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Neu-Ulm, Germany

On average approximately 50 % of patients treated on European intensive care units (ICU) suffer from an infection. Also on German ICUs, an increase in the prevalence of multidrug-resistant bacteria as well as the consumption of antibiotics have been noted. The treatment of infections caused by multidrug-resistant bacteria is a significant challenge as they lead to prolonged hospital stays, higher mortality and higher logistic and financial expenditure for hospitals. Further aspects are the sluggish development of new antibiotic drugs by the pharmaceutical industry and frequent problems with the delivery of established antibiotics. In meeting this challenge, the S3 guideline strategies to enhance rational use of antibiotics in hospitals were published by the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) in 2013. In this article we describe several important aspects of an antibiotic stewardship (ABS) program in a German teaching hospital with specific examples from the ICU of the Department of Anesthesiology in the University Clinic in Ulm, Germany. © 2016 Springer-Verlag Berlin Heidelberg Source

Rohde G.,Ruhr University Bochum | Straube E.,Friedrich - Schiller University of Jena | Essig A.,Universitatsklinik Ulm | Reinhold P.,Institute For Molekulare Pathogenese | Sachse K.,Institute For Molekulare Pathogenese
Deutsches Arzteblatt

Background: Zoonoses were already a subject of intense interest even before the SARS and avian influenza epidemics arose. For many years, chlamydiae have been hypothesized to be important zoonotic pathogens, because of their wide distribution and their infectious cycle. This article provides an overview of the current state of knowledge on this subject. Methods: The authors present a selective review of the literature as well as their own findings. Results: The scientific knowledge of the distribution and infectious cycle of chlamydiae is still inadequate. The laboratory diagnosis of chlamydial zoonoses remains unsatisfactory in both human and vet erinary medicine, as there are no commercially available sensitive and species-specific tests. Acute chlamydial infections are usually treated with macrolides, tetracyclines, or quinolones. Persistent varieties are not covered by standard therapy. Conclusions: There is a considerable need for research on chlamydial infections, especially with regard to the diagnosis and treatment of persistent varieties. Source

Barrech A.,Universitatsklinik Ulm
Public Health Forum

The structural changes and economic crises of the past decades have led to an increase in job insecurity among employees worldwide (OECD, 1997; Eurofound, 2012). Current research suggests that job insecurity is a work-related stressor which can have detrimental effects on psychological, as well as somatic health (Greenhalgh and Rosenblatt, 2010). To date, there is a lack of studies on preventive approaches, especially in work-settings. With regards to the individual and societal implications of job insecurity, the validation of appropriate interventions is called for. Source

Sarcoidosis is a rare systemic disease characterized by noncaseating granulomas in affected organs. With > 90 % of all cases lung involvement is the most frequent site of manifestation of sarcoidosis, nevertheless multiple other organs can be affected. Extrapulmonary manifestations are lymph nodes, skin, nervous system, heart, eyes, bone marrow, spleen or gastrointestinal tract including liver and pancreas. Involvement of the gastrointestinal tract is rare, it can affect the whole intestine and is most frequently found in the stomach. Despite its infrequent manifestation, gastrointestinal sarcoidosis can have a significant clinical impact depending on the organ involved, so that early diagnosis is warranted. Medical treatment mainly consists of immunosuppressive therapy, most frequently with corticosteroids being the first treatment of choice. Dosage and duration of therapy is not well established yet. In the literature very limited data are available on this topic with randomized trials missing completely. The aim of this paper is to give a summary of the available data to this date. © Georg Thieme Verlag KG. Source

Up to one-third of all schizophrenic patients suffer from auditory verbal hallucinations (AVH) that are resistant to antipsychotics. The use of repetitive transcranial magnetic stimulation (rTMS) is a therapeutic option that may disrupt or attenuate treatment resistant (TR) AVHs. This article reviews the available literature on the use of rTMS to treat AVHs, particularly focusing on randomised controlled trials, which have introduced new definitions (refractory AVHs), and techniques (active comparator strategies and imaging-guided rTMS). A number of meta-analyses are considered, which support a range of positive effect sizes for AVH attenuation in response to rTMS. Larger maintenance and follow-up studies with clearer clinical definitions of TR AVH are required. The underlying mechanism of action of rTMS on language networks needs further clarification and future trials should focus on methods for assessing AVH changes, time courses of response, and the development of response markers. © Georg Thieme Verlag KG Stuttgart · New York. Source

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