Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2024
Review[Clinical reasoning, the art of medicine and artificial intelligence].
"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.
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The human brain is a remarkable organ which, in addition to many vital functions, is also extremely adaptable and capable of learning. As a result, the brain is a highly individual organ that is shaped by culture. This complicates the search for a universally valid reason that must be anchored in the brain.
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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. ⋯ 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.
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Renal infarction is a rare cause for an acute renal failure. At the time being, there is no sufficient correlation to the consumption of cannabis described. ⋯ The correlation between thrombo-embolic events and the consumption of cannabis has to be more explored because of its recent legalization in Germany. It should be considered as a cardiovascular risk factor. Until today there are no recommendations for the anticoagulants.
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Menopause is an increasingly discussed topic in recent years. More women are demanding consultancy and help from their doctors via different channels, be it online or in menopause centers. The term genitourinary syndrome of menopause (GSM) comprises vaginal and urological symptoms such as mucosal dryness, itching and burning, dysuria or bleeding and pain during sexual intercourse. ⋯ Fezolinetant, a Neurokinin-3 receptor antagonist, is now available in Germany for the treatment of vasomotor symptoms in postmenopausal women with contraindications or aversion against steroid hormones. It modulates the thermoregulation center in the hypothalamus by blocking the KNDy-neurons. Studies on Elinzanetant, another representative of this class of drugs, are still ongoing.