Deutsches Arzteblatt international最新文献

{"title":"Physical Activity, Genetic Susceptibility, and Risk of Colorectal Cancer in Type 2 Diabetes: A Large Population-Based Cohort Study.","authors":"Yanjun Wu, Meijun Meng, Yufeng Liu, Ruijie Zeng, Jing Feng, Qizhou Lian, Yuying Ma, Lijun Zhang, Wentao Huang, Felix W Leung, Chongyang Duan, Weihong Sha, Hao Chen","doi":"10.3238/arztebl.m2025.0013","DOIUrl":"10.3238/arztebl.m2025.0013","url":null,"abstract":"<p><strong>Background: </strong>It is crucial to identify modifiable preventive measures to mitigate the risk of colorectal cancer (CRC) among patients with type 2 diabetes (T2D), a high-risk group for CRC. We conducted a study to investigate the potential association between various levels of physical activity (PA) and the incidence of CRC, taking account of genetic susceptibility, in a T2D population cohort.</p><p><strong>Methods: </strong>The study was based on UK Biobank (UKB) data on persons diagnosed with T2D; the participants were tracked until 2022. Hazard ratios (HR) and 95% confidence intervals (95% CI) for CRC were calculated using Cox regression models.</p><p><strong>Results: </strong>The 33 733 patients with T2D were followed up for a median of 13.62 years. During this time, 551 patients were diagnosed with CRC. Compared with low PA, the multivariable adjusted HR for CRC among T2D patients was 0.81, 95% CI [0.66; 0.98] and 0.74 [0.58; 0.94] in the groups with moderate and high PA, respectively. In right colon cancer, moderate and high levels of PA were associated with 31% (HR 0.69; 95% CI [0.51; 0.93]) and 42% (HR 0.58; 95% CI [0.40: 0.85]) reductions in the risk of CRC. High PA (HR 0.54; 95% CI [0.35; 0.84] was associated with a lower risk of CRC even in patients with a high polygenic risk score (PRS). Persons with low PRS and high PA had the lowest risk of CRC.</p><p><strong>Conclusion: </strong>Our study suggests that moderate to high PA helps to reduce the risk of CRC in T2D patients and that joint consideration of PA level and PRS could provide valuable insights for personalized strategies to prevent CRC.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"186-192"},"PeriodicalIF":6.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398246","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 Potential for Providing Treatment on an Outpatient Rather Than Inpatient Basis: A Nationwide Analysis of Hospital Discharge Data in Germany for the Year 2022.","authors":"Carolina Pioch, Reinhard Busse, Thomas Mansky, Ulrike Nimptsch","doi":"10.3238/arztebl.m2025.0012","DOIUrl":"10.3238/arztebl.m2025.0012","url":null,"abstract":"<p><strong>Background: </strong>In an expert analysis by the IGES Institute, it was examined which inpatient hospital treatments could also be carried out on an outpatient basis. A method of determining the feasibility of performing any particular treatment in the outpatient setting based on routine documentation was proposed in the report. A new version of the German catalogue of operations that can be per - formed on an outpatient basis and other outpatient procedures (the AOP catalogue) was issued accordingly. In addition, sector-blind (hybrid DRG) reimbursement of selected treatments was introduced, i.e., the amount of the reimbursement is now the same regardless of whether the treatment is provided on an inpatient or outpatient basis.</p><p><strong>Methods: </strong>The present analysis is based on German nationwide hospital discharge data from 2022. It was calculated how many inpatient treatments could have been carried out on an outpatient basis according to the criteria of the IGES report and the AOP catalogue, and how many cases would fall under hybrid DRGs.</p><p><strong>Results: </strong>Of 14.8 million inpatient treatment cases (excluding deliveries and neonates), 7.2% were identified that might have been provided on an outpatient basis according to both models, and a total of 17.3% and 21.8%, respectively, according to the IGES model or the AOP catalogue. The estimated number of potential hybrid DRG cases was 153 000, or 1.0%.</p><p><strong>Conclusion: </strong>Both the IGES model and the AOP catalogue identified a relevant potential for providing treatment on an outpatient rather than inpatient basis. However, the overlap between the two approaches is small. Further development of the AOP catalogue appears necessary for the more accurate identification of treatment cases that can be provided in the outpatient setting. The extent to which the new AOP catalogue and hybrid DRG remuneration can promote the provision of outpatient rather than inpatient care will need to be determined in future analyses.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"151-155"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254728","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 Accuracy of Physicians' Quantitative Estimates.","authors":"Lisa Margarete Knipps, Igor Fischer, Thomas Klenzner","doi":"10.3238/arztebl.m2025.0010","DOIUrl":"10.3238/arztebl.m2025.0010","url":null,"abstract":"<p><strong>Background: </strong>Doctors often describe sizes by comparison with everyday objects, e.g., a pinhead-sized tympanic defect or a dehiscence the size of a penny. But do they really know how big a pinhead is? We used an internet-based questionnaire to study whether quantities are accurately estimated and whether comparisons with everyday objects improve accuracy.</p><p><strong>Methods: </strong>In a prospective, single-center study conducted by internet-based questionnaire, physicians estimated the size of everyday objects, such as a pea or a one-euro coin, and SI units as they appeared on a computer screen and then estimated their own accuracy of estimation.</p><p><strong>Results: </strong>On average, the sizes of everyday objects and SI units were underestimated by 15% (95% confidence interval, [-17; -13]). The physicians' self-assessment was not correlated with their actual degree of accuracy. Board-certified specialists considered themselves better estimators than others; however, no difference in accuracy was found between specialists and resident physicians. Nor did the particular specialty have any effect on the accuracy of estimation, even though the participating radiologists and neurosurgeons considered themselves especially good estimators. The frequent use of aids such as rulers in clinical practice was not associated with a better accuracy of estimation.</p><p><strong>Conclusion: </strong>Underestimates of size, such as were frequently observed in this study, can cause inaccurate descriptions and faulty decision-making in clinical practice. We therefore recommend that quantities should be measured with the appropriate instruments, and that physicians should refrain from making eyeball estimates wherever possible, regardless of their medical specialty or degree of clinical experience.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"145-150"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566301","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":"Oliver Gross","doi":"10.3238/arztebl.m2024.0188","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0188","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 6","pages":"m1021-m1022"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689495","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":"A 50-Year Cough: Cerebellar Ataxia, Neuropathy, and Vestibular Areflexia Syndrome (CANVAS).","authors":"Hannes Erdmann, Angela Abicht, Michael Strupp","doi":"10.3238/arztebl.m2024.0247","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0247","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 6","pages":"167"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526825","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":"Nasal Foreign Body Following a Beach Vacation.","authors":"Clemens Hock, Holger Kaftan, Timo Moritz","doi":"10.3238/arztebl.m2024.0248","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0248","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 6","pages":"172"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526827","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":"Clinical Practice Guideline: Comprehensive Geriatric Assessment in the Hospital.","authors":"Barbara Kumlehn, Simone Brefka, Thomas Kocar, Filippo Maria Verri, Rainer Wirth, Michael Denkinger","doi":"10.3238/arztebl.m2024.0262","DOIUrl":"10.3238/arztebl.m2024.0262","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of older people are being treated in German hospitals. In 2022, more than 35.7 million hospitalized patients in Germany were of age 65 or older. Comprehensive geriatric assessment (CGA) can help to structure and improve the diagnosis and treatment of these patients, many of whom suffer from multimorbidity.</p><p><strong>Methods: </strong>The guideline group developed this guideline in accordance with the AWMF recommendations. Answers to questions were either evidence-based or consensus-based; the latter were established with a Delphi procedure followed by a consensus conference. The guideline was issued in May 2024.</p><p><strong>Results: </strong>The guideline contains twelve evidence-based and eight consensus-based recommendations and statements. The strongest evidence for the effectiveness of CGA was found in the wards for acute geriatric medicine, oncology, and orthopedics/trauma surgery, with weaker evidence from emergency departments and general surgery wards. Core elements of the guideline are the specification of a minimum duration of CGA (15 minutes), the definition of minimum requirements (six core dimensions: self-help ability, mobility, cognitive function/delirium, affect, nutrition, social situation), and setting-specific process recommendations. Specific screening instruments to identify patients who stand to benefit from CGA are recommended mainly in the oncological setting (G8 questionnaire).</p><p><strong>Conclusion: </strong>The German clinical practice guideline on CGA can serve as a guide to personalized geriatric medicine in the hospital. Further complex interventional studies are needed to evaluate the efficacy of CGA in other settings.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"156-162"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051644","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":"Johannes Fabian Holle","doi":"10.3238/arztebl.m2024.0219","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0219","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 6","pages":"m1018"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689497","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":"Vitreous Opacities in Familial Transthyretin Amyloidosis.","authors":"Claudia Auw-Haedrich, Thomas Neß","doi":"10.3238/arztebl.m2024.0225","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0225","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 6","pages":"172"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526829","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 Vitro Biopsy\": With Good Reason.","authors":"Markus Hallmann","doi":"10.3238/arztebl.m2024.0187","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0187","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"122 6","pages":"m1021"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689490","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}