Deutsche medizinische Wochenschrift (1946)最新文献

Delirium is an acute, fluctuating neurocognitive disorder characterized by disturbances in consciousness and attention. Unlike dementia, delirium has somatic causes and is reversible if the triggers are identified and treated. Elderly people are particularly at risk, especially those in hospitals or long-term care facilities.Its development is multifactorial. The threshold concept explains the interaction of predisposing factors such as age, dementia, multimorbidity, malnutrition, substance use, and triggering factors such as surgery, infections, pain, and immobilization. Early detection and risk minimization are important, such as promoting sleep, orientation, fluid intake, mobilization, and familiar caregivers. Screening should be carried out regularly for people at risk. The causes of infections, electrolyte imbalances, and fractures should also be clarified. The first measures taken are non-pharmacological, such as training, enhanced orientation, environmental design, sleep, mobilization, pain management, and family integration. Pharmacological measures have a purely symptomatic effect and may be useful in cases of hyperactive delirium with self-harm or harm to others. Interprofessional collaboration is always important for successful delirium management.

The proportion of patients over the age of 80 in intensive care is steadily increasing as a result of demographic change. According to recent European studies, around 10-15% of all intensive care patients belong to this age group. Age-related changes and increased susceptibility to complications highlight the importance of individually tailored, situation-specific intensive care for this patient group. This plays a decisive role in all treatment decisions, alongside multimorbidity and the risk of age discrimination. Modern intensive care for geriatric patients should be designed to pay increasing attention to frailty and functional parameters as markers for outcome.

Intensive care units must always be prepared to admit or accept critically ill patients for intensive care monitoring or therapy. External admissions can take place via the emergency physician or transfers from other hospitals, while internal patients can be transferred, for example from normal wards, the emergency department or functional areas such as the operating room (OR), cardiac catheterization laboratory, interventional radiology. All relevant information should be communicated during these handovers to ensure maximum patient safety. We would like to raise awareness of the possible dangers and risks of handovers in intensive care medicine and, at the same time, offer a proposal for a comprehensive, structured patient handover, taking into account existing handover schemes with a "4-phase model", with a focus on the necessary thought processes before and after the actual handover.

In recent years, the care of critically ill patients in the emergency room has become increasingly complex. The transition from the shock room to the intensive care unit is a particularly critical point at which it is decided whether initial stabilization will be transferred to structured care or whether there will be delays, loss of information or deterioration. Despite its importance, the interface between the resuscitation room and the intensive care unit is often poorly managed in terms of organization and communication in many hospitals. This article aims to highlight the various aspects of this interface, identify risks and suggest strategies for improvement.

Flow cytometry is an essential part of hematological stepwise diagnostics. It is the gold standard for diagnosing a range of hematological neoplasms. When performed and interpreted correctly, flow cytometry enables complex hematological diagnoses to be made within a very short time - provided that the indication and interpretation are correct.

In particular, the use of next-generation sequencing has led to the identification of many monogenic autoinflammatory diseases in recent years. This enormous increase in knowledge has contributed significantly to understanding new disease mechanisms and clearly defining clinical pictures. In addition, these studies make it possible to classify diseases into groups based on common pathophysiological mechanisms.

Serum/plasma thyroglobulin (TG) levels and neck ultrasonography are currently the mainstay of postoperative monitoring in patients with differentiated thyroid cancer (DTC). TG can be determined as a tumor marker in these patients under required levothyroxine treatment at TSH suppressive doses. The immunologic determination of TG as a laboratory parameter in the follow-up of thyroid malignancies always requires confirmation of the test result in order to detect interfering variables. There are two commonly used options: first, the TG recovery rate and second, the determination of anti-TG autoantibodies (TGAb). However, neither test adequately addresses the issue of correct TG determination. Heterophilic antibodies are another important source of interference. Mass spectroscopic TG determination is a more complex alternative that can be used in inconclusive cases.