Med Klin
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Case Reports Comparative Study
[Extreme sinus bradycardia (30/min) with acute right heart failure under tizanidine (Sirdalud). Possible pharmacological interaction with rofecoxib (Vioxx)].
The case of a 59-year-old healthy woman is described, who developed an extreme sinus bradycardia (30/min) with chest pain and acute right heart failure associated with gastrointestinal symptoms and elevation of the liver enzymes while simultaneously taking tizanidine (Sirdalud), diclofenac (Voltaren), and rofecoxib (Vioxx). The symptomatology resolved promptly after stopping the medication. ⋯ When prescribing Sirdalud, the possible pharmacological side effects and interactions should be taken into careful account.
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Complicated parapneumonic effusions (PPE) and pleural empyemas (PE) are associated with increased morbidity and mortality. Intrapleural fibrinolytic therapy (IFT) has been established, besides video-assisted thoracoscopy (VATS), in the management of PPE and PE. Combination of IFT and small-bore catheter drainage has previously not been investigated. ⋯ Proven applicability of IFT via small-bore catheter drainage seems to be effective in the face of long-term outcome. Further prospective and multicentric studies should be initiated to investigate the practicability of IFT via small-bore catheter drainage.
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Comparative Study
[Shared decision-making as a new quality indicator in nephrology: a nationwide survey in Germany].
Shared decision-making (SDM) as a model in physician-patient interaction is gaining relevance in the German health system. By applying this model, mid- and long-term improvements are expected especially in the outcomes of chronic diseases. Up to now, there has hardly been any empirical data available in German health services research regarding the state and development of SDM. This study establishes a baseline and provides actual data on this subject based on a German-wide survey of end-stage renal disease (ESRD) patients. ⋯ This paper provides a valid baseline for the prospective research of SDM in ESRD. The results indicate that dialysis patients are willing to participate in the process of medical decision-making. Characteristics and preferences of the patients should be taken into account not only in everyday clinical interactions. They could be monitored systematically within the framework of quality management and used as potential for quality improvement.
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It may be seen as regrettable that a measure which is suitable for improvement of quality in medicine is broadly discussed only in the context of risk avoidance. The system of reporting adverse events (incidents), known under its internationally used term CIRS, is based on the observation that there is a close correlation between the occurrence of severe incidents with consequences and milder incidents or near misses without consequences. By avoiding mild incidents the severe incidents will automatical also be reduced. ⋯ In Germany mistakes are usually seen under the aspects of a personal responsibility and they are prone to sanctions. But only when mistakes are accepted as occurring everywhere and with everybody and when they are regarded under the aspect of how to be avoided in future the necessary transparency can grow and an open dealing with mistakes can arise. This enables analyses with the only goal of quality improvement by avoidance of mistakes.