Anonymisieren oder personalisieren?

Background

The subjective state of health with respect to pain and psyche was surveyed utilizing validated pain questionnaires in patients undergoing special pain therapy and represents the basis for targeted treatment measures.

Objective

The purpose of this study was to investigate the possible distortion of answers due to social desirability of responses in chronic pain patients.

Material and methods

During two survey periods assessing patient satisfaction using both anonymized and personalized questionnaires, the effects arising from socially desirable response patterns were analyzed. The sample consisted of chronic pain patients being treated in an inpatient therapy setting.

Results

In both periods of observation no significant impact on the response behavior of chronic pain patients was found in personalized or anonymized questionnaires.

Conclusion

The results of the study suggest that the responses of chronic pain patients with respect to their subjective state of health are not influenced by social desirability. Thus, scoring systems such as the German pain questionnaire will not be influenced by social desirability in chronic pain patients and can therefore be used as a part of diagnostics and therapy planning.

     

Sneddon-Syndrom: Vaskulitis oder thrombotische Vaskulopathie?

Zusammenfassung Hintergrund: Livedo racemosa mit Beteiligung des Zentralnervensystems ist als Sneddon-Syndrom bekannt. Neuere Ergebnisse sprechen für das Vorliegen eines generalisierten und progredienten arteriellen Verschlußprozesses kleinerer und mittlerer Gefäße, dessen Ätiologie letztlich noch nicht bekannt ist. Ein Zusammenhang mit dem Antiphospholipidantikörpersyndrom, den Kollagenosen und Koagulopathien wird diskutiert, hereditäre und toxische Faktoren scheinen im Einzelfall eine Rolle zu spielen. Fallbeschreibung: Diagnostik und Verlauf eines Sneddon-Syndroms werden anhand einer Falldarstellung bei einer 56jährigen Patientin mit dementieller Entwicklung und Hemiparese nach langjährig vorbestehender Livedo racemosa beschrieben. MRT-, SPECT- und TCD-Befunde deuteten auf diffuse fleckförmige zerebrale Ischämien im Bereich kleinerer und mittelgroßer Gefäße hin. Weder histopathologische Untersuchungen von Haut, Hirngewebe noch Hirnhäuten zeigten richtungweisende Befunde. Allein laborchemische Parameter wiesen in die Richtung einer Vaskulitis. Die Livedo racemosa erfuhr eine positive Beeinflussung unter immunsuppressiver Therapie. Schlußfolgerung: Das Sneddon-Syndrom ist wahrscheinlich keine Krankheitsentität. Die Phänomenologie wird bei differenter Genese durch den Topos der pathologisch-anatomischen Veränderungen in der Dermis und dem Zentralnervensystem bestimmt. Eine Differenzierung in symptomatische und idiopathische Formen ist im Hinblick auf therapeutische Entscheidungsprozesse relevant. Abstract Background: Livedo reticularis generalisata (LR) in combination with affection of CNS is referred to as Sneddon's syndrome (SNS). Latest data suggest chronic progressive systemic disorder with occlusion of small and medium sized vessels (e. g., cutis, brain, kidneys, heart, eyes). No conclusive etiology is known, though there are correlations to the antiphospholipid syndrome, systemic secondary vasculitis and coagulopathies. Hereditary and toxic factors seem to play a role in pathogenesis in some cases. Case Report: Diagnostic procedure and clinical course of a 56-year-old woman with dementia and hemiparesis proceeded by LR is reported. MRI-, SPECT- and TCD-findings were congruent with diffuse ischemic lesions of the brain due to affection of small- and medium-sized vessels. Histopathological specimens of the brain, meninges and cutis were non diagnostic. Some laboratory findings suggested vasculitis as an underlying cause. LR improved under immunosuppressive therapy with prednisolone and azathioprin. Conclusion: SNS does not seem to be a nosological entity. A differentiation between primary (idiopathic) and secondary SNS is useful for different therapeutical approaches.     

Does This Child Have Bacterial Meningitis? A Systematic Review of Clinical Prediction Rules for Children with Suspected Bacterial Meningitis

Background

Acute meningitis is a relatively common phenomenon in children. Identifying which children are most likely to have bacterial meningitis vs. self-limiting aseptic meningitis is important, as these children require investigation and antibiotic treatment.

Objective

Our aim was to systematically identify and review the quality and performance of published clinical prediction rules (CPRs) for children with suspected bacterial meningitis.

Methods

Medline and Embase were searched for CPRs involving children 0–18 years of age with suspected bacterial meningitis, with cerebral spinal fluid (CSF) culture used as the reference diagnostic standard. CPR quality was assessed using 17 previously published items. CPR performance was evaluated using sensitivity, negative likelihood ratio, and the treatment frequency that would result if the rule was used.

Results

Eleven studies involving 6675 children with acute meningitis fulfilled all inclusion criteria and were entered in the study. They all describe the derivation or validation of six unique CPRs. A rigorously developed, high-performing, and well-validated CPR ready for clinical use to guide which children with suspected bacterial meningitis should be hospitalized and treated with intravenous antibiotics and which can be safely discharged home was not identified. Areas for quality improvement for future CPR studies include prospective validation using standardized inclusion criteria, adequate blinding, predictor reproducibility assessment, and meticulous follow-up of outcomes. The Bacterial Meningitis Score had the highest quality and performance and is the best candidate for prospective validation.

Conclusions

Until consistently high methodological quality and diagnostic performance are demonstrated through prospective validation, caution is warranted in the routine clinical use of existing CPRs for children with suspected bacterial meningitis.     

CRPS Typ II oder psychogene schmerzhafte Fingerkontraktur?

The case is described of a 45-year-old man with fixed contracture of the proximal interphalangeal joints (digits III–IV) after a stab wound injury in the forearm with subsequent compartment syndrome and partial ulnar injury. Despite neurographic recovery there was permanent contracture during rehabilitation, which was classified as psychogenic. Differential diagnostic aspects of this assumption will be discussed on the basis of clinical criteria as well as 3-phase skeleton scintigraphy and MRT for differentiation between complex regional pain syndrome (CRPS) type II and other posttraumatic changes. Readers are encouraged to make their own diagnosis on the basis of the clinical findings and to discuss the case online (http://www.blogs.springer.com/derschmerz).     

Sepsis,Pneumonia, and Meningitis: What Is the Difference?

Sepsis, pneumonia, and meningitis are types of infections seen frequently in the neonate. The signs of sepsis can be an overwhelming, systematic response, or the signs can be localized to the place of infection, whether lungs, spinal fluid, or bones. It is important for nurses to understand how the source of infection and progression of the disease can cause changes in the signs of infection. Infection can invade the bloodstream, produce an inflammatory reaction, and cause shock with resulting multiple-organ dysfunction. A conceptual model of the progression of sepsis in the neonate will be presented. The importance of understanding the progression in the disease process will assist the nurse to facilitate prompt and effective treatment for the infant with sepsis.     

Chronischer Schmerz: homogenes Syndrom oder heterogene Krankheitsbilder?

Ohne Zusammenfassung     

Fibromyalgie oder funktionelle Kopf- und Kiefergelenkstörung?

In patients who have been correctly treated by manual therapy but with continually recurring functional disorders and complaints of the spine, the craniomandibular region should be taken into consideration as it lies in direct neuromuscularly controlled interaction with the craniocervical region. This is also the case when there are no complaints of obvious symptoms of craniomandibular dysfunction (CMD) and an asymptomatic CMD is present. Many previously therapy-resistant patients can be helped by a coordinated synchronous treatment of CMD and functional disorders of the cervical spine. Special attention must also be paid to asymptomatic CMD, which is often overlooked due to the lack of symptoms. This problem area is discussed using a patient case report with the diagnosis of fibromyalgia syndrome as an example.     

Die Reisethrombose: Mediales Horrorszenario oder medizinisches Faktum?

Ohne Zusammenfassung

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Viral Meningitis: Which Patients Can Be Discharged from the Emergency Department?

Background

Even in an era when cases of viral meningitis outnumber bacterial meningitis by at least 25:1, most patients with clinical meningitis are hospitalized.

Objective

We describe the clinical characteristics of an unusual outbreak of viral meningitis that featured markedly elevated cerebrospinal fluid white blood cell counts (CSF WBC). A validated prediction model for viral meningitis was applied to determine which hospital admissions could have been avoided.

Methods

Data were collected retrospectively from patients presenting to our tertiary care center. Charts were reviewed in patients with CSF pleocytosis (CSF WBC > 7 cells/mm³) and a clinical diagnosis of meningitis between March 1, 2003 and July 1, 2003. Cases were identified through hospital infection control and by surveying all CSF specimens submitted to the microbiology laboratory during the outbreak.

Results

There were 78 cases of viral meningitis and 1 case of bacterial meningitis identified. Fifty-eight percent of the viral meningitis cases were confirmed by culture or polymerase chain reaction to be due to Enterovirus. Mean CSF WBC count was 571 cells/mm³, including 20 patients with a CSF WBC count > 750 cells/mm³ (25%) and 11 patients with values > 1000 cells/mm³ (14%). Sixty-four of 78 patients (82%) were hospitalized. Rates of headache, photophobia, nuchal rigidity, vomiting, and administration of intravenous fluids in the Emergency Department were no different between admitted and discharged patients. Only 26/78 (33%) patients with viral meningitis would have been admitted if the prediction model had been used.

Conclusions

Although not all cases of viral meningitis are necessarily suitable for outpatient management, use of a prediction model for viral meningitis may have helped decrease hospitalization by nearly 60%, even though this outbreak was characterized by unusually high levels of CSF pleocytosis.     

Ventiloffenes Foramen ovale:¶Konservative oder operative Therapie?

Zusammenfassung Ungeachtet der Schwierigkeiten bei der Best?tigung einer paradoxen Embolie konnte der Zusammenhang zwischen dem Vorliegen eines ventiloffenen Foramen ovale (PFO) und zerebraler Isch?mie-Ereignisse unklarer Ursache wiederholt nachgewiesen werden. Darüber hinaus wurde berichtet, da? das Risiko von Embolie-Rezidiven bei diesen Patienten 3–4% pro Jahr betr?gt. Eine zuverl?ssige Risikostratifikation der Patienten mit PFO auf der Basis klinischer oder echokardiographischer Befunde ist bisher – mit Ausnahme der h?modynamisch wirksamen Lungenembolie – in der Regel nicht m?glich. Das Vorliegen eines Vorhofseptumaneurysmas und eine weite ?ffnung des PFO w?hrend des Herzzyklus oder ein gro?er interatrialer Shunt bei der trans?sophagealen Kontrast-Echokardiographie werden jedoch von manchen Autoren als Risikofaktoren angesehen. Die sekund?re Pr?vention paradoxer Embolien mittels oraler Antikoagulanzen (Warfarin) beinhaltet das Risiko einer signifikanten Blutung (Inzidenzrate 2–5% pro Jahr) und mangelhaften Compliance der Patienten. Au?erdem scheint diese Therapieform wenig effektiv zu sein. Der chirurgische Verschlu? des PFO ist ein technisch ausgereifter, sicherer Eingriff. Erste Berichte best?tigen seine hohe Effektivit?t hinsichtlich der Rezidivprophylaxe, weitere prospektive Studien sind jedoch erforderlich, um die für eine chirurgische Behandlung geeigneten Patienten festzulegen. Kathetertechnische Verfahren zum PFO-Verschlu? stehen ebenfalls zur Verfügung und befinden sich derzeit in der Phase der klinischen Erprobung. Weitere technische Verbesserungen erscheinen jedoch erforderlich, um den Ablauf des interventionellen Eingriffes zu vereinfachen, die Stabilit?t dieser Systeme zu erh?hen und die Komplikationsgefahr zu minimieren. Eingegangen: 30. Juli 1999, Akzeptiert: 24. September 1999     

Meningitis: is a major cause of disability amongst Papua New Guinea children?

Purpose: This article is intended to focus on the need for the use of rehabilitation services, for children with meningitis in Papua New Guinea, which is one of largest developing country in The Pacific with diverse culture and landscape. Meningitis is the fifth leading disease that results in disability in the country. The first line of treatment is usually antibiotics, administration of vaccination is also recommended. Currently community based rehabilitation workers and Physiotherapist offer the rehabilitation services. There is a need for the other rehabilitation professionals and appropriate education to the CBR workers, caregivers for providing effective Rehabilitation. Method: Articles related to meningitis were recruited through various electronic database such as Ovid SP, MEDLINE, CINHAL, Google Scholar and HINARI and EBSCOhost for full text. The search includes journal articles, editorials, research reports, systematic reviews and books. Results: The neurological sequelae resulting from meningitis are increasing. There is a need for Hib vaccination to reduce the rate of mortality. Physiotherapists are new professionals that emerged since 2006 and are assisting in reducing the motor and neurological disability. Conclusions: A multidisciplinary approach is required to manage the child with meningitis. Adequate knowledge, resources and assistance about the condition among the health professionals, carers and teachers would enable the children to achieve the quality of life.

Implications for Rehabilitation

• Meningitis is a neurological disorder resulting from mild to severe neurological sequelea.

• The need for availability of cephalosporin is required to reduce the consequence of disease.

• Multidisciplinary approach will reduce the rate of disability resulting from meningitis.

     

Meningitis: is a major cause of disability amongst Papua New Guinea children?

Purpose: This article is intended to focus on the need for the use of rehabilitation services, for children with meningitis in Papua New Guinea, which is one of largest developing country in The Pacific with diverse culture and landscape. Meningitis is the fifth leading disease that results in disability in the country. The first line of treatment is usually antibiotics, administration of vaccination is also recommended. Currently community based rehabilitation workers and Physiotherapist offer the rehabilitation services. There is a need for the other rehabilitation professionals and appropriate education to the CBR workers, caregivers for providing effective Rehabilitation. Method: Articles related to meningitis were recruited through various electronic database such as Ovid SP, MEDLINE, CINHAL, Google Scholar and HINARI and EBSCOhost for full text. The search includes journal articles, editorials, research reports, systematic reviews and books. Results: The neurological sequelae resulting from meningitis are increasing. There is a need for Hib vaccination to reduce the rate of mortality. Physiotherapists are new professionals that emerged since 2006 and are assisting in reducing the motor and neurological disability. Conclusions: A multidisciplinary approach is required to manage the child with meningitis. Adequate knowledge, resources and assistance about the condition among the health professionals, carers and teachers would enable the children to achieve the quality of life. [Box: see text].