Wiener medizinische Wochenschrift
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The question of potential violence on the part of people with a mental disease has caused considerable controversy in recent decades. While in the eighties the prevailing opinion was that they have no increased risk of aggression, recent studies, especially from Scandinavia and Canada, show a moderate but reliable coherence between violent crime and paranoid and schizophrenic diseases. The danger of people with a mental disease is assessed essentially through the following five study-approaches: Studies to assess the criminal rate of hospitalised patients, the prevalence of mental disorder, studies on prisoners who are committed to a psychiatric facility, and long-term analyses of cohorts. ⋯ Other investigative questions are concerned with the influence of psychopathological symptoms, the importance of comorbid disturbances and sociological aspects. The studies agree that the risk of violence is decisively increased in people who suffer from schizophrenia, through additional substance abuse, comorbidity with personality disorders, absence of treatment and social desintegration. An unprejudiced approach to this sensitive theme of aggression in people with schizophrenia with regard to further effective prevention and therapy is required.
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Wien Med Wochenschr · May 2004
[Current development in the diagnostics and therapy of systemic fungal infections in cancer patients].
Invasive fungal infections are associated with a high morbidity and mortality. They are of growing concern and a severe infectious complication in cancer patients treated with intensive chemotherapy. Within the last five years substantial progress has been demonstrated for non-culture based diagnostics and treatment of invasive fungal infections. Recent developments in the epidemiology, diagnostics and treatment of fungal infections are reviewed and discussed in the context of the current state of art for the management of invasive fungal infections in cancer patients.
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Wien Med Wochenschr · May 2004
[Eating and drinking at the end of life. Nutritional support for cancer patients in palliative care].
Anorexia, malnutrition followed by cachexia is observed in up to 80% of cancer patients with advanced stages of their disease, particularly in head and neck cancer, gastro-intestinal cancer and lung cancer. Malnutrition is associated with an unfavourable prognosis and has been demonstrated to be associated with an increased morbidity and an increased readmission rate. ⋯ Early intervention and nutritional support may be helpful in preventing anorexia and further weight loss. Successful approaches in treating anorexia have been undertaken with corticosteroids and gestagenes.
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Wien Med Wochenschr · Jan 2004
Evidence-based medicine breaking the borders--a working model for the European Union to facilitate evidence-based health care.
The promotion of evidence-based health care to improve quality of care has become an important political agenda worldwide. In April 2003 the European Commission acknowledged the lack of evidence-based health care in the European Union. Nevertheless, neither the new eHealth 2005 Action Plan nor the Public Health Program 2003 explicitly state the facilitation of evidence-based health care as a goal. ⋯ S. examples of institutions in the field of evidence-based medicine, like Evidence-based Practice Centers, and the National Guideline Clearinghouse to the heterogeneous and legally restrictive environment of the European Union, particularly Article 152 of the European Union Treaty. In addition to increasing efficiency and decreasing redundancy, coordinating national efforts in best practice will also facilitate information sharing and knowledge transfer. The establishment of databases in native languages could also break down one of the main barriers existing between care providers and evidence-based medicine while adhering to the overall concepts of eHealth 2005.
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Wien Med Wochenschr · Jan 2003
Review[From pneumonic infiltration to parapneumonic effusion--from effusion to pleural empyema: internal medicine aspects of parapneumonic effusion development and pleural empyema].
Infectious processes cause the majority part of all clinically relevant pleural effusions which frequently complicate the course of pneumonia. The assessment of an inflammatory effusion requires a careful history, physical examination, imaging techniques and clinical workup. The presence of polymorphonuclear leukocytes, high LDH-activity (> 200 U/L) and protein level (> 3 g/dL) in a pleural effusion indicates acute inflammation. ⋯ Each patient must be individually evaluated to determine the nature of the exudate and the stage of the pleural space infection. Due to its high mortality rate (5%) a thoracic empyema requires prompt treatment. Diagnostic thoracentesis and withdrawal of liquid for the microbiological, cytological and biochemical analysis is urgently recommended in all cases to assess severity of the disease and the likelihood of a complicated or uncomplicated course, and to select the most appropriate treatment option.