BACKGROUND: A routine infectious disease service was established in January 1998 in order to optimize the antibiotic usage and prescription pattern of a neurologic intensive care unit (NICU). METHODS: Treatment guidelines for the most prevalent infections were implemented and individual antibiotic regimes were discussed at the bedside with infectious disease experts. RESULTS: This interdisciplinary cooperation reduced the total number of antibiotics prescribed by 38.1%, from 7,789 in 1997 to 4,822 in 1998, without compromising patient outcomes (mortality rate: 22/313 patients in 1997 vs. 32/328 patients in 1998). Total patient days (2,254 days vs. 2,296 days) and average length of stay in the NICU (7.2 days vs. 7.0 days) were comparable. Antimicrobial expenditure decreased by 44.8% (71,680 Euros in 1997 vs 39,567 Euros in 1998). Taking into account the costs for the infectious disease service (approximately 8,000 Euros in 1998), a total saving of 24,113 Euros was made. The dramatic reduction in antibiotic usage (mainly of carbapenems) resulted in a statistically significant decreased isolation of Stenotrophomonas maltophilia (p<0.05), Enterobacter cloacae (p<0.05), multiresistant Pseudomonas aeruginosa (p<0.05) and Candida spp. (p<0.05), without any change in the infection control guidelines. CONCLUSION: These data show that an infectious disease service can optimize and reduce antibiotic usage. This results in a decrease in the occurence of multiresistant gram-negative pathogens and Candida spp. in intensive care units and, at the same time, saves costs.

Anti-Bacterial Agents↗

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Higher morbidity risk for schizophrenia in males: fact or fiction?

Male to female ratios in published annual incidence rates for schizophrenia range from 0.70 to 3.47. These variations between studies are attributed to differences in sampling, diagnostic criteria, design characteristics, and methods of calculation, which limit the quality of the studies. In an effort to overcome these shortcomings, we collected a comprehensive sample of 392 consecutive first admissions with a diagnosis of schizophrenia or a similar disorder out of a population of 1.5 million in a central region of western Germany. In this large representative sample, no significant gender differences in the incidence of schizophrenia could be detected regardless of different diagnostic definitions.

Adolescent↗

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Application of epidemiological research toward a model for the etiology of schizophrenia.

Epidemiological surveys based on transnationally standardized assessment procedures have shown a relatively uniform worldwide incidence rate for a restrictively defined schizophrenia syndrome. The age-corrected morbid risk appears to remain unchanged over longer periods of time and to be equal for both sexes--apart from the higher age of onset in females. For explaining these findings a continuous model is proposed, similar to that used for modelling neurobiological and genetical assumptions. The nuclear syndrome of the schizophrenic psychosis is understood to be the lower end of a morbidity dimension extending through broadly defined schizophrenic syndromes, spectrum disorder and patterns of unspecific disturbances to lack of symptoms. It may be assumed that a genetically determined vulnerability is underlying this morbidity dimension and that high values of vulnerability entail a specific psychopathology, the schizophrenic psychosis. It appears that at lower values of vulnerability the specificity decreases, and that with increasing influence of personality and environmental factors the variety of manifesting psychiatric disorders increases.

Cross-Sectional Studies↗

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Squamous cell carcinoma antigen for monitoring cervical cancer.

The tumour-associated antigen was determined in the plasma of patients with squamous cell carcinoma (SCC) of the uterine cervix by radioimmunoassay. Setting a limit of 2 ng/ml, levels were abnormal in 13.4% of healthy controls, in 14% of patients with carcinoma in situ and in 62% of patients with invasive cervical SCC. The incidence of elevated SCC antigen levels and the absolute antigen plasma concentration were dependent upon the tumour load, increasing significantly with advanced stage disease. Abnormal SCC antigen values in operable cervical cancer declined to normal within one week after radical hysterectomy with pelvic lymphadenectomy. In cases of radiotherapy antigen values took 4-6 weeks after the start of treatment to return to normal. The success of both treatment modalities was announced by an early rise in the SCC antigen in the initial phase of therapy, followed by normalisation. After successful primary treatment and a complete remission during further follow-up SCC antigen in plasma was only increased in 3.8% of the cases. Retrospective evaluations in ten patients with progressive disease showed the reappearance of abnormal SCC titers and further increase preceeding the clinically detectable relapse or progression, with a median interval of 8 weeks. The present study indicates that SCC antigen determination is not useful for the early diagnosis of cervical cancer, but it is a potential means for monitoring the efficacy of individual anticancer therapy of SCC of the uterine cervix and for detecting recurrent disease.

Adenocarcinoma↗

PubMedDate not supplied

[Psychosomatic medicine -- does it have the right to exist as a separate discipline?].

In their "Recommendations for Clinical Research at Medical Schools and Universities" (1986), the Scientific Council of the Federal Republic of Germany described the quantity and quality of psychosomatic and psychotherapy-research generally as unsatisfactory. Although meanwhile in some fields, such as epidemiologic longitudinal studies, comparative therapy evaluation of controlled individual case studies, research has reached good-quality standard, essential deficits still remain. There are several reasons for the delay in implementing psycho-somatic-psychotherapeutic research after the establishment of departments of psychosomatic medicine and psycho-therapy at Medical Schools in the Federal Republic of Germany in 1970. For example 1.) psychosomatic research covers almost all disciplines of clinical medicine. Therefore, a variety of special knowledge is required. 2.) Global psychological theories that marked the beginning of psychosomatic medicine are obviously inadequate in providing useful approaches to causal explanations in psychosomatic medicine. The cultural complexity of mental life determining the substance of psychoanalytical hypo-theses is apparently not reflected in the comparatively simple, phylogenetically rooted psychic factors leading to pathophysiological processes. As a consequence, psychosomatic research will have to concentrate less on global theories and to focus more on heuristic models of limited range specific to the respective functional systems or illnesses. The need to carry out examinations on both mental and physical level requires knowledge of either methodology. In addition, the necessary access to patients and laboratories suggests that psycho-somatic departments should be closely connected with those of internal medicine or one of the other departments with many psychosomatic problems. Research and advanced training in psychotherapy, on the other hand, should be performed in close cooperation with the one department responsible for research and the provision of care for the mentally ill, with psychiatry. Thus it would be possible to definitely improve the present situation, which is characterized by an overburden of the usually small departments of psychosomatic medicine and psychotherapy with matters of psycho-therapeutic training, research training, clinical work and teaching. At any rate, psychosomatic medicine is having great prospects, in particular concerning research. The departments of psychosomatic medicine and psychotherapy should be better prepared and equipped for these future tasks.

Germany↗