Deutsche medizinische Wochenschrift
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Antibiotic stewardship (ABS) denotes structured and continuous measures to improve the quality of prescribing anti-infectives. The aim is to achieve optimal treatment results and to minimize undesirable effects, especially the emergence of antibiotic resistance. This review summarizes the most important ABS principles based on recently published studies with implications for the management of community-acquired pneumonia. ⋯ However, the implementation of ABS programs requires trained personnel and may be impeded by limited structural and time resources. Hence, electronic health records and computer-based interventions are useful support for ABS programs and offer potential to facilitate ABS in inpatient and outpatient care. PCR-based rapid diagnostic tests, PCT-guided algorithms and penicillin allergy testing are suitable procedures to supplement ABS programs.
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Community-acquired pneumonia (CAP) is one of the most common infectious diseases worldwide. To reduce the high morbidity and mortality of CAP, appropriate diagnosis, risk stratification and therapy are necessary. This review summarizes the current recommendations for the management of CAP in Germany. ⋯ A reevaluation in the first 48-72 hours is mandatory. A therapy duration of 5-7 days is usually sufficient. Preventive influenza and pneumococcal vaccination and nicotine withdrawal are important.
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Dtsch. Med. Wochenschr. · Mar 2020
Case Reports[Comorbidity of hypoglycaemia anxiety and panic disorder in a patient with type-1 diabetes - Combined treatment with cognitive-behavioral therapy and Continuous Glucose Monitoring (CGM) in a psychosomatic day-treatment center].
A patient with T1DM, panic disorder and hypoglycaemia fear diabetes duration 4 years, BMI 25. 6, was treated in the day clinic psychosomatics with a multimodal treatment approach. She reports severe fear of hypoglycaemia and repeated hypoglycaemia. Fearing hypoglycaemia, the patient changed her diabetes self-management and thus experienced limitations in her everyday functionality. ⋯ The combination of psychotherapeutic measures with CGM appears to be a helpful approach to the treatment of disease-specific mental disorders in diabetes mellitus.
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Gallstones develop in the gallbladder or the bile ducts. According to their chemical composition, gallstones can be divided into cholesterol stones, which are common, and the rare bile pigment stones. Altogether, up to 20 % of all adults develop gallstones and more than 20 % of them symptoms or complications. ⋯ In about one half of all patients biliary symptoms precede the three common and potentially life-threatening complications (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge about the genetics and pathophysiology of gallstones has improved, current treatment algorithms are predominantly invasive (ERC and surgery). Thus, better strategies are needed to prevent the formation of gallstones in general.