Häufige Magen-Darm-Beschwerden: Management der funktionellen Dyspepsie und des Reizdarm-Syndroms in der Praxis

Funktionelle Dyspepsie (FD) und Reizdarm-Syndrom (RDS), zwei häufige gastro-intestinale Entitäten mit überlappenden Symptomen, sollten nach den Rom-IV-Kriterien diagnostiziert werden. Dabei handelt es sich um eines oder mehrere der folgenden Symptome: bei FD um postprandiales Völlegefühl, frühes Sättigungsgefühl, Schmerzen oder Brennen epigastral; bei RDS um rezidivierende abdominale Schmerzen jeweils assoziiert mit Defäkation, Veränderungen der Stuhlfrequenz oder der Stuhlform. Zum Ausschluss struktureller Krankheiten ist auf Alarmsymptome zu achten. Für die Therapie bewährt sich bei beiden Krankheiten ein Stufenschema. Stufe 1: Arzt-Patienten-Gespräch mit Erläuterung von Diagnose und Prognose sowie Klärung der Therapieziele; Optimierung des Lebensstils; Einsatz von Phytotherapeutika; Stufe 2: Symptomorientierte Medikamente: bei FD Protonenpumpenhemmer bzw. Prokinetika; bei RDS Spasmolytika, Sekretagoga, Laxanzien, Gallensäurebinder, Antidiarrhoika, Antibiotika, Probiotika; Stufe. 3: viszerale Analgetika (Antidepressiva). // Frequent Gastro-Intestinal Disorders: Management of Functional Dyspepsia and Irritable Bowel Syndrome in Clinical Practice Abstract: Functional dyspepsia (FD) and irritable bowel syndrome (IBS), two common gastrointestinal entities with overlapping symptoms, should be diagnosed according to Rome IV criteria. This includes one or more of the following symptoms: in FD, postprandial fullness, early satiation, epigastric pain or burning; in IBS, recurrent abdominal pain associated with defecation, change in frequency of stool or form of stool. To exclude structural diseases, attention should be paid to alarm symptoms. As far as treatment is concerned, a stepwise scheme proves to be effective for both diseases. Step 1: doctor-patient discussion with explanation of diagnosis and prognosis as well as clarification of therapy goals; lifestyle adaptations; use of phytotherapeutics; step 2: symptom-oriented medication: for FD, PPIs or prokinetics; for IBS, antispasmodics, secretagogues, laxatives, bile acid sequestrants, antidiarrheals, antibiotics, probiotics; step 3: visceral analgesics (antidepressants)

Management of giant-cell arteritis in Switzerland: an online national survey.

AIMS OF THE STUDY To assess current practices in diagnosing, treating, and following-up giant-cell arteritis by specialists in Switzerland and to identify the main barriers to using diagnostic tools. METHODS We performed a national survey of specialists potentially caring for patients with giant-cell arteritis. The survey was sent by email to all members of the Swiss Societies of Rheumatology and for Allergy and Immunology. A reminder was sent to nonresponders after 4 and 12 weeks. Its questions covered the following dimensions: respondents' main characteristics, diagnosis, treatment, and imaging's role during follow-up. The main study results were summarized using descriptive statistics. RESULTS Ninety-one specialists, primarily aged 46-65 years (n = 53/89; 59%), working in academic or nonacademic hospitals or private practice, and treating a median of 7.5 (interquartile range [IQR]: 3-12) patients with giant-cell arteritis per year participated in this survey. Ultrasound of temporal arteries/large vessels (n = 75/90; 83%) and positron-emission-tomography-computed tomography (n = 52/91; 57%) or magnetic resonance imaging (n = 46/90; 51%) of the aorta/extracranial arteries were the most common techniques used to diagnose giant-cell arteritis with cranial or large vessel involvement, respectively. Most participants reported a short time to obtain imaging tests or arterial biopsy. The glucocorticoid tapering scheme, glucocorticoid-sparing agent, and glucocorticoid-sparing treatment duration varied among the participants. Most physicians did not follow a predefined repeat imaging scheme for follow-up and mainly relied on structural changes (vascular thickening, stenosis, or dilatation) to drive treatment choice. CONCLUSIONS This survey indicates that imaging and temporal biopsy are rapidly accessible for diagnosing giant-cell arteritis in Switzerland but highlights heterogeneous practice in many disease management areas

The evolution of the northern margin of the Tethys in eastern Switzerland

The former northern margin of Tethis is being studied in the Alpine chain by IGCP Project 198("Evolution of the Northern Margin of the Tethys"). This paper summarizes the present state of the knowlege from the opening phase of this Mesozoic to early Paleogene seaway in Eastern Switzerland. Basement rocks and sediments of the previous margin are now exposed here in the stack of the Alps and their European foreland

The Programmatic and Institutional (Re-)Configuration of the Swiss National Security Field

Traditionally, Swiss national security focused intimately on the military protection of national territory and institutions. Following the principles of armed neutrality and autonomous defense, the field was organized closely by the Defense Ministry and shied away from sizable international security partnerships. Since the end of the Cold War, however, the policy domain has moved far beyond such positions. It expanded from military and civil defense to activities such as integrated peace‐building, the fight against transnational organized crime, integrated border management, and critical infrastructure protection. This programmatic reorientation was accompanied by new institutional arrangements. Domestically, inter‐cantonal and federal policing were enhanced and intelligence services integrated. Army capabilities were directed to new mandates and new countrywide inter‐ministerial coordination platforms developed. Internationally, Switzerland joined the Partnership for Peace, Euro‐Atlantic Partnership Council, United Nations, and Schengen/Dublin frameworks. Despite these profound changes, Swiss security politics has not been subjected to particularly refined analysis. While government doctrines list threats and agencies with little pondering of their relevance and interconnections, political analysts are often caught up in polarized controversies around select issues such as the army budget, distinct weapons procurement programs, or neutrality tout court. Yet, also academia contributed surprisingly little to shedding light on the executive arm of the Swiss security field.ISSN:1424-7755ISSN:1420-3529ISSN:1662-637

Schweizer Sicherheitspolitik in der Praxis: Eine empirische Momentaufnahme

Wie hat sich der Schweizer Sicherheitsbereich seit Ende des Kalten Krieges entwickelt? Wer arbeitet heute mit wem zu welchen Gefahren? Basierend auf einer umfassenden und einzigartigen Datenerhebung kartiert dieser Beitrag die Entwicklung des gesamtschweizerischen Sicherheitsbereichs. Die Darstellung der praktischen Arbeitsteilungen, inneren und äusseren Kooperationen, beruflichen Profile und Werdegänge schafft einen analytisch differenzierten und empirisch fundierten Beitrag zu anhaltenden Diskussionen über die landesweite sicherheitspolitische Steuerung.ISSN:1024-060

Häufige Magen-Darm-Beschwerden: Management der funktionellen Dyspepsie und des Reizdarm-Syndroms in der Praxis

Frequent Gastro-Intestinal Disorders: Management of Functional Dyspepsia and Irritable Bowel Syndrome in Clinical Practic

Bulletin 2016 zur schweizerischen Sicherheitspolitik

ISSN:1024-060