Converting habits of antibiotic use for respiratory tract infections in German primary care (CHANGE-3) - process evaluation of a complex intervention.

BACKGROUND: Antimicrobial resistance remains a global challenge. In Germany, the national health agenda supports measures that enhance the appropriate, guideline-oriented use of antibiotics. The study "Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (CHANGE-3)" aimed at a sustainable reduction of antimicrobial resistance through converting patterns of prescribing practice and use of antibiotics and an increase in health literacy in primary care patients, practice teams, and in the general public. Embedded in a cluster-randomized trial of a multifaceted implementation program, a process evaluation focused on the uptake of program components to assess the fidelity of the implementation program in the CHANGE-3 study and to understand utilization of its educational components. METHODS: A mix of qualitative and quantitative methods was used. Semi-structured telephone interviews were conducted with General Practitioners, Medical Assistants, patients treated for respiratory tract infection and outreach visitors who had carried out individual outreach visits. A two-wave written survey (T1: 5 months after start, T2: 16 months after start) was conducted in general practitioners and medical assistants. Qualitative data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze survey data. RESULTS: Uptake of intervention components was heterogenous. Across all components, the uptake reported by General Practitioners varied from 20 to 88% at T1 and 31 to 63% at T2. Medical Assistants reported uptake from 22 to 70% at T1 and 6 to 69% at T2. Paper-based components could by and large be integrated in daily practice (64 to 90% in T1; 41 to 93% in T2), but uptake of digital components was low. A one-time outreach visit provided thematic information and feedback regarding actual prescribing, but due to time constraints were received with reluctance by practice teams. Patients were largely unaware of program components, but assumed that information and education could promote health literacy regarding antibiotics use. CONCLUSIONS: The process evaluation contributed to understanding the applicability of the delivered educational components with regards to the appropriate use of antibiotics. Future research efforts need to identify the best mode of delivery to reach the targeted population. TRIAL REGISTRATION: ISRCTN, ISRCTN15061174 . Registered 13 July 2018 - Retrospectively registered.

Low prevalence of porcine circovirus type 2 infections in farrowing sows and corresponding pre-suckling piglets in southern German pig farms.

Porcine circovirus type 2 (PCV2) is the assumed causative agent of a number of different diseases summarized as porcine circovirus diseases (PCVD). The virus is shed via different se- and excretions of PCV2 infected pigs. Transmission of the virus occurs horizontally and vertically either by oronasal or diaplacental infection. Recent research emphasizes the importance of diaplacental PCV2 infection or the infection in early stages of the piglet's life attributable to excretion of PCV2 by the dams within the suckling period. To estimate the prevalence of intrauterine PCV2 infections under field conditions in Bavaria the PCV2 status of farrowing sows (n=198) and corresponding pre-suckling piglets (n=590) of 20 piglet producing farms was examined. PCV2 viral load and anti-PCV2 antibodies in the serum of the sows and piglets were examined at time of farrowing or before colostrum intake, respectively. PCV2 excretion of the sows via saliva, feces and urine was examined additionally. PCV2 specific antibodies in the serum of the sows were detectable on 11 farms with a mean in herd seroprevalence of 35.5% in these farms. Only 0.65% of all samples collected from 198 sows were positive for PCV2 DNA (serum: 1%; feces: 0.5%; saliva: 0.5%; urine: 0.6%). PCV2 DNA was detectable in sample material from seronegative sows as well as from seropositive sows. In none of the pre-suckling serum samples of the piglets IgG antibodies against PCV2 or PCV2 DNA were present. No correlation between the antibody- and viremia status of the sows and the PCV2 excretion was detectable. In contrast to reports about a high prevalence of viremic pre-suckling piglets in the suckling period in North America, the results of the present study reveal that diaplacental infection with PCV2 is comparatively rare in Southern Germany and infection of piglets within the suckling period seems to be more likely.

Detrimental role of the airway mucin Muc5ac during ventilator-induced lung injury.

Acute lung injury (ALI) is associated with high morbidity and mortality in critically ill patients. At present, the functional contribution of airway mucins to ALI is unknown. We hypothesized that excessive mucus production could be detrimental during lung injury. Initial transcriptional profiling of airway mucins revealed a selective and robust induction of MUC5AC upon cyclic mechanical stretch exposure of pulmonary epithelia (Calu-3). Additional studies confirmed time- and stretch-dose-dependent induction of MUC5AC transcript or protein during cyclic mechanical stretch exposure in vitro or during ventilator-induced lung injury in vivo. Patients suffering from ALI showed a 58-fold increase in MUC5AC protein in their bronchoalveolar lavage. Studies of the MUC5AC promoter implicated nuclear factor κB in Muc5ac induction during ALI. Moreover, mice with gene-targeted deletion of Muc5ac⁻/⁻ experience attenuated lung inflammation and pulmonary edema during injurious ventilation. We observed that neutrophil trafficking into the lungs of Muc5ac⁻/⁻ mice was selectively attenuated. This implicates that endogenous Muc5ac production enhances pulmonary neutrophil trafficking during lung injury. Together, these studies reveal a detrimental role for endogenous Muc5ac production during ALI and suggest pharmacological strategies to dampen mucin production in the treatment of lung injury.

Malignant gastrointestinal lymphomas in patients with AIDS.

HIV-associated malignant lymphomas are a common complication in late HIV infection, and there is a high percentage of gastrointestinal tract involvement. Non-Hodgkin's lymphoma was found in 108 of 2,750 HIV-positive patients (3.9%) in our institution, whereas gastrointestinal manifestation was diagnosed in 48 of 108 patients (44.4%). 44 of these cases were found during endoscopy of the upper and lower gastrointestinal tract (or by laparotomy or laparoscopy in 4 cases). Endoscopy is a reliable procedure for the diagnosis of lymphoma. Unusual manifestations such as oral, esophageal or perianal lesions and multifocal disease were common findings. Life-threatening complications such as gastrointestinal bleeding, perforation, and obstruction occurred in 37.5%. High-grade B-cell lymphomas were found in all cases including mainly lymphoblastic, immunoblastic, centroblastic and Burkitt subtypes. 52% of the patients had disseminated lymphoma with Ann Arbor stage III or IV. Standard chemotherapy with cyclophosphamide, adriamycin, vincristine and prednisone was started in 25 patients and resulted in a mean survival time of 4.8 months. The prognosis of AIDS patients presenting with malignant gastrointestinal lymphoma depends mainly on the presence or absence of previous AIDS-defining diseases, not CD4 cells, lymphoma-associated gastrointestinal complications or the histopathologic lymphoma type at the time of diagnosis.

Problems identified with home infusion pumps.

A variety of infusion pumps and devices are available on the market today. In this article, the authors examine these products based on questionnaires sent out to typical consumers, including hospitals and caregivers. Using the results of this questionnaire, the authors identify whether or not users of home infusion pumps and devices find them difficult to operate.

[Treatment of gonorrhea with spectinomycin and penicillin]. / Die Behandlung der Gonorrhoe mit Spectinomycin und Penicillin.

In an open clinical trial, spectinomycin and penicillin G were compared with regard to clinical efficacy, side effects, as well as bacteriological sensitivity in patients suffering from acute gonorrhea. The study was concerned with 176 female patients of a harbor medical practice who were frequently changing partners. 87 out of these patients were treated with spectinomycin, 89 of them with penicillin G. Smear specimens of all patients were tested microscopically; in addition, we performed bacteriological tests (as agar diffusion test, tube dilution test, beta-lactamase test). Both spectinomycin and penicillin showed a good clinical efficacy, except for one case of resistance against penicillin. Afterwards, this patient was successfully treated with spectinomycin. Apart from intermittent pain in the injection area, no side effects have been reported in either group of patients.