Dtsch Med Wochenschr
· 2026 Feb · PMID 41730269
·
Publisher ↗
Patients experiencing frequent and severe migraine attacks require both drug and non-drug prophylactic treatments for migraines. Despite the large number of randomised controlled trials investigating different approaches...Patients experiencing frequent and severe migraine attacks require both drug and non-drug prophylactic treatments for migraines. Despite the large number of randomised controlled trials investigating different approaches to migraine prophylaxis, many questions regarding the management of migraine patients remain unanswered in everyday clinical practice. The International Headache Society (IHS) has therefore decided to formulate practical recommendations based on observational studies and expert consensus to address these questions.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41730268
·
Publisher ↗
Discharge letters, written in technical language for clinicians, are often incomprehensible to patients. Large Language Models (LLMs) offer a scalable solution by automatically translating these expert-level documents in...Discharge letters, written in technical language for clinicians, are often incomprehensible to patients. Large Language Models (LLMs) offer a scalable solution by automatically translating these expert-level documents into patient-friendly summaries. Initial evidence demonstrates that LLMs can significantly lower the reading difficulty of medical reports while maintaining high accuracy, as validated by physicians. A recent randomized clinical trial in Germany showed that LLM-generated patient letters significantly increase patient activation. For safe and effective implementation, specific prompting strategies, human-in-the-loop validation, and a clear understanding of the regulatory landscape are crucial. LLMs have the potential to support a paradigm shift in discharge communication, empowering patients to become active and informed partners in their care.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41730267
·
Publisher ↗
The diagnosis section in discharge letters (in some countries also referred to as problem list) plays a crucial role in ensuring continuity of care, yet its quality often falls short. While 96% of German physicians repor...The diagnosis section in discharge letters (in some countries also referred to as problem list) plays a crucial role in ensuring continuity of care, yet its quality often falls short. While 96% of German physicians report that the diagnosis section is essential for safe and effective follow-up care, only 37% are satisfied with their quality. Deficiencies include lack of ICD-10 codes, ambiguous abbreviations, and unstructured layouts caused by blind copy-pasting from previous reports, time pressure, and the absence of documentation standards.This article presents practical, physician-endorsed recommendations for writing concise, structured, and clinically relevant diagnosis sections. According to consensus amongst physicians, diagnoses should be structured in three segments: 1) current treatment diagnoses, 2) chronic conditions, and 3) previous diagnoses. A checklist for improving documentation quality is provided and a vision for the future outlined: disease-specific templates that can be integrated as Medical Information Objects (MIOs) into German electronic patient records.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41730266
·
Publisher ↗
The hospital discharge letter is the key communication tool between inpatient and outpatient care providers, ensuring the complete, structured, and comprehensible transfer of information necessary for seamless follow-up...The hospital discharge letter is the key communication tool between inpatient and outpatient care providers, ensuring the complete, structured, and comprehensible transfer of information necessary for seamless follow-up care. High-quality discharge letters maintain treatment continuity, reduce misunderstandings, prevent avoidable complications and readmissions, and serve as a critical interface document in healthcare. However, significant deficits in content, structure, and timeliness remain common due to insufficient training and the absence of binding standards.This article outlines the essential elements of an effective discharge letter: correct and complete addressee and patient data, a clinically relevant and complete list of diagnoses, a concise and interpretive summary (epicrisis) that answers the referring physician's key questions, concrete and feasible follow-up recommendations, a fully detailed and justified medication list, and - where appropriate - supplementary diagnostic documentation. Clarity, brevity, and usability take precedence over length and formality; unnecessary content such as marketing elements or redundant patient data should be avoided.Practical measures to improve quality include structured templates, targeted training with feedback, completeness checklists, and peer review. Evidence shows that optimizing discharge communication can reduce readmission rates by up to 30% and improve therapy adherence. In the digital era, the discharge letter remains a core instrument of patient safety and professional medical communication, reflecting the quality and patient-centredness of the treating team.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41662865
·
Publisher ↗
In 2025, Germany faces a dual transformation: the institutionalization of a federal Ministry for Digital Affairs and a controversial relaxation of data protection regulations, i.e. register for mentally ill people. These...In 2025, Germany faces a dual transformation: the institutionalization of a federal Ministry for Digital Affairs and a controversial relaxation of data protection regulations, i.e. register for mentally ill people. These developments coincide with increasing political polarization, which not only shapes public discourse but also exerts measurable effects on health behavior, trust in institutions, and access to care. Despite operating one of the world's most expensive health systems, structural inequalities in Germany persist, with life expectancy differing by up to eight years across socioeconomic groups. Public health authorities (Öffentlicher Gesundheitsdienst, ÖGD) could act as a corrective force, yet they remain underfunded, digitally underdeveloped, and vulnerable to political influence. This article argues that polarization has emerged as a social determinant of health, comparable in significance to income or education. We highlight the urgent need for institutional trustworthiness. We present the OSCADO-AI ethical code, an open-source, inter-operational, and privacy-conscious digital standard designed to enhance the resilience of public health institutions. By enabling transparent data use, secure communication, real-time surveillance, and collaborative platforms, OSCADO-AI strengthens both evidence-based decision-making and public trust. Case examples from Frankfurt illustrate how digital sovereignty and open infrastructures can protect democratic institutions against partisan interference while fostering citizen-centered health governance. Ultimately, the future of the German public health system depends on its capacity to combine medical independence, digital innovation, and civic accountability to reduce inequality and safeguard democracy.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41662864
·
Publisher ↗
Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome in patients with decompensated cirrhosis and is characterized by acute failure of one or more organ systems. Despite advances in clinical management, A...Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome in patients with decompensated cirrhosis and is characterized by acute failure of one or more organ systems. Despite advances in clinical management, ACLF continues to be associated with high short-term mortality.This article provides an up-to-date, guideline-based overview of the classification, diagnosis, and therapeutic approaches to ACLF, drawing on the latest literature and consensus definitions.ACLF is defined by acute decompensation of cirrhosis accompanied by failure of the liver and/or other organs including the kidneys, cardiovascular system, lungs, central nervous system, and coagulation. The EASL-CLIF Consortium criteria distinguish three grades of ACLF based on the number and type of organ failures; increasing grade correlates with sharply rising short- and medium-term mortality. Pathophysiologically, ACLF is characterized by an overwhelming systemic inflammatory response typically triggered by bacterial infections, severe alcoholic hepatitis, or gastrointestinal bleeding. Prognostication is guided by CLIF-C OF, CLIF-C ACLF, and CLIF-C AD scores, which can also help to identify patients at high risk for further decompensation. Management focuses on rapid identification and reversal of precipitating factors, organ support, and early evaluation for liver transplantation, as it remains the sole curative option in non-reversible ACLF. Preemptive TIPS placement is reserved for selected cases, with individualized risk assessment being critical due to the increased complication rate in severe multiorgan failure.ACLF remains the most severe complication of cirrhosis, marked by high short-term mortality. Early, guideline-based interventions and multidisciplinary management can improve outcomes. Accurate risk stratification and timely consideration of liver transplantation are essential to enhance patient survival.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41662863
·
Publisher ↗
Ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome-acute kidney injury (HRS-AKI) are frequent and clinically significant complications in patients with cirrhosis, each conferring a substantial inc...Ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome-acute kidney injury (HRS-AKI) are frequent and clinically significant complications in patients with cirrhosis, each conferring a substantial increase in mortality risk. Their pathogenesis is fundamentally driven by the development of splanchnic and systemic vasodilation secondary to portal hypertension, compounded by intestinal bacterial translocation. The diagnosis of ascites and SBP should be established without delay, employing a combination of laboratory testing and imaging modalities. In contrast, the diagnosis of HRS-AKI relies on the presence of cirrhosis with ascites together with the exclusion of alternative, more common causes of kidney injury. Management strategies vary by complication: ascites is typically addressed with diuretic therapy and placement of a transjugular intrahepatic portosystemic shunt (TIPS); SBP requires prompt initiation of antibiotic therapy combined with albumin administration; and HRS-AKI is treated with vasoconstrictor agents in conjunction with albumin.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41662862
·
Publisher ↗
Liver cirrhosis is considered as a multisystemic disease that affects also the immune system. The spectrum of immunological alterations that can be found in patients with liver cirrhosis is summarized as cirrhosis-associ...Liver cirrhosis is considered as a multisystemic disease that affects also the immune system. The spectrum of immunological alterations that can be found in patients with liver cirrhosis is summarized as cirrhosis-associated immune dysfunction (CAID). The mechanisms that are involved in the development of CAID are complex. Next to immune-mediated mechanisms causing the development of liver cirrhosis, one of the key mechanisms in the development of CAID is portal hypertension, leading to an impaired gut-liver-axis with an increased bacterial translocation to the blood stream. CAID can be assigned in the two key components systemic inflammation and immune deficiency. The intensity of components is variable and dynamic and depends on the stage of liver cirrhosis as well as the presence of incidental events (e.g. bacterial infections). In return, CAID increases the risk of infections and worsens the prognosis of the patient. The reduction of portal hypertension, inter alia by the insertion of a transjugular intrahepatic portosystemic shunt seems to be an important approach in the modulation of CAID. Further therapeutic approaches include the reduction of bacterial components to the blood and the modulation of impaired immune cell functions. Nevertheless, the only targeting approach of liver cirrhosis and CAID is still liver transplantation.
Dtsch Med Wochenschr
· 2026 Feb · PMID 41662861
·
Publisher ↗
Hepatic encephalopathy (HE) is a common and serious complication of liver cirrhosis, associated with significant morbidity and mortality. Pathophysiologically, it results from a complex interplay of hyperammonemia, syste...Hepatic encephalopathy (HE) is a common and serious complication of liver cirrhosis, associated with significant morbidity and mortality. Pathophysiologically, it results from a complex interplay of hyperammonemia, systemic inflammation, neuroinflammatory processes, and microbial dysbiosis. Clinically, HE ranges from subtle cognitive impairments (minimal HE) to coma (grade 4 HE). Diagnosis requires thorough clinical assessment and the use of specialized testing methods, particularly to detect subclinical alterations. In everyday practice, ammonia levels have limited diagnostic value but may be useful for differential diagnosis. The acute treatment of overt hepatic encephalopathy (OHE) is primarily based on the administration of lactulose, optionally supplemented with intravenous L-ornithine-L-aspartate. For secondary prophylaxis lactulose is the treatment of choice and in patients with recurrent episodes, the combination of rifaximin and lactulose is well established. Nutritional recommendations are a key component of therapy, especially to prevent sarcopenia. In cases of refractory HE or recurrent relapses despite guideline-based treatment, liver transplantation should always be considered. In general, early detection and individualized management of HE is essential to preserve and improve quality of life, prognosis, and functional independence of the affected patients.
Dtsch Med Wochenschr
· 2026 Jan · PMID 41558495
·
Publisher ↗
Flow cytometry is an essential part of hematological stepwise diagnostics. It is the gold standard for diagnosing a range of hematological neoplasms. When performed and interpreted correctly, flow cytometry enables compl...Flow cytometry is an essential part of hematological stepwise diagnostics. It is the gold standard for diagnosing a range of hematological neoplasms. When performed and interpreted correctly, flow cytometry enables complex hematological diagnoses to be made within a very short time - provided that the indication and interpretation are correct.
Dtsch Med Wochenschr
· 2026 Jan · PMID 41558494
·
Publisher ↗
Serum/plasma thyroglobulin (TG) levels and neck ultrasonography are currently the mainstay of postoperative monitoring in patients with differentiated thyroid cancer (DTC). TG can be determined as a tumor marker in these...Serum/plasma thyroglobulin (TG) levels and neck ultrasonography are currently the mainstay of postoperative monitoring in patients with differentiated thyroid cancer (DTC). TG can be determined as a tumor marker in these patients under required levothyroxine treatment at TSH suppressive doses. The immunologic determination of TG as a laboratory parameter in the follow-up of thyroid malignancies always requires confirmation of the test result in order to detect interfering variables. There are two commonly used options: first, the TG recovery rate and second, the determination of anti-TG autoantibodies (TGAb). However, neither test adequately addresses the issue of correct TG determination. Heterophilic antibodies are another important source of interference. Mass spectroscopic TG determination is a more complex alternative that can be used in inconclusive cases.
Dtsch Med Wochenschr
· 2026 Jan · PMID 41558493
·
Publisher ↗
A 56-year-old man presented with low back pain radiating to the left leg.CT of the lumbar spine revealed reduced disc height and a vacuum phenomenon. MRI demonstrated a left-sided disc herniation at L3-L4, considered the...A 56-year-old man presented with low back pain radiating to the left leg.CT of the lumbar spine revealed reduced disc height and a vacuum phenomenon. MRI demonstrated a left-sided disc herniation at L3-L4, considered the cause of symptoms. Intraoperatively, however, the disc material appeared unusually dark and pigmented.Histological analysis confirmed ochronotic pigment deposits, leading to the diagnosis of alkaptonuria (AKU).The surgical procedure was completed as planned. Postoperatively, the patient was referred for further internal medicine evaluation and genetic counselling.When encountering atypically pigmented tissue, surgeons should consider rare metabolic disorders such as AKU, allowing early diagnosis and appropriate long-term management.
Dtsch Med Wochenschr
· 2026 Jan · PMID 41558492
·
Publisher ↗
When discharging geriatric patients from inpatient care, hospital and family doctors must consider numerous factors to ensure seamless and safe follow-up treatment. Geriatric patients are usually multimorbid, take many m...When discharging geriatric patients from inpatient care, hospital and family doctors must consider numerous factors to ensure seamless and safe follow-up treatment. Geriatric patients are usually multimorbid, take many medications (polypharmacy), and have an increased risk of functional limitations or complications after discharge.
Dtsch Med Wochenschr
· 2026 Jan · PMID 41558491
·
Publisher ↗
The proportion of patients over the age of 80 in intensive care is steadily increasing as a result of demographic change. According to recent European studies, around 10-15% of all intensive care patients belong to this...The proportion of patients over the age of 80 in intensive care is steadily increasing as a result of demographic change. According to recent European studies, around 10-15% of all intensive care patients belong to this age group. Age-related changes and increased susceptibility to complications highlight the importance of individually tailored, situation-specific intensive care for this patient group. This plays a decisive role in all treatment decisions, alongside multimorbidity and the risk of age discrimination. Modern intensive care for geriatric patients should be designed to pay increasing attention to frailty and functional parameters as markers for outcome.
Dtsch Med Wochenschr
· 2026 Jan · PMID 41558490
·
Publisher ↗
Delirium is an acute, fluctuating neurocognitive disorder characterized by disturbances in consciousness and attention. Unlike dementia, delirium has somatic causes and is reversible if the triggers are identified and tr...Delirium is an acute, fluctuating neurocognitive disorder characterized by disturbances in consciousness and attention. Unlike dementia, delirium has somatic causes and is reversible if the triggers are identified and treated. Elderly people are particularly at risk, especially those in hospitals or long-term care facilities.Its development is multifactorial. The threshold concept explains the interaction of predisposing factors such as age, dementia, multimorbidity, malnutrition, substance use, and triggering factors such as surgery, infections, pain, and immobilization. Early detection and risk minimization are important, such as promoting sleep, orientation, fluid intake, mobilization, and familiar caregivers. Screening should be carried out regularly for people at risk. The causes of infections, electrolyte imbalances, and fractures should also be clarified. The first measures taken are non-pharmacological, such as training, enhanced orientation, environmental design, sleep, mobilization, pain management, and family integration. Pharmacological measures have a purely symptomatic effect and may be useful in cases of hyperactive delirium with self-harm or harm to others. Interprofessional collaboration is always important for successful delirium management.