Alexianer Krefeld GmbH

Krefeld, Germany

Alexianer Krefeld GmbH

Krefeld, Germany
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Galsky M.D.,Mount Sinai School of Medicine | Moshier E.,Mount Sinai School of Medicine | Krege S.,Alexianer Krefeld GmbH | Lin C.-C.,National Taiwan University Hospital | And 6 more authors.
Cancer | Year: 2013

BACKGROUND The current study was conducted to develop a pretreatment prognostic model for patients with unresectable and/or metastatic urothelial cancer who were treated with first-line, cisplatin-based chemotherapy. METHODS Individual data were pooled from 399 patients who were enrolled on 8 phase 2 and 3 trials evaluating cisplatin-based, first-line chemotherapy in patients with metastatic urothelial carcinoma. Variables selected for inclusion in the model were combined in a Cox proportional hazards model to produce a points-based nomogram with which to predict the median, 1-year, 2-year, and 5-year survival. The nomogram was validated externally using data from a randomized trial of the combination of methotrexate, vinblastine, doxorubicin plus cisplatin versus docetaxel plus cisplatin. RESULTS The median survival of the development cohort was 13.8 months (95% confidence interval, 12.1 months-16.0 months); 68.2% of the patients had died at the time of last follow-up. On multivariable analysis, the number of visceral metastatic sites, Eastern Cooperative Oncology Group performance status, and leukocyte count were each found to be associated with overall survival (P <.05), whereas the site of the primary tumor and the presence of lymph node metastases were not. All 5 variables were included in the nomogram. When subjected to internal validation, the nomogram achieved a bootstrap-corrected concordance index of 0.626. When applied to the external validation cohort, the nomogram achieved a concordance index of 0.634. Calibration plots suggested that the nomogram was well calibrated for all predictions. CONCLUSIONS Based on routinely measured pretreatment variables, a nomogram was constructed that predicts survival in patients with unresectable and/or metastatic urothelial cancer who are treated with cisplatin-based chemotherapy. This model may be useful in patient counseling and clinical trial design. © 2013 American Cancer Society.


PubMed | HELIOS Hospital, National Taiwan University Hospital, Indiana University, McMaster University and 4 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

256 Background: Models to predict the outcome of pts with metastatic UC, based on pre-treatment variables, have previously been developed. However, pts often request updated prognostic estimates based on their response to treatment. This is particularly relevant in first-line treatment of metastatic UC, a disease state for which a fixed number of cycles of chemotherapy are typically administered.Data were pooled from 317 pts enrolled on eight trials evaluating first-line cisplatin-based chemotherapy in metastatic UC. Variables were combined in a Cox proportional hazards model to produce a nomogram to predict survival from end of treatment. The nomogram was validated externally using data from a trial of MVAC versus docetaxel plus cisplatin (n=148).The median survival from end of treatment was 10.65 months [95% CI 9.20 - 13.24]; 69% of patients had died. Baseline (white blood count, ECOG performance status, number of visceral metastatic sites) and post-treatment (treatment response, duration of treatment, reason for treatment discontinuation) variables were evaluated. The Cox proportional hazard model is shown in the Table. The duration of treatment and reason for treatment discontinuation were not significantly associated with survival. The four significant variables were included in a nomogram. The nomogram achieved a bootstrap-corrected concordance index of 0.68. Upon external validation, the nomogram achieved a concordance index of 0.67.A model derived from pre- and post-treatment variables was constructed to predict survival from the end of first-line chemotherapy in pts with metastatic UC. This model may be useful for pt counseling and for stratification of trials exploring maintenance treatment. [Table: see text].


PubMed | HELIOS Hospital, National Taiwan University Hospital, Indiana University, National and Kapodistrian University of Athens and 3 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

251 Background: Advances in the first-line treatment of metastatic urothelial cancer (UC) have proven elusive. The lack of appropriate intermediate endpoints to screen the activity of novel regimens may be a barrier to progress, particularly in this disease state characterized by relatively high response rates but short response durations. Progression-free-survival (PFS) at fixed time points may overcome several of the limitations of response rate-based endpoints, but would be further supported by establishing benchmarks and demonstrating a correlation between PFS and overall survival (OS).Data were pooled from eight phase II and III trials evaluating first-line cisplatin-based chemotherapy in metastatic UC. Landmark analyses for progression at 3, 6, and 9 months after treatment initiation were performed to minimize lead-time bias. A proportional hazards model was used to assess the utility of PFS for predicting OS.545 patients were included in the analysis. The median PFS was 7.75 months (95% CI, 7.06, 8.18) and the median OS was 12.35 months (95% CI, 10.97, 13.44). The results of the landmark analysis, adjusted for performance status 1 and presence of visceral metastases, is shown in the Table. By using the Fleischer model, the estimated correlation between PFS and OS was 0.86 (bootstrap standard error 0.001, 95% CI 0.83, 0.89).PFS at 3, 6, and 9 months predicted OS in this analysis of patients with metastatic UC treated with first-line cisplatin-based chemotherapy. This analysis provides benchmarks, and support, for the use of PFS as an endpoint for phase II trials screening the activity of novel regimens as first-line treatment for metastatic UC. [Table: see text].


PubMed | HELIOS Hospital, McKesson, National Taiwan University Hospital, Indiana University and 5 more.
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2017

269 Background: Cisplatin-based combination chemotherapy is considered standard first-line treatment for patients with metastatic urothelial carcinoma. However, cisplatin-based chemotherapy is frequently avoided in elderly patients due to concerns regarding treatment-related toxicities. We analyzed the efficacy, and tolerability, of cisplatin-based chemotherapy in two age groups (< 70 versus 70 years old).Individual patient data was pooled from eight phase II and III trials evaluating cisplatin-based first-line chemotherapy in patients with metastatic urothelial carcinoma. Toxicities, treatment delivery, response proportions, and survival outcomes were compared between patients < 70 versus 70 years old.Of the 543 patients included in the analysis, 162 patients (30%) were 70 years old. Patients 70 years old had a significantly lower baseline calculated creatinine clearance (57 vs. 73 ml/min, p<0.0001). All other baseline characteristics, including PS and visceral metastases were well balanced between the two age groups. Patients 70 years received a median of 1 cycle less of chemotherapy compared with younger patients (median cycles 5 versus 6; p = 0.004). There was no significant difference in the proportions of patients experiencing Grade 3-4 renal failure, febrile neutropenia, or treatment-related death. Response rate among patients 70 years old was 50% compared to 52% for patients < 70 years old (p=0.65). There was no significant difference in survival between the age groups (p=0.91). The median survival of the patients 70 years old was 12.1 months compared to 12.8 months for patients < 70 years old. There was no significant difference in survival between age groups when controlling for baseline performance status and/or the presence of visceral metastases.Elderly patients, with adequate renal function and other baseline characteristics suitable for clinical trial enrollment, tolerate cisplatin-based chemotherapy similarly, and achieve comparable clinical outcomes, compared with their younger counterparts. Cisplatin-based therapy need not be withheld from such patients.


Leischker A.H.,Alexianer Krefeld GmbH | Kolb G.F.,Bonifatius Hospital
Zeitschrift fur Gerontologie und Geriatrie | Year: 2015

The prevalence of vitamin B12 deficiency increases with age. Patients with dementia and spouses of patients with dementia are at special risk for the development of vitamin B12 deficiency. In a normal diet this vitamin is present only in animal source foods; therefore, vegans frequently develop vitamin B12 deficiency if not using supplements or foods fortified with cobalamin. Apart from dementia, most of these manifestations are completely reversible under correct therapy; therefore it is crucial to identify and to treat even atypical presentations of vitamin B12 deficiency as early as possible.This article deals with the physiology and pathophysiology of vitamin B12 metabolism. A practice-oriented algorithm which also considers health economic aspects for a rational laboratory diagnosis of vitamin B12 deficiency is presented.In cases with severe neurological symptoms, therapy should be parenteral, especially initially. For parenteral treatment, hydroxocobalamin is the drug of choice. © 2014, Springer-Verlag Berlin Heidelberg.


Leischker A.H.,Alexianer Krefeld GmbH | Kolb G.F.,Alexianer Krefeld GmbH
Internistische Praxis | Year: 2016

Even mild anemia results in significantly decreased quality of life and reduced survival rate. Therefore, even mild anemias in the elderly should be worked up and treated. About one third of anemias in older people is caused by iron or vitamin deficiency and one third by chronic diseases. No cause of anemia can be evaluated in another third. Diagnosis of anemias in the elderly is much more challenging than in younger people: In the elderly, often more than one cause of anemia coexists. Therapy of anemia is based on the specific cause or the causes. In Iron Deficient Anemia (IDA), the first step is - beside treatment of the specific cause of the iron deficiency - to replace iron via the oral route. If oral iron replacement is not tolerated because of side effects or does not lead to a sufficient rise in the haemoglobin level, intravenous iron replacement therapy is indicated. New intravenous iron formulations have fewer serious side effects than older preparations. In addition, with newer formulations higher doses of iron can be applied during one session. In many cases, one single injection or infusion of iron is able to restore decreased iron storages. Folate deficiency is generally treated by oral preparations of folic acid; vitamin B12 deficiency is generally treated by parenteral replacement of hydroxycobalamin. Anemias caused by chronic kidney disease or by low risk myelodysplastic syndromes can - besides treating the underlying disease - be treated with erythrocyte-stimulating factors.


Ihl R.,Alexianer Krefeld GmbH
International Journal of Psychiatry in Clinical Practice | Year: 2013

Objective. We review four randomised, controlled trials investigating the efficacy of Ginkgo biloba extract EGb 761® in elderly patients with Alzheimer or vascular dementia with neuropsychiatric features. Methods. Patients with a total score of 9-23 in the Syndrom-Kurz test (SKT) cognitive test battery (cognitive domain) and with a composite score 6 and greater in the Neuropsychiatric Inventory (NPI; behavioural domain) were included. Three trials compared 2 × 120 mg/day or 1 × 240 mg/day EGb 761® to placebo while one used donepezil as an active control. The duration of randomised treatment was 22 or 24 weeks. Results. One thousand, two hundred and ninety-four patients were analysed for efficacy. Patients treated with EGb 761® showed improvements of cognitive performance and behavioural symptoms that were associated with advances in activities of daily living and a reduced burden to caregivers. Placebo-treated patients, on the other hand, showed only minimal improvements or signs of progression. In each placebo-controlled trial, EGb 761® was significantly superior in all mentioned domains (p < 0.01). In the actively controlled trial, EGb 761® and donezepil as well as a combination of both drugs had similar effects. Conclusions. The review supports the efficacy of EGb 761 ® in age-related dementia with neuropsychiatric features. The drug was safe and well-tolerated. © 2013 Informa Healthcare.


Leischker A.H.,Alexianer Krefeld GmbH | Leischker A.H.,Alexianer Tonisvorst GmbH
Unfallchirurg | Year: 2016

In the elderly, fractures and other severe injuries frequently lead to substantial restrictions in the activities of daily living (ADLs) resulting in dependency. Typical complications following a fracture include acute delirium, deep vein thrombosis, pneumonia and other infections. It has been demonstrated that early surgery (osteosynthesis) and early mobilization significantly decrease the risk of these complications. An interdisciplinary cooperation between orthopedic surgeons and geriatricians leads to a shorter length of hospitalization, better mobility and, most importantly, to an improvement in the quality of life. Furthermore, treatment on an interdisciplinary orthogeriatric traumatology ward can prevent patients becoming reliant on long-term care and therefore decreases the risk of being admitted to a nursing home. The role of the geriatrician in the treatment of orthogeriatric patients includes treatment of internal medical comorbidities, geriatric assessments, coordination of the geriatric team as well as diagnostics and treatment of osteoporosis. In the future, the geriatrician’s task will include the preoperative evaluation of orthogeriatric patients, which is already a routine procedure in many orthogeriatric centers. The aim of this article is to summarize the evidence from the currently available literature for interdisciplinary treatment of orthogeriatric patients and to give an overview of the diagnostic and therapeutic interventions relevant to the routine practice for the orthopedic surgeon. © 2015, Springer-Verlag Berlin Heidelberg.


Giving fluids via the subcutaneous route is a safe and effective technique for the prophylaxis and for the treatment of dehydration. Side effects occur rarely when using this access route compared to the intravenous route, which has a much higher rate of side effects. Subcutaneous infusions can be used to treat inpatients in a hospital setting, in nursing homes, and in patients living at home. One great advantage of the subcutaneous route is that it is not necessary to have a physician to prepare a subcutaneous line, which can also be performed by trained nursing staff. Agitated patients who frequently pull out their lines themselves are a group where the subcutaneous route is particularly useful. Subcutaneous infusions can avoid the necessity for admission of geriatric patients to a hospital. © Springer-Verlag 2012.


According to evidence-based data and comprehensive experiences depot-antipsychotics are valuable therapeutical options to ensure long-term adherence in the therapy of schizophrenia. Aripiprazole depot is a second generation depot-antipsychotic that claims to protect schizophrenic-patients against relapse in long-term therapy, to avoid hospitalization and thus to influence psychosocial functioning and prognosis of the patients positively. Clinical data of efficacy and safety and first experiences with the new depot formulation confirm that aripiprazole significantly reduces the relapse-rate compared with placebo. Thereby, it combines the known efficacy and safety profile of oral aripiprazole with the advantages of a sustained drug concentration of aripiprazole over one month.

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