The primary function of outpatient palliative care is to empower patients with life-threatening illnesses to optimize their quality of life by maximising their independence in their own home environment. In addition to a...The primary function of outpatient palliative care is to empower patients with life-threatening illnesses to optimize their quality of life by maximising their independence in their own home environment. In addition to addressing oncological diseases, the attention for palliative care towards non-oncological diseases is growing, a trend that is especially relevant for outpatient care. The early identification of the need for palliative care is of critical importance, as is the provision of effective palliative care within appropriate structures.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40436385
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The increasing frequency and intensity of wildfires, exacerbated by climate change, pose a significant threat to both the environment and human health. In addition to destroying ecosystems, these fires cause severe air p...The increasing frequency and intensity of wildfires, exacerbated by climate change, pose a significant threat to both the environment and human health. In addition to destroying ecosystems, these fires cause severe air pollution, particularly through fine particulate matter (PM2.5, diameter ≤ 2.5 µm), which can be transported over long distances. A recent example are the wildfires in Canada, whose smoke enveloped New York City in dense smog. Fine particulate matter increases the risk of cardiovascular and respiratory diseases, especially among vulnerable groups such as children, pregnant women, individuals with preexisting conditions, and the elderly. Globally, emissions from wildfires are linked to hundreds of thousands of premature deaths annually. Protective measures such as early warning systems, air filtration systems, and the use of masks can help reduce exposure. However, knowledge gaps remain, particularly regarding the specific components of pollutants and their interactions with environmental factors. Long-term research is essential to better understand the health impacts and to develop targeted prevention strategies. Wildfires underscore the urgent need for global climate protection measures and innovative approaches to public health preparedness.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40436384
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Lassa virus, Ebola virus, Marburg virus and Crimean Congo virus, as well as much rarer viruses that cause Viral Hemorrhagic Fevers (VHF), are zoonoses. Where these viruses are endemic, they cause both individual diseases...Lassa virus, Ebola virus, Marburg virus and Crimean Congo virus, as well as much rarer viruses that cause Viral Hemorrhagic Fevers (VHF), are zoonoses. Where these viruses are endemic, they cause both individual diseases, so-called "spill-over events" with isolated human cases after transmission from their animal reservoir, as well as epidemic outbreaks with cases of disease transmitted from person to person, and often high mortality. In this article, the focus will be on VHFs with the potential for human-to-human transmission; these diseases are so-called "high-consequence infectious diseases (HCID)" with partly considerable potential for epidemic spread and the risk of nosocomial disease transmission. In some cases, other viral infections without the possibility of human-to-human transmission, such as yellow fever or dengue fever, can also be accompanied by bleeding or multi-organ failure.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40436383
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We describe the case of a 79-year-old patient referred by a general practitioner because of chills, fever up to 39.2°C and nausea.Diagnostic workup revealed peripheral eosinophilia, abdominal livedo reticularis and a pro...We describe the case of a 79-year-old patient referred by a general practitioner because of chills, fever up to 39.2°C and nausea.Diagnostic workup revealed peripheral eosinophilia, abdominal livedo reticularis and a pronounced vascular risk profile with generalised arteriosclerosis. The patient was admitted to the hospital, diagnostic tests were performed, and management decisions were made.Atheroembolic disease with spontaneous cholesterol embolism.Depending on the source and size of the embolism as well as the localisation of the vascular occlusion, multiple symptoms are described in different organ systems. Skin manifestations (livedo, "blue toes") are the most common clinical manifestation. Diagnosis is confirmed by tissue biopsy. Treatment is symptomatic. Cornerstone is the aggressive reduction of cardiovascular risk factors.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40436382
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Polyvascular atherosclerosis is characterized by atherosclerosis in several vascular territories, leading to an extremely high risk of myocardial infarction, ischemic stroke, and cardiovascular death. These patients deri...Polyvascular atherosclerosis is characterized by atherosclerosis in several vascular territories, leading to an extremely high risk of myocardial infarction, ischemic stroke, and cardiovascular death. These patients derive a higher absolute risk reduction from preventive measures compared to individuals with monovascular atherosclerosis. The most important lifestyle factors are non-smoking and physical exercise. Pharmacological management includes lipid-lowering with an LDL-cholesterol target of <40mg/dl (1,0mmol/l) and blood-pressure control with a systolic target of 120mmHg. Diabetes type 2 in patients with polyvascular atherosclerosis should be treated with SGLT2-inhibitors and/or GLP1-receptor agonists. Patients with obesity and polyvascular disease should receive GLP1RA - regardless of the presence of diabetes. Thus, a comprehensive risk factor management in patients with polyvascular atherosclerosis is essential to improve long-term cardiovascular outcomes.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40436381
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Patients with polyvascular atherosclerosis are twice as likely to have cardiovascular events as patients with monovascular atherosclerosis. Anticoagulant therapy improves the prognosis and is therefore clearly recommende...Patients with polyvascular atherosclerosis are twice as likely to have cardiovascular events as patients with monovascular atherosclerosis. Anticoagulant therapy improves the prognosis and is therefore clearly recommended. Intensified anticoagulation is more effective in reducing risk but is associated with a higher risk of bleeding. Compared to patients with monovascular atherosclerosis, patients with polyvascular atherosclerosis benefit more, as the absolute risk of ischemic events is higher - with the same risk of bleeding.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40436380
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Polyvascular diseases are a severe, generalized form of atherosclerotic disease. They are often overlooked in routine clinical practice, despite being characterized by one of the highest cardiovascular event and mortalit...Polyvascular diseases are a severe, generalized form of atherosclerotic disease. They are often overlooked in routine clinical practice, despite being characterized by one of the highest cardiovascular event and mortality rates. Registry studies (e.g., REACH) recognized and investigated the severity of the disease early on. Randomized trials specifically designed for polyvascular diseases are needed in the future, especially with a view to adapting therapy accordingly. Until appropriate adaptations are scientifically supported, polyvascular patients should be identified and, if necessary, treated more strictly regarding their risk constellation.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388982
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A 20-year-old female patient was admitted via the medical emergency service to an accident and emergency department. Apart from obesity, no pre-existing medical conditions were known.The patient presented with hypotensio...A 20-year-old female patient was admitted via the medical emergency service to an accident and emergency department. Apart from obesity, no pre-existing medical conditions were known.The patient presented with hypotension, tachycardia, fever, somnolence and a brownish complexion. Computerised tomography revealed a diffuse cerebral oedema. Laboratory investigations demonstrated elevated inflammatory biomarkers, hyponatremia, renal failure, combined metabolic acidosis with severe ketonemia and slight lactatemia, primary hypothyroidism and adrenal failure. No indications for diabetes mellitus were obtained. The source of the infection could not be identified.Acute Addisonian crisis in the course of sepsis as the primary manifestation of autoimmune pluriglandular syndrome (APS) type 2.Due to treatment with initial hydrocortisone and broad-spectrum antibiotics, supportive measures and levothyroxine (in the further course) the situation could be stabilised within several days.The combination of the metabolism of starvation and endocrine diseases can lead to ketoacidosis in the absence of diabetes. The differential diagnosis of adrenal failure should be considered in this situation.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388981
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Bronchiectasis is a worldwide inflammatory disease with different epidemiology and heterogenous etiology. The disease burden is high for patients and economic costs can be immense. So far there are no special disease mod...Bronchiectasis is a worldwide inflammatory disease with different epidemiology and heterogenous etiology. The disease burden is high for patients and economic costs can be immense. So far there are no special disease modifying drugs available for patients with bronchiectasis other than cystic fibrosis. With rising numbers of newly diagnosed patients (prevalence 120/100000 in Germany) due to different reasons (idiopathic, postinfectious, genetic, asthma, COPD etc.) the awareness for this once called orphan disease should rise - not only among pulmonologists but also among general care practitioners. This article focuses on diagnostic algorithms and multimodal treatment options based on the latest studies and the recently published German bronchiectasis guideline from May 2024. It outlines what general care practitioners can do for their patients, what they should consider when treating an exacerbation and that special surveillance of these patients is needed in centers with expertise in this disease due to its complexity. With upcoming treatment options just as disease modifying drugs like DDP-1 inhibitors or inhaled antibiotics one can expect a change in disease treatment and outcome. Therefore, it is more and more important to raise awareness for bronchiectasis starting at the very basis when patients present at their general care practitioner with recurring productive cough, exacerbations, and further cardinal symptoms of bronchiectasis disease.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388980
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GLP-1 receptor agonists (GLP-1-RA) are emerging as promising agents beyond their established role in type 2 diabetes mellitus (T2DM) and obesity treatment, showing significant nephroprotective effects. The FLOW study dem...GLP-1 receptor agonists (GLP-1-RA) are emerging as promising agents beyond their established role in type 2 diabetes mellitus (T2DM) and obesity treatment, showing significant nephroprotective effects. The FLOW study demonstrated that semaglutide significantly slows the progression of chronic kidney disease (CKD) in T2DM patients. The nephroprotective mechanisms are multifactorial, including improved glycemic control, blood pressure reduction, antifibrotic, and anti-inflammatory effects. Early studies suggest that GLP-1-RA may also benefit patients without T2DM. Additionally, their combination with SGLT2 inhibitors is gaining relevance. Current evidence suggests that GLP-1-RA could play a key role in CKD management. Future studies will determine whether they can be established as a standard therapy to optimize care for high-risk patients.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388979
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People with diabetes mellitus have a significantly increased risk of developing cardiovascular diseases. The coexistence of these two conditions has a considerable impact on prognosis. In August 2023, the European Societ...People with diabetes mellitus have a significantly increased risk of developing cardiovascular diseases. The coexistence of these two conditions has a considerable impact on prognosis. In August 2023, the European Society of Cardiology published new guidelines that include specific recommendations for risk reduction in affected individuals. The key points of these guidelines, along with newly published data since then and their respective practical relevance, are presented in the following article.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388978
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Modern medicine, despite successful strategies to reduce preventable deaths in areas like traffic and workplaces, lacks comparable strategies. As cancer incidences are on the rise globally, early detection and interventi...Modern medicine, despite successful strategies to reduce preventable deaths in areas like traffic and workplaces, lacks comparable strategies. As cancer incidences are on the rise globally, early detection and intervention by targeted therapies can significantly improve treatment success. Furthermore, over 50% of severe cancer cases could be avoided or detected very early through targeted prevention. Especially for primary preventive measures so-called "Vision Zero" concepts could already be a reality today. Studies show the effectiveness and safety of the HPV vaccine, leading to significant reductions in HPV-associated cancers in countries where vaccination coverage is high. Despite improved national efforts, Germany ranks second to last in a European comparison of vaccination rates in eligible girls and boys.Similar trends are seen for early cancer detection programs. Only a fraction of eligible Germans participates in colorectal cancer screening, while the national program in the Netherlands achieves a 71% participation rate by being a low threshold offer. Molecular profiling and biomarker-guided therapy decisions after initial tumor diagnosis offer efficient and quality-assured treatment options. Installment of nationwide networks, that combine clinical competence centers and decentralized providers, enable a democratized access to modern diagnostics and precision treatment options.Vision Zero strategies, established in many societal areas, could be a blueprint for similar approaches in modern oncology. Despite significant health expenditures, the share for preventive measures remains low. Studies show that investments in prevention not only improve health but also have a high return on investment. A Vision Zero in oncology could not only improve care but also cut overall costs.
Kumlehn B, Brefka S, Verri FM
… +1 more, Denkinger M
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388977
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According to forecasts, 27 % of the German population will be aged 65 or over by 2050. Age-associated multimorbidity, functional impairment and need for care have a considerable impact on the healthcare system. A compreh...According to forecasts, 27 % of the German population will be aged 65 or over by 2050. Age-associated multimorbidity, functional impairment and need for care have a considerable impact on the healthcare system. A comprehensive geriatric assessment (CGA) is therefore essential to identify health risks at an early stage and make targeted treatment decisions. Numerous studies prove effectiveness of CGA regarding relevant clinical outcomes. In Germany, an S3 guideline with recommendations on CGA in hospitalised patients was published in 2024. There is also an S1 guideline with recommendations on assessment tools. Internationally, the UK, the Netherlands and Italy have published corresponding recommendations. In oncology, two guidelines recommend the systematic integration of CGA before starting cancer treatment. Guidelines emphasise the multidimensional and interprofessional implementation of CGA using standardised, validated instruments. In acute geriatrics, CGA has established as an integral part of care. Focussed screening is recommended in the emergency department. Orthogeriatric co-management has been shown to be associated with lower mortality and improved treatment outcomes. In oncology, CGA is becoming increasingly important for customising treatment. Prognostic tools such as the multidimensional prognostic index (MPI) enable targeted risk stratification. The implementation of CGA is hampered by limited time resources, staff shortages and inconsistent billing modalities. Clear recommendations on the selection of suitable assessment tools could improve utilisation and integration in the future. New technologies such as artificial intelligence and digital applications offer promising approaches for increasing efficiency. The development of a European guideline could help to establish CGA in various care structures.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388976
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The updated German S3 guideline on the prevention and treatment of obesity strongly recommends a multimodal lifestyle intervention, consisting of nutrition, exercise, and behavior therapy. Other options such as pharmacot...The updated German S3 guideline on the prevention and treatment of obesity strongly recommends a multimodal lifestyle intervention, consisting of nutrition, exercise, and behavior therapy. Other options such as pharmacotherapy and bariatric surgery should be used in combination with this basic treatment. Current nutritional strategies for moderate energy restriction are equivalent. Regular physical activity of 30-60 minutes per day is advised. At present, there is only rather limited access to obesity management programs in groups or individual face-to-face dietary counseling with only facultative and partial reimbursement by statutory health insurance (SHI). Recently, 2 digital health applications (DiGAs) have been approved for obesity treatment. Both DiGAs can be prescribed by medical doctors and are fully paid by SHI. Shared decision making is recommended considering patient-specific criteria and choices. The recently approved disease management program for obesity will hopefully facilitate an evidence-based obesity management.
Dtsch Med Wochenschr
· 2025 Jun · PMID 40388975
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Several new aspects concerning Raynaud's phenomenon (RP) are highlighted. Low weight is a known factor for the manifestation of RP, but RP may also be triggered by intended or unintended weight loss. RP is more frequent...Several new aspects concerning Raynaud's phenomenon (RP) are highlighted. Low weight is a known factor for the manifestation of RP, but RP may also be triggered by intended or unintended weight loss. RP is more frequent in presence of depression or anxiety disorders which may be revealed by questionnaires. The socioeconomic effect of RP is small in most of the patients; as far as they aren't engaged in professions with cold exposition, ability to work is not restricted. However, if systemic sclerosis (SSc) is the underlying disease of RP, disability rates are considerable due to finger necrosis and soft tissue damages. Capillaroscopy may be a decisive tool to disclose SSc being the underlying disorder for RP. However, a pathological capillaroscopy pattern is no proof of SSc and not diagnostic if antinuclear antibodies are absent; the predictive value of puffy fingers and specific antibodies is superior. Medical treatment is restricted to severe forms of RP, which are often caused by SSc. Calcium channel blockers have the highest propagation but should not be used in case of digital ulcers. Prostanoids seem to be of greater value, phophodiesterase inhibitors have a small effect and Bosentan may reduce the appearance of new ulcers. Botulinum-A may be considered if ulcers and pain are prevailing. With all options of treatment a considerable placebo effect has to be regarded. Promising case series for several drugs were followed by disillusioning controlled studies. Autologous fat or adipose-derived stem cell grafting is a recent therapeutic approach for SSc patients with severe and disabling course of disease who cannot use their hands anymore, but the best form of application is not yet determined.