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Tralau T, Oelgeschläger M, Kugler J, Bloch D, Braeuning A, Burgdorf T, Marx-Stoelting P, Ritz V, Schmeisser S, Trubiroha A, Zellmer S, Luch A, Schönfelder G, Solecki R, Hensel A. A prospective whole-mixture approach to assess risk of the food and chemical exposome. ACTA ACUST UNITED AC 2021; 2:463-468. [PMID: 37117676 DOI: 10.1038/s43016-021-00316-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/07/2021] [Indexed: 12/22/2022]
Abstract
Many widely used chemicals result in ubiquitous human exposure from multiple sources, including diet. Legislation mainly deals with the toxicological evaluation of single substances owing to a methodological and conceptual lack of alternatives, and does so within defined silos subject to over 40 distinct regulations in the EU alone. Furthermore, much of the research and many of the initiatives concerned with the assessment and evaluation of chemical mixtures and their potential effects on human health rely on retrospective analysis. Here we propose an approach for the prospective identification, assessment and regulation of mixtures relevant to human health. We address two distinct aspects of toxicology-which chemicals actually do occur together, and how potential mixture-related health hazards can be predicted-with an adapted concept of the exposome and large-scale hazard screens. The proactive use of the likelihood of co-exposure, together with the new approach of methods-based testing, may be a timely and feasible way of identifying those substances and mixtures where hazards may have been overlooked and regulatory action is needed. Ideally, we would generate co-exposure patterns for specific consumer groups, depending on lifestyle and dietary habits, to assess the specific risk of identified mixtures.
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Derderian CK, Derderian CA, Fernandez A, Glover CD, Goobie S, Hansen JK, King M, Kugler J, Lang SS, Meier-Haran P, Nelson O, Reddy SK, Reid R, Ricketts K, Rottgers SA, Singh D, Szmuk P, Taicher BM, Taylor J, Stricker PA. The Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference Methodology. Paediatr Anaesth 2021; 31:145-149. [PMID: 33174262 DOI: 10.1111/pan.14066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/23/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This article describes the methodology used for the Pediatric Craniofacial Collaborative Group (PCCG) Consensus Conference. DESIGN This is a novel Consensus Conference of national experts in Pediatric Craniofacial Surgery and Anesthesia, who will follow standards set by the Institute of Medicine and using the Research and Development/University of California, Los Angeles appropriateness method, modeled after the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Topics related to pediatric craniofacial anesthesia for open cranial vault surgery were divided into twelve subgroups with a systematic review of the literature. SETTING A group of 20 content experts met virtually between 2019 and 2020 and will collaborate in their selected topics related to perioperative management for pediatric open cranial vault surgery for craniosynostosis. These groups will also identify where future research is needed. CONCLUSIONS Experts in pediatric craniofacial surgery and anesthesiology are developing recommendations on behalf of the Pediatric Craniofacial Collaborative Group for perioperative management of patients undergoing open cranial vault surgery for craniosynostosis and identifying future research priorities.
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Affiliation(s)
- Courtney K Derderian
- Department of Anesthesia and Pediatric Anesthesia, University of Texas Southwestern, Children's Medical Center, Dallas, TX, USA
| | - Christopher A Derderian
- Department of Plastic Surgery and Craniofacial Surgery, University of Texas Southwestern, Children's Medical Center, Dallas, TX, USA
| | - Allison Fernandez
- Department of Anesthesia and Perioperative and Pain Medicine, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Chris D Glover
- Department of Anesthesia and Pediatric Anesthesia, Baylor University School of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Susan Goobie
- Department of Anesthesia and Pediatric Anesthesia, Harvard University School of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Jennifer K Hansen
- Department of Anesthesiology, Pediatric Division, Department of Anesthesiology, The University of Kansas Health System, Kansas City, KS, USA
| | - Michael King
- Department of Anesthesiology and Pediatric Anesthesiology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jane Kugler
- Department of Anesthesiology, Boys Town National Research Hospital, Omaha, NE, USA
| | - Shih-Shan Lang
- Department of Neurosurgery and Pediatric Neurosurgery, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Petra Meier-Haran
- Department of Anesthesia and Pediatric Anesthesia, Harvard University School of Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Olivia Nelson
- Department of Anesthesia and Pediatric Anesthesia, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Srijaya K Reddy
- Department of Anesthesia and Pediatric Anesthesia, University of Vanderbilt School of Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Russell Reid
- Department of Plastic and Reconstructive Surgery, University of Chicago School of Medicine, Comer Children's Hospital, Chicago, IL, USA
| | - Karene Ricketts
- Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Stephen A Rottgers
- Department of Plastic Surgery, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - Davinder Singh
- Department of Plastic Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Peter Szmuk
- Department of Anesthesia and Pediatric Anesthesia, University of Texas Southwestern, Children's Medical Center, Dallas, TX, USA
| | - Brad M Taicher
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Jesse Taylor
- Department of Plastic Surgery and Craniofacial Surgery, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Paul A Stricker
- Department of Anesthesia and Pediatric Anesthesia, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Fernandez AM, Reddy SK, Gordish-Dressman H, Muldowney BL, Martinez JL, Chiao F, Stricker PA, Abruzzese C, Apuya J, Beethe A, Benzon H, Binstock W, Brzenski A, Budac S, Busso V, Chhabada S, Cladis F, Claypool D, Collins M, Dabek R, Dalesio N, Falcon R, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie SM, Gosman A, Grap S, Gries H, Griffin A, Haberkern C, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Kars M, Kowalczyk-Derderian C, Kugler J, Labovsky K, Lakheeram I, Lee A, Masel B, Medellin E, Meier P, Mitzel Levy H, Muhly WT, Nelson J, Nicholson J, Nguyen KP, Nguyen T, Olutuye O, Owens-Stubblefield M, Ramesh Parekh U, Petersen T, Pohl V, Post J, Poteet-Schwartz K, Prozesky J, Reid R, Ricketts K, Rubens D, Ryan L, Skitt R, Soneru C, Spitznagel R, Singh D, Singhal NR, Sorial E, Staudt S, Stubbeman B, Sung W, Syed T, Szmuk P, Taicher BM, Thompson D, Tretault L, Ungar-Kastner G, Watts R, Wieser J, Wong K, Zamora L. Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction. Anesth Analg 2019; 129:1069-1078. [DOI: 10.1213/ane.0000000000003515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hoffmann T, Voigt K, Kugler J, Peschel L, Bergmann A, Riemenschneider H. Are German family practitioners and psychiatrists sufficiently trained to diagnose and treat patients with alcohol problems? BMC Fam Pract 2019; 20:115. [PMID: 31416419 PMCID: PMC6694527 DOI: 10.1186/s12875-019-1006-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2019] [Indexed: 11/18/2022]
Abstract
Background Harmful alcohol consumption in Germany is a serious public health problem: About 7.7 million adults in Germany can be classified as risky alcohol consumers, about 74,000 deaths per year are related to alcohol consumption, and about 1.8 million adults in Germany (18–64 years) are classified as alcohol dependent. A treatment rate of 9% of all alcohol dependent patients in Germany implies a lack of supply and misuse of medical care. The aim of the study was to examine whether family practitioners (FPs) and psychiatrists have sufficient skills to diagnose and treat patients with alcohol problems. Methods A total of 6324 FPs and psychiatrists in the states of Saxony and Rhineland-Palatinate in Germany were invited to participate in this survey. Nine hundred seventy-four participants (90.3%/FPs) could be included in the statistical analysis (response rate: 14.3%/FPs, 21.6%/psychiatrists). Data was analysed descriptively and logistical regressions were used to identify predictors for physicians’ ability to feel adequately trained to diagnose and treat patients with alcohol problems. Results In comparison to psychiatrists, less FPs reported feeling sufficiently trained to counsel patients with alcohol problems (81.5% vs. 44.8%). Regression analysis revealed that FPs who felt not adequately trained had less experience with patients with alcohol dependence (OR 7.4), had attended fewer hours on alcohol addiction in continuing medical education (OR 4.8), and were more likely to be female (OR 1.9). A minimum of 10 h of training was associated with improved self-assessed competence. Conclusion Harmful drinking is a serious public health problem, and patients with alcohol dependence represent a large and demanding patient group in primary health care setting. Our study shows that the lack of training is a severe barrier in the work with this patient group in the primary care setting.
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Affiliation(s)
- T Hoffmann
- Department of Health Sciences / Public Health, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - K Voigt
- Department of General Practice, Medical Clinic 3, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - J Kugler
- Department of Health Sciences / Public Health, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - L Peschel
- Department of Health Sciences / Public Health, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - A Bergmann
- Department of General Practice, Medical Clinic 3, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany
| | - H Riemenschneider
- Department of General Practice, Medical Clinic 3, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr 74, 01307, Dresden, Germany.
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Goobie S, Zurakowski D, Isaac K, Taicher B, Fernandez P, Derderian C, Hetmaniuk M, Stricker P, Abruzzese C, Apuya J, Beethe A, Benzon H, Binstock W, Brzenski A, Budac S, Busso V, Chhabada S, Chiao F, Cladis F, Claypool D, Collins M, Dabek R, Dalesio N, Falconl R, Fernandez A, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie SM, Gosman A, Grap S, Gries H, Griffin A, Haberkern C, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Kars M, Kowalczyk-Derderian C, Kugler J, Labovsky K, Lakheeram I, Lee A, Martinez JL, Masel B, Medellin E, Meier P, Levy HM, Muhly WT, Muldowney B, Nelson J, Nicholson J, Nguyen KP, Nguyen T, Olutuye O, Owens-Stubblefield M, Parekh UR, Petersen T, Pohl V, Post J, Poteet-Schwartz K, Prozesky J, Reddy S, Reid R, Ricketts K, Rubens D, Ryan L, Skitt R, Soneru C, Spitznagel R, Stricker P, Singh D, Singhal NR, Sorial E, Staudt S, Stubbeman B, Sung W, Syed T, Szmuk P, Taicher BM, Thompson D, Tretault L, Ungar-Kastner G, Watts R, Wieser J, Wong K, Zamora L. Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group. Br J Anaesth 2019; 122:215-223. [DOI: 10.1016/j.bja.2018.10.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022] Open
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Thompson DR, Zurakowski D, Haberkern CM, Stricker PA, Meier PM, Bannister C, Benzon H, Binstock W, Bosenberg A, Brzenski A, Budac S, Busso V, Capehart S, Chiao F, Cladis F, Collins M, Cusick J, Dabek R, Dalesio N, Falcon R, Fernandez A, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie S, Gries H, Griffin A, Groenewald CB, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Koh J, Kowalczyk-Derderian C, Kugler J, Labovsky K, Martinez JL, Mujallid R, Muldowney B, Nguyen KP, Nguyen T, Olutuye O, Soneru C, Petersen T, Poteet-Schwartz K, Reddy S, Reid R, Ricketts K, Rubens D, Skitt R, Sohn L, Staudt S, Sung W, Syed T, Szmuk P, Taicher B, Tetreault L, Watts R, Wong K, Young V, Zamora L. Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group. Anesth Analg 2018; 126:968-975. [PMID: 28922233 DOI: 10.1213/ane.0000000000002454] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis. We hypothesized that advantages of ESC from single-center studies would be validated based on combined data from a large multicenter registry. METHODS Thirty-one institutions contributed data from June 2012 to September 2015. We analyzed 1382 infants younger than 12 months undergoing open (anterior and/or posterior cranial vault reconstruction, modified-Pi procedure, or strip craniectomy) or endoscopic craniectomy. The primary outcomes included transfusion data, ICU utilization, hospital length of stay, and perioperative complications; secondary outcomes included anesthesia and surgical duration. Comparison of unmatched groups (ESC: N = 311, open repair: N = 1071) and propensity score 2:1 matched groups (ESC: N = 311, open repair: N = 622) were performed by conditional logistic regression analysis. RESULTS Imbalances in baseline age and weight are inherent due to surgical selection criteria for ESC. Quality of propensity score matching in balancing age and weight between ESC and open groups was assessed by quintiles of the propensity scores. Analysis of matched groups confirmed significantly reduced utilization of blood (26% vs 81%, P < .001) and coagulation (3% vs 16%, P < .001) products in the ESC group compared to the open group. Median blood donor exposure (0 vs 1), anesthesia (168 vs 248 minutes) and surgical duration (70 vs 130 minutes), days in ICU (0 vs 2), and hospital length of stay (2 vs 4) were all significantly lower in the ESC group (all P < .001). Median volume of red blood cell administered was significantly lower in ESC (19.6 vs 26.9 mL/kg, P = .035), with a difference of approximately 7 mL/kg less for the ESC (95% confidence interval for the difference, 3-12 mL/kg), whereas the median volume of coagulation products was not significantly different between the 2 groups (21.2 vs 24.6 mL/kg, P = .73). Incidence of complications including hypotension requiring treatment with vasoactive agents (3% vs 4%), venous air embolism (1%), and hypothermia, defined as <35°C (22% vs 26%), was similar between the 2 groups, whereas postoperative intubation was significantly higher in the open group (2% vs 10%, P < .001). CONCLUSIONS This multicenter study of ESC versus open craniosynostosis repair represents the largest comparison to date. It demonstrates striking advantages of ESC for young infants that may result in improved clinical outcomes, as well as increased safety.
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Affiliation(s)
- Douglas R Thompson
- From the Department of Anesthesiology and Pain Medicine, University of Washington-Seattle Children's Hospital, Seattle, Washington
| | - David Zurakowski
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles M Haberkern
- From the Department of Anesthesiology and Pain Medicine, University of Washington-Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics (adj.), University of Washington-Seattle Children's Hospital, Seattle, Washington
| | - Paul A Stricker
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Petra M Meier
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Goobie SM, Cladis FP, Glover CD, Huang H, Reddy SK, Fernandez AM, Zurakowski D, Stricker PA, Gries H, Soneru C, Falcon R, Petersen T, Kowalczyk‐Derderian C, Dalesio N, Budac S, Groenewald N, Rubens D, Thompson D, Watts R, Gentry K, Ivanova I, Hetmaniuk M, Hsieh V, Collins M, Wong K, Binstock W, Reid R, Poteet‐Schwartz K, Gries H, Hall R, Koh J, Colpitts K, Scott L, Bannister C, Sung W, Jain R, Chaudhry R, Fernandez A, Tuite GF, Ruas E, Drozhinin O, Tetreault L, Muldowney B, Ricketts K, Fernandez P, Sohn L, Hajduk J, Taicher B, Burkhart J, Wright A, Kugler J, Barajas‐DeLoa L, Gangadharan M, Busso V, Stallworth K, Staudt S, Labovsky K, Glover C, Huang H, Karlberg‐Hippard H, Capehart S, Streckfus C, Nguyen K, Manyang P, Martinez JL, Hansen J, Brzenski A, Chiao F, Ingelmo P, Mujallid R, Bosenberg A, Meier P, Haberkern C, Nguyen T, Benzon H. Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group. Paediatr Anaesth 2017; 27:271-281. [PMID: 28211198 DOI: 10.1111/pan.13076] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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] [Accepted: 11/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antifibrinolytic therapy significantly decreases blood loss and transfusion in pediatric cranial vault reconstructive surgery; however, concern regarding the side effects profile limits clinical use. AIMS The aim was to utilize the Pediatric Craniofacial Surgery Perioperative Registry database to identify the safety profile of antifibrinolytic therapy for cranial vault reconstructive surgery by reporting the incidence of adverse events as they relate to exposure to tranexamic acid and aminocaproic acid compared to no exposure to antifibrinolytics. METHODS The database was queried for cases of open cranial vault reconstructive surgery. Less invasive procedures such as neuro-endoscopic and spring-mediated cranioplasties were excluded. The outcomes evaluated included any perioperative neurological adverse event including seizures or seizure-like movements and thromboembolic events. RESULTS Thirty-one institutions reported a total of 1638 cases from 2010 to 2015. Total antifibrinolytic administration accounted for 59.5% (tranexamic acid, 36.1% and aminocaproic acid, 23.4%), with 40.5% not receiving any antifibrinolytic. The overall incidence of postoperative seizures or seizure-like movements was 0.6%. No significant difference was detected in the incidence of postoperative seizures between patients receiving tranexamic acid and those receiving aminocaproic acid [the odds ratio for seizures being 0.34 (95% confidence interval: 0.07-1.85) controlling for American Society of Anesthesia (ASA) physical class] nor in patients receiving antifibrinolytics compared to those not administered antifibrinolytics (the odds ratio for seizures being 1.02 (confidence interval 0.29-3.63) controlling for ASA physical class). One complicated patient in the antifibrinolytic group with a femoral venous catheter had a postoperative deep venous thrombosis. CONCLUSIONS This is the first report of an incidence of postoperative seizures of 0.6% in pediatric cranial vault reconstructive surgery. There was no significant difference in postoperative seizures or seizure-like events in those patients who received the tranexamic acid or aminocaproic acid vs those that did not. This report provides evidence of the safety profile of antifibrinolytic in children having noncardiac major surgery. Caution should prevail however in using antifibrinolytic in high-risk patients. Antifibrinolytic dosage regimes should be based on pharmacokinetic data avoiding high doses.
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Affiliation(s)
- Susan M Goobie
- Department of Anesthesiology, Critical Care, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Franklyn P Cladis
- Department of Anesthesiology, The Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chris D Glover
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Henry Huang
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Srijaya K Reddy
- Division of Anesthesiology, Children's National Health System, Washington, DC, USA
| | - Allison M Fernandez
- Department of Anesthesiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul A Stricker
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Kunzweiler K, Voigt K, Kugler J, Hirsch K, Bergmann A, Riemenschneider H. Factors influencing sleep quality among nursing staff: Results of a cross sectional study. Appl Nurs Res 2016; 32:241-244. [DOI: 10.1016/j.apnr.2016.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 01/05/2023]
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Paulus A, Hussack S, Kugler J. [Factors Influencing Lead Time in Multiple Sclerosis: Survey of Members of the German Multiple Sclerosis Society in Saxony-Anhalt]. Fortschr Neurol Psychiatr 2016; 84:487-93. [PMID: 27570906 DOI: 10.1055/s-0042-109395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple sclerosis is a neurodegenerative disease of the central nervous system in which the myelin layer is disrupted. Early diagnosis and early therapy are decisive for the course of the disease. METHODS To analyze the time to diagnosis and the factors having an influence on this process, members of the German Multiple Sclerosis Society in Saxony-Anhalt (n = 941) were surveyed. Thanks to a return rate of 424 questionnaires (response rate ≈45 %), the results provide a good overview of MS patients in this region. RESULTS Almost 80 % of the respondents were female. The median time to diagnosis was 6.35 years. On average, women were diagnosed 2.93 years later than men (p≤ 0.05; U test). CONCLUSION The time to diagnosis has decreased over the last decades. Younger age at the time of the first symptoms seems to be a positive factor for early diagnosis. A recall bias cannot be outruled since all the data are based on individual experience. The results of the self-help group samples cannot be generalized. Further surveys are needed to analyze why it takes over six years to establish the diagnosis of multiple sclerosis.
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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation for improving spasticity after stroke: A systematic review with meta-analysis. J Rehabil Med 2016; 48:565-70. [DOI: 10.2340/16501977-2097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Weidemann RR, Schönfelder T, Klewer J, Kugler J. Patient satisfaction in cardiology after cardiac catheterization : Effects of treatment outcome, visit characteristics, and perception of received care. Herz 2015; 41:313-9. [PMID: 26545602 DOI: 10.1007/s00059-015-4360-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 07/15/2015] [Revised: 09/04/2015] [Accepted: 09/14/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patient satisfaction is a key indicator for quality of care. However, recent data on determinants of satisfaction in invasive cardiology are lacking. Hence this study was conducted to identify determinants of patient satisfaction after hospitalization for cardiac catheterization. PATIENTS AND METHODS Data were obtained from 811 randomly selected patients discharged from ten hospitals responding to a mailed post-visit questionnaire. The satisfaction dimension was measured with a validated 42-item inventory assessing demographic and visit characteristics as well as medical, organizational, and service aspects of received care. Bivariate and multivariate statistical analyses were performed to identify predictors of satisfaction. RESULTS Patients were most satisfied with the kindness of medical practitioners and nurses. The lowest ratings were observed for discharge procedures and instructions. Multivariate analysis revealed five predictors of satisfaction: treatment outcome (OR, 2.14), individualized medical care (OR, 1.64), clear reply to patient's inquiries by physicians (OR, 1.63), kindness of nonmedical professionals (OR, 3.01), and room amenities (OR, 2.02). No association between demographic data and overall satisfaction was observed. CONCLUSION Five key determinants that can be addressed by health-care providers in order to improve patient satisfaction were identified. Our findings highlight the importance of the communicational behavior of health-care professionals and the transparency of discharge management.
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Affiliation(s)
- R R Weidemann
- Department of Health Sciences and Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
- Internal Medicine Department I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany.
| | - T Schönfelder
- Department of Health Sciences and Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - J Klewer
- Department of Public Health and Care Management, University of Applied Sciences Zwickau, Zwickau, Germany
| | - J Kugler
- Department of Health Sciences and Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Mehrholz J, Pohl M, Kugler J, Burridge J, Mückel S, Elsner B. Physical rehabilitation for critical illness myopathy and neuropathy: an abridged version of Cochrane Systematic Review. Eur J Phys Rehabil Med 2015; 51:655-661. [PMID: 26158919] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating. Secondary objectives were to assess effects on muscle strength and quality of life, and to assess adverse effects of physical rehabilitation. On 16 July 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register and on 14 July 2014 we searched CENTRAL, MEDLINE, EMBASE and CINAHL Plus. In July 2014, we searched the Physiotherapy Evidence Database (PEDro) and three trials registries for ongoing trials and further data about included studies with no language restrictions. We also handsearched relevant conference proceedings and screened reference lists to identify further trials. We planned to include randomised controlled trials (RCTs), quasi-RCTs and randomised controlled cross-over trials of any rehabilitation intervention in people with acquired weakness syndrome due to CIP/CIM. We would have extracted data, assessed the risk of bias and classified the quality of evidence for outcomes in duplicate, according to the standard procedures of The Cochrane Collaboration. Outcome data collection would have been for activities of daily living (for example, mobility, walking, transfers and self care). Secondary outcomes included muscle strength, quality of life and adverse events. The search strategy retrieved 3587 references. After examination of titles and abstracts, we retrieved the full text of 24 potentially relevant studies. None of these studies met the inclusion criteria of our review. No data were suitable to be included in a meta-analysis. There are no published RCTs or quasi-RCTs that examine whether physical rehabilitation interventions improve activities of daily living for people with CIP and CIM. Large RCTs, which are feasible, need to be conducted to explore the role of physical rehabilitation interventions for people with CIP and CIM. This paper is based on a Cochrane Review published in in the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 3, DOI: 10.1002/14651858.CD010942.pub2. (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.
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Affiliation(s)
- J Mehrholz
- Wissenschaftliches Institut, Private Europäische Medizinische Akademie,der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany -
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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (TDCS) for improving activities in patients after stroke. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.573] [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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Rehm J, Gmel G, Kiefer F, Kreutz R, Kugler J, Müller-Walther M, Sandow P, Weisser B. [Improvement of management of hypertension by implementation of alcohol screening and subsequent interventions in primary practice]. Dtsch Med Wochenschr 2014; 139:2457-62. [PMID: 25409405 DOI: 10.1055/s-0034-1387417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hypertension and alcohol use are both part of the five most important risk factors for burden of disease in Western Europe, mainly because of their impact on non-communicable diseases (NCD). Both risk factors are prevalent with high overlap among patients in primary care. Implementation of a screening for alcohol among patients of hypertension in primary care followed by brief intervention for problem alcohol use or formal treatment for people with alcohol dependence could constitute an important step to reach the goals of the Global WHO Action Plan for Prevention and Control of NCD. In addition, such an intervention could improve the management of hypertension. In a working group of experts from clinical practice and research the rationale and potential barriers for this intervention were discussed and steps for implementation in primary care were developed.
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Affiliation(s)
- Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden; Centre for Addiction and Mental Health, Toronto, Kanada; und Dalla Lana School of Public Health, Toronto, Kanada
| | - G Gmel
- Centre for Addiction and Mental Health, Toronto, Kanada
| | - F Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim; und Medizinische Fakultät Mannheim, Universität Heidelberg
| | - R Kreutz
- Institut für Klinische Pharmakologie und Toxikologie, Charité-Universitätsmedizin, Berlin
| | - J Kugler
- Lehrstuhl für Gesundheitswissenschaften/Public Health, Medizinische Fakultät, Technische Universität Dresden
| | | | - P Sandow
- Facharztpraxis für Allgemeinmedizin, Berlin
| | - B Weisser
- Institut für Sportwissenschaft, Abteilung Sportmedizin, Christian-Albrechts-Universität, Kiel
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Schramm A, Kugler J. Diabetes mellitus mit Augenkomplikation – unspezifische Diagnosekodierung im Morbi-RSA. Eine Analyse der Leistungsdaten der AOK PLUS. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1387018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Schramm A, Steinbronn R, Klewer J, Kugler J. Analyse der ambulanten Kodierqualität in Sachsen und Thüringen anhand von Leistungsdaten der AOK PLUS – die Verwendung des Zusatzkennzeichens „Z“ in der Diagnosedokumentation. Gesundheitswesen 2014; 76:750-4. [DOI: 10.1055/s-0033-1361110] [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: 10/25/2022]
Affiliation(s)
| | | | - J. Klewer
- Gesundheits-/Pflegewissenschaften, Westsächsiche Hochschule Zwickau
| | - J. Kugler
- Lehrstuhl Gesundheitswissenschaften/Public Health, Medizinische Fakultät, TU Dresden
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Elsner B, Kugler J, Pohl M, Mehrholz J. P 101. Transcranial direct current stimulation for improving function and activities of daily living in patients after stroke. First results of a systematic Cochrane-Review. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.179] [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: 11/26/2022]
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Elsner B, Kugler J, Pohl M, Mehrholz J. P 102. Transcranial direct current stimulation for improving aphasia after stroke. First results of a systematic Cochrane Review. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.180] [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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Schramm A, Klewer J, Kugler J. Analyse der ambulanten Kodierqualität von Diabetes mellitus - Abrechnung der budgetbefreienden Laborziffer 32005 bei der AOK PLUS. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354165] [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: 10/26/2022]
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Schramm A, Klewer J, Kugler J. Ambulante Kodierqualität bei Zustand nach Transplantation - Analyse der Leistungsdaten der AOK PLUS. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354121] [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: 10/26/2022]
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Velde C, Kugler J, Tiebel M. Development, behavioral problems and educational needs of children in a rural area of Saxony 2010/11 in relation to the socio-economic status. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354204] [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: 10/26/2022]
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Schramm A, Klewer J, Kugler J. Diabetes mellitus mit Augenkomplikation richtig kodiert? Eine Analyse der ambulanten Abrechnungsdaten der AOK PLUS. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354164] [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: 10/26/2022]
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Riemenschneider H, Hirsch K, Bartels A, Kämpfe C, Voigt K, Kugler J, Bergmann A. [Sexual risk behaviour of nursing students. A cross-sectional study at nursing schools in Saxony-Anhalt]. Gesundheitswesen 2013; 76:333-5. [PMID: 23868651 DOI: 10.1055/s-0033-1347261] [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: 10/26/2022]
Abstract
AIM This work describes the sexual risk behaviour of nursing students. METHODS 22 of 23 state-approved nursing schools in Saxony-Anhalt, Germany, participated in this cross-sectional study (study period 7/2005-5/2006). Participation was voluntarily and anonymous. RESULTS More male than female students (59.6% vs. 44.8%) used condoms to prevent STIs. More female students (58.9% vs. 43.4%) reported constant partnership with just one partner as an STI prevention method (chi² test, p<0.005). 29.6% of the nursing students reported >1 sexual partner in the past 12 months. 3.9% of the students demanded an HIV test from the partner, 69.3% had never tested themselves for HIV. 10.2% used no prevention against STIs. CONCLUSIONS Nursing students should be sensitised for sexual risk behaviour and STIs. This should be included in the content of teaching throughout the education, not least since nursing students are multiplicators and have an influence on health behaviour of the patients.
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Affiliation(s)
- H Riemenschneider
- Bereich Allgemeinmedizin, Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der TU Dresden
| | - K Hirsch
- Krankenpflegeschule des Klinikums Dorothea Christiane Erxleben, Quedlinburg
| | - A Bartels
- Bereich Allgemeinmedizin, Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der TU Dresden
| | - C Kämpfe
- Bereich Allgemeinmedizin, Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der TU Dresden
| | - K Voigt
- Bereich Allgemeinmedizin, Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der TU Dresden
| | - J Kugler
- Lehrstuhl Gesundheitswissenschaften/Public Health der Medizinischen Fakultät Carl, Gustav Carus der TU Dresden
| | - A Bergmann
- Bereich Allgemeinmedizin, Medizinische Klinik III, Universitätsklinikum Carl Gustav Carus der TU Dresden
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Schönfelder T, Klewer J, Kugler J. Erwartungen älterer Patienten an einen Krankenhausaufenthalt. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323470] [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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Schramm A, Kugler J, Klewer J. Diagnosekodierung der Krankheit Depression in der hausärztlichen Praxis – Analyse der Abrechnungsdaten der AOK PLUS. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323473] [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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Kugler J, Schönfelder T, Klewer J. Patientenzufriedenheit und Bereitschaft sich erneut in der gleichen Einrichtung behandeln zu lassen – Messen beide Konstrukte das Gleiche? Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323350] [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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Schaal T, Schönfelder T, Oehme J, Kugler J, Klewer J. Auswertungsergebnisse der Qualitätsberichte stationärer Pflegeeinrichtungen – Servicequalität statt Pflege? Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323453] [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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Peschel P, Kugler J. Zur Kinder- und Jugendmedizin im Krankenhaus – Zufriedenheitsbefragung bei Eltern und Jugendlichen. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323410] [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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Schramm A, Kugler J, Klewer J. Analyse der Kodierqualität in DMP-Verträgen anhand von Routinedaten der AOK PLUS. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323474] [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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Schramm A, Kugler J, Klewer J. Kodierqualität in der hausärztlichen Praxis – Analyse der Leistungsdaten der AOK PLUS – Die Diagnose Alter Myokardinfarkt. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323472] [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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Schönfelder T, Schaal T, Oehme J, Kugler J. Auswertungsergebnisse der Qualitätsberichte stationärer Pflegeeinrichtungen: Servicequalität statt Pflege? Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322094] [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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Schramm A, Kugler J. Analyse der ambulanten Kodierqualität in Sachsen und Thüringen anhand von Routinedaten der AOK PLUS - die Verwendung des Z-Zusatzkennzeichens in der Diagnosedokumentation. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322095] [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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Schönfelder T, Kugler J, Schaal T. Erwartungen älterer Patienten an einen Krankenhausaufenthalt. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322093] [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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Schönfelder T, Kugler J. Einflussfaktoren auf die Wahrnehmung der Behandlungsqualität in der Geburtshilfe – Die Bedeutung von demografischen Variablen, einrichtungsspezifischen Parametern sowie der subjektiven Einschätzung der erbrachten Leistungen. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293467] [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: 10/15/2022]
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Schönfelder T, Kugler J. Patientenpräferenzen in der Kinder- und Jugendheilkunde: Welche Aspekte des Krankenhausaufenthaltes sind für Eltern am wichtigsten? Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283628] [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: 10/17/2022]
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Schönfelder T, Kugler J. Einflussfaktoren auf die Wahrnehmung der Behandlungsqualität in der Inneren Medizin: Unterschiede in Abhängigkeit des Alters der Patienten. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283627] [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: 10/17/2022]
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Schönfelder T, Kugler J. Einflussfaktoren auf die Zufriedenheit von Patientinnen nach einer gynäkologischen Operation. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283626] [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: 10/17/2022]
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Lehmann S, Blüher M, Peschel P, Kugler J, Oberbach A. Kombinierter Präventionskurs zur nachhaltigen Risikominimierung des Metabolischen Syndroms? Effekte von Kraft und Kraftausdauer im Follow-up. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277532] [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: 10/18/2022]
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Clarke JL, Ennis MM, Lamborn KR, Prados MD, Puduvalli VK, Penas-Prado M, Gilbert MR, Groves MD, Hess KR, Levin VA, de Groot J, Colman H, Conrad CA, Loghin ME, Hunter K, Yung WK, Chen C, Damek D, Liu A, Gaspar LE, Waziri A, Lillehei K, Kavanagh B, Finlay JL, Haley K, Dhall G, Gardner S, Allen J, Cornelius A, Olshefski R, Garvin J, Pradhan K, Etzl M, Goldman S, Atlas M, Thompson S, Hirt A, Hukin J, Comito M, Bertolone S, Torkildson J, Joyce M, Moertel C, Letterio J, Kennedy G, Walter A, Ji L, Sposto R, Dorris K, Wagner L, Hummel T, Drissi R, Miles L, Leach J, Chow L, Turner R, Gragert MN, Pruitt D, Sutton M, Breneman J, Crone K, Fouladi M, Friday BB, Buckner J, Anderson SK, Giannini C, Kugler J, Mazurczac M, Flynn P, Gross H, Pajon E, Jaeckle K, Galanis E, Badruddoja MA, Pazzi MA, Stea B, Lefferts P, Contreras N, Bishop M, Seeger J, Carmody R, Rance N, Marsella M, Schroeder K, Sanan A, Swinnen LJ, Rankin C, Rushing EJ, Hutchins LF, Damek DM, Barger GR, Norden AD, Lesser G, Hammond SN, Drappatz J, Fadul CE, Batchelor TT, Quant EC, Beroukhim R, Ciampa A, Doherty L, LaFrankie D, Ruland S, Bochacki C, Phan P, Faroh E, McNamara B, David K, Rosenfeld MR, Wen PY, Hammond SN, Norden AD, Drappatz J, Phuphanich S, Reardon D, Wong ET, Plotkin SR, Lesser G, Mintz A, Raizer JJ, Batchelor TT, Quant EC, Beroukhim R, Kaley TJ, Ciampa A, Doherty L, LaFrankie D, Ruland S, Smith KH, Wen PY, Chamberlain MC, Graham C, Mrugala M, Johnston S, Kreisl TN, Smith P, Iwamoto F, Sul J, Butman JA, Fine HA, Westphal M, Heese O, Warmuth-Metz M, Pietsch T, Schlegel U, Tonn JC, Schramm J, Schackert G, Melms A, Mehdorn HM, Seifert V, Geletneky K, Reuter D, Bach F, Khasraw M, Abrey LE, Lassman AB, Hormigo A, Nolan C, Gavrilovic IT, Mellinghoff IK, Reiner AS, DeAngelis L, Omuro AM, Burzynski SR, Weaver RA, Janicki TJ, Burzynski GS, Szymkowski B, Acelar SS, Mechtler LL, O'Connor PC, Kroon HA, Vora T, Kurkure P, Arora B, Gupta T, Dhamankar V, Banavali S, Moiyadi A, Epari S, Merchant N, Jalali R, Moller S, Grunnet K, Hansen S, Schultz H, Holmberg M, Sorensen MM, Poulsen HS, Lassen U, Reardon DA, Vredenburgh JJ, Desjardins A, Janney DE, Peters K, Sampson J, Gururangan S, Friedman HS, Jeyapalan S, Constantinou M, Evans D, Elinzano H, O'Connor B, Puthawala MY, Goldman M, Oyelese A, Cielo D, Dipetrillo T, Safran H, Anan M, Seyed Sadr M, Alshami J, Sabau C, Seyed Sadr E, Siu V, Guiot MC, Samani A, Del Maestro R, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine VE, Parfenov VE, Poverennova IE, Hau P, Jachimczak P, Heinrichs H, Schlingensiepen KH, Shibui S, Kayama T, Wakabayashi T, Nishikawa R, de Groot M, Aronica E, Vecht CJ, Toering ST, Heimans JJ, Reijneveld JC, Batchelor T, Mulholland P, Neyns B, Nabors LB, Campone M, Wick A, Mason W, Mikkelsen T, Phuphanich S, Ashby LS, DeGroot JF, Gattamaneni HR, Cher LM, Rosenthal MA, Payer F, Xu J, Liu Q, van den Bent M, Nabors B, Fink K, Mikkelsen T, Chan M, Trusheim J, Raval S, Hicking C, Henslee-Downey J, Picard M, Reardon D, Kaley TJ, Wen PY, Schiff D, Karimi S, DeAngelis LM, Nolan CP, Omuro A, Gavrilovic I, Norden A, Drappatz J, Purow BW, Lieberman FS, Hariharan S, Abrey LE, Lassman AB, Perez-Larraya JG, Honnorat J, Chinot O, Catry-Thomas I, Taillandier L, Guillamo JS, Campello C, Monjour A, Tanguy ML, Delattre JY, Franz DN, Krueger DA, Care MM, Holland-Bouley K, Agricola K, Tudor C, Mangeshkar P, Byars AW, Sahmoud T, Alonso-Basanta M, Lustig RA, Dorsey JF, Lai RK, Recht LD, Reardon DA, Paleologos N, Groves M, Rosenfeld MR, Meech S, Davis T, Pavlov D, Marshall MA, Sampson J, Slot M, Peerdeman SM, Beauchesne PD, Faure G, Noel G, Schmitt T, Kerr C, Jadaud E, Martin L, Taillandier L, Carnin C, Desjardins A, Reardon DA, Peters KB, Herndon JE, Kirkpatrick JP, Friedman HS, Vredenburgh JJ, Nayak L, Panageas KS, Deangelis LM, Abrey LE, Lassman AB. Ongoing Clinical Trials. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wiesmeth S, Twork S, Schipper S, Wirtz M, Pöhlau D, Kugler J. Bedeutung depressiver und passiv-vermeidender Krankheitsverarbeitungs-Stile für die gesundheitsbezogene Lebensqualität Multiple-Sklerose-Erkrankter – Befragung von Patienten-Mitgliedern der Deutschen Multiple Sklerose Gesellschaft, NRW. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266580] [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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Schönfelder T, Kugler J, Klewer J. Determinanten der Patientenzufriedenheit: Untersuchungsergebnisse aus 39 Krankenhäusern. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266536] [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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Wiesmeth S, Twork S, Schipper S, Wirtz M, Pöhlau D, Kugler J. Die Bedeutung der Fatigue als Determinante für die gesundheitsbezogene Lebensqualität Multiple-Sklerose-Erkrankter – Befragung von Patienten-Mitgliedern des Landesverbandes Nordrhein-Westfahlen der Deutschen Multiple Sklerose Gesellschaft. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266205] [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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Schumacher B, Peschel P, Kugler J. Die Arztwahl Jugendlicher in Sachsen. Ein Stadt-Land-Vergleich. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266716] [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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Peschel P, Schoffer O, Kugler J. Die stationäre Versorgung von Kindern und Jugendlichen in Sachsen. Ein Vergleich mit Rheinland-Pfalz. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266696] [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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Menning M, Twork S, Kugler J. [Adherence, self-efficacy, physician visits in a clinical trial over 6 months in multiple sclerosis patients]. Gesundheitswesen 2010; 73:e84-8. [PMID: 20568036 DOI: 10.1055/s-0030-1255055] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lack of treatment adherence is a significant issue in multiple sclerosis (MS). The aim of this project was to examine whether establishing an observational situation in the context of a non-interventional study could positively affect the treatment adherence, quality of life as well as patient satisfaction in 206 MS patients treated with Copaxone(®). Apart from 3 standardised, anonymous surveys no further measures were taken. Self-efficacy increased in the patients, which was also reflected in a decline in physician visits in the monitoring period. The number of consultations initiated by the patient decreased very much between the second and third patient surveys. In the quality of life area "health", there was a significant improvement. After 3 months there was a discontinuation rate of 10.4%; after 6 months 8.8%. Even though this was not a controlled study, these results could indicate that, on a short-term basis, patients can be motivated to adhere--probably as a result of the psychological aspects of the observational situation. However, long-term changes in behaviour can probably only be achieved through qualified training.
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Affiliation(s)
- M Menning
- Lehrstuhl Gesundheitswissenschaften/Public Health, Medizinische Fakultät Carl Gustav Carus, TU Dresden.
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Hoffmann T, Twork S, Pöhlau D, Kugler J. Patientenorientierung im Internet – qualitative Bewertung von Internetseiten für Multiple-Sklerose-Betroffene. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238573] [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]
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Barton DL, Wos E, Qin R, Mattar B, Green N, Lanier K, Bearden J, Kugler J, Rowland K, Loprinzi C. A randomized controlled trial evaluating a topical treatment for chemotherapy-induced neuropathy: NCCTG trial N06CA. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9531 Background: Chemotherapy induced peripheral neuropathy (CIPN) is a prevalent dose limiting toxicity for several important cancer treatment agents. CIPN can impair function and cause distress. There are no proven pharmacologic treatments for established CIPN currently. This double blind randomized placebo controlled trial evaluated a compounded topical gel for this problem. The novelty of this treatment is that it might incorporate several agents with different mechanisms of action to provide relief locally without negative systemic effects. Methods: Patients with CIPN (rated ≥4 out of 10) for at least one month, related to previous and/or concurrent exposure to neurotoxic agents, were randomized to baclofen 10 mg, amitriptyline HCL 40 mg and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO) vs placebo (PLO) to determine its effect on numbness, tingling, pain, and motor function. Exclusion criteria included other causes and/or current treatment for peripheral neuropathy. The primary endpoint was the baseline adjusted sensory subscale of the EORTC QLQ-CIPN20, at 4 weeks. Results: Between February and May 2008, 208 patients were enrolled onto this trial. Four week data are shown in the table below, higher numbers being better. The percentage of patients that had improvements of at least 10, on a 100 point scale, in the motor subscale was statistically significantly higher in the BAK-PLO arm, p=.04. There were no unwanted toxicities associated with the BAK-PLO that were significantly different from placebo and no evidence of CNS or systemic toxicity. Conclusions: Topical treatment with BAK-PLO appears to moderately improve symptoms of CIPN. This topical gel was well tolerated without systemic side effects. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- D. L. Barton
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - E. Wos
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - R. Qin
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - B. Mattar
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - N. Green
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - K. Lanier
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - J. Bearden
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - J. Kugler
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - K. Rowland
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - C. Loprinzi
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
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Schild S, Graham D, Hillman S, Vora S, Yolanda G, Molina J, Shahidi H, Kugler J, Adjei A. Survival of patients (pts) treated with high-dose radiotherapy (RT) and concurrent chemotherapy for unresectable non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7544] [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: 11/20/2022] Open
Abstract
7544 Background: NCCTG N0028 was a trial that determined the MTD of RT that could be given with carboplatin & paclitaxel was 74 Gy/34 fractions. This secondary analysis was performed to determine the survival of pts treated on this trial. Methods: Eligible pts had medically or surgically unresectable NSCLC, PS=0–1, weight loss <10% in the prior 3 months(mo), no prior therapy, adequate laboratory & pulmonary functions. Included were 25 pts with clinical stages I (4pts), II (1 pt), IIIa (12 pts), & IIIb (8 pts). Treatment included: weekly I.V. paclitaxel (50mg/m2) & carboplatin (AUC=2) during RT. The RT included 2 Gy daily to an initial dose of 70 Gy. The total dose was increased in 4 Gy increments until the MTD was determined. RT was delivered with 3-D treatment planning but no elective nodal RT. Three pts received 70 Gy, 18 pts received 74 Gy, & 4 pts received 78Gy. Results: Pts were followed until death or from 10–67 mo (median: 28mo) in those alive at last evaluation. The median survival (MS) of the entire cohort was 42mo. The 5 stages I-II pts had a MS of 53 mo & the 20 stage III pts had MS of 42mo. Conclusions: Standard dose RT is unable to sterilize disease in the majority of pts with unresectable NSCLC. While the addition of chemotherapy has significantly improved survival of these pts, the MS is generally 15–24 mo. These preliminary results suggest higher than standard doses of RT may improve disease control & prolong survival. A phase III trial comparing standard-dose RT(60Gy) to high-dose RT (74Gy) is open and should more definitively address the issue of RT dose with concurrent chemotherapy for unresectable NSCLC. Future technological improvements in imaging & targeting will provide methods to safely administer even greater RT doses which will likely further improve disease control. No significant financial relationships to disclose.
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Affiliation(s)
- S. Schild
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - D. Graham
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - S. Hillman
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - S. Vora
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - G. Yolanda
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - J. Molina
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - H. Shahidi
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - J. Kugler
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
| | - A. Adjei
- Mayo Clinic & NCCTG, Scottsdale, AZ; Carle Cancer Center, Urbana, IL; Mayo Clinic & NCCTG, Rochester, MN; MeritCare Clinic Bemidji, Bemidji, MN; Illinois Cancer Care, Peoria, IL; Roswell Park Cancer Center, Buffalo, NY
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Hoffmann T, Twork S, Pöhlau D, Kugler J. Patientenorientierung im Internet – qualitative Bewertung von Internetseiten für Multiple-Sklerose-Betroffene. Akt Neurol 2009. [DOI: 10.1055/s-0028-1090238] [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]
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Peschel P, Schoffer O, Kugler J. Typ-2-Diabetes in der amtlichen Krankenhausstatistik – erste Analysen der Krankenhausstatistik des Forschungsdatenzentrums (FDZ) der Statistischen Landesämter. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221941] [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]
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