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  • 1
    Book
    Book
    Berlin, Heidelberg: Springer Berlin Heidelberg
    Language: German
    In: Springer-Lehrbuch,
    Description: Worauf beruhen therapeutische Richtlinien? Auf der statistischen Auswertung epidemiologischer Daten und Daten aus klinischen Studien. Überall im klinischen und praktischen Alltag stößt der Arzt auf die Endprodukte statistischer Auswertungen. Deshalb sollte jeder Medizinier, unabhängig von einer eventuellen Einbindung in klinische Studien, die einzelnen statistischen Methoden bewerten und korrekt einsetzen können. Im Weiss wird die Thematik knapp und verständlich dargestellt. Dabei sind die Inhalte einerseits eng an den Erfordernissen der Prüfung orientiert, andererseits - jenseits trockener Theorie - immer an praktischen Beispielen ausgeführt.
    Keywords: Mathematics ; Biomathematics ; Statistics ; Mathematics ; Physiological, Cellular and Medical Topics ; Statistics for Life Sciences, Medicine, Health Sciences ; Biology ; Statistics ; Mathematics
    ISBN: 9783662059852
    ISBN: 3662059851
    ISBN: 9783642113369
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  • 2
    In: Age and Ageing, 2016, Vol. 45(2), pp.262-267
    Description: Trial design: to further validate the FORTA (Fit fOR The Aged) concept, a bicentric randomised, controlled trial was run in two geriatric clinics. Methods: patients (≥65 years, ≥3 drugs or ≥60 years, ≥6 drugs) with three relevant diseases and hospitalisation for ≥5 days were randomised. In the intervention, but not the control group, a FORTA team instructed ward physicians on FORTA. FORTA is the first positive/negative listing approach labelling medications used to treat chronic illnesses in older patients from A (indispensable), B (beneficial), C (questionable) to D (avoid). The primary end point was the FORTA score: sum of medication errors classified as over-, under- and mistreatment. Consecutive patients were randomised to the intervention and control ward; outcome assessment was blinded. Results: four hundred and nine patients (age 81.5 years, 64% female, hospitalisation 17.4 days) were included. The primary end point was significantly ( P 〈 0.0001) more reduced in the intervention versus control groups (2.7 ± 2.25 versus 1 ± 1.8, mean ± SD, intergroup comparison of admission/discharge differences). Over- and under-treatment scores and use of A (increase) and D (decrease) drugs were significantly improved ( P 〈 0.01). The total number of adverse drug reactions (ADRs) was significantly reduced by FORTA ( P 〈 0.05, number needed to treat is 5). Activities of daily living and renal failure improved significantly ( P 〈 0.05). Blood pressure remained constant in the intervention, but decreased significantly in the control group. Conclusion: applying FORTA to hospitalised geriatric patients leads to improvement of medication quality and may improve secondary clinical end points (e.g. ADRs). The concept is amenable to successful communication and implementation. Registration (DRKS-ID): DRKS00000531. Funding: DFG-German Research Foundation (WE 1184/15-1).
    Keywords: Polypharmacy ; Geriatric Pharmacotherapy ; Clinical Trial ; Forta Score ; Activities Of Daily Living ; Older People
    ISSN: 0002-0729
    E-ISSN: 1468-2834
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  • 3
    Language: English
    In: Gastroenterology, 2011, Vol.140(5), pp.S-694-S-695
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
    Source: ScienceDirect Journals (Elsevier)
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  • 4
    Language: English
    In: The Journal of Urology, April 2012, Vol.187(4), pp.e374-e375
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 5
    Language: English
    In: The Journal of Urology, April 2011, Vol.185(4), pp.e884-e884
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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  • 6
    In: International Journal of Cancer, 15 April 2017, Vol.140(8), pp.1907-1917
    Description: Risk stratification of sentinel lymph node biopsy (SNB)‐positive patients with malignant melanoma differs among current classification systems. To improve classification of patients with rapidly progressive disease who may profit from adjuvant therapy with novel immune or targeted treatment modalities, a single‐center retrospective analysis was performed including all melanoma patients diagnosed with a positive SN at a university‐based skin cancer center over a 10‐year period (2002–2012) (96 of 419 patients). Sentinel node metastasis mitotic rate (SN‐MMR) and further histologic parameters were determined by blinded histological re‐evaluation and correlated with clinical follow‐up (overall [OS], melanoma‐specific [MSS], and disease‐free survival [DFS]). Median follow‐up was 53 months. In univariate analyses, SN tumor penetrative depth (TPD), maximum tumor diameter (MTD), number of positive SN, SN‐MMR and the S‐, Rotterdam, RDC, Hannover I and II classification systems correlated with OS, MSS and DFS. Multivariate Cox regression analyses showed that a binary classification system based only on the SN‐MMR (〈1 . ≥1 mitoses/mm) was the strongest independent prognostic indicator for all endpoints analyzed. Kaplan‐Meier analyses confirmed binary SN‐MMR to be superior to stratify patients into high‐ and low‐risk groups (45.45% . 87.92% 5‐yr MSS). The general prognostic validity of the published SN classification systems was confirmed. The novel SN‐MMR classification system may improve discrimination of patients with slowly and rapidly progressive disease. We therefore propose its implementation into clinical practice as the SN‐MMR can be easily and reliably determined in routine pathology reports. Its prognostic value for the selection of patients amenable to adjuvant therapies should be studied in clinical trials. What's new? Sentinel node biopsy (SNB) can show whether melanoma has metastasized, but it does not improve overall survival, because there is wide variation in the aggressiveness of tumors that test positive. These authors hoped to improve outcomes by subclassifying melanomas with positive SNB. They retrospectively evaluated a decade's worth of sentinel node biopsies in search of a classifying characteristic that could help predict survival. They found that sentinel node metastasis mitotic rate could distinguish patients with rapidly progressing disease from those with slowly progressing disease. This simple and cost‐effective test could help identify patients who would benefit from adjuvant therapy.
    Keywords: Mitotic Rate ; Adjuvant Therapy ; Immune Therapy ; Targeted Therapy ; Stage Iii Melanoma ; Pathologic Classification
    ISSN: 0020-7136
    E-ISSN: 1097-0215
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  • 7
    Language: English
    In: World journal of urology, April 2014, Vol.32(2), pp.317-22
    Description: To examine how much practice is essential to properly perform real-time sonoelastography (RTE) in the detection of PC. RTE of the prostate was performed in 60 PC patients prior to radical prostatectomy (RP). All patients were examined by a novice and an expert observer in a blinded fashion. The novice's results were validated with the results of the expert. Kappa indexes, sensitivities, specificities as well as the duration of the examination were assessed. Learning curves (LC) were obtained by assessment of 16 (LC A) and eight (LC B) prostate sectors. Cochrane-Armitage trend test, Chi(2) test and t test for paired samples were used. For the 16-sector method (LC A), overall sensitivity and specificity were 58.2 and 77.7 % and, for the 8-sector method, 68.3 and 64.5 %, respectively. For LC A, sensitivity rose over the whole study period (p = 0.0055). As a result, no learning plateau was reached. In contrast, a learning plateau with no constant rise in sensitivity (p = 0.4667) was reached for LC B after 30 examined patients. The mean examination time for both observers was 7.9 min (±3.7). When being trained by an expert examiner, skills in RTE of the prostate can be obtained quickly. Performed by a trained examiner, the examination itself is little time-consuming. Thus, RTE represents a user- and patient-friendly tool that can easily be integrated into the day-to-day practice of urologists.
    Keywords: Learning Curve ; Elasticity Imaging Techniques -- Methods ; Prostate -- Diagnostic Imaging ; Prostatic Neoplasms -- Diagnostic Imaging ; Urology -- Education
    ISSN: 07244983
    E-ISSN: 1433-8726
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  • 8
    Language: English
    In: PLoS ONE, 2012, Vol.7(1), p.e30069
    Description: Acute bacterial meningitis is a life-threatening disease in humans. Discussed as entry sites for pathogens into the brain are the blood-brain and the blood-cerebrospinal fluid barrier (BCSFB). Although human brain microvascular endothelial cells (HBMEC) constitute a well established human in vitro model for the blood-brain barrier, until now no reliable human system presenting the BCSFB has been developed. Here, we describe for the first time a functional human BCSFB model based on human choroid plexus papilloma cells (HIBCPP), which display typical hallmarks of a BCSFB as the expression of junctional proteins and formation of tight junctions, a high electrical resistance and minimal levels of macromolecular flux when grown on transwell filters. Importantly, when challenged with the zoonotic pathogen Streptococcus suis or the human pathogenic bacterium Neisseria meningitidis the HIBCPP show polar bacterial invasion only from the physiologically relevant basolateral side. Meningococcal invasion is attenuated by the presence of a capsule and translocated N. meningitidis form microcolonies on the apical side of HIBCPP opposite of sites of entry. As a functionally relevant human model of the BCSFB the HIBCPP offer a wide range of options for analysis of disease-related mechanisms at the choroid plexus epithelium, especially involving human pathogens.
    Keywords: Research Article ; Biology ; Medicine ; Infectious Diseases ; Microbiology ; Neurological Disorders
    E-ISSN: 1932-6203
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  • 9
    Language: English
    In: European Journal of Cancer, September 2018, Vol.101, pp.S32-S32
    Keywords: Medicine
    ISSN: 0959-8049
    E-ISSN: 1879-0852
    Source: ScienceDirect Journals (Elsevier)
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  • 10
    Language: English
    In: International Journal of Colorectal Disease, 2013, Vol.28(5), pp.679-688
    Description: Byline: Julia Konanz (1), Florian Herrle (1), Christel Weiss (2), Stefan Post (1), Peter Kienle (1) Keywords: Quality of life; Rectal cancer; Resection Abstract: Purpose Limits for sphincter preservation in rectal cancer have been expanded under the assumption that patients with a permanent colostomy have worse quality of life (QoL). Incontinence and painful defecation are common problems therefore, this study compares functional outcome and QoL after sphincter-sparing intersphincteric resection (ISR), low anterior resection (LAR), and abdominoperineal resection (APR) for rectal cancer. Methods From a prospective database, three matched groups of patients after surgery for rectal cancer between 1999 and 2009 were extracted. Median follow-up was 59 months. Of 131 patients receiving a questionnaire, 95 % could be analyzed further. Generic and disease-specific validated QoL (European Organization for Research and Treatment in Cancer QLQ-C30, CR38) and Wexner incontinence score were used. Results Global QoL was comparable between the groups. Physical functioning was significantly better after sphincter preservation surgery than APR (p〈0.05). Symptom scores for diarrhea (DIA) and constipation (CON) were higher after sphincter-preserving surgery (ISR: DIA 45.4, CON 20.2 LAR: DIA 34.1, CON 25.2) compared to APR (DIA 16.6, CON 12.0) (p〈0.05 and 〈0.01, respectively). Disease-specific QoL assessment showed significantly worse QoL regarding to male sexual function after APR (80.8) than after ISR (53.6) (p〈0.005). Regarding defecation, the ISR group showed significantly higher symptom scores than patients after LAR (p〈0.05). Wexner scores were significantly higher after ISR (12.9) than after LAR (9.5) (p〈0.005). Author Affiliation: (1) Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany (2) Institute of Medical Statistics and Biometry, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, 68167, Mannheim, Germany Article History: Registration Date: 18/03/2013 Accepted Date: 18/03/2013 Online Date: 10/04/2013 Article note: Julia Konanz and Florian Herrle are equal first author.
    Keywords: Quality of life ; Rectal cancer ; Resection
    ISSN: 0179-1958
    E-ISSN: 1432-1262
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