THERAPEUTISCHE UMSCHAU最新文献

Introduction: The physical and biological effects of hyperbaric oxygen therapy (HBOT) are used to treat various medical conditions, such as decompression sickness after diving accidents or in cases of gas embolism or CO-poisoning. Another, generally less well-known indication for HBOT is the use of HBOT in supporting the healing of chronic wounds. HBOT corrects tissue hypoxia, stimulates angiogenesis and collagen synthesis, reduces environmental oedema and has anti-inflammatory and anti-microbial effects. Various clinical studies have shown a positive effect of HBOT on wound healing, particularly in diabetic foot syndrome. Nevertheless, the indication for HBOT in wound healing disorders is not conclusively clarified for all forms of chronic wounds, which is partly due to the heterogeneity of the existing data. Barriers in application include potentially long treatment protocols and the distance to the nearest pressure chamber.

Introduction: Staying at moderate to high altitudes leads to hypobaric hypoxia due to the reduced atmospheric oxygen partial pressure, which can have clinically relevant effects in individuals with chronic respiratory diseases. This article summarizes current findings on altitude exposure in patients with asthma, chronic obstructive pulmonary disease (COPD), pulmonary vascular diseases (PVD), obstructive sleep apnea (OSA), interstitial lung diseases (ILD), and after lung transplantation. Pre-travel counseling should include functional testing, risk assessment, and preventive strategies. With appropriate preparation, altitude stays can be safe for many affected individuals.

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Introduction: Hypoxia represents a major physiological challenge in aviation, often underestimated due to its subtle onset and individually variable symptoms. This article summarizes the physical basis of decreasing oxygen partial pressure with altitude and its impact on human performance. Even at moderate altitudes (2500-4000 m), cognitive functions, reaction times, and visual performance decline significantly-often without the affected person noticing. At higher altitudes, time of useful consciousness rapidly decreases, especially in cases of sudden decompression. Although the body initiates compensatory mechanisms, such as hyperventilation and increased heart rate, these are limited and can lead to secondary complications. The key threat lies in the mismatch between actual impairment and perceived capability. Understanding hypoxia's mechanisms, recognizing early signs, and using oxygen systems correctly are critical to maintaining flight safety across all aviation sectors.

Introduction: More and more people are spending time at high altitudes, either recreationally or permanently. As altitude increases, the partial pressure of inspired oxygen decreases, leading to hypobaric hypoxia and triggering a wide range of physiological adaptations. This article discusses the most relevant (patho)physiological acclimatization effects at high altitudes in healthy subjects. Hypobaric hypoxia primarily affects respiration, circulation, blood, as well as sleep and brain function. Respiration responds immediately with increased ventilation (hypoxic ventilatory response), reducing CO₂ levels and causing respiratory alkalosis, which is later compensated renally. Above approximately 2500 m, periodic breathing often occurs, disrupting sleep. Cardiac output initially rises due to an increased heart rate but decreases later as stroke volume declines. Plasma volume contracts rapidly, raising hematocrit and increasing blood viscosity. In the long term, erythropoietin stimulates red blood cell production, enhancing oxygen transport capacity. Physical performance begins to decline linearly from around 1500 m, and maximum oxygen uptake remains limited despite acclimatization.

Introduction: People dive out of fascination or for economic reasons. Today, technical devices allow us land-dwelling organisms to breathe underwater. The effect of water pressure has a significant impact on physiological processes in the organism and leads to specific pathophysiologies. A sound knowledge of this is the basis of good medical care for people who dive to depths below the surface. Based on a number of exemplary accident scenarios, the article will examine the important pathophysiologies in diving medicine. Various accident mechanisms produce gas bubbles in the body, which can lead to symptoms in the central and peripheral nervous system. Barotrauma of the lungs can have fatal consequences. The importance of maximum oxygen supply as the most important therapeutic agent in any diving incident is discussed in detail. The medical assessment of diving fitness and competent advice are of great importance for safe diving. A well-founded examination reveals individual health risks and achieves the goal of prevention.

Introduction: Acute altitude illnesses are significant can occur in unacclimatized individuals at altitudes above 2,500 meters. They essentially comprise three clinical pictures: Acute Mountain Sickness (AMS), High Altitude Cerebral Edema (HACE), and High Altitude Pulmonary Edema (HAPE), which can manifest alone or in combination. All are triggered by hypobaric hypoxia, with individual predisposition, pre-existing medical comorbidities and in particular ascent rate and destination altitude influencing risk. AMS is the most common, presenting with headache, nausea, dizziness, and fatigue. Prevention includes slow ascent, pre-acclimatization, and eventually acetazolamide or dexamethasone. In severe cases, descent, oxygen therapy, and dexamethasone are key. HACE is considered a life-threatening complication of AMS with ataxia, altered consciousness, and neurological deficits. Pathophysiologically, vasogenic edema, hypoxic cell injury, and disturbed cerebrospinal fluid dynamics play a role. Treatment also includes descent, oxygen therapy, and dexamethasone. HAPE is a non-cardiogenic pulmonary edema due to an excessive hypoxic pulmonary vasoconstriction with consecutive elevation of pulmonary artery pressure and increased capillary pressure. Symptoms include dyspnea and cough; clinically, cyanosis and crackles are evident. Treatment requires descent, oxygen therapy, and possibly nifedipine or PDE-5-inhibitors. If untreated, HACE and HAPE progress rapidly and can be fatal. Prevention, early recognition and immediate treatment are crucial.

Introduction: Integrative oncology is gaining increasing importance in cancer care. Patients seek additional support that addresses not only physical, but also emotional and spiritual needs. At the same time, studies show positive effects of complementary therapy intervention on quality of life and symptom control. Nevertheless, healthcare professionals often remain uncertain in clinical practice regarding the safety, effectiveness, and communication of such therapies. This article provides an overview of continuing education and training opportunities in the field of integrative oncology in Switzerland, highlights existing gaps, and defines key competencies required for safe and evidence-informed application. Based on international recommendations, practice-relevant learning content, educational formats, and interprofessional teaching strategies are presented. A particular focus is placed on the development of multiprofessional, evidence-based, and practice-oriented educational programs that address various professional groups - from physicians and nurses to complementary therapists. The aim is to promote interprofessional collaboration through structured training and to ensure the safe and effective use of complementary therapies in the oncological setting.

Introduction: Palliative care focuses on the quality of life of people with life-limiting illnesses through bio-psycho-social-spiritual support and multiprofessional collaboration, as early as possible in the disease course and continuing until the end of life. In this context, many patients also seek integrative medical approaches which, with their salutogenetic and multidimensional orientation, align well with the core principles of palliative care. Using anthroposophic medicine and phytotherapy as examples, a spectrum of remedies, external applications, and artistic therapies is presented that can relieve symptoms and strengthen inner resources. A competent indication with careful consideration of benefits and burdens is essential. When applied appropriately, integrative interventions can contribute to providing individualized and comprehensive support for people at the end of life and effectively reinforce the principles of palliative care.

Introduction: In Switzerland, a wide range of integrative oncology (IO) treatments is offered by various medical disciplines. A certificate of competence (SIWF: Swiss Institute for Medical Education, allows to bill from basic incurance) can be obtained for five disciplines: anthroposophic medicine (VAOAS), classical homeopathy (SVHA), phytotherapy (SMGP), TCM/acupuncture (ASA), and clinical hypnosis (SMSH). For Mind Body Medicine a CAS can be obtained (SFMBM). Integrative Nursing is an important therapeutic partner in many medical disciplines, with own established education programmes. These seven core disciplines of IO are based on different concepts and traditions, but they also have, at least in part, commonalities such as a multidimensional view of humanity, a focus on salutogenesis, the strengthening of self-efficacy, and the importance of lifestyle factors and individualised therapy. These core disciplines are offered with varying availability at the centres of the Swiss Network for Integrative Oncology (SNIO: www.integrative-oncology.ch), generally accompanying conventional oncological therapies and close, transparent communication with oncology specialists. The SNIO aims to develop quality criteria, coordinating treatment offers, promote network research, and encourage further training in order to enable coordinated and quality-assured care.