Search

Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women’s University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale – geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch’s t-test, chi2 test, and Fisher’s exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.

ZusammenfassungDie saisonale Influenza verursacht eine signifikante Krankheitslast in der deutschen Bevölkerung und geht mit hohen volkswirtschaftlichen Kosten einher. Personen ab 60 Jahren sind aufgrund von Immunseneszenz und chronischen Erkrankungen besonders gefährdet und machen einen Großteil der influenzaassoziierten Hospitalisierungen und Todesfälle aus. Adjuvantierter, Hochdosis-, rekombinanter und zellbasierter Influenzaimpfstoff wurden entwickelt, um die Effektivität im Vergleich zu herkömmlichen Impfstoffen zu verbessern. Neueste Beobachtungsstudien zeigen eine bessere Effektivität des adjuvantierten Impfstoffs gegenüber herkömmlichen Impfstoffen und eine ähnliche Effektivität wie der Hochdosis-Impfstoff bei älteren Erwachsenen. Einige Länder berücksichtigten die neue Evidenz bereits in ihren Impfempfehlungen für die aktuelle oder frühere Saisons. Auch in Deutschland sollte die Verfügbarkeit der Impfstoffe für ältere Erwachsene sichergestellt sein, um einen hohen Impfschutz zu garantieren.

There is an urgent need for improved influenza vaccines especially for older adults due to the presence of immunosenescence. It is therefore highly relevant to compare enhanced influenza vaccines with traditional influenza vaccines with respect to their effectiveness.To compare vaccine efficacy and effectiveness of adjuvanted influenza vaccines (aTIV/aQIV) vs. non-adjuvanted standard-dose (TIV/QIV) and high-dose (TIV-HD/QIV-HD) influenza vaccines regarding influenza-related outcomes in older adults, complementing findings from the European Centre for Disease Prevention and Control (ECDC)'s systematic review of enhanced seasonal influenza vaccines from February 2020.A systematic literature search was conducted in Embase and MEDLINE to identify randomised controlled trials, observational studies and systematic reviews, published since ECDC's systematic review (between 7 February 2020 and 6 September 2021). Included studies were appraised with either the Cochrane Risk of Bias tool, ROBINS-I or AMSTAR 2.Eleven analyses from nine real-world evidence (RWE) studies comprising ∼53 million participants and assessing the relative vaccine effectiveness (rVE) of aTIV vs. TIV, QIV and/or TIV-HD in adults aged ≥65 years over the 2006/07-2008/09 and 2011/12-2019/20 influenza seasons were identified. Nine analyses found that aTIV was significantly more effective than TIV and QIV in reducing influenza-related outcomes by clinical setting and suspected influenza outbreaks (rVE ranging from 7.5% to 25.6% for aTIV vs. TIV and 7.1% to 36.3% for aTIV vs. QIV). Seven analyses found similar effectiveness of aTIV vs. TIV-HD in reducing influenza-related medical encounters, inpatient stays and hospitalisations/emergency room visits. In three analyses, aTIV was significantly more effective than TIV-HD in reducing influenza-related medical encounters and office visits (rVE ranging from 6.6% to 16.6%). Risk of bias of identified studies was moderate to high.Our study suggests that both adjuvanted and high-dose vaccines are effective alternatives for vaccination programmes in older adults and preferable over conventional standard-dose vaccines.

Objective: To investigate the effectiveness of individual oral health care training (IndOHCT) on dental plaque removal and denture cleaning in hospitalized geriatric inpatients. Background: The literature reveals neglect of hygiene and oral care in people aged over 65 years, especially in persons in need of care. Hospitalized geriatric inpatients have poorer dental health than those non-hospitalized. Furthermore, the existing literature reporting on oral healthcare training interventions for hospitalized geriatric inpatients is scarce. Materials and Methods: This pre-post-controlled intervention study dichotomized 90 hospitalized geriatric inpatients into an intervention group (IG) and a control group (CG). Inpatients in the IG received IndOHCT. Oral hygiene was assessed using the Turesky modified Quigley–Hein index (TmQHI) and the denture hygiene index (DHI), at baseline (T0), at a second examination (T1a), and after supervised autonomous tooth brushing and denture cleaning (T1b). The influence of the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Barthel Index (BI) scores on oral hygiene was examined. Results: There was no significant plaque reduction on teeth or dentures between T0 and T1a in either group. Between T1a and T1b, plaque reduction on the teeth was more effective in the IG than in the CG (p < 0.001). Inpatients with 1–9 remaining teeth removed significantly more dental plaque than inpatients with 10 or more remaining teeth. Inpatients with lower MMSE scores (p = 0.021) and higher age (p = 0.044) reached higher plaque reduction on dentures. Conclusions: IndOHCT improved oral and denture hygiene in geriatric inpatients by enabling them to clean their teeth and dentures more effectively.

Objective: Assuming that elderly patients suffer more severely from side effects of the standard therapies, less aggressive treatment protocols have been established, e.g. the NOA-8 study. This practice has been questioned by several retrospective studies using standard protocol. However, none of these [for full text, please go to the a.m. URL]

Aktuelle Entwicklungen Die Wirksamkeit von Impfungen ist durch die Immunseneszenz reduziert. Stärker immunogene Impfstoffe sind daher für Hochbetagte und Multimorbide von besonderer Bedeutung. Ausblick Die in der Entwicklung befindlichen Impfstoffe – Pneumokokken-, Norovirus-, Clostridium-difficile-, Hepatitis-B-Vakzine – betreffen zum einen Erkrankungen, für die bisher keine Impfungen für Senioren zur Verfügung stehen (z. B. Norovirus-Infektion), zum anderen werden stärker immunogene Vakzine mit einer breiteren Wirksamkeit entwickelt (z. B. Pneumokokken-Vakzine).