Dtsch Arztebl Int
-
Review Meta Analysis
Outcome-Relevant Effects of Shared Decision Making.
Shared decision making (SDM) is considered a gold standard for the cooperation of doctor and patient. SDM improves patients' overall satisfaction and their confidence in decisions that have been taken. The extent to which it might also positively affect patient-relevant, disease-related endpoints is a matter of debate. ⋯ The trials performed to date to addressing the effect of SDM on patient-relevant, disease-related endpoints are insufficient in both quantity and quality. Although just under half of the trials reviewed here indicated a positive effect, no final conclusion can be drawn. A consensus-based standardization of both SDM-promoting measures and appropriate clinical studies are needed.
-
25% of all women report involuntary loss of urine, and 7% may require treatment. ⋯ Well-validated treatments for pelvic floor dysfunction are available. Psychosomatic factors must be taken into account and can have a major effect on treatment outcomes.
-
In Germany, data on place of death is recorded from death certificates, but not further analyzed. Consequently, hardly any information is available at the population level regarding the distribution of place of death (e.g. home, hospital, palliative care unit, nursing home, hospice). ⋯ Most people in Germany die in institutions; the most common place of death is still the hospital, where more than half of all deaths take place. Only one death in four occurs at home. There is a marked secular trend away from dying at home or in the hospital, in favor of dying in a care or nursing home; death in palliative care units and hospices is also becoming more common.
-
Rates of cesarean section have risen around the world in recent years. Accordingly, much effort is being made worldwide to understand this trend and to counteract it effectively. A number of factors have been found to make it more likely that a cesarean section will be chosen, but the risks cannot yet be clearly defined. ⋯ Scientific advances, social and cultural changes, and medicolegal considerations seem to be the main reasons for the increased acceptibility of cesarean sections. Cesarean section is, however, associated with increased risks to both mother and child. It should only be performed when it is clearly advantageous.
-
The spectrum of primary neuroendocrine tumors of the lungs ranges from typical carcinoid tumors, which are relatively benign, to highly aggressive small-cell carcinoma. In this review, we summarize the treatment of bronchopulmonary carcinoid, a disease with an incidence of 0.5 per 100,000 persons per year in Western countries. ⋯ Because of their rarity, the treatment of bronchopulmonary carcinoid tumors presents an interdisciplinary challenge. Surgical resection, the treatment of choice for local carcinoid tumors, generally leads to long-term survival. The existing registers should be made more comprehensive so that the treatment of this disease can be better in the future.