General considerations on rapid desensitization for drug hypersensitivity - a consensus statement

Drug hypersensitivity reactions can occur with most drugs, are unpredictable, may affect any organ or system, and range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. However, for certain patients, the particular drug may be essential for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance of a compound responsible for a hypersensitivity reaction. It is performed by administering increasing doses of the medication concerned over a short period of time (from several hours to a few days) until the total cumulative therapeutic dose is achieved and tolerated. It is a high-risk procedure used only in patients in whom alternatives are less effective or not available after a positive risk/benefit analysis. Desensitization protocols have been developed and are used in patients with allergic reactions to antibiotics (mainly penicillin), insulins, sulfonamides, chemotherapeutic and biologic agents, and many other drugs. Desensitization is mainly performed in IgE-mediated reactions, but also in reactions where drug-specific IgE have not been demonstrated. Desensitization induces a temporary tolerant state, which can only be maintained by continuous administration of the medication. Thus, for treatments like chemotherapy, which have an average interval of 4 weeks between cycles, the procedure must be repeated for every new course. In this paper, some background information on rapid desensitization procedures is provided. We define the drugs and drug reactions indicated for such procedures, describe the possible mechanism of action, and discuss the indications and contraindications. The data should serve as background information for a database (accessible via the EAACI-homepage) with standardized protocols for rapid desensitization for antibiotics, chemotherapeutic agents, monoclonal antibodies/fusion proteins, and other drugs.

Can decision making in general surgery be based on evidence? An empirical study of Cochrane Reviews

BACKGROUND: This empirical study analyzes the current status of Cochrane Reviews (CRs) and their strength of recommendation for evidence-based decision making in the field of general surgery. METHODS: Systematic literature search of the Cochrane Database of Systematic Reviews and the Cochrane Collaboration's homepage to identify available CRs on surgical topics. Quantitative and qualitative characteristics, utilization, and formulated treatment recommendations were evaluated by 2 independent reviewers. Association of review characteristics with treatment recommendation was analyzed using univariate and multivariate logistic regression models. RESULTS: Ninety-three CRs, including 1,403 primary studies and 246,473 patients, were identified. Mean number of included primary studies per CR was 15.1 (standard deviation [SD] 14.5) including 2,650 (SD 3,340) study patients. Two and a half (SD 8.3) nonrandomized trials were included per analyzed CR. Seventy-two (77%) CRs were published or updated in 2005 or later. Explicit treatment recommendations were given in 45 (48%). Presence of a treatment recommendation was associated with the number of included primary studies and the proportion of randomized studies. Utilization of surgical CRs remained low and showed large inter-country differences. The most surgical CRs were accessed in UK, USA, and Australia, followed by several Western and Eastern European countries. CONCLUSION: Only a minority of available CRs address surgical questions and their current usage is low. Instead of unsystematically increasing the number of surgical CRs it would be far more efficient to focus the review process on relevant surgical questions. Prioritization of CRs needs valid methods which should be developed by the scientific surgical community.

Il plurilinguismo in un corso di tedesco per immigrati italiani ultrasettantenni a Berna

In diesem Artikel möchten wir einen Blick in die Sprachenvielfalt eines besonderen Deutschkurses werfen. Es handelt sich dabei um einen Kurs für pensionierte italienische Migrantinnen in Bern. Die Teilnehmerinnen, alle älter als 70 Jahre, mit meist geringer Schulbildung, haben sich dazu entschlossen, nach der Pensionierung die Sprache des Gastlandes zu erlernen oder ihre Kompetenzen zu verbessern. Wie frühere Studien zeigen konnten, hatten viele Immigranten der 60er Jahre in der Schweiz auf Grund der Diglossie (Werlen 2007) Probleme die deutsche Standardsprache zu erlernen oder sie haben keine der Varietäten gelernt weil Zeit, Motivation und Angebot fehlten. Ein weiteres Resultat dieser diglossischen Situation, mit welcher die Migranten konfrontiert sind, ist ihre Sprachkompetenz, welche als Varietätenkontinuum zwischen einem Deutschschweizer Dialekt und der Standardsprache betrachtet werden kann. Daher werden wir anhand einiger Unterrichtssequenztranskriptionen die sprachlichen Varietäten von vier Kursteilnehmerinnen analysieren und die Funktion der verschiedenen Sprachen und Sprachvarietäten innerhalb des Kurses bestimmen.