Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Nov 2019
[Multi-disciplinary anonymous survey on a university hospital's medical doctors' knowledge of established terms and parameters in evidence-based medicine].
Patient care according to the principles of evidence-based medicine (EbM) is defined by the Social Code (SGB, inter alia § 137f SGB V). As part of quality assurance in medicine, a mandatory further education for doctors is demanded. The aim of this investigation was to evaluate how familiar medical practitioners are with common terms and parameters of EbM. Another question was, at which point of the medical training a possible postgraduate training on EbM methods should take place. ⋯ Medical practitioners at university hospitals can be expected to have certain knowledge on common methods of clinical research. However, less than 50 % of the answer were correct and a need for further training in EbM-specific methods appears to be indicated. The survey did not provide information on the optimal timing of such offers during medical training.
-
Unknown liver lesions represent a common clinical challenge, for example in the context of routine ultrasound examinations of primary care physicians. There are different data on the prevalence of primary liver lesions in the literature. As such, a forensic autopsy series described focal liver lesions in about 50 % of all examined men between 35 and 69 years of age with an increasing incidence for older people. ⋯ Abscesses, inflammatory infiltrations or pseudotumors as well as sites of extramedullary haematopoiesis are observed much less frequently. Among the most frequent malignant focal liver lesions are metastases of other tumor entities such as colorectal cancer or pancreatic adenocarcinoma as well as hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCA). Other entities such as hepatic lymphomas or mesenchymal malignant neoplasia are extremely rare.
-
Dtsch. Med. Wochenschr. · Nov 2019
Case Reports[Non-occlusive Mesenteric Ischemia caused by Diabetic Ketoacidosis - Pneumatosis intestinalis and Portal Venous Gas as an Indication of Mesenteric Ischemia].
A 67-year-old woman was found lying naked on the bathroom floor for at least the last 12 hours. She had a medical history of insulin-dependent diabetes mellitus type 2 and a resection of the cecal pole. ⋯ The clinic of the AMI is manifold - with fatal consequences in case of delayed diagnosis. Serum parameters are often overestimated. In this case report a diabetic coma was responsible for the AMI. The diagnosis was based on sonographic imaging followed by computed tomography, so that the life-saving operation could be performed. Therefore, sonography should be considered as a mandatory examination of critically ill patients.
-
A delirium in patients in the intensive care unit (ICU) is a manifestation of a severe acute dysfunction of the brain. It has a high prevalence and is associated with a relevant increase in morbidity and mortality. A cholinergic deficit and dopaminergic overactivity are considered to be a cause of delirium. ⋯ Non-pharmacological measures are always the basis for the prevention of delirium: maintenance of the day-night rhythm, sleep promotion at night and stimulation during the day, involvement of relatives, the avoidance of dehydration and malnutrition, and others more. They are pharmacologically accompanied by an effective analgesia and a target and symptom-oriented sedation with well controllable, as little as possible delirogenic substances. Interdisciplinary and interprofessional cooperation is essential so that preventive concepts significantly reduce the risk of delirium, even in high-risk patients.
-
The therapeutic management of delirium is based on two major columns. The cornerstone of therapy is the non-pharmacological intervention using a multifactorial approach including early mobilization, reorientation, improvement of cerebral and cognitive activity and the consequent establishment of adequate wake-/sleep cycles. ⋯ However, in clinical routine several substances are commonly used for the management of delirium particularly in a symptom-oriented choice. Moreover, regarding delirium prophylaxis the choice of sedativum has an important clinical impact on the incidence of delirium.