Pop-up Langmuir probe diagnostic in the water cooled divertor of Wendelstein 7-X.

The design, development, and successful implementation of pop-up Langmuir probes installed in the water-cooled divertor of W7-X are described. The probes are controlled by drive coils (actuators) installed behind the divertor plates. These drive coils make use of the magnetic field in W7-X to move the probe tips into and out of the plasma. The drive coils were installed in the vacuum vessel after extensively testing the durability of the coils and analyzing the criteria for safe operation. The probe design is carefully tailored for each of the 36 probe tips in order to be suitable for the different magnetic field configurations used in W7-X and ensure that the probes do not present leading edges to the magnetic flux tubes. An electronic bridge circuit is used for measurement to compensate for the effects of signal propagation time on the long cable lengths used. The diagnostic is integrated with the segment control of W7-X for automated operation and control of the diagnostic. The evaluation of the results from the plasma operation is presented after accounting for appropriate sheath expansion for negative bias voltage on the probes.

Prognostic genomic alterations in patients undergoing liver resection for hepatocellular carcinoma.

INTRODUCTION: Genetic mutations and amplifications found in hepatocellular carcinoma (HCC) have a potentially prognostic impact. The aim of this study was to investigate the prognostic value of mutations and amplifications in HCC from patients that were liver resected. METHODS: Patients liver resected for HCC at Copenhagen University Hospital Rigshospitalet between May 2014 and January 2018 were included. DNA from freshly frozen tumour tissue was investigated with TruSight Oncology 500. Mutations and amplifications were correlated with disease-free survival and overall survival using multivariate Cox regression to assess the effect on prognosis. RESULTS: Of the 51 patients included, 88% were male and the median age was 69 years. Most patients had a single tumour (84%) with no vascular invasion (67%) in a non-cirrhotic liver (76% with fibrosis, 24% with cirrhosis). The median follow-up was 37 months. Patients with a MYC amplification (8%) were significantly younger than the remaining patients. Furthermore, they had a significantly shorter overall survival (15 months (95% CI: 0.0-31.6) vs. 59 months (95% CI: 34.4-83.6), p = < 0.001) and disease-free survival (8 months (95% CI: 4.6-11.4) vs. 19 months (95% CI: 12.3-25.7), p = 0.03). However, only overall survival remained statistically significant in the adjusted analysis. Furthermore, all patients with an ARID1A mutation (6%) had microvascular invasion and significantly larger tumours than the patients without ARID1A mutation. CONCLUSION: MYC amplifications had a prognostic influence on survival, whereas ARID1A gene mutations were correlated with microvascular invasion. These may serve as prognostic biomarkers and should be validated in large, independent cohort.

A prospective whole-mixture approach to assess risk of the food and chemical exposome.

Many widely used chemicals result in ubiquitous human exposure from multiple sources, including diet. Legislation mainly deals with the toxicological evaluation of single substances owing to a methodological and conceptual lack of alternatives, and does so within defined silos subject to over 40 distinct regulations in the EU alone. Furthermore, much of the research and many of the initiatives concerned with the assessment and evaluation of chemical mixtures and their potential effects on human health rely on retrospective analysis. Here we propose an approach for the prospective identification, assessment and regulation of mixtures relevant to human health. We address two distinct aspects of toxicology-which chemicals actually do occur together, and how potential mixture-related health hazards can be predicted-with an adapted concept of the exposome and large-scale hazard screens. The proactive use of the likelihood of co-exposure, together with the new approach of methods-based testing, may be a timely and feasible way of identifying those substances and mixtures where hazards may have been overlooked and regulatory action is needed. Ideally, we would generate co-exposure patterns for specific consumer groups, depending on lifestyle and dietary habits, to assess the specific risk of identified mixtures.

Are German family practitioners and psychiatrists sufficiently trained to diagnose and treat patients with alcohol problems?

BACKGROUND: Harmful alcohol consumption in Germany is a serious public health problem: About 7.7 million adults in Germany can be classified as risky alcohol consumers, about 74,000 deaths per year are related to alcohol consumption, and about 1.8 million adults in Germany (18-64 years) are classified as alcohol dependent. A treatment rate of 9% of all alcohol dependent patients in Germany implies a lack of supply and misuse of medical care. The aim of the study was to examine whether family practitioners (FPs) and psychiatrists have sufficient skills to diagnose and treat patients with alcohol problems. METHODS: A total of 6324 FPs and psychiatrists in the states of Saxony and Rhineland-Palatinate in Germany were invited to participate in this survey. Nine hundred seventy-four participants (90.3%/FPs) could be included in the statistical analysis (response rate: 14.3%/FPs, 21.6%/psychiatrists). Data was analysed descriptively and logistical regressions were used to identify predictors for physicians' ability to feel adequately trained to diagnose and treat patients with alcohol problems. RESULTS: In comparison to psychiatrists, less FPs reported feeling sufficiently trained to counsel patients with alcohol problems (81.5% vs. 44.8%). Regression analysis revealed that FPs who felt not adequately trained had less experience with patients with alcohol dependence (OR 7.4), had attended fewer hours on alcohol addiction in continuing medical education (OR 4.8), and were more likely to be female (OR 1.9). A minimum of 10 h of training was associated with improved self-assessed competence. CONCLUSION: Harmful drinking is a serious public health problem, and patients with alcohol dependence represent a large and demanding patient group in primary health care setting. Our study shows that the lack of training is a severe barrier in the work with this patient group in the primary care setting.

[Patient satisfaction in ambulatory cataract surgery : Differences between outpatients in a special surgery or in a hospital]. / Patientenzufriedenheit nach ambulanter Kataraktoperation : Unterschiede zwischen ambulant in einer Praxis und ambulant im Krankenhaus operierten Patienten.

BACKGROUND: The evaluation of patient satisfaction provides important information about subjective quality indicators from the patient's perspective. In Germany, cataract surgery is mostly done ambulatory in a special surgery or in a hospital. This study examines if there are differences in global patient satisfaction of either outpatient setting and if there are different determinants of global satisfaction with regard to the outpatient settings. PATIENTS AND METHODS: The survey comprises ambulatory operated cataract patients in Saxony between 2014 and 2015. A total of 4800 cataract patients sent back a standardized, written questionnaire. Regression analysis identified determinants of global patient satisfaction in both groups. RESULTS: The most influencing parameters for the global satisfaction were satisfaction with the treatment outcome, atmosphere and facilities in the surgery or hospital as well as the staff's level of kindness. CONCLUSION: Results of the conducted study show most identified determinants of patient satisfaction are associated with service variables, such as atmosphere and facilities in surgery or hospital and waiting time in surgery or hospital. These aspects should be focused on to improve patient satisfaction in cataract patients.

Factors influencing sleep quality among nursing staff: Results of a cross sectional study.

PURPOSE: Given the intense physical and mental demands placed on nurses and other caregivers, getting sufficient sleep is essential to maintaining both individual health and professional performance. The goal of our study is to describe and analyze the self-reported sleep quality of nursing staff and identify which factors have an influence on it. METHODS: The sample was comprised of 153 female nurses over the age of 20 years who completed written surveys regarding their health status and health behavior. Their responses were subjected to ANOVA analysis with post hoc follow-up tests and logit regression was used. RESULTS: 33% of female nursing staff reported poor quality sleep. Lower quality of life, tachycardia and unequal distribution of work load were most strongly associated with poor sleep quality. CONCLUSION: Our study indicates that reducing workplace stress is a good place to start in developing a proactive strategy. A comprehensive prevention strategy should include both behavioral and situational prevention elements. Future studies should focus on identifying causal factors and developing prevention strategies.

[Factors Influencing Lead Time in Multiple Sclerosis: Survey of Members of the German Multiple Sclerosis Society in Saxony-Anhalt]. / Multiple Sklerose - Ergebnisse einer Befragung der Mitglieder des DMSG-Landesverbandes e.V. in Sachsen-Anhalt: Durch welche Faktoren wird die Diagnosedauer beeinflusst?

BACKGROUND: Multiple sclerosis is a neurodegenerative disease of the central nervous system in which the myelin layer is disrupted. Early diagnosis and early therapy are decisive for the course of the disease. METHODS: To analyze the time to diagnosis and the factors having an influence on this process, members of the German Multiple Sclerosis Society in Saxony-Anhalt (n = 941) were surveyed. Thanks to a return rate of 424 questionnaires (response rate ≈45 %), the results provide a good overview of MS patients in this region. RESULTS: Almost 80 % of the respondents were female. The median time to diagnosis was 6.35 years. On average, women were diagnosed 2.93 years later than men (p≤ 0.05; U test). CONCLUSION: The time to diagnosis has decreased over the last decades. Younger age at the time of the first symptoms seems to be a positive factor for early diagnosis. A recall bias cannot be outruled since all the data are based on individual experience. The results of the self-help group samples cannot be generalized. Further surveys are needed to analyze why it takes over six years to establish the diagnosis of multiple sclerosis.

Patient satisfaction in cardiology after cardiac catheterization : Effects of treatment outcome, visit characteristics, and perception of received care.

BACKGROUND: Patient satisfaction is a key indicator for quality of care. However, recent data on determinants of satisfaction in invasive cardiology are lacking. Hence this study was conducted to identify determinants of patient satisfaction after hospitalization for cardiac catheterization. PATIENTS AND METHODS: Data were obtained from 811 randomly selected patients discharged from ten hospitals responding to a mailed post-visit questionnaire. The satisfaction dimension was measured with a validated 42-item inventory assessing demographic and visit characteristics as well as medical, organizational, and service aspects of received care. Bivariate and multivariate statistical analyses were performed to identify predictors of satisfaction. RESULTS: Patients were most satisfied with the kindness of medical practitioners and nurses. The lowest ratings were observed for discharge procedures and instructions. Multivariate analysis revealed five predictors of satisfaction: treatment outcome (OR, 2.14), individualized medical care (OR, 1.64), clear reply to patient's inquiries by physicians (OR, 1.63), kindness of nonmedical professionals (OR, 3.01), and room amenities (OR, 2.02). No association between demographic data and overall satisfaction was observed. CONCLUSION: Five key determinants that can be addressed by health-care providers in order to improve patient satisfaction were identified. Our findings highlight the importance of the communicational behavior of health-care professionals and the transparency of discharge management.

Physical rehabilitation for critical illness myopathy and neuropathy: an abridged version of Cochrane Systematic Review.

Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating. Secondary objectives were to assess effects on muscle strength and quality of life, and to assess adverse effects of physical rehabilitation. On 16 July 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register and on 14 July 2014 we searched CENTRAL, MEDLINE, EMBASE and CINAHL Plus. In July 2014, we searched the Physiotherapy Evidence Database (PEDro) and three trials registries for ongoing trials and further data about included studies with no language restrictions. We also handsearched relevant conference proceedings and screened reference lists to identify further trials. We planned to include randomised controlled trials (RCTs), quasi-RCTs and randomised controlled cross-over trials of any rehabilitation intervention in people with acquired weakness syndrome due to CIP/CIM. We would have extracted data, assessed the risk of bias and classified the quality of evidence for outcomes in duplicate, according to the standard procedures of The Cochrane Collaboration. Outcome data collection would have been for activities of daily living (for example, mobility, walking, transfers and self care). Secondary outcomes included muscle strength, quality of life and adverse events. The search strategy retrieved 3587 references. After examination of titles and abstracts, we retrieved the full text of 24 potentially relevant studies. None of these studies met the inclusion criteria of our review. No data were suitable to be included in a meta-analysis. There are no published RCTs or quasi-RCTs that examine whether physical rehabilitation interventions improve activities of daily living for people with CIP and CIM. Large RCTs, which are feasible, need to be conducted to explore the role of physical rehabilitation interventions for people with CIP and CIM. This paper is based on a Cochrane Review published in in the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 3, DOI: 10.1002/14651858.CD010942.pub2. (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.

[Improvement of management of hypertension by implementation of alcohol screening and subsequent interventions in primary practice]. / Verbessertes Hypertonie-Management durch Alkohol-Screening und Folgeinterventionen in der Hausarztpraxis.

Hypertension and alcohol use are both part of the five most important risk factors for burden of disease in Western Europe, mainly because of their impact on non-communicable diseases (NCD). Both risk factors are prevalent with high overlap among patients in primary care. Implementation of a screening for alcohol among patients of hypertension in primary care followed by brief intervention for problem alcohol use or formal treatment for people with alcohol dependence could constitute an important step to reach the goals of the Global WHO Action Plan for Prevention and Control of NCD. In addition, such an intervention could improve the management of hypertension. In a working group of experts from clinical practice and research the rationale and potential barriers for this intervention were discussed and steps for implementation in primary care were developed.

[Analysis of ambulatory coding quality in Saxony and Thuringia using AOK PLUS billing data - utilisation of the qualifying character "Z" in the documentation of diagnoses]. / Analyse der ambulanten Kodierqualität in Sachsen und Thüringen anhand von Leistungsdaten der AOK PLUS - die Verwendung des Zusatzkennzeichens "Z" in der Diagnosedokumentation.

As a part of the health care reform 2007 the German risk structure compensation scheme was extended so as to connect the financial cash flow towards the payers to morbidity information from ambulatory care. Within this context, morbidity information consists of prescriptions as well as coded ambulatory diagnoses. Accordingly, a high quality of coding is essential for a morbidity compatible allocation of funds. The aim of this study was to evaluate coding quality via qualifying characters as well as to identify future challenges. It focuses on diagnoses which are qualified as "assured" or "post-treatment" from about 350 million diagnoses of about 11 k practitioners' treatment of 2.7 million AOK PLUS insurants in Saxony and Thuringia during the years 2007-2010. The practitioners' documented diagnoses were aggregated within several groups according to the code of specialisation which is attached to the practitioner's 9-digit lifelong identification number (LANR). As a result, the number of "assured" diagnoses generally rose from year to year. Furthermore, diagnoses marked as "assumption" or "exclusion" remain constant over time. We identified a lack of diagnosis coding precision regarding the condition after certain medical events. In particular, general practitioners tend to use diagnosis codes qualified as "post-treatment" instead of using correct "assured" diagnoses qualified for conditions after certain events. Consequently, we expect adverse effects evaluating the cost of diseases as only "assured" diagnoses are considered within the risk transfer compensation scheme.

[Sexual risk behaviour of nursing students. A cross-sectional study at nursing schools in Saxony-Anhalt]. / Das sexuelle Risikoverhalten von Auszubildenden der Gesundheits- und Krankenpflege. Eine Querschnittstudie an Krankenpflegeschulen in Sachsen-Anhalt.

AIM: This work describes the sexual risk behaviour of nursing students. METHODS: 22 of 23 state-approved nursing schools in Saxony-Anhalt, Germany, participated in this cross-sectional study (study period 7/2005-5/2006). Participation was voluntarily and anonymous. RESULTS: More male than female students (59.6% vs. 44.8%) used condoms to prevent STIs. More female students (58.9% vs. 43.4%) reported constant partnership with just one partner as an STI prevention method (chi² test, p<0.005). 29.6% of the nursing students reported >1 sexual partner in the past 12 months. 3.9% of the students demanded an HIV test from the partner, 69.3% had never tested themselves for HIV. 10.2% used no prevention against STIs. CONCLUSIONS: Nursing students should be sensitised for sexual risk behaviour and STIs. This should be included in the content of teaching throughout the education, not least since nursing students are multiplicators and have an influence on health behaviour of the patients.

[Adherence, self-efficacy, physician visits in a clinical trial over 6 months in multiple sclerosis patients]. / Einfluss einer Verlaufsbeobachtung der medikamentösen Behandlung auf die Therapietreue von Patienten mit Multipler Sklerose.

Lack of treatment adherence is a significant issue in multiple sclerosis (MS). The aim of this project was to examine whether establishing an observational situation in the context of a non-interventional study could positively affect the treatment adherence, quality of life as well as patient satisfaction in 206 MS patients treated with Copaxone(®). Apart from 3 standardised, anonymous surveys no further measures were taken. Self-efficacy increased in the patients, which was also reflected in a decline in physician visits in the monitoring period. The number of consultations initiated by the patient decreased very much between the second and third patient surveys. In the quality of life area "health", there was a significant improvement. After 3 months there was a discontinuation rate of 10.4%; after 6 months 8.8%. Even though this was not a controlled study, these results could indicate that, on a short-term basis, patients can be motivated to adhere--probably as a result of the psychological aspects of the observational situation. However, long-term changes in behaviour can probably only be achieved through qualified training.

[Identification and grouping of pain patients according to claims data]. / Identifikation und Gruppierung von Schmerzpatienten anhand von Routinedaten einer Krankenkasse.

The ICD classification does not provide the opportunity to adequately identify pain patients. Therefore we developed an alternative method for the identification and classification of pain patients which is based on prescription and diagnoses data from the year 2006 of one nationwide sickness fund (DAK) and which is led by two main assumptions: 1. Beneficiaries without prescription of an analgetic drug but with a diagnosis pattern that is characteristic of patients who are treated with opioids are also likely to be pain patients. 2. Each combination of diagnosis groups can be traced back to one primary diagnosis out of a diagnosis group according to the patient classification system CCS (Clinical Classifications Software). The selection of this diagnosis group (CCS) allows for the allocation of the beneficiary to only one pain type. As a result we identified 65 combinations of CCS diagnosis groups--aggregated to nine "CCS pain types"--to which 77.1% of all patients with at least two opioid prescriptions can be allocated: 26.3% to pain due to arthrosis, 18.0% to pain due to intervertebral disc illnesses, 13.1% to other specific back pain, 6.7% to neuropathic pain, 4.5% to unspecific back pain, 4.2% to headache, 2.4% to pain after traumatic fractures, 1.3% to pain of multimorbid, high-maintenance patients, and 0.6% to cancer pain. Based on our method beneficiaries who have a high probability of suffering from moderate to strong pain can be identified and included in further claims data analyses of health care delivery and utilization pattern of pain-related disorders in Germany.

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.

[Current vaccination status of health-care personnel in Brandenburg, Saxony And Saxony-Anhalt]. / Aktueller Impfstatus in unterschiedlichen medizinischen Berufsgruppen in Brandenburg, Sachsen und Sachsen-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.

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]. / Lebens- und Versorgungsqualität von Mitgliedern des Sächsischen Landesverbandes der Deutschen Multiple Sklerose Gesellschaft. Ergebnisse einer schriftlichen Befragung.

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.