Skip to main content
Erschienen in: Wiener Medizinische Wochenschrift 5-6/2022

10.01.2022 | main topic

Polypharmacy in elderly people

verfasst von: Peter Dovjak, MD

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 5-6/2022

Einloggen, um Zugang zu erhalten

Summary

Polypharmacy characterizes ongoing prescription of multiple medications in a patient. Following the demographic change and growing number of elderly patients, polypharmacy is of major concern due to the associated risks and even mortality. Many causes made this geriatric syndrome more common in the past decade. First, the management of comorbidities is often lacking in disease-specific guidelines. Second, multimorbidity is rising due to the ageing population. Third, deprescribing methods are sparse, and results are conflicting. This mini review integrates the effects of polypharmacy on mortality and morbidity, the causes and confounders of polypharmacy, and presents a practical stepwise manual of deprescribing. The work is based on a literature search for randomized control trials and reviews in English and German from 2015 onwards in the PubMed database, with integration of relevant citations as a result of this search.
Literatur
1.
Zurück zum Zitat Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.PubMedPubMedCentral Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230.PubMedPubMedCentral
2.
Zurück zum Zitat Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013;42(1):62–9.PubMed Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing. 2013;42(1):62–9.PubMed
3.
Zurück zum Zitat Hsu HF, Chen KM, Belcastro F, Chen YF. Polypharmacy and pattern of medication use in community-dwelling older adults: a systematic review. J Clin Nurs. 2021;30(7–8):918–28.PubMed Hsu HF, Chen KM, Belcastro F, Chen YF. Polypharmacy and pattern of medication use in community-dwelling older adults: a systematic review. J Clin Nurs. 2021;30(7–8):918–28.PubMed
4.
Zurück zum Zitat O’Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e10505.PubMedPubMedCentral O’Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e10505.PubMedPubMedCentral
5.
Zurück zum Zitat Morin L, Laroche ML, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1–862.e9. Morin L, Laroche ML, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1–862.e9.
6.
Zurück zum Zitat Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71(12):1415–27.PubMed Tommelein E, Mehuys E, Petrovic M, Somers A, Colin P, Boussery K. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review. Eur J Clin Pharmacol. 2015;71(12):1415–27.PubMed
7.
Zurück zum Zitat Bradley MC, Motterlini N, Padmanabhan S, Cahir C, Williams T, Fahey T, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatr. 2014;14:72.PubMedPubMedCentral Bradley MC, Motterlini N, Padmanabhan S, Cahir C, Williams T, Fahey T, et al. Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatr. 2014;14:72.PubMedPubMedCentral
8.
Zurück zum Zitat Cooper JA, Cadogan CA, Patterson SM, Kerse N, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. 2015;5(12):e9235.PubMedPubMedCentral Cooper JA, Cadogan CA, Patterson SM, Kerse N, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open. 2015;5(12):e9235.PubMedPubMedCentral
9.
Zurück zum Zitat Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, et al. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med. 2019;10(1):9–36.PubMed Palmer K, Villani ER, Vetrano DL, Cherubini A, Cruz-Jentoft AJ, Curtin D, et al. Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis. Eur Geriatr Med. 2019;10(1):9–36.PubMed
10.
Zurück zum Zitat Abe N, Kakamu T, Kumagai T, Hidaka T, Masuishi Y, Endo S, et al. Polypharmacy at admission prolongs length of hospitalization in gastrointestinal surgery patients. Geriatr Gerontol Int. 2020;20(11):1085–90.PubMedPubMedCentral Abe N, Kakamu T, Kumagai T, Hidaka T, Masuishi Y, Endo S, et al. Polypharmacy at admission prolongs length of hospitalization in gastrointestinal surgery patients. Geriatr Gerontol Int. 2020;20(11):1085–90.PubMedPubMedCentral
11.
Zurück zum Zitat Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020;21(2):181–7.PubMed Davies LE, Spiers G, Kingston A, Todd A, Adamson J, Hanratty B. Adverse outcomes of polypharmacy in older people: systematic review of reviews. J Am Med Dir Assoc. 2020;21(2):181–7.PubMed
12.
Zurück zum Zitat Jennings ELM, Murphy KD, Gallagher P, O’Mahony D. In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis. Age Ageing. 2020;49(6):948–58.PubMed Jennings ELM, Murphy KD, Gallagher P, O’Mahony D. In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis. Age Ageing. 2020;49(6):948–58.PubMed
13.
Zurück zum Zitat Chang TI, Park H, Kim DW, Jeon EK, Rhee CM, Kalantar-Zadeh K, et al. Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Sci Rep. 2020;10(1):18964.PubMedPubMedCentral Chang TI, Park H, Kim DW, Jeon EK, Rhee CM, Kalantar-Zadeh K, et al. Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Sci Rep. 2020;10(1):18964.PubMedPubMedCentral
14.
Zurück zum Zitat Fialová D, Brkić J, Laffon B, Reissigová J, Grešáková S, Dogan S, et al. Applicability of EU(7)-PIM criteria in cross-national studies in European countries. Ther Adv Drug Saf. 2019;10:2042098619854014.PubMedPubMedCentral Fialová D, Brkić J, Laffon B, Reissigová J, Grešáková S, Dogan S, et al. Applicability of EU(7)-PIM criteria in cross-national studies in European countries. Ther Adv Drug Saf. 2019;10:2042098619854014.PubMedPubMedCentral
15.
Zurück zum Zitat Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: evaluating risks and deprescribing. Am Fam Physician. 2019;100(1):32–8.PubMed Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: evaluating risks and deprescribing. Am Fam Physician. 2019;100(1):32–8.PubMed
16.
Zurück zum Zitat Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1–535.12. Jokanovic N, Tan EC, Dooley MJ, Kirkpatrick CM, Bell JS. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc. 2015;16(6):535.e1–535.12.
17.
Zurück zum Zitat Pesante-Pinto JL. Clinical pharmacology and the risks of polypharmacy in the geriatric patient. Phys Med Rehabil Clin N Am. 2017;28(4):739–46.PubMed Pesante-Pinto JL. Clinical pharmacology and the risks of polypharmacy in the geriatric patient. Phys Med Rehabil Clin N Am. 2017;28(4):739–46.PubMed
18.
Zurück zum Zitat Cheng X, Yang Y, Schwebel DC, Liu Z, Li L, Cheng P, et al. Population ageing and mortality during 1990–2017: a global decomposition analysis. PLoS Med. 2020;17(6):e1003138.PubMedPubMedCentral Cheng X, Yang Y, Schwebel DC, Liu Z, Li L, Cheng P, et al. Population ageing and mortality during 1990–2017: a global decomposition analysis. PLoS Med. 2020;17(6):e1003138.PubMedPubMedCentral
19.
Zurück zum Zitat Curtin D, O’Mahony D, Gallagher P. Drug consumption and futile medication prescribing in the last year of life: an observational study. Age Ageing. 2018;47(5):749–53.PubMed Curtin D, O’Mahony D, Gallagher P. Drug consumption and futile medication prescribing in the last year of life: an observational study. Age Ageing. 2018;47(5):749–53.PubMed
20.
Zurück zum Zitat Hsu CC, Hsu YC, Chang KH, Lee CY, Chong LW, Lin CL, et al. Depression and the risk of peptic ulcer disease: a nationwide population-based study. Medicine. 2015;94(51):e2333.PubMedPubMedCentral Hsu CC, Hsu YC, Chang KH, Lee CY, Chong LW, Lin CL, et al. Depression and the risk of peptic ulcer disease: a nationwide population-based study. Medicine. 2015;94(51):e2333.PubMedPubMedCentral
21.
Zurück zum Zitat Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging. 2009;26(6):493–503.PubMed Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs Aging. 2009;26(6):493–503.PubMed
22.
Zurück zum Zitat Lunsky Y, Modi M. Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability. Psychiatr Serv. 2018;69(2):242–6.PubMed Lunsky Y, Modi M. Predictors of psychotropic polypharmacy among outpatients with psychiatric disorders and intellectual disability. Psychiatr Serv. 2018;69(2):242–6.PubMed
23.
Zurück zum Zitat Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.PubMed Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.PubMed
24.
Zurück zum Zitat Hanlon JT, Schmader KE. The medication appropriateness index at 20: where it started, where it has been, and where it may be going. Drugs Aging. 2013;30(11):893–900.PubMed Hanlon JT, Schmader KE. The medication appropriateness index at 20: where it started, where it has been, and where it may be going. Drugs Aging. 2013;30(11):893–900.PubMed
25.
Zurück zum Zitat Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045–51.PubMed Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45(10):1045–51.PubMed
26.
Zurück zum Zitat Rongen GA, Marquet P, van Gerven JMA, EACPT research working group. The scientific basis of rational prescribing. A guide to precision clinical pharmacology based on the WHO 6‑step method. Eur J Clin Pharmacol. 2021;77(5):677–83.PubMed Rongen GA, Marquet P, van Gerven JMA, EACPT research working group. The scientific basis of rational prescribing. A guide to precision clinical pharmacology based on the WHO 6‑step method. Eur J Clin Pharmacol. 2021;77(5):677–83.PubMed
27.
Zurück zum Zitat Scordo KA. Teaching students about the WHO guide to good prescribing. Nurse Pract. 2014;39(3):51–4.PubMed Scordo KA. Teaching students about the WHO guide to good prescribing. Nurse Pract. 2014;39(3):51–4.PubMed
28.
Zurück zum Zitat Kane RL, Shamliyan T, Talley K, Pacala J. The association between geriatric syndromes and survival. J Am Geriatr Soc. 2012;60(5):896–904.PubMed Kane RL, Shamliyan T, Talley K, Pacala J. The association between geriatric syndromes and survival. J Am Geriatr Soc. 2012;60(5):896–904.PubMed
29.
Zurück zum Zitat Wallace E, McDowell R, Bennett K, Fahey T, Smith SM. Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: a prospective cohort study. J Gerontol A Biol Sci Med Sci. 2017;72(2):271–7.PubMed Wallace E, McDowell R, Bennett K, Fahey T, Smith SM. Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: a prospective cohort study. J Gerontol A Biol Sci Med Sci. 2017;72(2):271–7.PubMed
30.
Zurück zum Zitat AGS Choosing Wisely Workgroup. American geriatrics society identifies another five things that healthcare providers and patients should question. J Am Geriatr Soc. 2014;62(5):950–60. AGS Choosing Wisely Workgroup. American geriatrics society identifies another five things that healthcare providers and patients should question. J Am Geriatr Soc. 2014;62(5):950–60.
31.
Zurück zum Zitat Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801–2.PubMed Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801–2.PubMed
32.
Zurück zum Zitat Gallagher P, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Montero Errasquín B, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175–88.PubMed Gallagher P, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Montero Errasquín B, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175–88.PubMed
33.
Zurück zum Zitat Gallagher P, O’Mahony D. STOPP (screening tool of older persons’ potentially inappropriate prescriptions): application to acutely ill elderly patients and comparison with beers’ criteria. Age Ageing. 2008;37(6):673–9.PubMed Gallagher P, O’Mahony D. STOPP (screening tool of older persons’ potentially inappropriate prescriptions): application to acutely ill elderly patients and comparison with beers’ criteria. Age Ageing. 2008;37(6):673–9.PubMed
34.
Zurück zum Zitat Mann E, Bohmdorfer B, Fruhwald T, Roller-Wirnsberger RE, Dovjak P, Duckelmann-Hofer C, et al. Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr. 2012;124(5–6):160–9.PubMed Mann E, Bohmdorfer B, Fruhwald T, Roller-Wirnsberger RE, Dovjak P, Duckelmann-Hofer C, et al. Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr. 2012;124(5–6):160–9.PubMed
35.
Zurück zum Zitat Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31–32):543–51.PubMedPubMedCentral Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31–32):543–51.PubMedPubMedCentral
36.
Zurück zum Zitat Thiem U, Theile G, Junius-Walker U, Holt S, Thürmann P, Hinrichs T, et al. Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium. Z Gerontol Geriatr. 2011;44(2):115–20.PubMed Thiem U, Theile G, Junius-Walker U, Holt S, Thürmann P, Hinrichs T, et al. Prerequisites for a new health care model for elderly people with multimorbidity: the PRISCUS research consortium. Z Gerontol Geriatr. 2011;44(2):115–20.PubMed
38.
Zurück zum Zitat Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9(6):430–4.PubMed Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9(6):430–4.PubMed
39.
Zurück zum Zitat Dovjak P. Tools in polypharmacy. Current evidence from observational and controlled studies. Z Gerontol Geriatr. 2012;45(6):468–72.PubMed Dovjak P. Tools in polypharmacy. Current evidence from observational and controlled studies. Z Gerontol Geriatr. 2012;45(6):468–72.PubMed
40.
Zurück zum Zitat Thompson W, Lundby C, Graabaek T, Nielsen DS, Ryg J, Søndergaard J, et al. Tools for deprescribing in frail older persons and those with limited life expectancy: a systematic review. J Am Geriatr Soc. 2019;67(1):172–80.PubMed Thompson W, Lundby C, Graabaek T, Nielsen DS, Ryg J, Søndergaard J, et al. Tools for deprescribing in frail older persons and those with limited life expectancy: a systematic review. J Am Geriatr Soc. 2019;67(1):172–80.PubMed
41.
Zurück zum Zitat Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug burden index and potentially inappropriate medications in community-dwelling older people: the impact of home medicines review. Drugs Aging. 2010;27(2):135–48.PubMed Castelino RL, Hilmer SN, Bajorek BV, Nishtala P, Chen TF. Drug burden index and potentially inappropriate medications in community-dwelling older people: the impact of home medicines review. Drugs Aging. 2010;27(2):135–48.PubMed
42.
Zurück zum Zitat Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7.PubMed Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781–7.PubMed
43.
Zurück zum Zitat O’Connell J, Burke É, Mulryan N, O’Dwyer C, Donegan C, McCallion P, et al. Drug burden index to define the burden of medicines in older adults with intellectual disabilities: an observational cross-sectional study. Br J Clin Pharmacol. 2018;84(3):553–67.PubMedPubMedCentral O’Connell J, Burke É, Mulryan N, O’Dwyer C, Donegan C, McCallion P, et al. Drug burden index to define the burden of medicines in older adults with intellectual disabilities: an observational cross-sectional study. Br J Clin Pharmacol. 2018;84(3):553–67.PubMedPubMedCentral
44.
Zurück zum Zitat Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508–13.PubMed Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508–13.PubMed
46.
Zurück zum Zitat Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging. 2008;25(12):1021–31.PubMed Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging. 2008;25(12):1021–31.PubMed
47.
Zurück zum Zitat Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.PubMed Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.PubMed
48.
Zurück zum Zitat Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;10:CD8165. Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;10:CD8165.
49.
Zurück zum Zitat Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.PubMed Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.PubMed
50.
Zurück zum Zitat Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008;56(10):1946–52.PubMedPubMedCentral Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008;56(10):1946–52.PubMedPubMedCentral
51.
Zurück zum Zitat Alzner R, Benvenuti-Falger U, Böhmdorfer B et al. Austrian Geriatric Society, Polypharmazie, facultas.wuv. Universitätsverlag, Vienna; 2016. Alzner R, Benvenuti-Falger U, Böhmdorfer B et al. Austrian Geriatric Society, Polypharmazie, facultas.wuv. Universitätsverlag, Vienna; 2016.
Metadaten
Titel
Polypharmacy in elderly people
verfasst von
Peter Dovjak, MD
Publikationsdatum
10.01.2022
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 5-6/2022
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-021-00903-0

Weitere Artikel der Ausgabe 5-6/2022

Wiener Medizinische Wochenschrift 5-6/2022 Zur Ausgabe

Buchbesprechung

Buchbesprechung

editorial

Editorial