Pub Date : 2024-09-06DOI: 10.3238/arztebl.m2024.0108
Jan Hoffmann, Angela Kribs, Martin Dübbers, Carsten Hagenbeck, Nadine Scholten
{"title":"Implementation of the Joint Federal Committee's Quality Assurance Guideline for Premature and Full-Term Neonates—The Allocation of Newborn Infants by Hospital Care Level in Germany.","authors":"Jan Hoffmann, Angela Kribs, Martin Dübbers, Carsten Hagenbeck, Nadine Scholten","doi":"10.3238/arztebl.m2024.0108","DOIUrl":"10.3238/arztebl.m2024.0108","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 18","pages":"608-609"},"PeriodicalIF":6.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.3238/arztebl.m2024.0137
Benedikt Kolbrink, Nassim Kakavand, Jakob C Voran, Helena U Zacharias, Axel Rahmel, Serge Vogelaar, Silke Schicktanz, Felix Braun, Roland Schmitt, Friedrich A von Samson-Himmelstjerna, Kevin Schulte
Background: Rigid age limits in the current allocation system for post-mortem donor kidneys in Germany may have problematic effects. The new German national transplantion registry enables data analysis with respect to this question.
Methods: Using anonymized data from the German national transplantion registry, we extracted and evaluated information on the recipients and postmortem donors of kidneys that were allocated in Germany through Eurotransplant over the period 2006-2020.
Results: Data on 19 664 kidney transplantations in Germany from 2006 to 2020 were analyzed. The median waiting time for kidney transplantation was 5.8 years. Persons under age 18 waited a median of 1.7 years; persons aged 18 to 64, 7.0 years; and persons aged 65 and older, 3.8 years. Over the period of observation, postmortem kidneys were transplanted into 401 people of age 64 (2.0% of all organ recipients) and 1,393 people of age 65 (7.1% of all organ recipients). The difference in waiting times between allocation programs for persons under age 65 (ETKAS, "Eurotransplant Kidney Allocation System") and those aged 65 and older (ESP, "Eurotransplant Senior Program") increased over the period of observation, from 2.6 years in 2006-2010 to 4.1 years in 2017-2020.
Conclusion: The rigid age limits in the current allocation rules for post-mortem kidney donations in Germany are prolonging the waiting times for transplants among patients aged 18 to 64. We think these rules need to be fundamentally reassessed.
{"title":"Allocation Rules and Age-Dependent Waiting Times for Kidney Transplantation.","authors":"Benedikt Kolbrink, Nassim Kakavand, Jakob C Voran, Helena U Zacharias, Axel Rahmel, Serge Vogelaar, Silke Schicktanz, Felix Braun, Roland Schmitt, Friedrich A von Samson-Himmelstjerna, Kevin Schulte","doi":"10.3238/arztebl.m2024.0137","DOIUrl":"10.3238/arztebl.m2024.0137","url":null,"abstract":"<p><strong>Background: </strong>Rigid age limits in the current allocation system for post-mortem donor kidneys in Germany may have problematic effects. The new German national transplantion registry enables data analysis with respect to this question.</p><p><strong>Methods: </strong>Using anonymized data from the German national transplantion registry, we extracted and evaluated information on the recipients and postmortem donors of kidneys that were allocated in Germany through Eurotransplant over the period 2006-2020.</p><p><strong>Results: </strong>Data on 19 664 kidney transplantations in Germany from 2006 to 2020 were analyzed. The median waiting time for kidney transplantation was 5.8 years. Persons under age 18 waited a median of 1.7 years; persons aged 18 to 64, 7.0 years; and persons aged 65 and older, 3.8 years. Over the period of observation, postmortem kidneys were transplanted into 401 people of age 64 (2.0% of all organ recipients) and 1,393 people of age 65 (7.1% of all organ recipients). The difference in waiting times between allocation programs for persons under age 65 (ETKAS, \"Eurotransplant Kidney Allocation System\") and those aged 65 and older (ESP, \"Eurotransplant Senior Program\") increased over the period of observation, from 2.6 years in 2006-2010 to 4.1 years in 2017-2020.</p><p><strong>Conclusion: </strong>The rigid age limits in the current allocation rules for post-mortem kidney donations in Germany are prolonging the waiting times for transplants among patients aged 18 to 64. We think these rules need to be fundamentally reassessed.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"559-565"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.3238/arztebl.m2024.0107
Joachim Berkefeld, Björn Misselwitz, Marco Stein
{"title":"Quality Assurance in Aneurysmal Subarachnoid Hemorrhage.","authors":"Joachim Berkefeld, Björn Misselwitz, Marco Stein","doi":"10.3238/arztebl.m2024.0107","DOIUrl":"10.3238/arztebl.m2024.0107","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":"121 17","pages":"573-574"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.3238/arztebl.m2024.0147
Philipp Ivanyi, Tabea Fröhlich, Viktor Grünwald, Stefanie Zschäbitz, Jens Bedke, Christian Doehn
Background: Approximately 15 000 people receive a diagnosis of renal cell carcinoma (RCC) in Germany each year; in 20-30% of cases, metastatic RCC (mRCC) is already present at the time of diagnosis. This disease in the metastatic stage is still mainly treated palliatively, yet the multimodal therapeutic landscape has changed markedly over the past 15 years, with the approval of many new treatments for patients with mRCC.
Methods: This review is based on prospective studies retrieved by a selective search in PubMed and the ASCO and ESMO databases and on the German and European oncological and urological guidelines for RCC.
Results: Drugs are the mainstay of treatment. mRCC can be treated with a combination of two immune checkpoint inhibitors (CPIs), a CPI and a tyrosine-kinase inhibitor (TKI) (evidence level IA), or a TKI as monotherapy (evidence level IIC-IC). With prognosis-based sequential drug treatment, a mean progressionfree survival of 12 to 24 months and an overall survival of approximately 50 months can be achieved from the time of initiation of first-line therapy. Aside from pharmacotherapy, the multidisciplinary tumor board should evaluate the indications for local treatments such as cytoreductive nephrectomy, metastasectomy, and radiotherapy, depending on the individual prognostic constellation and the patient's present condition.
Conclusion: Optimal individualized decisions require a high level of expertise and the collabo - ration of a multidisciplinary tumor board. Older prognostic parameters currently play a leading role in decision-making, while predictive parameters and molecular markers are not yet adequately validated.
{"title":"The Treatment of Metastatic Renal Cell Carcinoma.","authors":"Philipp Ivanyi, Tabea Fröhlich, Viktor Grünwald, Stefanie Zschäbitz, Jens Bedke, Christian Doehn","doi":"10.3238/arztebl.m2024.0147","DOIUrl":"10.3238/arztebl.m2024.0147","url":null,"abstract":"<p><strong>Background: </strong>Approximately 15 000 people receive a diagnosis of renal cell carcinoma (RCC) in Germany each year; in 20-30% of cases, metastatic RCC (mRCC) is already present at the time of diagnosis. This disease in the metastatic stage is still mainly treated palliatively, yet the multimodal therapeutic landscape has changed markedly over the past 15 years, with the approval of many new treatments for patients with mRCC.</p><p><strong>Methods: </strong>This review is based on prospective studies retrieved by a selective search in PubMed and the ASCO and ESMO databases and on the German and European oncological and urological guidelines for RCC.</p><p><strong>Results: </strong>Drugs are the mainstay of treatment. mRCC can be treated with a combination of two immune checkpoint inhibitors (CPIs), a CPI and a tyrosine-kinase inhibitor (TKI) (evidence level IA), or a TKI as monotherapy (evidence level IIC-IC). With prognosis-based sequential drug treatment, a mean progressionfree survival of 12 to 24 months and an overall survival of approximately 50 months can be achieved from the time of initiation of first-line therapy. Aside from pharmacotherapy, the multidisciplinary tumor board should evaluate the indications for local treatments such as cytoreductive nephrectomy, metastasectomy, and radiotherapy, depending on the individual prognostic constellation and the patient's present condition.</p><p><strong>Conclusion: </strong>Optimal individualized decisions require a high level of expertise and the collabo - ration of a multidisciplinary tumor board. Older prognostic parameters currently play a leading role in decision-making, while predictive parameters and molecular markers are not yet adequately validated.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"576-586"},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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