Dtsch Arztebl Int
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Review Meta Analysis
Assessing prognosis following cardiopulmonary resuscitation and therapeutic hypothermia-a critical discussion of recent studies.
The prognosis of patients who are comatose after cardiopulmonary resuscitation (CPR) is poor but can be improved by mild therapeutic hypothermia. We studied the question whether the known, reliable indicators of a poor prognosis after CPR are also valid for patients treated with CPR and hypothermia. ⋯ If the prognosis is poor, this should be thoroughly discussed with the patient's family, and the nature and extent of further intensive treatment should be reconsidered. The patient's wishes, if known, are paramount. Any decision to withhold care should be taken only if there are multiple concurrent indicators of a poor prognosis. If only one such indicator is present, or if the findings are inconsistent, such decisions should be postponed.
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Lists of potentially inappropriate medications (PIMs) for the elderly, such as the German PRISCUS list, have been published as expert recommendations with the aim of improving drug safety for this patient group. In this study, we tried to determine how often adverse drug events occur in the emergency department and what role PRISCUS medications might play in these events. ⋯ Elderly patients more frequently suffer from ADR and from the clinical consequences of medication errors. Elderly patients taking PIMs are more likely to suffer from ADRs and MEs, even though most drug-related events are still attributable to non-PIM.
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Randomized Controlled Trial
Dying with dementia: symptom burden, quality of care, and place of death.
No detailed information has been available until now about the care setting, circumstances and place of death, symptom burden, and quality of care of persons with end-stage dementia in Germany. ⋯ These data indicate the high symptom burden of persons with dementia in Germany at the end of their lives. They underscore the need for proper palliative care in all of the settings where persons with dementia die. Specialized in- and outpatient palliative care should not be offered only to patients with cancer, but should rather be made available to all who need it.
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Comparative Study
A comparison of the treatment of severe injuries between the former East and West German States.
The annual number of persons killed in road-traffic accidents in Germany declined by 36% from 2001 to 2008, yet official traffic statistics still reveal a marked difference in fatalities between the federal states of the former East and West Germany twenty years after German reunification. ⋯ Among the hospitals whose cases are included in the TR-DGU, there is no significant difference between the former East and West Germany with respect to mortality or any other clinically relevant variable. Hypothetically, the higher rate of death from road-traffic accidents in the former East Germany, as revealed by national traffic statistics, might be attributable to a difference in the quality of care received by trauma patients, but no such difference was found. Other potential reasons for it might be poorer road conditions, more initially fatal accidents, and lower accessibility of medical care in less densely populated areas.