Dtsch Arztebl Int
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Chronic leg ulcers are defined as those that show no tendency to heal after 3 months of appropriate treatment or are still not fully healed at 12 months. In this article, we present an approach to the challenging problem of chronic leg ulcers that is based on the principles of evidence-based medicine, i.e., the explicit use of the best available scientific evidence as a guide to treatment. ⋯ Physicians providing modern evidence-based management of chronic leg ulcers should make use of their own clinical experience in combination with the best current scientific evidence. It seems clear that the many available treatment options should be evaluated critically in an interdisciplinary setting. In particular, causally directed treatment must be provided in addition to symptomatic, stage-based local wound treatment.
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There are no up-to-date, representative studies on the frequency of maltreatment (abuse or neglect) among children and adolescents in Germany. ⋯ The frequencies of various types of abuse and neglect of children and adolescents that were retrospectively determined in this up-to-date study by questionnaire of a representative sample of the German population, and the correlations between them, correspond to those found in a German population-based study in 1995 and in recent American studies.
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Sunlight induces a wide variety of dermatoses. Their differential diagnosis is problematic not only because of similar phenotypes, but also because of confusing nomenclature and classification. ⋯ Photodermatoses are not life-threatening but can cause considerable suffering. Prevention is just as important as treatment.
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Euro 1.1 billion were spent in 2009 for disease management programs (DMPs) in Germany, among them the DMP for type 2 diabetes mellitus (T2DM). Earlier studies of DMPs failed to take sufficient account of patient- and physician-related selection effects. We used innovative methods to study the medical benefit of the DMP for T2DM among insurees of the Techniker Krankenkasse, a German health insurance provider. ⋯ The current DMP for T2DM in Germany is not adequately effective. This study does not reveal any clear medical benefit from DMP participation. Selection effects were largely eliminated by means of a sophisticated control group design. Analyses of other DMPs with this method are currently being planned.