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Wacker-Gussmann A, Schopen J, Engelhard J, Sitzberger C, Lienert N, Ewert P, Müller A, Schmidt G, Oberhoffer-Fritz R, Lobmaier SM. The Impact of Gestational Diabetes in Pregnancy on the Cardiovascular System of Children at One Year of Age. J Clin Med 2021; 10:jcm10245839. [PMID: 34945134 PMCID: PMC8707570 DOI: 10.3390/jcm10245839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/17/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication in pregnancy. The effect of GDM on the cardiovascular system after birth is still unclear. Between August 2015 and December 2018, 205 pregnant women were included in the prospective controlled observational study. Patients with GDM were assigned to the study group (n = 99), whereas (n = 107) healthy women served as controls. Postnatal follow up of their offspring was performed at 12 months of age. All included children (n = 125) underwent a specific standardized protocol including anthropometric data, such as weight, height, body mass index (BMI), blood pressure (BP) recordings and ultrasound measurements of the abdominal aortic intima-media-thickness (IMT). Furthermore, at least 10 min 3-channel electrocardiogram recording was done to evaluate the autonomic nervous system (ANS) by phase rectified signal averaging. There were no significant differences in anthropometric data between the groups, neither in the blood pressure nor in the intima-media-thickness of the aorta abdominals. However, in the study group, significantly lower average acceleration capacity (AAC) (study group −20.10 ± 3.04 ms, control group −18.87 ± 4.00 ms, p = 0.02) was found, indicating ANS activation at one year of age. Further studies are required to determine if these results are persistent and if these findings have long-term effects.
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Affiliation(s)
- Annette Wacker-Gussmann
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
- German Heart Center, Department of Congenital Heart Disease and Pediatric Cardiology, 80663 Munich, Germany; (J.S.); (P.E.)
- Correspondence:
| | - Judith Schopen
- German Heart Center, Department of Congenital Heart Disease and Pediatric Cardiology, 80663 Munich, Germany; (J.S.); (P.E.)
| | - Jana Engelhard
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Christina Sitzberger
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Nadine Lienert
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Peter Ewert
- German Heart Center, Department of Congenital Heart Disease and Pediatric Cardiology, 80663 Munich, Germany; (J.S.); (P.E.)
| | - Alexander Müller
- Department of Adult Cardiology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.M.); (G.S.)
| | - Georg Schmidt
- Department of Adult Cardiology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.M.); (G.S.)
| | - Renate Oberhoffer-Fritz
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Silvia Maria Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
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Sitzberger C, Oberhoffer-Fritz R, Freiberger A, Brössner A, Engelhard J, Felberbaum R, Wacker-Gußmann A. Cardiovascular risks of children conceived by assisted reproductive technologies: a systematic review. Gynäkologische Endokrinologie 2021. [DOI: 10.1007/s10304-021-00386-7] [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: 10/21/2022]
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Diel R, Obradovic M, Tyler S, Engelhard J, Kostev K. Real-world treatment patterns in patients with nontuberculous mycobacterial lung disease in general and pneumologist practices in Germany. J Clin Tuberc Other Mycobact Dis 2020; 20:100178. [PMID: 32802970 PMCID: PMC7419666 DOI: 10.1016/j.jctube.2020.100178] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Nontuberculous mycobacterial lung disease (NTMLD) is a rare, progressive disease with an increasing incidence worldwide. Aims The aim of this retrospective study was to analyze the baseline characteristics and management of NTMLD in general and pneumologist practices in Germany. Methods This retrospective study included patients with a culture-confirmed diagnosis of NTMLD documented between October 1, 2014 and September 30, 2019 by 125 general practitioners (GP) and 31 office-based pulmonologists from the IMS Disease Analyzer Database (IQVIA). Results A total of 159 patients managed by German GPs (mean age 59 ± 19 years, 51% female) and 236 patients managed by pulmonologists (mean age 62 ± 14 years, 58% female) were analyzed. In total, 45% (72/159) and 40% (94/236) of patients managed by GPs and pulmonologists respectively received antibiotic therapy for NTMLD. This therapy lasted for ≥ 6 months in 42%, for ≥ 12 months in 24%, and ≥ 18 months in 8% of patients. The average therapy duration was longer in patients treated by pulmonologists (241 ± 196 days) than in patients treated by GPs (113 ± 152 days). A total of 27% of patients managed by GPs and 45% of those managed by pulmonologists respectively received guideline-based therapy (GBT), defined as combination therapy with macrolide (azi-/ clarithromycin) + ethambutol + rifabutin/rifampicin, at least once; however, almost all patients (100% in the GP group, 96% in the pulmonologist group) also received non-GBT regimens intermediately. Conclusions A considerable number of patients with NTMLD were not managed in accordance with the German guidelines and a substantial proportion also discontinue therapy prematurely. NTMLD management should be improved through appropriate referral pathways and collaboration between expert centers and primary or secondary care physicians.
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Affiliation(s)
- R Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
| | | | - S Tyler
- Insmed Germany GmbH, Frankfurt, Germany
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Wachter R, Balas B, Klebs S, Kap E, Engelhard J, Fonseca AF, Schlienger R, Dworak M, Bruce Wirta S. P907Titration patterns and clinical characteristics of patients prescribed sacubitril/valsartan in the primary care and cardiology settings in Germany. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p907] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Wachter
- Universitätsklinikum Leipzig, Leipzig, Germany
| | - B Balas
- Novartis Pharma AG, Basel, Switzerland
| | - S Klebs
- Novartis Pharma GmbH, Nuremberg, Germany
| | - E Kap
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | - J Engelhard
- IQVIA Germany (IQVIA Commercial GmbH & Co. OHG), Frankfurt, Germany
| | | | | | - M Dworak
- Novartis Pharma GmbH, Nuremberg, Germany
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Klebs S, Balas B, Grunow S, Schindler M, Engelhard J, Proenca C, Calado F, Schlienger R, Dworak M, Bruce Wirta S. P4395Characteristics of patients with heart failure prescribed sacubitril/valsartan in the primary care setting in Germany. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4395] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bruce Wirta S, Klebs S, Grunow S, Schindler M, Engelhard J, Proenca C, Calado F, Schlienger R, Dworak M, Balas B. P608Characteristics of patients with heart failure prescribed sacubitril/valsartan in the primary care and cardiology settings in Germany. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p608] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kostev K, Schröder-Bernhardi D, Bode-Greuel K, Engelhard J. Einfluss der Compliance auf die Qualität der Einstellung von Patienten mit Typ-2-Diabetes mellitus in primärärztlichen Praxen in Deutschland. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549708] [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]
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Scheerer MF, Meng A, Engelhard J, Rist R, Proske O. Wirksamkeit von Dapagliflozin unter Alltagsbedingungen bei Patienten mit Typ 2 Diabetes mellitus in Deutschland. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549604] [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]
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Kostev K, Schröder-Bernhardi D, Bode-Greuel K, Engelhard J. Compliance von Patienten mit Typ-2-Diabetes mellitus in primärärztlichen Praxen in Deutschland. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549707] [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]
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Kalousidou N, Kyvernitakis I, Waehlert L, Engelhard J, Kostev K, Ziller V. [Pregnancy after breast cancer in germany - results of a retrospective database analysis]. Z Geburtshilfe Neonatol 2015; 219:176-80. [PMID: 25723470 DOI: 10.1055/s-0034-1395539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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 After the establishment of the FertiPROTEKT network in 2006, an impetus for possibilities of pregnancy during and after breast cancer was introduced. Nowadays, breast cancer survivors are confronted with the question how often women become pregnant after breast cancer and whether there have been significant changes in this respect during the past 10 years. The aim of the study was, therefore, to examine the change in frequency of pregnancies after breast cancer treatment and the time from the first breast cancer diagnosis to pregnancy over one decade, i. e., the period from 2010-2012 compared to the period from 2000-2002. METHODS The study is based on data from the IMS Disease Analyzer database, which enables access to anonymous data from registered physicians. Data from 102 gynecological practices were available for the present study. The study included women aged 20-45 with breast cancer. RESULTS A total of 179 pregnant women were included in this study from 2000-2002 and 2010-2012. 65 pregnancies were recorded in the period from 2000-2002, 114 pregnancies from 2010-2012. The time interval from the breast cancer diagnosis to pregnancy (analysed time period was 10 years) was 896 days (SD: 690) in the period from 2000-2002 and 552 days (SD: 696) in the period from 2010-2012 (p<0.001). CONCLUSION There was a significant increase in pregnancies within the first 2 years after the breast cancer diagnosis. These data are consistent with the intensified consultations after the introduction of the FertiPROTEKT network.
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Affiliation(s)
- N Kalousidou
- Hochschule Fresenius, Gesundheitsökonomie, Idstein
| | - I Kyvernitakis
- Universitätsklinikum Marburg - Zentrum f. Frauenheilkunde und Geburtshilfe, Marburg
| | - L Waehlert
- Hochschule Fresenius, Gesundheitsökonomie, Idstein
| | - J Engelhard
- IMS Health, Abt. Epidemiologie, Frankfurt am Main
| | - K Kostev
- IMS Health, Abt. Epidemiologie, Frankfurt am Main
| | - V Ziller
- Universitätsklinikum Marburg - Klinik für Gynäkologie und gynäkologische Endokrinologie, Marburg
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Waehlert L, Rex J, Engelhard J, Altmann V, Kostev K. Comparing Quality Effects Of Patient Care In Integrated And Regular Care For Patients With Hypertension. Value Health 2014; 17:A498. [PMID: 27201502 DOI: 10.1016/j.jval.2014.08.1490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- L Waehlert
- Fresenius University of applied sciences, Idstein, Germany
| | - J Rex
- IMS Health, Frankfurt am Main, Germany
| | | | - V Altmann
- IMS Health, Frankfurt am Main, Germany
| | - K Kostev
- IMS Health, Frankfurt am Main, Germany
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Garcia Alvarez L, Rathmann W, Bode-Greuel K, Engelhard J, Bush S, Schröder-Bernhardi D, Hiller J. Using an Innovative Approach to Build a Prospective Diabetes Cohort Registry of Patients With Type 2 Diabetes in Germany: DIAREG. Value Health 2014; 17:A553-A554. [PMID: 27201810 DOI: 10.1016/j.jval.2014.08.1813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - W Rathmann
- German Diabetes Center, Duesseldorf, Germany
| | | | | | - S Bush
- AstraZeneca, Hamburg Area, Germany
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Kostev K, Rex J, Engelhard J, Altmann V, Ehlken B, Rockel T, Kalder M. Treatment Discontinuation In Patients With Urinary Incontinence Suffering From Glaucoma. Value Health 2014; 17:A471. [PMID: 27201351 DOI: 10.1016/j.jval.2014.08.1337] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K Kostev
- IMS Health, Frankfurt am Main, Germany
| | - J Rex
- IMS Health, Frankfurt am Main, Germany
| | | | - V Altmann
- IMS Health, Frankfurt am Main, Germany
| | - B Ehlken
- IMS Health Germany, Munich, Germany
| | - T Rockel
- IMS Health, Frankfurt am Main, Germany
| | - M Kalder
- University Hospital of Gießen and Marburg, Marburg, Germany
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Kostev K, Ehlken B, Rex J, Engelhard J, Altmann V, Heilmaier C. Which Adverse Effects Influence the Dropout Rate in Selective Serotonin Reuptake Inhibitor (Ssri) Treatment? Value Health 2014; 17:A460. [PMID: 27201286 DOI: 10.1016/j.jval.2014.08.1272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K Kostev
- IMS Health, Frankfurt am Main, Germany
| | - B Ehlken
- IMS Health Germany, Munich, Germany
| | - J Rex
- IMS Health, Frankfurt am Main, Germany
| | | | - V Altmann
- IMS Health, Frankfurt am Main, Germany
| | - C Heilmaier
- FOM University of Applied Sciences, Essen, Germany
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Kostev K, Rex J, Engelhard J, Altmann V, Jockwig A. Prevalence of Chronic Diseases Among Older Patients (>65 Years) in German General Practitioner Practices. Value Health 2014; 17:A505. [PMID: 27201541 DOI: 10.1016/j.jval.2014.08.1532] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K Kostev
- IMS Health, Frankfurt am Main, Germany
| | - J Rex
- IMS Health, Frankfurt am Main, Germany
| | | | - V Altmann
- IMS Health, Frankfurt am Main, Germany
| | - A Jockwig
- Fresenius University of Applied Sciences, Idstein, Germany
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Schriefer J, Engelhard J, DiCesare L, Miller M, Schriefer J. Merging clinical pathway programs as part of overall health system mergers: a ten-step guide. Spectrum Health. Jt Comm J Qual Improv 2000; 26:29-38. [PMID: 10677820 DOI: 10.1016/s1070-3241(00)26003-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mergers, acquisitions, and reorganizations can be stressful and accompanied by ambivalence, confusion, and uncertainty. Providing clear and simple steps for merging clinical pathways may help organizations move through the transition process more smoothly. The ten steps according to which Spectrum Health merged its pathway program-conduct an inventory of previous efforts, plan for the ideal program, bring staff together early in the merger process, decide on a common format, standardize the development and revision process, standardize a reporting tool, create a clinical pathway manual, implement an educational plan, present the program to key customers, and appoint an advisory group-need not be done sequentially. The ten-step pathway merger program uses pathways as a means to improve the quality of the care provided, with a focus on multidisciplinary clinical pathway teamwork. Before the merger, the two hospital systems' pathway programs used different approaches to operations and pathway format. When the announcement to merge came in September 1997, steps to merge the clinical pathway programs began. DISCUSSION More than two years into the merger, Spectrum Health continues to struggle with the evolution of the health system. Clinical pathways represent just one of the significant and extensive issues related to organizational mergers; organizational values, finances, vision, mission, customer relations, strategic priorities, and people issues are a few of the others. Focusing on merging programs such as clinical pathway programs can help put one large piece of the merger puzzle in place and reduce some of the ambiguity associated with all mergers. Executive support is critical to the success of the clinical pathway program.
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Affiliation(s)
- J Schriefer
- Spectrum Health, Grand Rapids, MI 49503-2560, USA.
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Shalev E, Weiner E, Tzabari A, Engelhard J, Zuckerman H, Shalev J, Serr DM. Breast stimulation in late pregnancy. Effect on prostaglandin secretion. Gynecol Obstet Invest 1990; 29:125-7. [PMID: 2335311 DOI: 10.1159/000293317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The effect of breast stimulation on the prostaglandin secretion was tested in 13 patients at 38-40 weeks of gestation. Uterine contractions following breast stimulation were documented in all cases. There was an increase in prostaglandin metabolite levels 10 min after breast stimulation.
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Affiliation(s)
- E Shalev
- Department of Obstetrics and Gynecology, Central Emek Hospital, Afula, israel
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Engelhard J, Krüger K, Gottaut H. Investigation of the impurities and fission products in the AVR coolant gas at an average hot-gas temperature of 950°C. Nuclear Engineering and Design 1975. [DOI: 10.1016/0029-5493(75)90158-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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