Dtsch Arztebl Int
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Many new antitumor drugs have been approved in recent years. Their side-effect profiles are distinct from those of older drugs, and their adverse effects are sometimes highly specific, particularly with respect to the skin. ⋯ The recognition and proper management of cutaneous adverse effects is an important part of treatment with new antitumor drugs.
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Physical restraint is used primarily for patients at risk of falling, those with motor unrest and agitated behavior, and those who manifest an intention of doing harm to themselves or are at risk of suicide. The use of freedom-restraining measures (FRM), and, in particular, the use of physical restraints against the patient's will, can be a serious intrusion of basic human rights and, as such, an act of violence against the patient. The improper use of physical restraints can cause injuries of varying severity, which can sometimes be fatal. ⋯ To prevent such deaths, we recommend from a forensic medical standpoint that all possible alternatives to FRM should be used instead. If direct-contact restraints are truly necessary, they must be applied as recommended and the restrained person must be closely observed.
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Hyperphosphatemia has been identified in the past decade as a strong predictor of mortality in advanced chronic kidney disease (CKD). For example, a study of patients in stage CKD 5 (with an annual mortality of about 20%) revealed that 12% of all deaths in this group were attributable to an elevated serum phosphate concentration. Recently, a high-normal serum phosphate concentration has also been found to be an independent predictor of cardiovascular events and mortality in the general population. Therefore, phosphate additives in food are a matter of concern, and their potential impact on health may well have been underappreciated. ⋯ Prospective controlled trials are currently unavailable. In view of the high prevalence of CKD and the potential harm caused by phosphate additives to food, the public should be informed that added phosphate is damaging to health. Furthermore, calls for labeling the content of added phosphate in food are appropriate.
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5% to 8% of 70-year-olds and some 10% of persons over age 80 have atrial fibrillation (AF). ⋯ The treatment strategy for AF must be individualized on the basis of the patient's clinical manifestations. The mainstay of treatment is anticoagulation; the indication for anticoagulation depends on the patient's age, underlying disease, and left ventricular function.