THERAPEUTISCHE UMSCHAU最新文献

Introduction: Palliative care aims to treat patients who symptomatically are affected by an advanced, incurable disease. Dyspnoea is one of the most common symptoms in various diseases, not only the oncological ones. The treatment of these symptoms requires consideration from different points of view. In palliative care, the bio-psycho-socio-spiritual and cultural model is often applied. Here, different dimensions of the disease are considered, which are especially involved in the case of dyspnoea. The physiology of dyspnoea is very complex and is influenced by various neuronal as well as pulmonary anatomical structures. Various non-pharmacological as well as pharmacological treatment approaches can lead to a decrease in dyspnoea. In particular, active physiotherapy and assistive devices optimise the symptoms. From the pharmacological side, mainly opioids but also benzodiazepines, oxygen and Butylscopolamin are used. In the case of very advanced disease, the use of deep continuous sedation to relieve symptoms may be justified if the symptoms are refractory to therapy. Successful treatment of dyspnoea leads to a substantial improvement in the quality of life of palliative care patients.

Introduction: Any acute state of dyspnoea will lead to feelings of insecurity and anxiety. In this context the paper elucidates the conceptual horizon of anxiety, stretching from its status as «normal», essential element of conditio humana, to representing a symptom of another (somatic or mental) illness and to constituting a psychiatric disorder of its own. In any case of acute dyspnoea it is important to «normalize» the patient's anxiety, i.e. to contextualize it as a comprehensible reaction to the stressing experience and not as proof of personal weakness. If dyspnoea and anxiety occur in a patient with a preexisting psychiatric disorder, defining the appropriate therapeutic steps will be more complex and demanding, especially with regard to a targeted interdisciplinary cooperation (consultation liaison psychiatry). The paper highlights the principles of psychopharmacological and psychotherapeutical interventions, a stable therapeutical relationship always defining the center of any treatment procedure.

Introduction: In clinical practice, the differentiation of pulmonary embolism from other entities often remains difficult. Of utmost importance is the estimation of the pretest probability of the disease: predictive scoring systems and the use of clinical gestalt are equally useful tools. Exclusion or confirmation of the disease requires the rationale use of additional investigations (laboratory, imaging). In this article, we provide clinical engrams and outline our diagnostic algorithm. Based on the latest recommendations, we summarize the therapeutic approach for patients with pulmonary embolism. The importance of follow-up visits after the initial event is discussed in the last part. The assessment of risk factors promoting the development of venous thromboembolism is crucial for estimating the risk of recurrence. Excessive screening (thrombophilia testing or tumor investigations) are of minor relevance.

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Introduction: Often dyspnea is caused by cardiac disease which has a dismal prognosis if left untreated. This article is focused on primary care and provides an overview of the most important etiologies, evaluation algorithms and therapies.

Introduction: Endocrinological or metabolic disorders often affect a wide variety of functions of the organism. This can also include an impairment of respiratory function. Diabetic ketoacidosis as a result of insulin deficiency is a typical metabolic acidosis, which the body tries to compensate by an increased exhalation of carbon dioxide. This leads to the classic picture of "Kussmaul" breathing. Due to the increased use of SGLT2 inhibitors, which can reduce the otherwise typical hyperglycemia and thus complicate diagnosis, the occurrence of diabetic ketoacidosis has remained an important differential diagnosis in recent years. Pathologies of the thyroid gland can lead to dyspnea not only by morphological changes, for example in the case of goiter (compression). Functional disorders must also be considered here. Both hypo- and hyperthyroidism affect the cardiovascular system in different ways and may ultimately lead to the clinical picture of dyspnea. If the corresponding entities are thought of, the laboratory diagnosis of the aforementioned metabolic/endocrinological disorders is then basically straightforward. Accordingly, knowledge of these disorders as a differential diagnosis of tachy- and dyspnea is important.

Screening and Assessment for an Early Identification of Malnutrition in Older People Abstract: Malnutrition is common among older people and leads to numerous negative clinical consequences due to changes in body composition and body function. A prerequisite for successful prevention and treatment is the early identification of older persons with (risk of) malnutrition. Therefore, in geriatric settings, routine malnutrition screening with a validated tool (e.g., Mini Nutritional Assessment or Nutritional Risk Screening) is recommended at regular intervals. In case of a positive screening result, a subsequent nutritional assessment is performed to confirm the diagnosis, to clarify the causes and to determine the energy and protein deficit, in order to initiate a targeted nutritional therapy and to improve the nutritional status of the older persons and thereby the overall prognosis.

Non-pharmacological Therapies of Dementia - an Update Abstract: Non-pharmacological interventions for people with dementia are intended to improve quality of life and well-being, alleviate psychopathological and behavioral symptoms, and also offer caregivers support and opportunities to promote resilience. Against the background of the multiple failures in the field of pharmacological-therapeutic research, these approaches have become increasingly important. This is an up-to-date overview of the most important non-drug interventions for people with dementia and related recommendations for therapeutic use according to the current state of research and the recommendations of AWMF S3 guideline "dementia". The most important interventions from this therapeutic spectrum are cognitive stimulation to maintain cognitive functioning, physical activation, and creative therapeutic offers to promote communication skills and social participation. In the meantime, access to these diverse psychosocial interventions has also been supplemented by digital technology. What these interventions have in common is that they are based on the individual cognitive and physical resources of those affected, improve quality of life and mood, and promote participation and self-efficacy. In addition to psychosocial interventions, nutrition-related approaches ("medical food") and non-invasive neurostimulation have recently also shown potential in the context of non-drug therapy for people with dementia.

Relevance of Neuropsychology When Assessing Fitness to Drive After Stroke Abstract: Under normal circumstances, the mobility of oneself is often taken for granted. After a brain injury the quality of life is different and getting back into society may be difficult. Observing the patient's remaining qualities, the doctor or guardian will present guidelines. Often the patient no longer thinks of his former life, but only thinks of his taken away freedom. The doctor or guardian is often blamed for this. The patient will either accept the circumstances or could become aggressive or resentful. It is important for all to come together and present future guidelines. For street safety it is important and a duty for both parties to look into and solve this problem.