Deutsche medizinische Wochenschrift (1946)最新文献

{"title":"[Endoscopy in Inflammatory Bowel Diseases: From Proven to New].","authors":"Timo Rath, Markus F Neurath","doi":"10.1055/a-2344-7995","DOIUrl":"https://doi.org/10.1055/a-2344-7995","url":null,"abstract":"<p><p>Inflammatory bowel diseases with the 2 main forms - ulcerative colitis and Crohn's disease - are chronic relapsing diseases of the gastrointestinal tract in which dysregulation of the intestinal immune system against commensal components of the microbiome leads to perpetuated intestinal inflammation based on a genetic predisposition. While in the past symptom control was the focus of therapy, more recent data show that achieving endoscopic remission is superior to sole clinical symptom control for the further course and prognosis of the diseases. In this review article, we will present the significance of endoscopy for inflammatory bowel diseases, describe established scoring systems for endoscopic graduation of inflammatory activity and, last but not least, also present and review new endoscopic developments.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"419-426"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756768","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":"[Hospital service groups and quality indicators - A cross-comparison for pneumonia, ischemic stroke, and colorectal resection for carcinoma].","authors":"Ulrike Nimptsch, Daniel Schmithausen, Claudia Winklmair, Reinhard Busse, Boris Augurzky, Ralf Kuhlen","doi":"10.1055/a-2530-3973","DOIUrl":"10.1055/a-2530-3973","url":null,"abstract":"<p><p>In Germany, the Hospital Care Improvement Act (Krankenhausversorgungsverbesserungsgesetz) will introduce service groups for hospital reserve financing. The hospital planning of the federal states is also intended to allocate care contracts to hospitals based on service groups in conjunction with structural quality criteria. This paper analyzes service group-specific differences in treatment case characteristics as well as differences in process and outcome quality indicators.The study used the frequent treatment causes of pneumonia, cerebral infarction and colorectal resection for carcinoma as examples. Administrative data for the year 2023 from 422 hospitals were analyzed. Treatment cases were assigned to NRW hospital service groups and, in a cross comparison, to figures of the German Inpatient Quality Indicators (G-IQI).For the treatment causes of pneumonia (N=129666), cerebral infarction (N=95762) and colorectal resection for carcinoma (N=16578), more than 60% of cases were assigned to one dominant service group, while the remaining cases were distributed across different service groups. Care characteristics differed according to the service group assignment. For example, intracranial thrombectomy was documented in 10.3% of cases with cerebral infarction overall (9856 of 95762 cases). In the \"Stroke Unit\" service group, this proportion was 11.3% (6790 of 60246 cases), in the \"General Neurology\" service group it was 5.7% (836 of 14692 cases).The assignment of cases to service groups primarily reflects the type of care. To promote the intended control effect with the aim of increasing the hospital's specialization, the classification of service groups might be more strongly oriented towards the clinical care requirements of relevant treatment causes.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":" ","pages":"e18-e27"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665493","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":"[Multimorbidity in endocrinological diseases: Clinical implications of PCOS].","authors":"Sita Arjune, Cornelius Bollheimer, Ruth Hanßen","doi":"10.1055/a-2365-9507","DOIUrl":"https://doi.org/10.1055/a-2365-9507","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) is one of the most common endocrinological disorders in women of reproductive age. It affects up to 15% of this population worldwide and is characterized by a complex hormonal, metabolic and reproductive dysfunction. In this article, the multimorbidity of PCOS is reviewed, with a particular focus on the clinical implications and management of this complex disorder.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"496-502"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813222","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":"[70-year-old male patient with Polycythaemia vera and chronic leg ulcer].","authors":"Daniel Craus, Valentina Laura Müller, Alexander Kreuter","doi":"10.1055/a-2432-7259","DOIUrl":"https://doi.org/10.1055/a-2432-7259","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"403-404"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756716","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":"[New and current therapeutic goals of chronic inflammatory bowel disease].","authors":"Raul Lande, Irina Blumenstein","doi":"10.1055/a-2335-5901","DOIUrl":"https://doi.org/10.1055/a-2335-5901","url":null,"abstract":"<p><p>Chronic inflammatory bowel diseases (IBD), such as Crohn's disease (MC) and ulcerative colitis (CU), are serious immune-mediated diseases that affect the gastrointestinal tract and represent a considerable burden for patients. In recent decades, the treatment of IBD has shifted from symptomatic control to more precise, long-term goals. Advances in IBD research have led to therapy goals having been redefined and expanded in order to achieve complete inflammation control and prevent complications in the long term.An important component of modern therapeutic approaches is the definition of specific markers that serve as indicators for the achievement of these therapeutic goals. These markers enable objective monitoring of the success of treatment and thus offer a clear approach for controlling the therapy. The present article focuses on the new therapeutic goals in IBD treatment and discusses the role of therapeutic target markers in clinical practice.A central goal in modern IBD therapy is endoscopic healing, i.e. the complete macroscopic healing of the intestinal mucosa. In clinical practice this includes in particular an ulcer-free mucosa. In contrast to clinical remission alone, endoscopic healing provides an objective assessment of the inflammatory state and correlates strongly with an improved long-term prognosis.The histologic remission goes beyond endoscopic healing and aims to endoscopic healing to no longer detect signs of inflammation at the microscopic level. This is particularly relevant as the results show that patients who achieve a complete histological remission have an even lower recurrence rate and better long-term results than those who only achieve a clinical or endoscopic remission.Even though no curative therapy for IBD currently exists, the complete cure remains the ultimate goal of research. In current practice, this goal is still unattainable in current practice, but progress in genetic and immunological research offers hope. In the long term, the aim is to innovative approaches such as gene editing or immunotherapy to cure the disease. This could mean that patients are not only free of symptoms, but also freed from the burden of the disease in the long term.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"427-432"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756776","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":"[Advanced therapies: Un update on medical treamtent options in Crohn`s disease].","authors":"Agnieszka Kafel, Clara Rodriguez de Castro Zalona, Chiara Seiz, Elisabeth Schnoy","doi":"10.1055/a-2368-7173","DOIUrl":"https://doi.org/10.1055/a-2368-7173","url":null,"abstract":"<p><p>Crohn's disease is a chronic inflammatory bowel disease (IBD) that can manifest throughout the entire gastrointestinal tract from mouth to anus. It is characterized by so-called \"skip lesions\", which are affected sections of the intestine interspersed with healthy sections. In recent years, there have been significant progress and an expansion of medical treatment options for Crohn's disease with the approval of many new substances. Treatment goals have also become more ambitious, going beyond clinical symptom control to mucosal healing and, according to the STRIDE II criteria, to transmural healing in Crohn's disease in the future. If these goals are achieved, patients with Crohn's disease have a good chance of remaining in long-term remission and can expect fewer complications such as disease progression, hospitalization, anemia, fistulas, strictures, or surgeries. Despite having access to a variety of different substance classes in the treatment of Crohn's disease, in everyday practice we can see that these medications are not effective for some patients in the long-term. There is a so-called \"therapeutic ceiling\" in IBD, meaning that only about 40-50% of those affected are successfully managed long-term with one substance. Therefore, new medical treatment options for Crohn's disease always represent an opportunity to treat patients even better.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"405-411"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756719","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":"Demedikalisierung – weniger ist oft mehr.","authors":"Hans-Michael Mühlenfeld","doi":"10.1055/a-2492-9679","DOIUrl":"https://doi.org/10.1055/a-2492-9679","url":null,"abstract":"","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 8","pages":"438-450"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756784","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":"[Cardiovasular diseases and multimorbidity].","authors":"Markus Gosch, Matthias Pauschinger, Thomas Deneke","doi":"10.1055/a-2361-1753","DOIUrl":"https://doi.org/10.1055/a-2361-1753","url":null,"abstract":"<p><p>Cardiovascular diseases such as arteriosclerosis, arterial hypertension, heart failure or atrial fibrillation are most prevalent in advanced age and usually occur in combination with multimorbidity and functional deficits. Recommendations from guidelines can therefore only be applied to these patient groups to a limited extent. Due to the complexity and vulnerability of multimorbid, older adults, an interdisciplinary approach to care is required. For the future, there is a great need for studies that include these patient groups, also taking into account other outcome parameters.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"481-486"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812973","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":"[Multimorbidity and the Kidney].","authors":"Anna Maria Affeldt, Lena Pickert, Thomas Benzing, Ute Hoffmann","doi":"10.1055/a-2360-2837","DOIUrl":"https://doi.org/10.1055/a-2360-2837","url":null,"abstract":"<p><p>Multimorbidity, i.e. the simultaneous presence of 2 or more diseases, is common in patients with chronic kidney disease (CKD). Cardiovascular diseases such as coronary heart disease, heart failure, stroke or vascular dementia are of particular importance. CKD and comorbidities influence each other, which is why the current KDIGO guidelines emphasize the need for personalized treatment approaches. This applies in particular to older patients, who are especially frequently affected by CKD. The diagnosis of CKD patients should not only include typical comorbidities, but also a comprehensive risk assessment and an evaluation to avoid polypharmacy.Recognising CKD is of particular importance for patients with chronic diseases in old age, as kidney disease can have a profound effect on or worsen the course of other diseases and the limitation of kidney function has a significant influence on the treatment approach. Particular attention must be paid to the correct assessment of kidney function in older people in terms of determining the estimated glomerular filtration rate (eGFR). Here, a measurement of serum creatinine is not always sufficient due to lower muscle mass and may need to be supplemented by additional parameters to estimate the glomerular filtration rate, such as cystatin C.Depending on the eGFR, kidney disease is categorized into the stages CKD G1-G5. In addition, if kidney disease is suspected, a test for proteinuria should also be performed, preferably as a measurement of albumin excretion in spontaneous urine (albumin-to-creatinine ratio, ACR). Geriatric screening and assessment are also crucial to recognize the multimorbidity, frailty and psychosocial aspects of older patients.The treatment of multimorbidity in CKD patients focusses on progression reduction and secondary and tertiary prevention, whereby a healthy lifestyle, regular exercise and a balanced diet are also important. The prevention of cardiovascular disease, particularly in the case of high blood pressure and diabetes mellitus, requires individualized therapy, in which the choice and dosage of medication must also be taken into account, particularly in the case of advanced renal impairment. If heart failure and/or atrial fibrillation are also present, close interdisciplinary collaboration between nephrologists, cardiologists and GPs is helpful in order to optimize treatment. In addition, CKD patients with dementia face particular challenges in terms of medication and the avoidance of delirium and mental symptoms.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":"150 9","pages":"487-495"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813114","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":"[Healthcare landscape in internal medicine in Germany: A trend analysis over 10 years for the German Society of Internal Medicine (DGIM)].","authors":"Dirk Müller-Wieland, Elke Berger, Phillip Hengel, Reinhard Busse, Georg Ertl, Norbert Suttorp","doi":"10.1055/a-2328-6929","DOIUrl":"https://doi.org/10.1055/a-2328-6929","url":null,"abstract":"<p><p>The aim of the project is to analyse the status of the inpatient and outpatient care landscape with regard to medical staff, care structures and performance developments for internal medicine and its specialities.Various data sources were used, including the German Medical Association, the National Association of Statutory Health Insurance Physicians, the Federal Statistical Office and structured hospital quality reports.According to the German Medical Association, 58000 internists were registered in 2020, 45% (n=26,400) of whom worked in the inpatient sector and 48% (n=28,000) in the outpatient sector. The proportion of female, younger, part-time and salaried employees is increasing. The proportion of internists among all general practitioners rose from around 25% or 25,200 in 2013 to over 30% or 29,300 in 2020.According to the structured quality reports, 34% (n=166000) of the 494000 hospital beds in 2019 were allocated to internal medicine and 33% of these (n= 54500) to the various specialties. The number of beds per population remained almost unchanged from 2010 to 2017, both for internal medicine as a whole and across all specialities.In 2019, a good 7.2 million (36%) of the almost 20 million inpatient cases were treated in internal medicine departments. Of these, 69% or 5.0 million were in general internal medicine with an average length of stay of 6.9 days. In relation to general and specialized internal medicine, number of hospital beds, medical staff and cases differed from region to region.The proportion of younger, female, part-time and salaried doctors in internal medicine is increasing. The development of internal medicine varies regionally, which should be taken into account when reforming the healthcare system.</p>","PeriodicalId":93975,"journal":{"name":"Deutsche medizinische Wochenschrift (1946)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733723","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}