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Gantt DM, Misselwitz B, Boos V, Reitter A. Errors in the classification of pregnant women according to Robson ten-group classification system. Eur J Obstet Gynecol Reprod Biol 2024; 295:53-57. [PMID: 38335585 DOI: 10.1016/j.ejogrb.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The Robson Ten-Group Classification System (TGCS) is widely used as a classification system for perinatal analyses such as Caesarean section (CS) rates. In Germany, standardised data sets on deliveries are classified by quality assurance institutions using the TGCS. This observational study aims to evaluate potential errors in the TCGS classification of deliveries. STUDY DESIGN Manual TGCS classification of all 1370 deliveries in an obstetric unit in 2018 and comparison with semi-automatic TGCS classifications of the quality assurance institution. RESULTS In the manual classification, 259 out of 1370 births (18.9 %) were assigned to a different Robson group than in the semi-automatic classification. The proportions of births by Robson group were significantly different in TGCS group 1 (32.2 % vs. 37.6 %, p = 0.0034) and group 2 (18.4 % vs. 14.4 %, p = 0.0053). Concordance between manual and semi-automatic classifications ranged from 59.5 % in group 2 to 100.0 % in groups 6, 7, 8, and 9. The most frequent mismatches were for the parameters "onset of labour" in 184 cases (13.4 %), "parity" in 42 cases (3.1 %) and "previous uterine scars" in 23 cases (1.7 %). In the manual classification, there were significant differences in the CS rate in group 1 (7.9 % vs. 2.5 %, p < 0.0001), group 2 (30.2 % vs. 48.2 %, p < 0.0001), and group 4 (14.1 % vs. 37.4 %, p = 0.0004), compared to the semi-automatic classification. CONCLUSIONS Due to incorrect data entry and unclear definitions of criteria, quality assurance data in obstetric databases may contain a relevant proportion of errors, which could influence statistics with TGCS in context of CS rates in international comparisons.
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Affiliation(s)
| | - Björn Misselwitz
- Federal State Consortium of Quality Assurance Hesse (Landesarbeitsgemeinschaft Qualitätssicherung Hessen, LAGQH), Frankfurter Str. 10, 65760 Eschborn, Germany.
| | - Vinzenz Boos
- Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland.
| | - Anke Reitter
- Goethe-University Frankfurt, Theodor-Stern-Kai, 60596 Frankfurt am Main, Germany; Department of Obstetrics, Hospital Zollikerberg, Trichtenhauserstrasse 20, 8125 Zollikerberg, Switzerland.
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Belau MH, Misselwitz B, Meyding-Lamadé U, Bassa B. Trends in stroke severity at hospital admission and rehabilitation discharge before and during the COVID-19 pandemic in Hesse, Germany: a register-based study. Neurol Res Pract 2024; 6:18. [PMID: 38449050 PMCID: PMC10918907 DOI: 10.1186/s42466-024-00308-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected acute stroke care, resulting in a decrease in stroke admissions worldwide. We examined trends in stroke severity at hospital admission, including (1) probable need for rehabilitation (National Institutes of Health Stroke Scale score > 6 points) and (2) probable need for assistance (modified Rankin Scale score > 2 points), and discharge to rehabilitation after acute care among inpatients with acute ischemic stroke and intracerebral hemorrhage. METHODS We compared quality assurance data for acute ischemic stroke and intracerebral hemorrhage during the pandemic with the period before the pandemic in Hesse, Germany, using logistic regression analyses. RESULTS Fewer inpatients with a probable need for rehabilitation were present at the beginning of the second wave of the COVID-19 pandemic in September 2020 (adjusted OR (aOR) 0.85, 95% CI [0.73, 0.99]), at the end of the second national lockdown in May 2021 (aOR 0.81, 95% CI [0.70, 0.94]), and at the approaching peak of COVID-19 wave 4 in November 2021 (aOR 0.79, 95% CI [0.68, 091]). Rates of probable need for assistance were significantly lower at the beginning of COVID-19 wave 2 in August 2020 (aOR 0.87, 95% CI [0.77, 0.99]) and at the beginning of COVID-19 wave 3 in March 2021 (aOR 0.80, 95% CI [0.71, 0.91]). Rates of discharge to rehabilitation were lower from the beginning in October 2020 to the peak of COVID-19 wave 2 in December 2020 (aOR 0.83, 95% CI [0.77, 0.90]), at the beginning and end of COVID-19 wave 3 in March 2021 and May 2021 (aOR 0.86, 95% CI [0.79, 0.92]), respectively, and at the beginning of COVID-19 wave 4 in October 2021 (aOR 0.86, 95% CI [0.76, 0.98]). CONCLUSIONS The results suggest that the COVID-19 pandemic had an impact on stroke management during the pandemic, but the absolute difference in stroke severity at hospital admission and discharge to rehabilitation was small.
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Affiliation(s)
- Matthias Hans Belau
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Björn Misselwitz
- Federal State Consortium of Quality Assurance Hesse, Eschborn, Germany
| | - Uta Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest, Frankfurt (Main), Germany
| | - Burc Bassa
- Department of Neurology, Krankenhaus Nordwest, Frankfurt (Main), Germany
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Ebbeler D, Schneider M, Busse O, Berger K, Dröge P, Günster C, Misselwitz B, Timmesfeld N, Geraedts M. Associations between structure- and process-orientated measures and stroke long term mortality - an observational study based on routine data. J Stroke Cerebrovasc Dis 2023; 32:107241. [PMID: 37516024 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/26/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVES Various measures are used to improve the quality of stroke care. In Germany, these include concentrating treatment in specialized facilities (stroke units), mandatory quality comparisons of hospitals in some German states, and treatment according to prespecified structure and process specifications (neurological complex treatment 8-981 or 8-98b). These measures have previously only been analyzed individually and regarding short-term patient outcomes. This study analyzes these measures in combination, considering patients' comorbidities as well as stroke severity in a longitudinal perspective. MATERIALS/METHODS Analyses were based on data from 243,415 insurees of Germany's biggest health insurance (AOK) admitted to hospitals between 2007 and 2017 with cerebral infarction. Mortality risk was calculated using Cox regressions adjusted for various covariates. Kaplan-Meier analyses were differentiated by treatment site (stroke unit/external quality assurance/ Federal State Consortium of Quality Assurance Hesse - LAGQH) were performed, followed by log-rank tests and p-value adjustment. Trend analyses were performed for treatment types in combination with treatment sites. RESULTS All analyses showed significant advantages for patients who received Neurological Complex Treatment, especially when the treatment was performed under external quality assurance conditions and/or in stroke units. There was an increasing frequency of specialized stroke treatment. CONCLUSIONS Quality-enhancing structures and processes are associated with a lower mortality risk after stroke. There appears to be evidence of a cascading benefit from the implementation of neurological complex treatment, external quality assurance, and ultimately, stroke units. Consecutively, care should be concentrated in hospitals that meet these specifications. However, since measures are often applied in combination, it remains unclear which specific measures are crucial for patient outcome.
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Affiliation(s)
- Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Philipps University of Marburg, Karl-von-Frisch-Straße 4, Marburg 35043, Germany.
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Philipps University of Marburg, Karl-von-Frisch-Straße 4, Marburg 35043, Germany
| | - Otto Busse
- Stroke Unit Certification Committee, German Stroke Society, Berlin 10117, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster 48149, Germany
| | - Patrik Dröge
- AOK Research Institute, AOK Federal Association, Berlin 10178, Germany
| | - Christian Günster
- AOK Research Institute, AOK Federal Association, Berlin 10178, Germany
| | - Björn Misselwitz
- Federal State Consortium of Quality Assurance Hesse (LAGQH), Eschborn 65760, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum 44789, Germany
| | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps University of Marburg, Karl-von-Frisch-Straße 4, Marburg 35043, Germany
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Schmand C, Misselwitz B, Hudel H, Bedei I, Wolter A, Schenk J, Keil C, Köhler S, Axt-Fliedner R. Analysis of the Results of Sonographic Screening Examinations According to the Maternity Guidelines Before and After the Introduction of the Extended Basic Screening (IIb Screening) in Hesse. Ultraschall Med 2023; 44:e175-e183. [PMID: 35304733 DOI: 10.1055/a-1778-3585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM OF THE STUDY The aim of the study is to examine the detection rates of malformations before and after the introduction of extended basic screening in Hesse by the Federal Joint Committee (Gemeinsamer Bundesausschuss, GQH) on July 1, 2013. METHOD This is a retrospective, mainly exploratory data analysis of quality assurance data from the Office for Quality Assurance in Hesse (GQH). The data was collected in the period from January 1, 2010 to December 31, 2016 in the obstetric departments of the Hessian hospitals using documentation forms. The classification and evaluation of the diagnoses is based on ICD-10-GM-2019. RESULTS At least one malformation is present in 0.7% of the cases. With a share of 30.0%, most of the congenital malformations are from the musculoskeletal system. 12.2% of the malformations come from the facial cleft, closely followed by malformations of the circulatory system with 11.3%. The highest prenatal detection rate (PDR) is found in congenital malformations of the nervous system at 56.8%. The lowest PDR is found in those of the genital organs with 2.1%. The PDR of cardiovascular malformations is 32.9%. Overall, a PDR of 25.2% is achieved. There was no change in the number of prenatal malformation diagnoses after the introduction of extended basic ultrasound. The distribution of malformation diagnoses not detected prenatally to the organ systems also has not changed after the introduction. CONCLUSION The introduction of extended basic ultrasound did not bring the desired improvement with regard to the PDR in Hesse. Alternative approaches should be considered.
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Affiliation(s)
- Christine Schmand
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Björn Misselwitz
- Head of the office and project management, Office for Quality Assurance in Hesse, Eschborn, Germany
| | - Helge Hudel
- Department of Medical Statistics, Justus-Liebig-University, Giessen, Germany
| | - Ivonne Bedei
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Aline Wolter
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Johanna Schenk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Corinna Keil
- Prenatal Medicine and Fetal Therapy, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Siegmund Köhler
- Prenatal Medicine and Fetal Therapy, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Roland Axt-Fliedner
- Division of Prenatal Medicine, Departement of Obstetrics and Gynecology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
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Foerch C, Schaller-Paule MA, Steinmetz H, Misselwitz B, Bohmann FO. Reduction of Ischemic Stroke Associated Disability in the Population: A State-Wide Stroke Registry Analysis over a Decade. J Clin Med 2022; 11:jcm11236942. [PMID: 36498520 PMCID: PMC9737852 DOI: 10.3390/jcm11236942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022] Open
Abstract
(Background): Effective prevention strategies and acute therapies have been established and distributed in recent years to reduce the global burden of stroke. However, beyond randomized clinical trials, limited data exist on the real-world impact of these measures. Our goal was to analyze whether the stroke-associated disability in the population decreased over time based on a state-wide stroke registry analysis. (Methods): Consecutive data from a state-wide inpatient stroke registry covering the entire federal state of Hesse, Germany, were obtained. The clinical data of 141,287 patients with ischemic stroke (ICD-10: I63) admitted between 2010 and 2019 were included. The primary outcome was the odds ratio for a change of modified Ranking Scale (mRS) at discharge over time, estimated by ordinary logistic regression and adjusted for age and sex. The secondary outcome was the odds ratio for a lower National Institutes of Health Stroke Scale (NIHSS) score at hospital admission. (Results): The absolute number of severely disabled (mRS 4−5) stroke patients at discharge decreased over time (2010: 3223 (equivalent to 53/100,000 population); 2019: 2429 [39/100,000 population]). The odds at hospital admission for a higher mRS at discharge decreased significantly by 3.7% per year (OR 0.963 (95% CI 0.960−0.966), p < 0.001). The absolute number of severely affected stroke patients (NIHSS > 15) at admission declined over time (2010: 1589 [26/100,000]; 2019: 1185 [19/100,000]; p < 0.001). The odds for a higher NIHSS score at admission to hospital decreased by 3.8% per year (OR 0.962 (95% CI 0.959−0.965), p < 0.001). Trends were most prominent for patients aged 80 years and older and for patients with atrial fibrillation but absent in patients <60 years. (Conclusions): Stroke-associated disability in the population steadily decreased between 2010 and 2019. The improved prevention of severe strokes in elderly patients may be a major driver of this observation.
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Affiliation(s)
- Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany
| | - Martin A. Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg—University Mainz, 55131 Mainz, Germany
- Correspondence:
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany
| | | | - Ferdinand O. Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe-University, 60528 Frankfurt am Main, Germany
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Schaefer JH, Bohmann FO, Lieschke F, Misselwitz B, Foerch C. Divergence and Convergence of Sex-Specific Time Trends in Ischemic Stroke: 10-Year Analysis of a State-Wide Registry in Germany. J Am Heart Assoc 2022; 11:e027130. [PMID: 36250659 DOI: 10.1161/jaha.122.027130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The incidence of ischemic stroke was previously expected to rise among countries with an aging population. Lately, several studies from developed countries have reported a decline in certain cohorts. Whether this applies to all sexes, however, is uncertain, with limited data on the temporal development in incidence, treatment, and recovery. Methods and Results We analyzed a prospective stroke inpatient quality-assurance registry of the federal state of Hesse, Germany. Recruitment of all patients with a final diagnosis of ischemic stroke at hospital discharge (International Classification of Diseases, Tenth Revision [ICD-10]: I63) is mandatory by law. Incidence rates were calculated based on census data of all inhabitants and stratified according to age. Between 2010 and 2019, there were 141 277 patients included, 73 770 (52.2%) male patients and 67 507 (47.8%) female patients. Overall, the incidence of ischemic stroke was 228 per 100 000 in 2010 and 226 per 100 000 in 2019 (-0.8%; odds ratio [OR], 0.99 [95% CI, 0.96-1.02]; P=0.50). For male patients, the incidence increased continuously from 236 per 100 000 to 245 per 100 000 (+3.8%); in female patients it decreased from 220 per 100 000 to 208 per 100 000 (-5.6%). After adjusting for age, the OR for ischemic stroke between male and female patients was 1.40 in 2010 (95% CI, 1.35-1.44; P<0.001) and 1.48 in 2019 (95% CI, 1.43-1.53; P<0.001). This development was most pronounced in male patients aged 45 to 59 years with an increase from 151 per 100 000 to 176 per 100 000. In this age group, male patients showed increasing rates of prior strokes and atrial fibrillation, surpassing the prevalence in female patients over time. After multivariable regression analysis, male patients had a lower modified Rankin Scale at discharge compared with female patients, but this difference has decreased since 2015 (common OR in 2010, 0.83 [95% CI, 0.78-0.88]; common OR in 2019, 0.90 [95% CI, 0.84-0.95]), which coincided with rising rates of endovascular treatment. Conclusions Over the past decade in the federal state of Hesse, the overall incidence of ischemic stroke has declined predominantly in the female population. In contrast, for male patients, the incidence has risen by about 4%, with a steeper increase of 16% in male patients aged 45 to 59 years, which might be related to increasing rates of recurrent strokes and atrial fibrillation in this cohort. This finding provides a cautionary tale for effective secondary prevention. Female patients were generally less likely to achieve a favorable outcome, but since the introduction of endovascular treatment, the outcome gap is decreasing.
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Affiliation(s)
- Jan Hendrik Schaefer
- Department of Neurology University Clinic Frankfurt, Goethe University Frankfurt am Main Germany
| | - Ferdinand O Bohmann
- Department of Neurology University Clinic Frankfurt, Goethe University Frankfurt am Main Germany
| | - Franziska Lieschke
- Department of Neurology University Clinic Frankfurt, Goethe University Frankfurt am Main Germany
| | - Björn Misselwitz
- Federal State Consortium of Quality Assurance Hesse Eschborn Germany
| | - Christian Foerch
- Department of Neurology University Clinic Frankfurt, Goethe University Frankfurt am Main Germany
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Geraedts M, Ebbeler D, Timmesfeld N, Kaps M, Berger K, Misselwitz B, Günster C, Dröge P, Schneider M. Long-term outcomes of stroke unit care in older stroke patients: a retrospective cohort study. Age Ageing 2022; 51:6691374. [PMID: 36057988 DOI: 10.1093/ageing/afac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND older patients are less frequently treated in stroke units (SUs). Clinicians do not seem convinced that older patients benefit from specialised treatment in SU similarly to younger patients. OBJECTIVE our study aimed to compare older patients' long-term outcomes with and without SU treatment. METHODS this study used routinely collected health data of 232,447 patients admitted to hospitals in Germany between 2007 and 2017 who were diagnosed with ischaemic stroke (ICD 10 I63). The sample included 29,885 patients aged ≥90 years. The outcomes analysed were 10-, 30- and 90-day, and 1-, 3- and 5-year mortality and the combinations of death or recurrence, inpatient treatment and increase in long-term care needs. Bivariate chi-square tests and multivariable logistic regression analyses were used, adjusting for the covariates age, sex, co-morbidity, long-term care needs before stroke and socioeconomic status of the patients' region of origin. RESULTS between 2007 and 2017, 57.1% of patients aged <90 years and 49.6% of those aged ≥90 years were treated in a SU. The 1-year mortality rate of ≥90-year-olds was 56.9 and 61.9% with and without SU treatment, respectively. The multivariable-adjusted risk of death in ≥90-year-olds with SU treatment was odds ratio (OR) = 0.67 (95% confidence interval [CI] = 0.62-0.73) 10 days after the initial event and OR = 0.76 (95% CI = 0.71-0.82) 3 years after stroke. CONCLUSIONS even very old patients with stroke benefit from SU treatment in the short and long term. Therefore, SU treatment should be the norm even in older patients.
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Affiliation(s)
- Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
| | - Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ruhr-University Bochum, 44780 Bochum, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital of Giessen/Marburg, Justus-Liebig-University of Giessen, 35392 Giessen, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Westphalian-Wilhelms-University of Muenster, 48149 Münster, Germany
| | | | - Christian Günster
- WIdO - AOK Research Institute, AOK Federal Association, 10178 Berlin, Germany
| | - Patrik Dröge
- WIdO - AOK Research Institute, AOK Federal Association, 10178 Berlin, Germany
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitaet Marburg, 35043 Marburg, Germany
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Schaller-Paule MA, Foerch C, Bohmann FO, Lapa S, Misselwitz B, Kohlhase K, Rosenow F, Strzelczyk A, Willems LM. Predicting Poststroke Pneumonia in Patients With Anterior Large Vessel Occlusion: A Prospective, Population-Based Stroke Registry Analysis. Front Neurol 2022; 13:824450. [PMID: 35250827 PMCID: PMC8893016 DOI: 10.3389/fneur.2022.824450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To assess predictive factors for poststroke pneumonia (PSP) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) of the anterior circulation, with special regard to the impact of intravenous thrombolysis (IVT) and endovascular treatment (EVT) on the risk of PSP. As a secondary goal, the validity of the A2DS2, PNEUMONIA, and ISAN scores in LVO will be determined. Methods Analysis was based on consecutive data for the years 2017 to 2019 from the prospective inpatient stroke registry covering the entire federal state of Hesse, Germany, using the Kruskal-Wallis test and binary logistic regression. Results Data from 4,281 patients with LVO were included in the analysis (54.8% female, median age = 78 years, range = 18–102), of whom 66.4% (n = 2,843) received recanalization therapy (RCT). In total, 19.4% (n = 832) of all LVO patients developed PSP. Development of PSP was associated with an increase in overall in-hospital mortality of 32.1% compared with LVO patients without PSP (16.4%; p < 0.001). Incidence of PSP was increased in 2132 patients with either EVT (n = 928; 25.9% PSP incidence) or combined EVT plus IVT (n = 1,204; 24.1%), compared with 2,149 patients with IVT alone (n = 711; 15.2%) or conservative treatment only (n = 1,438; 13.5%; p < 0.001). Multivariate analysis identified EVT (OR 1.5) and combined EVT plus IVT (OR 1.5) as significant independent risk factors for PSP. Furthermore, male sex (OR 1.9), age ≥ 65 years (OR 1.7), dysphagia (OR 3.2) as well as impaired consciousness at arrival (OR 1.7) and the comorbidities diabetes (OR 1.4) and atrial fibrillation (OR 1.3) were significantly associated risk factors (each p < 0.001). Minor stroke (NIHSS ≤ 4) was associated with a significant lower risk of PSP (OR 0.5). Performance of risk stratification scores varied between A2DS2 (96.1% sensitivity, 20.7% specificity), PNEUMONIA (78.2% sensitivity and 45.1% specificity) and ISAN score (98.0% sensitivity, 20.0% specificity). Conclusion Nearly one in five stroke patients with LVO develops PSP during acute care. This risk of PSP is further increased if an EVT is performed. Other predictive factors are consistent with those previously described for all AIS patients. Available risk stratification scores proved to be sensitive tools in LVO patients but lack specificity.
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Affiliation(s)
- Martin A. Schaller-Paule
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- *Correspondence: Martin A. Schaller-Paule
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Ferdinand O. Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | | | - Konstantin Kohlhase
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Laurent M. Willems
- Department of Neurology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
- Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
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9
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Schaefer J, Bohmann FO, Misselwitz B, Foerch C. Abstract 60: Diverging Time Trends Of Gender-specific Ischemic Stroke Incidence - 10-year-analysis Of A State-wide Registry In Germany. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The incidence of ischemic stroke (IS) was previously expected to rise among countries with an ageing population. Lately, several studies from developed countries have reported a decline in certain cohorts. Whether this applies to all genders, however, is uncertain along with limited data on the temporal development in incidence, treatment, and recovery.
Methods:
We analyzed a prospective stroke inpatient quality assurance registry of the federal state of Hesse, Germany. Recruitment of all patients with a final diagnosis of ischemic stroke at hospital discharge (ICD10: I63) is mandatory by law. Stroke incidence rates were calculated based on census data of all inhabitants and stratified according to age.
Results:
Between 2010 and 2019 141,277 patients were included, 73,770 (52.2%) male and 67.507 (47.8%) female. Overall, the incidence of IS was 228/100,000 in 2010 and 226/100,000 in 2019 (OR 0.99; 95%-CI 0.96 to 1.02; p=0.50). For men, the incidence increased continuously from 236/100,000 to 245/100,000, in women it decreased from 220/100,000 to 208/100,000. After adjusting for age, the odds ratio for IS between men and women was 1.40 in 2010 (95%-CI 1.35 to 1.44; p<0.01) and 1.48 in 2019 (95%-CI 1.43 to 1.53; p<0.01). This trend was most pronounced in men aged 45 to 59 years with an increase from 151/100,000 to 176/100,000. In this age group, men had higher rates of prior strokes (16.3% vs. 14.3%; p<0.01), arterial hypertension (67.3% vs. 61.2%; p<0.01) and diabetes (20.6% vs. 17.9%; p<0.01) than women. Atrial fibrillation was more common in women (30.8% vs. 22.6%; p<0.01). The modified Rankin Scale (mRS) on hospital discharge has generally improved from 2010 to 2019 (median 2 vs. 2; Mann-Whitney-U-test p<0.01) with a more favorable outcome in men (mRS 0-2: OR 1.29; 95%-CI 1.26 to 1.32; p<0.01).
Discussion:
Over the last decade, the overall incidence of IS has declined predominantly in the female population. Contrarily, for men the incidence has risen by about 4% with a steeper increase of 17% in males aged 45-59 years. This finding could be explained by higher rates of prior strokes, arterial hypertension and diabetes in men compared to women. Notably, the high rate of recurrent strokes in men provides a cautionary tale for effective secondary prevention.
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Affiliation(s)
- Jan Schaefer
- Dept of Neurology, Goethe Univ, Frankfurt, Germany
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Abstract
The detection of metastasis in lymph nodes is greatly enhanced by the use of contrast media. Interstitial injection of lymphography contrast agents requires only injection of a low dose of the agent, and leads to high accumulation in regional lymph nodes with only minor side effects. We were able to show the suitability of liposome-encapsulated gadobutrol as an interstitially injectable lymphography contrast agent in an experimental animal model. For screening of possible lymphotrophic compounds a guinea pig model was used. Accumulation of the contrast agent in 3 successive lymph node groups was determined 4 h after subcutaneous injection of the contrast agent (about 0.1 ml of a 30 mmol Gd/1 solution resulting in a total dose of 10 μmol/kg) into the interdigital skin fold of a hind limb. The Gd concentration in the first lymph node group (popliteal) was 540 μmol/1 (16% dose/g tissue), in the second group (inguinal): 260 μmol/1 (8% dose/g tissue), and in the third group (iliacal): 910 μmol/1 (27% dose/g tissue). Moreover, this compound was completely eliminated and well tolerated.
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Affiliation(s)
- B. Misselwitz
- Research Laboratories of Schering AG, Berlin, Germany
| | - A. Sachse
- Research Laboratories of Schering AG, Berlin, Germany
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11
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Ebbeler D, Schneider M, Busse O, Berger K, Dröge P, Günster C, Kaps M, Misselwitz B, Timmesfeld N, Geraedts M. Spezialisierung der Schlaganfallversorgung in Deutschland:
Strukturveränderungen im Zeitraum von 2006–2017. Gesundheitswesen 2021; 85:242-249. [PMID: 34942663 DOI: 10.1055/a-1690-6786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Zusammenfassung
Hintergrund Um die Schlaganfallversorgung zu optimieren, wurden in
Deutschland in den letzten Jahren verschiedene
qualitätsfördernde Maßnahmen (qfM) in regional
unterschiedlichem Maß eingeführt. Ob sich diese
Maßnahmen über die Jahre flächendeckend etabliert
haben, ist unklar.
Methode Für die strukturbezogenen Analysen der Schlaganfallversorgung
in Deutschland wurden alle relevanten dokumentierten Schlaganfälle
(ICD-10) aus den Qualitätsberichten (QB) deutscher
Krankenhäuser und eine repräsentative Stichprobe von
Krankenversicherungsdaten (AOK) im Zeitraum von 2006 (QB)/2007 (AOK)
bis 2017 verwendet. Diese Informationen wurden u. a. durch Angaben
zu zertifizierten Stroke Units der Deutschen Schlaganfall-Gesellschaft (DSG)
und Daten zur Führung von regionalen Schlaganfall-Registern der
Arbeitsgemeinschaft Deutschsprachiger Schlaganfall-Register (ADSR)
ergänzt. Zur Verfolgung der Veränderungen des
Versor-gungsgeschehens im deutschen Bundesgebiet wurden die Daten mit
geografischen Daten (Bundesamt für Kartographie und
Geodäsie) verknüpft. Es erfolgten univariate Analysen der
Daten und eine Trend-Analyse der verschiedenen qfM im Jahresverlauf
(Konkordanzkoeffizient nach Kendall).
Ergebnisse Die QB Analysen zeigten einen Anstieg kodierter
Schlaganfälle in Krankenhäusern mit qfM um
14–20%. In 2006 wurden 80% der Schlaganfälle
(QB) in einem Krankenhaus mit min. einer qfM kodiert, in 2017 95%.
Diese Entwicklungen spiegelten sich auch in den AOK-Routinedaten wider,
wobei in 2007 89% und in 2017 97% der Patient:innen unter
mindestens einer qfM behandelt wurden. Dabei waren in 2007 bei 55%
der behandelnden Krankenhäuser qfM vorhanden, in 2017 bei
72%.
Schlussfolgerung Patient:innen werden inzwischen signifikant häufiger
in Krankenhäusern mit Spezialisierung auf die Schlaganfallversorgung
behandelt. Auch die verschiedenen qfM haben sich im Laufe der Jahre im
gesamten Bundesgebet verbreitet, jedoch existieren noch
Versorgungslücken, die geschlossen werden sollten, damit in Zukunft
alle Patient:innen qualitativ hochwertig behandelt werden
können.
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Affiliation(s)
- Dijana Ebbeler
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
| | - Michael Schneider
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
| | - Otto Busse
- Deutsche Schlaganfall-Gesellschaft e.V., Berlin,
Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin,
Westfälische Wilhelms- Universität Münster, Medizinische
Fakultät, Münster, Deutschland
| | - Patrik Dröge
- Wissenschaftliches Institut der AOK (WIdO), AOK-Bundesverband, Berlin,
Deutschland
| | - Christian Günster
- Wissenschaftliches Institut der AOK (WIdO), AOK-Bundesverband, Berlin,
Deutschland
| | - Manfred Kaps
- Neurologische Klinik, Universitätsklinikum
Gießen/Marburg, Justus-Liebig-Universität
Gießen, Gießen, Deutschland
| | - Björn Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH),
Hessische Krankenhausgesellschaft e. V. Eschborn,
Deutschland
| | - Nina Timmesfeld
- Abteilung für Medizinische Informatik, Biometrie und
Epidemiologie, Ruhr-Universität Bochum, Medizinische Fakultät,
Bochum, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie,
Philipps-Universität Marburg, Fachbereich Medizin, Marburg,
Deutschland
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Geraedts M, Ebbeler D, Timmesfeld N, Kaps M, Berger K, Misselwitz B, Günster C, Dröge P, Schneider M. Quality Assurance Measures and Mortality After Stroke. Dtsch Arztebl Int 2021; 118:857-863. [PMID: 34730084 PMCID: PMC8948340 DOI: 10.3238/arztebl.m2021.0339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality assurance for acute in-hospital care in Germany is based on compulsory comparisons between institutions, so-called external quality assurance (EQA). The effectiveness of EQA has not yet been adequately studied. The purpose of the QUASCH project, which is supported by the Innovation Fund of the Federal Joint Committee, is to investigate the association between EQA and health care outcomes, specifically with respect to stroke. METHODS The analyses were based on data from 379 825 patients insured by the AOK health insurance fund who were acutely admitted to a hospital because of stroke over the period 2007-2017. Data on 47 659 patients were derived from EQA documentation in the state of Hesse, in which stroke EQA had already been introduced in 2003; data on the remaining 332 166 patients were from other federal states, where 117 734 of these patients had been treated under EQA conditions. The association of EQA with mortality over the period of observation was analyzed by multivariate Cox regression, with the following covariates: age, sex, comorbidities, time period of occurrence, nursing care level, type of stroke, socio-economic deprivation in the region of origin, and treatment in a stroke unit. RESULTS Compared to treatment without EQA, mortality risk under EQA in the state of Hesse was significantly lower (hazard ratio [HR]: 0.93; 95% confidence interval: [0.92; 0.95]). The reduction in mortality risk with EQA was somewhat lower in the other federal states (HR: 0.96 [0.95; 0.97]). Treatment in a stroke unit was associated with a mortality risk that was lower still (HR: 0.86 [0.85; 0.87]). Mortality risk rose with age, comorbidities, and need for nursing care; it was lower in women and in persons whose stroke occurred in a later period. CONCLUSION Quality assurance measures are associated with lower mortality risk after stroke. The concentration of care in specially qualified institutions is associated with stronger effects than EQA alone.
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Affiliation(s)
- Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
| | - Dijana Ebbeler
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, Ruhr University Bochum
| | - Manfred Kaps
- Department of Neurology, University Hospital of Giessen/Marburg, Justus Liebig University of Giessen
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Medical Faculty, Westphalian Wilhelms University of Münster
| | | | - Christian Günster
- Research Institute of the AOK [German public health insurance company], AOK Federal Association
| | - Patrik Dröge
- Research Institute of the AOK [German public health insurance company], AOK Federal Association
| | - Michael Schneider
- Institute for Health Services Research and Clinical Epidemiology, Department of Medicine, Philipps University of Marburg
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13
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Richter D, Eyding J, Weber R, Bartig D, Misselwitz B, Grau A, Krogias C. The level of urbanization influences acute ischemic stroke care: A nationwide ecological study from Germany. J Neurol Sci 2021; 430:119983. [PMID: 34534884 DOI: 10.1016/j.jns.2021.119983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Regional differences in acute ischemic stroke (AIS) care are still reported for Germany but not fully understood. We aimed to analyze the impact of the level of urbanization on the application of proved treatment procedures and the incidence of hospitalized AIS cases in Germany. METHODS The level of urbanization of the 401 districts and district-free cities in Germany was defined according to the Federal Institute for Building, Urban Affairs and Spatial Research classification. Using nationwide administrative data, the application of intravenous thrombolysis (IVT), mechanical thrombectomy (MT), and the incidence of hospitalizations for AIS, were analyzed according to the place of residence of the patients. Data included all patients hospitalized for AIS in 2019 (n = 224,274) and sociodemographic information of 83,019,213 residents in Germany. RESULTS Sparsely populated districts had a significantly higher incidence of hospitalizations for AIS than cities (age-standardized: 271.8 versus 242.3 per 100,000 inhabitants, P < 0.001), but a lower use of MT (5.7% versus 8.4%, P < 0.001). In the adjusted negative binomial regression model, rurality remained an independent predictor for MT use and the incidence of AIS hospitalizations. The proportion of IVT did not significantly differ between sparsely populated districts and cities (15.6% versus 17.2%, P = 0.021). CONCLUSIONS Although there is a dense network of stroke units in Germany, the level of urbanization still influences AIS care, as we found a lower proportion of MT and a higher incidence of AIS hospitalizations in Germany's rural areas.
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Affiliation(s)
- Daniel Richter
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Germany
| | - Jens Eyding
- Medical Faculty, Ruhr University Bochum, Germany; Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Germany
| | - Ralph Weber
- Medical Faculty, Ruhr University Bochum, Germany; Department of Neurology, Alfried Krupp Krankenhaus Essen, Germany
| | - Dirk Bartig
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Germany
| | | | - Armin Grau
- Department of Neurology, Klinikum der Stadt Ludwigshafen a.Rh., Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Germany; Medical Faculty, Ruhr University Bochum, Germany.
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14
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Louwen F, Wagner U, Abou-Dakn M, Dötsch J, Lawrenz B, Ehm D, Surbek D, Essig A, Greening M, Schäfers R, Mattern E, Waterstradt IC, Kästner R, Lütje W, Kranke P, Messroghli L, Wenk M, Kehl S, Schlößer R, Lüdemann K, Maier B, Misselwitz B, Heller G, Bosch A, Nielsen R, Rothe C, Sirsch E, Kalberer BS, Vogel T, von Kaisenberg C, Nothacker M, Hülsewiesche B, Allert R, Jennewein L. Caesarean Section. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/084, June 2020). Geburtshilfe Frauenheilkd 2021; 81:896-921. [PMID: 34393255 DOI: 10.1055/a-1529-6141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022] Open
Abstract
Purpose This is an official S3-guideline of the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (ÖGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline contains evidence-based information and recommendations on indications, complications, methods and care associated with delivery by caesarean section for all medical specialties involved as well as for pregnant women. Methods This guideline has adapted information and recommendations issued in the NICE Caesarean Birth guideline. This guideline also considers additional issues prioritised by the Cochrane Institute and the Institute for Research in Operative Medicine (IFOM). The evaluation of evidence was based on the system developed by the Scottish Intercollegiate Guidelines Network (SIGN). A multi-part nominal group process moderated by the AWMF was used to compile this S3-level guideline. Recommendations Recommendations on consultations, indications and the process of performing a caesarean section as well as the care provided to the mother and neonate were drawn up.
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Affiliation(s)
- Frank Louwen
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Uwe Wagner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Gießen und Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | - Jörg Dötsch
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Köln, Köln, Germany
| | | | - David Ehm
- Praxis für Geburtshilfe und Gynäkologie, Bern, Switzerland
| | - Daniel Surbek
- Frauenklinik, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Andreas Essig
- Institut für Medizinische Mikrobiologie & Hygiene, Universitätsklinikum Ulm, Ulm, Germany
| | - Monika Greening
- Fachbereich Gesundheit und Pflege, Katholische Hochschule Mainz, Mainz, Germany
| | - Rainhild Schäfers
- Hebammenwissenschaft, Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum, Germany
| | - Elke Mattern
- Hebammenwissenschaft, Department für Angewandte Gesundheitswissenschaften, Hochschule für Gesundheit, Bochum, Germany
| | - Ina C Waterstradt
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Ralph Kästner
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum München, Ludwig-Maximilians-Universität München, München, Germany
| | - Wolf Lütje
- Klinik für Gynäkologie und Geburtshilfe, Evangelisches Amalie Sieveking Krankenhaus, Hamburg, Germany
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Leila Messroghli
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Manuel Wenk
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie am Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Rolf Schlößer
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | | | - Barbara Maier
- Gynäkologisch-geburtshilfliche Abteilung, Klinik Ottakring, ehem. Wilhelminenspital, Wien, Austria
| | | | - Günther Heller
- aQua - Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Göttingen, Germany
| | | | | | | | - Erika Sirsch
- Lehrstuhl für Akutpflege, Philosophisch-Theologische Hochschule Vallendar, Vallendar, Germany
| | | | - Thea Vogel
- Frauengesundheitszentrum e. V., Frankfurt a. M., Germany
| | - Constantin von Kaisenberg
- Pränatalmedizin und Geburtshilfe im Perinatalzentrum, Medizinische Hochschule Hannover, Hannover, Germany
| | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Berlin, Germany
| | - Barbara Hülsewiesche
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Roman Allert
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
| | - Lukas Jennewein
- Geburtshilfe und Pränatalmedizin, Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany
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15
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Boss EG, Bohmann FO, Misselwitz B, Kaps M, Neumann-Haefelin T, Pfeilschifter W, Kurka N. Quality assurance data for regional drip-and-ship strategies- gearing up the transfer process. Neurol Res Pract 2021; 3:38. [PMID: 34334134 PMCID: PMC8327429 DOI: 10.1186/s42466-021-00136-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke patients with large vessel occlusion (LVO) require endovascular therapy (EVT) provided by comprehensive stroke centers (CSC). One strategy to achieve fast stroke symptom 'onset to treatment' times (OTT) is the preclinical selection of patients with severe stroke for direct transport to CSC. Another is the optimization of interhospital transfer workflow. Our aim was to investigate the dynamics of the OTT of 'drip-and-ship' patients as well as the current 'door-in-door-out' time (DIDO) and its determinants at representative regional German stroke units. METHODS We determined the numbers of all EVT treatments, 'drip-and-ship' and 'direct-to-center' patients and their median OTT from the mandatory quality assurance registry of the federal state of Hesse, Germany (2012-2019). Additionally, we captured process time stamps from primary stroke centers (PSC) in a consecutive registry of patients referred for EVT in our regional stroke network over a 3 months period. RESULTS Along with an increase of the EVT rate, the proportion of drip-and-ship patients grew steadily from 19.4% in 2012 to 31.3% in 2019. The time discrepancy for the median OTT between 'drip-and-ship' and 'direct-to-center' patients continuously declined from 173 to 74 min. The largest share of the DIDO (median 92, IQR 69-110) is spent with the organization of EVT and consecutive patient transfer. CONCLUSIONS 'Drip-and-ship' patients are an important and growing proportion of stroke patients undergoing EVT. The discrepancy in OTT for EVT between 'drip-and-ship' and 'direct-to-center' patients has been reduced considerably. Further optimization of the DIDO primarily aiming at the processes after the detection of LVO is urgently needed to improve stroke patient care.
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Affiliation(s)
- Erendira G Boss
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany.
| | | | | | - Manfred Kaps
- Department of Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | | | - Natalia Kurka
- Department of Neurology, University Hospital Frankfurt, Frankfurt, Germany
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16
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Gruber K, Misselwitz B, Steinmetz H, Pfeilschifter W, Bohmann FO. Evaluation of Endovascular Treatment for Acute Basilar Occlusion in a State-Wide Prospective Stroke Registry. Front Neurol 2021; 12:678505. [PMID: 34177783 PMCID: PMC8226113 DOI: 10.3389/fneur.2021.678505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Context: Despite overwhelming evidence for endovascular therapy in anterior circulation ischemic stroke due to large-vessel occlusion, data regarding the treatment of acute basilar artery occlusion (BAO) are still equivocal. The BASICS trial failed to show an advantage of endovascular therapy (EVT) over best medical treatment (BMT). In contrast, data from the recently published BASILAR registry showed a better outcome in patients receiving EVT. Objective: The aim of the study was to investigate the safety and efficacy of EVT plus BMT vs. BMT alone in acute BAO. Methods: We analyzed the clinical course and short-term outcomes of patients with radiologically confirmed BAO dichotomized by BMT plus EVT or BMT only as documented in a state-wide prospective registry of consecutive patients hospitalized due to acute stroke. The primary endpoint was a favorable functional outcome (mRS 0-3) at hospital discharge assessed as common odds ratio using binary logistic regression. Secondary subgroup analyses and propensity score matching were added. Safety outcomes included mortality, the rate of intracerebral hemorrhages, and complications during hospitalization. Results: We included 403 patients with acute BAO (2017-2019). A total of 270 patients (67%) were treated with BMT plus EVT and 133 patients (33%) were treated with BMT only. A favorable outcome (mRS 0-3) was observed in 33.8% of the BMT and 26.7% of the BMT plus EVT group [OR.770, CI (0.50-1.2)]. Subgroup analyses for patients with a NIHSS score > 10 at admission to the hospital revealed a benefit from EVT [OR 3.05, CI (1.03-9.01)]. Conclusions: In this prospective, quasi population-based registry of patients hospitalized with acute BAO, BMT plus EVT was not superior to BMT alone. Nevertheless, our results suggest that severely affected BAO patients are more likely to benefit from EVT.
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Affiliation(s)
- Katharina Gruber
- Department of Neurology, University Hospital/ Goethe University Frankfurt, Frankfurt, Germany
| | | | - Helmuth Steinmetz
- Department of Neurology, University Hospital/ Goethe University Frankfurt, Frankfurt, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital/ Goethe University Frankfurt, Frankfurt, Germany
| | - Ferdinand O Bohmann
- Department of Neurology, University Hospital/ Goethe University Frankfurt, Frankfurt, Germany
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17
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Richter D, Weber R, Eyding J, Bartig D, Misselwitz B, Grau A, Hacke W, Krogias C. Acute ischemic stroke care in Germany - further progress from 2016 to 2019. Neurol Res Pract 2021; 3:14. [PMID: 33789773 PMCID: PMC8012074 DOI: 10.1186/s42466-021-00115-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022] Open
Abstract
Background Stroke Unit Care (SUC), intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are evidence-based treatment options for acute ischemic stroke (AIS). Using nationwide comprehensive administrative data from Germany, we recently reported nationwide development of AIS admissions, SUC rates, IVT rates and MT rates in Germany between 2010 and 2016. In this update paper, we analyze data on the further development of these data to 2019 after publication of time window extensions for recanalization therapies. Methods We considered all hospitalized cases with the main diagnosis of the ICD-10-GM code I63 (AIS) for the year 2019. We identified stroke therapies by using the corresponding Operating and Procedure Keys for IVT, MT and SUC out of the DRG statistics. Regional analyses are based on data from the 412 German administrative districts and cities. We compared the results with those from 2016. Results Number of hospitalized AIS patients showed a mild decrease in 2019 (n = 225,531) compared with 2016 (n = 227,687), with significant more AIS patients treated on a stroke unit in 2019 (n = 167,799; 74.4% vs. n = 164,270; 72.1%, p < 0.001). The rate of IVT further increased from 14.9% (n = 33,916) in 2016 to 16.3% (n = 36,745) in 2019 (p < 0.001). Similarly, the MT rate increased from 4.3% (n = 9795) in 2016 to 7.2% (n = 16,135) in 2019 (p < 0.001). There was still a high regional variability for MT (1.4 to 15.2%) according to the place of residence of the AIS patients. Conclusions In Germany, the rates of recanalization therapies in patients with AIS continued to increase from 2016 to 2019. Compared to IVT-rates and numbers, the respective data for MT procedures showed an even more pronounced increase.
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Affiliation(s)
- Daniel Richter
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Ralph Weber
- Medical Faculty, Ruhr University of Bochum, Bochum, Germany.,Department of Neurology, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Jens Eyding
- Medical Faculty, Ruhr University of Bochum, Bochum, Germany.,Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Dirk Bartig
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | | | - Armin Grau
- Department of Neurology, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany. .,Medical Faculty, Ruhr University of Bochum, Bochum, Germany.
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18
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Zöllner JP, Misselwitz B, Mauroschat T, Roth C, Steinmetz H, Rosenow F, Strzelczyk A. Intravenous thrombolysis or mechanical thrombectomy do not increase risk of acute symptomatic seizures in patients with ischemic stroke. Sci Rep 2020; 10:21083. [PMID: 33273538 PMCID: PMC7713428 DOI: 10.1038/s41598-020-78012-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022] Open
Abstract
Recent data have suggested that performing recanalizing therapies in ischemic stroke might lead to an increased risk of acute symptomatic seizures. This applies to both intravenous thrombolysis and mechanical thrombectomy. We therefore determined the frequency of acute symptomatic seizures attributable to these two recanalization therapies using a large, population-based stroke registry in Central Europe. We performed two matched 1:1 case–control analyses. In both analyses, patients were matched for age, stroke severity on admission and pre-stroke functional status. The first analysis compared patients treated with intravenous thrombolysis to a non-recanalization control group. To isolate the effect of mechanical thrombectomy, we compared patients with both mechanical thrombectomy and intravenous thrombolysis to those with only intravenous thrombolysis treatment in a second analysis. From 135,117 patients in the database, 13,356 patients treated with only intravenous thrombolysis, and 1013 patients treated with both intravenous thrombolysis and mechanical thrombectomy were each matched to an equivalent number of controls. Patients with intravenous thrombolysis did not suffer from clinically apparent acute symptomatic seizures significantly more often than non-recanalized patients (treatment = 199; 1.5% vs. control = 237; 1.8%, p = 0.07). Mechanical thrombectomy in addition to intravenous thrombolysis also was not associated with an increased risk of acute symptomatic seizures, as the same number of patients suffered from seizures in the treatment and control group (both n = 17; 1.7%, p = 1). In a large population-based stroke registry, the frequency of clinically apparent acute symptomatic seizures was not increased in patients who received either intravenous thrombolysis alone or in conjunction with mechanical thrombectomy.
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Affiliation(s)
- Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. .,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Björn Misselwitz
- Quality Assurance Office Hessen (GQH, Geschäftsstelle Qualitätssicherung Hessen), Eschborn, Germany
| | - Thomas Mauroschat
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Christian Roth
- Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany.,Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.,Department of Neurology and Epilepsy Center Hessen, Philipps-University Marburg, Marburg (Lahn), Germany
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19
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Haas K, Rücker V, Hermanek P, Misselwitz B, Berger K, Seidel G, Janssen A, Rode S, Burmeister C, Matthis C, Koennecke HC, Heuschmann PU. Association Between Adherence to Quality Indicators and 7-Day In-Hospital Mortality After Acute Ischemic Stroke. Stroke 2020; 51:3664-3672. [DOI: 10.1161/strokeaha.120.029968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background and Purpose:
Quality indicators (QI) are an accepted tool to measure performance of hospitals in routine care. We investigated the association between quality of acute stroke care defined by overall adherence to evidence-based QI and early outcome in German acute care hospitals.
Methods:
Patients with ischemic stroke admitted to one of the hospitals cooperating within the ADSR (German Stroke Register Study Group) were analyzed. The ADSR is a voluntary network of 9 regional stroke registers monitoring quality of acute stroke care across 736 hospitals in Germany. Quality of stroke care was defined by adherence to 11 evidence-based indicators of early processes of stroke care. The correlation between overall adherence to QI with outcome was investigated by assessing the association between 7-day in-hospital mortality with the proportion of QI fulfilled from the total number of QI the individual patient was eligible for. Generalized linear mixed model analysis was performed adjusted for the variables age, sex, National Institutes of Health Stroke Scale and living will and as random effect for the variable hospital.
Results:
Between 2015 and 2016, 388 012 patients with ischemic stroke were reported (median age 76 years, 52.4% male). Adherence to distinct QI ranged between 41.0% (thrombolysis in eligible patients) and 95.2% (early physiotherapy). Seven-day in-hospital mortality was 3.4%. The overall proportion of QI fulfilled was median 90% (interquartile range, 75%–100%). In multivariable analysis, a linear association between overall adherence to QI and 7-day in-hospital-mortality was observed (odds ratio adherence <50% versus 100%, 12.7 [95% CI, 11.8–13.7];
P
<0.001).
Conclusions:
Higher quality of care measured by adherence to a set of evidence-based process QI for the early phase of stroke treatment was associated with lower in-hospital mortality.
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Affiliation(s)
- Kirsten Haas
- Institute of Clinical Epidemiology and Biometry, University of Würzburg (K.H., V.R., P.U.H.)
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg (K.H., V.R., P.U.H.)
| | - Peter Hermanek
- Bavarian Permanent Working Party for Quality Assurance (BAQ), Munich (P.H.)
| | | | - Klaus Berger
- Quality Assurance Project ”Stroke Register Northwest Germany”, Institute of Epidemiology and Social Medicine, University of Münster (K.B.)
| | - Günter Seidel
- Department of Neurology, Asklepios Klinik Nord, Hamburg (G.S.)
| | - Alfred Janssen
- Quality Assurance in Stroke Management in North Rhine–Westphalia, Medical Association North Rhine (A.J.)
| | - Susanne Rode
- Office for Quality Assurance in Health Care Baden-Württemberg GmbH (QiG BW GmbH), Stuttgart (S.R.)
| | | | - Christine Matthis
- Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS), Institute of Social Medicine and Epidemiology, University of Lübeck (C.M.)
| | | | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg (K.H., V.R., P.U.H.)
- Clinical Trial Center, University Hospital Würzburg (P.U.H.)
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20
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Misselwitz B, Grau A, Berger K, Bruder I, Burmeister C, Hermanek P, Hohnhold R, Koennecke HC, Matthis C, Heuschmann PU. [Quality of care of acute ischemic stroke in Germany 2018]. Nervenarzt 2020; 91:484-492. [PMID: 32350547 DOI: 10.1007/s00115-020-00908-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In this overview the current quality of acute in-hospital care of stroke patients in Germany in 2018 is described based on standardized and evidence-based quality indicators. For this purpose the reports of the regional quality assurance projects for stroke care, which collaborated within the German-speaking Stroke Registers Study Group (ADSR) were analyzed. Overall, more than 280,000 acute admissions of stroke patients were documented in the included quality assurance projects. The results regarding the defined 16 quality indicators comprising diagnostics, acute treatment, rehabilitation and secondary prevention showed a high level of acute inpatient treatment of stroke in Germany. Only a few quality indicators, such as early transfer for thrombectomy indicated a great necessity for process optimization.
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Affiliation(s)
- B Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Frankfurter Str. 10-14, 65760, Eschborn, Deutschland.
| | - A Grau
- Neurologische Klinik mit Klinischer Neurophysiologie, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - K Berger
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Deutschland
| | - I Bruder
- Qualitätssicherung im Gesundheitswesen Baden-Württemberg GmbH (QiG), Stuttgart, Deutschland
| | | | - P Hermanek
- Bayerische Arbeitsgemeinschaft für Qualitätssicherung in der stationären Versorgung (BAQ), München, Deutschland
| | - R Hohnhold
- Externe Qualitätssicherung (EQS), Hamburg, Deutschland
| | - H C Koennecke
- Klinik für Neurologie - Stroke Unit, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - C Matthis
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - P U Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland
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21
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Schmidt S, Misselwitz B, Schuster R, Schrod L. [Critical Outcome and Hypoxic Ischemic Encephalopathy - A quality Assurance Issue]. Z Geburtshilfe Neonatol 2020; 224:360-366. [PMID: 33027822 DOI: 10.1055/a-1258-4639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study evaluates the predictive value of the critical status of a newborn as to the risk of developing hypoxic ischemic encephalopathy (HIE). METHODS On the basis of the data set from the perinatal survey in Hesse, Germany, in the year 2016, including 52,122 live births (singleton, 37+0 GA), cases of critical newborns were identified. A conjoined analysis with the data set of the neonatal survey from the identical period provided the basis to evaluate the relationship to cases compromised by HIE. RESULTS The incidence of cases with a critical outcome (n=11) and those with HIE (n=29) was low. The sensitivity of the status of the newborn for detecting a risk of HIE was 10.34%. The specificity was 99.98%. The positive predictive value was 27.35%. The negative predictive value was 99.95%. The detailed, confidential single-case analysis indicated the ability to avoid negative outcomes in about one third of cases with a critical status of the newborn (4/11) and HIE (9/29). DISCUSSION AND CONCLUSION The likelihood of developing encephalopathy (HIE) increases after a critical outcome after birth. Intensified monitoring of these newborns is justified. A single-case analysis identifies the potential ways to improve perinatal outcomes. Measures of external quality assurance should integrate the analysis of both perinatal and neonatal surveys as a basis for quality management (QM).
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Affiliation(s)
| | | | | | - Lothar Schrod
- Klinik für Kinder- und Jugendmedizin, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main
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22
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Seijmonsbergen-Schermers AE, van den Akker T, Rydahl E, Beeckman K, Bogaerts A, Binfa L, Frith L, Gross MM, Misselwitz B, Hálfdánsdóttir B, Daly D, Corcoran P, Calleja-Agius J, Calleja N, Gatt M, Vika Nilsen AB, Declercq E, Gissler M, Heino A, Lindgren H, de Jonge A. Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study. PLoS Med 2020; 17:e1003103. [PMID: 32442207 PMCID: PMC7244098 DOI: 10.1371/journal.pmed.1003103] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. METHODS AND FINDINGS In this multinational cross-sectional study, existing data on 4,729,307 singleton births at ≥37 weeks in 2013 from Finland, Sweden, Norway, Denmark, Iceland, Ireland, England, the Netherlands, Belgium, Germany (Hesse), Malta, the United States, and Chile were used to describe variations in childbirth interventions and outcomes. Numbers of births ranged from 3,987 for Iceland to 3,500,397 for the USA. Crude data were analysed in the Netherlands, or analysed data were shared with the principal investigator. Strict variable definitions were used and information on data quality was collected. Intervention rates were described for each country and stratified by parity. Uni- and multivariable analyses were performed, adjusted for population characteristics, and associations between rates of interventions, population characteristics, and outcomes were assessed using Spearman's rank correlation coefficients. Considerable intercountry variations were found for all interventions, despite adjustments for population characteristics. Adjustments for ethnicity and body mass index changed odds ratios for augmentation of labour and episiotomy. Largest variations were found for augmentation of labour, pain relief, episiotomy, instrumental birth, and cesarean section (CS). Percentages of births at ≥42 weeks varied from 0.1% to 6.7%. Rates among nulliparous versus multiparous women varied from 56% to 80% versus 51% to 82% for spontaneous onset of labour; 14% to 36% versus 8% to 28% for induction of labour; 3% to 13% versus 7% to 26% for prelabour CS; 16% to 48% versus 12% to 50% for overall CS; 22% to 71% versus 7% to 38% for augmentation of labour; 50% to 93% versus 25% to 86% for any intrapartum pain relief, 19% to 83% versus 10% to 64% for epidural anaesthesia; 6% to 68% versus 2% to 30% for episiotomy in vaginal births; 3% to 30% versus 1% to 7% for instrumental vaginal births; and 42% to 70% versus 50% to 84% for spontaneous vaginal births. Countries with higher rates of births at ≥42 weeks had higher rates of births with a spontaneous onset (rho = 0.82 for nulliparous/rho = 0.83 for multiparous women) and instrumental (rho = 0.67) and spontaneous (rho = 0.66) vaginal births among multiparous women and lower rates of induction of labour (rho = -0.71/-0.66), prelabour CS (rho = -0.61/-0.65), overall CS (rho = -0.61/-0.67), and episiotomy (multiparous: rho = -0.67). Variation in CS rates was mainly due to prelabour CS (rho = 0.96). Countries with higher rates of births with a spontaneous onset had lower rates of emergency CS (nulliparous: rho = -0.62) and higher rates of spontaneous vaginal births (multiparous: rho = 0.70). Prelabour and emergency CS were positively correlated (nulliparous: rho = 0.74). Higher rates of obstetric anal sphincter injury following vaginal birth were found in countries with higher rates of spontaneous birth (nulliparous: rho = 0.65). In countries with higher rates of epidural anaesthesia (nulliparous) and spontaneous births (multiparous), higher rates of Apgar score < 7 were found (rhos = 0.64). No statistically significant variation was found for perinatal mortality. Main limitations were varying quality of data and missing information. CONCLUSIONS Considerable intercountry variations were found for all interventions, even after adjusting for population characteristics, indicating overuse of interventions in some countries. Multivariable analyses are essential when comparing intercountry rates. Implementation of evidence-based guidelines is crucial in optimising intervention use and improving quality of maternity care worldwide.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
- * E-mail:
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eva Rydahl
- University College Copenhagen, Department of Midwifery, Copenhagen NV, Denmark
| | - Katrien Beeckman
- Nursing and Midwifery Research unit, faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium
| | - Lorena Binfa
- Department of Women´s and Newborn Health Promotion-School of Midwifery, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lucy Frith
- Department of Health Services Research, The University of Liverpool, Liverpool, United Kingdom
| | - Mechthild M. Gross
- Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Berglind Hálfdánsdóttir
- Midwifery Programme, Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Paul Corcoran
- National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta
| | - Neville Calleja
- Directorate for Health Information and Research, Gwardamangia, Malta
- Department of Public Health Department, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta
| | - Miriam Gatt
- Directorate for Health Information and Research, Gwardamangia, Malta
| | - Anne Britt Vika Nilsen
- Western Norway University of Applied Sciences (HVL), Department of Health and Caring Sciences, Bergen, Norway
| | - Eugene Declercq
- Boston University School of Public Health, Boston, United States of America
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Anna Heino
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Helena Lindgren
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
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23
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Zöllner JP, Konczalla J, Stein M, Roth C, Krakow K, Kaps M, Steinmetz H, Rosenow F, Misselwitz B, Strzelczyk A. Acute symptomatic seizures in intracerebral and subarachnoid hemorrhage: A population study of 19,331 patients. Epilepsy Res 2020; 161:106286. [PMID: 32065924 DOI: 10.1016/j.eplepsyres.2020.106286] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/07/2020] [Accepted: 02/04/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Risk factors for acute symptomatic seizures after stroke demonstrated in retrospective analyses should be confirmed in large population studies. While seizures following ischemic stroke have been studied intensively, less is known about seizure predictors in hemorrhagic stroke. This study sought to identify risk factors of acute symptomatic seizures and to elucidate associated short-term (in-hospital) morbidity and mortality rates in primary intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS We determined the frequency of all acute symptomatic seizures perceived by clinical staff after hemorrhagic stroke in a large population-based registry in a central European region between 2004 and 2016. Further, we analyzed risk factors for seizure occurrence, morbidity, and mortality in univariate and multivariate analyses. RESULTS Of 297,120 stroke patients, 19,331 experienced a hemorrhagic stroke. Frequency of acute seizures (without semiological differentiation) in this subpopulation was 4% (4.0% in ICH and 3.6% in SAH). The risk for acute symptomatic seizures was significantly increased in both stroke types in the presence of an acute non-neurological infection (odds ratio: 2.0 for ICH and 4.2 for SAH). A lower premorbid functional level also significantly increased the seizure risk (odds ratio: 2.0 for ICH and 3.1 for SAH). The odds of in-hospital mortality in the presence of acute seizures were significantly reduced in ICH patients (odds ratio: 0.7) but not in SAH patients. CONCLUSION Acute symptomatic seizures are equally common in ICH and SAH patients in this registry. Seizure risk is invariably increased in the presence of acute non-neurological infection. Mortality is reduced in ICH patients with seizures, but the exact reason for this relationship is not clear and might represent a biased finding.
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Affiliation(s)
- Johann Philipp Zöllner
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Jürgen Konczalla
- Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marco Stein
- Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany
| | - Christian Roth
- Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany; Department of Neurology and Epilepsy Center Hessen, Philipps University Marburg, Marburg (Lahn), Germany
| | - Karsten Krakow
- Asklepios Neurologische Klinik Falkenstein, Königstein-Falkenstein, Germany
| | - Manfred Kaps
- Department of Neurology, Justus Liebig University Giessen, Giessen, Germany
| | - Helmuth Steinmetz
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Adam Strzelczyk
- Department of Neurology and Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Neurology and Epilepsy Center Hessen, Philipps University Marburg, Marburg (Lahn), Germany
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Döbler K, Schrappe M, Kuske S, Schmitt J, Sens B, Boywitt D, Misselwitz B, Nothacker M, Geraedts M. Eignung von Qualitätsindikatorensets in der Gesundheitsversorgung für verschiedene Einsatzgebiete – Forschungs- und Handlungsbedarf. Gesundheitswesen 2019; 81:781-787. [PMID: 31574557 DOI: 10.1055/a-1007-0811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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25
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Raselli T, Wyss A, Gonzalez Alvarado MN, Weder B, Mamie C, Spalinger MR, Van Haaften WT, Dijkstra G, Sailer AW, Imenez Silva PH, Wagner CA, Tosevski V, Leibl S, Scharl M, Rogler G, Hausmann M, Misselwitz B. The Oxysterol Synthesising Enzyme CH25H Contributes to the Development of Intestinal Fibrosis. J Crohns Colitis 2019; 13:1186-1200. [PMID: 31220227 PMCID: PMC6751338 DOI: 10.1093/ecco-jcc/jjz039] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intestinal fibrosis and stenosis are common complications of Crohn's disease [CD], frequently requiring surgery. Anti-inflammatory strategies can only partially prevent fibrosis; hence, anti-fibrotic therapies remain an unmet clinical need. Oxysterols are oxidised cholesterol derivatives with important roles in various biological processes. The enzyme cholesterol 25-hydroxylase [CH25H] converts cholesterol to 25-hydroxycholesterol [25-HC], which modulates immune responses and oxidative stress. In human intestinal samples from CD patients, we found a strong correlation of CH25H mRNA expression with the expression of fibrosis markers. We demonstrate reduced intestinal fibrosis in mice deficient for the CH25H enzyme, using the sodium dextran sulphate [DSS]-induced chronic colitis model. Additionally, using a heterotopic transplantation model of intestinal fibrosis, we demonstrate reduced collagen deposition and lower concentrations of hydroxyproline in CH25H knockouts. In the heterotopic transplant model, CH25H was expressed in fibroblasts. Taken together, our findings indicate an involvement of oxysterol synthesis in the pathogenesis of intestinal fibrosis.
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Affiliation(s)
- T Raselli
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - A Wyss
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - M N Gonzalez Alvarado
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - B Weder
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - C Mamie
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - M R Spalinger
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - W T Van Haaften
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A W Sailer
- Chemical Biology & Therapeutics, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - C A Wagner
- Institute of Physiology, Zurich University, Zurich, Switzerland
| | - V Tosevski
- Mass Cytometry Facility, Zurich University, Zurich, Switzerland
| | - Sebastian Leibl
- Institute of Pathology and Molecular Pathology, University Hospital Zurich and Zurich University, Zurich, Switzerland
| | - M Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - G Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - M Hausmann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
| | - B Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich University, Zurich, Switzerland
- Corresponding author: Dr. Benjamin Misselwitz, Dept. of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Freiburgstr 18, 3010 Bern, Switzerland.
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Dudenhausen JW, Misselwitz B, Piedvache A, Maier RF, Weber T, Zeitlin J, Schmidt S. Characteristics, management and outcomes of very preterm triplets in 19 European regions. Int J Gynaecol Obstet 2019; 147:397-403. [PMID: 31402446 DOI: 10.1002/ijgo.12939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 06/11/2019] [Accepted: 08/09/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe obstetrical care and in-hospital outcomes in very preterm triplet pregnancies in a European multiregional cohort. METHODS Data from a prospective population-based study of very preterm births between 22 + 0 and 31 + 6 weeks of gestation in 19 regions from 11 European countries participating in the EPICE project in 2011/2012 were used to describe triplet pregnancies and compare them with twins and singletons. RESULTS Triplets constituted 1.1% of very preterm pregnancies (97/8851) and 3.3% of very preterm live births (258/7900); these percentages varied from 0% to 2.6% and 0% to 6% respectively across the regions. In-hospital mortality after live birth was 12.4% and did not differ significantly from singletons or twins or by birth order. However, 28.9% of mothers with a triplet pregnancy experienced at least one neonatal death. Ninety percent of live-born triplets were delivered by cesarean. Vaginal delivery was associated with an Apgar score of less than 7, but not with in-hospital mortality. CONCLUSIONS The prevalence of very preterm triplets varies across European regions. Most triplets were born by cesarean and those born vaginally had lower Apgar scores. Overall, in-hospital mortality after live birth was similar to singletons and twins.
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Affiliation(s)
| | | | - Aurelie Piedvache
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Rolf F Maier
- Children's Hospital, Philipps University Marburg, Marburg, Germany
| | - Tom Weber
- Department of Obstetrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Jennifer Zeitlin
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Stephan Schmidt
- Department of Obstetrics, University Hospital, Philipps University, Marburg, Germany
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Karbeyaz F, Müllhaupt B, Winder T, Misselwitz B, Mertens J, Siebenhuener A. High rates of hepatocellular carcinoma within two years of starting treatment for chronic hepatitis C with direct antiviral agents but not with PEG-interferon/ Ribavirin (HORRID Study). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Heller G, Bauer E, Schill S, Thomas T, Louwen F, Wolff F, Misselwitz B, Schmidt S, Veit C. Decision-to-Delivery Time and Perinatal Complications in Emergency Cesarean Section. Dtsch Arztebl Int 2018; 114:589-596. [PMID: 28927497 DOI: 10.3238/arztebl.2017.0589] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 10/06/2016] [Accepted: 06/14/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A decision-to-delivery interval (DDI) of no more than 20 minutes has long been considered a requirement for cesarean sections, even though there have hardly been any studies on this topic. We retrospectively investigated data relevant to DDI for emergency cesarean sections performed for the most common indications, namely, suspected and documented fetal asphyxia. METHODS We analyzed data on emergency in-hospital cesarean sections in the period 2008-2015. Low 5- and 10-minute Apgar scores (a scheme with points awarded for breathing, heart rate, muscle tone, skin coloration, and the elicitability of reflexes) were the primary endpoints; acid-base status in arterial cord blood and in-hospital neonatal death were the secondary endpoints. The raw analysis was supplemented by an analysis adjusted for various factors including gestational age, maternal age, and obstetrical presentation. RESULTS Data from 39 291 neonates were included. The DDI was up to 10 minutes in 64.6% of cases, from 11 to 20 minutes in 34.3%, and over 20 minutes in 1.1%. Low Apgar scores were less common in children whose emergency cesarean sections were performed within 10 minutes or within 20 minutes. For example, the adjusted odds ratio for a 10-minute Apgar score below 4 was 0.49 (95% confidence interval [0.25; 0.96] when a DDI of more than 20 minutes was used as the reference criterion. CONCLUSION This is the largest population-based, risk-adjusted analysis to be carried out on this topic to date. It reveals, for the first time, an association between DDI of 20 minutes or less and the avoidance of outcomes that are dangerous to the child. As it is not possible to predict such obstetrical emergencies in advance, it seems reasonable to ensure the availability of caredelivery structures that make it possible for emergency cesarean sections to be performed within 20 minutes of the decision to do so.
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Affiliation(s)
- Günther Heller
- Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Berlin, Germany; Department of Obstetrics and Prenatal Medicine, University Hospital of Frankfurt, Frankfurt, Germany; Women's Hospital Holweide, Kliniken der Stadt Köln, Cologne, Germany; Hesse Quality Assurance Office (GQH), Eschborn, Germany; Department of Obstetrics and Perinatal Medicine, University Hospitals of Gießen and Marburg, Marburg site, Marburg, Germany
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Reitter A, Doehring N, Maden Z, Hessler PA, Misselwitz B. [Is it Reasonable to Establish an Independently Managed Obstetric Unit in a Small Hospital and Does it Result in Measurable Changes in Quality of Maternity Care?]. Z Geburtshilfe Neonatol 2018; 223:147-156. [PMID: 30536274 DOI: 10.1055/a-0749-9024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION An independently managed, specialty obstetric unit in a small hospital setting resulted in measurable changes in quality of maternity care. MATERIAL AND METHODS We present obstetric data from a level I (basic care) hospital in Frankfurt, Germany. We compare data from the mandatory state register collected in 2013, when the obstetric unit was under single management with the gynaecology department, with data collected in 2016 after the establishment of independent obstetric unit and a specialised service. RESULTS Between 2013 and 2016, the birth rate in our hospital increased by 46.4%, from 803 to 1176 births/year. CS rates decreased by 8.9%, from 34.9 to 26% (p<0.01). Operative vaginal delivery rates increased by 5.2 (p<0.01%). Transfer of neonates to NICU decreased from 5.6% to 3.1% (p<0.01). Other obstetric interventions also decreased, including induction of labour (10.1 to 9.4%, p=0.632) and rate of episiotomy (13.4 to 1.1%, p<0.01). Rates of severe fetal acidosis (p<0.05) increased from no events in 2013 to 2 events in 2016. There were non-significant reductions in planned caesarean section for primiparous women and repeat caesarean section. CONCLUSION An independently managed, specialised obstetric unit separate from an Obstetric & Gynaecology Department previously under single management can lead to measurable changes and quality improvement in a short period of time.
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Affiliation(s)
- Anke Reitter
- Geburtshilfe und Pränatalmedizin, Krankenhaus Sachsenhausen, Frankfurt
| | - Norman Doehring
- Geburtshilfe und Pränatalmedizin, Krankenhaus Sachsenhausen, Frankfurt
| | - Zerrin Maden
- Geburtshilfe und Pränatalmedizin, Krankenhaus Sachsenhausen, Frankfurt
| | - Phillip A Hessler
- Operative Gynäkologie, Krankenhaus Sachsenhausen, Zentrum für Minimal-Invasive Chirurgie, Frankfurt
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Hagen M, Jennewein L, Misselwitz B, Louwen F. Adipositas in der Schwangerschaft – Risiken für Mutter und Kind in der prä-, peri- und postnatalen Phase. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Hagen
- Universitätsklinikum Frankfurt am Main, Klinik für Frauenheilkunde und Geburtshilfe, Frankfurt am Main, Deutschland
| | - L Jennewein
- Universitätsklinikum Frankfurt am Main, Klinik für Frauenheilkunde und Geburtshilfe, Frankfurt am Main, Deutschland
| | - B Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen, Eschborn, Deutschland
| | - F Louwen
- Universitätsklinikum Frankfurt am Main, Klinik für Frauenheilkunde und Geburtshilfe, Frankfurt am Main, Deutschland
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Schradin L, Timmesfeld N, Misselwitz B, Arabin B. Inwieweit werden „Choosing Wisely“ Kriterien bereits in der geburtshilflichen Praxis berücksichtigt? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- L Schradin
- Klinik für Frauenheilkunde und Geburtshilfe Mutter-Kind Zentrum der Philipps-Universität Marburg, Clara Angela Fondation Witten-Berlin
| | - N Timmesfeld
- Klinik für Frauenheilkunde und Geburtshilfe Mutter-Kind Zentrum der Philipps-Universität Marburg, Clara Angela Fondation Witten-Berlin
| | - B Misselwitz
- Klinik für Frauenheilkunde und Geburtshilfe Mutter-Kind Zentrum der Philipps-Universität Marburg, Clara Angela Fondation Witten-Berlin
| | - B Arabin
- Klinik für Frauenheilkunde und Geburtshilfe Mutter-Kind Zentrum der Philipps-Universität Marburg, Clara Angela Fondation Witten-Berlin
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Noever K, Kinkel J, Timmesfeld N, Misselwitz B, Arabin B. Mütterlicher Einfluss auf das Geburtsgewicht und die Länge bei Geburt von 2000 – 2015 anhand der Perinatalerhebung in Hessen zwischen 2000 und 2015. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- K Noever
- Mutter-Kind Zentrum der Philipps Universität Marburg
- Clara Angela Foundation Witten-Berlin
| | - J Kinkel
- Abteilung für Geburtshilfe Kantonsspital St. Gallen, CH
- Clara Angela Foundation Witten-Berlin
| | - N Timmesfeld
- Abteilung für medizinische Biometrie der Philipps Universität Marburg
- Clara Angela Foundation Witten-Berlin
| | | | - B Arabin
- Mutter-Kind Zentrum der Philipps Universität Marburg
- Clara Angela Foundation Witten-Berlin
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Arabin B, Noever K, Misselwitz B, Timmesfeld N. Raten, Risikofaktoren und Outcomeparameter von Übergewicht und Adipositas anhand der Hessischen Perintalerhebung 2000 – 2015. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- B Arabin
- Mutter-Kind Zentrum der Philipps-Universität Marburg/Clara Angela Foundation Witten
| | - K Noever
- Mutter-Kind Zentrum der Philipps-Universität Marburg/Clara Angela Foundation Witten
| | - B Misselwitz
- Mutter-Kind Zentrum der Philipps-Universität Marburg/Clara Angela Foundation Witten
| | - N Timmesfeld
- Mutter-Kind Zentrum der Philipps-Universität Marburg/Clara Angela Foundation Witten
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Lang BM, Biedermann L, van Haaften WT, de Vallière C, Schuurmans M, Begré S, Zeitz J, Scharl M, Turina M, Greuter T, Schreiner P, Heinrich H, Kuntzen T, Vavricka SR, Rogler G, Beerenwinkel N, Misselwitz B. Genetic polymorphisms associated with smoking behaviour predict the risk of surgery in patients with Crohn's disease. Aliment Pharmacol Ther 2018; 47:55-66. [PMID: 29052254 DOI: 10.1111/apt.14378] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/04/2017] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Smoking is a strong environmental factor leading to adverse outcomes in Crohn's disease, but a more benign course in ulcerative colitis. Several single nucleotide polymorphisms (SNPs) are associated with smoking quantity and behaviour. AIM To assess whether smoking-associated SNPs interact with smoking to influence the clinical course of inflammatory bowel diseases. METHODS Genetic and prospectively obtained clinical data from 1434 Swiss inflammatory bowel disease cohort patients (821 Crohn's disease and 613 ulcerative colitis) were analysed. Six SNPs associated with smoking quantity and behaviour (rs588765, rs1051730, rs1329650, rs4105144, rs6474412 and rs3733829) were combined to form a risk score (range: 0-12) by adding the number of risk alleles. We calculated multivariate models for smoking, risk of surgery, fistula, Crohn's disease location and ulcerative colitis disease extent. RESULTS In Crohn's disease patients who smoke, the number of surgeries was associated with the genetic risk score. This translates to a predicted 3.5-fold (95% confidence interval: 2.4- to 5.7-fold, P<.0001) higher number of surgical procedures in smokers with 12 risk alleles than individuals with the lowest risk. Patients with a risk score >7 had a significantly shorter time to first intestinal surgery. The genetic risk score did not predict surgery in ulcerative colitis or occurrence of fistulae in Crohn's disease. SNP rs6265 was associated with ileal disease in Crohn's disease (P<.05) and proctitis in ulcerative colitis (P<.05). CONCLUSIONS SNPs associated with smoking quantity is associated with an increased risk for surgery in Crohn's disease patients who smoke. Our data provide an example of genetics interacting with the environment to influence the disease course of inflammatory bowel disease.
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Affiliation(s)
- B M Lang
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland.,Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland
| | - L Biedermann
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - W T van Haaften
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland.,Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - C de Vallière
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - M Schuurmans
- Division of Pneumology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - S Begré
- Hohenegg Hospital, Meilen, Switzerland
| | - J Zeitz
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - M Scharl
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - M Turina
- Division of Visceral Surgery, University Hospital Zurich (USZ), Zurich, Switzerland
| | - T Greuter
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - P Schreiner
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - H Heinrich
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - T Kuntzen
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - S R Vavricka
- Division of Gastroenterology, Triemli Hospital Zurich, Zürich, Switzerland
| | - G Rogler
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
| | - N Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland.,Swiss Institute of Bioinformatics (SIB), Lausanne, Switzerland
| | - B Misselwitz
- Division of Gastroenterology, University Hospital Zurich (USZ) and Zurich University, Zurich, Switzerland
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Lang BM, Beerenwinkel N, Misselwitz B. Editorial: the influence of genetic factors in mediating the effects of tobacco smoke in IBD-Authors' reply. Aliment Pharmacol Ther 2018; 47:307-308. [PMID: 29265456 DOI: 10.1111/apt.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Linked ContentThis article is linked to Adams et al and Lang et al papers. To view these articles visit https://doi.org/10.1111/apt.14334 and https://doi.org/10.1111/apt.14378.
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Affiliation(s)
- B M Lang
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - N Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - B Misselwitz
- Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland
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Lutz C, Weder B, Hünerwadel A, Fagagnini S, Lang B, Beerenwinkel N, Rossel JB, Rogler G, Misselwitz B, Hausmann M. Myeloid differentiation primary response gene (MyD) 88 signalling is not essential for intestinal fibrosis development. Sci Rep 2017; 7:17678. [PMID: 29247242 PMCID: PMC5732165 DOI: 10.1038/s41598-017-17755-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/29/2017] [Indexed: 01/15/2023] Open
Abstract
Dysregulation of the immune response to microbiota is associated with inflammatory bowel disease (IBD), which can trigger intestinal fibrosis. MyD88 is a key component of microbiota signalling but its influence on intestinal fibrosis has not been clarified. Small bowel resections from donor-mice were transplanted subcutaneously into the neck of recipients C57BL/6 B6-MyD88tm1 Aki (MyD88-/-) and C57BL/6-Tg(UBC-green fluorescence protein (GFP))30Scha/J (GFP-Tg). Grafts were explanted up to 21 days after transplantation. Collagen layer thickness was determined using Sirius Red stained slides. In the mouse model of fibrosis collagen deposition and transforming growth factor-beta 1 (TGF-β1) expression was equal in MyD88+/+ and MyD88-/-, indicating that MyD88 was not essential for fibrogenesis. Matrix metalloproteinase (Mmp)9 expression was significantly decreased in grafts transplanted into MyD88-/- recipients compared to MyD88+/+ recipients (0.2 ± 0.1 vs. 153.0 ± 23.1, respectively, p < 0.05), similarly recruitment of neutrophils was significantly reduced (16.3 ± 4.5 vs. 25.4 ± 3.1, respectively, p < 0.05). Development of intestinal fibrosis appears to be independent of MyD88 signalling indicating a minor role of bacterial wall compounds in the process which is in contrast to published concepts and theories. Development of fibrosis appears to be uncoupled from acute inflammation.
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Affiliation(s)
- C Lutz
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - B Weder
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - A Hünerwadel
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - S Fagagnini
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - B Lang
- Department of Biosystems Sciences and Engineering, ETH Zurich, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - N Beerenwinkel
- Department of Biosystems Sciences and Engineering, ETH Zurich, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - J B Rossel
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - G Rogler
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - B Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - M Hausmann
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland.
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Tahtali D, Bohmann F, Kurka N, Rostek P, Todorova-Rudolph A, Buchkremer M, Abruscato M, Hartmetz AK, Kuhlmann A, Henke C, Stegemann A, Menon S, Misselwitz B, Reihs A, Weidauer S, Thonke S, Meyding-Lamadé U, Singer O, Steinmetz H, Pfeilschifter W. Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial. PLoS One 2017; 12:e0188231. [PMID: 29206838 PMCID: PMC5716597 DOI: 10.1371/journal.pone.0188231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background To meet the requirements imposed by the time-dependency of acute stroke therapies, it is necessary 1) to initiate structural and cultural changes in the breadth of stroke-ready hospitals and 2) to find new ways to train the personnel treating patients with acute stroke. We aimed to implement and validate a composite intervention of a stroke team algorithm and simulation-based stroke team training as an effective quality initiative in our regional interdisciplinary neurovascular network consisting of 7 stroke units. Methods We recorded door-to-needle times of all consecutive stroke patients receiving thrombolysis at seven stroke units for 3 months before and after a 2 month intervention which included setting up a team-based stroke workflow at each stroke unit, a train-the-trainer seminar for stroke team simulation training and a stroke team simulation training session at each hospital as well as a recommendation to take up regular stroke team trainings. Results The intervention reduced the network-wide median door-to-needle time by 12 minutes from 43,0 (IQR 29,8–60,0, n = 122) to 31,0 (IQR 24,0–42,0, n = 112) minutes (p < 0.001) and substantially increased the share of patients receiving thrombolysis within 30 minutes of hospital arrival from 41.5% to 59.6% (p < 0.001). Stroke team training participants stated a significant increase in knowledge on the topic of acute stroke care and in the perception of patient safety. The overall course concept was regarded as highly useful by most participants from different professional backgrounds. Conclusions The composite intervention of a binding team-based algorithm and stroke team simulation training showed to be well-transferable in our regional stroke network. We provide suggestions and materials for similar campaigns in other stroke networks.
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Affiliation(s)
- Damla Tahtali
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ferdinand Bohmann
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Natalia Kurka
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Rostek
- NICU Nursing Staff, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | | | | | | | - Andrea Kuhlmann
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Christian Henke
- Department of Neurology, Helios HSK Wiesbaden, Wiesbaden, Germany
| | - André Stegemann
- Department of Neurology, Sankt Katharinen-Krankenhaus, Frankfurt am Main, Germany
| | - Sanjay Menon
- Department of Neurology, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Björn Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Germany
| | - Anke Reihs
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Germany
| | - Stefan Weidauer
- Department of Neurology, Sankt Katharinen-Krankenhaus, Frankfurt am Main, Germany
| | - Sven Thonke
- Department of Neurology, Klinikum Hanau, Hanau, Germany
| | - Uta Meyding-Lamadé
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Oliver Singer
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
- * E-mail:
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Tanislav C, Allendörfer J, Pfeilschifter W, Fuest S, Stein M, Meyer M, Reuter I, Kaps M, Misselwitz B. One decade of oral anticoagulation in stroke patients: Results from a large country-wide hospital-based registry. Int J Stroke 2017; 13:308-312. [PMID: 28952913 DOI: 10.1177/1747493017733928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background New evidence regarding stroke prevention in atrial fibrillation has been published. Implementing knowledge into clinical practice remains challenging. Aims To investigate oral anticoagulants in stroke patients documented in a nationwide registry. Methods The database is an obligatory federal-state-wide hospital-based registry that covers more than 95% of all ischemic strokes, transient ischemic attacks and intracerebral hemorrhages in a community of more than six million inhabitants (Hesse/Germany). We analyzed oral anticoagulants prescribed on discharge in patients with stroke or transient ischemic attack during 2006-2015. Results From 2006 to 2015, we annually selected median 20,895 patients. From 2006 to 2015, the proportion of patients treated with oral anticoagulants increased (9.8% to 24%). The annual proportion of patients with atrial fibrillation remained constant (median: 23%). In atrial fibrillation patients treated with oral anticoagulants, the age increased (median 2008/2009: 76.9 years vs. 2014/2015 79.4 years). The percentage of treated individuals in atrial fibrillation increased dramatically (2006: 30.1% to 2015: 74.5%); in 2015, 30.8% of these patients received vitamin K antagonists and 70.2% new oral anticoagulants. Independent factors associated with new oral anticoagulants therapy were a previous medication with new oral anticoagulants and a treatment on stroke unit. Between new oral anticoagulants- and vitamin K antagonists-treated patients (2015), no differences in age were noted (both mean: 79.4 years). Conclusions The new oral anticoagulants availability enhanced a general trend treating more target patients with oral anticoagulants.
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Affiliation(s)
| | | | | | - Sven Fuest
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Marco Stein
- 4 Neurosurgery, Justus Liebig University, Giessen, Germany
| | - Marco Meyer
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Iris Reuter
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Manfred Kaps
- 1 Neurology, Justus Liebig University, Giessen, Germany
| | - Björn Misselwitz
- 5 Institute of quality assurance Hesse, Eschborn/Frankfurt, Germany
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Nowak B, Misselwitz B, Przibille O, Mehta RH. Pacemaker implantation and mortality: no role as a quality control indicator: Author's reply. Europace 2017; 19:1587. [PMID: 28934411 DOI: 10.1093/europace/eux270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bernd Nowak
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389, Frankfurt am Main, Germany
| | | | - Oliver Przibille
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389, Frankfurt am Main, Germany
| | - Rajendra H Mehta
- Duke Clinical Research Institute and, Duke University Medical Center, Durham, NC, USA
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Nowak B, Misselwitz B, Przibille O, Mehta RH. Is mortality a useful parameter for public reporting in pacemaker implantation? Results of an obligatory external quality control programme. Europace 2017; 19:568-572. [PMID: 28431064 DOI: 10.1093/europace/euw079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/01/2016] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate if public reporting of pacemaker implantation-associated mortality is meaningful in a large contemporary patient cohort. METHODS AND RESULTS The database of the obligatory external quality control programme in the Federal State of Hessen, Germany, of patients undergoing permanent pacemaker (PPM) implantation was evaluated retrospectively. We compared the baseline features of patients who died compared with those who did not during hospitalization after PPM. Of 5079 patients who underwent PPM implantation in 2009, 74 (1.5%) died during the hospital stay. Cause of death was available in 70/74 patients (94.6%) who died. Deceased patients were older (79.6 ± 8.7 vs. 76.3 ± 9.9 years, P = 0.006), had worse American Society of Anesthesiologists (ASA) physical status (P < 0.001), lower ejection fraction (P < 0.001), a greater prevalence of high-degree atrioventricular-block (44.3 vs. 35.0%, P = 0.001), and were more likely to receive single-chamber devices (41.4 vs. 25.0%, P < 0.002). Perioperative complications were similar in both cohorts. Death was not attributable directly to PPM procedure in any patients but was related to (i) non-device-related infections (28.6%), (ii) heart failure (25.7%), (iii) extracardiac diseases (21.4%), (iv) multiorgan failure (8.6%), (v) previous resuscitation with hypoxic brain damage (8.6%), and (vi) arrhythmogenic death (7.1%). CONCLUSION Mortality associated with PPM implantation in vast majority of cases was not related to the procedure, but to comorbidities and other existing diseases at the time of PPM implantation. Thus, PPM implantation in-hospital mortality should not be chosen for public reporting comparing hospital quality, even after adjusting for baseline risk.
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MESH Headings
- Aged
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/prevention & control
- Cardiac Pacing, Artificial/mortality
- Cardiac Pacing, Artificial/statistics & numerical data
- Causality
- Cohort Studies
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Female
- Hospital Mortality
- Hospitalization/statistics & numerical data
- Humans
- Incidence
- Male
- Outcome Assessment, Health Care/standards
- Outcome Assessment, Health Care/statistics & numerical data
- Pacemaker, Artificial/statistics & numerical data
- Quality Control
- Risk Assessment/methods
- Risk Management/statistics & numerical data
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Bernd Nowak
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389 Frankfurt a.M., Germany
| | | | - Oliver Przibille
- CCB, Cardioangiologisches Centrum Bethanien, Im Pruefling 23, D-60389 Frankfurt a.M., Germany
| | - Rajendra H Mehta
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA
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Tahtali D, Bohmann F, Rostek P, Misselwitz B, Reihs A, Heringer F, Jahnke K, Steinmetz H, Pfeilschifter W. [Crew resource management and simulator training in acute stroke therapy]. Nervenarzt 2017; 87:1322-1331. [PMID: 27431675 DOI: 10.1007/s00115-016-0162-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Time is of critical importance in acute stroke management. The establishment of thrombectomy now adds to the complexity and interdisciplinarity of the initial phase. In non-medical high-fidelity situations, such as aviation, crew resource management (CRM) has proven to be highly efficient. It has therefore also been implemented in professional cardiovascular life support training. In a setting where every minute counts, CRM and regular training of the high-fidelity stroke team could offer ways to improve treatment of acute stroke patients. OBJECTIVES We evaluated the effects of a CRM-based stroke team with regular simulation training on the quality of care (e.g. door to needle time and thrombolysis rate) as well as on staff satisfaction and perceived patient safety in the emergency department of a tertiary care neurocenter. MATERIAL AND METHODS We implemented a dedicated stroke team consisting of 7 persons who are notified by a collective call via speed dial and conceived a simulator-based team training for all new stroke team members which we conduct at monthly intervals. We recorded door to needle times of all consecutive patients, staff satisfaction in the emergency room and the acceptance of this new learning format. RESULTS This approach led to a relevant and sustained reduction of the mean door to needle time to less than 30 min. It improved perceived patient safety in residents with professional experience of less than 2 years. There was a very high acceptance within the stroke team training and staff and its usefulness was judged to be very high. CONCLUSION Even though our data do not allow positive effects on patient outcomes to be inferred, the implementation of a CRM-based stroke team and simulator training has had multiple positive effects on the workflow and work satisfaction in the treatment of acute stroke patients.
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Affiliation(s)
- D Tahtali
- Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - F Bohmann
- Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - P Rostek
- Anästhesie und Intensivpflege NICU, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - B Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Deutschland
| | - A Reihs
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Deutschland
| | - F Heringer
- Frankfurter interdisziplinäre Einrichtung für Notfallmedizin und Simulationstraining (FINeST), Goethe-Universität Frankfurt/Main, Frankfurt/Main, Deutschland
| | - K Jahnke
- Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - H Steinmetz
- Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - W Pfeilschifter
- Klinik für Neurologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Hillmann S, Wiedmann S, Rücker V, Berger K, Nabavi D, Bruder I, Koennecke HC, Seidel G, Misselwitz B, Janssen A, Burmeister C, Matthis C, Busse O, Hermanek P, Heuschmann PU. Stroke unit care in germany: the german stroke registers study group (ADSR). BMC Neurol 2017; 17:49. [PMID: 28279162 PMCID: PMC5343401 DOI: 10.1186/s12883-017-0819-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/10/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care. METHODS Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators. RESULTS In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago. CONCLUSIONS Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low.
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Affiliation(s)
- Steffi Hillmann
- Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany.
| | - Silke Wiedmann
- Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany
| | - Klaus Berger
- Quality Assurance Project"Stroke Register Northwest Germany", Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D3, 48149, Münster, Germany
| | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Rudower Straße 48, 12351, Berlin, Germany
| | - Ingo Bruder
- Office for Quality Assurance in Hospitals (GeQiK) Stuttgart at Baden-Wuerttembergische Hospital Federation, Stuttgart, Birkenwaldstr. 151, 70191, Stuttgart, Germany
| | | | - Günter Seidel
- Department of Neurology, Asklepios Klinik Nord, Hamburg,, Tangstedter Landstraße 400, 22417, Hamburg, Germany
| | - Björn Misselwitz
- Institute of Quality Assurance Hesse (GQH), Frankfurter Str. 10, 65760, Eschborn, Germany
| | - Alfred Janssen
- Quality Assurance in Stroke Management in North Rhine-Westphalia, Medical Association North Rhine, Tersteegenstr. 9, 40474, Düsseldorf, Germany
| | - Christoph Burmeister
- Institute of Quality Assurance Rhineland-Palatinate / SQMed, Wilhelm-Theodor-Römheld-Straße 34, 55130, Mainz, Germany
| | - Christine Matthis
- Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS), Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Otto Busse
- German Stroke Society, Berlin, Reinhardtstr. 27C, 10117, Berlin, Germany
| | - Peter Hermanek
- Bavarian Permanent Working Party for Quality Assurance, Munich, Westenriederstr. 19, 80331, Munich, Germany
| | - Peter Ulrich Heuschmann
- Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany
- Comprehensive Heart Failure Center, University of Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany
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Jasper D, Freitas-Queiroz N, Hollenstein M, Misselwitz B, Layer P, Navarro-Rodriguez T, Fox M, Keller J. Prolonged measurement improves the assessment of the barrier function of the esophago-gastric junction by high-resolution manometry. Neurogastroenterol Motil 2017; 29. [PMID: 27523737 DOI: 10.1111/nmo.12925] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/19/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Etiology of gastro-esophageal reflux disease (GERD) is multifactorial, but incompetence of the esophago-gastric junction (EGJ) appears to be of crucial importance. Established manometric parameters for assessment of EGJ barrier function are sub-optimal, potentially because they reflect only a very brief (up to 30 seconds), not necessarily representative period. This prospective, case-control study tested the performance of novel, high-resolution manometry (HRM) parameters of EGJ function in the assessment of GERD. METHODS Patients with reflux symptoms and healthy controls (HC) underwent standard HRM and 24-hour pH±impedance measurements. EGJ morphology, lower esophageal sphincter pressure integral (LES-PI), EGJ contractile integral (EGJ-CI) were compared with total-EGJ-CI, a novel parameter summarizing EGJ barrier function during the entire HRM protocol. Esophageal acid exposure ≥4.2%/24 h (A-Reflux-pos) or ≥73 reflux episodes in 24 hours (V-Reflux-pos) were considered pathological. KEY RESULTS Sixty five HC and 452 patients completed HRM, 380 (84%) patients underwent ambulatory reflux-monitoring. LES-PI, EGJ-CI and total-EGJ-CI correlated with EGJ morphology subtypes (all P<.00001). Only total-EGJ-CI was consistently lower in A-Reflux-pos and V-Reflux-pos subjects compared with HC and patients without GERD. Total-EGJ-CI was also the single best parameter for prediction of pathological reflux (optimal cut-off 47 mmHg cm, AUC 0.746, P<.0001). This cut-off value, approximately 1 SD below the mean normal value, showed modest sensitivity 54% and positive predictive value 46%, but good specificity 85% and negative predictive value 89% for GERD diagnosis. CONCLUSION & INFERENCES Total EGJ-CI, a new metric that summarizes EGJ contractility over time, allows an improved assessment of EGJ barrier function. Pathological reflux is unlikely if this metric is within the upper two-thirds of the normal range.
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Affiliation(s)
- D Jasper
- Department of Internal Medicine, Israelitic Hospital, Academic Hospital of the University of Hamburg, Hamburg, Germany
| | - N Freitas-Queiroz
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - M Hollenstein
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - B Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - P Layer
- Department of Internal Medicine, Israelitic Hospital, Academic Hospital of the University of Hamburg, Hamburg, Germany
| | - T Navarro-Rodriguez
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo, Brazil
| | - M Fox
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.,Department of Gastroenterology, Abdominal Center, St. Claraspital, Basel, Switzerland
| | - J Keller
- Department of Internal Medicine, Israelitic Hospital, Academic Hospital of the University of Hamburg, Hamburg, Germany
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Ang D, Hollenstein M, Misselwitz B, Knowles K, Wright J, Tucker E, Sweis R, Fox M. Rapid Drink Challenge in high-resolution manometry: an adjunctive test for detection of esophageal motility disorders. Neurogastroenterol Motil 2017; 29. [PMID: 27420913 DOI: 10.1111/nmo.12902] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/12/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIMS The Chicago Classification for diagnosis of esophageal motility disorders by high-resolution manometry (HRM) is based on single water swallows (SWS). Emerging data suggest that a "Rapid Drink Challenge" (RDC) increases sensitivity for motility disorders. This study establishes normal values and diagnostic thresholds for RDC in clinical practice. METHODS Two cohort studies were performed in patients with dysphagia or reflux symptoms (development and validation sets). Healthy subjects and patient controls provided reference values. Ten SWS and two 200-mL RDC were performed. Primary diagnosis for SWS was established by the Chicago Classification. Abnormal RDC was defined by impaired esophagogastric junction (EGJ) function (elevated integrated relaxation pressure during RDC [IRP-RDC]); incomplete inhibition of contractility during and ineffective contraction after RDC. Diagnostic thresholds identified in the development set were prospectively tested in the validation set. RESULTS Normal values were determined in healthy (n=95; age 37.8 ± 12) and patient controls (n=44; age 46.4 ± 15). Development and validation sets included 178 (54 ± 17 years) and 226 (53 ± 16 years) patients, respectively. Integrated relaxation pressure during RDC was higher for SWS than RDC in all groups (overall P<.001), except achalasia. Rapid Drink Challenge suppressed contractility, except in achalasia type III, spasm, and hypercontractile motility disorders (P<.001). An effective after-contraction was present more often in health than disease (P<.001). Optimal diagnostic thresholds identified in the development set (IRP-RDC ≥12 mmHg achalasia, IRP-RDC ≥ 8mmHg "all cause" EGJ dysfunction), were confirmed in the validation set (both, sensitivity ~85%, specificity >95%). CONCLUSIONS Rapid Drink Challenge contributes clinically relevant information to routine HRM studies, especially in patients with EGJ dysfunction.
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Affiliation(s)
- D Ang
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Department of Gastroenterology, Changi General Hospital, Singapore City, Singapore
| | - M Hollenstein
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - B Misselwitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - K Knowles
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Nottingham, UK
| | - J Wright
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Nottingham, UK
| | - E Tucker
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Nottingham, UK
| | - R Sweis
- Upper GI Physiology, University College London Hospital, London, UK
| | - M Fox
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,NIHR Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals, Nottingham, UK
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Schradin L, Arabin B, Laas U, Timmesfeld N, Misselwitz B. Werden Negativ-Kriterien (Choosing Wisely) bereits in der geburtshilflichen Praxis berücksichtigt? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pfeilschifter W, Farahmand D, Niemann D, Ikenberg B, Hohmann C, Abruscato M, Thonke S, Strzelczyk A, Hedtmann G, Neumann-Haefelin T, Kollmar R, Singer OC, Ferbert A, Steiner T, Steinmetz H, Reihs A, Misselwitz B, Foerch C. Estimating the Quantitative Demand of NOAC Antidote Doses on Stroke Units. Cerebrovasc Dis 2016; 42:415-420. [PMID: 27438461 DOI: 10.1159/000447952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit. METHODS We extracted data of patients with acute ischemic stroke and ICH (<24 h after symptom onset) in the years 2012-2015 from a state-wide prospective stroke inpatient registry. We selected 8 stroke units and determined the mode of OAT upon admission in 2012-2013. In 2015, the mode of OAT became a mandatory item of the inpatient registry. From the number of anticoagulated patients and the NOAC share, we estimated the current and future demand for NOAC antidote doses on stroke units. RESULTS Eighteen percent of ICH patients within 6 h of symptom onset or an unknown symptom onset were on OAT. Given a NOAC share at admission of 40%, about 7% of all ICH patients may qualify for NOAC reversal therapy. Thirteen percent of ischemic stroke patients admitted within 4 h presented on anticoagulation. Given the availability of an appropriate antidote, a NOAC share of 50% could lead to a 6.1% increase in thrombolysis rate. CONCLUSIONS Stroke units serving populations with a comparable demographic structure should prepare to treat up to 1% of all acute ischemic stroke patients and 7% of all acute ICH patients with NOAC antidotes. These numbers may increase with the mounting prevalence of atrial fibrillation and an increasing use of NOAC.
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Wiedmann S, Heuschmann PU, Hillmann S, Busse O, Wiethölter H, Walter GM, Seidel G, Misselwitz B, Janssen A, Berger K, Burmeister C, Matthis C, Kolominsky-Rabas P, Hermaneks P. The quality of acute stroke care- an analysis of evidence-based indicators in 260 000 patients. Dtsch Arztebl Int 2015; 111:759-65. [PMID: 25467052 DOI: 10.3238/arztebl.2014.0759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke patients should be cared for in accordance with evidence-based guidelines. The extent of implementation of guidelines for the acute care of stroke patients in Germany has been unclear to date. METHODS The regional quality assurance projects that cooperate in the framework of the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall-Register, ADSR) collected data on the care of stroke patients in 627 hospitals in 2012. The quality of the acute hospital care of patients with stroke or transient ischemic attack (TIA) was assessed on the basis of 15 standardized, evidence-based quality indicators and compared across the nine participating regional quality assurance projects. RESULTS Data were obtained on more than 260 000 patients nationwide. Intravenous thrombolysis was performed in 59.7% of eligible ischemic stroke patients patients (range among participating projects, 49.7-63.6%). Dysphagia screening was documented in 86.2% (range, 74.8-93.1%). For the following indicators, the defined targets were not reached for all of Germany: anti-aggregation within 48 hours, 93.4% (range, 86.6-96.4%); anticoagulation for atrial fibrillation, 77.6% (range, 72.4-80.1%); standardized dysphagia screening, 86.2% (range, 74.8-93.1%); oral and written information of the patients or their relatives, 86.1% (range, 75.4-91.5%). The rate of patients examined or treated by a speech therapist was in the target range. CONCLUSION The defined targets were reached for most of the quality indicators. Some indicators, however, varied widely across regional quality assurance projects. This implies that the standardization of care for stroke patients in Germany has not yet been fully achieved.
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Affiliation(s)
- Silke Wiedmann
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Comprehensive Heart Failure Center (CHFC), University of Würzburg, The Clinical Trial Center, University Hospital Würzburg, German Stroke Society (DSG), Berlin, Office for Quality Assurance in Hospitals (GeQiK), Stuttgart; Baden-Württemberg Hospital Association, Stuttgart, Germany, Department of Neurology, Vivantes-Klinikum Spandau, Berlin, Department of Neurology, Asklepios Klinik Nord, Hamburg, Institute of Quality Assurance Hesse (GQH), Quality Assurance in Stroke Management in North Rhine-Westphalia, Medical Association North Rhine, Quality Assurance Project "Stroke Register Northwest Germany", Institute of Epidemiology and Social Medicine, University of Münster, Institute of Quality Assurance Rhineland-Palatinate / SQMed, Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS), Institute of Social Medicine and Epidemiology, University of Lübeck, Erlangen Community Stroke Registry, Federal Health Reporting (GBE), Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Bavarian Permanent Working Party for Quality Assurance (BAQ), Munich
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Kyvernitakis I, Köhler C, Schmidt S, Misselwitz B, Großmann J, Hadji P, Kalder M. Impact of maternal body mass index on the cesarean delivery rate in Germany from 1990 to 2012. J Perinat Med 2015; 43:449-54. [PMID: 24914711 DOI: 10.1515/jpm-2014-0126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/19/2014] [Indexed: 11/15/2022]
Abstract
AIMS Maternal obesity is a risk factor for cesarean delivery (CD). The aim of this analysis was to determine the association between early-pregnancy body mass index (BMI) and the rate of CD over the past two decades. METHODS We retrospectively analyzed data from the perinatal quality registry of singleton deliveries in the state of Hesse in Germany from 1990 to 2012. We divided the patients into groups according to the WHO criteria for BMI: underweight (<18.5), normal weight (18.5-<25), overweight (25-<30), obese class I (30-<35), obese class II (35-<40), and obese class III (≥40). RESULTS The analysis included 1,092,311 patients with available data regarding maternal BMI and mode of delivery. The CD rates for underweight (<18.5), normal weight (18.5-<25), overweight (25-<30), obese class I (30-<35), obese class II (35-<40), and obese class III (≥40) women increased from 14.4%, 16.1%, 19.5%, 22.3%, 25%, and 26.9% in the year 1990 to 27.9%, 31.4%, 38.8%, 45.1%, 50.2%, and 55.2% in the year 2012, respectively (P<0.001). CONCLUSION Maternal BMI in early pregnancy is linearly associated with the incidence of CD. We found a disproportionate increase of CD in morbidly obese women compared with the CD incidence in the reference BMI population over the past two decades.
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Tanislav C, Milde S, Schwartzkopff S, Misselwitz B, Sieweke N, Kaps M. Baseline characteristics in stroke patients with atrial fibrillation: clinical trials versus clinical practice. BMC Res Notes 2015; 8:262. [PMID: 26108787 PMCID: PMC4480890 DOI: 10.1186/s13104-015-1237-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/17/2015] [Indexed: 11/29/2022] Open
Abstract
Background When applying information gathered from medical research to the clinical setting, it is imperative that the sample of the investigated patients be representative of the clinical population. Because of this fact, it is necessary to closely examine the sample’s baseline characteristics in clinical trials. Methods We analysed baseline data of relevant trials investigating considerable proportions of patients with atrial fibrillation (AF) in the secondary stroke prevention: EAFT, SIFA, Active-W, BAFTA, RE-LY, AVERROES, ARISTOTLE and ROCKET AF. For comparing baseline data stroke patients with AF documented in a statutory stroke registry were considered. In a subgroup of patients (members of a large insurance) data on subsequent prescription for oral anticoagulants (oAK) were available. Results In the stroke registry (n = 15,886) the mean age was higher than in the selected clinical trials (mean 77.7 versus 70–72 years). Among insurance members (n = 1,828), those with a prescription for oAK (n = 827) were older than patients recruited in clinical trials (mean 75.1 versus 70–72 years). Results also showed that the male sex was overrepresented in clinical trials (59–63% versus 46%). The distribution of vascular risk factors in recent clinical trials was comparable to proportions in the registry (hypertension: 77–85% versus 80%; diabetes mellitus: 20–26% versus 27%). Conclusions The majority of stroke patients with AF in the clinical setting are considerably older than those included in clinical trials. While the distribution of vascular risk factors in clinical trials corresponds to proportions observed in clinical practice, an overrepresentation of the male sex in clinical trials is evident.
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Affiliation(s)
- Christian Tanislav
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Sonja Milde
- Dresden International University, Dresden, Germany.
| | | | - Björn Misselwitz
- Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Germany.
| | - Nicole Sieweke
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Manfred Kaps
- Department of Neurology, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
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Reichelt J, Kyvernitakis I, Misselwitz B, Hadji P, Schmidt S, Kalder M. A population based evaluation of the mode of delivery in association with infertility treatment from 1990-2012. Z Geburtshilfe Neonatol 2015; 219:37-44. [PMID: 25734476 DOI: 10.1055/s-0034-1390414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study refers to population based data and investigates the development of the mode of delivery associated with infertility treatment over the last 23 years. METHODS All 1 202,557 deliveries in Hesse, Germany, between 1990 and 2012 were assessed. 2.2% of the study population, 26,761, had a delivery subsequent to infertility treatment based on the Hessian Perinatal Registry (HEPE). An evaluation in this subgroup was performed investigating the associations between the mode of delivery and the gestational week and the mother's age. RESULTS A continuous and significant (p<0.01) increase of cesarean section (CS) rates subsequent to infertility treatment (1990: 41,3%; 2012: 55,9%) as well as a conversely also significant (p<0.01) reduction of vaginal operative and spontaneous deliveries associated with infertility treatment between 1990 and 2012 was found. Furthermore, the preterm delivery rate and the proportion of deliveries of parturients older than 35 years of age in association with infertility treatment raised over the last years. Rates of full-term deliveries and deliveries of women younger than 35 years remained stable during the observation period. DISCUSSION The rate of cesarean section is continuously rising over the last 23 years with regard to parturients subsequent to infertility treatment. The CS rate is significantly higher compared to women with a spontaneous pregnancy and in comparison to the data from 20 years ago. Most recently, the number of CS (51,2%) exceeded the number of vaginal deliveries (48,8%) in Hesse subsequent to infertility treatment for the first time.
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Affiliation(s)
- J Reichelt
- Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - I Kyvernitakis
- Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - B Misselwitz
- GQH, Geschäftsstelle Qualitätssicherung Hessen, Eschborn, Germany
| | - P Hadji
- Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - S Schmidt
- Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
| | - M Kalder
- Gynäkologie und Geburtshilfe, Philipps-Universität Marburg, Marburg, Germany
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