Late-onset severe pneumonitis under osimertinib

Pneumonitis is a rare and possibly life threatening side effect of TKI-treatment. We present a patient with adenocarcinoma of the lung harboring an uncommon EGFR Exon 21 mutation treated with osimertinib as second-line therapy. After nine months of treatment, the patient developed progressing shortness of breath and night sweats. A severe late-onset predominantly eosinophilic pneumonitis was diagnosed, osimertinib treatment was discontinued and immunosuppressive treatment was initiated. This case report highlights late-onset pneumonitis as a side effect of third-generation TKI-treatment and possible options for subsequent tumor treatment.

[Quality of hospital care in Germany: analysis of the trend between 2004 and 2008 from external quality assurance data]

BACKGROUND AND OBJECTIVES

Introducing fixed fees for inpatient hospital care has raised fears of a negative influence on treatment quality. To address these concerns, an external quality assurance was implemented. The results of the quality indicators should indicate changes in the quality of inpatient care between 2004 and 2008.

METHODS

On the basis of the evaluation data delivered by the Federal Quality Assurance Agency, quality indicators with similar results of at least 3 subsequent years were included. A trend was identified with linear regression as well as with a constant change in the results. 204 quality indicators of 19 health care sectors of 6 diagnosis groups were included.

RESULTS

Half of the quality indicators showed a particularly striking quality improvement in the categories "indication" and "process". The lowest number of quality indicators with a quality improvement occurred in the cardiac surgery. To this diagnosis group also belong 13 of the 18 quality indicators with deterioration. Sixteen of the 18 quality indicators rank among the category "result".

CONCLUSION

The quality of inpatient care improved substantially from 2004 through 2008, measured against the quality indicators of the external comparable quality assurance. This corresponds to other analyses of a similar time period in Germany of the same or different data sources. Those analyses showed additionally that the subjective perceptions of clinicians and of nursing staff are significantly worse.

Rapid detection of Listeria monocytogenes by PCR-ELISA

A rapid detection system specific for Listeria monocytogenes based upon the polymerase chain reaction was developed. The specificity of the primers and the probe annealing to the coding region of the mpl gene proved positive with the DNA from a total of 103 L. monocytogenes strains, while DNA from another 73 Listeria and non-Listeria strains tested negative. To facilitate detection with large numbers of samples, a microtitre plate assay was established with biotinylated probes. Use of a standard DNA prevented false-negative results when used as an internal amplification control in the PCR-ELISA. As the described method required approximately 5-6 h to be completed it may prove useful in the detection of L. monocytogenes in food.