Dtsch Arztebl Int
-
"Burnout syndrome" is now a common reason for medical excuses from work, and thus an important topic in health-related economics. Much research is still needed, however, to establish the scientific basis for this entity, the criteria by which it might be diagnosed and classified, and how it should be treated. ⋯ High-quality controlled studies on burnout syndrome are lacking. A standardized and internationally accepted diagnostic instrument with a validated rating scale should be developed. There is also a need for epidemiological and health-economic studies on the prevalence, incidence, and cost of burnout. The etiology and pathogenesis of burnout should be studied with special regard to the possible role of neurobiological factors. Treatments for it should be studied systematically so that their effects can be judged at a high level of evidence. In view of the current lack of knowledge about what is called "burnout," the term should not be used as a medical diagnosis or as a basis for decisions regarding disability or other socioeconomic matters.
-
Review Meta Analysis
Midclavicular fracture: not just a trivial injury: current treatment options.
Conservative treatment was long recommended for midclavicular fractures because of the excellent results that were reported in the 1960's and 70's. Recently, however, the rucksack bandage has received competition from surgical treatment. The spectrum of operations ranges from classic plate osteosynthesis to intramedullary techniques and angle-stable implants. ⋯ In any case of midclavicular fracture, the type of fracture should be precisely analyzed and an individual treatment strategy should be developed in view of the patient's particular situation. Current studies show with a high level of evidence (level 1) that patients with dislocated fractures benefit from surgery.
-
Review Meta Analysis
Obesity in disabled children and adolescents: an overlooked group of patients.
There is an ongoing debate concerning the relationship between disability and obesity in childhood and adolescence. ⋯ Since a high proportion of disabled children and adolescents are overweight or obese, effective strategies for preventing and managing excess weight need to be developed so as not to further endanger their social participation. Moreover, risk factors for overweight in disabled children and adolescents should be identified and their weight status carefully monitored.
-
Review Meta Analysis
The diagnosis and treatment of hypertensive disorders of pregnancy: new findings for antenatal and inpatient care.
Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality. New guidelines and findings from clinical trials must be taken into account so that the diagnosis and treatment of HDP can be optimized. ⋯ Aside from hypertension and proteinuria, the definition of preeclampsia (PE) should also take organ dysfunction into account. Important aspects of antenatal care include the following: the early recognition of risk factors, measurement of the uterine arteries in the 1st and 2nd trimesters with Doppler ultrasonography (A diagnostic tool which is now well established), prophylactic oral administration of 100 mg of acetylsalicylic acid daily from the beginning of pregnancy, particularly in high-risk patients (EL I++), and appropriate measurement of blood pressure and urinary protein. Patients should be hospitalized whenever indicated. Therapeutic goals are adequate treatment of hypertension, as well as seizure prophylaxis with magnesium sulphate in severe preeclampsia to prevent maternal cerebrovascular complications (EL I++). If delivery is indicated, it should be performed, regardless of the gestational age (EL IV). Careful monitoring during the puerperium and a general medical review six weeks after delivery are essential. Women with preeclampsia have a significantly elevated long-term risk of developing cardiovascular diseases in later life (EL I++).
-
Review Meta Analysis
The morbidity and mortality associated with overweight and obesity in adulthood: a systematic review.
Overweight and obesity are generally thought to elevate morbidity and mortality. New data call this supposed association into question. ⋯ The prevailing notion that overweight increases morbidity and mortality, as compared to so-called normal weight, is in need of further specification. Obesity, however, is indeed associated with an elevated risk for most of the diseases studied.