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Variations Useful Brain Systems In between Fuzy Psychological Decline using along with with out Worry Groups: A Data Theory Study from SILCODE.
d erlernt werden. Damit ist das Fach in der 2. Schriftlichen Staatsexamensprüfung unterrepräsentiert und es erscheint eine vermehrte Prüfung der plastisch-chirurgischen Lernziele nötig.BACKGROUND  Unacceptable variation in colonoscopy quality exists. The Quality Improvement in Colonoscopy (QIC) study in 2011 improved quality by introducing an evidence-based "bundle" of measures into routine colonoscopy practice. The QIC bundle included minimal cecal withdrawal time of ≥ 6 minutes; hyoscine butylbromide use; supine patient position for transverse colon examination; rectal retroflexion. Colonoscopy quality was measured by adenoma detection rate (ADR). The current study measured whether these effects led to a sustained change in practice 3 years following implementation. METHODS  This observational study collected data from eight hospital trusts (sites) in the United Kingdom for a 6-month period, 3 years following QIC bundle implementation. Use of the antispasmodic, hyoscine butylbromide, was measured as a marker of bundle uptake. Bundle effectiveness was measured by ADR change. Comparisons were made between data before and immediately after implementation of the bundle. RESULTS  28 615 colonoscopies by 188 colonoscopists were studied. Hyoscine butylbromide use increased from 15.8 % pre-implementation to 47.4 % in the sustainability phase (P  less then  0.01) indicating sustained engagement with QIC measures. ADR was higher in the sustainability period compared with pre-intervention, but only reached statistical significance among the poorest-performing colonoscopists. CONCLUSIONS  The introduction of a simple, inexpensive, pragmatic intervention significantly changed practice over a sustained period, improving colonoscopy quality as measured by ADR, particularly in poorer performers. QIC demonstrates that an easy-to-implement quality improvement approach can deliver a sustained change in practice for many years post intervention. © Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  Gastric hyperplastic polyps (GHPs) have a risk of neoplastic transformation reaching 5 %. Current endoscopic resection techniques appear suboptimal with a high risk of local recurrence. This study assessed the outcomes of endoscopic resection for GHPs and identified risk factors for recurrence and neoplastic transformation. METHODS  This retrospective, multicenter, European study included adult patients with at least one GHP ≥ 10 mm who underwent endoscopic resection and at least one follow-up endoscopy. Patients with recurrent GHPs or hereditary gastric polyposis were excluded. All data were retrieved from the endoscopy, pathology, and hospitalization reports. RESULTS  From June 2007 to August 2018, 145 GHPs in 108 patients were included. Recurrence after endoscopic resection was 51.0 % (74 /145) in 55 patients. R0 resection or en bloc resection did not impact the risk of polyp recurrence. In multivariate analysis, cirrhosis was the only risk factor for recurrence (odds ratio [OR] 4.82, 95 % confidence interval [CI] 1.33 - 17.46; P = 0.02). Overall, 15 GHPs (10.4 %) showed neoplastic transformation, with size > 25 mm (OR 10.24, 95 %CI 2.71 - 38.69; P  25 mm, with a risk of high grade dysplasia appearing in polyps ≥ 50 mm. The risk of recurrence was high, particularly in cirrhosis patients, and long-term follow-up is recommended in such patients. © Georg Thieme Verlag KG Stuttgart · New York.The declaration and investigation of death cases is a non-delegable task of medical doctors and should be mastered in the same quality as all examinations on living patients. A person is death when at least one sign of death is established (livores mortis, rigor mortis, putrefaction, injuries incompatible with life, brain death). In all other cases of unconscious patients a sufficient cardiopulmonary resuscitation should be started.If the person is declared death, an external post mortem examination has to be realized as soon as possible. Emergency doctors should be informed about the regional juridical features. The investigation of the death scene scenario, potentially known pre-existing disorders of the patients as well as medical records should be added to the findings of the body surface to conclude the most plausible cause and manner of death of the corpse. Doctors must be alarmed, when petechial bleedings are established at the face or the conjunctives, raising the suspicion of strangling forces to the neck.Internal causes of death are often invisible from the body surface, resulting in difficulties to declare the cause of death of the individual by external's only. Injuries are most often visible and could be a hint of a crime scene scenario or external harm. © Georg Thieme Verlag KG Stuttgart · New York.The 12-lead resting ECG remains an indispensable diagnostic tool in patients with acute chest pain. This is particularly important as the identification of ST-segment elevations leads to the diagnosis of ST-segment elevation myocardial infarction (STEMI) and subsequent, immediate coronary reperfusion (usually via primary PCI). However, correct interpretation of the 12-lead ECG in patients with acute chest pain remains challenging. Apart from "classical" ST-segment elevations there are several "equivalents" in the ECG pointing towards an acute coronary occlusion. Among these, hyperacute T-waves, subtle ST-segment elevations, ST-segment elevation in leads aVR/V1 with concomitant ST-segment depression in ≥ 8 other leads and high R-peak with positive T-waves combined with horizontal ST-segment depression in leads V1/V2 can be found. This article provides a case-based presentation of STEMI equivalents on the ECG in order to improve correct ECG interpretation and prognosis of such patients. © Georg Thieme Verlag KG Stuttgart · New York.in English, German ANAMNESE UND KLINISCHER BEFUND  Eine Patientin mit T1DM, Panikstörung und Hypoglykämieangst (Diabetesdauer 4 Jahre, BMI 25,6) wurde in der Tagesklinik Psychosomatik mit einem multimodalen Behandlungsansatz behandelt. Sie berichtet von ausgeprägter Angst vor Hypoglykämie und von wiederholten Hypoglykämien. Aus Angst vor Hypoglykämien veränderte die Patientin ihr Diabetes-Selbstmanagement und erlebte damit Einschränkungen in ihrer Alltagsfunktionalität. UNTERSUCHUNG  Nach Aufnahme wurde bei der Patientin kein Blutzuckerwert unter 3,7 mmol/l (70 mg/dl) gemessen, allerdings zeigten sich Symptome einer leichten Hypoglykämie schon bei Blutzuckerwerten im unteren Normbereich. HbA1c bei Aufnahme bei 54 mmol/mol, 7,1 %. DIAGNOSEN  Diabetes mellitus Typ 1, Panikstörung und übersteigerte Angst vor Hypoglykämien. THERAPIE UND VERLAUF  Kombination aus kontinuierlicher Glukosemessung (CGM) und Beschwerdeprotokollen als Methode der kognitiven Verhaltenstherapie (KVT) in Ergänzung zu einem multimodalen Akzeptanz- und Commitment-Therapie (ACT)-basierten Gruppenpsychotherapieprogramm. Dies führte zur Verbesserung der Symptomdiskrimination und zur Reduktion von Sicherheits- und Vermeidungsverhalten. FOLGERUNG  Die Kombination von psychotherapeutischen Maßnahmen mit CGM erscheint als hilfreicher Ansatz zur Behandlung krankheitsspezifischer psychischer Störungen bei Diabetes mellitus.Biliary stenoses represent a differential diagnostic challenge. Diagnostic methods to clarify the underlying dignity are often invasive, and provide high specificity beside insufficient sensitivity. In many cases, an accurate diagnosis is only possible over time, and therefore limits curative treatment options. This article provides an overview of the diagnostic challenges and treatment options for unclear biliary stenosis. © Georg Thieme Verlag KG Stuttgart · New York.Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare, autoimmune mediated cholestatic liver diseases. Other auto-immune diseases are often associated with PBC and PSC, and inflammatory bowel disease is present in the majority of PSC patients. In the course of disease, chronic inflammation in the liver leads to fibrotic restructuring and ultimately cirrhosis. The diagnosis of PBC is confirmed serologically and PSC is diagnosed via cholangiography, whereas MRCP is preferred over ERCP. For PBC, the first line therapy is ursodeoxycholic acid (UDCA). Prognosis is strongly dependent on the response to UDCA. The only approved second line therapy is obeticholic acid (OCA). Alternatively, Budesonide or Fibrates are often used off-label. EN4 concentration In the management of PSC, prevention and adequate treatment of bacterial cholangitis play a major role. For both PBC and PSC novel treatments are currently being tested in clinical trials. Disease management should address compromising symptoms like pruritus and sicca as well as complications due to maldigestion and concomitant autoimmune diseases. The only curative treatment available is liver transplantation and should be considered at a MELD score of 15. © Georg Thieme Verlag KG Stuttgart · New York.Gallstones develop in the gallbladder or the bile ducts. According to their chemical composition, gallstones can be divided into cholesterol stones, which are common, and the rare bile pigment stones. Altogether, up to 20 % of all adults develop gallstones and more than 20 % of them symptoms or complications. Female sex, age, pregnancy, physical inactivity, obesity, overnutrition and genetic factors such as ABCB4 deficiency of the hepatic lecithin transporter are kown risk factors for gallstone formation. In about one half of all patients biliary symptoms precede the three common and potentially life-threatening complications (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge about the genetics and pathophysiology of gallstones has improved, current treatment algorithms are predominantly invasive (ERC and surgery). Thus, better strategies are needed to prevent the formation of gallstones in general. © Georg Thieme Verlag KG Stuttgart · New York.Fibromyalgia is characterized by chronic, widespread musculoskeletal pain and associated fatigue, sleep disturbances, and other cognitive and somatic symptoms. For many patients, these symptoms persist for years and lead to frequent health care use; for some, fibromyalgia and its symptoms can be debilitating. Although many treatments are available, management remains challenging. This article highlights the clinical features of fibromyalgia, discusses diagnostic criteria and their evolution, and reviews treatment options.Background Cannabis use disorder (CUD) is a growing concern, and evidence-based data are needed to inform treatment options. Purpose To review the benefits and risks of pharmacotherapies for the treatment of CUD. Data Sources MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, and clinical trial registries from inception through September 2019. Study Selection Pharmacotherapy trials of adults or adolescents with CUD that targeted cannabis abstinence or reduction, treatment retention, withdrawal symptoms, and other outcomes. Data Extraction Data were abstracted by 1 investigator and confirmed by a second. Study quality was dually assessed, and strength of evidence (SOE) was determined by consensus according to standard criteria. Data Synthesis Across 26 trials, the evidence was largely insufficient. Low-strength evidence was found that selective serotonin reuptake inhibitors (SSRIs) do not reduce cannabis use or improve treatment retention. Low- to moderate-strength evidence was found that buspirone does not improve outcomes and that cannabinoids do not increase abstinence rates (moderate SOE), reduce cannabis use (low SOE), or increase treatment retention (low SOE).
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