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Tumor-derived GDF-15 blocks LFA-1 dependent T cell recruitment and suppresses responses to anti-PD-1 treatment. Nat Commun 2023; 14:4253. [PMID: 37474523 PMCID: PMC10359308 DOI: 10.1038/s41467-023-39817-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/09/2023] [Indexed: 07/22/2023] Open
Abstract
Immune checkpoint blockade therapy is beneficial and even curative for some cancer patients. However, the majority don't respond to immune therapy. Across different tumor types, pre-existing T cell infiltrates predict response to checkpoint-based immunotherapy. Based on in vitro pharmacological studies, mouse models and analyses of human melanoma patients, we show that the cytokine GDF-15 impairs LFA-1/β2-integrin-mediated adhesion of T cells to activated endothelial cells, which is a pre-requisite of T cell extravasation. In melanoma patients, GDF-15 serum levels strongly correlate with failure of PD-1-based immune checkpoint blockade therapy. Neutralization of GDF-15 improves both T cell trafficking and therapy efficiency in murine tumor models. Thus GDF-15, beside its known role in cancer-related anorexia and cachexia, emerges as a regulator of T cell extravasation into the tumor microenvironment, which provides an even stronger rationale for therapeutic anti-GDF-15 antibody development.
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Surfactant administration during endotracheal CPAP: feasibility, risk factors for failure and short-term outcomes of DD-SURF. Acta Paediatr 2023. [PMID: 36946356 DOI: 10.1111/apa.16767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023]
Abstract
AIM Whereas there is agreement, that surfactant should be administered without mechanical ventilation, there is still a debate concerning the optimal method. DD-SURF combines the benefits of INSURE and less invasive surfactant administration (LISA). The efficacy of this approach has not been evaluated yet. METHODS Retrospective cohort study of all preterm newborns below 300/7 weeks gestational age admitted to the neonatal intensive care unit. Data on surfactant therapy, respiratory support during the first 96 hours of life and neonatal morbidities until hospital discharge were collected from the electronic patient charts to evaluate the efficacy and safety of our approach. RESULTS 222 newborns met the inclusion criteria. 174 (78%) received surfactant in the delivery room by the DD-SURF procedure. 21 infants (10%) were not extubated after surfactant administration (Surf-and-vent group). 75% of patients after DD-SURF did not require reintubation. Intraventricular hemorrhage and bronchopulmonary dysplasia occured more often in infants after DD-SURF failure than after successful DD-SURF. CONCLUSION DD-SURF potentially combines the benefits of INSURE and LISA and represents a useful alternative of surfactant delivery with comparable success rates to thin-catheter surfactant administration.
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Video recording in the delivery room: current status, implications and implementation. Pediatr Res 2021:10.1038/s41390-021-01865-0. [PMID: 34819653 DOI: 10.1038/s41390-021-01865-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022]
Abstract
Many factors determine the performance and success of delivery room management of newborn babies. Improving the quality of care in this challenging surrounding has an important impact on patient safety and on perinatal morbidity and mortality. Video recording (VR) offers the advantage to record and store work as done rather than work as recalled. It provides information about adherence to algorithms and guidelines, and technical, cognitive and behavioural skills. VR is feasible for education and training, improves team performance and results of research led to changes of international guidelines. However, studies thus far have not provided data regarding whether delivery room video recording affects long-term team performance or clinical outcomes. Privacy is a concern because data can be stored and individuals can be identified. We describe the current state of clinical practice in high- and low-resource settings, discuss ethical and medical-legal issues and give recommendations for implementation with the aim of improving the quality of care and outcome of vulnerable babies. IMPACT: VR improves performance by health caregivers providing neonatal resuscitation, teaching and research related to delivery room management, both in high as well low resource settings. VR enables information about adherence to guidelines, technical, behavioural and communication skills within the resuscitation team. VR has ethical and medical-legal implications for healthcare, especially recommendations for implementation of VR in routine clinical care in the delivery room. VR will increase the awareness that short- and long-term outcomes of babies depend on the quality of care in the delivery room.
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Prenatal diagnosis of exomphalos and prediction of outcome. Sci Rep 2021; 11:8752. [PMID: 33888820 PMCID: PMC8062495 DOI: 10.1038/s41598-021-88245-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 04/05/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to detect a parameter for predicting prenatal complications or postnatal surgical options after detecting a fetal exomphalos. This was a retrospective analysis of prenatal diagnosis and outcome of fetuses with 41 cases of exomphalos in between 2007 and 2017, considering the measurement of ratios. The 41 fetuses with exomphalos were examined, 34 cases (82.9%) with karyotyping and 16 cases (39%) with an abnormal karyotype. Outcome of 39 cases showed 6 abortions (15.4%), 15 terminations (38.5%), an intrauterine fetal death (2.5%) and 17 alive babies (43.6%), which were grouped in two: small exomphalos (n = 6, 35.3%) and big exomphalos (n = 11, 64.7%). Maximal diameter of exomphalos/abdomen circumference-ratio (EDmax/AC-ratio) with a cut-off of 0.24 showed a better predictive value of postnatal primary closure. Exomphalos is correlated with abnormal karyotype. EDmax/AC-ratio gives the best prediction for postnatal primary closure of the defect.
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Systemischer Lupus erythematodes, Hypothyreose und Kardiomyopathie in der Schwangerschaft: ein Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fetale Wachstumsrestriktion – transsektorale, interdisziplinäre und multiprofessionelle Betreuung von Schwangeren und Neugeborenen im FETONEONAT-Pfad – Ein Projekt des Innovationsfonds. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Die Versorgung und Reanimation des Neugeborenen. Notf Rett Med 2020; 23:257-259. [PMID: 32536802 PMCID: PMC7284680 DOI: 10.1007/s10049-020-00722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Geburtskohortenstudie EcoCare-PIn – Ergebnisse von Sekundärdatenanalysen zur Inanspruchnahme medizinischer Versorgungsleistungen bei Frühgeborenen mit dem Schwerpunkt regionaler Versorgungsunterschiede. DAS GESUNDHEITSWESEN 2016. [DOI: 10.1055/s-0036-1586622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Langfristige gesundheitliche und monetäre Folgen von Frühgeburt – eine prospektive Kohortenstudie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Endlich angekommen?! Das Belastungserleben und Rollenverständnis von Müttern mit frühgeborenen Kindern nach Entlassung aus der Klinik. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Steigender Konsum von Crystal in Sachsen und dessen Risiken für Schwangere und Neugeborene – Erfahrungen eines Perinatal-Zentrums. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Neonatale Morbidität und Mortalität bei hypertensiven Schwangerschaftserkrankungen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Fetale und neonatale Morbidität und Mortalität bei hypertensiven Schwangerschaftserkrankungen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ernährung Früh- und kranker Neugeborener: Bakterien in der Muttermilch – Freund oder Feind? Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Was passiert bei der Erstversorgung nach Sectio cesarea wirklich? Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Befundmuster in diffusionsgewichteten MRT-Sequenzen bei Neugeborenen mit Verdacht auf eine hypoxisch-ischämischen Enzephalopathie (HIE) und Zustand nach Hypothermiebehandlung. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1352540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Investigating the European perspective of neonatal point-of-care echocardiography in the neonatal intensive care unit--a pilot study. Eur J Pediatr 2013; 172:907-911. [PMID: 23440477 DOI: 10.1007/s00431-013-1963-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 05/28/2023]
Abstract
UNLABELLED Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers a training certificate for fnECHO. In Europe, the use and indications of fnECHO and the extent of point-of-care fnECHO training and accreditation are unknown. We aimed to assess utilisation and training of fnECHO in Europe. For this, we conducted an email survey of 45 randomly chosen tertiary NICUs in 17 European countries. The recall rate was 89 % (n = 40). Neonatologists with skills in fnECHO worked in 29 NICUs (74 %), but paediatric cardiologists would routinely perform most fnECHOs. Twenty-four-hour echocardiography service was available in 31 NICUs (78 %). Indications for fnECHO included assessment of haemodynamic volume status (53 %), presence or absence of pulmonary hypertension of the neonate (55 %), indication for and effect of volume replacement therapy (58 %), PDA assessment and monitoring of PDA treatment (80 %). Teaching of fnECHO was offered to trainees in 22 NICUs (55 %). Teaching of fnECHO was provided by paediatric cardiologists (55 %) or by neonatologists (45 %). Only six (15 %) national colleges accredited fnECHO teaching courses. CONCLUSION fnECHO is widely practiced by neonatologists across Europe for a broad range of clinical questions. However, there is a lack of formal training and accreditation of fnECHO skills. This could be addressed by designing a dedicated European fnECHO training programme and by agreeing on a common European certificate of fnECHO.
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Embolism in a neonate after TAPS and fetoscopic laser therapy of TOPS - Case Report. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1343544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Pathophysiology of neonatal transition and meaningful measures for the initial stabilisation of extremely premature neonates. Z Geburtshilfe Neonatol 2012; 216:201-4. [PMID: 23108963 DOI: 10.1055/s-0032-1323817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This report discusses the physiological aspects of neonatal transition from breathing liquid to air. Further, we discuss reasonable medical interventions to actively assist a gentle transition, and focus on team aspects of preparing both the perinatal team and parents for the challenging situation of preterm labour and delivery. Our aim is to critically evaluate current concepts on the physiology of neonatal transition and the current assessment of the newborn infant, to present means to facilitate non-traumatic pulmonary aeration and ways to foster successful teamwork and professional parental guidance in the delivery room. The authors report on their own work and on that of other research groups, as recently published in peer reviewed medical journals. When born, the newborn needs to rapidly clear his/her lungs from fluid to establish breathing. Active fluid transport and passive resorption help to establish the pulmonary functional residual capacity (FRC). Prenatal administration of corticosteroids helps to form and maintain the FRC of the newborn. Many very low gestational age neonates (ELGAN) will breathe at birth but require medical assistance. This is best done by giving distending positive airway pressure at levels of 5 cmH(2)O, or greater. Monitoring of these infants should be by peripheral pulse oximetry. Some ELGANs may require non-invasive ventilation and/or exogenous Surfactant replacement, and even fewer may require intubation and mechanical ventilation. The obstetric and neonatal teams need to coordinate their joined efforts to secure a safe delivery for mother and child. Ways of communication between teams and parents are presented. Many neonatal teams use video recording as a tool to assess and improve their work. We give insights into the use of video as a means to improve teamwork and patient care alike.
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Wann kommen extrem unreife Frühgeborene zur Welt? Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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The use of gating technology in bioengineering insulin-secreting cells from embryonic stem cells. Cytotechnology 2011; 41:145-51. [PMID: 19002951 DOI: 10.1023/a:1024878807264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Embryonic stem cells display the ability to differentiate in vitro into a variety of cell types. This process is induced by embryoid body formation, addition of several soluble growth factors to the culture medium and other strategies. However, none of the used factors is capable to drive differentiation to only one specific celltype. The use of gating technology has allowed to partially overcome this problem. The rational behind this technique is based on the transfection of stem cells with a transgene carrying expression cassettes for a cell type specific promoter, regulating expression ofa selectable marker to select one cell lineage from other cell lineages.Using this system, we have obtained insulin-secreting cells by transfecting mouse embryonic stem cells with a DNA construct providing resistance to neomycin under the control of the regulatory regions of the human insulin gene. Furthermore, gating technology has been successfully used to isolate other cell types such as cardiomyocytes and neural precursors from undifferentiated embryonic stem cells. This review focuses on the possibilities offered by this technology in embryonic stem cell bioengineering, mainly to obtain insulin-secreting cells. Advantages and considerations of this selection system will be also discussed.
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Delivery room management of very low birth weight infants in Germany, Austria and Switzerland--a comparison of protocols. Eur J Med Res 2010; 15:493-503. [PMID: 21159574 PMCID: PMC3352658 DOI: 10.1186/2047-783x-15-11-493] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 10/26/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Surveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, <1500g) at birth, despite regularly updated international guidelines. OBJECTIVE To investigate protocols for DR management of VLBWI in Germany, Austria and Switzerland and to compare these with the 2005 ILCOR guidelines. METHODS DR management protocols were surveyed in a prospective, questionnaire-based survey in 2008. Results were compared between countries and between academic and non-academic units. Protocols were compared to the 2005 ILCOR guidelines. RESULTS In total, 190/249 units (76%) replied. Protocols for DR management existed in 94% of units. Statistically significant differences between countries were found regarding provision of 24 hr in house neonatal service; presence of a designated resuscitation area; devices for respiratory support; use of pressure-controlled manual ventilation devices; volume control by respirator; and dosage of Surfactant. There were no statistically significant differences regarding application and monitoring of supplementary oxygen, or targeted saturation levels, or for the use of sustained inflations. Comparison of academic and non-academic hospitals showed no significant differences, apart from the targeted saturation levels (SpO2) at 10 min. of life. Comparison with ILCOR guidelines showed good adherence to the 2005 recommendations. SUMMARY Delivery room management in German, Austrian and Swiss neonatal units was commonly based on written protocols. Only minor differences were found regarding the DR setup, devices used and the targeted ranges for SpO2 and FiO2. DR management was in good accordance with 2005 ILCOR guidelines, some units already incorporated evidence beyond the ILCOR statement into their routine practice.
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Kreißsaal – der optimale Start ins Leben. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prädiktive Aussagekraft des spezifizierten Apgar-Score – Ergebnisse der TEST-Apgar-Studie. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aktueller Stand der Hypothermiebehandlung in Deutschland. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zielstellung eines deutschen Hypothermienetzwerkes – Ergebnisse einer Umfrage. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Elektrische Quadranten-Impedanzmessung zur Bestimmung von Tidalvolumina bei neugeborenen Schweinen. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Standardisierte Therapieempfehlungen verbessern die Ergebnisqualtiät. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Airway management during resuscitation of VLBW neonates during resuscitation in Germany, Austria and Switzerland. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Elternkurs in der Neonatologie. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Verbesserung des Angebots psychosozialer Versorgung der Eltern frühgeborener oder kanker neugeborener Kinder während des Klinikaufenthalts. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Die Auswirkungen von Hyperoxie auf die VEGF und TNFα Expression am Tiermodell der neonatalen Rattenlunge. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aussagekraft des von der American Academy of Pediatrics vorgeschlagenen Scores für reanimierte Neugeborene. KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Anreicherung von Muttermilch: Ist die unmittelbare Anreicherung besser verträglich? KLINISCHE PADIATRIE 2010. [DOI: 10.1055/s-0030-1261655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[From pay-for-effort to pay-for-performance--an analysis of the Swiss health care system with focus on the inpatient sector]. PRAXIS 2009; 98:1499-1509. [PMID: 20013686 DOI: 10.1024/1661-8157.98.25.1499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The Swiss health care system is facing the implementation of lump compensation in the form of diagnosis related groups from 2010 on. In addition there is an increasing discussion about the quality of health care in the media. We have analyzed current remuneration in Swiss health care and their steering effects on providers in order to deduct future developments in Swiss health care remuneration. METHODS Based on the remuneration contracts and tariff regularities at the Basel University Hospital we conducted an internet and literature search. The identified Swiss remuneration systems were classified after remuneration scales and remuneration item using a typology of performance-related remuneration systems. The steering effects of the remuneration systems on the providers were deducted. RESULTS Remuneration scales can be classified in <<costs incurred>>, <<standardized costs>> or <<negotiated costs>>. Remuneration items can be classified in <<activities>>, <<cases>> or <<outcome oriented cases>>. Remuneration systems can lead to increased or decreased services or to patient selection. In the Swiss health care system we find a trend away from traditional <<pay-for-effort>> to <<pay-for-performance>> remuneration systems. In that context diagnosis related groups are identified as an intermediate step in the development of remuneration systems. CONCLUSIONS Future developments of medical remuneration in terms of a consideration of quality of medical performance and negotiated costs seem likely in Switzerland in the long term. Both, economics and quality should be considered adequately in a health care remuneration system.
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Reduction of postoperative adhesions by perfluorocarbons: an experimental study in a rat model. Eur J Pediatr Surg 2009; 19:211-5. [PMID: 19551615 DOI: 10.1055/s-0029-1202250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Peritoneal adhesions are a well-known and frequently occurring postoperative complication. Many published studies have looked into the prophylaxis of adhesions following abdominal surgery, but only few clinically relevant agents have been reported. Most publications refer to adult patients and not to paediatric patient collectives. This experimental study in a rat model compares the effect of perfluorocarbons as adhesion prophylaxis with those of a well-known anti-adhesive agent Adept and with an untreated control group. We hypothesized that PFC might have a double effect: initially it could suppress the accumulation of monocytes and neutrophilic granulocytes, and subsequently it would work as a barrier to prevent contact between the visceral and parietal layers of the peritoneum. After a standardised operation, PFC was injected into the abdominal cavity of rats in the study group. Macroscopically, the PFC group did not fare significantly better, but nevertheless a clear tendency towards fewer adhesions after the application of PFC could be ascertained.
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Prozessoptimierung in der neonatologischen & pädiatrischen Intensivmedizin durch Patientendaten-Management-Systeme (PDMS). Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Die Wirkung von Perfluorocarbone auf die LPS induzierte Entzündungsreaktion von Alveolären Makrophagen und Typ-II Zellen. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Isoliertes Noncompaction des rechten Ventrikels–Neugeborenes mit extrem seltener Form einer kongenitalen Kardiomyopathie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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43
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Wachstum von Frühgeborenen <1500g vor und nach Einführung eines elektronischen Ernährungplans. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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44
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Perfluorocarbone vermindern die durch Hyperoxie bedingte Hemmung der postnatalen Lungenentwicklung. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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45
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VEGF im Urin als Indikator einer Transfusionsbedürftigkeit bei Früh- und Neugeborenen. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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VEGF-Applikation als Prävention von hyperoxiebedingten Lungenschäden. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Perfluorocarbone beeinflussen die Membranpermeabilität von Alveolären Typ II Zellen in Abhängigkeit ihrer Viskosität und Dichte. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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48
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Surfactantapplikation mit versus ohne erhaltenen PEEP – Beeinflussung der cerebralen Oxygenierung und Perfusion. Z Geburtshilfe Neonatol 2008. [DOI: 10.1055/s-2008-1078912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Surfactantapplikation mit versus ohne PEEP – Verteilung in der Lunge und Einfluss auf den Gasaustausch. Z Geburtshilfe Neonatol 2008. [DOI: 10.1055/s-2008-1078869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Neue Therapieansätze in der Behandlung des postoperativen Adhäsionsileus bei vlbw – ein tierexperimenteller Modell zum Einsatz von PFC zur Adhäsionsprophylaxe. Z Geburtshilfe Neonatol 2008. [DOI: 10.1055/s-2008-1078944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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