Dtsch Arztebl Int
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Conventional laboratory tests of blood coagulation yield only partial diagnostic information. "Point of care" (POC) devices are increasingly being used at the bedside perioperatively for rapid, detailed testing of hemostatic function and for treatment monitoring in patients with coagulopathies. In this review, we discuss the benefits and limitations of POC coagulation testing-in particular, its effects on the rate of perioperative transfusion of allogeneic blood products, on the frequency of other types of hemostatic treatment, and on the clinical outcome. ⋯ Despite certain limitations that must be borne in mind, POC techniques are a valuable means of testing various aspects of hemostasis rapidly and in detail. Their implementation in hemostatic treatment algorithms may reduce both the rate of transfusion of allogeneic blood products and the total cost of treatment for blood loss and coagulopathies. The putative effect of POC testing on perioperative morbidity and mortality has not yet been demonstrated.
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In Germany, 400 000 to 500 000 people are chronically infected with the hepatitis C virus (HCV), 70% to 80% of them with HCV genotype 1. Combined treatment with peginterferon-alfa and ribavirin leads to a sustained virologic response (SVR) in 40% to 50% of patients with genotype 1 and 70% to 80% of patients with genotypes 2 and 3. The HCV protease inhibitors boceprevir and telaprevir were approved for clinical use in Germany in 2011. ⋯ Individualized treatment durations are recommended for the treatment of chronic hepatitis C with peginterferon and ribavirin. Triple therapy in combination with either boceprevir or telaprevir leads to a higher rate of SVR both in previously untreated genotype 1 patients and in those who have failed prior antiviral treatment.\
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Delirium is common, has multiple causes and causes distress to numerous patients and their relatives. ⋯ In many cases, delirium can be diagnosed and treated in good time. Prevention is preferable to treatment.
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Demographic change, technical progress, and changing patterns of service use influence the future demand for physicians in the German health care system. The attitudes of medical students towards their later work in the health system is important for current health care planning. For that reason a nationwide survey aimed to identify major trends in preferred specialty, workplace characteristics (regional location, hospital) and perceived hindrances for clinical work. ⋯ Although the coming generation of physicians anticipate working in clincial settings in the future, shortfalls in the areas of primary care and in rural locations are likely if medical students adhere to their preferences stated in the questionnaire.