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  • 1
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    Online Resource
    OP-048 Pilot Study of Rehabilitation Outcomes in 205 Adults with Congenital Heart Disease (ACHD)
    Elsevier BV ; 2015
    In:  The American Journal of Cardiology Vol. 115 ( 2015-03), p. S22-
    Details
    In: The American Journal of Cardiology, Elsevier BV, Vol. 115 ( 2015-03), p. S22-
    Type of Medium: Online Resource
    ISSN: 0002-9149
    URL: Article
    DOI: 10.1016/j.amjcard.2015.01.094
    RVK:
    XA 18500
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2019595-3
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  • 2
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    Tissue inhibitor of metalloproteinase 1 and AST‐to‐Platelet Ratio Index as noninvasive biomarkers predict allograft fibrosis after pediatric liver transplantation
    Wiley ; 2019
    In:  Clinical Transplantation Vol. 33, No. 10 ( 2019-10)
    Details
    In: Clinical Transplantation, Wiley, Vol. 33, No. 10 ( 2019-10)
    Abstract: Assessing liver fibrosis in patients after liver transplantation is still largely dependent on liver biopsy. Especially in children, noninvasive methods are of utmost importance. We evaluated tissue inhibitor of metalloproteinase 1 (TIMP1) and AST‐to‐Platelet Ratio Index (APRI) and their potential as serum biomarkers to predict liver allograft fibrosis (LAF) in a pediatric cohort. Methods In this retrospective, observational study, we analyzed 91 protocol liver biopsy specimens from 73 children after pediatric liver transplantation (PLT) and compared histological stage of liver fibrosis using LAF Score (LAFSc) and Ishak Score (IshakSc) to TIMP1‐serum concentration and APRI using ROC analysis. Results In our cohort, TIMP1 and APRI reliably predict LAF. Depending on the histological scoring system, cutoff values for TIMP1 were 328 ng/mL (IshakSc ≥ IV) and 351 ng/mL (LAFSc ≥ 5) with AUC of 0.86 and 0.98. The cutoff for APRI was 0.8 with AUC of 0.87 (IshakSc ≥ IV) and 0.94 (LAFSc ≥ 5). Using LAFSc, TIMP1 and APRI showed excellent diagnostic accuracy to detect severe LAF (LAFSc ≥ 5) with PPV of ≥ 90% and NPV of 100%. Conclusion TIMP1 and APRI are accurate biomarkers to predict severe LAF in children. The use of TIMP1 and APRI will not replace but complement liver biopsies after PLT to further improve our understanding of each individual patient.
    Type of Medium: Online Resource
    ISSN: 0902-0063 , 1399-0012
    URL: Issue
    URL: Article
    DOI: 10.1111/ctr.v33.10
    DOI: 10.1111/ctr.13676
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2739458-X
    detail.hit.zdb_id: 2004801-4
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  • 3
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    Status quo and perspectives of dermatology hospitals in Germany: spectra of health care and staff situation
    Wiley ; 2021
    In:  JDDG: Journal der Deutschen Dermatologischen Gesellschaft Vol. 19, No. S5 ( 2021-10), p. 14-23
    Details
    In: JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Wiley, Vol. 19, No. S5 ( 2021-10), p. 14-23
    Abstract: Inpatient care in Germany has been subject to change since the introduction of the DRG‐based payment system. There have been no publications on important differentiating factors such as the spectrum of care and the staffing situation in dermatology. Methods Health care analysis of 115 dermatology hospitals in October 2019 using a structured survey questionnaire. Results On average, the spectrum of care included 31.0 % general dermatology, 33.6 % surgical dermatology, 15.6 % oncology, and 10.1 % allergology. The clinics had an average of 14 full‐time positions and 3 part‐time positions (university clinics: 23/5, non‐university clinics: 9/2). The mean nationwide proportion of women in the physician teams showed the following distribution: postgraduate physicians 73.3 %, senior physicians 53.0 %, directors 20.0 %. The applicant situation of senior physicians and specialists was assessed as predominantly poor, that of residents as predominantly good. Worse applicant situations were present in non‐university hospitals and in rural areas. The satisfaction of the medical directors with the current conditions of inpatient care showed a variable assessment independent of university hospital and non‐university hospital status. However, the threat to inpatient care was predominantly assessed as low (71.6 %). Conclusions The overall situation of inpatient dermatological care can be classified as predominantly good. In addition, the majority of dermatology clinics provide a wide range of care with regard to the variety of indications. The general conditions, which in some cases are rated as inadequate, require further measures.
    Type of Medium: Online Resource
    ISSN: 1610-0379 , 1610-0387
    URL: Issue
    URL: Article
    DOI: 10.1111/ddg.v19.S5
    DOI: 10.1111/ddg.14616
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2099463-1
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  • 4
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    Stationäre Versorgung von Hautkrankheiten in Deutschland: Multi‐Source‐Analyse zum aktuellen und zukünftigen Bedarf
    Wiley ; 2021
    In:  JDDG: Journal der Deutschen Dermatologischen Gesellschaft Vol. 19, No. S5 ( 2021-10), p. 25-54
    Details
    In: JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Wiley, Vol. 19, No. S5 ( 2021-10), p. 25-54
    Abstract: Hautkrankheiten werden in Deutschland stationär vorwiegend in den 115 Hautkliniken versorgt. Methoden Versorgungswissenschaftliche und gesundheitsökonomische Analyse der dermatologischen stationären Versorgung und Prädiktion des zukünftigen Versorgungsbedarfes auf der Basis von Primär‐ und Sekundärdaten. Ergebnisse Die ambulante und stationäre Versorgung der dermatologischen Behandlungsindikationen wird überwiegend durch Fachärzte für Dermatologie getragen. Stationär wurden 2018 833 491 Fälle behandelt, entsprechend 4,21 % aller stationären Fälle (19 808 687). Häufigste Behandlungsfälle waren: epithelialer Hautkrebs (gesamt 87 386, davon dermatologische Kliniken 52 608), gefolgt von Melanom (23 917/17 774), Psoriasis (19 291/13 352), Erysipel (73 337/11 260), sonstige Dermatitis (12 671/10 842), atopisches Ekzem (11 421/9734) und Herpes zoster (26 249/9652). Mit einer durchschnittlichen Verweildauer von 5,69 Tagen befanden sich die dermatologischen Kliniken im unteren Drittel. Der Anteil der in Hautkliniken versorgten stationären Indikationen war am höchsten bei Prurigo (95,2 %), Pemphigus (94,9 %), Parapsoriasis (94,6 %), Pemphigoid (90,3 %), Dermatitiden (85,6 %) und atopischem Ekzem (85,2 %). Während die Gesamtzahl der stationären Behandlungsfälle in Deutschland zwischen 2000 und 2018 um durchschnittlich 17,5 % gestiegen ist, ist dies bei Hautkrankheiten zu 26,6 % der Fall, bei einzelnen zu über 150 %. Die Projektion der heutigen auf die zukünftige stationäre Versorgung lässt einen weiterhin hohen Bedarf an stationärer Versorgung durch die Hautkliniken erwarten. Schlussfolgerung Die stationäre dermatologische Versorgung ist auch zukünftig ein unerlässlicher Bestandteil der qualifizierten, sozialrechtlich notwendigen Versorgung in Deutschland.
    Type of Medium: Online Resource
    ISSN: 1610-0379 , 1610-0387
    URL: Issue
    URL: Article
    DOI: 10.1111/ddg.v19.S5
    DOI: 10.1111/ddg.14620_g
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 5
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    Labral calcification in end‐stage osteoarthritis of the hip correlates with pain and clinical function
    Wiley ; 2018
    In:  Journal of Orthopaedic Research Vol. 36, No. 4 ( 2018-04), p. 1248-1255
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 36, No. 4 ( 2018-04), p. 1248-1255
    Abstract: The acetabular labrum of the hip (ALH) is recognized as a clinically important structure, but knowledge about the pathophysiology of this fibrocartilage is scarce. In this prospective study we determined the prevalence of ALH calcification in patients with end‐stage osteoarthritis (OA) and analyzed the relationship of cartilage calcification (CC) with hip pain and clinical function. Cohort of 80 patients (70.2 ± 7.6years) with primary OA scheduled for total hip replacement. Harris Hip Score (HHS) was recorded preoperatively. Total ALH and femoral head (FH) were sampled intraoperatively. CC of the ALH and FH was analyzed by high‐resolution digital contact radiography. Histological degeneration of the ALH (Krenn‐Score) and FH (OARSI‐Score) was determined. Multivariate linear regression model and partial correlation analyses were performed. The prevalence of cartilage calcification both in the ALH and FH was 100%, while the amount of CC in the ALH was 1.55 times higher than in the FH ( p   〈  0.001). There was a significant inverse regression between the amount of calcification of both the ALH and the FH and preoperative HHS ( β ALH  = −2.1, p  = 0.04), ( β FH  = −2.9, p  = 0.005), but pain was influenced only by ALH calcification ( β ALH  = −2.7, p  = 0.008). Age‐adjusted, there was a significant correlation between cartilage calcification and histological degeneration (ALH:r s  = 0.53, p   〈  0.001/FH: r s  = 0.30, p  = 0.007). Fibrocartilage and articular cartilage calcification are inseparable pathological findings in end‐stage osteoarthritis of the hip. Fibrocartilage calcification is associated with poor and painful hip function. Clinical significance: ALH fibrocartilage appears to be particularly prone to calcification, which may explain higher pain levels in individuals with a high degree of ALH calcification independent of age and histological degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1248–1255, 2018.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jorr.v36.4
    DOI: 10.1002/jor.23736
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 2050452-4
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  • 6
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    The natural history of Canavan disease: 23 new cases and comparison with patients from literature
    Springer Science and Business Media LLC ; 2021
    In:  Orphanet Journal of Rare Diseases Vol. 16, No. 1 ( 2021-12)
    Details
    In: Orphanet Journal of Rare Diseases, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2021-12)
    Abstract: Canavan disease (CD, MIM # 271900) is a rare and devastating leukodystrophy of early childhood. To identify clinical features that could serve as endpoints for treatment trials, the clinical course of CD was studied retrospectively and prospectively in 23 CD patients. Results were compared with data of CD patients reported in three prior large series. Kaplan Meier survival analysis including log rank test was performed for pooled data of 82 CD patients (study cohort and literature patients). Results Onset of symptoms was between 0 and 6 months. Psychomotor development of patients was limited to abilities that are usually gained within the first year of life. Macrocephaly became apparent between 4 and 18 months of age. Seizure frequency was highest towards the end of the first decade. Ethnic background was more diverse than in studies previously reported. A CD severity score with assessment of 11 symptoms and abilities was developed. Conclusions Early hallmarks of CD are severe psychomotor disability and macrocephaly that develop within the first 18 months of life. While rare in the first year of life, seizures increase in frequency over time in most patients. CD occurs more frequently outside Ashkenazi Jewish communities than previously reported. Concordance of phenotypes between siblings but not patients with identical ASPA mutations suggest the influence of yet unknown modifiers. A CD severity score may allow for assessment of CD disease severity both retrospectively and prospectively.
    Type of Medium: Online Resource
    ISSN: 1750-1172
    URL: Article
    DOI: 10.1186/s13023-020-01659-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2225857-7
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  • 7
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    Strukturen und Leistungsmerkmale der Hautkliniken in Deutschland: Aktuelle Bestandsaufnahme und Langzeitverlauf
    Wiley ; 2021
    In:  JDDG: Journal der Deutschen Dermatologischen Gesellschaft Vol. 19, No. S5 ( 2021-10), p. 5-13
    Details
    In: JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Wiley, Vol. 19, No. S5 ( 2021-10), p. 5-13
    Abstract: Zielsetzung der Studie war die Charakterisierung der Leistungsdaten der deutschen Hautkliniken. Methoden Im Zuge einer versorgungswissenschaftlichen Querschnittsanalyse wurde im Oktober 2019 ein strukturierter Erhebungsbogen an alle Hautkliniken ausgesendet. Ergebnisse Von den 115 Kliniken antworteten 95 (82,6 %), davon 34 (35,8 %) Universitätskliniken (UK) und 61 (64,2 %) nicht universitäre Kliniken (NUK), davon 78 % aus dem städtischen (43 % UK, 57 % NUK) und 22 % aus dem ländlichen Raum (10 % UK, 90 % NUK). Die dermatologischen Abteilungen umfassten durchschnittlich 45 stationäre und 11 teilstationäre Betten (UK: 52/13, NUK: 40/9). Versorgt wurden 2018 durchschnittlich 2302 stationäre Patienten (UK: 2874, NUK: 1983), der Case‐Mix‐Index lag bei 0,76 (UK: 0,74, NUK: 0,77, gesamter Bereich: 0,40–0,96). Die mittlere Liegedauer lag bei den UK mit 5,5 Tagen relevant unter den Daten von 2013 (5,9 Tage) und 2011 (7,1 Tage), bei den NUK mit 5,9 (2018) versus 5,1 Tagen (2013) ebenfalls signifikant niedriger. Schlussfolgerungen Die deutschen Hautkliniken weisen nach wie vor ein hohes Aufkommen an stationärer Versorgungsleistung auf, bei dem sich im Vergleich der letzten sechs Jahre nochmals eine Verdichtung mit kürzerer Liegedauer und höherer Belegungsdichte zeigte. Hautkliniken stellen eine essenzielle Säule der dermatologischen Versorgung dar.
    Type of Medium: Online Resource
    ISSN: 1610-0379 , 1610-0387
    URL: Issue
    URL: Article
    DOI: 10.1111/ddg.v19.S5
    DOI: 10.1111/ddg.14618_g
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2099463-1
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  • 8
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    Inpatient care for skin diseases in Germany: multi‐source analysis on the current and future health care needs
    Wiley ; 2021
    In:  JDDG: Journal der Deutschen Dermatologischen Gesellschaft Vol. 19, No. S5 ( 2021-10), p. 25-53
    Details
    In: JDDG: Journal der Deutschen Dermatologischen Gesellschaft, Wiley, Vol. 19, No. S5 ( 2021-10), p. 25-53
    Abstract: In Germany, skin diseases are mainly treated in the 115 dermatological hospitals. Methods Health care and health economic analysis of dermatological inpatient care and prediction of future care needs based on primary and secondary data. Results Outpatient and inpatient care for dermatologic treatment indications is predominantly provided by dermatology specialists. Inpatient treatment was provided for 833,491 cases in 2018, corresponding to 4.21 % of all inpatient cases (19,808,687). Most common treatment cases were: epithelial skin cancer (total 87,386, of which dermatology clinics 52,608), followed by melanoma (23,917/17,774), psoriasis (19,291/13,352), erysipelas (73,337/11,260), other dermatitis (12,671/10,842), atopic dermatitis (AD) (11,421/9,734), and herpes zoster (26,249/9,652). With an average length of stay of 5.69 days, dermatology hospitals were in the bottom third. The proportion of inpatient indications cared for in dermatology hospitals was highest for prurigo (95.2 %), pemphigus (94.9 %), parapsoriasis (94.6 %), pemphigoid (90.3 %), eczema other than AD (85.6 %), and AD (85.2 %). While the total number of inpatient treatment cases in Germany has increased by an average of 17.5 % between 2000 and 2018, this is the case for 26.6 % of skin diseases and over 150 % for individual ones. The projection of current to future inpatient care suggests a continued high demand for inpatient care by dermatology hospitals. Conclusion Inpatient dermatological care will continue to be an indispensable component of qualified, socially necessary care in Germany.
    Type of Medium: Online Resource
    ISSN: 1610-0379 , 1610-0387
    URL: Issue
    URL: Article
    DOI: 10.1111/ddg.v19.S5
    DOI: 10.1111/ddg.14620
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 9
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    Rationale and methods of the IDOMENEO health outcomes of the peripheral arterial disease revascularisation study in the GermanVasc registry
    Hogrefe Publishing Group ; 2018
    In:  Vasa Vol. 47, No. 6 ( 2018-10-01), p. 499-505
    Details
    In: Vasa, Hogrefe Publishing Group, Vol. 47, No. 6 ( 2018-10-01), p. 499-505
    Abstract: Abstract. Background: Atherosclerotic disease of the lower extremity arteries (PAD) remains a significant burden on global healthcare systems with increasing prevalence. Various guidelines on the diagnosis and treatment of patients with PAD are available but they often lack a sufficient evidence base for high-grade recommendations since randomized and controlled trials (RCT) remain rare or are frequently subject to conflicts of interest. This registry trial aims to evaluate the outcomes of catheter-based endovascular revascularisations vs. open-surgical endarterectomy vs. bypass surgery for symptomatic PAD on medical and patient-reported outcomes. Methods and design: The study is a prospective non-randomized multicentre registry trial including invasive revascularisations performed in 10 000 patients treated for symptomatic PAD at 30 to 40 German vascular centres. All patients matching the inclusion criteria are consecutively included for a recruitment period of six months (between May and December 2018) or until 10 000 patients have been included in the study registry. There are three follow-up measures at three, six, and 12 months. Automated completeness and plausibility checks as well as independent site visit monitoring will be performed to assure high internal and external validity of the study data. Study endpoints include relevant major cardiovascular and limb events and patient-reported outcomes from two Delphi studies with experts in vascular medicine and registry-based research. Discussion: It remains unclear if results from RCT can reflect daily treatment practice. Furthermore, great costs and complexity make it challenging to accomplish high quality randomized trials in PAD treatment. Prospective registry-based studies to collect real-world evidence can help to overcome these limitations.
    Type of Medium: Online Resource
    ISSN: 0301-1526 , 1664-2872
    URL: Article
    DOI: 10.1024/0301-1526/a000730
    Language: English
    Publisher: Hogrefe Publishing Group
    Publication Date: 2018
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  • 10
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    Long-term incidence of cancer after index treatment for symptomatic peripheral arterial disease – a health insurance claims data analysis
    Hogrefe Publishing Group ; 2020
    In:  Vasa Vol. 49, No. 6 ( 2020-10), p. 493-499
    Details
    In: Vasa, Hogrefe Publishing Group, Vol. 49, No. 6 ( 2020-10), p. 493-499
    Abstract: Summary: Background: Cancer as a concomitant condition in symptomatic peripheral arterial disease (PAD) patients could have an impact on further therapy and the long-term prognosis of these patients. Aim of this study was to investigate whether there is an increased incidence of cancer in PAD patients and to quantify the corresponding effect size. Materials and methods: Between January 1 st , 2008 and December 31 st , 2017, we analysed health insurance claims data from Germany’s second-largest insurance fund, BARMER. Symptomatic PAD patients suffering from intermittent claudication (IC) or chronic limb-threatening ischaemia (CLTI) were stratified by gender at index treatment. PAD patients were then followed until an incident cancer diagnosis was recorded. To adjust for age and gender, standardized incidence ratios (SIR) were computed using the 2012 German standard population as reference. Results: 96,528 PAD patients (47% female, 44% IC, mean age 72 years) were included in the current study. When compared to the overall population, female and male PAD patients have a significantly increased risk of incident cancer of the lung (SIR 3.5 vs. 2.6), bladder (SIR 3.2 vs. 4.0), pancreas (SIR 1.4 vs. 1.6), and colon (SIR 1.3 vs. 1.3). During ten years of follow-up, some 7% of males and 4% of females developed lung cancer. For bladder, colon and pancreas cancer, the cumulative hazards were 1% vs. 3.2%, 2.2% vs. 2.8%, and 0.7% vs. 0.9%, respectively. Conclusions: Patients suffering from symptomatic PAD face a markedly higher risk for incident cancer in the long-term follow-up. The cancer risk increased continuously for certain types and PAD was strongly associated with cancer of the lung, bladder, pancreas, and colon. Taking these results into account, PAD patients could benefit from secondary and tertiary screening. These results also emphasize the impact of common risk factors such as tobacco smoke as target for health prevention.
    Type of Medium: Online Resource
    ISSN: 0301-1526 , 1664-2872
    URL: Article
    DOI: 10.1024/0301-1526/a000901
    Language: English
    Publisher: Hogrefe Publishing Group
    Publication Date: 2020
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