Deutsches Arzteblatt international最新文献

{"title":"Midazolam for Post-Arrest Sedation in Pre-Hospital Emergency Care.","authors":"Gerrit Jansen, Eugen Latka, Michael Bernhard, Martin Deicke, Daniel Fischer, Annika Hoyer, Yacin Keller, André Kobiella, Sissy Linder, Bernd Strickmann, Lisa Marie Strototte, Karl Christian Thies, Kai Johanning, Vera von Dossow, Jochen Hinkelbein","doi":"10.3238/arztebl.m2023.0277","DOIUrl":"10.3238/arztebl.m2023.0277","url":null,"abstract":"<p><strong>Background: </strong>An out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) may need to be treated with airway management, emergency ventilation, invasive interventions, and post-arrest sedation. We investigated the influence of the use of midazolam for post-arrest sedation on achieving postresuscitation care targets and the associated risk of hemodynamic complications.</p><p><strong>Methods: </strong>All emergency rescue missions of the Dresden, Gütersloh, and Lippe medical rescue services in the years 2019-2021 were reviewed to identify adult patients who had OHCA, unconsciousness, and sustained ROSC with spontaneous circulation until arrival at the hospital; the findings were supplemented with data from the German Resuscitation Registry. Patients who received midazolam (alone or in combination with other anesthetic agents) for post-arrest sedation were compared with those who did not. The endpoints were the regaining of a systolic blood pressure ≥ 100 mmHg, end-tidal pCO2 35-45 mmHg, and oxygen saturation (SpO2) 94-98%. A propensity score analysis was used to adjust for age, sex, and variables potentially affecting hemodynamic status or the targets for oxygenation and ventilation.</p><p><strong>Results: </strong>There were 2335 cases of OHCA among 391 305 emer - gency rescue missions. 571 patients had ROSC before arrival in the hospital (24.5%; female, 33.6%; age, 68 ± 14 years). Of the 395 among them (69.2%) who were treated with postarrest sedation, 249 (63.0%) received midazolam. Patients who received midazolam reached the guideline- recommended targets for oxygenation, ventilation, and blood pressure more frequently than those who were not sedated: the respective odds ratios and 95% confidence intervals were 2.00 [1.20; 3.34], 1.57 [0.99; 2.48], and 1.41 [0.89; 2.21].</p><p><strong>Conclusion: </strong>The pre-hospital administration of midazolam leads to more frequent pre-hospital attainment of the oxygenation and ventilation targets in post-resuscitation care, without any evidence of an elevated risk of hemodynamic complications.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520418","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":"Perioperative Antibiotic Prophylaxis.","authors":"Christian Eckmann, Seven Johannes Sam Aghdassi, Alexander Brinkmann, Mathias Pletz, Jessica Rademacher","doi":"10.3238/arztebl.m2024.0037","DOIUrl":"10.3238/arztebl.m2024.0037","url":null,"abstract":"<p><strong>Background: </strong>Postoperative surgical site infections (SSI) account for almost 25% of all nosocomial infections in Germany and are a source of increased morbidity and mortality.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a selective search in PubMed and on national and international guidelines.</p><p><strong>Results: </strong>The individual risk factors for SSI must be assessed before any surgical procedure. A body-mass index above 30 kg/m2 is associated with an unadjusted risk ratio of 1.35 [1.28; 1.41] for SSI, which rises to 3.29 [2.99; 3.62] if the patient is also immunosuppressed. The risk of SSI is also significantly higher with certain types of procedure. Perioperative antibiotic prophylaxis (PAP) is clearly indicated for operations that carry a high risk of SSI (e.g., colorectal surgery) and for those that involve the implantation of alloplastic material (e.g., hip endoprostheses). PAP can usually be administered with basic antibiotics such as cefazoline. The basic principles of PAP are that it should be given by the anesthesia team in the interval from 60 minutes preoperatively up to shortly before the incision, and that its administration should only be for a short period of time, usually as a single shot. Continuing PAP onward into the postoperative period leads to increased toxicity, bacterial superinfections, and antibiotic resistance.</p><p><strong>Conclusion: </strong>The evidence shows that perioperative antibiotic prophylaxis is a component of a bundle of measures that can help prevent SSI. Strict indications and adherence to the basic principles of PAP are essential for therapeutic success.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027685","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":"Phenibutan-an Illegal Food Supplement With Psychotropic Effects and Health Risks.","authors":"Udo Bonnet, Norbert Scherbaum, Andreas Schaper, Michael Soyka","doi":"10.3238/arztebl.m2024.0003","DOIUrl":"10.3238/arztebl.m2024.0003","url":null,"abstract":"<p><strong>Background: </strong>Phenibut (β-phenyl-γ-aminobutyric acid) is an analog of the neurotransmitter gamma-aminobutyric acid (GABA). Like abapentin and pregabalin, it inhibits α2-δ-subunits of voltagedependent presynaptic calcium channels. The potential harm resulting from the use of these gabapentinoids is currently a matter of debate.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a selective literature search and on cases reported to the Giftinformationszentrum-Nord (GIZ-Nord), a poison information center at the University of Göttingen, Germany.</p><p><strong>Results: </strong>Phenibut is a prescription drug in Russia but its production, possession, use, trafficking, or administration is illegal in Germany. The phenibut toxicity syndrome resembles that of gabapentinoids and GABA mimetics: benzodiazepine-like with - drawal symptoms including epileptic seizures, delirium and paradoxical activation have been described, as have cases of abuse and dependence. A few cases of use in the setting of multidrug abuse, and of phenibut-related death, have been described to date in the USA. The GIZ-Nord received 17 inquiries about phenibut, 55 about gabapentin, and 126 about pregabalin over the period 2008-2022. Over the same period, the GIZ-Nord was informed of 1207 cases involving Z substances and 4324 involving benzodiazepines. In the majority of the registered intoxications, including those with phenibut, the symptoms were mild. Overdoses of phenibut (2-100 g) were reported in 15 of the 17 cases; 8 of the persons who had taken an overdose were somnolent. In such cases, observation in intensive care was recommended. Respiratory depression or coma was not encountered in any case, not even in the patient who had taken 100 g of phenibut.</p><p><strong>Conclusion: </strong>Phenibut causes symptoms resembling those of gabapentinoid and benzodiazepine use. There have been reports of phenibut use in combination with other psychotropic drugs; in particular, its use together with opiates could increase the risk of coma and respiratory depression. No deaths due to phenibut intoxication have been published in Germany or elsewhere in Western Europe, although such cases may have been overlooked, as this drug is still largely unknown to Western medicine.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912338","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":"Early Childhood Care in the Former East Germany and Mental Stress in Adulthood.","authors":"Lisa Braunheim, Ayline Heller, Claudia Helmert, Christoph Kasinger, Manfred E Beutel, Elmar Brähler","doi":"10.3238/arztebl.m2023.0276","DOIUrl":"10.3238/arztebl.m2023.0276","url":null,"abstract":"<p><strong>Background: </strong>It is still debated in Germany whether early childhood care outside the family might cause mental stress in adulthood. In the German Democratic Republic (GDR-the former East Germany before unification), children were often cared for outside the family from a very early age.</p><p><strong>Methods: </strong>To determine the relation between early childhood care outside the family and mental stress in adulthood, we carried out a survey among 1575 persons who were born and socialized in the GDR. They were classified into four care groups according to the age at which they were first cared for outside the family. Associations with depressiveness, somatization disorders, and anxiety disorders in adulthood were tested with logistic regression analysis. Care group-specific prevalences of experiences of abuse and neglect in childhood were estimated with analysis of variance.</p><p><strong>Results: </strong>Comparisons of persons cared for outside the family before the age of three, or from the age of three onward, with persons cared for within the family in their preschool years did not reveal any difference with respect to depressiveness (odds ratio [OR] = 0.95; 95% confidence interval [0.58; 1.55]; OR = 1.05 [0.63; 1.74]), somatization disorders (OR = 1.11 [0.74; 1.67]; OR = 1.09 [0.71; 1.66]), or anxiety disorders (OR = 0.87 [0.46; 1.64]; OR = 1.12 [0.59; 2.10]). Nor were there any intergroup differences with respect to experiences of abuse and neglect. Certain features of the very small group of children who had long-term care outside the family are discussed in the article.</p><p><strong>Conclusion: </strong>No relation was found between earlychildhood care in day-care centers in the GDR and mental stress in adulthood. The data were too sparse for any conclusions about specific aspects of care outside the home (e.g., quality or child-rearing norms).</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485190","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":"Artificial Intelligence and \"Decision Intelligence\".","authors":"Peter Hahn","doi":"10.3238/arztebl.m2023.0213","DOIUrl":"10.3238/arztebl.m2023.0213","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849068","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 Percentage of Antibiotic Resistance in Uncomplicated Community-Acquired Urinary Tract Infections.","authors":"Anja Klingeberg, Niklas Willrich, Marc Schneider, Guido Schmiemann, Ildikó Gágyor, Doreen Richter, Ines Noll, Tim Eckmanns","doi":"10.3238/arztebl.m2023.0267","DOIUrl":"10.3238/arztebl.m2023.0267","url":null,"abstract":"<p><strong>Background: </strong>Uncomplicated bacterial urinary tract infections(uUTIs) are commonly seen in outpatient practice. They are usuallytreated empirically with antibiotics. The pertinent German ClinicalPractice Guideline contains recommendations on antibiotic selection,with the additional advice that the local resistance situationshould be considered as well. However, up-to-date information onlocal resistance is often unavailable, because microbiological testingis mainly recommended for complicated UTIs. Resistance ratesare often higher in recurrent uUTIs than in single episodes. In thisstudy, we aimed to determine the resistance rates of Escherichiacoli (E. coli) in patients with community-acquired uUTIs and tomake these data available to the treating physicians.</p><p><strong>Methods: </strong>In a nationwide cross-sectional study in Germany (DRKS00019059), we determined the percentages of resistance to antibioticsrecommended for uUTIs (first choice: fosfomycin, nitro -xoline, mecillinam, nitrofurantoin, trimethoprim; second choice:cefpodoxime, ciprofloxacin, cotrimoxazole, levofloxacin, norfloxacin,ofloxacin) over the period 2019-2021. The data were stratified bysingle episodes vs. recurrent UTIs (rUTIs).</p><p><strong>Results: </strong>Data from 2390 subjects were analyzed. E. coli was foundin 75.4% of the samples with positive urine cultures (1082 out of1435). The resistance rate of E. coli in single episodes (n = 725)was less than 15% for all antibiotics tested. In rUTIs(n = 357), resistance rates were also less than 15%for the most part; the only exceptions were trimethoprim(21.4%) and cotrimoxazole (19.3%).</p><p><strong>Conclusion: </strong>For single episodes of uUTI, all of theantibiotics studied can be recommended, at least asfar as their resistance profiles are concerned. Forrecurrent UTI, all but trimethoprim and cotrimoxazolecan be recommended. The second-choice antibioticsexamined do not have a more favorable resistanceprofile than the first-choice antibiotics.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466228","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":"In Reply.","authors":"Kai Wehkamp, Stefan Schreiber, Michael Krawczak","doi":"10.3238/arztebl.m2023.0214","DOIUrl":"10.3238/arztebl.m2023.0214","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140849069","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":"Symbol-Based Artificial Intelligence.","authors":"Patrick Auer","doi":"10.3238/arztebl.m2023.0212","DOIUrl":"10.3238/arztebl.m2023.0212","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859712","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":"Compression Therapy in Acute Deep Venous Thrombosis of the Lower Limb and for the Prevention of Post-Thrombotic Syndrome.","authors":"Dorothea Thieme, Birgit Linnemann, Katja Mühlberg, Thomas Noppeney, Maria Kreutz, Marcus Thieme","doi":"10.3238/arztebl.m2024.0001","DOIUrl":"10.3238/arztebl.m2024.0001","url":null,"abstract":"<p><strong>Background: </strong>After an acute deep venous thrombosis (DVT) of the lower limb, 20% to 63% of patients develop post-thrombotic syndrome (PTS). In this review, we address the efficacy of compression therapy in the treatment of acute DVT of the lower limb, and for the prevention of PTS.</p><p><strong>Methods: </strong>12 randomized controlled trials (RCTs) and one meta-analysis, with a total of 3751 patients, were identified in a structured literature search.</p><p><strong>Results: </strong>Two RCTs showed that adding compression therapy to drug treatment in the first 9 days of the acute phase of lower limb DVT led to more rapid pain relief (p<0.050) and less swelling (remaining difference in circumference, 1 cm versus 3 cm, p<0.050). As for the prevention of PTS, four RCTs showed a short-term benefit or no benefit of compression therapy. In three further RCTs, medical compression stockings (MCS) brought about a 16% to 27% absolute reduction of the frequency and severity of PTS (47% vs. 20 %, p<0.001; 40% vs. 21% (95% confidence intervals [29.9; 50.1] and [12.7; 29.5], respectively; and 58% vs. 42%, relative risk [RR] 0.73 [0,55; 0.96]). The benefit of MCS was also confirmed in a recent meta-analysis (RR 0.66 [0.44; 0.99], I2 = 88%). Thigh-length MCS were not superior to knee-length MCS for the prevention of PTS (33% vs. 36%, hazard ratio [HR] 0.93 [0.62; 1.41]). Individual, symptomoriented tailoring of the duration of treatment was not inferior to a fixed treatment duration of 24 months (29% vs. 28%; odds ratio [OR] 1.06 [0.78;1.44]).</p><p><strong>Conclusion: </strong>Compression therapy relieves symptoms in acute DVT and lessens the frequency and severity of PTS. It is therefore recommended as standard treatment.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520410","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":"In Reply.","authors":"Jochen Schmitt, Olaf Schoffer, Monika Klinkhammer-Schalke","doi":"10.3238/arztebl.m2023.0265","DOIUrl":"10.3238/arztebl.m2023.0265","url":null,"abstract":"","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":null,"pages":null},"PeriodicalIF":7.7,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854593","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}