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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A succinct summary of the 2023 guidelines on the management of infectious endocarditis of the European Society of Cardiology is presented. Main new aspects are (1) the importance of treating complicated endocarditis at a hospital with an endocarditis team and cardiac surgery, (2) a less restrictive recommendation for antibiotic prophylaxis, which now favors an individualized indication in patients with intermediary risk, e.g. bicuspid aortic valve and degenerative or rheumatic native valve disease, undergoing orodental interventions, while there is a clear recommendation for prophylaxis in high-risk patients (e.g. having prosthetic valves). (3) In patients with left-sided endocarditis caused by streptococci, enterococcus faecalis, staphylococcus aureus, or coagulase-negative staphylococci, who are stable after at least 10 days of in-hospital intravenous appropriate antibiotic therapy, step-down ambulatory (oral or parenteral) further antibiotic therapy is recommended.
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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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Dietary recommendations for patients on dialysis are changing as our understanding of enteral microbiotal metabolism and bioavailability of nutrients from food improves. A diet low in phosphate and potassium is recommended for patients on hemodialysis. However, the absolute content does not reflect bioavailability: How much phosphate or potassium is taken up depends on food source (plant vs. animal) and to which grade it is processed. ⋯ The energy and protein requirements on dialysis are high: 25-35 kcal and 1-1,2 g protein per kg body weight per day (in relation to "ideal" body weight, if patient is overweight). Protein energy wasting is associated with higher stages of kidney disease, and malnutrition is associated with worse survival on dialysis. Nutritional status should be assessed on a regular basis using validated scores, and malnutrition should be addressed and treated.
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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.