Dtsch Arztebl Int
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Guidelines are one of the means by which health care organizations try to improve health care and lower its cost. Studies have shown, however, that guidelines are still not being adequately implemented. In this exploratory study, we examine the link between physicians' knowledge of and compliance with guidelines: specifically, guidelines for the treatment of three cardiovascular diseases (arterial hypertension, heart failure and chronic coronary heart disease [CHD]) in primary care. ⋯ These preliminary findings imply that physicians' knowledge of guidelines does not in itself lead to better guideline implementation. Further studies are needed to address this important issue.
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Awareness while under general anesthesia, and the later recall of what happened during surgery, can be experienced by patients as horrific events that leave lasting mental trauma behind. Patients may have both auditory and tactile perception, potentially accompanied by feelings of helplessness, inability to move, pain, and panic ranging to an acute fear of death. For some patients, the experience of awareness under anesthesia has no sequelae; for others, however, it can lead to the development of post-traumatic stress disorder, consisting of complex psychopathological phenomena such as anxiety, insomnia, nightmares, irritability, and depression possibly leading to suicidality. ⋯ Strategies for avoiding awareness phenomena under anesthesia include the training of staff to know about the problem and, specifically, the use of benzodiazepines, the avoidance of muscle relaxants if possible, and shielding the patient from excessive noise. EEG monitoring is effective but provides no guarantee against awareness. If awareness under anesthesia occurs despite these measures, the patient must be given expert, interdisciplinary treatment as soon after the event as possible in order to minimize its potential sequelae.
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Multi-center observational studies in surgery can yield important findings, as long as they are appropriately designed and monitored and employ modern methods of statistical analysis. ⋯ This multi-center observational study yields valid findings about the epidemiology and overall quality of medical care for colon carcinoma in Germany.
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Because the volume of patient admissions to an emergency department (ED) cannot be precisely planned, the available resources may become overwhelmed at times ("crowding"), with resulting risks for patient safety. The aim of this study is to identify modern triage instruments and assess their validity and reliability. ⋯ Five-level triage systems are valid and reliable methods for assessment of the severity of incoming patients' conditions by nursing staff in the emergency department. They should be used in German emergency departments to assign treatment priorities in a structured and dependable fashion.