Dtsch Arztebl Int
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This study analyzes healthcare management patterns in the German Federal State of North Rhine-Westphalia, with regard to time-to-surgery and operative technique in the management of femoral neck fracture. ⋯ Structured dialog with individual hospitals revealed the following causes for the differences in care provision: guideline recommendations and the recommendations of the Federal Office for Quality Assurance ltd. (Bundesgeschäftsstelle Qualitätssicherung, BQS GmbH), are not accepted as the basis for practice in all quarters; in some areas the necessary staff to ensure timely surgery are lacking. This situation cannot be defended to a wider public, given the clear indications from international literature that a short time to surgery reduces postoperative mortality as well as the incidence of key complications, such as pressure sores, thromboembolisms and pneumonia.
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Cancers of the pancreas are identified in 11 800 to 13 500 patients each year in Germany. Epidemiological studies prove smoking and chronic alcohol consumption as causes of about 30% of pancreatic cancers. ⋯ Pancreatic cancer is even today for more than 95% of the patients incurable. Strategies to prevent pancreatic cancer are intended to stop smoking and chronic alcohol consumption and early surgical extirpation of cystic neoplastic lesions. For patients with established pancreatic cancer risk a follow-up protocol is discussed.
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In non-small cell lung cancer (NSCLC) surgical resection is the treatment of choice in stages I and II of the disease; but even of this selected group of patients, almost half suffer recurrence following complete resection, usually in the form of distant metastases. The role of adjuvant systemic chemotherapy has been investigated extensively in the last two decades. ⋯ There is currently no indication for adjuvant chemotherapy in patients with stage IA disease, whereas the role of adjuvant chemotherapy for stage IB disease remains controversial. To treat a patient with stage IB disease should be an individualized decision depending on age, tumor size, vascular invasion, and patient preference. Adjuvant chemotherapy is now the standard of care after complete resection of stage II-IIIA NSCLC. Patients considered for adjuvant chemotherapy should be under 75 years of age, have no contraindications to cisplatin-based chemotherapy, and should be in a good performance status after surgery. Currently the standard adjuvant chemotherapy regimen is a combination containing cisplatin and vinorelbine.
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This study analyzes the prevalence and associated factors for smoking and passive smoking among young people. ⋯ These results show that adolescents are an important target group for anti-smoking interventions and that the main settings for these interventions are the school, the family, and the peer group.
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More than 3% of the total population will suffer from epilepsy at some time during their lives. One quarter of newly diagnosed cases worldwide are children. With optimal treatment, around 70% will enter remission. In the long run, antiepileptic drugs can be discontinued in almost half of affected individuals. Most patients with epilepsy undergo normal cognitive development. This relatively good prognosis contrasts with persistent public stigma surrounding the condition. ⋯ A classification of epileptic seizures and epileptic syndromes is provided by the International League Against Epilepsy (ILAE). Epilepsies are mainly split into symptomatic forms (i.e. those with a recognizable cause) and idiopathic forms, which result from a genetic predisposition and imply no other pathology aside from epilepsy. The classification of epilepsy syndromes is based on assumed etiology, and seizure symptomatology. Drug therapy is usually started after a second unprovoked seizure. The best possible seizure control, continuation of a successful school career, and preservation of a stable family situation are equally important therapeutic aims.