Wiener medizinische Wochenschrift
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Economic evaluation of healthcare programmes helps us to assure the efficient use of healthcare resources. Cost-minimisation analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis are the most commonly applied evaluation types. ⋯ Furthermore, checklists have been developed for systematic critical appraisal of economic evaluations. Even though economic evaluations increase the transparency of resource allocation decisions and make decision criteria more explicit, they do not replace public discussions on the availability of overall resources for the public health care system.
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Wien Med Wochenschr · Jan 2009
Review[Pruritus and dryness of the skin in chronic kidney insufficiency and dialysis patients - a review].
The uremic pruritus is a very painful symptom suffered by chronic haemodialysis patients and is observed in 22 to 74% of the subjects. The causes of uremic pruritus have not yet been clarified. During the last 20 to 30 years it has been focused on altogether 5 different pathophysiological hypotheses: stimulating influences (e.g. calcium phosphate deposits in the epidermis), stimuli (e.g. secondary hyperparathyroidism), neuropathic injuries (e.g. disturbance of the cutaneous innervation in patients with uremic peripheral neuropathy), and central nervous changes (e.g. accumulation of endorphins in uremic patients which is associated with increasing pruritus), and immunologic conditions. ⋯ It has been demonstrated that older patients have decreased urea levels within the stratum corneum of the epidermis, whereas in patients with terminal kidney insufficiency - despite dryness of the skin - as a paradox finding elevated levels of urea have been assessed in the stratum corneum. Because of this reason, the meaning of urea as part of the "natural moisturizing factors" system is not understood, until now. However, there are very promising results of clinical phase II studies showing a significant effect of topical application of 2.5% L-arginine hydrochlorid ointment - a semi-essential amino acid - on improvement of dryness and, in particular, on improvement of pruritus in haemodialysis patients.
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Wien Med Wochenschr · Jan 2008
Review Comparative StudyThe neonatal coagulation system and the vitamin K deficiency bleeding - a mini review.
Coagulation factors do not cross the placental barrier but are synthesized independently by the conceptus. At birth, activities of the vitamin K dependent factors II, VII, IX, and X and the concentrations of the contact factors XI and XII are reduced to about 50% of normal adult values. The levels of the factors V, VIII, XIII, and fibrinogen are similar to adult values. ⋯ Subsequently, the actual schedule of vitamin K prophylaxis as recommended by the "Osterreichische Gesellschaft für Kinder- und Jugendheilkunde" is given as follows: i) the oral treatment of healthy full-term babies and orally fed preterm babies, ii) the parenteral treatment of small preterm and sick full-term babies, and iii) the treatment of mothers under medication with enzyme-inducing drugs with vitamin K during the last 15-30 days of pregnancy. The regimes of prophylactic vitamin K treatment of different countries are also given. Finally, the therapeutic use of vitamin K is addressed; the potential use of fresh-frozen plasma, prothrombin complex preparations, and recombinant factor VIIa is discussed.
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Wien Med Wochenschr · Jan 2008
Review Comparative Study[Minimizing perioperative risk - an interdisciplinary effort].
Physicians involved in perioperative care have to face new challenges because of the continuing aging of the population and medical progress, which facilitates even more invasive surgery. The risk of surgical procedures is elevated in patients with cardiac co-morbidity necessitating an optimization of both clinical condition and preoperative therapy of these patients. ⋯ Physicians should start beforehand the interdisciplinary preparation of surgical patients as out-patients and should continue this approach during the stay in hospital. In this review, we describe the major perioperative cardiac, pulmonary and vascular risks for physicians involved in the treatment of surgical patients.
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Wien Med Wochenschr · Jan 2008
Review Comparative Study[Bleeding risk and perioperative management of patients anticoagulated with vitamin K antagnosists].
There is little consensus on the optimal perioperative management for most patients on oral anticoagulation with vitamin K antagonists. Bridging therapy is not recommended for the majority of patients on oral anticoagulation as most are at low risk for perioperative stroke. Though most clinicians choose an aggressive perioperative strategy for patients with high thromboembolic risk (e.g., mechanical mitral valve replacement) by withholding warfarin perioperatively and the use of full-dose heparin, prophylactic dose heparin is given for lower risk cagegories (e.g., bileaflet aortic valve replacement and atrial fibrillation). ⋯ Rapid reversal of excessive anticoagulation should be undertaken in patients with serious bleeding at any degree of anticoagulation. Vitamin K therapy is an effective treatment for INR prolongation in patients with vitamin K-associated coagulopathy; coagulation factor replacement is required, in addition, in patients with major bleeding or with an indication for immediate correction of their INR. Patients receiving prothrombin complex concentrate have a more rapid and more complete reversal of their anticoagulation as compared with fresh frozen plasma.