Deutsches Arzteblatt international最新文献

Background: Now that the Cannabis Act legalizing the use of cannabis has come into effect in Germany, the frequency of cannabis use in Germany may rise, and with it the number of cannabisrelated visits to emergency departments.

Methods: In this narrative review, we identify and evaluate the observed trends in case numbers after cannabis legalization in other countries, the common reasons for emergency department visits, and the options for treatment. Data on trends in cannabis-related emergency contacts in Germany were provided by the Poison Control Center North and are evaluated descriptively.

Results: The prevalence of cannabis use in Europe is estimated at 8%. In Canada, after legalization, cannabis use among the total population aged 15 years and over rose from 15% in 2017 to 25% in 2021, and hospital admissions doubled from 15/100 000 in 2017 to 32/100 000 in 2022. Acute intoxication is the most common reason for hospital admission and is often accompanied by acute anxiety and panic attacks. The risk of developing psychosis increases with THC content and frequency of use. Cannabinoid hyperemesis syndrome manifests itself with abdominal pain and severe, cyclical vomiting. The most important acute measure is to replace the often massive fluid loss. Benzodiazepines and antipsychotic drugs can be given as symptomatic treatment.

Conclusion: The legalization of cannabis use can be expected to lead to an increase in cannabis-related emergencies in Germany as well. As the clinical manifestations are often nonspecific, the targeted investigation of possible cannabis use is indicated so that the affected patients can be given appropriate treatment and assistance.

Background: Well-organized programs for colorectal cancer (CRC) screening with fecal occult blood testing (FOBT) can reach over 70% of the eligible population. FOBT was opportunistic in Germany up to 2019. Until March 2025, it was offered annually to persons aged 50 to 54 and twice per year to persons aged 55 and above. Cross-sectional analyses revealed only moderate annual adherence rates, but it remained unclear whether the tests were used regularly by a small share of the population or sporadically by a large share of the population.

Methods: We used anonymized data from BARMER, a German statutory health insurance carrier, to study trends in adherence to annual FOBT screening among persons aged 50 to 54 over the years 2010-2022. The data pertained to 945 214 men and women who were born in the period 1960-1968.

Results: Despite the offer of annual screening, only 22.5% of men and 55.1% of women had at least one FOBT between the ages of 50 and 54. Only 0.1% of men and 1.8% of women used the screening annually as offered. The use of screening has declined even further in recent years. CRC was found in 1.4% of follow-up colonoscopies in both men and women.

Conclusion: The opportunistic mode of offering annual FOBT for CRC screening in Germany is highly ineffective, as most of the eligible population did not have even a single test from age 50 to age 54.

Background: Patients with cancer suffer from cancer- and treatment-specific, psychosocial and care-related stress and mental disturbances.

Methods: This article is based on pertinent publications retrieved by a search in PubMed, as well as on the German clinical practice guideline on psycho-oncology.

Results: The most common mental disorders in cancer patients are anxiety disorders, affective disorders, and adjustment disorders. The point prevalence of any mental disorder in patients with cancer is 20% to 50%. Common disease-associated psychological symptoms include distress (a non-specific experience of emotional discomfort), demoralization, and fear of cancer recurrence or progression. These can cause severe suffering even if they do not meet the diagnostic criteria for any particular mental disorder. Mental comorbidity is associated with complications of treatment, lesser adherence to treatment, lower quality of life, and increased mortality. Psychotherapeutic interventions are effective and show moderate to large effects in current meta-analyses with respect to the reduction of anxiety and depression and improvement in quality of life. These effects persist over several months of follow-up. The empirical evidence for psychopharmacotherapy in cancer patients is limited. Psychopharmacological treatment should be integrated into an overall psycho-oncological treatment plan.

Conclusion: A large body of evidence shows that mental comorbidity is common among cancer patients and harmful to them. Psychotherapeutic interventions lessen the symptoms of mental distur - bances and improve quality of life. Nonetheless, despite improvements in recent years, there are remaining barriers to the adequate provision of psychosocial care.

Background: With approximately 1.6 million people affected in Germany, atrial fibrillation (AF) is the most common arrhythmia. The management of AF, from prevention to treatment, including anticoagulation, is therefore of major clinical importance in terms of these patients' quality of life and their mortality.

Methods: This first German clinical practice guideline on AF was developed in accordance with the Regelwerk Leitlinien (rules for guidelines) of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizi - nischen Fachgesellschaften e. V., AWMF). The available evidence on all relevant issues was retrieved by a systematic literature search and evaluated with the participation of many medical specialty societies.

Results: AF is classified on clinical grounds as paroxysmal, persis - tent, longstanding persistent, or permanent. It is associated with a 1.5- to 2-fold increase in mortality and a 4- to 5-fold increase in the risk of stroke. Nonetheless, general screening for AF is not currently recommended, as the data on this question are conflicting. Lifestyle interventions and the reduction of risk factors lessen the frequency of AF. Female sex is only a minor risk factor; the CHA2DS2-VA-Score is recommended to assess the risk of thromboembolic events. If it is 2 or higher, oral anticoagulation (OAC) is indicated, of a type that should be decided on an individual basis. In patients with cardiovascular risk factors, early rhythm control has been shown to reduce prognostically relevant cardio - vascular endpoints (3.9 versus 5.0 per 100 patientyears). Multiple studies have shown that catheter ablation is superior to drug-based antiarrhythmic therapy in patients with paroxysmal symptomatic AF as well as in those with heart failure and AF.

Conclusion: It is hoped that the recommendations contained in this guideline will lead to intensified measures for the prevention of AF, resulting in a lower prevalence of AF and its adverse sequelae. The available evidence supports the evaluation of the indications for OAC, early rhythm control, and the use of catheter ablation, especially in patients with paroxysmal AF or heart failure.