Joachim Erlenwein

Bio: Joachim Erlenwein is an academic researcher from University of Göttingen. The author has contributed to research in topics: Medicine & Chronic pain. The author has an hindex of 14, co-authored 80 publications receiving 640 citations.

Reduced task-induced variations in the distribution of activity across back muscle regions in individuals with low back pain.

Abstract: This study investigated change in the distribution of lumbar erector spinae muscle activity and pressure pain sensitivity across the low back in individuals with low back pain (LBP) and healthy controls. Surface electromyographic (EMG) signals were recorded from multiple locations over the lumbar erector spinae muscle with a 13×5 grid of electrodes from 19 people with chronic nonspecific LBP and 17 control subjects as they performed a repetitive lifting task. The EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG amplitude distribution. Pressure pain thresholds (PPT) were recorded before and after the lifting task over a similar area of the back. For the control subjects, the EMG RMS progressively increased more in the caudal region of the lumbar erector spinae during the repetitive task, resulting in a shift in the distribution of muscle activity. In contrast, the distribution of muscle activity remained unaltered in the LBP group despite an overall increase in EMG amplitude. PPT was lower in the LBP group after completion of the repetitive task compared to baseline (average across all locations: pre: 268.0±165.9 kPa; post: 242.0±166.7 kPa), whereas no change in PPT over time was observed for the control group (320.1±162.1 kPa; post: 322.0±179.5 kPa). The results demonstrate that LBP alters the normal adaptation of lumbar erector spinae muscle activity to exercise, which occurs in the presence of exercise-induced hyperalgesia. Reduced variability of muscle activity may have important implications for the provocation and recurrence of LBP due to repetitive tasks.

[Dipyrone (metamizole) : Considerations on monitoring for early detection of agranulocytosis].

Abstract: BACKGROUND Dipyrone (metamizole) is a non-opioid analgesic commonly used in Germany, which can, in very rare cases, cause life-threatening agranulocytosis. The prescribing information calls for regular monitoring of the differential blood count in cases of long-term treatment. However, there is uncertainty about how this testing should be handled in practice. OBJECTIVES Which recommendations can be derived from the published literature for evaluating blood cell counts during treatment with metamizole and which other options for monitoring exist? METHODS Data from recent epidemiological studies, reviews, and spontaneously reported cases were evaluated. RESULTS Agranulocytosis can emerge at highly variable intervals ranging from the first day of metamizole treatment to months after treatment has begun. As a result, there is no conclusive, evidence-based recommendation for the time intervals at which blood cell counts should be tested. Therefore, the onset of clinical symptoms should be used as trigger for monitoring blood cell counts to enable early diagnosis and avoid agranulocytosis-related complications. In addition to general symptoms like fever, sore throat, fatigue, and muscle pain, mucosal ulcerations, severe angina, and systemic infections leading to sepsis are typical of agranulocytosis. CONCLUSIONS Providing patients and medical staff with better information about early symptoms of agranulocytosis could be a sensible way to prevent complications. Any suspicion of agranulocytosis should immediately lead to a differential blood count and to the withdrawal of all drugs possibly associated with agranulocytosis. Patients should be monitored and treated according to the severity of their symptoms.

Akutschmerztherapie in der stationären Versorgung an deutschen Krankenhäusern

Abstract: Ziel der vorliegenden Untersuchung war es, aktuelle Struktur- und Prozessdaten zur Akutschmerztherapie an deutschen Krankenhausern zu erheben und vor dem Hintergrund der 2007 publizierten S3-Leitlinie zur Behandlung akuter perioperativer und posttraumatischer Schmerzen und anderer Initiativen wie dem Benchmarking oder der Zertifizierung des Schmerzmanagements zu analysieren. Alle bei der Deutschen Gesellschaft fur Anasthesiologie und Intensivmedizin (DGAI) erfassten Chefarzte wurden anhand eines standardisierten Fragebogens zu Strukturen und Prozessen der Akutschmerztherapie in ihren Kliniken befragt. Es konnten 403 Fragebogen (46 %) ausgewertet werden. Ein Anteil von 81 % der Hauser gab an, uber einen Akutschmerzdienst (ASD) zu verfugen, wovon 45 % definierte Qualitatskriterien erfullten. Schriftliche Standards fur die Versorgung auf der Normalstation hatten 97 % der Krankenhauser, in 96 % wurden Schmerzen perioperativ regelmasig erfasst (meist Ruhe- und/oder Belastungsschmerz, nur in 16 % auch funktionelle Beeintrachtigungen). In 62 % erfolgten auserhalb dieser Routine keine weiteren Messungen, z. B. zur Effektivitatskontrolle nach Bedarfsmedikationen. Auch fur nichtoperative Abteilungen existierten in 51 % der Krankenhauser schriftliche Behandlungsstandards zur Akutschmerztherapie. Haufig waren interdisziplinare Arbeitsgruppen und/oder Schmerzbeauftragte zur klinikweiten Steuerung sowohl fur die Akutschmerztherapie in operativen als auch in nichtoperativen Abteilungen etabliert. Als spezielle Therapieverfahren waren die patientenkontrollierte i.v.-Analgesie (PCIA) und Periduralanalgesie (PDA) am weitesten verbreitet (> 90 % aller Kliniken). Im vergangenen Jahrzehnt etablierte sich in der Akutschmerztherapie neben der intravenosen auch die orale Applikation von Opioiden, einschlieslich der retardierten Praparate. Es wurden reprasentative Daten fur deutsche Krankenhauser erfasst. Die in der S3-Leitlinie zum Akutschmerz empfohlenen organisatorischen Voraussetzungen fur eine adaquate Schmerztherapie scheinen sich in der stationaren Versorgung in den vergangenen Jahren zunehmend etabliert zu haben. Auch wenn die organisatorische Umsetzung der Akutschmerztherapie in nichtoperativen Bereichen im Durchdringungsgrad ergebnismasig nicht der perioperativen Versorgung gleicht, sind adaquate Ansatze zu erkennen. In allen Bereichen sind moderne systemisch-medikamentose (z. B. medikamentose Algorithmen) und invasive Analgesietechniken (z. B. PDA) weitgehend verfugbar.

Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia the official statement of the American Thoracic Society and the Infectious Disease Society of America (特集 救急診療ガイドライン) -- (海外のガイドライン)

Abstract: Executive Summary Introduction Methodology Used to Prepare the Guideline Epidemiology Incidence Etiology Major Epidemiologic Points Pathogenesis Major Points for Pathogenesis Modifiable Risk Factors Intubation and Mechanical Ventilation Aspiration, Body Position, and Enteral Feeding Modulation of Colonization: Oral Antiseptics and Antibiotics Stress Bleeding Prophylaxis, Transfusion, and Glucose Control Major Points and Recommendations for Modifiable Risk Factors Diagnostic Testing Major Points and Recommendations for Diagnosis Diagnostic Strategies and Approaches Clinical Strategy Bacteriologic Strategy Recommended Diagnostic Strategy Major Points and Recommendations for Comparing Diagnostic Strategies Antibiotic Treatment of Hospital-acquired Pneumonia General Approach Initial Empiric Antibiotic Therapy Appropriate Antibiotic Selection and Adequate Dosing Local Instillation and Aerosolized Antibiotics Combination versus Monotherapy Duration of Therapy Major Points and Recommendations for Optimal Antibiotic Therapy Specific Antibiotic Regimens Antibiotic Heterogeneity and Antibiotic Cycling Response to Therapy Modification of Empiric Antibiotic Regimens Defining the Normal Pattern of Resolution Reasons for Deterioration or Nonresolution Evaluation of the Nonresponding Patient Major Points and Recommendations for Assessing Response to Therapy Suggested Performance Indicators

Nosocomial Bloodstream Infection in Critically Ill Adults: Excess Length of Stay, Extra Costs, and Attributable Mortality

Abstract: OBJECTIVE To determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients. DESIGN Pairwise-matched (1:1) case-control study. SETTING Surgical intensive care unit (SICU) in a tertiary health care institution. PATIENTS All patients admitted in the SICU between July 1, 1988, and June 30, 1990, were eligible. Cases were defined as patients with nosocomial bloodstream infection; controls were selected according to matching variables in a stepwise fashion. METHODS Matching variables were primary diagnosis for admission, age, sex, length of stay before the day of infection in cases, and total number of discharge diagnoses. Matching was successful for 89% of the cohort; 86 matched case-control pairs were studied. MAIN OUTCOME MEASURES Crude and attributable mortality, excess length of hospital and SICU stay, and overall costs. RESULTS Nosocomial bloodstream infection complicated 2.67 per 100 admissions to the SICU during the study period. The crude mortality rates from cases and controls were 50% and 15%, respectively (P < .01); thus, the estimated attributable mortality rate was 35% (95% confidence interval, 25% to 45%). The median length of hospital stay significantly differed between cases and controls (40 vs 26 days, respectively; P < .01). When only matched pairs who survived bloodstream infection were considered (n = 41), cases stayed in the hospital a median of 54 days vs 30 days for controls (P < .01), and cases stayed in the SICU a median of 15 days vs 7 days for controls (P < .01). Thus, extra hospital and SICU length of stay attributable to bloodstream infection was 24 and 8 days, respectively. Extra costs attributable to the infection averaged $40,000 per survivor. CONCLUSIONS The attributable mortality from nosocomial bloodstream infection is high in critically ill patients. The infection is associated with a doubling of the SICU stay, an excess length of hospital stay of 24 days in survivors, and a significant economic burden.