Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2024
[Impact of legal documentation requirements on physician practice using a regional specialty hospital as an example: an inventory].
Doctors in German hospitals are critical of their working conditions. They complain about long working hours, inadequate remuneration for their work, poor training and development opportunities, and increasing time spent on administrative tasks. As these points of criticism are largely based on subjective perception, in the present study we documented in detail the workflows of physicians in a major regional hospital, determined the time taken for the workflows, and performed a statistical evaluation of the data. ⋯ This pilot study was the first to determine, in real time, the work processes of doctors from different specialties at a German hospital. We noted a disparity between administrative and patient-related tasks in the in-patient setting. Legal and economic requirements exert a negative impact on medical care. We need to develop strategies for effective utilization of medical resources and for ensuring a high standard of medical care.
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Dtsch. Med. Wochenschr. · Aug 2024
[Community-Acquired Bacterial Meningoencephalitis: The New Guideline].
Updating the vaccination recommendations against meningococci and pneumococci, in particular the introduction of the B vaccine as the standard vaccination for infants from January 2024 and the adaptation of the pneumococcal vaccination strategy for infants and adults aged 60 and over with the latest conjugate vaccines (PCV13, PCV15, PCV20). Emphasis on the need for rapid diagnostic lumbar puncture and simultaneous serum and cerebrospinal fluid analysis to increase diagnostic precision. The introduction of procalcitonin (PCT) in serum as an additional biomarker to differentiate between bacterial and viral meningitis. ⋯ Adaptation of antibiotic recommendations based on the current resistance situation, in particular for meningococcal meningitis, consideration of penicillin G only after resistance testing. Clarification of the areas and duration of use of dexamethasone in bacterial meningitis, particularly in pneumococcal meningitis and the controversial data situation in Listeria meningitis. New findings on the safe use of heparin in septic sinus thrombosis without increased risk of hemorrhage.
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Dtsch. Med. Wochenschr. · Aug 2024
[Frailty in Oncology: Updated Recommendations for Clinical Practice].
Frailty is a clinical condition associated with aging and resulting in increased risk of adverse outcomes upon exogenous or endogenous stressors. In oncology, cancer treatment itself can be a stressor event. In older cancer patients, frailty therefore not only enhances the probability of age-related health events such as institutionalization or falls, but also of treatment complications such as toxicity and interruption or discontinuation of therapy. ⋯ Based on these data, the American Society of Clinical Oncology (ASCO) updated the clinical practice guidelines for the assessment and management of vulnerabilities in older adults receiving systemic cancer therapy. The guideline recommends the use of a new GA-tool named 'practical geriatric assessment' (PGA) to foster the implementation of GA-based frailty assessment and management in routine cancer care. This article describes the background and key aspects of these recent advances.
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The KDIGO Update 2024 was supplemented by new "Clinical Practice Points", which were derived from the current evidence but are not necessarily comprehensively proven by prospective controlled studies. The most significant change in the Update 2024 for Lupus nephritis concerns the recommendations for induction therapy for lupus nephritis classes III and IV. The basis is still high-dose glucocorticoid treatment and the use of hydroxychloroquine. ⋯ Due to the inconsistency and variability of the conditions under which blood pressure measurements are carried out in practice, an international consensus statement was issued which defines 4 steps to achieve sufficient validity of the measurement results. CKD-MBD Controversies Conference 2023: The update for CKD-MBD, which was discussed in the Controversies Conference 2023, is in progress and has not been released yet. However, there were no serious contradictions between the 2023 data and the 2017 guidelines - the risk assessment regarding calcium-containing phosphate binders may have been put into perspective.