Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2021
[Specialist examination: Is the current format still up-to-date?]
The non-standardized oral specialist examination is the final step of the specialist medical training in Germany. The debate on its current format has long been at the centre of discussions on further training policies. The purpose of this article is to draw attention to relevant structural deficits of the German specialist examination - also in comparison to German-speaking neighboring countries and pan-European developments - and to provide possible approaches to a more structured oral examination.
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Dtsch. Med. Wochenschr. · Sep 2021
[When people with type 1 diabetes become adults - Diabetes technology and transition - do we need new models?]
Approximately 40 % of adolescents with type 1 diabetes lose contact with specialty care at transfer to adult care, with a marked increase in risk for poor outcomes. Adolescents showed a 2,5-fold increased risk of an HbA1c level > 9 % after transfer, compared with adolescents who remained in pediatric care. While the use of modern technologies is rapidly increasing in pediatric diabetology, fewer resources are available to address the rapidly changing digital transformation of type 1 diabetes therapy in adult diabetology, not least because of the large number of patients with type 2 diabetes who require care. ⋯ One possible solution would be the creation of regional treatment centers with pediatric and internal medicine care for people with intensive diabetes therapy and use of diabetes technology, as well as the use of telemedicine capabilities. International comparisons show that in centers where pediatric and internal medicine diabetes teams provide age-appropriate care within the same treatment facility, the transition is much less complicated and people with type 1 diabetes benefit from shared experience in the use of diabetes technologies across the lifespan. However, the implementation of such concepts under the framework of the German health care system requires a rethinking among the involved stakeholders and does not seem promising without pressure from the affected people with type 1 diabetes.
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Dtsch. Med. Wochenschr. · Sep 2021
[Managing transition - Medical follow-up care for adults with congenital heart defects].
Currently, due to medical advances, more than 500 000 patients with congenital heart defects (CHD) are living in Germany, including more than 330 000 adults. In CHD, the aspect of transition from childhood and adolescence to adulthood is becoming increasingly important to ensure long-term success of the provided treatments. ⋯ Adults with congenital heart defects in Germany are insufficiently managed by existing specialized and accredited care structures, despite the great need for follow-up, and their care is largely provided by primary care physicians (general practitioners and internists) and non-specialized cardiologists. Optimized, future-oriented care requires regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD in the long-term course.
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Dtsch. Med. Wochenschr. · Sep 2021
[Rheumatic diseases - Transition from pediatric to adult-oriented care].
Adolescence and young adulthood represent a vulnerable phase of life, especially for young people with a chronic rheumatic disease. On the one hand, the chronic disease can impair the biopsychosocial development of young people. On the other hand, risk behaviour common in adolescence and young adulthood can negatively influence the course and outcome of the rheumatic disease. ⋯ To ensure continuity of care and the best possible outcomes for those affected, young people need education, support, and guidance. They must be prepared to be appropriately responsible and capable of managing their own health and well-being as adults. The key principles to be considered in the care of adolescents and young adults with rheumatic diseases and what is known so far about transitional care in rheumatology are presented in this paper.
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Type-2-diabetes (T2D) increases the risk for several cancers and cancer has become the major cause of death of T2D-patients. T2D is causally associated with colorectal, pancreatic, gallbladder, biliary, hepatocellular, gastric, esophageal, oral, breast, endometrial, ovary, kidney and thyroid cancers as well as leukemias. When T2D goes along with tobacco smoking, alcohol use, physical inactivity, excess body weight, poor diet, familial risk or certain chronic infections, the cumulative cancer risk rises, and T2D-patients often suffer from cancer disease at younger age. T2D-patients should be encouraged to join cancer screening programmes even at younger age than the average non-diabetic population.