Der Internist
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Outpatient specialist medical care targets the intersectoral and interdisciplinary cooperation between hospital physicians and panel physician structures in the diagnostics and treatment of certain disease symptoms under the same framework conditions. The administrative coordination bundled through one person has contributed to an effective placement of applications. In this way the daunting effect of bureaucratic hurdles for potential team members could be intercepted. A close and constructive collaboration of all participants is helpful to come to terms with the new treatment structure and to achieve the anticipated targets for patients, panel physicians and hospitals.
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For decades the healthcare treatment has persisted in the rigid boundaries of sectoral provision of services. Patients are all too often left to fall by the wayside, as loss of information and deficits in agreement between sectors are more often the rule than the exception. ⋯ The planning and safeguarding of treatment are cross-sectoral at a regional level. The latitude for innovative treatment solutions must be clearly extended beyond the innovation fund in order to adapt the healthcare to the altered requirements.
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Erdheim-Chester disease (ECD) is nowadays classified as belonging to those neoplasms with origins in the myeloid dendritic cell lines. The clonal alterations maintain a chronic inflammatory condition, which dominates the pathogenesis and clinical expression. Characteristic for ECD are many skeletal manifestations; however, the multisystem disease affects many other organs (including the respiratory tract, heart, retroperitoneum, eyes, central nervous system and endocrine system). ⋯ Up to the discovery of activating mutations, interferon-alpha was used as the first line treatment; however, in view of the superiority of kinase inhibitors, the first line treatment with interferon-alpha currently appears to be questionable. The prognosis for untreated ECD is exceptionally poor and interferon-alpha leads to a clear improvement. Further progress is hoped for with the use of targeted treatments.
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Since the early 2000s, legislators have allowed the establishment of medical care centers to supplement and increase the flexibility of medical cooperation models. Several legal changes in subsequent years were unable to prevent that, contrary to the original intention, almost 90% of the newly founded facilities were established in urban cores and medium-sized centers; that concentration processes and monopolization were encouraged; and that the freedom of choice for patients was restricted. ⋯ Regionally networked medical care center structures combine the advantages of optimized patient care with the growing desire of the younger generation of physicians for flexible working conditions within employment. With increasing acceptance on the part of the medical profession, networked medical care centers are able to create local structures for the expansion of modern intersectoral care and, at the same time, can be available for outpatient specialist training in internal medicine.
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Approximately 40% of patients with heart failure show cognitive deficits, such as concentration difficulties, attention deficits, and memory impairment. Affected patients have a higher rate of rehospitalization and an increased mortality. This could be due to low adherence mediated by a lack of disease-specific knowledge and strategies to deal with symptom exacerbation. ⋯ In this respect the heart failure itself as well as cardiovascular risk factors and comorbidities play a role. Orientating neuropsychological screening tests can show a first indication of the presence of cognitive impairment. When identified, the causes can be specifically treated and care can be optimized through certain measures, such as the involvement of caregivers and healthcare providers.