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Wannheden C, Hasson H, Hager A, Karlgren K, Pukk Härenstam K. Now What? Collective Sensemaking and Sensegiving in the Cystic Fibrosis Community in Sweden During the Initial Phase of the COVID-19 Pandemic. Health Commun 2023; 38:3102-3112. [PMID: 36250348 DOI: 10.1080/10410236.2022.2134705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic's effects on people's lives and society induced a need for rapid individual and collective sensemaking, including communication forums enabling stakeholders in the health ecosystem to share information, solve problems, and learn. This study specifically focused on the needs of the patients and family caregivers living with cystic fibrosis (CF) or primary ciliary dyskinesia (PCD), conditions that lead to chronic infections and inflammation in the airways. We explored how CF and PCD patients, family caregivers, and clinicians collectively received, processed, and used information about COVID-19 to facilitate self-care and health care decisions at the beginning of the pandemic. We applied macrocognitive theory to analyze qualitatively the questions and answers exchanged in a series of six webinars facilitated by a CF learning network at the beginning of the pandemic (March - April 2020). We identified three macrocognitive functions: sensemaking, decision-making, and replanning. We further generated nine themes: (a) understanding the nature of COVID-19, (b) exploring self-care needs and possibilities, (c) understanding health care possibilities, (d) making decisions about prevention and testing, (e) managing COVID-19 within families, (f) adjusting planned care, (g) replanning chronic care management, (h) defining COVID-19 health care strategies, and (i) refining health care policies. The exchange of questions and answers played a central role in facilitating important cognitive processes, which enabled a rapid anticipation of needs and adaptation of services to support patients, family caregivers, and clinicians during the COVID-19 pandemic.
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Affiliation(s)
- Carolina Wannheden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
| | - Henna Hasson
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm
| | | | - Klas Karlgren
- MINT, Health Informatics Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
- Education Center, Department of Research, Education, Development and Innovation, Södersjukhuset
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences
| | - Karin Pukk Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
- Pediatric Emergency Department, Astrid Lindgren Children's Hospital, Karolinska University Hospital
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Oates GR, Mims C, Geurs R, Bergquist R, Hager A, Guimbellot JS, Hartzes AM, Gutierrez HH. Mobile health platform for self-management of pediatric cystic fibrosis: Impact on patient-centered care outcomes. J Cyst Fibros 2023; 22:823-829. [PMID: 37085386 DOI: 10.1016/j.jcf.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Previously, we adapted a mobile health platform (Genia) to the needs of patients and families in a pediatric CF center in the United States. In this feasibility study, we tested the impact of Genia on measures of patient-centered care. METHODS In a one-group pre-post study with adolescents with CF and caregivers of children with CF, we tested Genia's effect over 6 months on patient satisfaction with chronic illness care (PACIC) and shared decision-making (CollaboRate). Feasibility and acceptability were assessed with exit interviews and app analytics. RESULTS The intervention included 40 participants: 30 caregivers of children with CF age ≤14 years and 10 patients with CF age ≥15 years. The use of Genia was associated with increased satisfaction with care (p = 0.024), including delivery system and decision support (p = 0.017), goal setting (p = 0.006), and shared decision-making (p<0.001). The use of Genia was associated with nominal improvements in all QOL domains and symptom scales. The platform was feasible, with participants recording more than 4,400 observations (mean 84.2) and submitting 496 weekly reports (mean 13.8) and 70 quarterly reports (mean 1.8), and acceptable (95% retention rate). For participants, the most useful app feature was pre-visit reports (66.7%), and the top symptom trackers were those for cough (23.7%), appetite (21.1%), energy (18.4%), and medicines (18.4%). CONCLUSION The use of Genia over 6 months was feasible, acceptable, and associated with improved measures of patient-centered care. Study results support wider use of Genia in clinical settings. Efficacy for clinical outcomes should be assessed in a randomized clinical trial.
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Affiliation(s)
- Gabriela R Oates
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Cathy Mims
- Children's of Alabama, Birmingham, AL, USA
| | - Robin Geurs
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rikard Bergquist
- Motivo Management, LLC, Reno, NV, USA; Upstream Dream AB, Stockholm, Sweden
| | | | - Jennifer S Guimbellot
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anastasia M Hartzes
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hector H Gutierrez
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Hager A, Wannheden C. N-of-1 Analytics Makerspace: A Prototype for Cystic Fibrosis Self-Care and Co-Care. Stud Health Technol Inform 2023; 302:480-481. [PMID: 37203724 DOI: 10.3233/shti230180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We have designed a prototype N-of-1 analytics makerspace, which is a collaborative work environment that provides a space for different stakeholders in healthcare to learn new skills and work together on projects that can improve individual patient care and the effectiveness of healthcare systems. Our prototype was designed to study the use of antibiotics in self-management for children with cystic fibrosis in Sweden but is intended to be disease agnostic and potentially include other complex medical conditions in the future.
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Affiliation(s)
| | - Carolina Wannheden
- Medical Management Centre, Department of LIME, Karolinska Institutet, Sweden
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Stern H, Kretschmer A, Spix C, Hager A, Scholtissek H, Ewert P, Meierhofer C. Evolution of Cancer Incidence in Children after Cardiac Catheterization: Comparison of the Years 1980–1998 and 1999–2013. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- H. Stern
- Deutsches Herzzentrum München, München, Deutschland
| | | | - C. Spix
- German Childhood Cancer Registry (GCCR), Mainz, Deutschland
| | - A. Hager
- Deutsches Herzzentrum München, München, Deutschland
| | | | - P. Ewert
- Deutsches Herzzentrum München, München, Deutschland
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Scholtissek H, Sheho N, Spix C, Kretschmer A, Hager A, Ewert P, Meierhofer C, Stern H. Increased cancer incidence in children after cardiac catheterization within the first 8 years of life, a single center experience between 1999 and 2013. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Children with congenital heart disease are exposed to ionising radiation early in their lives when tissue sensitivity for radiation is highest. This might provoke DNA fractures and cancer development. Our first study with an observation period from 1980–1998 showed a 4.4-fold increased cancer risk for children who had at least one cardiac catheterization in the first year of life.
Objectives
This study aimed to reassess the risk of cancer for children who underwent at least one cardiac catheterization between 1999 and 2013 with a follow-up of seven years.
Methods
This retrospective, single-center study included 2765 children who underwent at least one cardiac catheterization before eight years of age between January 1999 and December 2013. 1688 received their first cardiac catheterization in the first year of life, 1074 between first and eighth year of life. Catheterization and patient data were obtained from our database, and cancer diagnoses up to age 15 were matched with German Childhood Cancer Registry. For each tumor patient and for each of the 60 randomly selected control patients cumulative effective radiation doses were calculated.
Results
37667.16 person-years were evaluated. A total of ten patients developed a malignant tumor, while 5.82 were expected (SIR 1.72; CI 0.82–3.16; p=0.0722). Eight of these ten tumors developed in patients who received their first cardiac catheterization in the first year of life, while 3.99 were expected (SIR 2.0; CI 0.71–3.62; p=0.1095). The cancer group performed an average of 3.7 cardiac catheterizations per patient, with a mean cumulative effective dose of 24,79mSv. In the control group consisting of 60 patients, 2.1 cardiac catheterizations were performed per patient with an average cumulative effective dose of 21.04mSv. Three of the ten tumor patients have chromosomal abnormalities. The cancers observed are two leukemia, two lymphoma, two CNS tumors, one osteosarcoma, two nephroblastoma and one hepatoblastoma.
Conclusion
There is still an increased risk of cancer development for children with congenital heart disease exposed to ionizing radiation early in life. However, due to technical development and increased sensitivity to this fact, we observed a decrease in cancer disease compared to our previous study with catherization between 1980 and 1998.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Stiftung Kinderherz
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Affiliation(s)
| | - N Sheho
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - C Spix
- University Medical Center of the Johannes Gutenberg University, German Childhood Cancer Registry , Mainz , Germany
| | - A Kretschmer
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - A Hager
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - P Ewert
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - C Meierhofer
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - H Stern
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
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Oberndorfer S, Woehrer A, Borkovec M, Marosi C, Payer F, Urbanic-Purkart T, Nowosielski M, Iglseder S, Stockhammer G, Kleindienst W, Florea C, Hager A, Tinchon A, Stultschnig M, Surboeck B, Pichler J, Leibetseder A, Weiss S, Hutterer M, Seebrecht L, Roetzer T, Hainfellner A, Hainfellner J. OS06.6.A Real-World Pattern of Care Study on Glioblastoma in the Austrian Population. Final results from 2014-2020. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Austrian ABTR-SANO Glioblastoma Registry is the first population-based assessment of patterns of care for patients with Glioblastoma across Austrian healthcare institutions. The primary aim is to assess the real world effectiveness of administered therapies.
Material and Methods
Clinical data are collected via a common web-based IT platform “ABTR-SANO Net” since 2014. The database and the ongoing evaluation of clinical parameters, as well as interims analysis are provided in cooperation with a review board. First Outcome analysis, including patients from 2014-2020, was performed at the end of 2021.
Results
Eleven centers across Austria are involved, and the data of 1416 patients (m/f ratio: 1,35, median age: 66 years) were recently analyzed in detail. Age, extent of resection, as well as ECOG was associated with improved survival. Methylated MGMT Status also showed a moderate survival benefit. Patients with re-resection and re-radiation also exhibited improved survival, which however may be attributed to a selection bias.Second line treatment manly comprised of antiangiogenic treatment, followed by alkylated agents, re-radiation and re-surgery. Median overall survival of all patients was 344 days and clearly age dependent (best for <50 years, worse for>80 years).
Conclusion
This is the first population based outcome analysis of Glioblastoma in Austria. Results regarding prognostic markers and outcome are mostly comparable with international data. Robust population based data are important in order to monitor quality of health care, and to match the data with results from clinical studies.
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Affiliation(s)
- S Oberndorfer
- Department Neurology, University Clinic , St Poelten , Austria
- KL-Institute for Neurology and Neuropsychology , St. Poelten, St. Poelten , Austria
| | - A Woehrer
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - M Borkovec
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - C Marosi
- Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - F Payer
- Department Neurology, University Clinic Graz , Graz , Austria
| | | | - M Nowosielski
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - S Iglseder
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - G Stockhammer
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - W Kleindienst
- Department Neurology, CDK-University Clinic Salzburg , Salzburg , Austria
| | - C Florea
- Department Neurology, CDK-University Clinic Salzburg , Salzburg , Austria
| | - A Hager
- Department Neurology, LKH Wiener Neustadt , Wiener Neustadt , Austria
| | - A Tinchon
- Department Neurology, KLPU, University Clinic , St Pölten , Austria
| | - M Stultschnig
- Department Neurology, Clinic Klagenfurt , Klagenfurt , Austria
| | - B Surboeck
- Department Neurology, KFJ Vienna , Vienna , Austria
| | - J Pichler
- Department Internal Medicine, J Kepler University Clinic, Linz , Linz , Austria
| | - A Leibetseder
- Department Neurology, J Kepler University Clinic, Linz , Linz , Austria
| | - S Weiss
- Department Neurolopathology, J Kepler University Clinic Linz , Linz , Austria
| | - M Hutterer
- Department Neurology, J Kepler University Clinic, Linz , Linz , Austria
| | - L Seebrecht
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - T Roetzer
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - A Hainfellner
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - J Hainfellner
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
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7
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Hock J, Nagdyman N, Meierhofer C, Ewert P, Hager A. Are there correlations between lung volume and exercise capacity in children and adolescents with native Ebstein's anomaly? Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Patients with Ebstein’s Anomaly (EA) represent a wide clinical range with patients needing surgery in infancy and others needing no surgery throughout life. Exercise capacity in EA is often impaired. However, lung function is rarely investigated.
Purpose
This study examines lung volumes in native EA and their correlation with exercise capacity.
Methods
This retrospective study investigated 35 children with native EA (14 ± 4 years, 17 female), who underwent a cardiopulmonary exercise test (CPET) including spirometry to examine peak oxygen uptake (peakV’O2), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and its ratio (FEV/FVC). Percentage in peakV’O2 <80% represents a reduced exercise capacity, and values <60% are defined as impaired. Z-scores below -1.64 categorize restrictive (FVC) or obstructive (FEV1/FVC) patterns. To analyse correlations between CPET and lung volumes Spearman’s rank test was performed.
Results
Reduced exercise capacity was found in 17 children (47%), and further seven (20%) children showed impaired exercise capacity. Seven patients (20%) had a restrictive lung volume pattern and three patients (9%) showed obstructive patterns. One patient showed both. Eleven (92%) patients with an impaired lung function had at least a reduced exercise capacity with a median of 64 [53;73] %predicted. Lung volumes correlate significantly with %peakV’O2 (z-FVC: r=0.500, p=0.002 and z-FEV1: r=0.443, p=0.008).
Conclusions
Most young patients with native EA have impaired results in exercise capacity and a third has reduced lung volumes. Low lung volumes correlate with worse exercise capacity. Thus, the lung function should also be taken into consideration when looking at the performance of these and medical aftercare.
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Affiliation(s)
- J Hock
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - N Nagdyman
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - C Meierhofer
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - P Ewert
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
| | - A Hager
- Deutsches Herzzentrum Technische Universitat, Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
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Nagdyman N, Kalies J, Hager A, Meierhofer C, Clevert D, Zachoval R, Ewert P. How Common Is Liver Fibrosis in Adult Patients with Ebstein's Anomaly and Can It Serve as an Additional Criterion for Surgical Indication? Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- N. Nagdyman
- Deutsches Herzzentrum München, München, Deutschland
| | - J. Kalies
- Deutsches Herzzentrum München, München, Deutschland
| | - A. Hager
- Deutsches Herzzentrum München, München, Deutschland
| | | | - D. Clevert
- Clinic of Radiology, Großhadern, München, Deutschland
| | - R. Zachoval
- Medizinische Klinik I, Großhadern, München, Deutschland
| | - P. Ewert
- Deutsches Herzzentrum München, München, Deutschland
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Hock J, Nagdyman N, Ewert P, Cleuziou J, Meierhofer C, Hager A. Cardiopulmonary Exercise Performance in Adults with Native Ebstein's Anomaly—A Comparison of Cyanotic versus Acyanotic Patients. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Hock
- Deutsches Herzzentrum München, München, Deutschland
| | - N. Nagdyman
- Deutsches Herzzentrum München, München, Deutschland
| | - P. Ewert
- Deutsches Herzzentrum München, München, Deutschland
| | - J. Cleuziou
- Deutsches Herzzentrum München, München, Deutschland
| | | | - A. Hager
- Deutsches Herzzentrum München, München, Deutschland
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10
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Schmiel M, Kido T, Heinisch P, Vodiskar J, Strbad M, Georgiev S, Ewert P, Hager A, Hörer J, Ono M. Risk Factors for Development of Aortopulmonary Collaterals during Staged Single-Ventricle Reconstruction. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Schmiel
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Deutsches Herzzentrum München, München, Deutschland
| | - T. Kido
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - P. Heinisch
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - J. Vodiskar
- Department of Congenital and Pediatric Heart Surgery, Technische Universität, Deutsches Herzzentrum München, Munich, Deutschland
| | - M. Strbad
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - S. Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - P. Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - A. Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - J. Hörer
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - M. Ono
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
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Schmiel M, Kido T, Heinisch P, Vodiskar J, Strbad M, Georgiev S, Ewert P, Hager A, Hörer J, Ono M. Incidence and Risk Factors for the Development of Aortopulmonary Collaterals in Patient with Hypoplastic Left Heart Syndrome. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- M. Schmiel
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, München, Deutschland
| | - T. Kido
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, München, Deutschland
| | - P. Heinisch
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, München, Deutschland
| | - J. Vodiskar
- Department of Congenital and Pediatric Heart Surgery, Technische Universität, Deutsches Herzzentrum München, Munich, Deutschland
| | - M. Strbad
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, München, Deutschland
| | - S. Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - P. Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - A. Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Technische Universität München, Deutsches Herzzentrum München, Munich, Deutschland
| | - J. Hörer
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, München, Deutschland
| | - M. Ono
- Department of Congenital and Pediatric Heart Surgery, Technische Universität München, Deutsches Herzzentrum München, München, Deutschland
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Oates G, Geurs R, Mims C, Bergquist R, Hager A, Gutierrez H. 275: A mobile health platform for pediatric cystic fibrosis: Impact on patient-reported outcomes and patient-centered care. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Rutland SB, Bergquist RP, Hager A, Geurs R, Mims C, Gutierrez HH, Oates GR. A Mobile Health Platform for Self-Management of Pediatric Cystic Fibrosis: Qualitative Study of Adaptation to Stakeholder Needs and Integration in Clinical Settings. JMIR Form Res 2021; 5:e19413. [PMID: 33496667 PMCID: PMC7872830 DOI: 10.2196/19413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/03/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background Cystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision making. Objective The aim of this study is to adapt a mobile health (mHealth) app originally developed in Sweden to the needs of patients, families, and health care providers in a CF center in the United States and to test it as a platform for sharing patient-generated health data with the CF health care team. Methods Focus groups with health care providers of patients with CF, adolescents with CF, and caregivers of children with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of patient-generated health data to a secure Research Electronic Data Capture database was tested. Protocols for data management and clinical follow-up were also developed. Results A total of 5 focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the health care team; language and presentation; sharing and privacy; and settings and accounts. Overall, health care providers recommended changes to align the mHealth platform with US standards of care, people with CF and their caregivers requested more tracking functionalities, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta testers of the modified platform reported issues related to translatability to US environment and various bugs. Conclusions This study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered to meet both end users’ needs and evidence-based practice recommendations.
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Affiliation(s)
- Sarah B Rutland
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | | | | | - Robin Geurs
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Cathy Mims
- Children's of Alabama, Birmingham, AL, United States
| | - Hector H Gutierrez
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gabriela R Oates
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
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Hager A, Lindblad S, Brommels M, Salomonsson S, Wannheden C. Sharing Patient-Controlled Real-World Data Through the Application of the Theory of Commons: Action Research Case Study. J Med Internet Res 2021; 23:e16842. [PMID: 33464212 PMCID: PMC7854041 DOI: 10.2196/16842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/15/2020] [Accepted: 12/17/2020] [Indexed: 12/25/2022] Open
Abstract
Background Technological advances have radically changed the opportunities for individuals with chronic conditions to practice self-care and to coproduce health care and research. Digital technologies enable patients to perform tasks traditionally carried out by health care professionals in a more convenient way, at lower costs, and without compromising quality. Patients may also share real-world data with other stakeholders to promote individual and population health. However, there is a need for legal frameworks that enable patient privacy and control in such sharing of real-world data. We believe that this need could be met by the conceptualization of patient-controlled real-world data as knowledge commons, which is a resource shared by a group of people. Objective This study aimed to propose a conceptual model that describes how patient-controlled real-world data can be shared effectively in chronic care management, in a way that supports individual and population health, while respecting personal data privacy and control. Methods An action research approach was used to develop a solution to enable patients, in a self-determined way, to share patient-controlled data to other settings. We chose the context of cystic fibrosis (CF) care in Sweden, where coproduction between patients, their families, and health care professionals is critical in the introduction of new drugs. The first author, who is a lawyer and parent of children with CF, was a driver in the change process. All coauthors collaborated in the analysis. We collected primary and secondary data reflecting changes during the time period from 2012 to 2020, and performed a qualitative content analysis guided by the knowledge commons framework. Results Through a series of changes, a national system for enabling patients to share patient-controlled real-world data to different stakeholders in CF care was implemented. The case analysis resulted in a conceptual model consisting of the following three knowledge commons arenas that contributed to patient-controlled real-world data collection, use, and sharing: (1) patient world arena involving the private sphere of patients and families; (2) clinical microsystem arena involving the professional sphere at frontline health care clinics; and (3) round table arena involving multiple stakeholders from different settings. Based on the specification of property rights, as presented in our model, the patient can keep control over personal health information and may grant use rights to other stakeholders. Conclusions Health information exchanges for sharing patient-controlled real-world data are pivotal to enable patients, health care professionals, health care funders, researchers, authorities, and the industry to coproduce high-quality care and to introduce and follow-up novel health technologies. Our model proposes how technical and legal structures that protect the integrity and self-determination of patients can be implemented, which may be applicable in other chronic care settings as well.
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Affiliation(s)
| | | | - Mats Brommels
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Stina Salomonsson
- Center for Observational and Real World Evidence, Merck Sharp and Dohme, Stockholm, Sweden
| | - Carolina Wannheden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Silfverplatz A, Jarblad A, Fältström C, Sixhöj A, Hager A, Grimhusen M, Hjelte L, de Monestrol I. P073 The Cystic Fibrosis Atlas approach to community-based discovery and explanation of improvement needs and inequalities of care. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hock J, Hager A, Oberhoffer R. Increased Exercise Capacity after Inspiratory Ventilatory Training in Young Patients with the Repaired Tetralogy of Fallot: A Randomized Controlled Trial. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Apitz C, Abdul-Khaliq H, Albini S, Beerbaum P, Dubowy KO, Gorenflo M, Hager A, Hansmann G, Hilgendorff A, Humpl T, Kaestner M, Koestenberger M, Kozlik-Feldmann R, Latus H, Michel-Behnke I, Miera O, Quandt D, Sallmon H, Schranz D, Schulze-Neick I, Stiller B, Warnecke G, Pattathu J, Lammers AE. Neue hämodynamische Definition der pulmonalen Hypertonie. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00792-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Zusammenfassung
Eine pathologische Druckerhöhung im pulmonalen Gefäßsystem (pulmonale Hypertonie, PH) wurde bisher definiert durch einen invasiv gemessenen mittleren pulmonalarteriellen Druck (mPAP) ≥25 mm Hg in Ruhe. Auf dem 6th World Symposium on Pulmonary Hypertension (WSPH) in Nizza 2018 wurde eine neue Definition der PH vorgeschlagen, die die Senkung der Obergrenze des normalen mPAP von 24 auf 20 mm Hg beinhaltet.
Obwohl keine Evidenz aus pädiatrischen Studien hierfür vorliegt, wurde diese neue PH-Definition (mPAP >20 mm Hg) aus Gründen der Einheitlichkeit auch von der pädiatrischen „Task Force“ des WSPH 2018 übernommen.
Die vorliegende Stellungnahme der Arbeitsgemeinschaft Pulmonale Hypertonie (AGPH) der Deutschen Gesellschaft für Pädiatrische Kardiologie und angeborene Herzfehler e. V. (DGPK) erläutert die zugrunde liegende Rationale und mögliche Konsequenzen dieser Definitionsänderung. Insbesondere stellt sie klar, dass diese Änderung der Definition aktuell keinen Einfluss auf die Verschreibung von Medikamenten zur gezielten spezifischen Therapie der pulmonalarteriellen Hypertonie hat.
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Eugene Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Andreas Hager
- Upstream Dream, Alviksvagen 43, SE-167 55, Stockholm, Bromma, Sweden
| | - Amy Price
- MedicineX, Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA
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Feltgen N, Mele B, Dietlein T, Erb C, Eckstein A, Hager A, Heiligenhaus A, Helbig H, Hoerauf H, Hoffmann E, Pauleikhoff D, Schittkowski M, Seitz B, Sucker C, Suffo S, Schaudig U, Tost F, Thurau S, Walter P, Koscielny J. [Management of anticoagulants in ophthalmic surgery-a survey among ophthalmic surgeons in Germany]. Ophthalmologe 2019; 115:585-591. [PMID: 29770858 DOI: 10.1007/s00347-018-0732-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION As our population ages and comorbidities rise, ophthalmic surgeons are increasingly faced with patients on anticoagulant therapy or with clotting disorders. The ophthalmic surgeon has to weigh the perioperative risk of haemorrhage when anticoagulation continues against the risk of thromboembolism caused by discontinuation or changing the patient's medication (bridging, switching, cessation). There are currently no guidelines or recommendations. METHODS A survey was sent to the DOG (German Ophthalmologic Society) divisions and associated surgical organizations to determine the status quo. A questionnaire was sent out and filled out by the different groups of specialists. RESULTS All four divisions of the DOG and four associated organizations returned completed questionnaires. Surgical interventions were listed that are carried out during anticoagulant therapy without exceptions, as well as interventions that were classified to require medical adjustment. Although the assessments varied, general consensus was achieved regarding interventions not requiring adjustments due to anticoagulants (i. e., intravitreal injection, cataract surgery, laser and corneal operations, simple muscle surgery), and those interventions requiring adjustments in medications (glaucoma operations, complex retina surgery, eye socket surgery, complex surgery of the lid). CONCLUSION Main result of this survey was the specification of serious bleeding complications which are permanent vision loss and re-operation. They could serve as endpoint parameters for essential future investigations. Nevertheless, this survey makes clear that the decision about an adjustment of anticoagulant medication in ophthalmic surgery is currently made individually and not based on established standards.
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Affiliation(s)
- N Feltgen
- Klinik für Augenheilkunde, Universitätsklinikum Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
| | - B Mele
- DOG Geschäftsstelle, Platenstr. 1, 80336, München, Deutschland
| | - T Dietlein
- Klinik für Augenheilkunde, Universitätsklinikum Köln, Köln, Deutschland
| | - C Erb
- Augenklinik am Wittenbergplatz, Berlin, Deutschland
| | - A Eckstein
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Essen, Deutschland
| | - A Hager
- Augenarztpraxis am Elsterplatz, Berlin, Deutschland
| | | | - H Helbig
- Klinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - H Hoerauf
- Klinik für Augenheilkunde, Universitätsklinikum Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - E Hoffmann
- Klinik für Augenheilkunde, Universitätsklinikum Mainz, Mainz, Deutschland
| | - D Pauleikhoff
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - M Schittkowski
- Klinik für Augenheilkunde, Universitätsklinikum Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - C Sucker
- Gerinnungszentrum Berlin Dr. Sucker, Berlin, Deutschland
| | - S Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | - U Schaudig
- Augenklinik, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - F Tost
- Klinik für Augenheilkunde, Universitätsklinikum Greifswald, Greifswald, Deutschland
| | - S Thurau
- Klinik für Augenheilkunde, Universitätsklinikum München, LMU, München, Deutschland
| | - P Walter
- Klinik für Augenheilkunde, Universitätsklinikum Aachen, Aachen, Deutschland
| | - J Koscielny
- Gerinnungsambulanz und Hämophiliezentrum an der Charité, Berlin, Deutschland
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20
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Grande SW, Longacre MR, Palmblad K, Montan MV, Berquist RP, Hager A, Kotzbauer G. Empowering Young People Living With Juvenile Idiopathic Arthritis to Better Communicate With Families and Care Teams: Content Analysis of Semistructured Interviews. JMIR Mhealth Uhealth 2019; 7:e10401. [PMID: 30794202 PMCID: PMC6406228 DOI: 10.2196/10401] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 11/02/2018] [Accepted: 11/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Young people living with juvenile idiopathic arthritis (JIA) face a number of communication barriers for achieving optimal health as they transition from pediatric care into adult care. Despite growing interest in mobile or wireless technologies to support health (mHealth), it is uncertain how these engagement tools might support young people, their families, and care teams to optimize preference-based treatment strategies. Objective This study aims to examine how an mHealth patient support system (mPSS) might foster partnership between young people living with JIA, their families, and care teams. Methods Semistructured interviews with young people (5-15 years old), their families, and JIA care teams were conducted using researcher-developed interviews guides. Transcribed data were qualitatively analyzed using conventional content analysis. Results We conducted semistructured interviews with 15 young people, their parents, and 4 care team members. Content analysis revealed the potential of an mPSS to support productive dialogue between families and care teams. We identified four main themes: (1) young people with JIA face communication challenges, (2) normalizing illness through shared experience may improve adherence, (3) partnership opens windows into illness experiences, and (4) readiness to engage appears critical for clinic implementation. Conclusions A human-centered mPSS design that offers JIA patients the ability to track personally relevant illness concerns and needs can enhance communication, generate consensus-based treatment decisions, and improve efficiency and personalization of care. Technology that supports continuous learning and promotes better understanding of disease management may reduce practice burden while increasing patient engagement and autonomy in fostering lasting treatment decisions and ultimately supporting personalized care and improving outcomes.
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Affiliation(s)
- Stuart W Grande
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Meghan R Longacre
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Karin Palmblad
- Karolinska Institutet, Department of Women and Child Health, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Greg Kotzbauer
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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21
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Longacre M, Grande S, Hager A, Montan M, Bergquist RP, Martensson M, Kotzbauer G. Clinical Adoption of mHealth Technology to Support Pediatric Cystic Fibrosis Care in Sweden: Qualitative Case Study. JMIR Pediatr Parent 2018; 1:e11080. [PMID: 31518297 PMCID: PMC6715072 DOI: 10.2196/11080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/25/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have potential to improve self-management and care co-ordination of pediatric chronic diseases requiring complex care, such as cystic fibrosis (CF). Barriers to implementation include the lack of support and infrastructure to use mHealth in the clinical microsystem. Coproducing mHealth technology with patients, clinicians, and designers may increase the likelihood of successful integration into the clinical setting. OBJECTIVE This study explored the development, adoption, and integration of a new, co-produced mHealth platform (Genia) for the management of pediatric CF in Sweden. METHODS A retrospective, qualitative case study approach was used. The case was defined as the process of introducing and using Genia at the Pediatric Cystic Fibrosis Center at Skåne University Hospital in Lund, Sweden. Data sources included interviews, presentations, meeting notes, and other archival documents created between 2014 and 2017. To be included, data sources must have described or reflected upon the Genia adoption process. Iterative content analysis of data source materials was conducted by 2 qualitatively trained researchers to derive themes characterizing the mHealth clinical adoption process. RESULTS In total, 4 core themes characterized successful clinical integration of Genia in Lund: cultural readiness to use mHealth; use of weekly huddles to foster momentum and rapid iteration; engagement in incremental "Genia Talk" to motivate patient adoption; and co-design approach toward pediatric chronic care. CONCLUSIONS Principles of quality improvement, relational co-ordination, user-centered design, and coproduction can facilitate the integration of mHealth technology into clinical care systems for pediatric CF care.
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Affiliation(s)
- Meghan Longacre
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Stuart Grande
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | | | | | | | - Maria Martensson
- Lund Pediatric Cystic Fibrosis Center, Skane University Hospital, Lund, Sweden
| | - Greg Kotzbauer
- The Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
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Fritz C, Hock J, Oberhoffer R, Ewert P, Hager A, Mueller J. P1617Broad cardiovascular autonomic dysfunction in adolescent and adult patients with different types of congenital heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Fritz
- German Heart Center of Munich, Munich, Germany
| | - J Hock
- German Heart Center of Munich, Munich, Germany
| | - R Oberhoffer
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - P Ewert
- German Heart Center of Munich, Munich, Germany
| | - A Hager
- German Heart Center of Munich, Munich, Germany
| | - J Mueller
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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Abstract
Antithrombotic treatment with oral anticoagulants and antiplatelet agents can increase the risk for perioperative bleeding. In contrast to other surgical fields, the optimal perioperative management in ophthalmic surgery has not yet been exactly defined and, thus, is not standardized. In this contribution, we provide an overview of currently available oral anticoagulants and discuss potential strategies for the management of these agents in different ophthalmic surgical procedures.
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Affiliation(s)
- C Sucker
- Gerinnungszentrum Berlin Dr. Sucker, Tauentzienstraße 7b/c, 10789, Berlin, Deutschland.
| | - A Hager
- Gerinnungsambulanz, Charité, Berlin, Deutschland
| | - J Koscielny
- Augenarztpraxis am Elsterplatz, Kissinger Straße 1, 14199, Berlin, Deutschland
| | - N Feltgen
- Augenklinik, Universitätsmedizin Göttingen, Göttingen, Deutschland
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24
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Hosny M, Tanase D, Georgiev S, Genz T, Hager A, Ewert P, Abdellatef A, Ahmed A, Bambul P, Eicken A. Acute and Long-term Outcomes for Recoarctation and Arterial Hypertension in Patients with Stent Therapy of the Aortic Coarctation. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Hosny
- German Heart Centre Munich, Munich, Germany
| | - D. Tanase
- German Heart Centre Munich, Munich, Germany
| | | | - T. Genz
- German Heart Centre Munich, Munich, Germany
| | - A. Hager
- German Heart Centre Munich, Munich, Germany
| | - P. Ewert
- German Heart Centre Munich, Munich, Germany
| | | | - A. Ahmed
- Pediatrics, Zagazig University, Zagazig, Egypt
| | - P. Bambul
- German Heart Centre Munich, Munich, Germany
| | - A. Eicken
- German Heart Centre Munich, Munich, Germany
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Spirk D, Stuck AK, Hager A, Engelberger RP, Aujesky D, Kucher N. Electronic alert system for improving appropriate thromboprophylaxis in hospitalized medical patients: a randomized controlled trial. J Thromb Haemost 2017; 15:2138-2146. [PMID: 28836340 DOI: 10.1111/jth.13812] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Indexed: 11/30/2022]
Abstract
Essentials Venous thromboembolism (VTE) prophylaxis in hospitalized medical patients remains inconsistent. We implemented an electronic alert system featuring a validated risk assessment model for VTE. In this randomized controlled study, the e-alert system did not improve VTE prophylaxis. Many electronic alerts were ignored by ordering physicians. SUMMARY Background The use of thromboprophylaxis among acutely ill hospitalized medical patients remains inconsistent. Objective To improve thromboprophylaxis use by implementing a computer-based alert system combined with a Geneva Risk Score calculation tool in the electronic patient chart and order entry system. Patients/Methods Consecutive patients admitted to the general internal medicine wards of the University Hospital Bern, Switzerland were randomized to the alert group, in which an alert and the Geneva Risk Score calculation tool was issued in the electronic patient chart, or to the control group, in which no alert was issued. The primary endpoint was the rate of appropriate thromboprophylaxis during hospital stay. Results Overall, 1593 patients (alert group, 804; control group, 789) were eligible for analysis. The median age was 67 years (interquartile range, 53-79 years) and 47% were female. Appropriate thromboprophylaxis was administered to 536 (66.7%) patients from the alert group and to 526 (66.7%) patients from the control group. Among the 804 patients from the alert group, a total of 446 (55.5%) either had no score calculation by the physician in charge (n = 348) or had a calculated score result that was inconsistent with information from the patient chart (n = 98). Appropriate thromboprophylaxis was less often administered to patients with no score or an inconsistent score result than to 358 patients with a consistent score result (62.6% versus 71.8%). Conclusions The electronic alert (e-alert) system did not improve appropriate thromboprophylaxis, most likely because many e-alerts were ignored by ordering physicians. The use of appropriate thromboprophylaxis in the control group was higher than expected.
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Affiliation(s)
- D Spirk
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - A K Stuck
- Swiss Cardiovascular Center, Division of Vascular Medicine, University of Bern, University Hospital Bern, Bern, Switzerland
| | - A Hager
- Department of Medical Informatics, University of Bern, University Hospital Bern, Bern, Switzerland
| | - R P Engelberger
- Swiss Cardiovascular Center, Division of Vascular Medicine, University of Bern, University Hospital Bern, Bern, Switzerland
- Division of Angiology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - D Aujesky
- Department of General Internal Medicine, University of Bern, University Hospital Bern, Bern, Switzerland
| | - N Kucher
- Swiss Cardiovascular Center, Division of Vascular Medicine, University of Bern, University Hospital Bern, Bern, Switzerland
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Ono M, Burri M, Cleuziou J, Pabst J, Baran E, Hager A, Schreiber C, Lange R. Long-Term Outcome of Patients Undergoing Total Cavopulmonary Connection in Preteen, Teenage, and Adult Age: Analysis of 50 Consecutive Patients. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Ono
- German Heart Center Munich, Munich, Germany
| | - M. Burri
- German Heart Center Munich, Munich, Germany
| | | | - J. Pabst
- German Heart Center Munich, Munich, Germany
| | - E. Baran
- German Heart Center Munich, Munich, Germany
| | - A. Hager
- German Heart Center Munich, Munich, Germany
| | | | - R. Lange
- German Heart Center Munich, Munich, Germany
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Boukovala M, Müller J, Ewert P, Hager A. Treatment Effects on the Quality of Life of Patients with Congenital Heart Disease: A Retrospective Review of 1,084 Patients. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Boukovala
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - J. Müller
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - P. Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany
| | - A. Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität München, München, Germany
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Bambul Heck P, Eicken A, Kasnar-Samprec J, Ewert P, Hager A. Early pulmonary arterial hypertension immediately after closure of a ventricular or complete atrioventricular septal defect beyond 6 months of age. Int J Cardiol 2017; 228:313-318. [DOI: 10.1016/j.ijcard.2016.11.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/21/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022]
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Kaemmerer H, Apitz C, Brockmeier K, Eicken A, Gorenflo M, Hager A, deHaan F, Huntgeburth M, Kozlik-Feldmann R, Miera O, Diller GP. [Pulmonary hypertension in grown-ups with congenital heart disease: Recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S70-S79. [PMID: 27760453 DOI: 10.1055/s-0042-114530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for different forms of PH, and specifically address PH associated with congenital heart disease (CHD). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH in grown-ups with congenital heart disease (GUCH). This article summarizes the results and recommendations of this working group.
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Kovacs G, Dumitrescu D, Barner A, Greiner S, Grünig E, Hager A, Köhler T, Kozlik-Feldmann R, Kruck I, Lammers A, Mereles D, Meyer A, Meyer FJ, Pabst S, Seyfarth HJ, Sinning C, Sorichter S, Stähler G, Wilkens H, Held M. [Clinical classification and initial diagnosis of pulmonary hypertension: recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S10-S18. [PMID: 27760445 DOI: 10.1055/s-0042-114523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed information about the clinical classification and diagnosis of pulmonary hypertension, and furthermore provide novel recommendations for risk stratification and follow-up assessments. However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the clinical classification and initial diagnosis of PH. This article summarizes the results and recommendations of this working group.
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Neidenbach R, Müller J, Ewert P, Hager A. Decreased Hand-Grip Strength in Adolescents and Adults with Congenital Heart Disease Depending on Cyanosis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bambul Heck P, Pringsheim M, Ewert P, Hager A. Coarctation, Long-Term Follow-up, and Quality of Life: Predictive Value of Clinical Variables. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Callegari A, Neidenbach R, Milanesi O, Castaldi B, Ono M, Müller J, Ewert P, Hager A. A Restrictive Ventilatory Pattern Is Common in Patients with Univentricular Heart after Fontan Palliation and Associated with a Reduced Exercise Capacity and a Reduced Quality of Life. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Seibel I, Cordini D, Rehak M, Hager A, Riechardt AI, Heufelder J, Joussen AM. Visuslimitierende Komplikationen und deren Therapie nach Protonentherapie beim Aderhautmelanom. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Riechardt AI, Pilger D, Cordini D, Seibel I, Hager A, Rehak M, Joussen AM. Risikofaktoren und Therapieoptionen zur Behandlung des rubeotischen Sekundärglaukoms nach Radiatio. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hager A, Koscielny J, Schlomberg J, Seibel I, Joussen AM. Perioperatives Management ophthalmologischer Patienten unter antithrombotischer Therapie. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nürnberg D, Seibel I, Hager A, Duncker T, Riechardt AI, Klein JP, Rehak M, Joussen AM. Anti-VEGF Therapie bei symptomatischer peripher exsudativ hämorrhagischer Chorioretinopathie mit Makulabeteiligung. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ono M, Cleuziou J, Kasnar-Samprec J, Burri M, Strbad M, Vogt M, Hager A, Lange R, Schreiber C, Hörer J. Bessere Hämodynamik und Leistungsfähigkeit im Langzeitverlauf bei Patienten mit pulsatilem pulmonalen Fluss nach atrioventrikulären Fontanmodifikation. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Georgiev S, Eicken A, Tanase D, Fratz S, Hager A, Ewert P. Percutaneous Pulmonary Valve Implantation in the „Native” Right Ventricular Outflow Tract. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ziermann F, Hörer J, Fratz S, Lange R, Hager A. Häufigkeit von Begleitherzfehlern bei 92 Patienten mit Fehlabgängen der Koronararterien aus der Pulmonalarterie. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1556026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Eugene C Nelson
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, 35 Centerra Parkway, Suite 300, Lebanon, NH 03766, USA Dartmouth-Hitchcock Health, Lebanon, NH, USA
| | - Elena Eftimovska
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | | - Andreas Hager
- Genia, Stockholm, Sweden Hansen Law, Stockholm, Sweden
| | - John H Wasson
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, 35 Centerra Parkway, Suite 300, Lebanon, NH 03766, USA
| | - Staffan Lindblad
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden Quality Register Centre, Stockholm, Sweden
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Gorenflo M, Apitz C, Miera O, Stiller B, Schranz D, Berger F, Hager A, Kaemmerer H. [Pulmonary hypertension/pulmonary arterial hypertension in congenital heart disease and therapy of pulmonary arterial hypertension in children]. Dtsch Med Wochenschr 2014; 139 Suppl 4:S166-70. [PMID: 25489686 DOI: 10.1055/s-0034-1387491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M Gorenflo
- Klinik Kinderheilkunde II, Pädiatrische Kardiologie und Angeborene Herzfehler, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Deutschland
| | - C Apitz
- Kinderkardiologie, Universitätsklinikum Gießen, Deutschland
| | - O Miera
- Klinik für angeborene Herzfehler/Kinderkardiologie, Deutsches Herzzentrum Berlin, Deutschland
| | - B Stiller
- Klinik für Angeborene Herzfehler und Pädiatrische Kardiologie ZKJ, Universitäts Herzzentrum Freiburg Bad Krozingen
| | - D Schranz
- Kinderkardiologie, Universitätsklinikum Gießen, Deutschland
| | - F Berger
- Klinik für angeborene Herzfehler/Kinderkardiologie, Deutsches Herzzentrum Berlin, Deutschland
| | - A Hager
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Deutschland
| | - H Kaemmerer
- Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Deutschland
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Seibel I, Cordini D, Rehak M, Hager A, Riechardt AI, Heufelder J, Gollrad J, Joussen AM. Rezidive nach Protonentherapie, wo liegen die Risikofaktoren? Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Heufelder J, Gollrad J, Hager A, Kufeld M, Pasemann D, Rehak M, Joussen AM. Vergleich perkutaner strahlentherapeutischer Verfahren in der Therapie der altersbedingten Maukaldegeneration. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hager A, Seibel I, Müller B, Apitzsch B, Joussen AM. Pharmakologische Vitreolyse mit Jetrea® – Ergebnisse und Erwartungen. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nürnberg D, Seibel I, Böker A, Gollrad J, Heufelder J, Cordini D, Hager A, Joussen AM, Rehak M. Therapie von uvealen Metastasen. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brockmann C, Hager A, Rehak M, Seibel I, Riechardt AI, Joussen AM. Brachytherapie mittels Rutheniumapplikator bei vasoproliferativen retinalen Tumoren. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hager A, Seibel I, Riechardt A, Rehak M, Joussen AM. Does ocriplasmin affect the RPE-photoreceptor adhesion in macular holes? Br J Ophthalmol 2014; 99:635-8. [PMID: 25403647 DOI: 10.1136/bjophthalmol-2014-305620] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/22/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND To evaluate the anatomical outcome of patients after vitrectomy due to persisting symptomatic vitreomacular traction (VMT), including full-thickness macular holes (FTMHs) of less than 400 µm, after ocriplasmin treatment. METHODS Retrospective, single centre, consecutive interventional case series. Patients were treated with a single intravitreal injection of ocriplasmin (Jetrea, Thrombogenics Inc, USA, Alcon/Novartis EU). MAIN OUTCOME MEASURES resolution of VMT, closure of FTMH and anatomical outcome of vitrectomy after unsuccessful treatment with ocriplasmin. RESULTS Five patients were treated with ocriplasmin injection. VMT persisted in all but one case. Four patients underwent pars-plana vitrectomy (PPV) for treatment of persistent VMT and FTMH (n=2, size of macular hole <400 µm) in spectral-domain optical coherence tomography (SD-OCT). FTMHs were closed in both cases within the first week postoperatively. After PPV, in three eyes newly developed subretinal fluid was detected, which persisted up to several months postoperatively. CONCLUSIONS Data on ocriplasmin remain controversial. We report on four cases with resolution of VMT following PPV after unsuccessful ocriplasmin treatment. Newly developed subretinal fluid has been described after ocriplasmin treatment, predominantly in cases with resolution of VMT. We also detected this newly developed subretinal fluid after vitrectomy, which persisted for several weeks up to 7 months in two cases with FTMHs. This may be attributable to loosening of the photoreceptor complex due to enzyme activity of ocriplasmin. Long-term effects of ocriplasmin are still to be evaluated using SD-OCT.
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Affiliation(s)
- A Hager
- Department of Ophthalmology, Charite -Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - I Seibel
- Department of Ophthalmology, Charite -Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - A Riechardt
- Department of Ophthalmology, Charite -Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - M Rehak
- Department of Ophthalmology, Charite -Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - A M Joussen
- Department of Ophthalmology, Charite -Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Rutz T, Seligmann M, Bruch G, Meierhofer C, Martinoff S, Ewert P, Hager A, Stern H, Fratz S. Impact of percutaneous pulmonary valve implantation on right to left pulmonary artery flow ratio and its consequences on ventilatory efficiency. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1393982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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