Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2020
["The last doctor's visit": External post mortem during emergency medical services].
The declaration and investigation of death cases is a non-delegable task of medical doctors and should be mastered in the same quality as all examinations on living patients. A person is death when at least one sign of death is established (livores mortis, rigor mortis, putrefaction, injuries incompatible with life, brain death). In all other cases of unconscious patients a sufficient cardiopulmonary resuscitation should be started. ⋯ Doctors must be alarmed, when petechial bleedings are established at the face or the conjunctives, raising the suspicion of strangling forces to the neck. Internal causes of death are often invisible from the body surface, resulting in difficulties to declare the cause of death of the individual by external's only. Injuries are most often visible and could be a hint of a crime scene scenario or external harm.
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Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, autoimmune mediated cholestatic liver diseases. Other auto-immune diseases are often associated with PBC and PSC, and inflammatory bowel disease is present in the majority of PSC patients. In the course of disease, chronic inflammation in the liver leads to fibrotic restructuring and ultimately cirrhosis. ⋯ For both PBC and PSC novel treatments are currently being tested in clinical trials. Disease management should address compromising symptoms like pruritus and sicca as well as complications due to maldigestion and concomitant autoimmune diseases. The only curative treatment available is liver transplantation and should be considered at a MELD score of 15.
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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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Dtsch. Med. Wochenschr. · Mar 2020
[One and a Half Decades of Disease Management Programs - Status Quo From the Point of View of General Practitioners].
In 2003, disease management programs (DMP) were established to improve the care of chronically ill outpatient patients. Since then, there has been a lot of controversy over the meaning and benefits of structured treatment programs, especially among primary care physicians. The present study examines the attitudes and experiences of general practitioners in relation to DMP, how they assess these one and a half decades after their introduction, and where DMP need to be improved. ⋯ From a primary care point of view, a substantial improvement in DMP would mean a simplification of the documentation and administration effort, better regulated and smoother cooperation with other care levels, a greater degree of decision flexibility, a greater and more differentiated offer of compulsory training, and an increased involvement of primary care experience in the process of DMP development as well as a better reward.
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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.