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Summary Background and objective Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterm infants but have been associated with a number of serious complications. We performed a survey in Austria and Germany to assess the use of UVCs and PICCs in preterm infants with a birth weight Methods Electronic survey of participating centers of the NeoVitaA trial. Main outcome parameter was the reported rates of UVC- and PICC-associated complications (infection, thrombosis, emboli, organ injury, arrhythmia, dislocation, miscellaneous). Results In total, 20 neonatal intensive care units (NICU) providing maximal intensive care in Austria and Germany (level I) were contacted, with a senior neonatologist response rate of 12/20 (60%). The reported rates for UVC with a dwell time of 1–10 days were bacterial infection: 4.2 ± 3.4% (range 0–10%); thrombosis: 7.3 ± 7.1% (0–20%); emboli: 0.9 ± 2.0% (0–5%); organ injury: 1.1 ± 1.9% (0–5%); cardiac arrhythmia: 2.2 ± 2.5% (0–5%); and dislocation: 5.4 ± 8.7% (0–30%); and for PICCs with a dwell time of 1–14 days bacterial infection: 15.0 ± 3.4% (range 2.5–30%); thrombosis; 4.3 ± 3.5% (0–10%); emboli: 0.8 ± 1.6% (0–5%); organ injury: 1.5 ± 2.3% (0–5%); cardiac arrhythmia: 1.5 ± 2.3% (0–5%), and dislocation: 8.5 ± 4.6% (0–30%). Conclusion The catheter-related complication rates reported in this survey differed between UVCs and PICCs and were higher than those reported in the literature. To generate more reliable data on this clinically important issue, we plan to perform a large prospective multicenter randomized controlled trial investigating the non-inferiority of a prolonged UVC dwell time (up to 10 days) against the early change (up to 5 days) to a PICC.

Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterm infants but have been associated with a number of serious complications. We performed a survey in Austria and Germany to assess the use of UVCs and PICCs in preterm infants with a birth weight 1250 g and associated rates of catheter-related adverse events.Electronic survey of participating centers of the NeoVitaA trial. Main outcome parameter was the reported rates of UVC- and PICC-associated complications (infection, thrombosis, emboli, organ injury, arrhythmia, dislocation, miscellaneous).In total, 20 neonatal intensive care units (NICU) providing maximal intensive care in Austria and Germany (level I) were contacted, with a senior neonatologist response rate of 12/20 (60%). The reported rates for UVC with a dwell time of 1-10 days were bacterial infection: 4.2 ± 3.4% (range 0-10%); thrombosis: 7.3 ± 7.1% (0-20%); emboli: 0.9 ± 2.0% (0-5%); organ injury: 1.1 ± 1.9% (0-5%); cardiac arrhythmia: 2.2 ± 2.5% (0-5%); and dislocation: 5.4 ± 8.7% (0-30%); and for PICCs with a dwell time of 1-14 days bacterial infection: 15.0 ± 3.4% (range 2.5-30%); thrombosis; 4.3 ± 3.5% (0-10%); emboli: 0.8 ± 1.6% (0-5%); organ injury: 1.5 ± 2.3% (0-5%); cardiac arrhythmia: 1.5 ± 2.3% (0-5%), and dislocation: 8.5 ± 4.6% (0-30%).The catheter-related complication rates reported in this survey differed between UVCs and PICCs and were higher than those reported in the literature. To generate more reliable data on this clinically important issue, we plan to perform a large prospective multicenter randomized controlled trial investigating the non-inferiority of a prolonged UVC dwell time (up to 10 days) against the early change (up to 5 days) to a PICC.HINTERGRUND UND ZIEL: Nabelvenenkatheter („umbilical venous catheters“ [UVC]) und periphere zentrale Venenkatheter (PICC) werden häufig bei Frühgeborenen eingesetzt, sind jedoch mit einer Reihe von schwerwiegenden Komplikationen verbunden. In Österreich und Deutschland wurde eine Umfrage durchgeführt, um die Verwendung von UVC und PICC bei Frühgeborenen mit einem Geburtsgewicht 1250 g und die damit verbundenen Raten von katheterbedingten unerwünschten Ereignissen zu bewerten.Elektronische Befragung der teilnehmenden Zentren der NeoVitaA-Studie. Hauptergebnisparameter waren die gemeldeten Raten von UVC- und PICC-assoziierten Komplikationen (Infektion, Thrombose, Embolie, Organverletzung, Arrhythmie, Dislokation, Sonstiges).Insgesamt wurden 20 neonatale Intensivstationen (NICU) mit maximaler Intensivpflege in Österreich und Deutschland (Level I) kontaktiert, wobei 12/20 (60 %) von leitenden Neonatologen beantwortet wurden. Die gemeldeten Raten für UVC mit einer Verweildauer von 1 bis 10 Tagen waren bakterielle Infektionen: 4,2 ± 3,4 % (Bereich: 0–10 %); Thrombose: 7,3 ± 7,1 % (0–20 %); Embolie: 0,9 ± 2,0 % (0–5 %); Organverletzung: 1,1 ± 1,9 % (0–5 %); Herzrhythmusstörungen: 2,2 ± 2,5 % (0–5 %); und Dislokation: 5,4 ± 8,7% (0–30 %); und bei PICC mit einer Verweildauer von 1 bis 14 Tagen bakterielle Infektionen: 15,0 ± 3,4 % (Bereich: 2,5–30 %); Thrombose: 4,3 ± 3,5 % (0–10 %); Embolie: 0,8 ± 1,6 % (0–5 %); Organverletzung: 1,5 ± 2,3 % (0–5 %); Herzrhythmusstörungen: 1,5 ± 2,3 % (0–5 %) und Verrenkungen: 8,5 ± 4,6 % (0–30 %).Die in dieser Umfrage berichteten katheterbedingten Komplikationsraten unterschieden sich zwischen UVC und PICC und waren höher als die in der Literatur berichteten. Um zuverlässigere Daten zu diesem klinisch wichtigen Thema zu erhalten, ist eine große prospektive, multizentrische, randomisierte, kontrollierte Studie geplant, in der die Nichtunterlegenheit einer verlängerten UVC-Verweildauer (bis zu 10 Tage) gegenüber dem frühen Wechsel (bis zu 5 Tage) zu einem PICC untersucht werden soll.

In an open trial with 18 healthy male volunteers (21-45 years old) the effect of processed (test) and non-processed (reference) coffee samples of same origin on the gastric potential difference (GPD) was studied. Test coffee samples were processed with the patented "Darboven improvement procedure" before roasting. All treatment groups were subdivided according to the Helicobacter pylori status of the volunteers. The evaluation of the target parameters Reizindex (RI), area under the baseline (AUB), maximum potential difference (Pdmax) and total time (ttot) revealed a significant lower RI (p = 0.0282) and AUB (p = 0.0136), and a significant shorter ttot (p = 0.0286) for the processed coffee. Total cholesterol, high-density lipoprotein (HDL) cholesterol, and pancreatic peptides showed a comparable marked increase of the arithmetic mean with both coffee samples, however, being more intense in the Helicobacter pylori-positive subgroup than in the Helicobacter pylori-negative subgroup. No negative findings concerning tolerability and safety could be seen. In conclusion, the test coffee samples processed with a new method to improve the stomach mucosal irritation-potential of coffee charges revealed a remarkably lower stomach mucosal irritation.

In this paper we evaluate the use of appreciative inquiry in focus groups with public health nurses, managers and policy makers across Canada as part of our project to generate policy recommendations for building public health nursing capacity. The focus group protocol successfully involved participants in data collection and analysis through a unique combination of appreciative inquiry and nominal group process. This approach resulted in credible data for analysis, and the final analysis met scientific research standards. The evaluation revealed that our process was effective in engaging participants when their time available was limited, no matter what their position or public health setting, and in eliciting solution-focused results. By focusing on what works well in an organisation, appreciative inquiry enabled us to identify the positive attributes of organisations that best support public health nursing practice and to develop practical policy recommendations because they were based on participants’ experience. Further, appreciative inquiry was especially effective with public health policy makers and nurses as it is consistent with the strength-based, capacity building approaches inherent in public health nursing practice.

Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.

OBJECTIFS: 1) Décrire l’effectif infirmier de santé communautaire au Canada; 2) Comparer, dans les compétences politiques et les secteurs de la santé communautaire, les éléments qui aident les infirmières et les infirmiers de santé communautaire à travailler de manière efficace ou qui les empêchent de le faire; 3) Définir les caractéristiques organisationnelles qui aident les membres d’un sous-secteur communautaire - infirmières et infirmiers de santé publique - à mettre en pratique la totalité de leurs compétences. MÉTHODES: Notre étude comprenait une analyse des bases de données de soins infirmiers de l’Institut canadien d’information sur la santé (1996-2007), une étude menée auprès de plus de 13 000 infirmières et infirmiers de santé communautaire au Canada et 23 groupes de discussion composés de décideurs en santé publique et d’infirmières et d’infirmiers de santé publique de première ligne. RÉSULTATS: En 2007, plus de 53 000 infirmières et infirmiers autorisés et infirmières et infirmiers auxiliaires autorisés travaillaient en santé communautaire au Canada, soit environ 16 p. 100 de l’ensemble de l’effectif infirmier. Les infirmières et les infirmiers de santé communautaire étaient en moyenne plus âgés que les autres de leur profession. Les infirmières et les infirmiers de santé communautaire travaillent habituellement dans les centres de santé communautaire, à domicile et dans les unités ou les services de santé publique. Pour effectuer leur travail de manière efficace, les infirmières et infirmiers de santé communautaire doivent avoir confiance en leurs compétences professionnelles, entretenir de bonnes relations en sein de leur équipe, travailler dans des milieux de travail favorables et obtenir le soutien communautaire. La plupart des infirmières et des infirmiers avaient confiance en leurs compétences et entretenaient de bonnes relations avec les autres infirmières et infirmiers ainsi que professionnels, quoique moins souvent avec les médecins. Ils avaient des opinions différentes relativement au salaire et à la sécurité d’emploi, et la plupart d’entre eux auraient aimé avoir plus de possibilités d’apprentissage, de renseignements sur les politiques et les pratiques ainsi que d’occasions de faire le bilan de leur travail. Ils désiraient que leur collectivité déploie de plus grands efforts pour s’occuper des déterminants sociaux de la santé et pour fournir des ressources de qualité. Certains facteurs doivent être réunis pour assurer la réussite des soins infirmiers de santé publique: une politique gouvernementale solide, une culture organisationnelle favorable et de bonnes pratiques de gestion. Parmi les caractéristiques organisationnelles considérées comme des mesures de soutien favorables à un travail optimal, soulignons la flexibilité du financement, de la conception des programmes et des descriptions de travail; une vision organisationnelle précise axée sur les valeurs partagées et les besoins communautaires; la planification coordonnée de la santé publique entre les compétences; une direction solide qui fait ouvertement la promotion de la santé publique, qui attache de l’importance au travail du personnel et qui investit dans l’éducation et la formation. Conclusion: L’utilisation interchangeable et non uniforme des titres des infirmières et des infirmiers de santé communautaire et de leurs employeurs fait en sorte qu’il est difficile de discerner les différences au sein de ce secteur, comme les soins à domicile, la santé publique, etc. Nos études ont également permis de constater que les infirmières et les infirmiers de santé communautaire: travaillent dans des milieux où ils partagent la vision et les buts de leur organisme et travaillent en collaboration dans une ambiance qui incite à l’action et qui favorise l’autonomie; travaillent bien ensemble, mais ont besoin de temps, de financement flexible et de soutien de la part de la direction pour créer des liens avec la collectivité et leurs clients, et pour former des équipes avec d’autres professionnels; pourraient maintenir leurs compétences et leur confiance en leurs aptitudes professionnelles en ayant davantage accès à de la formation continue, aux politiques, aux données probantes et aux séances de bilan. REMERCIEMENTS: Nous désirons remercier les membres de notre équipe de recherche pour avoir guidé les activités de l’étude. D(r) David Butler-Jones, administrateur en chef de la santé publique du Canada; Audrey Laporte, Université de Toronto; Sandra MacDonald-Rencz, directrice générale, Bureau de la politique des soins infirmiers, Santé Canada; Barbara Oke, retraitée, directrice générale, Bureau des services de soins infirmiers, Direction générale de la santé des Premières nations et des Inuits; Susan Matthews, Système de santé de Niagara; Lynnette Leeseberg Stamler, Association canadienne des écoles de sciences infirmières; Rosemarie Goodyear Association canadienne des infirmières et infirmiers en santé communautaire; D(r) Cory Neudorf et D(r) Steven Whitehead, région sanitaire de Saskatoon; Paul Fisher et Chris Bailey, Conseil canadien de réglementation des soins infirmiers auxiliaires; Ron Wall, Agence de la santé publique du Canada; D(r) John Blatherwick, retraité, Vancouver Coastal Health; Lynn Jobin, Direction générale de la santé publique du Québec; Valerie St. John, Ministry of Health Services de la Colombie-Britannique. Nous remercions les personnes suivantes, qui ont contribué à la préparation du présent rapport: Suzanne Ross, consultante en politique de santé; Maureen Best, Mount Royal College; Penny Nelligan, consultante en santé publique; Mary Crea et Alina Dragan, coordonnatrices de la recherche; Rebecca Ganann, étudiante au doctorat. Les organismes suivants ont financé la présente recherche: Fondation canadienne de recherche sur les services de santé; Agence de la santé publique du Canada; Santé Canada (Division des stratégies en matière de ressources humaines en santé; Bureau de la politique des soins infirmiers; Direction générale de la santé des Premières nations et des Inuits); Ministry of Health Services de la Colombie-Britannique (Nursing Directorate; Communicable Diseases and Addictions Prevention Branch); Université McMaster, Nursing Health Services Research Unit; Vancouver Coastal Health. La reconnaissance de la contribution financière de ces organismes ne sous-entend pas l’approbation des résultats ou de l’analyse.

Axel Schlitt*, Ralf S. von Bardeleben, Anne Ehrlich, Antje Eimermacher, Dirk Peetz, Manfred Dahm, Hans J. Rupprecht Department of Medicine II, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany Coordination Center for Clinical Studies, Johannes Gutenberg-University Mainz, Mainz, Germany Clinic for Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg-University Mainz, Mainz, Germany Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University Mainz, Mainz, Germany

Background: Hepatitis B surface antigen (HBsAg) clearance marks the prime event of HBV elimination in chronic hepatitis B and is associated with better overall outcome. Despite reliable viral suppression under standard treatment with nucleos(t)ide analogues (NUCs) the goal of HBsAg clearance is rarely achieved. Also synchronous combination of NUCs with pegylated interferon-α-2a (peg-IFNα) has not been superior compared to peg-IFNα monotherapy in prospective randomized trials. However, sequential addition of peg-IFNα to an ongoing NUC regimen has provided higher HBsAg clearance rates in uncontrolled pilot studies. Methods/Design: In this protocol we investigate the sequential addition of open-label peg-IFNα for 48 weeks to an ongoing NUC regimen following patients written informed consent. Included are patients with HBeAg negative chronic hepatitis B and a suppressed HBV DNA (

Objective: To compare the effectiveness of controlled-released carbamazepine (CR-CBZ) to levetiracetam (LEV) and to lamotrigine (LTG) in elderly patients with newlydiagnosedfocalepilepsy.Methods: Randomized, double-blind, parallel-group trial conducted between January2007andAugust2011,in47ambulatoryorhospitalsitesinGermany,Austria,orSwit-zerland. Eligible participants were aged ≥60, had new-onset epilepsy, had no acute ill-nessasthecauseoftheirseizures,andhadnocontraindicationtothedrugsinthetrial.Patients were randomized 1:1:1 to CR-CBZ, LTG, or LEV. Doses were up-titrated for6 weeks and could be maintained or adjusted depending on seizure relapse or tolera-bility over an additional period of 52 weeks. Primary outcome was the retention totreatment at week 58; secondary measures related to seizure and adverse event fre-quency.Results: Of 361 randomized patients, 359 were included (CR-CBZ n = 121, LTGn = 117, LEV n = 122) in the modified intent-to-treat population (mean age [range]71.4 [60–95] years). At week 58, the retention rate for LEV was significantly higherthan for CR-CBZ (61.5% vs. 45.8%, p = 0.02), and similar to LTG (55.6%). Seizure free-dom rates at weeks 30 and 58 were not different across the groups. Twice as manypatients receiving CR-CBZ discontinued due to adverse events or death compared tothose in the LEV group (32.2% vs. 17.2%; odds ratio 2.28, 95% confidence interval [CI]1.25–4.19, p = 0.007), whereas discontinuation was intermediate for LTG (26.3%).Mediandailydosesofcompleters(n = 195)wereCR-CBZ380.0 mg/day(333.0–384.0),LTG95 mg/day(94.0–97.0),andLEV950 mg/day(940.0–985.0).Significance: In the initial monotherapy of focal epilepsy in the elderly, 1-year reten-tion to LEV was higher compared to CR-CBZ due to better tolerability. Retention ofLTG was intermediate and close to LEV, but did not differ significantly from eithercomparators.NCT00438451,www.clinicaltrials.gov.KEY WORDS: Elderly, Monotherapy, Antiepileptic drugs, Levetiracetam, Carbamaz-epine.

Background Preclinical data suggested all-trans retinoic acid (tretinoin) as a potential antiviral agent against chronic hepatitis C infection. Aims To assess efficacy, safety, and tolerability of tretinoin in combination with peg-interferon and ribavirin in genotype-1 infected patients with prior non-response. Method We performed an open-label multicentre clinical trial. Patients were randomised to either receive additional tretinoin (45 mg/m 2 /day) for 12 weeks (arm A), or peg-interferon and ribavirin alone (arm B). Primary endpoint was the slope of the third phase of viral decline (M δ ) as determined in an established kinetic model known to correlate with treatment outcome. Secondary endpoints were additional kinetic parameters, viral response rates, safety, and tolerability. Results 27 patients in arm A and 30 patients in arm B were treated per protocol until week 12. Viral kinetic parameters did not differ. Rates of early virological response (>2 log 10 drop at week 12) were similar (10/27 versus 11/30 patients). In arm A, patients experienced a higher rate and intensity of adverse events, most commonly skin and mucosal dryness, and headache. Conclusion Addition of tretinoin was safe and acceptably well tolerated. However, it did not influence viral kinetics and thus cannot be further considered as a treatment option.

Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.

Factors from porcine duodenal mucosa extract (CHR extract) prepared according to Cricket al. [J Physiol (London) 110: 367, 1949] interacted with isolated suspended rat pancreatic zymogen granules in vitro, resulting in the release of amylase and trypsin-activatable protease from the granule. CHR extract also caused a rapid drop in the turbidity of suspended granules in the pH range within which the granules were otherwise stable. The release of amylase was proportional to both the amount of CHR extract added, and the amount of zymogen granules present. The effects were not due to bile salts, and could not be elicited by equivalent levels of highly purified pancreozymin or pure secretin. Fractionation of CHR extract on Sephadex G-25 led to resolution of two factors, A and B, both of which caused amylase release. Factor A, of apparent higher molecular weight, caused the turbidity loss. Factor B caused no turbidity change, but elicited both enzyme release and activation of previously released amylase. Both f...