Deutsche medizinische Wochenschrift
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Risks of thrombosis, bleeding and renal impairment are increasing with age. The efficacy and safety of the direct oral anticoagulants (DOACs) in fragile patients (age > 75 years and/or creatinine clearance levels < 50 ml/min and/or body weight below 50 kg) with indication for anticoagulation is one of the most challenging topic in cardiovascular medicine. New registry data from subgroup analyses of landmark studies and registries point towards to superiority of DOACs. This article summarizes new insights and describes pathways for anticoagulation in fragile patients.
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Dtsch. Med. Wochenschr. · Oct 2020
Case Reports[Quadruple negative SARS-CoV-2-PCR: still COVID-19 pneumonia!]
A 78-year-old man fell ill with weakness, coughing and fever 19 days after a cruise in early April 2020 and was admitted 4 days later with increasing shortness of breath. ⋯ In case of a high degree of clinical suspicion in combination with typical findings of thoracic imaging, the suspected diagnosis COVID-19 disease should be maintained even in case of multiple negative SARS-CoV-2-PCR. Seroconversion occurs a few days to 2 weeks after the onset of symptoms and can be used to confirm the diagnosis.
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A pericardial effusion can be caused by malignant, infectious and autoimmune diseases or by trauma, such as a coronary artery rupture during a cath procedure. In the case of a cardiac tamponade a pericardiocentesis has to be performed immediately. ⋯ The risks of a pericardiocentesis include injuries to the lungs and liver as well as the heart itself, such as puncture of the right ventricle or the rupture of a coronary artery. This article is a step-by-step description of how to safely perform an ultrasound-guided pericardiocentesis.
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Dtsch. Med. Wochenschr. · Oct 2020
[How complete is the Germany-wide standardised medication list ("Bundeseinheitlicher Medikationsplan")? An analysis at hospital admission.]
At inpatient admission, the timeliness and completeness of the Germany-wide standardised medication list ("Bundeseinheitlicher Medikationsplan") often seems inappropriate. It is also unclear which characteristics of the lists increase the probability of discrepancies. ⋯ The timeliness, completeness and aspects of patient safety must be comprehensively validated. Medication lists that are older than 1 month should be checked particularly critically with regard to information on strength and dosage and the plan should be updated accordingly at regular intervals.
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Artificial intelligence (AI) is currently transforming all aspects of our daily life, including the practice of medicine. Artificial neural networks are a key method of AI. They can very effectively detect subtle patterns in imaging data and speech or text data. ⋯ Our focus is on AI-based analysis of endoscopy images, non-invasive imaging and histology images. In these applications, AI can support human pattern recognition. Beyond detection and classification of pathological findings, AI can predict clinical outcome from subtle image features.