Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2022
[White Paper - Improving the care of patients with impairments following sepsis and infections].
Hundreds of thousands of individuals who experience lasting sequelae after sepsis and infections in Germany do not receive optimal care. In this White Paper we present measures for improvement, which were developed by a multidisciplinary expect panel as part of the SEPFROK project. Improved care rests on four pillars: 1. cross-sectoral assessment of sequelae and a structured discharge and transition management, 2. interdisciplinary rehabilitation and aftercare with structural support, 3. strengthening the specific health literacy of patients and families, and 4. increased research into causes, prevention and treatment of sequelae. To achieve this, appropriate cross-sectoral care structures and legal frameworks must be created.
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Low back pain is the leading symptom of a family of inflammatory rheumatic diseases grouped under the umbrella term "spondyloarthritides". This paper discusses the main clinical, laboratory, and imaging features of spondyloarthritides in the diagnostic context of low back pain. It also highlights the current therapeutic principles of axial spondyloarthritis.
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Dtsch. Med. Wochenschr. · Apr 2022
[Role of cardiovascular magnetic resonance in cardiovascular diagnostics].
Cardiovascular magnetic resonance (CMR) has become an accepted method for noninvasive imaging in cardiology. As part of a multimodality concept, this method can contribute valuable diagnostic aspects, often even as a first-choice method in a variety of diseases. Currently the availability is still limited, but the increasing time efficiency, technical stability and the growing competence will lead to more guideline-compliant use. ⋯ As with any diagnostic method a qualified application is crucial. In recent years, the technique itself has become much more stable and consensus recommendations of the Society for Cardiovascular Magnetic Resonance are available for the main indications, both for the MRI scan procedure and for the evaluation. Appropriate qualifications and certification opportunities are offered both nationally and internationally.
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Dtsch. Med. Wochenschr. · Apr 2022
[Autoimmune Hepatitis - What is important for clinical practice?]
Autoimmune hepatitis is a rare but chronic autoimmune-mediated liver disease. Key features are elevated transaminases, hypergammaglobulinemia, presence of specific autoantibodies and typical histological features. Diagnostic scores are helpful in establishing the diagnosis. ⋯ First-line therapy includes steroids and azathioprine and results in biochemical and histological remission in the majority of patients. In most cases, lifelong therapy is required. Every patient should receive regular follow-up surveillance including biochemical parameters as well as sonography and elastography.
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Dtsch. Med. Wochenschr. · Apr 2022
[Safety and effectiveness of oral anticoagulation in patients with atrial fibrillation and renal insufficiency - a real-world perspective].
Non-vitamin-K dependent oral anti-coagulants (NOAC) are the current therapeutic standard for preventing strokes in patients with atrial fibrillation (AF) and should be preferred over vitamin K antagonists (VKA) in this indication. This recommendation applies also to patients with VHF and concomitant chronic kidney disease (CKD). ⋯ In addition, RWE in respect to the indication showed that the superiority of NOAC versus the VKA warfarin can also be extrapolated to phenprocoumon, the commonly used VKA in Germany. Furthermore, data include evidence that the typical progression of CKD appears to be less pronounced in individuals treated with NOAC compared to those treated with VKA.