Praxis最新文献

Introduction: In patients with acute uncomplicated diverticulitis current guidelines recommend that antibiotics should not be used reflexively or routinely, but rather selectively: starting with Hinchey stage 1b, i.e. in the case of localized pericolic abscess. Antibiotic-free diverticulitis therapy is therefore generally possible up to Hinchey stage 1a. We recommend carefully evaluating the patient, taking exclusion criteria into account and re-examining the patient after 48-72 hours. Keywords: Diverticulitis, antibiotics, treatment without antibiotics, complications.

Introduction: Due to widespread diseases with increasing numbers of patients, such as metabolic syndrome, metabolic liver diseases are becoming the most common liver diseases of the future. The article explains key changes, including the nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease.

Introduction: We present a case with eosinophilic granulomatosis with polyangiitis (EGPA). We provide an overview of eosinophilic lung diseases and underline challenges in diagnosis and management of those diseases. Furthermore, we discuss the severity classification of EGPA and provide insight into the current treatment regimen.

Introduction: The guidelines on Helicobacter pylori (HP) have changed considerably. HP should always be considered a persistent and not a transient infection. A positive HP test should always be treated in order to prevent complications such as gastric or duodenal ulcers and gastric carcinoma. The prevalence of HP has been decreasing for many years but remains high among immigrants from many countries. Because the antimicrobial resistance situation has deteriorated significantly, we always recommend resistance testing before first-line therapy.

Introduction: Reducing pain is an indubitable ethical requirement; the need for pain treatment is compelling. Modern pain therapy should take place in an interdisciplinary context in order to use the advantages of combined somatic and psychological therapies. The aim is to support patients in strengthening their self-efficacy and developing strategies for accepting (some residual) chronic pain. Interventional pain therapy should be favored over administering analgesics on a long-term basis. Both psychotherapeutic and body therapy techniques should be used to strengthen self-efficacy and acceptance. Successes in pain therapy from a cooperation between the various disciplines create the conditions for patients to become active again themselves and to try to give any remaining pain the space it deserves in their lives.

Introduction: In order to correctly interpret laboratory findings, it is essential to be aware of the limitations and background of laboratory values and correction formulas for everyday clinical practice. The determination of total calcium is sufficient as a screening test, while the determination of ionised calcium is the clinical gold standard. An albumin correction can lead to misinterpretations, unnecessary additional diagnostics and therapies and should be critically questioned.

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Introduction: Residency programmes and curricula in primary care (PC) provide low-threshold access to PC training, with the aim of attracting more physicians into these setting. Alumni from the canton of Zurich were asked about their careers and the content of PC curricula. Of 178 alumni, 46.6 % (83 alumni) completed the survey. 79.5 % had completed training and 84.3 % reported that they intended to work in PC in the medium term. The majority work in the canton of Zurich. Dermatology, otorhinolaryngology, rheumatology and psychiatry were rated as the most attractive specialties within a curriculum. The majority of alumni are aiming for a career in PC in the medium term. Accordingly, the programmes are an important instrument for promoting young talents.

Introduction: Splenic rupture after a colonoscopy is a rare, but potentially life-threatening complication. It should be considered in patients with acute pain in the left upper abdomen, arterial hypotension or even hemorrhagic shock. The diagnosis is made using computer tomography or sonography. Treatment depends on the severity and includes conservative management, arterial embolization or splenectomy.

Introduction: Our stop smoking counselling clinic at the University Hospital Zurich is based on a concept with various elements that are provided in a longer initial consultation and at least four follow-up consultations within about 3 months. Depending on the medical context, mental state, level of motivation and previous experience of the smoker, the content, intervals and number of sessions required can vary individually. As a rule, repeated counselling is supplemented by medication support, and relatively often by combination medication therapies. The frequency of treatment is high in the first 3 months because the need for support and the risk of relapse are greatest then. Initially, counselling sessions take place every 2 to 4 weeks, then they are extended individually to 6 to 8 weeks. Ideally, counselling should be provided for a period of 6 months. This allows for reliable support over a period of several months and for adjustments to be made to the plan of action if necessary.