Deutsche medizinische Wochenschrift (1946)最新文献

Rapid advancements in Artificial Intelligence (AI) have significantly impacted multiple sectors of our society, including healthcare. While conventional AI has been instrumental in solving mainly image recognition tasks and thereby adding in well-defined situations such as supporting diagnostic imaging, the emergence of generative AI is impacting on one of the main professional competences: doctor-patient interaction.A convergence of natural language processing (NLP) and generative AI is exemplified by intelligent chatbots like ChatGPT. A first study that has compared the empathy and quality of responses between ChatGPT and human physicians in a healthcare setting has shown that ChatGPT can outperform human physicians in both quality and empathy of answers to medical questions. The results suggest that generative AI models like ChatGPT could serve as valuable adjuncts in medical consultations, potentially improving patient engagement and reducing clinician workload.

Beyond the role: WHO WE CAN TRULY BE AS DOCTORS. WHY PROFESSIONAL IDENTITY FORMATION IS MORE THAN KNOWLEDGE AND SKILLS: How do we become - and remain - the kind of doctors we truly aspire to be? This article explores how self-reflection and teaching methods from narrative medicine can open up space for developing a professional identity within medical training. From clinical, educational, and lived illness perspectives, the authors argue that vulnerability, subjectivity, and humanity are fundamental to the medical profession.

Tremor is the most common movement disorder in clinical neurology and it significantly impacts patients' quality of life. In primary care, particularly among older adults, differentiating between tremor types is essential for early diagnosis and appropriate management, especially when Parkinson's disease is suspected. This review provides a concise overview of tremor classification and diagnostic strategies, with a focus on distinguishing Parkinsonian tremor from other common tremor syndromes such as essential, dystonic, functional, orthostatic, and secondary tremors.Key clinical characteristics, including tremor type (rest, postural, kinetic, re-emergent), frequency, distribution, and associated neurological signs, are discussed in detail. The hallmark of Parkinsonian tremor, an asymmetric resting tremor with a "pill-rolling" quality and possible re-emergence after postural, is highlighted as a critical diagnostic clue, particularly when accompanied by bradykinesia and non-motor prodromal symptoms such as REM sleep behaviour disorder, constipation, or hyposmia.The article outlines a pragmatic diagnostic pathway, including clinical examination, structured anamnesis, medication review, and the use of neuro-imaging or DAT-SPECT when indicated. Therapeutic options are also discussed, ranging from dopaminergic medication to advanced interventions like deep brain stimulation or focused ultrasound for refractory tremor. The review aims to support non-expert clinicians in making accurate early diagnoses and initiating therapy.

Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system (CNS). Approximately one million people are affected worldwide; in Germany the prevalence is approximately 250,000. The disease typically manifests in young adulthood between the ages of 20 and 40, with women affected approximately three times more often. Due to its sociomedical significance, knowledge of the disease and current treatment options is essential for general practitioners, even though the disease is likely to be relatively rare in primary care practices.

Polyneuropathies are among the most common neurological diseases and the complaints they cause are a frequent reason for a consultation in general medical care. Around 5-8% of people over the age of 55 are affected, with an upward trend due to the ageing population, the increase in diabetes mellitus and many new neurotoxic drugs. As the name "poly" indicates, several peripheral nerves are affected. Depending on the cause, motor, sensory or even autonomic nerves can be affected individually or in combination. Sensory and motor symptoms occur (sensitive: numbness, prickling, tingling, unsteady gait and sharp, jabbing, throbbing or burning pain; motor: muscle cramps, muscle weakness, skeletal deformities). Clinically, polyneuropathies usually present insidiously with these symptoms and frequently with pain in the feet, often symmetrical and distally emphasized ("stocking pattern"). The disease can affect the insulating layer of the nerves (myelin) and/or the extension of the nerve cell (neurite, axon) itself. The etiology is diverse, ranging from metabolic to toxic to genetic causes. Early diagnosis is crucial in order to treat any underlying disease and, if possible, prevent progression and complications. This paper describes the causes of polyneuropathies and, in particular, a valuable diagnostic procedure for investigating the causes. It is emphasized that the physiological loss of nerve fibers in older patients can also be the cause of a (mild) polyneuropathy or, in the sense of a "double crash", can trigger a clinically manifest polyneuropathy together with another possible cause.

General practice is 'talking medicine' and communication is an essential part of every medical activity, and also influences key outcome parameters (e.g. adherence, healing success) and even job satisfaction of physicians. In this article, the principles of patient-centred communication (in contrast to physician-centred communication) were described. Basic techniques such as active listening, paraphrasing, reflecting and summarizing were taught with formulation examples. Case examples illustrate typical consultations in practice where patient-centred communication is indicated and helpful. Furthermore, tips are given on how to deal with patients' emotions and reactance. At last, the importance of good training and owns self-care is emphasised.

Climate change is the greatest existential threat to planetary and human health, driven by shifts in the Earth's weather and atmospheric conditions due to human activities. It causes extreme temperatures, increased droughts, wildfires, dust storms, coastal flooding, storm surges, hurricanes, and various compounded events. The impacts of climate change on health are complex and include pathways that contribute to non-communicable diseases like cardiovascular disease. A collaborative effort among medical professionals, researchers, public health officials, and policymakers is crucial to mitigate the effects of global warming. This review provides an overview of how climate change affects cardiovascular health through direct exposures like temperature changes, air pollution, wildfires, dust storms, and extreme weather conditions. We also identify vulnerable populations and suggest mitigation strategies.

Pneumonia is one of the most important nosocomially acquired infections in Germany. Rational management strategies contribute to optimizing treatment and minimizing the development of resistance. The calculated antimicrobial therapy should take into account the severity, the risk of multi-resistant pathogens and P. aeruginosa as well as the local resistance situation. The infection occurs more frequently in non-ventilated patients, yet the evidence for ventilator-associated pneumonia is better, mainly due to easier microbiological diagnostics. The spectrum of pathogens does not differ significantly between the two disease entities. E. coli, K. pneumoniae, P. aeruginosa and, in the gram-positive spectrum, S. aureus and S. pneumoniae are the most common pathogens detected. Early detection, particularly in sepsis, followed by targeted diagnostic measures are relevant managing the disease. Calculated antibiotic therapy taking into account the severity of the disease and the patient's individual risk of multi-resistant pathogens, should be administered promptly. A re-evaluation of the diagnosis and therapy after 48-72 hours is crucial for the success of treatment and the rational use of antibiotics. All findings obtained to confirm the diagnosis and assess the course of the disease should be reviewed with regard to the accuracy of the diagnosis, the therapeutic response and the possibility of optimizing antibiotic therapy. If there is a response to treatment, which is primarily expressed in a clinical improvement, the recommended treatment duration of 7 days should not be exceeded. If there is no improvement in symptoms, microbiological findings, complications and differential diagnoses should be checked. Pharmacokinetic and pharmacodynamic principles should be considered with regard to the substances and the duration of application and dosage.