Dtsch Arztebl Int
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Randomized Controlled Trial
Continuous or Interrupted Suture for Hepaticojejunostomy in Pancreaticoduodenectomy (the HEKTIK Trial): Findings of a Randomized, Controlled, Single-Center Superiority Trial.
Over 6000 pancreaticoduodenectomies are performed each year in Germany, and hepaticojejunostomy is a crucial step of the procedure. An anastomotic leak of hepaticojejunostomy can cause major postoperative complications. The aim of this trial was to compare the morbidity and efficiency of continuous versus interrupted suturing for hepaticojejunostomy in pancreaticoduodenectomy. ⋯ These data imply that continuous and interrupted suturing techniques yield equally good clinical outcomes in hepaticojejunostomies of hepatic ducts with diameter 5 mm or more. Continuous suturing is, however, both faster and cheaper.
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Sudden cardiac death (SCD) is the death of an apparently healthy person within one hour of the onset of symptoms, or within 24 hours of last being seen alive and well-with no evidence of an extra-cardiac cause. In autopsied cases, SCD is defined as the natural unexpected death of unknown or cardiac cause. The reported incidence figures for SCD vary widely. ⋯ The affected families should be investigated systematically so that appropriate diagnoses and treatments can be established.
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Single-use medical gloves achieve their purpose only when properly used. Proper use also helps avoid undesired consequences such as excessive waste and CO2 emissions, as well as inadequate hand hygiene. ⋯ Limiting the use of single-use medical gloves to its proper indications promotes the safety of health-care professionals and patients and has beneficial ecological and economic effects as well.
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Observational Study
Evaluation of an Automated Decision Aid for the Further Referral of Emergency Room Patients: A Prospective Cohort Study.
Instruments for the initial evaluation of emergency room patients as an aid to their onward referral to ambulatory care structures are a matter of current interest. In this study, we assess the safety of the software application SmED-Kontakt+ for this purpose. SmED is an abbreviation for Strukuturierte Medizinische Ersteinschätzung Deutschland, "structured initial medical evaluation in Germany." ⋯ SmED-Kontakt+ generally assessed these patients' needs for further care as more urgent than the treating physicians did. Nevertheless, the percentage of potentially endangered patients was higher than expected. We conclude that further care should be provided in timely fashion with an obligatory appointment. The sites of further ambulatory care should be immediately accessible and properly equipped. Patients should not be referred for further care at later times on the basis of an SmED-Kontakt+ assessment.
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According to current evidence, every 10th to 11th adult with chronic kidney disease (CKD) has a monogenic disease of the kidney. ⋯ Awareness of the high prevalence of monogenic kidney diseases in adults with CKD and alertness to their suggestive clinical features are crucial for the timely initiation of targeted diagnostic testing. The molecular genetic identification of these diseases is a prerequisite for appropriate patient management.