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":" Forthcoming","pages":"519-526"},"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}
Jerena Manoharan, Max B Albers, Anja Rinke, Jan Adelmeyer, Jannis Görlach, Detlef K Bartsch
{"title":"Multiple Endocrine Neoplasia Type 1.","authors":"Jerena Manoharan, Max B Albers, Anja Rinke, Jan Adelmeyer, Jannis Görlach, Detlef K Bartsch","doi":"10.3238/arztebl.m2024.0094","DOIUrl":"10.3238/arztebl.m2024.0094","url":null,"abstract":"<p><strong>Background: </strong>Multiple endocrine neoplasia type 1 (MEN1) is a rare genetic disease of autosomal dominant inheritance, with an estimated prevalence of 3-20/100 000. Its main feature is neuroendocrine neoplasia in the parathyroid glands, the endocrine pancreas, the duodenum, and the pituitary gland. In this article, we review the diagnostic and therapeutic options for MEN1-associated tumors.</p><p><strong>Methods: </strong>We present an analysis and evaluation of retrospective case studies retrieved from PubMed, guidelines from Germany and abroad, and our own experience.</p><p><strong>Results: </strong>The disease is caused by mutations in the MEN1 gene. Mutation carriers should participate in a regular, specialized screening program from their twenties onward. The early diagnosis and individualized treatment of MEN1-associated tumors can prevent the development of life-threatening hormonal syndromes and prolong the expected life span of MEN1 patients from 55 to 70 years, as well as improving their quality of life. Surgical treatment is based on the location, size, growth dynamics, and functional activity of the tumors. The evidence for treatment strategies is derived from retrospective studies only (level III evidence) and the optimal treatment is often a matter of debate. This is a further reason for treatment in specialized centers.</p><p><strong>Conclusion: </strong>MEN1 is a rare disease, and, consequently, the evidence base for its treatment is limited. Carriers of disease-causing mutations in the MEN1 gene should be cared for in specialized interdisciplinary centers, so that any appreciable tumor growth or hormonal activity can be detected early and organ-sparing treatment can be provided.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"527-533"},"PeriodicalIF":6.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305671","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}
Tobias Weiglein, Markus Zimmermann, Wolf-Dirk Niesen, Florian Hoffmann, Matthias Klein
{"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":" Forthcoming","pages":"508-518"},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526356/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maren Dreier, Melanie Brinkmann, Jona Theodor Stahmeyer, Melissa Hemmerling, Christian Krauth, Ulla Walter
{"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":" Forthcoming","pages":"497-504"},"PeriodicalIF":6.5,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526357/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
