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  • SpringerLink  (32)
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  • 1
    Language: German
    In: Zeitschrift für die gesamte Versicherungswissenschaft, 2002, Vol.91(2), pp.223-235
    ISSN: 0044-2585
    E-ISSN: 1865-9748
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  • 2
    Language: English
    In: Journal of Community Health, 2011, Vol.36(4), pp.669-674
    Description: To describe the participatory approach used to develop “Good For The Neighborhood” (GFTN), a community program to improve the health of four underserved communities. A core program was developed involving a “park and stay” approach to impact four underserved predominately minority communities (two predominately African American, 1 predominately Latino, and the Seneca Nation of Indians). The core program includes health screenings, risk assessments, health education, and exposure to health services. An extensive tracking and evaluation system was developed to determine participation and impact on the community. Multi-methods (key informant interviews, focus groups, surveys) were implemented to gain feedback from community partners and participants as to how to adopt the program to meet the needs of the community. GFTN has been sustained for over 3 years and has reached over 3,500 predominately minority individuals in four communities with 1/3 of participants engaging regularly in the program. The program has evolved in the four communities to meet specific needs. A “park and stay” approach in partnership with the community has led to a strong program that community partners and residents embrace. Community ownership and social networking, including word-of-mouth from residents is essential to establishing a successful program.
    Keywords: Community health ; Health disparities ; Evaluation ; Community based participatory research ; Minorities
    ISSN: 0094-5145
    E-ISSN: 1573-3610
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  • 3
    Language: English
    In: The Patient - Patient-Centered Outcomes Research, 2017, Vol.10(4), pp.381-387
    Description: Changes in economic conditions and healthcare delivery models have shifted more healthcare costs to patients, resulting in greater patient financial responsibilities. As a result, it is important to understand the potential impact of financial literacy on patients’ healthcare behavior. With the focus on delivering better health outcomes at lower costs, factors that influence patient behavior are important considerations for healthcare providers. Although researchers have proposed a variety of conceptual models that identify influential factors, those models do not fully address financial literacy and its potential impact patients’ healthcare decisions. This article examines existing models of patient healthcare decision-making and current research on factors affecting patient decision-making and behavior and then presents recommendations for closing the identified gap in our current knowledge.
    Keywords: Decision Making ; Financing, Personal ; Health Services -- Statistics & Numerical Data;
    ISSN: 1178-1653
    E-ISSN: 1178-1661
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  • 4
    Language: German
    In: BIOspektrum, 2011, Vol.17(5), pp.537-540
    Description: In vielen Säugetierarten gab es bis jetzt keine effektiven Werkzeuge für eine gezielte Genmodifikation. Die Entwicklung der Zinkfingernuklease-Technologie ermöglicht nun auch in diesen Organismen eine schnelle und einfache Genommanipulation. Most mammalian species lack useful tools for targeted gene modification. With the discovery of the zinc-finger nuclease technology it is now possible to achieve rapid and easy genome manipulations in mammals.
    Keywords: Life Sciences ; Biochemistry, General ; Life Sciences, General ; Human Genetics ; Developmental Biology ; Pharmacology/Toxicology ; Microbiology ; Sciences (General);
    ISSN: 0947-0867
    E-ISSN: 1868-6249
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  • 5
    Language: English
    In: Journal of Thrombosis and Thrombolysis, 2016, Vol.42(2), pp.161-166
    Description: Dabigatran and rivaroxaban are novel, vitamin K-independent oral anticoagulants (NOACs) and act via antagonism of the coagulation factor (F) IIa (dabigatran) or FXa (rivaroxaban), respectively. Compared to vitamin-K-antagonists, NOACs have shown non-inferiority of risk and benefit in patients with non valvular atrial fibrillation (AF). In clinical practice there is increasing use of NOACs combined with platelet inhibitors in patients with AF and coronary artery disease. However, whether NOACs affect the function of platelet inhibitors remains incompletely known. This observational study aimed to assess the platelet function in patients receiving dabigatran or rivaroxaban and concomitant platelet inhibitors. A single centre observational study was performed analysing the platelet aggregation of patients treated with dabigatran or rivaroxaban with or without concomitant platelet inhibitors. Measurements before the initiation of NOAC therapy served as the respective control group. Platelet aggregation was measured by multiple electrode aggregometry and was induced with adenosine diphosphate (ADP, 6.5 µM) and arachidonic acid (AA, 0.5 mM), respectively. In order to evaluate whether NOACs interact with platelet inhibition by ASA or the P2Y 12 -antagonist clopidogrel, 87 patients were grouped according to their concomitant antiplatelet medication. Comparing the ADP- and AA-induced platelet aggregation in patients without concomitant platelet inhibitors (n = 45) no significant differences under therapy with dabigatran (d) or rivaroxaban (r) compared to the control group (c) were observed. In patients taking clopidogrel as a concomitant platelet inhibitor (n = 21), neither dabigatran nor rivaroxaban affected the ADP-induced platelet aggregation (c 20 ± 11, d 21 ± 14, r 18 ± 8 AU*min, p = 0.200). Patients receiving dabigatran or rivaroxaban in combination with ASA (n = 42; 21 ASA only, 21 ASA + clopidogrel) showed no significant differences of the AA-induced aggregation compared to the control group (c 10 ± 8, d 9 ± 7, r 10 ± 8 AU*min, p = 0.810). The antiplatelet effects of ASA and clopidogrel monitored by AA- or ADP-induced platelet aggregation were not affected by NOAC therapy.
    Keywords: Dabigatran ; Rivaroxaban ; ASA ; Clopidogrel
    ISSN: 0929-5305
    E-ISSN: 1573-742X
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  • 6
    Language: English
    In: Journal of Thrombosis and Thrombolysis, 2016, Vol.42(4), pp.558-565
    Description: High platelet reactivity (HPR) after P2Y 12 -inhibition in patients undergoing coronary stenting is associated with an increased risk for thromboembolic events and coronary death. So far it is not known how HPR affects the clinical outcome of different treatment strategies in patients with atrial fibrillation (AF) undergoing coronary stenting. In this single centre, observational study the antiplatelet effect of P2Y 12 -inhibitors in AF patients undergoing coronary stenting was investigated using impedance aggregometry. Patients received either dual antiplatelet therapy (DAPT) or triple therapy (TT). HPR was defined as the ratio of ADP-to TRAP-induced aggregation (r-ADP-agg) ≥50 %. Thromboembolic and bleeding events were assessed within the first 30 days after stenting. Out of 910 screened patients 167 patients were available for the present analysis. HPR was found in 5 of 43 (12 %) patients treated with DAPT and in 18 of 124 (15 %) patients treated with TT. In patients receiving TT, HPR was not a risk factor for thromboembolic events compared to patients with adequate response to P2Y 12 -inhibitors (6 vs. 8 %, p = 0.712). There was a trend for less bleeding events in patients with HPR compared to r-ADP-agg 〈50 % in the TT group (0 vs. 16 %, p = 0.077). Our data suggest that HPR after P2Y 12 -antagonism in patients receiving TT due to AF and coronary stenting might protect from bleeding without increasing thromboembolic risk. Future studies will need to investigate if patients with AF receiving coronary stenting benefit from a reduction of antithrombotic therapy.
    Keywords: Atrial fibrillation ; Percutaneous coronary intervention ; Antithrombotic therapy ; High platelet reactivity ; r-ADP-agg
    ISSN: 0929-5305
    E-ISSN: 1573-742X
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  • 7
    Language: English
    In: Infection, 2019, Vol.47(2), pp.195-200
    Description: Byline: Cihan Papan (1,2), Melanie Meyer-Buehn (1), Gudrun Laniado (1), Johannes Huebner (1) Keywords: Children; Neonates; Skin and soft tissue infections; Bite and burn wounds; Health-care associated infections; Multiplex PCR. Abstract: Background Skin and soft tissue infections have a high disease burden in children. The emergence of multidrug-resistant bacteria over the last decades has heavily influenced hospitalization rates, morbidity and mortality. In addition, with increased survival rates in neonatology and oncology, health-care associated infections are more frequently encountered. There is a growing need for fast and feasible diagnostic tools for the recognition of microorganisms and drug resistances. Methods In this prospective study, we compared results of routine culture with the multiplex PCR based Unyvero Implant and Tissue Infection (ITI) application. Specimens were obtained from different sources from neonates and children. Results We analyzed specimens from 29 patients (72.4% male) with a median age of 8.1 years (range 0.03--15.2). Concordance between Unyvero ITI and culture was reached in 16 of 29 samples (55.2%). Unyvero ITI yielded an overall sensitivity and specificity of 76.3% and 96.5%, respectively. Accuracies were best for non-fermenting bacteria, for which sensitivity was 100% and specificity 98.2%. Detection rates were lower for Gram-positive bacteria (68.8 and 95.2%, respectively). Unyvero correctly detected one bla .sub.OXA-24/40 producing Acinetobacter baumannii, while none of the six gyrA87 had a correlate in antimicrobial susceptibility testing. Conclusions Unyvero ITI quickly provides additional information relevant for clinical decision-makers. Sensitivity of the PCR must be improved especially for Gram-positive bacteria, and further studies are needed to assess the impact on clinical decision-making and outcome. Author Affiliation: (1) 0000 0004 1936 973X, grid.5252.0, University Children's Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilians University, Munich, Germany (2) 0000 0001 2190 4373, grid.7700.0, Pediatric Infectious Diseases, University Children's Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany Article History: Registration Date: 11/08/2018 Received Date: 26/06/2018 Accepted Date: 11/08/2018 Online Date: 21/08/2018 Article note: Electronic supplementary material The online version of this article ( https://doi.org/10.1007/s15010-018-1192-7) contains supplementary material, which is available to authorized users.
    Keywords: Children ; Neonates ; Skin and soft tissue infections ; Bite and burn wounds ; Health-care associated infections ; Multiplex PCR.
    ISSN: 0300-8126
    E-ISSN: 1439-0973
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  • 8
    Language: English
    In: Infection, 2018, Vol.46(2), pp.189-196
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s15010-017-1088-y Byline: Cihan Papan (1,2), Melanie Meyer-Buehn (1), Gudrun Laniado (1), Thomas Nicolai (1), Matthias Griese (1), Johannes Huebner (1) Keywords: Children; Neonates; Bacterial pneumonia; Bronchoalveolar lavage; Multiplex PCR Abstract: Background Pneumonia is a major healthcare problem. Rapid pathogen identification is critical, but often delayed due to the duration of culturing. Early, broad antibacterial therapy might lead to false-negative culture findings and eventually to the development of antibiotic resistances. We aimed to assess the accuracy of the new application Unyvero P50 based on multiplex PCR to detect bacterial pathogens in respiratory specimens from children and neonates. Methods In this prospective study, bronchoalveolar lavage fluids, tracheal aspirates, or pleural fluids from neonates and children were analyzed by both traditional culture methods and Unyvero multiplex PCR. Results We analyzed specimens from 79 patients with a median age of 1.8 (range 0.01--20.1). Overall, Unyvero yielded a sensitivity of 73.1% and a specificity of 97.9% compared to culture methods. Best results were observed for non-fermenting bacteria, for which sensitivity of Unyvero was 90% and specificity 97.3%, while rates were lower for Gram-positive bacteria (46.2 and 93.9%, respectively). For resistance genes, we observed a concordance with antibiogram of 75% for those specimens in which there was a cultural correlate. Conclusions Unyvero is a fast and easy-to-use tool that might provide additional information for clinical decision making, especially in neonates and in the setting of nosocomial pneumonia. Sensitivity of the PCR for Gram-positive bacteria and important resistance genes must be improved before this application can be widely recommended. Author Affiliation: (1) 0000 0004 1936 973X, grid.5252.0, University Children's Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilians University, Lindwurmstr. 4, 80337, Munich, Germany (2) 0000 0001 2190 4373, grid.7700.0, Pediatric Infectious Diseases, Medical Faculty Mannheim, University Children's Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany Article History: Registration Date: 22/10/2017 Received Date: 04/08/2017 Accepted Date: 21/10/2017 Online Date: 31/10/2017 Article note: Electronic supplementary material The online version of this article (https://doi.org/10.1007/s15010-017-1088-y) contains supplementary material, which is available to authorized users.
    Keywords: Children ; Neonates ; Bacterial pneumonia ; Bronchoalveolar lavage ; Multiplex PCR
    ISSN: 0300-8126
    E-ISSN: 1439-0973
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  • 9
    Language: English
    In: Infection, 2019, Vol.47(1), pp.51-58
    Description: Byline: Anna Eichinger (1), Alexandra Hagen (1), Melanie Meyer-Buhn (1), Johannes Huebner (1) Keywords: Antimicrobial stewardship; Point-of-care test; FilmArray; Meningitis; Encephalitis Abstract: Background Sepsis-like illness with suspected meningitis or encephalitis is a common reason for using empiric antimicrobial therapy in infants and children. However, in cases of viral meningitis not covered by these antimicrobials, this management is ineffective and due to side effects potentially harmful. Methods A retrospective analysis of cerebrospinal fluid (CSF) multiplex PCRs (Biofire FilmArray.sup.[R]) in children with clinical suspicion of meningitis, encephalitis or sepsis-like illness was performed over the period of 1 year. Subsequently, a subgroup of children (age of 8--84 days of life) diagnosed with viral meningitis (enterovirus, HHV-6, human parechovirus) was compared to an age-matched control group. Results During the study period, the multiplex PCR panel was performed on 187 individual CSF samples that met the inclusion criteria. About half of the patients (92/187) were less than 1 year of age. In 27 cases (14.4%), the PCR yielded a positive result with the majority (12/27) being indicative of an enteroviral infection. In the age group of 8--84 days of life, 36.4% of the patients had a positive result. When the patients with a PCR positive for a viral agent were compared to an age-matched group of patients, no differences were observed regarding symptoms and laboratory parameters. However, the duration of antimicrobial therapy could be significantly reduced through the use of multiplex PCR. Conclusion The use of on-site diagnostic multiplex PCR was able to reduce the use of antimicrobials in selected cases. This test can guide clinical decisions earlier during the course of medical care compared to standard diagnostics. Author Affiliation: (1) 0000 0004 1936 973X, grid.5252.0, Division of Pediatric Infectious Disease, Dr. v. Hauner Children's Hospital, LMU Munich, University of Munich (LMU), Lindwurmstra[sz]e 4, 80337, Munich, Germany Article History: Registration Date: 30/08/2018 Received Date: 07/06/2018 Accepted Date: 30/08/2018 Online Date: 05/09/2018 Article note: Electronic supplementary material The online version of this article ( https://doi.org/10.1007/s15010-018-1212-7) contains supplementary material, which is available to authorized users.
    Keywords: Antimicrobial stewardship ; Point-of-care test ; FilmArray ; Meningitis ; Encephalitis
    ISSN: 0300-8126
    E-ISSN: 1439-0973
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  • 10
    Language: German
    In: Zeitschrift für die gesamte Versicherungswissenschaft, 1996, Vol.85(2), pp.567-581
    ISSN: 0044-2585
    E-ISSN: 1865-9748
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