Dtsch Med Wochenschr
· 2026 May · PMID 42150539
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Musculoskeletal complaints of the shoulder/pelvic girdle are symptoms frequently described in patient care and are attributed to degenerative changes associated with increasing patient age. Polymyalgia rheumatica(PMR) is...Musculoskeletal complaints of the shoulder/pelvic girdle are symptoms frequently described in patient care and are attributed to degenerative changes associated with increasing patient age. Polymyalgia rheumatica(PMR) is the second most common differential diagnosis of an inflammatory genesis after rheumatoid arthritis and should be ruled out. Patients diagnosed with PMR exhibit symptoms such as acute weakness, pain, morning stiffness in the neck, shoulders and pelvis. The manifestation of B-symptoms is possible. The clinical examination should encompass differential diagnoses and complications, such as giant cell arteritis. Laboratory testing shows elevated levels of inflammatory markers in almost all cases. Arthrosonography reveals tenosynovitis of the biceps tendon, bursitis or joint effusion of the hip. The initial treatment for PMR is the administration of steroids. In cases of disease activity, methotrexate, sarilumab or rituximab may be considered as potential treatment options.
Prelog M, Gärtner B, Leischker A
… +3 more, Rieger C, Vonberg RP, Schwarz TF
Dtsch Med Wochenschr
· 2026 May · PMID 42081914
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In October 2024, the Standing Committee on Vaccination (STIKO) adjusted its recommendation on seasonal influenza vaccination for people aged 60 and over. Based on new study data, the MF59-adjuvanted influenza vaccine is...In October 2024, the Standing Committee on Vaccination (STIKO) adjusted its recommendation on seasonal influenza vaccination for people aged 60 and over. Based on new study data, the MF59-adjuvanted influenza vaccine is now recommended as equivalent to the high-dose vaccine: The MF59-adjuvanted vaccine was shown to be superior in terms of effectiveness compared to non-adjuvanted standard vaccines in older adults. The immune response to the adjuvanted vaccine was broader and stronger than to the standard vaccine. The MF59-adjuvanted vaccine had a similar safety profile to the high-dose vaccine, both showing slightly increased local and systemic reactogenicity compared to the standard vaccine. STIKO believes that recommending both vaccines could increase acceptance and willingness to be vaccinated in the target population.
Dtsch Med Wochenschr
· 2026 May · PMID 42081913
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Surgical and endovascular procedures are established treatments for extracranial stenoses of the internal carotid artery (ICA) according to current guidelines. Revascularization is generally recommended for symptomatic I...Surgical and endovascular procedures are established treatments for extracranial stenoses of the internal carotid artery (ICA) according to current guidelines. Revascularization is generally recommended for symptomatic ICA stenoses between 50% and 99%. For asymptomatic stenoses, optimal medical therapy is the primary focus; revascularization should be considered for stenoses between 60% and 99%, depending on the individual risk. The choice between endarterectomy (CEA) and carotid artery stent implantation (CAS) is made by an interdisciplinary team, considering patient- and anatomy-specific factors. Interventional therapy is well-established; however, studies show an increased incidence of minor strokes and transient ischemic attacks (TIAs), which is why patient selection and embolic protection are becoming increasingly important in the field of endovascular revascularization. Technological advancements, such as innovative double-layer stents for improved plaque coverage, increase the safety of the procedure, and reduce the peri-procedural stroke rate. Anatomical features are essential for successful treatment when selecting devices and planning procedures.
Dtsch Med Wochenschr
· 2026 May · PMID 42081912
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Invasive treatment of carotid stenosis is directed towards the prevention of ischemic stroke. Contemporary guidelines, based on the best available evidence, recommend carotid endarterectomy for symptomatic carotid stenos...Invasive treatment of carotid stenosis is directed towards the prevention of ischemic stroke. Contemporary guidelines, based on the best available evidence, recommend carotid endarterectomy for symptomatic carotid stenosis of 50-99%. Revascularization should ideally be performed within 48 hours to 14 days following the index ischemic event. In asymptomatic patients, intervention is indicated in the presence of clinical or morphological markers associated with an increased risk of carotid stenosis-related stroke. Carotid artery stenting represents a complementary alternative to endarterectomy, particularly in patients at high surgical risk. Given that several recommendations are based on expert opinion rather than high-level evidence, interdisciplinary decision-making plays a crucial role. Patients with limited life expectancy should not undergo invasive treatment; all patients with carotid artery disease should receive optimal medical therapy.
Dtsch Med Wochenschr
· 2026 May · PMID 42081911
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Carotid artery stenosis is a major cause of ischemic stroke, with prevalence increasing with age and vascular risk factors. Targeted diagnosis in patients with acute cerebrovascular disease and high-risk populations, com...Carotid artery stenosis is a major cause of ischemic stroke, with prevalence increasing with age and vascular risk factors. Targeted diagnosis in patients with acute cerebrovascular disease and high-risk populations, combined with consistent conservative management, is essential to significantly reduce stroke risk. This article reviews current diagnostic strategies, including duplex ultrasound as the cornerstone of non-invasive assessment, and discusses pharmacological and non-pharmacological treatment approaches. Medical therapy-including antiplatelet therapy, statins, and vascular risk factor control-is crucial across all stenosis stages and may suffice even in some cases traditionally considered for revascularization. Current research focuses on individualized therapy guided by risk stratification to identify patients for whom conservative management alone provides optimal stroke prevention. Interdisciplinary decision-making is essential to tailor treatment strategies.
Klemmt M, van Baal K, Bonin M
… +4 more, Fleischmann C, Neuderth S, Henking T, Stiel S
Dtsch Med Wochenschr
· 2026 May · PMID 42081909
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BACKGROUND: Although medical consultation is not mandatory when drawing up living wills, it is recommended. General practitioners (GPs) can be suitable contact persons for drawing up and updating advance directive docume...BACKGROUND: Although medical consultation is not mandatory when drawing up living wills, it is recommended. General practitioners (GPs) can be suitable contact persons for drawing up and updating advance directive documents. The aim of this study is to record the frequency and type of GP counselling on advance directive documents. It also aims to record the subjective level of competence and knowledge of GPs with regard to counselling on advance directive documents. METHOD: An online survey was conducted between October and November 2024. The target group was all general practitioners practising in Lower Saxony. An adapted version of a field-tested questionnaire was used, including a case vignette-based knowledge test on advance care planning documents. The data were evaluated using descriptive and inferential statistics. RESULTS: Data from 502 GPs were included. 85.1% of respondents stated that they advise their patients on advance directive documents. Reasons for not counselling patients include a lack of need of patients or a lack of qualification of GPs. The participants rated their subjective counselling competence as rather high. Uncertainties were reported in dealing with patients' emotions and fears. The objective knowledge test showed an average score of 22.5 out of a possible 30 points. A high level of knowledge was particularly evident in relation to the conditions for the effectiveness of living wills. There are knowledge gaps in the area of representation law. DISCUSSION: The majority of GPs surveyed counsel patients on advance directive documents. However, there are clear knowledge gaps and uncertainties that may influence the quality of counselling.
Wintel M, Bernhard J, Beck JS
… +5 more, Fuchs A, Tobian F, Lindner AK, Mockenhaupt FP, Denkinger CM
Dtsch Med Wochenschr
· 2026 Jun · PMID 42013869
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BACKGROUND: Dengue fever is a mosquito-borne viral infectious disease with an estimated 100-400 million infections worldwide every year. The currently highest case numbers are also reflected in the specialized centers in...BACKGROUND: Dengue fever is a mosquito-borne viral infectious disease with an estimated 100-400 million infections worldwide every year. The currently highest case numbers are also reflected in the specialized centers in Germany. A pilot project for the surveillance of highly infectious imported diseases at the tropical medicine centers in Berlin, Heidelberg and Augsburg used dengue fever to pilot joint data collection, transmission and analysis. METHODS: Patients with dengue fever were included in the survey. Demographic, anamnestic and clinical-laboratory data were recorded and then transferred to an online database (RedCap) accessible to all participating centers. RESULTS: In the pilot phase (August to December 2023) 42 patients were included (median age: 35.5 years; travel duration: median 20 days). The countries of infection were South (East) Asia (64.3%), Central America (30.9%) and Africa (4.8%). The mostly classic symptoms (fever, headache, joint and muscle pain, exanthema) began during the trip in almost two thirds of cases. The diagnosis was based on the detection of the NS1 antigen in 71.4% and on serology in 28.6%. The piloted system proved to be practicable for detecting infectious threats in terms of pandemic preparedness. CONCLUSION: The joint detection of an infectious disease was successfully piloted. Dengue fever presented itself in its classic form. Growing case numbers and the risk of autochthonous transmission are increasingly bringing dengue fever into the focus of differential diagnosis in Germany.
In the treatment of patients with progressive diseases, such as COPD or IPF, there are significant communication gaps across all sectors. Measures to improve communication include advance care planning, determining the p...In the treatment of patients with progressive diseases, such as COPD or IPF, there are significant communication gaps across all sectors. Measures to improve communication include advance care planning, determining the patient's wishes, early palliative care, and avoiding unnecessary hospitalization, intensive care, and post-discharge over-treatment, such as long-term invasive ventilation outside of the hospital.
Effective communication is fundamental to every patient-centred treatment decision. In the context of intensive care, however, it is a challenging process, as the values and beliefs of those involved in the conversation...Effective communication is fundamental to every patient-centred treatment decision. In the context of intensive care, however, it is a challenging process, as the values and beliefs of those involved in the conversation must be taken into account. Added to this is the life-threatening situation, which is accompanied by intense emotions and stress for relatives. To ensure patient-centred care, communication must therefore be regarded as an essential intensive care intervention.
Air travel exposes the human body to environmental conditions that differ greatly from those on the ground. Reduced cabin pressure, low humidity, temperature fluctuations, and rapid time zone changes can pose physiologic...Air travel exposes the human body to environmental conditions that differ greatly from those on the ground. Reduced cabin pressure, low humidity, temperature fluctuations, and rapid time zone changes can pose physiological challenges, particularly for individuals with pre-existing health conditions. This article discusses preventive measures to minimize these health risks.
More and more people are traveling to tropical and subtropical regions, whether for business or pleasure. Therefore, sound travel medicine advice is an essential part of preventive healthcare. This advice includes vaccin...More and more people are traveling to tropical and subtropical regions, whether for business or pleasure. Therefore, sound travel medicine advice is an essential part of preventive healthcare. This advice includes vaccination recommendations, malaria prophylaxis, individual risk assessment, education, and up-to-date interdisciplinary knowledge. This knowledge is especially important for vulnerable groups, such as pregnant women, children, and people with chronic illnesses.
In the outpatient (i.e., pre- and post-hospital) and inpatient care of patients with chronic progressive diseases, such as chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF), there are se...In the outpatient (i.e., pre- and post-hospital) and inpatient care of patients with chronic progressive diseases, such as chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF), there are serious communication gaps across sectors, particularly regarding advanced care planning and palliative care treatment. Strategies to avoid over-treatment in intensive care are needed.
Pregnant patients require intensive medical treatment relatively rarely: in industrialized countries they account for only about 2% of ICU-patients. Compared to pregnancy, the need for intensive care occurs more often in...Pregnant patients require intensive medical treatment relatively rarely: in industrialized countries they account for only about 2% of ICU-patients. Compared to pregnancy, the need for intensive care occurs more often in the immediate postpartum setting, primarily due to peripartum complications such as severe haemorrhage, hypertensive crises, or sepsis. The treatment of such patients requires a multiprofessional and interdisciplinary approach involving obstetricians, neonatologists, intensive care physicians, nursing staff, and other specialists, as well as, if necessary, psychologists. Particular importance is attached to involving the (competent-to-consent) patient and her relatives in clinical decision-making processes. In the case of fetal viability, and if the mother's condition is stable, transfer to a hospital with connected obstetrics and neonatology should be considered. Maternal X-ray examinations are possible during pregnancy, taking into account the fetal radiation dose.