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Schaefer M.,Psychotherapy and Addiction Medicine | Sarkar R.,Asklepios Westklinikum Hamburg | Knop V.,Goethe University Frankfurt | Effenberger S.,Charite - Medical University of Berlin | And 18 more authors.
Annals of Internal Medicine | Year: 2012

Background: Depression is a major complication during treatment of chronic hepatitis C virus (HCV) infection with interferon-α (IFN-α). It is unclear whether antidepressants can prevent IFN-induced depression in patients without psychiatric risk factors. Objective: To examine whether preemptive antidepressant treatment with escitalopram can decrease the incidence or severity of depression associated with pegylated IFN-α in HCV-infected patients without a history of psychiatric disorders. Design: Randomized, multicenter, double-blind, prospective, placebo-controlled, parallel-group trial. (ClinicalTrials.gov registration number: NCT00136318) Setting: 10 university and 11 academic hospitals in Germany. Patients: 181 HCV-infected patients with no history of psychiatric disorders enrolled between August 2004 and December 2008. Intervention: Escitalopram, 10 mg/d (n = 90), or placebo (n = 91) administered 2 weeks before and for 24 to 48 weeks during antiviral therapy. Measurements: The primary end point was the incidence of depression, defined as a Montgomery-Asberg Depression Rating Scale (MADRS) score of 13 or higher. Secondary end points were time to depression, incidence of major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, quality of life, sustained virologic response, tolerability, and safety. Results: 32% (95% CI, 21% to 43%) of the patients in the escitalopram group developed a MADRS score of 13 or higher compared with 59% (CI, 48% to 69%) in the placebo group (absolute difference, 27 percentage points [CI, 12 to 42 percentage points]; P < 0.001). Major depression was diagnosed in 8% of the patients in the escitalopram group and 19% in the placebo group (absolute risk difference, 11 percentage points [CI, 5 to 15 percentage points]; P = 0.031). Tolerability and safety parameters did not differ between the groups. In the escitalopram group, 56% (CI, 46% to 66%) of patients achieved a sustained virologic response compared with 46% (CI, 37% to 57%) in the placebo group (P = 0.21). Limitations: Results might not be generalizable to patients with previous psychiatric disease. Some patients withdrew or developed temporary elevated MADRS scores after randomization but before the study medication was started. Conclusion: Prophylactic antidepressant treatment with escitalopram was effective in reducing the incidence and severity of IFN-associated depression in HCV-infected patients without previous psychiatric disease. Primary Funding Source: Roche Pharma and Lundbeck. © 2012 American College of Physicians. Source


Madlener K.,Hamostaseologie und Transfusionsmedizin | Hamm C.,Universitatsklinikum Giessen Marburg
Herz | Year: 2012

Two novel oral anticoagulants, namely the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitor rivaroxaban, have recently been approved for treatment of atrial fibrillation. They differ in many ways from vitamin K antagonists, including rapid onset of action, shorter half-life, fewer drug-drug interactions, lack of a need for monitoring and no need for titration or dose adjustments. Commonly available global coagulation time assessments (e.g. prothrombin time and activated partial thromboplastin time) are highly influenced by rivaroxaban and dabigatran but these assays are relatively insensitive. Ideally these anticoagulant agents would be assessable using a sensitive and standardized test with a linear dose-response curve. Optimized assays are currently under investigation and may quantify the anticoagulant effect. At present the therapeutic ranges for dose adjustment have not yet been established. © Urban & Vogel 2012. Source


The following paper provides an overview of refinancing of the services of Austrian healthcare institutions. Following an introduction to service-oriented healthcare institution financing of Austria, the example of radio-frequency kyphoplasty (DFine Europe GmbH) is used to illustrate its application to individual cases as an example. This procedure is particularly suitable since the augmentation of vertebral bodies has meanwhile become a standardized procedure and net benefits have been proven [1-4]. On the other hand, the procedure is innovative and improves on both clinical [5] and economic [6] constraints of conventional kyphoplasty procedures. It is furthermore possible to simulate various scenarios for added payments and deductions and outline the effects of added services without constructing complex clinical processes. Finally, there is a critical consideration of the illustration of radio-frequency kyphoplasty in the service-oriented hospital financing system, also against the background of guidance in healthcare policy. Source


The minimum common dietary salt requirement for adults amounts between 0,5 and 2,0 g/d. The upper limit of common salt consumption above whose the risk for cardiovascular diseases increases, is above 6 g/d. The optimal salt consumption can be estimated at 3-4 g/d. The present common salt consumption in western industrialized nations is with 8-12 g/d too high. Therefore, it is justified to recommend a decrease in the common salt consumption on 5-6 g/d to the general population. Possible risks of this recommendation are foreseeable and controllable. A general limitation of the common salt consumption is to achieve only by reduction of the salt content of processed foods (bread, cheese, meat and sausages), fast food, restaurant and canteen meals because 75-80% of common salt included daily are provided with these. The results in former investigations on unfavourable effects on lipid-, insulin- and uric acid values were only observed in short-time investigations with non-physiological, extreme common salt restriction. Slight increases of neurohormonal activities over long time (plasma renin, aldosterone, catecholamines) represents no cardiovascular risk factor. © 2011 Dustri-Verlag Dr. Karl Feistle. Source


Schaaf H.,Tinnitus Klinik Dr. Hesse im Krankenhaus Arolsen | Gieler U.,Universitatsklinikum Giessen Marburg
HNO | Year: 2010

Basic requirements and results of tinnitus retraining therapy (TRT) as well as other habituation therapies with psychotherapeutic approaches in the treatment of tinnitus are examined closely in this literature review. In German-speaking countries experts generally aim for involvement of psychotherapists beyond the classic TRT developed by Jastreboff and Hazell. On the basis of a validated diagnostic test such as the Tinnitus Questionnaire according to Hiller and Goebel (1998), such a therapy regime is more effective than the "classic" procedure. Under different treatment approaches, cognitive behavioural therapy elements have been proven to be effective-even as a component of the TRT-as well as integrated variants in psychodynamic therapies. We have to give consideration to the fact that in all studies about the selection and inclusion criteria selective test conditions were established which suggest that in each case diverse patient groups were studied. In the overall picture it becomes apparent that depending on the severity of the tinnitus and accompanying hearing problems a dysfunction-oriented and staged approach makes sense. © 2010 Springer-Verlag. Source

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