During the discussion on the elimination of certain groups of drugs and disorders from the list of obligatory services to be remunerated by state health insurances, vague, undefined terms such as "controversial" are being applied to phytopharmaceuticals and their fields of application. This may be traced back to an ignorance and global rejection of available scientific documentation. The rational background of modern phytopharmaceuticals are discussed.
Brief intervention, early intervention and secondary prevention are terms used in modern treatment of alcoholism that are gaining importance. By "intervention" in this connection is meant a "mediatory intervention". In various national and international projects, such an intervention on the part of the general practitioner has led to a significant reduction in the amounts drunk by patients abusing alcohol, and has thus contributed to the prevention of alcohol dependence. The present paper describes what is meant by the term short intervention, and describes the chances offered by this type of treatment in the area of basic medical care. Special attention is drawn to the technique of motivational interviewing and the FRAMES concept.
Ambulatory care of patients with tumors of the biliary system and pancreas undergoing bilioduodenal drainage for obstructive jaundice is increasingly being provided by the family doctor in cooperation with an endoscopy center. The greatest risk for the patient is the development of acute cholitis caused by blockage of the endoprosthesis with the need for immediate replacement of the latter. Apart from the clinical examination, laboratory data and ultrasonography are often required to establish the diagnosis and enable an adequate assessment of the bile flow situation to be made. Additional diagnostic procedures (e.g. endosonography and computed tomography) are needed only for the primary diagnostic work-up. The data obtained from our patients show that family doctors are well attuned to the leading symptoms, and that delays in acting on suspected obstruction of the biliary stent rarely occur.
Important intervention trials performed during the last decades and years are presented and critically reviewed. These long-term studies with hard end points have demonstrated positive results for four different antihypertensive classes: diuretics, beta blockers, calcium channel blockers and ACE inhibitors. The major issue is the prevention of hypertensive complications such as myocardial infarction, heart failure or stroke. For achieving this primary goal blood pressure reduction--or ideally normalization--is of decisive importance. As recommended by the Deutsche Hochdruckliga (German "Hypertension League") specific and individualized treatment of hypertension should consider target organ protecting effects of the various antihypertensive agents. In many cases combination therapy will be necessary to control hypertension (blood pressure target < 140/90 mmHg).
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