Abstract:
BACKGROUND:Although the number of elderly patients with fractures is increasing, there have been only a few studies to date of the efficacy of collaborative treatment by trauma surgeons and geriatricians. METHODS:Data on patients over age 75 with femoral neck, trochanteric, proximal humeral, and pelvic ring fractures were evaluated from the eras before and after the establishment of a certified center for geriatric traumatology (CGT) (retrospective analysis, n = 169; prospective analysis, n = 216). Moreover, data were also analyzed from younger patients (aged 65-74) with the same types of fracture who were not treated in the CGT. The main outcome parameter was in-hospital mortality. Other ones were the frequency and length of stays in the intensive care unit, the overall length of hospital stay, and the use of inpatient rehabilitation after acute hospitalization. RESULTS:Before the CGT was established, 20.7% of all patients over age 75 (95% confidence interval [CI], 14.8-27%) were treated in an intensive care unit; the corresponding figure after the establishment of the CGT was 13.4% (95% CI, 9.3-18.5%, p = 0.057). The mean length of stay in the intensive care unit before and after establishment of the CGT was 48 hours (95% CI, 32-64 hours) and 53 hours (95% CI, 29-77 hours), respectively (p = 0.973). The in-hospital mortality declined from 9.5% (95% CI, 5.3-13.8%) to 6.5% (95% CI, 3.7-9.5%, p = 0.278), while the overall length of hospital stay increased from 13.7 days (95% CI, 12.6-14.8 days) to 16.9 days (95% CI, 16.1-17.7 days, p<0.001). The percentage of patients transferred to an inpatient rehabilitation facility upon discharge decreased slightly, from 53.8% to 49.1%. Among the younger patients who were not treated in the CGT, no comparable trends were seen toward lower in-hospital mortality or toward less treatment in an intensive care unit. In fact, the developments over time in the younger age group tended to be in the opposite direction.0.001). The percentage of patients transferred to an inpatient rehabilitation facility upon discharge decreased slightly, from 53.8% to 49.1%. Among the younger patients who were not treated in the CGT, no comparable trends were seen toward lower in-hospital mortality or toward less treatment in an intensive care unit. In fact, the developments over time in the younger age group tended to be in the opposite direction. CONCLUSION:The collaborative treatment of elderly patients with fractures by trauma surgeons and geriatric physicians can markedly improve their acute care.
journal_name
Dtsch Arztebl Intjournal_title
Deutsches Arzteblatt internationalauthors
Grund S,Roos M,Duchene W,Schuler Mdoi
10.3238/arztebl.2015.0113subject
Has Abstractpub_date
2015-02-13 00:00:00pages
113-9issue
7issn
1866-0452pii
arztebl.2015.0113journal_volume
112pub_type
杂志文章abstract:BACKGROUND:The N-methyl-D-aspartate (NMDA) antagonist dextromethorphan has been available in pharmacies without a prescription since 1954 as an antitussive agent. There is an alarming increase in reports of its abuse. Dextromethorphan is avidly taken, mainly by young people, as a psychoactive drug. The currently availa...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2010.0537
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Patients with ovarian cancer usually present to a family physician with nonspecific symptoms, most often abdominal pain. The outcome depends above all on the stage of the disease when it is diagnosed and on the quality of treatment. METHODS:This article is based on a review of selected publications from 200...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0635
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Psychiatric emergencies such as acute psychomotor agitation or suicidality often arise in non-psychiatric settings such as general hospitals, emergency services, or doctors' offices and give rise to stress for all persons involved. They may be life-threatening and must therefore be treated at once. In this a...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0222
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Numerous studies from around the world have shown a positive association between case numbers and the quality of medical care. The evidence to date suggests that conformity to guidelines for the treatment of patients with breast cancer is better in German hospitals that have higher case numbers. METHODS:We ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,多中心研究
doi:10.3238/arztebl.2015.0585
更新日期:2015-08-31 00:00:00
abstract:BACKGROUND:The many varieties of cystic pancreatic tumor, and especially intraductal papillary mucinous neoplasia (IPMN), have attracted increased attention recently. Their incidence may be rising, and their histopathological evaluation and classification have become more precise than before. METHODS:We discuss the cu...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0788
更新日期:2011-11-01 00:00:00
abstract:BACKGROUND:The German Standing Committee on Vaccination Recommendations (Ständige Impfkommission, STIKO) recommends standard vaccination against pneumococcal infections for all persons aged 60 or older, and for all persons of any age with an increased health risk. It is not known how many persons in the target group in...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2013.0743
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:International studies show that aggressive behavior against primary care physicians is not an uncommon occurrence. There has been no systematic study to date of the nature and frequency of such occurrences in Germany. METHODS:A four-page questionnaire was sent to a nationwide random sample of 1500 primary c...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2015.0159
更新日期:2015-03-06 00:00:00
abstract:BACKGROUND:Inflammatory bowel diseases are common in Europe, with prevalences as high as 1 in 198 persons (ulcerative colitis) and 1 in 310 persons (Crohn's disease). METHODS:This review is based on pertinent articles retrieved by a search in PubMed and in German and European guidelines and Cochrane reviews of control...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2016.0072
更新日期:2016-02-05 00:00:00
abstract:INTRODUCTION:The choice of type of heart valve prosthesis is determined by the patient's age since bioprostheses have a limited lifespan. This article reviews current recommendations and the literature on cardiac valve replacement. METHODS:Selective literature search in Medline/PubMed back to 1996 and review of curren...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0143
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:Basically two types of sweating exist: thermoregulatory and emotional sweating. They are controlled by different centers: thermo regulatory sweating is regulated predominantly by the hypothalamus, emotional sweating predominantly by the limbic system. Enhanced sweating, called hyperhidrosis, can be generaliz...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2009.0032
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Breast cancer is the most common cancer in women. The German S3 guideline of 2012 has now been updated to take account of advances in the early detection, diagnostic evaluation, treatment, and follow-up care of this disease. METHODS:The updating process was based on the adaptation of identified source guide...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2018.0316
更新日期:2018-05-04 00:00:00
abstract:BACKGROUND:Pre-hospital hypotension in trauma patients is associated with high mortality. Especially for patients with severe traumatic brain injury (TBI), arterial normotension or even hypertension (AHT) is considered an important mechanism for sustaining adequate cerebral perfusion pressure. The effect of pre-hospita...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2012.0849
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment. METHODS:Standardized autopsies were ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0500
更新日期:2020-07-20 00:00:00
abstract:BACKGROUND:It is estimated that 1 million persons in Germany suffer from hepatic cirrhosis, which is the final stage of chronic inflammation of the liver. Cirrhosis has multiple causes, all of which lead to structural changes of the liver and to portal hypertension. The main complications of cirrhosis arise in turn: Th...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2013.0126
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:One-third of all patients with epilepsy have persistent seizures despite medical treatment. If the origin of the seizures can be localized to a particular site in the brain, epilepsy surgery is a treatment option that addresses the cause of the problem. METHOD:The presurgical assessment and surgical treatme...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2014.0313
更新日期:2014-05-02 00:00:00
abstract:BACKGROUND:High-altitude travel, for mountain climbing, trekking, or sightseeing, has become very popular. Therefore, the awareness of its dangers has increased, and many prospective travelers seek medical advice before setting forth on their trip. METHODS:We selectively searched the literature for relevant original a...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0839
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:The estimated prevalence of fetal alcohol syndrome (FAS) is 8 for every 1000 live births. FAS has serious, lifelong consequences for the affected children and their families. A variety of professionals deal with persons who have FAS, including pediatricians, general practitioners, neurologists, gynecologists...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2013.0703
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords. METHODS:This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoa...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2015.0329
更新日期:2015-05-08 00:00:00
abstract:BACKGROUND:Overweight and obesity are generally thought to elevate morbidity and mortality. New data call this supposed association into question. METHODS:The Cochrane, Pubmed, and other databases were systematically searched for a combination of relevant terms and subject headings. Meta-analyses and cohort studies ba...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2009.0641
更新日期:2009-10-01 00:00:00
abstract:INTRODUCTION:Intermittent paradoxical closure of the vocal cords can induce major attacks of dyspnea. Such attacks, called "vocal cord dysfunction" (VCD), are an important element in the differential diagnosis of intractable bronchial asthma. METHODS:Selective review of the literature. RESULTS:The etiology of VCD is ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0699
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:Nail disorders can arise at any age. About half of all nail disorders are of infectious origin, 15% are due to inflammatory or metabolic conditions, and 5% are due to malignancies and pigment disturbances. The differential diagnosis of nail disorders is often an area of uncertainty. METHODS:This review is b...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2016.0509
更新日期:2016-07-25 00:00:00
abstract:BACKGROUND:In Germany, rehabilitation is considered to be indicated after an acute hospital stay for the treatment of a severe cardiac condition. In comparative studies, at least 51% of German hospital patients with coronary heart disease (CHD) who were entitled to rehabilitative measures actually took part n rehabilit...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2015.0527
更新日期:2015-08-03 00:00:00
abstract:INTRODUCTION:Autopsy studies of persons who died of cancer have shown the lungs to be the sole site of metastasis in about 20% of cases. The resection of pulmonary metastases is indicated for palliative purposes if they contain a large volume of necrotic tumor, infiltrate the thoracic wall to produce pain, or cause hem...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2012.0645
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Pulsatile tinnitus, unlike idiopathic tinnitus, usually has a specific, identifiable cause. Nonetheless, uncertainty often arises in clinical practice about the findings to be sought and the strategy for work-up. METHODS:Selective literature review and evaluation of our own series of patients. RESULTS:Puls...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2013.0451
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Urinary tract infections (UTI) are among the leading reasons for treatment in adult primary care medicine, accounting for a considerable percentage of antibiotic prescriptions. Because this problem is so common and so significant in routine clinical practice, a high level of diagnostic accuracy is essential....
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2010.0361
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Multiple sclerosis (MS) is the most common autoimmune disease of the central nervous system. There are at least 150 000 persons with MS in Germany. Recent years have seen the approval of new drugs against. METHODS:This article is based on pertinent literature retrieved by a selective search in PubMed as wel...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2016.0879
更新日期:2016-12-26 00:00:00
abstract:BACKGROUND:The German Federal Law on Radiation Control contains no special provisions for X-ray studies in children and adolescents, even though exposure to ionizing radiation must be kept especially low in young persons, because their tissues are highly radiosensitive. Children, who have many years left to live, are m...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0407
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:A meta-analysis of studies from multiple countries has shown that the incidence of incisional hernia varies from 4% to 10% depending on the type of operation. No epidemiological surveys have been conducted so far. The worst possible complication of an incisional hernia if it is not treated surgically is inca...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析
doi:10.3238/arztebl.2018.0031
更新日期:2018-01-19 00:00:00
abstract:BACKGROUND:When gunshot and blast injuries affect only a single person, first aid can always be delivered in conformity with the relevant guidelines. In contrast, when there is a dynamic casualty situation affecting many persons, such as after a terrorist attack, treatment may need to be focused on immediately life-thr...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0237
更新日期:2017-04-07 00:00:00
abstract:BACKGROUND:In Germany, public interest in a vegan diet is steadily growing. There are, however, no current data on the macro- and micronutrient status of vegans. METHODS:In a cross-sectional study entitled "The Risks and Benefits of a Vegan Diet" (RBVD), we investigated the dietary intake, basic laboratory parameters,...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2020.0575
更新日期:2020-08-31 00:00:00