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Efficient swallowing without functional and structural limitations is indispensable for adequate oral intake of food and fluids. Regardless of food consistencies, food forms, or tablet forms, the act of swallowing is an extremely complex movement pattern involving the participation of up to 100 muscles. Impaired swallowing can occur in many neurological disorders, with stroke and neurodegenerative diseases being the most common. With advancing age, various changes occur in the body that also affect swallowing function and physiology in healthy older individuals, a condition known as presbyphagia. This process becomes visible as early as the age of 65, with its intensity and prevalence increasing with age and potentially progressing into a clinically relevant swallowing disorder called dysphagia. Despite its clinical relevance, swallowing disorders in older adults are underestimated by primary care providers as well as by seniors themselves. This paper highlights the key elements of diagnosis and therapy of swallowing disorders in the elderly, which will gain importance in outpatient primary care and in the primary care of the aging population. Consistent and structured swallowing diagnostics and therapy are crucial to efficiently prevent aspiration pneumonia with significant health economic consequences, such as frequent rehospitalizations. In addition, intact swallowing is essential for efficient oral medication intake and their effectiveness, as medications that are not swallowed cannot exert their effects or their pharmacokinetics may be compromised. [ABSTRACT FROM AUTHOR]

Due to their advantageous benefit-risk-profile, direct oral anticoagulants (DOACs) are preferred over vitamin-K-antagonists for stroke prevention in atrial fibrillation as well as therapy and secondary prevention of venous thromboembolism. This guideline provides information on the practical use of DOACs, their advantages and disadvantages and limitations. It is based on recommendations from international guidelines (ESC, EHRA, DGA) and adapts them for the general practitioner setting in Switzerland. [ABSTRACT FROM AUTHOR]

The article deals with the medical obligation to verify the oral order of medication preparation in an emergency situation. It is stated that a registered nurse can independently prepare a medically ordered injection and generally does not need to be verified by a doctor. However, the doctor is obliged to check the prepared medications if the label on the ampoule deviates from the instruction. The article also describes a specific case in which a wrong administration of medication occurred due to misunderstandings in communication. The court ruled that the doctor had violated her duty to control, but the dismissal was not justified as it was a one-time mistake and the doctor had not received a warning before. However, the appellate court ruled differently and dismissed the lawsuit, as the error was classified as grossly negligent. The plaintiff filed an extraordinary appeal, which was deemed admissible and justified by the Supreme Court. It was determined that the doctor did not have a supervisory duty towards the nurse, as she acted independently as a registered nurse. The Higher Regional Court of Graz considered the dismissal justified, while the Supreme Court (OGH) granted the doctor's claims in its decision of August 31, 2022, 9 Ob A 75/22b. The OGH argued that the doctor's one-time mistake in an emergency situation was not so serious that the continuation of the employment relationship would be unreasonable. The doctor had not made similar mistakes before and had never been warned for misconduct. The OGH relied on the relevant legal bases, in particular § 15 GuKG and § 49 ÄrzteG, as well as on relevant case law and literature. The general dimension of the text deals with the importance of quality-assuring communication. It is emphasized that incidents like the disputed case mentioned in the text should lead to appropriate measures through functioning quality assurance systems. These measures could include regular clarifications about communication behavior and a verifying control according to the "check and re-check" system, for example. The goal is to avoid similar sources of errors and optimize patient safety. [Extracted from the article]

Intravenous thrombolysis (IVT) treatment with alteplase (rtPA) is an essential part of the routine treatment of patients with ischemic stroke since its introduction in the late 1990s. Rapid treatment is of essential importance. For patients with an unclear time window, various mismatch concepts have been established to identify salvageable brain tissue prior to IVT. Numerous official contraindications for rtPA are not evidence-based; for example, current data from observational studies show that systemic thrombolytic treatment is possible even in patients receiving direct oral anticoagulant (DOAC) treatment. Tenecteplase (TNK) is an alternative thrombolytic agent with some pharmacologic advantages. The most recent guidelines indicate that TNK is particularly advantageous over rtPA in patients treated in combination with endovascular stroke therapy (EST). The combination of IVT and EST should primarily be performed in the 4.5‑h time window in patients without contraindications; in the later time window EST alone is conceivable if it can be performed without delay. [ABSTRACT FROM AUTHOR]

Geriatric patients often have cardiovascular diseases that require differentiated perioperative management of hemostasis. The operation-related bleeding risk and the individual thromboembolism risk mutually influence each other, so that a differentiated preoperative assessment of the further prescription of coagulation-modulating medication is required. In many cases the active coagulation medication can be interrupted without replacement or continued unchanged. In cardiovascular diseases with antiplatelet medication, the preoperative risk-benefit assessment for most operations leads to the continuation of previous platelet aggregation inhibitor monotherapy; however, if there is a high risk of cardiovascular thromboembolism with dual platelet inhibition, the individual perioperative medication should be closely coordinated with a geriatrician or cardiologist. In most cases, the intake of vitamin K antagonists (VKA) can be preoperatively interrupted. In cases of high risk of thromboembolism, a temporary bridging with heparin must be carried out. The introduction of the four new direct oral antagonists (DOAC) has made the perioperative management of anticoagulation much easier. Bridging with heparin is not necessary. Perioperatively, only the dosage and timing of interruption of the DOACs have to be determined individually depending on the operative bleeding risk as well as the age, body weight and kidney function of the patient. If bleeding complications arise under the influence of the DOACs, antidotes are available for three of the four DOACs, which in acute cases can be used in addition to prothrombin complex concentrates and fresh frozen plasma to normalize coagulation. [ABSTRACT FROM AUTHOR]

The article "Recurrence prophylaxis of venous thromboembolism in cancer patients" presents a randomized clinical study that examines the effectiveness of direct oral anticoagulants (DOACs) compared to low molecular weight heparins in the recurrence prophylaxis of venous thromboembolism in cancer patients. The study was conducted in the USA and included 671 individuals with various types of cancer. After six months, it was found that the recurrence rate under DOACs was 6.1%, while it was 8.8% in patients treated with heparin. No statistically significant differences were found in terms of secondary endpoints such as severe bleeding or adverse effects. The study suggests that DOACs could have a comparable prophylactic effectiveness to low molecular weight heparins and could therefore represent a progress in the treatment of cancer patients.In the second article "Comparison of osteoporosis medications," a systematic review of therapies for fracture prevention in low bone density and osteoporosis is presented. The review is based on 34 randomized studies and 36 observational studies from the years 2014-2022. Various medications such as bisphosphonates, parathyroid hormones, monoclonal antibodies, and selective estrogen receptor modulators were compared. The results show that bisphosphonates and denosumab can reduce the risk of hip fractures, vertebral fractures, and other fractures in postmenopausal women with osteoporosis compared to placebo. Positive effects of abaloparatide, teriparatide, and the sequential administration of romosozumab and alendronate in women at high risk of fractures were also observed. However, the optimal treatment duration is unclear and requires further investigation. [Extracted from the article]

Pulmonary embolism remains a diagnostic and therapeutic challenge. In recent decades, the clinical picture of pulmonary embolism has changed and the prognosis has improved. Anticoagulation with heparin is the standard therapy. Previously, the diagnosis was based on clinical symptoms, ECG changes, and X-ray images, which were however inaccurate. Nowadays, CT angiography is used for diagnosis. The incidence of pulmonary embolism has increased due to increased CT examinations. However, the diagnosis remains difficult as it is confirmed in less than 10-15% of cases. Treatment is based on the guidelines of the European Society of Cardiology and includes the use of D-dimer thresholds, risk stratification, and the use of direct oral anticoagulants. The decision for long-term anticoagulation is based on weighing the thromboembolic and bleeding risks. However, there are uncertainties and different recommendations regarding long-term anticoagulation in patients with weak transient risk factors. [Extracted from the article]