Dtsch Arztebl Int
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Review Meta Analysis Comparative Study
Fluid replacement with hydroxyethyl starch in critical care--a reassessment.
Hydroxyethyl starch (HES) is used for fluid replacement in millions of patients around the world every year, yet it has been found to have adverse effects that have a negative impact on patient survival. Recent clinical trials with a modern HES solution (HES 130) and meta-analyses now enable a reassessment of its risks and benefits. ⋯ Because of safety concerns, fluid replacement with HES in critically ill patients cannot be recommended. Evidence for its superior efficacy, safety and cost effectiveness in preoperative use is also lacking.
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Review Meta Analysis
Type 2 diabetes: prevalence and relevance of genetic and acquired factors for its prediction.
The epidemiology of type 2 diabetes in Germany is of major societal interest, as is the question of the predictive value of genetic and acquired risk factors. ⋯ The prevalence of type 2 diabetes in Germany has risen in recent years. The discovery of new genetic variants that confer a higher risk of developing the disease has improved our understanding of insulin secretion in diabetes pathogenesis rather than the prediction of individual diabetes risk ("personalized medicine").
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Review Meta Analysis
Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis.
More than 125,000 hip fractures occur in Germany every year, with a one-year mortality of about 25%. To improve treatment outcomes, models of cooperation between trauma surgery and geriatrics have been developed. Their benefit has not yet been unequivocally demonstrated. ⋯ Only a few randomized controlled trials of early orthogeriatric treatment have been performed, and these trials are of limited quality. Due to low case numbers, a benefit from interdisciplinary orthogeriatric treatment could not clearly be demonstrated. Further trials are needed.
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Review Meta Analysis
Urethral stricture: etiology, investigation and treatments.
Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious consequences for the entire urinary tract. Its prevalence among men in industrial countries is estimated at 0.9%. It produces obstructive and irritative urinary symptoms and can ultimately impair renal function. Urethral strictures can be caused by diagnostic or therapeutic urological procedures. These procedures are being performed ever more commonly, because the population is aging; thus, urethral strictures will probably become more common as well. ⋯ Urethral strictures must be recognized and treated so that their most serious long-term complication, impaired renal function, can be prevented. The clinical utility of urethrotomy is limited by a high recurrence rate.
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Review Meta Analysis
Assessing prognosis following cardiopulmonary resuscitation and therapeutic hypothermia-a critical discussion of recent studies.
The prognosis of patients who are comatose after cardiopulmonary resuscitation (CPR) is poor but can be improved by mild therapeutic hypothermia. We studied the question whether the known, reliable indicators of a poor prognosis after CPR are also valid for patients treated with CPR and hypothermia. ⋯ If the prognosis is poor, this should be thoroughly discussed with the patient's family, and the nature and extent of further intensive treatment should be reconsidered. The patient's wishes, if known, are paramount. Any decision to withhold care should be taken only if there are multiple concurrent indicators of a poor prognosis. If only one such indicator is present, or if the findings are inconsistent, such decisions should be postponed.