Deutsche medizinische Wochenschrift (1946)最新文献

Gastrointestinal infections are widespread and a major cause of global mortality, mainly affecting young children and the elderly. In Germany, each resident typically experiences one episode yearly. After COVID-19 pandemic, gastrointestinal infection rates have significantly increased again. Acute gastroenteritis typically presents with sudden stool changes, vomiting, and fever. In Germany, common pathogens include norovirus, rotavirus, Campylobacter spp., and Salmonella spp. New German guidelines on infectious gastroenteritis (published 2023) reflect recent studies and international treatment standards. The diagnosis of acute gastroenteritis should be based on clinical presentation and a thorough medical history, with stool testing reserved for severe cases or suspected outbreaks. Symptomatic treatment and rehydration of the patient are usually sufficient. Antibiotic treatment is generally not recommended except in severe cases, risk situations or the detection of specific pathogens.

Following medical studies and licensing, the choice of a specialty represents a critical starting point for female physicians' careers in Germany. With female doctors comprising 49,2% of the total physician workforce by the end of 2023, their influence in the medical field is undeniable. This demographic shift necessitates effective career planning, as women increasingly dominate medical specialties, including 62,8% in general practice and 51,9% in internal medicine compared to surgery (26,8%).The training phase is sensitive, coinciding with personal decisions regarding partnerships, family planning, and potential relocations. A structured approach to training is essential to navigate the complexities of specialty selection while managing personal aspirations and responsibilities. Regulatory frameworks from regional medical boards outline requirements and provide opportunities for part-time training to accommodate family needs. Networking and mentorship play pivotal roles in facilitating career advancement and addressing the unique challenges faced by female physicians.Building professional networks is crucial for career development. Mentorship offers invaluable guidance, while social media facilitates broader connections within the medical community. Effective communication is a key competency, fostering trust with patients and enhancing interdisciplinary collaboration.As female physicians continue to rise in numbers and influence within Germany's medical landscape, targeted strategies for career development, including networking and effective communication, are vital. The evolving training landscape underscores the importance of supportive structures that empower women in medicine to navigate their professional journeys successfully.

Atypical hemolytic uremic syndrome (aHUS) is an important differential diagnosis in thrombotic microangiopathy (TMA). The absence of definitive biomarkers usually allows for aHUS to be diagnosed only through a process of exclusion. Due to the unfavorable prognosis if adequate therapy is delayed or not provided, differential diagnostic considerations and initiation of treatment must occur promptly. The presented guideline is intended to serve as an aid in this process.

Compression therapy is a recognized method for reducing oedema and should be used for venous and lymphatic disorders. It is important to differentiate between phleboedema and lymphoedema, as different bandaging techniques and materials are used in each case. This article provides an insight into this.

In addition to the one-year advanced training program in infectious diseases that has been in place for several years, a six-year-full specialist training in internal medicine and infectious diseases (ID) has recently been introduced in Germany. While recommendations for ID training program curricula were developed, there is no description of genuine ID activities in Germany, nor have any working standards been defined to date. However, this seems to be necessary, both for the structural implementation of ID in German hospitals and for ensuring the quality-of-care. The current article therefore outlines standards for core ID activities as well as quality requirements for efficient ID training programs. As long as no separate speciality for pediatric ID is established in Germany, these principles should also apply in paediatrics and adolescent medicine.

German surveillance data from 2022 reported a prevalence of nosocomial infections among hospitalized patients of 5,2%. Clostridioides-difficile-infections (CDI) are the most frequent cause of nosocomial diarrhea. They are usually caused by antibiotic exposure and the subsequent changes in the gut microbiota. Clinical manifestation ranges from asymptomatic colonization over moderate diarrhea to severe pseudomembranous colitis. According to the current German Gastrointestinal Infection Guidelines, fidaxomicin is the preferred treatment option for CDI, especially in patients at high risk of recurrence or those already suffering from recurrence. Vancomycin can also be used as an alternative for initial CDI treatment. Fecal microbiota transplantation is considered a treatment approach for patients with multiple recurrences.

Traveler's diarrhea is a common and, in most cases, self-limiting illness among long-distance travelers. Pathogen diagnostics are indicated for severe or dysenteric courses as well as for increased risk of severe courses. A central component of pathogen diagnostics is stool culture. To detect specific pathogens, this is expanded to include stool microscopy, PCR, and antigen diagnostics. If there is a fever, a blood culture and, depending on exposure, malaria diagnosis should be carried out. Empirical anti-infective therapy is only indicated for febrile or bloody diarrhea or if there is a high risk of a severe course. To further guide therapy, pathogen detection should be sought. Qualified travel advice should always be provided before traveling.

The German Maternity Protection Act was first enacted in 1952 and has since been revised multiple times to ensure the protection of pregnant employees. The 2018 reform introduced significant updates to align the law with the modern labor market and the needs of expectant mothers. The aims are twofold: protecting the health of mothers and their unborn children and reducing occupational disadvantages.One of the most important measures that employers have been required to implement since 2018 is the individual risk assessment. This workplace analysis takes into account the pregnant employee's health condition and the specific workplace environment. The goal is to enable pregnant women to continue working whenever possible, with general employment restrictions only applied when absolutely necessary.A key example of the feasibility and importance of individual risk assessments can be seen in demanding medical fields such as cardiology and internal intensive care medicine. These fields often present potential health risks due to exposure to infectious agents or the physical strains associated with shift work. As a result, medical societies and employers are called upon to develop tailored protection plans that enable pregnant physicians to continue working, provided that neither their own health nor that of their unborn child is at risk. It is therefore more important for more professional societies to address the topic of pregnancy and maternity protection, to inform their members about the legal framework and guidelines, and to provide them with a template on how to practically facilitate professional participation during pregnancy and breastfeeding in their respective fields or individual stages of training.This approach could serve as a model for other medical societies. A position paper evaluating all stages of training within each field could help provide clear guidance on occupational safety during pregnancy, reducing uncertainty for both employees and employers.