Abstracts by keywords: care situation
The second part of the review on the diagnosis and care of patients with metabolically associated steatohepatitis (MASH) addresses the challenges and recommendations, taking into account the current S2k guidelines. The diagnostic algorithm focuses on a screening procedure for the early detection of MASH, with primary care physicians playing a key role. Elevated liver function tests or an abnormal fatty liver index (FLI) indicate further testing and, if necessary, referral to a specialist. Early identification is essential, especially in high-risk groups such as individuals with type 2 diabetes, obesity, or metabolic syndrome, to enable preventive action. Comprehensive metabolic diagnostics are a prerequisite for preventing disease progression. However, the care situation in the diagnosis of MASH is characterized by a number of limitations, including the limited application of the screening algorithm and the challenges of making a definitive diagnosis using liver biopsy. The discrepancy between the diagnosed number of MASH cases and the presumed prevalence indicates a significant number of undiagnosed cases, which ultimately leads to therapeutic deficits.
03.06.2024
According to estimates, around 260,000 people in Germany are affected by a stroke every year [1]. Numerous underlying diseases can result in the spastic syndrome (SMD; synonymous use: spastic movement disorder, spasticity, spasticity). The manifestation of the spastic syndrome is possible at different times in the course of the respective underlying disease [2,3]. In addition to multiple sclerosis, a craniocerebral trauma, a spinal cord lesion or cerebral palsy, stroke is one of the most common and causative underlying diseases [4]. Stroke survivors have almost a 50% chance of developing spasticity one to three months later [5,6]. Spastic movement disorders are damage to the central nervous system and the central nervous sensorimotor cell and pathway systems (“spastic movement disorder”, SMD). The disease is characterized by a massive limitation of joint mobility and therefore overall mobility, as well as involuntary activation of muscles [7]. In Germany, 250,000 people are probably affected and suffer from the disease and the associated reductions in quality of life [8].
21.09.2022
Damage to the central nervous system and the central nervous sensorimotor cell and pathway systems often result in spastic movement disorders (SMD). According to the guidelines for the treatment of spasticity syndrome (AWMF/DGN), spasticity is defined as "increased, speed-dependent stretch resistance of the skeletal muscles, which occurs as a result of a lesion of the descending motor pathways of the central nervous system (CNS) (cerebrum, brainstem, spinal cord) and usually accompanied by other symptoms such as muscle paresis, slowing of movement, increased intrinsic muscle reflexes, pathologically uninhibited synergism and spastic dystonia". In earlier studies, spasticity was described as a "rate-dependent increase in muscle tone resulting from hyperexcitability of the spinal tonic stretch reflex" [1]. An expanded definition of the SPASM group refers to spasticity as positive phenomena produced due to a disturbance in sensorimotor control resulting from a lesion of the first motor neuron. The manifestation is persistent involuntary activation of muscles [2]. SMD is a common syndrome of diseases such as stroke, multiple sclerosis or traumatic brain injury. According to estimates, up to 260,000 people in Germany suffer a stroke every year [3]. Almost half of survivors (up to 46%) experience spasticity within the first three months after the stroke [4, 5]. Spasticity can also develop at a later point in time [4]. Severe paralysis and sensory disorders are predictors of the development of spasticity, e.g. B. as a result of a stroke, and can be associated with severe limitations in coping with everyday life [6]. If you look at the time periods after a stroke in more detail, it can be seen that within the first four weeks at 4% to 27% the patient spasticity could be observed. The prevalence increases to 19% to 26.7% in the post-acute phase (one to three months). Over a period of three months there is a PSS (Post Stroke Spasticity) of 17% to 42.6% [4].
22.07.2022
Spastic movement disorder (short: SB; synonymous use: spasticity, spasticity) is the name given to the increased health-dependent muscle tension resulting from damage to the central sensorimotor system as well as uncontrolled cloni, spasms and spastic dystonias [1]. The most common cause of SB is a stroke, but multiple sclerosis, traumatic brain injury, a spinal cord lesion or cerebral palsy can also cause so-called spastic paralysis [2]. It is assumed that around 250,000 patients in Germany are affected [3]. Depending on the underlying disease, SB can manifest itself at very different times in the course of the disease [4, 5]. Between 20 and 40% of patients develop SB within the first year after the stroke [3, 6-8]. In patients with multiple sclerosis, approximately half of the patients are affected by SB during the course of their disease [9-11]. It is not uncommon for SB to cause nursing restrictions or dependencies in carrying out activities of daily living and pain, which is accompanied by a significant reduction in the patient's quality of life [12, 13]. If adequate therapy is provided too late or insufficiently, complications such as pain, contractures, skin lesions up to pressure ulcers and significant impairment of activities of daily living can result. To avoid this, it is therefore advisable to initiate management of SB as early as possible, when the first relevant symptoms appear [14].
04.04.2019
Spastic movement disorder (SB) occurs as a result of damage to the central nervous system. Accordingly, SB is a symptom of numerous underlying diseases, including stroke, multiple sclerosis and infantile cerebral palsy [1, 2]. A current extrapolation from data from the Leipzig forums suggests that around 530,000 patients are affected by SB that requires treatment. A lack of care or inadequate care can have a significant impact on the quality of life of those affected. In addition to sometimes severe impairments in everyday life, contractures, ulcerations and pain can occur as accompanying illnesses. This often results in a higher need for care or a higher level of care classification [2, 3]. SB cannot be cured, but its severity and comorbidities can be reduced. Suitable therapeutic procedures are described in the specialist literature and the corresponding guidelines [4-8]. However, it can be assumed that the reality of care in Germany shows a different picture. A survey should therefore clarify what the treatment of those affected is like [9]. A total of 109 general practitioners from Germany were surveyed by post about their patient clientele with SB and their care. Since the treatment decision of the respective doctor should not be interfered with, a non-interventional, retrospective study design was chosen. The questionnaire sent out included a total of 26 questions on general information about the patient clientele, non-invasive and drug therapy and collaboration with other specialist disciplines. On average, each GP provides care to approximately 24 patients with SB.