Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2024
[Atrial fibrillation in the elderly - the geriatric perspective].
Atrial fibrillation is the most common cardiac arrhythmia in older adults. As a result of the positive data on ablation, the focus has shifted to rhythm control. The method of choice is pulmonary vein isolation. ⋯ Oral anticoagulation remains an essential component of pharmacological therapy for atrial fibrillation. Older adults require an individualised treatment approach, which should be based on current guidelines and complementary tools. The assessment of functionality should be taken into account in therapy and goal planning.
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Dtsch. Med. Wochenschr. · Mar 2024
[After intensive care therapy : Outpatient intensive nursing care].
Outpatient intensive nursing care offers individuals who require specialized intensive nursing care on a permanent basis the opportunity to survive outside of an intensive care unit in an ambulatory environment. With advancements in surgical and intensive medical practices, coupled with demographic changes in the population resulting in a higher number of older, multimorbid patients, the available treatment options have been continuously extended. ⋯ Presently, this group constitutes the majority of patients receiving outpatient intensive nursing care in Germany and represents a substantial cost factor in healthcare. The care of these patients is governed by the Guideline of the Joint Federal Committee on the Prescription of Outpatient Intensive Nursing Care (AKI-RL), which is based on the Intensive Care and Rehabilitation Strengthening Act (GKV-IPReG) 2021.
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In clinical practice, dementia must be distinguished from other disorders of cognition, social behavior, and emotional control. A dedicated stepwise diagnosis must differentiate reversible causes with urgent need for action from slowly progressive processes.
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Relatives of intensive care patients make an important contribution to recovery and perform a variety of tasks. Due to the demands on the relatives and their services in the ICU and after their discharge, stressful psychological, physical, social, and financial consequences can arise or worsen. Relatives often compensate deficiencies in treatment, especially through a lack of communication and a lack of continuity of care. ⋯ Structured communication between relatives and the treatment team as well as active involvement in nursing treatments can alleviate stress symptoms and the feeling of powerlessness. Prescient discharge management for ICU patients and their relatives reduces PICS risk. Specific and comprehensive offerings of advice and support for relatives can help to perform and process the effort between everyday life and care tasks.
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Suicidal tendencies are all thoughts, feelings and actions that are aimed at ending one's own life. GPs should recognize and address this in their patients, as they can intervene and coordinate further treatment. However, not every patient discloses - and it is not always possible to prevent suicide.