22 results on '"Kuhr, Kathrin"'
Search Results
2. Scleroderma Renal Crisis: Risk Factors for an Increasingly Rare Organ Complication.
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Moinzadeh, Pia, Kuhr, Kathrin, Siegert, Elise, Blank, Norbert, Sunderkoetter, Cord, Henes, Jörg, Krusche, Martin, Schmalzing, Marc, Worm, Margitta, Schmeiser, Tim, Günther, Claudia, Aberer, Elisabeth, Susok, Laura, Riemekasten, Gabriela, Kreuter, Alexander, Zeidler, Gabriele, Juche, Aaron, Hadjiski, Denitsa, Müller-Ladner, Ulf, and Gaebelein-Wissing, Noemi
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- 2020
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3. Scleroderma Renal Crisis: Risk Factors for an Increasingly Rare Organ Complication
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Moinzadeh, Pia, Kuhr, Kathrin, Siegert, Elise, Blank, Norbert, Sunderkoetter, Cord, Henes, Jörg, Krusche, Martin, Schmalzing, Marc, Worm, Margitta, Schmeiser, Tim, Günther, Claudia, Aberer, Elisabeth, Susok, Laura, Riemekasten, Gabriela, Kreuter, Alexander, Zeidler, Gabriele, Juche, Aaron, Hadjiski, Denitsa, Müller-Ladner, Ulf, Gaebelein-Wissing, Noemi, Distler, Jörg H.W., Sárdy, Miklós, Krieg, Thomas, and Hunzelmann, Nicolas
- Abstract
Objective.Scleroderma renal crisis (SRC) is a severe life-threatening manifestation in patients with systemic sclerosis (SSc). However, the knowledge about risk factors for SRC is limited. We determined here the frequency of SRC and identified risk factors for the prediction of SRC.Methods.Based on regular followup data from the German Network for Systemic Scleroderma, we used univariate and multivariate generalized estimating equations to analyze the association between clinical variables, SSc subsets, therapy [i.e., angiotensin-converting enzyme inhibitors (ACEi), corticosteroids], and the occurrence of SRC.Results.Data of 2873 patients with 10,425 visits were available for analysis with a mean number of registry visits of 3.6 ± 2.8 and a mean time of followup of 3.6 ± 3.8 years. In total, 70 patients developed SRC (70/2873, 2.4%). Of these patients, 57.1% (40/70) were diagnosed with diffuse cutaneous SSc, 31.4% (22/70) with limited cutaneous SSc, and 11.4% (8/70) with SSc-overlap syndromes. Predictive independent factors with the highest probability for SRC were positive anti-RNA polymerase antibodies (RNAP), a history of proteinuria prior to SRC onset, diminished DLCO, and a history of hypertension. Interestingly, positive antitopoisomerase autoantibodies did not predict a higher risk for SRC. Further, patients with SRC were significantly more frequently treated with ACEi and corticosteroids without being independently associated with SRC.Conclusion.In this cohort, SRC has become a rare complication. By far the highest risk for SRC was associated with the detection of anti-RNAP and proteinuria.
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- 2020
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4. Internal Versus External Electrical Cardioversion of Atrial Arrhythmia in Patients With Implantable Cardioverter-Defibrillator
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Lüker, Jakob, Kuhr, Kathrin, Sultan, Arian, Nölker, Georg, Omran, Hazem, Willems, Stephan, Andrié, René, Schrickel, Jan W., Winter, Stefan, Vollmann, Dirk, Tilz, Roland R., Jobs, Alexander, Heeger, Christian-H., Metzner, Andreas, Meyer, Sven, Mischke, Karl, Napp, Andreas, Fahrig, Andreas, Steinhauser, Susanne, Brachmann, Johannes, Baldus, Stephan, Mahajan, Rajiv, Sanders, Prashanthan, and Steven, Daniel
- Abstract
Supplemental Digital Content is available in the text.
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- 2019
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5. Non–Guideline-concordant Treatment of Testicular Cancer Is Associated With Reduced Relapse-free Survival
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Paffenholz, Pia, Heidegger, Isabel Maria, Kuhr, Kathrin, Loosen, Sven Heiko, Pfister, David, and Heidenreich, Axel
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The treatment of testicular cancer (TC) requires a multimodal approach. We retrospectively evaluated the diagnostic work-up, treatment, and outcomes of 131 patients with respect to the European Association of Urology guidelines. Of 131 patients, 18% had received non–guideline-concordant treatment, with undertreatment having a negative effect on relapse-free survival. Thus, implementation of guidelines is needed to decrease the mortality of TC.
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- 2018
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6. Is ‘gut feeling’ by medical staff better than validated scores in estimation of mortality in a medical intensive care unit? – The prospective FEELING-ON-ICU study
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Radtke, Anne, Pfister, Roman, Kuhr, Kathrin, Kochanek, Matthias, and Michels, Guido
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The aim of the FEELING-ON-ICU study was to compare mortality estimations of critically ill patients based on ‘gut feeling’ of medical staff and by Acute Physiology And Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA).
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- 2017
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7. Comparison of DXA Scans and Conventional X-rays for Spine Morphometry and Bone Age Determination in Children.
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Hoyer-Kuhn, Heike, Knoop, Kai, Semler, Oliver, Kuhr, Kathrin, Hellmich, Martin, Schoenau, Eckhard, and Koerber, Friederike
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Conventional lateral spine and hand radiographs are the standard tools to evaluate vertebral morphometry and bone age in children. Beside bone mineral density analyses, dual-energy X-ray absorptiometry (DXA) measurements with lower radiation exposure provide high-resolution scans which are not approved for diagnostic purposes. Data about the comparability of conventional radiographs and DXA in children are missing yet. The purpose of the trial was to evaluate whether conventional hand and spine radiographs can be replaced by DXA scans to diminish radiation exposure. Thirty-eight children with osteogenesis imperfecta or secondary osteoporosis or short stature (male, n = 20; age, 5.0–17.0 yr) were included and assessed once by additional DXA (GE iDXA) of the spine or the left hand. Intraclass correlation coefficients (ICCs) were used to express agreement between X-ray and iDXA assessment. Evaluation of the spine morphometry showed reasonable agreement between iDXA and radiography (ICC for fish-shape, 0.75; for wedge-shape, 0.65; and for compression fractures, 0.70). Bone age determination showed excellent agreement between iDXA and radiography (ICC, 0.97). IDXA-scans of the spine in a pediatric population should be used not only to assess bone mineral density but also to evaluate anatomic structures and vertebral morphometry. Therefore, iDXA can replace some radiographs in children with skeletal diseases. [ABSTRACT FROM AUTHOR]
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- 2016
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8. Randomized Control of Sympathetic Drive With Continuous Intravenous Esmolol in Patients With Acute ST-Segment Elevation Myocardial Infarction: The BEtA-Blocker Therapy in Acute Myocardial Infarction (BEAT-AMI) Trial.
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Er, Fikret, Dahlem, Kristina M., Nia, Amir M., Erdmann, Erland, Waltenberger, Johannes, Hellmich, Martin, Kuhr, Kathrin, Le, Minh Tam, Herrfurth, Tina, Taghiyev, Zulfugar, Biesenbach, Esther, Yüksel, Dilek, Eran-Ergöknil, Aslihan, Vanezi, Maria, Caglayan, Evren, and Gassanov, Natig
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Objectives This study sought to evaluate the role of esmolol-induced tight sympathetic control in patients with ST-segment elevation myocardial infarction (STEMI). Background Elevated sympathetic drive has a detrimental effect on patients with acute STEMI. The effect of beta-blocker-induced heart rate mediated sympathetic control on myocardial damage is unknown. Methods The authors conducted a prospective, randomized, single-blind trial involving patients with STEMI and successful percutaneous intervention (Killip class I and II). Patients were randomly allocated to heart rate control with intravenous esmolol for 24 h or placebo. The primary outcome was the maximum change in troponin T release as a prognostic surrogate marker for myocardial damage. A total of 101 patients were enrolled in the study. Results There was a significant difference between patients allocated to placebo and those who received sympathetic control with esmolol in terms of maximum change in troponin T release: the median serum troponin T concentration increased from 0.2 ng/ml (interquartile range [IQR] 0.1 to 0.7 ng/ml) to 1.3 ng/ml (IQR: 0.6 to 4.7 ng/ml) in the esmolol group and from 0.3 ng/ml (IQR: 0.1 to 1.2 ng/ml) to 3.2 ng/ml (IQR: 1.5 to 5.3 ng/ml) in the placebo group (p = 0.010). The levels of peak creatine kinase (CK), CK subunit MB (CK-MB), and n-terminal brain natriuretic peptide (NT-proBNP) were lower in the esmolol group compared with placebo (CK 619 U/l [IQR: 250–1,701 U/l] vs. 1,308 U/l [IQR: 610 to 2,324 U/l]; p = 0.013; CKMB: 73.5 U/l [IQR: 30 to 192 U/l] vs. 158.5 U/l [IQR: 74 to 281 U/l]; p = 0.005; NT-proBNP: 1,048 pg/ml (IQR: 623 to 2,062 pg/ml] vs. 1,497 pg/ml [IQR: 739 to 3,318 pg/ml]; p = 0.059). Cardiogenic shock occurred in three patients in the placebo group and in none in the esmolol group. Conclusions Esmolol treatment statistically significantly decreased troponin T, CK, CK-MB and NT-proBNP release as surrogate markers for myocardial injury in patients with STEMI. (Heart Rate Control After Acute Myocardial Infarction; DRKS00000766 ) [ABSTRACT FROM AUTHOR]
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- 2016
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9. Focus on the surgical approach to transcatheter aortic valve implantation: Complications, outcome, and preoperative risk adjustment.
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Scherner, Maximilian, Madershahian, Navid, Ney, Svenja, Kuhr, Kathrin, Rosenkranz, Stephan, Rudolph, Tanja K., Kuhn, Elmar, Slottosch, Ingo, Deppe, Antje, Choi, Yeong-Hoon, Baldus, Stephan, and Wahlers, Thorsten
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Objective Perioperative complications in patients undergoing transcatheter aortic valve implantation remain a major issue affecting outcome. Because preoperative risk adjustment remains challenging and a valid scoring system is missing, we sought to determine the incidence of peri- and postprocedural complications of transapical (TA) or transaortic (TAO) access to define the influence of specific complications on early safety, 30-day mortality, and 1-year survival. Furthermore, we aimed to develop a risk-stratification model to allow an estimation of the perioperative risk and the 1-year survival rate, based on the individual preoperative condition of each patient. Methods We performed an outcome analysis of 230 consecutive patients who underwent aortic valve implantation via transapical or transaortic access between 2008 and 2012, with regard to Valve Academic Research Consortium II criteria, including univariate and multivariable regression analysis, to develop a risk-stratification model. Results Thirty-day mortality was 12.7%. Estimated 1-year survival was 0.69 (95% confidence interval [CI], 0.631-0.757), and 3-year survival was 0.554 (95% CI, 0.474-0.634). Univariate logistic regression analysis revealed a significant influence on 30-day mortality in case of life-threatening bleeding (16.1-fold), abdominal complications (8.5-fold), and acute kidney injury (3.2-fold). Pacemaker implantation (odds ratio, 1.55; 95% CI, 0.42-5.81; P = .512) was not a significant predictor. Concerning use of intraprocedural hemodynamic bridging therapy via cardiopulmonary bypass (CPB), Cox regression analysis revealed no significant survival difference after 1 year. A preoperative risk-stratification model for 1-year survival revealed that a logistic European System for Cardiac Operative Risk Evaluation score >20%, preoperative existing coronary artery disease, and prior myocardial infarction appeared to be significant predictors for diminished survival. Conclusions Concerning intraprocedural complications, CPB support for hemodynamic stabilization is a safe treatment option. Therefore, the heart team approach with CPB standby represents a life-saving option. Attention should also be drawn to specialized and individual postoperative care, because nonprocedure-specific complications clearly affect postoperative short- and long-term outcome. In addition, the risk-stratification model might facilitate preoperative decision making. [ABSTRACT FROM AUTHOR]
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- 2015
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10. Outcome-Relevant Effects of Shared Decision Making.
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Hauser, Katarina, Koerfer, Armin, Kuhr, Kathrin, Albus, Christian, Herzig, Stefan, and Matthes, Jan
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Background: Shared decision making (SDM) is considered a gold standard for the cooperation of doctor and patient. SDM improves patients' overall satisfaction and their confidence in decisions that have been taken. The extent to which it might also positively affect patient-relevant, disease-related endpoints is a matter of debate. Methods: We systematically searched the PubMed database and the Cochrane Library for publications on controlled intervention studies of SDM. The quality of the intervention and the risk of bias in each publication were assessed on the basis of pre-defined inclusion and exclusion criteria. The effects of SDM on patient-relevant, disease-related endpoints were compared, and effect sizes were calculated. Results: We identified 22 trials that differed widely regarding the patient populations studied, the types of intervention performed, and the mode of implementation of SDM. In ten articles, 57% of the endpoints that were considered relevant were significantly improved by the SDM intervention compared to the control group. The median effect size (Cohen's d) was 0.53 (0.14-1.49). In 12 trials, outcomes did not differ between the two groups. In all 22 studies identified, 39% of the relevant outcomes were significantly improved compared with the control groups. Conclusion: The trials performed to date to addressing the effect of SDM on patient-relevant, disease-related endpoints are insufficient in both quantity and quality. Although just under half of the trials reviewed here indicated a positive effect, no final conclusion can be drawn. A consensus-based standardization of both SDM-promoting measures and appropriate clinical studies are needed. [ABSTRACT FROM AUTHOR]
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- 2015
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11. Vasoactive Therapy in Systemic Sclerosis: Real-life Therapeutic Practice in More Than 3000 Patients
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Moinzadeh, Pia, Riemekasten, Gabriela, Siegert, Elise, Fierlbeck, Gerhard, Henes, Joerg, Blank, Norbert, Melchers, Inga, Mueller-Ladner, Ulf, Frerix, Marc, Kreuter, Alexander, Tigges, Christian, Lahner, Nina, Susok, Laura, Guenther, Claudia, Zeidler, Gabriele, Pfeiffer, Christiane, Worm, Margitta, Karrer, Sigrid, Aberer, Elisabeth, Bretterklieber, Agnes, Genth, Ekkehard, Simon, Jan C., Distler, Joerg H.W., Hein, Ruediger, Schneider, Matthias, Seitz, Cornelia S., Herink, Claudia, Steinbrink, Kerstin, Sárdy, Miklos, Varga, Rita, Mensing, Hartwig, Mensing, Christian, Lehmann, Percy, Neeck, Gunther, Fiehn, Christoph, Weber, Manfred, Goebeler, Matthias, Burkhardt, Harald, Buslau, Michael, Ahmadi-Simab, Keihan, Himsel, Andrea, Juche, Aaron, Koetter, Ina, Kuhn, Annegret, Sticherling, Michael, Hellmich, Martin, Kuhr, Kathrin, Krieg, Thomas, Ehrchen, Jan, Sunderkoetter, Cord, and Hunzelmann, Nicolas
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Objective.Vasculopathy is a key factor in the pathophysiology of systemic sclerosis (SSc) and the main cause for Raynaud phenomenon (RP), digital ulcers (DU), and/or pulmonary arterial hypertension (PAH). It is so far unknown how patients with SSc are treated with vasoactive agents in daily practice. To determine to which extent patients with SSc were treated with different vasoactive agents, we used data from the German Network for Systemic Scleroderma registry.Methods.The data of 3248 patients with SSc were analyzed.Results.Patients were treated with vasoactive drugs in 61.1% of cases (1984/3248). Of these, 47.6% received calcium channel inhibitors, followed by 34.2% treated with angiotensin-converting enzyme (ACE) inhibitors, 21.1% treated with intravenous (IV) prostanoids, 10.1% with pentoxifylline, 8.8% with angiotensin 1 receptor antagonists (AT1RA), 8.7% with endothelin 1 receptor antagonists (ET1RA), 4.1% with phosphodiesterase type 5 (PDE5) inhibitors, and 5.3% with others. Patients with RP received vasoactive therapy in 63.3% of cases, with DU in 70.1%, and with PAH in 78.2% of cases. Logistic regression analysis revealed that patients with PAH were significantly more often treated with PDE5 inhibitors and ET1RA, and those with DU with ET1RA and IV prostanoids. In addition, 41.8% of patients were treated with ACE inhibitors and/or AT1RA. Patients registered after 2009 received significantly more often ET1RA, AT1RA, and IV prostanoids compared with patients registered prior to 2005.Conclusion.These data clearly indicate that many patients with SSc do not yet receive sufficient vasoactive therapy. Further, in recent years, a marked change of treatment regimens can be observed.
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- 2016
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12. Aortic valve replacement after previous heart surgery in high-risk patients: Transapical aortic valve implantation versus conventional aortic valve replacement—a risk-adjusted and propensity score-based analysis.
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Scherner, Maximilian, Madershahian, Navid, Kuhr, Kathrin, Rosenkranz, Stephan, Stöger, Elisabeth, Rahmanian, Parwis, Choi, YeongHoon, Slottosch, Ingo, Wippermann, Jens, Strauch, Justus, and Wahlers, Thorsten
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Objective: Cardiac reoperations have been associated with increased morbidity and mortality compared with first-time surgery. We analyzed our experience with reoperative aortic valve replacement (redo-AVR) and compared these results with those from patients who had undergone transapical aortic valve implantation (TA-AVI) as a second heart operation. Methods: In the present retrospective observational comparative study, we analyzed the outcome of 136 patients with previous cardiac surgery who had undergone conventional redo-AVR (n = 59; since 2006) or TA-AVI (n = 77; since 2008) with respect to the 30-day outcomes (Valve Academic Research Consortium criteria), 1- and 3-year survival, and the risk factors for both approaches after previous heart surgery. Results: Neither group differed significantly in their risk profile, leading to similar Society of Thoracic Surgeon score and EuroSCORE. The 30-day mortality was 3.39% (n = 2) in the redo-AVR group and 7.8% (n = 6) in the redo TA-AVI group (P = .465). The overall combined safety endpoint at 30 days was significantly lower for the TA-AVI patients (18.1% vs 33.9% in redo-AVR; P = .036). The unadjusted and adjusted 1-year survival showed no difference between the 2 groups. The unadjusted 3-year survival revealed a 2.1-fold greater mortality risk after TA-AVI (P = .055). Adjustment by multivariate Cox regression analysis (hazard ratio, 1.427; 95% confidence interval, 0.635-3.209; P = .389) and propensity score (hazard ratio, 1.571; 95% confidence interval, 0.575-4.291; P = .378) led to a >50% risk reduction, resulting in similar 3-year survival in the 2 groups. Conclusions: Redo-AVR can be performed with acceptable results in high-risk patients and still serves as the reference standard. Reoperative valve surgery by TA-AVI is feasible and results in comparable short- and mid-term survival. [Copyright &y& Elsevier]
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- 2014
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13. AV Fistula Creation in Paediatric Patients: Outcome is Independent of Demographics and Fistula Type Reducing Usage of Venous Catheters
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Matoussevitch, Vladimir, Taylan, Christina, Konner, Klaus, Gawenda, Michael, Kuhr, Kathrin, Hoppe, Bernd, and Brunkwall, Jan
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Purpose Even though early transplantation is still the first-line therapy in paediatric patients with end-stage renal disease (ESRD), up to 30% of these patients still require haemodialysis (HD). Creating an arteriovenous fistula (AVF) is quite challenging, particularly in children, leading to disproportional use of catheters. In this paper, we describe our experience in the creation of AVF with currently no in-dwelling catheters in children and adolescents on HD.Methods From January 2009 to December 2013, there were 34 patients rated as unfit for transplantation for at least the next 6 months or who had already been on HD through a central venous catheter (CVC). Three patients aged between 12 months and 3 years and weighing 9-12 kg were not suitable for AVF. Finally 31 patients, from 6 to 19 years of age with a mean weight of 43.3 ± 14.5 kg (19-80 kg), were assigned to the alternative of AVF.Results During the above-mentioned time period, 31 patients were provided with 32 AVFs; 26 received a distal radiocephalic fistula, five a Gracz-type fistula and one a brachio-basilic fistula. All but two fistulae matured primarily, within an average time of 45 (range: 16-191) days until the first dialysis. The fistula's 1-year primary and primary assisted patency rates were 78% and 94%, respectively.Conclusions The creation of a native vascular access is an effective and durable procedure in paediatric and adolescent patients. It reduces using of CVCs and is appropriate both for long-term treatment and as a bridging procedure until renal transplantation.
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- 2015
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14. Analysis of Procedural Effects of Percutaneous Edge-to-Edge Mitral Valve Repair by 2D and 3D Echocardiography.
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Altiok, Ertunc, Hamada, Sandra, Brehmer, Kathrin, Kuhr, Kathrin, Reith, Sebastian, Becker, Michael, Schröder, Jorg, Almalla, Mohammad, Lehmacher, Walter, Marx, Nikolaus, and Hoffmann, Rainer
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MEDICAL research ,MITRAL valve diseases ,HEART diseases ,TRANSESOPHAGEAL echocardiography ,MEDICAL technology - Abstract
The article presents a study that determines the functional and morphological effects of percutanous mitral valve repair (PMVR) using three dimensional (3D) transesophageal echocardiography (TEE). It shows that patients in whom vena contrata area could be reduced >50% had a smaller preprocedural mitral annulus area. It indicates that TEE demonstrates significant reduction of regurgitant volume after PMVR.
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- 2012
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15. “Tendency to excuse” and patient satisfaction of those suffering with breast cancer
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Davoll, Sabine, Kowalski, Christoph, Kuhr, Kathrin, Ommen, Oliver, Ernstmann, Nicole, and Pfaff, Holger
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The purpose of this study was to analyse the extent to which breast cancer patients excuse inconveniences that occur during their hospitalisation, and how this “tendency to excuse” affects their satisfaction with the hospital stay.Breast cancer patients undergoing treatment at one of 51 breast centres in North Rhine-Westphalia (Germany) in 2009 were asked to complete the Cologne Patient Questionnaire-Breast Cancer (CPQ-BC). For the analyses, the “tendency to excuse” scale was subdivided into three groups. Linear regressions were performed to investigate associations between the “tendency to excuse” and patient satisfaction.88 % (3,950) of the patients completed the questionnaire. The results show that the inpatients excused inconsistencies to a moderate degree. The “excusers” and “non-excusers” showed greater satisfaction with hospital services than the “medium-excusers”.The “tendency to excuse” scale could aid future data analysis of patient satisfaction surveys by identifying patients who are more likely to answer in an unbiased fashion. According to hospital survey outcomes, adjusting for the “tendency to excuse” scale however, does not lead to substantially different results when comparing health care providers.
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- 2013
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16. Analysis of Procedural Effects of Percutaneous Edge-to-Edge Mitral Valve Repair by 2D and 3D Echocardiography
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Altiok, Ertunc, Hamada, Sandra, Brehmer, Kathrin, Kuhr, Kathrin, Reith, Sebastian, Becker, Michael, Schröder, Jörg, Almalla, Mohammad, Lehmacher, Walter, Marx, Nikolaus, and Hoffmann, Rainer
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Analysis of procedural effects in patients undergoing percutaneous mitral valve repair (PMVR) using the edge-to-edge technique is complex, and common methods to define mitral regurgitation severity based on 2-dimensional (2D) echocardiography are not validated for postprocedural double-orifice mitral valve. This study used 3D transesophageal echocardiography (TEE) to determine the functional and morphological effects of PMVR.
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- 2012
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17. Quantitative Analysis of Endocardial and Epicardial Left Ventricular Myocardial Deformation—Comparison of Strain-Encoded Cardiac Magnetic Resonance Imaging with Two-Dimensional Speckle-Tracking Echocardiography
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Altiok, Ertunc, Neizel, Mirja, Tiemann, Sonja, Krass, Vitali, Kuhr, Kathrin, Becker, Michael, Zwicker, Christian, Koos, Ralf, Lehmacher, Walter, Kelm, Malte, Marx, Nikolaus, and Hoffmann, Rainer
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Quantitative analysis of segmental myocardial deformation of different myocardial layers has become possible using strain-encoded cardiac magnetic resonance imaging (SENC) and speckle-tracking echocardiography (STE). We evaluated and compared the quantitative analysis of myocardial deformation using SENC and STE.
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- 2012
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18. Response by Lüker et al to Letter Regarding Article, “Internal Versus External Electrical Cardioversion of Atrial Arrhythmia in Patients With Implantable Cardioverter-Defibrillator: A Randomized Clinical Trial”
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Lüker, Jakob, Kuhr, Kathrin, Sultan, Arian, Nölker, Georg, Omran, Hazem, Willems, Stephan, Andrié, René, Schrickel, Jan W., Winter, Stefan, Vollmann, Dirk, Tilz, Roland R., Jobs, Alexander, Heeger, Christian-H., Metzner, Andreas, Meyer, Sven, Mischke, Karl, Napp, Andreas, Fahrig, Andreas, Steinhauser, Susanne, Brachmann, Johannes, Baldus, Stephan, Mahajan, Rajiv, Sanders, Prashanthan, and Steven, Daniel
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- 2020
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19. Statin Recapture Therapy before Coronary Artery Bypass Grafting Trial: Rationale and study design of a multicenter, randomized, double-blinded controlled clinical trial.
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Liakopoulos, Oliver J., Kuhn, Elmar W., Hellmich, Martin, Kuhr, Kathrin, Krause, Petra, Reuter, Hannes, Thurat, Meike, Choi, Yeong-Hoon, and Wahlers, Thorsten
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Introduction Patients undergoing coronary artery bypass grafting (CABG) are still at significant risk for postoperative major adverse cardiac and cerebrovascular events (MACCEs). Recent clinical evidence shows that cardioprotection in patients receiving a chronic statin treatment can be “recaptured” by a high-dose statin therapy given shortly before an ischemia-reperfusion sequence. Evaluation of this novel therapeutic approach in the setting of CABG seems promising because myocardial ischemia-reperfusion injury plays a pivotal role in poor clinical outcomes that may be improved by a simple preoperative statin recapture treatment. Methods The investigator-initiated StaRT-CABG trial is a multicenter, randomized, double-blinded, 2-parallel group controlled clinical study in 2,630 patients. The trial aims to evaluate whether a high-dose statin recapture therapy given shortly before CABG reduces the incidence of MACCE at 30 days after surgery (primary composite outcome: all-cause mortality, nonfatal myocardial infarction, and cerebrovascular events). Consenting patients who are on chronic statin therapy before surgery will be randomized to receive either oral statin reloading therapy or matching placebo 12 and 2 hours before CABG. Key secondary end points include enzymatic myocardial injury; new-onset atrial fibrillation; length of stay in the intensive care unit and hospital; need for repeat coronary revascularization at 30 days; and, finally, all-cause mortality at 12 months after surgery. Implications The StaRT-CABG trial is expected to provide highly relevant clinical data on the efficacy of this novel therapeutic approach to optimize the care for patients with coronary artery disease undergoing CABG. [ABSTRACT FROM AUTHOR]
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- 2015
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20. Changes Over Time in the Utilization of Disease-Related Internet Information in Newly Diagnosed Breast Cancer Patients 2007 to 2013.
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Kowalski, Christoph, Kahana, Eva, Kuhr, Kathrin, Ansmann, Lena, and Pfaff, Holger
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BREAST cancer patients ,BREAST cancer diagnosis ,MEDICINE information services ,COMPUTERS in medical care ,HEALTH surveys - Abstract
Background: As the number of people with Internet access rises, so does the use of the Internet as a potentially valuable source for health information. Insight into patient use of this information and its correlates over time may reveal changes in the digital divide based on patient age and education. Existing research has focused on patient characteristics that predict Internet information use and research on treatment context is rare. Objective: This study aims to (1) present data on the proportion of newly diagnosed breast cancer patients treated in German breast centers from 2007 to 2013 who used the Internet for information on their disease, (2) look into correlations between Internet utilization and sociodemographic characteristics and if these change over time, and (3) determine if use of Internet information varies with the hospitals in which the patients were initially treated. Methods: Data about utilization of the Internet for breast cancer-specific health information was obtained in a postal survey of breast cancer patients that is conducted annually in Germany with a steady response rate of 87% of consenting patients. Data from the survey were combined with data obtained by hospital personnel (eg, cancer stage and type of surgery). Data from 27,491 patients from 7 consecutive annual surveys were analyzed for this paper using multilevel regression modeling to account for clustering of patients in specific hospitals. Results: Breast cancer patients seeking disease-specific information on the Internet increased significantly from 26.96% (853/3164) in 2007 to 37.21% (1485/3991) in 2013. Similar patterns of demographic correlates were found for all 7 cohorts. Older patients (≥70 years) and patients with <10 years of formal education were less likely to use the Internet for information on topics related to their disease. Internet use was significantly higher among privately insured patients and patients living with a partner. Higher cancer stage and a foreign native language were associated with decreased use in the overall model. Type of surgery was not found to be associated with Internet use in the multivariable models. Intraclass correlation coefficients were small (0.00-0.03) suggesting only a small contribution of the hospital to the patients' decision to use Internet information. There was no clear indication of a decreased digital divide based on age and education. Conclusions: Use of the Internet for health information is on the rise among breast cancer patients. The strong age- and education-related differences raise the question of how relevant information can be adequately provided to all patients, especially to those with limited education, older age, and living without a partner. [ABSTRACT FROM AUTHOR]
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- 2014
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21. W1871 Single Dilatation of Symptomatic Schatzki Rings: Late Results of a Prospective Follow Up Investigation.
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Mueller, Michaela, Eckardt, Volker F., Jochem, Koenig, and Kuhr, Kathrin
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- 2009
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22. Silent night: retrospective database study assessing possibility of “weekend effect” in palliative care
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Voltz, Raymond, Kamps, Robert, Greinwald, Ralf, Hellmich, Martin, Hamacher, Stefanie, Becker, Gerhild, Kuhr, Kathrin, and Gaertner, Jan
- Abstract
ObjectiveTo compare the mortality of patients in a palliative care unit on working days with that on weekends and public holidays.DesignRetrospective database study.SettingPalliative care unit in Germany.PopulationAll admissions to palliative care unit between 1 January 1997 and 31 December 2008.Main outcome measureThe impact of day type (working days or weekends and public holidays) on mortality was analysed using Poisson regression models.ResultsA total of 2565 admitted patients and 1325 deaths were recorded. Of the deaths, 448 (33.8%) occurred on weekends and public holidays. The mortality rate on weekends and public holidays was 18% higher than that on working days (mortality rate ratio 1.18, 95% confidence interval 1.05 to 1.32; P=0.005).ConclusionPatients in the palliative care unit were at higher risk of dying on weekends and public holidays. In the absence of a prospective study, the exact reasons for this correlation are unclear.
- Published
- 2014
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