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Furaijat G, Bettac L, Kächele M, Grüner B, Skrabal C, Barth TFE, Parlak M, Hagemann JB, Peters L, Walther G, Kersten J. An unusual presentation of invasive Fusarium aortitis in a patient who is immunocompromised: A case report. Int J Infect Dis 2023; 134:102-105. [PMID: 37279826 DOI: 10.1016/j.ijid.2023.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
Fusarium (F.) species are ubiquitous filamentous fungi that may cause various opportunistic infections, especially in patients who are immunocompromised. A rare manifestation of disseminated fusariosis affects the aortic valve and results in invasive aortitis, which poses a significant challenge for clinicians in diagnosis and treatment. Here, we report a case of a patient, aged 54 years, who is immunocompromised, presenting initially with Fusarium keratitis and chorioretinitis in both eyes and a new endovascular aortic mass. Positron emission tomography/computed tomography was performed, suggesting aortitis. Transoesophageal echocardiography and electrocardiogram-guided computed tomography-angiography confirmed a large intraluminal mass in the ascending aorta. The aortic mass and a part of the ascending aorta were resected surgically, and a filamentous fungus with the microscopic features of the genus Fusarium was isolated and later identified molecularly as F. petroliphilum. The course of the treatment was complicated by perioperative cerebral embolization and mesenteric ischemia. These complications could be attributed to a preoperatively existing occlusion of the superior and inferior mesenteric artery and a subtotal stenosis of the celiac trunk. This case report describes a rare manifestation of disseminated fusariosis, frequently characterized by protracted clinical courses with poor prognosis. Fusariosis may manifest at different sites at different times or persist as a long-lasting disease with reactivation. This case highlights the importance of the interdisciplinary approach for effectively treating invasive mycoses.
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Affiliation(s)
- Ghefar Furaijat
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Lucas Bettac
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Martin Kächele
- University of Ulm, Department of Internal Medicine I, Ulm, Germany
| | - Beate Grüner
- University of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Christian Skrabal
- University of Ulm, Department of Cardiac, Thoracic and Vascular Surgery, Ulm, Germany
| | | | - Melih Parlak
- University of Ulm, Department of Ophthalmology, Ulm, Germany
| | | | - Lynn Peters
- University of Ulm, Department of Internal Medicine III, Division of Infectious Diseases, Ulm, Germany
| | - Grit Walther
- German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research, and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Johannes Kersten
- University of Ulm, Division of Sports and Rehabilitation Medicine, Ulm, Germany.
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Heinz J, Röver C, Furaijat G, Kaußner Y, Hummers E, Debray T, Hay AD, Heytens S, Vik I, Little P, Moore M, Stuart B, Wagenlehner F, Kronenberg A, Ferry S, Monsen T, Lindbaek M, Friede T, Gagyor I. Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data. BMJ Open 2020; 10:e035883. [PMID: 33004385 PMCID: PMC7534728 DOI: 10.1136/bmjopen-2019-035883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Uncomplicated urinary tract infection (UTI) in women is a common reason to present in general practice and is usually treated with antibiotics to reduce symptom severity and duration. Results of recent clinical trials indicate that non-antibiotic treatment approaches can also be effective. However, it remains unclear which patients would benefit from antibiotic treatment and which can effectively and safely be treated without antibiotics. This systematic review and meta-analysis aims to estimate the effect of treatment strategies to reduce antibiotic use in comparison with immediate antibiotic treatment and to identify prognostic factors and moderators of treatment effects. A further aim is to identify subgroups of patients benefiting from a specific therapy. METHODS AND ANALYSIS A systematic literature search will be performed to identify randomised controlled trials which investigated the effect of treatment strategies to reduce antibiotic use in female adults with uncomplicated UTI compared with immediate antibiotic treatment. Therefore, the primary outcome of the meta-analysis is incomplete recovery. Anonymised individual patient data (IPD) will be collected. Aggregate data will be used for pairwise comparisons of treatment strategies using meta-analysis models with random effects accounting for potential between-study heterogeneity. Potential effect moderators will be explored in meta-regressions. For IPD, generalised linear mixed models will be used, which may be adjusted for baseline characteristics. Interactions of baseline variables with treatment effects will be explored. These models will be used to assess direct comparisons of treatment, but might be extended to networks. ETHICS AND DISSEMINATION The local institutional review and ethics board judged the project a secondary analysis of existing anonymous data which meet the criteria for waiver of ethics review. Dissemination of the results will be via published scientific papers and presentations. Key messages will be promoted for example, via social media or press releases. PROSPERO REGISTRATION NUMBER CRD42019125804.
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Affiliation(s)
- Judith Heinz
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Christian Röver
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Ghefar Furaijat
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
- Department of Emergency Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Yvonne Kaußner
- Department of General Practice, Julius Maximilians University Wuerzburg Faculty of Medicine, Wuerzburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Thomas Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alastair D Hay
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Stefan Heytens
- Department of Public Health and Primary Care, University of Ghent, Gent, Belgium
| | - Ingvild Vik
- Department of General Practice, The Antibiotic Centre of Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway
| | - Paul Little
- Primary Care Population Sciences and Medical Education Unit, University of Southampton School of Medicine, Southampton, UK
| | - Michael Moore
- Primary Care Population Sciences and Medical Education Unit, University of Southampton School of Medicine, Southampton, UK
| | - Beth Stuart
- Primary Care Population Sciences and Medical Education Unit, University of Southampton School of Medicine, Southampton, UK
| | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Sven Ferry
- Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden
| | - Tor Monsen
- Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden
| | - Morten Lindbaek
- Department of General Practice, The Antibiotic Centre of Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Ildiko Gagyor
- Department of General Practice, Julius Maximilians University Wuerzburg Faculty of Medicine, Wuerzburg, Germany
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Kleinert E, Müller F, Kruse S, Furaijat G, Simmenroth A. [Usability and Efficiency of a Digital Communication Assistance Tool to Obtain Medical History from Non-German-Speaking Patients]. Gesundheitswesen 2020; 83:531-537. [PMID: 32413911 DOI: 10.1055/a-1144-2848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM In the DICTUM-Friedland study, a medical history-taking app was implemented in an initial reception facility for refugees and asylum seekers. This app can be used to obtain from patients information about the most frequent general medical complaints and risk factors in 13 different languages or dialects. A report (synopsis) is generated, based on each patient's given data, in the German language. Usability and efficiency of obtaining medical history were the criteria evaluated in order to test and optimize the app for use in a broader general medical setting. METHODS From May to December 2018, the app was tested in the waiting room of the general medical ward in the refugee camp in Friedland in southern Lower Saxony, Germany. Patients were asked to complete a short digital questionnaire about the usability of the app immediately after finishing the query. Sociodemographic data were partly collected with the same questionnaire and partly extracted from patient records. The efficiency was evaluated on the basis of the correspondence between the entered complaints (ICPC-2) and the diagnoses of the doctors (ICD-10). RESULTS In total, the app was used 353 times, and based on these, 283 medical histories were taken. The median time for entering the complaints was 10:27 minutes. The use of the audio output (60% of patients used this option) did not influence the usability. The majority of the users (76%) rated the app as easy to use and 65% of the users stated that they were able to enter their main complaints. Both assessments were independent of the age and sex of the users, but the educational level had a slightly more positive influence. The efficiency test showed that 51% (n=144) of the synopses matched fully and 28% (n=79) of the synopses matched partially with the medical diagnoses. CONCLUSION The systematic survey of the most frequent general medical complaints enables a more precise medical history taking in patients with whom a normal interview is not possible due to language barriers. Thus it serves as a support for the medical history taking. The app is easy to use and not prone to the errors of online translations.
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Affiliation(s)
- Evelyn Kleinert
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Frank Müller
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Stefan Kruse
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Ghefar Furaijat
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen
| | - Anne Simmenroth
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen Abteilung Allgemeinmedizin, Gottingen.,Institut für Allgemeinmedizin, Universitätsklinikum Würzburg, Wurzburg
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Müller F, Chandra S, Furaijat G, Kruse S, Waligorski A, Simmenroth A, Kleinert E. A Digital Communication Assistance Tool (DCAT) toObtain Medical History from Foreign-LanguagePatients: Development and Pilot Testing in a PrimaryHealth Care Center for Refugees. Int J Environ Res Public Health 2020; 17:ijerph17041368. [PMID: 32093286 PMCID: PMC7068523 DOI: 10.3390/ijerph17041368] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/18/2022]
Abstract
Background: Language barriers play a critical role in the treatment of migrant and refugee patients. In Germany, primary care interpreters are often not available especially in rural areas or if patients demand spontaneous or urgent consultations. Methods: In order to enable patients and their physicians to communicate effectively about the current illness history, we developed a digital communication assistance tool (DCAT) for 19 different languages and dialects. This paper reports the multidisciplinary process of the conceptual design and the iterative development of this cross-cultural user-centered application in an action-oriented approach. Results: We piloted our app with 36 refugee patients prior to a clinical study and used the results for further development. The acceptance and usability of the app by patients was high. Conclusion: Using digital tools for overcoming language barriers can be a feasible approach when providing health care to foreign-language patients.
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Affiliation(s)
- Frank Müller
- Department of General Practice, University Medical Center Göttingen/Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany or (S.K.); (E.K.)
- Correspondence:
| | - Shivani Chandra
- Institute for Health System Solutions and Virtual Care (WIHV), Women’s College Hospital, 76 Grenville St, Toronto, ON M5S 1B2, Canada;
- Crossroads Clinic, Women’s College Hospital, 76 Grenville St, Toronto, ON M5S 1B2, Canada
| | - Ghefar Furaijat
- Department of General Practice, University Medical Center Göttingen/Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany or (S.K.); (E.K.)
| | - Stefan Kruse
- Department of General Practice, University Medical Center Göttingen/Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany or (S.K.); (E.K.)
| | | | - Anne Simmenroth
- Department of General Practice, University Medical Center Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany;
| | - Evelyn Kleinert
- Department of General Practice, University Medical Center Göttingen/Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany or (S.K.); (E.K.)
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Kleinert E, Müller F, Furaijat G, Hillermann N, Jablonka A, Happle C, Simmenroth A. Does refugee status matter? Medical needs of newly arrived asylum seekers and resettlement refugees - a retrospective observational study of diagnoses in a primary care setting. Confl Health 2019; 13:39. [PMID: 31452677 PMCID: PMC6700982 DOI: 10.1186/s13031-019-0223-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/12/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Providing adequate healthcare to newly arrived refugees is considered one of the significant challenges for the German healthcare system. These refugees can be classified mainly into two groups: asylum seekers (who have applied for asylum after arrival in Germany and are waiting for the refugee-status decision) and resettlement refugees (who have already been granted asylum status before arriving in Germany). Whereas earlier studies have explored the health status of asylum seekers especially in terms of mental and behavioural disorders and infectious diseases without distinguishing between these two groups, our study aims to evaluate possible relationships of asylum status and medical needs of these two groups with a special focus on mental and behavioural disorders and infectious diseases. METHODS In this retrospective observational study, collected data on all asylum-seeker and resettlement-refugee patients (N = 2252) of a German reception centre (August 2017 to August 2018) is analysed by absolute and relative frequencies and medians. Patient data, collected by chart review, include age, gender, country of origin, asylum status, and diagnoses (ICD-10). To describe the relationship between sociodemographic factors (including asylum status) and diagnoses, we used tests of significance and bivariate correlations with Spearman correlation coefficients. All collected data are pseudonymised. RESULTS Of all 2252 patients, 43% were resettlement refugees. In almost all ICD-10 categories, asylum seekers received significantly more diagnoses than resettlement refugees. According to our data, asylum seekers presented with mental and behavioural disorders nine times more often (9%) than resettlement refugees (1%). In the case of infectious diseases, the results are mixed: asylum seekers were twice as frequently (11%) diagnosed with certain infectious and parasitic diseases than resettlement refugees (5%), but resettlement refugees were treated twice as often (22% of the asylum seekers and 41% of the resettlement refugees) for diseases of the respiratory system, of which 84% were acute respiratory infections (in both groups). CONCLUSION This study indicates that patients with unregulated migration more frequently present symptoms of psychiatric diseases and somatoform symptoms than resettlement refugees. A health policy approach within migration policy should aim to enable persecuted persons to migrate under regulated and safe conditions. TRIAL REGISTRATION German Clinical Trials Register: DRKS00013076, retrospectively registered on 29.09.2017.
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Affiliation(s)
- Evelyn Kleinert
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Ghefar Furaijat
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Nele Hillermann
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- German Center for Infection Research, Partner site Hanover-Brunswick, Hannover, Germany
| | - Christine Happle
- Department of Pediatrics, Neonatology, and Allergology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Anne Simmenroth
- Department of General Practice, University Medical Centre Göttingen / Georg-August-University, Humboldtallee 38, 37073 Göttingen, Germany
- Department of General Practice, University Medical Centre Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
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Furaijat G, Kleinert E, Simmenroth A, Müller F. Implementing a digital communication assistance tool to collect the medical history of refugee patients: DICTUM Friedland - an action-oriented mixed methods study protocol. BMC Health Serv Res 2019; 19:103. [PMID: 30728030 PMCID: PMC6366114 DOI: 10.1186/s12913-019-3928-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Language barriers play a decisive role in determining the outcomes of medical consultations between healthcare providers and their foreign patients. This issue is a significant challenge to the German healthcare system, especially with the rising number of refugees in recent years. The communication gap between healthcare professionals and their non-German speaking patients sometimes leads to unnecessary medical re-admission, insufficient medical history, incorrect diagnosis, and treatment plans. In this study, we aim to assess the usability and accuracy of a novel digital translation tool in collecting medical history from patients in their native language and to check its effects on healthcare outcomes. Methods The study aims to monitor the implementation of a new digital communication assistance tool (DCAT) and to investigate its impact on the mutual understanding between refugee patients and their German general practitioners (GPs). In the first study phase, an action-oriented approach is used to implement DCAT. In the second study phase, DCAT use will be evaluated with a mixed methods design. The main outcome assesses the re-consultation rates of patients before and after using DCAT. Secondary outcomes include the usability of the tool, its acceptance and perceived quality by patients, the accuracy of the information collected as determined from analysing the reasons for the consultation (ICPC-2 codes), and diagnosis (ICD-10 codes). The acceptance by patients, socio-demographic factors and native language are also taken into account. The research designs for both study phases include questionnaires, semi-structured interviews, non-participant observation and analysis of collected patients’ data. All the collected data is pseudonymised. Discussion The DCAT study is one of the new research projects in primary healthcare investigating the usability, accuracy, and acceptance of digital translation tools during medical encounters. We aim to eliminate significant communication errors and misunderstandings in medical consultations, thereby improving the quality of healthcare outcomes. By applying an action research design, we will attain a more comprehensive evaluation of DCAT scopes and limits. The results of this study are expected to give an in-depth understanding of possible applications and benefits of digital translation tools for patient care. Trial registration German Clinical Trials Register DRKS00013076, 29/09/2017. Electronic supplementary material The online version of this article (10.1186/s12913-019-3928-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ghefar Furaijat
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Evelyn Kleinert
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany
| | - Anne Simmenroth
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany.,Department of General Practice, University Medical Centre Würzburg/Julius-Maximilian-University, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Frank Müller
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany
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