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1. Improvement in Stage of Lung Cancer Diagnosis With Incidental Pulmonary Nodules Followed With a Patient Tracking System and Computerized Registry

Author

Laurie L. Carr, MD, Debra S. Dyer, MD, Pearlanne T. Zelarney, MS, and Elizabeth O. Kern, MD, MS

Subjects
Incidental pulmonary nodules, Lung cancer screening, Lung nodule follow-up, Lung nodule registry and tracking, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Introduction: Given that an incidental pulmonary nodule (IPN) on chest computed tomography (CT) may represent nascent lung cancer, timely follow-up imaging is critical to assess nodule growth and the need for tissue sampling. We previously reported our institution’s systematic process to identify and track patients with an IPN associated with improved CT on follow-up. We hypothesized that this improvement may have led to a higher frequency of early-stage lung cancer. To evaluate this, we performed a study to determine whether cases of early-stage lung cancer were more likely to have had our tracking system applied to suspicious findings. Methods: An observational study was performed by identifying cases of lung cancer that were detected as IPNs on chest CT scans performed at our institution, from 2006 to 2016. A total of 314 cases were dichotomized into early-stage (stage 1) or late-stage (stages II to IV) disease. A multivariant regression analysis with modeling was used to determine factors associated with a diagnosis of early-stage disease. Factors included the use of the tracking system and nodule registry. Results: The following factors were independently associated with early-stage lung cancer: index nodule diameter, (OR = 0.971, confidence interval [CI]: 0.948–0.995], p = 0.016), adenocarcinoma histology (OR = 2.930 [CI: 1.695–5.064], p = 0.0001) and use of tracker phrases on CT reports (OR = 1.939 [CI: 1.126–3.339], p = 0.016). Conclusions: The application of a patient tracking system and computerized lung nodule registry lead to an increased frequency in the diagnosis of stage 1 NSCLC from IPNs. This is a meaningful outcome for patients and should be adapted for IPN management.

Published
2022
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2. Improvement in Stage of Lung Cancer Diagnosis With Incidental Pulmonary Nodules Followed With a Patient Tracking System and Computerized Registry

Author

Laurie L. Carr, Debra S. Dyer, Pearlanne T. Zelarney, and Elizabeth O. Kern

Subjects
Pulmonary and Respiratory Medicine, Oncology
Abstract

Given that an incidental pulmonary nodule (IPN) on chest computed tomography (CT) may represent nascent lung cancer, timely follow-up imaging is critical to assess nodule growth and the need for tissue sampling. We previously reported our institution's systematic process to identify and track patients with an IPN associated with improved CT on follow-up. We hypothesized that this improvement may have led to a higher frequency of early-stage lung cancer. To evaluate this, we performed a study to determine whether cases of early-stage lung cancer were more likely to have had our tracking system applied to suspicious findings.An observational study was performed by identifying cases of lung cancer that were detected as IPNs on chest CT scans performed at our institution, from 2006 to 2016. A total of 314 cases were dichotomized into early-stage (stage 1) or late-stage (stages II to IV) disease. A multivariant regression analysis with modeling was used to determine factors associated with a diagnosis of early-stage disease. Factors included the use of the tracking system and nodule registry.The following factors were independently associated with early-stage lung cancer: index nodule diameter, (OR = 0.971, confidence interval [CI]: 0.948-0.995],The application of a patient tracking system and computerized lung nodule registry lead to an increased frequency in the diagnosis of stage 1 NSCLC from IPNs. This is a meaningful outcome for patients and should be adapted for IPN management.

Published
2021

3. Narrow linewidth semiconductor DFB laser with linear frequency modulation for FMCW LiDAR

Author

S. Boudreau, R. Korn, A. Babin, P. Chrétien, O. Kern, A. Desbiens, S. Ayotte, Michel Morin, E. Baumgart, É. Girard-Deschênes, F. Costin, L. P. Perron, M. Wichmann, N. Caspers, G. Paré-Olivier, and K. Bédard

Subjects
Distributed feedback laser, Optical fiber, Silicon photonics, Materials science, business.industry, Laser, Semiconductor laser theory, law.invention, Laser linewidth, Optics, Lidar, law, business, Frequency modulation
Abstract

Monolithic distributed feedback semiconductor lasers (1550 nm) for FMCW LiDAR applications have been designed, fabricated and tested. The strong optical frequency modulation distortion observed when a standard DFB laser is modulated with a triangular current waveform is significantly mitigated in our laser. A 100 kHz frequency modulation with amplitude of 0.9 GHz and nonlinear distortion of 0.3%, calculated as the standard deviation of the optical frequency after removal of a linear fit, was measured through an unbalanced fiber interferometer. This was achieved without electronic pre-distortion of the triangular waveform. The 60 kHz intrinsic linewidth of the laser was unaffected by the modulation. Two lasers were co-packaged in a 2.6 cm3 multi-layer ceramic package and coupled to fiber pigtails with micro-lenses. The pins of the ceramic package were soldered to a printed circuit board containing the current sources driving the lasers. This optical source was used in a two-channel LiDAR demonstrator built from off-the-shelf fiber optic components and a twodimensional gimbal scanning mirror. This demonstrator enabled detecting a target with 10 % Lambertian reflectivity up to a distance of >120 m and recording point clouds of different scenes. This shows that FMCW LiDAR in combination with highly coherent and linear DFB laser sources is a very promising technology for long range sensing. A version under development will include a silicon photonics chip for further integration and functionality including I/Q detection.

Published
2021
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4. Development and Implementation of Team-Based Panel Management Tools: Filling the Gap between Patient and Population Information Systems

Author

Amy Hirsch Shumaker, Brook Watts, Renée H. Lawrence, Paul E. Drawz, Elizabeth F. O. Kern, and Cameron Carter

Subjects
Medical home, Quality management, Process management, Leadership and Management, Population, Population health, 03 medical and health sciences, 0302 clinical medicine, Nursing, Patient-Centered Care, Information system, Electronic Health Records, Medicine, 030212 general & internal medicine, Program Development, education, Patient Care Team, education.field_of_study, Delivery of Health Care, Integrated, business.industry, End user, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, Information technology, Work (electrical), Models, Organizational, Hospital Information Systems, 0305 other medical science, business
Abstract

Effective team-based models of care, such as the Patient-Centered Medical Home, require electronic tools to support proactive population management strategies that emphasize care coordination and quality improvement. Despite the spread of electronic health records (EHRs) and vendors marketing population health tools, clinical practices still may lack the ability to have: (1) local control over types of data collected/reports generated, (2) timely data (eg, up-to-date data, not several months old), and accordingly (3) the ability to efficiently monitor and improve patient outcomes. This article describes a quality improvement project at the hospital system level to develop and implement a flexible panel management (PM) tool to improve care of subpopulations of patients (eg, panels of patients with diabetes) by clinical teams. An in-depth case analysis approach is used to explore barriers and facilitators in building a PM registry tool for team-based management needs using standard data elements (eg, laboratory values, pharmacy records) found in EHRs. Also described are factors that may contribute to sustainability; to date the tool has been adapted to 6 disease-focused subpopulations encompassing more than 200,000 patients. Two key lessons emerged from this initiative: (1) though challenging, team-based clinical end users and information technology needed to work together consistently to refine the product, and (2) locally developed population management tools can provide efficient data tracking for frontline clinical teams and leadership. The preliminary work identified critical gaps that were successfully addressed by building local PM registry tools from EHR-derived data and offers lessons learned for others engaged in similar work. (Population Health Management 2016;19:232-239).

Published
2016
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6. Unter Blaujacken : Seeabenteuer

Author

J. H. O. Kern and J. H. O. Kern

Abstract

Ernste und heitere Geschichten aus dem Leben deutscher Seeleute, Band 2. Inhalt:Tolles Wetter und ein toller MenschDie Verteidigung der'Antilope'Die Plünderung der'Sigismund'Knecht, Neffe und Erbe In neuer deutscher Rechtschreibung und Korrektur gelesen.

Published
2018

7. Auf hoher See : Seeabenteuer

Author

J. H. O. Kern and J. H. O. Kern

Abstract

Ernste und heitere Geschichten aus dem Leben deutscher Seeleute, Band 1. Inhalt:Im'Passat'Der beherzte deutsche SchiffsjungeDas gestörte SedanfestBestrafung eines MördersDer jugendliche Leichtsinn rächt sich bitterMit einem Kriegsboot auf der LauerGott beugt den StarrsinnPeter Fretwurst In neuer deutscher Rechtschreibung und Korrektur gelesen.

Published
2018

8. The Pathologized Counselor: Effectively Integrating Vulnerability and Professional Identity

Author

Erin O. Kern

Subjects
education.field_of_study, business.industry, media_common.quotation_subject, Population, Applied psychology, Vulnerability, Identity (social science), Cognitive reframing, Relational-cultural therapy, Public relations, Creativity, Mental health, Psychiatry and Mental health, Clinical Psychology, Narrative, business, education, Psychology, media_common
Abstract

PERSPECTIVES is a special feature included in this issue of Journal of Creativity in Mental Health that provides mental health professionals with an opportunity to discuss their positions on a variety of creativity related topics. In this article, Erin Kern, a doctoral candidate, shares her perspective on the importance of integrating counselor vulnerability and professional identity.Counselors are often expected to represent the “normal” population, impervious to having their own mental health issues. However, many counselors are wounded healers, struggling to achieve integration of their own vulnerabilities with their professional identity. This article focuses on the importance of such integration to accomplish greater levels of authenticity in counseling, working, and supervisory relationships. The introduction of the superhero narrative facilitates the awareness that counselors can reframe instances of vulnerability as an opportunity for authenticity, bravery, and strength. The acknowledgment and own...

Published
2014
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9. Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

Author

Klionsky, D.J. Abdelmohsen, K. Abe, A. Abedin, M.J. Abeliovich, H. Arozena, A.A. Adachi, H. Adams, C.M. Adams, P.D. Adeli, K. Adhihetty, P.J. Adler, S.G. Agam, G. Agarwal, R. Aghi, M.K. Agnello, M. Agostinis, P. Aguilar, P.V. Aguirre-Ghiso, J. Airoldi, E.M. Ait-Si-Ali, S. Akematsu, T. Akporiaye, E.T. Al-Rubeai, M. Albaiceta, G.M. Albanese, C. Albani, D. Albert, M.L. Aldudo, J. Algül, H. Alirezaei, M. Alloza, I. Almasan, A. Almonte-Beceril, M. Alnemri, E.S. Alonso, C. Altan-Bonnet, N. Altieri, D.C. Alvarez, S. Alvarez-Erviti, L. Alves, S. Amadoro, G. Amano, A. Amantini, C. Ambrosio, S. Amelio, I. Amer, A.O. Amessou, M. Amon, A. An, Z. Anania, F.A. Andersen, S.U. Andley, U.P. Andreadi, C.K. Andrieu-Abadie, N. Anel, A. Ann, D.K. Anoopkumar-Dukie, S. Antonioli, M. Aoki, H. Apostolova, N. Aquila, S. Aquilano, K. Araki, K. Arama, E. Aranda, A. Araya, J. Arcaro, A. Arias, E. Arimoto, H. Ariosa, A.R. Armstrong, J.L. Arnould, T. Arsov, I. Asanuma, K. Askanas, V. Asselin, E. Atarashi, R. Atherton, S.S. Atkin, J.D. Attardi, L.D. Auberger, P. Auburger, G. Aurelian, L. Autelli, R. Avagliano, L. Avantaggiati, M.L. Avrahami, L. Azad, N. Awale, S. Bachetti, T. Backer, J.M. Bae, D.-H. Bae, J.-S. Bae, O.-N. Bae, S.H. Baehrecke, E.H. Baek, S.-H. Baghdiguian, S. Bagniewska-Zadworna, A. Bai, H. Bai, J. Bai, X.-Y. Bailly, Y. Balaji, K.N. Balduini, W. Ballabio, A. Balzan, R. Banerjee, R. Bánhegyi, G. Bao, H. Barbeau, B. Barrachina, M.D. Barreiro, E. Bartel, B. Bartolomé, A. Bassham, D.C. Bassi, M.T. Bast, R.C., Jr. Basu, A. Batista, M.T. Batoko, H. Battino, M. Bauckman, K. Baumgarner, B.L. Bayer, K.U. Beale, R. Beaulieu, J.-F. Beck, G.R., Jr. Becker, C. Beckham, J.D. Bédard, P.-A. Bednarski, P.J. Begley, T.J. Behl, C. Behrends, C. Behrens, G.M.N. Behrns, K.E. Bejarano, E. Belaid, A. Belleudi, F. Bénard, G. Berchem, G. Bergamaschi, D. Bergami, M. Berkhout, B. Berliocchi, L. Bernard, A. Bernard, M. Bernassola, F. Bertolotti, A. Bess, A.S. Besteiro, S. Bettuzzi, S. Bhalla, S. Bhattacharyya, S. Bhutia, S.K. Biagosch, C. Bianchi, M.W. Biard-Piechaczyk, M. Billes, V. Bincoletto, C. Bingol, B. Bird, S.W. Bitoun, M. Bjedov, I. Blackstone, C. Blanc, L. Blanco, G.A. Blomhoff, H.K. Boada-Romero, E. Böckler, S. Boes, M. Boesze-Battaglia, K. Boise, L.H. Bolino, A. Boman, A. Bonaldo, P. Bordi, M. Bosch, J. Botana, L.M. Botti, J. Bou, G. Bouché, M. Bouchecareilh, M. Boucher, M.-J. Boulton, M.E. Bouret, S.G. Boya, P. Boyer-Guittaut, M. Bozhkov, P.V. Brady, N. Braga, V.M.M. Brancolini, C. Braus, G.H. Bravo-San-Pedro, J.M. Brennan, L.A. Bresnick, E.H. Brest, P. Bridges, D. Bringer, M.-A. Brini, M. Brito, G.C. Brodin, B. Brookes, P.S. Brown, E.J. Brown, K. Broxmeyer, H.E. Bruhat, A. Brum, P.C. Brumell, J.H. Brunetti-Pierri, N. Bryson-Richardson, R.J. Buch, S. Buchan, A.M. Budak, H. Bulavin, D.V. Bultman, S.J. Bultynck, G. Bumbasirevic, V. Burelle, Y. Burke, R.E. Burmeister, M. Bütikofer, P. Caberlotto, L. Cadwell, K. Cahova, M. Cai, D. Cai, J. Cai, Q. Calatayud, S. Camougrand, N. Campanella, M. Campbell, G.R. Campbell, M. Campello, S. Candau, R. Caniggia, I. Cantoni, L. Cao, L. Caplan, A.B. Caraglia, M. Cardinali, C. Cardoso, S.M. Carew, J.S. Carleton, L.A. Carlin, C.R. Carloni, S. Carlsson, S.R. Carmona-Gutierrez, D. Carneiro, L.A.M. Carnevali, O. Carra, S. Carrier, A. Carroll, B. Casas, C. Casas, J. Cassinelli, G. Castets, P. Castro-Obregon, S. Cavallini, G. Ceccherini, I. Cecconi, F. Cederbaum, A.I. Ceña, V. Cenci, S. Cerella, C. Cervia, D. Cetrullo, S. Chaachouay, H. Chae, H.-J. Chagin, A.S. Chai, C.-Y. Chakrabarti, G. Chamilos, G. Chan, E.Y.W. Chan, M.T.V. Chandra, D. Chandra, P. Chang, C.-P. Chang, R.C.-C. Chang, T.Y. Chatham, J.C. Chatterjee, S. Chauhan, S. Che, Y. Cheetham, M.E. Cheluvappa, R. Chen, C.-J. Chen, G. Chen, G.-C. Chen, G. Chen, H. Chen, J.W. Chen, J.-K. Chen, M. Chen, M. Chen, P. Chen, Q. Chen, Q. Chen, S.-D. Chen, S. Chen, S.S.-L. Chen, W. Chen, W.-J. Chen, W.Q. Chen, W. Chen, X. Chen, Y.-H. Chen, Y.-G. Chen, Y. Chen, Y. Chen, Y. Chen, Y.-J. Chen, Y.-Q. Chen, Y. Chen, Z. Chen, Z. Cheng, A. Cheng, C.H.K. Cheng, H. Cheong, H. Cherry, S. Chesney, J. Cheung, C.H.A. Chevet, E. Chi, H.C. Chi, S.-G. Chiacchiera, F. Chiang, H.-L. Chiarelli, R. Chiariello, M. Chieppa, M. Chin, L.-S. Chiong, M. Chiu, G.N.C. Cho, D.-H. Cho, S.-G. Cho, W.C. Cho, Y.-Y. Cho, Y.-S. Choi, A.M.K. Choi, E.-J. Choi, E.-K. Choi, J. Choi, M.E. Choi, S.-I. Chou, T.-F. Chouaib, S. Choubey, D. Choubey, V. Chow, K.-C. Chowdhury, K. Chu, C.T. Chuang, T.-H. Chun, T. Chung, H. Chung, T. Chung, Y.-L. Chwae, Y.-J. Cianfanelli, V. Ciarcia, R. Ciechomska, I.A. Ciriolo, M.R. Cirone, M. Claerhout, S. Clague, M.J. Cl� ria, J. Clarke, P.G.H. Clarke, R. Clementi, E. Cleyrat, C. Cnop, M. Coccia, E.M. Cocco, T. Codogno, P. Coers, J. Cohen, E.E.W. Colecchia, D. Coletto, L. Coll, N.S. Colucci-Guyon, E. Comincini, S. Condello, M. Cook, K.L. Coombs, G.H. Cooper, C.D. Cooper, J.M. Coppens, I. Corasaniti, M.T. Corazzari, M. Corbalan, R. Corcelle-Termeau, E. Cordero, M.D. Corral-Ramos, C. Corti, O. Cossarizza, A. Costelli, P. Costes, S. Cotman, S.L. Coto-Montes, A. Cottet, S. Couve, E. Covey, L.R. Cowart, L.A. Cox, J.S. Coxon, F.P. Coyne, C.B. Cragg, M.S. Craven, R.J. Crepaldi, T. Crespo, J.L. Criollo, A. Crippa, V. Cruz, M.T. Cuervo, A.M. Cuezva, J.M. Cui, T. Cutillas, P.R. Czaja, M.J. Czyzyk-Krzeska, M.F. Dagda, R.K. Dahmen, U. Dai, C. Dai, W. Dai, Y. Dalby, K.N. Valle, L.D. Dalmasso, G. D'amelio, M. Damme, M. Darfeuille-Michaud, A. Dargemont, C. Darley-Usmar, V.M. Dasarathy, S. Dasgupta, B. Dash, S. Dass, C.R. Davey, H.M. Davids, L.M. Dávila, D. Davis, R.J. Dawson, T.M. Dawson, V.L. Daza, P. de Belleroche, J. de Figueiredo, P. de Figueiredo, R.C.B.Q. de la Fuente, J. De Martino, L. De Matteis, A. De Meyer, G.R.Y. De Milito, A. De Santi, M. de Souza, W. De Tata, V. De Zio, D. Debnath, J. Dechant, R. Decuypere, J.-P. Deegan, S. Dehay, B. Del Bello, B. Del Re, D.P. Delage-Mourroux, R. Delbridge, L.M.D. Deldicque, L. Delorme-Axford, E. Deng, Y. Dengjel, J. Denizot, M. Dent, P. Der, C.J. Deretic, V. Derrien, B. Deutsch, E. Devarenne, T.P. Devenish, R.J. Di Bartolomeo, S. Di Daniele, N. Di Domenico, F. Di Nardo, A. Di Paola, S. Di Pietro, A. Di Renzo, L. Di Antonio, A. Díaz-Araya, G. Díaz-Laviada, I. Diaz-Meco, M.T. Diaz-Nido, J. Dickey, C.A. Dickson, R.C. Diederich, M. Digard, P. Dikic, I. Dinesh-Kumar, S.P. Ding, C. Ding, W.-X. Ding, Z. Dini, L. Distler, J.H.W. Diwan, A. Djavaheri-Mergny, M. Dmytruk, K. Dobson, R.C.J. Doetsch, V. Dokladny, K. Dokudovskaya, S. Donadelli, M. Dong, X.C. Dong, X. Dong, Z. Donohue, T.M., Jr. Donohue-Jr, T.M. Doran, K.S. D'orazi, G. Dorn, G.W., II Dosenko, V. Dridi, S. Drucker, L. Du, J. Du, L.-L. Du, L. du Toit, A. Dua, P. Duan, L. Duann, P. Dubey, V.K. Duchen, M.R. Duchosal, M.A. Duez, H. Dugail, I. Dumit, V.I. Duncan, M.C. Dunlop, E.A. Dunn, W.A., Jr. Dupont, N. Dupuis, L. Durán, R.V. Durcan, T.M. Duvezin-Caubet, S. Duvvuri, U. Eapen, V. Ebrahimi-Fakhari, D. Echard, A. Eckhart, L. Edelstein, C.L. Edinger, A.L. Eichinger, L. Eisenberg, T. Eisenberg-Lerner, A. Eissa, N.T. El-Deiry, W.S. El-Khoury, V. Elazar, Z. Eldar-Finkelman, H. Elliott, C.J.H. Emanuele, E. Emmenegger, U. Engedal, N. Engelbrecht, A.-M. Engelender, S. Enserink, J.M. Erdmann, R. Erenpreisa, J. Eri, R. Eriksen, J.L. Erman, A. Escalante, R. Eskelinen, E.-L. Espert, L. Esteban-Martínez, L. Evans, T.J. Fabri, M. Fabrias, G. Fabrizi, C. Facchiano, A. Færgeman, N.J. Faggioni, A. Fairlie, W.D. Fan, C. Fan, D. Fan, J. Fang, S. Fanto, M. Fanzani, A. Farkas, T. Faure, M. Favier, F.B. Fearnhead, H. Federici, M. Fei, E. Felizardo, T.C. Feng, H. Feng, Y. Feng, Y. Ferguson, T.A. Fernández, Á.F. Fernandez-Barrena, M.G. Fernandez-Checa, J.C. Fernández-López, A. Fernandez-Zapico, M.E. Feron, O. Ferraro, E. Ferreira-Halder, C.V. Fesus, L. Feuer, R. Fiesel, F.C. Filippi-Chiela, E.C. Filomeni, G. Fimia, G.M. Fingert, J.H. Finkbeiner, S. Finkel, T. Fiorito, F. Fisher, P.B. Flajolet, M. Flamigni, F. Florey, O. Florio, S. Floto, R.A. Folini, M. Follo, C. Fon, E.A. Fornai, F. Fortunato, F. Fraldi, A. Franco, R. Francois, A. François, A. Frankel, L.B. Fraser, I.D.C. Frey, N. Freyssenet, D.G. Frezza, C. Friedman, S.L. Frigo, D.E. Fu, D. Fuentes, J.M. Fueyo, J. Fujitani, Y. Fujiwara, Y. Fujiya, M. Fukuda, M. Fulda, S. Fusco, C. Gabryel, B. Gaestel, M. Gailly, P. Gajewska, M. Galadari, S. Galili, G. Galindo, I. Galindo, M.F. Galliciotti, G. Galluzzi, L. Galluzzi, L. Galy, V. Gammoh, N. Gandy, S. Ganesan, A.K. Ganesan, S. Ganley, I.G. Gannagé, M. Gao, F.-B. Gao, F. Gao, J.-X. Nannig, L.G. Véscovi, E.G. Garcia-Macía, M. Garcia-Ruiz, C. Garg, A.D. Garg, P.K. Gargini, R. Gassen, N.C. Gatica, D. Gatti, E. Gavard, J. Gavathiotis, E. Ge, L. Ge, P. Ge, S. Gean, P.-W. Gelmetti, V. Genazzani, A.A. Geng, J. Genschik, P. Gerner, L. Gestwicki, J.E. Gewirtz, D.A. Ghavami, S. Ghigo, E. Ghosh, D. Giammarioli, A.M. Giampieri, F. Giampietri, C. Giatromanolaki, A. Gibbings, D.J. Gibellini, L. Gibson, S.B. Ginet, V. Giordano, A. Giorgini, F. Giovannetti, E. Girardin, S.E. Gispert, S. Giuliano, S. Gladson, C.L. Glavic, A. Gleave, M. Godefroy, N. Gogal, R.M., Jr. Gokulan, K. Goldman, G.H. Goletti, D. Goligorsky, M.S. Gomes, A.V. Gomes, L.C. Gomez, H. Gomez-Manzano, C. Gómez-Sánchez, R. Gonçalves, D.A.P. Goncu, E. Gong, Q. Gongora, C. Gonzalez, C.B. Gonzalez-Alegre, P. Gonzalez-Cabo, P. González-Polo, R.A. Goping, I.S. Gorbea, C. Gorbunov, N.V. Goring, D.R. Gorman, A.M. Gorski, S.M. Goruppi, S. Goto-Yamada, S. Gotor, C. Gottlieb, R.A. Gozes, I. Gozuacik, D. Graba, Y. Graef, M. Granato, G.E. Grant, G.D. Grant, S. Gravina, G.L. Green, D.R. Greenhough, A. Greenwood, M.T. Grimaldi, B. Gros, F. Grose, C. Groulx, J.-F. Gruber, F. Grumati, P. Grune, T. Guan, J.-L. Guan, K.-L. Guerra, B. Guillen, C. Gulshan, K. Gunst, J. Guo, C. Guo, L. Guo, M. Guo, W. Guo, X.-G. Gust, A.A. Gustafsson, Å.B. Gutierrez, E. Gutierrez, M.G. Gwak, H.-S. Haas, A. Haber, J.E. Hadano, S. Hagedorn, M. Hahn, D.R. Halayko, A.J. 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Zhang, J. Zhang, J.-P. Zhang, L. Zhang, L. Zhang, L. Zhang, M.-Y. Zhang, X. Zhang, X.D. Zhang, Y. Zhang, Y. Zhang, Y. Zhang, Y. Zhang, Y. Zhao, M. Zhao, W.-L. Zhao, X. Zhao, Y.G. Zhao, Y. Zhao, Y. Zhao, Y.-X. Zhao, Z. Zhao, Z.J. Zheng, D. Zheng, X.-L. Zheng, X. Zhivotovsky, B. Zhong, Q. Zhou, G.-Z. Zhou, G. Zhou, H. Zhou, S.-F. Zhou, X.-J. Zhu, H. Zhu, H. Zhu, W.-G. Zhu, W. Zhu, X.-F. Zhu, Y. Zhuang, S.-M. Zhuang, X. Ziparo, E. Zois, C.E. Zoladek, T. Zong, W.-X. Zorzano, A. Zughaier, S.M.

Published
2016

10. Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)

Author

Klionsky, D.J. Abdelmohsen, K. Abe, A. Abedin, M.J. Abeliovich, H. Arozena, A.A. Adachi, H. Adams, C.M. Adams, P.D. Adeli, K. Adhihetty, P.J. Adler, S.G. Agam, G. Agarwal, R. Aghi, M.K. Agnello, M. Agostinis, P. Aguilar, P.V. Aguirre-Ghiso, J. Airoldi, E.M. Ait-Si-Ali, S. Akematsu, T. Akporiaye, E.T. Al-Rubeai, M. Albaiceta, G.M. Albanese, C. Albani, D. Albert, M.L. Aldudo, J. Algül, H. Alirezaei, M. Alloza, I. Almasan, A. Almonte-Beceril, M. Alnemri, E.S. Alonso, C. Altan-Bonnet, N. Altieri, D.C. Alvarez, S. Alvarez-Erviti, L. Alves, S. Amadoro, G. Amano, A. Amantini, C. Ambrosio, S. Amelio, I. Amer, A.O. Amessou, M. Amon, A. An, Z. Anania, F.A. Andersen, S.U. Andley, U.P. Andreadi, C.K. Andrieu-Abadie, N. Anel, A. Ann, D.K. Anoopkumar-Dukie, S. Antonioli, M. Aoki, H. Apostolova, N. Aquila, S. Aquilano, K. Araki, K. Arama, E. Aranda, A. Araya, J. Arcaro, A. Arias, E. Arimoto, H. Ariosa, A.R. Armstrong, J.L. Arnould, T. Arsov, I. Asanuma, K. Askanas, V. Asselin, E. Atarashi, R. Atherton, S.S. Atkin, J.D. Attardi, L.D. Auberger, P. Auburger, G. Aurelian, L. Autelli, R. Avagliano, L. Avantaggiati, M.L. Avrahami, L. Azad, N. Awale, S. Bachetti, T. Backer, J.M. Bae, D.-H. Bae, J.-S. Bae, O.-N. Bae, S.H. Baehrecke, E.H. Baek, S.-H. Baghdiguian, S. Bagniewska-Zadworna, A. Bai, H. Bai, J. Bai, X.-Y. Bailly, Y. Balaji, K.N. Balduini, W. Ballabio, A. Balzan, R. Banerjee, R. Bánhegyi, G. Bao, H. Barbeau, B. Barrachina, M.D. Barreiro, E. Bartel, B. Bartolomé, A. Bassham, D.C. Bassi, M.T. Bast, R.C., Jr. Basu, A. Batista, M.T. Batoko, H. Battino, M. Bauckman, K. Baumgarner, B.L. Bayer, K.U. Beale, R. Beaulieu, J.-F. Beck, G.R., Jr. Becker, C. Beckham, J.D. Bédard, P.-A. Bednarski, P.J. Begley, T.J. Behl, C. Behrends, C. Behrens, G.M.N. Behrns, K.E. Bejarano, E. Belaid, A. Belleudi, F. Bénard, G. Berchem, G. Bergamaschi, D. Bergami, M. Berkhout, B. Berliocchi, L. Bernard, A. Bernard, M. Bernassola, F. Bertolotti, A. Bess, A.S. Besteiro, S. Bettuzzi, S. Bhalla, S. Bhattacharyya, S. Bhutia, S.K. Biagosch, C. Bianchi, M.W. Biard-Piechaczyk, M. Billes, V. Bincoletto, C. Bingol, B. Bird, S.W. Bitoun, M. Bjedov, I. Blackstone, C. Blanc, L. Blanco, G.A. Blomhoff, H.K. Boada-Romero, E. Böckler, S. Boes, M. Boesze-Battaglia, K. Boise, L.H. Bolino, A. Boman, A. Bonaldo, P. Bordi, M. Bosch, J. Botana, L.M. Botti, J. Bou, G. Bouché, M. Bouchecareilh, M. Boucher, M.-J. Boulton, M.E. Bouret, S.G. Boya, P. Boyer-Guittaut, M. Bozhkov, P.V. Brady, N. Braga, V.M.M. Brancolini, C. Braus, G.H. Bravo-San-Pedro, J.M. Brennan, L.A. Bresnick, E.H. Brest, P. Bridges, D. Bringer, M.-A. Brini, M. Brito, G.C. Brodin, B. Brookes, P.S. Brown, E.J. Brown, K. Broxmeyer, H.E. Bruhat, A. Brum, P.C. Brumell, J.H. Brunetti-Pierri, N. Bryson-Richardson, R.J. Buch, S. Buchan, A.M. Budak, H. Bulavin, D.V. Bultman, S.J. Bultynck, G. Bumbasirevic, V. Burelle, Y. Burke, R.E. Burmeister, M. Bütikofer, P. Caberlotto, L. Cadwell, K. Cahova, M. Cai, D. Cai, J. Cai, Q. Calatayud, S. Camougrand, N. Campanella, M. Campbell, G.R. Campbell, M. Campello, S. Candau, R. Caniggia, I. Cantoni, L. Cao, L. Caplan, A.B. Caraglia, M. Cardinali, C. Cardoso, S.M. Carew, J.S. Carleton, L.A. Carlin, C.R. Carloni, S. Carlsson, S.R. Carmona-Gutierrez, D. Carneiro, L.A.M. Carnevali, O. Carra, S. Carrier, A. Carroll, B. Casas, C. Casas, J. Cassinelli, G. Castets, P. Castro-Obregon, S. Cavallini, G. Ceccherini, I. Cecconi, F. Cederbaum, A.I. Ceña, V. Cenci, S. Cerella, C. Cervia, D. Cetrullo, S. Chaachouay, H. Chae, H.-J. Chagin, A.S. Chai, C.-Y. Chakrabarti, G. Chamilos, G. Chan, E.Y.W. Chan, M.T.V. Chandra, D. Chandra, P. Chang, C.-P. Chang, R.C.-C. Chang, T.Y. Chatham, J.C. Chatterjee, S. Chauhan, S. Che, Y. Cheetham, M.E. Cheluvappa, R. Chen, C.-J. Chen, G. Chen, G.-C. Chen, G. Chen, H. Chen, J.W. Chen, J.-K. Chen, M. Chen, M. Chen, P. Chen, Q. Chen, Q. Chen, S.-D. Chen, S. Chen, S.S.-L. Chen, W. Chen, W.-J. Chen, W.Q. Chen, W. Chen, X. Chen, Y.-H. Chen, Y.-G. Chen, Y. Chen, Y. Chen, Y. Chen, Y.-J. Chen, Y.-Q. Chen, Y. Chen, Z. Chen, Z. Cheng, A. Cheng, C.H.K. Cheng, H. Cheong, H. Cherry, S. Chesney, J. Cheung, C.H.A. Chevet, E. Chi, H.C. Chi, S.-G. Chiacchiera, F. Chiang, H.-L. Chiarelli, R. Chiariello, M. Chieppa, M. Chin, L.-S. Chiong, M. Chiu, G.N.C. Cho, D.-H. Cho, S.-G. Cho, W.C. Cho, Y.-Y. Cho, Y.-S. Choi, A.M.K. Choi, E.-J. Choi, E.-K. Choi, J. Choi, M.E. Choi, S.-I. Chou, T.-F. Chouaib, S. Choubey, D. Choubey, V. Chow, K.-C. Chowdhury, K. Chu, C.T. Chuang, T.-H. Chun, T. Chung, H. Chung, T. Chung, Y.-L. Chwae, Y.-J. Cianfanelli, V. Ciarcia, R. Ciechomska, I.A. Ciriolo, M.R. Cirone, M. Claerhout, S. Clague, M.J. Clària, J. Clarke, P.G.H. Clarke, R. Clementi, E. Cleyrat, C. Cnop, M. Coccia, E.M. Cocco, T. Codogno, P. Coers, J. Cohen, E.E.W. Colecchia, D. Coletto, L. Coll, N.S. Colucci-Guyon, E. Comincini, S. Condello, M. Cook, K.L. Coombs, G.H. Cooper, C.D. Cooper, J.M. Coppens, I. Corasaniti, M.T. Corazzari, M. Corbalan, R. Corcelle-Termeau, E. 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Pozuelo-Rubio, M. Prak, K. Prange, R. Prescott, M. Priault, M. Prince, S. Proia, R.L. Proikas-Cezanne, T. Prokisch, H. Promponas, V.J. Przyklenk, K. Puertollano, R. Pugazhenthi, S. Puglielli, L. Pujol, A. Puyal, J. Pyeon, D. Qi, X. Qian, W.-B. Qin, Z.-H. Qiu, Y. Qu, Z. Quadrilatero, J. Quinn, F. Raben, N. Rabinowich, H. Radogna, F. Ragusa, M.J. Rahmani, M. Raina, K. Ramanadham, S. Ramesh, R. Rami, A. Randall-Demllo, S. Randow, F. Rao, H. Rao, V.A. Rasmussen, B.B. Rasse, T.M. Ratovitski, E.A. Rautou, P.-E. Ray, S.K. Razani, B. Reed, B.H. Reggiori, F. Rehm, M. Reichert, A.S. Rein, T. Reiner, D.J. Reits, E. Ren, J. Ren, X. Renna, M. Reusch, J.E.B. Revuelta, J.L. Reyes, L. Rezaie, A.R. Richards, R.I. Richardson, R. Richetta, C. Riehle, M.A. Rihn, B.H. Rikihisa, Y. Riley, B.E. Rimbach, G. Rippo, M.R. Ritis, K. Rizzi, F. Rizzo, E. Roach, P.J. Robbins, J. Roberge, M. Roca, G. Roccheri, M.C. Rocha, S. Rodrigues, C.M.P. Rodríguez, C.I. de Cordoba, S.R. Rodriguez-Muela, N. Roelofs, J. Rogov, V.V. Rohn, T.T. Rohrer, B. Romanelli, D. Romani, L. Romano, P.S. Roncero, M.I.G. Rosa, J.L. Rosello, A. Rosen, K.V. Rosenstiel, P. Rost-Roszkowska, M. Roth, K.A. Roué, G. Rouis, M. Rouschop, K.M. Ruan, D.T. Ruano, D. Rubinsztein, D.C. Rucker, E.B., III Rudich, A. Rudolf, E. Rudolf, R. Ruegg, M.A. Ruiz-Roldan, C. Ruparelia, A.A. Rusmini, P. Russ, D.W. Russo, G.L. Russo, G. Russo, R. Rusten, T.E. Ryabovol, V. Ryan, K.M. Ryter, S.W. Sabatini, D.M. Sacher, M. Sachse, C. Sack, M.N. Sadoshima, J. Saftig, P. Sagi-Eisenberg, R. Sahni, S. Saikumar, P. Saito, T. Saitoh, T. Sakakura, K. Sakoh-Nakatogawa, M. Sakuraba, Y. Salazar-Roa, M. Salomoni, P. Saluja, A.K. Salvaterra, P.M. Salvioli, R. Samali, A. Sanchez, A.M.J. Sánchez-Alcázar, J.A. Sanchez-Prieto, R. Sandri, M. Sanjuan, M.A. Santaguida, S. Santambrogio, L. Santoni, G. Dos Santos, C.N. Saran, S. Sardiello, M. Sargent, G. Sarkar, P. Sarkar, S. Sarrias, M.R. Sarwal, M.M. Sasakawa, C. Sasaki, M. Sass, M. Sato, K. Sato, M. Satriano, J. Savaraj, N. Saveljeva, S. Schaefer, L. Schaible, U.E. Scharl, M. Schatzl, H.M. Schekman, R. Scheper, W. Schiavi, A. Schipper, H.M. Schmeisser, H. Schmidt, J. Schmitz, I. Schneider, B.E. Schneider, E.M. Schneider, J.L. Schon, E.A. Schönenberger, M.J. Schönthal, A.H. Schorderet, D.F. Schröder, B. Schuck, S. Schulze, R.J. Schwarten, M. Schwarz, T.L. Sciarretta, S. Scotto, K. Scovassi, A.I. Screaton, R.A. Screen, M. Seca, H. Sedej, S. Segatori, L. Segev, N. Seglen, P.O. Seguí-Simarro, J.M. Segura-Aguilar, J. Seiliez, I. Seki, E. Sell, C. Semenkovich, C.F. Semenza, G.L. Sen, U. Serra, A.L. Serrano-Puebla, A. Sesaki, H. Setoguchi, T. Settembre, C. Shacka, J.J. Shajahan-Haq, A.N. Shapiro, I.M. Sharma, S. She, H. Shen, C.-K.J. Shen, C.-C. Shen, H.-M. Shen, S. Shen, W. Sheng, R. Sheng, X. Sheng, Z.-H. Shepherd, T.G. Shi, J. Shi, Q. Shi, Q. Shi, Y. Shibutani, S. Shibuya, K. Shidoji, Y. Shieh, J.-J. Shih, C.-M. Shimada, Y. Shimizu, S. Shin, D.W. Shinohara, M.L. Shintani, M. Shintani, T. Shioi, T. Shirabe, K. Shiri-Sverdlov, R. Shirihai, O. Shore, G.C. Shu, C.-W. Shukla, D. Sibirny, A.A. Sica, V. Sigurdson, C.J. Sigurdsson, E.M. Sijwali, P.S. Sikorska, B. Silveira, W.A. Silvente-Poirot, S. Silverman, G.A. Simak, J. Simmet, T. Simon, A.K. Simon, H.-U. Simone, C. Simons, M. Simonsen, A. Singh, R. Singh, S.V. Singh, S.K. Sinha, D. Sinha, S. Sinicrope, F.A. Sirko, A. Sirohi, K. Sishi, B.J.N. Sittler, A. Siu, P.M. Sivridis, E. Skwarska, A. Slack, R. Slaninová, I. Slavov, N. Smaili, S.S. Smalley, K.S.M. Smith, D.R. Soenen, S.J. Soleimanpour, S.A. Solhaug, A. Somasundaram, K. Son, J.H. Sonawane, A. Song, C. Song, F. Song, H.K. Song, J.-X. Song, W. Soo, K.Y. Sood, A.K. Soong, T.W. Soontornniyomkij, V. Sorice, M. Sotgia, F. Soto-Pantoja, D.R. Sotthibundhu, A. Sousa, M.J. Spaink, H.P. Span, P.N. Spang, A. Sparks, J.D. Speck, P.G. Spector, S.A. Spies, C.D. Springer, W. Clair, D.S. Stacchiotti, A. Staels, B. Stang, M.T. Starczynowski, D.T. Starokadomskyy, P. Steegborn, C. Steele, J.W. Stefanis, L. Steffan, J. Stellrecht, C.M. Stenmark, H. Stepkowski, T.M. Stern, S.T. Stevens, C. Stockwell, B.R. Stoka, V. Storchova, Z. Stork, B. Stratoulias, V. Stravopodis, D.J. Strnad, P. Strohecker, A.M. Ström, A.-L. Stromhaug, P. Stulik, J. Su, Y.-X. Su, Z. Subauste, C.S. Subramaniam, S. Sue, C.M. Suh, S.W. Sui, X. Sukseree, S. Sulzer, D. Sun, F.-L. Sun, J. Sun, J. Sun, S.-Y. Sun, Y. Sun, Y. Sun, Y. Sundaramoorthy, V. Sung, J. Suzuki, H. Suzuki, K. Suzuki, N. Suzuki, T. Suzuki, Y.J. Swanson, M.S. Swanton, C. Swärd, K. Swarup, G. Sweeney, S.T. Sylvester, P.W. Szatmari, Z. Szegezdi, E. Szlosarek, P.W. Taegtmeyer, H. Tafani, M. Taillebourg, E. Tait, S.W.G. Takacs-Vellai, K. Takahashi, Y. Takáts, S. Takemura, G. Takigawa, N. Talbot, N.J. Tamagno, E. Tamburini, J. Tan, C.-P. Tan, L. Tan, M.L. Tan, M. Tan, Y.-J. Tanaka, K. Tanaka, M. Tang, D. Tang, D. Tang, G. Tanida, I. Tanji, K. Tannous, B.A. Tapia, J.A. Tasset-Cuevas, I. Tatar, M. Tavassoly, I. Tavernarakis, N. Taylor, A. Taylor, G.S. Taylor, G.A. Taylor, J.P. Taylor, M.J. Tchetina, E.V. Tee, A.R. Teixeira-Clerc, F. Telang, S. Tencomnao, T. Teng, B.-B. Teng, R.-J. Terro, F. Tettamanti, G. Theiss, A.L. Theron, A.E. Thomas, K.J. Thomé, M.P. Thomes, P.G. Thorburn, A. Thorner, J. Thum, T. Thumm, M. Thurston, T.L.M. Tian, L. Till, A. Ting, J.P.-Y. Ting, J.P.Y. Titorenko, V.I. Toker, L. Toldo, S. Tooze, S.A. Topisirovic, I. Torgersen, M.L. Torosantucci, L. Torriglia, A. Torrisi, M.R. Tournier, C. Towns, R. Trajkovic, V. Travassos, L.H. Triola, G. Tripathi, D.N. Trisciuoglio, D. Troncoso, R. Trougakos, I.P. Truttmann, A.C. Tsai, K.-J. Tschan, M.P. Tseng, Y.-H. Tsukuba, T. Tsung, A. Tsvetkov, A.S. Tu, S. Tuan, H.-Y. Tucci, M. Tumbarello, D.A. Turk, B. Turk, V. Turner, R.F.B. Tveita, A.A. Tyagi, S.C. Ubukata, M. Uchiyama, Y. Udelnow, A. Ueno, T. Umekawa, M. Umemiya-Shirafuji, R. Underwood, B.R. Ungermann, C. Ureshino, R.P. Ushioda, R. Uversky, V.N. Uzcátegui, N.L. Vaccari, T. Vaccaro, M.I. Váchová, L. Vakifahmetoglu-Norberg, H. Valdor, R. Valente, E.M. Vallette, F. Valverde, A.M. Van den Berghe, G. Van Den Bosch, L. van den Brink, G.R. van der Goot, F.G. van der Klei, I.J. van der Laan, L.J.W. van Doorn, W.G. van Egmond, M. van Golen, K.L. Van Kaer, L. Campagne, M.L. Vandenabeele, P. Vandenberghe, W. Vanhorebeek, I. Varela-Nieto, I. Vasconcelos, M.H. Vasko, R. Vavvas, D.G. Vega-Naredo, I. Velasco, G. Velentzas, A.D. Velentzas, P.D. Vellai, T. Vellenga, E. Vendelbo, M.H. Venkatachalam, K. Ventura, N. Ventura, S. Veras, P.S.T. Verdier, M. Vertessy, B.G. Viale, A. Vidal, M. Vieira, H.L.A. Vierstra, R.D. Vigneswaran, N. Vij, N. Vila, M. Villar, M. Villar, V.H. Villarroya, J. Vindis, C. Viola, G. Viscomi, M.T. Vitale, G. Vogl, D.T. Voitsekhovskaja, O.V. von Haefen, C. von Schwarzenberg, K. Voth, D.E. Vouret-Craviari, V. Vuori, K. Vyas, J.M. Waeber, C. Walker, C.L. Walker, M.J. Walter, J. Wan, L. Wan, X. Wang, B. Wang, C. Wang, C.-Y. Wang, C. Wang, C. Wang, C. Wang, D. Wang, F. Wang, F. Wang, G. Wang, H.-J. Wang, H. Wang, H.-G. Wang, H. Wang, H.-D. Wang, J. Wang, J. Wang, M. Wang, M.-Q. Wang, P.-Y. Wang, P. Wang, R.C. Wang, S. Wang, T.-F. Wang, X. Wang, X.-J. Wang, X.-W. Wang, X. Wang, X. Wang, Y. Wang, Y. Wang, Y. Wang, Y.-J. Wang, Y. Wang, Y. Wang, Y.T. Wang, Y. Wang, Z.-N. Wappner, P. Ward, C. Ward, D.M.V. Warnes, G. Watada, H. Watanabe, Y. Watase, K. Weaver, T.E. Weekes, C.D. Wei, J. Weide, T. Weihl, C.C. Weindl, G. Weis, S.N. Wen, L. Wen, X. Wen, Y. Westermann, B. Weyand, C.M. White, A.R. White, E. Whitton, J.L. Whitworth, A.J. Wiels, J. Wild, F. Wildenberg, M.E. Wileman, T. Wilkinson, D.S. Wilkinson, S. Willbold, D. Williams, C. Williams, K. Williamson, P.R. Winklhofer, K.F. Witkin, S.S. Wohlgemuth, S.E. Wollert, T. Wolvetang, E.J. Wong, E. Wong, G.W. Wong, R.W. Wong, V.K.W. Woodcock, E.A. Wright, K.L. Wu, C. Wu, D. Wu, G.S. Wu, J. Wu, J. Wu, M. Wu, M. Wu, S. Wu, W.K.K. Wu, Y. Wu, Z. Xavier, C.P.R. Xavier, R.J. Xia, G.-X. Xia, T. Xia, W. Xia, Y. Xiao, H. Xiao, J. Xiao, S. Xiao, W. Xie, C.-M. Xie, Z. Xie, Z. Xilouri, M. Xiong, Y. Xu, C. Xu, C. Xu, F. Xu, H. Xu, H. Xu, J. Xu, J. Xu, J. Xu, L. Xu, X. Xu, Y. Xu, Y. Xu, Z.-X. Xu, Z. Xue, Y. Yamada, T. Yamamoto, A. Yamanaka, K. Yamashina, S. Yamashiro, S. Yan, B. Yan, B. Yan, X. Yan, Z. Yanagi, Y. Yang, D.-S. Yang, J.-M. Yang, L. Yang, M. Yang, P.-M. Yang, P. Yang, Q. Yang, W. Yang, W.Y. Yang, X. Yang, Y. Yang, Y. Yang, Z. Yang, Z. Yao, M.-C. Yao, P.J. Yao, X. Yao, Z. Yao, Z. Yasui, L.S. Ye, M. Yedvobnick, B. Yeganeh, B. Yeh, E.S. Yeyati, P.L. Yi, F. Yi, L. Yin, X.-M. Yip, C.K. Yoo, Y.-M. Yoo, Y.H. Yoon, S.-Y. Yoshida, K.-I. Yoshimori, T. Young, K.H. Yu, H. Yu, J.J. Yu, J.-T. Yu, J. Yu, L. Yu, W.H. Yu, X.-F. Yu, Z. Yuan, J. Yuan, Z.-M. Yue, B.Y.J.T. Yue, J. Yue, Z. Zacks, D.N. Zacksenhaus, E. Zaffaroni, N. Zaglia, T. Zakeri, Z. Zecchini, V. Zeng, J. Zeng, M. Zeng, Q. Zervos, A.S. Zhang, D.D. Zhang, F. Zhang, G. Zhang, G.-C. Zhang, H. Zhang, H. Zhang, H. Zhang, J. Zhang, J. Zhang, J. Zhang, J.-P. Zhang, L. Zhang, L. Zhang, L. Zhang, M.-Y. Zhang, X. Zhang, X.D. Zhang, Y. Zhang, Y. Zhang, Y. Zhang, Y. Zhang, Y. Zhao, M. Zhao, W.-L. Zhao, X. Zhao, Y.G. Zhao, Y. Zhao, Y. Zhao, Y.-X. Zhao, Z. Zhao, Z.J. Zheng, D. Zheng, X.-L. Zheng, X. Zhivotovsky, B. Zhong, Q. Zhou, G.-Z. Zhou, G. Zhou, H. Zhou, S.-F. Zhou, X.-J. Zhu, H. Zhu, H. Zhu, W.-G. Zhu, W. Zhu, X.-F. Zhu, Y. Zhuang, S.-M. Zhuang, X. Ziparo, E. Zois, C.E. Zoladek, T. Zong, W.-X. Zorzano, A. Zughaier, S.M.

Published
2016

11. Diabetes Nurse Case Management Training Program: Enhancing Care Consistent With the Chronic Care and Patient-Centered Medical Home Models

Author

Sharon A. Watts, Renée H. Lawrence, and Elizabeth F O Kern

Subjects
Chronic care, Medical home, medicine.medical_specialty, Quality management, business.industry, Endocrinology, Diabetes and Metabolism, Collaborative Care, Nursing, Intervention (counseling), Family medicine, Health care, Internal Medicine, Medicine, Outpatient clinic, business, Glycemic
Abstract

M any patients remain at high risk for diabetes complications because of poor glycemic control.1–4 Case management, defined as “the assignment of authority to a professional (the case manager) who is not the provider of direct health care, but who oversees and is responsible for coordinating and implementing care,”5 is an effective intervention to improve glycemic control.6–8 The use of nurses as case managers (NCMs) for patients with poor glycemic control follows the Chronic Care Model (CCM) of collaborative care in that a proactive approach is undertaken by the health care team to improve outcomes.9 Similarly, the use of NCMs is aligned with the core principles of the Patient-Centered Medical Home (PCMH) model (e.g., enhanced access and coordinated and comprehensive care).10,11 However, research findings have not always shown that NCMs improve clinical outcomes.12 A recent evaluation of the Kaiser Permanente Northern California's care management program suggests that an important consideration for achieving success in clinical outcomes is ensuring that the NCM program encourages needed intensification of medication regimens for patients.13 However, finding and hiring nurses previously trained in glucose pattern management, including having the knowledge to make specific recommendations about adjustment of hypoglycemic medications, may present a barrier to health care organizations seeking to implement an effective NCM program. This article describes an internal training program for NCMs to improve glycemic control for patients in the Cleveland Veterans Administration (VA) health care system. This quality improvement (QI) training project allowed existing nursing staff members to become diabetes NCMs by providing them with the necessary skills to help address the growing gap between the care needs of patients with diabetes and the level of diabetes expertise available. The Cleveland VA operates 12 community-based outpatient clinics in northeast Ohio, …

Published
2011
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12. Early Urinary Markers of Diabetic Kidney Disease: A Nested Case-Control Study From the Diabetes Control and Complications Trial (DCCT)

Author

Wanjie Sun, Elizabeth F. O. Kern, Miriam F. Weiss, Penny Erhard, and Saul Genuth

Subjects
Adult, Glycation End Products, Advanced, Male, medicine.medical_specialty, Adolescent, endocrine system diseases, Urology, Arginine, urologic and male genital diseases, Diabetic nephropathy, Young Adult, chemistry.chemical_compound, Predictive Value of Tests, Internal medicine, Diabetes mellitus, Acetylglucosaminidase, medicine, Albuminuria, Humans, Diabetic Nephropathies, Pentosidine, Type 1 diabetes, Proteinuria, business.industry, Lysine, nutritional and metabolic diseases, medicine.disease, female genital diseases and pregnancy complications, Diabetes Mellitus, Type 1, Endocrinology, chemistry, Nephrology, Case-Control Studies, Nested case-control study, Female, Microalbuminuria, medicine.symptom, business, Biomarkers
Abstract

Urinary markers were tested as predictors of macroalbuminuria or microalbuminuria in patients with type 1 diabetes.Nested case-control of participants in the Diabetes Control and Complications Trial (DCCT).87 cases of microalbuminuria were matched to 174 controls in a 1:2 ratio, while 4 cases were matched to 4 controls in a 1:1 ratio, resulting in 91 cases and 178 controls for microalbuminuria. 55 cases of macroalbuminuria were matched to 110 controls in a 1:2 ratio. Controls were free of micro-/macroalbuminuria when their matching case first developed micro-/macroalbuminuria.Urinary N-acetyl-beta-d-glucosaminidase (NAG), pentosidine, advanced glycation end product (AGE) fluorescence, and albumin excretion rate (AER).Incident microalbuminuria (2 consecutive annual AERs40 butor = 300 mg/d) or macroalbuminuria (AER300 mg/d).Stored urine samples from DCCT entry and 1-9 years later when macro- or microalbuminuria occurred were measured for the lysosomal enzyme NAG and the AGE pentosidine and AGE fluorescence. AER and adjustor variables were obtained from the DCCT.Submicroalbuminuric AER levels at baseline independently predicted microalbuminuria (adjusted OR, 1.83; P0.001) and macroalbuminuria (adjusted OR, 1.82; P0.001). Baseline NAG excretion independently predicted macroalbuminuria (adjusted OR, 2.26; P0.001) and microalbuminuria (adjusted OR, 1.86; P0.001). Baseline pentosidine excretion predicted macroalbuminuria (adjusted OR, 6.89; P = 0.002). Baseline AGE fluorescence predicted microalbuminuria (adjusted OR, 1.68; P = 0.02). However, adjusted for NAG excretion, pentosidine excretion and AGE fluorescence lost the predictive association with macroalbuminuria and microalbuminuria, respectively.Use of angiotensin-converting enzyme inhibitors was not directly ascertained, although their use was proscribed during the DCCT.Early in type 1 diabetes, repeated measurements of AER and urinary NAG excretion may identify individuals susceptible to future diabetic nephropathy. Combining the 2 markers may yield a better predictive model than either one alone. Renal tubule stress may be more severe, reflecting abnormal renal tubule processing of AGE-modified proteins, in individuals susceptible to diabetic nephropathy.

Published
2010
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13. Development and Validation of a Questionnaire to Assess Carbohydrate and Insulin-Dosing Knowledge in Youth With Type 1 Diabetes

Author

Mark R. Palmert, Michaela B. Koontz, Elaine A. Borawski, Elizabeth F O Kern, MaryAnn O'Riordan, Leona Cuttler, and Judy McConnell

Subjects
Male, Research design, medicine.medical_specialty, Educational measurement, Adolescent, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Test validity, Patient Education as Topic, Cronbach's alpha, Surveys and Questionnaires, Diabetes mellitus, Internal medicine, Dietary Carbohydrates, Internal Medicine, medicine, Humans, Insulin, Child, Original Research, Advanced and Specialized Nursing, Type 1 diabetes, Dose-Response Relationship, Drug, business.industry, Clinical Care/Education/Nutrition/Psychosocial Research, Reproducibility of Results, medicine.disease, Self Care, Diabetes Mellitus, Type 1, Knowledge, Endocrinology, Carbohydrate Metabolism Disorder, Educational Status, Female, Educational Measurement, business
Abstract

OBJECTIVE The American Diabetes Association advocates insulin regimens for youth with type 1 diabetes that involve adjusting insulin dose based on carbohydrate intake and blood glucose level. Implementing these regimens requires knowledge about carbohydrate content of foods and subsequent calculations of insulin dose, skills that may be difficult to gauge in practice. Therefore, we sought to develop and validate a questionnaire, the PedCarbQuiz (PCQ), to assess carbohydrate and insulin-dosing knowledge in youth with type 1 diabetes. RESEARCH DESIGN AND METHODS After development by an expert panel, the PCQ was administered to 75 youth with type 1 diabetes or their parents. Reliability was assessed by Cronbach α and split-half testing. To assess validity, scores were correlated with A1C, expert assessments, parent educational level, and complexity of insulin regimen. RESULTS PCQ mean score was 87 ± 9.7% (range 42–98%). Cronbach α was 0.88, and correlation of split halves was 0.59 (P < 0.0001). Higher PCQ scores correlated significantly with lower A1C (r = −0.29, P = 0.01) and expert assessments (r = 0.56, P < 0.001). Scores were significantly higher in parents with college degrees than in those without (P = 0.01) and in participants with more complex insulin regimens (P = 0.003). CONCLUSIONS The PCQ is a novel, easily administered instrument to assess knowledge about carbohydrates and insulin dosing calculations. Initial analyses support the reliability and validity of the PCQ.

Published
2009
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14. Building a Diabetes Registry from the Veterans Health Administration's Computerized Patient Record System

Author

Scott Beischel, Elizabeth F O Kern, Randal Stalnaker, Sharon A. Watts, Susan Kirsh, and David C. Aron

Subjects
Symposium, business.industry, Endocrinology, Diabetes and Metabolism, Biomedical Engineering, Bioengineering, Veterans health, medicine.disease, Patient record, World Wide Web, Disease registry, Diabetes mellitus, Internal Medicine, medicine, Medical emergency, business, Administration (government)
Abstract

Background: Little information is available describing how to implement a disease registry from an electronic patient record system. The aim of this report is to describe the technology, methods, and utility of a diabetes registry populated by the Veterans Health Information Systems Architecture (VistA), which underlies the computerized patient record system of the Veterans Health Administration (VHA) in Veteran Affairs Integrated Service Network 10 (VISN 10). Methods: VISN 10 data from VistA were mapped to a relational SQL-based data system using KB_SQL software. Operational definitions for diabetes, active clinical management, and responsible providers were used to create views of patient-level data in the diabetes registry. Query Analyzer was used to access the data views directly. Semicustomizable reports were created by linking the diabetes registry to a Web page using Microsoft asp.net2. A retrospective observational study design was used to analyze trends in the process of care and outcomes. Results: Since October 2001, 81,227 patients with diabetes have enrolled in VISN 10: approximately 42,000 are currently under active management by VISN 10 providers. By tracking primary care visits, we assigned 91% to a clinic group responsible for diabetes care. In the Cleveland Veterans Affairs Medical Center (VAMC), the frequency of mean annual hemoglobin A1c levels ≥9% has declined significantly over 5 years. Almost 4000 patients have been seen in diabetes intervention programs in the Cleveland VAMC over the past 4 years. Conclusions: A diabetes registry can be populated from the database underlying the VHA electronic patient record database system and linked to Web-based and ad hoc queries useful for quality improvement.

Published
2008
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15. Shared medical appointments based on the chronic care model: a quality improvement project to address the challenges of patients with diabetes with high cardiovascular risk

Author

David Davidson, Kristina Pascuzzi, Mary Ellen O'Day, Sharon A. Watts, David C. Aron, Gerald Strauss, Susan Kirsh, and Elizabeth F O Kern

Subjects
Program evaluation, medicine.medical_specialty, Outpatient Clinics, Hospital, Hospitals, Veterans, Leadership and Management, education, Blood Pressure, Appointments and Schedules, symbols.namesake, Risk Factors, Diabetes mellitus, Health care, Diabetes Mellitus, medicine, Humans, Outpatient clinic, General Nursing, Fisher's exact test, Aged, Glycated Hemoglobin, Chronic care, Academic Medical Centers, Chi-Square Distribution, Primary Health Care, business.industry, Health Policy, Process Assessment, Health Care, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, Group Processes, Editorial, Blood pressure, Cardiovascular Diseases, Health Care Surveys, Chronic Disease, symbols, Physical therapy, Original Article, business, Chi-squared distribution, Program Evaluation, Total Quality Management
Abstract

Objective: The epidemic proportions and management complexity of diabetes have prompted efforts to improve clinic throughput and efficiency. One method of system redesign based on the chronic care model is the Shared Medical Appointment (SMA) in which groups of patients (8–20) are seen by a multi-disciplinary team in a 1–2 h appointment. Evaluation of the impact of SMAs on quality of care has been limited. The purpose of this quality improvement project was to improve intermediate outcome measures for diabetes (A1c, SBP, LDL-cholesterol) focusing on those patients at highest cardiovascular risk. Setting: Primary care clinic at a tertiary care academic medical center. Subjects: Patients with diabetes with one or more of the following: A1c >9%, SBP blood pressure >160 mm Hg and LDL-c >130 mg/dl were targeted for potential participation; other patients were referred by their primary care providers. Patients participated in at least one SMA from 4/05 to 9/05. Study design: Quasi-experimental with concurrent, but non-randomised controls (patients who participated in SMAs from 5/06 through 8/06; a retrospective period of observation prior to their SMA participation was used). Intervention: SMA system redesign Analytical methods: Paired and independent t tests, χ2 tests and Fisher Exact tests. Results: Each group had up to 8 patients. Patients participated in 1–7 visits. At the initial visit, 83.3% had A1c levels >9%, 30.6% had LDL-cholesterol levels >130 mg/dl, and 34.1% had SBP ⩾160 mm Hg. Levels of A1c, LDL-c and SBP all fell significantly postintervention with a mean (95% CI) decrease of A1c 1.4 (0.8, 2.1) (p

Published
2007
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16. Failure of ICD-9-CM Codes to Identify Patients with Comorbid Chronic Kidney Disease in Diabetes

Author

Mangala Rajan, David C. Aron, Donald R. Miller, Leonard M. Pogach, Chin-Lin Tseng, Elizabeth F O Kern, Miriam Maney, and Anjali Tiwari

Subjects
Adult, Male, medicine.medical_specialty, Cross-sectional study, Renal function, Comorbidity, Medicare, Sensitivity and Specificity, Diabetic nephropathy, International Classification of Diseases, Internal medicine, Diabetes mellitus, Diabetes Mellitus, Prevalence, medicine, Humans, Diabetic Nephropathies, In patient, Aged, business.industry, Health Policy, Methodological Issues, Middle Aged, medicine.disease, United States, United States Department of Veterans Affairs, Cross-Sectional Studies, Physical therapy, Kidney Failure, Chronic, Female, business, Glomerular Filtration Rate, Kidney disease
Abstract

To determine prevalence of chronic kidney disease (CKD) in patients with diabetes, and accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to identify such patients.Secondary data from 1999 to 2000. We linked all inpatient and outpatient administrative and clinical records of U.S. veterans with diabetes dually enrolled in Medicare and the Veterans Administration (VA) health care systems.We used a cross-sectional, observational design to determine the sensitivity and specificity of renal-related ICD-9-CM diagnosis codes in identifying individuals with chronic kidney disease.We estimated glomerular filtration rate (eGFR) from serum creatinine and defined CKD as Stage 3, 4, or 5 CKD by eGFR criterion according to the Kidney Disease Outcomes Quality Initiative guidelines. Renal-related ICD-9-CM codes were grouped by algorithm.Prevalence of CKD was 31.6 percent in the veteran sample with diabetes. Depending on the detail of the algorithm, only 20.2 to 42.4 percent of individuals with CKD received a renal-related diagnosis code in either VA or Medicare records over 1 year. Specificity of renal codes for CKD ranged from 93.2 to 99.4 percent. Patients hospitalized in VA facilities were slightly more likely to be correctly coded for CKD than patients hospitalized in facilities reimbursed by Medicare (OR 5.4 versus 4.1, p=.0330)CKD is a common comorbidity for patients with diabetes in the VA system. Diagnosis codes in administrative records from Medicare and VA systems are insensitive, but specific markers for patients with CKD.

Published
2006
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17. Abdominal Catastrophe Revisited: The Risk and Outcome of Enteric Peritoneal Contamination

Author

James A. Schulak, L N Newman, Carolyn P. Cacho, Miriam F. Weiss, and Elizabeth O. Kern

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, 030232 urology & nephrology, Peritonitis, Retrospective cohort study, General Medicine, medicine.disease, Surgery, Peritoneal dialysis, 03 medical and health sciences, 0302 clinical medicine, Nephrology, medicine, In patient, 030212 general & internal medicine, Risk factor, Complication, business, Survival analysis, Kidney disease
Abstract

ObjectivePeritonitis from a visceral source is associated with striking morbidity and mortality in patients treated with peritoneal dialysis (PD). Surgical intervention for both diagnosis and repair is definitive. However, because the antecedents of enteric injury leading to peritonitis are unpredictable, no preventive strategy has been proposed or adopted. The goal of this study was to examine risk factors influencing the occurrence and outcome of anatomically documented peritonitis of enteric origin.DesignRetrospective chart and database review.SettingPeritoneal dialysis unit in tertiary-care referral hospital.Patients330 patients treated with PD for end-stage renal disease between 1988 and 2000.Main Outcome MeasuresPrevalence of peritonitis of anatomically documented enteric origin over two consecutive time periods within the study interval: period 1, from 1 January 1988 through 30 June 1996; period 2, from 1 July 1996 through 30 June 2000.ResultsAt least 1 episode of peritonitis occurred in 202 of 330 patients during the entire study period of 12.5 years (600.74 patient-years of care). There were 543 episodes of peritonitis. Anatomically documented visceral injury caused bacterial peritonitis in 41 patients with a total of 63 discrete episodes, an incidence rate of 0.1048 per patient-year. Peritonitis-free survival was compared between the two periods using Kaplan–Meier analysis. The curve representing risk distribution for anatomically documented visceral peritonitis remained constant over the two periods, in contrast to improvements found in all other types of peritonitis, taken as a group ( p = 0.044). Logistic regression modeling showed that the only risk factor associated with development of anatomically documented visceral peritonitis was older age. There was no influence of race, sex, time on PD, and underlying disease etiology. 31 deaths were attributed to peritonitis during the study period. The mortality rate from enteric peritonitis due to visceral injury was 46.3% (19/41 cases), compared to 7.5% for all other peritonitis taken as a group (12/161 cases, p < 0.0001).ConclusionsThe experience at University Hospitals of Cleveland suggests that abdominal catastrophe occurs in approximately 10% of all patients treated with PD, and is associated with high mortality, which has not changed over time. Therefore, peritonitis due to spontaneous visceral injury presents a great diagnostic and therapeutic challenge. It is important to develop a research strategy to understand this devastating complication.

Published
2002
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18. Knee joint arthroplasty in a patient with haemophilia A and high inhibitor titre using recombinant factor VIIa (NovoSeven®): a new case report and review of the literature

Author

L. Grunebaum, F. Bonnomet, J. Lecocq, L. Barbier, J. Sibilia, A. Faradji, D. Desprez, and O. Kern

Subjects
medicine.medical_specialty, Rehabilitation, biology, business.industry, Abnormal bleeding, medicine.medical_treatment, Haemophilia A, Hematology, General Medicine, Knee Joint, medicine.disease, Haemophilia, Arthroplasty, Surgery, Recombinant factor VIIa, Arthropathy, medicine, biology.protein, business, Genetics (clinical)
Abstract

Elective orthopaedic surgery is regularly withheld from patients with haemophilia and high inhibitor titre despite the presence of severe arthropathy and urgent medical need. A knee joint arthroplasty was performed in a patient with severe haemophilia A and a high inhibitor titre using recombinant factor VIIa (rFVIIa) as the sole coagulation factor. There was no abnormal bleeding during surgery although an increased blood loss through surgical drains did occur during the first 6 h postoperatively. Rehabilitation was started on day 1 and continued for 3 months. Walking commenced on day 4. After 1 year of follow-up, the clinical outcome of surgery was considered excellent with no pain, knee mobility at 0-5-90 degrees, and an International Knee Society score of 95/100. No rFVIIa-associated side-effects or thrombotic complications were reported. In conclusion, knee joint arthroplasty is now an option for haemophilia patients with a high inhibitor titre. An international review of all available data on elective orthopaedic surgery in inhibitor patients is required so that the optimal treatment regime can be defined and the short- and long-term risk-benefit ratio of surgery compared to that of noninhibitor patients.

Published
2001
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19. Verwaltungskosten in der gesetzlichen Krankenversicherung

Author

F. Beske and A. O. Kern

Subjects
Complementary and Manual Therapy, Gynecology, medicine.medical_specialty, Complementary and alternative medicine, business.industry, medicine, Physical Therapy, Sports Therapy and Rehabilitation, business
Abstract

Das Sachleistungssystem wird hinsichtlich des Verwaltungsaufwands im Vergleich zu anderen Finanzierungssystemen als besonders kostengunstig angesehen. Zuverlassige Untersuchungen zu dieser Frage einschlieslich internationaler Vergleiche fehlen. Mit dieser Arbeit werden erstmals Kosten erfasst, die als Verwaltungskosten in Krankenkassen, bei Leistungserbringern und in der Wirtschaft zur Durchfuhrung des Sachleistungssystems entstehen. Die Daten sind mit Vorbehalt zu werten, da es im Rahmen dieser Untersuchung nicht moglich war, vertiefte Studien durchzufuhren. Abrufbereite Daten liegen auch nur fur Teilbereiche vor, z.B. fur die gesetzlichen Krankenkassen. Fur zuverlassige Aussagen sind umfassendere Untersuchungen erforderlich. Verwaltungskosten entstehen bei den gesetzlichen Krankenkassen, aber auch bei Dritten. Leistungserbringer haben gegenuber den Krankenkassen Dokumentations- und Berichtspflichten sowie Anforderungen an die Abrechnungsgestaltung zu erfullen, den Leistungskatalog gemeinsam mit ihren Organisationen zu gestalten, Honorarvereinbarungen zu treffen und die Rechnungslegung durchzufuhren. Vom Arbeitgeber werden administrationsbedingte Verwaltungsleistungen fur die gesetzliche Krankenversicherung erbracht. Kosten staatlicher Aufsichtsfuhrung uber die Krankenkassen durch das Bundesversicherungsamt und die Landesversicherungsamter stellen einen weiteren Bestandteil von Verwaltungsleistungen dar. Die Verwaltungsleistungen belaufen sich nach dieser Untersuchung fur das Jahr 1997 auf mindestens 26 Mrd. DM, davon Krankenkassen 14,1 Mrd. DM, Leistungserbringer 6,4 Mrd. DM und Wirtschaft 5,5 Mrd. DM. Bezogen auf die Ausgaben der GKV im Jahr 1997 betragt der Verwaltungskostenanteil 10,7%. Diese Untersuchung kann nur eine grobe Schatzung der Verwaltungskosten in den verschiedenen Leistungsbereichen und Institutionen geben, die Bestandteil der GKV finanzierten Leistungserbringung sind. Haufig sind mangelnde Auskunftsbereitschaft oder eine ungenugende Informationslage Ursache dafur, dass die Verwaltungskosten nicht zuverlassiger bestimmt werden konnten. Im Sinne einer effizienten Organisation der Leistungserbringung ware fur alle Leistungsbereiche zu prufen, inwieweit Verwaltungsaufgaben verringert werden konnen. Alle am Sachleistungssystem Beteiligten sollten von vermeidbaren Verwaltungsaufgaben entlastet werden, damit ein moglichst groser Teil der GKV-Ausgaben fur Leistungsausgaben zur Verfugung steht.

Published
2000
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21. Le syndrome de Claude Bernard-Horner et son contraire, le syndrome de Pourfour du Petit, en anesthésie-réanimation

Author

C Speeg-Schatz, P Ségura, O Kern, and JM Wagner

Subjects
Gynecology, medicine.medical_specialty, Anesthesiology and Pain Medicine, Philosophy, CLAUDE BERNARD-HORNER SYNDROME, medicine, Iatrogenic disease, General Medicine
Abstract

Resume Objectif Analyser les cas de syndrome de Claude Bernard-Horner (SCBH) et de son contraire, le syndrome de Pourfour du Petit (SPDP), rencontres en anesthesie-reanimation, en fonction des donnees recentes de la litterature. Sources des donnees Pour cet article, les publications parues en langue francaise, anglaise et allemande dans les journaux d'anesthesie et de reanimation, ainsi que dans les ouvrages de la specialite, ont ete analysees. Selection des articles Toutes les etudes observationnelles concernant ces syndromes, qu'il s'agisse de cas cliniques ou de lettres a l'editeur, forment la base de ce travail. Extraction des donnees Une attention particuliere a ete accordee au diagnostic, traitement et pronostic des syndromes relevant d'une cause iatrogene. Synthese des donnees Le SCBH resulte d'une paralysie de la chaine sympathique cervicale homolaterale et comporte un ptosis de la paupiere superieure, une legere ascension de la paupiere inferieure, une enophtalmie, un myosis, un retrecissement de la fente palpebrale, une congestion nasale associee a une anhidrose et une rougeur de l'hemiface du cote atteint. L'anesthesie locoregionale (anesthesie intra-orale, bloc du plexus brachial, anesthesie epidurale thoracique, lombaire ou caudale, analgesie interpleurale) est la principale cause anesthesique de SCBH. Le SCBH determine par un anesthesique local est transitoire. Il peut etre le signe annonciateur d'un bloc etendu et d'un collapsus cardiovasculaire. La ponction de la veine jugulaire interne est la principale circonstance de survenue d'un SCBH definitif. Quand il est transitoire, il regresse dans les 3 mois suivant la ponction. Les autres causes de SCBH sont la position operatoire, le drain pleural, la chirurgie du cou, le traumatisme cervica. Un collyre mydriatique tel que la phenylephrine corrige le ptosis pendant moins de 1 heure et determine une vision trouble du fait de la mydriase. Un ptosis prononce necessite un traitement chirurgical. Le SPDP est l'inverse du SCBH et resulte d'une stimulation de la chaine sympathique cervicale homolaterale. Il peut preceder un SCBH. Il comporte un risque de conjonctivite, de keratite et d'epiphora en cas d'exophtalmie majeure. Le SPDP est generalement decrit comme une mydriase unilaterale. Le SPDP a les memes causes que le SCBH. Les collyres myotiques sont peu efficaces. Une retraction palpebrale prononcee requiert une tarsorraphie, des pommades et l'occlusion palpebrale nocturne. Une partie des SCBH et la majorite des SPDP survenant en anesthesie-reanimation restent meconnus ou sont reconnus avec retard, en particulier quand ils sont peu prononces et transitoires ou quand ils surviennent chez des patients inconscients et en position horizontale.

Published
1998
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22. The microsurgical transoral decompression for treatment of diseases and injuries of the craniocervical junction

Author

U. Weber, C. Klöckner, J. Zierski, and O. Kern

Subjects
medicine.medical_specialty, business.industry, Decompression, Postoperative complication, Craniocervical junction, Autologous bone, Iliac crest, Surgery, medicine.anatomical_structure, Plate osteosynthesis, Orthopedic surgery, Medicine, Orthopedics and Sports Medicine, business, Cervical disc
Abstract

Besides the microsurgical ventral decompression for treatment of cervical disc prolapses, combined with an intercorporal fusion using an autologous bone graft from the iliac crest and a plate osteosynthesis, the microsurgical, transoral approach to the craniocervical junction has proven to be an effective procedure for adequate indications. Even for surgical treatment of diseases and injuries of the craniocervical junction ventral, anterolateral, lateral and dorsal approaches are applicable alone or in combination. The special anatomic and functional conditions of this region, however, obviously require that the indicational criteria for the various approaches differ from those selected for the other cervical segments. The postoperative complication risk requires that particulary critical consideration be given to the question of isolated transoral interventions. The same holds true for the question as the necessity for additional ventral stabilisation in combined dorsoventral interventions. This report is about 20 patients who underwent transoral decompression, about the indications and the procedure typical problems.

Published
1998
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23. Survival benefit of nephrologic care in patients with diabetes mellitus and chronic kidney disease

Author

Donald R. Miller, Anjali Tiwari, Miriam Maney, Leonard M. Pogach, Mangala Rajan, Chin-Lin Tseng, and Elizabeth F O Kern

Subjects
Male, medicine.medical_specialty, Lower risk, Cohort Studies, Ambulatory care, Internal medicine, Internal Medicine, medicine, Ambulatory Care, Diabetes Mellitus, Humans, Survival rate, Referral and Consultation, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Mortality rate, Hazard ratio, medicine.disease, Confidence interval, Surgery, Survival Rate, Nephrology, Kidney Failure, Chronic, Female, Stage 4 chronic kidney disease, business, Kidney disease
Abstract

Background The association of nephrologic care and survival in patients with diabetes mellitus and chronic kidney disease is unknown. Methods Using data from 1997 to 2000, we conducted a retrospective cohort study of Veterans Health Administration clinic users having diabetes mellitus and stage 3 or 4 chronic kidney disease. The baseline period was 12 months and median follow-up was 19.3 months. Degree of consistency of visits to a nephrologist, defined as the number of calendar quarters in which there was 1 visit or more (range, 0-4 quarters), and covariates were calculated from the baseline period. The outcome measure was dialysis-free death. Results Of 39 031 patients, 70.0%, 22.4%, and 7.6% had early stage 3, late stage 3, and stage 4 chronic kidney disease, respectively, and 3.1%, 9.5%, and 28.2%, respectively, visited a nephrologist. Dialysis-free mortality rates were 9.6, 14.1, and 19.4, respectively, per 100 person-years. More calendar quarters with visits to a nephrologist were associated with lower mortality: adjusted hazard ratios were 0.80 (95% confidence interval, 0.67-0.97), 0.68 (95% confidence interval, 0.55-0.86), and 0.45 (95% confidence interval, 0.32-0.63), respectively, when the groups having 2, 3, and 4 visits were compared with those who had no visits. One visit only was not associated with a difference in mortality when compared with no visits (adjusted hazard ratio,1.02; 95% confidence interval, 0.89-1.16). Conclusions The consistency of outpatient nephrologic care was independently associated in a graded fashion with lower risk of deaths in patients with diabetes and moderately severe to severe chronic kidney disease. However, only a minority of patients had any visits to a nephrologist.

Published
2008

24. Facility variation in utilization of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with diabetes mellitus and chronic kidney disease

Author

Anjali, Tiwari, Chin-Lin, Tseng, Elizabeth F O, Kern, Miriam, Maney, Donald R, Miller, and Leonard, Pogach

Subjects
Adult, Male, Hospitals, Veterans, Angiotensin-Converting Enzyme Inhibitors, Middle Aged, Severity of Illness Index, Drug Utilization, Medical Records, United States, Diabetes Complications, Angiotensin Receptor Antagonists, Age Distribution, Diabetes Mellitus, Type 2, Humans, Kidney Failure, Chronic, Multicenter Studies as Topic, Female, Aged, Glomerular Filtration Rate, Retrospective Studies
Abstract

To evaluate facility-level variation in prescription rates of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) medications for patients with diabetes mellitus (DM) and chronic kidney disease (CKD).Retrospective database analysis from 143 Veterans Health Administration facilities.Subjects with DM aged 18 to 75 years were identified as having stage 2-4 CKD using estimated glomerular filtration rate (eGFR) based on an index eGFR in 1999 and a subsequent eGFR 90-365 days later. Whether ACEI/ARB medications were prescribed within 1 year after the index eGFR was determined. Variation in facility-level rates was evaluated separately for subjects age65 years and 65 to 75 years from facilities with more than 50 subjects per age group.A total of 103 853 subjects had stage 2 CKD; 51 728, stage 3; and 3233, stage 4. However, 25% of facilities had fewer than 50 patients age65 years with either stage 3 or 4 CKD. The median (range) facility-level prescription rates of ACEI/ARB for stage 2 and combined stage 3-4 CKD were 58.5% (44.3%-71.2%) and 73.3% (51.7%-84.6%), respectively, for subjects age65 years; and 56.5% (38.1%-71.4%) and 68.4% (51.6%-80.1%), respectively, for subjects aged 65 to 75 years. Spearman rank correlation between facility rankings by age group was 0.72 for stage 2 (139 facilities) and 0.49 for stage 3-4 (111 facilities) (P.001).Although ascertainment of prescription rates of ACEI/ARB to CKD patients is feasible using electronic health records, small sample size at the healthcare-system level preclude their utility for public reporting.

Published
2007

25. Outcome of adult umbilical cord blood transplant patients admitted to a medical intensive care unit

Author

E F O Kern, Mary J. Laughlin, R B Hejal, J A Kern, N. Naeem, A Eyzaguirre, and Hillard M. Lazarus

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Adolescent, Cord Blood Stem Cell Transplantation, Umbilical cord, law.invention, Hospitals, University, Patient Admission, law, Risk Factors, Internal medicine, Intensive care, Medicine, Humans, Transplantation, Homologous, Vasoconstrictor Agents, Survival analysis, Preparative Regimen, APACHE, Aged, Retrospective Studies, Transplantation, business.industry, Platelet Count, Retrospective cohort study, Hematology, Middle Aged, Myeloablative Agonists, Prognosis, Intensive care unit, Survival Analysis, Thrombocytopenia, Intensive Care Units, medicine.anatomical_structure, Treatment Outcome, Hematologic Neoplasms, Female, business
Abstract

Umbilical cord blood transplant (UCBT) has emerged as an alternate source of stem cells for transplantation in patients with hematologic malignancies. However, outcomes of adult UCBT patients requiring ICU admission remain unknown. In order to identify predictors of ICU transfer and mortality in UCBT patients, the course and outcome of all adult (> or = 16 years old) patients who underwent UCBT between 1 January 1998 and 31 December 2003 at University Hospitals of Cleveland were analyzed. Forty-four patients underwent UCBT during the study period and 25 (57%) required ICU transfer. Use of a myeloablative preparative regimen was a significant predictor of ICU transfer (P = 0.03). An infusion of higher numbers of nucleated cells was protective from ICU transfer (P = 0.05). For those patients transferred to the ICU, mortality was 72%. The univariate predictors of mortality, at the time of ICU admission were a high APACHE III score (P = 0.0004), use of vasopressors (P = 0.03), and a low platelet count (P = 0.03). We conclude that transfer of UCBT patients to an ICU may be predicted by their preparative regimen, while ICU mortality may be predicted by physiologic parameters upon admission.

Published
2006

26. Assessing 24-hour blood glucose patterns in diabetic paitents treated by peritoneal dialysis

Author

William D, Schwing, Penny, Erhard, Lynda N, Newman, Megan M, Nodge, Barbara J, Czechanski, Susan M, Orlin, Sarah M, Walden, Kim, Behm, Carolyn P, Cacho, Lavina A, Negrea, David S, Siu, Elizabeth O, Kern, and Miriam F, Weiss

Subjects
Blood Glucose, Glycated Hemoglobin, Diabetes Mellitus, Humans, Monitoring, Ambulatory, Peritoneal Dialysis
Abstract

The minute-to-minute effect on blood glucose levels of high-dextrose peritoneal dialysate is not known. We arranged for 7 patients with diabetes, treated by peritoneal dialysis (PD), to wear a continuous glucose monitoring system (CGMS: Medtronic MiniMed, Northridge, CA, U.S.A.). A sensor was inserted subcutaneously into the skin of the patient's abdomen or back to measure glucose in the interstitial fluid. Readings were recorded every 5 minutes for up to 72 hours. The portion of the day during which the patient's blood glucose levels were greater than 180 mg/dL (calculated as a percentage of time) was recorded. Most of the patients participating in the study had elevated levels of glycohemoglobin and hemoglobin A1c, and, for a large percentage of the day, showed blood glucose tracings well above the recommended standards of control. Representative CGMS tracings from patients with type 1 and type 2 diabetes are shown.

Published
2004

27. Abdominal catastrophe revisited: the risk and outcome of enteric peritoneal contamination

Author

Elizabeth O, Kern, Lynda N, Newman, Carolyn P, Cacho, James A, Schulak, and Miriam F, Weiss

Subjects
Adult, Male, Time Factors, Middle Aged, Peritonitis, Survival Analysis, Viscera, Enterobacteriaceae, Risk Factors, Outcome Assessment, Health Care, Humans, Kidney Failure, Chronic, Female, Catastrophic Illness, Peritoneal Dialysis, Aged, Retrospective Studies
Abstract

Peritonitis from a visceral source is associated with striking morbidity and mortality in patients treated with peritoneal dialysis (PD). Surgical intervention for both diagnosis and repair is definitive. However, because the antecedents of enteric injury leading to peritonitis are unpredictable, no preventive strategy has been proposed or adopted. The goal of this study was to examine risk factors influencing the occurrence and outcome of anatomically documented peritonitis of enteric origin.Retrospective chart and database review.Peritoneal dialysis unit in tertiary-care referral hospital.330 patients treated with PD for end-stage renal disease between 1988 and 2000.Prevalence of peritonitis of anatomically documented enteric origin over two consecutive time periods within the study interval: period 1, from 1 January 1988 through 30 June 1996; period 2, from 1 July 1996 through 30 June 2000.At least 1 episode of peritonitis occurred in 202 of 330 patients during the entire study period of 12.5 years (600.74 patient-years of care). There were 543 episodes of peritonitis. Anatomically documented visceral Injury caused bacterial peritonitis in 41 patients with a total of 63 discrete episodes, an incidence rate of 0.1048 per patient-year. Peritonitis-free survival was compared between the two periods using Kaplan-Meier analysis. The curve representing risk distribution for anatomically documented visceral peritonitis remained constant over the two periods, in contrast to improvements found in all other types of peritonitis, taken as a group (p= 0.044). Logistic regression modeling showed that the only risk factor associated with development of anatomically documented visceral peritonitis was older age. There was no influence of race, sex, time on PD, and underlying disease etiology. 31 deaths were attributed to peritonitis during the study period. The mortality rate from enteric peritonitis due to visceral injury was 46.3% (19/41 cases), compared to 7.5% for all other peritonitis taken as a group (12/161 cases, p0.0001).The experience at University Hospitals of Cleveland suggests that abdominal catastrophe occurs in approximately 10% of all patients treated with PD, and is associated with high mortality, which has not changed over time. Therefore, peritonitis due to spontaneous visceral injury presents a great diagnostic and therapeutic challenge. It is important to develop a research strategy to understand this devastating complication.

Published
2002

28. 275 Modulation of PIP2 levels through small molecule inhibition of PIP5K

Author

David R. Jones, O. Kern, Jennifer C. McKelvie, D. Fitzgerald, Sarita Maman, Michael J. Waring, C.D. Jones, E. MacDonald, M. Riddick, N. Divecha, Vikki Flemington, Graeme R. Robb, Kurt Gordon Pike, Robert J.K. Wood, I. Treinies, Martin E. Swarbrick, S. Cosulich, James M. Smith, Karen Roberts, and David M. Andrews

Subjects
Cancer Research, Oncology, Modulation, Chemistry, Biophysics, Small molecule
Published
2014
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29. Implementation and Evaluation of a Multicomponent Quality Improvement Intervention to Improve Efficiency of Hepatitis C Screening and Diagnosis

Author

Yngve Falck-Ytter, Brook Watts, Amy Hirsch, Renee H. Lawrence, Davis T. Shumaker, and Elizabeth F O Kern

Subjects
medicine.medical_specialty, Quality management, Leadership and Management, business.industry, Hepatitis C Antibodies, Hepatitis C, Quality Improvement, United States, Interrupted Time Series Analysis, Test (assessment), Intervention (counseling), Completion rate, Emergency medicine, Ambulatory, medicine, Reflex, Humans, Mass Screening, Operations management, business, Veterans Affairs
Abstract

Article-at-a-Glance Background Given recent advances in hepatitis C virus (HCV) treatment, health systems must ensure that patients with a positive HCV antibody receive timely determination of their HCV status through viral testing. At the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, viral testing was completed within six months of the first instance of a positive HCV antibody test for only 45% of patients. Beginning in 2008, three sequential improvements were implemented to close this care gap. Methods The three sequential improvements phases were as follows: (1) improving patient-centeredness of screening process in ambulatory patients, (2) local implementation of the Department of Veterans Affairs national HCV reflex testing policy, and (3) local evaluation of the efficiency and effectiveness of local implementation of reflex testing. Results From 2005 through 2013, 40 to 150 unique patients/quarter required viral testing following a positive antibody test. The firsts and second-phase improvements resulted in a 68% and 96% completion rate for timely viral testing during respective improvement phases. In the third improvement phase, remaining process problems related to the reflex testing process were identified using a locally developed electronic HCV population management application, resulting in a sustained rate of 100% completion of timely viral testing. Interrupted time series analysis revealed that the implementation of HCV reflex testing had the largest impact on the ability to complete timely viral testing. Conclusions A continuous quality improvement approach, supported by an HCV population management application, achieved the complete closure of an important HCV care gap. Reflex testing should be initiated at facilities that have yet to adopt this approach.

Published
2014
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30. Knee joint arthroplasty in a patient with haemophilia A and high inhibitor titre using recombinant factor VIIa (NovoSeven): a new case report and review of the literature

Author

A, Faradji, F, Bonnomet, J, Lecocq, L, Grunebaum, D, Desprez, O, Kern, L, Barbier, and J, Sibilia

Subjects
Adult, Male, Isoantibodies, Blood Loss, Surgical, Humans, Factor VIIa, Arthroplasty, Replacement, Knee, Hemophilia A, Recombinant Proteins
Abstract

Elective orthopaedic surgery is regularly withheld from patients with haemophilia and high inhibitor titre despite the presence of severe arthropathy and urgent medical need. A knee joint arthroplasty was performed in a patient with severe haemophilia A and a high inhibitor titre using recombinant factor VIIa (rFVIIa) as the sole coagulation factor. There was no abnormal bleeding during surgery although an increased blood loss through surgical drains did occur during the first 6 h postoperatively. Rehabilitation was started on day 1 and continued for 3 months. Walking commenced on day 4. After 1 year of follow-up, the clinical outcome of surgery was considered excellent with no pain, knee mobility at 0-5-90 degrees, and an International Knee Society score of 95/100. No rFVIIa-associated side-effects or thrombotic complications were reported. In conclusion, knee joint arthroplasty is now an option for haemophilia patients with a high inhibitor titre. An international review of all available data on elective orthopaedic surgery in inhibitor patients is required so that the optimal treatment regime can be defined and the short- and long-term risk-benefit ratio of surgery compared to that of noninhibitor patients.

Published
2001

31. [Social wealth in Germany II]

Author

F, Beske and A O, Kern

Subjects
Adult, Adolescent, National Health Programs, Cost-Benefit Analysis, Infant, Middle Aged, Socioeconomic Factors, Child, Preschool, Germany, Quality of Life, Humans, Child, Life Style, Aged
Published
2000

32. Block of the brachial plexus branches by the humeral route. A prospective study in 503 ambulatory patients. Proposal of a nerve-blocking sequence

Author

E, Gaertner, O, Kern, G, Mahoudeau, G, Freys, T, Golfetto, and B, Calon

Subjects
Adult, Aged, 80 and over, Male, Adolescent, Lidocaine, Nerve Block, Middle Aged, Bupivacaine, Electric Stimulation, Ambulatory Surgical Procedures, Arm, Humans, Brachial Plexus, Female, Prospective Studies, Anesthetics, Local, Child, Aged
Abstract

Brachial plexus is usually approached by the supraclavicular or axillary route. A technique for selective blockade of the branches of the plexus at the humeral canal using electrolocation has recently been proposed. The aim of the present study was to assess the feasibility of this technique in the ambulatory patient and to determine the optimal sequence of nerve-blocking.The nerves originating from the brachial plexus were located in the humeral canal, at the junction of the proximal and the middle third of the arm, with a stimulator and blocked using either lidocaine or a mixture of lidocaine and bupivacaine, depending on the anticipated duration of surgery. The minimal stimulating intensity eliciting an adequate response, type of local anaesthetic and injected volume, and time of onset of surgical anaesthesia were collected.The study included 503 consecutive ambulatory patients due to undergo surgery of the elbow, wrist or hand in one year. Suitable anaesthesia was obtained with the humeral blockade in 82.1% of cases. In the remaining 17.9%, an additional block at the elbow was required, mainly for ulnar and median nerves. The onset times of sensory blocks were the longest for the median nerve, similar for the radial and ulnar nerves, shorter for the musculocutaneous nerve and the shortest for the medial brachial and antebrachial cutaneous nerves. The difference was more significant with the lidocaine-bupivacaine mixture, than with lidocaine alone (P0.001 vs P0.05, respectively). The onset times of motor blocks were the longest for the median nerve (P0.05) and the shortest for the musculocutaneous nerve (P0.001). Neither nervous nor vascular complications occurred.This study shows that the nerve block at the humeral canal is an efficient and safe technique. Considering the onset times of nerve blocks, the following sequence for blockade can be recommended: median, ulnar, radial, musculocutaneous, medial (brachial and antebrachial) cutaneous nerves. The selective blockade of the main nerves of the upper limb at the humeral canal can be recommended for surgery of the forearm and the hand in the ambulatory patient.

Published
1999

34. [Claude Bernard-Horner syndrome and its opposite, Pourfour du Petit syndrome, in anesthesia and intensive care]

Author

P, Ségura, C, Speeg-Schatz, J M, Wagner, and O, Kern

Subjects
Adult, Male, Neurologic Examination, Horner Syndrome, Adolescent, Resuscitation, Iatrogenic Disease, Mydriasis, Infant, Superior Cervical Ganglion, Syndrome, Middle Aged, Reflex, Pupillary, Enophthalmos, Postoperative Complications, Child, Preschool, Blepharoptosis, Humans, Anesthesia, Female, Child, Aged
Abstract

To analyse cases of Horner's syndrome (HS) and its opposite, Pourfour du Petit's syndrome (PPS), occurring in anaesthesia and intensive therapy with consideration of the data of current literature.For this paper we have reviewed the French, English and German literature published in anaesthesia and intensive care journals using Medline search and the current textbooks.All observational studies on these syndromes, whether clinical cases or letters to the editor, form the basis for this article.The articles were analysed mainly with regard to diagnosis, therapy and prognosis of syndromes due to iatrogenic causes.HS is caused by a paralysis of the ipsilateral sympathetic cervical chain and includes a ptosis of the upper eyelid, a slight elevation of the lower lid, a sinking of the eyeball, a constriction of the pupil, a narowing of the palpebral fissure, a nasal stuffiness associated with anhidrosis, and flushing of the affected side of the face. Regional anaesthesia (intra-oral anaesthesia, brachial plexus block, epidural anaesthesia whether by thoracic, lumbar or caudal approach, as well as interpleural analgesia) is the main anaesthetic cause for HS. HS due to the effect of a local anaesthetic is transient, it can precede a high spinal block and a cardiovascular collapse. HS from puncture of the internal jugular vein is most often permanent. When transient, HS regresses within 3 months after puncture. Other causes of HS include intraoperative posture, pleural drain, neck surgery, neck trauma. A mydriatic collyrium, such as phenylephrine, resolves ptosis for less than 1 hour and results in blurred vision from pupillary dilation. Major ptosis requires surgery. PPS is the reciprocal HS and is caused by a stimulation of the ipsilateral sympathetic cervical chain. PPS can precede HS. It carries a risk for conjunctivitis, keratitis and epiphora in case of major exophthalmia. PPS is often reported as an unilateral mydriasis. PPS has the same causes as HS. Myotic collyriums are relatively inefficient. Major lid retraction requires a tarsorraphy, pomades and nocturnal lid occlusion. A part of HS and most PPS occurring in anaesthesia and intensive care remain unrecognized or are recognized with delay, especially if they remain minor and transient or when they occur in unconscious patients, in horizontal posture.

Published
1998

35. [Femur head preserving therapy, using vascular pedicled iliac bone graft, in segmental femoral head necrosis]

Author

O, Kern, C, Klöckner, and U, Weber

Subjects
Ilium, Microsurgery, Bone Transplantation, Treatment Outcome, Femur Head Necrosis, Arthroplasty, Replacement, Hip, Bone Screws, Humans, Bone Plates, Magnetic Resonance Imaging, Follow-Up Studies
Abstract

Various therapeutic options have been proposed in the treatment of femoral head necrosis ranging from conservative management to total hip arthroplasty. Since microsurgical techniques are routinely used in orthopaedic surgery, the importance of revascularization has increased in recent years. Vascularized bone grafting as well as various osteotomies have been considered for the stages II and III according to Ficat and II, III and IV of the criteria of the ARCO system respectively, which also bases on MRI-findings. We investigated the results of 80 patients with avascular necrosis of the femoral head treated with a vascular pedicled iliac bone graft, perfused by the A. circumflexa ilium profunda, between 1988 and 1996. Mean follow-up was 5.6 years. The evaluation was based on the harris hip score, clinical and radiological examination as well as a subjective assessment using a VAS (visual analog scale). The clinical results according to the harris hip score were good or excellent in 86.1%. These results correlate with the subjective assessment of pain and of the hip joint function with an average of 7.9 points using the VAS (max. 10 points). Unchanged radiological appearance over the follow-up period was observed in 47.5% using the ARCO criterias. Reviewing the studies using vascularized grafts, about 50% of the patients with a stage II and III according to Ficat and II, III and IV of the ARCO respectively show an unchanged stage of the disease 5-6 years after the procedure. Therefore, transplantation of a vascular pedicled iliac bone graft possibly offers the chance to intervene causally in the course of the disease with only little alteration of the biomechanics of the hip joint.

Published
1998

36. [Microsurgical transoral decompression in diseases of and injuries to the cranio-cervical junction]

Author

C, Klöckner, O, Kern, J, Zierski, and U, Weber

Subjects
Male, Tomography, Emission-Computed, Single-Photon, Microsurgery, Mouth, Bone Screws, Bone Neoplasms, Decompression, Surgical, Odontoid Process, Cervical Vertebrae, Fiber Optic Technology, Humans, Female, Spondylitis, Ankylosing, Osteoblastoma, Bone Plates, Plasmacytoma
Abstract

Besides the microsurgical ventral decompression for treatment of cervical disc prolapses, combined with an intercorporal fusion using an autologous bone graft from the iliac crest and a plate osteosynthesis, the microsurgical, transoral approach to the craniocervical junction has proven to be an effective procedure for adequate indications. Even for surgical treatment of diseases and injuries of the craniocervical junction ventral, anterolateral, lateral and dorsal approaches are applicable alone or in combination. The special anatomic and functional conditions of this region, however, obviously require that the indicational criteria for the various approaches differ from those selected for the other cervical segments. The postoperative complication risk requires that particulary critical consideration be given to the question of isolated transoral interventions. The same holds true for the question as the necessity for additional ventral stabilisation in combined dorsoventral interventions. This report is about 20 patients who underwent transoral decompression, about the indications and the procedure typical problems.

Published
1998

37. [Economic wealth in Germany]

Author

F, Beske and A O, Kern

Subjects
Financing, Personal, National Health Programs, Socioeconomic Factors, Germany, Humans, Health Care Costs, Health Expenditures, Forecasting
Published
1997

39. Freie Vorträge

Author

J. Windolf, R. Inglis, D. Hollander, J. Rueger, K. Pahlke, A. Meier-Hellmann, M. Oberhoffer, K. Reinhart, R. Neidhardt, M. Keel, O. Trentz, W. Ertel, U. Haug, C. Willy, H. Gerngroß, H. J. ten Duis, H. Roerdink, W. Timens, L. De Leij, D. Remmers, H.-C. Pape, M. Grotz, A. Gruner, G. Regel, H. Tscherne, R. Kretschmer, W. Gnann, M. Maghsudi, C. Neumann, M. Nerlich, T. Mutzbauer, M. Georgieff, H. Breitfuß, H. Resch, R. Fröhlich, P. Povacz, G. Möllenhoff, C. Josten, J. Buchholz, G. Muhr, St. D. Cook, J. P. Ryaby, J. D. Heckman, Th. K. Kristiansen, W. Mutschler, R. Wirbel, M. Schulte, U. Schmid, G. Herr, R. Schnettler, O. Wieland, K. Weber, M. Fell, A. Meißner, M. Wennmacher, R. Rahmanzadeh, R. Hente, Th. Schildhauer, Th. Wachtel, A.-M. Weinberg, F. Draijer, F. Maurer, W. Quirini, P. M. Rommens, P. L. Broos, U. Stöckle, R. Hoffmann, N. P. Südkamp, N. Haas, J. Steinbeck, J. Jerosch, J. Stechmann, V. Güth, C. Klöckner, O. Wörsdörfer, H. Pickel, M. Hofmeister, M. Militz, V. Bühren, H.-J. Helling, A. Prokop, G. Ullrich, H.-G. Brochhagen, K. E. Rehm, E. J. Müller, O. Russe, M. Weißkopf, N. Südkamp, O. Kern, B. Bouillon, R. Löbach, T. Tiling, H. Lill, C. Moor, A. Schmidt, V. Echtermeyer, K. Weise, D.-H. Boack, Th. Mittlmeier, A. Wichelhaus, W. Dee, St. Winckler, E. Brug, E. Ziring, J. Petermann, E. Walthers, L. Götzen, M. Prymka, T. Bach, J. Höher, Th. Tiling, B. Brand, A. Buchgraber, H. H. Pässler, K. Mann, K. Lange, W.-D. Reinbold, J. M. Strauss, S. Schmiel, H. Gehling, M. Hessmann, L. Gotzen, A. Knop, H.-G. Breyer, Ch. Voigt, R. Ramanzadeh, K. Platte, Th. Gelis, R. D. Hanrath, A. Poell, T. Brandt, F. Bonnaire, E. H. Kuner, M. Rösch, F. Gebhard, P. Steffen, L. Kinzl, U. B. Brückner, N. Ishaque, I. Augele, H. Kienapfel, K. J. Klose, M. Pröbstel, J. Richter, M. Börner, C. Khodadadyan, M. Raschke, Th. Beier, S. Giggel, F. Mohr, F. Schier, P. Schandelmaier, Ch. Krettek, A. Kohl, M. Dietrich, C. A. Müller, U. Pfister, J. Rudolf, B. Könemann, St. L. Henry, P. A. W. Ostermann, M. P. Hahn, D. Seligson, R. Minholz, and T. Dubowy

Published
1996
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40. Free vascularized muscle flap transplantation in the treatment of chronic osteomyelitis

Author

A, Eisenschenk, O, Kern, M, Lehnert, and U, Weber

Subjects
Adult, Male, Leg, Bone Transplantation, Chronic Disease, Humans, Female, Osteomyelitis, Middle Aged, Surgical Flaps, Follow-Up Studies
Abstract

We are reporting our experience with the efficacy of free tissue transfer in treatment of chronic lower-extremity osteomyelitis; 23 latissimus dorsi flaps and 11 rectus abdominis flaps were used. In our series, success was achieved after a mean follow-up of 36.1 months in 79% and after additional wound debridement in 94%. Indications, methods, results and complications are reported.

Published
1994

41. The impacts of leaf shape and arrangement on light interception and potential photosynthesis in southern beech (Nothofagus cunninghamii)

Author

Mark J. Hovenden, Stephen O Kern, and Gregory J. Jordan

Subjects
Ecophysiology, Nothofagus, Photoinhibition, biology, Plant Science, Noon, Photosynthesis, Atmospheric sciences, biology.organism_classification, Botany, Solstice, Interception, Agronomy and Crop Science, Beech
Abstract

The impact of differences in leaf shape, size and arrangement on the efficiency of light interception, and in particular the avoidance of photoinhibition, are poorly understood. We therefore estimated light exposure of branches in the cool temperate rainforest tree, Nothofagus cunninghamii (Hook.) Oerst., in which leaf shape, size and arrangement vary systematically with altitude and geographic origin. Measurements of incident photosynthetic photon flux density (PPFD) were made in the laboratory at solar angles corresponding to noon at summer solstice, winter solstice and equinox on branches collected from a common garden experiment. Tasmanian plants showed more self-shading than Victorian plants in summer and equinox. This was related to branch angle, leaf arrangement and leaf shape. Using a modelled light response-curve, we estimated the carbon assimilation rate and the flux density of excess photons at different incident PPFD. Victorian plants had higher predicted assimilation rates than Tasmanian plants in summer and equinox, but were exposed to substantially greater levels of excess photons. Because of the shape of the light-response curve, self-shading appears to reduce the plant's exposure to excess photons, thus providing photoprotection, without substantially reducing the carbon assimilation rate. This is dependent on both regional origin and season.

Published
2004
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42. Die mikrochirurgische transorale Dekompression bei Erkrankungen und Verletzungen des kraniozervikalen Übergangs

Author

J. Zierski, C. Klöckner, O. Kern, and U. Weber

Subjects
medicine.medical_specialty, Decompression, business.industry, Postoperative complication, Craniocervical junction, Autologous bone, Iliac crest, Surgery, Plate osteosynthesis, medicine.anatomical_structure, Bone plate, medicine, Orthopedics and Sports Medicine, Cervical disc, business
Abstract

Besides the microsurgical ventral decompression for treatment of cervical disc prolapses, combined with an intercorporal fusion using an autologous bone graft from the iliac crest and a plate osteosynthesis, the microsurgical, transoral approach to the craniocervical junction has proven to be an effective procedure for adequate indications. Even for surgical treatment of diseases and injuries of the craniocervical junction ventral, anterolateral, lateral and dorsal approaches are applicable alone or in combination. The special anatomic and functional conditions of this region, however, obviously require that the indicational criteria for the various approaches differ from those selected for the other cervical segments. The postoperative complication risk requires that particulary critical consideration be given to the question of isolated transoral interventions. The same holds true for the question as the necessity for additional ventral stabilisation in combined dorsoventral interventions. This report is about 20 patients who underwent transoral decompression, about the indications and the procedure typical problems.

Published
1998
Full Text
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43. Kopferhaltende Therapie mit dem gefäßgestielten Beckenkammspan bei der segmentalen Hüftkopfnekrose

Author

C. Klöckner, O. Kern, and U. Weber

Subjects
medicine.medical_specialty, business.industry, Visual analogue scale, medicine.medical_treatment, Avascular necrosis, medicine.disease, Revascularization, Surgery, Transplantation, Femoral head, medicine.anatomical_structure, Harris Hip Score, Orthopedic surgery, medicine, Orthopedics and Sports Medicine, Femur, Radiology, business
Abstract

Various therapeutic options have been proposed in the treatment of femoral head necrosis ranging from conservative management to total hip arthroplasty. Since microsurgical techniques are routinely used in orthopaedic surgery, the importance of revascularization has increased in recent years. Vascularized bone grafting as well as various osteotomies have been considered for the stages II and III according to Ficat and II, III and IV of the criteria of the ARCO system respectively, which also bases on MRI-findings. We investigated the results of 80 patients with avascular necrosis of the femoral head treated with a vascular pedicled iliac bone graft, perfused by the A. circumflexa ilium profunda, between 1988 and 1996. Mean follow-up was 5.6 years. The evaluation was based on the harris hip score, clinical and radiological examination as well as a subjective assessment using a VAS (visual analog scale). The clinical results according to the harris hip score were good or excellent in 86.1%. These results correlate with the subjective assessment of pain and of the hip joint function with an average of 7.9 points using the VAS (max. 10 points). Unchanged radiological appearance over the follow-up period was observed in 47.5% using the ARCO criterias. Reviewing the studies using vascularized grafts, about 50% of the patients with a stage II and III according to Ficat and II, III and IV of the ARCO respectively show an unchanged stage of the disease 5-6 years after the procedure. Therefore, transplantation of a vascular pedicled iliac bone graft possibly offers the chance to intervene causally in the course of the disease with only little alteration of the biomechanics of the hip joint.

Published
1998
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44. Does uremic enterocolitis exist?

Author

R. Wanitschke, O. Kern, Helmut E. Gabbert, R. Wagner, and P. Höhn

Subjects
Enterocolitis, Pathology, medicine.medical_specialty, business.industry, medicine.medical_treatment, Pseudomembranous colitis, medicine.disease, Intestinal absorption, Nephrectomy, Uremia, Intestinal mucosa, medicine, medicine.symptom, business, Human Pathology, Pathological
Abstract

In rats a severe but compensated chronic renal insufficiency was induced by stepwise 9/10 nephrectomy. Despite this severe chronic renal insufficiency we observed no relevant pathological changes in the intestinal mucosa. In particular, we found no evidence of mucosal erosions, ulceration or pseudomembranous colitis, findings which are traditionally thought to be characteristic of the uremic state. This was also true of those animals dying prematurely from uremia. Thus serious doubts arise about the existence of “uremic enterocolitis”, doubts which also proved justified after a critical review of the literature on human pathology.

Published
1981
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48. On the Scandinavian Element in English: Discussion

Author

P. O. Kern, G. Hempl, Albert E. Egge, H. Schmidt-Wartenberg, F. J. Lange, and S. W. Cutting

Subjects
Linguistics and Language, Engineering, Literature and Literary Theory, business.industry, Element (category theory), business, Language and Linguistics, Linguistics
Published
1898
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