Der Anaesthesist
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Since October 2011 new guidelines exist for temperature management in critical care. According to the guidelines the term targeted temperature management (TTM) should replace the term therapeutic hypothermia. There is now a strong recommendation for TTM using 32-34°C as the preferred treatment for out-of-hospital adult cardiac arrest with a first registered electrocardiography rhythm of ventricular fibrillation or pulseless ventricular tachycardia and still unconscious after restoration of spontaneous circulation. A TTM of 32.5-35.5°C is also recommended for the treatment of term newborns who sustain asphyxia and exhibit acidosis and/or encephalopathy.
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Data from natural sources show counter-intuitive distribution patterns for the leading digits to the left of the decimal point and the digit 1 is observed more frequently than all other numbers. This pattern, which was first described by Newcomb and later confirmed by Benford, is used in financial and tax auditing to detect fraud. Deviations from the pattern indicate possible falsifications. ⋯ Thus, the method used in the present study seems to be sensitive for detecting fraud. Additional statements of specificity cannot yet be made as this requires further analysis of data that is definitely not falsified. Future studies exploring conformity might help prevent falsified studies from being published.
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An Addisonian crisis marks an acute adrenocortical failure which can be caused by decompensation of a chronic insufficiency due to stress, an infarct or bleeding of the adrenal cortex and also abrupt termination of a long-term glucocorticoid medication. This article reports the case of a 25-year-old patient with Crohn's disease who suffered an Addisonian crisis with hypotension, hyponatriemia and hypoglycemia during an emergency laparotomy after he had terminated prednisolone medication on his own authority. ⋯ Under this treatment regimen hemodynamic stabilization was achieved. Reduction of the administration of hydrocortisone after 3 days resulted in cardiovascular insufficiency which required an escalation of the hydrocortisone substitution.
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The article illustrates the ethical principles and the legal context of end-of-life decision-making in the intensive care unit (ICU). After a long period of preference for medical paternalism, patient autonomy has now developed into the standard for medical decision-making. Medical interventions are justified by medical indications and patient consent. ⋯ A mentally incompetent patient will can be explored by studying the written anticipated advance directive in which the patient has formulated value priorities. The binding character of patient advance directives was regulated in German law in 2009; the decision has to be made in a dialogue between the physician and the proxy. A judgment of the German High Court in 2010 confirmed that even an active withdrawal of therapeutic measures, such as mechanical ventilation is legal.
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Expert opinions have an important place for expert testimony in medical disputes. The report should contain a summary about facts and causality between the damage and the medical treatment in question as well as describe the current medical standard. The fulfillment of scientific criteria was investigated in 179 anesthesiological expert opinions from 150 arbitration cases. ⋯ Conclusive statements about the causality between the damage and the medical treatment in question were available only in 60% of the reports. The study findings suggest that anesthesia expert reports present a high incidence of non-scientific claims. The development of guidelines for expert witnesses by the medical societies is urgently recommended.