Therapeutische Umschau. Revue thérapeutique
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Spontaneous coronary artery dissection Abstract. Spontaneous coronary artery dissection (SCAD) is an increasingly recognized etiology of acute coronary syndrome (ACS) and an important cause of myocardial infarction in women. First described in 1931, SCAD is defined as a spontaneous tear in a coronary artery that is not associated with atherosclerosis, trauma or medical intervention. ⋯ But it is suggested that management should be different to atherosclerotic myocardial infarction. Conservative medical treatment is favored in the majority of cases, with percutaneous coronary intervention (PCI) being reserved for high risk patients due to poor interventional outcomes and higher failure rates. However, there is still a lack of data on this poorly understood condition and the optimal management has yet to be determined.
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Arthrocentesis in the Emergency Department Abstract. Acute joint swelling is a common presentation to the emergency department. Although routine investigations like clinical exam, labs and eventually x-ray are usually obtained, definitive diagnosis must be established since timely recognition of septic arthritis in particular is crucial. ⋯ Antibiotic therapy should be withheld until the sampling of synovial fluid has been completed. After exclusion of septic arthritis, acute arthritis due to crystal arthropathy (CPPD or gout) is treated with either glucocorticoid-infiltration of the joint or with nonsteroidal anti-inflammatory drugs. In this article, the different technical aspects of arthrocentesis are discussed, including asepsis, landmark- and ultrasound-guided access, preanalytics and interpretation of the laboratory results.
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Extraintestinal manifestations in chronic inflammatory bowel diseases Abstract. Chronic inflammatory bowel diseases (IBD) are inflammatory gastrointestinal disorders that are not limited to the gastrointestinal tract. Various organ systems may be involved, making IBD a systemic disease. ⋯ Early detection of EIM allows targeted therapy and reduces the overall morbidity of the affected patients. Of importance is the fact that EIM can occur in up to 25 % of all IBD patients before the onset of the first Crohn's episode or ulcerative colitis. Therefore, dermatologists, ophthalmologists and rheumatologists should beware of this possible association in EIM and the simultaneous occurrence of intestinal symptoms.
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Easy come, easy go? Current strategies for maintaining the effects of pulmonary rehabilitation in COPD patients Abstract. Pulmonary rehabilitation (PR) is a comprehensive treatment method in the non-drug management of chronic respiratory diseases. Most evident data exists for COPD patients. ⋯ They are still subject of current research. Therefore concrete recommendations are still missing and further studies are necessary. This review aims to give an overview of the existing results in this field.
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«Patient education in the context of rehabilitation» Self-management interventions and patient coaching integral components of pulmonary rehabilitation (PR) Abstract. Integration of effective self management interventions to pulmonary rehabilitation may not be considered as an option but as an integral part to make sustainable changes to patient behavior which will positively affect the maintenance of PR treatment effects. While it is well established that pulmonary rehabilitation (PR) improves functional / exercise capacity and health-related quality of life, one recognized important goal of PR is to influence health behaviors (smoking cessation, physical activity, breathing management, medication adherence, recognizing and supported self-managing exacerbations) in chronic pulmonary disease that promote successful disease management and better prognosis. ⋯ However, an evolution of traditional patient education from giving information only to effective self- management coaching is necessary as an evidence based integral part of best practice and quality in PR. Crucially this demands a healthcare system that 1) support self-management; 2. provide flexible access to professional advice; 3. ideally ensure continuity of care and 4. Pay for effective self-management interventions.