Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · May 2020
ReviewMedical practice and placebo response: an inseparable bond?
The history of medicine and the history of placebo are closely intertwined. To understand placebo and its effects this article gives a brief overview about its history, the possible mechanisms of action and its counterpart, nocebo. The Catholic Church used placebo around the sixteenth century for the separation from real and incorrect exorcisms, but it needed Henry Beecher during World War II to quantify the placebo effect as control arm in well-designed studies. ⋯ Conclusion: Placebo and nocebo are both underestimated and underresearched in their value. Through further investigation doctors could strengthen the placebo response and prevent adverse effects to help their patients at low cost. These techniques would benefit the patient-doctor relationship, which is the alter of a trust-based successful therapy.
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Wien. Klin. Wochenschr. · May 2020
ReviewA critical examination of the main premises of Traditional Chinese Medicine.
Traditional Chinese Medicine (TCM) consists of a plethora of therapeutic approaches aiming to both characterize and treat diseases. Its utilization has gained significant popularity in the western world and is even backed by the World Health Organization's decision to include TCM diagnostic patterns into the new revision of the International Classification of Diseases code, the global standard for diagnostic health information. As these developments and potentially far-reaching decisions can affect modern healthcare systems and daily clinical work as well as wildlife conservation, its underlying factual basis must be critically examined. ⋯ Nevertheless, the (re-)discovery of artemisinin more than 50 years ago introduced a novel development in TCM: the commingling of Eastern and Western medicine, the appreciation of both systems. The need for more rigorous approaches, fulfilment of and agreement to current guidelines to achieve high-quality research are of utmost relevance. Thereby, ancient knowledge of herbal species and concoctions may serve as a possible treasure box rather than Pandora's box.
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Wien. Klin. Wochenschr. · Mar 2020
ReviewDiagnosis and treatment of hypothyroidism in old people : A new old challenge.
To review the diagnosis and the treatment of both subclinical and overt hypothyroidism in old people, which could represent a challenge for the clinicians. ⋯ The administration of replacement therapy in older adults should consider frailty, polypharmacy and a high risk to develop overtreatment symptoms. On the other hand, older patients with untreated or undertreated hypothyroidism may develop a state of myxedema coma.
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The development of new devices and treatment options has greatly increased the interest in heart valve diseases. In this context, the consideration of gender differences in diagnosis, treatment success, and prognosis is of great importance. ⋯ It is the purpose of this review article to give an overview of gender-related differences in patients with valvular heart disease, regarding clinical presentation, treatment, and outcomes. In light of the emerging treatment possibilities, future research should emphasize the role of gender since both sexes benefit from tailored management.
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Wien. Klin. Wochenschr. · Feb 2020
ReviewWhat is new in the 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy?
Cardiovascular diseases during pregnancy are the most common causes of pregnancy-associated mortality. Vaginal delivery is the preferred mode of birth in the majority of pregnancies. It is recommended that patients with modified World Health Organization (mWHO) class IV risk are counselled against pregnancy. ⋯ Specific medications should not be principally withheld in pregnancy but the risk-benefit ratio should be carefully evaluated prior to administration. Beta blockers are recommended during and after pregnancy for congenital long QT syndrome and catecholaminergic polymorphic ventricular tachycardia. Low molecular weight heparin is the ideal substance for prophylaxis and treatment of venous thromboembolism in pregnancy under weekly monitoring of anti-factor Xa activity.