Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Jul 2015
Multicenter Study[Staffing needs of an intensive care unit in consideration of applicable hygiene guidelines--an exploratory analysis].
The patient burden in intensive care units (ICU) has continually increased worldwide over the past decades. Age, co-morbidities and an increasing complexity of conditions and treatments increase the number of patients who are either colonized or infected with antibiotic-resistant pathogens. To prevent nosocomial infections, hygiene guidelines play an important role. ⋯ The results show that current staffing is not sufficient under the given hygiene guidelines and that a nurse to patient ratio of one will be necessary to meet the requirements. In a national survey of university hospitals, however, we found that the current nurse to patient ratio is 1: 2.47 in German intensive care units. The apparent staffing shortage is compensated by an extraordinary personal commitment of nurses caring for patients in the ICU.
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Dtsch. Med. Wochenschr. · Jul 2015
["Do-not-rescuscitate"--Results of introducing a standardized order sheet on documentation quality].
DNR orders have been used internationally since the 1970 s. Despite the growing importance of patient preference in German law, there is little data on DNR orders in Germany Methods: The prevalence of DNR orders was assessed on the hospital wards. Healthcare were asked about their experiences and opinions in two polls. The charts of all deceased patients were reviewed for DNR notes for 9 month before and after introduction of the new DNR order sheets. ⋯ INTRODUCTION of DNR order sheets in a German hospital lead to objective improvements in the quality of end-of life care documentation while the prevalence of DNR orders remained unchanged.
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The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency has issued European-wide restrictions on the use of codeine-containing medicines for cough and cold in children at the age of 0-12 because of the risk of serious side effects, including the risk of breathing problems. The PRAC further recommended that "codeine must not be used in people of any age who are known to convert codeine into morphine at a faster rate than normal ('ultra-rapid metabolisers')". The reasons for this variability in codeine biotransformation lay in a genetic polymorphism in the liver enzyme CYP2D6 leading to 3% of the northern European population being ultrarapid metabolisers due to a gene duplication of the enzyme. This is the first restriction of a common drug in CYP2D6 ultrarapid metabolizers, and more use of pharmacogenetic biomarkers for stratified benefit-risk assessment in drug regulation can be expected and will be a first step to Individualized Medicine Regulation.
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Non-alcoholic fatty liver disease is the most common chronic liver disease in Europe and in the USA with rising prevalence. Patients with a metabolic syndrome (diabetes mellitus, obesity, dyslipidemia) are patients at risk with the highest prevalence for NAFLD. ⋯ A specific treatment for NASH is not available at the moment. Therefore, the treatment of risk factors and metabolic syndrome has high priority.