Dtsch Arztebl Int
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Review Comparative Study
Bilateral endoprosthetic total hip or knee arthroplasty.
More than 300 000 joint replacement operations are performed in Germany every year, and the number is rising. In this article, we consider the question of simultaneous bilateral joint replacement at the hips or knees. Such procedures are indicated in patients suffering from bilateral, symptomatic arthrosis. ⋯ Simultaneous bilateral hip arthroplasty is safer for the patient and facilitates rehabilitation, regardless of the patient's age and ASA status (ASA, American Society of Anesthesiologists). With regard to the knees, there are two additional issues, namely the more frequent need for transfusion and somewhat higher mortality of a simultaneous bilateral procedure. Therefore, we recommend simultaneous bilateral knee arthroplasty only for patients in ASA classes 1 and 2. Simultaneous bilateral arthroplasty of either the hip or knee incurs lower costs than two separate operations.
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Recent years have seen a rise in overall anesthesia-related mortality. ⋯ A recent increase in the percentage of older and multimorbid patients among persons undergoing surgery, along with the advent of newer types of operation that would have been unthinkable in the past, has led to an apparent rise in anesthesia-associated mortality, even though the quality of anesthesiological care is no worse now than in the past. On the contrary, in recent years, better anesthetic management has evidently played an important role in improving surgical outcomes.
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Epidemic keratoconjunctivitis (EKC) is a highly contagious infection of the ocular surface. 316 cases were diagnosed in Germany in the first 8 months of 2010, corresponding to a 300% increase above the typical figures for recent years. This outbreak motivates us to present the current recommendations concerning EKC. ⋯ The first priority in the treatment of patients with definite or suspected EKC is the rigorous application of hygienic measures in medical facilities, particularly because there is still no effective drug treatment for this disease. No virostatic agent has yet been demonstrated to influence its course, either subjectively or objectively.
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The mass panic at the Love Parade 2010 attracted a great deal of public attention in Germany and abroad. The goals of this paper are to summarize the available data on the injured persons and their treatment, and to assess the preparations that should be made for such an eventuality and the acute measures that should be taken if it occurs. ⋯ These data permit a detailed view of the medical care that was provided. In situations of this kind, the main problems can be dealt with through targeted and structured preparation and optimized emergency plans which consider both foreseeable and unforeseeable events. Priority must be given to rapid diagnostic assessment and clinical decision-making; the prerequisites for these are transparent institutional structures and clear assignments of responsibility.
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Comparative Study
Concordance analysis: part 16 of a series on evaluation of scientific publications.
In this article, we describe qualitative and quantitative methods for assessing the degree of agreement (concordance) between two measuring or rating techniques. An assessment of concordance is particularly important when a new measuring technique is introduced. ⋯ Concordance analysis is needed to establish the validity of a new diagnostic measuring or rating technique or to demonstrate the near-equivalence of multiple measuring or rating techniques. Erroneous approaches to concordance analysis can lead to false conclusions.