Therapeutische Umschau. Revue thérapeutique
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Elderly patients are the most important target group of pharmacotherapy. Older individuals often suffer from multiple co-morbidities, which often results in polypharmacy. A therapy based on guidelines can be problematic and is only rarely examined in clinical trials of elderly patients. ⋯ The use of these tools is considered to be potentially useful in improving the quality of drug therapy for elderly people. Further, a regular medication review is recommended. The determination of the renal function, which is often limited in the elderly, resulting in a required dose adjustment of the medication as well as the choice of a low initial dose when starting a new drug in the elderly may also contribute to increased medication safety.
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Review
[Interventional treatment of atrial fibrillation - indication, techniques and success rates].
Atrial fibrillation is the most common cardiac arrhythmia occurring in 2 % of the population. Aside from initiating oral anticoagulation in patients with an increased risk for thromboembolic complications, rhythm control often is the therapeutic target, particularly in the young and highly symptomatic. ⋯ In the case of long-standing persistent atrial fibrillation, there is no agreement about the ablation strategy and the success rates are significantly lower. This review addresses the underlying pathophysiology, the ablation techniques, success rates and complications as well as alternative invasive treatment options.
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Ionizing radiation is the most thoroughly investigated exogenous noxa. Since the early 20th century it is well known that using ionizing radiation in diagnostic procedures causes cancer - physicians themselves frequently being struck by this disease in those early days of radiology. Radiation protection therefore plays an important role. ⋯ Nowadays the main source of low dose ionizing radiation from medical diagnostics is due to computertomography (CT). Large recent clinical studies from the UK and Australia investigating cancer incidence after exposition to CT in childhood and adolescence confirm that low doses in the range of 5 mSv already significantly increase the risk of malignant diseases during follow up. Imaging techniques as ultrasound and magnetic resonance tomography therefore should be preferred whenever appropriate.
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For general practitioners, emergency assessment of a critically ill or injured child can be difficult, as history is usually given by caregivers, physical examination may be challenging due to lack of cooperation and vital signs are potentially difficult to interpret because of age-related variations. The Pediatric Assessment Triangle (PAT) is a rapid and simple observational tool to standardize the initial assessment of children regardless of complaint or underlying diagnosis. ⋯ It allows clinicians to assess whether an urgent intervention is necessary or whether a more detailed history and physical examination may be done. Respiratory distress, gastro-enteritis with dehydration, febrile convulsions and traumatic brain injury constitute four common pediatric complaints that are encountered in a general practitioners consultation and will be discussed in some detail.
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New key technologies such as array-based molecular karyotyping and high throughput sequencing are currently introduced in pre- and postnatal diagnostic testing. These greatly improved genomic testing approaches are beginning to fundamentally change diagnostic strategies in the clinical setting. Molecular karyotyping in the fetus is now routinely performed in high risk situations or on parental request. ⋯ This approach allows for increased diagnostic yield in monogenic disorders and defining of more detailed genoptype-phenotype correlations. In addition, whole-exome or whole-genome sequencing has led to the identification of the genetic basis of many known genetic disorders and to the identification and delineation of novel disorders thus allowing a diagnosis in more patients. Fulfilling the potential of the increasing number of options for genetic testing for accurate diagnosis requires close collaboration between clinical geneticists and paediatricians.