Medizinische Klinik最新文献

Background and purpose: In Germany, accredited CME articles have to present ten multiple-choice questions (MCQs) per article for knowledge assessment [1]. It was the aim of this study to describe the selection of key messages for construction of MCQs and their relation to clinical relevance of the content.

Methods: 23 CME articles in two specialist journals (Der Orthopäde [The Orthopedist] and Der Unfallchirurg [The Trauma Surgeon]) were analyzed. First, the key messages of the text as marked by the authors were identified, and then, a subset of top key messages was selected on the basis of clinical relevance. This was followed by a description, to what extent both sets of messages had been used for the construction of MCQs.

Results: 1,333 key messages were identified which could have been used for 1,048 test items in 216 MCQs. 256 key messages had never been used in MCQs. 434 key messages had been used as clinically meaningful distractors and 235 as senseless distractors, respectively. In only 144 cases, the key message was the topic of the MCQ. Even top key messages could only be found in 23-90% of the test items of MCQs, which had a key message as topic.

Conclusion: Specialist CME in print media contains too much information to be adequately mirrored in the limited number of MCQs. However, the more deliberate use of key messages in the MCQs could yield a better result compared to the present situation.

Background and purpose: The initiative "Healthy Lower Rhine ... against Stroke" aims at improving stroke knowledge in the community, i.e., knowledge of stroke symptoms and proper action when stroke signs occur (call emergency number 112) in order to reduce prehospital times/delay. An expert group in the district of Wesel decided to raise an inventory of stroke-care quality in the whole district. Samples of patient data were drawn in all hospitals in the district of Wesel, in order to gain a database for evaluation of possible effects on prehospital time due to the intervention.

Material and methods: All hospitals in the Wesel district collected data from patients presenting with stroke signs. Data collection was performed for a time span of 3 months before (T0 in 2003) and during (T1 in 2005) the public-health intervention. Standardized data collection was performed with a short version of the questionnaire issued by the German Stroke Registers Study Group (ADSR). Influential factors on prehospital time and means of transportation were analyzed by multivariate logistic regression.

Results: The portion of patients hospitalized within a <3-h window after onset of stroke symptoms did no vary between 2003 and 2005 (27.3% vs. 27.5%). In 2005, acute care of stroke patients was performed more frequently in the emergency department (33% in 2003 vs. 84% in 2005). Before the start of the stroke intervention, seven clinics collected data on 326 patients, and in 2005, 375 patients were registered by all eight hospitals in the district of Wesel. Mean age of patients rose from 72 to 74 years. The portion of men dropped from 50% to 43%.

Conclusion and perspective: Obviously, prehospital delay was not reduced after a 2-year run of a stroke campaign. It is recommended to carry out a second survey into community stroke knowledge in the district of Wesel. If a significant trend of improved knowledge should be detected, a new evaluation through clinic data sampling would make sense.

Background: Visceral leishmaniasis is a rare imported infectious disease in Germany. Approximately ten to 30 cases are recorded annually. The classic symptoms are often misinterpreted as lymphoma of the spleen.

Case report: A 46-year-old patient presented with fever, malaise, night sweats, pancytopenia, and splenomegaly 8 months after a 2-week trip to Majorca Island (Spain). Bone marrow biopsy showed no evidence of malignant lymphoma. Serology confirmed the suspected clinical diagnosis of visceral leishmaniasis. Cytology and polymerase chain reaction from bone marrow aspirate were positive for Leishmania infantum. Treatment with liposomal amphotericin B was initiated and led to complete recovery.

Conclusion: Visceral leishmaniasis is an important differential diagnosis for the clinical triad of fever, pancytopenia, and splenomegaly. An accurate travel history is therefore of paramount importance. Without treatment, the case fatality rate is high. A complete recovery is usually achieved with adequate therapy (liposomal amphotericin B, miltefosine).

Case report: The case of a 34-year-old female patient with rheumatoid arthritis (RA) is reported, who was treated with homeopathic medicine without DMARD (disease-modifying antirheumatic drugs) therapy for 13 years. She required bilateral knee replacement surgery. Her arthritis was highly active. On X-ray analysis, her wrists, metacarpophalangeal and proximal interphalangeal joints displayed marked structural damage.

Conclusion: There are very few controlled clinical trials investigating the efficacy of homeopathic remedies in RA, and none of them has shown a significant benefit for the patients. This lack of efficacy is underscored by the case presented here. It is medical malpractice to treat patients with homeopathic drugs while withholding an effective DMARD therapy.