General practice is 'talking medicine' and communication is an essential part of every medical activity, and also influences key outcome parameters (e.g. adherence, healing success) and even job satisfaction of physician...General practice is 'talking medicine' and communication is an essential part of every medical activity, and also influences key outcome parameters (e.g. adherence, healing success) and even job satisfaction of physicians. In this article, the principles of patient-centred communication (in contrast to physician-centred communication) were described. Basic techniques such as active listening, paraphrasing, reflecting and summarizing were taught with formulation examples. Case examples illustrate typical consultations in practice where patient-centred communication is indicated and helpful. Furthermore, tips are given on how to deal with patients' emotions and reactance. At last, the importance of good training and owns self-care is emphasised.
The patient (male, two expert reports: 61 and 63 years old) experienced symptoms of a flu-like infection with rapid deterioration and cognitive complaints. He has been an employee of the municipal building yard with a se...The patient (male, two expert reports: 61 and 63 years old) experienced symptoms of a flu-like infection with rapid deterioration and cognitive complaints. He has been an employee of the municipal building yard with a sewage treatment plant for approximately 24 years.Acute renal insufficiency (creatinine 9.7 mg/dl), increased anti-Leptospira IgM antibodies and Leptospira DNA using PCR were detected. The CT neurocranium without contrast medium did not reveal any relevant abnormalities.Sepsis with multiorgan failure including a type 2 myocardial infarction and acute renal failure in the context of leptospirosis was diagnosed.Antibiotic therapies with piperacillin/tazobactam, clarithromycin and meropenem were given. Regarding acute renal failure, renal function was significantly improved by using temporary hemodialysis. After an assessment, leptospirosis was recognized as occupational disease No. 3102 in accordance with Appendix 1 of the Occupational Diseases Ordinance.Physicians should take a work history and, if there is reasonable suspicion, are legally obliged to report suspected occupational diseases. The primary infection and such a complex course (including costs) can be prevented by adequate occupational safety.
Polyneuropathies are among the most common neurological diseases and the complaints they cause are a frequent reason for a consultation in general medical care. Around 5-8% of people over the age of 55 are affected, with...Polyneuropathies are among the most common neurological diseases and the complaints they cause are a frequent reason for a consultation in general medical care. Around 5-8% of people over the age of 55 are affected, with an upward trend due to the ageing population, the increase in diabetes mellitus and many new neurotoxic drugs. As the name "poly" indicates, several peripheral nerves are affected. Depending on the cause, motor, sensory or even autonomic nerves can be affected individually or in combination. Sensory and motor symptoms occur (sensitive: numbness, prickling, tingling, unsteady gait and sharp, jabbing, throbbing or burning pain; motor: muscle cramps, muscle weakness, skeletal deformities). Clinically, polyneuropathies usually present insidiously with these symptoms and frequently with pain in the feet, often symmetrical and distally emphasized ("stocking pattern"). The disease can affect the insulating layer of the nerves (myelin) and/or the extension of the nerve cell (neurite, axon) itself. The etiology is diverse, ranging from metabolic to toxic to genetic causes. Early diagnosis is crucial in order to treat any underlying disease and, if possible, prevent progression and complications. This paper describes the causes of polyneuropathies and, in particular, a valuable diagnostic procedure for investigating the causes. It is emphasized that the physiological loss of nerve fibers in older patients can also be the cause of a (mild) polyneuropathy or, in the sense of a "double crash", can trigger a clinically manifest polyneuropathy together with another possible cause.
Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system (CNS). Approximately one million people are affected worldwide; in Germany the prevalence is approximately 250,000. Th...Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system (CNS). Approximately one million people are affected worldwide; in Germany the prevalence is approximately 250,000. The disease typically manifests in young adulthood between the ages of 20 and 40, with women affected approximately three times more often. Due to its sociomedical significance, knowledge of the disease and current treatment options is essential for general practitioners, even though the disease is likely to be relatively rare in primary care practices.
Tremor is the most common movement disorder in clinical neurology and it significantly impacts patients' quality of life. In primary care, particularly among older adults, differentiating between tremor types is essentia...Tremor is the most common movement disorder in clinical neurology and it significantly impacts patients' quality of life. In primary care, particularly among older adults, differentiating between tremor types is essential for early diagnosis and appropriate management, especially when Parkinson's disease is suspected. This review provides a concise overview of tremor classification and diagnostic strategies, with a focus on distinguishing Parkinsonian tremor from other common tremor syndromes such as essential, dystonic, functional, orthostatic, and secondary tremors.Key clinical characteristics, including tremor type (rest, postural, kinetic, re-emergent), frequency, distribution, and associated neurological signs, are discussed in detail. The hallmark of Parkinsonian tremor, an asymmetric resting tremor with a "pill-rolling" quality and possible re-emergence after postural, is highlighted as a critical diagnostic clue, particularly when accompanied by bradykinesia and non-motor prodromal symptoms such as REM sleep behaviour disorder, constipation, or hyposmia.The article outlines a pragmatic diagnostic pathway, including clinical examination, structured anamnesis, medication review, and the use of neuro-imaging or DAT-SPECT when indicated. Therapeutic options are also discussed, ranging from dopaminergic medication to advanced interventions like deep brain stimulation or focused ultrasound for refractory tremor. The review aims to support non-expert clinicians in making accurate early diagnoses and initiating therapy.
Feischen M, Jordan S, Kalsdorf B
… +1 more, Schmiedel S
Dtsch Med Wochenschr
· 2025 Aug · PMID 40774306
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A 50-year-old patient presented to his family doctor with pain and livid, subcutaneous nodules on the right hand.Laboratory chemistry and native radiologic examinations were unremarkable. An attempt at NSAID therapy was...A 50-year-old patient presented to his family doctor with pain and livid, subcutaneous nodules on the right hand.Laboratory chemistry and native radiologic examinations were unremarkable. An attempt at NSAID therapy was unsuccessful. On the basis of the clinical picture, immunomodulating therapy was carried out on suspicion of rheumatoid arthritis.Due to significant clinical worsening, hand surgery was needed and MM was detected by biopsy.Combination antimycobacterial therapy was initiated. Four months later, visual disturbances and polyneuropathy occurred. The cause was a supratherapeutic dose of ethambutol. After a change in therapy had been carried out, almost a complete regression of symptoms could be achieved.Infectious diseases with a low local prevalence, for example caused by non-tuberculous mycobacteria, and their therapeutic management should be left to treatment centers with a high level of infectiological expertise. When treating unselected patients with unclear skin lesions, the question of aquarium exposure should be raised.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40774305
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Home mechanical ventilation (HMV) has evolved significantly over the past decade. While initially used primarily for neuromuscular diseases, the increasing application of non-invasive ventilation (NIV) for chronic obstru...Home mechanical ventilation (HMV) has evolved significantly over the past decade. While initially used primarily for neuromuscular diseases, the increasing application of non-invasive ventilation (NIV) for chronic obstructive pulmonary disease (COPD) has demonstrated significant benefits in reducing mortality and hospitalizations. Concurrently, the prevalence of obesity hypoventilation syndrome (OHS) is rising, necessitating adapted treatment strategies. The newly updated German S3-guideline differentiates between NIV and invasive ventilation and includes refined indication criteria, particularly for COPD. Furthermore, it incorporates ethical considerations regarding decision-making in ventilation therapy and end of life. Alternative treatment options for chronic respiratory insufficiency are also gaining clinical and scientific attention. High flow therapy, which is already being used effectively for acute respiratory insufficiency, is increasingly being used for chronic respiratory insufficiency. Furthermore, the implementation of the Intensive Care and Rehabilitation Strengthening Act (IPREG) has established new quality standards in long-term mechanical ventilation, yet challenges persist in its nationwide application.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40774304
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Climate change is the greatest existential threat to planetary and human health, driven by shifts in the Earth's weather and atmospheric conditions due to human activities. It causes extreme temperatures, increased droug...Climate change is the greatest existential threat to planetary and human health, driven by shifts in the Earth's weather and atmospheric conditions due to human activities. It causes extreme temperatures, increased droughts, wildfires, dust storms, coastal flooding, storm surges, hurricanes, and various compounded events. The impacts of climate change on health are complex and include pathways that contribute to non-communicable diseases like cardiovascular disease. A collaborative effort among medical professionals, researchers, public health officials, and policymakers is crucial to mitigate the effects of global warming. This review provides an overview of how climate change affects cardiovascular health through direct exposures like temperature changes, air pollution, wildfires, dust storms, and extreme weather conditions. We also identify vulnerable populations and suggest mitigation strategies.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40774303
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Acute pancreatitis (AP) is a potentially life-threatening disease, often progressing in 2 phases: initial sterile inflammation, followed by later infected necrosis. Advances in care have shifted management toward a minim...Acute pancreatitis (AP) is a potentially life-threatening disease, often progressing in 2 phases: initial sterile inflammation, followed by later infected necrosis. Advances in care have shifted management toward a minimally invasive, step-up approach. AP is diagnosed based on typical abdominal pain, elevated lipase, or characteristic imaging - amylase is no longer essential. In hypertriglyceridemic AP, plasmapheresis offers no proven benefit. (Endo)sonography is mandatory. Contrast-enhanced CT should be delayed unless necrosis is suspected or diagnosis remains uncertain; optimal timing is ≥72h, ideally after 7 days. Prognostic tools (BISAP, Ranson) and markers (hematocrit, lactate, BUN) are insufficient to predict severe or necrotizing AP. Post-hoc, the revised Atlanta classification may be more effective than the determinant-based classification. Emergency ERC (<24h) is only warranted in cholangitis. Without cholangitis, ERC within 72h is adequate; biliary sphincterotomy and pancreatic stenting reduce post-ERC pancreatitis. Opioids are superior to NSAIDs and are first-line for analgesia. Early, goal-directed fluid resuscitation with balanced crystalloids improves outcomes, while excessive fluids (>3mL/kg/h) should be avoided. Enteral/oral nutrition within 24h reduces the risk of infected necrosis and is preferred over parenteral feeding. Antibiotic prophylaxis is not recommended, even in necrotizing AP; infected necrosis is rare in the first 2 weeks. Procalcitonin may support therapeutic decisions. Necrosis should be managed stepwise: antibiotics, then drainage, then delayed minimally-invasive necrosectomy. Endoscopic access is preferred; open surgery is obsolete. Outcomes improve significantly in specialized, high-volume centers with critical care, interventional endoscopy/radiology, and pancreatic surgery expertise.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40774302
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The "Green Intensive Care Unit" addresses the challenge of reducing the ecological footprint of the healthcare sector, which is responsible for 4.4% of greenhouse gas emissions worldwide. In Germany, the healthcare secto...The "Green Intensive Care Unit" addresses the challenge of reducing the ecological footprint of the healthcare sector, which is responsible for 4.4% of greenhouse gas emissions worldwide. In Germany, the healthcare sector accounts for 5.2% of national emissions. Intensive care units in particular are resource-intensive due to their high energy consumption, waste generation and the use of disposable materials. Sustainability in intensive care medicine aims to combine ecological responsibility with excellent patient care. This includes the introduction of overarching sustainability strategies, greater digitalization and the efficient use of resources. Energy-efficient equipment, improved waste management systems and the targeted optimization of processes reduce the consumption of resources. Conscious handling of medicines, appropriate use of protective materials and the use of sustainable materials also help to minimize the ecological footprint. In addition, the promotion of palliative care and advanced care planning makes it possible to avoid overuse while ensuring the quality of patient care. These approaches are based on a current S1 guideline (by the DGIIN) and offer practicable solutions to promote sustainability in intensive care medicine without compromising on care. Successful implementation requires a deep awareness of sustainable action and close integration with higher-level healthcare structures.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40774301
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Antimicrobial prophylaxis is an important cornerstone for reducing morbidity and mortality of cancer patients. Important strides have been made in recent years in vaccination, drug prophylaxes and the use of growth-facto...Antimicrobial prophylaxis is an important cornerstone for reducing morbidity and mortality of cancer patients. Important strides have been made in recent years in vaccination, drug prophylaxes and the use of growth-factor support. We detail these changes to the respective recommendations here.Patients with malignant disease are recommended to receive vaccinations against common respiratory pathogens (COVID-19, influenza, pneumococci, and RSV). For both influenza (now trivalent vaccine) and pneumococci (now PCV20), the preferred vaccine has changed. A VZV vaccination using an inactivated virus-subunit is also recommended to prevent reactivations. The profound B-cell depletion caused by CAR-T cell therapy is increasingly being considered in vaccination recommendations.In high-risk situations, antibiotic prophylaxis using fluoroquinolones can be used. However, due to increasing resistance and significant side effects, this approach is being critically evaluated.Posaconazole is recommended as the standard prophylaxis for patients with neutropenia >7 days (<0,5G/L) and hematologic malignancies. Isavuconazole offers an effective alternative for patients who cannot tolerate posaconazole. Interactions between antifungal agents and oncological therapies are becoming increasingly relevant, with particular attention to the CYP-450-enzyme inducing/inhibiting substances. Non-pharmacological measures to prevent fungal infections are now part of the recommendations. These include smoking cessation.Pharmacological prophylaxis for COVID-19 is generally not recommended.The thresholds for primary growth-factor-support have been lowered: G-CSF is generally recommended if the risk of febrile neutropenia is >20%, or, if patient inherent risk factors are present, >10%. A new long-acting, non-PEG-containing G-CSF preparation was approved in 2024.Good collaboration between oncologists and general practitioners is essential to translate these recommendations into clinical practice.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40774300
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Autoimmune liver diseases are rare, but among rare diseases they are relatively frequent. Autoimmune hepatitis (AIH) is a very heterogeneously presenting disease and lacks specific diagnostic tests. Unfortunately, steroi...Autoimmune liver diseases are rare, but among rare diseases they are relatively frequent. Autoimmune hepatitis (AIH) is a very heterogeneously presenting disease and lacks specific diagnostic tests. Unfortunately, steroid-free treatment can be achieved for only a minority of patients in real-life settings. Treatment algorithms provided by clinical practice guidelines help to reduce the rate of side effects and to increase the response rate. Diagnosis and first-line treatment of primary biliary cholangitis (PBC) is easier than in AIH. The challenges of PBC are to identify patients at risk for disease progression and to offer the most effective and safest second-line treatment for the individual patient. Treatment options for primary sclerosing cholangitis (PSC) are very limited. Therefore, the clinical focus should be on identification of patients at risk for the need of liver transplant and on screening for malignant complications such as cholangiocarcinoma or colorectal carcinoma in case of associated colitis. Genetic cholestatic liver diseases (GCD) are rare monogenetic disorders presenting in early infancy to later in life and are associated with significant morbidity. Cholestatic pruritus is a hallmark symptom in most GCD significantly impacting of quality of life and requiring surgical or pharmacologic intervention or even liver transplant. Selective inhibitors of ileal bile acid transport (IBAT) have been introduced as novel treatment option interrupting enterohepatic circulation of bile acids. Aside from their proven effect on pruritus, it remains unclear whether chronic liver damage by bile acid toxicity may also be reduced. Besides the risk for development of biliary cirrhosis, an elevated risk for hepatobiliary malignoma is present in GCD, and patients need lifelong tumor surveillance. The often multisystemic nature of GCD requires highly specialized multidisciplinary treatment in dedicated centers and careful transition to adult medicine is warranted.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40763755
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Pneumonia is one of the most important nosocomially acquired infections in Germany. Rational management strategies contribute to optimizing treatment and minimizing the development of resistance. The calculated antimicro...Pneumonia is one of the most important nosocomially acquired infections in Germany. Rational management strategies contribute to optimizing treatment and minimizing the development of resistance. The calculated antimicrobial therapy should take into account the severity, the risk of multi-resistant pathogens and as well as the local resistance situation. The infection occurs more frequently in non-ventilated patients, yet the evidence for ventilator-associated pneumonia is better, mainly due to easier microbiological diagnostics. The spectrum of pathogens does not differ significantly between the two disease entities. and, in the gram-positive spectrum, and are the most common pathogens detected. Early detection, particularly in sepsis, followed by targeted diagnostic measures are relevant managing the disease. Calculated antibiotic therapy taking into account the severity of the disease and the patient's individual risk of multi-resistant pathogens, should be administered promptly. A re-evaluation of the diagnosis and therapy after 48-72 hours is crucial for the success of treatment and the rational use of antibiotics. All findings obtained to confirm the diagnosis and assess the course of the disease should be reviewed with regard to the accuracy of the diagnosis, the therapeutic response and the possibility of optimizing antibiotic therapy. If there is a response to treatment, which is primarily expressed in a clinical improvement, the recommended treatment duration of 7 days should not be exceeded. If there is no improvement in symptoms, microbiological findings, complications and differential diagnoses should be checked. Pharmacokinetic and pharmacodynamic principles should be considered with regard to the substances and the duration of application and dosage.
Jahns KM, Dreher M, Triantafyllias K
… +2 more, Haßdenteufel L, Schwarting A
Dtsch Med Wochenschr
· 2025 Aug · PMID 40763754
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Systemic sclerosis (SSc) is a connective tissue disease of multifactorial origin in which autoimmune inflammatory reactions lead to fibrosis of multiple tissues. In the past, renal crisis was a common complication with a...Systemic sclerosis (SSc) is a connective tissue disease of multifactorial origin in which autoimmune inflammatory reactions lead to fibrosis of multiple tissues. In the past, renal crisis was a common complication with a very high mortality. Due to the recommendation for a more cautious use of corticosteroids and the use of ACE inhibitors as an acute treatment reduced the incidence of a renal crisis and improved overall survival since the 1980s. However, lung involvement including pulmonary arterial hypertension, interstitial lung disease and lung fibrosis is now the most common cause of death in SSc. An early detection, including the use of HR-CT screening, and adequate treatment of interstitial lung disease are therefore of the utmost importance. Mycophenolate mofetil (MMF) has proven to be an effective therapeutic agent for the pulmonary manifestation. Nintedanib is the only drug approved in Germany for SSc-associated progressive lung fibrosis. Studies have shown the best prognostic improvements with early combination therapy of MMF in combination with Nintedanib.
Frei-Stuber L, Utpatel K, Hammer S
… +1 more, Nowak D
Dtsch Med Wochenschr
· 2025 Aug · PMID 40763753
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A 77-year-old former MTA had been exposed to ionizing radiation for several years, e.g. during X-ray fluoroscopy and mouth pipetting of radioactive isotopes. There was no family history of lymphoma risk. She reported red...A 77-year-old former MTA had been exposed to ionizing radiation for several years, e.g. during X-ray fluoroscopy and mouth pipetting of radioactive isotopes. There was no family history of lymphoma risk. She reported reduced performance, dizziness and mental stress.Imaging (MRI, PET-CT) and histology showed multiple B-cell NHL of different subtypes. Pulmonary function was slightly impaired; laboratory showed mild anemia.Recurrent non-Hodgkin's lymphoma (B-cell series), recognized as an occupational disease due to ionizing radiation (OD No. 2402 ODO).Treatments included radiotherapy, immunochemotherapies, CAR T-cell therapy, Nivolumab and Ibrutinib. Despite multiple remissions, cutaneous recurrences occurred. Currently remission under Ibrutinib.Physicians (in the following, this refers to all genders) should take a work history and, if there is reasonable suspicion, they are legally obliged to report suspected occupational diseases (which is more important than confidentiality). Occupational safety, including radiation protection, must be optimized in order to avoid damage to health (resulting).
Dtsch Med Wochenschr
· 2025 Aug · PMID 40763752
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Heart failure and atrial fibrillation are among the most common cardiovascular diseases and are closely linked in terms of development, pathophysiology, and prognosis. In addition to shared risk factors, direct pathophys...Heart failure and atrial fibrillation are among the most common cardiovascular diseases and are closely linked in terms of development, pathophysiology, and prognosis. In addition to shared risk factors, direct pathophysiological interactions have been shown to mutually promote the development and progression of each condition. It is therefore essential to recognize and treat both diseases in parallel.