THERAPEUTISCHE UMSCHAU最新文献

Introduction:

Introduction: Gout is an inflammatory arthritis that is commonly associated with chronic diseases such as chronic kidney disease (CKD), hypertension, coronary vascular disease, and the metabolic syndrome. Therefore, the management of gout (treatment of the acute flare, lowering serum urate [sUA]) needs to take these co-morbid conditions in consideration. Recent advances in gout therapy showed the effectiveness of new and existing therapies in gout management and we will summarize those we consider to have the largest impact on our clinical practice in this article.

Introduction: Crystal arthropathies present a complex entity for radiological diagnostics, often reflecting rheumatologic and other diseases. Over the past decades, the evidence and applicability of various radiological techniques, with and without the use of ionizing radiation, have significantly evolved. This article provides an overview of the current evidence on the use of different modalities and their advantages and disadvantages for the diagnosis and therapy monitoring of crystal arthropathies, based on the latest guidelines from relevant professional societies. In addition to established methods such as X-ray, ultrasound and MRI, this work also addresses newer methods such as dual-energy computed tomography (CT) and photon-counting CT.

Introduction: Calcium pyrophosphate deposition (CPPD) disease plays an important - and sometimes underestimated - role in rheumatology practice. Clinically, CPP-arthritis is often indistinguishable from gout and is therefore commonly referred to as "pseudogout". In contrast to gout, CPPD cannot be cured but can only be treated symptomatically. The pathophysiology, diagnosis, therapy and new therapeutic approaches to CPPD are discussed below.

Introduction: Gout is a common form of inflammation, characterized by sudden, severe attacks of pain, swelling, redness and tenderness. The diagnosis is based on the typical clinical pattern, but the definitive diagnosis requires the identification of urat crystals in the joint fluid or in ultrasound or DECT. The differential diagnosis includes always infection or other crystal arthropathies, in atypical presentation also other forms of arthritis, e.g. peripheral spondylarthritis.

Introduction: Dyspnea is a common and distressing symptom in patients with advanced malignant and non-malignant diseases. It is a subjective experience that can only be described by the patients themselves and can be associated with a massive reduction in quality of life, including social isolation and wish to hasten death. Often there is an affective component such as anxiety or panic. Objective parameters do not necessarily correlate with the subjective experience. Health professionals often underestimate and inadequately treat the burden of dyspnea. The introduction of the concept of chronic breathlessness syndrome or acute-on-chronic-breathlessness aims to illustrate the nature of the condition and facilitate the identification and access to appropriate treatment. The management of dyspnea is complex, and for effective treatment, a combination of general, non-pharmacological, and pharmacological measures is usually advisable. Opioids should be offered to patients with incurable cancer and refractory dyspnea for symptom relief. They can be supplemented with benzodiazepines in cases of concomitant anxiety. The administration of oxygen is only indicated in cases of hypoxemia. Key measures include education, self-management skills acquisition and advance care planning for emergency situations.

Introduction: Oral health problems appear in up to 80 % of palliative care patients. Almost all of these patients suffer from a dry mouth which is often the result of medication side effects. Even though a dry mouth is not a disease by itself, it enhances the risk of developing other more serious oral lesions and diseases. Stomatitis, an inflammatory response to radio- or oncological treatment induced lesions, is very painful and may interfere severely with the ingestion of food and fluids. Finally, oral fungal infections are very common in immunosuppressed patients. Each of these entities comes with specific symptoms and signs which may impair food and fluid intake but also have consequences on the quality of life in these patients. Hence, a systematic and standardized evaluation is essential and can be accomplished with little effort by all health care professionals.

Introduction: Food and nutrition play a major role in our lives. They include physical, psychological as well as cultural and social aspects. Illnesses increase the risk of altered food intake/absorption - of malnutrition. This applies in particular to palliative situations. The causes of malnutrition can be diverse. Malnutrition often leads to reduced performance and can therefore have a major impact on the quality of life and independency of patients. The aim of nutritional therapy interventions is therefore to maintain or improve the quality of life of patients with a life-threatening illness. The initially defined goals can change as the disease progresses. At the beginning of a life-threatening illness, adequate nutritional interventions are usually very effective. However, the benefits of nutritional therapy often change as the disease progresses and they often lose importance. For this reason, decision-making is an important process: Depending on the phase of illness, the prognosis and the patient's preferences, the nutritional therapy interventions needs to be reconsidered in regard of indication, individual benefit and the desired treatment goal on a regular base. As every medical intervention, nutritional therapy must regularly be adapted to the treatment goal if necessary.

Introduction: Palliative care for elderly, mostly multimorbid people is an integrative concept that is included at an early stage of illness in addition to curative and rehabilitative treatments. Goals of treatment and in the rest of life are regularly discussed during the course in order to set individual priorities and to plan or question clarifications, treatments and nursing measures. The prognosis, the patient's wishes and values, the possible benefits and burdens of an intervention play a central role in the decision-making process. Advance care planning makes it easier to make decisions at a later stage, especially in the case of dementia, which increasingly impairs the ability to make judgments. Older people suffer not only from destressing symptoms such as pain, but also from functional limitations that affect their quality of life. In addition to symptom-alleviating interventions, rehabilitative measures are also part of the palliative concept. In pain treatment, age-adapted adjustments to the medication are to be considered and the multidimensionality of the pain experience must be taken into account. In the case of cognitive impairment, appropriate observation tools help to identify possible pain. In the context of dementia, palliative treatment of neuropsychiatric symptoms should be considered if the patient suffers from them.

Introduction: It is a GP's task to identify patients as palliative patients at an early stage using suitable instruments. As part of a multidimensional basic assessment, the needs and expectations of the patient and their loved ones are recorded. During the interview, open questions are cla-rified, concerns are addressed and treatment options are discussed; a treatment goal is then jointly developed. Based on this treatment goal, an advance care plan is drawn up in consultation with the advising specialist and, if possible, with the involvement of a trusted person. The treatment goal, decisions and measures to be taken in an emergency are recorded in appropriate documents, which also serve to coordinate and communicate between persons involved in treatment.