Acura Kliniken

Background: Patients with inflammatory rheumatic diseases (IRD) are susceptible to influenza infections and their complications. However, they may avoid vaccination for fear of exacerbating their IRD. This study evaluates the 2023/24 influenza vaccine in IRD patients, aiming to provide recommendations for this group in the upcoming season. Methods: In this prospective, longitudinal study, we assessed the self-reported impact of influenza vaccination on patients with IRD. Participants were recruited nationwide between October and December 2023 and completed an online questionnaire after vaccination as well as at three and six months of follow-up. Results: Among 633 patients, 87.5% were female, with a median age of 50.4 (18-84) years. Post-vaccination, 50% experienced injection site pain; 41% reported no side effects. IRD flares occurred in 5%, with 1% requiring changes to immunomodulation. Among 428 patients with follow-up, influenza infections were reported in 38 patients (8.9%), including 10 (2.3%) with reinfections. No severe cases requiring hospitalization were reported. Spondyloarthritis patients had higher susceptibility to influenza (p = 0.002), accounting for 55.3% of infections. IRD flare-ups in the 12 months before vaccination predicted infections (p = 0.002). Conclusions: The 2023/24 vaccine was well tolerated by IRD patients, with no impact on the course of the disease in 95% of cases. Only 9% of patients reported influenza infections, none of which were severe. In light of these findings, physicians are advised to recommend vaccination to eligible IRD patients prior to or in the respective season.

BackgroundIn contrast to critical care transport of adults or newborns, transport of pediatric critical care patients in Germany is neither regulated by law nor centrally organized. Due to their different therapeutic needs compared to newborns or adults, critically ill children may receive insufficient treatment during transport. In some regions in Germany, pediatric centers provide specialized pediatric retrieval teams, while others organize each transport individually. Currently, no valid data on pediatric critical care transports in Germany are available, nor are they recorded in a structured manner.ObjectivesTo establish a nationwide registry for pediatric intensive care transports in Germany. The aim is to describe and analyze the need for and current practice of specialized transports. This data may be used for future demand planning.SettingTransports are documented by pediatric centers admitting pediatric patients via intensive care transports.Inclusion criteriaAll interhospital pediatric intensive care transports of children, aged >27 days and >41 + 0 weeks of corrected gestational, age to <18 years, are eligible for data entry.MethodsThe study is designed as a prospective, multicenter registry. Transport data will be collected locally at participating pediatric centers and then submitted digitally and anonymized via a secure, web-based platform.DiscussionWe anticipate high participation from pediatric intensive care units and expect to present valid data on the need for pediatric intensive care transports in Germany. This data may serve as a foundation for nationwide demand planning for pediatric intensive care transport resources.

The issue of hallucinations in large language models (LLMs) remains a critical barrier to the adoption of AI in enterprise and other high-stakes applications. Despite advancements in retrieval-augmented generation (RAG) systems, current state-of-the-art methods fail to achieve more than 80% accuracy in generating faithful and factually correct outputs, even when provided with relevant and accurate context. In this work, we introduce Acurai, a novel systematic approach that achieves 100% hallucination-free responses in LLMs by reformatting queries and context data prior to input. Leveraging a deep understanding of LLM internal representations, the importance of noun-phrase dominance, and the role of discrete functional units (DFUs), Acurai ensures alignment between input context and generated output. We validate this method using the RAGTruth corpus, demonstrating its ability to eliminate 100% hallucinations for both GPT-4 and GPT-3.5 Turbo. Acurai sets a new standard for achieving consistent, accurate, and faithful AI responses, marking a significant step forward in the development of trustworthy AI systems.

In rheumatoid arthritis, time spent using ineffective medications may lead to irreversible disease progression. Despite availability of targeted treatments, only a minority of patients achieve sustained remission, and little evidence exists to direct the choice of biologic disease-modifying antirheumatic drugs in individual patients. Machine learning was used to identify a rule to predict the response to sarilumab and discriminate between responses to sarilumab versus adalimumab, with a focus on clinically feasible blood biomarkers. The decision tree model GUIDE was trained using a data subset from the sarilumab trial with the most biomarker data, MOBILITY, to identify a rule to predict disease activity after sarilumab 200 mg. The training set comprised 18 categorical and 24 continuous baseline variables; some data were omitted from training and used for validation by the algorithm (cross-validation). The rule was tested using full datasets from four trials (MOBILITY, MONARCH, TARGET, and ASCERTAIN), focusing on the recommended sarilumab dose of 200 mg. In the training set, the presence of anti-cyclic citrullinated peptide antibodies, combined with C-reactive protein > 12.3 mg/l, was identified as the “rule” that predicts American College of Rheumatology 20% response (ACR20) to sarilumab. In testing, the rule reliably predicted response to sarilumab in MOBILITY, MONARCH, and ASCERTAIN for many efficacy parameters (e.g., ACR70 and the 28-joint disease activity score using CRP [DAS28-CRP] remission). The rule applied less to TARGET, which recruited individuals refractory to tumor necrosis factor inhibitors. The potential clinical benefit of the rule was highlighted in a clinical scenario based on MONARCH data, which found that increased ACR70 rates could be achieved by treating either rule-positive patients with sarilumab or rule-negative patients with adalimumab. Well-established and clinically feasible blood biomarkers can guide individual treatment choice. Real-world validation of the rule identified in this post hoc analysis is merited. NCT01061736, NCT02332590, NCT01709578, NCT01768572.

Despite recent improvements in the treatment of systemic lupus erythematosus (SLE), disease activity, comorbidities and drug toxicity significantly contribute to the risk of progressive irreversible damage accrual and increased mortality in patients with this chronic disease. Moreover, even lupus patients in remission often report residual symptoms, such as fatigue, which have a considerable impact on their health-related quality of life. In recent decades, SLE treatment has moved from the use of hydroxychloroquine, systemic glucocorticosteroids and conventional immunosuppressive drugs to biologic agents, of which belimumab is the first and only biologic agent approved for the treatment for SLE to date. Novel therapies targeting interferons, cytokines and their receptors, intracellular signals, plasma cells, T lymphocytes and co-stimulatory molecules are being evaluated. In the context of a holistic approach, growing evidence is emerging of the importance of correct lifestyle habits in the management of lupus manifestations and comorbidities. The aim of this paper is to provide an overview of current pharmacological and non-pharmacological treatment options and emerging therapies in SLE.

Im Vergleich zu Rheumapatienten mit gelenkbezogenen entzündlichen oder degenerativen Erkrankungen befällt der „systemische Lupus erythematodes“ (SLE) vornehmlich Frauen im Alter zwischen 15 und 35 Jahren. Der SLE ist eine heterogene Autoimmunerkrankung, die mehrere Organsysteme abhängig von der ethnischen Zugehörigkeit mit einer Prävalenz von 5–68 / 100.000 (europäische Bevölkerung), bzw. 240–500 / 100.000 (Nordamerika) betrifft [1]-[3]. In Deutschland leiden schätzungsweise 31.000 Menschen an SLE (2010) [4]. Trotz der Verbesserung der Gesamtüberlebensraten in der Vergangenheit zeigt eine aktuelle Untersuchung, dass auch in wirtschaftlich hochentwickelten westlichen Staaten das 15-Jahres-Gesamtüberleben bei 82 % stagniert, d. h. dass 18 % der jungen Lupus-Patienten 15 Jahre nicht überleben [5]. Hauptursachen für die erhöhte Mortalität sind neben der Krankheitsaktivität mit Organschäden auch medikamentös-bedingte Komplikationen, kardiovaskuläre Komorbiditäten (Diabetes mellitus, Arterielle Hypertonie etc.) und schwere Infektionen.

IntroductionThe aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) both in rheumatologic and non-rheumatologic rehabilitation centers. In addition, we sought to evaluate the practice value of existing screening recommendations of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO).MethodsThe analysis was performed in four rehabilitation clinics (rheumatology, psychosomatic medicine, oncology, and cardiology) with at least 200 patients per clinic tested for MRSA.ResultsNine (1.1%) of the 842 patients were colonized with MRSA. Only five of them should have been tested according to the commission’s recommendations. The prevalence was 0.5% (n = 207) in rheumatologic, 0.9% (n = 224) in psychosomatic, 1.4% (n = 209) in oncologic and 1.5% (n = 202) in cardiologic patients. We found a greater exposure to risk factors in cardiologic and oncologic patients. Among patients with carrier status, a higher percentage was exposed to three potential risk factors not applied by the commission.ConclusionsThe prevalence of MRSA in our cohort correlates with data from previous studies. The low percentage among rheumatologic patients suggests that they are not more likely to reveal MRSA carrier status than other patient groups and that long-term immunosuppression does not necessarily represent a risk factor for MRSA colonization. Since only five out of nine patients with carrier status would have been detected following the recommendations of the KRINKO, further studies on potential risk factors are warranted.