Dtsch Arztebl Int
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Many clinical trials have a crossover design. Certain considerations that are relevant to the crossover design, but play no role in standard parallel-group trials, must receive adequate attention in trial planning and data analysis for the results to be of scientific value. ⋯ Crossover trials in which the results are not analyzed separately by sequence group are of limited, if any, scientific value. It is also essential to guard against carryover effects. Whenever ignoring such effects proves unjustified, the treatment effect must be analyzed solely via an analysis of the data obtained during the first trial period. Even the use of this restricted dataset yields results whose validity is not beyond question.
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Osteomyelitis was described many years ago but is still incompletely understood. Its exogenously acquired form is likely to become more common as the population ages. We discuss biofilm formation as a clinically relevant pathophysiological model and present current recommendations for the treatment of osteomyelitis. ⋯ Surgery combined with anti-infective chemotherapy leads to long-lasting containment of infection in 70% to 90% of cases. Suitable drugs are not yet available for the eradication of biofilm-producing bacteria.
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Acute mesenteric ischemia is still fatal in 50% to 70% of cases. This consensus paper was written with the participation of physicians from all of the involved specialties for the purpose of improving outcomes. Mesenteric ischemia must be recognized as a vascular emergency requiring rapid and efficient clinical evaluation and treatment. ⋯ Rapid diagnosis (within 4 to 6 hours of symptom onset) and interdisciplinary cooperation in the provision of treatment are required if the poor outcome of this condition is to be improved.
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Target values for cardiovascular risk factors in patients with coronary heart disease (CHD) are stated in guidelines for the prevention of cardiovascular disease. We studied secular trends in risk factors over a 12-year period among CHD patients in the region of Münster, Germany. ⋯ The observed trends in cardiovascular risk factors under-score the vital need for better preventive strategies in patients with CHD.
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Secular trends in health-related behavior, the frequency of illness, and life satisfaction in rural areas are inadequately documented. Such information is essential for the planning of health-care policy. ⋯ Over the long term, there have been both improvements, particularly in lifestyle, and turns for the worse, e.g., in life satisfaction. While the latter might be due to the increasing marginalization of rural eastern Germany, we interpret the observed improvements as benefits of modernization.