Antibody persistence after primary vaccination with a hexavalent DTPa-HBV-IPV/HiB vaccine coadministered with a meningococcal C-CRM197 vaccine and response to a DTPa-IPV/HiB booster at 18 months of age

Children 17-20 months of age (N = 344) received a diphtheria-tetanus toxoids-acellular pertussis (DTPa)-inactivated poliovirus vaccine (IPV)/Haemophilus influenzae (Hib) booster after a 3-dose primary vaccination course with DTPa-hepatitis B vaccine-IPV/Hib plus conjugate meningococcal C vaccine-CRM. Seroprotection rates were >80% (diphtheria, tetanus, hepatitis B, polio and polyribosylribitol phosphate) before and > or =96.6% (diphtheria, tetanus, polio and polyribosylribitol phosphate) after booster vaccination. The booster was well-tolerated (fever >39.5 degrees C after <2% of doses; large swelling reactions after 6.3% of doses).     

Rational antibiotic therapy and the position of ampicillin/sulbactam

In the current context of increasing antimicrobial resistance, it is important to use antibiotics rationally and to re-assess regularly the clinical usefulness of commonly used agents. This review focuses on the efficacy of the beta-lactam ampicillin co-administered with the beta-lactamase inhibitor sulbactam, either parenterally (ampicillin/sulbactam) or orally (sultamicillin), for the treatment of bacterial infections. Clinical findings from the past decade confirm the results of numerous older studies and together provide good evidence to support the continued use of ampicillin/sulbactam and sultamicillin in hospital- and community-acquired infections both in adults and children. This is also recognised in recent published national and international guidelines, many of which recommend ampicillin/sulbactam as first-line therapy for various respiratory and skin infections.     

Booster vaccination of adults with reduced-antigen-content diphtheria,Tetanus and pertussis vaccine: Immunogenicity 5 years post-vaccination

At 60 months post-vaccination, adults (mean age 45.6 years) randomised to receive combined reduced-antigen-content diphtheria–tetanus and acellular pertussis vaccine (dTpa) versus tetanus–diphtheria (Td) + monovalent acellular pertussis (pa) were seroprotected against diphtheria (≥0.016 IU/mL Vero cell assay) and tetanus (≥0.1 IU/mL ELISA assay) in 94.4% and 96.2%, respectively (dTpa), compared with 93.7% and 90.6% (Td + pa). Anti-FHA, anti-PT and anti-PRN antibodies (≥5 EL.U/mL) were maintained in 100%, 89.5% and 95.0% of dTpa versus 100%, 85.5% and 90.6% of pa vaccine recipients. At 5 years post boosting, antibody levels to diphtheria and tetanus are similar amongst adults receiving a dTpa or dT, and pertussis antibodies remain above pre-booster levels in at least 85%.     

Bridging Health Care and the Workplace: Formulation of a Return-to-Work Intervention for Breast Cancer Patients Using an Intervention Mapping Approach

Purpose An increasing number of breast cancer (BC) survivors of working age require return to work (RTW) support. Objective of this paper is to describe the development of a RTW intervention to be embedded in the care process bridging the gap between hospital and workplace. Method The Intervention Mapping (IM) approach was used and combined formative research results regarding RTW in BC patients with published insights on occupational therapy (OT) and RTW. Four development steps were taken, starting from needs assessment to the development of intervention components and materials. Results A five-phased RTW intervention guided by a hospital-based occupational therapist is proposed: (1) assessing the worker, the usual work and contextual factors which impacts on (re-)employment; (2) exploration of match/differences between the worker and the usual work; (3) establishing long term goals, broken down into short term goals; (4) setting up tailored actions by carefully implementing results of preceding phases; (5) step by step, the program as described in phase 4 will be executed. The occupational therapist monitors, measures and reviews goals and program-steps in the intervention to secure the tailor-made approach of each program-step of the intervention. Conclusion The use of IM resulted in a RTW oriented OT intervention. This unique intervention succeeds in matching individual BC patient needs, the input of stakeholders at the hospital and the workplace.     

Treatment of pneumonia in elderly patients

Pneumonia represents the leading cause of infection-related death and the fifth cause of overall mortality, in the elderly. Several risk factors for acquiring pneumonia in older age have been reported, such as alcoholism, lung and heart diseases, nursing home residence and swallowing disorders. The clinical characteristics of pneumonia in the elderly differ substantially compared with younger patients, and the severity of the disease is strongly associated with increased age and age-related comorbidities. Streptococcus pneumoniae is the leading pathogen responsible for pneumonia in elderly; enteric Gram-negative rods should be considered in nursing-home-acquired pneumonia, as well anaerobes in patients with aspiration pneumonia. Antimicrobial therapy should take into account the most recent guidelines, which are briefly presented in this review. A special consideration should be given to the preventive measures, including vaccination, oral care and nutrition.     

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.     

Respiratory tract infections: when is antibiotic therapy indicated?

Antibiotic therapy of purulent bronchitis is a matter of continuing controversy. However, recent studies on the pathogenicity of airway hyperreactivity, granulocyte-mediated bronchial obstruction, and histamine production of Haemophilus influenzae indicate an important role for viral and bacterial infections in exacerbations of chronic obstructive lung disease (COLD). Considering the different stages of COLD in relation to lung function, bacterial pathogens, and relevant findings and symptoms of the individual patient, antibiotic treatment should be based on three different degrees of severity.