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Hannover, Germany

Torres A.,University of Barcelona | Blasi F.,University of Milan | Peetermans W.E.,University Hospital | Viegi G.,CNR Institute of Clinical Physiology | And 2 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2014

The purpose of this paper was to generate up-to-date information on the aetiology of community-acquired pneumonia (CAP) and its antibiotic management in adults across Europe. Structured searches of PubMed identified information on the aetiology of CAP and its antibiotic management in individuals aged >15 years across Europe. We summarise the data from 33 studies published between January 2005 and July 2012 that reported on the pathogens identified in patients with CAP and antibiotic treatment in patients with CAP. Streptococcus pneumoniae was the most commonly isolated pathogen in patients with CAP and was identified in 12.0-85.0 % of patients. Other frequently identified pathogens found to cause CAP were Haemophilus influenzae, Gram-negative enteric bacilli, respiratory viruses and Mycoplasma pneumoniae. We found several age-related trends: S. pneumoniae, H. influenzae and respiratory viruses were more frequent in elderly patients aged ≥65 years, whereas M. pneumoniae was more frequent in those aged <65 years. Antibiotic monotherapy was more frequent than combination therapy, and beta-lactams were the most commonly prescribed antibiotics. Hospitalised patients were more likely than outpatients to receive combination antibiotic therapy. Limited data on antibiotic resistance were available in the studies. Penicillin resistance of S. pneumoniae was reported in 8.4-20.7 % of isolates and erythromycin resistance was reported in 14.7-17.1 % of isolates. Understanding the aetiology of CAP and the changing pattern of antibiotic resistance in Europe, together with an increased awareness of the risk factors for CAP, will help clinicians to identify those patients most at risk of developing CAP and provide guidance on the most appropriate treatment. © 2014 The Author(s).

Rummel M.J.,Justus Liebig University | Niederle N.,Klinikum Leverkusen | Maschmeyer G.,Ernst von Bergmann Klinikum | Banat G.A.,Justus Liebig University | And 16 more authors.
The Lancet | Year: 2013

Background: Rituximab plus chemotherapy, most often CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), is the first-line standard of care for patients with advanced indolent lymphoma, and for elderly patients with mantle-cell lymphoma. Bendamustine plus rituximab is effective for relapsed or refractory disease. We compared bendamustine plus rituximab with CHOP plus rituximab (R-CHOP) as first-line treatment for patients with indolent and mantle-cell lymphomas. Methods: We did a prospective, multicentre, randomised, open-label, non-inferiority trial at 81 centres in Germany between Sept 1, 2003, and Aug 31, 2008. Patients aged 18 years or older with a WHO performance status of 2 or less were eligible if they had newly diagnosed stage III or IV indolent or mantle-cell lymphoma. Patients were stratified by histological lymphoma subtype, then randomly assigned according to a prespecified randomisation list to receive either intravenous bendamustine (90 mg/m2 on days 1 and 2 of a 4-week cycle) or CHOP (cycles every 3 weeks of cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 on day 1, and prednisone 100 mg/day for 5 days) for a maximum of six cycles. Patients in both groups received rituximab 375 mg/m2 on day 1 of each cycle. Patients and treating physicians were not masked to treatment allocation. The primary endpoint was progression-free survival, with a non-inferiority margin of 10%. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00991211, and the Federal Institute for Drugs and Medical Devices of Germany, BfArM 4021335. Findings: 274 patients were assigned to bendamustine plus rituximab (261 assessed) and 275 to R-CHOP (253 assessed). At median follow-up of 45 months (IQR 25-57), median progression-free survival was significantly longer in the bendamustine plus rituximab group than in the R-CHOP group (69·5 months [26·1 to not yet reached] vs 31·2 months [15·2-65·7]; hazard ratio 0·58, 95% CI 0·44-0·74; p<0·0001). Bendamustine plus rituximab was better tolerated than R-CHOP, with lower rates of alopecia (0 patients vs 245 (100%) of 245 patients who recieved ≥3 cycles; p<0·0001), haematological toxicity (77 [30%] vs 173 [68%]; p<0·0001), infections (96 [37%] vs 127 [50%]); p=0·0025), peripheral neuropathy (18 [7%] vs 73 [29%]; p<0·0001), and stomatitis (16 [6%] vs 47 [19%]; p<0·0001). Erythematous skin reactions were more common in patients in the bendamustine plus rituximab group than in those in the R-CHOP group (42 [16%] vs 23 [9%]; p=0·024). Interpretation: In patients with previously untreated indolent lymphoma, bendamustine plus rituximab can be considered as a preferred first-line treatment approach to R-CHOP because of increased progression-free survival and fewer toxic effects. Funding: Roche Pharma AG, Ribosepharm/Mundipharma GmbH.

Introduction: Academisation, as intended by the health allied professions (i. e., physiotherapy, occupational therapy, speech and swallowing therapy), is not restricted to an education at a higher level, but also includes the claim for active research in separate and independent university institutes. Focussed on the situation in Germany, the present study examines the advantages and drawbacks of this development from the perspective of the medical specialty of Physical Medicine and Rehabilitation (PMR) in order to find adequate strategies to cope with future challenges. Methods: Based on available literature including comments and position papers, the pros and cons of academisation were critically examined, separately regarding objective medical and economic arguments and consequences as well as specific interests of the different health care professions. Results: An academic education of at least a portion of all therapists may lead to a more reflective clinical use of therapies according to the principles of evidence based medicine, although there is currently no clear-cut evidence for its superiority when compared with conventional college education. Other advantages are an improved qualification of college teachers, the acquisition of management skills, and the education of motivated and well educated therapists who may participate in scientific projects. Objections may be raised towards a direct access of patients to therapists as well as a general need for separate university institutes for the therapeutic professions in parallel to existing PRM units. Besides an improved quality of professional practice, the attempt to gain autonomy from physicians seems to be a strong motive for academisation of the health allied professions. Discussion: On the long term, there is a risk of a complete transfer of responsibilities for physical therapy and rehabilitation to the therapeutic professions with a corresponding reduced representation of the German PRM specialty at the university level. However, there are also chances inherent in this process, such as the education of qualified therapists to join scientific projects. Hence, deliberate strategies have to be elaborated to respond to these developments. © Georg Thieme Verlag KG Stuttgart · New York.

Introduction: In the last decade, an increasing number of randomized-controlled trials dealing with innovative new physiotherapeutic approaches for the treatment of Parkinsons disease have been published. Recent meta-analyses reflect this development by providing a much broader basis to evaluate their clinical effects. However, some discrepancies exist between these reports when regarding the selection of clinical trials and the estimation of therapeutic effects. The purpose of this review is to present an updated compilation of available evidence for beneficial effects of the different therapies and their clinical application. Methods: An electronic search was performed in the databases Medline, PubMed, and Google Scholar for meta-analyses, published between January 2000 and March 2014. Results: 8 meta-analyses could be identified. Level Ia evidence can be found for the efficacy of exercise, dance and cueing therapy. Also treadmill training reached level Ia evidence, although there are some discrepancies between 2 meta-analyses with different criteria for study selection. Tai Chi/Qigong and LSTV-BIG therapy reached Ib level, positive effects of a repetitive training of compensatory steps could be demonstrated on IIb level. No long lasting effect could be ascertained for whole-body vibration therapy. Positive effects of conventional physiotherapy on flexibility, and motor- and ADL functions are reported in only 3 studies. Effects sizes were always low to moderate, reaching up to 0.56. Almost all patients tested were in less advanced stages of their disease (i.e., Hoehn Yahr 2-3). General problems for an evaluation are a variable content, intensity and duration of tested treatments, as well as control groups with and without any therapy. Conclusion: The new physiotherapeutic concepts offer a promising new approach for treating symptoms of Parkinsons disease. Best effects can be expected in the treatment of bradykinesia and postural instability, so that the tested methods can be considered as a complementary approach to treat symptoms not sufficiently ameliorated by drug therapy or surgical intervention. Considering all published studies, a best practice concept is not yet available. © Georg Thieme Verlag KG Stuttgart, New York.

Poddubnyy D.,Charite - Medical University of Berlin | Rudwaleit M.,Endokrinologikum | Haibel H.,Charite - Medical University of Berlin | Listing J.,German Rheumatism Research Center | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Objective: To investigate the influence of non-steroidal anti-inflammatory drugs (NSAIDs) intake on radiographic spinal progression over 2 years in patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (SpA). Methods: 164 patients with axial SpA (88 with AS and 76 with non-radiographic axial SpA) were selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and the data on NSAIDs intake. Spinal radiographs were scored by two trained readers in a concealed randomly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) system. An index of the NSAID intake counting both dose and duration of drug intake was calculated. Results: High NSAIDs intake (NSAID index≥50) in AS was associated with lower likelihood of significant radiographic progression defined as an mSASSS worsening by ≥2 units: OR=0.15, 95% CI 0.02 to 0.96, p=0.045 (adjusted for baseline structural damage, elevated C reactive protein (CRP) and smoking status) in comparison with patients with low NSAIDs intake (NSAID index<50). This effect was most pronounced in patients with baseline syndesmophytes plus elevated CRP: mean mSASSS progression was 4.36±4.53 in patients with low NSAIDs intake versus 0.14±1.80 with high intake, p=0.02. In non-radiographic axial SpA, no significant differences regarding radiographic progression between patients with high and low NSAIDs intake were found. Conclusion: A high NSAIDs intake over 2 years is associated with retarded radiographic spinal progression in AS. In non-radiographic axial SpA this effect is less evident, probably due to a low grade of new bone formation in the spine at this stage..

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