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Ratmann PD, Boeddinghaus J, Nestelberger T, Lopez-Ayala P, Huré G, Gehrke J, Koechlin L, Wildi K, Mueller P, Bima P, Wussler D, Gisler N, Miro O, Martín-Sánchez FJ, Christ M, Gualandro DM, Twerenbold R, Gimenez MR, Keller DI, Buser A, Mueller C. Extending the no objective testing rules to patients triaged by the European Society of Cardiology 0/1-hour algorithms. Eur Heart J Acute Cardiovasc Care 2022; 11:834-840. [PMID: 36179255 DOI: 10.1093/ehjacc/zuac120] [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] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/04/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
AIMS After rule-out of non-ST elevation myocardial infarction (NSTEMI) with the European Society of Cardiology (ESC) 0/1 h-algorithms, it is unclear which patients require further anatomical or functional cardiac testing. To test the safety and efficacy of the no-objective-testing (NOT)-rules after NSTEMI rule-out by the ESC 0/1 h-algorithms. METHODS AND RESULTS International, prospective, diagnostic multicentre study enrolling adult patients presenting with chest pain to the emergency department. Central adjudication of final diagnosis by two independent cardiologists using information including cardiac imaging. Primary endpoints were the safety and efficacy of the NOT-rules for the rule-out of major adverse cardiovascular events (MACE). Secondary endpoints included 365-day and 2-year MACE. Among 4804 and 4569 patients with available 0/1 h high-sensitivity cardiac troponin (hs-cTn)T-Elecsys or hs-cTnI-Architect concentrations, 2783 (58%) and 2252 (49%) were eligible for application of the NOT-rules after rule-out of NSTEMI by the ESC hs-cTnT/I-0/1h-algorithm. The first rule identified 26% of patients with a sensitivity of 100% (95%CI 98.3-100%) and a negative predictive value (NPV) of 100% (95% CI, n.c.). The second and third rules both identified 31% of patients with a sensitivity of 99.5% (95% CI 97.4-99.9%) and a NPV of 99.9% (95% CI 99.2-99.9%). Similar findings emerged for hs-cTnI. High safety was confirmed for rule-out of 365-day and 2-year MACE and proven to be superior to the HEART Score. CONCLUSION All three NOT-rules performed very well for rule-out of MACE. The third NOT-rule best balanced feasibility, safety, and efficacy by identifying nearly one out of three patients as low-risk and may not require further cardiac testing. https://clinicaltrials.gov/ct2/show/NCT00470587.
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Affiliation(s)
- Paul David Ratmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Pedro Lopez-Ayala
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Gabrielle Huré
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Juliane Gehrke
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Luca Koechlin
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Critical Care Research Group, The Prince Charles Hospital, Brisbane and the University of Queensland, 627 Rode Rd, Chermside Queensland 4032, Australia
| | - Philip Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Paolo Bima
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Nicolas Gisler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Oscar Miro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Emergency Department, Hospital Clinic, C. de Villarroel 170, 08036 Barcelona, Spain
| | - F Javier Martín-Sánchez
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
- Emergency Department, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Michael Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Spitalstrasse 16, CH-6000 Luzern, Switzerland
| | - Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- Cardiology Department, Heart Center Leipzig, Strümpellstraße 39, D-04289 Leipzig, Germany
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Schmelzbergstrasse 8, CH-8091 Zurich, Switzerland
| | - Andreas Buser
- Blood Transfusion Centre, Swiss Red Cross, Hebelstrasse 10, CH-4056 Basel, Switzerland
- Department of Hematology, University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
- GREAT network, Via Antonio Serra, 54, 00191 Rome, Italy
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Nestelberger T, Boeddinghaus J, Lopez Ayala P, Gehrke J, Twerenbold R, Cullen L, Mueller C. Utility of Echocardiography in Patients With Suspected Acute Myocardial Infarction and Left Bundle-Branch Block. J Am Heart Assoc 2021; 10:e021262. [PMID: 34514839 PMCID: PMC8649530 DOI: 10.1161/jaha.121.021262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy.,Division of Cardiology Vancouver General HospitalUniversity of British Columbia Vancouver British Columbia Canada
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Pedro Lopez Ayala
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Juliane Gehrke
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
| | - Louise Cullen
- GREAT Network Rome Italy.,Emergency and Trauma Centre Department Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital BaselUniversity of Basel Switzerland.,GREAT Network Rome Italy
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Lopez-Ayala P, Nestelberger T, Boeddinghaus J, Koechlin L, Ratmann PD, Strebel I, Gehrke J, Meier S, Walter J, Rubini Gimenez M, Mutschler E, Miro O, Lopez-Barbeito B, Martin-Sanchez FJ, Rodriguez-Adrada E, Keller DI, Newby LK, Twerenbold R, Giannitsis E, Lindahl B, Mueller C. Novel Criteria for the Observe-Zone of the ESC 0/1h-hs-cTnT Algorithm. Circulation 2021; 144:773-787. [PMID: 34376064 DOI: 10.1161/circulationaha.120.052982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The non-ST elevation myocardial infarction (NSTEMI) guidelines of the European Society of Cardiology (ESC) recommend a 3h cardiac troponin determination in patients triaged to the observe-zone of the ESC 0/1h-algorithm; however, no specific cut-off for further triage is endorsed. Recently, a specific cut-off for 0/3h high-sensitivity cardiac troponin T (hs-cTnT) change (7ng/L) was proposed warranting external validation. Methods: Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. Final diagnoses were centrally adjudicated by two independent cardiologists applying the 4th universal definition of MI, based on complete cardiac work-up, cardiac imaging and serial hs-cTnT. Hs-cTnT concentrations were measured at presentation, after 1h and 3h. The objective was to externally validate the proposed cut-off, and if necessary, derive and internally as well as externally validate novel 0/3h-criteria for the observe-zone of the ESC 0/1h-hs-cTnT-algorithm in an independent multicenter cohort. Results: Among 2076 eligible patients, application of the ESC 0/1h-hs-cTnT-algorithm triaged 1512 patients (72.8%) to either rule-out or rule-in of NSTEMI, remaining 564 patients (27.2%) in the observe-zone (adjudicated NSTEMI prevalence 120/564 patients, 21.3%). The suggested 0/3h-hs-cTnT-change of <7ng/L triaged 517 patients (91.7%) towards rule-out, resulting in a sensitivity of 33.3% (95%CI 25.5-42.2), missing 80 patients with NSTEMI, and ≥7ng/L triaged 47 patients towards rule-in (8.3%), resulting in a specificity of 98.4% (95%CI 96.8-99.2). Novel derived 0/3h-criteria for the observe-zone patients ruled-out NSTEMI with a 3h hs-cTnT concentration <15 ng/L and a 0/3h-hs-cTnT absolute change <4 ng/L, triaging 138 patients (25%) towards rule-out, resulting in a sensitivity of 99.2% (95%CI 96.0-99.9), missing 1 patient with NSTEMI. A 0/3h-hs-cTnT absolute change ≥6 ng/L triaged 63 patients (11.2%) towards rule-in, resulting in a specificity of 98% (95%CI 96.2-98.9) Thereby, the novel 0/3h-criteria reduced the number of patients in the observe zone by 36%, and the number of T1MI by 50%. Findings were confirmed in both internal and external validation. Conclusions: A combination of a 3h hs-cTnT concentration (<15 ng/L) and a 0/3h absolute change (<4 ng/L) is necessary to safely rule-out NSTEMI in patients remaining in the observe-zone of the ESC 0/1h-hs-cTnT-algorithm. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT00470587.
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Affiliation(s)
- Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Department of Cardiac Surgery, University Hospital Basel, University of Basel, Switzerland
| | - Paul David Ratmann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy
| | - Juliane Gehrke
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy
| | - Severin Meier
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joan Walter
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | | | - Eugenio Mutschler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Oscar Miro
- GREAT network, Rome, Italy; Emergency Department, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain
| | - Beatriz Lopez-Barbeito
- GREAT network, Rome, Italy; Emergency Department, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain
| | | | | | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - L Kristin Newby
- Division of Cardiology, Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy; University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala, Sweden
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT network, Rome, Italy
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Binz T, Rietschel L, Streit F, Hofmann M, Gehrke J, Herdener M, Quednow B, Martin N, Rietschel M, Kraemer T, Baumgartner M. Endogenous cortisol in keratinized matrices: Systematic determination of baseline cortisol levels in hair and the influence of sex, age and hair color. Forensic Sci Int 2018; 284:33-38. [DOI: 10.1016/j.forsciint.2017.12.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 01/03/2023]
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Meinck M, Ernst F, Pippel K, Gehrke J, Coners E. Medikamentenversorgung in Einrichtungen stationärer Pflege: Auffälligkeitsgründe in Qualitätsprüfungen Medizinischer Dienste. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586539] [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: 10/21/2022]
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Strahl A, Gerlich C, Wolf HD, Gehrke J, Müller-Garnn A, Vogel H. [Quality Assurance in Sociomedical Evaluation by Peer Review: A Pilot Project of the German Statutory Pension Insurance]. Gesundheitswesen 2014; 78:156-60. [PMID: 25531159 DOI: 10.1055/s-0034-1390450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The sociomedical evaluation by the German Pension Insurance serves the purpose of determining entitlement to disability pensions. A quality assurance concept for the sociomedical evaluation was developed, which is based on a peer Review process. Peer review is an established process of external quality assurance in health care. The review is based on a hierarchically constructed manual that was evaluated in this pilot project. METHODS The database consists of 260 medical reports for disability pension of 12 pension insurance agencies. 771 reviews from 19 peers were included in the evaluation of the inter-rater reliability. Kendall's coefficient of concordance W for more than 2 raters is used as primary measure of inter-rater reliability. RESULTS Reliability appeared to be heterogeneous. Kendalls W varies for the particular criteria from 0.09 to 0.88 and reached for primary criterion reproducibility a value of 0.37. CONCLUSION The reliability of the manual seemed acceptable in the context of existing research data and is in line with existing peer review research outcomes. Nevertheless, the concordance is limited and requires optimisation. Starting points for improvement can be seen in a systematic training and regular user meetings of the peers involved.
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Affiliation(s)
- A Strahl
- Abteilung für Med. Psychologie und Psychotherapie, Med. Soziologie und Rehabilitationswissenschaften, Universität Würzburg, Würzburg
| | - C Gerlich
- Abteilung für Med. Psychologie und Psychotherapie, Med. Soziologie und Rehabilitationswissenschaften, Universität Würzburg, Würzburg
| | - H-D Wolf
- Abteilung für Med. Psychologie und Psychotherapie, Med. Soziologie und Rehabilitationswissenschaften, Universität Würzburg, Würzburg
| | - J Gehrke
- Bereich Sozialmedizin, Deutsche Rentenversicherung Bund, Berlin
| | - A Müller-Garnn
- Bereich Sozialmedizin, Deutsche Rentenversicherung Bund, Berlin
| | - H Vogel
- Abteilung für Med. Psychologie und Psychotherapie, Med. Soziologie und Rehabilitationswissenschaften, Universität Würzburg, Würzburg
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Strahl A, Gerlich C, Müller-Garrn A, Brüggemann S, Gehrke J, Vogel H. Formative und summative Evaluation eines Peer-Schulungsprogramms für das trägerübergreifende Qualitätssicherungsverfahren der sozialmedizinischen Begutachtung bei Erwerbsminderungsrenten. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1387039] [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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Gehrke J, Müller-Garnn A. Die Nachvollziehbarkeit von Gutachten. Ergebnisse einer Analyse von Gutachtenmängeln. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1386907] [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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Gehrke J, Müller-Garrn A. Sozialmedizinische Begutachtung: Automatisierte Textanalyse von Mängeln in Gutachten bei Anträgen auf Erwerbsminderungsrente. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354147] [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: 10/26/2022]
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Bücking B, Balzer-Geldsetzer M, Dodel R, Ruchholtz S, Reese JP, Gehrke J. Factors influencing short-term functional recovery of geriatric hip fracture patients - a prospective observational study. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354220] [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: 10/26/2022]
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Vogel H, Strahl A, Gerlich C, Wolf HD, Müller-Garnn A, Gehrke J. Qualitätssicherung der sozialmedizinischen Begutachtung der Deutschen Rentenversicherung mit dem Peer Review-Verfahren. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354133] [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: 10/26/2022]
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Vogel H, Gerlich C, Löffler S, Meng K, Holderied A, Mai H, Gehrke J. Qualitätssicherung in der sozialmedizinischen Begutachtung: Entwicklung eines Prüffragenkatalogs zum Peer Review der Begutachtung von Erwerbsminderung durch die Deutsche Rentenversicherung. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283665] [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: 10/17/2022]
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Gehrke J. Sozialmedizinische Begutachtung der Deutschen Rentenversicherung: Qualitätssicherung von Gutachten bei Anträgen auf Erwerbsminderung. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266384] [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: 10/19/2022]
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Kasprowicz N, Bauerschmitz G, Gehrke J, Janni W. Hämostase durch Foley-Katheter bei Zervikalgravidität – Fallbericht und Diskussion der Therapieoptionen. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1250180] [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: 10/19/2022] Open
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Friebe-Hoffmann U, Gehrke J, Stanniegel H, Neubert J, Adams O, Oette M, Niehuis T. Single Centre Analyse zur HIV Transmissionsprophylaxe: Hohe Transmissionsrate wegen fehlender HIV Testung in der Schwangerschaft. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088714] [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: 10/19/2022] Open
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Gehrke J. Das Qualitätssicherungskonzept der sozialmedizinischen Begutachtung der Deutschen Rentenversicherung: Einführung und Überblick. Gesundheitswesen 2008. [DOI: 10.1055/s-0028-1086315] [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: 10/21/2022]
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Rohwetter M, Gehrke J. Einleitung in den Workshop „Qualitätssicherung der sozialmedizinischen Begutachtung“. Gesundheitswesen 2008. [DOI: 10.1055/s-0028-1086314] [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: 10/21/2022]
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Friebe-Hoffmann U, Gehrke J, Neubert J, Stannigel H, Adams O, Koch S, Oette M, Niehues T. Single Centre Analyse zur HIV Transmissionsprophylaxe: Hohe Transmissionsrate wegen fehlender HIV-Testung in der Schwangerschaft. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983638] [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: 10/21/2022] Open
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Friebe-Hoffmann U, Gehrke J, Neubert J, Adams O, Oette M, Niehues T. HIV Transmissionsprophylaxe: Hohe Transmissionsrate wegen fehlender HIV Testung in der Schwangerschaft–Single Centre Analyse. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002831] [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: 10/21/2022]
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Abstract
OBJECTIVE The improvement of health-related information services is one major issue in reforming the German health care system to provide more transparency in health care services for patients and persons covered by the German statutory health insurance system. To meet the general need for specific medical information a telephone-based health information service may give individual advice and provide a helpful selection of information. The study aims at users expectations and preferences with regard to health information services. More particularly, users perception concerning the type of health information and the ways of choosing the information were to be explored. METHOD The study included 160 participants of different ages. Prototypical medical advice conversations were presented to the participants consisting of/identifying the consumer's inquiry, followed by the expert's answering sequence. The answers were based on typical inquiries from medical information providers focussing on treatment methods and illnesses. Health information from these conversations with its special contents were ranked by preference judgements resulting in Thurstone scalings. RESULTS In terms of different health questions, the participants' judgements showed general preference structures for special health information, independent from any personal attitude towards medical information services. Great emphasis was placed on the medical conversation competence of the service provider, which is evident from recognising the specific needs and selection of information of a caller. Overall such health information was preferred that strengthened the patient's and user's autonomy and ability for decision making. CONCLUSION Patients and persons covered by German statutory health insurance are characterised as users of information by special preferences. Identifying these preferences permits a reasonable selection of information and individual advice. Therefore, these services provide a major advantage over non-interactive health information services (print media, internet sites).
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Affiliation(s)
- J Gehrke
- IGES Institut für Gesundheits- und Sozialforschung GmbH, Berlin.
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22
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Dempfle C, Schraml M, Besenthal I, Hansen R, Gehrke J, Korte W, Risch M, Quehenberger P, Handler S, Minar E, Schulz I, Zerback R. Multicentre evaluation of a new point-of-care test for the quantitative determination of D-dimer. Clin Chim Acta 2001; 307:211-8. [PMID: 11369360 DOI: 10.1016/s0009-8981(01)00436-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Imprecision studies, interference testing and multicentre method comparisons using patient samples were carried out with of a new point-of-care test for D-dimer (CARDIAC D-Dimer). The CV of the within-series and the day-to-day imprecision with blood samples and control materials were between 7% and 13%. Compared with Tina-quant D-Dimer, CARDIAC D-Dimer showed a good correlation and accuracy (n=353; r=0.91; y=1.06x-0.03), compared with STA LIATEST D-Dimer some poorer accuracy (n=304; r=0.91; y=1.12x-0.03). No interference was detected for different hematocrit values (16% to 51%) and in investigations with hemoglobin (up to 0.13 mmol/l), biotin (up to 30 microg/l), bilirubin (up to 340 micromol/l), intralipid (up to 31.1 mmol/l) and rheumatic factor (up to 79 IU/ml). Overdosing or underdosing by 10 microl did not affect the test result. The diagnostic sensitivity of CARDIAC D-Dimer for the detection of acute venous thromboembolic diseases was 100% in our study. With CARDIAC D-Dimer reliable quantitative D-dimer results can be easily obtained. Because of the good analytical and clinical agreement with Tina-quant D-Dimer, it should be suitable for ruling out venous thromboembolic diseases.
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Affiliation(s)
- C Dempfle
- Klinik für Innere Medizin I, Universitätsklinikum Mannheim, Mannheim, Germany.
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23
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Abstract
Two experiments were performed to investigate the organization of spatial information in perception and memory. Participants were confronted with map-like configurations of objects which were grouped by color (Experiment 1) or shape (Experiment 2) so as to induce cognitive clustering. Two tasks were administered: speeded verification of spatial relations between objects and unspeeded estimation of the Euclidean distance between object pairs. In both experiments, verification times, but not distance estimations, were affected by group membership. Spatial relations of objects belonging to the same color or shape group were verified faster than those of objects from different groups, even if the spatial distance was identical. These results did not depend on whether judgments were based on perceptually available or memorized information, suggesting that perceptual, not memory processes were responsible for the formation of cognitive clusters.
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Affiliation(s)
- B Hommel
- University of Leiden, Section of Experimental and Theoretical Psychology, The Netherlands.
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24
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Abstract
This study examines the impact of peripheral nerve block, that is, the elimination of tactile feedback on synchronization performance. In a tapping experiment in which subjects were instructed to tap in synchrony with an auditory pacing signal, three different tasks were studied under conditions with and without peripheral nerve block: standard tapping with tactile contact, isometric tapping, and contact-free tapping. In addition, the maximum tapping rate was registered both with and without peripheral nerve block. It was found that the anticipatory error, usually observed in synchronization tasks, was affected by the peripheral nerve block in the standard tapping and the isometric tapping task. In both tasks, local anesthesia led to an increase in asynchrony between the pacing signal and the tap. Performance remained unimpaired in those tasks in which tactile information was assumed to play a minor role (maximum tapping rate and contact-free tapping). The results clearly demonstrate the importance of tactile feedback for the timing of movements. The predictions of a model assuming a strong correlation between the amount of sensory feedback and the size of the negative asynchrony in synchronization tasks were examined and discussed.
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Affiliation(s)
- G Aschersleben
- Max-Planck-Institut für Psychologische Forschung, Munich, Germany.
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25
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26
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Abstract
Recently, a magneto binding assay was conducted. The operational principle is based on a 'sandwich' mode of detection, where the target analyte (Concanavalin A) becomes bound nonselectively by protein adsorption between the solid support (silica carrier particles) and the ferromagnetic label (magneto markers). A magnetic transducer was employed for the detection. The binding assay gave a linear response in the dynamic range of 0-1.9 microM and proved to be sensitive by having a limit of detection at 250 nM. Furthermore, the relative standard deviation observed was 6.2% (n = 3). The demonstration of the 'sandwich' approach is a step toward achieving magneto immunoassays (MIA).
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Affiliation(s)
- K Kriz
- European Institute of Science, Lund, Sweden
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27
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Abstract
It is a common practice in many hospitals to have all skeletal radiographs read by a second physician, usually a radiologist, as well as by the treating physician. A two-part study was performed in order to examine the cost and clinical benefit of this practice for plain films ordered by orthopedists. In the first part of this study, the attending orthopedic surgeons were surveyed about the clinical usefulness and effect on patient care of 1000 radiologic reports from plain films ordered on orthopedic patients. In the second part, the charts of 272 patients who had 704 radiographs were reviewed with the goal of identifying any discrepancies between the orthopedic interpretation and the radiologic reading. Thirty-eight reports were discarded because they were not reports of plain skeletal films. One hundred twenty-nine of the remaining 962 radiologic reports were never read by the attending orthopedist. The average time between the taking of the film and an orthopedic attending reading the printed report was 6.1 days. Three radiology reports contained findings that were incorrect. Only one report contained findings that the orthopedist was unaware, and one report may have led to an alteration in treatment. No reports resulted in an unplanned trip to the operating room or a patient being called back to the clinic. Of the 272 chart reviews (704 reports), 70 had no orthopedic interpretation recorded and 94 had no radiologic report in the chart. Twelve discrepancies were noted in the cases that had both reports. Four fracture displacements were identified by orthopedists, but not on the written radiology report; three of these required a return to the operating room. Four instances of hardware displacement or breakage were noted by orthopedists, but not commented on by the radiologists. Three incidental injuries (two fractures and an acromioclavicular injury) were noted on printed reports of films taken for other reasons, but not commented on by the orthopedist, and not treated. A dorsal bunion was noted on one film by the orthopedist, but not by the radiologist. From this study, one can conclude that the benefit of routine duplicate radiograph interpretation by a second physician does not justify its cost.
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Affiliation(s)
- J Anglen
- Division of Orthopedic Surgery, University of Missouri Hospitals and Clinics, Columbia 65212, USA
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28
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Abstract
An unusual fracture-dislocation of the calcaneus is presented in which tendinous interposition in the subtalar joint prevented the possibility of closed reduction. This situation has been reported in the literature in only five previous patients. The position of the flexor hallucis tendon in the joint could be visualized on the preoperative computed tomographic scan. The patient was treated operatively with reduction through a lateral approach without a supplemental medial incision.
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Affiliation(s)
- J O Anglen
- Orthopaedic Trauma Service, University of Missouri Hospitals and Clinics, Columbia, USA
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Gehrke J. Classification of mitral valve prolapse. Ultrasound Med Biol 1983; Suppl 2:319-324. [PMID: 6545739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The scope of diagnosing mitral valve prolapse (MVP) has been enlarged by the earlier reported real-time B-scan criteria of small or "localised MVP". This form is believed to be the precursor of the overt MVP which is then readily diagnosed by angiocardiography and 1- and 2-dimensional echocardiography (1- and 2-dE). Rheumatic heart disease (RHD) is believed to be recognisable much earlier as well, by the previously reported 1- and 2-dE features of "early commissural fusion" (ECF). 30 patients in whom overt or localised MVP were diagnosed previously were reviewed for overt or early signs of ECF. In all patients early or overt echo features of RHD could be visualised. Thus RHD may be the most important cause of acquired MVP, even though it is rarely considered in recent classifications. It is proposed that RHD is perhaps the unifying link for all forms of MVP. GOTTLIEB and CHUNG were asking for such a unifying link "since the present classification is dubious at best. It offers nothing to use clinically and may actually be in error, since the primary form may be a less overt expression of the secondary form." It is proposed that mostly unrecognised rheumatic fever may be the underlying first lesion leading to the various different mechanisms described for MVP. If this can be confirmed, a new approach to primary prevention of rheumatic fever and its subclinical forms may be necessary. There is also some evidence to suggest that RHD may be the early and unrecognised microlesion in the coronary arteries as well and thus the important early factor in the development of macroscopic coronary artery disease.
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31
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Doi YL, McKenna WJ, Gehrke J, Oakley CM, Goodwin JF. M mode echocardiography in hypertrophic cardiomyopathy: diagnostic criteria and prediction of obstruction. Am J Cardiol 1980; 45:6-14. [PMID: 7188655 DOI: 10.1016/0002-9149(80)90213-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Gehrke J. The significance of the M-scan echographic diastolic posterior motion of the posterior mitral valve leaflet in mitral stenosis. Ann Radiol (Paris) 1979; 22:542-3. [PMID: 517942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gehrke J, Pagand J. Interventricular septal motion in mitral and aortic regurgitation. Ann Radiol (Paris) 1979; 22:541. [PMID: 517941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gehrke J. Velocity of left ventricular ejection: the major factor in the mechanism of left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM). Ann Radiol (Paris) 1979; 22:315-6. [PMID: 159015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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35
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Gehrke J. Echocardiography, a supplementary diagnostic tool, to differentiate between the angiographic appearance of a bulging septum and squeezing apical contraction in right ventricular volume overload and hypertrophic cardiomyopathy. Ann Radiol (Paris) 1979; 22:317-8. [PMID: 159016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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36
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Gehrke J, Goodwin JF. Septal motion in hypertrophic cardiomyopathy: its possible pathophysiological mechanism and histological manifestation in M- and real-time B-scan echocardiography. Basic Res Cardiol 1979; 74:95-108. [PMID: 571274 DOI: 10.1007/bf01907688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Gehrke J. [Interventricular septal motion in hypertrophic cardiomyopathy. Additonal knowledge from real-time b-scan echocardiography (author's transl)]. Z Kardiol 1977; 66:556-8. [PMID: 919664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
M-scan echocardiography had suggested that interventricular septal motion in patients with Hypertrophic Cardiomyopathy is immobile. In this study special attention was paid to this septal motion during Real-time B-scan (RTBS) investigations of 15 patients with proven Hypertrophic Cardiomyopathy. RTBS recordings have shown that the basal part of the interventricular septum (IVS), which bulges into the left ventricular outflow tract (LVOT), exhibits a forceful contraction towards the cardiac apex, while the more apical portion moves normally towards the left ventricular posterior wall. The direction of the basal septal motion is more or less at right angles to the single ultrasonic beam in M-scanning. The amplitude of this motion, therefore, can only be appreciated with M-mode according to that component of motion which moves parallel to the ultrasonic beam. According to the angle of incidence of the ultrasound waves, septal motion may be recorded as mobile or apparently immobile, and the transition zone from apical to posterior septal motion can be appreciated in a semiquantitative manner by using a Continuous Sweep Technique. From these observations and considerations it has emerged that the left ventricular internal diameter and the rate of change of this dimension in the region of the "immobile" basal septum does not allow conclusions to be drawn about the overall haemodynamic situation of the left ventricle in patients with Hypertrophic Cardiomyopathy. Furthermore, this study is another demonstration of the importance of the combined application of M-and RTBS echocardiography for optimal non-invasive clinical cardiac diagnosis.
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Gehrke J. [M- and real-time b-scan diagnostic criteria and pit-falls in right ventricular volume overload (author's transl)]. Z Kardiol 1977; 66:429-32. [PMID: 899144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The observation of a characteristic "see-saw" motion of the interventricular septum (IVS) in real-time B-scan (RTBS) in right ventricular volume overload (RVVO) reveals features which have not been taken into account in diagnostic M-scan echocardiography. From an investigation of 20 patients it became apparent that the criteria (1) increase in right ventricular internal diameter and (2) "paradoxical" septal motion, so far used for the M-scan diagnosis of RVVO, should be complemented by further criteria: (3) hypertrophy of the IVS in longstanding RVVO, (4) increase in septal amplitude of motion towards the cardiac apex, (5) selective increasing apical septal hypertrophy and (6) an apparent random septal motion without any resultant main direction as an indication of a displaced fulcrum of the septal "see-saw". All features may be visualised by carrying out a continuous sweep in M-scanning. The criteria 2-5 may be understood as a result of increased apical work load compensating for the haemodynamic loss of the reversed upper septal motion ("RUSM"). The diagnosis of RVVO can be made more readily and reliably with RTBS echocardiography, underlining the utility of a combined use of one- and two-dimensional ultrasonography in diagnostic cardiology.
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Gehrke J. [Critical appraisal of one-and two-dimenisonal echocardiography in hypertrophic cardiomyopathy]. Ann Radiol (Paris) 1977; 20:409-11. [PMID: 560166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Gehrke J, Leeman S. Proceedings: Grey scale, a valuable tool in the differential diagnosis of hypertrophic cardiomyopathy. Br J Radiol 1976; 49:730. [PMID: 986215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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41
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Gehrke J. Proceedings: New observations on systolic anterior motion of mitral valve leaflets in hypertrophic cardiomyopathy. Br Heart J 1976; 38:314. [PMID: 944045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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42
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Abstract
Twenty patients undergoing routine left ventricular single-plane angiography have been investigated by an ultrasonic triggered B-scan technique to provide a two-dimensional cross-sectional image of the left ventricle in end-systole end-diastole. An area-length method has been used to establish the correlation between the angiographic and the echocardiographic assessments of left ventricular chamber volume (r equals 0.88) and ejection fraction (r equals 0.81). Differences between the two techniques are discussed, and it is concluded that in approximately 80 per cent of patients triggered B-scanning may provide a safe, non-invasive, and convenient technique for the determination of volumes and certain functional parameters, especially in patients with dilated hearts and irregular left ventricular shape, where M-scanning is known to be less reliable.
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Henson D, Smith RD, Gehrke J, Neapolitan C. Effect of cortisone on nonfatal mouse cytomegalovirus infection. Am J Pathol 1967; 51:1001-11. [PMID: 4295103 PMCID: PMC1965411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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44
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Gehrke J. [The effect of physical therapy. Terrain therapy, medical exercise therapy for lipid metabolism in Ohlstadt-Obb]. Med Welt 1967; 39:2305-8. [PMID: 5608842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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45
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Henson D, Smith RD, Gehrke J. Murine cytomegalovirus: observations on growth in vitro, cytopathic effect, and inhibition with 5-Iododeoxyuridine. Arch Gesamte Virusforsch 1966; 18:433-44. [PMID: 4296905 DOI: 10.1007/bf01246575] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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46
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Henson D, Smith RD, Gehrke J. Non-fatal mouse cytomegalovirus hepatitis. Combined morphologic, virologic and immunologic observations. Am J Pathol 1966; 49:871-88. [PMID: 4288830 PMCID: PMC1907270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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