Therapeutische Umschau. Revue thérapeutique
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Review Comparative Study
[Palliative Sedation: Comments on a controversial topic].
Palliative Sedation: Comments on a controversial topic Abstract. Palliative sedation (PS) is an accepted medical practice for terminally ill patients. It intends the alleviation of unbearable suffering by intentionally lowering the level of consciousness. ⋯ Most ethical controversies are related to the latter form of PS: 1: Is existential or psychosocial suffering a possible indication for PS? 2: What is the earliest possible time point to start PS? 3: The withdrawal or withholding of artificial nutrition and hydration during PS. A critical reflection of these ethical controversial aspects within the treatment team is highly desirable. However, the patient's well-being and the respect for the patient's decisions that are based on experiences which are made only by him or her, must remain the guiding principle for medical actions.
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Acute ischaemic stroke - Update Abstract. Intravenous thrombolysis and / or endovascular therapy are effective and safe in acute ischaemic stroke if patients are selected accordingly. Despite bleeding complications, disability rates may be lowered by treatment. Latest studies investigated intravenous thrombolysis with rt-PA in a treatment window of > 4.5 hours after symptom onset or in case of unknown symptom onset, the application of tenecteplase as thrombolytic agent applied intravenously with and without endovascular therapy, endovascular therapy in a treatment window of > 6 - 24 hours or in case of unknown symptom onset as well as outcome in dependence of general anaesthesia or conscious sedation for endovascular therapy.
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Pneumococci are the leading bacterial causes of respiratory tract infections, bacteremia and meningitis. Pneumococcal conjugate vaccines (PCV) are effective and safe in young children. ⋯ This in turn led to marked reductions in IPD and pneumonia in non-vaccinated age groups, particularly elderly adults as evidence of herd protection. Recently it was shown that the 13-valent PCV13 is effective and safe in adults leading to the age-independent recommendation of PCV13 in all persons with risk factors.
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The number of individuals with autoimmune diseases treated with immunosuppressive drugs is increasing steadily. The variety of immunosuppressive drugs and in particular biological therapies is also rising. The autoimmune disease itself as well as the immunosuppressive therapy increases the risk of infection in this population. ⋯ Live vaccines are generally contraindicated under immunosuppressive therapy due to safety concerns. However, specific exceptions apply. Furthermore, certain time intervals for the administration of live vaccines after pausing or ceasing an immunosuppressive therapy should be respected.