Dtsch Arztebl Int
-
Ampullary or papillary carcinoma is a malignant tumor arising from the mucosa in the region of the major duodenal papilla, also known as the ampulla of Vater. Uniform treatment recommendations are lacking both for the adjuvant situation and for palliative care. ⋯ The current state of the evidence on the treatment of ampullary carcinoma is poor. Therapeutic decisions should be discussed in an interdisciplinary tumor board and should, in our opinion, take the histological subtype into account.
-
Randomized Controlled Trial
A Multimodal Prevention Program for Stress Reduction—Results of a Randomized Controlled Trial.
Stress-reducing preventive measures and the elements of which they are made up have been inadequately studied to date. In this trial, we studied the stress experienced over the twelve months from the beginning of the intervention by subjects who underwent a two-week-long multimodal prevention program for stress reduction with a psycho-educative component, with a refresher at six months, compared to that experienced by subjects in two control groups (CG-B: prevention program without psychoeducation, CG-C: no intervention). ⋯ This exploratory trial reveals a lessening of subjectively experienced stress after participation in a two-part prevention program for stress reduction with a specific psychoeducative component.
-
Around the world, survival rates after cardiac arrest range between <14% for in-hospital (IHCA) and <10% for outof- hospital cardiac arrest (OHCA). This situation could potentially be improved by using extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (CPR), i.e. by extracorporeal cardiopulmonary resuscitation (ECPR). ⋯ ECPR can potentially improve survival rates after cardiac arrest compared to conventional CPR when used in experienced, high-volume centers in highly selected patients (young age, initial shockable rhythm, witnessed cardiac arrest, therapy-refractory high-quality CPR). No general recommendation for the use of ECPR can be issued at present.
-
Observational Study
Over- and Undertreatment With Levothyroxine—Findings of the Population-Based Rhineland Study.
Levothyroxine is a very commonly prescribed drug, and treatment with it is often insufficient or excessive. Nonetheless, there have been only a few reports on the determinants of inadequate levothyroxine treatment. ⋯ Levothyroxine intake was high in our sample, and suboptimal despite monitoring. Our findings underscore the need for careful dosing and for due consideration of deintensification of treatment where appropriate.