Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · May 2020
[Nighttime restlessness in elderly patients: differential diagnosis and treatment - Differential diagnosis and therapy].
Elderly individuals, particularly those with cognitive impairment, are oftentimes restless during the night, and this increases the distress of relatives, professional carers and themselves. A number of conditions other than dementia need to be considered from nyctophobia and insomnophobia, to pain, specific motor disorders during sleep, parasomnias as REM-sleep behaviour disorder, dipping, hypoglycemia, withdrawal or excessive tea, coffee and alcohol consumption. A clear-cut differential diagnosis between dementia and delirium is not always possible, as dementia is the major risk factor for confusional states decreasing the vulnerability by anticholinergic medication and any other disruptive factor, biological or psychological. ⋯ Quetiapine or mirtazapine at low dosages can be employed in patients with psychotic or depressive symptoms. Melatonin and its derivatives hold promise for chronic circadian rhythm disorders. There is no "one fits all" recipe for this notorious problem and each case needs to be examined individually.
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In recent years, high-flow oxygen therapy (HFNC) has become established and proven as an oxygenation method for patients with severe respiratory restrictions in most intensive care units. Advantages of this method, which is used especially for patients with hypoxaemia, are the easy application and the compliance by the patient. Devices are used which enable individual oxygen therapy by means of humidification, warming up and gas flow regulation options.
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Dtsch. Med. Wochenschr. · May 2020
[Do decision-makers in the German healthcare system misjudge the situation of a branch office? - Motivation of physicians to set up in a GP's practice in the area of the Association of Statutory Health Insurance Physicians North-Rhine].
The aim of the study was to illustrate motives for a GP's branch from the current point of view by branch (expectations fulfilled) and before branch (motivation). In addition, obstructive or beneficial factors of a branch should be identified. ⋯ The fact that escaping from the stationary sector is the main driving force behind the settlement must be thought-provoking. Since this survey approach was not based on specialist groups or the level of training, but on a complete survey of established persons over a five-year period, it can be stated that the current incentive structures of a branch should be rethought due to the age structure of the interviewees.