[Prevention of dementia]. / Prävention demenzieller Erkrankungen.

With increasing life expectancy, the prevalence of dementia is increasing worldwide. Dementia is among the greatest challenges for healthcare and social systems of the future. Approximately 40% of newly diagnosed cases of dementia are associated with risk factors that can potentially be influenced by preventive measures. Based on the evidence from longitudinal studies, systematic reviews and meta-analyses, the Lancet commission on dementia prevention, intervention and care has defined 12 risk factors that are associated with an increased risk for dementia: low level of education, hearing impairment, traumatic brain injury, arterial hypertension, diabetes mellitus, smoking, excessive alcohol consumption, depression, obesity, social isolation, and air pollution.

[Prevention of dementia]. / Prävention demenzieller Erkrankungen.

With increasing life expectancy, the prevalence of dementia is increasing worldwide. Dementia is among the greatest challenges for healthcare and social systems of the future. Approximately 40% of newly diagnosed cases of dementia are associated with risk factors that can potentially be influenced by preventive measures. Based on the evidence from longitudinal studies, systematic reviews and meta-analyses, the Lancet commission on dementia prevention, intervention and care has defined 12 risk factors that are associated with an increased risk for dementia: low level of education, hearing impairment, traumatic brain injury, arterial hypertension, diabetes mellitus, smoking, excessive alcohol consumption, depression, obesity, social isolation, and air pollution.

Comprehensive geriatric assessment.

Geriatric assessment is a multidimensional and interdisciplinarily deployed diagnostic process to evaluate functional capacities and impairments in geriatric patients. The results of geriatric assessment are the basis for planning of therapeutic interventions in the multidisciplinary geriatrics team. Geriatric assessment adds essential information to the state-of-the-art diagnostic tests, such as physical examination, laboratory tests, or imaging techniques, to acquire a holistic picture about health and functional problems and needs of geriatric patients. Studies have demonstrated that geriatric assessment and the following geriatric treatment improves prognosis and increases the chance of older patients remaining in their own home after discharge from hospital after admission for an acute disease.

Dysbiosis, gut barrier dysfunction and inflammation in dementia: a pilot study.

BACKGROUND: Dementia is an increasing public health threat worldwide. The pathogenesis of dementia has not been fully elucidated yet. Inflammatory processes are hypothesized to play an important role as a driver for cognitive decline but the origin of inflammation is not clear. We hypothesize that disturbances in gut microbiome composition, gut barrier dysfunction, bacterial translocation and resulting inflammation are associated with cognitive dysfunction in dementia. METHODS: To test this hypothesis, a cohort of 23 patients with dementia and 18 age and sex matched controls without cognitive impairments were studied. Gut microbiome composition, gut barrier dysfunction, bacterial translocation and inflammation were assessed from stool and serum samples. Malnutrition was assessed by Mini Nutritional Assessment Short Form (MNA-SF), detailed information on drug use was collected. Microbiome composition was assessed by 16S rRNA sequencing, QIIME 2 and Calypso 7.14 tools. RESULTS: Dementia was associated with dysbiosis characterized by differences in beta diversity and changes in taxonomic composition. Gut permeability was increased as evidenced by increased serum diamine oxidase (DAO) levels and systemic inflammation was confirmed by increased soluble cluster of differentiation 14 levels (sCD14). BMI and statin use had the strongest impact on microbiome composition. CONCLUSION: Dementia is associated with changes in gut microbiome composition and increased biomarkers of gut permeability and inflammation. Lachnospiraceae NK4A136 group as potential butyrate producer was reduced in dementia. Malnutrition and drug intake were factors, that impact on microbiome composition. Increasing butyrate producing bacteria and targeting malnutrition may be promising therapeutic targets in dementia. TRIAL REGISTRATION: NCT03167983 .

["Memory acute"-treatment concept for inpatient remobilization of acutely ill patients with dementia]. / "Memory Akut" ­ Versorgungskonzept zur stationären Remobilisation von akut erkrankten Demenzpatienten.

BACKGROUND: Acute hospitals are generally not designed for people with dementia. Behavioral issues pose the greatest challenge. This article reports on the results of a prospective controlled study designed to assess whether dementia patients benefit from a remobilization strategy in a memory clinic (IG-MA) following hospital discharge. METHODS: Between January and September 2018 patients with moderate to severe dementia discharged from hospital following acute episodes were admitted to an IG-MA for remobilization. The IG-MA unit provides specially qualified personnel and an adapted environment. Control groups were formed from the standard remobilization unit (KG1-AGR) and four care homes (KG2-PWH). RESULTS: Patients in the IG-MA (n = 22) had a worse functional status at admission according to the Barthel index (BI), the timed "up and go" test (TUG) and the Esslinger transfer scale (ETS) than patients in the KG1-AGR (n = 59). Outcomes significantly improved in both groups (IG-MA and KG1-AGR) without a clear difference between groups: IG-MA (BI from 35 to 57.8 points, TUG from 30.8 s to 23 s, ETS from 2.1 to 1.1 points) vs. KG1-AGR (BI from 44.7 to 62.4 points, TUG from 28.6 s to 20.2 s, ETS from 1.7 to 0.9 points). There were differences in cognitive ability at admission (mini mental state examination, MMSE: IG-MA 13.6 points vs. KG1-AGR 20 points). The length of stay in the IG-MA was on average 5 days longer. Early discharge was mostly the result of complications and transfer to acute hospitals in the IG-MA group (22.7%) and in the KG1-AGR group this was mostly due to care issues (27.1%). The KG2-PWH group did not show any significant functional improvements in the first 4 weeks as measured by the BI. CONCLUSION: Moderate to severely affected dementia patients with behavioral problems benefited from treatment in a specially designed remobilization unit following hospital discharge after an acute event.

Towards using fNIRS recordings of mental arithmetic for the detection of residual cognitive activity in patients with disorders of consciousness (DOC).

BACKGROUND: Recently, fNIRS has been proposed as a promising approach for awareness detection, and a possible method to establish basic communication in patients with disorders of consciousness (DOC). AIM: Using fNIRS, the present study evaluated the applicability of auditory presented mental-arithmetic tasks in this respect. METHODS: We investigated the applicability of active attention to serial subtractions for awareness detection in ten healthy controls (HC, 21-32 y/o), by comparing the measured patterns to patterns induced by self-performance of the same task. Furthermore, we examined the suitability of ignoring the given task as additional control signal to implement a two-class brain-computer interface (BCI) paradigm. Finally, we compared our findings in HC with recordings in one DOC patient (78 y/o). RESULTS AND CONCLUSION: Results of the HC revealed no differences between the self-performance and the attention condition, making the attention task suitable for awareness detection. However, there was no general difference between the ignore and attend condition, making the tasks less suitable for BCI control. Despite inconsistent correlations between the patient data and the HC group, single runs of the patient recordings revealed task-synchronous patterns - however, we cannot conclude whether the measured activation derives from instruction based task performance and thus awareness.

Effects of an enhanced iron dense foods offering in the daily meals served in geriatric institutions on measures of iron deficiency anemia.

BACKGROUND: Iron deficiency is one of the most common causes of anemia in geriatric patients. Although the oral iron intake is often inadequate, the potential of iron dense foods in the daily meals of geriatric institutions is rarely considered. To test during a 1- year span whether an improved frequency of iron dense foods in the daily meals has an impact on the oral iron intake, the hemoglobin concentration and anemia prevalence of institutionalized geriatric patients. A parallel, open, pre-and post-oral nutrition intervention study. Two geriatric hospitals participated as intervention centers and one as comparison center. METHODS: In the two intervention centers, a menu plan adapted with iron dense foods was applied. In the comparison center the regular meals provisions was continued. At months 1, 6 and 12 of the intervention time the routine blood-parameter hemoglobin was taken from the geriatric hospital's medical report. Component analysis assessed the nutrient density of the offered meals. 2-day-weighing records realized at month 1 and 6 of intervention-time assessed the iron intake. Ninety-nine geriatric patients in the intervention centers and 37 in the comparison center. All of them had multiple chronic diseases and an average age of 84 years. With the non-parametric Friedmann-Test for repeated measurements, we establish differences within the groups. With the Mann-Whitney-U-Test, we establish differences between the groups. For dichotomous variables, the chi-square-test was used. A p-value of< 0.05 was considered statistically significant for all analyses. RESULTS: In the intervention centers the iron intake (p < 0.001) and the hemoglobin concentration (p = 0.002) improved significantly (p < 0.001). As in the comparison center the frequency of meat and sausage offerings was twice as much as recommended also the hemoglobin concentration improved (p = 0.001). CONCLUSION: Geriatric patients with anemia or low hemoglobin level benefit optimally from a diet rich in iron dense foods. Enhanced access to such can indeed correct iron deficiency anemia. TRIAL REGISTRATION: The ethics committee of the Municipality of Vienna ( EK-13-043-0513 ) approved the study.

Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study.

BACKGROUND: Widespread inappropriate use of antimicrobial substances drives resistance development worldwide. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antimicrobial agents prescribed in LTCFs are for urinary tract infections (UTI). We aimed to increase the number of appropriate antimicrobial treatments for UTIs in LTCFs using a multi-faceted antimicrobial stewardship intervention. METHODS: We performed a non-randomized cluster-controlled intervention study. Four LTCFs of the Geriatric Health Centers Graz were the intervention group, four LTCFs served as control group. The main components of the intervention were: voluntary continuing medical education for primary care physicians, distribution of a written guideline, implementation of the project homepage to distribute guidelines and videos and onsite training for nursing staff. Local nursing staff recorded data on UTI episodes in an online case report platform. Two blinded reviewers assessed whether treatments were adequate. RESULTS: 326 UTI episodes were recorded, 161 in the intervention group and 165 in the control group. During the intervention period, risk ratio for inadequate indication for treatment was 0.41 (95% CI 0.19-0.90), p = 0.025. In theintervention group, the proportion of adequate antibiotic choices increased from 42.1% in the pre-intervention period, to 45.9% during the intervention and to 51% in the post-intervention period (absolute increase of 8.9%). In the control group, the proportion was 36.4%, 33.3% and 33.3%, respectively. The numerical difference between intervention group and control group in the post-intervention period was 17.7% (difference did not reach statistical significance). There were no significant differences between the control group and intervention group in the safety outcomes (proportion of clinical failure, number of hospital admissions due to UTI and adverse events due to antimicrobial treatment). CONCLUSIONS: An antimicrobial stewardship program consisting of practice guidelines, local and web-based education for nursing staff and general practitioners resulted in a significant increase in adequate treatments (in terms of decision to treat the UTI) during the intervention period. However, this difference was not maintained in the post-intervention phase. Continued efforts to improve the quality of prescriptions further are necessary. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov NCT04798365.

Sustained Increase in Very Low Influenza Vaccination Coverage in Residents and Healthcare Workers of Long-Term Care Facilities in Austria after Educational Interventions.

Residents of long-term care facilities (LTCFs) are particularly at risk for influenza infections. We aimed to improve influenza vaccination coverage among residents and healthcare workers (HCWs) in four LTCFs by implementing educational programs and enhanced vaccination services. We compared vaccination coverage before and after the interventions (2017/18 and 2018/19 seasons). Data on vaccination adherence were recorded during a four-year observational period (2019/20 to 2022/23 seasons). Following the interventions, vaccination coverage increased significantly from 5.8% (22/377) to 19.1% (71/371) in residents and from 1.3% (3/234) to 19.7% (46/233) in HCWs (p < 0.001). During the observational period (2019/20 to 2022/23 seasons), vaccination coverage remained high in residents but decreased in HCWs. Vaccination adherence was significantly higher in residents and HCWs in LTCF 1 compared to the other three LTCFs. Our study suggests that a bundle of educational interventions and enhanced vaccination services can be an effective method for improving influenza vaccination coverage in LTCFs in both residents and HCWs. However, vaccination rates are still well below the recommended targets and further efforts are needed to increase vaccine coverage in our LTCFs.

Endocrine therapy plus zoledronic acid in premenopausal breast cancer.

BACKGROUND: Ovarian suppression plus tamoxifen is a standard adjuvant treatment in premenopausal women with endocrine-responsive breast cancer. Aromatase inhibitors are superior to tamoxifen in postmenopausal patients, and preclinical data suggest that zoledronic acid has antitumor properties. METHODS: We examined the effect of adding zoledronic acid to a combination of either goserelin and tamoxifen or goserelin and anastrozole in premenopausal women with endocrine-responsive early breast cancer. We randomly assigned 1803 patients to receive goserelin (3.6 mg given subcutaneously every 28 days) plus tamoxifen (20 mg per day given orally) or anastrozole (1 mg per day given orally) with or without zoledronic acid (4 mg given intravenously every 6 months) for 3 years. The primary end point was disease-free survival; recurrence-free survival and overall survival were secondary end points. RESULTS: After a median follow-up of 47.8 months, 137 events had occurred, with disease-free survival rates of 92.8% in the tamoxifen group, 92.0% in the anastrozole group, 90.8% in the group that received endocrine therapy alone, and 94.0% in the group that received endocrine therapy with zoledronic acid. There was no significant difference in disease-free survival between the anastrozole and tamoxifen groups (hazard ratio for disease progression in the anastrozole group, 1.10; 95% confidence interval [CI], 0.78 to 1.53; P=0.59). The addition of zoledronic acid to endocrine therapy, as compared with endocrine therapy without zoledronic acid, resulted in an absolute reduction of 3.2 percentage points and a relative reduction of 36% in the risk of disease progression (hazard ratio, 0.64; 95% CI, 0.46 to 0.91; P=0.01); the addition of zoledronic acid did not significantly reduce the risk of death (hazard ratio, 0.60; 95% CI, 0.32 to 1.11; P=0.11). Adverse events were consistent with known drug-safety profiles. CONCLUSIONS: The addition of zoledronic acid to adjuvant endocrine therapy improves disease-free survival in premenopausal patients with estrogen-responsive early breast cancer. (ClinicalTrials.gov number, NCT00295646.)

Interviews with patients with advanced cancer--another step towards an international cancer pain classification system.

PURPOSE: Patients' involvement in the development of assessment tools is recommended, and the European Palliative Care Research Collaborative has adhered to this when developing a shared language for cancer pain, an international assessment and classification system. Study objectives were to investigate how patients ranked the relevance of several previously identified pain domains, to investigate patients' perception of the pain experience and to disclose additional, relevant pain domains for cancer pain classification to those identified in the literature. METHODS: Semistructured interviews with advanced cancer patients treated with opioids were performed and analysed verbatim. Patients scored the relevance of predefined pain domains on an 11-point Numerical Rating Scale. RESULTS: Thirty-three Norwegian and Austrian patients were included (16 females and 17 males); the mean age was 63 years, and the mean Karnofsky performance score was 65. The ranking of domains was as follows etiology (mean Numerical Rating Scale score, 8.5), duration (8.0), intensity (7.4), coping (7.1), physical (5.9) and psychological functioning (5.8). Sleep was identified as a new candidate domain to include in the system. The patients emphasised consequences of having pain, for example, poor physical functioning and psychological distress. CONCLUSIONS: Previously identified pain domains were confirmed to be relevant to the patients; however, the ranking differed from the experts' ranking. Sleep disturbances may be added as a domain in a future classification system.

Prospective Surveillance of Healthcare-Associated Infections in Residents in Four Long-Term Care Facilities in Graz, Austria.

Healthcare-associated infections (HCAI) are a common cause for residents' mortality and morbidity associated with a significant socio-economic burden. Data on HCAIs in Austrian long-term care facilities are scare. Therefore, we evaluated the incidence rate of HCAIs per 1000 resident days in four LTC facilities in Graz, Austria, characterized the spectrum of HCAIs and the use of antimicrobial substances. We conducted a prospective surveillance study from 1 January to 31 December 2018 in four LTCFs of the Geriatric Health Centre of the City of Graz (total of 388 beds). Nursing staff collected data on HCAIs once a week using an electronic reporting system. During the 12-month surveillance period, 252 infections of 165 residents were recorded. The overall incidence rate of HCAIs was 2.1 per 1000 resident days. Urinary tract infections were the most commonly recorded HCAIs (49%, 124/252, 1.03 per 1000 resident days), followed by skin and soft tissue infections and respiratory tract infections. Beta-lactams (ATC class J01C) were prescribed most frequently (63/212), followed by fluoroquinolones (J01M; 54/212). In conclusion, the overall incidence rate for HCAIs was relatively low at 2.1 per 1000 resident days. Our real-life data can serve as a basis for future antimicrobial stewardship and infection prevention interventions.

Analysis of COVID-19 outbreaks in 3 long-term care facilities in Graz, Austria.

BACKGROUND: Nursing homes and long-term care facilities (LTCF) caring for elderly and chronically ill residents are at high risk to experience severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) outbreaks. We report an outbreak of coronavirus disease 2019 (COVID-19) in 3 LTCFs of the Geriatric Health Centres of Graz, Austria lasting from March 22 to April 14, 2020. AIM: The objectives of our study were: (1) to elucidate contributing factors and transmission pathways of SARS-CoV-2, (2) to analyze symptoms of COVID-19 in the residents and health care workers. METHODS: We carried out a retrospective outbreak analysis. FINDINGS: Thirty-six of /277 residents of 3 LTCFs were infected with SARS-CoV-2. Only a quarter of COVID-19 cases among residents had fever ≥38.1°C and 19% suffered from cough. Six of 36 residents remained asymptomatic. Hospitalization rate was 58% in residents. Overall, 33% (12/36) residents infected with SARS-CoV-2 died. Nineteen of 214 health care workers were tested positive for SARS-CoV-2. Universal rt-PCR testing for SARS-CoV-2 of all residents and health care workers as well as infection control measures contributed to ending the outbreaks. CONCLUSIONS: Delayed recognition of possible COVID-19 cases due to either mild symptoms or symptoms that were perceived as atypical early in the pandemic contributed to the transmission of SARS-CoV-2 in LTCFs. This emphasizes the importance of low-threshold testing in LTCF residents.

Diabetes Management According to Health Status in Older Adults with Type 2 Diabetes Staying in Geriatric Care Facilities.

BACKGROUND: About 25% of adults >70 years suffer from type 2 diabetes. Due to the heterogeneity of the geriatric population, guidelines emphasize the need to individualize glycemic goals and simplify treatment strategies with the main focus of avoiding hypoglycemia. The aim of this study was to assess glycemic control in patients with type 2 diabetes in geriatric care facilities based on their individual health status. METHODS: 170 medical records of older adults with type 2 diabetes in geriatric care facilities were retrospectively assessed (64.7% female, age 80 ± 9 years; glycated hemoglobin 6.8% ± 3.6% [51 ± 16 mmol/mol]; body mass index 27.9 ± 5.8 kg/m2). Based on the individual health status, patients were allocated to three groups (healthy n = 27, complex n = 86, and poor n = 57). RESULTS: The overall blood glucose (BG) value was highest in the poor health group with 188 ± 47 mg/dL (poor) vs 167 ± 42 mg/dL (complex) vs 150 ± 34 mg/dL (healthy). BG values of 1.6% (poor) vs 2.8% (complex) vs 1.5% (healthy) of patients were below 90 mg/dL. 36.8% (poor) vs 23.4% (complex) vs 18.5% (healthy) of patients received insulin as the main diabetes therapy, but of these only 14.3% (poor) vs 20% (complex) vs 40% (healthy) were treated with basal insulin. CONCLUSIONS: Overall, BG values were higher in the poor and complex health group. There were a few low BG values in all groups. Although recommended by international guidelines, basal insulin therapy with its low complexity and low hypoglycemic risk is still underused, especially in the poor health group. Therefore, simplification of diabetes therapy should be considered further.

[Palliative sedation therapy for severe dyspnoea]. / Palliative Sedierung zur Symptomkontrolle massiver Dyspnoe.

In this case study we report on a patient with advanced myxofibrosarcoma and lung metastases, suffering from severe dyspnoea. Symptoms were not manageable by means of standard palliative care, which made palliative sedation therapy necessary in order to alleviate dyspnoea. On the basis of this case study, indications, drugs, therapy monitoring and ethical aspects of palliative sedation therapy are discussed.

Low prevalence of Clostridium difficile colonization in patients in long-term care facilities in Graz, Austria: A point-prevalence study.

BACKGROUND: We aimed to determine the prevalence of asymptomatic colonization by C. difficile in stool of residents in four long-term care facilities (LTCFs) in Graz, Austria and to identify factors associated with colonization. METHODS: We conducted a point-prevalence study in March 2018. Stool samples were examined by GDH enzyme immunoassay and when positive a toxin A/B-enzyme immunoassay was carried out. Additionally, all samples were tested by toxin A and B PCR and were plated manually as well as in automated fashion onto selective C. difficile agar. RESULTS: In 4/144 (2.8%) residents the GDH assay was positive. Each resident was colonized by a different C. difficile ribotype. C. difficile was not detected in any of the environmental samples. Significantly more colonized residents (60%) had stayed at a hospital in the 3 months previous to the study compared to 10% of non-colonized patients (p=0.01). CONCLUSIONS: The prevalence of colonization by toxigenic C. difficile was 2.8% in patients in LTCFs in Graz, Austria.

Anemia is a significant prognostic factor in local relapse-free survival of premenopausal primary breast cancer patients receiving adjuvant cyclophosphamide/methotrexate/5-fluorouracil chemotherapy.

PURPOSE: To determine the effects of anemia on local relapse-free, relapse-free, and overall survival (LRFS, RFS, and OS, respectively) in premenopausal, primary breast cancer patients receiving adjuvant polychemotherapy, and to determine which conventional prognostic factors affected these outcomes. EXPERIMENTAL DESIGN: Four hundred twenty-four premenopausal patients with early-stage primary breast cancer and hormone receptor-expressing tumors were treated with i.v. cyclophosphamide/methotrexate/5-fluorouracil (CMF) polychemotherapy as part of an adjuvant phase III trial (Austrian Breast and Colorectal Cancer Study Group Trial 5). The influence of anemia (hemoglobin <12 g/dL) on LRFS, RFS, and OS was evaluated in a retrospective analysis. RESULTS: Of 424 patients, 77 (18.2%) developed anemia on CMF chemotherapy. After a median follow-up time of 5 years, 8.9% of nonanemic patients had local relapse compared with 19.6% of anemic patients (P=0.0006). Although mastectomy was associated with anemia (26% versus 13.7% in breast conserving surgery; P=0.002), multivariate analysis did not show mastectomy per se to be a significant risk factor for LRFS. Age, lymph node status, and hemoglobin had an independent significant influence on LRFS (P<0.005). Anemic patients had a relative risk of 2.96 (95% confidence interval, 1.41-6.23) for developing local relapse in comparison with nonanemic patients. CONCLUSION: Premenopausal breast cancer patients who developed anemia during the CMF regimen had significantly worse LRFS. In Austrian Breast and Colorectal Cancer Study Group Trial 5, anemia may have contributed to an almost doubled incidence of local recurrence in the chemotherapy arm. Molecular targets associated with tumor hypoxia and distinct from erythropoiesis should receive further attention in experimental and clinical settings.

Cyclin D1 expression in breast cancer patients receiving adjuvant tamoxifen-based therapy.

PURPOSE: The objective of our study was to determine the clinical relevance of cyclin D1 expression in hormone receptor-positive breast cancer patients who were treated with tamoxifen-based therapy. EXPERIMENTAL DESIGN: We assessed expression of cyclin D1 in surgical specimens of breast carcinoma by means of immunohistochemistry. Patients had been enrolled in either Austrian Breast and Colorectal Cancer Study Group (ABCSG) Trial 05 or ABCSG Trial 06 and received tamoxifen as part of their adjuvant treatment. Overall survival and relapse-free survival were analyzed with Cox models adjusted for clinical and pathologic factors. RESULTS: Cyclin D1 was expressed in 140 of 253 (55%) tumors of ABCSG Trial 05 and in 569 of 948 (60%) tumors of ABCSG Trial 06. Expression of cyclin D1 was associated with poor outcome in both cohorts. Overall survival was significantly shorter in patients with cyclin D1-positive tumors compared with patients with cyclin D1-negative tumors [adjusted hazard ratio (HR) for death (ABCSG Trial 05), 2.47; 95% confidence interval (95% CI), 1.08-5.63; P = 0.03; adjusted HR for death (ABCSG Trial 06), 1.78; 95% CI, 1.36-2.34; P < 0.0001]. Relapse-free survival was also shorter in patients with cyclin D1-positive tumors than in patients with cyclin D1-negative tumors [adjusted HR for relapse (ABCSG Trial 05), 2.73; 95% CI, 1.50-4.96; P = 0.001; adjusted HR for relapse (ABCSG Trial 06), 1.52; 95% CI, 1.14-2.04; P = 0.005]. CONCLUSION: Cyclin D1 expression is an independent poor prognostic factor in women with early-stage, hormone receptor-positive breast cancer who received adjuvant tamoxifen-based therapy.

The potential risk of neoadjuvant chemotherapy in breast cancer patients--results from a prospective randomized trial of the Austrian Breast and Colorectal Cancer Study Group (ABCSG-07).

PURPOSE: To evaluate the impact that pre- and postoperatively administered chemotherapy with cyclophosphamide, methotrexate and fluorouracil (CMF) and postoperative chemotherapy vs. postoperative chemotherapy alone have on long-term prognosis. PATIENTS AND METHODS: The ABCSG conducted a nationwide randomized phase III trial in high-risk endocrine non-responsive breast cancer patients comparing pre- and postoperative chemotherapy containing CMF as preoperative treatment vs. postoperative chemotherapy alone between 1991 and 1999. From 1996 the ABCSG-07 protocol was amended to also allow randomization of high-risk endocrine-responsive patients. Of 423 eligible patients with high-risk primary breast cancer, 203 patients were randomly assigned to preoperatively receive three cycles of CMF (cyclophosphamide, methotrexate, fluorouracil; 600/40/600 mg/m(2)) intravenously on day 1 and 8, while 195 patients received postoperative chemotherapy alone. In both groups, three cycles of CMF were given initially, and another three cycles of CMF were administered in node-negative patients, whereas node-positive patients received three cycles of EC (epirubicin, cyclophosphamide; 70/600 mg/m(2)). RESULTS: Overall response rate to preoperative chemotherapy with three cycles of CMF was 56.2%; complete pathological response was achieved in 12 patients (5.9%). Recurrence-free survival was significantly better in patients receiving chemotherapy postoperatively (HR 0.7, 0.515-0.955; P = 0.024). No survival difference was observed between the two therapy groups (HR 0.800, 0.563-1.136; P = 0.213). DISCUSSION: Preoperative chemotherapy with CMF has to be considered as insufficient in high-risk breast cancer patients. Delayed surgery and anthracycline-based chemotherapy result in shorter recurrence-free survival but not overall survival.

Optimizing medical care for geriatric patients in Austria: defining a top five list of "Choosing Wisely" recommendations using the Delphi technique.

PURPOSE: Inappropriate use of diagnostic and therapeutic medical procedures is common and potentially harmful for older patients. The Austrian Society of Geriatrics and Gerontology defined a consensus of five recommendations to avoid overuse of medical interventions and to improve care of geriatric patients. METHODS: From an initial pool of 147 reliable recommendations, 20 were chosen by a structured selection process for inclusion in a Delphi process to define a list of five top recommendations for geriatric medicine. 12 experts in the field of geriatric medicine scored the recommendations in two Delphi rounds. RESULTS: The final five recommendations are concerning urinary catheters in elderly patients, percutaneous feeding tubes in patients with advanced dementia, antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia, and screening for breast, colorectal, prostate, or lung cancer, and the use of antimicrobials to treat asymptomatic bacteriuria. CONCLUSIONS: The selected recommendations have the potential to improve medical care for older patients, to reduce side effects caused by unnecessary medical procedures, and to save costs in the health care system.