[Current vaccination status of health-care personnel in Brandenburg, Saxony And Saxony-Anhalt]

OBJECTIVE AND METHODS

A complete vaccination status against infectious diseases is important for protecting health care professionals as well as patients. A survey based on a written questionnaire was conducted to record the actual vaccination status against diphtheria, hepatitis A und B, mumps, measles, poliomyelitis, rubella and tetanus. 642 general practitioners (family physicians and surgeons), 298 medical students and 962 nursing students from areas of eastern Germany completed the questionnaire.

RESULTS AND CONCLUSIONS

There was no complete vaccination status against those diseases covered by the survey. Physicians had a good immunisation rate against tetanus (96.2%) and diphtheria (91.8%). The number of physicians without immunisation against measles (42.9%), HA (29.3%) and HB (12.7%) was unsatisfactory. Less than 50% of nursing students and medical students could show a complete vaccination status against MMR. In both student groups there were also gaps for vaccines against tetanus, diphtheria, HA and HB. Complete vaccination status was found to be in the range of 74-81% for tetanus, 51-66% for diphtheria, 47-63% for HA and 62-73% for HB. Furthermore, there is a need for actions to raise the immunisation rates and for improving the health protection for all persons involved (professionals and patients) in the health care system.

Renal failure and rhabdomyolysis associated with sitagliptin and simvastatin use

BACKGROUND

Sitagliptin is a new oral glucose-lowering medication that acts via the incretin hormone system. The most common side-effects are headache and pharyngitis, and few serious adverse events were observed during clinical trials. Dose adjustment is recommended in renal insufficiency, but long-term safety experience is limited.

CASE REPORT

We present a patient with chronic renal insufficiency who developed leg pain, weakness and tenderness after starting treatment with high-dose sitagliptin while on simvastatin. The patient had acute renal failure and rhabdomyolysis that resolved with cessation of sitagliptin, simvastatin, ezetimibe, diuretics and olmesartan. All drugs except sitagliptin, ezetimibe and simvastatin were resumed, and the patient was subsequently started on lovastatin without recurrence of rhabdomyolysis.

CONCLUSIONS

High doses of sitagliptin may have worsened this patient's renal failure and precipitated rhabdomyolysis by increasing circulating levels of simvastatin. Given the high likelihood that sitagliptin will be co-administered with statins and renally active medications, further study of long-term safety of sitagliptin in renal sufficiency may be warranted.

Locomotor training for walking after spinal cord injury

BACKGROUND

Locomotor training for walking is used in rehabilitation after spinal cord injury (SCI) and might help to improve walking.

OBJECTIVES

To assess the effects of locomotor training on improvement in walking for people with traumatic SCI.

SEARCH STRATEGY

We searched the Cochrane Injuries Group Specialised Register (last searched June 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2); MEDLINE (1966 to June 2007); EMBASE (1980 to June 2007); National Research Register (2007, Issue 2); CINAHL (1982 to June 2007); AMED (Allied and Complementary Medicine Database) (1985 to June 2007); SPORTDiscus (1949 to June 2007); PEDro (the Physiotherapy Evidence database) (searched June 2007); COMPENDEX (engineering databases) (1972 to June 2007); INSPEC (1969 to June 2007); and the National Research Register, Zetoc, and Current Controlled Trials research and trials registers. We also handsearched relevant conference proceedings, checked reference lists and contacted study authors in an effort to identify published, unpublished and ongoing trials.

SELECTION CRITERIA

We included randomised controlled trials (RCT) that compared locomotor training to any other exercise provided with the goal of improving walking function after SCI or to a no-treatment control group.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcomes were the speed of walking and walking capacity at follow up.

MAIN RESULTS

Four RCTs involving 222 patients were included in this review. Overall, the results were inconclusive. There was no statistically significant effect of locomotor training on walking function after SCI comparing bodyweight supported treadmill training with or without functional electrical stimulation or robotic-assisted locomotor training.

AUTHORS' CONCLUSIONS

There is insufficient evidence from RCTs to conclude that any one locomotor training strategy improves walking function more than another for people with SCI. Research in the form of large RCTs is needed to address specific questions about the type of locomotor training which might be most effective in improving walking function of people with SCI.

[Quality of life and care of members of the Saxonian branch of the German Society for Multiple Sclerosis. Results of a written questionnaire]

Although multiple sclerosis is the most common neurological inflammatory disease among young adults in Europe and Northern America, population-based studies on the quality of life and care of persons affected by multiple sclerosis have not yet been frequently published in Germany. The aim of this study was to assess the quality of life and care as seen by members of the Saxonian branch of the German Society for Multiple Sclerosis. Between October 2002 and January 2003 a representative survey of the members (n=757) of the Saxonian branch of the German Society for Multiple Sclerosis was conducted on the basis of a written questionnaire. Multiple linear and logistical regression analyses were used to find determinants of the self-assessed quality of life and medical care. As a result of these multivariate analyses, the strong impact of disease-specific factors on the physical, mental and social well-being of participants was confirmed. The study hereby revealed that with disease progression the quality of life of affected persons, particularly elderly and invalid patients, patients with bladder and stool problems, and patients with mental problems, was significantly reduced. For these patients symptomatic treatment, which can mitigate the serious consequences of the disease, is of high importance. The fact that these patient groups partly reported a stronger dissatisfaction with their medical care situation indicates that it may not be adequate. With regard to drug treatment with beta interferons and azathioprin, a strong difference was observed between the number of patients who had already taken a beta interferon in the past and the number of patients who were currently on beta interferon, which indicates a high rate of patients breaking off the treatment. The results of this study suggest that there is potential for improvement of the medical and therapeutic care of persons affected by Multiple Sclerosis in Saxony. Adequate care, which takes into consideration the individually diverging disease courses, symptoms and psychosocial consequences, is required in order to maintain or optimize the quality of life.

Electromechanical-assisted training for walking after stroke

BACKGROUND

Electromechanical and robotic-assisted gait training devices are used in rehabilitation and might help to improve walking after stroke.

OBJECTIVES

To investigate the effect of automated electromechanical and robotic-assisted gait training devices for improving walking after stroke.

SEARCH STRATEGY

We searched the Cochrane Stroke Group Trials Register (last searched September 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2006), MEDLINE (1966 to September 2006), EMBASE (1980 to September 2006), CINAHL (1982 to October 2006), AMED (1985 to October 2006), SPORTDiscus (1949 to August 2006), the Physiotherapy Evidence Database (PEDro, searched September 2006) and the engineering databases COMPENDEX (1972 to October 2006) and INSPEC (1969 to October 2006). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists and contacted authors in an effort to identify further published, unpublished and ongoing trials.

SELECTION CRITERIA

We included studies using random assignment.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcome was the proportion of patients walking independently (without assistance or help of a person) at follow up.

MAIN RESULTS

Eight trials (414 participants) were included in this review. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of becoming independent in walking (odds ratio (OR) 3.06, 95% confidence interval (CI) 1.85 to 5.06; P < 0.001), and increased walking capacity (mean difference (MD) = 34 metres walked in six minutes, 95% CI 8 to 60; P = 0.010), but did not increase walking velocity significantly (MD = 0.08 m/sec, 95% CI -0.01 to 0.17; P = 0.08). However, the results must be interpreted with caution because (1) variations between the trials were found with respect to duration and frequency of treatment and differences in ambulatory status of patients, and (2) some trials tested electromechanical devices in combination with functional electrical stimulation.

AUTHORS' CONCLUSIONS

Patients who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than patients receiving gait training without these devices. However, further research should address specific questions, for example, which frequency or duration of electromechanical-assisted gait training might be most effective and at what time after stroke, and follow-up studies are needed to find out how long the benefit lasts. Future research should include estimates of the costs (or savings) due to electromechanical gait training.

Immunomodulating drugs in multiple sclerosis: compliance, satisfaction and adverse effects evaluation in a German multiple sclerosis population

OBJECTIVE

To assess the compliance, satisfaction and adverse effects of immunomodulating drugs in a German multiple sclerosis (MS) population.

RESEARCH DESIGN AND METHODS

A standardised, anonymous questionnaire was sent to the 1985 members with MS of the Berlin section of the German Multiple Sclerosis Association. Patients were questioned with regards to sociodemographic data, MS-related topics, therapy, adverse effects and compliance. The response rate was 51.1%, from which 681 patients were selected who were experienced in therapy with interferon beta 1a or 1b or glatiramer acetate.

RESULTS

Most participants were treated with beta-interferons and only one-third with glatiramer acetate. Patients were moderately satisfied with their medication. Approximately 75.5% of patients had used the medication for longer than 2 years, especially those with a relapsing-remitting course (RRMS). Around one-third of all participants had their immunomodulating drug changed, mostly only once. The main reasons for discontinuation of the therapy were adverse effects, physician's recommendation and lack of treatment effect. Mood-related adverse effects (e.g., depression), fever and pain were perceived as most disturbing. Regression analysis revealed that dependence on a wheelchair and a secondary progressive course predicted a low compliance to treatment.

CONCLUSION

Treating MS is a challenge and to positively influence the course of the disease it is necessary to administer medication in a constant manner. Our data showed a moderate compliance and satisfaction with the immunomodulating medication. Adverse effects and perceived lack of treatment effect were reasons for discontinuation of therapy. To increase compliance and satisfaction with treatment, adequate information about MS, the therapeutic options, handling of medication, side-effects and their management are necessary. Additionally, realistic therapeutic aims should be discussed with the patients.

[Coping training for patients with multiple sclerosis. Evaluation from a neurologic standpoint]

BACKGROUND

Multiple sclerosis (MS) is a challenging disease for patients, the social environment, and therapists. We analysed how coping training and compliance of MS patients are assessed by neurologists in private practice.

METHOD

One thousand five hundred and seventy-five neurologists in private practice were asked to fill in short, standardised, anonymous questionnaires concerning number of MS patients treated per year, experience with coping training methods, assessments of requirements, aims, location, and suitable trainer, financial aspects of coping training, assessment of patient compliance concerning immunomodulating therapies, and possibilities of increasing compliance.

RESULTS

The response rate was 25.7% (404 questionnaires). Of these, 344 (21.8%) could be included in the analysis. Many neurologists had no experience with coping training methods but saw a reasonable demand, especially for newly diagnosed MS patients, those with psychological problems, and for their relatives. Most of them would like to provide such training themselves in their own locations. Useful aims of coping training included reduction of anxiety, uncertainty, and depression and increased patient compliance and well-being. They proposed that coping training should mainly be financed by health care insurers and patients. Neurologists assessed the compliance of MS patients concerning immunomodulating therapies as being moderate to high. Increased compliance was understood as better doctor-patient conversations, involvement of MS nurses, and support from self-help groups.

CONCLUSION

There is a reasonable need of coping training for MS patients that is also seen by privately practicing neurologists, the main therapists for MS patients. The selection of adequate and scientifically reliable training should be improved. Thus coping with the disease, compliance, and well-being can all be improved.

The Faces Symbol Test, a newly developed screening instrument to assess cognitive decline related to multiple sclerosis: first results of the Berlin Multi-Centre FST Validation Study

Reliable, language-independent, short screening instruments to test for cognitive function in patients with multiple sclerosis (MS) remain rare, despite the high number of patients affected by cognitive decline. We developed a new, short screening instrument, the Faces Symbol Test (FST), and compared its diagnostic test characteristics with a composite of the Digit Symbol Substitution Test (DSST) and the Paced Auditory Serial Addition Test (PASAT), in 108 MS patients and 33 healthy controls. An Informant-Report Questionnaire, a Self-Report Questionnaire, and a neurologist's estimation of the Every Day Life Cognitive Status were also applied to the MS patients. The statistical analyses comprised of a receiver operating characteristic analysis for test accuracy and for confounding variables. The PASAT and DSST composite score estimated that 36.5% of the MS patients had cognitive impairment. The FST estimated that 40.7% of the MS patients were cognitively impaired (sensitivity 84%; specificity 85%). The FST, DSST and PASAT results were significantly correlated with the patients' physical impairment, as measured by the Expanded Disability Status Scale (EDSS). The results suggest that the FST might be a culture-free, sensitive, and practical short screening instrument for the detection of cognitive decline in patients with MS, including those in the early stages. Multiple Sclerosis 2007; 13: 402-411. http://msj.sagepub.com