Deutsche medizinische Wochenschrift
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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.
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Dtsch. Med. Wochenschr. · Mar 2024
[Reflux symptoms and upper abdominal pain: Reflux, Gastritis and whatever could be behind it].
Reflux symptoms and upper abdominal pain are very common symptoms in general population. Both symptoms are visceral and thus cannot be linked to an organ or a disease. Diagnostic work-up revealed organic disease in up to 30%, when patients present with dyspeptic symptoms. Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) represent the most frequent and important disorders in western countries, when diagnostic work-up is done in patients with reflux symptoms and abdominal pain.
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Dtsch. Med. Wochenschr. · Mar 2024
[Venous thromboembolism - was is new in the revised AWMF guideline?].
For the diagnosis of a lower-extremity deep vein thrombosis (LEDVT), venous duplex ultrasound is the method of first choice. If a qualified ultrasonography is not timely available, D-dimer testing, and limited ultrasound protocols (point-of-care ultrasound, POCUS) can contribute to therapeutic decision-making when clinical probability is low. A DOAC-based treatment regimen is preferable to a vitamin K antagonist for both acute therapy and secondary prophylaxis of venous thromboembolism (VTE). ⋯ Weight restrictions are no longer recommended for apixaban and rivaroxaban, but determination of DOAC trough and peak levels is recommended in the extremely obese and patients after bariatric surgery. In cancer-associated VTE, the direct factor Xa inhibitors are a good and safe alternative to low-molecular weight heparins (LMWH) for many patients; the adherence to oral therapy is also higher. Meaningful initial documentation and structured follow-up after LEDVT and pulmonary embolism (PE) are important in order to make an individualized risk-benefit assessment at the end of the therapy phase with regard to continued pharmacological secondary prophylaxis and to reassess patients' symptoms indicating post-thrombotic syndrome (PTS) or chronic thromboembolic pulmonary hypertension (CTEPH).
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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
[Diagnostic stewardship in outpatient and hospital medicine with focus on microbiological urinary and bloodstream diagnostics].
Targeted infection diagnosis supports decision-making in the rational use of antibiotics usually encompassed as Antibiotic Stewardship (ABS). Similar to ABS, the term "Diagnostic Stewardship" (DGS) is suggested, whereas DGS includes, beneath general, predominantly microbiological infection diagnostics - with specific pathogen detection, conventional via culture or immunology, increasingly also using molecular biological methods. Especially in microbiology, pre-analytics, analytics and post-analytics play an essential role. Pathogen characterization is accompanied by an antimicrobial susceptibility test (with S-I-R classification), which deserves special attention, especially in the context of ABS. All of these aspects are dealt with in this work and represented using two practical examples of urinary and bloodstream diagnostics that are relevant for outpatients and inpatients.