Deutsche medizinische Wochenschrift
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Convalescent plasma was discussed as a therapeutic option early in the course of the COVID-19 pandemic. However, until the onset of the pandemic, only the results of mostly small single-arm studies in other infectious diseases were available, which did not prove efficacy. In the meantime, the results of more than 30 randomized trials of COVID-19 convalescent plasma (CCP) for treatment of COVID-19 are available 1. Despite the heterogeneity of the results, conclusions for an optimal use are possible.
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Dtsch. Med. Wochenschr. · Mar 2023
[Guideline-based digital smoking cessation with computer, tablet or smartphone].
Tobacco smoking is related with a substantial morbidity and mortality as well as with tremendous socioeconomic burden. Therefore, an early successful smoking cessation bears an enormous medical and socioeconomic importance. The gold standard of smoking cessation, a combination of behavioral und pharmacologic therapy reaches only few smokers every year and so, guideline-based, low-threshold and broadly available digital cessation support could considerably increase the annual cessation rate. With the digital cessation program "Nichtraucherhelden" such a guideline-based program is available in Germany since December 2016. ⋯ The study shows that a digital guideline-based cessation program is feasible and effectual. For confirmation a control and randomized study is required.
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Dtsch. Med. Wochenschr. · Mar 2023
[Fluid Management in Intensive Care Patients - New Strategies and optimal target?].
Adequate therapy with intravenous fluids is crucial in the initial treatment of critically ill patients. Both hypovolemia and hypervolemia are associated with organ dysfunction and adverse outcomes. A recent international randomized trial investigated a restrictive volume management in comparison with a standard volume regimen. 90-day-mortality was not significantly reduced in the group with restrictive fluid administration. ⋯ Regarding the absence of evidence-based criterias and treatment goals for volume management in shock patients, an individualised approach resorting to diverse monitoring tools should be considered. UItrasound-based assessment of IVC diameter and echocardiography are excellent non-invasive tools to evaluate volume status. Passive leg raising (PLR) test represents a valid method for the assessment of volume responsiveness.
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The CRB-65 score is recommended as a risk predictor, as well as consideration of unstable comorbidities and oxygenation. ⋯ Patients after community-acquired pneumonia have increased acute and long-term mortality due to cardiovascular events in particular. The focus of research is on improved pathogen identification, a better understanding of the host response with the potential of developing specific therapeutics, the role of comorbidities, and the long-term consequences of the acute illness.