Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2024
[Rheumatoid arthritis: Appraisement of the new security warnings for JAK-inhibitors].
Januskinase-Inhibitors (JAKI) are highly effective substances (JAKi) for the treatment of rheumatoid arthritis (RA). In terms of efficiency in reduction of disease activity and induction of remission they are partially prior to biologic (b) DMARDs. Presently the four substances tofacitinib, baricitinib, upadacitinib and filgotinib are approved for the treatment of RA. ⋯ On the basis of this trial the Committee for Medical Products for Human Use (CHMP) of the European Medicines Agency (EMA) formulated actual recommendations for prescription of JAKi in order to reduce the risk of severe undesirable effects. These apply not only for tofacitinib but as well for all other JAKI named above, as a class effect was supposed. The data and their consequences are discussed and evaluated in this work.
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In clinical practice, dementia must be distinguished from other disorders of cognition, social behavior, and emotional control. A dedicated stepwise diagnosis must differentiate reversible causes with urgent need for action from slowly progressive processes.
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Understanding genetic predisposition has a significant impact on the management of patients with endocrine tumours, including therapy, early detection and prevention. These tumours, which develop as part of a familial predisposition, often manifest early in life and frequently affect several endocrine organs. In the following article, both common syndromes, such as multiple endocrine neoplasia (MEN) syndromes, and rare syndromes, such as familial isolated pituitary adenoma (FIPA), are presented based on their indicator diseases.
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Dtsch. Med. Wochenschr. · Mar 2024
[After intensive care therapy : Outpatient intensive nursing care].
Outpatient intensive nursing care offers individuals who require specialized intensive nursing care on a permanent basis the opportunity to survive outside of an intensive care unit in an ambulatory environment. With advancements in surgical and intensive medical practices, coupled with demographic changes in the population resulting in a higher number of older, multimorbid patients, the available treatment options have been continuously extended. ⋯ Presently, this group constitutes the majority of patients receiving outpatient intensive nursing care in Germany and represents a substantial cost factor in healthcare. The care of these patients is governed by the Guideline of the Joint Federal Committee on the Prescription of Outpatient Intensive Nursing Care (AKI-RL), which is based on the Intensive Care and Rehabilitation Strengthening Act (GKV-IPReG) 2021.
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Many intensive care patients are affected by serious persistent or new physical, cognitive, psychological, and social consequences after discharge (post-ICU syndrome). This has an impact on the rest of life as well as the prognosis. To reduce or avoid these complications and structured treatment after discharge must be essential goals of intensive care medicine. ⋯ Ultimately, the treatment of intensive care patients must not end when they are discharged from the intensive care unit or hospital. Patients at risk for the very different facets of a PICS must be identified and linked to appropriate care institutions. This requires the establishment of post-ICU facilities, such as consultation hours in clinics or outpatient clinics.