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Miller C, Scholand J, Wieditz J, Pancaro C, Rosewich H, Nemeth M. Factors Influencing Willingness to Participate in Clinical Studies in Pediatric Anesthesia (FILIPPA): A vignette-based, structured interview study. Paediatr Anaesth 2024. [PMID: 38757570 DOI: 10.1111/pan.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Informed consent is a relevant backdrop for conducting clinical trials, particularly those involving children. While several factors are known to influence the willingness to consent to pediatric anesthesia studies, the influence of study design on consenting behavior is unknown. AIMS To quantify the impact of study complexity on willingness to consent to pediatric anesthesia studies. METHODS We conducted a vignette-based interview study by presenting three hypothetical studies to 106 parents or legal guardians whose children were scheduled to undergo anesthesia. These studies differed in level of complexity and included an example of a prospective observational study, a randomized controlled trial, and a phase-II-pharmacological study. Primary outcome was the willingness to consent, using a 5-point Likert scale ranging from "absolutely consent" to "absolutely decline". Secondary outcomes were the effects of child-related (such as sex, age, previous anesthesia, research exposure) and proxy-related factors. RESULTS Response probabilities for "absolute consent" were 90.9% [95% CI 85.3-96.5] for the observational study, 48.6% [95% CI 38.3-58.9] for the randomized controlled trial, and 32.7% [95% CI 23.9-41.6] for the phase-II-pharmacological study. Response probabilities for "absolutely decline" were 1.6% [95% CI 0.3-2.8], 14.4% [95% CI 8.3-20.5], and 24.7% [95% CI 16.6-32.7], respectively. Significant effects were found for previous research exposure (OR = 0.486 [95% CI 0.256-0.923], p = .027), older age (OR = 0.963 [95% CI 0.927-0.999], p = .045) and the gender of the parent or legal guardian, as mothers were less willing to consent (OR = 0.234 [95% CI 0.107-0.512], p < .001). CONCLUSIONS Willingness to consent decreased with increasing level of study complexity. When conducting more complex studies, greater efforts need to be made to increase the enrollment of pediatric patients.
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Affiliation(s)
- Clemens Miller
- Neurosurgical Critical Care Unit, Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan Scholand
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Johannes Wieditz
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Carlo Pancaro
- Department of Anesthesiology, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Hendrik Rosewich
- Department of Pediatrics and Adolescent Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Marcus Nemeth
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
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Gold SM, Friede T, Meyer B, Moss-Morris R, Hudson J, Asseyer S, Bellmann-Strobl J, Leisdon A, Ißels L, Ritter K, Schymainski D, Pomeroy H, Lynch SG, Cozart JS, Thelen J, Román CAF, Cadden M, Guty E, Lau S, Pöttgen J, Ramien C, Seddiq-Zai S, Kloidt AM, Wieditz J, Penner IK, Paul F, Sicotte NL, Bruce JM, Arnett PA, Heesen C. Internet-delivered cognitive behavioural therapy programme to reduce depressive symptoms in patients with multiple sclerosis: a multicentre, randomised, controlled, phase 3 trial. Lancet Digit Health 2023; 5:e668-e678. [PMID: 37775187 PMCID: PMC10921847 DOI: 10.1016/s2589-7500(23)00109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Depression is three to four times more prevalent in patients with neurological and inflammatory disorders than in the general population. For example, in patients with multiple sclerosis, the 12-month prevalence of major depressive disorder is around 25% and it is associated with a lower quality of life, faster disease progression, and higher morbidity and mortality. Despite its clinical relevance, there are few treatment options for depression associated with multiple sclerosis and confirmatory trials are scarce. We aimed to evaluate the safety and efficacy of a multiple sclerosis-specific, internet-based cognitive behavioural therapy (iCBT) programme for the treatment of depressive symptoms associated with the disease. METHODS This parallel-group, randomised, controlled, phase 3 trial of an iCBT programme to reduce depressive symptoms in patients with multiple sclerosis was carried out at five academic centres with large outpatient care units in Germany and the USA. Patients with a neurologist-confirmed diagnosis of multiple sclerosis and depressive symptoms were randomly assigned (1:1:1; automated assignment, concealed allocation, no stratification, no blocking) to receive treatment as usual plus one of two versions of the iCBT programme Amiria (stand-alone or therapist-guided) or to a control condition, in which participants received treatment as usual and were offered access to the iCBT programme after 6 months. Masking of participants to group assignment between active treatment and control was not possible, although raters were masked to group assignment. The predefined primary endpoint, which was analysed in the intention-to-treat population, was severity of depressive symptoms as measured by the Beck Depression Inventory-II (BDI-II) at week 12 after randomisation. This trial is registered at ClinicalTrials.gov, NCT02740361, and is complete. FINDINGS Between May 3, 2017, and Nov 4, 2020, we screened 485 patients for eligibility. 279 participants were enrolled, of whom 101 were allocated to receive stand-alone iCBT, 85 to receive guided iCBT, and 93 to the control condition. The dropout rate at week 12 was 18% (50 participants). Both versions of the iCBT programme significantly reduced depressive symptoms compared with the control group (BDI-II between-group mean differences: control vs stand-alone iCBT 6·32 points [95% CI 3·37-9·27], p<0·0001, effect size d=0·97 [95% CI 0·64-1·30]; control vs guided iCBT 5·80 points [2·71-8·88], p<0·0001, effect size d=0·96 [0·62-1·30]). Clinically relevant worsening of depressive symptoms was observed in three participants in the control group, one in the stand-alone iCBT group, and none in the guided iCBT group. No occurrences of suicidality were observed during the trial and there were no deaths. INTERPRETATION This trial provides evidence for the safety and efficacy of a multiple sclerosis-specific iCBT tool to reduce depressive symptoms in patients with the disease. This remote-access, scalable intervention increases the therapeutic options in this patient group and could help to overcome treatment barriers. FUNDING National Multiple Sclerosis Society (USA).
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Affiliation(s)
- Stefan M Gold
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Medizinische Klinik mS Psychosomatik, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; German Center for Mental Health (DZPG), Berlin, Germany; Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany.
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Meyer
- Research Department, GAIA AG, Hamburg, Germany
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joanna Hudson
- Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Susanna Asseyer
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Leisdon
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Leonie Ißels
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristin Ritter
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Schymainski
- Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hayley Pomeroy
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sharon G Lynch
- Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Julia S Cozart
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Joan Thelen
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Cristina A F Román
- Kessler Foundation, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Margaret Cadden
- Harvard Medical School, Massachusetts General Hospital/Brigham and Women's Hospital, Boston, MA, USA
| | - Erin Guty
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Stephanie Lau
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Caren Ramien
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susan Seddiq-Zai
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Maria Kloidt
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Wieditz
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nancy L Sicotte
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jared M Bruce
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Peter A Arnett
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätklinikum Hamburg-Eppendorf, Hamburg, Germany
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Lier M, Jebens C, Lorey-Tews A, Heyne T, Kunze-Szikszay N, Wieditz J, Bräuer A. What is the best way to keep the patient warm during technical rescue? Results from two prospective randomised controlled studies with healthy volunteers. BMC Emerg Med 2023; 23:83. [PMID: 37537546 PMCID: PMC10401780 DOI: 10.1186/s12873-023-00850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Accidental hypothermia is a manifest problem during the rescue of entrapped victims and results in different subsequent problems as coagulopathy and wound infection. Different warming methods are available for the preclinicial use. However, their effectiveness has hardly been evaluated. METHODS In a first step a survey among German fire brigades was performed with questions about the most used warming methods. In a second step two crossover studies were conducted. In each study two different warming method were compared with forced air warming - which is the most frequently used and highly effective warming method in operation rooms (Study A: halogen floodlight vs. forced air warming; Study B: forced air warming vs. fleece blanket). In both studies healthy volunteers (Study A: 30 volunteers, Study B: 32 volunteers) were sitting 60 min in a cold store. In the first 21 min there was no subject warming. Afterwards the different warming methods were initiated. Every 3 min parameters like skin temperature, core body temperature and cold perception on a 10-point numeric rating scale were recorded. Linear mixed models were fitted for each parameter to check for differences in temperature trajectories and cold perception with regard to the different warming methods. RESULTS One hundred fifty-one German fire brigades responded to the survey. The most frequently used warming methods were different rescue blankets (gold/silver, wool) and work light (halogen floodlights). Both studies (A and B) showed significantly (p < 0.05) higher values in mean skin temperature, mean body temperature and total body heat for the forced air warming methods compared to halogen floodlight respectively fleece blanket shortly after warming initiation. In contrast, values for the cold perception were significantly lower (less unpleasant cold perception) during the phase the forced air warming methods were used, compared to the fleece blanket or the halogen floodlight was used. CONCLUSION Forced air warming methods used under the standardised experimental setting are an effective method to keep patients warm during technical rescue. Halogen floodlight has an insufficient effect on the patient's heat preservation. In healthy subjects, fleece blankets will stop heat loss but will not correct heat that has already been lost. TRIAL REGISTRATION The studies were registered retrospectively on 14/02/2022 on the German Clinical Trials registry (DRKS) with the number DRKS00028079.
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Affiliation(s)
- Martin Lier
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
| | - Christopher Jebens
- Department of Anesthesiology, Intensive care, Emergency and Pain medicine, Asklepios Clinic Altona, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany
| | - Annette Lorey-Tews
- Department of Anesthesiology and Intensive care medicine, Buchholz Hospital, Steinbecker Strasse 44, 21244, Buchholz in der Nordheide, Germany
| | - Tim Heyne
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Nils Kunze-Szikszay
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Johannes Wieditz
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073, Göttingen, Germany
| | - Anselm Bräuer
- Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
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Meissner K, Dahan A, Olofsen E, Göpfert C, Blood J, Wieditz J, Kharasch ED. Morphine and Hydromorphone Effects, Side Effects, and Variability: A Crossover Study in Human Volunteers. Anesthesiology 2023; 139:16-34. [PMID: 37014986 PMCID: PMC10517626 DOI: 10.1097/aln.0000000000004567] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Balancing between opioid analgesia and respiratory depression continues to challenge clinicians in perioperative, emergency department, and other acute care settings. Morphine and hydromorphone are postoperative analgesic standards. Nevertheless, their comparative effects and side effects, timing, and respective variabilities remain poorly understood. This study tested the hypothesis that IV morphine and hydromorphone differ in onset, magnitude, duration, and variability of analgesic and ventilatory effects. METHODS The authors conducted a randomized crossover study in healthy volunteers. Forty-two subjects received a 2-h IV infusion of hydromorphone (0.05 mg/kg) or morphine (0.2 mg/kg) 1 to 2 weeks apart. The authors measured arterial opioid concentrations, analgesia in response to heat pain (maximally tolerated temperature, and verbal analog pain scores at discrete preset temperatures to determine half-maximum temperature effect), dark-adapted pupil diameter and miosis, end-expired carbon dioxide, and respiratory rate for 12 h after dosing. RESULTS For morphine and hydromorphone, respectively, maximum miosis was less (3.9 [3.4 to 4.2] vs. 4.6 mm [4.0 to 5.0], P < 0.001; median and 25 to 75% quantiles) and occurred later (3.1 ± 0.9 vs. 2.3 ± 0.7 h after infusion start, P < 0.001; mean ± SD); maximum tolerated temperature was less (49 ± 2 vs. 50 ± 2°C, P < 0.001); verbal pain scores at end-infusion at the most informative stimulus (48.2°C) were 82 ± 4 and 59 ± 3 (P < 0.001); maximum end-expired CO2 was 47 (45 to 50) and 48 mmHg (46 to 51; P = 0.007) and occurred later (5.5 ± 2.8 vs. 3.0 ± 1.5 h after infusion start, P < 0.001); and respiratory nadir was 9 ± 1 and 11 ± 2 breaths/min (P < 0.001), and occurred at similar times. The area under the temperature tolerance-time curve was less for morphine (1.8 [0.0 to 4.4]) than hydromorphone (5.4°C-h [1.6 to 12.1] P < 0.001). Interindividual variability in clinical effects did not differ between opioids. CONCLUSIONS For morphine compared to hydromorphone, analgesia and analgesia relative to respiratory depression were less, onset of miosis and respiratory depression was later, and duration of respiratory depression was longer. For each opioid, timing of the various clinical effects was not coincident. Results may enable more rational opioid selection, and suggest hydromorphone may have a better clinical profile. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Konrad Meissner
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Germany
- Department of Anaesthesiology, Leiden University Medical Center, The Netherlands
- Department of Anesthesiology, Washington University in St. Louis, St. Louis MO, USA
| | - Albert Dahan
- Department of Anaesthesiology, Leiden University Medical Center, The Netherlands
| | - Erik Olofsen
- Department of Anaesthesiology, Leiden University Medical Center, The Netherlands
| | - Christine Göpfert
- Department of Anesthesiology, Washington University in St. Louis, St. Louis MO, USA
| | - Jane Blood
- Department of Anesthesiology, Washington University in St. Louis, St. Louis MO, USA
| | - Johannes Wieditz
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Germany
- Department of Medical Statistics, Universitätsmedizin Göttingen, Germany
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5
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Maj R, Palermo P, Gattarello S, Brusatori S, D’Albo R, Zinnato C, Velati M, Romitti F, Busana M, Wieditz J, Herrmann P, Moerer O, Quintel M, Meissner K, Sanderson B, Chiumello D, Marini JJ, Camporota L, Gattinoni L. Ventilatory ratio, dead space, and venous admixture in patients with acute respiratory distress syndrome. Br J Anaesth 2023; 130:360-367. [PMID: 36470747 PMCID: PMC9718027 DOI: 10.1016/j.bja.2022.10.035] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Ventilatory ratio (VR) has been proposed as an alternative approach to estimate physiological dead space. However, the absolute value of VR, at constant dead space, might be affected by venous admixture and CO2 volume expired per minute (VCO2). METHODS This was a retrospective, observational study of mechanically ventilated patients with acute respiratory distress syndrome (ARDS) in the UK and Italy. Venous admixture was either directly measured or estimated using the surrogate measure PaO2/FiO2 ratio. VCO2 was estimated through the resting energy expenditure derived from the Harris-Benedict formula. RESULTS A total of 641 mechanically ventilated patients with mild (n=65), moderate (n=363), or severe (n=213) ARDS were studied. Venous admixture was measured (n=153 patients) or estimated using the PaO2/FiO2 ratio (n=448). The VR increased exponentially as a function of the dead space, and the absolute values of this relationship were a function of VCO2. At a physiological dead space of 0.6, VR was 1.1, 1.4, and 1.7 in patients with VCO2 equal to 200, 250, and 300, respectively. VR was independently associated with mortality (odds ratio [OR]=2.5; 95% confidence interval [CI], 1.8-3.5), but was not associated when adjusted for VD/VTphys, VCO2, PaO2/FiO2 (ORadj=1.2; 95% CI, 0.7-2.1). These three variables remained independent predictors of ICU mortality (VD/VTphys [ORadj=17.9; 95% CI, 1.8-185; P<0.05]; VCO2 [ORadj=0.99; 95% CI, 0.99-1.00; P<0.001]; and PaO2/FiO2 (ORadj=0.99; 95% CI, 0.99-1.00; P<0.001]). CONCLUSIONS VR is a useful aggregate variable associated with outcome, but variables not associated with ventilation (VCO2 and venous admixture) strongly contribute to the high values of VR seen in patients with severe illness.
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Affiliation(s)
- Roberta Maj
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Palermo
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Gattarello
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Brusatori
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Rosanna D’Albo
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Carmelo Zinnato
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Mara Velati
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Romitti
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Mattia Busana
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Johannes Wieditz
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Peter Herrmann
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Onnen Moerer
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Micheal Quintel
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Konrad Meissner
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany
| | - Barnaby Sanderson
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Davide Chiumello
- Department of Anaesthesiology and Intensive Care, ASST Santi Paolo e Carlo Hospital, University of Milan, Milan, Italy
| | - John J. Marini
- Department of Pulmonary and Critical Care Medicine, Regions Hospital, St. Paul, MN, USA
| | - Luigi Camporota
- Department of Adult Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Luciano Gattinoni
- Department of Anaesthesiology, Medical University of Göttingen, University Medical Centre Göttingen, Göttingen, Germany.
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Miller C, Bräuer A, Wieditz J, Klose K, Pancaro C, Nemeth M. Modeling iatrogenic intraoperative hyperthermia from external warming in children: A pooled analysis from two prospective observational studies. Paediatr Anaesth 2023; 33:114-122. [PMID: 36268791 DOI: 10.1111/pan.14580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Maintenance of normothermia is an important quality metric in pediatric anesthesia. While inadvertent hypothermia is effectively prevented by forced-air warming, this therapeutic approach can lead to iatrogenic hyperthermia in young children. AIMS To estimate the influence of external warming by forced air on the development of intraoperative hyperthermia in anesthetized children aged 6 years or younger. METHODS We pooled data from two previous clinical studies. Primary outcome was the course of core temperature over time analyzed by a quadratic regression model. Secondary outcomes were the incidence of hyperthermia (body core temperature >38°C), the probability of hyperthermia over the duration of warming in relation to age and surface-area-to-weight ratio, respectively, analyzed by multiple logistic regression models. The influence of baseline temperature on hyperthermia was estimated using a Cox proportional hazards model. RESULTS Two hundred children (55 female) with a median age of 2.1 [1st -3rd quartile 1-4.2] years were analyzed. Mean temperature increased by 0.43°C after 1 h, 0.64°C after 2 h, and reached a peak of 0.66°C at 147 min. Overall, 33 children were hyperthermic at at least one measurement point. The odds ratios of hyperthermia were 1.14 (95%-CI: 1.07-1.22) or 1.13 (95%-CI: 1.06-1.21) for every 10 min of warming therapy in a model with age or surface-area-to weight ratio (ceteris paribus), respectively. Odds ratio was 1.33 (95%-CI: 1.07-1.71) for a decrease of 1 year in age and 1.63 (95%-CI: 0.93-2.83) for an increase of 0.01 in the surface-to-weight-area ratio (ceteris paribus). An increase of 0.1°C in baseline temperature increased the hazard of becoming hyperthermic by a factor of 1.33 (95%-CI: 1.23-1.43). CONCLUSIONS In children, external warming by forced-air needs to be closely monitored and adjusted in a timely manner to avoid iatrogenic hyperthermia especially during long procedures, in young age, higher surface-area-to-weight ratio, and higher baseline temperature.
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Affiliation(s)
- Clemens Miller
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Anselm Bräuer
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Johannes Wieditz
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany.,Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Katharina Klose
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
| | - Carlo Pancaro
- Department of Anesthesiology, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Marcus Nemeth
- Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany
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Solar S, Wieditz J, Lordick F, Mehnert-Theuerkauf A, Oechsle K, van Oorschot B, Thomas M, Asendorf T, Nauck F, Alt-Epping B. Screening versus multidimensional assessment of symptoms and psychosocial distress in cancer patients from the time of incurability. Front Oncol 2023; 13:1002499. [PMID: 36776341 PMCID: PMC9908949 DOI: 10.3389/fonc.2023.1002499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Previous symptom prevalence studies show a diverse spectrum of symptoms and a large diversity in symptom intensities in patients being just diagnosed as having incurable cancer. It is unclear, how physical symptoms and psychosocial burden should be recorded in order to determine the variable need for palliative care and further support. Therefore, we compared two different strategies for detecting physical symptoms and psychosocial burden of patients with newly diagnosed incurable cancer and their effects on the further course of the disease. Methods SCREBEL is a controlled, randomized, non-blinded, longitudinal study of the research network of the Palliative Medicine Working Group (APM) of the German Cancer Society (DKG). We compared: a less complex repeated brief screening for symptoms and burden in patients using the NCCN Distress Thermometer and IPOS questionnaire versus a multidimensional comprehensive assessment using the FACT-G and their entity-specific questionnaires, the PHQ4 scales, SCNS-34-SF, IPOS and NCCN Distress Thermometer. The primary study endpoint was quality of life (QoL), measured using FACT-G, after six months. Secondary study endpoints were QoL by using evaluation of secondary scores (NCCN DT, IPOS, PHQ4, SCNS-SF-34G) at time 6 months, the number of hospital days, the utilization of palliative care, emergency services, and psychosocial care structures. To assess effects and differences, multiple linear regression models were fitted and survival analyses were conducted. Results 504 patients were included in the study. 262 patients were lost to follow-up, including 155 fatalities. There were no significant differences between the low-threshold screening approach and a comprehensive assessment with respect to symptoms and other aspects of QoL. Using the IPOS, we were able to measure an improvement in the quality of life in the low-threshold screening arm by a decrease of 0.67 points (95%-CI: 0.34 to 0.99) every 30 days. (p<0.001). Data on the involvement of emergency facilities and on supportive services were insufficient for analysis. Conclusion A comprehensive, multidimensional assessment did not significantly differ from brief screening in preserving several dimensions of quality of life. These findings may positively influence the implementation of structured low-threshold screening programs for supportive and palliative needs in DKG certified cancer centers.DRKS -No. DRKS00017774 https://drks.de/search/de/trial/DRKS00017774.
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Affiliation(s)
- Stefanie Solar
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Wieditz
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany,*Correspondence: Johannes Wieditz,
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital of Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Hospital of Leipzig, Leipzig, Germany
| | - Karin Oechsle
- Palliative Care Unit, Center of Oncology, University Hospital of Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Michael Thomas
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany,Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany,Department of Palliative Medicine, University Hospital of Heidelberg, Heidelberg, Germany
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8
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Solar S, Wieditz J, Lordick F, Mehnert-Theuerkauf A, Oechsle K, van Oorschot B, Thomas M, Asendorf T, Nauck F, Alt-Epping B. Screening versus multidimensional assessment of symptoms and psychosocial distress in cancer patients from the time of incurability. Front Oncol 2023; 13:1002499. [PMID: 36776341 DOI: 10.3389/fonc.2023.1002499.pmid:36776341;pmcid:pmc9908949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/10/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVE Previous symptom prevalence studies show a diverse spectrum of symptoms and a large diversity in symptom intensities in patients being just diagnosed as having incurable cancer. It is unclear, how physical symptoms and psychosocial burden should be recorded in order to determine the variable need for palliative care and further support. Therefore, we compared two different strategies for detecting physical symptoms and psychosocial burden of patients with newly diagnosed incurable cancer and their effects on the further course of the disease. METHODS SCREBEL is a controlled, randomized, non-blinded, longitudinal study of the research network of the Palliative Medicine Working Group (APM) of the German Cancer Society (DKG). We compared: a less complex repeated brief screening for symptoms and burden in patients using the NCCN Distress Thermometer and IPOS questionnaire versus a multidimensional comprehensive assessment using the FACT-G and their entity-specific questionnaires, the PHQ4 scales, SCNS-34-SF, IPOS and NCCN Distress Thermometer. The primary study endpoint was quality of life (QoL), measured using FACT-G, after six months. Secondary study endpoints were QoL by using evaluation of secondary scores (NCCN DT, IPOS, PHQ4, SCNS-SF-34G) at time 6 months, the number of hospital days, the utilization of palliative care, emergency services, and psychosocial care structures. To assess effects and differences, multiple linear regression models were fitted and survival analyses were conducted. RESULTS 504 patients were included in the study. 262 patients were lost to follow-up, including 155 fatalities. There were no significant differences between the low-threshold screening approach and a comprehensive assessment with respect to symptoms and other aspects of QoL. Using the IPOS, we were able to measure an improvement in the quality of life in the low-threshold screening arm by a decrease of 0.67 points (95%-CI: 0.34 to 0.99) every 30 days. (p<0.001). Data on the involvement of emergency facilities and on supportive services were insufficient for analysis. CONCLUSION A comprehensive, multidimensional assessment did not significantly differ from brief screening in preserving several dimensions of quality of life. These findings may positively influence the implementation of structured low-threshold screening programs for supportive and palliative needs in DKG certified cancer centers.DRKS -No. DRKS00017774 https://drks.de/search/de/trial/DRKS00017774.
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Affiliation(s)
- Stefanie Solar
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Wieditz
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, University Hospital of Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Hospital of Leipzig, Leipzig, Germany
| | - Karin Oechsle
- Palliative Care Unit, Center of Oncology, University Hospital of Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Center for Palliative Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Michael Thomas
- Thoraxklinik and National Center for Tumor Diseases at Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Bernd Alt-Epping
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
- Department of Palliative Medicine, University Hospital of Heidelberg, Heidelberg, Germany
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Wieditz J, Pokern Y, Schuhmacher D, Huckemann S. Characteristic and necessary minutiae in fingerprints. J R Stat Soc Ser C Appl Stat 2021. [DOI: 10.1111/rssc.12520] [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: 11/30/2022]
Affiliation(s)
- Johannes Wieditz
- Institute for Mathematical Stochastics Georg‐August‐Universtität Göttingen Göttingen Germany
| | - Yvo Pokern
- Department of Statistical Science University College London London UK
| | - Dominic Schuhmacher
- Institute for Mathematical Stochastics Georg‐August‐Universtität Göttingen Göttingen Germany
| | - Stephan Huckemann
- Institute for Mathematical Stochastics Georg‐August‐Universtität Göttingen Göttingen Germany
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