Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Oct 2023
[Precautionary planning at the end of life from a palliative care point of view].
What happens when you are no longer able to make medical decisions yourself? The constant increase in the number of people in need of care has led to the concept of advance care planning (ACP). This is a forward-looking, ongoing, and constantly reflective process of discussion regarding preferences and values for future medical and nursing treatments. ⋯ The implementation strategy is dependent on this, as presented in studies. This also includes the financial support of such implementation projects, because only the talks alone, which are exclusively refinanced by §132g SGB V, do not lead to a cultural change regarding the importance of self-determination and dealing with living wills, as well as an improvement in treatment, care, and support for people in the health system.
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Today, peripheral artery disease (PAD) is treated with the most modern endovascular and open surgical revascularisation procedures. But the short and long-term success of these interventions is decisively determined by the conservative therapy of PAD, which therefore represents the absolute basic therapy of every PAD. ⋯ This paper presents the spectrum of both drug and non-drug strategies and focuses on aspects such as platelet inhibition and anticoagulation regimes, lipid-lowering options as well as the benefits and necessity of exercise programs to promote collaterals and improve quality of life by extending the pain-free walking distance. Proven strategies to overcome smoking addiction, use and purpose of vasoactive substances are highlighted as well as the potential risks of diabetic foot syndrome for limb salvage and prevention of wounds.
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Dtsch. Med. Wochenschr. · Oct 2023
[Provision planning at the end of life from a legal point of view].
In the event of the loss of the ability to give consent and thus the possibility of legally validating one's own will, the law regularly provides for a mandatory third-party representation for the patient. However, their design can be influenced preventively, for which purpose those affected are given three options. These options are: patient's decree, health Power of Attorney, guardianship order. ⋯ The written form of the advance directives forms an objective basis for mutual control of future decision-makers in the event of questions of interpretation. Absolute certainty that the current will of the patient corresponds to the future and that it is reliably determined and implemented in the decision-making situation is not possible. Nevertheless, the task is to come as close as possible to this ideal image in clinical reality.
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Patients with insomnia suffer from problems falling asleep and/or maintaining sleep. This has a negative effect on their daytime wellbeing and performance. Insomnia is primarily diagnosed by a detailed clinical history, supplemented by questionnaires and sleep diaries. ⋯ It is treated according to guidelines with cognitive behavioural therapy for insomnia (CBT-I). CBT-I is offered in individual or group format as well as online-supported treatment. If behavioural therapy is not effective or not available, pharmacotherapy can be discussed.