Innere Medizin (Heidelberg, Germany)最新文献

{"title":"[Update on pneumonia-Clinical management 2025 in consideration of the current guidelines].","authors":"L Reinke, R Worth, D Pape, J Heyckendorf, A Friedrichs","doi":"10.1007/s00108-025-01879-4","DOIUrl":"10.1007/s00108-025-01879-4","url":null,"abstract":"<p><p>Pneumonia is one of the most frequent infectious diseases that lead to hospitalization. It is a decisive turning point and frequently leads to death, particularly in old and comorbid people (so-called terminal event). It is classified into community-acquired pneumonia, hospital-acquired pneumonia and pneumonia due to severe immunosuppression. The three entities differ especially in the spectrum of pathogens to be expected, the site of development and therefore in the calculated anti-infective treatment and initial diagnostics. The continuous re-evaluation of the course and the focal points as well as adaptation of the treatment are essential for the optimal outcome of the patient. Even after surviving an acute disease, in cases of possibly deteriorated functional status there is a need for good aftercare with management of comorbidities, social interventions and when necessary, treatment of persisting organ dysfunction. Prophylaxis by vaccination is essential.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"390-401"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Focus: artificial intelligence in medicine-Legal aspects of using large language models in clinical practice].","authors":"Eva Weicken, Mirja Mittermaier, Thomas Hoeren, Juliana Kliesch, Thomas Wiegand, Martin Witzenrath, Miriam Ballhausen, Christian Karagiannidis, Leif Erik Sander, Matthias I Gröschel","doi":"10.1007/s00108-025-01861-0","DOIUrl":"10.1007/s00108-025-01861-0","url":null,"abstract":"<p><strong>Background: </strong>The use of artificial intelligence (AI) and natural language processing (NLP) methods in medicine, particularly large language models (LLMs), offers opportunities to advance the healthcare system and patient care in Germany. LLMs have recently gained importance, but their practical application in hospitals and practices has so far been limited. Research and implementation are hampered by a complex legal situation. It is essential to research LLMs in clinical studies in Germany and to develop guidelines for users.</p><p><strong>Objective: </strong>How can foundations for the data protection-compliant use of LLMs, particularly cloud-based LLMs, be established in the German healthcare system? The aim of this work is to present the data protection aspects of using cloud-based LLMs in clinical research and patient care in Germany and the European Union (EU); to this end, key statements of a legal opinion on this matter are considered. Insofar as the requirements for use are regulated by state laws (vs. federal laws), the legal situation in Berlin is used as a basis.</p><p><strong>Materials and methods: </strong>As part of a research project, a legal opinion was commissioned to clarify the data protection aspects of the use of LLMs with cloud-based solutions at the Charité - University Hospital Berlin, Germany. Specific questions regarding the processing of personal data were examined.</p><p><strong>Results: </strong>The legal framework varies depending on the type of data processing and the relevant federal state (Bundesland). For anonymous data, data protection requirements need not apply. Where personal data is processed, it should be pseudonymized if possible. In the research context, patient consent is usually required to process their personal data, and data processing agreements must be concluded with the providers. Recommendations originating from LLMs must always be reviewed by medical doctors.</p><p><strong>Conclusions: </strong>The use of cloud-based LLMs is possible as long as data protection requirements are observed. The legal framework is complex and requires transparency from providers. Future developments could increase the potential of AI and particularly LLMs in everyday clinical practice; however, clear legal and ethical guidelines are necessary.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"436-441"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Real world data show effectiveness of new respiratory syncytial virus (RSV) vaccines].","authors":"Ulrich Matt, Sirka Nitschmann, Susanne Herold","doi":"10.1007/s00108-025-01852-1","DOIUrl":"10.1007/s00108-025-01852-1","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"442-444"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Stress-Strain-Recovery-Resilience: how do all these fit together?]","authors":"Thomas Uhlig","doi":"10.1007/s00108-025-01872-x","DOIUrl":"10.1007/s00108-025-01872-x","url":null,"abstract":"<p><p>From a psychological point of view resilience is closely related to aspects of stress. As a further development of the classical stress model, the skills of individuals are described in the context of psychological resource models which enable an appropriate coping with situations that trigger stress. These differential aspects of the stress reaction are frequently highlighted in the literature on psychology. Based on a sophisticated description of stressors (i.e., environmental stimuli which are able to induce stress) characters of a person, such as personality, age, gender and strategies of coping are responsible for the expression of the stress response. The individual \"translation\" of the effects of stressors into a (stress) response is mediated by various somatic systems and aspects of emotionality. At the different levels of the stress reaction restoration processes occur which are helpful in modifying the potentially harmful effects of stressors and a homeostasis is restored. These restoration processes can be systematically described as a buffer function for the extent of a stress reaction and can be influenced in a targeted way. Therefore, the term resilience which has been used for some time appears to be a type of metaphor for psychological processes which have been known for a long time in the context of psychological research on stress and recovery.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"341-349"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Resilience is job satisfaction using nephrology as an example].","authors":"Mariam Abu-Tair","doi":"10.1007/s00108-025-01862-z","DOIUrl":"10.1007/s00108-025-01862-z","url":null,"abstract":"<p><p>The shortage of specialists in medicine has become an everyday occurrence in both the medical and nursing fields. There is a great need for young talent in all areas of the healthcare sector. The strain on people working in this field is enormous and is perceived differently in different areas of work, depending on their professional and educational background. If we look at the medical field alone, students' wishes, requirements, objectives and necessities with regard to everyday working life are different from those of postgraduate training assistants or the management level consisting of senior physicians and chief physicians. Various measures are required to counteract the shortage of junior staff on the one hand and to meet all requirements in patient care on the other, while achieving and maintaining a high level of job satisfaction. These must be coordinated and adapted to the different needs of the various levels. Working conditions in the interactive, interprofessional, interdisciplinary, financial and social context need to be revised in many areas in order to maintain the attractiveness of the medical profession. A resilient medical team can defy many adversities, but this requires a contribution from all sides.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"385-389"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Climate resilience and health: the planet's vital signs are flashing red].","authors":"Martin Herrmann, Christian M Schulz","doi":"10.1007/s00108-025-01867-8","DOIUrl":"10.1007/s00108-025-01867-8","url":null,"abstract":"<p><p>Six of the nine Earth systems are dangerously stressed: climate change, biodiversity loss, land use, pollution, freshwater availability, and the global biogeochemical cycles of nitrogen and phosphorus. Analogous to human multi-organ failure, cascading planetary tipping points threaten to cause irreversible damage to our societies. This ecological crisis is already manifesting in a variety of health risks, from heat-related deaths and respiratory diseases to mental health. For future generations, continuing business as usual in the present means much less prosperity, security, freedom, and-most importantly-health. The ecological crisis is the greatest threat to human health in the 21st century. Climate resilience is defined as the necessary integration of climate adaptation and mitigation, and is a central component of preventive health care. Key action areas include: 1) considering the current and future health impacts of the ecological crisis in prevention, diagnosis, and treatment; 2) educating policymakers about climate resilience and health, and deriving concrete actions for municipalities, states, and federal governments; 3) implementing climate-sensitive health advice in outpatient and inpatient settings and educating the public; 4) initiating and participating in municipal, regional, and national sectoral and cross-sectoral action alliances; 5) monitoring greenhouse gas emissions and developing implementation plans for emission-free health facilities; and finally, 6) prioritizing climate resilience and health in research and education. Special attention is given to measures that have multiple positive effects on both human health and Earth systems, known as co-benefits. By not limiting themselves to medical measures alone, but overcoming displacement and intervening in political and societal processes, health experts can play a key role in combating this crisis.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"365-372"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Blood vessels as a target organ: from Ormond's disease to immunoglobulin G4-related diseases].","authors":"Marco Krasselt, Bimba Hoyer","doi":"10.1007/s00108-025-01891-8","DOIUrl":"https://doi.org/10.1007/s00108-025-01891-8","url":null,"abstract":"<p><p>Immunoglobulin G4-related disease (IgG4-RD) is a rare and clinically diverse entity with an estimated incidence of 0.8-1.4 per 100,000 person-years. Typical sites of manifestation include the head and neck area, the hepato-pancreato-biliary system, and the retroperitoneum. Perhaps the best-known variant is retroperitoneal fibrosis, formerly known as Ormond's disease. Biopsy and histological examination are of great diagnostic importance, as relying solely on serum IgG4 is problematic and not sufficiently specific. Therapeutically, in addition to the initial administration of glucocorticoids, treatment with B cell-directed antibodies, particularly rituximab, has become clinically established. Initial studies demonstrate the effectiveness of other therapies targeting B cells. Although the disease has received more clinical attention in recent years, it is still necessary to further increase awareness of IgG4-RD to enable optimal treatment for patients.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitteilungen der DGIM.","authors":"","doi":"10.1007/s00108-025-01887-4","DOIUrl":"https://doi.org/10.1007/s00108-025-01887-4","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":"66 4","pages":"414-429"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Resilience as an integral component of action competence in internal medicine].","authors":"Franziska Reinhardt, Jonas Tesarz, Imad Maatouk","doi":"10.1007/s00108-024-01830-z","DOIUrl":"10.1007/s00108-024-01830-z","url":null,"abstract":"<p><p>Physicians in internal medicine are exposed to high levels of stress. Conditions of chronic emotional fatigue and burnout are widespread. Resilience, the ability to cope with difficult situations and to adapt to adverse circumstances, is essential. Resilient physicians remain calm, make clear decisions and are in a position to support the collegial environment as well as to requisition and utilize support themselves. Resilience can be described at a biological level and is influenced by biological mechanisms, such as the hypothalamic-pituitary-adrenal axis; , even resilience of patients should be more strongly considered in internal medicine. Resilient patients can cope better with the stress due to the disease and sequelae of the treatment, which not only facilitates the healing and regeneration process but also strengthens the adaptability to altered life situations in the case of newly occurring health challenges. Interventions that activate the individual coping strategies and social support can positively influence the course of chronic diseases. A high level of resilience contributes to the quality of patient care. In addition to biological factors, this is based particularly on psychological and social factors and can be specifically promoted and trained.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"350-359"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Rare cause of recurrent hypoglycemia].","authors":"Ifigeneia Barmpa, Apostolos Chatzitomaris, Eva Maria Lüngen, Ralf Lobmann","doi":"10.1007/s00108-025-01889-2","DOIUrl":"https://doi.org/10.1007/s00108-025-01889-2","url":null,"abstract":"<p><p>Non-islet cell tumor hypoglycemia (NICTH) is a rare cause of hypoglycemia, resulting from excessive secretion of insulin-like growth factor 2 (IGF-2) or pro-IGF‑2, which leads to subsequent activation of the insulin receptor. Doege-Potter syndrome is often used synonymously with NICTH, especially in cases with fibrous primary tumors in the thorax. In the current patient, tumor progression was observed over a short period without the possibility of debulking surgery. Therefore, oral therapy with prednisolone was initiated. Treatment with diazoxide or the somatostatin analogue octreotide is not recommended for NICTH.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}