Dtsch Arztebl Int
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Review Meta Analysis
Persistent vegetative state and minimally conscious state: a systematic review and meta-analysis of diagnostic procedures.
Acute brain damage can cause major disturbances of consciousness, ranging all the way to the persistent vegetative state (PVS), which is also known as "unresponsive wakefulness syndrome". PVS can be hard to distinguish from a state of minimal preserved consciousness ("minimally conscious state," MCS); the rate of misdiagnosis is high and has been estimated at 37-43%. In contrast, PVS is easily distinguished from brain death. We discuss the various diagnostic techniques that can be used to determine whether a patient is minimally conscious or in a persistent vegetative state. ⋯ The basic diagnostic evaluation for differentiating PVS from MCS consists of a standardized clinical examination. In the future, modern diagnostic techniques may help identify patients who are in a subclinical minimally conscious state.
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Review Meta Analysis
Drug treatments for pruritus in adult palliative care.
Pruritus is a rare but troublesome symptom in palliative-care patients with a variety of underlying diseases. The pharmacotherapy of pruritus is often off-label, and an evidence-based evaluation is needed. ⋯ In view of the diverse etiologies of pruritus in palliative-care patients, careful consideration should be given to the choice of drug used to treat it. The substances listed here have moderate to strong antipruritic effects and merit further study in RCTs of high methodological quality.
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Review Meta Analysis
The efficacy and duration of vaccine protection against human papillomavirus: a systematic review and meta-analysis.
The German Standing Committee on Vaccination (STIKO) recommends vaccination against human papillomaviruses (HPV) of the high-risk types 16 and 18. The duration of protection afforded by HPV vaccines has been reported in multiple studies to date but has not been systematically evaluated. ⋯ Long-term observation does not indicate any loss of antiviral protection after vaccination against HPV 16 and 18, although the evidence for long-term protection is of lesser quality than that for short-term protection.
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Review Meta Analysis
Iatrogenic nerve injuries: prevalence, diagnosis and treatment.
Iatrogenic nerve injuries can result from direct surgical trauma, mechanical stress on a nerve due to faulty positioning during anesthesia, the injection of neurotoxic substances into a nerve, and other mechanisms. Treating physicians should know the risk factors and the procedure to be followed when an iatrogenic nerve injury arises. ⋯ A thorough knowledge of the anatomy of the vulnerable nerves and of variants in their course can lessen the risk of iatrogenic nerve injury. When such injuries arise, early diagnosis and planning of further management are the main determinants of outcome. If adequate nerve regeneration does not occur, surgical revision should optimally be performed 3 to 4 months after the injury, and 6 months afterward at the latest. On the other hand, if postoperative high resolution ultrasound reveals either complete transection of the nerve or a neuroma in continuity, surgery should be performed without any further delay. If the surgeon becomes aware of a nerve transection during the initial procedure, then either immediate end-to-end suturing or early secondary management after three weeks is indicated.
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Review Meta Analysis
Intensified hemodialysis in adults, and in children and adolescents.
There are now almost 70 000 dialysis patients in Germany. Conventional hemodialysis does not adequately compensate for malnutrition, arterial hypertension, renal osteopathy, and diminished performance ability. Various strategies for intensified hemodialysis have been implemented in an attempt to lower the considerable morbidity and mortality of end-stage renal failure. ⋯ Intensified hemodialysis techniques improve arterial blood pressure, uremia-associated variables, and psychosocial variables. They also lower the necessary doses of antihypertensive drugs and phosphate binders. Dietary restrictions need not be as stringent. Further prospective trials are needed for a reliable assessment of the effect of intensified hemodialysis on mortality and quality of life.