Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2020
[Difficult Decisions in Therapy of Severe Stroke and Progressed Neurodegenerative Disease - Decision process in fields of limited communication and willing capability].
Severe stroke and neurodegenerative diseases often cause limitations in communication and willing capability. Decision processes in these conditions assume primarily a positive medical indication for any intervention. If not obtainable from an individual by itself, by a disposal or by a legal custodian, the presumed will of a patient has to be detected carefully. ⋯ Pain in demented persons is often underrated and undertreated. The diagnosis of dementia alone does not limit the indication for curative therapy in general. Ethical comitees or ethical visits are helpful instruments to find out an adequate decision in difficult situations.
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Dtsch. Med. Wochenschr. · Mar 2020
[Removal of impacted cerumen by irrigation of the external auditory canal - Step-by-step].
Cerumen impaction is a common consultation issue at general medical practices and causes symptoms like hearing loss, itching, pain or tinnitus. Without any indication of eardrum perforation, ear irrigation with warm water is a safe, effective and fast aid.
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Nosocomial pneumonia is one of the leading entities of nosocomial infections in Germany and worldwide with invasive ventilation being one of the major risk factors. However nosocomial pneumonia without ventilator support is an underappreciated complication as demonstrated by prevalence studies of the European Centre for Disease Control in 2011 and 2016. ⋯ For non-ventilated patients early mobilization and/or frequent position changes, correct use of feeding tubes and mouth care are key components. In preoperative patients training of a simple breathing exercise combined with mnemonic aids for its use in the postoperative period has been proven to be helpful.