Med Klin
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COPD is a frequent disease, affecting approximately one in four smokers. In older patients > 70 years of age, the proportion of individuals who never have smoked increases up to one in three individuals. Severe disease is present in 10%, and the limitation of performance is usually caused by airway obstruction, in a smaller portion of patients by the loss of alveolar surface (emphysema). ⋯ First data are rather disappointing. Ultimate alternative remains lung transplantation with life expectancy ranging between 5-6 years independent of age. Indeed, consequent application of previously described measures might preserve a stable state over many years.
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Oral anticoagulant (OAC) therapy should be temporarily interrupted for an elective procedure or surgery, and perioperative prophylaxis with heparins should be initiated in patients who face a high or moderate risk of thrombosis. To date, the optimal heparin dose has not been established. The authors investigated the efficacy and safety of a risk-adapted regimen with the low-molecular-weight heparin enoxaparin in two different, body weight-adapted regimens. ⋯ The absence of thromboembolic events confirms the efficacy of enoxaparin in perioperative bridging. The rate of major bleedings was low and, of note, no cases of HIT II were noted. Reducing the dose to half the standard was shown to be effective and well tolerated in patients with moderate risk. Likewise, enoxaparin in a reduced dose can be safely used in patients with renal insufficiency who require bridging.
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Comparative Study
[Methodological challenges and potentials of health-related quality of life evaluation in children with chronic health conditions under medical health care].
Health-related quality of life (HRQoL) denotes the patients' perception of well-being and function in physical, emotional, mental, social and everyday life areas. In adult medicine, HRQoL has been established as an outcome criterion to evaluate the quality and effect of different therapies. During the past 20 years, a multitude of instruments to assess HRQoL has been developed, mostly for adults, complying with psychometric standards concerning the reliability, validity and sensitivity of the scales. ⋯ Generic and disease-specific (targeted) instruments can be applied. Frequently used generic measures are described and an international project to develop a set of quality of life instruments for children with chronic conditions is reported. The application of these measures in the research context using examples from a German prospective study in pediatric rehabilitation is exemplarily described and highlights the potential benefit of implementing these methods in epidemiologic and clinical studies.