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Busch HJ, Wolfrum S, Michels G, Baumgärtel M, Bodmann KF, Buerke M, Burst V, Enghard P, Ertl G, Fach WA, Hanses F, Heppner HJ, Hermes C, Janssens U, John S, Jung C, Karagiannidis C, Kiehl M, Kluge S, Koch A, Kochanek M, Korsten P, Lepper PM, Merkel M, Müller-Werdan U, Neukirchen M, Pfeil A, Riessen R, Rottbauer W, Schellong S, Scherg A, Sedding D, Singler K, Thieme M, Trautwein C, Willam C, Werdan K. [Clinical acute and emergency medicine curriculum-focus on internal medicine : Recommendations for advanced training in internal medicine in the emergency department]. Med Klin Intensivmed Notfmed 2024; 119:1-50. [PMID: 38625382 PMCID: PMC11098871 DOI: 10.1007/s00063-024-01113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/17/2024]
Abstract
In Germany, physicians qualify for emergency medicine by combining a specialty medical training-e.g. internal medicine-with advanced training in emergency medicine according to the statutes of the State Chambers of Physicians largely based upon the Guideline Regulations on Specialty Training of the German Medical Association. Internal medicine and their associated subspecialities represent an important column of emergency medicine. For the internal medicine aspects of emergency medicine, this curriculum presents an overview of knowledge, skills (competence levels I-III) as well as behaviours and attitudes allowing for the best treatment of patients. These include general aspects (structure and process quality, primary diagnostics and therapy as well as indication for subsequent treatment; resuscitation room management; diagnostics and monitoring; general therapeutic measures; hygiene measures; and pharmacotherapy) and also specific aspects concerning angiology, endocrinology, diabetology and metabolism, gastroenterology, geriatric medicine, hematology and oncology, infectiology, cardiology, nephrology, palliative care, pneumology, rheumatology and toxicology. Publications focussing on contents of advanced training are quoted in order to support this concept. The curriculum has primarily been written for internists for their advanced emergency training, but it may generally show practising emergency physicians the broad spectrum of internal medicine diseases or comorbidities presented by patients attending the emergency department.
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Affiliation(s)
- Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Matthias Baumgärtel
- Klinikum Nürnberg, Universitätsklinik für Innere Medizin 3 der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | | | - Michael Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - Volker Burst
- Schwerpunkt Klinische Akut- und Notfallmedizin und Klinik II für Innere Medizin, Uniklinik Köln, Köln, Deutschland
| | - Philipp Enghard
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Georg Ertl
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Wolf Andreas Fach
- MVZ CCB am AGAPLESION Bethanien Krankenhaus, Frankfurt (Main), Deutschland
| | - Frank Hanses
- Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken und Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Deutschland
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Stefan John
- Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Klinikum Nürnberg-Süd, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie des Universitätsklinikums Düsseldorf, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
| | - Christian Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Kliniken Köln und Universität Witten/Herdecke, Köln, Deutschland
| | - Michael Kiehl
- Medizinische Klinik I, Klinikum Frankfurt (Oder), Frankfurt (Oder), Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Alexander Koch
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | | | - Peter Korsten
- Klinik für Rheumatologie und Klinische Immunologie, St. Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - Philipp M Lepper
- Klinik für Akut- und Notfallmedizin, Universität und Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | | | - Ursula Müller-Werdan
- Medizinische Klinik für Geriatrie und Altersmedizin, der Charité - Universitätsmedizin Berlin und EGZB, Berlin, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Reimer Riessen
- Internistische Intensivstation 93, Dept. f. Innere Medizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolfgang Rottbauer
- Klinik für Innere Medizin II (Kardiologie, Angiologie, Pneumologie, Intensivmedizin, Sport- und Rehabilitationsmedizin), Universitätsklinikum Ulm, Ulm, Deutschland
| | | | | | - Daniel Sedding
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland
| | - Katrin Singler
- Universitätsklinik für Innere Medizin - Geriatrie & Institut für Biomedizin des Alterns, Klinikum Nürnberg Paracelsus Medizinische Privatuniversität & Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg & Erlangen, Deutschland
| | - Marcus Thieme
- Abteilung Innere Medizin und REGIOMED Gefäßzentrum, REGIOMED Klinikum Sonneberg, Sonneberg und Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Carsten Willam
- Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland.
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Jia Y, Jiang Y, He Y, Zhang W, Zou J, Magar KT, Boucetta H, Teng C, He W. Approved Nanomedicine against Diseases. Pharmaceutics 2023; 15:pharmaceutics15030774. [PMID: 36986635 PMCID: PMC10059816 DOI: 10.3390/pharmaceutics15030774] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 03/03/2023] Open
Abstract
Nanomedicine is a branch of medicine using nanotechnology to prevent and treat diseases. Nanotechnology represents one of the most effective approaches in elevating a drug‘s treatment efficacy and reducing toxicity by improving drug solubility, altering biodistribution, and controlling the release. The development of nanotechnology and materials has brought a profound revolution to medicine, significantly affecting the treatment of various major diseases such as cancer, injection, and cardiovascular diseases. Nanomedicine has experienced explosive growth in the past few years. Although the clinical transition of nanomedicine is not very satisfactory, traditional drugs still occupy a dominant position in formulation development, but increasingly active drugs have adopted nanoscale forms to limit side effects and improve efficacy. The review summarized the approved nanomedicine, its indications, and the properties of commonly used nanocarriers and nanotechnology.
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Affiliation(s)
- Yuanchao Jia
- Nanjing Vtrying Pharmatech Co., Ltd., Nanjing 211122, China
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Yuxin Jiang
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Yonglong He
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Wanting Zhang
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Jiahui Zou
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | | | - Hamza Boucetta
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China
| | - Chao Teng
- School of Pharmacy, China Pharmaceutical University, Nanjing 211198, China
- Correspondence: (C.T.); (W.H.)
| | - Wei He
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China
- Correspondence: (C.T.); (W.H.)
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Schönherr SG, Ranft D, Lippmann N, Lübbert C. Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study. PLoS One 2021; 16:e0258690. [PMID: 34648594 PMCID: PMC8516227 DOI: 10.1371/journal.pone.0258690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/01/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Institution-specific guidelines (ISGs) within the framework of antimicrobial stewardship programs offer locally tailored decision support taking into account local pathogen and resistance epidemiology as well as national and international guidelines. OBJECTIVES To assess the impact of ISGs for antimicrobial therapy on antibiotic consumption and subsequent changes in resistance rates and Clostridioides difficile infections (CDIs). METHODS The study was conducted at the Leipzig University Hospital, a 1,451-bed tertiary-care medical center, and covered the years 2012 to 2020. Since 2014, ISGs were provided to optimize empirical therapies, appropriate diagnostics, and antimicrobial prophylaxis. We used interrupted time series analysis (ITSA) and simple linear regression to analyze changes in antimicrobial consumption, resistance and CDIs. RESULTS Over the study period, 1,672,200 defined daily doses (DDD) of antibiotics were dispensed, and 85,645 bacterial isolates as well as 2,576 positive C. difficile cultures were collected. Total antimicrobial consumption decreased by 14% from 2012 to 2020, without clear impact of the deployment of ISGs. However, implementation of ISGs was associated with significant decreases in the use of substances that were rarely recommended (e.g., fluoroquinolones). Over the whole study period, we observed declining resistance rates to most antibiotic classes of up to 25% in Enterobacterales, staphylococci, and Pseudomonas aeruginosa. Switching from ceftriaxone to cefotaxime was associated with reduced resistance to third-generation cephalosporins. The number of CDI cases fell by 65%, from 501 in 2012 to 174 in 2020. CONCLUSIONS Well-implemented ISGs can have a significant, immediate, and lasting impact on the prescription behavior. ISGs might thereby contribute to reduce resistance rates and CDI incidences in the hospital setting.
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Affiliation(s)
- Sebastian G. Schönherr
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
| | - Donald Ranft
- Hospital Pharmacy, Leipzig University Hospital, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
- * E-mail:
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