Leila Harhaus, Nora F Dengler, Karsten Schwerdtfeger, Annette Stolle
{"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":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542565/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Severely Affected Persons Are Still Left Behind.","authors":"Wolfgang Freund, Klaus Gehring","doi":"10.3238/arztebl.m2024.0022","DOIUrl":"10.3238/arztebl.m2024.0022","url":null,"abstract":"","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Target Corridor for Older People not Justified.","authors":"Armin Mainz","doi":"10.3238/arztebl.m2024.0019","DOIUrl":"10.3238/arztebl.m2024.0019","url":null,"abstract":"","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah Clas, Christian Ehrnthaller, Oliver Herrmann, Dirk Theodor Schraeder, Wolfgang Böcker, Kirsi Manz, Peter Thaller
{"title":"Quality of Life and Patient Satisfaction After the Provision of an Orthopedic Knee Scooter.","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 co - ordination needed to use crutches, a wheelchair may become necessary, or they might find themselves forced to continue weightbearing 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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542569/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Importance of the Pineal Gland.","authors":"Bernhard Hauns","doi":"10.3238/arztebl.m2024.0028","DOIUrl":"10.3238/arztebl.m2024.0028","url":null,"abstract":"","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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