Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2018
[Piperacillin/Tazobactam Shortage: Central Restriction and Alternative Recommendations as Effective Antibiotic-Stewardship Intervention at a Maximal Care Hospital].
Drug supply bottleneck is a worldwide challenge, e. g. the antibiotics Piperacillin/Tazobactam shortage in 2016/2017. The efficacy of an appropriate replacement management was evaluated at the University Hospital Frankfurt (UHF). ⋯ Drug shortages challenge hospital antibiotic-stewardship programs by enforced use of broad spectrum-antibiotics, endanger patient safety and require rational replacement strategies, following infectious diseases- and microbiological outlines. Whilst personnel expenditures are higher, antimicrobial-stewardship interventions may successfully contribute to prevent additional medication costs.
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Dtsch. Med. Wochenschr. · Apr 2018
[Work and Training Conditions of Young German Physicians in Internal Medicine - Results of a Second Nationwide Survey by Young Internists from the German Society of Internal Medicine and the German Professional Association of Internists.]
Medical specialty training is the basis for career development of young internists and it is vital for the delivery of high-quality medical care. In 2014 the young internists of two professional bodies in Germany conducted a survey among their young members and described major factors influencing training and working conditions. We present the results of a follow-up survey to describe changes of these factors over time. An additional focus is set on the difficulties of balancing medical career and family. ⋯ These results demonstrate that there is still a serious need for adjusting training and working conditions of young internists in Germany. Especially the role and increasing importance of female physicians has to be recognized by enabling a successful integration of medical career and family.
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Dtsch. Med. Wochenschr. · Apr 2018
Case Reports[Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Metastatic Gastric Cancer].
A 53-year-old woman with relapsed metastatic gastric cancer after multimodal therapy was hospitalized 6 months after the end of treatment due to acute dyspnea. ⋯ PTTM is a rare and often fatal tumor-associated pulmonary complication.
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Dtsch. Med. Wochenschr. · Apr 2018
[Regional Aspects in Treatment of Patients with Acute Myocardial Infarction in the North-East of Germany].
In recent decades, guideline-based therapy of myocardial infarction has led to a considerable reduction in myocardial infarction mortality. However, there are relevant differences in acute care and the extent of infarction mortality. The objective of this survey was to analyze the current care situation of patients with acute myocardial infarction in the region of northeast Germany (Berlin, Brandenburg and Mecklenburg-Vorpommern). ⋯ The investigated population of patients with acute MI in Berlin, Brandenburg and Mecklenburg-Vorpommern demonstrated a comparable inpatient and post-hospital care and 1-year prognosis regardless of the federal state assignment. Referral to coronary angiography and adequate implementation of evidence-based medication demonstrated a significant prognostic impact.
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In suspected gastrointestinal bleeding (GIB), standard operating procedures help in risk stratification, early patient management and endoscopy. If variceal bleeding is suspected, specific medication (vasoconstrictors, antimicrobial therapy) are additive to standard pharmacological management (PPI, erythromycin) prior to endoscopy. ⋯ In high risk patients, insertion of a covered TIPS should be considered. In refractory or recurrent bleeding, stent insertion or balloon compression help to bridge the time for TIPS preparation.