Wiesbaden, Germany
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Ell C.,Dr Horst Schmidt Kliniken GmbH | Layer P.,Abt. Innere Medizin | Halphen M.,Norgine Ltd
Current Medical Research and Opinion | Year: 2014

Background: Colonoscopy requires effective bowel preparation for adequate mucosal visualization. Safety and acceptability of bowel preparation are key components in colorectal cancer screening (CRC) populations.Objective: To compare the efficacy, safety and acceptability of bowel preparation with polyethylene glycol (PEG), ascorbic acid, sodium ascorbate (ascorbate components), sodium sulfate and electrolytes (PEG+Asc) or sodium phosphate (NaP).Methods: Consenting adults undergoing elective out-patient colonoscopy for CRC were randomized to take 2 L PEG+Asc or 90 mL NaP (control) following manufacturer's instructions. PEG+Asc was taken the evening before and morning of the colonoscopy; NaP was taken the morning and evening before colonoscopy. Participants followed a restricted diet specific to each preparation. Primary endpoint was bowel cleansing success (100% colon mucosa visible) rated by an independent expert panel (all experienced endoscopists) unaware of treatment allocations. Subject reported outcomes about the preparations were elicited. Adverse events were recorded.Clinical trial registration: Clinicaltrials.gov: NCT00427089.Results: Successful bowel cleansing rate was significantly higher in the PEG+Asc (N=242) than the NaP (N=114) group (PEG+Asc 93.4% [95% CI 89.5-96.2] versus NaP 22.8% [15.5-31.6%], p<0.0001). Subject reported outcomes on acceptability of the two different preparations were not significantly different (p=0.238). However, taste ratings for PEG+Asc were significantly better versus NaP (mean VAS: 31.2 and 38.1 respectively, p=0.0111). The proportion of patients prepared to receive the same preparation again was significantly higher in the PEG+Asc group (88.4% vs. 78.1%, p<0.0001).Conclusions: PEG+Asc provided superior bowel cleansing to NaP and was well tolerated. Findings for PEG+Asc are aligned with previous similar studies; however, differences observed in NaP cleansing results, especially for the proximal colon segments, may be due to factors including: differences in demographics and population types and the use of the validated Harefield Cleansing Scale as an assessment tool combined with expert reviews, which may have resulted in conservative cleansing assessments. © 2014 All rights reserved: reproduction in whole or part not permitted.


Awa W.L.,University of Ulm | Boehm B.O.,University of Ulm | Kapellen T.,University of Leipzig | Rami B.,Medical University of Vienna | And 4 more authors.
European Journal of Endocrinology | Year: 2010

Objective: To investigate HLA-DR genotype in association with chronological age or calendar year of disease onset and the time trend of genotype frequencies from 1969 to 2009. Additionally, to examine genotype frequency in relation to B-cell-, islet cell antibodies (ICA)-, autoantibodies to insulin-, insulinoma antigen 2 (IA2)-, glutamic acid decarboxylase-antibody positivity, thyroid antibody positivity, thyroid diseases or coeliac antibody positivity. Genotype associations with gender and ethnicity are also analyzed. Subjects and methods: HLA-typed children and juveniles (n=1445) aged ≤20 years at disease onset from the German/Austrian DPV-database were examined. χ 2 statistics and mixed hierarchical logistic regression models were used to compare genotype frequencies and establish associations with age at disease manifestation, autoimmune antibodies/diseases, ethnicity and time trend. Results: Subjects aged <6 years predominantly carried the genotype HLA-DR3/4 (25.2%), whereas in subjects aged >12 years the most prevalent HLA-DR genotype was X/X (18.1%). IA2 positivity was associated with HLA-DR4/X and HLA-DR3/4 positivity (P=0.011), and hypothyroidism was linked to HLA-DR4/4 (P=0.0103). More females carried the HLA-DR4/4 genotype (18.2 vs 12.7% P=0.0048) or were thyroid antibody positive (24.5 vs 14.7% P=0.0001). Larger numbers of <6 year olds were coeliac antibody positive than >12 year olds (14.8 vs 9.1% P=0.0037). No associations between migration background and B-cell-, thyroid- or coeliac-antibody positivity, and no time trend were found. Conclusion: HLA-DR genotype associated with age at disease onset, ICA positivity and hypothyroidism; female gender with thyroid antibody positivity and low age of diabetes onset with coeliac antibody positivity. © 2010 European Society of Endocrinology.


Stein M.,Justus Liebig University | Misselwitz B.,Institute of Quality Assurance Hesse | Hamann G.F.,Dr Horst Schmidt Kliniken GmbH | Scharbrodt W.,Justus Liebig University | And 2 more authors.
Stroke | Year: 2012

Background and Purpose-In most European societies and in the United States, the percentage of patients ≥80 years has been rising over the past century. The present study was conducted to observe this demographic change and its impact on patients with intracerebral hemorrhage (ICH). Methods-We reviewed patients' data with the diagnosis of ICH from January 2007 to December 2009. All data were collected out of a prospective stroke registry covering the entire state of Hesse, Germany. Incidence rates and absolute numbers of patients with ICH for 2009 to 2050 were calculated. Results-Of 3448 patients, 34% had an age ≥80 years. Hospital mortality was 35.9% for patients ≥80 years and 20.0% for patients <80 years. Unfavorable outcome (modified Rankin Scale score >2) was more often found in patients ≥80 years compared with patients <80 years (84.9% versus 74.8%). By the year 2050, the proportion of all patients with ICH ≥80 years will be 2.5-fold higher than in 2009. The total number of ICH cases will increase approximately 35.2% assuming that ICH probability stays the same. The number of patients who die in the hospital will increase approximately 60.2%. The total number of patients with severe disability due to ICH will increase approximately 36.8%. Conclusions-If current treatment strategies according to age remain unchanged, an increase of in-hospital mortality and a higher proportion of patients who need lifelong care after ICH can be expected in the coming decades. © 2012 2012 American Heart Association, Inc.


PubMed | Dr. Horst Schmidt Kliniken GmbH, Community Hospital, Charité - Medical University of Berlin, 6 Hospital for Children and Adolescents and 6 more.
Type: Journal Article | Journal: Diabetes technology & therapeutics | Year: 2016

The latest American Association of Clinical Endocrinologists/American College of Endocrinologists consensus statement published in 2014 does not recommend continuous subcutaneous insulin infusion (CSII) in patients with mental health problems. This study investigated the use and discontinuation of CSII in daily routine care of type 1 diabetes (T1D) patients with or without comorbid mental disorders.Insulin-treated T1D patients (n=48,700) between 5 and 30 years of age (median [interquartile range], 15.6 [12.0-17.7] years) from the German/Austrian diabetes patient follow-up registry (DPV) were studied. A comorbid diagnosis and/or specific treatment of mental disorder was documented in 3,158 (6.5%) patients: attention-deficit hyperactivity disorder (ADHD), n=1,352; depression, n=692; eating disorders, n=395; needle phobia, n=319; anxiety/obsessive compulsive disorder (OCD), n=231; and psychosis and/or neuroleptic medication, n=169. Multivariable logistic regression with age, sex, diabetes duration, and migration background as independent variables was used to compare groups.After adjustment for confounders, use of CSII was more common in patients with depression (41.5%), anxiety/OCD (41.4%), or needle phobia (75.8%) compared with patients without mental disorders (34.6%) (each P<0.05). By contrast, psychotic patients (26.2%, P<0.05) used CSII less often, and patients with ADHD (36.3%) or eating disorders (33.9%) used it with a similar frequency. Compared with patients without mental disorders (5.1%), the rate of CSII discontinuation was higher in patients with ADHD (9.7%), depression (8.2%), or eating disorders (10.0%) (P<0.05, respectively) but similar in patients with anxiety/OCD (6.0%), psychosis (4.2%), or needle phobia (5.3%).In routine diabetes care, CSII use and discontinuation vary widely among T1D patients with mental disorders and indicate clear differences from the latest recommendations.


Al-Nawas B.,Universitatsmedizin Mainz | Grotz K.A.,Dr. Horst Schmidt Kliniken GmbH
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2011

Due to changing demographics in our society, there are an increasing number of patients with risk factors presenting for dental care. Unfortunately valid screening instruments to identify these patients are lacking. Especially in elderly patients, there is often an association between the high number of prescribed medications and oral symptoms. Using supportive therapy in oncology (e.g., radio(chemo)therapy) as an example, the role of modern dentistry and its interaction with general medicine is illustrated. Modern substances, e.g., antiangiogenetics, with still unknown side effects represent challenging new developments in the field of oral medicine. Even with some examples of positive representation of patients with risk factors in the health systems, e.g., § 28 SGB V, it is clear that the pressure on the costs in the health systems leads to an undertreatment of patients with risk factors. Only by adapting dental and postgraduate training with respect to these aspects, together with better financial reimbursement of the additional efforts, will this trend be overcome. © 2011 Springer Medizin Verlag.


Critically ill patients in the intensive care unit (ICU) are predisposed to pharmacokinetic drug interactions because of the complexity of the drug regimens received in the intensive care setting. Drugs may affect the absorption, distribution, metabolism and/or elimination of an object drug and consequently alter the intended pharmacologic response and potentially lead to an adverse event. The paper presents an overview of pharmacokinetic drug-drug interactions which can occur with commonly used drugs in the ICU and outlines the underlying types and mechanisms. © 2012 Springer-Verlag.


Stolz E.,Justus Liebig University | Hamann G.F.,Dr. Horst Schmidt Kliniken GmbH | Kaps M.,Justus Liebig University | Misselwitz B.,Geschaftsstelle Qualitatssicherung Hessen
Deutsches Arzteblatt | Year: 2011

Background: Using data from the mandatory quality assurance program for stroke care in Hesse, we analyze regional differences in thrombolysis rates and infer some ways in which care can be improved. Methods: We identified 7707 patients with acute ischemic stroke who were admitted to hospital within 3 hours of symptom onset in 2007 and 2008, and we determined the local thrombolysis rate district by district. In order to exclude the possibility that the observed local differences in thrombolysis rates might be accounted for, in large part, by off-label thrombolysis procedures, we further narrowed down the subgroup of patients who underwent thrombolysis to the 1108 patients admitted within 2 hours of symptom onset. We also analyzed the local thrombolysis rates for patients who were primarily referred to stroke units. Results: The overall thrombolysis rate among patients admitted within 3 hours of symptom onset was 19%, varying locally from 6% to 35%. Among patients admitted within 2 hours of symptom onset, the local thrombolysis rate ranged from 13% to 85%. Even in patients primarily referred to stroke units, the local thrombolysis rate ranged from 8% to 44% in the 3-hour group and from 16% to 62% in the 2-hour group. Conclusion: Local thrombolysis rates vary unexpectedly widely across the state of Hesse. The care of patients with acute stroke after they reach the hospital urgently needs critical reappraisal and improvement.


Rifampicin is an effective and important antibiotic in the treatment of tuberculosis. Due to its activity e. g. against resistant staphylococci (MRSA) it is increasingly used as a combination partner in the treatment of MRSA infections. Regardless of a still limited evidence in this indication, it is possible, that serious, clinically relevant pharmacokinetic interactions will occur. Due to its potency to induce CYP enzymes and transport proteins Rifampicin shows one of the highest potential for such drug interactions. Given the complex and diverse influences on metabolism and transport of other drugs, physicians should be aware of these interactions with concomitantly administered drugs. In general, for substances with a narrow therapeutic index the dosage of that medication has to be adjusted after the start and after discontinuation of rifampicin therapy. For some drugs the concomitant administration of rifampicin is contraindicated. The article provides an updated overview of the possible interactions.


Hohmann C.,Klinikum Fulda GAG | Eickhoff C.,Center for Drug Information and Pharmacy Practice | Kaemmerer W.,Dr. Horst Schmidt Kliniken GmbH | Schulz M.,Goethe University Frankfurt
Clinical and Applied Thrombosis/Hemostasis | Year: 2012

Despite the existence of antithrombotic guidelines, there is low compliance with these guidelines in clinical practice. Until now pharmacy interns (PIs) have not been involved in this process. The objectives were to involve PIs to evaluate compliance with antithrombotic guidelines for VTE prophylaxis in surgery patients, and in cases of noncompliance to carry out pharmaceutical interventions. The study was conducted in 7 hospitals in Germany involving 27 PIs within the project "Pharmacy interns on the ward" (P-STAT 2). Pharmacy interns determined the thromboembolic risk, documented antithrombotic medication, and checked the compliance with current antithrombotic guidelines. A total of 6491 patients were enrolled; 5695 patients received antithrombotic prophylaxis. Antithrombotic guideline was followed in 77.5% patients. Many patients are not receiving appropriate VTE prophylaxis or heparin bridging regimen despite the fact that evidence-based antithrombotic guidelines are available. Pharmacy interns may play an important role in antithrombotic management. © 2012 The Author(s).


Schutz N.,Dr. Horst Schmidt Kliniken GmbH | Marker-Hermann E.,Dr. Horst Schmidt Kliniken GmbH
Zeitschrift fur Rheumatologie | Year: 2012

Multiple myeloma (MM) is a disease of the elderly with an incidence of 4/100,000 per year and can occur as a comorbidity especially in elderly patients with rheumatoid arthritis (RA). For MM and also for RA interleukin-6 (IL-6) is a pathogenetically important cytokine in both disease events. This article presents the case of a female patient who achieved sustained remission of RA and stabilization of MM with quantitative reduction of paraprotein by treatment with tocilizumab. The question whether tocilizumab represents a meaningful treatment approach for treatment of RA when MM is also present will be discussed.

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