Silvia Sander

Risk Factors for Alveolar Echinococcosis in Humans

A case-control study of alveolar echinococcosis cases in Germany identifies several risk factors for the disease.

Prospective Randomized Trial of Early Versus Late Enteral Iron Supplementation in Infants With a Birth Weight of Less Than 1301 Grams

Objectives. To examine whether early enteral iron supplementation (EI) would improve serum ferritin as a measure of nutritional iron status at 2 months of age and would prevent definite iron deficiency (ID) in infants with a birth weight of <1301 g. Methods. Infants were randomly assigned to receive enteral iron supplementation of 2 to 6 mg/kg/day as soon as enteral feedings of >100 mL/kg/day were tolerated (EI) or at 61 days of life (late enteral iron supplementation [LI]). Nutritional iron status was assessed: 1) at birth, 2) at 61 days of life, 3) when the infants reached a weight of 1.6 times birth weight, and 4) before blood was transfused at a hematocrit of <.25. ID was defined by any one of the following criteria: ferritin, <12 μg/L; transferrin saturation, <17%; or increase of absolute reticulocyte counts by >50% one week after the onset of enteral iron supplementation. Restrictive red cell transfusion guidelines were followed and all transfusions were documented. Erythropoietin was not administered. The primary outcome variables were: 1) ferritin at 61 days and 2) the number of infants with ID. Results. Ferritin at 61 days was not different between the groups. Infants in the LI group were more often iron-deficient (26/65 vs 10/68) and received more blood transfusions after day 14 of life. No adverse effects of EI were noted. Conclusions. EI is feasible and probably safe in infants with birth weight <1301 g. EI may reduce the incidence of ID and the number of late blood transfusions. ID may occur in very low birth weight infants despite early supplementation with iron and should be considered in the case of progressive anemia. preterm infant, iron supplementation, iron deficiency, blood transfusion.

Randomized Trial of Early Versus Late Enteral Iron Supplementation in Infants With a Birth Weight of Less Than 1301 Grams: Neurocognitive Development at 5.3 Years' Corrected Age

BACKGROUND. Iron deficiency in early childhood may impair neurodevelopment. In a masked, randomized, controlled trial of early versus late enteral iron supplementation in preterm infants with birth weights of <1301 g, early iron supplementation reduced the incidence of iron deficiency and the number of blood transfusions. OBJECTIVE. We sought to examine whether early enteral iron supplementation improves neurocognitive and motor development in these infants. METHODS. Children who participated in the above mentioned trial were evaluated by applying the Kaufmann Assessment Battery for Children and the Gross Motor Function Classification Scale at the age of school entry. RESULTS. Of the 204 infants initially randomized, 10 died and 30 were lost to follow-up. A total of 164 (85% of the survivors) were evaluated at a median corrected age of 5.3 years. In this population (n = 164), the mean (±SD) mental processing composite in the early iron group was 92 (±17) versus 89 (±16) in the late iron group. An abnormal neurologic examination was found in 17 of 90 versus 26 of 74, and a Gross Motor Function Classification Scale score of >1 was found in 2 of 90 versus 5 of 74, respectively. Fifty-nine of 90 children in the early iron group were without disability, compared with 40 of 74 in the late iron group. Severe disability was found in 5 of 90 versus 6 of 74 children and 67 of 90 versus 49 of 74 qualified for regular schooling, respectively. CONCLUSIONS. Early enteral iron supplementation showed a trend toward a beneficial effect on long-term neurocognitive and psychomotor development and showed no evidence for any adverse effect. Because the initial study was not designed to evaluate effects on neurocognitive development, the power was insufficient to detect small but potentially clinically relevant improvements. Additional studies are required to confirm the trend towards a better outcome observed in the early iron group.

Plasma viscosity and fibrinogen in relation to haemodynamic findings in chronic congestive heart failure

The aim of this study was to investigate an inflammatory response indicated by fibrinogen and plasma viscosity in relation to haemodynamic and clinical findings of patients with stable CHF due to coronary heart disease (CHD).

Accidental falls among community-dwelling older adults : improving the identification process of persons at risk by nursing staff

SummaryElderly persons living in the community are a heterogeneous population. Among them, the screening of persons at risk of falling is still a matter of debate. The aim of this analysis was to improve the identification process of elderly persons living in the community at risk for falling by nursing staff of community- based services. A secondary analysis was performed with the data from a prospective non-randomized interventional trial. The study included 268 community-dwelling older adults (mean age of 82 years, 81.3% female) from Ulm and Neu-Ulm with a followup period of 12 months. Fall risk indicators were extracted from the nursing assessment and analysis with crude odds ratios revealed the following risk indicators for falls: assistance when transferring, bathing and climbing a flight of stairs as well as fall history. Afterwards, fall risk indicators were selected by backward elimination in a multiple logistic regression. Variable selection identified a positive fall history and the need for assistance when bathing as important risk indicators. These two risk indicators could be used as a screening tool, which would be easy to perform by nursing staff in their daily work. This screening test defined as more than one fall in the last 12 months or bathing assistance, the first ADL to be affected in the disablement process, has a sensitivity of 85.3% and a specificity of 42.1%.ZusammenfassungZu Hause lebende ältere Menschen stellen eine heterogene Population dar. In dieser ist das Screening nach Menschen mit einem erhöhten Sturzrisiko noch in der Diskussion. Ziel dieser Analyse war, diesen Identifikationsprozess für Mitarbeiter aus der ambulanten Pflege zu verbessern. Eine Sekundäranalyse der Daten einer prospektiven, nicht-randomisierten Interventionsstudie wurde durchgeführt. Die Studie schloss 268 zu Hause lebende ältere Menschen (Durchschnittsalter 82 Jahre, 81,3% Frauen) aus Ulm und Neu-Ulm ein. Die Nachuntersuchung erfolgte nach 12 Monaten. Sturzrisikoindikatoren wurden aus dem Pflegeassessment entnommen und eine Analyse mit rohen Odds Ratios zeigte folgende Sturzrisikoindikatoren: Hilfsbedarf beim Transfer, beim Baden und beim Treppensteigen sowie vorausgegangene Stürze. Danach wurden Sturzindikatoren mit Backward Elimination in einer multiplen logistischen Regression selektiert. Als wichtige Sturzindikatoren wurden nur vorausgegangene Stürze und Hilfsbedarf beim Baden identifiziert. Diese beiden Risikoindikatoren könnten als Screening-Test genutzt werden. Die Durchführung ist einfach und kann vom Pflegepersonal im täglichen Arbeitsalltag erfolgen. Dieser Screening-Test definiert als mehrere Stürze in den letzten 12 Monaten oder Hilfsbedarf beim Baden, die erste betroffene ADL im Alterungsprozess, hat eine Sensitivität von 85,3% und eine Spezifität von 42,1%.

Quality of Life After Sphincter-Preserving Rectal Cancer Resection

BACKGROUND With an increasing number of cancer survivors quality of life (QoL) becomes more and more important in the treatment of rectal cancer (RC). QoL after sphincter-preserving anterior resection (AR), however, was found nonsuperior to abdominoperineal resection. The aim of our study was to evaluate QoL after AR compared with colon cancer patients after right hemicolectomy (CC) and healthy lay persons without history of cancer (HL) in long-term follow-up. PATIENTS AND METHODS Consecutive alive RC patients (n = 293) who received an AR between 1998 and 2008 were included. CC patients (n = 201) and HL of the same age were used as a surgical and a nonsurgical control group, respectively. QoL was assessed using European Organization of Research and Treatment of Cancer questionnaires QLQ-C 30 and -CR 38. RESULTS Questionnaires from 116 RC patients, 105 CC patients, and 103 HL were evaluable with a median time after surgery of 5 years. The global health status did not differ. Social functioning, future perspectives, and financial difficulties tended to poorer scores in the cancer groups. Physical functioning was better in RC and CC patients compared with HL. Defecation problems and diarrhea were more frequent in RC patients (P < .05). An additional open question revealed a median stool frequency of 3, 2, and 1 per day for RC, CC, and HL, respectively. Defecation problems were more frequent in RC patients who received radiation therapy (P < .05). CONCLUSION Diarrhea and defecation problems impaired QoL after AR for RC, which was worsened after radiation therapy. To improve QoL of RC patients in the future, physicians have to focus on minimization of gastrointestinal side effects while optimizing surgical reconstruction.

Stürze bei zu Hause lebenden älteren Menschen: Verbesserung der Identifikation von Personen mit erhöhtem Risiko durch Pflegepersonal

SummaryElderly persons living in the community are a heterogeneous population. Among them, the screening of persons at risk of falling is still a matter of debate. The aim of this analysis was to improve the identification process of elderly persons living in the community at risk for falling by nursing staff of community- based services. A secondary analysis was performed with the data from a prospective non-randomized interventional trial. The study included 268 community-dwelling older adults (mean age of 82 years, 81.3% female) from Ulm and Neu-Ulm with a followup period of 12 months. Fall risk indicators were extracted from the nursing assessment and analysis with crude odds ratios revealed the following risk indicators for falls: assistance when transferring, bathing and climbing a flight of stairs as well as fall history. Afterwards, fall risk indicators were selected by backward elimination in a multiple logistic regression. Variable selection identified a positive fall history and the need for assistance when bathing as important risk indicators. These two risk indicators could be used as a screening tool, which would be easy to perform by nursing staff in their daily work. This screening test defined as more than one fall in the last 12 months or bathing assistance, the first ADL to be affected in the disablement process, has a sensitivity of 85.3% and a specificity of 42.1%.ZusammenfassungZu Hause lebende ältere Menschen stellen eine heterogene Population dar. In dieser ist das Screening nach Menschen mit einem erhöhten Sturzrisiko noch in der Diskussion. Ziel dieser Analyse war, diesen Identifikationsprozess für Mitarbeiter aus der ambulanten Pflege zu verbessern. Eine Sekundäranalyse der Daten einer prospektiven, nicht-randomisierten Interventionsstudie wurde durchgeführt. Die Studie schloss 268 zu Hause lebende ältere Menschen (Durchschnittsalter 82 Jahre, 81,3% Frauen) aus Ulm und Neu-Ulm ein. Die Nachuntersuchung erfolgte nach 12 Monaten. Sturzrisikoindikatoren wurden aus dem Pflegeassessment entnommen und eine Analyse mit rohen Odds Ratios zeigte folgende Sturzrisikoindikatoren: Hilfsbedarf beim Transfer, beim Baden und beim Treppensteigen sowie vorausgegangene Stürze. Danach wurden Sturzindikatoren mit Backward Elimination in einer multiplen logistischen Regression selektiert. Als wichtige Sturzindikatoren wurden nur vorausgegangene Stürze und Hilfsbedarf beim Baden identifiziert. Diese beiden Risikoindikatoren könnten als Screening-Test genutzt werden. Die Durchführung ist einfach und kann vom Pflegepersonal im täglichen Arbeitsalltag erfolgen. Dieser Screening-Test definiert als mehrere Stürze in den letzten 12 Monaten oder Hilfsbedarf beim Baden, die erste betroffene ADL im Alterungsprozess, hat eine Sensitivität von 85,3% und eine Spezifität von 42,1%.

Lasting Resolution of Diabetic Macular Edema and Stable Improvement of Visual Acuity after Treatment with Pars Plana Vitrectomy

We refer to our earlier publication in this journal [1] in which we – in agreement with the results obtained by many other investigators – reported a short-term beneficial effect of pars plana vitrectomy (PPV) on the morphological and functional characteristics of eyes with diabetic macular edema. Since the duration of a Received: August 14, 2007 Accepted after revision: April 11, 2008 Published online: April 22, 2009