Der Internist
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The number of hematopoietic stem cell transplantations is continuously increasing. On the one hand reduced intensity conditioning and improved supportive therapies allow for transplantations in patients with significant comorbidities and up to their eighth decade of life. ⋯ Recent developments in general critical care such as sepsis bundles and non-invasive ventilation contribute to a better outcome of these patients. However, treatment algorithms that identify patients potentially benefitting from intensive care but also reduce overtreatment of moribund patients represent a central multidisciplinary challenge not only for the treating transplant physician and intensivist.
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The majority of clinical complaints derive from disorders of calcium metabolism and are associated with a wide variety of clinical symptoms caused by numerous diseases with entirely different types of pathophysiology. The prognosis varies from favorable to fatal depending on the pathophysiology of the underlying disorder of calcium metabolism; therefore, the diagnostic work-up aims to quickly identify the underlying disease causing the disturbance in calcium homeostasis. Every clinical situation with a diminished state of calcium absorption is treated with calcium and vitamin D in varying doses whereas every disorder with an increased calcium absorptive or resorptive state is treated with improved diuresis in addition to antiresorptive drugs, such as bisphosphonates. In many situations the management of a disturbed calcium balance requires an interdisciplinary approach in order to treat the underlying disease in parallel with correction of the calcium homeostasis.
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Herbal medicines are popular. It is frequently assumed that they are effective and safe. Sound knowledge of existing, or lacking, data on the efficacy and safety is required for advice and for the decision whether or not to use a particular herbal drug. ⋯ Overall, although knowledge about herbal drugs has grown in recent years, it is generally still unsatisfactory. The active recommendation to use an herbal drug is usually not advisable. However, a patient's request for a licensed herbal drug may be acceptable if there is no conventional concomitant comedication that is known or expected to interact, no contra-indication, and no other (conventional) treatment with better, or better known, benefit-risk ratio.
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How physicians within the specialty of internal medicine perceive their stress-related working conditions, especially due to a changing health system with an impact on workflows and working hours, is examined in this study. ⋯ This study should be a cause for concern, since current data suggest a future shortage of qualified employers in the specialty of internal medicine. Taking this into account, working conditions in hospitals should be improved in order to bind current employees and attract new employees.