Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2018
[The Frequency of Ethical Conflicts in Primary Care and the Need for Ethical Consultations - The Perspective of General Practitioners].
Our knowledge about ethical conflicts in primary care is limited. The aim of this study was to ascertain the frequency of ethical conflicts and the need of professional consultation services - seen from the perspective of general practitioners (GPs). ⋯ Although GPs experienced several of the ethical conflicts frequently, only one-third requested an ethical consultation. Low threshold offers may be a way to make ethical consultations more attractive for GPs.
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Dtsch. Med. Wochenschr. · Aug 2018
Review[Osteoarthropathies and Myopathies associated with Disorders of the Thyroid Endocrine System].
Triiodothyronine (T3) is a key regulator of bone, muscle and articular cartilage. Musculoskeletal symptoms of hyperthyroidism include loss of bone mass finally leading to osteoporosis and weakness of the skeletal musculature. Hypothyroidism on the other side frequently leads to muscle stiffness and cramping and, occasionally, results in rhabdomyolysis. ⋯ Recent findings underline the importance of local T3 generation by deiodinase type 2 and support the existence of local hypo- or hyperthyroidism. In the review, the implications of the recent literature for current understanding of osteoarthritis, myopathies and diabetic osteoarthropathy will be discussed. Further emphasis will be placed on the association of autoimmune thyroiditis with musculoskeletal diseases and fibromyalgia.
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Dtsch. Med. Wochenschr. · Aug 2018
[Integration of Palliative Care into the Comprehensive Cancer Center of Germany - Consultation Hours and Fellowship Rotations of the Specialized Palliative Care].
Comprehensive Cancer Centers are characterized by interdisciplinary exchange for meeting increasingly complex care needs during the course of the disease. Tumor consultations hours and fellowship rotations build hereby bridges between the subjects and disciplines. ⋯ Outpatient structures of the palliative care have been insufficiently implemented to a consultation hour within Comprehensive Cancer Centers. The existing effort to integrate palliative care into the oncological course of disease requires further structuring in order to increase the visibility of palliative care services. Fellowship rotations in the palliative care department are regularly implemented in the network even if only for some of the subjects in order to raise awareness of the possibilities of the palliative care.
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Dtsch. Med. Wochenschr. · Aug 2018
Review[Recommendation for Calcitonin Screening in Nodular Goiter].
Medullary thyroid cancer (MTC) arises from parafollicular C cells of the thyroid gland and is characterized by a calcitonin secretion. Basal calcitonin correlates with the tumor mass and is used as highly sensitive and specific tumor marker for MTC. Based on former assays, unspecific calcitonin increase has frequently been seen in Hashimoto's thyroiditis, kidney insufficiency, proton pump inhibitors etc. ⋯ Lower calcitonin values should be re-evaluated in intervals of 3 - 6 months; rising calcitonin levels may indicate an MTC. In this case, thyroid operation should be performed. The cure rate of MTC with calcitonin values < 100 pg/ml is nearly 100 % done by high volume surgeons.
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Dtsch. Med. Wochenschr. · Aug 2018
[Infusion of Daratumumab in Combination Therapies - Practical Information for The Outpatient Area].
Combination therapies such as Dara-Rd and Dara-Vd show significantly higher survival rates after 12 months than the respective therapies without Daratumumab. The initial infusion of Daratumumab is associated with a high incidence of IRR. Dosage and speed of infusion of Daratumumab have to be strictly controlled. ⋯ This does not only overwhelm the patient, but also the most ambulant structures. The split-dose concept means to divide the dose into infusions on different days. Again, the dosage is crucial for good compatibility.