Deutsche medizinische Wochenschrift (1946)最新文献

This article explores potential future scenarios for the medical field based on current trends, technological advancements, and social dynamics. By examining advances in artificial intelligence, immersive technologies, genomics, and digital health infrastructure, the paper envisions a healthcare system poised for transformative change. The anticipated role of AI as a digital assistant in diagnostics, resource management, and personalized medicine is highlighted, alongside the implications for clinical workflows. Immersive technologies, such as VR and AR, promise enhancements in medical education, patient care, and therapeutic interventions. Advances in genomics and gene editing technologies such as CRISPR further open possibilities for personalized treatment regimens and potential cures for genetic diseases. However, these innovations introduce new ethical challenges around privacy, data security, and clinical accountability. The article also addresses the healthcare implications of climate change, aging populations, and global conflicts, urging preparedness and resilience within healthcare systems. Taken together, it emphasizes the need for a balanced approach to innovation, integrating ethical considerations to foster a future where medicine remains empathetic and human-centered, even as it becomes more data-driven and technologically complex.

The success story of haematology and oncology extends from Virchow's concept of "cellular pathology" to the possibilities of personalized cancer therapy, which molecular oncology offers today. This article highlights the beginnings and developments of chemotherapy, immunotherapy, as well as molecular oncology and psycho-oncology over the past 150 years.

The development of emergency medicine reflects the progressive professionalization and structuring of one of the oldest fields of medicine. From the first rescue stations in Vienna to modern emergency departments, this article shows the significant progress and challenges that have led to today's comprehensive emergency care, which have been decisively accompanied and shaped by the Deutsche Medizinische Wochenschrift over the last 150 years.

An important prerequisite for ascertaining rational antibiotic prescribing is the availability and evaluation of antibiotic use data. In this study we report evolving trends of antibiotic use in German hospitals during the last decade.Using drug dispensing data from acute care hospital pharmacies, we calculated yearly antibiotic use density values for the period from 2012/13 through to 2021/22. Use density was expressed as daily doses per 100 patient days, using both hospital adapted doses of antibiotics ("recommended daily dose", RDD) as well as WHO-"defined daily doses" (DDD). The 2021/22 data were extrapolated to estimate the hospital consumption in DDD per 1000 population and day.The overall antibiotic use density remained stable during the observation period. It was 41.9 RDD/100 patient days (median, n=169 hospitals, interquartile range 35-48 RDD/100) in the year 2012/13 and 42.1 RDD/100 (median, n=329, interquartile range 35-48 RDD/100) in the year 2021/22, respectively. The estimated national use per population in 2021/22 was 1.85 DDD per 1000 inhabitants and day. The antibiotic use levels in university hospitals (54.0 RDD/100) were higher than in non-university hospitals that showed a similar use density across different hospital size categories (medians between 39.8 and 44.0 RDD/100). Overall, penicillin use increased over time (change in proportion +63%), while fluoroquinolones (- 54%) and first and second generation cephalosporins (- 41%) were prescribed less frequently. Antibiotic use density in intensive care units was approximately twice as high as in normal wards. High levels of antibiotic use were also observed in haematology-oncology divisions at teaching hospitals (median 96.8 RDD/100), in urology (medians between 65.1 and 70.5 RDD/100) and oto-rhino-laryngology (medians between 49.1 and 60.9 RDD/100) and urology divisions.During the last decade, there was no increasing use of antibiotics in German acute care hospitals. We observed shifts in selected drug classes, in particular an increasing use of penicillins. The estimated hospital antibiotic consumption per population was slightly above the European average.

Chronic constipation is one of the most common health disorders in all of medicine. Its extent ranges from mild discomfort, which is usually easy to improve, to severe functional limitations that may significantly reduce quality of life and may be refractory to various treatment approaches. Our understanding of the pathomechanism has grown considerably in recent years and has also led to important new therapeutic developments. The resulting treatment options and recommendations are presented in the current update of the S2k constipation guideline in an evidence-based and practical manner. The respective significance of traditional and recent drug developments is classified and categorized in modern "step-up" treatment strategies. In particular, numerous important aspects of everyday practice are addressed, such as questions on long-term treatment and therapeutic options in specific constellations (adequate treatment of constipation in older people, constipation during pregnancy, and drug-induced [especially opioid-induced]constipation).The most important new developments (i.e. new therapeutic approaches, but also re-evaluations of "traditional" laxatives and the importance of careful diagnostics in therapy-refractory patients) are summarized in this article.

"Clinical reasoning" refers to all the thought processes that physicians use to make a diagnosis and determine a treatment and care plan. Artificial intelligence (AI) will enhance, improve, and accelerate human clinical diagnostic thinking, but it is unlikely to replace it. Its application in medicine has the potential to drastically reduce medical diagnostic errors and give doctors more time to care for their patients. Here, we provide an overview of some of the key elements of clinical diagnostic reasoning and the potential impacts of AI on clinical reasoning.

An effective patient handover is a core element of high-quality patient care. Communication during patient handover in the intensive care unit is particularly challenging due to the clinical complexity and rapid changes in patient trajectories, complex interdisciplinary and interprofessional interfaces, linguistic barriers, situational and structural disruptive factors, personnel stress factors as well as the communication and error culture of the teams. In addition to avoiding disruptive factors and creating optimal communication conditions and human resources, the use of standardized and structured handovers with the help of protocols and checklists, as recommended in the literature, plays a decisive role as part of a bundle of measures for effective and safe patient care.

While genetic kidney diseases were long regarded as a rare cause of kidney failure, it has been shown in recent years that they account for a relevant proportion of cases. In cohorts of kidney transplant recipients, a monogenic cause is found in up to 30% of cases. Identifying the genetic cause of kidney disease has become much easier thanks to technological advances in DNA sequencing. The focus has now shifted to understanding the significance of the findings and identifying diagnostic gaps. It is still not possible to clarify all CKD cases of unclear aetiology. Besides very effective generic treatments for monogenic kidney disease (e.g., ACE-inhibitor use in Alport Syndrome), increasing knowledge of the pathophysiology of genetic kidney diseases has led to a growing number of targeted therapies. These include the treatment of ADPKD with Tolvaptan, which has now been in use for 10 years. Recently, exciting, and completely new approaches have been added, such as the first siRNA therapies in nephrology for primary hyperoxaluria type 1, the targeted treatment of hyperphagia in Bardet-Biedl syndrome, the therapy of APOL1-associated kidney disease or the use of the HIF-2 antagonist Belzutifan for renal cell carcinoma associated with Von-Hippel-Lindau syndrome. The new possibilities in the treatment of patients with genetic kidney diseases have also clearly revealed deficits in current patient care. Centers of excellence with extensive experience in this area therefore play an important role in improving care. This also applies to the further training of colleagues in the field. In Germany, the National Action Alliance for People with Rare Diseases (NAMSE) and the nationwide establishment of - to date - 36 centers for rare diseases play an important role in this regard.

There is a legal entitlement to participate in outpatient exercise groups in accordance with the German Social Code (Book IX) which regulates and facilitates prescriptions for patients with chronic respiratory diseases. A medical examination with specific inclusion and exclusion criteria prior to admission to an exercise group ensures safe participation.Traditional outpatient exercise groups are conducted in face-to-face groups for 60 to 90 minutes, once a week, with structured warm-up, main and cool-down phases. In addition, since the coronavirus pandemic, the introduction of online exercise groups via videoconferencing has enabled flexible participation (even without a prescription). To date, more than 11,000 German patients have participated in online exercise groups since 2021.Scientific evidence confirms the significant benefits of regular exercise, such as improved physical performance and reduced breathlessness. The psychosocial benefits and the promotion of self-efficacy are additionally supported by the supervision of a specialized trainer. Regular exercise (e.g. in outpatient exercise groups) is an inexpensive and very effective form of therapy to improve the quality of life of people with chronic respiratory diseases.