Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2024
Review[Environmental diagnostics for venous thromboembolism - thrombophilia and tumor screening].
Inadequate treatment of venous thromboembolism can have fatal consequences that are often irreversible. If the indication is given, long-term therapeutic anticoagulation may be necessary to reduce the risk of recurrence for those affected. ⋯ A careful assessment of possible contributing factors is therefore essential. If uncertainty persists, comprehensive environmental diagnostics with regard to thrombophilia or cancer can be helpful.
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Dtsch. Med. Wochenschr. · Oct 2024
Review[Laboratory diagnostics of autoimmune liver diseases in primary care settings - short review].
Elevated liver enzymes (ELE) are common in Germany. Primary care physicians are paramount in the early detection of liver diseases. The aim of this article is to provide an overview of autoimmune liver disease for primary care physicians (PCP) with a focus on laboratory diagnostics. ⋯ Laboratory diagnostics is the central step in the diagnosis of autoimmune liver diseases. However, general laboratory screening for ELE is not advisable. Rather, it is important to recognize, that no validated key figures are yet available for these markers in the primary care setting. The interpretation of these laboratory values is therefore complex. It is therefore advisable to consider determining these specific laboratory parameters, taking into account the common (and less common) causes that can lead to ELE.
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Women have a higher lifetime risk of venous thromboembolism (VTE) than men. Hormone-associated risk factors such as pregnancy, contraception and hormone replacement therapy contribute significantly to this. ⋯ Affected women should be informed that the risk of VTE recurrence is increased in a subsequent pregnancy and usually requires VTE prophylaxis with low molecular weight heparin during pregnancy. If the suspicion of recurrent VTE arises during pregnancy, diagnostics must be carried out promptly so that deep vein thrombosis and/or pulmonary embolism can be reliably confirmed or ruled out.
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Dtsch. Med. Wochenschr. · Oct 2024
[Assisted suicide in Switzerland, a model in the international discussion about medical aid in dying: framework conditions and long-term development of a new societal and medical-ethical phenomenon].
In the observation period between 1999 and 2022, the Swiss Federal Statistical Office recorded 14 170 assisted suicide (AS) cases. During this 24-year period, the annual number of cases increased significantly: While only 63 cases were observed in 1999, the number of cases in 2022 amounted to almost 1600, corresponding to 2.1 % of all deaths in Switzerland. The most common underlying disease group for AS was cancer, accounting for 40 % of cases. AS is mainly chosen by women (unchanged over time at 58 % of cases) and is primarily a geriatric phenomenon: In 2022, the median age of those who opted for assisted dying was 81 years; the median age of those who chose AS due to cancer was 77 years, while the median age of those who died with non-cancer-related AS was 84 years.
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As staff shortage in intensive care medicine increases, sustainable recruitment and retention of qualified professionals becomes increasingly crucial. Current surveys indicate that sufficient onboarding is a key element to success in this context. ⋯ This paper was developed under the leadership of the Junge DIVI, a multidisciplinary and multiprofessional initiative of young professionals, within the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI). It was based on a systematic literature research and consensus-building among various professional groups and disciplines, offering - for the first time - uniform, standardized, practical guidance for implementing structured onboarding for different professionals in intensive care units in Germany.