Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany.

BACKGROUND: In mildly to moderately malnourished adolescent patients with anorexia nervosa (AN), accelerated refeeding protocols using higher initial calory supply coupled with phosphate supplements were not associated with a higher incidence of refeeding syndrome (RS). It is unclear whether this is also a feasible approach for extremely malnourished, adult AN patients. METHODS: Outcomes of a clinical refeeding protocol involving a targeted initial intake of ≥2000 kcal/day, routine supplementation of phosphate and thiamine as well as close medical monitoring, were evaluated. A retrospective chart review including AN patients with a body mass index (BMI) <13 kg/m² was conducted, to describe changes in weight, BMI, and laboratory parameters (phosphate, creatine kinase, hematocrit, sodium, liver enzymes, and blood count) over four weeks. RESULTS: In 103 female patients (age, mean ± standard deviation (SD) = 23.8 ± 5.3 years), BMI between admission and follow-up increased from 11.5 ± 0.9 to 13.1 ± 1.1 kg/m² and total weight gain within the first four weeks was 4.2 ± 2.0 kg (mean, SD). Laboratory parameter monitoring indicated no case of RS, but continuous normalization of blood parameters. CONCLUSIONS: Combined with close medical monitoring and electrolyte supplementation, accelerated refeeding may also be applied to achieve medical stabilization in extremely underweight adults with AN without increasing the risk of RS.

Comparison of AIMS2-SF, WOMAC, x-ray and a global physician assessment in order to approach quality of life in patients suffering from osteoarthritis.

BACKGROUND: Chronic diseases like osteoarthritis (OA) substantially affect different dimensions of quality of life (QoL). The aim of the study was to reveal possible factors which mainly influence general practitioners (GPs) assessment of patients' QoL. METHODS: 220 primary care patients with OA of the knee or the hip treated by their general practitioner for at least one year were included. All GPs were asked to assess patients' QoL based on the patients' history, actual examination and existing x-rays by means of a visual analog scale (VAS scale), resulting in values ranging from 0 to 10. Patients were asked to complete the McMaster Universities Osteoarthritis Index (WOMAC) and the Arthritis Impact Measurement Scale2 Short Form (AIMS2-SF) questionnaire. RESULTS: Significant correlations were revealed between "GP assessment" and the AIMS2-SF scales "physical" (rho = 0.495) and "symptom" (rho = 0.598) as well as to the "pain" scale of the WOMAC (rho = 0.557). A multivariate ordinal regression analysis revealed only the AIMS2-SF "symptom" scale (coefficient beta = 0.2588; p = 0.0267) and the x-ray grading according to Kellgren and Lawrence as significant influence variables (beta = 0.6395; p = 0.0004). CONCLUSION: The results of the present study suggest that physicians' assessment of patients' QoL is mainly dominated by physical factors, namely pain and severity of x-ray findings. Our results suggest that socioeconomic and psychosocial factors, which are known to have substantial impact on QoL, are underestimated or missed. Moreover, the overestimation of x-ray findings, which are known to be less correlated to QoL, may cause over-treatment while important and promising targets to increase patients' QoL are missed.

The CONTENT project: a problem-oriented, episode-based electronic patient record in primary care.

In order to obtain a proper knowledge base in primary care, a form of electronic patient record is needed that takes into account the specific characteristics of the doctor-patient encounter, the patient population, the presentation of diseases and the associated prevalences. However, in real life this has not happened for several reasons. For the most part, existing patient records are determined by invoicing requirements rather than by endeavours to meet the intrinsic needs of primary care. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork) is an ambitious scientific project in Germany to establish a system for adequate record keeping and analysis in primary care. Based on a classification system designed for the special situation of primary care, a scientific network is being established consisting of participating surgeries, general practitioners, computer scientists and statisticians. The project is supported by the German Federal Ministry of Education and Research. The aims are strictly scientific and the underlying hypothesis is that the knowledge-gaining process can be accelerated by combining the experience of many, especially with respect to complex interactions of factors and the analysis of rare events. Aside from maintaining a morbidity registry, within the CONTENT framework various prospective and retrospective studies on particular epidemiological and health economic research topics will be conducted.

Use of a patient information leaflet to influence patient decisions regarding mode of administration of NSAID medications in case of acute low back pain.

Despite dissuasive recommendations, intramuscular (i.m.) injections of NSAIDS are still a widespread treatment of acute pain in General Practice as well as among orthopaedic physicians. Most physicians argue that patients who are used to receive NSAIDS i.m. would insist on this application mode while being convinced of its therapeutic superiority for pain relief. Therefore, the aim of the study was to find out if patients' decision can be influenced towards an oral application by receiving a simple information leaflet. An information leaflet, providing information about the risks of NSAIDS particularly in case of i.m. application was provided to 161 patients with acute low back pain. Decision in favour or against i.m. application of NSAIDS was documented. Severity of disease was assessed by the Roland Morrison pain questionnaire and visual analogue scale (VAS) at the first visit and again 3-5 days later. From May to December 2004, 161 patients, visiting their GP (13 practices) with acute pain and demanding an injection were included in the study. After reading the information leaflet, 139 of the 161 (86.3%) patients decided for an oral application instead of receiving an injection of NSAIDS as in the past. This effect was statistically significant (P