The use of benzodiazepines in the management of behavioral symptoms in demented patients.

Hard data on the efficacy of benzodiazepines in the treatment of behavioral disturbances in Alzheimer's disease are not available. Short-acting benzodiazepines, such as oxazepam, appear safer than long-acting benzodiazepines and more efficient than placebo in the short-term (4-8 weeks) treatment of behavioral disturbances in geriatric, psychogeriatric, and demented patients. It is unknown whether oxazepam is superior to neuroleptic drugs or other commonly prescribed sedatives in this context. To some extent these findings may apply to patients with Alzheimer's disease as well, but there are several arguments against an uncritical extrapolation of conclusions drawn from other geriatric populations to patients with Alzheimer's disease. When, despite the lack of well-founded knowledge in this field, such a treatment modality is chosen, short-acting benzodiazepines should be preferred over long-acting agents. Drug interactions and pharmacokinetic aspects of the specific agent in the individual patient should always be considered carefully. Future studies on the treatment of behavioral disturbances in Alzheimer's disease need to clarify which specific behavioral symptoms should be treated pharmacologically, which therapeutic agents have the most advantageous risk-benefit ratio in this context, and what is the optimal treatment duration.

Clinical status, psychosocial impairments, medical treatment and health care costs for patients with inflammatory bowel disease (IBD) in Germany: an online IBD registry.

BACKGROUND: The aim of this cross-sectional study was to establish an online inflammatory bowel disease (IBD) registry for a first picture of the situation of IBD outpatients' treatment in Germany. METHODS: Between March 2006 and July 2007 IBD outpatients from 24 gastroenterological specialist practices and two hospitals in Germany were enrolled in an Internet-based registry to evaluate the outpatients' clinical status, psychological impairments, provided health care, as well as medical treatment and medication costs. RESULTS: 1032 IBD patients (ulcerative colitis/UC: 519; Crohn's disease/CD: 511; indeterminate colitis: 2) were enrolled in the study (age: 43 ± 14 years/M ± SD). Disease duration of all patients averaged 10 ± 8.5 years. In 519 UC-patients (49% male; 33% pancolitis), 66% were in remission as were 55% of CD patients (37 % male; 41 % active smokers). Associated with higher rates of disease activity (CDAI ≥ 150; CAI>4) were corticosteroids (CD, UC), topical medication (UC), relevant reported depressive symptoms (15%; 6-31%) and impairments in sexuality (21%; 9-42%). Relevant medication groups prescribed were oral aminosalicylates (UC: 70%; CD: 47%); immunosuppressive therapy - mostly azathioprine/6 MP (CD: 47%; UC: 26%), and Infliximab (CD: 8%; UC: 3%). Strongly associated with their clinical disease activity in UC as well as CD patients, 15% (6-31%) reported relevant depressive symptoms and 21% (9-42%) relevant impairments in sexuality. CONCLUSIONS: The registry constitutes a large complemental database for the patient population in Germany. About one third of the IBD patients were not in clinical remission (CDAI ≥150/CAI >4) (CD: 45%; UC: 27%), although high rates of immunosuppressive drugs (CD: 47%; UC 26%) were administered. This study shows a large burden of active disease associated with an unexpectedly high (co)morbidity and high psychosocial impairments, indicating a reduced health state in IBD patients.

[Germ cell tumors - documentation of diagnosis and therapy by means of a web-based modular database system]. / Keimzelltumoren - Dokumentation von Diagnostik und Therapie mittels Web-basierten modularen Dokumentationssystems.

PROBLEM: Health telematics is gaining ground worldwide as it promises the bridging of distances in space and time as well as a highly effective use of financial and other resources. In Germany the development and introduction of a national telematic platform is in the foreground at present. However, there are a number of more specialised projects already in existence. The aim of this study was to develop an internet platform to document the quality of individual sections of treatment for patients with germ cell tumours in Berlin and to improve the therapy in conformity with the S2 guidelines. MATERIAL AND METHODS: As a pilot project, a web-based modular database system (WBMDS) was developed, which can be used by any physician involved in the treatment of germ cell tumour patients from any computer connected to the internet. RESULTS: The WBMDS proved to be a practicable system of documentation. Data protection was ensured by pseudonyms as well as symmetrical and asymmetrical coding. The size of the extended documentation mask that had initially seemed to be necessary for valid documentation appeared to be too user-unfriendly with its 833 items. To meet the requirements of the user as well as of the documentation, a compact variant with 496 input fields was designed. On a random basis, treatment not in conformity with the guidelines could be detected in 20 % of 151 patients with the help of this system. CONCLUSION: For the successful use of an oncological database the following showed to be essential:[nl]Queries clearly defined for later statistical evaluation,[nl]clear separation between the phases of planning and implementation,[nl]a size of the database that does not make excessive demands on the user,[nl]intensive training of the users.[nl]The modular database system established proved to be well suitable for a quality-ensuring longitudinal case documentation, which can also be applied to other tumour entities.