery. The degree of weakness and the duration of symptoms have been identified as risk factors for incomplete recovery. Early surgery can be considered in patients with mild paresis (MRC 4/5) in case of functional impairment (e.g., quadriceps paresis).Conclusion: Longer symptom duration and lower motor scores are associated with worse outcome and a lower chance of neurologic recovery. The recovery rate for motor deficits ranges from 33% to 75%, depending on the timing and modality of treatment as well as the motor score.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"440-448"},"PeriodicalIF":6.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247461","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

The Early Diagnosis and Treatment of Chronic Renal Insufficiency. 慢性肾功能不全的诊断与治疗》。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-06-28 DOI: 10.3238/arztebl.m2024.0072

Kai-Michael Hahn, Frank Strutz

{"title":"The Early Diagnosis and Treatment of Chronic Renal Insufficiency.","authors":"Kai-Michael Hahn, Frank Strutz","doi":"10.3238/arztebl.m2024.0072","DOIUrl":"10.3238/arztebl.m2024.0072","url":null,"abstract":"Background: Chronic renal insufficiency (CRI) is becoming more common and has an increasing impact on public health. In Germany, approximately one in ten adults has CRI. Its most serious consequence is generally not the development of end-stage renal failure, but rather the markedly increased cardiovascular risk as kidney function declines.Methods: This review is based on the findings of a selective search in PubMed for literature about the treatment options for CRI, and on our overview of the existing guideline recommendations on diagnostic testing. .Results: Patients with diabetes mellitus and arterial hypertension are at especially high risk of developing CRI. For these patients, some of the guidelines recommend regular testing for albuminuria and measurement of the glomerular filtration rate (GFR), though sometimes only when specific risk constellations are present. The treatment of CRI has evolved in recent years. At first, aside from general measures, only RAS inhibitors were available as a specific therapy for CRI. With the extension of the approval of SGLT-2 inhibitors to non-diabetic CRI patients, the options for treatment have become wider. Two randomized controlled trials have revealed the benefit of SGLT-2 inhibitors with respect to their primary combined endpoints: time to a specified eGFR reduction and renal/cardiovascular death (HR 0.61 [0.51; 0.72] and 0.72 [0.64; 0.82]). The potential side effects and contraindications of SGLT-2 inhibitors must be taken into account. A further treatment option for diabetics with CRI has become available with the approval of the non-steroidal mineralocorticoid receptor antagonist finerenone.Conclusion: In patients with risk factors, renal function should be regularly tested.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"428-435"},"PeriodicalIF":6.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141174830","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

Initial Medical Assessment by the 116117 Patient Service. 由 116117 病人服务处进行初步医疗评估。

IF 6.5 2区医学

Deutsches Arzteblatt international Pub Date : 2024-06-28 DOI: 10.3238/arztebl.m2024.0047

Beate Zoch-Lesniak, Edgar Steiger, Lars E Kroll, Dominik von Stillfried

引用次数: 0