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Therapy choices for cystic echinococcisis (CE) are stage-specific: surgical, minimally invasive, medical or observation without intervention. PAIR (percutaneous aspiration, instillation of a scolicide, and re-aspiration) has been considered the treatment of choice for uncomplicated echinococcal liver cysts. However, PAIR carries the risk of toxic cholangitis or hypernatremia and that the cyst frequently refills with bile after withdrawing the catheter. We treated a patient with a giant CE 1 liver cyst with puncture drainage (PD) under albendazole coverage. Drainage enabled us to monitor the morphology of protoscolices under praziquantel (PZQ) co-medication. Protoscolices degenerated within 5 days of PZQ 50 mg/kg/d. The cyst cavity solidified with no evidence of reactivation or secondary spread. Percutaneous treatments can replace surgery in a significant number or cases with hepatic CE. PD allows to assess microscopically the viability of protoscolices under co-medication with PZQ–albendazole and to avoid the instillation of topical scolicides.

Objectives Infections as a result of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP). Methods This prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks. Results Among all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16–3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17–6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62–5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64–6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068–2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses. Conclusions Clinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.

Die Lunge ist aufgrund ihres direkten Kontakts mit der Umwelt gegenuber einer Vielzahl von Viren exponiert. Im folgenden Beitrag werden Infektionen durch 4 virale Erreger dargestellt, die zu pulmonalen Manifestationen fuhren konnen, die in Deutschland aufgrund ihrer Seltenheit wenig bekannt sind. Bei der zoonotischen Influenza, dem „Middle East respiratory syndrome“ (MERS) und der Infektion durch Hantaviren handelt es sich um zoonotische Infektionen, wahrend es sich bei den Masern um eine rein humane Erkrankung handelt. Allen 4 Infektionen gemein sind die potenziell schweren pulmonalen Komplikationen mit hoher Mortalitat. Uber den einzelnen Patienten hinaus konnen die Masern, MERS und auch die zoonotische Influenza zu weiteren Ubertragungen mit weitreichenden Konsequenzen fuhren. Der Beitrag beleuchtet fur die jeweiligen Erreger relevante Aspekte von Epidemiologie, klinischem Verlauf, Therapie und Pravention. Diese Kenntnisse erscheinen wichtig, da jederzeit mit dem Auftreten von Fallen in Deutschland gerechnet werden muss.

Epidemiologische Studien zur Epilepsie sind in Deutschland immer noch rar. Die erste EPIDEG-Studie (EPIDemiology of Epilepsies in Germany) wurde 1995 durchgefuhrt, um die Pravalenz behandelter Patienten mit Epilepsie zu schatzen und ihre Versorgungssituation zu erfassen. Die EPIDEG-Studie wurde 2010 wiederholt, um zu untersuchen, ob sich die Pravalenz der Epilepsien und die Versorgungssituation geandert haben. Basierend auf einer Zufallsauswahl, erhielten 3991 Arzte verschiedener Fachrichtungen einen kurzen Erhebungsbogen, mit dem die Anzahl der behandelten Patienten mit Epilepsie, uberwiesenen Patienten, Patienten mit Anfallen und Patienten mit neu diagnostizierter Epilepsie im letzten Jahr erfasst wurden. Die Responderrate betrug 31,3 %. Die statistische Auswertung erfolgte mit explorativ-deskriptiven Verfahren. Die geschatzte Pravalenz behandelter Epilepsien war im Jahr 2010 mit 5,5 pro 1000 hoher als 1995 mit 4,7 pro 1000. Jedoch war 2010 der Anteil von anfallsfreien (>1 Jahr) Patienten bei Neurologen (70,3 % vs. 60,1 %) und Hausarzten (71,4 % vs. 57,6 %) deutlich hoher als 1995, wahrend dieser bei Kinderarzten (62,1 % vs. 62,3 %) unverandert blieb. Die geschatzte Anzahl der Patienten, die an Neurologen uberwiesen oder von diesen behandelt werden, ist von 193.000 auf 266.000 angestiegen. Inzwischen wird auch eine grose Anzahl von Kindern mit Epilepsie von Neuropadiatern (mit)behandelt. Die Anzahl von Epilepsiepatienten pro Neurologe ist in den neuen Bundeslandern weiterhin hoher als in den alten Bundeslandern, was die geringere Arztdichte von Neurologen in den neuen Bundeslandern widerspiegelt. Entsprechendes gilt fur Neuropadiater. Die Anzahl der Epilepsiepatienten in Deutschland ist gestiegen, wozu vermutlich die alter werdende Bevolkerung beigetragen hat. Die gleichzeitige Zunahme anfallsfreier Patienten weist auf eine verbesserte Behandlung und Versorgung hin.

Background First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. Objectives Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. Methods We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). Results Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp]. Conclusions Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.

Es werden Infektionen der Lunge durch Viren, Bakterien, Pilze und Parasiten dargestellt, die in Deutschland nicht endemisch und wenig bekannt sind. Die zoonotische Influenza, das „middle east respiratory syndrome“ (MERS) und die Pest konnen mit potenziell schweren pulmonalen Komplikationen mit hoher Mortalitat und der Gefahr einer nosokomialen Ausbreitung einhergehen, sodass Betroffene isoliert werden mussen. Die Melioidose, Blastomykose, Parakokzidioidomykose und Histoplasmose werden oft zunachst als ambulant erworbene Pneumonie mit typischem Erregerspektrum verkannt. Ein wichtiger Schlussel zur Diagnose ist die Anamnese mit Abfrage moglicher Expositionen in Endemiegebieten. Die Paragonimiasis manifestiert sich meist wenige Wochen nach dem Verzehr erregerhaltiger roher Meeresfruchte, typisch ist eine ausgepragte Eosinophilie. Es werden fur die jeweiligen Erreger relevante Aspekte von Epidemiologie, klinischem Verlauf, Therapie und ggf. Pravention beleuchtet, da jederzeit mit Fallen in Deutschland gerechnet werden muss.

There is lack of standardization of practices and limited evidence on efficacy and safety of nebulization of antimicrobials. We sought to determine inhalation practices in one tertiary care hospital by performing a cross-sectional survey. Eleven adult ICUs were included in the analysis. Three units followed established protocols. Ventilation circuit filters were exchanged at least daily in all but one units. Dosages of aminoglycosides and CMS depended on indication and unit. Nebulization of antimicrobials was generally regarded as safe and efficacious. Our data indicate that approach to nebulization of antimicrobials may be heterogeneous even in a single center. Electronic supplementary material The online version of this article (10.1007/s10096-020-04017-0) contains supplementary material, which is available to authorized users.

Background The burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization. Methods The study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers’ perception and knowledge about hand hygiene were assessed before and after the intervention. Results At baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p

Cystic echinococcosis (CE) is not covered by current refugee screening protocols. After we had detected CE among several refugees attending our clinic from Afghanistan and the Middle East, serological examinations for CE were performed for apparently healthy unaccompanied minor refugees from these regions.

Objective The objective of the present study was to collect systematic data on the care of adult patients with tuberous sclerosis complex (TSC) in German epilepsy centers, to describe the characteristics of patients in this age group, and to clarify whether and how the recommended interdisciplinary care is implemented. Methods This retrospective survey involved 12 major epilepsy centers in Germany. Aggregated data were collected based on an electronic questionnaire that addressed the sociodemographic data, characteristics of the epilepsy syndromes, and general healthcare setting of adult patients with TSC. Results The survey included 262 patients (mean age: 36.2 ± 9.0 years) with TSC, most of whom were reported to live in either a home for persons with a disability (37.0%), a residential care home (6.9%), or with their parents (31.1%). A further 13.0% were self-sustaining, and 8.8% were living with a partner. Most patients presented with focal (49.6%) or multifocal (33.2%) epilepsy, with complex partial, dialeptic, and automotor seizures in 66% of patients and generalized tonic–clonic seizures in 63%. Drug-refractory epilepsy was seen in 78.2% of patients, and 17.6% were seizure-free at the time of the survey. Of the 262 patients, presurgical diagnostics were performed in 27% and epilepsy surgery in 9%, which rendered 50% of these patients seizure-free. Renal screening had been performed in 56.1% within the last three years and was scheduled to be performed in 58.0%. Cases of renal angiomyolipoma were present in 46.9% of the patients. Dermatologic and pulmonary screenings were known to be planned for only few patients. Conclusion Despite TSC being a multisystem disorder causing considerable impairment, every fifth adult patient is self-sustaining or living with a partner. In clinical practice, uncontrolled epilepsy and renal angiomyolipoma are of major importance in adult patients with TSC. Most patients suffer from focal or multifocal epilepsy, but epilepsy surgery is performed in less than 10% of these patients. Interdisciplinary TSC centers may help to optimize the management of patients with TSC regardless of age and ensure early and adequate treatment that also considers the advances in new therapeutic options.

Education for patients, for families, for professionals, and for officials is one of the most important tools for improving knowledge about epilepsy and fighting discrimination. There are many educational initiatives worldwide, but they are often known only at a local level. Studies on epilepsy educational programs are rare and therefore published to a limited extent. The newly established International Bureau for Epilepsy (IBE) Education Commission enforces the exchange of educational activities and best practices, discussing education content and topics, target groups, and their educational needs, timing, tutors, and funding. A brief review of examples of all continents will be given. The needs for studies and for more exchange and closer cooperation will be addressed with proposals for further actions.

The prevalence and incidence of epilepsies in elderly is high. Due to demographic development, the portion of elderly patients with epilepsy will continue to rise over the next decades. In this study, we aimed to investigate seizure semiology, etiology, comorbidity, and therapy in elderly patients dependent on onset of epilepsy and in comparison with younger patients. In a prospective multicentre study, 202 epilepsy patients were included in a consecutive manner and subdivided into three groups (group A1: >65 years, onset of epilepsy after the age of 65 years; group A2: >65 years with early onset epilepsy, seizure onset before the age of 50 years; and group B

Objective To estimate the changes in direct and indirect costs induced by patients with rheumatoid arthritis (RA) in German rheumatology, between 2002 and 2011. To examine the impact of functional status on various cost domains. To compare the direct costs incurred by patients at working age (18–64 years) to patients at an age of retirement (≥65 years). Methods We analysed data from the National Database of the German Collaborative Arthritis Centres with about 3400 patients each year. Costs were calculated using fixed prices as well as annually updated cost factors. Indirect costs were calculated using the human capital as well as the friction cost approaches. Results There was a considerable increase in direct costs: from €4914 to €8206 in patients aged 18–64, and from €4100 to €6221 in those aged ≥65, attributable to increasing prescription of biologic agents (18–64 years from 5.6% to 31.2%, ≥65 years from 2.8% to 19.2%). This was accompanied by decreasing inpatient treatment expenses and indirect costs due to sick leave and work disability. The total growth of cost, on average, was €2437–2981 for patients at working age, and €2121 for patients at retirement age. Conclusions The increase in treatment costs for RA over the last decade was associated with lower hospitalisation rates, better functional status and a lower incidence of work disability, offsetting a large proportion of risen drug costs. Since the rise in drug costs has manifested a plateau from 2009 onwards, no relevant further increase in total costs for patients with RA treated in German rheumatology is expected.

SummaryObjective We investigated the efficacy of epilepsy nurses on satisfaction with counseling about epilepsy in a randomized, controlled, prospective trial. Methods Patients with epilepsy treated by neurologists in outpatient clinics were consecutively enrolled and randomly allocated to either the epilepsy nurse (EN) group (n = 92) or the control group (n = 95). Patients in the EN group were advised according to their needs by epilepsy nurses. The control group received routine care without additional counseling. The EN group completed the questionnaires before the first consultation (T1) and 6 months later (T2); the control group completed the questionnaires twice with an interval of 6 months. Primary outcome measure was satisfaction of patients with information and support. Secondary outcome measures were satisfaction with patient–doctor relationship, organization of treatment, epilepsy knowledge, coping, and restrictions in daily life. Anxiety and depression (Hospital Anxiety and Depression Scale) and global Quality of Life (item from QOLIE-31) were also assessed. Statistical analysis included generalized estimating equation (GEE) and nonparametric tests. Results Satisfaction with information and support improved significantly in the EN group compared to the control group (GEE, interaction group × time, p = 0.001). In addition, Epilepsy Knowledge (p = 0.014) and Coping (subscale Information Seeking) (p = 0.023) improved. Increase in satisfaction with counseling was dependent on patients' needs for information and on the amount of received information (Jonckheere-Terpstra test, p < 0.001). No differences between the groups were observed on other epilepsy-specific scales. Significance A reliable questionnaire for satisfaction with epilepsy care has been developed. Epilepsy nurses improve the satisfaction of patients with counseling and information about epilepsy and concomitant problems.

Introduction Despite the success of epilepsy surgery, recent reports suggest a decline in surgical numbers. We tested these trends in our cohort to elucidate potential reasons. Patients and methods Presurgical, surgical and postsurgical data of all patients undergoing presurgical evaluation in between 1990 and 2013 were retrospectively analysed. Patients were grouped according to the underlying pathology. Results A total of 3060 patients were presurgically studied, and resective surgery was performed in 66.8% (n=2044) of them: medial temporal sclerosis (MTS): n=675, 33.0%; benign tumour (BT): n=408, 20.0%; and focal cortical dysplasia (FCD): n=284, 13.9%. Of these, 1929 patients (94.4%) had a follow-up of 2 years, and 50.8% were completely seizure free (Engel IA). Seizure freedom rate slightly improved over time. Presurgical evaluations continuously increased, whereas surgical interventions did not. Numbers for MTS, BT and temporal lobe resections decreased since 2009. The number of non-lesional patients and the need for intracranial recordings increased. More evaluated patients did not undergo surgery (more than 50% in 2010–2013) because patients were not suitable (mainly due to missing hypothesis: 4.5% in 1990–1993 up to 21.1% in 2010–2013, total 13.4%) or declined from surgery (maximum 21.0% in 2010–2013, total 10.9%). One potential reason may be that increasingly detailed information on chances and risks were given over time. Conclusions The increasing volume of the presurgical programme largely compensates for decreasing numbers of surgically remediable syndromes and a growing rate of informed choice against epilepsy surgery. Although comprehensive diagnostic evaluation is offered to a larger group of epilepsy patients, surgical numbers remain stable.

OBJECTIVE: To examine the attitudes toward counseling about sudden unexpected death in epilepsy (SUDEP) and other epilepsy risk factors among Austrian, German, and Swiss neurologists and neuropediatricians, and to determine factors associated with not discussing SUDEP. METHODS: Questionnaires were sent to approximately 5,000 neurologists and neuropediatricians in 2014 regarding respondents' demographics, their working environments, and how often they discussed SUDEP, suicidal ideations on anticonvulsive medication, driving restrictions, and risks in daily life activities. RESULTS: In total, 519 surveys were completed (respondents' mean age: 45.5 years, 41.6% female, 66.9% adult neurologists, 31.0% neuropediatricians). A minority of 2.7% reported that they counseled all of their patients on SUDEP, 8.7% counseled most of the time (50-90%), 20.8% sometimes (10-49%), 44.5% rarely (1-9%), and 23.3% reported not counseling about SUDEP at all. In contrast, 92.9% reported that they counseled all patients about driving restrictions and 81.5% about risks in daily life activities. Suicidal ideations were discussed in 59.0% for some and in 3.3% for all patients, whereas 35.1% of respondents reported never discussing suicidal ideations. Independent predictors of not discussing SUDEP were no additional epilepsy training, no or uncertain SUDEP cases in the past

In den letzten Jahren haben geschlechtsspezifische Aspekte bei der Rheumatoiden Arthritis (RA) zunehmende Beachtung gefunden. Wahrend die Dominanz der Frauen und der fruhere Erkrankungsbeginn bei ihnen unumstritten sind, werden sowohl der unterschiedliche Phanotyp der RA bei den Geschlechtern sowie auch Veranderungen der RA in Abhangigkeit vom Manifestationsalter heftig diskutiert. Neben den aktuellen Daten aus der Rheumatologischen Kerndokumentation der Regionalen Kooperativen Rheumazentren wird die wesentliche aktuelle Literatur zu dieser Thematik ausgewertet. Dabei zeigt sich, dass Frauen mit RA eine deutlich grosere Krankheitslast aufweisen, gemessen mit der Schmerzangabe, der Krankheitsaktivitat und einer begleitenden Fibromyalgie-Symptomatik einschlieslich Fatigue. Der groste Unterschied zu den Mannern mit RA besteht im schlechteren Funktionsstatus der Frauen. Diese Differenz scheint sich im Krankheitsverlauf der RA noch weiter zu vergrosern. Zur radiologischen Progression liegen unterschiedliche Daten vor, diese Frage bleibt offen. Unbestritten ist, dass Manner schneller eine Remission der RA erreichen als Frauen. Die Grunde fur diese Differenzen werden diskutiert. Hormonelle Unterschiede und unterschiedlicher Korperbau scheinen eine ebenso wichtige Rolle zu spielen wie Unterschiede in der Verhaltensweise zwischen Mannern und Frauen. Weitere Studien zu diesen Fragen sind dringend notwendig. Es konnten sich daraus unterschiedliche Therapiestrategien fur Manner und Frauen entwickeln.

This article reports on the first efforts of systematically collecting national data regarding the prevalence of transsexualism and sex reassignment surgery (SRS) in Italy. The Italian Ministry of Health and the clinics offering such treatment were asked to cooperate by providing their data. Various problems were encountered in data collection, mainly due to the missing standardization of the record procedures in the clinics. The number of persons who underwent SRS, their age, nationality, the type of surgery and the sex ratio are reported. The resulting prevalence, lower than in other countries, suggests that the data is not complete. A standardization of the record procedures would make accessible full data and allow a reliable evaluation of the prevalence of transsexualism in Italy.

The objective of the study was a follow-up of the treatment outcome of Finnish transsexuals who sought sex reassignment during the period 1970–2002 and a comparison of the results and duration of treatment of compliant and noncompliant patients. Fifteen male-to-female transsexuals and 17 female-to-male transsexuals who had undergone hormone and surgical treatment and legal sex reassignment in Finland completed a questionnaire on psychosocial data and on their experience with the different phases of clinical assessment and treatment. The changes in their vocational functioning and social and psychic adjustment were used as outcome indicators. The results and duration of the treatment of compliant and noncompliant patients were compared. The patients benefited significantly from treatment. The noncompliant patients achieved equally good results as the compliant ones, and did so in a shorter time. A good treatment outcome could be achieved even when the patient had told the assessing psychiatrist a ...

The assessment of behavioral change as a result of inpatient treatment in forensic psychiatry is an important precondition for violence risk prediction in forensic psychiatry. In relation to a multitude of diagnostically based risk assessment instruments, there is a shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments that are behaviorally based and therefore appropriate for use within varied psychiatric contexts. There is also a need for instruments which will offer assessors the opportunity to examine possible relationships between criteria of social risk and criteria of more general aspects of social functioning. Tapping the issues pointed out above, the authors present an overview of a normatively based social profiling instrument (the BEST-Index), and discuss evidence for its validity, reliability, and aspects of clinical utility.

A survey on various issues related to the DSM-IV-TR gender identity disorder diagnosis was conducted among 201 organizations concerned with the welfare of transgender people from North America, Europe, Africa, Asia, Oceania, and Latin America. Forty-three organizations from all continents completed the survey. A majority of 55.8% believed the diagnosis should be excluded from the 2013 edition. The major reason for wanting to keep the diagnosis in the DSM was health care reimbursement. Regardless of whether groups were for or against the removal of the diagnosis, the survey revealed a broad consensus that if the diagnosis remains in the DSM, there needs to be an overhaul of the name, criteria, and language to minimize stigmatization of transgender individuals.

Inflammation is a central issue in medicine. Inflammatory processes may be local or systemic, acute or chronic, and they may be benign or fatal. In bacterial or viral infections fast and reliable diagnosis is essential for appropriate treatment, e.g. antimicrobial therapy. The time to diagnosis is critical because uncontrolled infections may lead to sepsis with a mortality rate close to 50%. Beside clinical signs, laboratory markers are important in detecting, differentiating, and monitoring inflammation, particularly acute infections. Currently several inflammation markers including leukocyte count and leukocyte differentiation, C-reactive protein (CRP), procalcitonin (PCT), and interleukins (IL) 6 and 8, is available, and potential future serum markers are under development. In this article the clinical use of these markers in routine laboratory and in point-of-care testing is described and the diagnostic value of the four groups of laboratory marker is compared. Current data show that leukocyte count or, better, neutrophil count, CRP, and PCT are well suited to support of rapid diagnosis of inflammation and infections in children and adults whereas measurement of IL-6 and 8 are preferable for detection of sepsis in neonates.

Background: Assessment of living skills and violence risk in forensic psychiatric patients is a priority for clinicians. Suitably fine-grained instruments are rare.Aim: We cross-validate a norm-based psychometric assessment battery (the Behavioral Status Index [BEST-Index]) against known valid instruments. Method: Parallel cohort studies were undertaken in five European countries. Inpatients (N = 231) from 24 forensic psychiatric clinics were assessed three times, using five instruments measuring living skills, psychological symptoms, aggression, and violence risk. Results: Positive clinical changes were noted in communication and living skills, with little change in violence risk, which was low to medium for 90 percent of patients. Clinical congruence was observed between logically cognate items of cross-validators and the BEST-Index. Discussion: Evidence for the scientific and clinical utility of the BEST-Index as an effective guideline for treatment priorities and outcomes is discussed.

PURPOSE The aim of the study was to evaluate the efficacy of the modular educational program for children with epilepsy and their parents (FAMOSES). This program was developed by an interdisciplinary project group to improve knowledge, coping, treatment outcome, emotional and practical adaptation to the condition. METHODS A prospective, controlled, multi-center, pre-post study design was used to examine the efficacy of the program in the treatment group compared to the waiting group (control group). Questionnaires included epilepsy specific scales regarding knowledge, attitudes, restrictions in daily living, epilepsy related fears, coping with the chronic disease and generic instruments (quality of life, KINDL). 55 parents of the treatment group completed the questionnaires three months before the course and three months later; the corresponding waiting group included 48 parents. Respectively, 31 children, who participated in the program, completed the questionnaires immediately before the course and three months later; the corresponding waiting group included 19 children. RESULTS Children, who attended the program, showed improvements in the domains perceived restrictions (significant, medium effect size), absence from school and seizure frequency. Not significantly greater compared to the control group were the improvements of knowledge, attitudes and fears regarding to the epilepsy. Parents of the treatment group showed significant enhancements in epilepsy specific knowledge (large effect size), attitudes toward the epilepsy, management of epileptic seizures and significant reductions of fears and restrictions of their child with epilepsy (small to medium effect sizes).

Epilepsy is a common neurological disease, which affects people of all ages. Patients often have deficits regarding their knowledge of epilepsy. Many of them have recurrent seizures, psychosocial, and emotional problems and report restrictions in daily living as a result of their epilepsy. Meanwhile, a variety of psychoeducational programs have been developed with the intention to improve knowledge, coping with epilepsy, quality of life, compliance, and health status. This review article discusses the content and designs of formal patient educational programs for persons with epilepsy and reviews their role in improving patient outcomes. A systematic research of medical and psychological literature reveals that a sizeable amount of literature has been produced within the last decade that focuses on (psycho-) educational programs for adults, adolescents, and children with epilepsy as well as their families. These educational programs vary considerably in regard to content, didactic approach, and objectives. It is sometimes difficult to differentiate educational programs from psychological treatments or other interventions (e.g. by specialist epilepsy nurses). Information given about the theoretical frameworks guiding interventions, teaching strategies, and methodological approach of the programs is often sparse or lacking. The crucial point is that only very few educational programs have been evaluated in a randomized controlled trial. Furthermore, the methods of evaluation (e.g. questionnaires, inclusion and exclusion criteria, randomization, follow-up period) vary substantially and sometimes the number of subjects included in the study is too small for sufficient statistical evaluation. Overall, from the small number of evaluated programs it is evident that educational programs can improve epilepsy-related knowledge, improve the management of seizures, and reduce misinformation and misconceptions about epilepsy. They can support adults, adolescents, and children with epilepsy and their families and enable them to cope with the disease; they can sometimes also reduce seizure frequency and improve compliance with antiepileptic drugs. The effects on emotional disorders (e.g. depression) and quality of life are less obvious. Evaluated or standardized psychoeducational programs are available for specific target groups of patients with epilepsy. The review indicates that it is reasonable to perform or to adapt these educational programs for the benefit of the patients. Future research should focus on controlled evaluation studies of educational programs.

Die Symptome epileptischer Anfalle im Alter konnen von den Symptomen epileptischer Anfalle im Kindes- und mittleren Erwachsenenalter abweichen und moglicherweise ubersehen werden. Wir untersuchten in einer Pilotstudie in Altenheimen, ob durch eine standardisierte Befragung bisher nicht erkannte Altersepilepsien diagnostiziert werden konnen. Berichtete Sturze, Bewusstseinsverlust und Krampfe waren die Kriterien fur weitere diagnostische Abklarungen. In der Gesamtstichprobe von 389 Bewohnern wurden 11 Bewohner mit einer Altersepilepsie (2,8%) identifiziert. Davon hatten 7 (1,8%) Bewohner eine bekannte Altersepilepsie, bei 4 (1%) Bewohnern wurde eine Epilepsie neu diagnostiziert. Weitere 5 (1,3%) Bewohner konnten nicht abschliesend geklart werden, so dass moglicherweise noch weitere Altersepilepsien bestanden. Das Ergebnis der Pilotstudie lasst vermuten, dass Altersepilepsien bei Bewohnern von Altenheimen erheblich unterdiagnostiziert werden. Eine fruhzeitige, korrekte Diagnose und Behandlung der Altersepilepsien ist sowohl im Hinblick auf die Prognose als auch auf die sozialen Folgen der Epilepsie von groser Bedeutung.

Porsche has built a new wind tunnel in its central R&D Center in Weissach. Significant improvements of this wind tunnel over the existing one include augmented ground effect simulation technologies, increased wind speed and suitability for aeroacoustic testing. Beyond this, the new wind tunnel is part of an integrated building complex, also comprising of a new automotive design facility and extensive model workshops. The present publication describes the fundamental ideas driving this concept, as well as technical key features of the new wind tunnel.

Summary: Purpose: To evaluate the efficacy of the educational program MOSES (Modular Service Package Epilepsy). It was developed to improve patients' knowledge and understanding about their epilepsy, its treatment, and psychosocial consequences. The program intends to improve patients' coping with the disease, to strengthen self-esteem, and to support patients to become experts in managing their epilepsy. Methods: A controlled, randomized study design was used to examine the efficacy of MOSES. Patients from 22 epilepsy centers in Germany, Austria, and Switzerland were randomly allocated to either MOSES group (treatment group) or waiting-list group (control group). The 242 patients were aged from 16 to 80 years. The MOSES group (n = 113) completed the questionnaires immediately before the educational course (T1) and 6 months later (T2), and the control group (n = 129), 6 months before (T1) and immediately before (T2) the course. The questionnaires included generic instruments (SF-36, Rosenberg self-esteem Scale, von Zerssen Depression Scale), and epilepsy-specific scales (Restrictions in Daily Life, Epilepsy-Related Fears, Coping with Epilepsy and Adaptation). Depression was used as a moderator variable. Seizure frequency and satisfaction with therapy also were assessed. Multivariate analysis of variance (MANOVA) with repeated measurements and univariate analyses of variance were performed. Results: The MANOVA showed that participants of the educational program improved significantly. Univariate analyses revealed improvements in knowledge (p < 0.001) and coping with epilepsy (p = 0.004), whereas important effects of MOSES on other epilepsy-specific measures and on generic questionnaires (SF-36, self-esteem) were not found. Participants of the MOSES program also improved in seizure outcome (p = 0.041) and became more satisfied with the therapy [better tolerability of antiepileptic drug (AED) therapy, fewer side effects; p = 0.014]. In addition, participants expressed being highly satisfied with the program. Conclusions: The study clearly indicates the need for patient education. Even patients with a long history of epilepsy and with additional handicaps or diseases benefitted from the MOSES program.

Item does not contain fulltext Background: Detailed neuropathological information on the structural brain lesions underlying seizures is valuable for understanding drug-resistant focal epilepsy. Methods: We report the diagnoses made on the basis of resected brain specimens from 9523 patients who underwent epilepsy surgery for drug-resistant seizures in 36 centers from 12 European countries over 25 years. Histopathological diagnoses were determined through examination of the specimens in local hospitals (41%) or at the German Neuropathology Reference Center for Epilepsy Surgery (59%). Results: The onset of seizures occurred before 18 years of age in 75.9% of patients overall, and 72.5% of the patients underwent surgery as adults. The mean duration of epilepsy before surgical resection was 20.1 years among adults and 5.3 years among children. The temporal lobe was involved in 71.9% of operations. There were 36 histopathological diagnoses in seven major disease categories. The most common categories were hippocampal sclerosis, found in 36.4% of the patients (88.7% of cases were in adults), tumors (mainly ganglioglioma) in 23.6%, and malformations of cortical development in 19.8% (focal cortical dysplasia was the most common type, 52.7% of cases of which were in children). No histopathological diagnosis could be established for 7.7% of the patients. Conclusions: In patients with drug-resistant focal epilepsy requiring surgery, hippocampal sclerosis was the most common histopathological diagnosis among adults, and focal cortical dysplasia was the most common diagnosis among children. Tumors were the second most common lesion in both groups. (Funded by the European Union and others.) 9 p.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Objectives: Due to demographic change and high incidence of epilepsy in elderly, the number of elderly with epilepsies is increasing. However, only few studies investigated the impact of epilepsy on quality of life (QoL). We investigated how epilepsy affects different aspects of QoL dependent on the age of the patients and the age of onset of epilepsy. Materials and methods: In a multicenter, cross-sectional study, three patient groups were recruited from five centers: Group A1: 45 elderly (≥65 years.) with late onset of epilepsy (≥65 years), group A2: 51 elderly (≥65 years.) with early-onset, long-lasting epilepsy (≤50 years), group B: 41 young adults (≤50 years) with epilepsy. Statistical analysis of differences between groups was performed using generalized linear models. Results: Elderly with late-onset epilepsy (group A1) had a significantly lower seizure frequency, were treated with less anti-epileptic drugs (AEDs), and reported a better tolerability of AED treatment, but had more comorbidities compared with groups A2 and B. After adjusting for seizure frequency, tolerability of AEDs and comorbidity, young adults (group B) reported the highest overall QoL, whereas patients of group A1 and A2 did not differ significantly. Epilepsy-related fears, especially fears of stigmatization, were significantly higher in elderly with long-lasting epilepsy compared with groups A1 and B. Conclusion: Seizure-related variables, tolerability of AEDs and comorbidity have a stronger impact on QoL and on restrictions due to epilepsy than age, age at onset of epilepsy or duration of epilepsy. However, some results indicate group-specific patterns of impairment and epilepsy-related fears.

By applying medium frequency (MF) powered twin magnetron arrangements, typical problems of reactive direct current (DC) sputter deposition of electrically insulating materials can be solved. Inherent properties of this new deposition method are a high ion bombardment of the substrate during deposition and the possibility to deposit transparent layers in the transition mode of the cathode characteristic. This leads to modified film properties compared to the DC method. This is shown here for the case of SnO 2 .

This article will touch on the following topics: the law and law reforms, incidence of sexual offenses, national survey studies, treatment, and a recently started research project on psychotherapy process research at the Department of Psychotherapy at Ulm University.

Two cubic-shaped phantoms of water equivalent (WE) material, one homogeneous and one with a lung substitute were used to simulate an intact breast. They were irradiated with a constant dose using an isocentric tangential field of 6- and 18-MV photons, respectively. The absorbed dose was measured at the isocentre for a range of the lateral distances of the isocentre from the edge of the phantoms. Four currently available treatment planning systems (TPS), two with a 2-dimensional (2-D) and two with a 3-dimensional (3-D) algorithm were used to calculate the dose at same points in each phantom. A comparison of the results showed that for the homogeneous phantom, the 2-D algorithms over-estimated the dose by up to 10% for 6-MV photons at an isocentre depth of 1 cm laterally below the surface and 3.6% for 18-MV photons at 2 cm below the surface. For the 3-D algorithms, agreement with measurement was within ±3% at all lateral isocentre depths for both energies. For the inhomogeneous phantom, as expected, the differences were generally greater as all 4 TPS ignore electron transport and photon scatter from heterogeneities. Agreement with measurement generally improved with increasing lateral depth of the isocentre below the surface. Calculations using an anatomical breast phantom showed that when changing from a 2-D to a 3-D algorithm, differences of 5–10% between the prescribed dose and the dose delivered to the patient can be expected, depending on the algorithm used, the photon energy and the lateral depth of the dose reference point below the skin.

Aim: The long-acting insulin analogue detemir (Levemir®) has structural and physicochemical properties which differ from human insulin. The aim of the present study was to test whether this leads to altered hormone and symptom response during hypoglycaemia. Methods: 12 healthy subjects [6f/6m, age 32 ± 6 years (mean ± s.d.), body mass index (BMI) 24.2 ± 2.5 kg/m2] underwent a 200-min stepwise hypoglycaemic clamp (45 min steps of 4.4, 3.7, 3.0 and 2.3 mmol/l) with either detemir or human insulin in random order. A bolus of detemir (660 mU/kg) or human insulin (60 mU/kg) was given before insulin was infused at a rate of 5 (detemir) or 2 (human insulin) mU/kg/min. Blood was drawn and a semi-quantitative symptom questionnaire was administered before and after each plateau of the hypoglycaemic clamp. Cognitive function was assessed during each step. Results: Blood glucose levels and glucose infusion rates were comparable with detemir and human insulin. The total symptom score was higher with detemir during the 3 and 2.3 mmol glucose step compared to human insulin (p = 0.048). Especially sweating was increased with detemir (p = 0.02) with an earlier and faster increase during the clamp (interaction insulin × time: p = 0.04). No significant differences between detemir and human insulin in cortisol, norepinephrine, epinephrine, glucagon, growth hormone, lactate or free fatty acid (FFA) levels during hypoglycaemia were observed, and there were no significant differences in cognitive function tests. Conclusions: Insulin detemir increased symptom awareness during hypoglycaemia compared to human insulin in healthy individuals, whereas counter-regulatory hormone response and cognitive function were unaltered.

Summary Aim of the study To find determinants of quality of life (QOL) in long-term follow-up after temporal lobe epilepsy (TLE) surgery in adults. Methods The QOLIE-31 questionnaire was sent to 400 of 524 patients who were operated on for refractory TLE between 1991 and 2003 in the Bethel Epilepsy Centre fulfilling the inclusion criteria of this study. Mainly patients with severe cognitive deficits and patients with progressive brain disorders were excluded. There were 222/400 patients who replied to the QOLIE-31 questionnaire and 147/222 of these patients replied to an additional questionnaire. Results Univariate analyses showed that seizure freedom, presence of auras, intake of antiepileptic drugs (AEDs), severity of AED side effects, and driving a car were significantly correlated with all subscales of QOLIE-31. Furthermore, employment status, psychiatric problems, tumors and hippocampus sclerosis pathology, the presence of a partner, age at reply, age at surgery and medical co-morbidities were significantly correlated with some subscales of the QOLIE-31. Multivariate analyses (stepwise regression analyses) revealed that especially the time since the last seizure and the severity of AED side effects had a strong impact on QOL. However, aura at last follow-up, psychiatric treatment and employment were seen in the multivariate analyses as significant predictors of some QOL subscales as well. Most subscales of QOL showed a steep, non-linear increase within the first years of seizure freedom and remained relatively stable except for cognitive function which showed continuous improvement parallel to seizure freedom. For patients who were seizure free since surgery, side effects of AED and/or psychiatric treatment were the strongest determinants of QOL. Conclusion Duration of seizure freedom and AED side effects have the strongest impact on QOL in the long-term follow-up. Therefore it is important not only to register intake of AEDs but also to assess side effects of AEDs. Persistence of auras also had an impact on different facets of QOL, but was significantly correlated with intake of AEDs. Apart from factors directly related to epilepsy QOL was dependent of psychosocial factors as employment status, psychiatric complications, and driving a car underlining the necessity of postoperative rehabilitation in this group.

Background It is known that most adult patients with epilepsy often have poor knowledge of their disorder, treatment options, and social and vocational consequences, despite the huge amount of information available. Being pressed for time, health care professionals often are not able to provide the repetitive counseling and instruction necessary to address epilepsy care adequately. Therefore educational programs are considered extremely important in filling the gap. Method For German-speaking countries, two educational programs called famoses, modulares Schulungsprogramm Epilepsie fűr Familien [modular service package epilepsy for families], were developed by a multidisciplinary group of neuropediatricians, psychologists, social workers, and educators. The aims of the famoses programs are to improve children’s and parents’ knowledge about epilepsy and to help patients of childhood age and their parents achieve a better understanding of their disease, gain more self-confidence, and reduce specific fears regarding epilepsy. famoses comprises two different educational programs: famoses for kids with epilepsy within the developmental period of ages 7 to 13, and famoses for parents or caretakers. The programs are designed for interactive small-group education. Results The child-centered educational program is based on a fictional story: The children are sailors on a virtual cruise, sailing from island to island, accompanied by educated trainers. On each island there is something new to discover about epilepsy. The parent (and caretaker)-centered educational program covers different topics—overview and content of the program, basic knowledge, diagnostics, therapy, prognosis and development, and living with epilepsy—within six modules. The program was implemented in Germany and Switzerland in the spring of 2005 and is now operating in different epilepsy centers. Conclusion Within comprehensive therapeutic management of epilepsy, educational programs for patients, and for parents (caretakers) of children with epilepsy, are considered to be extremely important. Such educational programs have two main goals: to increase knowledge about the disorder, and to strengthen the patients’ responsibility for themselves, with the consequence of living with as few limitations as possible. famoses is an effective component of this comprehensive care. The program has been operating successfully in different epilepsy centers in Germany and Switzerland since the spring of 2005.

*Department of Pediatric Neurology, University Children’s Hospital, Heidelberg; †Society of Epilepsy Research, Bielefeld; and‡University Children’s Hospital, Mannheim, GermanySummary: Purpose: To estimate the incidence rate of epilep-sies and epileptic syndromes in German children and adoles-cents aged 1 month to

For the catchment of the upper Hase, with an area of approximately 700 km2 in southwestern Lower Saxony, Germany, rainfall-runoff simulations were carried out for the period between 1989 and 1997 on a monthly basis. The subcatchments of 11 gauging stations were determined within a Geographic Information System (GIS) on the basis of a Digital Elevation Model (DEM) and river network data. The hydrological model is based on rainfall data and information about artificial discharge and removal of water. An effective actual evaporation coefficientcient was calibrated for one subcatchment under consideration of typical landuse pattern and used for all other subcatchments. Nitrogen loads and concentrations could be separated into point and non-point sources. Nitrate content is mainly determined by diffuse input, whereas ammonium is related to sewage discharges. Nitrate could be well correlated to subcatchment groundwater nitrate concentrations averaged from the monitoring data of private water wells for 1991–93.