Deutsches Arzteblatt international最新文献

{"title":"Evaluation of a Digital Decision Aid for Knee Replacement Surgery—A Stepped-Wedge, Cluster-Randomized Trial.","authors":"Jörg Lützner, Stefanie Deckert, Franziska Beyer, Waldemar Hahn, Jürgen Malzahn, Martin Sedlmayr, Klaus-Peter Günther, Jochen Schmitt, Toni Lange","doi":"10.3238/arztebl.m2024.0152","DOIUrl":"10.3238/arztebl.m2024.0152","url":null,"abstract":"<p><strong>Background: </strong>We studied whether an individualized digital decision aid can improve decision-making quality for or against knee arthroplasty.</p><p><strong>Methods: </strong>An app-based decision aid (EKIT tool) was developed and studied in a stepped-wedge, cluster-randomized trial. Consecutive patients with knee osteoarthritis who were candidates for knee replacement were included in 10 centers in Germany. All subjects were asked via app on a tablet about their symptoms, prior treatments, and preferences and goals for treatment. For the subjects in the intervention group, the EKIT tool was used in the doctor-patient discussion to visualize the individual disease burden and degree of fulfillment of the indication criteria, and structured information on knee arthroplasty was provided. In the control group, the discussion was conducted without the EKIT tool in accordance with the local standard in each participating center. The primary endpoint was the quality of the patient's decision on the basis of the discussion of indications, as measured with the Hip and Knee Quality Decision Instrument (HK-DQI). (Registration number: ClinicalTrials.gov:NCT04837053).</p><p><strong>Results: </strong>1092 patients were included, and data from 1055 patients were analyzed (616 in the intervention group and 439 in the control group). Good decision quality, as rated by the HK-DQI, was achieved by 86.0% of patients in the intervention group and 67.4% of patients in the control group (relative risk, 1.24; 95 % confidence interval, [1.15; 1.33]).</p><p><strong>Conclusion: </strong>A digital decision aid significantly improved the quality of decision-making for or against knee replacement surgery. The widespread use of this instrument may have an even larger effect, as this trial was conducted mainly in hospitals with high case numbers.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life and Patient Satisfaction After the Provision of an Orthopedic Knee Scooter—a Multicenter Randomized Controlled Trial.","authors":"Hannah Clas, Christian Ehrnthaller, Oliver Herrmann, Dirk Theodor Schraeder, Wolfgang Böcker, Kirsi Manz, Peter Thaller","doi":"10.3238/arztebl.m2024.0121","DOIUrl":"10.3238/arztebl.m2024.0121","url":null,"abstract":"<p><strong>Background: </strong>Partial or total avoidance of weight-bearing by a lower limb is regularly needed after trauma and surgery. There are approximately 200 such cases per 100 000 persons per year. Forearm crutches have mainly been used in Germany until now to keep these patients mobile. For those who lack the strength or coordination needed to use crutches, a wheelchair may become necessary, or they might find themselves forced to continue weight-bearing on the affected limb, with possible impending adverse consequences and complications.</p><p><strong>Methods: </strong>The supplementary use of a new type of orthopedic scooter by patients who must avoid weight-bearing by a lower limb, wholly or in part, was studied in a multicenter randomized controlled trial involving 88 subjects. The endpoints were improvement in quality of life (EQ5D, SF36) and improved abilities in everyday life (retrospective registration: DRKS00032980).</p><p><strong>Results: </strong>Patients who used orthopedic knee scooters (KS) reported a better overall state of health more frequently than those who used forearm crutches (UC) (SF-36 score: 67 [KS group], 95% CI [61; 73]; 59 [UC group], [53; 64]). They also reported less anxiety and depressed mood, greater mobility, and more independence than the patients who used crutches. In addition, they more frequently reported being able to transport themselves 4 x 500 meters in less than 20 minutes (n = 30 [KS], 63.8% [48.5; 77.3]; n = 6 [UC], 14.6% [5.6, 29.2]).</p><p><strong>Conclusion: </strong>The supplementary use of an orthopedic knee scooter can improve these patients' mobility and independence and prolong the distance over which they can transport themselves. For many patients, this form of treatment may well shorten the time of their total or partial inability to work and thus lower the socioeconomic costs of lower limb injuries and surgery.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Guideline: The Treatment of Peripheral Nerve Injuries.","authors":"Leila Harhaus, Nora F Dengler, Karsten Schwerdtfeger, Annette Stolle","doi":"10.3238/arztebl.m2024.0071","DOIUrl":"10.3238/arztebl.m2024.0071","url":null,"abstract":"<p><strong>Background: </strong>Nerve lesions often heal incompletely, leading to lifelong functional impairment and high costs for the health care system. The updated German clinical practice guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function.</p><p><strong>Methods: </strong>The recommendations are based on an assessment of all the evidence revealed by a systematic search of the literature, as well as on the expertise of the multiprofessional guideline group.</p><p><strong>Results: </strong>Only a few publications contain high-quality evidence. This version of the guideline contains a more detailed discussion of war injuries, iatrogenic injuries, MR neurography, and specific treatments than the previous version. As for the different methods of nerve replacement, a comparison of autologous transplantation versus the use of conduits and tubes revealed no significant difference between these two methods on the mBMRC scale, and minimal superiority of autologous transplantation with respect to two-point discrimination. As for the use of nerve transfers when nerve reconstruction is not feasible or unlikely to succeed, nerve transfer yielded slightly better results than proximal reconstruction for elbow flexion, but the difference did not reach statistical significance (mBMRC ≥ 3: RR 1.16, 95% confidence interval [1.02; 1.32]). The treatment of neuromas with targeted muscle reinnervation was superior to the classic approach in decreasing both stump pain (MD 2.0 +/- 2.8) and phantom limb pain (MD 3.4 +/- 4.03).</p><p><strong>Conclusion: </strong>The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daylight Saving Time Transitions and Risk of Heart Attack—a Systematic Review and Meta-Analysis.","authors":"Anke Hurst, Peter Morfeld, Philip Lewis, Thomas C. Erren","doi":"10.3238/arztebl.m2024.007","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.007","url":null,"abstract":"BACKGROUND\u0000The health risks of daylight saving time transitions are intensely debated. Disturbed circadian rhythms and lack of sleep after transitions might increase the risk of acute myocardial infarction (AMI). The only meta-analysis on the risk of AMI has now been considerably expanded.\u0000\u0000\u0000METHODS\u0000In this systematic review and meta-analysis (including meta-regressions and sensitivity analyses), we examine the frequency of AMI in the first few weeks after daylight saving time transitions (OSF registration www.doi.org/10.17605/OSF.IO/7CFKS). Eight databases were searched for pertinent literature up to September 2023. Authors were contacted for additional information. Study quality was rated using the Newcastle-Ottawa Scale.\u0000\u0000\u0000RESULTS\u0000Twelve studies from ten countries were included in the meta-analysis. Nine were of adequate quality, and three were of good quality. The pooled relative risk (RR) of AMI after daylight saving time onset (spring) was 1.04 (95% confidence interval [1.02; 1.07], I2: 57.3%), and 1.02 ([0.99; 1.05], I2: 51.6%) after daylight saving time offset (autumn). Recalculation after the exclusion of one study with inconsistencies yielded pooled RR values of 1.04 [1.01; 1.06] and 1.00 [0.99; 1.02], with the spring results being heterogeneous (I2: 56.9%) and the autumn results homogeneous (I2: 17.1%).\u0000\u0000\u0000CONCLUSION\u0000Current evidence suggests that there may be an increased risk of AMI after the spring transition, although there is moderate to marked heterogeneity among the studies that support this conclusion. More easily interpretable studies, such as those already conducted in the field of economics, should clarify associations with the aid of discontinuity regression and placebo tests. To this end, comparative risk analyses using years or places wherein daylight saving time was not practiced would be suitable.","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141801642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Onset of Impaired Consciousness.","authors":"Tobias Weiglein, Markus Zimmermann, Wolf-Dirk Niesen, Florian Hoffmann, Matthias Klein","doi":"10.3238/arztebl.m2024.0079","DOIUrl":"10.3238/arztebl.m2024.0079","url":null,"abstract":"<p><strong>Background: </strong>Mortality in patients with acute onset of impaired consciousness is high: as many as 10% do not survive. The spectrum of differential diagnoses is wide, and more than one underlying condition is found in one-third of all cases. In this article, we describe a structured approach to patients with acute onset of impaired consciousness in the emergency department.</p><p><strong>Methods: </strong>This review is based on pertinent articles retrieved by a selective search of PubMed and on the AWMF guidelines on the most common causes of impairment of consciousness.</p><p><strong>Results: </strong>Impairments of consciousness are classified as quantitative (reduced wakefulness) or qualitative (abnormal content of consciousness). Of all such cases, 45-50% have a primary neurological cause, and approximately 20% are of metabolic or infectious origin. Some cases are due to intoxications, cardiovas - cular disorders, or psychiatric disorders. Important warning signs (\"red flags\") in acute onset of impaired consciousness are a hyperacute onset, pupillomotor disturbances, focal neurologic deficits, meningismus, headache, tachycardia and tachypnea (with or without fever), muscle contractions, and skin abnormalities. Patients with severely impaired consciousness should be initially treated in the shock room according to the ABCDE scheme.</p><p><strong>Conclusion: </strong>Acute onset of impaired consciousness is a medical emergency. Red flags must be rapidly recognized and treatment initiated immediately. Patients with severely impaired consciousness of new onset and uncertain cause, status epilepticus, lack of protective reflexes, or a new, acute neuro - logic deficit should be admitted via the resuscitation room.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intended and Actual Participation in the Colorectal Cancer Screening Program.","authors":"Maren Dreier, Melanie Brinkmann, Jona Theodor Stahmeyer, Melissa Hemmerling, Christian Krauth, Ulla Walter","doi":"10.3238/arztebl.m2024.0087","DOIUrl":"10.3238/arztebl.m2024.0087","url":null,"abstract":"<p><strong>Background: </strong>The public generally has a positive view of colorectal cancer screening, but there is still room for improvement in participation rates. The aim of this study was to identify factors that are associated with intended and actual participation.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of a random sample of insurees of the AOK (a statutory health insurance carrier) in the German federal state of Lower Saxony. 50-year-old men and 55-year-old women who were eligible for their first screening colonoscopy received a written questionnaire in June 2020, three weeks after being invited to undergo colorectal cancer screening. For those who intended to do so, we used multivariable logistic regression analysis to determine any statistical associations between sociodemographic and medical characteristics and participation rates within 30 months.</p><p><strong>Results: </strong>82.7% of the respondents (239/298) intended to participate, and 43.3% (129/298) actually did so within 30 months. The participation rates among persons who had already decided to have a stool test or a colonoscopy were 50.7% (36/71) and 55.2% (58/105), respectively; the participation rate among undecided persons was 33.3% (19/57). The strongest association in the regression model was with an already made appointment (OR = 11.1, 95% confidence interval: [3.9; 31.8]). After exclusion of the existingappointment variable from the regression model, living in a smaller town (OR = 2.41 [1.08; 5.35]) and a stated preference for colonoscopy (OR = 2.52; [1.20; 5.27]) were positively associated with participation. Insurees with a parent affected by colorectal cancer participated less frequently, even after adjustment for prior colonoscopies (OR = 0.31 [0.12; 0.80]).</p><p><strong>Conclusion: </strong>The wide gap between intended and actual participation implies that there is potential for improvement in the prevention of colorectal cancer, and that certain groups of people could benefit from targeted support in making their intention to undergo screening a reality. Because of the methodological limitations of this initial investigation, its findings need to be confirmed by further studies.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daylight Saving Time Transitions and Risk of Heart Attack.","authors":"Anke Hurst, Peter Morfeld, Philip Lewis, Thomas C Erren","doi":"10.3238/arztebl.m2024.0078","DOIUrl":"10.3238/arztebl.m2024.0078","url":null,"abstract":"<p><strong>Background: </strong>The health risks of daylight saving time transitions are intensely debated. Disturbed circadian rhythms and lack of sleep after transitions might increase the risk of acute myocardial infarction (AMI). The only meta-analysis on the risk of AMI has now been considerably expanded.</p><p><strong>Methods: </strong>In this systematic review and meta-analysis (including meta-regressions and sensitivity analyses), we examine the frequency of AMI in the first few weeks after daylight saving time transitions (OSF registration www.doi.org/10.17605/OSF.IO/7CFKS). Eight databases were searched for pertinent literature up to September 2023. Authors were contacted for additional information. Study quality was rated using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Twelve studies from ten countries were included in the meta-analysis. Nine were of adequate quality, and three were of good quality. The pooled relative risk (RR) of AMI after daylight saving time onset (spring) was 1.04 (95% confidence interval [1.02; 1.07], I2: 57.3%), and 1.02 ([0.99; 1.05], I2: 51.6%) after daylight saving time offset (autumn). Recalculation after the exclusion of one study with inconsistencies yielded pooled RR values of 1.04 [1.01; 1.06] and 1.00 [0.99; 1.02], with the spring results being heterogeneous (I2: 56.9%) and the autumn results homogeneous (I2: 17.1%).</p><p><strong>Conclusion: </strong>Current evidence suggests that there may be an increased risk of AMI after the spring transition, although there is moderate to marked heterogeneity among the studies that support this conclusion. More easily interpretable studies, such as those already conducted in the field of economics, should clarify associations with the aid of discontinuity regression and placebo tests. To this end, comparative risk analyses using years or places wherein daylight saving time was not practiced would be suitable.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply.","authors":"Nora Eisemann","doi":"10.3238/arztebl.m2024.0066","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0066","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study Did not Deliver on its Promise.","authors":"Stephan Kühne","doi":"10.3238/arztebl.m2024.0065","DOIUrl":"https://doi.org/10.3238/arztebl.m2024.0065","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuralgic Amyotrophy.","authors":"Johannes Fabian Holle, Volker Limmroth, Wolfram Windisch, Maximilian Zimmerman","doi":"10.3238/arztebl.m2024.0077","DOIUrl":"10.3238/arztebl.m2024.0077","url":null,"abstract":"<p><strong>Background: </strong>Neuralgic amyotrophy (NA) is a multifactorial, monophasic neuritis that mainly affects the nerves of the shoulder girdle. It is characterized by very severe pain and by weakness that arises some time after the pain. Its reported incidence is high (100 cases per 100 000 persons per year), but our data suggest that many or most cases are diagnosed late or not at all.</p><p><strong>Methods: </strong>This review of the epidemiology, pathophysiology, diagnosis, and treatment of NA is based on pertinent publications retrieved by a selective literature search, and on data provided by the scientific institute of AOK, a German statutory health-insurance carrier.</p><p><strong>Results: </strong>It is currently thought that the combination of a genetic predisposition, an immunological trigger factor, and mechanical stress on the affected nerve segment(s) is pathophysiologically determinative. The prognosis of untreated NA is poor, with 25% of patients remaining unable to work at three years. The main form of treatment is with corticosteroids that are administered as early as possible. If there is evidence of nerve constriction or torsion, surgery may also help. There have only been six controlled cohort studies on the treatment of NA, and no randomized trials. It is not uncommon for the acute phase to develop into a chronic pain syndrome requiring multidimensional treatment.</p><p><strong>Conclusion: </strong>Particularly in view of the high incidence and improved therapeutic options, NA should be included in the differential diagnosis of all patients with suggestive symptoms.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141247583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}