Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 2008
[Advance health care directives: perception and reality. Results of a random survey].
Knowledge and values prevalent with regard to advanced directive in the general German population have so far not been adequately taken into account as a topic of regulatory initiatives. This leads to unnecessary uncertainty about actual decision-making concerning therapeutic measures. ⋯ Indispensable preconditions for formulating advance directives is that they can be fully applied in a clinical context an should thoroughly reflect personal values as well as realistic and detailed knowledge of medical decisions at the end of a person's life. Counseling of patients who wish to formulate an advance directive should therefore be primarily a task for physicians and not of lawyers.
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Dtsch. Med. Wochenschr. · Feb 2008
Review[Needleless connection valves--commentary from a clinical perspective].
Needle-less connection valves (NFCs) for infusion systems, blood drawing- or i. v. injection ports may offer significant benefits to the patient and the attending health care workers. On the other hand, a number of recent reports described a relationship between an increased incidence density of catheter-associated infections and the introduction of certain NFCs in clinical practice. ⋯ In addition, the introduction into clinical practice should be supervised by continuously performed surveillance for catheter-associated infections. Taking these prerequisites into account, NFCs may increase the safety and feasibility of intravenous therapy using central venous catheters in high-risk patients.
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Dtsch. Med. Wochenschr. · Feb 2008
Review[Natriuretic peptides--when should they be used in heart failure?].
B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are widely being used as biomarkers in acute and chronic heart failure. These cardiac neurohormones are mainly being secreted from the left and right ventricles as a response to ventricular volume expansion, pressure overload and resultant increased wall tension. ⋯ The measurement of natriuretic peptides is at present largely an addition in the diagnosis of acute heart failure, as long as possible errors in interpretation are taken into account.
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Dtsch. Med. Wochenschr. · Feb 2008
[Handsearching for randomized controlled clinical trials in German medical journals].
The identification of all available and relevant study reports is mandatory for a comprehensive inclusion of all eligible randomised controlled trials (RCTs) and controlled clinical trials (CCTs) in systematic reviews. Incorrect indexing and incomplete compilation of health care journals in electronic databases impair the result of a systematic literature search. An additional search in medical journals which are not listed in electronic databases is necessary to obtain greater search completeness. ⋯ There is a gap between the number of handsearch results and the number of Medline-indexed RCTs and CCTs for almost every searched health care journal. Although many journals have already been searched and many clinical trials could be identified, the hand-searching project will be continued prospectively and retrospectively to ensure the completeness of the literature compilation. Journals and volumes that are not indexed in Medline should always be searched for and the identified reports should be published in the Cochrane Library.