Dtsch Arztebl Int
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Carpal tunnel syndrome is by far the most common peripheral nerve compression syndrome, affecting approximately one in every six adults to a greater or lesser extent. Splitting the flexor retinaculum to treat carpal tunnel syndrome is the second most common specialized surgical procedure in Germany. Cubital tunnel syndrome is rarer by a factor of 13, and the other compression syndromes are rarer still. ⋯ Evidence-based diagnostic methods and treatment recommendations are now available for the two most common peripheral nerve compression syndromes. Further controlled trials are needed for most of the rarer syndromes, especially the controversial ones.
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Hip replacement ranks among the more successful operations on the musculoskeletal system, but it can have serious complications. A common one is dislocation of the total hip endoprosthesis, an event that arises in about 2% of patients within 1 year of the operation. Physicians should be aware of how this problem can be prevented and, if necessary, treated, so that the degree of trauma due to hip dislocation after hip replacement surgery can be kept to a minimum. ⋯ The dislocation of a total hip endoprosthesis is an emotionally traumatizing event that should be prevented if possible. Preoperative risk assessment should be performed and the operation should be performed with optimal technique, including the best possible physical configuration of implant components, soft-tissue balance, and an adequately experienced orthopedic surgeon.
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Some three million Russian-speaking immigrants from the former Soviet Union live in Germany today. Many of them underwent a different kind of medical socialization than the indigenous population, but the experiences and expectations of this group of patients have hardly been studied to date. ⋯ Physicians in Germany should be more aware of the culturally based expectations of immigrant patients in order to understand their needs better, improve the physician-patient relationship, and ensure equal opportuities in health care. For example, many immigrants would prefer their doctors to communicate with them in a manner that non-immigrants would consider paternalistic.
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A minority of patients with asthma have uncontrolled or partially controlled asthma despite intensive treatment. These patients present a special challenge because of the extensive diagnostic evaluation that they need, insufficient evidence regarding personalized treatments, and their high consumption of health-care resources. ⋯ The diagnosis and treatment of severe asthma is time consuming and requires special experience. There is a need for competent treatment centers, continuing medical education, and research on the prevalence of severe asthma.
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Review Meta Analysis
Drug treatments for pruritus in adult palliative care.
Pruritus is a rare but troublesome symptom in palliative-care patients with a variety of underlying diseases. The pharmacotherapy of pruritus is often off-label, and an evidence-based evaluation is needed. ⋯ In view of the diverse etiologies of pruritus in palliative-care patients, careful consideration should be given to the choice of drug used to treat it. The substances listed here have moderate to strong antipruritic effects and merit further study in RCTs of high methodological quality.