Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Nov 2015
Multicenter Study[Recent antibiotic use in German acute care hospitals - from benchmarking to improved prescribing and quality care].
In view of increasing rates of bacterial resistance and Clostridium difficile infections efforts to enhance appropriate and intelligent antibiotic prescribing have become important. A prerequisite is the availability of reliable antibiotic use data. So far antibiotic consumption data in this country had only a very limited coverage of acute care hospitals. ⋯ Prescribing of antibiotics on almost every second day of hospitalization was extensive and highly variable, and the frequent use of cephalosporins is noteworthy. It is possible that the development of resistance and the rate of Clostridium difficile infection is associated with the diverse antibiotic use intensity and preferences for prescribing of cephalosporins and fluoroquinolones. Continuous antibiotic use surveillance and evaluation of prescribing patterns in acute care with feedback and benchmarking will help optimizing antibiotic use and better assessing strategies to minimize resistance and Clostridium difficile infection, and eventually improve patient safety.
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Fine needle aspiration of peripheral lymph nodes is a minimal invasive procedure to extract material for cytological analyses. The method is safe, rapidly to apply, less expensive and almost painless for the patient. The puncture of low-lying lymph nodes shoud be performed via ultrasound navigation.
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Dtsch. Med. Wochenschr. · Nov 2015
[Diagnosing osteoporosis: what is new in the 2014 DVO guideline?].
Suitable diagnostic strategies beyond general measures of fracture prevention which allow the identification of those individuals who are likely to benefit most from medical treatment are of utmost importance for an efficient treatment of osteoporosis. Since 2003 the "Dachverband Osteologie" (DVO) provides recommendations for the diagnostics and treatment of osteoporosis in German speaking regions. The most recent update was in November 2014. ⋯ In addition to the fracture risks listed in the previous version of the DVO guideline the list now also includes monoclonal gammopathy of unknown significance, ankylosing spondylitis, COPD, heart failure, celiac disease, type 2 diabetes mellitus, long-term treatment with proton pump inhibitors and a treatment with high-dose inhaled glucocorticoids. For all persons with an increased fracture risk the guideline recommends a diagnostic workup, comprising medical history, clinical examination including assessment of fall risk, DXA measurements at the lumbar spine, proximal total femur and femoral neck, blood analysis and, if indicated, appropriate imaging procedures. The trabecular bone score offers a new diagnostic option for fracture prediction.
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Dtsch. Med. Wochenschr. · Nov 2015
[Symptom experience of patients after allogenic renal transplantation].
Quality of life and medication adherence of patients after renal transplantation (RTx) is most affected by problems associated with immunosuppressive symptoms. However, these problems are often underestimated in frequency and level of distress by professionals involved in transplantation. The aim of this study was to determine symptom occurrence and distress associated with current immunosuppressive medication following RTx. ⋯ The study results increase awareness for a careful symptom assessment and provide the basis for strategies to control symptoms. That should lead to improved quality of life and medication adherence with long patient and graft survival.