Med Klin
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The Program for National Disease Management Guidelines (German DM-CPG Program) was established in 2002 by the German Medical Association (umbrella organization of the German Chambers of Physicians) and joined by the Association of the Scientific Medical Societies (AWMF; umbrella organization of more than 150 professional societies) and by the National Association of Statutory Health Insurance Physicians (NASHIP) in 2003. The program provides a conceptual basis for disease management, focusing on high-priority health-care topics and aiming at the implementation of best practice recommendations for prevention, acute care, rehabilitation and chronic care. It is organized by the German Agency for Quality in Medicine, a founding member of the Guidelines International Network (G-I-N). ⋯ Within the last year, DM-CPGs have been published for asthma, chronic obstructive pulmonary disease, type 2 diabetes, and coronary heart disease. In addition, experts from national patient self-help groups have been developing patient guidance based upon the recommendations for health-care providers. The article describes background, methods, and tools of the DM-CPG Program, and is the first of a publication series dealing with innovative recommendations and aspects of the program.
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Biography Historical Article
[Illness and death of Wolfgang Amadeus Mozart (1756-1791). A contribution to the Mozart Year 2006].
In the Mozart year 2006 also medicine has to deal with the music genius W. A. Mozart. ⋯ The exact cause of death remains speculative. The story of a tall stranger dressed in somber gray who assigned Mozart to write a Requiem Mass and the circumstances of Mozart's funeral have additionally contributed to the generation of legends. However, if one gathers all known facts, there is no evidence that Mozart was murdered, and the exact cause of his death remains unclear.
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The health care for patients with incurable, advanced diseases is increasingly attended to in Germany. Among other things, this is enforced by the debate on euthanasia and by the criticism of the inadequate structure of services and processes of care. The palliative care approach refers to cancer as well as to non-cancer patients; due to demographic changes, it becomes more and more important for an increasing number of old and very old patients with particular complex needs (e. g., caused by multimorbidity, dementia and chronic pain). ⋯ However, the statements on the current situation and the recommendations for improvement are based only slightly on valid scientific data. This article (written from the perspective of health services research) provides an overview on the topic with particular respect to the structure of specialized palliative care services (such as palliative care teams and palliative care units) and to the political framework. Open questions on diverse levels are picked out as a central theme, and the need for interdisciplinary, application-oriented research is pointed out.
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Erdheim-Chester disease is a rare non-Langerhans' cell histiocytosis of unknown etiology with typical osteosclerotic long-bone findings. However, clinical symptoms are mostly due to disease involvement of other tissues, particularly of the lung, heart and retroperitoneum. ⋯ In patients with extensive pulmonary fibrosis and coincidence of other organ manifestations such as periaortic or retroperitoneal fibrosis and particularly in case of symmetrical osteosclerotic bone lesions, Erdheim-Chester disease should be considered. Immunosuppressive therapy can lead to a stabilization or even improvement of the disease.