Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · May 2020
[Do decision-makers in the German healthcare system misjudge the situation of a branch office? - Motivation of physicians to set up in a GP's practice in the area of the Association of Statutory Health Insurance Physicians North-Rhine].
The aim of the study was to illustrate motives for a GP's branch from the current point of view by branch (expectations fulfilled) and before branch (motivation). In addition, obstructive or beneficial factors of a branch should be identified. ⋯ The fact that escaping from the stationary sector is the main driving force behind the settlement must be thought-provoking. Since this survey approach was not based on specialist groups or the level of training, but on a complete survey of established persons over a five-year period, it can be stated that the current incentive structures of a branch should be rethought due to the age structure of the interviewees.
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In patients admitted with acute myocardial infarction, cardiogenic shock remains the most common cause of death. Multidisciplinary care in a specialized center and guideline-compliant treatment of cardiogenic shock are crucial for the survival and prognosis of affected patients. ⋯ Nevertheless, early revascularization of the culprit-lesion is proved to be the most important treatment modality. Although the use of active mechanical circulatory support appears to be a promising therapeutic concept to improve clinical outcome in patients with infarct-related cardiogenic shock, in the few previous randomized trials mechanical circulatory support failed to show beneficial effects on short-term and long-term survival.
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Dtsch. Med. Wochenschr. · May 2020
Review[Reclassification of diabetes mellitus based on pathophysiologic and genetic features].
Diabetes mellitus has been defined by hyperglycemia, but in addition to hyperglycemia, there are several other factors determining the clinical course and complications. We review the current classification of diabetes and recent attempts to identify new subphenotypes. Notably, there are anthropometry-pathophysiology based and genome-based subphenotyping approaches. They aim to improve the prediction of disease course and complications and could pave the way for precision medicine in the therapy of diabetes.
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The Coronavirus Disease Pandemic 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2), started in December 2019 in China. SARS-CoV-2 is easily transmitted by droplet infection. After an incubation period of 1-14 days, COVID-19 shows a mild course in 80 % of observed cases and a severe course in 20 %, with a lethality rate of 0.3-5.8 %. ⋯ So far there are neither effective drugs nor vaccinations available, so only public health interventions such as physical distancing and hygiene measures on the one hand and targeted testing followed by isolation and quarantine measures on the other hand are available. China has shown that maximum use of these measures can control the epidemic. The further course and also the consequences for the global economy cannot be clearly predicted at present.