Deutsche medizinische Wochenschrift (1946)最新文献

The growing proportion of women in medical studentship and medical practice contrasts with their under-represented role in leadership positions in medical professional associations in Germany. Against this background, the proportion of women in top positions of medical professional associations in Germany has been analysed.A total of 1460 individuals were counted in the analysis of the composition of the boards/presidia of the 183 professional societies. The proportion of women on the boards/executive committees was 32.6%. Of the 183 professional societies, 47 (25.7%) were led by a woman as president. 72 (39.3%) women served as vice presidents. Only 39 (21.3%) professional societies had a proportion of women on the boards/executive committees ≥50%.There is a significant imbalance of female leadership positions in medical professional associations in Germany. To address this inequality, a strategy with multiple initiatives is needed that includes both career development programmes such as mentoring and the design of congress participation to ensure a balanced gender representation.

Systemic sclerosis (SSc) is a connective tissue disease of multifactorial origin in which autoimmune inflammatory reactions lead to fibrosis of multiple tissues. In the past, renal crisis was a common complication with a very high mortality. Due to the recommendation for a more cautious use of corticosteroids and the use of ACE inhibitors as an acute treatment reduced the incidence of a renal crisis and improved overall survival since the 1980s. However, lung involvement including pulmonary arterial hypertension, interstitial lung disease and lung fibrosis is now the most common cause of death in SSc. An early detection, including the use of HR-CT screening, and adequate treatment of interstitial lung disease are therefore of the utmost importance. Mycophenolate mofetil (MMF) has proven to be an effective therapeutic agent for the pulmonary manifestation. Nintedanib is the only drug approved in Germany for SSc-associated progressive lung fibrosis. Studies have shown the best prognostic improvements with early combination therapy of MMF in combination with Nintedanib.

Acute pancreatitis (AP) is a potentially life-threatening disease, often progressing in 2 phases: initial sterile inflammation, followed by later infected necrosis. Advances in care have shifted management toward a minimally invasive, step-up approach. AP is diagnosed based on typical abdominal pain, elevated lipase, or characteristic imaging - amylase is no longer essential. In hypertriglyceridemic AP, plasmapheresis offers no proven benefit. (Endo)sonography is mandatory. Contrast-enhanced CT should be delayed unless necrosis is suspected or diagnosis remains uncertain; optimal timing is ≥72h, ideally after 7 days. Prognostic tools (BISAP, Ranson) and markers (hematocrit, lactate, BUN) are insufficient to predict severe or necrotizing AP. Post-hoc, the revised Atlanta classification may be more effective than the determinant-based classification. Emergency ERC (<24h) is only warranted in cholangitis. Without cholangitis, ERC within 72h is adequate; biliary sphincterotomy and pancreatic stenting reduce post-ERC pancreatitis. Opioids are superior to NSAIDs and are first-line for analgesia. Early, goal-directed fluid resuscitation with balanced crystalloids improves outcomes, while excessive fluids (>3mL/kg/h) should be avoided. Enteral/oral nutrition within 24h reduces the risk of infected necrosis and is preferred over parenteral feeding. Antibiotic prophylaxis is not recommended, even in necrotizing AP; infected necrosis is rare in the first 2 weeks. Procalcitonin may support therapeutic decisions. Necrosis should be managed stepwise: antibiotics, then drainage, then delayed minimally-invasive necrosectomy. Endoscopic access is preferred; open surgery is obsolete. Outcomes improve significantly in specialized, high-volume centers with critical care, interventional endoscopy/radiology, and pancreatic surgery expertise.

Antimicrobial prophylaxis is an important cornerstone for reducing morbidity and mortality of cancer patients. Important strides have been made in recent years in vaccination, drug prophylaxes and the use of growth-factor support. We detail these changes to the respective recommendations here.Patients with malignant disease are recommended to receive vaccinations against common respiratory pathogens (COVID-19, influenza, pneumococci, and RSV). For both influenza (now trivalent vaccine) and pneumococci (now PCV20), the preferred vaccine has changed. A VZV vaccination using an inactivated virus-subunit is also recommended to prevent reactivations. The profound B-cell depletion caused by CAR-T cell therapy is increasingly being considered in vaccination recommendations.In high-risk situations, antibiotic prophylaxis using fluoroquinolones can be used. However, due to increasing resistance and significant side effects, this approach is being critically evaluated.Posaconazole is recommended as the standard prophylaxis for patients with neutropenia >7 days (<0,5G/L) and hematologic malignancies. Isavuconazole offers an effective alternative for patients who cannot tolerate posaconazole. Interactions between antifungal agents and oncological therapies are becoming increasingly relevant, with particular attention to the CYP-450-enzyme inducing/inhibiting substances. Non-pharmacological measures to prevent fungal infections are now part of the recommendations. These include smoking cessation.Pharmacological prophylaxis for COVID-19 is generally not recommended.The thresholds for primary growth-factor-support have been lowered: G-CSF is generally recommended if the risk of febrile neutropenia is >20%, or, if patient inherent risk factors are present, >10%. A new long-acting, non-PEG-containing G-CSF preparation was approved in 2024.Good collaboration between oncologists and general practitioners is essential to translate these recommendations into clinical practice.

According to long-term studies, patients with adrenal insufficiency (AI) exhibit a reduced quality of life and increased mortality. In addition to cardiovascular and malignant diseases, the risk of mortality is particularly increased by adrenal crises. Fatal adrenal crises could be completely prevented by timely intravenous or subcutaneous administration of glucocorticoids. In the case of an established diagnosis of AI, a deterioration in the general condition, gastroenteritis symptoms, exsiccosis and a clinical picture of sepsis must lead to the suspicion of an adrenal crisis. However, the diagnosis is only confirmed by the response to glucocorticoids. So-called check-point inhibitors are becoming increasingly important as a cause of AI. Therefore, AI and adrenal crises continue to pose a challenge for patients, their relatives and the treating physicians.

Atrial fibrillation (AF) is the most common arrhythmia among patients with cardiomyopathies and cardiac channelopathies, significantly increasing the risk of thromboembolic events and heart failure. This review aims to provide an overview on the management of AF in these populations, focusing on the integration of the "AF-CARE" concept, introduced in the 2024 ESC guidelines. AF-CARE emphasizes a comprehensive approach involving rhythm and rate control, stroke prevention, and the management of comorbidities. Given the elevated thromboembolic risk, anticoagulation decisions are guided by the specific cardiomyopathy and the CHA2DS2-VA score. Recent evidence supports rhythm control as the preferred strategy over rate control for better clinical outcomes. Continuous monitoring and individualized care are recommended to optimize long-term prognosis and quality of life in these patients.

Heart failure and atrial fibrillation are among the most common cardiovascular diseases and are closely linked in terms of development, pathophysiology, and prognosis. In addition to shared risk factors, direct pathophysiological interactions have been shown to mutually promote the development and progression of each condition. It is therefore essential to recognize and treat both diseases in parallel.

The "Green Intensive Care Unit" addresses the challenge of reducing the ecological footprint of the healthcare sector, which is responsible for 4.4% of greenhouse gas emissions worldwide. In Germany, the healthcare sector accounts for 5.2% of national emissions. Intensive care units in particular are resource-intensive due to their high energy consumption, waste generation and the use of disposable materials. Sustainability in intensive care medicine aims to combine ecological responsibility with excellent patient care. This includes the introduction of overarching sustainability strategies, greater digitalization and the efficient use of resources. Energy-efficient equipment, improved waste management systems and the targeted optimization of processes reduce the consumption of resources. Conscious handling of medicines, appropriate use of protective materials and the use of sustainable materials also help to minimize the ecological footprint. In addition, the promotion of palliative care and advanced care planning makes it possible to avoid overuse while ensuring the quality of patient care. These approaches are based on a current S1 guideline (by the DGIIN) and offer practicable solutions to promote sustainability in intensive care medicine without compromising on care. Successful implementation requires a deep awareness of sustainable action and close integration with higher-level healthcare structures.