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Barresi F, Foster-Witassek F, Rickli H, Pedrazzini G, Roffi M, Puhan M, Dressel H, Radovanovic D. Acute myocardial infarction and work inability: insights from the AMIS Plus registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1156] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The impact of acute myocardial infarction (AMI) on the ability to pursue professional life is not well defined. Using a nationwide database, we aimed to describe the ability to return to work after AMI in Switzerland and identify factors associated therewith.
Methods
AMI patients of working-age enrolled in the AMIS Plus registry between 01/2006 and 09/2020 with data on self-reported work status before and 12 months after AMI were included. Using the Kruskal-Wallis rank sum test or Fisher's exact test we compared patient characteristics between those who did not reduce work hours, those who reduced, and those no longer working 12 months after the AMI.
Results
Of 4315 AMI patients (median (IQR) age 54 (49, 59)), 3204 (74.3%) did not reduce work, 592 (13.7%) reduced and 519 (12.0%) stopped working. Patients not reducing were youngest (median age (IQR)): 54y (49y, 58y), those who reduced: 56y (51y, 60y), those who stopped: 56y (51y, 61y), p<0.001) and more often men (no reduction: 90%, reduced: 80%, stopped: 82%, p<0.001). Patients who reduced showed worst cardiac function at AMI reflected in the highest rates of Killip class>2 (no reduction: 1.8%, reduced: 5.2%, stopped: 3.3%, p<0.001) and resuscitation before admission (no reduction: 4.1%, reduced: 6.9%, stopped: 4.0%, p=0.008). Patients who stopped work had the most comorbidities such as past AMI (no reduction: 8.6%, reduced: 10%, stopped: 13%, p=0.003), hypertension (no reduction: 45%, reduced: 50%, stopped: 54%, p<0.001), diabetes (no reduction: 10%, reduced: 13%, stopped: 16%, p<0.001) and cerebrovascular disease (no reduction: 0.8%, reduced: 1.2%, stopped: 2.3%, p=0.007). There was no significant difference for rehabilitation participation during follow up (no reduction: 84%, reduced: 86%, stopped: 84%, n.s. for all group comparisons). Multivariable regression showed that the reduction group had a higher proportion of women (OR 2.30; 95% CI 1.80–2.93 p<0.001) and were more likely to have a Killip class >2 at admission (OR 2.58; 95% CI 1.54–4.31 p<0.001) as compared to the no reduction group whereas the comparison between no reduction and work stop identified comorbidities (past MI (OR 1.46; 95% CI 1.07–1.94 p=0.016), diabetes (OR 1.59; 95% CI 1.21–2.09 p=0.001), cerebrovascular disease (OR 2.53; 95% CI 1.22–5.25 p=0.013)) and being female (OR 1.98; 95% CI 1.51–2.58 p<0.001) as major predictors for work stop.
Conclusion
Our data showed that 1:7 had reduced and 1:8 stopped professional activity 1 year after AMI. Younger age, being male and lower rates of comorbidities such as a past AMI, hypertension, diabetes and cerebrovascular disease were important factors associated with returning to work after AMI. Work reduction was significantly related with worse cardiac function whereas work stop was more related with comorbidities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Barresi
- University of Zurich, EBPI, Division of Occupational and Environmental Medicine , Zurich , Switzerland
| | - F Foster-Witassek
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute , Zurich , Switzerland
| | - H Rickli
- Cantonal Hospital St. Gallen, Department of Cardiology , St. Gallen , Switzerland
| | - G Pedrazzini
- Cardiocentro Ticino, Department of Cardiology , Lugano , Switzerland
| | - M Roffi
- Geneva University Hospitals, Division of Cardiology , Geneva , Switzerland
| | - M Puhan
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute , Zurich , Switzerland
| | - H Dressel
- University of Zurich, EBPI, Division of Occupational and Environmental Medicine , Zurich , Switzerland
| | - D Radovanovic
- University of Zurich, AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute , Zurich , Switzerland
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2
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Abbassi F, Gero D, Muller X, Bueno A, Figiel W, Robin F, Laroche S, Picard B, Shankar S, Ivanics T, van Reeven M, van Leeuwen OB, Braun HJ, Monbaliu D, Breton A, Vachharajani N, Bonaccorsi Riani E, Nowak G, McMillan RR, Abu-Gazala S, Nair A, Bruballa R, Paterno F, Weppler Sears D, Pinna AD, Guarrera JV, de Santibañes E, de Santibañes M, Hernandez-Aleja R, Olthoff K, Ghobrial RM, Ericzon BG, Ciccarelli O, Chapman WC, Mabrut JY, Pirenne J, Müllhaupt B, Ascher NL, Porte RJ, de Meier VE, Polak WG, Sapisochin G, Attia M, Weiss E, Adam RA, Cherqui D, Boudjema K, Zienewicz K, Jassem W, Puhan M, Dutkowski P, Clavien PA. Novel benchmark values for redo liver transplantation – does the outcome justify the effort? Br J Surg 2022. [DOI: 10.1093/bjs/znac178.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
In the era of organ shortage, redo liver transplantation (reLT) is frequently discussed in terms of expected poor outcome, high cost and therefore wasteful resources. However, there is a lack of benchmark data to reliably assess outcomes after reLT. The aim of this study was to define the ideal reLT case, and to establish clinically relevant benchmark values for best achievable outcome in reLT.
Methods
We collected data on reLT between January 2010 and December 2018 from 22 high volume transplant centers on three continents. Benchmark cases were defined as recipients with model of end-stage liver disease score <=25, absence of portal vein thrombosis, no mechanical ventilation before surgery, receiving a graft from a donor after brain death. In addition, early reLT including those for primary non-function (PNF) were excluded. Clinically relevant endpoints covering intra- and postoperative course were selected and complications were graded by severity using the Clavien-Dindo classification and the comprehensive complication index (CCI). The benchmark cutoff for each outcome was derived from the 75th percentile of the median values of all benchmark centers, indicating the “best achievable” result. To assess the utility of the newly established benchmark values, we analyzed patients who received reLT for PNF (non-benchmark patients).
Results
Out of 1110 reLT 413 (37.2%) qualified as benchmark cases. Benchmark values included: Length of intensive care unit and hospital stay: <=6 and <=24 days, respectively; Clavien-Dindo grade >=3a complications and the CCI at 1 year: <=76% and <=72.2, respectively; in-hospital and 1-year mortality rates: <=14.0% and <=14.3%, respectively. The cutoffs for transplant-specific complications such as biliary complications at 1 year, outflow problems at 1 year and hepatic artery thrombosis at discharge were <=27.3%, <=2.5% and <=4.8%, respectively. Patients receiving a reLT for PNF showed mean outcome values all outside the reLT benchmark values. In-hospital mortality rate was 34.4% and the mean CCI at discharge 68.8.
Conclusion
ReLT remains associated with high morbidity and mortality. The availability of benchmark values for outcome parameters of reLT may serve for comparison in any future analyses of individuals, patient groups, or centers, but also in the evaluation of new therapeutic strategies and principles.
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Affiliation(s)
- F Abbassi
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - D Gero
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - X Muller
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - A Bueno
- Department of Liver Studies, Kings’ College Hospital , London, United Kingdom
| | - W Figiel
- Department of General, Abdominal and Transplant Surgery, Medical University of Warsaw , Warsaw, Poland
| | - F Robin
- Department of HPB Surgery and Transplantation, University Hospital Rennes , Rennes, France
| | - S Laroche
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - B Picard
- Department of Anesthesiology and Critical Care, Beaujon Teaching Hospital , Clinchy, France
| | - S Shankar
- Department of Abdominal Transplant and Hepatobiliary Surgery, The Leeds Teaching Hospital trust , Leeds, United Kingdom
| | - T Ivanics
- University Health Network Toronto Multi-Organ Transplant Program, , Toronto, Canada
| | - M van Reeven
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - O B van Leeuwen
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - H J Braun
- Division of Transplant Surgery, University of California , San Francisco, USA
| | - D Monbaliu
- Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven , Leuven, Belgium
| | - A Breton
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - N Vachharajani
- Department of Surgery, Division of Abdominal Transplantation, Washington University in St. Louis School of Medicine , St. Louis, USA
| | - E Bonaccorsi Riani
- Department of Abdominal and Transplant Surgery, University Hospital St. Luc , Brussels, Belgium
| | - G Nowak
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - R R McMillan
- Weill Cornell Medical Center, Houston Methodist Hospital , Houston, USA
| | - S Abu-Gazala
- Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania , Philadelphia, USA
| | - A Nair
- Division of Transplantation and Hepatobiliary Surgery, University of Rochester , Rochester, USA
| | - R Bruballa
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - F Paterno
- Division of Liver Transplant, Rutgers New Jersey Medical School University Hospital , Newark, USA
| | - D Weppler Sears
- Department of Abdominal and Transplant Surgery , Cleveland Clinic Florida, Weston, USA
| | - A D Pinna
- Department of Abdominal and Transplant Surgery , Cleveland Clinic Florida, Weston, USA
| | - J V Guarrera
- Division of Liver Transplant, Rutgers New Jersey Medical School University Hospital , Newark, USA
| | - E de Santibañes
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - M de Santibañes
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - R Hernandez-Aleja
- Division of Transplantation and Hepatobiliary Surgery, University of Rochester , Rochester, USA
| | - K Olthoff
- Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania , Philadelphia, USA
| | - R M Ghobrial
- Weill Cornell Medical Center, Houston Methodist Hospital , Houston, USA
| | - B-G Ericzon
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - O Ciccarelli
- Department of Abdominal and Transplant Surgery, University Hospital St. Luc , Brussels, Belgium
| | - W C Chapman
- Department of Surgery, Division of Abdominal Transplantation, Washington University in St. Louis School of Medicine , St. Louis, USA
| | - J-Y Mabrut
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - J Pirenne
- Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven , Leuven, Belgium
| | - B Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich , Zurich, Switzerland
| | - N L Ascher
- Division of Transplant Surgery, University of California , San Francisco, USA
| | - R J Porte
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - V E de Meier
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - W G Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - G Sapisochin
- University Health Network Toronto Multi-Organ Transplant Program, , Toronto, Canada
| | - M Attia
- Department of Abdominal Transplant and Hepatobiliary Surgery, The Leeds Teaching Hospital trust , Leeds, United Kingdom
| | - E Weiss
- Department of Anesthesiology and Critical Care, Beaujon Teaching Hospital , Clinchy, France
| | - R A Adam
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - D Cherqui
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - K Boudjema
- Department of HPB Surgery and Transplantation, University Hospital Rennes , Rennes, France
| | - K Zienewicz
- Department of General, Abdominal and Transplant Surgery, Medical University of Warsaw , Warsaw, Poland
| | - W Jassem
- Department of Liver Studies, Kings’ College Hospital , London, United Kingdom
| | - M Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University Hospital Zurich , Zurich, Switzerland
| | - P Dutkowski
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - P-A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
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3
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Vuille-dit-Bille RN, Staerkle RF, Soll C, Troller R, Muff J, Choudhury R, Holland-Cunz SG, Grochola LF, Samra J, Puhan M, Breitenstein S. Extended lymph node resection versus standard resection for pancreatic head and peri-ampullary adenocarcinoma: A systemic review. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
For patients with pancreatic and peri-ampullary adenocarcinoma, it has been hypothesized that extended lymphadenectomy may result in higher R0 resection rates and improved survival. As such, the objective of this systematic review was to compare the oncologic outcomes after pancreaticoduodenectomy (PD) with standard lymphadenectomy (SLA) versus PD with extended lymphadenectomy (ELA).
Methods
A Cochrane systematic review was conducted to identify all randomized controlled trials comparing PD with SLA versus PD with ELA for participants with periampullary or pancreatic cancer. The following electronic databases were reviewed: the Cochrane Central Register of Controlled Trials; MEDLINE; PubMed and EMBASE. The methodological quality of the included studies was assessed using the Cochrane risk of bias criteria and the quality of evidence for important outcomes using GRADE. Extended lymphadenectomy included the interaortocaval space, left side of the celiac trunk, and superior mesenteric artery.
Results
Seven randomized controlled trials were included with 843 patients (421 ELA and 422 SLA). No difference in overall survival (1- and 3-years after surgery) was seen between groups. Mortality and morbidity rates (including pancreatic fistula, delayed gastric emptying, and postoperative bleeding) were similar between the two groups. Operative time was significantly longer following extended resection (Mean Difference 50.1 min; 95% CI 19.2 to 81.1 min; P = 0.001). Total amount of blood loss during surgery was significantly increased following extended resection (Mean Difference 137 ml; 95% CI 12 to 263 ml; P = 0.03), as well as transfusion requirements (Mean Difference 0.15 units; 95% CI 0.13 to 0.17 units; P < 0.00001).
More lymph nodes were retrieved during ELA (Mean Difference 11 nodes; 95% CI 7 to 15 nodes; P < 0.00001). Incidence of positive resection margins was not different between groups.
Conclusion
There is no indication for extended lymphadenectomy in pancreatic head resection as a routine procedure.
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Affiliation(s)
- R N Vuille-dit-Bille
- Department of Pediatric Surgery, University Children’s Hospital of Basel, Basel, Switzerland
| | - R F Staerkle
- Department of Visceral Surgery, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - C Soll
- Department of Visceral Surgery, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - R Troller
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - J Muff
- Department of Pediatric Surgery, University Children’s Hospital of Basel, Basel, Switzerland
| | - R Choudhury
- Department of Surgery, University of Colorado, Aurora, USA
| | - S G Holland-Cunz
- Department of Pediatric Surgery, University Children’s Hospital of Basel, Basel, Switzerland
| | - L F Grochola
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - J Samra
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, St. Leonards, Australia
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - S Breitenstein
- Department of Visceral and Thoracic Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
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4
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Vonlanthen R, Widmer J, Thalheimer A, Himpens J, Hollymann M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS.
Methods
The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software.
Results
Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.
Conclusion
Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- D Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - S Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - E Deleus
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Lloyd
- Department of Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, USA
| | - E Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - G Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - I Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A San Martin
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - L Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - H Sammalkorpi
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - J L Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - T Tatarian
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - T Wiggins
- Bariatric and Metabolic Surgery Center, Musgrove Park Hospital, Taunton, United Kingdom
| | - E Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - J -P Goreux
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
| | - R Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - M Hollymann
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Aggarwal
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - A Beekley
- Bariatric and Metabolic Surgery Center, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - M Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - A Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Juuti
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - P Salminen
- Department of Surgery, University of Turku, Turku, Finland
| | - G Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - A Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C Boza
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - R Rosenthal
- Bariatric and Metabolic Surgery Department, Cleveland Clinic Florida, Weston, USA
| | - K Higa
- Bariatric and Metabolic Surgery Center, Fresno Heart and Surgical Hospital, Fresno, USA
| | - M Lannoo
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - E J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - B Dillemans
- Department of Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - P -A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingkom
| | - M Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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Frei A, Strassmann A, Guler M, Carron T, Steurer-Stey C, Dalla Lana K, Giroud P, Peytremann-Bridevaux I, Puhan M. EVALUATION OF THE IMPLEMENTATION OF THE “LIVING WELL WITH COPD” SELF-MANAGEMENT PROGRAM IN SWITZERLAND. Chest 2020. [DOI: 10.1016/j.chest.2020.05.341] [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: 11/16/2022] Open
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6
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Brakema EA, van Gemert FA, van der Kleij RMJJ, Salvi S, Puhan M, Chavannes NH. COPD's early origins in low-and-middle income countries: what are the implications of a false start? NPJ Prim Care Respir Med 2019; 29:6. [PMID: 30837469 PMCID: PMC6401185 DOI: 10.1038/s41533-019-0117-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/28/2019] [Indexed: 01/16/2023] Open
Affiliation(s)
- E A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
| | - F A van Gemert
- Department of General Practice Groningen, Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - S Salvi
- Chest Research Foundation, Pune, India
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
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7
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Hovaguimian F, Tschopp C, Beck-Schimmer B, Puhan M. Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta-analysis. Acta Anaesthesiol Scand 2018; 62:1182-1193. [PMID: 29947091 DOI: 10.1111/aas.13168] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postoperative cognitive complications are associated with substantial morbidity and mortality. Ketamine has been suggested to have neuroprotective effects in various settings. This systematic review evaluates the effects of intraoperative ketamine administration on postoperative delirium and postoperative cognitive dysfunction (POCD). METHODS Medline, Embase and Central were searched to 4 March 2018 without date or language restrictions. We considered randomised controlled trials (RCTs) comparing intraoperative ketamine administration versus no intervention in adults undergoing surgery under general anaesthesia. Primary outcomes were postoperative delirium and POCD. Non-cognitive adverse events, mortality and length of stay were considered as secondary outcomes. Data were independently extracted. The quality of the evidence (GRADE approach) was assessed following recommendations from the Cochrane collaboration. Risk ratios were calculated for binary outcomes, mean differences for continuous outcomes. We planned to explore the effects of age, specific anaesthesia regimen, depth of anaesthesia and intraoperative haemodynamic events through subgroup analyses. RESULTS Six RCTs were included. The incidence of postoperative delirium did not differ between groups (4 trials, 557 patients, RR 0.83, 95% CI [0.25, 2.80]), but patients receiving ketamine seemed at lower risk of POCD (3 trials, 163 patients, RR 0.34, 95% CI [0.15, 0.73]). However, both analyses presented limitations. Therefore, the quality of the evidence (GRADE) was deemed low (postoperative delirium) and very low (POCD). CONCLUSION The effect of ketamine on postoperative delirium remains unclear but its administration may offer some protection towards POCD. Large, well-designed randomised trials are urgently needed to further clarify the efficacy of ketamine on neurocognitive outcomes.
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Affiliation(s)
- F. Hovaguimian
- Institute of Anaesthesiology; University of Zurich and University Hospital of Zurich; Zurich Switzerland
| | - C. Tschopp
- Institute of Anaesthesiology; University of Zurich and University Hospital of Zurich; Zurich Switzerland
| | - B. Beck-Schimmer
- Institute of Anaesthesiology; University of Zurich and University Hospital of Zurich; Zurich Switzerland
| | - M. Puhan
- Epidemiology, Biostatistics and Prevention Institute; University of Zurich; Zurich Switzerland
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Halank M, Speich R, Petkova D, Saxer S, Müller-Mottet S, Hasler E, Kolditz M, Wilkens H, Ehlken N, Lichtblau M, Egenlauf B, Kähler C, Lüneburg N, Mertens D, Schulz U, Barner A, Grünig E, Puhan M, Ulrich S. [Quality of life in pulmonal arterial hypertension and in chronic thromboembolic pulmonary hypertension]. Dtsch Med Wochenschr 2014; 139 Suppl 4:S126-35. [PMID: 25489682 DOI: 10.1055/s-0034-1387482] [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: 10/24/2022]
Affiliation(s)
- M Halank
- Medizinische Klinik I, Universitätsklinikum der Technischen Universität Dresden, Deutschland
| | - R Speich
- Klinik für Pneumologie, Universitätsspital Zürich, Schweiz
| | - D Petkova
- Klinik für Pneumologie, Universitätsspital Varna, Bulgarien
| | - S Saxer
- Klinik für Pneumologie, Universitätsspital Zürich, Schweiz
| | | | - E Hasler
- Klinik für Pneumologie, Universitätsspital Zürich, Schweiz
| | - M Kolditz
- Medizinische Klinik I, Universitätsklinikum der Technischen Universität Dresden, Deutschland
| | - H Wilkens
- Klinik für Pneumologie, Universitätsspital Homburg, Deutschland
| | - N Ehlken
- Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - M Lichtblau
- Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - B Egenlauf
- Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - C Kähler
- Universitätsklinik für Innere Medizin VI, Medizinische Universität Innsbruck, Österreich
| | - N Lüneburg
- Instituts für Klinische Pharmakologie und Toxikologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - D Mertens
- Praxis für interventionelle Angiologie, Kaiserslautern
| | - U Schulz
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Deutschland
| | - A Barner
- Krankenhaus & Sanatorium Dr. Barner, Psychosomatische Akut- und Rehaklinik, Braunlage, Deutschland
| | - E Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik am Universitätsklinikum Heidelberg, Deutschland
| | - M Puhan
- Institut für Epidemiologie, Biostatistik und Prävention, Universitätsspital Zürich, Schweiz
| | - S Ulrich
- Klinik für Pneumologie, Universitätsspital Zürich, Schweiz
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9
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Gillissen A, Buhl R, Kardos P, Puhan M, Rabe K, Rothe T, Sauer R, Welte T, Worth H, Menz G. Studienendpunkte bei der chronisch-obstruktiven Lungenerkrankung (COPD): „Minimal Clinically Important Difference”. Pneumologie 2008; 62:149-55. [DOI: 10.1055/s-2007-996182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg 2007; 94:1451-60. [PMID: 17968980 DOI: 10.1002/bjs.6007] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical strategy for acute colorectal obstruction due to colorectal cancer remains controversial. One-, two- and three-stage surgical procedures, and preoperative stenting of the stenosis as a bridge to surgery, are available. METHODS A systematic review was conducted, searching MEDLINE, EMBASE and CENTRAL, as well as bibliographies of included studies, to identify randomized and non-randomized controlled trials that compared two or more surgical procedures in acute colonic obstruction. RESULTS After screening 1748 titles and abstracts, 209 were selected for full text assessment; 29 studies with 2286 patients were finally included. In general, the quality of the studies was limited, with only three randomized trials. Eight non-randomized studies comparing one-stage with two- or three-stage surgery consistently favoured a one-stage procedure in terms of mortality (relative risk difference from - 2 to - 27 per cent), but reported morbidity rates were not different. Trials of different one-stage procedures (segmental and total/subtotal colectomy) showed none to be clearly superior. Stenting procedures were superior to non-stenting treatments. CONCLUSION One-stage surgery appears to be superior to two- or three-stage procedures. Stenting is a promising option, allowing the resection to be carried out in an elective setting.
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Affiliation(s)
- S Breitenstein
- Department of Visceral and Transplantation Surgery, Zurich, Switzerland
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Abstract
Clinical manifestations of chronic obstructive pulmonary disease (COPD) and progress of disease are heterogeneous. A single parameter such as lung function is insufficient to capture manifestations of COPD and to estimate the prognosis of patients. A number of additional parameters such as level of physical activity, cardiovascular co-morbidity or history of exacerbations should be considered. If a validated assessment including the most important prognostic parameters becomes available, COPD management could become more individualized and patient-centered than it currently is.
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Affiliation(s)
- M Puhan
- Horten Zentrum für praxisorientierte Forschung und Wissenstransfer, Universität Zürich.
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12
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Muntener M, Kunz U, Eichler K, Puhan M, Schmid D, Jaeger P, Strebel R. DIAGNOSTIC YIELD OF A PSA THRESHOLD FOR PROSTATE BIOPSY OF 2.5 NG/ML COMPARED TO 4 NG/ML. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s1569-9056(06)60864-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Puhan M, Scharplatz M, Troosters T, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Schünemann HJ, Goldstein R, Mador MJ, McKim D, Stahl E, Puhan M, Griffith LE, Grant B, Austin P, Collins R, Guyatt GH. A randomised trial to evaluate the self-administered standardised chronic respiratory questionnaire. Eur Respir J 2005; 25:31-40. [PMID: 15640320 DOI: 10.1183/09031936.04.00029704] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The original chronic respiratory questionnaire (CRQ), one of the most widely used measures of health-related quality of life (HRQL) in chronic respiratory disease (CRD), is traditionally interviewer administered (IA) and includes an individualised dyspnoea domain. The present authors studied the impact of self-administered (SA) and standardised dyspnoea questions on CRQ measurement properties. In a factorial design multicentre trial, 177 patients with CRD (mean age 67.7 yrs; mean forced expiratory volume in one second per cent predicted 44.6%) were randomised to CRQ-IA (n = 86) or CRQ-SA (n = 91), and to initially complete the standardised or individualised items before and after respiratory rehabilitation. While maintaining validity, the CRQ-SA proved more responsive to changes in HRQL than the CRQ-IA in all domains. Compared with the standardised dyspnoea domain, the individualised dyspnoea domain indicated greater responsiveness. The correlations of baseline scores and change scores with other HRQL instruments indicated good validity of the CRQ-SA. In conclusion, self-administration and standardisation of the chronic respiratory questionnaire maintains validity and responsiveness relative to the interviewer-administered chronic respiratory questionnaire. These results challenge the assumption that interviewer-administered questionnaires are superior to self-administered questionnaires in older patients with chronic respiratory disease.
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Affiliation(s)
- H J Schünemann
- Department of Medicine, University Health Sciences Centre, Room 2C12, Hamilton, Ontario L8N 3Z5, Canada.
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Scharplatz M, Puhan M, Steurer J, Bachmann LM. [Pharmacogenetics. Tailored therapy in medicine -- opportunities and challenges]. Praxis (Bern 1994) 2004; 93:359-365. [PMID: 15052854 DOI: 10.1024/0369-8394.93.10.359] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This article provides a general introduction into the field of pharmacogenetics and discusses its opportunities and limits. Pharmacogenetic research explores genetic variability between patients to explain observed differences in effectiveness of a drug therapy or adverse event profiles. Sometimes drug therapy is unfavourable: Patients may respond only partially to a drug therapy, do not respond at all, or suffer from serious adverse events. The reasons for the varying effectiveness of a drug therapy are due to factors like absorption; metabolism, elimination and target interaction. Recent research has led to a better understanding of the molecular genetic mechanisms behind those factors. Numerous new polymorphisms have been described, for example for the beta 2-adrenergic receptor or the cytochrome which can either improve or reduce the response to drug therapy. Two polymorphisms for the tumour necrosis factor alpha have shown to be associated with an increased risk of serious adverse events (hypersensibility: fever, rash, gastrointestinal symptoms) if treated with abacavir (HIV-treatment). Pharmacogenetic tests provide information about certain polymorphisms and raise the hope for an individualized pharmacotherapy. Yet, not only genetic but also environmental factors influence the effectiveness of a therapy. Even though results from research implies that pharmacogenetics has a great potential to maximize the effectiveness of pharmacotherapy and to reduce the incidence of drug-related adverse events, extensive clinical research both on effectiveness and costs is required to assess the true benefits of these exciting new technologies.
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Affiliation(s)
- M Scharplatz
- Horten-Zentrum für praxisorientierte Forschung und Wissenstransfer, Zürich.
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16
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Abstract
The aim of this survey was to characterize respiratory rehabilitation programmes for patients with COPD in Switzerland. Rate of return of questionnaires was 94%. In 2001, 2238 patients with COPD followed an inpatient (1790) or outpatient (448) respiratory rehabilitation programme. This corresponds to 1% of all patients with COPD in Switzerland. Physical exercise is estimated to be significantly more important compared to breathing exercises, patient education and psychosocial support although this prioritization is not as pronounced as in the current literature. Disease-specific instruments to measure health related quality of life that represents the most important outcome measure for patients with COPD should be implemented in practice. Thereby both the components of rehabilitation programmes and predictive factors for a successful rehabilitation could be evaluated.
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Affiliation(s)
- M Puhan
- Zürcher Höhenklinik Wald, Faltigerg-Wald.
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