Innere Medizin (Heidelberg, Germany)最新文献

{"title":"[Implementation of the Hospital Plan North-Rhine/Westphalia 2022 : New structures for inpatient treatment].","authors":"Gero Scheiermann, Helmut Watzlawik","doi":"10.1007/s00108-026-02163-9","DOIUrl":"10.1007/s00108-026-02163-9","url":null,"abstract":"<p><p>Hospital planning is of central importance in public healthcare as it aims to safeguard the comprehensive and needs-oriented treatment of the population. The aim of the Hospital Plan North-Rhine/Westphalia (NRW) is a requirement-conform, qualitatively high-grade and also economically viable inpatient care for the population in all regions. The coordination between the service providers should be promoted and the stability of the system as a whole should be increased in favor of patients, employees and hospitals. The core guiding principle is a consistent patient orientation. The incorporation of hospital operators, health insurance providers, the medical profession and other parties involved has proven to be the decisive factor for success. The planning follows a strategic reorientation from a primarily quantitative management to a qualitative and performance-oriented management. Key instruments for this are the concentration of complex services and the simultaneous safeguarding of local basic care. The core of the new planning system is the departure from the bed-related planning in favor of a performance group-oriented structure. The Hospital Planning NRW plays a nationwide pioneering role in this concept. The NRW performance group model relies on targeted control effects by the selection of the service groups (general and specific service groups). The planning is carried out at different regional levels which enables a differentiated and needs-based control. The planning is procedurally characterized by a 2‑stage approach. Firstly, it is checked which hospitals fulfil the qualitative minimum requirements and subsequently in the case of an oversupply, a selection decision is made based on established criteria. In addition, characteristic is the conception of the hospital plan as a \"learning system\" that is continuously developed further. This article describes the background and legal principles of the Hospital Plan NRW. The objectives, systematics and requirements planning are outlined. Finally, an interim balance is drawn up and a look into the future is given. The implementation of the Hospital Plan NRW so far can be rated as positive.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"953-959"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563594","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":"Fortbildungen des BDI.","authors":"","doi":"10.1007/s00108-026-02181-7","DOIUrl":"https://doi.org/10.1007/s00108-026-02181-7","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":"67 9","pages":"1008-1012"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868140","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":"[Symptom burden in chronic kidney disease-nephrological assessment compared to patients' perspectives (SOMA.CK study)].","authors":"Birte Jessen, Bernd Löwe, Christian Schmidt-Lauber, Tobias B Huber, Meike Shedden-Mora","doi":"10.1007/s00108-026-02155-9","DOIUrl":"10.1007/s00108-026-02155-9","url":null,"abstract":"<p><strong>Background: </strong>Individuals with nondialysis chronic kidney disease (ND-CKD) often report high somatic symptom burden, though traditional clinical approaches associate symptom burden only with advanced disease stages.</p><p><strong>Objectives: </strong>This study compared the symptom burden in ND-CKD as perceived by physicians and patients.</p><p><strong>Materials and methods: </strong>In a German-wide online survey, nephrologists identified the three most common symptoms and the mean symptom burden in CKD using an adapted version of the Chronic Kidney Disease Symptom Burden Index (CKD-SBI). Their assessments were compared with patients' self-reports (CKD-SBI) from the SOMA.CK study.</p><p><strong>Results: </strong>Responses from N = 108 nephrologists (average professional experience = 14.3 years) were compared with responses from N = 222 individuals with ND-CKD (average age = 61.22 years, standard deviation [SD] = 14.90). Nephrologists most frequently named fatigue (69.44%), oedema (38.89%) and arterial hypertension (35.19%), while patients named nycturia (74.30%), fatigue (61.30%) and sleeping problems (47.30%). Nephrologists significantly overestimated the overall symptom burden and the symptom burden of five single symptoms, while they assessed the severity of 12 symptoms lower and 15 symptoms as comparable.</p><p><strong>Conclusion: </strong>A discrepancy between the symptom burden reported by physicians and patients with ND-CKD was shown. Thus, giving greater consideration to the patients' perspectives in symptom assessment is recommended.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"1025-1034"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550933","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":"GKV-Spargesetz.","authors":"","doi":"10.1007/s00108-026-02179-1","DOIUrl":"https://doi.org/10.1007/s00108-026-02179-1","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":"67 9","pages":"1001-1007"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868086","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":"[Distributive justice in healthcare during times of change: a medical ethics perspective].","authors":"Urban Wiesing","doi":"10.1007/s00108-026-02143-z","DOIUrl":"10.1007/s00108-026-02143-z","url":null,"abstract":"<p><p>This paper examines existing funding structures and options for cost savings in the healthcare sector from the perspective of fairness. Funding via wage-related contributions with an income ceiling is criticised since other forms of income are not taken into account and the wealthy are relatively spared. The separation of statutory and private health insurance creates inequalities. Three options for savings are examined: avoiding unnecessary measures, increasing the efficiency of effective services, and prioritisation based on need, benefit, and cost. The advantages of the first two options over prioritisation are outlined, as are the respective responsibilities.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"978-984"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304303","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":"[The health insurers' perspective on defining and managing healthcare needs].","authors":"Jürgen Malzahn, Petra Höft Budde, Veronika Kneißl, Katrin Meyer","doi":"10.1007/s00108-026-02117-1","DOIUrl":"10.1007/s00108-026-02117-1","url":null,"abstract":"<p><p>The German healthcare system, despite its high performance, fails to achieve the goal of needs-based service provision. Supply-induced demand, regional disparities and misaligned financial incentives lead to overuse, underuse and misuse of healthcare services. Planning instruments are often based on data reflecting actual utilization rather than capturing the true healthcare needs of the population. The aim of this article is to analyze how needs orientation can be systematically achieved through new planning, financing and organizational frameworks. Drawing on current legislation, empirical data and sector-specific policy positions, the study examines which structural transformations are required. The analysis demonstrates that the existing legal framework does not enable needs-based service regulation. A shift away from a supply-driven system towards a planning approach that incorporates morbidity, demographic trends, accessibility and quality of care is essential. Central levers for reform include a quality-oriented hospital restructuring, appropriately designed cross-sectoral care facilities, a comprehensive primary care system, needs-oriented emergency care, consistent oitpatient substitution of inpatient cases, flexible regional decision-making capacities and cross-sectoral needs-based planning with unified service categories and quality requirements, involving regional stakeholders. A scientific instrument for needs assessment can align planning and financing, thereby enabling more reliable, efficient and patient-centered care. Only an integrated reform strategy will enable resources to be used efficiently, reduce excess capacities and align healthcare provision with the actual needs of the population.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"962-969"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045088","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":"Strukturfragen im Gesundheitswesen: Was heißt eigentlich „bedarfsgerecht“?","authors":"Sebastian Schellong, Jochen Schmitt, Kevin Schulte","doi":"10.1007/s00108-026-02177-3","DOIUrl":"https://doi.org/10.1007/s00108-026-02177-3","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":"67 9","pages":"943-944"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868233","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":"[Needs-based equity: an international comparison].","authors":"Fabian Kleinke, Aletta Boerkoel, Stefan Mathis-Edenhofer, Manuela Raddatz, Neeltje van den Berg","doi":"10.1007/s00108-026-02142-0","DOIUrl":"10.1007/s00108-026-02142-0","url":null,"abstract":"<p><p>The distribution of healthcare resources represents a major challenge for modern health systems. This article compares how Germany, the Netherlands, Austria, Sweden, and England plan their healthcare provision to achieve needs-based equity. German outpatient healthcare planning relies mainly on fixed physician-to-population ratios and covers only physicians and psychotherapists. In contrast, other countries use more comprehensive approaches: The Netherlands regulates training capacities for 79 different health professions using simulation models to predict future workforce needs. Austria integrates planning across hospital beds, healthcare personnel, and geographic accessibility based on the \"Best Point of Service\" principle. Sweden uses population-based models that incorporate the Care Need Index, which considers social and health factors alongside legally guaranteed treatment timelines. England applies weighted funding formulas that explicitly consider preventable deaths and socioeconomic disadvantage when allocating resources. This comparison shows significant opportunities for Germany to improve its planning system, especially by including multiple healthcare professions, coordinating across care sectors, addressing social inequalities in health, and integrating non-physician professions such as midwives into systematic planning. The findings indicate that moving from simple population ratios toward outcome-focused planning methods that account for socioeconomic factors is essential for achieving true needs-based equity in healthcare.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"945-952"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297648","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":"[Personalized pharmacotherapy of colorectal cancer].","authors":"Nadine Schulte","doi":"10.1007/s00108-026-02133-1","DOIUrl":"10.1007/s00108-026-02133-1","url":null,"abstract":"<p><strong>Background: </strong>Treatment of colorectal cancer has fundamentally evolved due to molecular characterization and biomarker-driven strategies.</p><p><strong>Objectives: </strong>To summarize key personalized treatment approaches in colorectal cancer with a focus on clinically relevant molecular subgroups.</p><p><strong>Current data: </strong>Molecular biomarkers increasingly guide treatment decisions. Microsatellite instability-high (MSI-H)/deficient mismatch repair (dMMR) tumors show pronounced responses to immune checkpoint inhibitors and represent a distinct therapeutic entity. In the adjuvant setting, recent data identify for the first time a predictive biomarker for a targeted pharmacologic intervention: patients with alterations in the phosphoinositide 3‑kinase (PI3K) pathway significantly benefit from adjuvant aspirin therapy, emphasizing the importance of molecular testing even in early-stage disease. In metastatic colorectal cancer, molecular stratification is essential. For BRAF V600E-mutated tumors, the BREAKWATER study demonstrates that targeted therapy in first-line combination with chemotherapy significantly improves response rates and survival. Additional targets such as HER2 and emerging immunologic and cellular therapies continue to expand treatment options.</p><p><strong>Conclusions: </strong>Colorectal cancer treatment is increasingly evolving into a precision oncology approach. Integration of molecular biomarkers enables tailored therapy decisions and opens new options, particularly in adjuvant and metastatic settings.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"1044-1052"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165849","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":"[Equity in healthcare through behavioral changes? : Choosing Wisely and co.]","authors":"Sebastian M Schellong","doi":"10.1007/s00108-026-02159-5","DOIUrl":"10.1007/s00108-026-02159-5","url":null,"abstract":"<p><p>An important component of medical care in line with demand is the prevention of overuse. Both internationally and in Germany, there are numerous examples of low-value care, i.e., measures that contribute neither to the health of the individual nor to the health status of entire patient or population groups in a meaningful way. These measures waste large shares of resources in healthcare and have harmful effects from a medical perspective for individuals as well as for the community. The driving forces behind overuse are diverse and lie both in systemic factors and in the personal behavior of doctors and patients. Since 2012, internationally with \"Choosing Wisely,\" and since 2015, in Germany with \"Klug entscheiden,\" initiatives have been in place aiming to effect behavioral change at a personal level. The tools are thematically well-focused recommendations that identify individual measures as low-value care, aiming to position doctors and patients at a critical distance from their application. The present article deals with the driving forces for medical overuse, describes the \"Choosing Wisely\" and \"Klug entscheiden\" campaigns, and attempts to estimate their potential effectiveness.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"970-977"},"PeriodicalIF":0.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551718","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}