Quality of care in an inflammatory bowel disease clinical trial center : a prospective study evaluating patients' satisfaction.

BACKGROUND AND STUDY AIMS: Quality of care is a very timely topic in medicine. We designed a questionnaire to measure perceived quality of care and to explore areas of improvement. PATIENTS AND METHODS: In this prospective study a questionnaire was developed and administered to all patients with inflammatory bowel disease participating in a randomized clinical trial. The questionnaire was based on validated surveys and supplemented with novel, relevant questions. Factors associated with (poor) quality of care were identified. RESULTS: Between October 2016 and January 2017, all 107 patients participating in a randomized controlled trial completed the questionnaire (63% male, 76% ulcerative colitis, median age of 47 years). The median satisfaction score was 9 out of 10. Areas of improvement were that too little attention was paid to the disease impact on family and work, dietary and exercise pattern, daily activities and quality of life. Multivariate analysis showed that clinical remission [5.77 (2.03-16.39), p=0.001] was a predictor of good quality of care. CONCLUSIONS: In this large IBD trial bureau, inflammatory bowel disease patients were very satisfied with the quality of care. Domains for quality improvement, such as attention to the impact of IBD on family and work, were identified.

Left ventricular assist device for end-stage heart failure: results of the first LVAD destination program in the Netherlands.

PURPOSE: Mechanical circulatory support with a continuous-flow left ventricular assist device (LVAD) may be a valuable treatment in end-stage heart failure patients for an extended period of time. The purpose of this study was to evaluate the safety and efficacy of implantation of a continuous-flow LVAD in end-stage heart failure patients within the first destination program in the Netherlands. METHODS: A third-generation LVAD was implanted in 16 heart failure patients (age 61 ± 8; 81 % male; left ventricular ejection fraction 20 ± 6 %) as destination therapy. All patients were ineligible for heart transplant. At baseline, 3 and 6 months, New York Heart Association (NYHA) functional class, quality-of-life and exercise capacity were assessed. Clinical adverse events were registered. RESULTS: Survival at 30 days and 6 months was 88 and 75 %, respectively. In the postoperative phase, 6 (38 %) patients required continuous veno-venous haemofiltration for renal failure and 2 (13 %) patients required extracorporeal membrane oxygenation because of severe right ventricular failure. During follow-up, NYHA functional class and quality-of-life improved from 3.7 ± 0.1 to 2.3 ± 0.1 and 57 ± 5 to 23 ± 3 at 6 months (P < 0.001), respectively. The 6 min walking distance improved from 168 ± 42 m to 291 ± 29 m at 6 months (P = 0.001). CONCLUSION: Continuous-flow LVAD therapy is a promising treatment for patients with end-stage heart failure ineligible for heart transplant.

Comparison of methohexital and etomidate as anesthetic agents for electroconvulsive therapy in affective and psychotic disorders.

BACKGROUND: ECT is a well-established treatment for severe depression. The available data on psychosis are limited, but reliable. Its therapeutic potential relies on the induction of a generalized seizure. Besides other narcotics, methohexital and etomidate are used for general anesthesia in ECT. Since prolonged seizures have been reported following the use of etomidate, it can be deduced that the substances might differ in their anticonvulsant properties, resulting in a lower increase in stimulus intensity during the course of treatment under etomidate. Besides this hypothesis, we aimed to investigate the differential effects of etomidate and methohexital on clinical features, ECT parameters and side effects of the treatment. METHODS: We performed a retrospective analysis of treatment data of patients with affective and psychotic diagnosis who received general anesthesia for ECT either with etomidate or with methohexital. RESULTS: ECT with etomidate and methohexital was equally effective. During the course of therapies the administered electric charge increased significantly and equally in both treatment groups. In the methohexital group, but not in the etomidate group, electroencephalographic seizure duration had a declining trend during the course of therapies. We observed more side effects during and immediately after ECT in the methohexital group than in the etomidate group. LIMITATIONS: The limitations of this study are that the patients received various psychotropic co-medications, which influence ictal parameters differently, and, secondly, the study is based on a retrospective analysis. CONCLUSION: The results of our analysis suggest that etomidate and methohexital affect ictal parameters to different extents. Longer seizure duration and fewer side effects are in favor of etomidate.

[Psycho-oncology]. / Psychoonkologie.

Psycho-oncology addresses the psychosocial care of patients with cancer. Systematic research on the interactions between biological, psychological and social factors before, during and after cancer has only been carried out for a few decades. All cancer patients, their relatives and the treating medical team should receive low-threshold offers for psychosocial support. The demand for interdisciplinary counselling and therapy detected by clinical diagnosis and by systematic screening, is not satisfactorily covered and is continuously increasing. In collaboration between the involved professional groups, education and professional qualifications for psycho-oncologists are still being developed.

Treatment options in end-stage heart failure: where to go from here?

Chronic heart failure is a major healthcare problem associated with high morbidity and mortality. Despite significant progress in treatment strategies, the prognosis of heart failure patients remains poor. The golden standard treatment for heart failure is heart transplantation after failure of medical therapy, surgery and/or cardiac resynchronisation therapy. In order to improve patients' outcome and quality of life, new emerging treatment modalities are currently being investigated, including mechanical cardiac support devices, of which the left ventricular assist device is the most promising treatment option. Structured care for heart failure patients according to the most recent international heart failure guidelines may further contribute to optimal decision-making. This article will review the conventional and novel treatment modalities of heart failure.

Real time control for reduced aeration and chemical consumption: a full scale study.

The use of the activated sludge process (ASP) for the nitrification/denitrification of wastewaters is commonplace throughout the UK and many other parts of the industrial world. Associated with this process are significant costs arising from aeration requirements and for selected sites, the need to provide an external carbon source. These costs can constitute up to of 50% of the total running cost of the whole plant and as such, any effort to reduce them could realise significant benefits. This paper investigates the use of real time control (RTC) using online sensors and control algorithms to optimise the operation of the ASP, leading to greater efficiency and sustainability. Trials were undertaken at full scale to assess the benefit of such a system at a 250,000 population equivalent (PE) works on the south coast of the UK, using Activated sludge model No.1 (ASM 1) as a basis for the control system. Initial results indicate that it is possible to significantly reduce both aeration and chemical consumption costs whilst still delivering the required effluent quality. Over the trial period the aeration requirements were consistently reduced by 20% whereas, a reduction in methanol consumption of in excess of 50% was observed.

[Early recognition centres for patients at risk of developing schizophrenia in Germany]. / Früherkennung und Frühbehandlung bei Patienten mit erhöhtem Schizophrenierisiko in Deutschland.

AIM OF THE STUDY: This survey gives a review over the development of early diagnosis and treatment of patients being at risk of developing psychoses in Germany. METHODS: A survey was carried out at 34 psychiatric departments at university hospitals in Germany from January until June 2008. RESULTS: So far, 12 early detection centres have been set up in Germany offering outpatient diagnostic and intervention services. CONCLUSIONS: Early recognition and intervention of psychoses has greatly improved in Germany in the last ten years. Therefore more research is imperative.

Persistent dyspnea complaints at long-term follow-up after an episode of acute pulmonary embolism: results of a questionnaire.

BACKGROUND: There is a lack of information on long term complications of patients with pulmonary embolism (PE), including chronic complaints of dyspnea. METHODS: Consecutive patients with a prior diagnosis of acute PE and an age and gender matched control group with no medical history of PE were presented with a questionnaire, designed to establish the presence, severity and possible causes of dyspnea in the clinical course of PE. RESULTS: The questionnaire was taken in 48 PE-survivors 40+/-7.4 months after PE; 27 patients (56%) had complaints of dyspnea. Sixteen (35%) were categorized as NYHA class II, 6 (13%) as class III and 5 (10%) as class IV. Overall, 19 patients (70%) had new or worsened complaints after PE. The study included 61 controls. Corrected for gender, age and medical history, the control group was significantly less dyspnoeic compared to the PE survivors (p<0.001). Corrected for gender and age, patients were 4 times more often in NYHA class II (OR 3.6 95%CI 1.4-9.7) and 7-fold more often in NYHA class III or IV (OR 6.5 95%CI 1.7-24), both compared to control subjects. CONCLUSION: A large percentage of patients with prior PE have persistent complaints of dyspnea at long term follow-up. The majority of them developed new or worsened dyspnea after the thrombo-embolic event. In comparison to a control population without a medical history of VTE, PE patients were overall significantly more dyspnoeic. An explanation for this phenomenon needs to be studied in further functional work-up of these patients.

Instrumentation, control and automation for full-scale manure-based biogas systems.

In recent years manure-based biogas plants (MBBP) have won more and more importance, because of the numerous ecological advantages. The processes are similar to processes, which have been well known for many decades in anaerobic wastewater/sludge treatment. As a result of technical progress and permanently rising prices for non-renewable energy, MBBPs have become more and more economically reasonable. Because of the economies of scale law more and more larger MBBPs are being built (250-2000 kW(el)). With regard to investment costs, reactor volumes and complexity etc., these (centralized) plants are comparable with small wastewater treatment plants (WWTP). Consequently, as actually in the case of the small WWTPs a rising use of instrumentation, control and automation (ICA) for larger MBBPs can be observed.