Zeitschrift für ärztliche Fortbildung und Qualitätssicherung
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Z Arztl Fortbild Qualitatssich · Apr 1998
Review[Early detection and diagnosis of invasive mycoses].
An invasive mycosis may cause death in high-risk patients. An early systemic antimycotic therapy can save life. Therefore, a continuous mycological monitoring in one week intervals is necessary in high-risk patients beginning with the day of admission. ⋯ Only by interpreting the time course of the mycological findings and the patient's clinical status, an invasive mycosis may be diagnosed with some certainty. In any case, additional procedures like radiological techniques (i.e. CT-scan), histology etc. should be used.
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Clinical practice guidelines can be used to achieve optimal utilization of scarce resources for the medical management of defined patient groups. However, this does not mean that the total amount of resources allocated to these patient groups will be reduced automatically. Examples of different health economic consequences for guideline implementation will be discussed, especially with regards to the cost-effectiveness to therapy and to the total health care budget. ⋯ Quality criteria of sound evidence-based guidelines are introduced. Evidence-based guidelines that are developed in cooperation with recognized clinical experts attain wide acceptance among physicians. Sound evidence-based guidelines comprising cost-benefit relations of therapy can be the core of an internal health care reform.
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Sympathetic reflex dystrophy and phantom pain. Diagnosis, therapy and prognosis].
The incidence of phantom limb pain has been significantly underestimated for many years. However, studies published during the recent decade indicate that the real incidence of phantom limb pain may be between 60% and 90%. Reflex sympathetic dystrophy (RSD) occurs with an incidence of about 15.000 new cases every year in Germany. ⋯ None of the patients treated with a combination of local anaesthetics and low dose morphine developed phantom limb pain. Therapy of choice for RSD is the sympathetic blockade. The most suitable method is intravenous regional sympathetic blockade (IVRSB) with guanethidine (2).
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Indications and limits of nerve block techniques].
Repetitive nerve blocks as a monotherapeutic treatment are loosing importance in the therapy of chronic pain. Such invasive methods for pain reduction are just one strategy in the interdisciplinary and multimodal planning of pain therapy. ⋯ Furthermore, it is necessary for the physician to know the typical complications of the invasive treatment and to be able to manage them. It is recommended to document the pain course.
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Z Arztl Fortbild Qualitatssich · Jan 1998
Review[Non-opioid analgesics and co-analgesics in therapy of chronic pain].
Efficacy and side effects of non-opioid-analgesics were analysed in a standardized review of placebo-controlled or double-blind studies. In rheumatoid arthritis, ibuprofen showed the best ratio of effectiveness and side-effects. Naproxen, diclofenac and meloxicam may serve as alternatives. ⋯ The dose administered in the management of chronic pain should be low in order to reduce the incidence of side-effects. The frequency of side-effect-related discontinuation of chronic pain medication was calculated as follows: ibuprofen 3.8%, aspirin 4.7%, piroxicam 4.8%, naproxen 7.4%, meloxicam 13.0% and diclofenac 17.8%. Since differences in efficacy were not clinically relevant, the indication for a special non-opioid-analgesic medication should focus on the prevention of side-effects.