Vaccination coverage in immunosuppressed patients - Results of a regional health services research study [Impfschutz bei immunsupprimierten - Ergebnisse eines regionalen versorgungsforschungsprojekts]
Teich N.,Internistische Gemeinschaftspraxis fur Verdauungsund Stoffwechselkrankheiten |
Klugmann T.,Internistische Gemeinschaftspraxis fur Verdauungsund Stoffwechselkrankheiten |
Tiedemann A.,Klinikum St. Georg GGmbH |
Holler B.,University of Leipzig |
And 3 more authors.
Deutsches Arzteblatt | Year: 2011
Background: Patients with chronic inflammatory diseases are at elevated risk of infections that can be prevented by vaccination. This elevated risk is due not just to these patients' primary illnesses, but also to the immunosuppressive treatment that they often receive. We studied the vaccination rate in a random sample of patients with two types of inflammatory bowel dis ease (IBD), namely, Crohn's disease and ulcerative colitis. In particular, we asked unvaccinated patients why they had refused the vaccine. Methods: From April to September 2009, we gave a 38-item questionnaire to 203 consecutive patients with IBD (57% with Crohn's disease, 63% female, median age 36 years) who had not received vaccination counseling for at least one year, and inspected the patients' vaccination cards. We compared the findings to the current recommendations of the German Federal Standing Committee on Vaccination (Ständige Impfkommission). Results: 83% of the patients had a vaccination card. Substantial deficiencies in vaccination were found. Only 67% of the patients had been immunized against tetanus in the previous 10 years, and only 21% against pertussis. Only 28% were vaccinated against seasonal influenza in 2008, and only 9% had ever received antipneumococcal vaccine. A subgroup analysis in which we compared 39 patients taking TNF-blockers to 67 patients who never had any type of immunosuppressive treatment revealed no difference in vaccination rates. 80% of all patients said they were willing to receive all of the officially recommended vaccinations. 22% of all patients said they avoided vaccinations for fear of side effects, while 15% said they did so because their immune system was supposedly "not intact", and 9% because they feared vaccination would worsen their IBD. Conclusion: In this random sample, the vaccination rate fell far behind the recommendations. In particular, there was a marked discrepancy between patients' willingness to be vaccinated and the actual provision of vaccination. These findings imply that physicians need to be more aware of the possibly inadequate vaccination state of their immunosuppressed patients.
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2011.2.4.3-1 | Award Amount: 8.89M | Year: 2012
Patients with diabetes are at risk of developing diabetic nephropathy, which will ultimately result in the requirement for renal replacement therapy and is also associated with high cardiovascular morbidity and mortality. Detection of low concentrations of albuminuria in urine (microalbuminuria) is the current clinical standard for detecting those at significant risk and targeting preventive treatment. However, albuminuria is of low specificity at early stages of disease, and of considerable biological variability, hence a poor predictor at early stages of disease. In two independent studies we have demonstrated that urinary proteomics offers the prospect of detecting nephropathy earlier in the preclinical phase, enabling targeted treatment at an earlier stage. We propose to assess the potential of this technology to identify normoalbuminuric patients at risk and to target therapy with an aldosterone receptor antagonist (spironolactone) as add-on to recommended therapy including angiotensin converting enzyme (ACE) inhibition or angiotensin II receptor blockers (ARBs) according to national guidelines. We will test the following hypotheses: (1) urinary proteomics predicts progression of albuminuria (as a surrogate marker for the development of overt nephropathy) in a cohort of 3280 type 2 diabetic patients with normal urinary albumin excretion, and (2) early initiation of intensive preventive therapy directed by urinary proteomics reduces progression of albuminuria in those 20 % at high risk and thereby delay progression to overt nephropathy and spare treatment for those with low risk, paving the way of personalised medicine. This will be the first biomarker-directed therapy trial for primary prevention of diabetic kidney disease. Additional clinical and circulating biomarkers will be assessed and models to predict progression of albuminuria including clinical factors, biomarkers and proteomics will be developed.
Liebscher K.,Institute For Transfusionsmedizin Und Klinische Hamostaseologie |
Huschke K.,Klinikum St. Georg GGmbH |
Hammer T.,Klinikum St. Georg GGmbH
Anasthesiologie und Intensivmedizin | Year: 2013
Efforts to improve and assure quality in the field of haemotherapy have been promoted significantly during the past few years. In accordance with German guidelines (haemotherapy), the patient must be informed about the risk of an allogeneic blood transfusion prior to elective surgery if the transfusion can be expected to be associated with a risk above 10%. The process requires both a valid blood typing and antibody screening result. A sufficient amount of erythrocyte concentrates must also be provided. One problem consists in the estimation of the blood loss associated with the scheduled surgery in combination with the required transfusion products. However, since the perioperative transfusion frequency varies strongly, application of in-house data is mandatory. The establishment of a supply guideline for elective surgical interventions has hitherto proved a time-consuming procedure at our tertiary care hospital with its eleven fields of surgery. We have therefore developed a computer-aided process to create a blood supply guideline (in German: BBR). This concept uses data available in various hospital computer systems, e.g. KIS (PC-Blut, Martin Schmidt Softwareentwicklung GmbH, i.s.h.med, Siemens AG). The blood supply guideline does not need regular updating since its implementation in the software reflects the precise and current blood transfusion requirements pertaining to any observation period selected. © Anästh Intensivmed.
Teich N.,Internistische Gemeinschaftspraxis fur Verdauungs und Stoffwechselkrankheiten |
Schiefke I.,Klinikum St. Georg GGmbH
Aktuelle Ernahrungsmedizin | Year: 2011
Nutritional concepts in acute pancreatitis have changed. Early enteral nutrition widely replaced parenteral nutrition alone in severe acute pancreatitis. First trials suggest early oral refeeding as nutritional treatment of choice in patients with mild acute pancreatitis. In this review, we summarize the current knowledge on nutrition in acute pancreatitis and discuss future developments. © Georg Thieme Verlag KG Stuttgart · New York.
Thuss-Patience P.C.,Charité - Medical University of Berlin |
Kretzschmar A.,Klinikum St Georg GGmbH |
Dogan Y.,Charité - Medical University of Berlin |
Rothmann F.,Klinikum Ernst von Bergmann |
And 7 more authors.
British Journal of Cancer | Year: 2011
Background: No comparisons of different doses of docetaxel-capecitabine in patients with advanced gastric cancer have been performed. Methods: Patients with previously untreated metastatic/locally advanced gastro-oesophageal or gastric adenocarcinoma were enrolled in a prospective multicentre phase II trial. Two sequential cohorts received docetaxel 75 mg m2 (day 1) plus capecitabine 1000 mg m2 twice daily (days 1-14) (cohort I) or docetaxel 60 mg m2 (day 1) plus capecitabine 800 mg m2 twice daily (days 1-14) (cohort II) every 3 weeks. The primary end point was confirmed overall response rate. Results: In all, 91 patients were enrolled (cohort I, n=40; cohort II, n=51) and 87 were evaluable for efficacy (n=38, 49, respectively). Overall response rate was 50.0% in cohort I and 23.5% in cohort II (exploratory analysis, P=0.014). Median times to tumour progression and overall survival were 5.6 and 10.1 months in cohort I and 3.7 and 7.2 months in cohort II, respectively. Dose reductions for docetaxel and capecitabine were required in 50.0% and 57.5% of patients in cohort I and 11.8% and 15.7% in cohort II, respectively. Conclusion: Starting treatment with full doses and reducing promptly seems to be the more promisingly effective strategy than starting cautiously with lower doses. Docetaxel/capecitabine 75/2000 mg m 2 is a manageable, convenient outpatient combination with promising efficacy against advanced gastric cancer. © 2011 Cancer Research UK.
Guideline of the German Society for Nutritional Medicine (DGEM): Methodology for the guideline-update clinical nutrition [Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM): Methodik zum Leitlinien-Update Klinische Ernährung]
Stingel K.,University of Hohenheim |
Schutz T.,Universitatsmedizin Leipzig |
Koller M.,University of Regensburg |
Lochs H.,Innsbruck Medical University |
And 2 more authors.
Aktuelle Ernahrungsmedizin | Year: 2013
Purpose: Under the direction of the German Society of Nutritional Medicine the already existing guidelines of the German Society of Nutritional Medicine and the European Society for Clinical Nutrition and Metabolism (ESPEN) on the subjects Enteral Nutrition and Parenteral Nutrition will be updated and combined to one guideline on Clinical Nutrition. Methods: 13 interdisciplinary teams of altogether 96 experts in clinical nutrition were working on the guideline-update. A structured literature search applying a defined search strategy with inclusion criteria and specified keywords was the basis of the update. The strength of the evidence was evaluated according to published standards. Furthermore, the outcome-parameters of the trials were also evaluated by a system specially designed for this guideline-update. It was verified, if individual recommendations of other guidelines could be accepted or adapted. On this basis, recommendations were formulated which were not only based on the evidence levels of the studies but also on the judgment of the working groups concerning the consistence, clinical relevance and validity of the evidence. The initial recommendations were discussed and reworked under the nominal working group process. The voting of statements throughout the plenum took place in a preliminary voting and following consensus conference by the Delphi principle. Results: The several chapters of the guideline-update Clinical Nutrition reflect the current medical knowledge in the field of enteral and parenteral nutrition and summarize the evidence when nutritional support is indicated and which goals can be reached. They will be published gradually within a year. © Georg Thieme Verlag KG Stuttgart · New York.
Gutz S.,Klinikum St. Georg GGmbH
Atemwegs- und Lungenkrankheiten | Year: 2012
Patients with non-small-cell lung cancer who harbor an activating mutation of the epidermal growth factor receptor (EGFR) benefit regarding response, improvement of symptoms and progression-free survival significantly better from treatment with EGFR-tyrosine-kinase-inhibitors (TKI) compared to platinum-based chemotherapy. After a median time of 10 months several mechanisms as second-site mutations, MET-gene-amplification or overexpression of hepatocyte growth factor (HGF) induce a resistance to the TKI. Irreversible EGFR-TKI, MET-inhibitors or IGF-1-receptor-inhibitors are potential options to overcome the resistance and are currently proved in numerous trials. © 2012 Dustri-Verlag Dr. Karl Feistle.
Gille J.,Klinikum St. Georg GGmbH |
Seyfarth H.-J.,University of Leipzig |
Gerlach S.,Klinikum St. Georg GGmbH |
Malcharek M.,Klinikum St. Georg GGmbH |
And 2 more authors.
Anesthesiology Research and Practice | Year: 2012
Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia). Due to possible induction of hypotonic blood circulation, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine) should be administered with the greatest care. A method of treating elevations in pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone) in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike. © 2012 Jochen Gille et al.
Windisch W.,Witten/Herdecke University |
Storre J.H.,Witten/Herdecke University |
Storre J.H.,University Hospital Freiburg |
Kohnlein T.,Klinikum St. Georg GGmbH
Expert Review of Respiratory Medicine | Year: 2015
There is an ongoing discussion on whether long-term non-invasive positive pressure ventilation (NPPV) should be used in chronic hypercapnic chronic obstructive pulmonary disease (COPD) patients. Early trials had failed to show convincing physiological and clinical effects using NPPV with assisted modes of ventilation and rather low inflation pressures. In particular, long-term survival could not be improved and findings on health-related quality of life had been conflicting. Remarkably, high-intensity NPPV using higher inflation pressures and back-up rates has recently been shown to be capable of improving blood gases, lung function, and health-related quality of life. Subsequently, a large study using this technique also showed a substantial improvement in the prognosis in these patients. Therefore, there is now increasing evidence to support physiologically effective NPPV in hypercapnic COPD patients, but how to best select patients still needs to be defined. The present article summarizes the physiological background and the current evidence on NPPV in COPD in addition to future considerations. © 2015 Informa UK, Ltd.
Kohnlein T.,Klinikum St. Georg GGmbH
Atemwegs- und Lungenkrankheiten | Year: 2016
Patients with advanced stage COPD may develop chronic ventilatory insufficiency, which is associated with worsened overall prognosis. Long-term non-invasive ventilation is an option to treat ventilatory insufficiency. In the last decades, there was much debate about the application of non-invasive ventilation in chronic hypercapnic COPD patients. A recent large clinical trial revealed clear advantages for patients with long-term home non-invasive ventilation. The initiation of home non-invasive ventilation should only be considered in patients who had been stable and free of exacerbations over a period of at least 3 months. © 2016 Dustri-Verlag Dr. Karl Feistle.