Die abgelaufene S3-DEGAM-Leitlinie (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin) wurde 2021–2025 interdisziplinär neu erarbeitet und 2025 als S2k-DEGAM-Leitlinie „Schwindel in der Hausarztpraxis“ veröffentlicht. Sie richtet sich auch an Ärztinnen und Ärzte für HNO-Heilkunde, Neurologie, Innere Medizin, Radiologie, Psychotherapie und Physiotherapie. Das Symptom Schwindel stellt mit einer Jahresprävalenz von 2–5
Background:Severe functional tricuspid regurgitation (TR) in the setting of arrhythmogenic right ventricular cardiomyopathy (ARVC) represents a challenging clinical entity, often complicated by progressive right ventricular (RV) dysfunction and limited interventional options. Case summary:We report the first worldwide case of successful transcatheter tricuspid valve replacement (TTVR) with the EVOQUE™ system in a 37-year-old patient with ARVC, severe TR, and a cardiac resynchronization therapy defibrillator (CRT-D), following failed transcatheter edge-to-edge repair (TEER). The procedure resulted in immediate elimination of TR and the patient experienced marked symptomatic improvement. Discussion:This case highlights the feasibility of TTVR in complex RV pathology, underscoring procedural considerations such as lead-valve interaction, risk of afterload mismatch, and prevention of right heart failure. TTVR with the EVOQUE™ system is feasible in selected patients with ARVC, severe functional TR, prior failed repair, and existing CRT-D leads. Success depends on meticulous pre-procedural planning, intra-procedural imaging, and vigilant haemodynamic management to mitigate RHF risk. This case broadens the spectrum of structural interventions in patients with ARVC and symptomatic TR not suitable for surgery or TEER and supports consideration of TTVR as a bridge-to-transplant strategy.
Since 2020, psychotherapists and physicians have been allowed to prescribe digital health applications for mental disorders (DHA-MD). The aim of the study was to examine the actual relevance of DHA-MD for mental health care by asking psychotherapists and physicians for their opinion on the need for DHA-MD and how often they actually prescribe them. Moreover, we wanted to identify reasons for (not) prescribing DHA-MD.In spring 2024, 1000 psychological psychotherapists and physicians registered by the National Association of Statutory Health Insurance Physicians in Germany were selected stratified by region and community size. They received a self-developed questionnaire by post, which was additionally published online by, for instance, expert associations. Additionally, we conducted semi-structured interviews with selected participants. Questionnaires were analysed both descriptively and via Spearman's Rank Correlation Test. A qualitative content analysis according to Mayring was done for the interviews.In total, 321 participants filled out the questionnaires, and 16 were interviewed. The need for DHA-MD on a scale of 0-10 was rated≤2 (median 2) by 61% (n=198) of the participants. The median of DHA-MD prescriptions in a regular calender quarter was 0 with a range up to 20. The share of participants prescribing at least one PsyDiGA was slightly higher (n=23, 29%) among physicians compared to psychological psychotherapists (n=60, 25%). There was no difference in the assessment of need for DHA-MD between the two professions. According to the interviews, requirements for confidence in and prescription of DHA-MD comprised guaranteed data protection, sufficient proof of concept, and knowledge about the contents of DHA-MD.Reasons for the low number of prescriptions and perceived need for DHA-MD may be less experience with DHA-MD or a lack of perceived necessity in participants' practice routine. The demand for transparency concerning data protection, proof of concept, and content of DHA-MD show mental health professionals' expectations of high quality concerning DHA-MD.
