Vienna General Hospital Research Articles

“Go forth …”

"Go therefore and make disciples of all nations, baptizing them in the name of the Father and of the Son and of the Holy Spirit," (Matt. 28:19) was one of the early golden verses from the Bible I memorized when I was in elementary school at the Armenian Evangelical School in Lebanon. (1) Who was being addressed? I asked myself. The church, my missionary teachers or me as a girl? The question remained with me until I learned the theology of mission of my church and became involved in the ecumenical movement. Mission: An ecumenical journey While at the Evangelical School, I faced a dilemma: On Sunday I attended the liturgy in the Armenian Orthodox church with my family, and during the week, I attended Bible studies and memorized golden verses at school. My parents explained to me the missionary nature of our church as the eucharistic community where discipleship meant internal conversion, commitment to Christian values of love and justice, and serving the world. My parents' explanation of God's mission contrasted with the school's message of repentance and personal salvation. In my mind, I was a sinner during the week and God's child growing up to serve humanity on Sundays. This different understanding of mission made me question the theology of mission of my church. In our history classes we learned that Armenians were the first people to adopt Christianity as national religion in 301 CE. How could the founders of our faith, the apostles Thaddeus and Bartholomew, who evangelized Armenia, and our church fathers be wrong? How about our Muslim neighbours and friends? While my parents assured me that my neighbours and friends were not doomed to go to hell, yet I always feared for them. My role as a girl-child having received the message "go forth" was clarified later when I joined the Middle East Council of Churches (MECC) and the World Council of Churches (WCC) respectively as staff. My ecumenical quest, which led to the creation of the European Project for Interreligious Learning (EPIL), began with my work at the Ecumenical Youth and Students Secretariat of the Middle East in Beirut (2) and as development secretary. The next step was my appointment as executive secretary for Inter-Church Aid and Development Programme, the only woman executive in the newly constituted Middle East Council of Churches in 1974. During the 1970s Paulo Freire was a staff member at the WCC and his pedagogy (3)--based on "conscientization"/"awareness building" and liberation of the poor and the oppressed through reflection and action in the liberational methodological rhythm of See, Judge, and Act-guided our work. As head of the development department, I was further inspired by the WCC Commission on Churches Participation in Development (CCPD) with its emphasis on development as a process to promote social justice, self-reliance, and economic growth. The 1980s brought a new understanding of mission to the ecumenical movement through the WCC central committee's approval in 1982 of the document "Mission and Evangelism: An Ecumenical Affirmation." (4) The document included the Orthodox pneumatology and showed the interrelationship between Christololgy and the Holy Spirit, as later explained by the current Catholicos of Cilicia, Aram I: The Triune God is the source of life. The Holy Spirit is the giver of life, the life-giving presence of the Triune God. Like breath, the Holy Spirit inspires and empowers life in human beings and in the whole creation. Without the presence of the Spirit all things in creation "die and return to dust" (Psalm 104:29). The Holy Spirit is not only the generator of life, but the one who sustains it. (5) The clarification that God is Trinity and the risen Christ is active in the Spirit as manifested through the Pentecost emphasized the cosmic nature of salvation and opened a new way of reflecting on creation, reconciliation, and healing. …

Mission on the Move for Justice and Peace

Mission on the move: Toward witnessing in religiously plural societies "Mission on the Move" means mission still moving out of traditional perceptions of what mission is; and if "witness" is a new word for mission, it means re-conceptualizing what "witness" means in multi-faith/ religiously plural societies. This is a difficult process as the concept of "mission" carries with it a long history and biblical authority. Further, it has often been aligned with political powers and misused for non-religious purposes. Its practice has focused on converting the other into one's own religious likeness rather than sharing (in a variety of ways) the transformative power of the gospel in one's own life. The European Project for Interreligious Learning (EPIL) is an educational project for Christian and Muslim women from five countries in Europe and the Middle East. It is a two-year intensive learning process that was originally developed and launched as a cooperation by the World Council of Churches (WCC) and the Protestant Academy Boldern, Switzerland. It owes much to concepts of ecumenical learning and "Learning in Community" and to the liberation pedagogy of Paulo Freire. The first phase of this project (comprising three cycles) took place 2000-2013. In the course of each two-year cycle, participants spent five weeks in live-in situations where they had to deal with cultural and religious differences and explore how these might be harnessed to live more peacefully and fairly. "Interreligious dialogue and engagement should be the way for religions to relate to one another." This statement from the Birmingham Pluralist Summit (September 2003) (1) was the basis of the learning process. There would be no proselytizing and no attempt at missionization on either side. For the Christian participants in EPIL, this marked a relational shift from "mission" (as a hierarchical relationship) to witnessing in the form of presence to and with "the other." Learnings about religion became narratives and conversation--telling each other what religion meant concretely in the lives of participants. It was a work of "translation" that taught students more and at a deeper level about their own faiths than about the faith of the respective other. At the same time it heightened the students' sense of respect, even awe at the richness of religious experiences. And in the course of time it developed into something close to "the communication of love in action," (2) an attentiveness to the needs of the other woman, her limitations, her potential, and the realization of her humanness. If the classical response to "the other" used to be fear of difference (with all the consequences, including suppression and even elimination of the other) there has occurred a shift to valuing diversity, to perceiving it as enriching and helpful in solving the many problems of daily living together. In the discourse developing on a pluralist "theology of religions"/ "interreligious theology" we observe a shift from holding one's own religious truths as only truths (exclusivist approach) to acknowledging that "the great world religions with their diverse teachings and practices constitute authentic paths to the supreme Good." (3) To be "on the move" then could refer in a sense to a concept of living together in complex societies with a multitude of cultural expressions and religious beliefs. A concept that allows us to be attentive to insights and ideas emerging in many locations and that preserves a certain fluidity and openness to different ways of life and different approaches to problem solving. This works on the assumption that cooperation, respect, and acceptance of the different religious perspectives can produce results that draw all into the process of building life together within a culture of justice and peace. Being "on the move": EPIL's pedagogical concept In the educational process of EPIL, being on the move has been the most decisive factor. …

Incidental epileptiform discharges in patients of a tertiary centre

ObjectiveThis controlled study set out to assess the rate of incidental epileptiform discharges (ED) during routine EEG and the incidence of epilepsy within a 4-year follow-up period in patients without a history of epilepsy. MethodsWe retrospectively analyzed electroencephalography (EEG) recordings of 1750 consecutive patients referred to the Department of Neurology at the Vienna General Hospital between January 1 and December 31, 2009. The incidence of epilepsy in patients with ED and no prior history of epilepsy was compared with a disease control group matched for gender and neuroimaging findings. ResultsED were identified in 26 (4%) of 629 patients without a history of epilepsy. Sixteen (62%) of these patients developed epilepsy during follow-up compared with five (19%) of the disease controls (p=0.01), yielding an adjusted odds ratio of 8.8 (95% CI 2.1–37.7) for developing epilepsy in patients with ED and no prior history of epilepsy. ConclusionsIncidental ED during routine EEG significantly increase the likelihood of developing epilepsy. SignificancePatients with incidental ED should be specifically asked for any signs and symptoms suggestive of seizures, since they appear more prone to develop epilepsy.

Accuracy of Radioactively Labeled Autologous Leukocytes in Patients with Infected Prosthetic Joints

Objective: A serious complication of joint replacement surgery is infection, which results in prolonged invalidity due to decrease in joint function and hospitalization, often resulting in removal and subsequent re-implantation after lengthy antibiotic therapy. Labeled leukocyte scintigraphy (LS) is considered a valuable tool in preoperative diagnosis of prosthetic joint infections. The aim of this study was to examine imaging of in vitro radioactively labeled autologous leukocytes and bone marrow scans in their accuracy and reliability in detecting infection in patients with prosthetic joints. Furthermore, inflammation markers CRP and WBC count were analyzed for their accuracy in detecting prosthetic joint infection. Methods: This single center study included all patients suspected of having prosthetic joint infections between January and September 2013 at the Vienna General Hospital. A total of 45 mL blood was drawn from a peripheral vein and leukocytes were radioactively labeled with Tc-99m-HMPAO according to protocol. The labeled leukocytes were then re-injected into a peripheral vein. A whole body scintigraphy and local images were recorded with a double-headed gamma camera four hours after re-injection. Additional local images were taken taken approximately 24 hours following re-injection. In the case of positive LS, bone marrow scintigraphy was conducted 48 hours after re-injection. Local images were recorded 30 minutes after injection of 370 MBq Tc-99m-nanocolloid. Results: This study included a total of 50 patients. All the patients underwent subsequent bacterial and histological testing via joint aspiration or operation of the joint. The most common joint investigated was knee (27), followed by hip (9), shoulder (2), and elbow (1). Other cases involved the complete femur (6), tibia (2), leg (2), and foot (1). Pathogens isolated from the joints included Staphylococcus epidermidis and Candida albicans. The sensitivity of LS was 63%, specificity 90%, PPV 56% and NPV 93%. Overall accuracy was calculated to be 86%. Pre-diagnostic testing with CRP and WBC was conducted in 43 patients. Mean CRP was 3,9 mg/dl. Thirty-one patients had a CRP-level higher and 12 patients lower than the cut-off. The sensitivity was 57%, specificity 28%, PPV 13%, NPV 77% and accuracy 33%. Lastly, only 3 patients had WBC counts higher than the cut-off. WBC count had a sensitivity of 0%, specificity 92%, PPV 0%, NPV 88% and overall accuracy 82%. Conclusion: While this study showed that CRP and WBC are not accurate pre-diagnostic markers for prosthetic joint infection, it was able to demonstrate that Tc-99m-HMPAO labeled autologous leukocytes in patients presenting with symptoms of prosthetic joint infection is accurate. LS is a feasible imaging method in patients with infection of prosthetic joints and may

Editorial introductions

Editorial introductions

Successful implementation of infection control strategies prevents P. aeruginosa transmission among cystic fibrosis patients inside the hospital.

Background: The aim of this study was to characterise the epidemiology of P. aeruginosa isolated from cystic fibrosis (CF) patients at the Vienna General Hospital (VGH) by molecular genetic fingerprinting in order to understand transmission ways and to evaluate the established infection control protocols.Methods: The outpatient clinic for CF patients at the VGH cares for children and adolescents up to the age of 18 years. Among an average of 139 patients cared for at the clinic, 41 were tested positive for P. aeruginosa during the study period. Fifty P. aeruginosa isolates, obtained between August 2010 and March 2012 from routine examinations of CF patients, were subject to molecular characterization using the DiversiLab® method.Results: 42 distinguishable molecular-biological patterns were identified, 7 of which were found multiple times. 40 out of 42 genotypes were retrieved from single patients only, while two patterns were present in two patients each.Nine patients presented with two or more phenotypically diverse P. aeruginosa isolates. In five of these cases the retrieved isolates belonged to the same genotype.Conclusion: The broad genetic heterogeneity of P. aeruginosa in the studied patient population suggests that the majority of CF patients cared for at the VGH acquire P. aeruginosa from environmental sources. It may be concluded that implemented infection control guidelines have been successful in preventing nosocomial transmission of P. aeruginosa among CF patients within the VGH and patient-to-patient transmission outside the hospital. Chronic polyclonal infection/colonization was rare in the study population.

Management of Merkel cell carcinoma of unknown primary origin: the Vienna Medical School experience

Merkel cell carcinoma is a rare, but highly aggressive skin tumor. We describe our single-institution experience with the diagnosis and treatment of Merkel cell carcinoma of unknown primary (MCCUP). We conducted a retrospective medical chart review of patients treated with MCCUP at the Vienna General Hospital between 2002 and 2011. Clinicopathologic variables and outcomes were analyzed. Of the entire cohort of 57 patients, 8 patients (14%) were diagnosed with MCCUP. Three patients presented with parotid gland involvement, four patients with positive inguinal lymph nodes and one with axillar lymph nodes. CK20 staining was positive in all tumor specimens, whereas MCPyV protein was positive in four out of six patients. The primary surgical modality in five cases was wide local excision. In one patient excisional biopsy was followed by re-resection. In one case only excisional biopsy was performed due to metastatic disease at first diagnosis. Two patients underwent concomitant parotidectomy and neck dissection, and four patients received adjuvant radiation therapy. Median recurrence-free survival was 20 months. Four patients died, three of disease and one of other cause. Recurrent disease was observed in two patients and treated with radiotherapy and chemotherapy. The 1- and 3-year overall survival rates were 87.5 and 37.5%, respectively. The 1- and 3-year disease-specific survival rates were 87.5 and 62.5%, respectively. Our study shows a poor outcome in patients with MCCUP, particularly in patients with node involvement of the trunk. We therefore suggest an aggressive and multimodal treatment approach for patients with MCCUP.

P4.049 Lopinavir/Ritonavir in Combination with Tenofovir/Emtricitabine as Post Exposure Prophylaxis (PEP) to HIV - an Effective and Well Tolerated Regimen

IntroductionPEP to HIV is a course of antiretroviral drugs administered within 72 hrs after events with high risk of exposure to HIV aiming to reduce the odds of established infection....

Obduktionsbefunde in Wien seit Lorenz Biermayer – eine durchgehende 195jährige Dokumentation

Vienna has a long tradition of clinical autopsies. In the period from 1817 to 2012 there are over 300,000 autopsies documented in the Vienna General Hospital. From five other community hospitals with departments for pathology and some closed hospitals, autopsy reports exist since 1865. Until the nineteenth century the reports are written in Kurrent, then Latin script and since the 1920s they are stored as machine written copies. This incredible high number of preserved reports was only possible because of the tradition started by Rokitansky and the possibility of storing this large amount of records in the Pathologic anatomical collection in the Narrenturm, the Vienna Municipal Archives and various hospitals. The aim of this study was to create a documentary of the repositories of the autopsy records, to make the records available and easier accessible for different kinds of research. The autopsy records should be easier to find and access, be it for the use in statistics or other scientific projects.

Effectiveness of an automated surveillance system for intensive care unit-acquired infections

This study assessed the effectiveness of a fully automated surveillance system for the detection of healthcare-associated infections (HCAIs) in intensive care units. Manual ward surveillance (MS) and electronic surveillance (ES) were performed for two intensive care units of the Vienna General Hospital. All patients admitted for a period longer than 48 h between 13 November 2006 and 7 February 2007 were evaluated according to HELICS-defined rules for HCAI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and personnel time spent per surveillance type were calculated. Ninety-three patient admissions were observed, whereby 30 HCAI episodes were taken as a reference standard. Results with MS versus ES were: sensitivity 40% versus 87%, specificity 94% versus 99%, PPV 71% versus 96%, NPV 80% versus 95%, and time spent per surveillance type 82.5 h versus 12.5 h. In conclusion, ES was found to be more effective than MS while consuming fewer personnel resources.

Inflammatory bone loss

Inflammatory bone loss

Prenatal genetic counseling and consanguinity

To evaluate the prevalence of consanguineous patients at a Western European prenatal genetic counseling clinic and to describe demographic as well as health-related characteristics of this patient group. Retrospective analysis of 1964 primary consultations at the Prenatal Genetic Counseling Outpatient Clinic at the Medical University of Vienna General Hospital in Austria. Characteristics of consanguineous patients were compared with those of a control group of not-related unions. A total of 8.9% (174/1964) of all patients lived in a consanguineous union, meaning they were related as second cousin or closer [78.7% (137/174) first cousin, 14.4% (25/174) second cousin, 6.3% (11/174) first cousin once removed or 0.6% (1/174) uncle/niece]. Consanguineous patients were significantly younger (26.6 ± 5.4 vs 30.4 ± 6.5, p < 0.01) and of non-Austrian background [92.5% (161/174) vs 32.8% (57/174), p < 0.01] than not-related controls. Forty-six per cent (80/174) were referred during an ongoing pregnancy. The main counseling issue was family history of consanguinity (ICD Z84.3) in 31.6% (55/174) of cases. Estimations of the prevalence of consanguinity among the general population in Western Europe likely highly underestimate the evaluated prevalence among patients referred for prenatal genetic counseling. Counseling strategies need to take into consideration that consanguineous patients are more likely to be young and have an immigrant background.

Knowledge-based tacrolimus therapy for kidney transplant patients.

Immunosuppressive therapy is necessary when patients with chronic kidney disease receive a kidney transplant. Certain immunosuppressive agents need therapeutic drug monitoring. The goal of this paper was to identify adaptation rules for Tacrolimus therapy from a clinical data set. For knowledge acquisition, patient data from 1995 to 2008 from the Department of Nephrology and Dialysis of the Vienna General Hospital were used, including patient demographics, laboratory parameters, time since kidney transplantation and other immuno-suppressive drugs administered. Tacrolimus was chosen from the available immunosuppressive drugs. By applying a regression tree, we create homogeneous groups of data. Models were generated for these groups that can predict the level of the drug concentration for the next ward round. A knowledge base was developed on the basis of the determined models, which is used within a clinical decision support system for Tacrolimus therapy planning, which was integrated into clinical routine.

Automated red blood cell exchange as an adjunctive treatment for severe Plasmodium falciparum malaria at the Vienna General Hospital in Austria: a retrospective cohort study

BackgroundSevere falciparum malaria is associated with considerable rates of mortality, despite the administration of appropriate anti-malarial treatment. Since overall survival is associated with total parasite biomass, blood exchange transfusion has been proposed as a potential method to rapidly reduce peripheral parasitaemia. However, current evidence suggests that this treatment modality may not improve outcome. Automated red blood cell exchange (also referred to as “erythrocytapheresis”) has been advocated as an alternative method to rapidly remove parasites from circulating blood without affecting patients’ volume and electrolyte status. However, only limited evidence from case reports and case series is available for this adjunctive treatment. This retrospective cohort study describes the use of automated red blood cell exchange for the treatment of severe malaria at the Medical University of Vienna.MethodsEpidemiologic data for imported malaria cases in Austria are reported and data of patients treated for malaria at the General Hospital/Medical University of Vienna were extracted from electronic hospital records.ResultsBetween 2000 and 2010, 146 patients were hospitalized at the Medical University of Vienna due to malaria and 16 of those were classified as severe malaria cases. Eleven patients of this cohort were potentially eligible for an adjunctive treatment with automated red blood cell exchange. Five patients eventually underwent this procedure within a period of seven hours (range: 3–19 hours) after hospital admission. Six patients did not undergo this adjunctive treatment following the decision of the treating physician. The procedure was well tolerated in all cases and rapid reduction in parasite counts was achieved without occurrence of haemodynamic complications. One patient died within seven days, whereas four patients survived without any sequelae.Discussion and conclusionAutomated red blood cell exchange was a safe and efficient procedure to rapidly clear peripheral parasitaemia. Whether the fast reduction in parasite biomass may ultimately improve patient survival remains however unclear. Randomized controlled trials are needed to conclusively appreciate the value of this adjunctive treatment.

Evaluation of educational needs in patients with diabetes mellitus in respect of medication use in Austria

Effective control of diabetes mellitus type 1 (DM1) and type 2 (DM2) can reduce the development and progression of diabetic complications. Therefore, patient education should be considered as an integral part of diabetes management. The aim of the study was to assess DM patients' perception of knowledge for their medication and attitude towards self-management and pharmacist's role. The study was conducted at the diabetes out-patient clinic at the Vienna General Hospital (AKH), Division of Endocrinology and Metabolism, Department of Internal Medicine III, Austria. The study was a cross sectional survey using patient data from a validated patient questionnaire and medical records. Medical records were evaluated by applying a medication assessment tool. To assess the quality of diabetes self management the following outcome measures are considered: HbA1c levels, pre- and post-prandial blood glucose levels, prevention of acute episodes of hypo- and hyperglycaemia, reduction of macrovascular risk factors, short term quality of life, adverse effects and treatment tolerance. The present study comprised 225 patients with DM1 and 201 patients with DM2, respectively. In comparison to DM2 patients, cardio- and cerebrovascular diseases were diagnosed very rarely in patients with DM1. The risk for these diseases was higher in patients with other factors of the metabolic syndrome, in addition. Overall, 118 of these patients participated in the questionnaire. The level of positive response on diabetes self-care and knowledge with respect to medication for the prevention of diabetes complications, glycaemic control, and treatment goals in diabetes was 81.8 %. The comparison of patients' perceptions of diabetes self-care and knowledge showed differences among subgroups. Higher perceived knowledge and self-care apparently was associated with DM1. Additional findings of this study indicate that patients do not expect community pharmacists to be integrated in a multidisciplinary diabetes care team. Although the level of positive response was found to be high there is still a minority of patients whose level of comprehension appears to be insufficient. Intense pharmaceutical care including patients' education within a multidisciplinary team could contribute to improvements in those patients.

P-107 - Temperament and its relationship to alcohol dependence

Introduction Alcohol dependence is a complex psychiatric disorder. Objectives To investigate the role of temperament on the course of alcohol dependence. Aims To further investigate the role of temperaments in alcohol dependent patients and to analyse the differences in relevant clinical features in correlation with the different temperament distributions. Methods The patients‘case files of 116 alcohol dependent patients, according to ICD-10 and DSM-IV-TR, admitted to the Vienna General Hospital between 02/08 and 03/09, were examined retrospectively. The brief-TEMPS-M auto-questionnaire was used to assess the temperamental distribution. The dimensions of alcohol dependence have been assessed using the Lesch Alcoholism Typology, a computerized structured interview. The potential effect of temperamental scores on various outcomes describing the course of illness is investigated using multi-variable regression models. Results Cyclothymic score was the only temperament which significantly influenced the age of onset of alcohol abuse and age of onset of alcohol dependence. Backward selection among temperaments exhibits depressive temperament as most important effect regarding the likelihood of suicide-attempts in the patient‘s case history and anxious temperament as most important effect regarding having psychiatric treatment focusing on alcohol dependence prior to current in- or outpatient stay. Conclusion Dominant cyclothymic, but also depressive and anxious temperament, seem to be negative predictors for the course of illness in alcohol dependence.

Response to Letters Regarding Article, “Comparison Between Transcatheter and Surgical Prosthetic Valve Implantation in Patients With Severe Aortic Stenosis and Reduced Left Ventricular Ejection Fraction”

We thank Subramanian et al and Ranucci et al for their insightful comments with regard to our study.1 In response to the comments of Ranucci et al, we provide the following statements. 1. The important variability in the 30-day mortality rates (8% to 33%) reported in previous studies is essentially related to the differences in the cutoff values used for the left ventricular ejection fraction (LVEF), but also, and more importantly, it is related to the differences in the baseline risk profile of the study populations. The fact that the mortality (12%) observed in our surgical aortic valve replacement (SAVR) series is higher than that (8% to 10%) of some previous series is essentially related to the worse-risk profile of the patients included in this series. 2. The assessment of SAVR operative risk was based on a comprehensive analysis of the factors included in the risk scores, and those (eg, frailty) not included in these scores, as well. All patients included in the transcatheter aortic valve implantation (TAVI) series had been refused for SAVR by at least 2 cardiac surgeons. 3. We agree that the presence of reduced LVEF should not be used as the sole argument to recommend TAVI rather than SAVR in patients with severe aortic stenosis. SAVR remains the standard of care in the vast majority of patients with reduced LVEF and high …

Pandemic influenza A H1N1 vaccine in recipients of solid organ transplants: Immunogenicity and tolerability outcomes after vero cell derived, non-adjuvanted, whole-virion vaccination

During the 2009/10 pandemic of influenza A (H1N1), the American Society of Transplantation and other health organizations recommended that immunocompromised patients should be vaccinated as the key preventive measure. Since there are no data available for the immunogenicity of the unadjuvanted pandemic influenza vaccine in immunocompromised patients – as opposed to the adjuvanted preparation – the objective of this study was to evaluate the immunogenicity of an adjuvant-free H1N1 vaccine in recipients of solid organ transplants. Patients were recruited at the Vienna General Hospital, Austria. The vaccination schedule consisted of 2 doses of a whole-virion, vero cell derived, inactivated, non-adjuvanted influenza A/California/07/2009 (H1N1) vaccine given with an interval of 3 weeks. A hemagglutination inhibition (HI) assay on blood samples obtained prior to the first and after each vaccination was used for serologic analysis. The primary immunologic endpoint was the seroconversion rate, defined as the proportion of subjects with an individual 4-fold increase in HI titer of at least 1:40. In addition, virus-specific IgG antibodies to the pandemic H1N1 strain were measured using a commercially available ELISA. Twenty-five organ transplant patients (16 males, 9 females) aged 25–79 years were vaccinated and provided blood samples for serologic analysis. The time elapsed since transplantation was 10 months to 25 years (mean: 9 years; 95% CI 6–13 years). The vaccine was well tolerated and no local adverse events were noticed. After two vaccinations 37% of the patients demonstrated seroconversion in the HI assay as defined above and 70% had virus-specific IgG antibodies. Among the HI vaccine responders were 6 of 14 heart transplant recipients and 1 of 4 liver transplant recipients. The number and type of immunosuppressive agents did not significantly differ in their effect on the immune response. Our results show that the novel vero cell derived and adjuvant-free pandemic A/California/07/2009 (H1N1) influenza vaccine induced limited but measurable immune responses in adult recipients of solid organ transplants.

The yield of routine electroencephalography in the detection of incidental nonconvulsive status epilepticus – A prospective study

ObjectiveDiagnosis of NCSE is challenging, because the clinical presentation ranges from minimally altered mental status to coma without tonic–clonic activity. According to the largest retrospective study to date the incidence of NCSE is about 0.2%. MethodsWe prospectively investigated electroencephalography (EEG) recordings of 2514 consecutive patients that were referred to the Electrophysiology Unit of Department of Neurology, Vienna General Hospital between November 2009 and February 2011 (i.e. 16months). ResultsThe incidence of NCSE in our study population was 0.8%, i.e. the EEG of 19 patients fulfilled the criteria of NCSE. In 53% of these patients the NCSE was not suspected by treating physicians. A severely reduced level of consciousness was found in 78% of patients with a suspected NCSE and in 30% of patients with an unsuspected NCSE, although the results were not statistically significant (p=0.081). The delay between the admission to the hospital and diagnosis ranged between 0 and 51days. ConclusionsNCSE was an unsuspected finding in more than half of the patients. Consciousness was severely impaired in only one third of these patients. SignificanceThese results highlight the importance of urgent EEG for the diagnosis of NCSE in patients even without significant impairment of consciousness.

P02-271 - The reliability of a brief diagnostic interview, the trips, for the assessment of psychiatric disorders according to ICD-10 in primary care and non-psychiatric medical settings

IntroductionAlthough there are instruments for the assessment of DSM-IV mental disorders in primary care, there is no brief instrument to assess mental disorders in primary care according to the ICD-10.AimsThe aim of the study was to assess the reliability of a new diagnostic interview, the TRIPS, designed for the assessment of anxiety-, mood-, and alcohol related disorders according to ICD-10 by non-mental health professionals.MethodsAt first, all Patients completed a screening questionnaire and were subsequently assessed by the staff of somatic departments of a Vienna General Hospital with the TRIPS. Within a week, patients were re-assessed by psychiatrists of the department of psychiatry with the Composite International Diagnostic Interview (CIDI).ResultsFinally, 290 patients could be assessed with both instruments. With the CIDI, 106 out of 290 patients (37%) got any diagnosis of a mental disorder, 74 (26%) had a mood disorder, 64 (22%) an anxiety disorder and 10 patients (3%) an alcohol-related disorder.Sensitivity of the TRIPS was 88%, specificity was 76% and diagnostic accuracy was 80% for any disorder, and 88%, 83%, and 84% respectively for any mood disorder, 72%, 88%, and 84% for any anxiety disorder, and 60%, 98%, and 97% for alcohol related disorders.ConclusionsThe results show that the TRIPS is a useful instrument with sufficient reliability to detect anxiety disorders and mood disorders in patients with somatic disorders by health professionals without psychiatric training. Due to the low base rate the test criteria for alcohol-related disorders cannot be interpreted sufficiently.