Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Sep 2020
Review[Acute and chronic diarrhea: a roadmap to differential diagnosis and therapy].
Diarrhea is among the most frequently reported symptoms in clinical practice. Acute diarrhea is usually caused by infectious agents with a self-limited disease course. In contrast, differential diagnosis of chronic diarrhea may be challenging. The aim of this review is to provide the reader with an overview on the causes, pathomechanisms, differential diagnosis and clinical management of acute and chronic diarrhea in adults.
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Dtsch. Med. Wochenschr. · Sep 2020
Review[Malnutrition In older people - Screening And Assessment].
Malnutrition is widespread in older people and if not treated leads to numerous negative clinical consequences, such as functional decline and in-hospital complications as well as increased health care costs. Prerequisites for a successful prevention and therapy of malnutrition are the early identification of persons at risk or those affected and a detailed assessment of their nutritional situation. Based on the current literature, this article provides an overview of important aspects considered in the screening and assessment of malnutrition in older people, such as the use of malnutrition screening tools, the application of diagnostic criteria, the quantification of energy and protein deficiencies, the identification of potential causes of malnutrition and the determination of individual preferences and resources.
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Dtsch. Med. Wochenschr. · Sep 2020
Review[Out-of-hospital cardiac arrest: current diagnostic and therapeutical concepts].
Out-of-hospital circulatory arrest represents a challenging situation in emergency medicine even until today. Despite optimal emergency care and clinical treatment pathways, we are faced with a mortality rate above 90 %. It is possible to improve the survival rate to more than 40 % under ideal clinical and preclinical conditions. ⋯ Mechanical circulatory support devices may be considered adjunct to pharmacological measures for hemodynamic stabilization. Due to lack of evidence, these devices are currently under evaluation and prospectively randomized trials. We expect new treatment algorithms for optimal care of these high-risk patients in the near future.
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Since publication of the European Society guidelines for the diagnosis and treatment of acute and chronic heart failure in 2016, numerous studies provided new evidence how to further optimize heart failure therapy. Besides recent device-based therapeutic options, promising new drug developments give a glimmer of hope that the prognosis of this progressive heart disease could be somehow more controlled in the near future. At the same time, the variety of therapeutic options as well as the number of concomitant comorbidities makes the complex therapy of chronic heart failure more difficult than ever. This review aims to provide an update and practical support on the recent pharmacotherapeutic options in chronic heart failure.
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Sarcopenia is characterized by a generalized loss of muscle function, strength and mass and is codable in Germany since 2018 in the ICD-10-GM (M62.50). For screening in primary care, it is possible to determine muscle function and strength by means of a sarcopenia questionnaire (SARC-F) as a self-filler with 5 questions of restrictions. With an increased score of 4 and higher, an examination of the musculature and a determination of the skeletal muscle mass index should be performed via dual energy X-ray absorption measurement (DXA) or bioelectric impedance analysis (BIA). ⋯ The severity of the disease is defined by additional examinations such as gait speed, timed up and go test (TUG) and/or short physical performance battery (SPPB). Patients with sarcopenia suffer from increasing immobility and disability and have an increased risk of falls, fractures and mortality. Frequently, co-morbidities should be clarified in all affected patients.