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Objectives: Aspergillus fumigatus is the most prevalent filamentous fungus in the respiratory tract of patients with cystic fibrosis (CF). The aim of this prospective multicentre study was to investigate the prevalence of azole-resistant A. fumigatus (ARAF) in respiratory secretions from CF patients across Germany and to characterize ARAF isolates by phenotypic and molecular methods.Methods: Twelve tertiary care centres from Germany participated in the study. In total, 2888 A. fumigatus isolates from 961 CF patients were screened for ARAF by using azole-containing agar plates. Antifungal susceptibility testing of isolates was performed by broth microdilution according to EUCAST guidelines. Analysis of mutations mediating resistance was performed using PCR and sequencing of the cyp51A gene. Furthermore, genotyping by microsatellite PCR was performed.Results: Of a total of 2888 A. fumigatus isolates, 101 isolates from 51 CF patients were found to be azole resistant (prevalence per patient 5.3%). The Essen centre had the highest prevalence (9.1%) followed by Munich (7.8%), Münster (6.0%) and Hannover (5.2%). Most ARAF isolates (n = 89) carried the TR34/L98H mutation followed by eight G54E/R, one TR46/Y121F/T289A and one F219S mutation. In two isolates no mutation was found. Genotyping results showed no major clustering. Forty-five percent of CF patients with ARAF had previously received azole therapy.Conclusions: This is the first multicentre study analysing the prevalence of ARAF isolates in German CF patients. Because of a resistance rate of up to 9%, susceptibility testing of A. fumigatus isolates from CF patients receiving antifungal treatment should be part of standard diagnostic work-up. [ABSTRACT FROM AUTHOR]

Purpose: This study estimates the healthcare costs associated with breast cancer (BC) for different treatment phases (initial, intermediate, terminal) in Germany from the payer's perspective., Methods: The analysis uses claims data from the AOK Bayern covering 2011-2014 for continuously insured BC patients identified through inpatient and outpatient diagnoses. We calculate the healthcare costs attributable to BC using a control group design comparing the target population to a 1:2 matched control group adjusted for age, gender, and comorbidities. For incident and prevalent BC cases, we calculate age-standardized phase-specific incremental costs stratified by cost domain., Results: The initial, intermediate, and terminal phases comprise 3841, 28,315, and 1767 BC cases, respectively. BC-related incremental costs follow a u-shaped curve, with costs highest near diagnosis and death, and lower in between. With average costs of €33,237 per incident and €28,211 per prevalent case in the remaining 11 months before death, the highest BC-related incremental healthcare costs can be found in the terminal phase. In the initial phase, there were mean incremental costs of €21,455 the first 11 months after diagnosis. In the intermediate phase, incremental costs totaled €2851 per incident and €2387 per prevalent case per year. Healthcare costs decreased with age in most phases. The cost drivers depend on the treatment phase, with cytostatic drugs and inpatient treatment showing the highest economic impact in most phases., Conclusion: The study concludes that BC care costs impose a relevant economic burden on statutory health insurance and vary substantially depending on the treatment phase.

In this study a commercially available multiplex real-time PCR (AsperGenius®) was evaluated for its efficacy in detecting Aspergillus fumigatus and azole resistance markers in comparison with conventional culture methods and galactomannan (GM) testing from BAL fluids in allogeneic HSCT recipients. Between January 2015 and May 2017 100 allogeneic HSCT recipients with pulmonary infiltrates and suspicion of invasive fungal infection were recruited to the study from a tertiary care center in Germany. BAL fluid was routinely assessed using the following diagnostic tests: AsperGenius® PCR assay, GM testing (cut-off: 1.0) and conventional culture. Susceptibility testing of azoles was performed by using Etest and, in case presenting elevated MICs, PCR for mutations in the cyp51A gene was carried out. Criteria of EORTC/MSG were used to classify the patients for invasive fungal disease. According to the EORTC/MSG criteria 23 patients presented with probable invasive aspergillosis (IA). Aspergillus PCR showed a sensitivity of 65% for probable IA cases. A combination of PCR and GM results in BAL displayed a sensitivity of 96% (22/23) and 100% specificity. Mutations in the cyp51A gene were detected by PCR in three cases (3/23; 13%) which were also found resistant with the culture method. In one case a Y121F/T289A mutation and in two cases a L98H were found. The combination of a commercial Aspergillus PCR assay and GM testing from BAL demonstrated a high sensitivity and specificity for diagnosing IA in allogeneic HSCT recipients. The Aspergillus PCR assay was not superior in detecting azole resistant A. fumigatus compared to culture., (© The Author(s) 2019. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

Background: Prematurity is a main issue in modern obstetrical care. The purpose of the present study was to evaluate the perinatal outcome of premature infants weighing less than 1500 g according to the mode of delivery., Patients and Methods: 122 patients with infants weighing less than 1500 g were enrolled in this retrospective study (26 to 32 weeks of gestation). The perinatal outcomes of 26 infants born by vaginal delivery were compared to 96 infants delivered by caesarean section., Results: The rates of rupture of membranes, preterm labour and intravenous tocolysis were significantly increased in patients after vaginal delivery. Preeclampsia and pathological cardiotocograms were increased in patients after caesarean section. Infants born by vaginal delivery showed a significant increase of peri- and intraventricular haemorrhage grade III, periventricular leukomalacia, C-reactive protein 24 hours postpartum and mortality until the seventh day of life. However, the rate of bronchopulmonary dysplasia was significantly increased in infants born by caesarean section (p < 0.05)., Conclusions: These data suggest that the mode of delivery affects the perinatal outcome of infants weighing less than 1500 g. Based on the results of the present study, it appears unclear which mode of delivery should be preferred, depending on particular material and fetal factors.

Personal digital assistants (PDAs) are increasingly used by many professional and private users. They replace and combine common calendars, directories, to-do-lists and much more. Supplemented by useful additional software they can assist the clinician in his daily routine work. This concerns typical medical information as well as administrative work but gets more importance with regard to the planned introduction of diagnosis related groups in Germany however. Exact coding of medical performance is essential for this future invoice system. How PDAs can be used convenient in this respect will be shown with examples from our department.

Internet presentations are common tools for better medical communication and better scientific work. Meanwhile a great number of gynecological and obstetrical institutions present data via the world wide web within a wide range of quality and performance. Specific HTML editors offer quick and easy presentations, but only advanced internet techniques enable interesting multimedia presentations. N-tier applications are the future standard and we must integrate them in general informatical systems. New Concepts, actual tools and general problems will be discussed and new principles similar to actual E commerce techniques are able to solve our special medical demands.

While computer applications are widely accepted in clinical chemical departments, small numbers of computer systems are used in gynecological endocrinological laboratories. Modern applications should be integrated in local area networks and clinical information systems that improve communication and data exchange within hospitals and the outer resources. Better communication may improve medical quality and will lead to a better therapy for gynecological endocrinological patients.

Medical and commercial data are essential for sufficient clinical management. While regional quality studies--for example the German Perinatal Data Study--are mighty tools to compare the quality of departments in total--the integration of evaluated individual quality indicators in data processing systems can highly improve clinical results and clinical management. The evaluation of quality indicators improves the benefit of quality management. Parameters monitoring the contentment of patients are extremely valuable information. Quality management and information management are closely linked.

The scientific and commercial use of the internet has caused a revolution in information technologies and has influenced medical communication and documentation. Web browsers are the becoming universal starting point for all kinds of client-server applications. Many commercial and medical systems--such as information reservation systems--are being shifted towards web-based systems. This paper describes new techniques. Security problems are the main topics for further developments in medical computing.

Rapid development and innovative research in medical computer science influences physicians work. Not only new hardware but also network implementation changed the way of decision making techniques in medicine. The main reason for acceptance and distribution of the internet is the possibility to present information in a reasonable and contemporary way. A self-labeling of medical information by web authors and systematic critical appraisal of health-related internet information by third parties may help to filter harmful health information and to positively identify and select high quality information. The German Work Group for Information Technologies in Gynecology and Obstetrics (AIG) informs physicians about health care issues related to computer science.

In 2003 diagnosis related groups (DRG's) will be established in Germany as a new system for describing costs of inpatient treatment. Principles of medical controlling are explained, the development from the system formerly used in Germany towards DRG's is described and computer-based assistance already available is pointed out and evaluated critically.

The documentation of operations in the field of gynecology and obstetrics is regulated by social laws in Germany. Only by optimal encoding of diagnoses and procedures an efficient cashing with the health insurance's can be achieved. This requires profound knowledge of the invoice modalities and usually support by computer systems. The Internet offers in this respect some assistance, which in the following is pointed out and evaluated critically.

The switch to the new millennium causes greater difficulties in computing concerning hard- and software. It is not foreseeable how much each computer will be hit by that. Due to the common use of computers in all parts of medicine the possible crash of data banks and networks across hospitals could afflict the regular care of patients in wards and outpatient clinics. The ability of each computer to go to the new millennium can be checked by simply performed tests or by highly specialized programmes as well. As many mistakes occur in co-operation of hardware and software, it is hard to fix the system. To continue the use of a data bank it is necessary to change the data bank's date format and all applications at the same time. Programmers and providers offer their advice via internet.

Within the last months a great number of internet pages have become a highly interesting source of up-to-date information in gynecological endocrinology. Most of these World Wide Web-pages present actual scientific fields and abstracts with close relations to basic science, while clinical discussion groups are still rare. The potential of internet presentations will strongly influence communication in cases of gynecological endocrinology.

For decades scientific sessions and conferences were a proven way to spread and exchange scientific results worldwide--not only in the field of medicine. With growing availability and accessibility of information on the internet and WWW conferences are now not only listed and announced on a multitude of websites, but also are prepared ahead from simple registration to online discussions. By means of selected examples information is provided on how keeping oneself informed about former or planned conferences by using the internet.

Within the last two years Internet pages have become a highly interesting source of up-to-date information. The scientific value of those homepages for reproductive medicine differ in a wide range. The Internet still remains a very interesting source for up-to-date information covering the field of infertility treatment with a growing influence on patient decisions and with increasing economical impact.

The Internet is a rapid growing world wide computer cluster using the TCP/IP communication protocol. In case of scientific data exchange Internet communication is of extraordinary value. Low data security and low data transfer rates are still problems for medical data exchange. New Internet tools--specially new cryptological techniques--are able to improve the communication security for obstetrical and gynecological data.

Genital tuberculosis still occurs and is difficult to diagnose. The symptoms are mostly uncharacteristic, whereas infertility and chronic pelvic infections are frequently diagnosed. In the period between 1970 to 1990, we found 21 women with this diagnosis. The occurrence seems to have shifted to greater age and milder clinical disease and are mostly observed within the framework of the sterility complex. We conclude, that primary treatment should be conservative. Intrauterine pregnancies after treatment are very rare, but, in one case, a normal pregnancy and delivery was occurred.