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Ralph P, Schlager D, Lee W, Wafa R, Williamson E, Butler G, Ralph D, Sangster P. Fertility preservation and sperm quality in adolescent transgender patients prior to hormonal treatment. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00726-1] [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: 02/12/2023]
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Merrett C, Schlager D, Yasmin E, Seshadri S, Serhal P, Ralph D, Sangster P. P–128 Audit of testicular sperm in assisted conception for non-azoospermic infertile couples. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.127] [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: 11/13/2022] Open
Abstract
Abstract
Study question
What live birth rate do we see when we use testicular sperm in ART for non-azoospermic couples after at least one previous failed cycle?
Summary answer
In our cohort of couples 24% had a live birth using testicular sperm and therefore was not higher than national average ART rates.
What is known already
There is increased interest in using testicular sperm in assisted reproduction technology (ART) to improve outcomes after previous failed cycles. Mehta et al. reported results of a 50% live birth rate using testicular sperm in the first cycle for couples with oligospermia and a history of failed cycles with ejaculated sperm. We aim to audit our results in a similar population of couples.
Study design, size, duration
St Peters Andrology Centre in London, United Kingdom completed 128 surgical testicular sperm retrievals reviewed between the two-year period of 2018–2019. We conducted a retrospective audit of their paper-based records to identify those couples with injectable sperm on their semen analysis and who had previous cycles attempts using ejaculated sperm.
Participants/materials, setting, methods
We identified 27 couples who underwent testicular sperm extraction despite having an ejaculated semen analysis with injectable sperm and at least one previous failed cycle. A systematic review of their paper and electronic medical record was conducted to assess live birth rates and fertilization rates from ART.
Main results and the role of chance
Couples had an average male age of 41 (range 31–60) and an average female age of 38 (range 30–45). The men had an average serum testosterone of 15 nmol/L (range 8–35 nmol/L) and an average serum FSH of 8.9 IU/L (range 1.7–30 IU/L). 59% (n = 17) of men had a DNA fragmentation index completed with an average score of 41% (range 31%–51[Y1]%). In the women the mean serum anti-Müllerian hormone (AMH) was 15.8 pmol/l (range 1–64 pmol/l). With ejaculated sperm the fertilization rate was 59% (95% CI [27%, 59%]) and blastocyst conversion rate was 43% (95% CI [50%, 69%]). There was no statistical significance with testicular sperm where the fertilization rate was 58% (95% CI [51%, 65%]) and blastocyst conversion rate was 54% (95% CI [40%, 67%]). Overall, there were 7 clinical pregnancies in this population of couples. Of these clinical pregnancies, 2 miscarried and 5 progressed to a live birth. This audit yielded a live birth rate per cycle of 15% and a live birth rate per couple of 24%.
Limitations, reasons for caution
Limitations of the study are low number of patients and absence of a control group.
Wider implications of the findings: We recommend caution and further analysis going forward using testicular sperm in ART where ejaculated sperm in available.
Trial registration number
Not applicable
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Affiliation(s)
- C Merrett
- University College London Hospital, Andrology, London, United Kingdom
| | - D Schlager
- University of Freiburg, Department of Urology, Hugstetter, Germany
| | - E Yasmin
- University College London Hospital, Reproductive Medicine, London, United Kingdom
| | - S Seshadri
- The Centre for Reproductive & Genetic Health, Reproductive Medicine, London, United Kingdom
| | - P Serhal
- University College London Hospital, Reproductive Medicine, London, United Kingdom
| | - D Ralph
- University College London Hospital, Andrology, London, United Kingdom
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Leiber C, Katzenwadel A, Schlager D. [The "right" patient for implant surgery in urology : Why patient selection, informed consent, and communication are so important for patient satisfaction]. Urologe A 2021; 60:732-739. [PMID: 34061221 DOI: 10.1007/s00120-021-01546-0] [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] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
In implant surgery for erectile dysfunction and urinary incontinence, adequate patient selection is essential for postoperative therapy success. Several scientific studies report patient satisfaction rates for penile implants and artificial urinary sphincter implantation of over 90%. Nevertheless, studies also report, that between 5 and 30% of the patients are not satisfied with the result of their operation. Sufficient patient information and consent prior surgical procedure in urological prosthetics are a key determinant for later patient satisfaction and therapy success. Diligent assessment of realistic expectations, possible complications, and risks must be made. Unrealistic and exaggerated expectations need to be met and discussed with the patient. Therefore adequate physician-patient communication is essential. Especially in the case of surgical revision or for patients with risk factors, the probability of complications is higher and may significantly increase later dissatisfaction. Also, the involvement of the partner plays a major role in later patient satisfaction in urological implant surgery. Finally, there is a group of patients for which the risk of later dissatisfaction is particularly high. These are patients with compulsive/obsessive behavior, unrealistic expectations, patients after revision surgery, self-entitled patients, as well as those patients who deny the extent of their illness, visit multiple surgeons (surgeon hopping) or have psychiatric illnesses. These patients are referred to with the acronym "CURSED" patients.
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Affiliation(s)
- C Leiber
- Klinik für Urologie Department Chirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland.
| | - A Katzenwadel
- Klinik für Urologie Department Chirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland
| | - D Schlager
- Klinik für Urologie Department Chirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland
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Merrett C, Schlager D, Yasmin E, Seshadri S, Serhal P, Ralph D, Sangster P. Audit of testicular sperm in assisted conception for non-azoospermic infertile couples. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00891-5] [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: 11/15/2022]
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5
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Schlager D, Sigle A, Suarez-Ibarrola R, Marian P, Gratzke C. Safety and side effects of transperineal prostate biopsy without antibiotic prophylaxis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00535-2] [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: 11/25/2022]
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Schoeb DS, Schwarz J, Hein S, Schlager D, Pohlmann PF, Frankenschmidt A, Gratzke C, Miernik A. Mixed reality for teaching catheter placement to medical students: a randomized single-blinded, prospective trial. BMC Med Educ 2020; 20:510. [PMID: 33327963 PMCID: PMC7745503 DOI: 10.1186/s12909-020-02450-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/11/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Cost-effective methods to facilitate practical medical education are in high demand and the "mixed-reality" (MR) technology seems suitable to provide students with instructions when learning a new practical task. To evaluate a step-by-step mixed reality (MR) guidance system for instructing a practical medical procedure, we conducted a randomized, single-blinded prospective trial on medical students learning bladder catheter placement. METHODS We enrolled 164 medical students. Students were randomized into 2 groups and received instructions on how to perform bladder catheter placement on a male catheterization training model. One group (107 students) were given their instructions by an instructor, while the other group (57 students) were instructed via an MR guidance system using a Microsoft HoloLens. Both groups did hands on training. A standardized questionnaire covering previous knowledge, interest in modern technologies and a self-evaluation was filled out. In addition, students were asked to evaluate the system's usability. We assessed both groups's learning outcome via a standardized OSCE (objective structured clinical examination). RESULTS Our evaluation of the learning outcome revealed an average point value of 19.96 ± 2,42 for the control group and 21.49 ± 2.27 for the MR group - the MR group's result was significantly better (p = 0.00). The self-evaluations revealed no difference between groups, however, the control group gave higher ratings when evaluating the quality of instructions. The MR system's assessment showed less usability, with a cumulative SUS (system usability scale) score of 56.6 (lower half) as well as a cumulative score of 24.2 ± 7.3 (n = 52) out of 100 in the NASA task load index. CONCLUSIONS MR is a promising tool for instructing practical skills, and has the potential to enable superior learning outcomes. Advances in MR technology are necessary to improve the usability of current systems. TRIAL REGISTRATION German Clinical Trial Register ID: DRKS00013186.
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Affiliation(s)
- D. S. Schoeb
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - J. Schwarz
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - S. Hein
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - D. Schlager
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - P. F. Pohlmann
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - A. Frankenschmidt
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - C. Gratzke
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - A. Miernik
- Department of Urology, Faculty of Medicine, Medical Center – University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
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Schlager D, Lee W, Williamson E, Wafa R, Ralph D, Sangster P. Fertility preservation and sperm quality in adolescent transgender patients prior to hormonal treatment. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32921-9] [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: 10/23/2022] Open
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Schlager D, Chierigo F, Cakir O, Ralph D, Leiber C. HP-9-1 Autophotography Underestimates Clinical Extent of Peyronie's Disease for Penile Deformity Assessment. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.149] [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: 11/15/2022]
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9
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Schlager D, Lee W, Wafa R, Williamson E, Ralph D, Sangster P. P-06-12 Fertility Preservation and Sperm Quality in Transgender Patients Prior to Hormonal Treatment. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.355] [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: 10/24/2022]
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Herden J, Ebert T, Schlager D, Pretzer J, Zumbé J, Sommerfeld HJ, Schafhauser W, Kriegmair M, Garcia Schürmann M, Distler F, Baur H, Oberpenning F, Reimann M, Schmidt S, Laabs S, Planz B, Gronau E, Platz G, Göll A, Buse S, Jones J, Haupt G, Waldner M, Heidenreich A, Khaljani E, Rübben H, Schultze-Seemann W, Weib P. [Treatment mapping of lower urinary tract symptoms due to benign prostatic hyperplasia-an analysis of the Governing Body of German Prostate Centers]. Urologe A 2020; 59:1082-1091. [PMID: 32274545 DOI: 10.1007/s00120-020-01192-y] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND Due to the high incidence and demographic development, there is an urgent need for healthcare research data on lower urinary tract symptoms due to benign prostatic hyperplasia (LTUS/BPH). Since 2005 the Governing Body of German Prostate Centers (DVPZ) has been collecting data from 22 prostate centers in order to determine the quality and type of cross-sectoral care in particular for LUTS/BPH patients. OBJECTIVES Presentation of the DVPZ database in general, as well as an investigation of treatment patterns for medical and instrumental therapies. MATERIALS AND METHODS The analysis is based on UroCloud data sets from 30 November 2017. In the UroCloud data on diagnostics, therapy and course of disease are recorded in a web-based manner. RESULTS A total of 29,555 therapies were documented for 18,299 patients (1.6/patient), divided into 48.5% instrumental, 29.2% medical treatment, and 18.0% "wait and see" (in 4.3% no assignment was possible). Patients treated with an instrumental therapy were oldest (median: 72 years, interquartile range: 66-77), had the largest prostate volumes (50 ml, 35-75 ml), and were mostly bothered by symptoms (International Prostate Symptom Score = 19/4). The majority of patients under medical treatment received alphablockers (56%); phytotherapeutics were used least frequently (3%). Instrumental therapies are dominated by transurethral resection (TUR) of the prostate (60.0%), open prostatectomy (9.4%) and laser therapy (5.0%), with laser therapy having the shortest hospital stay (5 days) and the lowest transfusion and re-intervention rates (1.0% and 4.6%, respectively). CONCLUSIONS The DVPZ certificate covers the complete spectrum of cross-sectoral care for LUTS/BPH patients and documents the use of the various therapies as well as their application and effectiveness in the daily routine setting.
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Affiliation(s)
- J Herden
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland. .,Prostatazentrum Köln, Campus Universitätsklinikum, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Ebert
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland.,Prostatazentrum Metropolregion Nürnberg, Nürnberg, Deutschland
| | - D Schlager
- Prostatazentrum Freiburg, Freiburg, Deutschland
| | - J Pretzer
- Berliner Prostatazentrum, Berlin, Deutschland
| | - J Zumbé
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland.,Prostatazentrum Leverkusen, Leverkusen, Deutschland
| | | | - W Schafhauser
- Prostatazentrum Hochfranken-Fichtelgebirge, Marktredwitz, Deutschland
| | - M Kriegmair
- Prostatazentrum Urologie Centrum München, Planegg, Deutschland
| | | | - F Distler
- Prostatazentrum Nürnberg-Mittelfranken, Nürnberg, Deutschland
| | - H Baur
- Prostatazentrum Nymphenburg, München, Deutschland
| | | | - M Reimann
- Prostatazentrum Moers, Moers, Deutschland
| | - S Schmidt
- Prostatazentrum Rhein-Ruhr, Oberhausen, Deutschland
| | - S Laabs
- Prostatazentrum Elbe-Weser, Stade, Deutschland
| | - B Planz
- Prostatazentrum Emscher-Lippe, Gladbeck, Deutschland
| | - E Gronau
- Prostatazentrum Münsterland, Münster, Deutschland
| | - G Platz
- Prostatazentrum Mainspitze, Rüsselsheim, Deutschland
| | - A Göll
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland.,Prostatazentrum Alfred Krupp Krankenhaus, Essen, Deutschland
| | - S Buse
- Prostatazentrum Alfred Krupp Krankenhaus, Essen, Deutschland
| | - J Jones
- Prostatazentrum Hochtaunus, Bad Homburg, Deutschland
| | - G Haupt
- Prostatazentrum Speyer, Speyer, Deutschland
| | - M Waldner
- Prostatazentrum Köln, Campus Hohenlind, Köln, Deutschland
| | - A Heidenreich
- Prostatazentrum Köln, Campus Universitätsklinikum, Kerpener Str. 62, 50937, Köln, Deutschland
| | - E Khaljani
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland
| | - H Rübben
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland
| | - W Schultze-Seemann
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland.,Prostatazentrum Freiburg, Freiburg, Deutschland
| | - P Weib
- Dachverband der Prostatazentren Deutschlands e. V., Berlin, Deutschland.,Kompetenznetz Prostata Siegen, Siegen, Deutschland
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Schlager D, Schütz J, Brandenburg A, Miernik A. Automated stone/tissue autofluorescence analysis in real-time – an ex vivo evaluation of an intelligent laser lithotripsy system. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/s1569-9056(18)32236-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schneidewind L, Kranz J, Schlager D, Pelzer AE. [Nationwide survey among institutes of microbiology in academic medicine : Is the interdisciplinary approach the right way to treat patients with urogenital infections?]. Urologe A 2017; 56:779-784. [PMID: 28144694 DOI: 10.1007/s00120-017-0328-1] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing antibiotic resistance is a current and severe problem in medicine, especially in urology. Multidisciplinary antibiotic stewardship programmes are an important approach to counteract increasing resistance rates. This approach includes collaboration between urologists and microbiologists. OBJECTIVES The primary endpoint was to describe the current setting of interdisciplinary work of urologists and microbiologists in university hospitals in Germany. The secondary endpoints were the identification of problems of this interdisciplinary approach in daily routine and implications for the future in patient treatment. MATERIALS AND METHODS A newly developed, 24-item questionnaire was sent to 34 German microbiology departments at medical universities between June and October 2016; the departments were contacted up to four times. Only complete questionnaires were included in our analysis. RESULTS The response rate was 50.0%. In the majority of the urological cases a microbiologist was only contacted sporadically and asked for advice, but on the other hand most of the microbiologists think that this contact and discussion about the patient is reasonable and preferable. Of the respondents, 82.4% think that with a consequent interdisciplinary approach there might be lower antibiotic resistance rates in the future. One essential problem of ideal microbial diagnostics and therapeutic advice is that the microbiologist does not receive all relevant information upon request. This might be the case in up to 76.5%. Other problems are of economic nature or shortage of manpower. CONCLUSION Interdisciplinary patient care between urologists and microbiologists is reasonable and preferable. This approach has the potential of decreasing antibiotic resistance rates in the future.
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Affiliation(s)
- L Schneidewind
- Institut für Virologie, Universitätsklinikum des Saarlandes Universität des Saarlandes, Kirrberger Straße 100, 66424, Homburg/Saar, Deutschland.
| | - J Kranz
- St.-Antonius-Hospital Eschweiler, Klinik für Urologie und Kinderurologie, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - D Schlager
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg (Brsg.), Deutschland
| | - A E Pelzer
- Klinik für Urologie, Hospital Wels-Grieskirchen, Wels, Österreich
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Walker D, Kabitz HJ, Schwörer A, Schlager D, Walterspacher S, Storre JH, Röcker K, Windisch W, Verges S, Spengler C. Biometrische Abschätzung der Zwerchfell-Kontraktilität während normokapnischer Hyperpnoe. Pneumologie 2013. [DOI: 10.1055/s-0033-1334642] [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: 10/27/2022]
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Walker D, Walterspacher S, Schlager D, Ertl T, Röcker K, Windisch W, Kabitz HJ. Charakteristika der Zwerchfellermüdung während körperlicher Ausbelastung. Pneumologie 2013. [DOI: 10.1055/s-0033-1334675] [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: 10/27/2022]
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15
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Walker D, Ertl T, Walterspacher S, Schlager D, Windisch W, Kabitz HJ. Verlauf der Atemmuskelfunktion während eines mehrwöchigen Atemmuskeltrainings. Pneumologie 2013. [DOI: 10.1055/s-0033-1334645] [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: 10/27/2022]
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Walterspacher S, Schlager D, Walker D, Müller-Quernheim J, Windisch W, Kabitz HJ. Atemmuskelfunktion bei interstitiellen Lungenerkrankungen. Pneumologie 2013. [DOI: 10.1055/s-0033-1334511] [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: 10/27/2022]
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17
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Kabitz HJ, Walker D, Schwörer A, Walterspacher S, Sonntag F, Schlager D, Röcker K, Windisch W. Kompensation der Zwerchfell-Ermüdung während körperlicher Ausbelastung. Pneumologie 2010. [DOI: 10.1055/s-0030-1251113] [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: 10/19/2022]
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Abstract
As emergency physicians become familiar with the use of ultrasonography, this safe procedure will likely become a standard technique having multiple uses in the emergency department. Ultrasonography assists in foreign body localization and retrieval and is potentially important in applications, such as reliable endotracheal tube placement, visualization of ingested medication, vascular access, and drainage of collected fluids.
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Affiliation(s)
- D Schlager
- Department of Emergency Medicine, San Francisco, California, USA
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Abstract
STUDY OBJECTIVE To evaluate the safety of using ultrasound to image exploding bullets that have not detonated. METHODS We evaluated various types of exploding bullets using ultrasonography at various depths with various transducers and using standard radiography. RESULTS None of the unexploded bullets subjected to ultrasonography or standard radiography exploded. CONCLUSION Our results suggest that evaluation of exploding bullets with ultrasonography is safe.
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Affiliation(s)
- D Schlager
- Department of Emergency Medicine, Kaiser Permanente Medical Center, Santa Rosa, California, USA
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Schlager D. Evolutionary perspectives on paranoid disorder. Psychiatr Clin North Am 1995; 18:263-79. [PMID: 7659598] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Certain subtypes of DD may represent abnormal forms of previously well-characterized, content-specific behaviors that represent evolved adaptations to challenges of social interaction and mating. Such rare delusional states may be manifestations of an adaptive hypersensitivity to important environmental threats or opportunities, or may be a byproduct of behavioral misfiring triggered by unfamiliar environmental cues or perceptions.
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Affiliation(s)
- D Schlager
- Department of Psychiatry and Behavioral Science, School of Medicine, State University of New York at Stony Brook, USA
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Abstract
This study of primary care patients sought to estimate the prevalence of and functional impairment associated with winter-seasonal depression. Three hundred three patients visiting a primary care clinic in January or February were assessed for seasonal patterns of health change, current DSM-III-R major depressive disorder (MDD), and current functional status. Approximately 9% of patients met criteria for MDD with winter-seasonal pattern, and an additional 29% reported seasonal mood changes without meeting criteria for current MDD. Multivariate analysis revealed that the functional impairment associated with such winter seasonality exceeded that associated with any of the common chronic medical conditions measured, and that such dysfunction was evident even in the absence of a diagnosable depressive disorder (MDD). Winter-seasonal pain was reported by one quarter of the overall sample and by half of those with current MDD, supporting preliminary reports that pain may be a common presenting symptom in seasonal affective disorder. The findings suggest that efforts at detection and treatment of such syndromes in primary care settings would be justified.
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Affiliation(s)
- D Schlager
- Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook 11794-8101
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Abstract
The objective of this study was to examine the use of limited, goal-directed, two-dimensional ultrasound studies performed by emergency physicians and to assess the frequency, variety, and accuracy of their readings. A 1-year prospective study was performed by using an emergency department (ED) ultrasound machine with a 3.5-mHz mechanical oscillating sector transducer and a 5.0-mHz vaginal transducer. In a series of proctoring sessions, radiologists trained emergency physicians to do limited, goal-directed ultrasonography. Laser print ultrasonograms were collected from all ED ultrasound examinations performed during a 1-year period and were compared with either formal ultrasonograms performed in the radiology department, the patient's hospital record, or both. Sensitivity, specificity, and positive predictive value (PPV), as well as negative predictive values (NPV), were calculated. The setting was a 104-bed community hospital with an ED volume of 25,000 patients annually, and patients whom the emergency physician believed needed ultrasound studies in the ED were entered. ED ultrasonography was performed in 167 patients by 14 physicians during a 1-year period. For 132 patients who completed formal follow-up, the overall diagnostic accuracy of interpretations of ED ultrasonograms yielded a sensitivity of .95, specificity of .98, PPV of .99, and NPV of .89. Eleven categories of ultrasound use were reported. The three studies most commonly performed were for gallbladder disease (53%), intrauterine pregnancy (28%), and abdominal aortic aneurysms (7%). Accuracy of ED gallbladder ultrasonograms for 65 patients showed a sensitivity of .86, specificity of .97, PPV of .97, and NPV of .85.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Schlager
- Department of Emergency Medicine, Kaiser Permanente Medical Center, Santa Rosa, CA
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Abstract
Among a large workplace population interviewed over a year, current symptoms were assessed using the Hopkins Symptom Checklist (HSCL). Variation in symptoms by date of assessment was observed among the 314 women but not the 1556 men. Among women, symptoms were greatest during late autumn and winter, and significant inverse correlations were found between available daylight at the time of assessment and standard symptom dimensions of anxiety and somatisation, as well as an expanded mood scale more inclusive of depressive symptoms within the check-list. The amplitude of the seasonal effect was such that the prevalence of female 'cases', as defined by HSCL criteria, was twice as high during winter than during the rest of the year. The data are consistent with a role for light-dark exposure in eliciting or synchronizing annual mood rhythms. The sex-by-season interactions may contribute to the sex differences in overall prevalence of depression.
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Affiliation(s)
- D Schlager
- State University of New York at Stony Brook 11794-8101
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25
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Abstract
STUDY OBJECTIVE To determine the ability of an emergency physician to detect a variety of foreign bodies in an experimental model using a portable ultrasound device. DESIGN Ten pieces of beef were sliced into cubes approximately 6 cm on each side. Six different groups of foreign bodies were examined: gravel, cactus spine, glass, metal, wood, and plastic. An independent observer placed the objects in a random fashion into the beef cubes. One hundred twenty observations were made using sets of ten beef cubes at a time. Five foreign bodies were placed into each set of ten beef cubes. INTERVENTIONS A blinded emergency physician used a portable ultrasound with a 7.5-MHz transducer to determine the presence or absence of a foreign body in each cube. MEASUREMENTS AND MAIN RESULTS Ultrasound detected 59 of 60 foreign bodies, including all cubes of meat embedded with gravel, cactus spine, plastic, metal, and wood. Glass was detected nine of ten times. Of the 60 cubes of meat with no foreign bodies, one false-positive was recorded. This yielded sensitivity, specificity, positive predictive value, and negative predictive value of 98%. Positive determinations by ultrasound were significantly greater in the meat cubes with foreign bodies compared with the control group with no foreign bodies (P less than .001 by chi 2). Although the subset of glass foreign bodies had one false-positive and one false-negative, it was not significantly different in comparison with the other groups (P greater than .05 by chi 2). CONCLUSION Ultrasound has promise as a diagnostic tool for the detection of a variety of foreign bodies. Further clinical studies using ultrasound for the detection of foreign bodies are warranted.
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Affiliation(s)
- D Schlager
- Section of Emergency Medicine, College of Medicine, University of Arizona, Tucson 85724
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26
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Affiliation(s)
- M Terman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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27
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Abstract
Historically, burn treatment in Denmark has included several unique elements. Current Danish treatment includes prolonged tap water irrigation of burns, which largely replaces the use of narcotics for pain control in both the inpatient and outpatient settings. Burns on hands and feet are dressed for maximum mobility. Other burns are left open. Mortality is 10% to 15% below expectations.
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Affiliation(s)
- D Schlager
- Section of Emergency Medicine, University of Arizona College of Medicine, Tucson 85724
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28
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Lee YS, Dickinson DB, Schlager D, Velu JG. Antigen E content of pollen from individual plants of short ragweed (Ambrosia artemisiifolia). J Allergy Clin Immunol 1979; 63:336-9. [PMID: 429713 DOI: 10.1016/0091-6749(79)90128-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A study was conducted to ascertain how much variation in allergenic potency of ragweed pollen occurs among individual plants and different plant populations in a restricted geographic area. Seeds of the short ragweed (Ambrosia artemisiifolia) were collected from 38 different sites in Champaign County, Ill. Plants from these seeds were grown under similar conditions, and antigen E (AgE) was determined on pollen samples harvested from individual plants. The populations from various sites in Champaign County differed by as much as severalfold with respect to mean AgE values. There were statistically significant differences among population means, although large variations occurred among plants within populations. Further research was conducted to learn whether the level of AgE was determined by genetic factors within the plants. Genetic regulation was indicated by the finding that 3 plants which had unusually low levels of pollen AgE all produced offspring with significantly lower mean AgE levels than those of control plants.
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