Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 2009
Review[Pruritus and dryness of the skin in chronic kidney insufficiency and dialysis patients - a review].
The uremic pruritus is a very painful symptom suffered by chronic haemodialysis patients and is observed in 22 to 74% of the subjects. The causes of uremic pruritus have not yet been clarified. During the last 20 to 30 years it has been focused on altogether 5 different pathophysiological hypotheses: stimulating influences (e.g. calcium phosphate deposits in the epidermis), stimuli (e.g. secondary hyperparathyroidism), neuropathic injuries (e.g. disturbance of the cutaneous innervation in patients with uremic peripheral neuropathy), and central nervous changes (e.g. accumulation of endorphins in uremic patients which is associated with increasing pruritus), and immunologic conditions. ⋯ It has been demonstrated that older patients have decreased urea levels within the stratum corneum of the epidermis, whereas in patients with terminal kidney insufficiency - despite dryness of the skin - as a paradox finding elevated levels of urea have been assessed in the stratum corneum. Because of this reason, the meaning of urea as part of the "natural moisturizing factors" system is not understood, until now. However, there are very promising results of clinical phase II studies showing a significant effect of topical application of 2.5% L-arginine hydrochlorid ointment - a semi-essential amino acid - on improvement of dryness and, in particular, on improvement of pruritus in haemodialysis patients.
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Wien Med Wochenschr · Jan 2009
Practice Guideline[Allergic rhinitis and its impact on asthma (ARIA update 2008). The Austrian perspective].
In 1999, during the ARIA (Allergic Rhinitis and its Impact on Asthma) WHO workshop, an evidence-based document was produced using an extensive review of the literature available up to December of the same year. An update of the ARIA guidelines was soon needed and started in 2004. ⋯ This goal was achieved with the most recently published ARIA update 2008. The present article is the result of consecutive efforts of the authors of the ARIA update 2008 to accomplish the nationwide comprehensive distribution of information by publication in important national journals, like the WMW.
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Economic evaluation of healthcare programmes helps us to assure the efficient use of healthcare resources. Cost-minimisation analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis are the most commonly applied evaluation types. ⋯ Furthermore, checklists have been developed for systematic critical appraisal of economic evaluations. Even though economic evaluations increase the transparency of resource allocation decisions and make decision criteria more explicit, they do not replace public discussions on the availability of overall resources for the public health care system.
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Wien Med Wochenschr · Jan 2009
[Establishing an advance directive--summary of practical experience].
Since the Federal Act on Advance Directives came into force, some experience has been gained with its use in practice. This article aims at concentrating the practical experience and establishing a first summary of results. ⋯ This article does not cover the subject from a theoretical point of view and it purposefully does not concentrate so much on academic or literary discussion. In fact, it describes the results that could be found in everyday practical use and is intended to give assistance to those confronted with advance directives, in this context especially to physicians who support patients in the process of creating such a document.