Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2024
Review[Vaccination against RSV infections - update and perspective].
Almost 60 years after a disastrous clinical vaccine trial in children, which resulted in enhanced disease and even deaths, the world of RSV vaccination is currently undergoing a dramatic positive change and development, closely linked to advances in new vaccine technologies. Three licensed safe and highly efficacious vaccines, Abrysvo, Arexvy and mRESVIA, reduce the incidence of RSV lower respiratory disease by 80% in people older than 60 years of age. ⋯ In the coming years, results of numerous pediatric candidate RSV vaccine studies are expected, although particular caution seems advisable for historical reasons. In summary, the field of RSV vaccination has been revolutionized in the last 2 years and we will see further significant progress soon.
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An effective patient handover is a core element of high-quality patient care. Communication during patient handover in the intensive care unit is particularly challenging due to the clinical complexity and rapid changes in patient trajectories, complex interdisciplinary and interprofessional interfaces, linguistic barriers, situational and structural disruptive factors, personnel stress factors as well as the communication and error culture of the teams. In addition to avoiding disruptive factors and creating optimal communication conditions and human resources, the use of standardized and structured handovers with the help of protocols and checklists, as recommended in the literature, plays a decisive role as part of a bundle of measures for effective and safe patient care.
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Chronic constipation is one of the most common health disorders in all of medicine. Its extent ranges from mild discomfort, which is usually easy to improve, to severe functional limitations that may significantly reduce quality of life and may be refractory to various treatment approaches. Our understanding of the pathomechanism has grown considerably in recent years and has also led to important new therapeutic developments. ⋯ The respective significance of traditional and recent drug developments is classified and categorized in modern "step-up" treatment strategies. In particular, numerous important aspects of everyday practice are addressed, such as questions on long-term treatment and therapeutic options in specific constellations (adequate treatment of constipation in older people, constipation during pregnancy, and drug-induced [especially opioid-induced]constipation). The most important new developments (i.e. new therapeutic approaches, but also re-evaluations of "traditional" laxatives and the importance of careful diagnostics in therapy-refractory patients) are summarized in this article.
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Dtsch. Med. Wochenschr. · Nov 2024
Review[Esophageal cancer: new developments in prevention and therapy].
Esophageal carcinomas comprise 2 entities, squamous cell carcinoma and adenocarcinoma, which differ in pathogenesis and treatment. Elimination of inflammatory influences and risk factors, such as obesity and gastroesophageal reflux that contribute to a rising incidence of adenocarcinoma, is crucial for tumor prevention. In Germany, general endoscopic screening for upper GI tumors is not recommended, whereas endoscopic surveillance is applied in the presence of Barrett's metaplasia. ⋯ Systemic treatment options for both tumor entities have been significantly expanded due to the successful use of immune checkpoint inhibitors in adjuvant and palliative treatment regimen. Determination of PD-L1 and MSI status has therefore become decisive for the choice of therapy. In metastatic stages of adenocarcinoma, chemotherapy can now be supplemented by multiple antibodies directed against Her2, PD1, or claudin 18.2, and the antibody-drug conjugate trastuzumab deruxtecan has become a Her2-targeted option in second line treatment.
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Dtsch. Med. Wochenschr. · Nov 2024
[Outpatient exercise training for chronic lung disease - for whom, how and why?].
There is a legal entitlement to participate in outpatient exercise groups in accordance with the German Social Code (Book IX) which regulates and facilitates prescriptions for patients with chronic respiratory diseases. A medical examination with specific inclusion and exclusion criteria prior to admission to an exercise group ensures safe participation. Traditional outpatient exercise groups are conducted in face-to-face groups for 60 to 90 minutes, once a week, with structured warm-up, main and cool-down phases. ⋯ Scientific evidence confirms the significant benefits of regular exercise, such as improved physical performance and reduced breathlessness. The psychosocial benefits and the promotion of self-efficacy are additionally supported by the supervision of a specialized trainer. Regular exercise (e.g. in outpatient exercise groups) is an inexpensive and very effective form of therapy to improve the quality of life of people with chronic respiratory diseases.