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205. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

Author

Haase, Robert, Schlattmann, Peter, Gueret, Pascal, Andreini, Daniele, Pontone, Gianluca, Alkadhi, Hatem, Hausleiter, Jörg, Garcia, Mario J, Leschka, Sebastian, Meijboom, Willem B, Zimmermann, Elke, Gerber, Bernhard, Schoepf, U Joseph, Shabestari, Abbas A, Nørgaard, Bjarne L, Meijs, Matthijs F L, Sato, Akira, Ovrehus, Kristian A, Diederichsen, Axel C P, Jenkins, Shona M M, Knuuti, Juhani, Hamdan, Ashraf, Halvorsen, Bjørn A, Mendoza-Rodriguez, Vladimir, Rochitte, Carlos E, Rixe, Johannes, Wan, Yung Liang, Langer, Christoph, Bettencourt, Nuno, Martuscelli, Eugenio, Ghostine, Said, Buechel, Ronny R, Nikolaou, Konstantin, Mickley, Hans, Yang, Lin, Zhang, Zhaqoi, Chen, Marcus Y, Halon, David A, Rief, Matthias, Sun, Kai, Hirt-Moch, Beatrice, Niinuma, Hiroyuki, Marcus, Roy P, Muraglia, Simone, Jakamy, Réda, Chow, Benjamin J, Kaufmann, Philipp A, Tardif, Jean-Claude, Nomura, Cesar, Kofoed, Klaus F, Laissy, Jean-Pierre, Arbab-Zadeh, Armin, Kitagawa, Kakuya, Laham, Roger, Jinzaki, Masahiro, Hoe, John, Rybicki, Frank J, Scholte, Arthur, Paul, Narinder, Tan, Swee Y, Yoshioka, Kunihiro, Röhle, Robert, Schuetz, Georg M, Schueler, Sabine, Coenen, Maria H, Wieske, Viktoria, Achenbach, Stephan, Budoff, Matthew J, Laule, Michael, Newby, David E, Dewey, Marc, COME-CCT Consortium, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, University of Zurich, and Cardiology

Subjects
Computed Tomography Angiography, stable chest pain, ACCURACY, Coronary Vessels/diagnostic imaging, Settore MED/11 - Malattie dell'Apparato Cardiovascolare, Coronary Artery Disease, 2700 General Medicine, 030204 cardiovascular system & hematology, Chest pain, BIVARIATE METAANALYSIS, Coronary artery disease, Angina, 0302 clinical medicine, Positive predicative value, Medicine, 030212 general & internal medicine, SPECIFICITY, Computed tomography angiography, Computed Tomography Angiography/methods, medicine.diagnostic_test, 10042 Clinic for Diagnostic and Interventional Radiology, obstructive coronary artery disease, General Medicine, Coronary Vessels, 3. Good health, PREVALENCE, Pre- and post-test probability, Predictive value of tests, Radiology, medicine.symptom, SENSITIVITY, INTERVENTIONS, Coronary Artery Disease/complications, medicine.medical_specialty, OF-CARDIOLOGY FOUNDATION, 610 Medicine & health, computed tomography angiography (Englisch), AMERICAN-COLLEGE, Angina Pectoris, 03 medical and health sciences, Predictive Value of Tests, MANAGEMENT, Humans, cardiovascular diseases, Probability, CTA, business.industry, Research, Angina Pectoris/diagnostic imaging, 10181 Clinic for Nuclear Medicine, PERFORMANCE, medicine.disease, Confidence interval, Feasibility Studies, business
Abstract

Objective To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. Design Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. Data sources Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. Eligibility criteria for selecting studies Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. Results Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, Pv 0.907 (0.897 to 0.916), Pv all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). Conclusions In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. Systematic review registration PROSPERO CRD42012002780.

Published
2019

209. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data.

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, Haase, Robert, Schlattmann, Peter, Gueret, Pascal, Andreini, Daniele, Pontone, Gianluca, Alkadhi, Hatem, Hausleiter, Jörg, Garcia, Mario J, Leschka, Sebastian, Meijboom, Willem B, Zimmermann, Elke, Gerber, Bernhard, Schoepf, U Joseph, Shabestari, Abbas A, Nørgaard, Bjarne L, Meijs, Matthijs F L, Sato, Akira, Ovrehus, Kristian A, Diederichsen, Axel C P, Jenkins, Shona M M, Knuuti, Juhani, Hamdan, Ashraf, Halvorsen, Bjørn A, Mendoza-Rodriguez, Vladimir, Rochitte, Carlos E, Rixe, Johannes, Wan, Yung Liang, Langer, Christoph, Bettencourt, Nuno, Martuscelli, Eugenio, Ghostine, Said, Buechel, Ronny R, Nikolaou, Konstantin, Mickley, Hans, Yang, Lin, Zhang, Zhaqoi, Chen, Marcus Y, Halon, David A, Rief, Matthias, Sun, Kai, Hirt-Moch, Beatrice, Niinuma, Hiroyuki, Marcus, Roy P, Muraglia, Simone, Jakamy, Réda, Chow, Benjamin J, Kaufmann, Philipp A, Tardif, Jean-Claude, Nomura, Cesar, Kofoed, Klaus F, Laissy, Jean-Pierre, Arbab-Zadeh, Armin, Kitagawa, Kakuya, Laham, Roger, Jinzaki, Masahiro, Hoe, John, Rybicki, Frank J, Scholte, Arthur, Paul, Narinder, Tan, Swee Y, Yoshioka, Kunihiro, Röhle, Robert, Schuetz, Georg M, Schueler, Sabine, Coenen, Maria H, Wieske, Viktoria, Achenbach, Stephan, Budoff, Matthew J, Laule, Michael, Newby, David E, Dewey, Marc, COME-CCT Consortium, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, Haase, Robert, Schlattmann, Peter, Gueret, Pascal, Andreini, Daniele, Pontone, Gianluca, Alkadhi, Hatem, Hausleiter, Jörg, Garcia, Mario J, Leschka, Sebastian, Meijboom, Willem B, Zimmermann, Elke, Gerber, Bernhard, Schoepf, U Joseph, Shabestari, Abbas A, Nørgaard, Bjarne L, Meijs, Matthijs F L, Sato, Akira, Ovrehus, Kristian A, Diederichsen, Axel C P, Jenkins, Shona M M, Knuuti, Juhani, Hamdan, Ashraf, Halvorsen, Bjørn A, Mendoza-Rodriguez, Vladimir, Rochitte, Carlos E, Rixe, Johannes, Wan, Yung Liang, Langer, Christoph, Bettencourt, Nuno, Martuscelli, Eugenio, Ghostine, Said, Buechel, Ronny R, Nikolaou, Konstantin, Mickley, Hans, Yang, Lin, Zhang, Zhaqoi, Chen, Marcus Y, Halon, David A, Rief, Matthias, Sun, Kai, Hirt-Moch, Beatrice, Niinuma, Hiroyuki, Marcus, Roy P, Muraglia, Simone, Jakamy, Réda, Chow, Benjamin J, Kaufmann, Philipp A, Tardif, Jean-Claude, Nomura, Cesar, Kofoed, Klaus F, Laissy, Jean-Pierre, Arbab-Zadeh, Armin, Kitagawa, Kakuya, Laham, Roger, Jinzaki, Masahiro, Hoe, John, Rybicki, Frank J, Scholte, Arthur, Paul, Narinder, Tan, Swee Y, Yoshioka, Kunihiro, Röhle, Robert, Schuetz, Georg M, Schueler, Sabine, Coenen, Maria H, Wieske, Viktoria, Achenbach, Stephan, Budoff, Matthew J, Laule, Michael, Newby, David E, Dewey, Marc, and COME-CCT Consortium

Abstract

OBJECTIVE: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES: Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS: Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability we

Published
2019

210. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups:Meta-analysis of individual patient data

Author

Haase, Robert, Schlattmann, Peter, Gueret, Pascal, Andreini, Daniele, Pontone, Gianluca, Alkadhi, Hatem, Hausleiter, Jörg, Garcia, Mario J., Leschka, Sebastian, Meijboom, Willem B., Zimmermann, Elke, Gerber, Bernhard, Schoepf, U. Joseph, Shabestari, Abbas A., Nørgaard, Bjarne L., Meijs, Matthijs F.L., Sato, Akira, Ovrehus, Kristian A., Diederichsen, Axel C.P., Jenkins, Shona M.M., Knuuti, Juhani, Hamdan, Ashraf, Halvorsen, Bjørn A., Mendoza-Rodriguez, Vladimir, Rochitte, Carlos E., Rixe, Johannes, Wan, Yung Liang, Langer, Christoph, Bettencourt, Nuno, Martuscelli, Eugenio, Ghostine, Said, Buechel, Ronny R., Nikolaou, Konstantin, Mickley, Hans, Yang, Lin, Zhang, Zhaqoi, Chen, Marcus Y., Halon, David A., Rief, Matthias, Sun, Kai, Hirt-Moch, Beatrice, Niinuma, Hiroyuki, Marcus, Roy P., Muraglia, Simone, Jakamy, Réda, Chow, Benjamin J., Kaufmann, Philipp A., Tardif, Jean Claude, Nomura, Cesar, Kofoed, Klaus F., Laissy, Jean Pierre, Arbab-Zadeh, Armin, Kitagawa, Kakuya, Laham, Roger, Jinzaki, Masahiro, Hoe, John, Rybicki, Frank J., Scholte, Arthur, Paul, Narinder, Tan, Swee Y., Yoshioka, Kunihiro, Röhle, Robert, Schuetz, Georg M., Schueler, Sabine, Coenen, Maria H., Wieske, Viktoria, Achenbach, Stephan, Budoff, Matthew J., Laule, Michael, Newby, David E., Dewey, Marc, Haase, Robert, Schlattmann, Peter, Gueret, Pascal, Andreini, Daniele, Pontone, Gianluca, Alkadhi, Hatem, Hausleiter, Jörg, Garcia, Mario J., Leschka, Sebastian, Meijboom, Willem B., Zimmermann, Elke, Gerber, Bernhard, Schoepf, U. Joseph, Shabestari, Abbas A., Nørgaard, Bjarne L., Meijs, Matthijs F.L., Sato, Akira, Ovrehus, Kristian A., Diederichsen, Axel C.P., Jenkins, Shona M.M., Knuuti, Juhani, Hamdan, Ashraf, Halvorsen, Bjørn A., Mendoza-Rodriguez, Vladimir, Rochitte, Carlos E., Rixe, Johannes, Wan, Yung Liang, Langer, Christoph, Bettencourt, Nuno, Martuscelli, Eugenio, Ghostine, Said, Buechel, Ronny R., Nikolaou, Konstantin, Mickley, Hans, Yang, Lin, Zhang, Zhaqoi, Chen, Marcus Y., Halon, David A., Rief, Matthias, Sun, Kai, Hirt-Moch, Beatrice, Niinuma, Hiroyuki, Marcus, Roy P., Muraglia, Simone, Jakamy, Réda, Chow, Benjamin J., Kaufmann, Philipp A., Tardif, Jean Claude, Nomura, Cesar, Kofoed, Klaus F., Laissy, Jean Pierre, Arbab-Zadeh, Armin, Kitagawa, Kakuya, Laham, Roger, Jinzaki, Masahiro, Hoe, John, Rybicki, Frank J., Scholte, Arthur, Paul, Narinder, Tan, Swee Y., Yoshioka, Kunihiro, Röhle, Robert, Schuetz, Georg M., Schueler, Sabine, Coenen, Maria H., Wieske, Viktoria, Achenbach, Stephan, Budoff, Matthew J., Laule, Michael, Newby, David E., and Dewey, Marc

Abstract

Objective To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. Design Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. Data sources Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. Eligibility criteria for selecting studies Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. Results Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were

Published
2019

217. Selective carious tissue removal using subjective criteria or polymer bur: study protocol for a randomised controlled trial (SelecCT)

Author

Schwendicke, Falk, Leal, Soraya, Schlattmann, Peter, Paris, Sebastian, Dias Ribeiro, Ana Paula, Gomes Marques, Marta, and Hilgert, Leandro Augusto

Subjects
Male, Polymers, dental, Dentistry and Oral Medicine, oral medicine, Equivalence Trials as Topic, Dental Caries, paediatric dentistry, stomatognathic system, Protocol, Cluster Analysis, Humans, Single-Blind Method, Child, caries, clinical trials, Dental Atraumatic Restorative Treatment, stomatognathic diseases, carious, Female, Dental Cavity Preparation, 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit, Follow-Up Studies
Abstract

Introduction Selective (incomplete/partial) carious tissue removal is suitable for treating deep carious lesions in teeth with vital, asymptomatic pulps. In the periphery of a cavity, removal to hard dentin is performed, while in pulpo-proximal areas, leathery or soft dentin is left to avoid pulp exposure. As the decision of what contains ‘soft’ or ‘leathery’ dentin is subjective, using self-limiting burs which help to standardise the hardness of the remaining dentin, has been suggested to increase the reliability of carious tissue removal. The trial compares subjectively measured selective carious tissue removal in deep lesions in primary teeth with objectively measured selective removal with a self-limiting bur (Polybur, Komet). Methods and analysis A community-based single-blind clustered randomised controlled superiority trial nested into a larger evaluation is performed. Recruitment for this trial has been concluded. We have recruited 115 children aged 6–8 years with ≥1 vital primary molar with a deep dentin lesion. The unit of randomisation was the child, with all eligible molars per child treated identically. Treatment was performed in a mobile dental unit. Subjective and objective carious tissue removal was performed at random. Teeth were restored using glass ionomer cement (Equia Forte, GC). Our primary outcome will be the time until complications occur, evaluated via multilevel survival analysis. Secondary outcomes will be the time until extraction is needed, subjective satisfaction of the child with the treatment (measured using a Likert scale) and cost-effectiveness. Re-examination will be performed after 12, 24 and 36 months (the final examination is expected in 2020). Ethics and dissemination This trial has been approved by the Ethics Committee of the Health Sciences of the University of Brasília (CAAE 51310415.0.0000.0030). Trial results will be published in peer-reviewed journals and presented on conferences. Trial registration number NCT02754466.

Published
2018

222. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data

Author

Haase, Robert, primary, Schlattmann, Peter, additional, Gueret, Pascal, additional, Andreini, Daniele, additional, Pontone, Gianluca, additional, Alkadhi, Hatem, additional, Hausleiter, Jörg, additional, Garcia, Mario J, additional, Leschka, Sebastian, additional, Meijboom, Willem B, additional, Zimmermann, Elke, additional, Gerber, Bernhard, additional, Schoepf, U Joseph, additional, Shabestari, Abbas A, additional, Nørgaard, Bjarne L, additional, Meijs, Matthijs F L, additional, Sato, Akira, additional, Ovrehus, Kristian A, additional, Diederichsen, Axel C P, additional, Jenkins, Shona M M, additional, Knuuti, Juhani, additional, Hamdan, Ashraf, additional, Halvorsen, Bjørn A, additional, Mendoza-Rodriguez, Vladimir, additional, Rochitte, Carlos E, additional, Rixe, Johannes, additional, Wan, Yung Liang, additional, Langer, Christoph, additional, Bettencourt, Nuno, additional, Martuscelli, Eugenio, additional, Ghostine, Said, additional, Buechel, Ronny R, additional, Nikolaou, Konstantin, additional, Mickley, Hans, additional, Yang, Lin, additional, Zhang, Zhaqoi, additional, Chen, Marcus Y, additional, Halon, David A, additional, Rief, Matthias, additional, Sun, Kai, additional, Hirt-Moch, Beatrice, additional, Niinuma, Hiroyuki, additional, Marcus, Roy P, additional, Muraglia, Simone, additional, Jakamy, Réda, additional, Chow, Benjamin J, additional, Kaufmann, Philipp A, additional, Tardif, Jean-Claude, additional, Nomura, Cesar, additional, Kofoed, Klaus F, additional, Laissy, Jean-Pierre, additional, Arbab-Zadeh, Armin, additional, Kitagawa, Kakuya, additional, Laham, Roger, additional, Jinzaki, Masahiro, additional, Hoe, John, additional, Rybicki, Frank J, additional, Scholte, Arthur, additional, Paul, Narinder, additional, Tan, Swee Y, additional, Yoshioka, Kunihiro, additional, Röhle, Robert, additional, Schuetz, Georg M, additional, Schueler, Sabine, additional, Coenen, Maria H, additional, Wieske, Viktoria, additional, Achenbach, Stephan, additional, Budoff, Matthew J, additional, Laule, Michael, additional, Newby, David E, additional, and Dewey, Marc, additional

Published
2019
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223. Aircraft Noise and the Risk of Stroke

Author

Weihofen, Verena Maria, primary, Hegewald, Janice, additional, Euler, Ulrike, additional, Schlattmann, Peter, additional, Zeeb, Hajo, additional, and Seidler, Andreas, additional

Published
2019
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224. Leptin gene polymorphisms are associated with weight gain during lithium augmentation in patients with major depression

Author

Bopp, Sandra K., primary, Heilbronner, Urs, additional, Schlattmann, Peter, additional, Mühleisen, Thomas W., additional, Bschor, Tom, additional, Richter, Christoph, additional, Steinacher, Bruno, additional, Stamm, Thomas J., additional, Merkl, Angela, additional, Herms, Stefan, additional, Köhler, Stephan, additional, Sterzer, Philipp, additional, Hellweg, Rainer, additional, Heinz, Andreas, additional, Cichon, Sven, additional, Lang, Undine E., additional, Schulze, Thomas G., additional, Adli, Mazda, additional, and Ricken, Roland, additional

Published
2019
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225. Risk Factors for Invasive CandidaInfection in Critically Ill Patients

Author

Thomas-Rüddel, Daniel O., Schlattmann, Peter, Pletz, Mathias, Kurzai, Oliver, and Bloos, Frank

Abstract

Current guidelines recommend empirical antifungal therapy in patients with sepsis with high risk of invasive Candidainfection. However, many different risk factors have been derived from multiple studies. These risk factors lack specificity, and broad application would render most ICU patients eligible for empirical antifungal therapy.

Published
2022
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227. Jillian Russyll (AKA Jill) Tate

Author

Plebani, Mario, primary, Gillery, Philippe, additional, Jahnke, Heike, additional, Lackner, Karl, additional, Lippi, Giuseppe, additional, Melichar, Bohuslav, additional, Payne, Deborah A., additional, and Schlattmann, Peter, additional

Published
2018
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231. Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M, Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Jörg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U Joseph, Shabestari, Abbas Arjmand, Nørgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F L, Brodoefel, Harald, Jenkins, Shona M M, Øvrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjørn Arild, Mendoza Rodriguez, Vladimir, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp, Büchel, Ronny Ralf, Herzog, Bernhard, Clouse, Melvin, Halon, David A, Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, Dewey, Marc, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M, Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Jörg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U Joseph, Shabestari, Abbas Arjmand, Nørgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F L, Brodoefel, Harald, Jenkins, Shona M M, Øvrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjørn Arild, Mendoza Rodriguez, Vladimir, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp, Büchel, Ronny Ralf, Herzog, Bernhard, Clouse, Melvin, Halon, David A, Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, and Dewey, Marc

Abstract

OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

Published
2018

232. Correction to: Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M., Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Jörg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U. Joseph, Shabestari, Abbas Arjmand, Nørgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F. L., Brodoefel, Harald, Jenkins, Shona M. M., Øvrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjørn Arild, Rodriguez, Vladimir Mendoza, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp A., Buechel, Ronny Ralf, Herzog, Bernhard A., Clouse, Melvin, Halon, David A., Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, Dewey, Marc, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de pathologie cardiovasculaire, Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M., Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Jörg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U. Joseph, Shabestari, Abbas Arjmand, Nørgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F. L., Brodoefel, Harald, Jenkins, Shona M. M., Øvrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjørn Arild, Rodriguez, Vladimir Mendoza, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp A., Buechel, Ronny Ralf, Herzog, Bernhard A., Clouse, Melvin, Halon, David A., Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, and Dewey, Marc

Abstract

The original version of this article, published on 19 March 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The names of the authors Philipp A. Kaufmann, Ronny Ralf Buechel and Bernhard A. Herzog were presented incorrectly.

Published
2018

233. (1,3)-beta-D-glucan-based diagnosis of invasive Candida infection versus culturebased diagnosis in patients with sepsis and with an increased risk of invasive Candida infection (CandiSep): study protocol for a randomized controlled trial

Author

Bloos, Frank, Held, Juergen, Schlattmann, Peter, Brillinger, Nicole, Kurzai, Oliver, Cornely, Oliver A., Thomas-Rueddel, Daniel, Bloos, Frank, Held, Juergen, Schlattmann, Peter, Brillinger, Nicole, Kurzai, Oliver, Cornely, Oliver A., and Thomas-Rueddel, Daniel

Abstract

Background: The time to diagnosis of invasive Candida infection (ICI) is often too long to initiate timely antifungal therapy in patients with sepsis. Elevated serum (1,3)-beta-D-glucan (BDG) concentrations have a high diagnostic sensitivity for detecting ICI. However, the clinical significance of elevated BDG concentrations is unclear in critically ill patients. The goal of this study is to investigate whether measurement of BDG in patients with sepsis and a high risk for ICI can be used to decrease the time to empiric antifungal therapy and thus, increase survival. Methods/design: This prospective multicenter open randomized controlled trial is being conducted in 19 German intensive care units. All adult patients with severe sepsis or septic shock and an increased risk for ICI are eligible for enrolment. Risk factors are total parenteral nutrition, previous abdominal surgery, previous antimicrobial therapy, and renal replacement therapy. Patients with proven ICI or those already treated with systemic antifungal substances are excluded. Patients are allocated to a BDG or standard care group. The standard care group receives targeted antifungal therapy as necessary. In the BDG group, BDG serum samples are taken after randomization and 24 h later. Antifungal therapy is initiated if BDG is >= 80 pg/ml in at least one sample. We plan to enroll 312 patients. The primary outcome is 28-day mortality. Other outcomes include antifungal-free survival within 28 days after enrolment, time to antifungal therapy, and the diagnostic performance of BDG compared to other laboratory tests for early ICI diagnosis. The statistical analysis will be performed according to the intent-to-treat principle. Discussion: Because of the high risk of death, American guidelines recommend empiric antifungal therapy in sepsis patients with a high risk of ICI despite the limited evidence for such a recommendation. In contrast, empiric antifungal therapy is not recommended by European guidelines. BDG

Published
2018

234. Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset

Author

Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M., Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Joerg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U. Joseph, Shabestari, Abbas Arjmand, Norgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F. L., Brodoefel, Harald, Jenkins, Shona M. M., Ovrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjorn Arild, Mendoza Rodriguez, Vladimir, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp A., Buechel, Ronny Ralf, Herzog, Bernhard A., Clouse, Melvin, Halon, David A., Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, Dewey, Marc, Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M., Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Joerg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U. Joseph, Shabestari, Abbas Arjmand, Norgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F. L., Brodoefel, Harald, Jenkins, Shona M. M., Ovrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjorn Arild, Mendoza Rodriguez, Vladimir, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp A., Buechel, Ronny Ralf, Herzog, Bernhard A., Clouse, Melvin, Halon, David A., Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, and Dewey, Marc

Abstract

To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. aEuro cent Duke clinical score is not implemented correctly in NICE guideline 95. aEuro cent Pretest probability assessment in NICE guideline 95 is impossible for most patients. aEuro cent Improved clinical decision making requires accurate pretest probability calculation. aEuro cent These refinements are essential for appropriate use of cardiac CT.

Published
2018

235. Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset (vol 28, pg 4006, 2018)

Author

Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M., Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Joerg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U. Joseph, Shabestari, Abbas Arjmand, Norgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F. L., Brodoefel, Harald, Jenkins, Shona M. M., Ovrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjorn Arild, Mendoza Rodriguez, Vladimir, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp A., Buechel, Ronny Ralf, Herzog, Bernhard A., Clouse, Melvin, Halon, David A., Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, Dewey, Marc, Roehle, Robert, Wieske, Viktoria, Schuetz, Georg M., Gueret, Pascal, Andreini, Daniele, Meijboom, Willem Bob, Pontone, Gianluca, Garcia, Mario, Alkadhi, Hatem, Honoris, Lily, Hausleiter, Joerg, Bettencourt, Nuno, Zimmermann, Elke, Leschka, Sebastian, Gerber, Bernhard, Rochitte, Carlos, Schoepf, U. Joseph, Shabestari, Abbas Arjmand, Norgaard, Bjarne, Sato, Akira, Knuuti, Juhani, Meijs, Matthijs F. L., Brodoefel, Harald, Jenkins, Shona M. M., Ovrehus, Kristian Altern, Diederichsen, Axel Cosmus Pyndt, Hamdan, Ashraf, Halvorsen, Bjorn Arild, Mendoza Rodriguez, Vladimir, Wan, Yung Liang, Rixe, Johannes, Sheikh, Mehraj, Langer, Christoph, Ghostine, Said, Martuscelli, Eugenio, Niinuma, Hiroyuki, Scholte, Arthur, Nikolaou, Konstantin, Ulimoen, Geir, Zhang, Zhaoqi, Mickley, Hans, Nieman, Koen, Kaufmann, Philipp A., Buechel, Ronny Ralf, Herzog, Bernhard A., Clouse, Melvin, Halon, David A., Leipsic, Jonathan, Bush, David, Jakamy, Reda, Sun, Kai, Yang, Lin, Johnson, Thorsten, Laissy, Jean-Pierre, Marcus, Roy, Muraglia, Simone, Tardif, Jean-Claude, Chow, Benjamin, Paul, Narinder, Maintz, David, Hoe, John, de Roos, Albert, Haase, Robert, Laule, Michael, Schlattmann, Peter, and Dewey, Marc

Published
2018

238. Comparison of the multinomial generalized linear mixed model with three alternative generalized mixed models in the meta-analysis of diagnostic accuracy trials with non-evaluable index test results

Author

Pham, Jenny and Schlattmann, Peter

Subjects
ddc: 610, 610 Medical sciences, Medicine, Biometrie
Abstract

For the meta-analysis of diagnostic test accuracy trials with a dichotomous understanding of the disease, one state-of-the-art model is the bivariate Generalized Linear Mixed Model (GLMM) which assumes the true positive and true negative counts to follow a binomial distribution drawn from the diseased[for full text, please go to the a.m. URL], 62. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS)

Published
2017
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239. Die diagnostische Wertigkeit des APHAB

Author

Löhler, Jan, Wollenberg, Barbara, Schlattmann, Peter, Gräbner, Frederike, and Schönweiler, Rainer

Subjects
ddc: 610, 610 Medical sciences, Medicine
Abstract

Einleitung: Der APHAB (Abbreviated Profile of Hearing Aid Benefit) ist ein Fragebogen, der im Rahmen einer Hörgeräteversorgung nach der Hilfsmittelrichtlinie verpflichtend eingesetzt werden muss. Er ist in vielen Sprachen erhältlich und untersucht anhand von vier Subskalen (Hören[zum vollständigen Text gelangen Sie über die oben angegebene URL], 88. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

Published
2017

240. Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial

Author

Napp, Adriane E., Haase, Robert, Laule, Michael, Schuetz, Georg M., Rief, Matthias, Dreger, Henryk, Feuchtner, Gudrun, Friedrich, Guy, Spacek, Miloslav, Suchanek, Vojtech, Kofoed, Klaus Fuglsang, Engstroem, Thomas, Schroeder, Stephen, Drosch, Tanja, Gutberlet, Matthias, Woinke, Michael, Maurovich-Horvat, Pal, Merkely, Bela, Donnelly, Patrick, Ball, Peter, Dodd, Jonathan D., Quinn, Martin, Saba, Luca, Porcu, Maurizio, Francone, Marco, Mancone, Massimo, Erglis, Andrejs, Zvaigzne, Ligita, Jankauskas, Antanas, Sakalyte, Gintare, Haran, Tomasz, Ilnicka-Suckiel, Malgorzata, Bettencourt, Nuno, Gama-Ribeiro, Vasco, Condrea, Sebastian, Benedek, Imre, Adjic, Nada Cemerlic, Adjic, Oto, Rodriguez-Palomares, Jose, del Blanco, Bruno Garcia, Roditi, Giles, Berry, Colin, Davis, Gershan, Thwaite, Erica, Knuuti, Juhani, Pietila, Mikko, Kepka, Cezary, Kruk, Mariusz, Vidakovic, Radosav, Neskovic, Aleksandar N., Diez, Ignacio, Lecumberri, Inigo, Geleijns, Jacob, Kubiak, Christine, Strenge-Hesse, Anke, Do, The-Hoang, Fromel, Felix, Gutierrez-Ibarluzea, Inaki, Benguria-Arrate, Gaizka, Keiding, Hans, Katzer, Christoph, Mueller-Nordhorn, Jacqueline, Rieckmann, Nina, Walther, Mario, Schlattmann, Peter, Dewey, Marc, and DISCHARGE Trial Grp

Subjects
Male, Cost-Benefit Analysis, invasive coronary angiography, Pilot Projects, Coronary Artery Disease, 030204 cardiovascular system & hematology, Chest pain, Coronary Angiography, Coronary artery disease, 0302 clinical medicine, Outcome Assessment, Health Care, angiography, 030212 general & internal medicine, Myocardial infarction, Computed tomography, Computed tomography angiography, Neuroradiology, media_common, medicine.diagnostic_test, Angiography, General Medicine, Middle Aged, Comparative effectiveness, 3. Good health, Pre- and post-test probability, Europe, Female, Radiology, medicine.symptom, medicine.medical_specialty, comparative effectiveness, nuclear medicine and imaging, 03 medical and health sciences, medicine, media_common.cataloged_instance, Humans, Radiology, Nuclear Medicine and imaging, European union, Aged, Retrospective Studies, business.industry, Invasive coronary angiography, computed tomography, medicine.disease, adverse events, radiology, radiology, nuclear medicine and imaging, Adverse events, Quality of Life, business, Tomography, X-Ray Computed, Follow-Up Studies
Abstract

More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). In this trial, patients with a low-to-intermediate pretest probability (10–60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. • Coronary artery disease (CAD) is a major cause of morbidity and mortality. • Invasive coronary angiography (ICA) is the reference standard for detection of CAD. • Noninvasive computed tomography angiography excludes CAD with high sensitivity. • CT may effectively reduce the approximately 2 million negative ICAs in Europe. • DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

Published
2017

242. Social Disparities and Incapability to Work Due to Illness or Disability among Working-Age Population in Thailand.

Author

Nitkhamhan, Bandit, Laohasiriwong, Wongsa, Puttanapong, Nattapong, and Schlattmann, Peter

Subjects
LOGISTIC regression analysis, DISABILITIES, DISEASES, ADULT education, OLDER people
Abstract

This research aimed to determine the prevalence and investigate whether social economic factors were associated with incapability to work due to illness or disability among working-age population in Thailand. This cross-section study used the data from the National Labor Force Survey conducted by the National Statistical Office in 2015. The samples were Thai working aged people (aged 15 and 59 years old). The multilevel logistic regression analysis was performed to determine the relationships between socioeconomic factors and incapability to work due to illness or disability when controlling random variations among all provinces as well as other factors presented adjusted odds ratio and 95% confident intervals. 141,202 of respondents, 1.98% were incapability to work due to illness or disability. Factors associated with incapability to work due to illness or disability among them were male, single, household size of ≥4 persons and not head of the family, had low level of education and late adults. There were social disparities among those who incapability to work due to illness or disability. Systematically support for educations and job opportunities are needed organization necessary to paid on the prevention. [ABSTRACT FROM AUTHOR]

Published
2020

243. Meta-analysis on the immunohistological detection of inflammatory cardiomyopathy in endomyocardial biopsies.

Author

Katzmann, Julius L., Schlattmann, Peter, Rigopoulos, Angelos G., Noutsias, Ewa, Bigalke, Boris, Pauschinger, Matthias, Tschope, Carsten, Sedding, Daniel, Schulze, P. Christian, and Noutsias, Michel

Subjects
CELL adhesion molecules, CARDIOMYOPATHIES, META-analysis, DIGITAL images, IMAGE analysis
Abstract

Meta-analysis on immunohistological (IHC) concepts for the detection of inflammatory cardiomyopathy (InfCM) in endomyocardial biopsies (EMB). We included 61 publications, with 10,491 patients (mean age 47.1 years; men 66%) who underwent EMB and IHC evaluation. The 460 control patients were devoid of IHC proof of InfCM. The mean IHC detection rate of InfCM was 50.8% (95% CI 47.7-53.8%; range 18.4-91.7%). A publication bias was excluded (Funnel Plot p = 0.4264). This IHC detection rate was significantly (p < 0.0001) higher compared to the histological detection of myocarditis according to the Dallas criteria (mean 8.04%; 95% CI 5.08-12.5%; subset of 3274 patients in 30 publications). However, 13 different diagnostic IHC criteria were described in the publications, with various thresholds of diverse phenotypes of quantified infiltrates, and endothelial expression of diverse cell adhesion molecules (CAM), quantified either visually or by digital image analysis (DIA). The comparison of IHC with cardiac magnetic resonance (CMR) data available in a subset of 13 publications with 1185 patients revealed a sensitivity for CMR of 69% (95% CI 58-79%), a specificity of 73% (95% CI 59-84%), and a ROC-AUC of 0.77 (95% CI 0.73-0.81). This meta-analysis encompassing 10,491 patients confirms a mean detection rate of InfCM in 50.8% of EMB, being significantly more sensitive compared to the histological Dallas criteria. IHC cannot be fully substituted by CMR. However, standardization of the diverse IHC markers and protocols seems pertinent, especially considering the published adverse prognostic impact of IHC-confirmed InfCM and its published suitability for the selection of candidates responding favorably to immunosuppression. [ABSTRACT FROM AUTHOR]

Published
2020
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245. Automated objective and marker-free facial grading using photographs of patients with facial palsy.

Author

Mothes, Oliver, Modersohn, Luise, Volk, Gerd Fabian, Klingner, Carsten, Witte, Otto W., Schlattmann, Peter, Denzler, Joachim, and Guntinas-Lichius, Orlando

Subjects
FACIAL paralysis, PHOTOGRAPHS, BIOMETRIC identification, LOGISTIC regression analysis
Abstract

Purpose: An automated, objective, fast and simple classification system for the grading of facial palsy (FP) is lacking. Methods: An observational single center study was performed. 4572 photographs of 233 patients with unilateral peripheral FP were subjectively rated and automatically analyzed applying a machine learning approach including Supervised Descent Method. This allowed an automated grading of all photographs according to House-Brackmann grading scale (HB), Sunnybrook grading system (SB), and Stennert index (SI). Results: Median time to first assessment was 6 days after onset. At first examination, the median objective HB, total SB, and total SI were grade 3, 45, and 5, respectively. The best correlation between subjective and objective grading was seen for SB and SI movement score (r = 0.746; r = 0.732, respectively). No agreement was found between subjective and objective HB grading [Test for symmetry 80.61, df = 15, p < 0.001, weighted kappa = − 0.0105; 95% confidence interval (CI) = − 0.0542 to 0.0331; p = 0.6541]. Also no agreement was found between subjective and objective total SI (test for symmetry 166.37, df = 55, p < 0.001) although there was a nonzero weighted kappa = 0.2670; CI 0.2154–0.3186; p < 0.0001). Based on a multinomial logistic regression the probability for higher scores was higher for subjective compared to objective SI (OR 1.608; CI 1.202–2.150; p = 0.0014). The best agreement was seen between subjective and objective SB (ICC = 0.34645). Conclusions: Automated Sunnybrook grading delivered with fair agreement fast and objective global and regional data on facial motor function for use in clinical routine and clinical trials. [ABSTRACT FROM AUTHOR]

Published
2019
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246. Effects of late cyclosporine withdrawal on renal graft function and survival

Author

Pagonas, Nikolaos, primary, Yusefi, Kourosh, additional, Seibert, Felix S., additional, Bauer, Frederic, additional, Markakis, Konstantinos, additional, Sasko, Benjamin, additional, Zidek, Walter, additional, Götze, Theresa, additional, Schlattmann, Peter, additional, Viebahn, Richard, additional, Babel, Nina, additional, and Westhoff, Timm H., additional

Published
2018
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247. (1,3)-β-D-glucan-based diagnosis of invasive Candida infection versus culture-based diagnosis in patients with sepsis and with an increased risk of invasive Candida infection (CandiSep): study protocol for a randomized controlled trial

Author

Bloos, Frank, primary, Held, Jürgen, additional, Schlattmann, Peter, additional, Brillinger, Nicole, additional, Kurzai, Oliver, additional, Cornely, Oliver A., additional, and Thomas-Rüddel, Daniel, additional

Published
2018
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