1
|
Buechi CA, Siegenthaler F, Sahli L, Papadia A, Saner FAM, Mohr S, Rau TT, Solass W, Imboden S, Mueller MD. Real-World Data Assessing the Impact of Lymphovascular Space Invasion on the Diagnostic Performance of Sentinel Lymph Node Mapping in Endometrial Cancer. Cancers (Basel) 2023; 16:67. [PMID: 38201495 PMCID: PMC10778553 DOI: 10.3390/cancers16010067] [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: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND SLN mapping has emerged as a standard of care in endometrial cancer due to its high sensitivity and significant reduction in morbidity. Although lymphovascular space invasion (LVSI) is a known risk factor for lymph node metastasis and recurrence, evidence on the reliability of SLN mapping in LVSI-positive patients is scarce. The aim of this study was to determine the impact of LVSI on the diagnostic performance of SLN mapping. METHODS This retrospective cohort study included patients with endometrial cancer who underwent primary surgical treatment at the Bern University Hospital, Switzerland, between 2012 and 2022. RESULTS LVSI was present in 22% of patients and was significantly associated with lymph node metastasis (p < 0.001) and recurrence (p < 0.001). In node-negative patients with only SLN mapping performed, LVSI was an independent predictor of recurrence during multivariable Cox regression analysis (p = 0.036). The negative predictive value of SLN mapping was 91.5% and was significantly lower in tumors with LVSI (75.0%) compared to LVSI-negative tumors (95.6%, p = 0.004). CONCLUSION The presence of LVSI was significantly associated with worse oncological outcomes. LVSI was an independent predictor of recurrence in node-negative patients with only SLN mapping performed. Furthermore, the negative predictive value of SLN mapping was significantly lower in LVSI-positive tumors.
Collapse
Affiliation(s)
- Carol A. Buechi
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Laura Sahli
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale of Lugano, 6900 Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Flurina A. M. Saner
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Stefan Mohr
- Department of Gynecology and Obstetrics, Bürgerspital Solothurn, 4500 Solothurn, Switzerland;
| | - Tilman T. Rau
- Institute of Pathology, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany
| | - Wiebke Solass
- Institute of Tissue Medicine and Pathology, University of Bern, 3008 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| |
Collapse
|
2
|
Mohr S, Imboden S, Siegenthaler F, Mueller MD. Complementary use of indocyanine green and technetium to enhance sentinel lymphadenectomy in vulvar cancer. Int J Gynecol Cancer 2023:ijgc-2023-004562. [PMID: 37648407 DOI: 10.1136/ijgc-2023-004562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Michael David Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Mohr S, Imboden S, Mueller MD, Kuhn A. Laparoscopic sacrocolpopexy mesh excision step-by-step. Int Urogynecol J 2023; 34:1987-1989. [PMID: 36897370 PMCID: PMC10415470 DOI: 10.1007/s00192-023-05494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to demonstrate the surgical procedure of laparoscopic mesh removal after sacrocolpopexy to aid clinicians facing mesh complications. METHODS Video footage shows the laparoscopic management of mesh failure and mesh erosion after sacrocolpopexy with narrated video sequences of two patients. RESULTS Laparoscopic sacrocolpopexy represents the gold standard in advanced prolapse repair. Mesh complications occur infrequently but infections, failure of prolapse repair and mesh erosions necessitate mesh removal and repeat sacrocolpopexy if applicable. The video deals with two women referred to our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, after laparoscopic sacrocolpopexies that were carried out in remote hospitals. Both patients were asymptomatic more than 1 year after surgery. CONCLUSIONS Complete mesh removal after sacrocolpopexy and repeat prolapse surgery can be challenging but is feasible and is aimed at improving patients' complaints and symptoms.
Collapse
Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| | - Annette Kuhn
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| |
Collapse
|
4
|
Buda A, Paniga C, Taskin S, Mueller M, Zapardiel I, Fanfani F, Puppo A, Casarin J, Papadia A, De Ponti E, Grassi T, Mauro J, Turan H, Vatansever D, Gungor M, Ortag F, Imboden S, Garcia-Pineda V, Mohr S, Siegenthaler F, Perotto S, Landoni F, Ghezzi F, Scambia G, Taskiran C, Fruscio R. The Risk of Recurrence in Endometrial Cancer Patients with Low-Volume Metastasis in the Sentinel Lymph Nodes: A Retrospective Multi-Institutional Study. Cancers (Basel) 2023; 15:cancers15072052. [PMID: 37046712 PMCID: PMC10093146 DOI: 10.3390/cancers15072052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/19/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
The aim of this study was to assess the impact of low-volume metastasis (LVM) on disease-free survival (DFS) in women with apparent early-stage endometrial cancer (EC) who underwent sentinel lymph node (SLN) mapping. Patients with pre-operative early-stage EC were retrospectively collected from an international collaboration including 13 referring institutions. A total of 1428 patients were included in this analysis. One hundred and eighty-six patients (13%) had lymph node involvement. Fifty-nine percent of positive SLN exhibited micrometastases, 26.9% micrometastases, and 14% isolated tumor cells. Seventeen patients with positive lymph nodes did not receive any adjuvant therapy. At a median follow-up of 33.3 months, the disease had recurred in 114 women (8%). Patients with micrometastases in the lymph nodes had a worse prognosis of disease-free survival compared to patients with negative nodes or LVM. The rate of recurrence was significantly higher for women with micrometastases than those with low-volume metastases (HR = 2.61; p = 0.01). The administration of adjuvant treatment in patients with LVM, without uterine risk factors, remains a matter of debate and requires further evaluation.
Collapse
Affiliation(s)
- Alessandro Buda
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Cristiana Paniga
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Salih Taskin
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Michael Mueller
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Puppo
- Department of Obstetrics and Gynecology, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of the Italian Switzerland, 6900 Lugano, Switzerland
| | - Elena De Ponti
- Medical Physics Department, Foundation IRCCS San Gerardo Hospital, 20900 Monza, Italy
| | - Tommaso Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Jessica Mauro
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Hasan Turan
- Department of Obstetrics and Gynecology, İstanbul Training and Research Hospital, University of Health Sciences, 34766 İstanbul, Turkey
| | - Dogan Vatansever
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Mete Gungor
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, 34750 İstanbul, Turkey
| | - Firat Ortag
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Sara Imboden
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefan Mohr
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefania Perotto
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| |
Collapse
|
5
|
Baetzner AS, Wespi R, Hill Y, Gyllencreutz L, Sauter TC, Saveman BI, Mohr S, Regal G, Wrzus C, Frenkel MO. Preparing medical first responders for crises: a systematic literature review of disaster training programs and their effectiveness. Scand J Trauma Resusc Emerg Med 2022; 30:76. [PMID: 36566227 PMCID: PMC9789518 DOI: 10.1186/s13049-022-01056-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adequate training and preparation of medical first responders (MFRs) are essential for an optimal performance in highly demanding situations like disasters (e.g., mass accidents, natural catastrophes). The training needs to be as effective as possible, because precise and effective behavior of MFRs under stress is central for ensuring patients' survival and recovery. This systematic review offers an overview of scientifically evaluated training methods used to prepare MFRs for disasters. It identifies different effectiveness indicators and provides an additional analysis of how and to what extent the innovative training technologies virtual (VR) and mixed reality (MR) are included in disaster training research. METHODS The systematic review was conducted according to the PRISMA guidelines and focused specifically on (quasi-)experimental studies published between January 2010 and September 2021. The literature search was conducted via Web of Science and PubMed and led to the inclusion of 55 articles. RESULTS The search identified several types of training, including traditional (e.g., lectures, real-life scenario training) and technology-based training (e.g., computer-based learning, educational videos). Most trainings consisted of more than one method. The effectiveness of the trainings was mainly assessed through pre-post comparisons of knowledge tests or self-reported measures although some studies also used behavioral performance measures (e.g., triage accuracy). While all methods demonstrated effectiveness, the literature indicates that technology-based methods often lead to similar or greater training outcomes than traditional trainings. Currently, few studies systematically evaluated immersive VR and MR training. CONCLUSION To determine the success of a training, proper and scientifically sound evaluation is necessary. Of the effectiveness indicators found, performance assessments in simulated scenarios are closest to the target behavior during real disasters. For valid yet inexpensive evaluations, objectively assessible performance measures, such as accuracy, time, and order of actions could be used. However, performance assessments have not been applied often. Furthermore, we found that technology-based training methods represent a promising approach to train many MFRs repeatedly and efficiently. These technologies offer great potential to supplement or partially replace traditional training. Further research is needed on those methods that have been underrepresented, especially serious gaming, immersive VR, and MR.
Collapse
Affiliation(s)
- Anke S. Baetzner
- grid.7700.00000 0001 2190 4373Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Rafael Wespi
- grid.5734.50000 0001 0726 5157Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Yannick Hill
- grid.12380.380000 0004 1754 9227Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands ,Institute of Brain and Behaviour Amsterdam, Amsterdam, Netherlands ,Lyda Hill Institute for Human Resilience, Colorado Springs, USA
| | - Lina Gyllencreutz
- grid.12650.300000 0001 1034 3451Department of Nursing, Umeå University, Umeå, Sweden ,grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Thomas C. Sauter
- grid.5734.50000 0001 0726 5157Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Britt-Inger Saveman
- grid.12650.300000 0001 1034 3451Department of Nursing, Umeå University, Umeå, Sweden ,grid.12650.300000 0001 1034 3451Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Stefan Mohr
- grid.5253.10000 0001 0328 4908Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg Regal
- grid.4332.60000 0000 9799 7097Center for Technology Experience, AIT Austrian Institute of Technology, Vienna, Austria
| | - Cornelia Wrzus
- grid.7700.00000 0001 2190 4373Psychological Institute and Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Marie O. Frenkel
- grid.7700.00000 0001 2190 4373Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
6
|
Kushwah V, Münzer J, Feenstra V, Mohr S, Paudel A. Impact of Extractables/Leachables from Filter Materials on the Stability of Protein-Based Pharmaceutical Products. AAPS PharmSciTech 2022; 23:233. [PMID: 36002610 DOI: 10.1208/s12249-022-02374-x] [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: 05/05/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022] Open
Abstract
The manufacturing of biopharmaceutical drug solutions can involve close contact with various polymeric components, including common filter membranes. Potential leachable substances from filters may interact with the protein and thereby increase the structural damage and aggregation. The main aim of the study deals with the assessment of extractable and leachable (E/L) from different filters and the potential effect of E/Ls on protein (human granulocyte-colony stimulating factor (rh-GCSF) stability. The present study examines the E/L profile of five different polymeric filter membranes using various chromatographic techniques including LC-MS and GC-MS. In order to investigate their effect on protein stability, G-CSF (human granulocyte colony-stimulating factor) formulations were spiked with filter leachable stock solutions at two different pH levels. The spiked formulations were further analyzed with respect to their aggregation behavior. The results demonstrated a higher E/L content in the case of polyamide (PA), polycarbonate (PC), and polyethersulfone (PES) filters as compared to the polytetrafluoroethylene (PTFE) and regenerative cellulose (RC) filter materials. The E/L from RC and PES was found surface-active, whereas E/L from PA and RC significantly altered the particle size/structure resulting in the aggregation of proteins. Furthermore, bisphenol A was found to be one of the E/L substances from PC filters and can impose significant health problems when administered along with pharmaceutical products. The present study reports a qualitative rank ordering of the filter membranes in terms of their propensity to generate E/Ls and thus can be helpful in selecting a suitable membrane filter.
Collapse
Affiliation(s)
- Varun Kushwah
- Research Center for Pharmaceutical Engineering, Inffeldgasse 13/2, 8010, Graz, Austria
| | - Juliana Münzer
- Research Center for Pharmaceutical Engineering, Inffeldgasse 13/2, 8010, Graz, Austria
| | - Verena Feenstra
- Research Center for Pharmaceutical Engineering, Inffeldgasse 13/2, 8010, Graz, Austria
| | - Stefan Mohr
- Research Center for Pharmaceutical Engineering, Inffeldgasse 13/2, 8010, Graz, Austria
| | - Amrit Paudel
- Research Center for Pharmaceutical Engineering, Inffeldgasse 13/2, 8010, Graz, Austria. .,Institute for Process and Particle Engineering, Graz University of Technology, Inffeldgasse 13/3, 8010, Graz, Austria.
| |
Collapse
|
7
|
Hoehn D, Mohr S, Nowakowski Ł, Mueller MD, Kuhn A. A prospective cohort trial evaluating sexual function after urethral diverticulectomy. Eur J Obstet Gynecol Reprod Biol 2022; 272:144-149. [PMID: 35313135 DOI: 10.1016/j.ejogrb.2022.03.021] [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: 12/22/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Dyspareunia is a main symptom of urethral diverticulum in the female population, reported up to 60% of patients. Pain may cease after diverticulectomy as published in previous retrospective studies. To date scarce or no data exists on the postoperative outcome in terms of sexual function. The present study wants to quantify sexual function and evaluate lower urinary tract symptoms in sexually active patients after resection of urethral diverticulum. STUDY DESIGN In this prospective cohort trial at a tertiary referral center, we evaluated 40 female patients who presented with symptomatic urethral diverticulum and were sexually active. All of them underwent a standardized surgical procedure with inverted U-shape colpotomy between 2008 and 2018. The patients completed the Female Sexual Function Index (FSFI), which is determined by the mean score of the different domains, and underwent urodynamic assessment both at baseline examination before surgery and 12 months postoperatively. For statistical analysis, we conducted a paired Wilcoxon rank sum test analyzing the non-normally distributed non-parametric variables of the female sexual function index. RESULTS In two patients a malignancy was found in postoperative histology and received a different therapeutical approach. They have been excluded from statistical analysis. Sexual function improved in all domains (n = 38): total score (Z = -5.4, P < 0.000), satisfaction (Z = -5.3, P < 0.000), pain (Z = -5.4, P < 0.000), arousal (Z = -2.6, P = 0.010), lubrication (Z = -2.4, P = 0.020), desire (Z = -2.6, P = 0.009) and orgasm (Z = -2.2, P = 0.029). Maximum urethral closure pressure deteriorated from 39 to 36 cmH2O (P = 0.0008) and residual urine increased from 10 ml to 20 ml after surgery (P = 0.0019). No statistical significance is found for bladder capacity and free urinary flow. CONCLUSIONS All domains of the female sexual function index improved. Patients' bothersome symptoms, mainly pain may cease and sexual satisfaction increases, which is reassuring concerning patients' preoperative consent. We should be aware that occasionally an unexpected malignancy may be detected and it is mandatory to examine all excised tissue histologically. Lower urinary tract function remains clinically unchanged, although maximum urethral closure pressure deteriorated and postvoid residual increased though not being clinically significant.
Collapse
Affiliation(s)
- Diana Hoehn
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
| | - Stefan Mohr
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
| | - Łukasz Nowakowski
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland; 2nd Department of Gynaecology, Medical University of Lublin, Poland
| | - Michael D Mueller
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
| | - Annette Kuhn
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
| |
Collapse
|
8
|
Frenkel MO, Pollak KM, Schilling O, Voigt L, Fritzsching B, Wrzus C, Egger-Lampl S, Merle U, Weigand MA, Mohr S. Stressors faced by healthcare professionals and coping strategies during the early stage of the COVID-19 pandemic in Germany. PLoS One 2022; 17:e0261502. [PMID: 35041679 PMCID: PMC8765664 DOI: 10.1371/journal.pone.0261502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has exerted great pressure on national health systems, which have aimed to ensure comprehensive healthcare at all times. Healthcare professionals working with COVID-19 patients are on the frontline and thereby confronted with enormous demands. Although early reports exist on the psychological impact of the pandemic on frontline medical staff working in Asia, little is known about its impact on healthcare professionals in other countries and across various work sectors. The present cross-sectional, online survey sought to investigate common work stressors among healthcare professionals, their psychological stress as well as coping resources during the pandemic. METHODS A sample of 575 healthcare professionals (57% male) in three different sectors (hospital, prehospital emergency care, and outpatient service) reported their experiences concerning work and private stressors, psychological stress, and coping strategies between April 17, 2020 and June 5, 2020. To capture pandemic-specific answers, most of the items were adapted or newly developed. Exploratory factor analyses (EFA) were conducted to detect underlying latent factors relating to COVID-specific work stressors. In a next step, the effects of these latent stressors across various work sectors on psychological stress (perceived stress, fatigue, and mood) were examined by means of structural equation models (SEM). To add lived experience to the findings, responses to open-ended questions about healthcare professionals' stressors, effective crisis measures and prevention, and individual coping strategies were coded inductively, and emergent themes were identified. RESULTS The EFA revealed that the examined work stressors can be grouped into four latent factors: "fear of transmission", "interference of workload with private life", "uncertainty/lack of knowledge", and "concerns about the team". The SEM results showed that "interference of workload with private life" represented the pivotal predictor of psychological stress. "Concerns about the team" had stress-reducing effects. The latent stressors had an equal effect on psychological stress across work sectors. On average, psychological stress levels were moderate, yet differed significantly between sectors (all p < .001); the outpatient group experienced reduced calmness and more stress than the other two sectors, while the prehospital group reported lower fatigue than the other two sectors. The prehospital group reported significantly higher concerns about the team than the hospital group (p < .001). In their reports, healthcare professionals highlighted regulations such as social distancing and the use of compulsory masks, training, experience and knowledge exchange, and social support as effective coping strategies during the pandemic. The hospital group mainly mentioned organizational measures such as visiting bans as effective crisis measures, whereas the prehospital sector most frequently named governmental measures such as contact restrictions. CONCLUSION The study demonstrated the need for sector-specific crisis measures to effectively address the specific work stressors faced by the outpatient sector in particular. The results on pandemic-specific work stressors reveal that healthcare professionals might benefit from coping strategies that facilitate the utilization of social support. At the workplace, team commitment and knowledge exchange might buffer against adverse psychological stress responses. Schedules during pandemics should give healthcare workers the opportunity to interact with families and friends in ways that facilitate social support outside work. Future studies should investigate cross-sector stressors using a longitudinal design to identify both sector- and time-specific measures. Ultimately, an international comparison of stressors and measures in different sectors of healthcare systems is desirable.
Collapse
Affiliation(s)
| | | | - Oliver Schilling
- Psychological Institute, Heidelberg University, Heidelberg, Germany
| | - Laura Voigt
- Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Benedikt Fritzsching
- Corona specialized physician practice, Heidelberg, Germany
- Head of outpatient service for pediatric patients with fever, Heidelberg, Germany
| | - Cornelia Wrzus
- Psychological Institute, Heidelberg University, Heidelberg, Germany
| | - Sebastian Egger-Lampl
- Center for Technology Experience, Austrian Institute of Technology (AIT) GmbH, Seibersdorf, Austria
| | - Uta Merle
- Department for Gastroenterology, Infectious diseases and Intoxication, University Hospital Heidelberg, Germany
| | | | - Stefan Mohr
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
9
|
Duloquin G, Graber M, Baptiste L, Mohr S, Garnier L, Ndiaye M, Thomas Q, Hervieu-Bègue M, Osseby GV, Giroud M, Béjot Y. [Acute management of spontaneous intracerebral hemorrhage]. Rev Med Interne 2021; 43:293-300. [PMID: 34953622 DOI: 10.1016/j.revmed.2021.11.004] [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: 10/28/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022]
Abstract
Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients' outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.
Collapse
Affiliation(s)
- G Duloquin
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Graber
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - L Baptiste
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - S Mohr
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - L Garnier
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Ndiaye
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - Q Thomas
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Hervieu-Bègue
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - G-V Osseby
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - M Giroud
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France
| | - Y Béjot
- Service hospitalo-universitaire de neurologie, CHU Dijon Bourgogne, Registre Dijonnais des AVC, EA7460, université de Bourgogne, UBFC, Dijon, France.
| |
Collapse
|
10
|
Duloquin G, Graber M, Baptiste L, Mohr S, Garnier L, Ndiaye M, Blanc-Labarre C, Hervieu-Bègue M, Osseby GV, Giroud M, Béjot Y. [Management of ischemic stroke in the acute phase]. Rev Med Interne 2021; 43:286-292. [PMID: 34481684 DOI: 10.1016/j.revmed.2021.08.003] [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: 06/30/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Ischemic stroke accounts for 80% of overall stroke, and is one of the leading causes of death, disability and dementia in worldwide. Management of patients with acute ischemic stroke dramatically improved over time with the implementation of intensive care stroke units, the development of acute recanalization strategies, the optimization of the management of post-stroke complications, and the prevention of early stroke recurrence. The objective of this article is to provide a general overview of the current management of patients with acute ischemic stroke aiming at improving post-stroke outcome.
Collapse
Affiliation(s)
- G Duloquin
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - M Graber
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - L Baptiste
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - S Mohr
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - L Garnier
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - M Ndiaye
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - C Blanc-Labarre
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - M Hervieu-Bègue
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - G-V Osseby
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - M Giroud
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France
| | - Y Béjot
- EA7460, UBFC, registre dijonnais des AVC, service hospitalo-universitaire de neurologie, CHU de Dijon-Bourgogne, université de Bourgogne, Dijon, France.
| |
Collapse
|
11
|
Alidjanov JF, Khudaybergenov UA, Ayubov BA, Pilatz A, Mohr S, Münst JC, Ziviello Yuen ON, Pilatz S, Christmann C, Dittmar F, Mirsaidov NM, Buch-Heberling M, Naber KG, Bjerklund Johansen TE, Wagenlehner FME. Linguistic and clinical validation of the acute cystitis symptom score in German-speaking Swiss women with acute cystitis. Int Urogynecol J 2021; 32:3275-3286. [PMID: 34170341 PMCID: PMC8227360 DOI: 10.1007/s00192-021-04864-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Global Prevalence Study of Infections in Urinary tract in Community Setting (GPIU.COM) includes epidemiological aspects of acute cystitis (AC) in women in Germany and Switzerland. The primary study relates to the German version of the Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for self-diagnosis and monitoring the symptomatic course of AC in women. The current study aimed to analyze the validity and reliability of the German ACSS in German-speaking female patients with AC in Switzerland. METHODS Anonymized patient data were collected and analyzed from women with AC at the first visit (diagnosis) and follow-up visits as baseline and controls, respectively. Data from 97 patients with a median age of 41 years underwent analysis. Psychometric and diagnostic characteristics of the ACSS were measured and statistically analyzed. RESULTS Average internal consistency of the ACSS resulted in a Cronbach's alpha (95% CI) of 0.86 (0.83; 0.89) and did not differ significantly between the Swiss and German cohorts. Diagnostic values of the ACSS for the Swiss cohort were relatively lower than for the German cohort, possible due to discrepancies between definitions of UTI in national guidelines. CONCLUSIONS The analysis showed that the German version of the ACSS is also suitable for use in the German-speaking female population of Switzerland. Minor differences in definitions of AC between German and Swiss guidelines explain the observed discrepancies in diagnostic values of the ACSS between cohorts.
Collapse
Affiliation(s)
- Jakhongir F Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Rudolph-Buchheim str. 7, 35392, Giessen, Hessen, Germany.
| | | | - Bekhzod A Ayubov
- Department of Urological Surgery, Republican Specialized Scientific-Practical Medical Center of Urology, Tashkent, Uzbekistan
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia C Münst
- Department of Gynaecology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | | | | | - Corina Christmann
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Florian Dittmar
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Nodir M Mirsaidov
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Mareike Buch-Heberling
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Truls E Bjerklund Johansen
- Department of Urology of Oslo University Hospital, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| |
Collapse
|
12
|
Siegenthaler F, Imboden S, Knabben L, Mohr S, Papadia A, Mueller MD. Exploratory Study of the Clinical Value of Near-Infrared Sentinel Lymph Node Mapping With Indocyanine Green in Vulvar Cancer Patients. Front Oncol 2021; 11:652458. [PMID: 33968754 PMCID: PMC8100341 DOI: 10.3389/fonc.2021.652458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to evaluate the clinical value of indocyanine green sentinel lymph node (SLN) mapping in patients with vulvar cancer. The conventional procedure of SLN mapping in vulvar cancer includes peritumoral injection of technetium-99m nanocolloid before surgery and intraoperative injection of a blue dye. However, these techniques harbor some limitations. Near-infrared fluorescence imaging with indocyanine green has gained popularity in SLN mapping in different types of cancer. Methods We analyzed retrospectively vulvar cancer patients at our institution between 2013 and 2020 undergoing indocyanine green SLN mapping by applying video telescope operating microscope system technology. Results 64 groins of 34 patients were analyzed. In 53 groins we used technetium-99m nanocolloid, in four patent blue, and in five both techniques, additionally to indocyanine green for SLN detection. In total, 120 SLNs were identified and removed. The SLN detection rate of indocyanine green was comparable to technetium-99m nanocolloid (p=.143) and higher than patent blue (p=.003). The best results were achieved using a combination of ICG and technetium-99m nanocolloid (detection rate of 96.9%). SLN detection rates of indocyanine green were significantly higher in patients with positive lymph nodes (p=.035) and lymphatic space invasion (p=.004) compared to technetium-99m nanocolloid. Conclusion Indocyanine green SLN mapping in vulvar cancer is feasible and safe, with reasonable detection rates. Due to its easy application and few side effects, it offers a sound alternative to the conventional SLN mapping techniques in vulvar cancer. In patients with lymph node metastasis, indocyanine green even outperformed technetium-99m nanocolloid in terms of detection rate.
Collapse
Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ente Ospedaliere Cantonale, University of the Italian Switzerland, Lugano, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
13
|
Mohr S, Gygax LN, Imboden S, Mueller MD, Kuhn A. Screening for HPV and dysplasia in transgender patients: Do we need it? Eur J Obstet Gynecol Reprod Biol 2021; 260:177-182. [PMID: 33836363 DOI: 10.1016/j.ejogrb.2021.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Aim of this study was the evaluation of prevalence of HPV infection and resulting genital dysplasia to assess the necessity and reasonability of pap smears and HPV testing in transgender patients. HPV is the most common sexually transmitted infection and responsible for the majority of genital dysplasias and malignancies. However, few data exist about the prevalence of HPV and dysplasia in transgender people. METHODS This retrospective data analysis of prospectively collected data includes all patients seen in our specialized outpatient clinic for transgender people. Gynecologic exam, colposcopy, cellular swabs and HPV typing were carried out. Primary endpoint was the prevalence of HPV and genital dysplasias in transgender patients. Secondary endpoints were the subtypes of HPV, demographic data, sexual orientation and co-morbidities in these patients. RESULTS We investigated overall 98 patients whereof 53 were transwomen and 45 transmen. Of those, 10.2 % had positive HPV tests and 10.2 % dysplastic changes in the PAP and one case of invasive anal carcinoma (1.02 %). Comorbidities included recurrent urinary tract infections, psychologic comorbidies and other, possibly hormone replacement related conditions. CONCLUSION The results underline the necessity of a routine gynecological examination including PAP and/or HPV screening and vaccinating, respectively, no matter of sexual orientation or comorbidities. Monitoring the existent anatomy may prevent invasive carcinoma requiring more invasive therapies. Moreover, concomitant pathologies are present and require long-term care of these patients almost all using hormone therapy and carrying several specific risk factors. Transgender-focused guidelines to take into account these peculiarities are needed.
Collapse
Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Linda N Gygax
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Annette Kuhn
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| |
Collapse
|
14
|
Imboden S, Bollinger Y, Härmä K, Knabben L, Fluri M, Nirgianakis K, Mohr S, Kuhn A, Mueller MD. Predictive Factors for Voiding Dysfunction after Surgery for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2021; 28:1544-1551. [PMID: 33476749 DOI: 10.1016/j.jmig.2021.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/25/2020] [Revised: 01/03/2021] [Accepted: 01/10/2021] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the prognostic value of pre- and perioperative factors for voiding dysfunction after surgery for deep infiltrating endometriosis (DIE). DESIGN Single-center retrospective cohort study. SETTING University hospital. PATIENTS A total of 198 women with DIE in the posterior compartment who underwent surgery and a postoperative bladder scan. INTERVENTIONS Surgical resection of the DIE nodule from the dorsal compartment. MEASUREMENTS AND MAIN RESULTS After surgery, 41% of the patients initially experienced voiding dysfunction (defined as >100 mL postvoid residual urine volume at second bladder scan). The number decreased to 11% by the time of hospital discharge. Among those with a need for self-catheterization after discharge (n = 17), voiding dysfunction lasted for a median of 41 days before a return to normal bladder function, with a residual urine volume of <100 mL. The preoperative presence of DIE nodules in the ENZIAN compartment B was associated with postoperative voiding dysfunction (p = .001). The hazard ratio for elevated residual urine volume was highest when the disease stage was B3 (hazard ratio 6.43; CI, 2.3-18.2; p <.001), describing a nodule diameter of >3 cm in lateral distension. Receiver operating characteristic curve analyses showed that a first residual urine volume >220 mL has a good predictive value for the risk of intermittent self-catheterization (area under the receiver operating characteristic curve 0.893; p <.001). CONCLUSION Postoperative voiding dysfunction is frequent; of note, in most cases the problem is temporary. When DIE with an ENZIAN classification B is noted intraoperatively and, most of all, when the diameter of the lesion is >3 cm, a higher risk of postoperative voiding dysfunction is to be expected.
Collapse
Affiliation(s)
- Sara Imboden
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)..
| | - Yaelle Bollinger
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Kirsi Härmä
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Laura Knabben
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Mihaela Fluri
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Konstantinos Nirgianakis
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Stefan Mohr
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Annette Kuhn
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| |
Collapse
|
15
|
|
16
|
Höhn D, Mohr S, Mueller MD, Kuhn A. Sexual function after resection of urethral diverticulum. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717169] [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: 10/23/2022] Open
|
17
|
Lerner D, Mohr S, Schild J, Göring M, Luiz T. An Immersive Multi-User Virtual Reality for Emergency Simulation Training: Usability Study. JMIR Serious Games 2020; 8:e18822. [PMID: 32735548 PMCID: PMC7428918 DOI: 10.2196/18822] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/28/2020] [Accepted: 06/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Virtual reality (VR) is increasingly used as simulation technology in emergency medicine education and training, in particular for training nontechnical skills. Experimental studies comparing teaching and learning in VR with traditional training media often demonstrate the equivalence or even superiority regarding particular variables of learning or training effectiveness. OBJECTIVE In the EPICSAVE (Enhanced Paramedic Vocational Training with Serious Games and Virtual Environments) project, a highly immersive room-scaled multi-user 3-dimensional VR simulation environment was developed. In this feasibility study, we wanted to gain initial insights into the training effectiveness and media use factors influencing learning and training in VR. METHODS The virtual emergency scenario was anaphylaxis grade III with shock, swelling of the upper and lower respiratory tract, as well as skin symptoms in a 5-year-old girl (virtual patient) visiting an indoor family amusement park with her grandfather (virtual agent). A cross-sectional, one-group pretest and posttest design was used to evaluate the training effectiveness and quality of the training execution. The sample included 18 active emergency physicians. RESULTS The 18 participants rated the VR simulation training positive in terms of training effectiveness and quality of the training execution. A strong, significant correlation (r=.53, P=.01) between experiencing presence and assessing training effectiveness was observed. Perceived limitations in usability and a relatively high extraneous cognitive load reduced this positive effect. CONCLUSIONS The training within the virtual simulation environment was rated as an effective educational approach. Specific media use factors appear to modulate training effectiveness (ie, improvement through "experience of presence" or reduction through perceived limitations in usability). These factors should be specific targets in the further development of this VR simulation training.
Collapse
Affiliation(s)
- Dieter Lerner
- Fraunhofer Institute for Experimental Software Engineering, Research Program Digital Healthcare, Kaiserslautern, Germany
| | - Stefan Mohr
- University Hospital Heidelberg, Clinic of Anesthesiology, Heidelberg, Germany
| | - Jonas Schild
- Hannover University of Applied Sciences and Arts, Interactive Reality Experiences, Hannover, Germany
| | - Martin Göring
- University Hospital Heidelberg, Clinic of Anesthesiology, Heidelberg, Germany
| | - Thomas Luiz
- Fraunhofer Institute for Experimental Software Engineering, Research Program Digital Healthcare, Kaiserslautern, Germany
| |
Collapse
|
18
|
Siegenthaler F, Knabben L, Mohr S, Nirgianakis K, Imboden S, Mueller MD. What is the future of indocyanine green and near-infrared imaging in the surgical management of endometriosis? Acta Obstet Gynecol Scand 2020; 99:1419-1420. [PMID: 32356567 DOI: 10.1111/aogs.13884] [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] [Received: 04/18/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| |
Collapse
|
19
|
Chaters GL, Johnson PCD, Cleaveland S, Crispell J, de Glanville WA, Doherty T, Matthews L, Mohr S, Nyasebwa OM, Rossi G, Salvador LCM, Swai E, Kao RR. Analysing livestock network data for infectious disease control: an argument for routine data collection in emerging economies. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180264. [PMID: 31104601 DOI: 10.1098/rstb.2018.0264] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Livestock movements are an important mechanism of infectious disease transmission. Where these are well recorded, network analysis tools have been used to successfully identify system properties, highlight vulnerabilities to transmission, and inform targeted surveillance and control. Here we highlight the main uses of network properties in understanding livestock disease epidemiology and discuss statistical approaches to infer network characteristics from biased or fragmented datasets. We use a 'hurdle model' approach that predicts (i) the probability of movement and (ii) the number of livestock moved to generate synthetic 'complete' networks of movements between administrative wards, exploiting routinely collected government movement permit data from northern Tanzania. We demonstrate that this model captures a significant amount of the observed variation. Combining the cattle movement network with a spatial between-ward contact layer, we create a multiplex, over which we simulated the spread of 'fast' ( R0 = 3) and 'slow' ( R0 = 1.5) pathogens, and assess the effects of random versus targeted disease control interventions (vaccination and movement ban). The targeted interventions substantially outperform those randomly implemented for both fast and slow pathogens. Our findings provide motivation to encourage routine collection and centralization of movement data to construct representative networks. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.
Collapse
Affiliation(s)
- G L Chaters
- 1 Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow G12 8QQ , UK
| | - P C D Johnson
- 1 Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow G12 8QQ , UK
| | - S Cleaveland
- 1 Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow G12 8QQ , UK
| | - J Crispell
- 2 School of Veterinary Medicine, University College Dublin , Dublin , Ireland
| | - W A de Glanville
- 1 Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow G12 8QQ , UK
| | - T Doherty
- 3 Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh , Easter Bush Campus, Midlothian EH25 9RG , UK
| | - L Matthews
- 1 Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow G12 8QQ , UK
| | - S Mohr
- 1 Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow , Glasgow G12 8QQ , UK
| | - O M Nyasebwa
- 6 Department of Veterinary Services, Ministry of Livestock and Fisheries, Nelson Mandela Road , Dar Es Salaam , Tanzania
| | - G Rossi
- 3 Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh , Easter Bush Campus, Midlothian EH25 9RG , UK
| | - L C M Salvador
- 3 Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh , Easter Bush Campus, Midlothian EH25 9RG , UK.,4 Department of Infectious Diseases, University of Georgia , Athens, GA 30602 , USA.,5 Institute of Bioinformatics, University of Georgia , Athens, GA 30602 , USA
| | - E Swai
- 6 Department of Veterinary Services, Ministry of Livestock and Fisheries, Nelson Mandela Road , Dar Es Salaam , Tanzania
| | - R R Kao
- 3 Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh , Easter Bush Campus, Midlothian EH25 9RG , UK
| |
Collapse
|
20
|
Borras L, Boucherie M, Mohr S, Lecomte T, Perroud N, Huguelet P. Increasing self-esteem: Efficacy of a group intervention for individuals with severe mental disorders. Eur Psychiatry 2020; 24:307-16. [DOI: 10.1016/j.eurpsy.2009.01.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 01/18/2009] [Indexed: 10/21/2022] Open
Abstract
AbstractBackgroundIndividuals with psychosis are known to have a lower self-esteem compared to the general population, in part because of social stigma, paternalistic care, long periods of institutionalization and negative family interactions. This study aimed at assessing the efficacy of a self-esteem enhancement program for individuals with severe mental illness and at analyzing the results in their European context.MethodA randomized cross-over study including 54 outpatients with a diagnosis of schizophrenia from Geneva, Switzerland, was conducted. Twenty-four were recruited from an outpatient facility receiving traditional psychiatric care whereas 30 came from an outpatient facility with case-management care. Psychosocial, diagnostic and symptom measures were taken for all the subjects before treatment, after treatment, and at 3-months' follow-up.ResultsResults indicated significant positive self-esteem module effects on self-esteem, self-assertion, active coping strategies and symptom for the participants receiving case-management care. Results were not significant for those receiving traditional care. However, 71% of all participants expressed satisfaction with the module.ConclusionIndividuals with schizophrenia appear to be benefit from the effects of the self-esteem module, particularly when they are involved in a rehabilitation program and followed by a case manager who liaises with the other partners of the multidisciplinary team. This encourages reconsidering the interventions' format and setting in order to ensure lasting effects on the environment and in turn on coping, self-esteem and overall empowerment.
Collapse
|
21
|
Siegenthaler F, Knabben L, Mohr S, Nirgianakis K, Imboden S, Mueller MD. Visualization of endometriosis with laparoscopy and near-infrared optics with indocyanine green. Acta Obstet Gynecol Scand 2020; 99:591-597. [PMID: 31943126 DOI: 10.1111/aogs.13803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/23/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. MATERIAL AND METHODS In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. CLINICAL TRIAL REGISTRATION clinicaltrials.gov NCT03850158. RESULTS In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. CONCLUSIONS The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal surgery and low rASRM stages have a significant positive effect on the ICG detection rate. NIR fluorescence imaging with ICG was helpful in the resection of deep infiltrating nodules in providing a better visualization of endometriosis.
Collapse
Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| |
Collapse
|
22
|
Mohr S, Amylidi-Mohr SK, Stadelmann P, Sculean A, Persson R, Eick S, Surbek DV. Systemic Inflammation in Pregnant Women With Periodontitis and Preterm Prelabor Rupture of Membranes: A Prospective Case-Control Study. Front Immunol 2019; 10:2624. [PMID: 31787985 PMCID: PMC6854050 DOI: 10.3389/fimmu.2019.02624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/29/2019] [Accepted: 10/22/2019] [Indexed: 12/22/2022] Open
Abstract
Aims: Periodontal disease is associated with adverse pregnancy outcome, but the underlying pathophysiologic mechanism is still unknown. In this prospective, longitudinal, non-interventional case-control study, 45 women with preterm premature rupture of membranes and 26 controls with uncomplicated pregnancies were examined at three time-points (T1: 20–34 weeks of gestations; T2: within 48 h after delivery; T3: 4–6 weeks post partum). Examinations included subgingival, blood, vaginal, and placenta sampling for microbiologic, cytokine, and histology assessment. Objective of this study was to test the hypothesis that systemic inflammatory changes and not specific bacteria are predominantly involved in the association between periodontal disease and adverse pregnancy outcome. Results: Demographic data and gestational age at T1 were comparable between groups. While there was no correlation between vaginal and gingival fluid microbiome, cytokine levels in the assessed compartments differed between cases, and controls. Vaginal smears did not show a higher rate of abnormal flora in the cases at the onset of preterm premature rupture of membranes. Number and variety of bacteria in the case group placental membranes and vagina were higher, but these bacteria were not found in membranes at birth. Conclusions: On the basis of our results we speculate that an inflammatory pathway sequentially involving periodontal tissue, maternal serum, and finally vaginal compartment contributes to the underlying pathomechanism involved in preterm premature rupture of membranes associated with periodontitis.
Collapse
Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sofia K Amylidi-Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascale Stadelmann
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Rutger Persson
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Oral Health Sciences, Division of Health Sciences, Research Professor, University of Washington, Seattle, WA, United States
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Daniel V Surbek
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
23
|
Äkäslompolo S, Drewelow P, Gao Y, Ali A, Bozhenkov S, Fellinger J, Geiger J, Hartmann D, Hathiramani D, Jakubowski M, McNeely P, Mohr S, Niemann H, Pisano F, Rust N, Puig Sitjes A, Sleczka M, Wolf R. Armoring of the Wendelstein 7-X divertor-observation immersion-tubes based on NBI fast-ion simulations. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.01.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
24
|
Graber M, Mohr S, Baptiste L, Duloquin G, Blanc-Labarre C, Mariet AS, Giroud M, Béjot Y. Air pollution and stroke. A new modifiable risk factor is in the air. Rev Neurol (Paris) 2019; 175:619-624. [PMID: 31153597 DOI: 10.1016/j.neurol.2019.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/27/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022]
Abstract
Evidence from epidemiological studies has demonstrated that outdoor air pollution is now a well-known major problem of public health, mainly in low and middle income countries. Contrasting with myocardial infarction, there are few data on the association of air pollution and stroke. METHODS We propose a narrative literature review of the effects and the underlying biological mechanisms of short- and long-term exposure to air pollutants on stroke risk and mortality, using the following key-words: stroke, cerebrovascular events, ischemic and haemorrhage stroke, transient ischaemic attack, mortality, air pollution and air pollutants. RESULTS Twenty-one papers were selected. Air pollution, of which whose small particulate matter are the most toxic, contributes to about one-third of the global burden of stroke. We can identify vulnerable patients with classical neuro-vascular risk factors or a prior history of stroke or transient ischemic attack or persons living in low-income countries. Biological mechanisms of this new morbid association are discussed. CONCLUSION Air pollution should be recognized as a silent killer inducing stroke whose mortality rates remain elevated by its role as a new modifiable neurovascular risk factor, needing public health policies.
Collapse
Affiliation(s)
- M Graber
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - S Mohr
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - L Baptiste
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - G Duloquin
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - C Blanc-Labarre
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| | - A S Mariet
- Clinical investigation center of Dijon (Inserm CIC 1432), university of Burgundy and Franche Comté, Inserm, biostatistique, biomathématique, pharmacoepidemiologie et maladies infectieuses (B2 PHI), UMR 1181, university Hospital of Dijon, Dijon, France
| | - M Giroud
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France.
| | - Y Béjot
- Dijon Stroke Registry (Inserm, Santé Publique France), EA7460, university hospital of Dijon, university of Burgundy and Franche-Comté, Dijon, France
| |
Collapse
|
25
|
Graber M, Baptiste L, Mohr S, Blanc-Labarre C, Dupont G, Giroud M, Béjot Y. A review of psychosocial factors and stroke: A new public health problem. Rev Neurol (Paris) 2019; 175:686-692. [PMID: 31130312 DOI: 10.1016/j.neurol.2019.02.001] [Citation(s) in RCA: 4] [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: 01/08/2019] [Accepted: 02/11/2019] [Indexed: 11/15/2022]
Abstract
The role of psychosocial factors (PSF) in increased risk of stroke is a novel public health challenge, but unclear definitions for PSF and the multiple stroke subtypes have led to inconsistent reports. A review of this issue is therefore warranted. METHODS Several databases were used for this narrative systematic review (Medline, Embase and Cochrane Library). Two independent reviewers evaluated articles from between 2001 and 2018 on the themes of PSF and stroke/transient ischemic attack (TIA). PSF criteria were job strain, psychological interpersonal and behavioral stress, and social deprivation. Ischemic and hemorrhagic stroke and TIA subtypes were also identified. RESULTS Forty-five cohorts, five case-control studies and two meta-analyses were included. Despite mixed results, PSF were associated with an increased risk of ischemic and hemorrhagic stroke in populations of all ages, and more predominantly in women. CONCLUSION This broad review shows that the presence of PSF is associated with an increased risk stroke and TIA. As such, PSF must figure in both public health policy and stroke prevention programs, similar to other established metabolic and environmental factors.
Collapse
Affiliation(s)
- M Graber
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - L Baptiste
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - S Mohr
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - C Blanc-Labarre
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - G Dupont
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - M Giroud
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - Y Béjot
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| |
Collapse
|
26
|
|
27
|
Hathiramani D, Ali A, Anda G, Barbui T, Biedermann C, Charl A, Chauvin D, Czymek G, Dhard C, Drewelow P, Dudek A, Effenberg F, Ehrke G, Endler M, Ennis D, Fellinger J, Ford O, Freundt S, Gradic D, Grosser K, Harris J, Hölbe H, Jakubowski M, Knaup M, Kocsis G, König R, Krause M, Kremeyer T, Kornejew P, Krychowiak M, Lambertz H, Jenzsch H, Mayer M, Mohr S, Neubauer O, Otte M, Perseo V, Pilopp D, Rudischhauser L, Schmitz O, Schweer B, Schülke M, Stephey L, Szepesi T, Terra A, Toth M, Wenzel U, Wurden G, Zoletnik S, Pedersen TS. Upgrades of edge, divertor and scrape-off layer diagnostics of W7‐X for OP1.2. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2018.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
|
29
|
Mohr S, Siegenthaler F, Imboden S, Kuhn A, Mueller MD. Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment. J Minim Invasive Gynecol 2017; 24:1079-1080. [DOI: 10.1016/j.jmig.2017.04.001] [Citation(s) in RCA: 7] [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] [Received: 01/21/2017] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 11/30/2022]
|
30
|
Mohr S, Marthaler C, Imboden S, Monga A, Mueller MD, Kuhn A. Bulkamid (PAHG) in mixed urinary incontinence: What is the outcome? Int Urogynecol J 2017; 28:1657-1661. [DOI: 10.1007/s00192-017-3332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
|
31
|
Müller U, Schuermann F, Dobrowolny H, Frodl T, Bogerts B, Mohr S, Steiner J. Assessment of Pharmacological Treatment Quality: Comparison of Symptom-triggered vs. Fixed-schedule Alcohol Withdrawal in Clinical Practice. Pharmacopsychiatry 2016; 49:199-203. [DOI: 10.1055/s-0042-104508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- U. Müller
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| | - F. Schuermann
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| | - H. Dobrowolny
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| | - T. Frodl
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| | - B. Bogerts
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| | - S. Mohr
- Department of Psychiatry and Psychotherapy at Langenhangen, Hospitals of Hannover Region, Hannover, Germany
| | - J. Steiner
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke-University, Magdeburg, Germany
| |
Collapse
|
32
|
Papadia A, Mohr S, Imboden S, Lanz S, Bolla D, Mueller MD. Laparoscopic Indocyanine Green Sentinel Lymph Node Mapping in Pregnant Cervical Cancer Patients. J Minim Invasive Gynecol 2016; 23:270-3. [DOI: 10.1016/j.jmig.2015.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
|
33
|
Llusa M, Mohr S, Baumgartner R, Paudel A, Koscher G, Khinast J. Continuous low-dose feeding of highly active pharmaceutical ingredients in hot-melt extrusion. Drug Dev Ind Pharm 2016; 42:1360-4. [DOI: 10.3109/03639045.2015.1135938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marcos Llusa
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - Stefan Mohr
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | | | - Amrit Paudel
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - Gerold Koscher
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - Johannes Khinast
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
- Institute for Particle and Process Engineering, Graz University of Technology, Graz, Austria
| |
Collapse
|
34
|
Papadia A, Imboden S, Siegenthaler F, Gasparri ML, Mohr S, Lanz S, Mueller MD. Laparoscopic Indocyanine Green Sentinel Lymph Node Mapping in Endometrial Cancer. Ann Surg Oncol 2016; 23:2206-11. [PMID: 26790667 PMCID: PMC4889624 DOI: 10.1245/s10434-016-5090-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Indexed: 11/18/2022]
Abstract
Background In endometrial cancer (EMCA), indocyanine green (ICG) sentinel lymph node (SLN) mapping has been reported, mainly in conjunction with robotic surgery. Objective We aimed to evaluate detection rates, sensitivity, and false negative (FN) rate of laparoscopic ICG SLN mapping in EMCA, and to evaluate differences in surgical outcomes between patients subjected to SLN biopsy only versus lymphadenectomy. Methods A retrospective analysis of EMCA patients undergoing ICG SLN mapping ± pelvic (PLND) and/or para-aortic lymphadenectomy (PALND) was performed. Detection rates were calculated for the entire cohort. Sensitivity and FN rates were calculated for patients undergoing lymphadenectomy after SLN mapping, and surgical outcome was compared among patients undergoing SLN mapping only versus lymphadenectomy. Results Of 75 patients, 33 underwent SLN mapping and 42 underwent SLN mapping followed by PLND/PALND. Overall and bilateral detection rates were 96 % (72/75) and 88 % (66/75), respectively, and the median number of removed SLNs, pelvic non-SLNs (NSLN) and para-aortic NSLNs was 3, 27, and 19, respectively. With a FN rate of 8.3 %, only one patient had bilateral FN SLNs and a metastatic para-aortal NSLN. Estimated blood loss (EBL) and operative (OR) time were significantly lower in patients undergoing SLN mapping only. No differences in complication rates between patients undergoing SLN mapping only and patients undergoing lymphadenectomy were recorded. Conclusions Laparoscopic ICG SLN mapping has excellent overall and bilateral detection rates and a low FN rate. Compared with lymphadenectomy, SLN biopsy is associated with significantly lower EBL and shorter OR time.
Collapse
Affiliation(s)
- Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland.
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland.,Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Susanne Lanz
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| |
Collapse
|
35
|
Huguelet P, Brandt PY, Mohr S. [The assessment of spirituality and religiousness in patients with psychosis]. Encephale 2016; 42:219-25. [PMID: 26806141 DOI: 10.1016/j.encep.2015.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/09/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES There is evidence that psychiatrists are rarely aware of how religion may intervene in their patient's life. That is particularly obvious concerning patients with psychosis. Yet, even for patients featuring delusions with religious content, religious activities and spiritual coping may have a favourable influence. Indeed, patients with psychosis can use religion to cope with life difficulties related to their psychotic condition, in a social perspective but also in order to gain meaning in their lives. Also, religion may be part of explanatory models about their disorder with, in some cases, a significant influence on treatment adhesion. PATIENTS AND METHODS This paper describes a prospective randomized study about a spiritual assessment performed by the psychiatrists of patients with schizophrenia. The outpatient clinics in which the sample was collected are affiliated with the department of psychiatry at the university hospitals of Geneva. Eighty-four outpatients with psychosis were randomized into two groups: an experimental group receiving both traditional treatment and spiritual assessment with their psychiatrist and a control group of patients receiving only their usual treatment. Psychiatrists were supervised by a clinician (PH) and a psychologist of religions (PYB) for each patient in the spiritual assessment group. Data were collected from both groups before and after 3 months of clinical follow-up. RESULTS Spiritual assessment was well-tolerated by all patients. Moreover, their wish to discuss religious matters with their psychiatrist persisted following the spiritual assessment. Even though clinicians acknowledged the usefulness of the supervision for some patients, especially when religion was of importance for clinical care, they reported being moderately interested in applying spiritual assessments in clinical settings. Compared to the control group, there were no differences observed in the 3 months' outcome in terms of primary outcome measures for satisfaction with care, yet the attendance at the appointments was significantly increased in the group with spiritual assessment. The same result was found when restricting analyses to patients for whom an intervention was suggested or patients who invested more in religion. Areas of potential intervention were frequent both in a psychiatric and psychotherapeutical perspective. CONCLUSIONS Spiritual assessment appears to be useful for patients with psychosis. This is in accordance with the recommendations of the World Psychiatric Association which promotes considering the whole person in clinical care. Spiritual assessment is quite simple to perform, providing that clinicians do not prescribe or promote religion, and that no critical comments are made concerning religious issues. Clinicians do not need to know in depth the religious domains of each of their patients, as it appears that each patient accommodates his/her religious background his/her own way.
Collapse
Affiliation(s)
- P Huguelet
- Département de santé mentale et de psychiatrie, hôpitaux universitaires de Genève, 8, rue du 31-Decembre, 1207 Genève, Suisse.
| | - P-Y Brandt
- Faculty of Theology, Lausanne University, BFSH 2, 1015 Lausanne, Suisse
| | - S Mohr
- Département de santé mentale et de psychiatrie, hôpitaux universitaires de Genève, 8, rue du 31-Decembre, 1207 Genève, Suisse
| |
Collapse
|
36
|
Planchette C, Pichler H, Wimmer-Teubenbacher M, Gruber M, Gruber-Woelfler H, Mohr S, Tetyczka C, Hsiao WK, Paudel A, Roblegg E, Khinast J. Printing medicines as orodispersible dosage forms: Effect of substrate on the printed micro-structure. Int J Pharm 2015; 509:518-527. [PMID: 26541301 DOI: 10.1016/j.ijpharm.2015.10.054] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/28/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022]
Abstract
We present our recent advancements in developing a viable manufacturing process for printed medicine. Our approach involves using a non-contact printing system that incorporates both piezoelectric- and solenoid valve-based inkjet printing technologies, to deliver both active and inactive pharmaceutical materials onto medical-graded orodispersible films. By using two complimentary inkjet technologies, we were able to dispense an extensive range of fluids, from aqueous drug solutions to viscous polymer coating materials. Essentially, we demonstrate printing of a wide range of formulations for patient-ready, orodispersible drug dosage forms, without the risk of drug degradation by ink heating and of substrate damages (by contact printing). In addition, our printing process has been optimized to ensure that the drug doses can be loaded onto the orally dissolvable films without introducing defects, such as holes or tears, while retaining a smooth surface texture that promotes patient adherence and allows for uniform post-coatings. Results show that our platform technology can address key issues in manufacturing orodispersible drug dosage forms and bring us closer to delivering personalized and precision medicine to targeted patient populations.
Collapse
Affiliation(s)
- C Planchette
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria; University of Technology, Institute of Fluid Mechanics and Heat Transfer, Graz, Austria.
| | - H Pichler
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | | | - M Gruber
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - H Gruber-Woelfler
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria; University of Technology, Institute of Process and Particle Technology, Graz, Austria
| | - S Mohr
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - C Tetyczka
- Karl-Franzens University, Institute of Pharmaceutical Sciences, Department Pharmaceutical Technology, Graz, Austria
| | - W-K Hsiao
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - A Paudel
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - E Roblegg
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria; Karl-Franzens University, Institute of Pharmaceutical Sciences, Department Pharmaceutical Technology, Graz, Austria
| | - J Khinast
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria; University of Technology, Institute of Process and Particle Technology, Graz, Austria
| |
Collapse
|
37
|
Papadia A, Imboden S, Mohr S, Lanz S, Nirgianakis K, Mueller MD. Indocyanine Green Fluorescence Imaging in the Surgical Management of an Iatrogenic Lymphatic Fistula: Description of a Surgical Technique. J Minim Invasive Gynecol 2015; 22:1304-6. [DOI: 10.1016/j.jmig.2015.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
|
38
|
Backhaus K, Roeder N, Bunzemeier H, Mohr S, Leifke C. Strategische Zukunftsplanung mithilfe der Szenarioanalyse. Z Herz- Thorax- Gefäßchir 2015. [DOI: 10.1007/s00398-015-0013-x] [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: 11/28/2022]
|
39
|
Huguelet P, Mohr S, Boucherie M, Yaron M, Perroud N, Bianchi-Demicheli F. [An exploration of sexual desire and sexual activities of women with psychosis]. Rev Med Suisse 2015; 11:1691-1695. [PMID: 26591078] [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: 06/05/2023]
Abstract
Most clinicians avoid discussing sexuality with patients with severe mental disorders. Sexual disturbances can be related to medication, to psychological issues such as self-stigma and anhedonia, and to the social context. We studied desire and sexual practices in women suffering from schizophrenia, in comparison with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. This finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.
Collapse
|
40
|
Meindl C, Stranzinger S, Dzidic N, Salar-Behzadi S, Mohr S, Zimmer A, Fröhlich E. Permeation of Therapeutic Drugs in Different Formulations across the Airway Epithelium In Vitro. PLoS One 2015; 10:e0135690. [PMID: 26274590 PMCID: PMC4537286 DOI: 10.1371/journal.pone.0135690] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/26/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary drug delivery is characterized by short onset times of the effects and an increased therapeutic ratio compared to oral drug delivery. This delivery route can be used for local as well as for systemic absorption applying drugs as single substance or as a fixed dose combination. Drugs can be delivered as nebulized aerosols or as dry powders. A screening system able to mimic delivery by the different devices might help to assess the drug effect in the different formulations and to identify potential interference between drugs in fixed dose combinations. The present study evaluates manual devices used in animal studies for their suitability for cellular studies. METHODS Calu-3 cells were cultured submersed and in air-liquid interface culture and characterized regarding mucus production and transepithelial electrical resistance. The influence of pore size and material of the transwell membranes and of the duration of air-liquid interface culture was assessed. Compounds were applied in solution and as aerosols generated by MicroSprayer IA-1C Aerosolizer or by DP-4 Dry Powder Insufflator using fluorescein and rhodamine 123 as model compounds. Budesonide and formoterol, singly and in combination, served as examples for drugs relevant in pulmonary delivery. RESULTS AND CONCLUSIONS Membrane material and duration of air-liquid interface culture had no marked effect on mucus production and tightness of the cell monolayer. Co-application of budesonide and formoterol, applied in solution or as aerosol, increased permeation of formoterol across cells in air-liquid interface culture. Problems with the DP-4 Dry Powder Insufflator included compound-specific delivery rates and influence on the tightness of the cell monolayer. These problems were not encountered with the MicroSprayer IA-1C Aerosolizer. The combination of Calu-3 cells and manual aerosol generation devices appears suitable to identify interactions of drugs in fixed drug combination products on permeation.
Collapse
Affiliation(s)
- Claudia Meindl
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | | | - Neira Dzidic
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | | | - Stefan Mohr
- Research Center Pharmaceutical Engineering GmbH, Graz, Austria
| | - Andreas Zimmer
- Department of Pharmaceutical Technology, Institute of Pharmaceutical Sciences, Karl-Franzens-University of Graz, Graz, Austria
| | - Eleonore Fröhlich
- Center for Medical Research, Medical University of Graz, Graz, Austria
| |
Collapse
|
41
|
Beynon C, Erk AG, Potzy A, Mohr S, Popp E. Point of care coagulometry in prehospital emergency care: an observational study. Scand J Trauma Resusc Emerg Med 2015; 23:58. [PMID: 26260487 PMCID: PMC4542099 DOI: 10.1186/s13049-015-0139-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022] Open
Abstract
Background Haemostatic impairment can have a crucial impact on the outcome of emergency patients, especially in cases of concomitant antithrombotic drug treatment. In this prospective observational study we used a point of care (POC) coagulometer in a prehospital physician-based emergency medical system in order to test its validity and potential value in the treatment of emergency patients. Methods During a study period of 12 months, patients could be included if venous access was mandatory for further treatment. The POC device CoaguChek® was used to assess international normalized ratio (INR) after ambulance arrival at the scene. Results were compared with in-hospital central laboratory assessment of INR. The gain of time was analysed as well as the potential value of POC testing through a questionnaire completed by the responsible prehospital emergency physician. Results A total of 103 patients were included in this study. POC INR results were highly correlated with results of conventional assessment of INR (Bland-Altman-bias: 0.014). Using a cutoff value of INR >1.3, the device’s sensitivity to detect coagulopathy was 100 % with a specificity of 98.7 %. The median gain of time was 69 min. Treating emergency physicians considered the value of prehospital POC INR testing ‘high’ in 9 % and ‘medium’ in 21 % of all patients. In patients with tracer diagnosis ‘neurology’, the value of prehospital INR assessment was considered ‘high’ or ‘medium’ (63 %) significantly more often than in patients with non-neurological tracer diagnoses (24 %). Conclusions Assessment of INR through a POC coagulometer is feasible in prehospital emergency care and provides valuable information on haemostatic parameters in patients. Questionnaire results suggest that POC INR testing may present a valuable technique in selected patients. Whether this information translates into an improved management of respective patients has to be evaluated in further studies.
Collapse
Affiliation(s)
- Christopher Beynon
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Angelina G Erk
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Anna Potzy
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Stefan Mohr
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| |
Collapse
|
42
|
Imboden S, Papadia A, Nauwerk M, McKinnon B, Kollmann Z, Mohr S, Lanz S, Mueller MD. A Comparison of Radiocolloid and Indocyanine Green Fluorescence Imaging, Sentinel Lymph Node Mapping in Patients with Cervical Cancer Undergoing Laparoscopic Surgery. Ann Surg Oncol 2015; 22:4198-203. [PMID: 26122376 PMCID: PMC4644188 DOI: 10.1245/s10434-015-4701-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 02/05/2023]
Abstract
Background and Purpose 99TC combined with blue-dye mapping
is considered the best sentinel lymph node (SLN) mapping technique in cervical cancer. Indocyanine green (ICG) with near infrared fluorescence imaging has been introduced as a new methodology for SLN mapping. The aim of this study was to compare these two techniques in the laparoscopic treatment of cervical cancer. Methods Medical records of patients undergoing laparoscopic SLN mapping for cervical cancer with either 99Tc and patent blue dye (Group 1) or ICG (Group 2) from April 2008 until August 2012 were reviewed. Sensitivity, specificity, and overall and bilateral detection rates were calculated and compared. Results Fifty-eight patients were included in the study—36 patients in Group 1 and 22 patients in Group 2. Median tumor diameter was 25 and 29 mm, and mean SLN count was 2.1 and 3.7, for Groups 1 and 2, respectively. Mean non-SLN (NSLN) count was 39 for both groups. SLNs were ninefold more likely to be affected by metastatic disease compared with NSLNs (p < 0.005). Sensitivity and specificity were both 100 %. Overall detection rates were 83 and 95.5 % (p = nonsignificant), and bilateral detection rates were 61 and 95.5 % (p < 0.005), for Groups 1 and 2, respectively. In 75 % of cases, SLNs were located along the external or internal iliac nodal basins. Conclusions ICG SLN mapping in cervical cancer provides high overall and bilateral detection rates that compare favorably with the current standard of care.
Collapse
Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland.
| | - Mélina Nauwerk
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Brett McKinnon
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Zahraa Kollmann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Susanne Lanz
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| |
Collapse
|
43
|
Mohr S, Schott J, Hoenemann L, Feibicke M. Glyceria maxima as new test species for the EU risk assessment for herbicides: a microcosm study. Ecotoxicology 2015; 24:309-320. [PMID: 25380672 DOI: 10.1007/s10646-014-1379-3] [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] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Abstract
In its recent guidance document on tiered risk assessment for plant protection products for aquatic organisms, the European Food Safety Authority (EFSA) proposed to use Glyceria maxima as monocotyledonous grass species for the testing of special herbicide groups. However, published toxicity data for this species is very limited and there is no test guideline for Glyceria sp. For this reason a microcosm study was conducted in order to gain experience on the degree of sensitivity of G. maxima to the herbicidal substances clodinafop-propargyl (grass herbicide) and fluroxypyr (auxin) in comparison to the already established test organism water milfoil Myriophyllum spicatum and the duckweed species Landoltia punctata. Five concentrations without replicates were tested for each test substance using 10 microcosms and three microcosms served as controls. The experiment was run for 8 weeks. Morphological endpoints were used to determine growth and EC50 values. The results show that M. spicatum was most sensitive to fluroxypyr (37 days EC50 for roots: 62 µg/L) and G. maxima most sensitive to clodinafop-propargyl (22 days EC50 for total shoot length: 48 µg/L) whereas the duckweed species was considerable less sensitive. Hence, G. maxima turns out to be a good candidate for testing grass specific herbicides, supporting its inclusion as an additional macrophyte test for the risk assessment of herbicides as proposed by the EFSA.
Collapse
Affiliation(s)
- S Mohr
- Umweltbundesamt, Schichauweg 58, 12307, Berlin, Germany,
| | | | | | | |
Collapse
|
44
|
Mohr S, Herbst J, Baumgartner A, Stadelmann P, Sculean A, Persson R, Eick S, Surbek D. 391: Inflammatory cascade and not hematogenic bacterial infection leads from periodontitis to preterm premature rupture of membranes. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
45
|
Stadelmann PFM, Eick S, Salvi GE, Surbek D, Mohr S, Bürgin W, Ramseier CA, Sculean A. Increased periodontal inflammation in women with preterm premature rupture of membranes. Clin Oral Investig 2014; 19:1537-46. [PMID: 25420538 DOI: 10.1007/s00784-014-1371-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/14/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To evaluate possible differences in periodontal inflammatory, microbiological and clinical parameters between women with preterm premature rupture of membranes (PPROM) and controls with uncomplicated pregnancies. MATERIALS AND METHODS Fifty-six women (32 test (PPROM) and 24 controls (uncomplicated pregnancies)) were examined at three time-points (T1: gestational weeks 20-35, T2: within 48 h after parturition, T3: 4-6 weeks after parturition). The examinations included assessment of the Periodontal Screening Index, collection of gingival crevicular fluid (GCF) and subgingival as well as vaginal bacterial sampling. RESULTS Periodontal inflammation was found to be higher in the test compared with the control group (p < 0.05) and decreased over time in both groups (p < 0.05). Microbiological outcomes showed no intergroup differences (p > 0.05) in prevalence of bacteria, but a decrease in subgingival periodontopathogens from T1 to T2 in the test group (p < 0.05) was observed. Interleukin (IL)-1β levels in GCF at T2 were not different between groups (p > 0.05). In women with PPROM, GCF levels of IL-8 (p < 0.05) and C-reactive protein (p < 0.05) were lower and IL-10 levels higher (p < 0.05) compared with controls. CONCLUSIONS Periodontal inflammation is elevated during pregnancy and seems to be more pronounced in women with PPROM. CLINICAL RELEVANCE The findings of the present study revealed an association between periodontal inflammation and PPROM, thus emphasizing the importance of optimizing self-performed oral hygiene in pregnant women.
Collapse
Affiliation(s)
- Pascale F M Stadelmann
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Weiß JA, Mohr S, Schmid MG. Indirect Chiral Separation of New Recreational Drugs by Gas Chromatography-Mass Spectrometry Using Trifluoroacetyl-L-Prolyl Chloride as Chiral Derivatization Reagent. Chirality 2014; 27:211-5. [DOI: 10.1002/chir.22414] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/10/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Jennifer A. Weiß
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences; Karl-Franzens University Graz; Graz Austria
| | - Stefan Mohr
- Research Center Pharmaceutical Engineering; Graz Austria
| | - Martin G. Schmid
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences; Karl-Franzens University Graz; Graz Austria
| |
Collapse
|
47
|
Simoes E, Kronenthaler A, Rieger M, Rall KK, Schäffeler N, Hiltner H, Gröber-Grätz D, Ueding E, Mohr S, Brucker SY. Studie zur Gestaltung der Transitionsversorgung bei Seltenen Erkrankungen am Beispiel von Patientinnen mit genitalen Fehlbildungen – Design und erste Ergebnisse (BMBF Förderkennzeichen 01GY1125). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
48
|
Christmann C, Christoph P, Mohr S, Brandner S, Imboden S, Kuhn A. Is obstruction an issue after adjustable sling insertion for recurrent stress urinary incontinence? Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
49
|
Taschwer M, Seidl Y, Mohr S, Schmid MG. Chiral Separation of Cathinone and Amphetamine Derivatives by HPLC/UV Using Sulfated ß-Cyclodextrin as Chiral Mobile Phase Additive. Chirality 2014; 26:411-8. [DOI: 10.1002/chir.22341] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/15/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Magdalena Taschwer
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences; Karl-Franzens-University Graz; Graz Austria
| | - Yvonne Seidl
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences; Karl-Franzens-University Graz; Graz Austria
| | - Stefan Mohr
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences; Karl-Franzens-University Graz; Graz Austria
- Research Center Pharmaceutical Engineering; Graz Austria
| | - Martin G. Schmid
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Sciences; Karl-Franzens-University Graz; Graz Austria
| |
Collapse
|
50
|
Mohr S, Schott J, Maletzki D, Hünken A. Effects of toxicants with different modes of action on Myriophyllum spicatum in test systems with varying complexity. Ecotoxicol Environ Saf 2013; 97:32-39. [PMID: 23928028 DOI: 10.1016/j.ecoenv.2013.06.030] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 06/02/2023]
Abstract
At the international workshop Aquatic Macrophyte Risk Assessment for Pesticides (AMRAP), it was noted that the EU risk assessment under the directive 91/414/EEC for herbicides, based only on algae and the monocotyledonous duckweed species Lemna sp., offers no certain protection against some growth regulating auxins. Therefore, AMRAP members proposed the introduction of the dicotyledonous water milfoil Myriophyllum as additional test species. This study was aimed to compare toxicity results from three test systems (TS) with varying complexity, namely Water TS, Sediment TS and Microcosm TS using Myriophyllum spicatum as test organism. As test substances, the photosynthesis inhibiting herbicide isoproturon, the growth regulating auxins fluroxypyr and 2,4-dichlorophenoxyacetic acid (2,4-D), and the non-specific acting toxicant 3,5-dichlorophenol (3,5-DCP) were chosen. It was assessed if and why the sensitivity of M. spicatum towards the four toxicants varied in the different test systems and if the addition of sucrose to the medium used in the Water TS had an effect on the sensitivity of Myriophyllum. All TS were suitable for detecting negative effects of toxicants with different modes of action on M. spicatum. The lowest variability of endpoints was found in the Water TS with lowest experimental complexity. For auxins, the endpoint weight did not result in robust EC50 values in all TS, whereas root related endpoints, which are also ecologically relevant, turned out to be very sensitive with low variance. Sucrose in the medium of the Water TS did not seem to influence the sensitivity of M. spicatum towards isoproturon and 3,5-DCP but may have increased the sensitivity of M. spicatum roots when exposed to 2,4-D. However, the findings of all TS resulted in similar risk estimations if root endpoints were not considered.
Collapse
Affiliation(s)
- S Mohr
- Umweltbundesamt, Schichauweg 58, 12307 Berlin, Germany.
| | | | | | | |
Collapse
|