Dtsch Arztebl Int
-
About 1% of adults suffer from painful osteoarthritis of the ankle. The current literature contains no information on the percentage of such patients who derive long-term relief of symptoms from conservative treatment. Advanced ankle osteoarthritis can be treated with non-joint-preserving measures, such as total ankle replacement and ankle fusion. ⋯ Total ankle replacement is a good treatment option for complete, end-stage ankle arthritis. It can restore joint function and make the patient mobile with little or no pain. There are, however, many contraindications to be taken into account. There is a need for further studies of the biomechanics of arthritic and replaced ankle joints and for long-term follow-up studies of total ankle replacement.
-
Comment Letter
Significance of the respiratory rate in emergency medicine.
-
25-90% of all patients undergoing elective surgery suffer from inadvertent postoperative hypothermia, i.e., a core body temperature below 36°C. Compared to normothermic patients, these patients have more frequent wound infections (relative risk [RR] 3.25, 95% confidence interval [CI] 1.35-7.84), cardiac complications (RR 4.49, 95% CI 1.00-20.16), and blood transfusions (RR 1.33, 95% CI 1.06-1.66). Hypothermic patients feel uncomfortable, and shivering raises oxygen consumption by about 40%. ⋯ Inadvertent perioperative hypothermia can adversely affect the outcome of surgery and the patient's postoperative course. It should be actively prevented.
-
International studies show that aggressive behavior against primary care physicians is not an uncommon occurrence. There has been no systematic study to date of the nature and frequency of such occurrences in Germany. ⋯ The frequency and extent of aggression and violence against primary care physicians in Germany is comparable to those reported by international studies. Strategies for dealing with this problem should be developed. In particular, the issue of safety on emergency call needs to be addressed.
-
Inexpensive techniques for measurement and data storage now enable medical researchers to acquire far more data than can conveniently be analyzed by traditional methods. The expression "big data" refers to quantities on the order of magnitude of a terabyte (1012 bytes); special techniques must be used to evaluate such huge quantities of data in a scientifically meaningful way. Whether data sets of this size are useful and important is an open question that currently confronts medical science. ⋯ Big data techniques can be used, for example, to evaluate observational data derived from the routine care of entire populations, with clustering methods used to analyze therapeutically relevant patient subgroups. Such analyses can provide complementary information to clinical trials of the classic type. As big data analyses become more popular, various statistical techniques for causality analysis in observational data are becoming more widely available. This is likely to be of benefit to medical science, but specific adaptations will have to be made according to the requirements of the applications.