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de Jong CMM, van den Hout WB, van Dijk CE, Heim N, van Dam LF, Dronkers CEA, Gautam G, Ghanima W, Gleditsch J, von Heijne A, Hofstee HMA, Hovens MMC, Huisman MV, Kolman S, Mairuhu ATA, van Mens TE, Nijkeuter M, van de Ree MA, van Rooden CJ, Westerbeek RE, Westerink J, Westerlund E, Kroft LJM, Klok FA. Cost-Effectiveness of Performing Reference Ultrasonography in Patients with Deep Vein Thrombosis. Thromb Haemost 2023. [PMID: 37984402 DOI: 10.1055/a-2213-9230] [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: 11/22/2023]
Abstract
BACKGROUND The diagnosis of recurrent ipsilateral deep vein thrombosis (DVT) with compression ultrasonography (CUS) may be hindered by residual intravascular obstruction after previous DVT. A reference CUS, an additional ultrasound performed at anticoagulant discontinuation, may improve the diagnostic work-up of suspected recurrent ipsilateral DVT by providing baseline images for future comparison. OBJECTIVES To evaluate the cost-effectiveness of routinely performing reference CUS in DVT patients. METHODS Patient-level data (n = 96) from a prospective management study (Theia study; NCT02262052) and claims data were used in a decision analytic model to compare 12 scenarios for diagnostic management of suspected recurrent ipsilateral DVT. Estimated health care costs and mortality due to misdiagnosis, recurrent venous thromboembolism, and bleeding during the first year of follow-up after presentation with suspected recurrence were compared. RESULTS All six scenarios including reference CUS had higher estimated 1-year costs (€1,763-€1,913) than the six without reference CUS (€1,192-€1,474). Costs were higher because reference CUS results often remained unused, as 20% of patients (according to claims data) would return with suspected recurrent DVT. Estimated mortality was comparable in scenarios with (14.8-17.9 per 10,000 patients) and without reference CUS (14.0-18.5 per 10,000). None of the four potentially most desirable scenarios included reference CUS. CONCLUSION One-year health care costs of diagnostic strategies for suspected recurrent ipsilateral DVT including reference CUS are higher compared to strategies without reference CUS, without mortality benefit. These results can inform policy-makers regarding use of health care resources during follow-up after DVT. From a cost-effectiveness perspective, the findings do not support the routine application of reference CUS.
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Affiliation(s)
- Cindy M M de Jong
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences - Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Noor Heim
- National Health Care Institute, The Netherlands
| | - Lisette F van Dam
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
- Department of Emergency Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Charlotte E A Dronkers
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Gargi Gautam
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Waleed Ghanima
- Department of Internal Medicine, Østfold Hospital Trust, Gralum, Norway
- Department of Haematology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Anders von Heijne
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Herman M A Hofstee
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marcel M C Hovens
- Department of Vascular Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stan Kolman
- Department of Vascular Medicine, Diakonessen Hospital, Utrecht, The Netherlands
| | - Albert T A Mairuhu
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Thijs E van Mens
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Mathilde Nijkeuter
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A van de Ree
- Department of Vascular Medicine, Diakonessen Hospital, Utrecht, The Netherlands
| | | | | | - Jan Westerink
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Eli Westerlund
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Linsen SS, Teschke M, Heim N, Mercuri LG. Is the risk of chronic pain after total temporomandibular joint replacement independent of its indications? A prospective cohort study. Br J Oral Maxillofac Surg 2023; 61:337-343. [PMID: 37230824 DOI: 10.1016/j.bjoms.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Chronic pain is a possible long-term complication after alloplastic temporomandibular joint reconstruction (TMJR). This study was developed to evaluate various subjective and objective measurements to determine the presence and degree of TMJ pain in patients treated with TMJR regardless of the indication for the operation. A prospective, single-centre study was performed. Data on 36 patients (56 TMJR) were collected preoperatively and at follow up two to three years postoperatively. The primary outcome variable was subjective TMJ pain (none/mild, moderate/severe) at follow up. The predictor variables were objective pressure pain thresholds (PPTs) at the ipsilateral joint(s) and muscle(s), functional parameters (incisal range of motion, maximum voluntary clenching), subjective oral health-related quality of life (OHRQoL), and demographic and surgical variables. The number of patients with moderate/severe pain decreased from 17 preoperatively to 10 at follow up. Self-reported TMJ pain was significantly reduced in the entire group (p = 0.001). Patients with moderate/severe pain at follow up were more restricted in their OHRQoL but did not differ in PPT and functional parameters from the no/mild pain group. Moderate/severe TMJ pain at follow up was associated with unilateral TMJR and more preoperative pain. This study provides preliminary evidence that despite good pain reduction in most patients, persistent pain after TMJR is common and, in rare cases, may even worsen regardless of the original diagnosis. At follow up there was a close relation between OHRQoL and TMJ pain. TMJ pain after TMJR cannot be confirmed by objective measurement methods (PPTs and functional parameters).
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Affiliation(s)
- S S Linsen
- Department of Prosthodontics, Preclinical Education and Dental Material Science, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany.
| | - M Teschke
- Private Practice, Zeppelinstr.24, 61352 Bad Homburg, Germany
| | - N Heim
- Department of Oral- and Maxillofacial Plastic Surgery, University Hospital Bonn, Welschnonnenstr. 17, 53111 Bonn, Germany
| | - L G Mercuri
- Department of Orthopaedic Surgery, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States; Department of Bioengineering, University of Illinois Chicago, 851 S Morgan St, Chicago, IL 60607, United States; Stryker/TMJ Concepts, 6059 King Drive, Ventura, CA 93003, United States
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Warwas FB, Heim N, Berger M, Kramer FJ, Wiedemeyer V. Retrospective study on the pharyngeal airspace in the lateral cephalogram - A mathematical model to predict changes due to bimaxillary orthognathic surgery. J Craniomaxillofac Surg 2022; 50:817-824. [PMID: 36376159 DOI: 10.1016/j.jcms.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was the development of a statistical model for reliable prediction of Posterior Airway Space (PAS) changes in lateral cephalograms (LCR) of patients after bimaxillary orthognathic surgery. The LCRs of patients who underwent bimaxillary orthognathic surgery were retrospectively analyzed. The anteroposterior dimension of the PAS was measured at three levels in the pre-operative and postoperative LCR: On the nasopharyngeal (SPAS), oropharyngeal (MAS), and hypopharyngeal level (IAS). The data of 139 patients were collected. The following changes of the PAS were measured: in class II patients SPAS: 0.291 mm (SD = 2.570 mm); MAS: 2.444 mm (SD = 2.986 mm); IAS: 0.750 mm (SD = 3.017 mm); in class III patients SPAS: 1.377 mm (SD 3.212 mm); MAS: 0.962 (SD: = 3.135 mm); IAS: 0.370 mm (SD = 3.468 mm). Linear regression analysis showed for class II patients, a significant influence of mandibular movement on MAS (p = 0.049) and a significant effect of maxillary and mandibular movements on SPAS (p = 0.001) and MAS (p = 0.022) in class III patients. The other jaw displacements had no significant impact on the investigated PAS levels. While the presented method does not permit exact prediction of the dimension of the PAS, it is still an easily accessible method of orientation for the surgeon. The surgeon can initiate three-dimensional examinations to provide exact three-dimensional prediction based on this calculation.
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Affiliation(s)
- F B Warwas
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany.
| | - N Heim
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany
| | - M Berger
- University of Bonn, Faculty of Medicine, Department of Medical Biometry, Informatics and Epidemiology Venusberg Campus 1, 53127, Bonn, Germany
| | - F-J Kramer
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany
| | - V Wiedemeyer
- Universityclinic of Bonn, Department of Oral, Cranio-Maxillo and Facial Plastic Surgery, Venusberg Campus 1, 53127, Bonn, Germany
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Jäger A, Heim N, Kramer FJ, Setiawan M, Peitz M, Konermann A. A novel serum-free medium for the isolation, expansion and maintenance of stemness and tissue-specific markers of primary human periodontal ligament cells. Ann Anat 2020; 231:151517. [PMID: 32229241 DOI: 10.1016/j.aanat.2020.151517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/20/2019] [Revised: 02/21/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Periodontal ligament (PDL) cell cultures are classically maintained in serum-containing media. However, unwanted side-effects of these conditions on cellular and molecular characteristics demand a serum-free alternative. Even though these limitations are well known and efforts for the development of adequate serum-free alternatives have been made, these approaches for replacement remained unsuccessful so far. This study aimed at developing a well-defined, serum-free formulation supporting both isolation from tissue samples and efficient expansion of PDL cells. Here, of particular focus was the perpetuation of tissue-characteristic markers detectable in primary tissues and of stemness features. BASIC PROCEDURES Primary PDL cell cultures from generally healthy human donors (n = 3) were maintained in basal media N2B27 and E6 together with different concentrations of growth and attachment factors. Cell proliferation was recorded via microscopy and WST assay. Gene expression of RUNX2, Periostin, ALP, CD73, CD90, CD105, CD45, SOX10 and SOX2 was compared to primary PDL explants via qRT-PCR. Immunocytochemistry was performed for anti-CD105, SSEA-3, CD271, HNK1. Serum-containing sDMEM medium served as control. MAIN FINDINGS N2B27 medium substituted with 25 ng/mL EGF, 25 ng/mL IGF1, 0.5 mg/mL Fetuin plus gelatine coating (designated N2B27-PDLsf) emerged as potent serum-free formulation ensuring adequate culture isolation and expansion. Here, PDL primary tissue signature markers RUNX2 and Periostin remained stable in N2B27-PDLsf compared to controls (229.0-fold ±101.0 and 83.2-fold ±9.6 increase). Additionally, stemness markers ALP and CD105 were significantly upregulated on transcriptional, and CD105 and SOX2 on protein level. PRINCIPAL CONCLUSIONS This investigation identified a novel serum-free medium for the isolation, and expansion of primary human PDL cells with constantly high proliferation rates. Here, purity and stemness properties are maintained. Thus, N2B27-PDLsf represents a valid replacement for serum-containing media in PDL cultures.
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Affiliation(s)
- A Jäger
- Department of Orthodontics, Medical Faculty, University of Bonn, 53111 Bonn, Germany
| | - N Heim
- Department of Oral & Maxillofacial Plastic Surgery, University of Bonn, 53105 Bonn, Germany
| | - F J Kramer
- Department of Oral & Maxillofacial Plastic Surgery, University of Bonn, 53105 Bonn, Germany
| | - M Setiawan
- Department of Orthodontics, Medical Faculty, University of Bonn, 53111 Bonn, Germany
| | - M Peitz
- Institute of Reconstructive Neurobiology, Life and Brain Center, University of Bonn, 53127 Bonn, Germany
| | - A Konermann
- Department of Orthodontics, Medical Faculty, University of Bonn, 53111 Bonn, Germany.
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Ettema R, Heim N, Hamaker M, Emmelot-Vonk M, van der Mast R, Schuurmans M. Validity of a screening method for delirium risk in older patients admitted to a general hospital in the Netherlands. Gen Hosp Psychiatry 2018; 55:44-50. [PMID: 30384003 DOI: 10.1016/j.genhosppsych.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Delirium is an impactful, frequently occurring complication in older hospital patients. Consequently, risk stratification of delirium was included in a set of mandatory safety measures in general hospitals in the Netherlands. This risk stratification contains three consensus-based questions that have not been validated. Therefore, we evaluated their predictive performance and examined whether other routinely collected patient data can improve the prediction of delirium. METHOD Using data from a continuous data registry from a general hospital, the prediction of the three questions was compared with the occurrence of delirium in 3786 older patients. Regression models were fitted that included other patient-related delirium risk factors. The performance was expressed by discrimination and calibration. RESULTS Delirium occurrence was 16.8%. The three questions, a regression model with the three questions, a full model and a reduced model - including the three questions, age, use of glasses, number of medications and Katz-ADL - showed sensitivities of 0.88, 0.88, 0.92 and 0.91 and specificities of 0.52, 0.52, 0.53 and 0.54, when treated as dichotomous models respectively. The three risk models had C-statistics of 0.81, 0.86 and 0.86, with excellent p-values of the U-statistics. CONCLUSION The three risk-stratification questions show promising results but substantial overprediction (49% predicting positive). Further validation should be done outside the Netherlands, given the potential bias as a result of clinical activities following the risk stratification. The reduced model shows excellent calibration performance, indicating good prediction in each individual patient. In clinical practice, this advantage adds to clinical reasoning.
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Affiliation(s)
- Roelof Ettema
- Julius Center for Health Sciences and Primary Care, Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, the Netherlands; Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, P.O. Box 12011, 3501 AA Utrecht, the Netherlands.
| | - Noor Heim
- Julius Center for Health Sciences and Primary Care, Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, the Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, B1P, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Marije Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Hospital, P.O. Box 80250, 3508 TG Utrecht, the Netherlands.
| | - Mariëlle Emmelot-Vonk
- Department of Geriatrics, University Medical Center Utrecht, P.O Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Roos van der Mast
- Department of Psychiatry, Leiden University Medical Center, B1P, P.O. Box 9600, 2300 RC Leiden, the Netherlands; Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium.
| | - Marieke Schuurmans
- Julius Center for Health Sciences and Primary Care, Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, the Netherlands; Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, P.O. Box 12011, 3501 AA Utrecht, the Netherlands.
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Lucke JA, van der Mast RC, de Gelder J, Heim N, de Groot B, Mooijaart SP, Blauw GJ. The Six-Item Cognitive Impairment Test Is Associated with Adverse Outcomes in Acutely Hospitalized Older Patients: A Prospective Cohort Study. Dement Geriatr Cogn Dis Extra 2018; 8:259-267. [PMID: 30140275 PMCID: PMC6103363 DOI: 10.1159/000490240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/19/2018] [Indexed: 02/03/2023] Open
Abstract
Aim The study aim was to investigate whether cognitive impairment, measured by the Six-Item Cognitive Impairment Test (6-CIT), is an independent predictor of adverse outcomes in acutely hospitalized older patients. Methods This was a prospective multicenter study including acutely hospitalized patients aged 70 years and older. Multivariable logistic regression was used to investigate whether impaired cognition (6-CIT ≥11 points) was an independent predictor of 90-day adverse outcome, a composite measure of functional decline and mortality. Secondary endpoints were hospital length of stay, new institutionalization, and in-hospital mortality. Results In total, 196 (15.6%) of 1,252 included patients had a 6-CIT ≥11. Median age was 80 years (interquartile range 74–85). Patients with impaired cognition had higher rates of 90-day adverse outcome (41.7% compared to 30.3% in 1,056 not cognitively impaired patients, p = 0.009). Impaired cognition was a predictor of 90-day adverse outcome with a crude odds ratio (OR) of 1.64 (95% CI 1.13–2.39), but statistical significance was lost when fully corrected for possible confounders (OR 1.44, 95% CI 0.98–2.11). For all secondary outcomes, impaired cognition was an independent predictor. Conclusions In the acute hospital setting, the 6-CIT is associated with 90-day adverse outcome and is an independent predictor of hospital length of stay, new institutionalization, and in-hospital mortality.
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Affiliation(s)
- Jacinta A Lucke
- Section of Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Jelle de Gelder
- Section of Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Noor Heim
- Section of Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Simon P Mooijaart
- Section of Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Institute for Evidence-Based Medicine in Old Age (IEMO), Leiden, the Netherlands
| | - Gerard J Blauw
- Section of Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Grieshaber P, Heim N, Herzberg M, Niemann B, Roth P, Böning A. Active Chest Tube Clearance after Cardiac Surgery Reduces Postoperative Reexploration Rates. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627978] [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: 10/28/2022]
Affiliation(s)
- P. Grieshaber
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - N. Heim
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - M. Herzberg
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - B. Niemann
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - P. Roth
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
| | - A. Böning
- Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Giessen, Giessen, Germany
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Ettema R, Heim N, Hamaker M, Emmelot-Vonk M, van der Mast R, Schuurmans M. VALIDITY OF A SCREENING METHOD FOR DELIRIUM RISK IN OLDER PATIENTS ADMITTED TO A GENERAL HOSPITAL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3505] [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: 11/14/2022] Open
Affiliation(s)
- R. Ettema
- University Utrecht, Utrecht, Utrecht, Netherlands,
- University of Applied Sciences Utrecht, The Netherlands, Utrecht, Utrecht, Netherlands,
| | - N. Heim
- University Utrecht, Utrecht, Utrecht, Netherlands,
| | - M. Hamaker
- Diakonessenhuis, Utrecht, Utrecht, Netherlands,
| | | | - R. van der Mast
- University Hospital Leiden, Leiden, Zuid Holland, Netherlands
| | - M. Schuurmans
- University Utrecht, Utrecht, Utrecht, Netherlands,
- University of Applied Sciences Utrecht, The Netherlands, Utrecht, Utrecht, Netherlands,
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Heim N, van Stel HF, Ettema RG, van der Mast RC, Inouye SK, Schuurmans MJ. HELP! Problems in executing a pragmatic, randomized, stepped wedge trial on the Hospital Elder Life Program to prevent delirium in older patients. Trials 2017; 18:220. [PMID: 28514964 PMCID: PMC5436415 DOI: 10.1186/s13063-017-1933-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
Abstract
Background A pragmatic, stepped wedge trial design can be an appealing design to evaluate complex interventions in real-life settings. However, there are certain pitfalls that need to be considered. This paper reports on the experiences and lessons learned from the conduct of a cluster randomized, stepped wedge trial evaluating the effect of the Hospital Elder Life Program (HELP) in a Dutch hospital setting to prevent older patients from developing delirium. Methods We evaluated our trial which was conducted in eight departments in two hospitals in hospitalized patients aged 70 years or older who were at risk for delirium by reflecting on the assumptions that we had and on what we intended to accomplish when we started, as compared to what we actually realized in the different phases of our study. Lessons learned on the design, the timeline, the enrollment of eligible patients and the use of routinely collected data are provided accompanied by recommendations to address challenges. Results The start of the trial was delayed which caused subsequent time schedule problems. The requirement for individual informed consent for a quality improvement project made the inclusion more prone to selection bias. Most units experienced major difficulties in including patients, leading to excluding two of the eight units from participation. This resulted in failing to include a similar number of patients in the control condition versus the intervention condition. Data on outcomes routinely collected in the electronic patient records were not accessible during the study, and appeared to be often missing during analyses. Conclusions The stepped wedge, cluster randomized trial poses specific risks in the design and execution of research in real-life settings of which researchers should be aware to prevent negative consequences impacting the validity of their results. Valid conclusions on the effectiveness of the HELP in the Dutch hospital setting are hampered by the limited quantity and quality of routine clinical data in our pragmatic trial. Executing a stepped wedge design in a daily practice setting using routinely collected data requires specific attention to ethical review, flexibility, a spacious time schedule, the availability of substantial capacity in the research team and early checks on the data availability and quality. Trial registration Netherlands Trial Register, identifier: NTR3842. Registered on 24 January 2013.
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Affiliation(s)
- Noor Heim
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roelof G Ettema
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Research Center for Innovations in Health Care, Faculty of Health Care, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Department of Psychiatry, CAPRI-University of Antwerp, Antwerp, Belgium
| | - Sharon K Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Research Center for Innovations in Health Care, Faculty of Health Care, Utrecht University of Applied Sciences, Utrecht, The Netherlands
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Heim N, Faron A, Fuchs J, Martini M, Reich RH, Löffler K. Die Lesbarkeit von onlinebasierten Patienteninformationen in der Augenheilkunde. Ophthalmologe 2016; 114:450-456. [DOI: 10.1007/s00347-016-0367-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Heim N, Rolden H, van Fenema EM, Weverling-Rijnsburger AWE, Tuijl JP, Jue P, Oleksik AM, de Craen AJM, Mooijaart SP, Blauw GJ, Westendorp RGJ, van der Mast RC, van Everdinck IEC. The development, implementation and evaluation of a transitional care programme to improve outcomes of frail older patients after hospitalisation. Age Ageing 2016; 45:643-51. [PMID: 27298381 DOI: 10.1093/ageing/afw098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 09/22/2015] [Accepted: 04/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND fragmented healthcare systems are poorly suited to treat the increasing number of older patients with multimorbidity. OBJECTIVE to report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients. METHODS the programme was drafted in co-creation with organisations representing older adults, care providers and knowledge institutes. Conducting an action research project, the incidence of adverse outcomes within 3 months after hospital admission, and long-term care expenses (LTCE) were compared between samples in 2010-11 (pre-programme) and 2012-13 (post-programme) in frail and non-frail patients. Hospitalised patients aged ≥70 years were included in four hospitals in the targeted region. RESULTS developed innovations addressed (i) improved risk management; (ii) delivery of integrated, function-oriented care; (iii) specific geriatric interventions; and (iv) optimisation of transfers. The incidence of adverse outcomes was compared in 813 and 904 included patients respectively in the two samples. In frail patients, the incidence of adverse outcomes decreased from 49.2% (149/303) in the pre-programme sample to 35.5% (130/366) in the post-programme sample. The risk ratio (RR), adjusted for heterogeneity between hospitals, was 0.72 (95% CI: 0.60-0.87). In non-frail patients the incidence of adverse outcomes remained unchanged (RR: 1.02, 95% CI: 0.76-1.36). LTCE were similar in the two samples. CONCLUSIONS by involving stakeholders in designing and developing the transitional care programme, commitment of healthcare providers was secured. Feasible innovations in integrated transitional care for frail older patients after hospitalisation were sustainably implemented from within healthcare organisations.
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Affiliation(s)
- Noor Heim
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Herbert Rolden
- Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands
| | - Esther M van Fenema
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jolien P Tuijl
- Department of Geriatrics, Bronovo Hospital, The Hague, Netherlands
| | - Peter Jue
- Department of Geriatric Medicine, Rijnland Hospital, Leiderdorp, Netherlands
| | - Anna M Oleksik
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Gerard Jan Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands Department of Geriatrics, Bronovo Hospital, The Hague, Netherlands
| | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands Department of Public Health and Center of Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
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Hofman SE, Lucke JA, Heim N, de Gelder J, Fogteloo AJ, Heringhaus C, de Groot B, de Craen AJM, Blauw GJ, Mooijaart SP. Prediction of 90-day mortality in older patients after discharge from an emergency department: a retrospective follow-up study. BMC Emerg Med 2016; 16:26. [PMID: 27412243 PMCID: PMC4944462 DOI: 10.1186/s12873-016-0090-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/02/2016] [Indexed: 11/24/2022] Open
Abstract
Background Older people frequently attend the emergency department (ED) and have a high risk of poor outcome as compared to their younger counterparts. Our aim was to study routinely collected clinical parameters as predictors of 90-day mortality in older patients attending our ED. Methods We conducted a retrospective follow-up study at the Leiden University Medical Center (The Netherlands) among patients aged 70 years or older attending the ED in 2012. Predictors were age, gender, time and way of arrival, presenting complaint, consulting medical specialty, vital signs, pain score and laboratory testing. Cox regression analyses were performed to analyse the association between these predictors and 90-day mortality. Results Three thousand two hundred one unique patients were eligible for inclusion. Ninety-day mortality was 10.5 % for the total group. Independent predictors of mortality were age (hazard ratio [HR] 1.06, 95 % confidence interval [95 % CI] 1.04-1.08), referral from another hospital (HR 2.74, 95 % CI 1.22-6.11), allocation to a non-surgical specialty (HR: 1.55, 95 % CI 1.13-2.14), increased respiration rate (HR up to 2.21, 95 % CI 1.25-3.92), low oxygen saturation (HR up to 1.96, 95 % CI 1.19-3.23), hypothermia (HR 2.27, 95 % CI 1.28-4.01), fever (HR 0.43, 95 % CI 0.24-0.75), high pain score (HR 1.55, 95 % CI 1.03-2.32) and the indication to perform laboratory testing (HR 3.44, 95 % CI 2.13-5.56). Conclusions Routinely collected parameters at the ED can predict 90-day mortality in older patients presenting to the ED. This study forms the first step towards creating a new and simple screening tool to predict and improve health outcome in acutely presenting older patients.
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Affiliation(s)
- Susanna E Hofman
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Jacinta A Lucke
- Department of Emergency Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.
| | - Noor Heim
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Jelle de Gelder
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Anne J Fogteloo
- Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Christian Heringhaus
- Department of Emergency Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Gerard Jan Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, The Netherlands.,Institute for Evidence-based Medicine in Old Age
- IEMO, PO Box 9600, Leiden, 2300 RC, The Netherlands
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13
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de Gelder J, Lucke JA, Heim N, de Craen AJM, Lourens SD, Steyerberg EW, de Groot B, Fogteloo AJ, Blauw GJ, Mooijaart SP. Predicting mortality in acutely hospitalized older patients: a retrospective cohort study. Intern Emerg Med 2016; 11:587-94. [PMID: 26825335 PMCID: PMC4853459 DOI: 10.1007/s11739-015-1381-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/19/2015] [Indexed: 02/01/2023]
Abstract
Acutely hospitalized older patients have an increased risk of mortality, but at the moment of presentation this risk is difficult to assess. Early identification of patients at high risk might increase the awareness of the physician, and enable tailored decision-making. Existing screening instruments mainly use either geriatric factors or severity of disease for prognostication. Predictive performance of these instruments is moderate, which hampers successive interventions. We conducted a retrospective cohort study among all patients aged 70 years and over who were acutely hospitalized in the Acute Medical Unit of the Leiden University Medical Center, the Netherlands in 2012. We developed a prediction model for 90-day mortality that combines vital signs and laboratory test results reflecting severity of disease with geriatric factors, represented by comorbidities and number of medications. Among 517 patients, 94 patients (18.2 %) died within 90 days after admission. Six predictors of mortality were included in a model for mortality: oxygen saturation, Charlson comorbidity index, thrombocytes, urea, C-reactive protein and non-fasting glucose. The prediction model performs satisfactorily with an 0.738 (0.667-0.798). Using this model, 53 % of the patients in the highest risk decile (N = 51) were deceased within 90 days. In conclusion, we are able to predict 90-day mortality in acutely hospitalized older patients using a model with directly available clinical data describing disease severity and geriatric factors. After further validation, such a model might be used in clinical decision making in older patients.
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Affiliation(s)
- Jelle de Gelder
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Jacinta A Lucke
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Noor Heim
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Shantaily D Lourens
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne J Fogteloo
- Department of Internal Medicine, Section Acute Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerard J Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Institute of Evidence-Based Medicine in Old Age, IEMO, Leiden, The Netherlands
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Heim N, Faron A, Wiedemeyer V, Teschke M, Reich RH, Martini M. [Delayed Infection after Upper Lip Augmentation with Absorbable Hyaluronic Acid Filler]. HANDCHIR MIKROCHIR P 2015; 47:268-70. [PMID: 26287329 DOI: 10.1055/s-0035-1549917] [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: 10/23/2022] Open
Abstract
Since introduction of the first fillers in the 1980s a multitude of substances has been developed and approved for facial contour augmentation and correction of skin defects. Here we present the interesting case of a patient who presented to us with a delayed infection 6 weeks after augmentation of the upper lip with a hyaluronic acid. We observed full convalescence after operative and high-dose antibiotic treatment of the abscesses. Generally speaking, complications after augmentation with resorbable fillers are rare. However, complications might occur even within unexpected time periods and therefore need our special attention.
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Affiliation(s)
- N Heim
- Abteilung für Mund-, Kiefer- und Plastische Gesichtschirurgie, Uniklinik Bonn, Bonn
| | - A Faron
- Abteilung für Mund-, Kiefer- und Plastische Gesichtschirurgie, Uniklinik Bonn, Bonn
| | - V Wiedemeyer
- Abteilung für Mund-, Kiefer- und Plastische Gesichtschirurgie, Uniklinik Bonn, Bonn
| | - M Teschke
- Abteilung für Mund-, Kiefer- und Plastische Gesichtschirurgie, Uniklinik Bonn, Bonn
| | - R H Reich
- Abteilung für Mund-, Kiefer- und Plastische Gesichtschirurgie, Uniklinik Bonn, Bonn
| | - M Martini
- Abteilung für Mund-, Kiefer- und Plastische Gesichtschirurgie, Uniklinik Bonn, Bonn
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15
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Heim N, van Fenema EM, Weverling-Rijnsburger AWE, Tuijl JP, Jue P, Oleksik AM, Verschuur MJ, Haverkamp JS, Blauw GJ, van der Mast RC, Westendorp RGJ. Optimal screening for increased risk for adverse outcomes in hospitalised older adults. Age Ageing 2015; 44:239-44. [PMID: 25432981 PMCID: PMC4339728 DOI: 10.1093/ageing/afu187] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: screening for frailty might help to prevent adverse outcomes in hospitalised older adults. Objective: to identify the most predictive and efficient screening tool for frailty. Design and setting: two consecutive observational prospective cohorts in four hospitals in the Netherlands. Subjects: patients aged ≥70 years, electively or acutely hospitalised for ≥2 days. Methods: screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed. Results: follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome (predictive power 0.58–0.66), but the percentage of positively screened patients (13–72%), sensitivity (24–89%) and specificity (35–91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70–80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort. Conclusions: the VMS-tool plus age (VMS+) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments.
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Affiliation(s)
- Noor Heim
- Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands
| | | | | | - Jolien P Tuijl
- Department of Geriatrics, Bronovo Hospital, The Hague, The Netherlands
| | - Peter Jue
- Department of Geriatric Medicine, Rijnland Hospital, Leiden, The Netherlands
| | - Anna M Oleksik
- Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands
| | | | - Jasper S Haverkamp
- Department of Cardiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerard Jan Blauw
- Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands Department of Geriatrics, Bronovo Hospital, The Hague, The Netherlands
| | | | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics, LUMC, Leiden, The Netherlands Leyden Academy on Vitality and Ageing, Leiden University Medical Centre, Leiden, The Netherlands
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Maurer F, Wolf A, Fink T, Rittershofer B, Heim N, Volk T, Baumbach JI, Kreuer S. Wash-out of ambient air contaminations for breath measurements. J Breath Res 2014; 8:027107. [DOI: 10.1088/1752-7155/8/2/027107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kreuer S, Hellbrück R, Fink T, Heim N, Volk T, Baumbach JI, Wolf A. Development of a device to measure MCC-IMS peaks of pure analytes (IMS-BOX). ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s12127-013-0140-6] [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: 10/26/2022]
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18
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von Kalle T, Heim N, Hospach T, Langendörfer M, Winkler P, Stuber T. Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO). ROFO-FORTSCHR RONTG 2013; 185:655-61. [PMID: 23696017 DOI: 10.1055/s-0033-1335283] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [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
PURPOSE The diagnosis of CRMO often involves a long patient history. We evaluated the spectrum of bone involvement in whole-body magnetic resonance imaging (WB-MRI) and assessed its potential contribution to a more rapid diagnosis. MATERIALS AND METHODS WB-MRI (1.5 T, coronal STIR sequences) in 53 children and adolescents (mean age 11 years, 4.8 - 15.1) with histologically (n = 37) or clinically (n = 16) confirmed CRMO were retrospectively reviewed by two experienced pediatric radiologists. RESULTS WB-MRI revealed multifocal lesions in all but one patients. Only 26 of them had presented with multifocal complaints. We detected 1 - 27 geographic lesions/patient (mean 9.7). 510 of 513 lesions were significantly hyperintense compared to normal bone marrow. The pelvis, lower extremities, shoulders and spine were most frequently involved. 40 patients (75 %) had bilateral symmetrical involvement of bones. Most of the lesions were located in tubular bones, in 87 % adjacent to one or both sides of a growth plate. 32 % of lesions showed periosteal involvement. Of 456 affected bones, 33 (7.2 %) were deformed, 6 (18 %) were vertebra plana. CONCLUSION In the absence of more specific diagnostic criteria, WB-MRI can, in synopsis with clinical findings, substantially contribute to a rapid diagnosis of CRMO. It discovers the typical pattern of multifocal and bilateral bone involvement more often than has been reported for targeted MRI. It readily reveals the characteristic proximity of lesions to growth plates, the sacroiliac joint and triradiate cartilage and helps to uncover asymptomatic spinal complications.
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Affiliation(s)
- T von Kalle
- Radiologisches Institut, Olgahospital Klinikum Stuttgart, Germany.
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de Hollander EL, Bemelmans WJ, Boshuizen HC, Friedrich N, Wallaschofski H, Guallar-Castillón P, Walter S, Zillikens MC, Rosengren A, Lissner L, Bassett JK, Giles GG, Orsini N, Heim N, Visser M, de Groot LC. The association between waist circumference and risk of mortality considering body mass index in 65- to 74-year-olds: a meta-analysis of 29 cohorts involving more than 58 000 elderly persons. Int J Epidemiol 2012; 41:805-17. [PMID: 22467292 DOI: 10.1093/ije/dys008] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the elderly, the association between waist circumference (WC) and mortality considering body mass index (BMI) remains unclear, and thereby also the evidence base for using these anthropometric measures in clinical practice. This meta-analysis examined the association between WC categories and (cause-specific) mortality within BMI categories. Furthermore, the association of continuous WC with lowest and increased mortality risks was examined. METHODS Age- and smoking-adjusted relative risks (RRs) of mortality associated with WC-BMI categories and continuous WC (including WC and WC(2)) were calculated by the investigators and pooled by means of random-effects models. RESULTS During a 5-year-follow-up of 32 678 men and 25 931 women, we ascertained 3318 and 1480 deaths, respectively. A large WC (men: ≥102 cm, women: ≥88 cm) was associated with increased all-cause mortality RRs for those in the 'healthy' weight {1.7 [95% confidence interval (CI): 1.2-2.2], 1.7 (95% CI: 1.3-2.3)}, overweight [1.1(95% CI: 1.0-1.3), 1.4 (95%: 1.1-1.7)] and obese [1.1 (95% CI: 1.0-1.3), 1.6 (95% CI: 1.3-1.9)] BMI category compared with the 'healthy' weight (20-24.9 kg/m(2)) and a small WC (<94 cm, men; <80 cm, women) category. Underweight was associated with highest all-cause mortality RRs in men [2.2 (95% CI: 1.8-2.8)] and women [2.3 (95% CI: 1.8-3.1]. We found a J-shaped association for continuous WC with all-cause, cardiovascular (CVD) and cancer, and a U-shaped association with respiratory disease mortality (P < 0.05). An all-cause (CVD) mortality RR of 2.0 was associated with a WC of 132 cm (123 cm) in men and 116 cm (105 cm) in women. CONCLUSIONS Our results showed increased mortality risks for elderly people with an increased WC-even across BMI categories- and for those who were classified as 'underweight' using BMI. The results provide a solid basis for re-evaluation of WC cut-points in ageing populations.
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Affiliation(s)
- Ellen L de Hollander
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Heim N, Snijder MB, Heymans MW, Deeg DJH, Seidell JC, Visser M. Optimal cutoff values for high-risk waist circumference in older adults based on related health outcomes. Am J Epidemiol 2011; 174:479-89. [PMID: 21673122 DOI: 10.1093/aje/kwr093] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The authors aimed to explore optimal cutoffs for high-risk waist circumference (WC) in older adults to assess the health risks of obesity. Prospective data from 4,996 measurements in 2,232 participants aged ≥70 years were collected during 5 triennial measurement cycles (1992/1993-2005/2006) of a population-based cohort study, the Longitudinal Aging Study Amsterdam (Amsterdam, the Netherlands). Cross-sectional associations of WC with pain, mobility limitations, incontinence, knee osteoarthritis, cardiovascular disease, and diabetes were studied. Generalized estimating equations models were fitted with restricted cubic spline functions in order to carefully study the shapes of the associations. Model fits for applying different cutoffs to categorize WC in the association with all outcomes were tested using the quasi-likelihood under the Independence Criterion (QIC). On the basis of the spline regression curves, potential WC cutoffs of approximately 109 cm in men and 98 cm in women were proposed. Based on the model fit, cutoffs between 100 cm and 106 cm were equally applicable in men but should not be higher. In women, the QIC confirmed an optimal cutoff of 99 cm.
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Heim N, Snijder MB, Heymans MW, Deeg DJH, Seidell JC, Visser M. Exploring cut-off values for large waist circumference in older adults: a new methodological approach. J Nutr Health Aging 2010; 14:272-7. [PMID: 20305993 DOI: 10.1007/s12603-010-0060-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 10/19/2022]
Abstract
BACKGROUND There is an ongoing debate about the applicability of current criteria for large waist circumference (WC) in older adults. OBJECTIVES Our aim was to explore cut-off values for large WC in adults aged 70 years and older, using previously used and new methods. DESIGN Prospective cohort study. PARTICIPANTS Data of 1049 participants of the Longitudinal Aging Study Amsterdam (LASA) (1995-1996), aged 70-88y, were used. MEASUREMENTS Measured BMI and WC, and self-reported mobility limitations. RESULTS Linear regression analyses showed that the values of WC corresponding to BMI of 25kg/m2 and 30kg/m2 were higher than the current cut-offs. Cut-offs found in men were 97 and 110cm, whereas 88 and 98cm represented the cut-offs in women. Areas under the Receiver Operating Characteristic (ROC) curves showed that the accuracy to predict mobility limitations improved when the higher cut-offs were applied. Spline regression curves showed that the relationship of WC with mobility limitations was U-shaped in men, while in women, the risk for mobility limitations increased gradually with increasing WC. However, at the level of current cut-off values for WC the odds for mobility limitations were not increased. CONCLUSION Based on results of extensive analyses, this study suggests that the cut-offs for large WC should be higher when applied to older adults. The association of WC with other negative health outcomes needs to be investigated to establish the final cut-points.
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Affiliation(s)
- N Heim
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
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Abstract
Cross-sectional studies suggest an association between BMI and pain. This prospective study investigated the associations of measured BMI and waist circumference with prevalent and incident pain in older adults. The study included participants of the Longitudinal Aging Study Amsterdam, aged 55-85 years at baseline (1992-1993). Pain was assessed using a subscale of the Nottingham Health Profile at baseline (N = 2,000), after 3 years (N = 1,478) and 6 years (N = 1,271) of follow-up. The overall prevalence of pain was 32.7% at baseline and increased significantly with higher quartiles of BMI or waist circumference. After adjustment for age, education, depression, smoking, physical activity, and chronic diseases, multiple logistic regression analyses showed odds ratios (ORs (95% confidence interval)) for prevalent pain of 2.16 (1.32-3.54) in men and 1.93 (1.26-2.95) in women comparing the highest with the lowest quartile of BMI. Of the participants without pain at baseline, those in the highest quartile of BMI had a twofold increased odds for incident pain after 3 years of follow-up. After 6 years of follow-up, ORs for incident pain were 2.34 (1.17-4.72) in men and 2.78 (1.36-5.70) in women. Additional adjustment for weight change did not change these associations. Similar results were found for the associations between waist circumference and pain. Exploring the reversed causal relation, analyses showed no significant associations between prevalent pain and weight gain. In conclusion, the prevalence of pain is higher among obese older men and women compared to their normal-weight peers. Furthermore, obese older adults are at increased odds to develop pain.
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Affiliation(s)
- Noor Heim
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands.
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Tyedmers J, Lerner M, Bies C, Dudek J, Skowronek MH, Haas IG, Heim N, Nastainczyk W, Volkmer J, Zimmermann R. Homologs of the yeast Sec complex subunits Sec62p and Sec63p are abundant proteins in dog pancreas microsomes. Proc Natl Acad Sci U S A 2000; 97:7214-9. [PMID: 10860986 PMCID: PMC16525 DOI: 10.1073/pnas.97.13.7214] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.6] [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: 11/18/2022] Open
Abstract
Cotranslational protein transport into dog pancreas microsomes involves the Sec61p complex plus a luminal heat shock protein 70. Posttranslational protein transport into the yeast endoplasmic reticulum (ER) involves the so-called Sec complex in the membrane, comprising a similar Sec61p subcomplex, the putative signal peptide receptor subcomplex, and the heat shock protein 40-type subunit, Sec63p, plus a luminal heat shock protein 70. Recently, human homologs of yeast proteins Sec62p and Sec63p were discovered. Here we determined the concentrations of these two membrane proteins in dog pancreas microsomes and observed that the canine homologs of yeast proteins Sec62p and Sec63p are abundant proteins, present in almost equimolar concentrations as compared with Sec61alphap monomers. Furthermore, we detected fractions of these two proteins in association with each other as well as with the Sec61p complex. The J domain of the human Sec63p was shown to interact with immunoglobulin heavy chain binding protein. Thus, the membrane of the mammalian ER contains components, known from the posttranslationally operating protein translocase in yeast. We suggest that these components are required for efficient cotranslational protein transport into the mammalian ER as well as for other transport processes.
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Affiliation(s)
- J Tyedmers
- Medizinische Biochemie und Molekularbiologie, Universität des Saarlandes, D-66421 Homburg, Germany
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Gaudet R, Heim N, Merviel P, Lemercier D, Dumont A, Audry G, Uzan S. Prenatal diagnosis of a congenital bladder diverticulum. Case report and benefits of prenatal diagnosis. Fetal Diagn Ther 1999; 14:301-5. [PMID: 10529575 DOI: 10.1159/000020944] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 11/19/2022]
Abstract
A case of congenital bladder diverticulum diagnosed at 37 weeks of gestation (measured from the first day after the last day of the last menstrual period) is reported. Delivery took place 24 h later. A postnatal urologic work-up confirmed the diagnosis of asymptomatic congenital bladder diverticulum. The infant underwent laparotomic surgery at the age of 6 months, with an extravesical diverticulectomy and ureteral reimplantation. There were no complications. This is the first case reported in the literature of a prenatal diagnosis of a congenital bladder diverticulum. This new aspect allows early management and avoidance of the diagnostic meanders to which the discovery of a pelvic mass might lead, as well as the complications that can follow bladder diverticula.
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Affiliation(s)
- R Gaudet
- Service de Gynécologie, Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Paris, France.
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Abstract
BACKGROUND/AIMS Mother-to-infant transmission of hepatitis C virus (HCV) has been reported, but the transmission route is unknown. The aim of our study was to detect HCV RNA in amniotic fluid of pregnant women seropositive for HCV. METHODS Twenty-two HCV seropositive women were included in the study (median age: 39 years). An amniocentesis was performed in all patients during the 4th month of pregnancy. Sixteen women also tested positive for HCV RNA in serum. The range of HCV RNA titers was 0.3 to 15.1x10(6) Eq/ml (Quantiplex HCV RNA 2.0 Assay, Chiron Diagnostics). Of these 16 viremic patients, four had an anterior placenta, ten had a posterior placenta and the position of the placenta was not determined in two cases. PCR (Amplicor HCV, Roche Diagnostics) was used to detect HCV RNA in the amniotic fluid. We also studied 11 HCV seronegative women as a control group. RESULTS In the viremic group (n = 16), HCV RNA was detected once in amniotic fluid. The positive specimen was collected from a patient with an HCV RNA serum value equal to 1.1x10(6) Eq/ml. The placenta was in an anterior position. A PCR inhibitor was detected in one case. No HCV RNA was detected in the amniotic fluid of six seropositive non-viremic patients, nor in the control group. Serum HCV RNA was negative in the ten children tested. The woman whose amniotic fluid contained HCV RNA was the mother of one of them. CONCLUSIONS HCV RNA detection in amniotic fluid is rarely positive. The anterior position of the placenta in the only positive detection cannot rule out contamination of the amniotic fluid during the transplacental amniocentesis.
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Affiliation(s)
- C Delamare
- Service de Virologie, Hôpital Saint Antoine, Paris, France.
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26
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Dominguez S, Boudghene F, Houry S, Heim N, Callard P, Grangé JD. [Septic shock during the immediate post-partum period revealing a liver abscess in a woman with Crohn's disease]. Gastroenterol Clin Biol 1999; 23:775-8. [PMID: 10470534] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Liver abscess is a rare complication of Crohn's disease. We report one case in a 27 year-old woman, presenting as a sepsis after delivery. Crohn's disease was quiescent at presentation. Pregnancy was the only predisposing condition. An intestinal fistula was diagnosed by ultrasonography. The patient was treated by antibiotics, bowel resection and surgical drainage of the abscess.
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Affiliation(s)
- S Dominguez
- Service d'Hépato-Gastroentérologie, Hôpital Tenon, Paris
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27
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Siffroi JP, Heim N, Benzacken B, Franco JC, Le Bourhis C. Unexpected inherited chromosomal translocation during prenatal diagnosis for maternal age: risk for a nondetectable karyotype imbalance in offspring. Fetal Diagn Ther 1998; 13:271-5. [PMID: 9813419 DOI: 10.1159/000020853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An unexpected t(1;19) translocation is described in a fetus. Inherited from the mother, this translocation was found during the course of a normal prenatal diagnosis made for maternal age. The very short length of chromosomal translocated segments and their labelling pattern made high-resolution cytogenetic methods and fluorescence in situ hybridization techniques necessary for the correct identification of this karyotype rearrangement, both in mother and fetus. Different modes of meiotic segregation, leading to potential erroneous prenatal diagnoses, are discussed.
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Affiliation(s)
- J P Siffroi
- Laboratoire d'Histologie, Biologie de la Reproduction et Cytogénétique, Hôpital Tenon, Paris, France.
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Goffinet F, Paris J, Heim N, Nisand I, Breart G. Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women. Eur J Obstet Gynecol Reprod Biol 1997; 71:11-9. [PMID: 9031954 DOI: 10.1016/s0301-2115(96)02606-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [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: 02/03/2023]
Abstract
OBJECTIVE To assess the predictive value of Doppler umbilical artery velocimetry in a low-risk population with normal fetal biometry. STUDY DESIGN Multicenter prospective study in 17 hospitals with prenatal clinics in France. Two thousand sixteen women who, before 28 weeks gestation were defined as at low risk after routine consultation and after ultrasound. Doppler umbilical artery velocimetry was performed between 28 and 34 weeks gestation. Confounding factors were used to perform multivariate regression. RESULTS 1903 cases were analysed and 192 (10.1%) had an abnormal Doppler Resistance Index (RI). The abnormal Doppler group contained a significantly higher frequency of severe and moderate small for gestational age infants (SGA), both severe and moderate with a sensitivity of 25.5 and 18.8% respectively. There was no difference in hypertensive disorders or criteria of fetal distress. Mean birth weight was very significantly lower in the abnormal group (162 g). Birth weight was very significantly linked to RI after taking into account confounding variables in the multiple linear regression model (continuous relationship). After multiple logistic regression, the odds ratio associated with an abnormal Doppler result, adjusted for all the confounding factors, was 2.3 (95% CI 1.5-3.7) for moderate SGA and 3.5 (95% CI of 1.8-7.1) for severe SGA. CONCLUSION Low umbilical Doppler RI is predictive with moderate or severe SGA in a low-risk population with normal fetal biometry, even when the information generally available in clinical practice and ultrasound parameters are taken into account. There is a continuous relationship between RI and birthweight. This predictive value cannot, however, lead to an improvement in neonatal health unless effective measures to prevent SGA exist and umbilical Doppler should not be used in low-risk population on a routine basis.
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Affiliation(s)
- F Goffinet
- Epidemiology unit INSERM 149, Paris, France
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Heim N, Schuller A. [Ambulatory management during the transformation process--a survey of physicians in new German districts]. Gesundheitswesen 1997; 59:29-35. [PMID: 9138644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The transformation of the health care system in the former GDR is demonstrated empirically on the basis of postal surveys conducted in 1990/91 with reference to the following spheres: 1. Routine problems. In diagnosis and therapy, the central problem was that the equipment required was often either lacking or defective. 2. Social perception. Female doctors regarded themselves as more understanding, progressive, sensitive, and friendly than their male colleagues. 3. Dynamics of transformation. The percentage of doctors with a practice of their own increased from 1990 to 1991 from 4.2 to 61.4%. 4. Reasons for starting a private practice. For male doctors the motives of greater latitudes in defining working hours and work routines as well as long-term expectations of increasing income were significantly more important than for female doctors. 5. Initial problems. Three aspects proved to be the most significant: too little time for family, work load too high, accounting problems. 6. Job satisfaction. In the course of time, the greatest increase in satisfaction was found to be related to possibilities of advanced professional training and income. A significant trend toward decreasing satisfaction was noted for dimensions such as work load, relationship between work and leisure, as well as secretarial work and accounting.
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Affiliation(s)
- N Heim
- Abt. Medizinsoziologie, Freie Universität Berlin, Universitätsklinikum Benjamin Franklin
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Vayssière CF, Heim N, Camus EP, Hillion YE, Nisand IF. Determination of chorionicity in twin gestations by high-frequency abdominal ultrasonography: counting the layers of the dividing membrane. Am J Obstet Gynecol 1996; 175:1529-33. [PMID: 8987937 DOI: 10.1016/s0002-9378(96)70102-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [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: 02/03/2023]
Abstract
OBJECTIVE Our aim was to determine whether chorionicity in twin gestations can be diagnosed by use of high-frequency ultrasonography to count the layers of intraamniotic membrane. STUDY DESIGN This prospective study of 66 twin pregnancies between 13 and 38 weeks' gestation used transabdominal ultrasonography at 10 MHz. The pregnancy was classified as monochorionic when two layers were counted and as dichorionic when three or four layers were counted. The findings of the examiner, who had no other information about chorionicity, were compared with those of the histopathologic examination of the placenta. RESULTS Ultrasonography allowed chorionicity to be determined correctly in 60 of 63 cases (95%; 100% in the second trimester and 92% in the third. The predictive value for dichorionicity was 100% (48/48) and the sensitivity 94% (48/51). The 12 monochorionic diamniotic pregnancies in which the membrane was visualized were all correctly diagnosed. In a thirteenth case, with severe oligohydramnios, the membrane could not be seen. Two patients were lost to follow-up. In 95% of the cases (63/66) only one examination was required to diagnose chorionicity. Intraobserver variability was 0% (0/26). Interobserver variability, tested by photographs, was 3% (2/65). CONCLUSIONS This technique should be the first-line method for determining chorionicity in the second and third trimesters because it is the most effective. Its excellent reproducibility may be attributable to the use of high-frequency ultrasonography.
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Affiliation(s)
- C F Vayssière
- Department of Obstetrics and Gynecology, Université de Paris V Faculte de Medicine, Centre Hospitalier Intercommunale Leon Touhladjian, Poissy, France
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Grangé G, Favre R, Goffinet F, Heim N, Peterschmitt C, Kohler A, Gutedel A, Nisand I. [Comparative value of transverse abdominal diameter and fetal abdominal perimeter. 3844 biometric examinations]. J Gynecol Obstet Biol Reprod (Paris) 1995; 24:843-849. [PMID: 8636619] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Assess charts of abdominal size as they are used in a routine ultrasound screening, on a non selected population with 5 operators, to compare the interest of transverse abdominal diameter (TAD) with abdominal circumference (AC). METHOD Retrospective study, in the department of Antenatal Diagnosis of the Centre Médico-Chirurgical et Obstétrical between September 1991 and August 1994. MAIN OUTCOME MEASURES Abdominal biometry and gestational age to characterize the prenatal trophicity. Neonatal weight and gestational age at birth to characterize neonatal trophicity. RESULTS Between 32 and 36 weeks, the TAD charts detected only one SGA (small for gestational age) out of 10. However, the AC sensitivity was 54.5% with a specificity of 94%. In the same period, the TAD charts suspect LGA (large for gestational age) for one exam out of two. The charts of AC have about the same performance to detect LGA and SGA. CONCLUSION For a routine ultrasound screening between 32 and 36 weeks gestational age, the AC charts have to be preferred to TAD charts.
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Abstract
Suicide notes written by German men and women ( ns = 20) were found to be quite similar in content except for a tendency for the men to mention specific precipitating events more often than did the women.
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Affiliation(s)
- D Lester
- Psychology Program, Richard Stockton State College, Pomona, NJ 08240
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Abstract
People who completed suicide in West Berlin and left suicide notes were found to differ in sex, age, method used for suicide and the reason for suicide, compared with those not leaving notes. These results suggest that conclusions from research into the psychodynamics of suicide based on suicide notes may be biased.
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Affiliation(s)
- N Heim
- Institut für Soziale Medizin, Freie Universität, Berlin
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Heim N, Konkol N. [Distribution of suicides in West Germany (1981-1986)]. Offentl Gesundheitswes 1989; 51:608-13. [PMID: 2531312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Based on data from official suicide statistics the suicide rates of all 11 federal states of FRG between the years 1981 to 1986 are analysed. The age-standardised suicide rates show a configuration of high rates in the North of Germany (Hamburg, Bremen, Berlin, Schleswig-Holstein, Niedersachsen). The lowest rates (total, males and females) were found in Nordrhein-Westfalen. In addition, the influence of religion, unemployment and population density (capital cities) on social suicide rates are empirically demonstrated and discussed.
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Abstract
The empirical study presented concerns juvenile court cases (aggressive offences) in West Berlin during which the offenders (N = 94) were subject to psychiatric expert testimony (1975-1982). The conditional factors determining forensic-psychiatric testimony are examined and the investigation shows, with the aid of discriminant analysis, that differences in the form of the expertise given are best explained by the variable 'convention-orientation'. Ratings on the quality of psychiatric letters (N = 49) were based on the semantic differential technique. Employing factor analysis, three independent aspects determining the quality of expert opinion are revealed, namely the factors 'cogency of message', role-conception', and 'recipient-orientation'.
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Degrange M, Sadoun M, Heim N. [Dental ceramics. Part 2: The new ceramics]. J Biomater Dent 1987; 3:61-9. [PMID: 3482834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Data are reported on the sexual behavior of 39 released sex offenders who agreed voluntarily to surgical castration while imprisoned in West Germany. Findings indicated that frequency of coitus, masturbation, and sexual thoughts are seen as strongly reduced after castration. Sexual desire and sexual arousability are perceived by the subjects as having been considerably impaired by castration. In comparison with other studies, however, it was shown that male sexual capacity was not extinguished soon after castration. Particularly noteworthy is that 11 of 35 castrates (31%) stated they were still able to engage in sexual intercourse. Rapists proved to be sexually more active after castration than homosexuals or pedophiliacs. There seems to be a strong effect on sexual behavior only if castration is performed on males between the age of 46 and 59 years. In general, the findings do not justify recommending surgical castration as a reliable treatment for incarcerated sex offenders.
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