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Early identification of patients at risk for malnutrition followed by individualized nutrition interventions is a central step to the provision of appropriate nutrition care. However, a health care professional (HCP)-based nutrition screening is not always consistently integrated into routine care. Patient-reported (PR) nutrition screening could thus potentially alleviate the burden on the HCPs and contribute to a greater number of patients who are identified and treated for malnutrition. In 2021 a Quality Improvement Project (QIP) at our out-patient oncology clinic was undertaken to implement the change from a HCP-based nutrition screening to a PR-screening. This was followed by a retrospective analysis in which the primary outcome measure was the rate of nutrition consultations initiated for patients undergoing cancer therapy. In total n = 1657 patient data sets derived from comparable time periods before and after the QIP were analyzed and compared. Both groups had a comparable mean age and gender distribution. The most common diagnosis in both groups was gastrointestinal tumors. The change in routine care from a HCP-based nutrition screening to a PR-screening led to a significant increase in nutrition consultation rates (RD = 19%; p < 0.001; 95% CI 14.4%-23.5%) and screening rates (RD = 30.5%; p < 0.001; 95% CI 26.2%-34.7%). The change to PR-screening potentially facilitates an increase in nutrition screening rates. This in turn leads to an increased rate of patients identified at risk for malnutrition and thus referrals for nutrition consultations. Our findings indicate that a PR nutrition screening tool could play a role in closing the care gap and contribute to reducing rates of malnutrition among this population where screening is not consistently integrated into routine care.
Paroxysmal supraventricular tachycardia have their origin above the His bundle. However, this definition has a historical origin and is imprecise regarding AV-reentry tachycardia using an accessory pathways since this tachycardia use the ventricule a part of the reentry-circuit. The most common supraventricular tachycardia is the atrioventricular nodal re-entry tachycardia, which is caused by a re-entrant tachycardia that involves the AV node and the atrial tissue followed by the atrioventricular re-entry tachycardia using an accessory pathway. More prevalent are sinus tachycardia, which is often physiologic and atrial fibrillation/flutter which are covered in detail by other articles within this issue of Therapeutischen Umschau. Therefore, the main topic of this review is the discussion of the mechanisms, diagnosis and treatment of AV nodal reentry tachycardia, AV reentry tachycardia using an accessory pathway and to a less extent focal atrial tachycardia. Supraventrikuläre Tachykardien sind definitionsgemäß Tachykardien, die ihren Ursprungsort oberhalb der His-Bündel-Bifurkation haben. Der Ausdruck supraventrikulär ist aber ungenau und historisch bedingt. Die häufigsten supraventrikulären Tachykardien im eigentlichen Sinn umfassen die AV-Knoten-Reentry-Tachykardie und die AV-Reentry-Tachykardie, wobei die letztere die Ventrikel als integraler Bestandteil der kreisenden Erregung braucht und somit also nicht rein supraventrikulär ist. Die häufigste supraventrikuläre Tachykardie überhaupt ist aber die Sinustachykardie, die in der Regel physiologisch ist, gefolgt von Vorhofflimmern und Vorhofflattern. Da Vorhofflimmern und Vorhofflattern in dieser Ausgabe der Therapeutischen Umschau gesondert besprochen werden, liegt der Fokus dieser Übersichtsarbeit in der Diskussion von Mechanismen, Diagnostik und Therapie der AV-Knoten-Reentry-Tachykardie, der AV-Reentry-Tachykardie via akzessorische Leitungsbahn und am Rande auch der fokalen atrialen Tachykardie.
A 78-year-old previously healthy and very active patient is urgently admitted to a hospital on a late Saturday evening for his first attack of angina pectoris. Referring to a previously drafted living will (kept at home) he refuses his consent for transfer to the intensive care unit (ICU). A DNAR (Do Not Attempt Resuscitation) order is entered in the patient's chart. After his condition has stabilized in the emergency room the patient is transferred to an ordinary ward. By the next morning the patient has been admitted to the ICU after successful cardiopulmonary resuscitation following cardiac arrest, which had occurred on the ward while the patient was left unobserved for a moment. In fact, he is intubated and artificially ventilated. He is in a critical state and his neurological outcome is uncertain. A number of hotly debated issues arise: Was it wrong to resuscitate the patient? Focusing on the DNAR order, how should the decision-making process look like, and what about the further management of the case? Could any help be expected from the new guidelines on DNAR decision-making recently published by the Swiss Academy of Medical Sciences (www.samw.ch)? The case presented illustrates the ethical complexity of modern clinical practice in general. It is true that the article raises a lot of unanswered questions, but at the same time it is looking ahead and gives insights into what a structured ethical decision-making process looks like. The article is meant to stimulate involvement with practical clinical ethics; which is why it has been placed at the beginning of the present issue of Therapeutische Umschau.
The Ganga River is the largest river in India which, originates in the Himalayas and along with the Brahmaputra River, another Himalayan river, transports enormous amounts of sediments from the Indian sub-continent to the Bay of Bengal. Because of the important role of river sediments in the biogeochemical cycling of elements, the Ganga river sediments, collected from its origin to the down stretches, were studied in the present context, to assess the heavy metals associated with different chemical fractions of sediments. The fractionation of metals were studied in the sediments using SM&T protocol for the extraction of heavy metals and geo-accumulation index (GAI) (Muller, Schwermetalle in den sedimenten des rheins - Veranderungen seit. Umschau, 79, 778-783, 1979) and Metal Enrichment Factor (MEF) in different fractions were calculated. As with many river systems, residual fractions constitute more than 60% of total metals, except Zn, Cu and Cr. However, the reducible and organic and sulfide components also act as major sinks for metals in the down stretches of the river, which is supported by the high GAI and MEF values. The GAI values range between 4 and 5 and MEF exceed more than 20 for almost all the locations in the downstream locations indicating to the addition of metals through urban and industrial effluents, as compared to the low metals concentrations with less GAI and MEF in the pristine river sediments from the rivers in Himalayas.
The most significant advances in the field of Brucella classification since the last meeting have been in the field of Brucella phages reviewed by Corbel & Morgan (1980) Handbuch der Bakteriellen Infektionen bei Tieren, 4, Ed Blobel & Schliesser) and Corbel & Morgan (Bergey's Manual of Determinative Bacteriology. In press). The Berkeley phages, especially the BK2 variant has been found to be able to lyse smooth B. melitensis, as well as smooth strains of the other species. A further advance has been the isolation of phages which lyse rough strains of B. abortus as well as B. canis and B. ovis. The most recent comprehensive account of the world-wide distribution of brucellosis has been given by Hansen and Müller (1982. Tierarztl Umschau 37, 564-570), supplemented by recent reviews by Morgan, Hellman, Weber, Meyer, and Wundt (1980) in Handbuch der Bakteriellen Infektionen bei Tieren 4). Except in those countries where B. abortus infection has been eradicated in cattle, the disease still remains a world-wide problem in cattle, sheep, goats and pigs as well as in wild animal reservoirs in certain parts of the world.
Estimate the expenditure of computer-related worktime resulting from the use of clinical decision support systems (CDSS) to prevent adverse drug reactions (ADR) among patients undergoing chronic pain therapy and compare the employed check systems with respect to performance and practicability. Data were collected retrospectively from 113 medical records of patients under chronic pain therapy during 2012/2013. Patient-specific medications were checked for potential drug-drug interactions (DDI) using two publicly available CDSS, Apotheken Umschau (AU) and Medscape (MS), and a commercially available CDSS AiDKlinik® (AID). The time needed to analyze patient pharmacotherapy for DDIs was taken with a stopwatch. Measurements included the time needed for running the analysis and printing the results. CDSS were compared with respect to the expenditure of time and usability. Only patient pharmacotherapies with at least two prescribed drugs and fitting the criteria of the corresponding CDSS were analyzed. Additionally, a qualitative evaluation of the used check systems was performed, employing a questionnaire asking five pain physicians to compare and rate the performance and practicability of the three CDSSs. The AU tool took a total of 3:55:45 h with an average of 0:02:32 h for 93 analyzed patient regimens and led to the discovery of 261 DDIs. Using the Medscape interaction checker required a total of 1:28:35 h for 38 patients with an average of 0:01:58 h and a yield of 178 interactions. The CDSS AID required a total of 3:12:27 h for 97 patients with an average time of analysis of 0:01:59 h and the discovery of 170 DDIs. According to the pain physicians the CDSS AID was chosen as the preferred tool. Applying a CDSS to examine a patients drug regimen for potential DDIs causes an average extra expenditure of work time of 2:09 min, which extends patient treatment time by 25 % on average. Nevertheless, the authors believe that the extra expenditure of time employing a CDSS is outweighed by their benefits, including reduced ADR risks and safer clinical drug management.
Heavy metal concentrations were examined in surface sediments from 79 sites within the Altata-Ensenada del Pabellon lagoon system. Data were normalized to separate natural from anthropogenic factors using aluminum and lithium as conservative elements and following two different discriminating criteria. For the normalization process, the natural metal concentrations were assumed to vary consistently with aluminum and lithium, unless the metal contents were of human origin. Strong linear correlations (P < .001) were observed between the conservative elements and the metals measured. According to Szefer's normalizing criteria, about 90% of the polluted sites, for at least one metal, occurred near agricultural discharge drains. In accordance with the Muller [Umschau 79 (1979) 778.] scale, this lagoon system is subject to pollutant effects only with regard to Pb (moderately to strongly polluted). It was concluded that either Al and Li could be useful to normalize granulometric variability in heavy metal studies of these lagoon sediments, and that Summers' normalization criterion proved more rigorous than Szefer's for these types of sediments.
FeLV infection is still considered to account for most disease-related deaths in pet cats. Different treatment attempts with various drugs were performed in the past but none resulted in healing or complete virus elimination. Therefore, it caused a sensation when Horber and Mayr [Horber, D., Mayr, B., 1991. Prax. 19, 311-314; Horber, D., Schnabl, W., Mayr, B., 1992. Tierarztl. Umschau 47, 556-560; Mayr, B., Horber, D., 1992. Kleintierprax. 37, 515-518] published that they were able to cure 80 to 100% FeLV-infected cats from viremia by using an immunomodulating compound. Articles in cat breeder and cat owner journals appeared assuming that obviously there is a rescue for FeLV-infected cats suffering from this deadly infection. The immunomodulator [Buttner, M., 1993. Comp. Immun. Microbiol. Infect. Dis. 18, 1-10] used in those studies was the so-called 'paramunity inducer' PIND-ORF (Baypamun, Bayer, Leverkusen, Germany) consisting of inactivated parapox ovis virus. Since that time, Baypamun is the most commonly used drug for treatment of FeLV infection in Germany and other European countries. Four placebo-controlled double-blind trials were performed to determine the therapeutic efficacy of Baypamun and other compounds in naturally FeLV-infected cats under controlled conditions.
Temporomandibular disorders - a biopsychosocial perspective Abstract. Clinicians encountering patients complaining of jaw joint symptoms need to see and understand the patients' somatic complaint in the context of possible biographic, psychological and social burdens and to select the appropriate therapeutic options accordingly. Zusammenfassung. Bei Kiefergelenkbeschwerden besteht die ärztliche Aufgabe darin, die im Vordergrund beklagten somatischen Beschwerden in Zusammenhang mit allfälligen biographischen, psychischen und sozialen Faktoren zu verstehen und daraus therapeutische Optionen abzuleiten.
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Cardiological rehabilitation, the comprehensive efficient treatment of chronic cardiac patients, is presented with regard to its difficult theoretical and practical development from the viewpoint of a senior specialist in this field practising in Central Europe. The accompanying WHO lifestyle concept is now considered to be scientifically well-founded, but has not yet been practically implemented on a large scale nor incorporated in the teaching schedule. A requirement for the future is a special medical philosophy for chronic heart patients, i.e., further development of the theoretical basis of rehabilitation, practical application of the scientific recommendations on the importance of life-style alterations, a greatly improved network of all doctors treating chronic heart patients, updating of the training of general medical specialists as well as cardiologists in Public Health, and intensified objective assessment of research on the cardiological rehabilitation of in- and outpatients.
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