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Terkildsen Maindal H, Vinther-Jensen K, Sørensen K, Bertram M, Aaby A. A National Position Paper: Health Literacy from a Structural Perspective-A path to equity in health? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.155] [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: 11/14/2022] Open
Abstract
Abstract
Background
Health literacy (HL) as an enabler of health equity and health promotion. HL is closely linked to other social determinants of health such as age, sex, education, social status and ethnicity. HL responsiveness is the degree to which systems or organizations make it easier for people to navigate, understand, and use information and services. HL can be enhanced through individual support, by targeting the responsiveness of the health professional workforce, or by taking a structural or organizational HL perspective.
Methods
In Denmark, the HL Network, which is part of Danish Society for Public Health, developed a position paper for approaching HL from a structural level. In 2018-2019 a rapid literature review was conducted followed by three different methodologies: (i) stakeholder meetings, (ii) expert interviews (policy, practice, research) and (iii) thematic meeting focusing on different dimension of the initial recommendation for the position paper, which was published at the National Conference for Public Health.
Results
In the position paper eight recommendations were developed to improve HL in Denmark from a structural perspective. The recommendations overall aim to prevent low HL and its consequences by targeting health services at the organizational level. The recommendations are: Integrate HL into Danish health policies and strategiesDevelop HL throughout the life courseInclude HL in health education curriculaIntegrate HL at organizational levelsIntegrate HL into partnership and co-creation processesMeasure and monitor HL using local and national dataDevelop, test and evaluate HL interventionsConsider HL in all forms of health communication
Conclusions
The recommendations can support the integration of a health literate thinking into current national health strategies, including the ongoing efforts to achieve the 17 UN Global SDGs, and thereby contribute to the equitable distribution of health in the Danish population.
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Affiliation(s)
- H Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - K Sørensen
- Global Health Literacy Academy, Aarhus, Denmark
| | - M Bertram
- Department of Public health, University of Southern Denmark, Esbjerg, Denmark
| | - A Aaby
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Loncarevic N, Bertram M, Tanggaard Andersen P. Danish policymakers and research evidence in public health policy process. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.597] [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: 11/14/2022] Open
Abstract
Abstract
Background
Evidence-informed policymaking in public health, understood as interaction of the best available research evidence and “other types of evidence”, is known to have sound influence on population well-being. However, lack of using and producing research evidence by public health policymakers has been well documented. The aim of this study was to assess policymakers’ research involvement in the research process as well as motivators and barriers for the use and production of research evidence.
Methods
A cross-sectional online survey was carried out in the period of Dec 2018 - Jan 2019 using a pre-tested, self-administrated questionnaire. Participants were Danish policymakers’ members of the Danish Society of Public Health (DSPH) and with practical experience being involved in a health policy-making process. The questionnaire was distributed through the DSPH members email list. Reported outcome variables; for this abstract are parts of the larger study: health policymakers’ research involvement in the last 12Mo; policymakers’ motivators and barriers to use and produce research in policy-making.
Results
Response rate: 100/480 (15%). 78% were involved in critical evaluation of research for policy-making; 77% were able to identify relevant research literature; 41% did not use research evidence; 40% did not conduct any surveys; 57% did not write research reports; 65% never used reference systems; 46% did not analyze any research data. The three motivators reported to use and produce research in the last 12Mo were: identification of the problem that needs to be addressed; development of research skills; and job satisfaction. The three main barriers were: other job-related priorities; lack of time for research; lack of research funding.
Conclusions
This study reinforced that public health policymakers need more practical knowledge and skills as well as organizational support and management to use and produce research evidence for evidence-informed policy-making.
Key messages
Successful evidence-informed policymaking requires capacity-building interventions targeting policymakers, supported, implemented and evaluated by their organizations. Policymakers do not dismiss evidence-informed policy practice, but their “positions” and conditions at a work place sometimes do not allow them to fully follow it.
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Affiliation(s)
- N Loncarevic
- Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - M Bertram
- Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - P Tanggaard Andersen
- Unit for Health Promotion, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Gazzard S, Cullen-McEwen L, van der Wolde J, Nikolic-Paterson D, Tesch G, de Matteo R, Bertram M, Bertram J. SUN-131 IS PODOCYTE NUMBER AT BIRTH A RISK FACTOR FOR RENAL PATHOPHYSIOLOGY IN LATER LIFE? Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.530] [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: 11/28/2022] Open
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Cao B, Bray F, Meheus F, Ilbawi A, Bertram M, Soerjomataram I. Global impact of attaining the Sustainable Development Goal target for NCDs on longevity and economy. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.246] [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: 11/13/2022] Open
Affiliation(s)
- B Cao
- International Agency for Research on Cancer, Lyon, France
| | - F Bray
- International Agency for Research on Cancer, Lyon, France
| | - F Meheus
- International Agency for Research on Cancer, Lyon, France
| | - A Ilbawi
- World Health Organization, Geneva, Switzerland
| | - M Bertram
- World Health Organization, Geneva, Switzerland
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Bertram M. Danish Society of Public Health introduces a series of Public Health Barometers. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.151] [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: 11/13/2022] Open
Affiliation(s)
- M Bertram
- Danish Society of Public Health, Esbjerg, Denmark
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Loncarevic N, Bertram M, Dorgelo A, Jansen J, Aro AR. One-year sustainability of Stewardship policy interventions in Denmark and The Netherlands. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.138] [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: 11/13/2022] Open
Affiliation(s)
- N Loncarevic
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - M Bertram
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | | | - J Jansen
- Nederlands Huisartsen Genootschap, Utrecht, Netherlands
| | - AR Aro
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
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Ahmed Z, Pauszek SJ, Ludi A, LaRocco M, Khan EUH, Afzal M, Arshed MJ, Farooq U, Arzt J, Bertram M, Brito B, Naeem K, Abubakar M, Rodriguez LL. Genetic diversity and comparison of diagnostic tests for characterization of foot-and-mouth disease virus strains from Pakistan 2008-2012. Transbound Emerg Dis 2017; 65:534-546. [PMID: 29034593 DOI: 10.1111/tbed.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/21/2017] [Indexed: 02/06/2023]
Abstract
We report the laboratory analysis of 125 clinical samples from suspected cases of foot-and-mouth disease (FMD) in cattle and Asian buffalo collected in Pakistan between 2008 and 2012. Of these samples, 89 were found to contain viral RNA by rRT-PCR, of which 88 were also found to contain infectious FMD virus (FMDV) by virus isolation (VI), with strong correlation between these tests (κ = 0.96). Samples that were VI-positive were serotyped by antigen detection ELISA (Ag-ELISA) and VP1 sequence acquisition and analysis. Sequence data identified FMDV serotypes A (n = 13), O (n = 36) and Asia-1 (n = 41), including three samples from which both serotypes Asia-1 and O were detected. Serotype A viruses were classified within three different Iran-05 sublineages: HER-10, FAR-11 and ESF-10. All serotype Asia-1 were within Group VII (Sindh-08 lineage), in a genetic clade that differs from viruses isolated prior to 2010. All serotypes O were classified as PanAsia-2 within two different sublineages: ANT-10 and BAL-09. Using VP1 sequencing as the gold standard for serotype determination, the overall sensitivity of Ag-ELISA to correctly determine serotype was 74%, and serotype-specific sensitivity was 8% for serotype A, 88% for Asia-1 and 89% for O. Serotype-specific specificity was 100% for serotype A, 93% for Asia-1 and 94% for O. Interestingly, 12 of 13 serotype A viruses were not detected by Ag-ELISA. This study confirms earlier accounts of regional genetic diversity of FMDV in Pakistan and highlights the importance of continued validation of diagnostic tests for rapidly evolving pathogens such as FMDV.
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Affiliation(s)
- Z Ahmed
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA.,Oak Ridge Institute for Science and Education, PIADC Research Participation Program, Oak Ridge, TN, USA
| | - S J Pauszek
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA
| | - A Ludi
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA.,Oak Ridge Institute for Science and Education, PIADC Research Participation Program, Oak Ridge, TN, USA
| | - M LaRocco
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA
| | - E-U-H Khan
- Progressive Control of Foot and Mouth Disease in Pakistan, Food & Agriculture Organization of the United Nations Office, NARC Premises, Islamabad, Pakistan
| | - M Afzal
- Progressive Control of Foot and Mouth Disease in Pakistan, Food & Agriculture Organization of the United Nations Office, NARC Premises, Islamabad, Pakistan
| | - M J Arshed
- Progressive Control of Foot and Mouth Disease in Pakistan, Food & Agriculture Organization of the United Nations Office, NARC Premises, Islamabad, Pakistan
| | - U Farooq
- Animal Health Program, Animal Sciences Institute, National Agricultural Research Center, Islamabad, Pakistan
| | - J Arzt
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA
| | - M Bertram
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA.,Oak Ridge Institute for Science and Education, PIADC Research Participation Program, Oak Ridge, TN, USA
| | - B Brito
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA.,Oak Ridge Institute for Science and Education, PIADC Research Participation Program, Oak Ridge, TN, USA
| | - K Naeem
- Animal Health Program, Animal Sciences Institute, National Agricultural Research Center, Islamabad, Pakistan
| | - M Abubakar
- National Veterinary Laboratories, Islamabad, Pakistan
| | - L L Rodriguez
- USDA/ARS Foreign Animal Disease Research Unit, Plum Island Animal Disease Center, Greenport, NY, USA
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Aro AR, Tudisca V, Radl-Karimi C, Lau CJ, Bertram M, Syed AM, Skovgaard T, Cori L, Bianchi F, Valente A. Contextualization of indicators for evidence-informed policy making: results from Denmark and Italy. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167.019] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Loncarevic N, Bertram M, Tudisca V, Valente A, Aro AR. Defining domains of evidence-informed policymaking: pathway from frameworks to indicators. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.080] [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: 11/14/2022] Open
Affiliation(s)
- N Loncarevic
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - M Bertram
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - V Tudisca
- Institute of Researchers on Population and Social Policies, National Research Council Italy, Rome, Italy
| | - A Valente
- Institute of Researchers on Population and Social Policies, National Research Council Italy, Rome, Italy
| | - AR Aro
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Loncarevic N, Bertram M, Gulis G, Radl-Karimi C, Aro AR. Stewardship approach in comparing cross-country policy intervention results challenges and options. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.078] [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: 11/13/2022] Open
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11
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Pohl M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak D, Platz T, Rollnik J, Scheidtmann K, Thomas R, von Rosen F, Wallesch C, Woldag H, Peschel P, Mehrholz J. Patientenklientel und Rehabilitationsverlauf in der neurologisch-neurochirurgischen Frührehabilitation – ein Vergleich der Jahre 2002 und 2014. Akt Neurol 2016. [DOI: 10.1055/s-0042-117711] [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. Pohl
- HELIOS Klinik Schloss Pulsnitz GmbH, Fachklinik für Neurologisch-Neurochirurgische Rehabilitation, Pulsnitz
| | - M. Bertram
- Kliniken Schmieder Heidelberg, Neurological Rehabilitation, Heidelberg
| | - C. Bucka
- Neurologische Klinik Westend, Neurological Rehabilitation, Bad Wildungen
| | - M. Hartwich
- Asklepios Schlossberg Klinik Bad Konig, Neurologische Rehabilitation, Bad Konig
| | - M. Jöbges
- Brandenburg Klinik, Neurologie, Bernau
| | - G. Ketter
- Neurologisches Rehabilitationszentrum Godeshohe, Neurologische Rehabilitation, Bonn
| | - B. Leineweber
- Abteilung neurologisch-neurochirurgische Frührehabilitation, Neurologische Klinik GmbH Bad Neustadt, Bad Neustadt/Saale
| | - M. Mertl-Rötzer
- Schon Klinik Bad Aibling, Neurologische Frührehabilitation, Bad Aibling
| | - D. Nowak
- Helios Klinik Kipfenberg, Neurologische Fachklinik, Kipfenberg
| | - T. Platz
- BDH-Kinik Greifswald, Aninstitut Ernst-Moritz-Arndt-Universität Greifswald, Neurologisches Rehabilitationszentrum und Querschnittgelähmtenzentrum, Greifswald
| | - J. Rollnik
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf gGmbH, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hannover
| | - K. Scheidtmann
- Hegau-Jugendwerk GmbH, Neurologische Rehabilitation, Gailingen
| | - R. Thomas
- Asklepios Kliniken Schildautal, Neurologische Frührehabilitation, Seesen
| | - F. von Rosen
- Schon Klinik Bad Staffelstein, Neurologische Frührehabilitation, Bad Staffelstein
| | - C. Wallesch
- BDH-Klinik Elzach, Klinik für Neurologische Rehabilitation, Elzach
| | - H. Woldag
- NRZ Neurologisches Rehabilitationszentrum Leipzig, Neurologische Rehabilitation, Bennewitz
| | - P. Peschel
- Technische Universitat Dresden, Lehrstuhl für Gesundheitswissenschaften/Public Health, Dresden
| | - J. Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Wissenschaftliches Institut, Kreischa
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Pohl M, Bertram M. [Efficacy of early neurological and neurosurgical rehabilitation : Evidence-based treatment, outcome and prognostic factors]. Nervenarzt 2016; 87:1043-1050. [PMID: 27531205 DOI: 10.1007/s00115-016-0183-0] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early neurological and neurosurgical rehabilitation (ENNR) as a complex post-acute form of treatment for patients with severe neurological diseases and continued need for intensive care is well established in Germany. OBJECTIVE To assess the efficacy of ENNR from the perspective of evidence-based medicine as well as to present data on the outcome of ENNR patients including the analysis of prognostic factors. MATERIAL AND METHODS A search was carried out in PubMed databases to identify early rehabilitation treatment forms evaluated by randomized controlled trials and with respect to large multicenter surveys of outcome and prognostic factors. RESULTS For ENNR as a complex treatment concept, effectiveness not has been shown with regard to evidence-based medicine but it includes individually effective treatment forms. In two large multicenter evaluations the average duration of treatment was between 51 and 57 days and mortality was between 6 % and 10 %, increasing with the proportion of mechanically ventilated patients. Lower need for nursing support on admission indicated better outcome, whereas mechanical ventilation was more likely to be associated with poor outcome. Long-term outcome was negatively influenced by mechanical ventilation as well as severe neurogenic dysphagia with and without the need for a tracheal cannula and/or percutaneous endoscopic gastrostomy (PEG) and also by severely impaired communication at the end of ENNR. DISCUSSION These prognostic factors indicate the primary aims of ENNR, which are to reduce the need for nursing support and to establish the capability for rehabilitation. If these aims are achieved, favorable functional and long-term outcome can be expected for ENNR patients. The presented studies verify the sustained efficacy of ENNR as an essential part of the overall treatment concept for severely neurologically impaired patients.
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Affiliation(s)
- M Pohl
- Helios Klinik Schloss Pulsnitz, Wittgensteiner Strasse 1, 01896, Pulsnitz, Deutschland.
| | - M Bertram
- Kliniken Schmieder, Heidelberg, Deutschland
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Rollnik JD, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Scheidtmann K, Thomas R, von Rosen F, Wallesch CW, Woldag H, Peschel P, Mehrholz J, Pohl M. Criterion validity and sensitivity to change of the Early Rehabilitation Index (ERI): results from a German multi-center study. BMC Res Notes 2016; 9:356. [PMID: 27440117 PMCID: PMC4955142 DOI: 10.1186/s13104-016-2154-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022] Open
Abstract
Background Evaluation of functional status is difficult in neurological and neurosurgical early rehabilitation patients. The Early Rehabilitation Index (ERI) was introduced in Germany over 20 years ago, but since then validation studies are lacking. The ERI (range −325 to 0 points) includes highly relevant items including the necessity of intermittent mechanical ventilation or tracheostomy. Methods The present paper analyzed data from a German multi-center study, enrolling 754 neurological early rehabilitation patients. Together with ERI, Barthel Index (BI), Glasgow Coma Scale (GCS), Glasgow Outcome Score Extended, Coma Remission Scale (CRS), Functional Ambulation Categories and length of stay were obtained. Results ERI showed significant improvements from admission to discharge (p < 0.001). In addition, there were significant correlations of the ERI upon admission and at discharge with BI, CRS and GCS. Conclusions Evaluation of our study data suggest that the ERI may be used as a valid assessment instrument for neurological and neurosurgical early rehabilitation patients.
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Affiliation(s)
- Jens D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Associated Institute of Hannover Medical School (MHH), Greitstr. 18-28, Hessisch Oldendorf, 31840, Germany.
| | - M Bertram
- Kliniken Schmieder Heidelberg, Heidelberg, Germany
| | - C Bucka
- Neurologische Klinik Westend, Bad Wildungen, Germany
| | - M Hartwich
- Asklepios Schlossberg Klinik Bad König, Bad König, Germany
| | - M Jöbges
- Brandenburg Klinik Bernau, Bernau bei Berlin, Germany
| | - G Ketter
- Neurologisches Rehabilitationszentrum "Godeshöhe"Bonn, Bonn, Germany
| | - B Leineweber
- Neurologische Klinik GmbH Bad Neustadt, Bad Neustadt, Germany
| | | | - D A Nowak
- Helios Klinik Kipfenberg, Kipfenberg, Germany
| | - T Platz
- BDH-Klinik Greifswald, Greifswald, Germany
| | | | - R Thomas
- Asklepios Kliniken Schildautal Seesen, Seesen, Germany
| | - F von Rosen
- Schön Klinik Bad Staffelstein, Bad Staffelstein, Germany
| | | | - H Woldag
- Neurologisches Rehabilitationszentrum Leipzig, Leipzig, Germany
| | - P Peschel
- Department of Public Health, University of Dresden, Dresden, Germany
| | - J Mehrholz
- Klinik Bavaria Kreischa, Kreischa, Germany
| | - M Pohl
- Klinik Schloss Pulsnitz, Pulsnitz, Germany
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Grandmougin D, Vanhuyse F, Fiore A, Delolme MC, Liu Y, Laurent N, Bertram M, Folliguet T, Tran N, Maureira JP. Effects of the self-myocardial retroperfusion with aortic-coronary sinus shunt on cardiac output and ischemic events in high-risk patients undergoing OPCAB surgery. J Cardiovasc Surg (Torino) 2015; 56:929-937. [PMID: 24647320] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Despite controversies, off-pump coronary artery bypass (OPCAB) surgery has become a routine procedure. Obvious advantages have been demonstrated in high-risk patients. However, OPCAB surgery has limitations in specific high-risk situations with hazards of operative deleterious events. We describe an innovative procedure of self-myocardial retroperfusion (SMR) with an aortic-coronary sinus shunt (ACSS). We prospectively evaluated the protective effects and benefits of SMR in high-risk coronary patients with impaired LVEF. METHODS Eighteen consecutive high-risk (ES>10) coronary patients (mean age: 65.94 years; range: 34-85; mean ES: 26.97%) with LVEF≤35% who were not eligible for IABP were assigned for OPCAB surgery. Following sternotomy, the cardiac indexes (CI) were measured before, during SMR and after completion of coronary artery bypasses. Operative events with and without SMR were accurately collected, and postoperative cardiac Troponin T release was measured. RESULTS OPCAB procedures were performed in all patients. Intraoperative use of SMR significantly increased CI (P=3.1041810.10-8) and reversed deleterious operative events (ECG changes/low cardiac output). Hospital mortality was 0%. Incidence of transient atrial fibrillation was 33.33%. Neither stroke nor renal insufficiency was observed. The mean graft number/patient was 2.05. Mean postoperative cardiac Troponin T value was 0.79 μg/L. Beating heart preservation optimized by SMR contributed to reduce ischemia-reperfusion injury, as validated by an immediate increase of CI after completion of coronary bypasses (P=3.35009.10-9). CONCLUSION The concept of SMR with an ACSS during OPCAB procedures definitely improved CI and reversed ischemic features in high-risk patients and should be considered as an operative temporary myocardial assistance.
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Affiliation(s)
- D Grandmougin
- Department of Cardiovascular Surgery and Transplantations, ILCV Louis Mathieu, CHU- NancyVandoeuvre-lès-Nancy, France -
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Loncarevic N, Radl-Karimi C, Bertram M, Gulis G, Thøgersen M, Skovgaard T, Aro AR. Politicians learned to request more research knowledge - intervention results from Denmark. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv173.034] [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: 11/14/2022] Open
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16
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Berger B, Bertram M, Kanitz J, Pretzer K, Seifert G. “Like walking into an empty room”: Effects of eurythmy therapy on stress perception in comparison with a sports intervention from the subjects’ perspective – A qualitative study. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.09.011] [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: 11/15/2022]
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17
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Giordano M, Vonken EPA, Bertram M, Mali WPTM, Viergever MA, Neukirchen C. Spatially regularized region-based perfusion estimation in peripherals using angiographic C-arm systems. Phys Med Biol 2012; 57:7239-59. [PMID: 23075827 DOI: 10.1088/0031-9155/57/22/7239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The outcome assessment of endovascular revascularization procedures in the lower limbs is currently carried out by x-ray digital subtraction angiography (DSA). Due to the two-dimensional nature of this technique, only visual assessment of arterial blood flow is possible and no tissue blood flow information (i.e. perfusion) is available to assess the effective restoration of blood supply to the tissue. In this work, we propose a method for interventional perfusion estimation in peripherals using C-arms which is based on DSA and two additional 3D images reconstructed from rotational scans. The method assumes spatial homogeneity of contrast within multiple regions identified by segmentation of the reconstructed 3D images. A dedicated segmentation method which relies on local contrast homogeneity and connectivity of anatomical structures is introduced. Region-based perfusion is obtained by mapping the 2D blood flow information from DSA to the 3D segments by solving an inverse problem. Instability of the solution due to the spatial overlap of the regions is addressed by applying spatial and temporal regularizations. The method was evaluated on data simulated from CT perfusion scans of the lower limb. Blood flow values estimated with the optimal number of segmented regions exhibited errors of 1 ± 4 and 2 ± 11 ml/100 ml min(-1) for the two analyzed cases, respectively, which showed to be sufficient to differentiate hypoperfused and normally perfused areas. The use of spatial and temporal regularization proved to be an effective way to limit inaccuracies due to instability in the solution of the inverse problem. Results in general proved the feasibility of C-arm interventional perfusion imaging by a combination of temporal information derived from DSA and spatial information derived from 3D reconstructions.
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Affiliation(s)
- M Giordano
- Philips Research Laboratories, Weißhausstraße 2, Aachen, Germany.
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Ditsuwan V, Veerman JL, Barendregt J, Bertram M, Vos T. Incorporating data into global burden of disease method to assess national burden of road traffic injuries in Thailand. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590w.11] [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: 11/04/2022]
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Lock G, Helmich F, Bertram M. Drohendes Leberversagen nach Chemoimmuntherapie-induzierter Reaktivierung einer Hepatitis B - erfolgreiche Therapie mit Entecavir. Dtsch Med Wochenschr 2012; 137:1248-50. [DOI: 10.1055/s-0032-1305038] [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: 10/28/2022]
Affiliation(s)
- G. Lock
- Klinik für Innere Medizin, Albertinenkrankenhaus Hamburg
| | - F. Helmich
- Klinik für Innere Medizin, Albertinenkrankenhaus Hamburg
| | - M. Bertram
- Hämatoonkologische Schwerpunktpraxis, Hamburg
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Ditsuwan V, Veerman L, Suvapan D, Bertram M, Vos T. Long-term health consequences of road traffic injuries: a representative cohort study in Thailand. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sarpaczki E, Bertram M, Grüttner J, Brandt T. [Patient in a posthypoxic vegetative state. Favorable outcome despite unfavorable prognostic parameters]. Nervenarzt 2010; 81:1504-1507. [PMID: 21088820 DOI: 10.1007/s00115-010-3107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- E Sarpaczki
- Kliniken Schmieder Heidelberg, Neurologisches Fach- und Rehabilitationskrankenhaus, Heidelberg, Speyererhofweg 1, 69117, Heidelberg.
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Ditsuwan V, Veerman L, Bertram M, Vos T. A historical perspective on sobriety checkpoints in Thailand: is there evidence for effectiveness? Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.187] [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: 11/03/2022]
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Bülow V, Fuchs B, Bertram M. Untersuchungen über den Erreger der infektiösen Anämie bei Hühnerküken (CAA) in vitro: Vermehrung, Titration, Serumneutralisationstest und indirekter Immunfluoreszenztest. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1439-0450.1985.tb02009.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scheffer C, Bertram M, Neumann M, Tauschel D, Edelhäuser F. Active student involvement in integrative clinical care—A qualitative and quantitative study on learning experiences, professional development and progress in competencies in integrative medicine. Eur J Integr Med 2009. [DOI: 10.1016/j.eujim.2009.08.103] [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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Sarpaczki E, Bertram M, Grüttner J, Brandt T. Good outcome in a patient with prolonged comatose state, critically elevated serum neuron-specific enolase and electroencephalic burst-suppression pattern. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238637] [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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Abstract
In German neurorehabilitation, the ambiguous term "early rehabilitation" reflects the multidisciplinary, rehabilitative treatment of severely impaired patients in continuing need of acute and intensive care (including weaning from the respirator in selected cases). The actual definition of this treatment is discussed, which hitherto corresponded to Phase B according to recommendations of the German Federal Study Group for Rehabilitation (BAR) and now has started to be integrated into the diagnosis-related group system. The tasks and aims of early rehabilitation are to support and enhance neuroplastic remission of nervous system functional loss and continued medical care, improve vigilance, establish cooperativity, and evaluate the rehabilitation potential including compensatory and adaptive strategies organizing posthospital care, reducing the need of nursing support, and improving quality of life. Some special aspects of early rehabilitative care are presented here in more detail. To fulfill these tasks, a multidisciplinary team is required including various therapists qualified for neurorehabilition, physicians (including a neurologist), nurses, and social workers. Outcome data were assessed using our 5-year prospective early rehabilitation registry. Fifty-five percent of patients improved to reach the next step of neurorehabilitation (Phase C), with significant gain in function even in the subgroup of aged and most severely disabled patients. The trend to transfer patients very early in the postacute Phase to early rehabilitation facilities, with open medical problems and increased risk of complications, makes close cooperation and interaction with acute medical centers necessary.
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Bertram M, Hohmann S, Wiegert J. SU-FF-I-22: Scatter Correction for Flat Detector Cone-Beam CT Based On Simulated Sphere Models. Med Phys 2007. [DOI: 10.1118/1.2760399] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
BACKGROUND Multi-item scales for monitoring alcohol withdrawal reactions have been used since the 1970s, and since 1985 we have used a modified version of the Clinical Institute Withdrawal Assessment (CIWA) in our general hospitals. This study was conducted to determine whether a shorter version of the scale would prove easier to use without loss of accuracy. METHODS A simultaneous 'crossover' clinical audit using two hospitals. The shortened scale was developed from the existing one, and had 10 items as opposed to the previous 18. The patients were followed throughout their course and the incidences of complication, the frequency of sedation, the delay in initiating monitoring and the ease of use were recorded. RESULTS There were 106 patients managed with the old scale and 96 with the new. The rate of complication was not different, being 16% in patients managed using the old scale and 14.5% using the new scale; the rates of sedation were 49 and 48%, respectively. Patients managed with the new scale had a shorter course with a median duration of 27.6 h compared with 40 h. The time from admission to first recording of a score was 5.4 h for the new scale and 4.8 h for the old, which is not a significant difference. Both scores were used according to instructions, but staff reported that the shortened scale was easier to use. CONCLUSIONS We conclude that a shortened form of the CIWA alcohol withdrawal scale works as well as the original and is simple to use.
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Affiliation(s)
- A Foy
- Department of General Medicine, The Newcastle Mater Misericordiae Hospital, Newcastle, New South Wales, Australia.
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Abstract
The relative proportions of metal residing in ore in the lithosphere, in use in products providing services, and in waste deposits measure our progress from exclusive use of virgin ore toward full dependence on sustained use of recycled metal. In the U.S. at present, the copper contents of these three repositories are roughly equivalent, but metal in service continues to increase. Providing today's developed-country level of services for copper worldwide (as well as for zinc and, perhaps, platinum) would appear to require conversion of essentially all of the ore in the lithosphere to stock-in-use plus near-complete recycling of the metals from that point forward.
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Affiliation(s)
- R B Gordon
- Department of Geology and Geophysics, Yale University, P.O. Box 208109, New Haven, CT 06511, USA
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Graedel TE, van Beers D, Bertram M, Fuse K, Gordon RB, Gritsinin A, Kapur A, Klee RJ, Lifset RJ, Memon L, Rechberger H, Spatari S, Vexler D. Multilevel cycle of anthropogenic copper. Environ Sci Technol 2004; 38:1242-1252. [PMID: 14998044 DOI: 10.1021/es030433c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A comprehensive contemporary cycle for stocks and flows of copper is characterized and presented, incorporating information on extraction, processing, fabrication and manufacturing, use, discard, recycling, final disposal, and dissipation. The analysis is performed on an annual basis, ca. 1994, at three discrete governmental unit levels--56 countries or country groups that together comprise essentially all global anthropogenic copper stocks and flows, nine world regions, and the planet as a whole. Cycles for all of these are presented and discussed, and a "best estimate" global copper cycle is constructed to resolve aggregation discrepancies. Among the most interesting results are (1) transformation rates and recycling rates in apparently similar national economies differ by factors of two or more (country level); (2) the discard flows that have the greatest potential for copper recycling are those with low magnitude flows but high copper concentrations--electronics, electrical equipment, and vehicles (regional level); (3) worldwide, about 53% of the copper that was discarded in various forms was recovered and reused or recycled (global level); (4) the highest rate of transfer of discarded copper to repositories is into landfills, but the annual amount of copper deposited in mine tailings is nearly as high (global level); and (5) nearly 30% of copper mining occurred merely to replace copper that was discarded. The results provide a framework for similar studies of other anthropogenic resource cycles as well as a basis for supplementary studies in resource stocks, industrial resource utilization, waste management, industrial economics, and environmental impacts.
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Affiliation(s)
- T E Graedel
- Center for Industrial Ecology, School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut 06511, USA.
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Graedel TE, Bertram M, Kapur A, Reck B, Spatari S. Exploratory data analysis of the multilevel anthropogenic copper cycle. Environ Sci Technol 2004; 38:1253-1261. [PMID: 14998045 DOI: 10.1021/es0304345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A comprehensive multilevel contemporary cycle for stocks and flows of copper is analyzed by the tools of exploratory data analysis (EDA). The analysis is performed at three discrete spatial levels--country (56 countries or country groups that comprise essentially all anthropogenic stocks and flows of copper), eight world regions, and the planet as a whole. Among the most interesting results are the following: (1) EDA is employable and valuable for use in the analysis of material flows, especially those across multiple spatial levels; (2) All distributions of country-level stock and flow data are highly skewed, a few countries having large magnitudes, many having small magnitudes; (3) Rates of fabrication of copper-containing products for the countries are poorly correlated with rates of extraction, reflecting the fact that many countries that extract copper do not fabricate products from copper to any significant degree and vice versa; (4) Virtually all countries are adding copper to stock (in pipe, wire, etc.); These rates of addition are highly correlated with rates of copper entering use in all regions and are higher in regions under vigorous development; (5) With weak confidence, the rate of copper landfilling by regions is about one-half the rate of copper discarded; (6) The statistical distributions of both country-level and regional-level copper cycle parameters have successively lower standard deviations at later life stages; and (7) Copper flow distributions at different life stages tend to reflect those of lower spatial level extreme values, but Asia's and Europe's regional patterns are much more reflective of country-level distributions as a whole.
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Affiliation(s)
- T E Graedel
- Center for Industrial Ecology, School of Forestry and Environmental Studies, Yale University, New Haven, Connecticut 06511, USA.
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Affiliation(s)
- M. Bertram
- Institute of Solid State and Materials Research (IFW) Dresden e.V., Helmholtzstraße 20, D‐01069 Dresden, Germany
| | - H. Wendrock
- Institute of Solid State and Materials Research (IFW) Dresden e.V., Helmholtzstraße 20, D‐01069 Dresden, Germany
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Beta C, Bertram M, Mikhailov AS, Rotermund HH, Ertl G. Controlling turbulence in a surface chemical reaction by time-delay autosynchronization. Phys Rev E Stat Nonlin Soft Matter Phys 2003; 67:046224. [PMID: 12786477 DOI: 10.1103/physreve.67.046224] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2003] [Revised: 02/06/2003] [Indexed: 05/24/2023]
Abstract
A global time-delay feedback scheme is implemented experimentally to control chemical turbulence in the catalytic CO oxidation on a Pt(110) single crystal surface. The reaction is investigated under ultrahigh vacuum conditions by means of photoemission electron microscopy. We present results showing that turbulence can be efficiently suppressed by applying time-delay autosynchronization. Hysteresis effects are found in the transition regime from turbulence to homogeneous oscillations. At optimal delay time, we find a discontinuity in the oscillation period that can be understood in terms of an analytical investigation of a phase equation with time-delay autosynchronization. The experimental results are reproduced in numerical simulations of a realistic reaction model.
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Affiliation(s)
- C Beta
- Fritz-Haber-Institut der Max-Plack-Gesellschaft, Faradayweg 4-6, 14195 Berlin, Germany
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Grau AJ, Reis A, Buggle F, Al-Khalaf A, Werle E, Valois N, Bertram M, Becher H, Grond-Ginsbach C. Monocyte function and plasma levels of interleukin-8 in acute ischemic stroke. J Neurol Sci 2001; 192:41-7. [PMID: 11701151 DOI: 10.1016/s0022-510x(01)00590-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [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: 11/24/2022]
Abstract
Activated monocytes may contribute to the pathogenesis of ischemic stroke. We tested the hypothesis that release products and procoagulant activity of monocytes are increased in acute ischemic stroke. In patients on days 1, 3 and 7 after ischemic stroke and in age- and sex-matched healthy control subjects, we assessed plasma levels of interleukin 8 (IL-8) and neopterin (enzyme linked immunosorbent assay, ELISA) and investigated superoxidanion release (ferricytochrome C reduction), procoagulant activity (one-stage clotting assay) and tissue factor (TF) gene transcription (reverse transcriptase polymerase chain reaction) by monocytes. As compared to control subjects (n=23), IL-8 levels were increased on day 1 after stroke (n=22; p=0.005) and remained elevated on days 3 and 7. Neopterin levels were elevated on days 3 and 7 (p<0.05, respectively) but not on day 1. Neopterin and IL-8 were not correlated with monocyte counts. Superoxid anion production by stimulated and unstimulated monocytes was not different between groups. TF mRNA could neither be detected in monocytes from patients investigated within 12 h after ischemia (n=12) nor in control subjects (n=10) and procoagulant activity of cells was similar in both groups. Our results indicate increased monocyte activation after ischemic stroke although not all activation parameters were elevated. We found no support for the hypothesis that circulating monocytes express TF and possess increased procoagulant activity. Elevated IL-8 may contribute to stroke pathophysiology by activating polymorphonuclear leukocyte (PMNL) activation early after ischemia.
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Affiliation(s)
- A J Grau
- Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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35
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Zimprich A, Grabowski M, Asmus F, Naumann M, Berg D, Bertram M, Scheidtmann K, Kern P, Winkelmann J, Müller-Myhsok B, Riedel L, Bauer M, Müller T, Castro M, Meitinger T, Strom TM, Gasser T. Mutations in the gene encoding epsilon-sarcoglycan cause myoclonus-dystonia syndrome. Nat Genet 2001; 29:66-9. [PMID: 11528394 DOI: 10.1038/ng709] [Citation(s) in RCA: 355] [Impact Index Per Article: 15.4] [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: 11/08/2022]
Abstract
The dystonias are a common clinically and genetically heterogeneous group of movement disorders. More than ten loci for inherited forms of dystonia have been mapped, but only three mutated genes have been identified so far. These are DYT1, encoding torsin A and mutant in the early-onset generalized form, GCH1 (formerly known as DYT5), encoding GTP-cyclohydrolase I and mutant in dominant dopa-responsive dystonia, and TH, encoding tyrosine hydroxylase and mutant in the recessive form of the disease. Myoclonus-dystonia syndrome (MDS; DYT11) is an autosomal dominant disorder characterized by bilateral, alcohol-sensitive myoclonic jerks involving mainly the arms and axial muscles. Dystonia, usually torticollis and/or writer's cramp, occurs in most but not all affected patients and may occasionally be the only symptom of the disease. In addition, patients often show prominent psychiatric abnormalities, including panic attacks and obsessive-compulsive behavior. In most MDS families, the disease is linked to a locus on chromosome 7q21 (refs. 11-13). Using a positional cloning approach, we have identified five different heterozygous loss-of-function mutations in the gene for epsilon-sarcoglycan (SGCE), which we mapped to a refined critical region of about 3.2 Mb. SGCE is expressed in all brain regions examined. Pedigree analysis shows a marked difference in penetrance depending on the parental origin of the disease allele. This is indicative of a maternal imprinting mechanism, which has been demonstrated in the mouse epsilon-sarcoglycan gene.
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Affiliation(s)
- A Zimprich
- Department of Neurology, Klinikum Grobhadern, Ludwig-Maximilians-University, Munich, Germany
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Bertram M, Mikhailov AS. Pattern formation in a surface chemical reaction with global delayed feedback. Phys Rev E Stat Nonlin Soft Matter Phys 2001; 63:066102. [PMID: 11415168 DOI: 10.1103/physreve.63.066102] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2000] [Indexed: 05/23/2023]
Abstract
We consider effects of global delayed feedback on anharmonic oscillations in the reaction-diffusion model of the CO oxidation reaction on a Pt(110) single-crystal surface. Depending on the feedback intensity and the delay time, we find that various spatiotemporal patterns can be induced. These patterns are characterized using a transformation to phase and amplitude variables designed for anharmonic oscillations. Typical feedback-induced patterns represent traveling phase flips, asynchronous oscillations, and dynamical clustering. Three different types of cluster patterns are identified: amplitude clusters, phase clusters, and cluster turbulence. For phase clusters, two different front instabilities are possible. A pitchfork bifurcation leads to propagation of cluster fronts. An instability of the state of phase balance results in spatial front oscillations.
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Affiliation(s)
- M Bertram
- Fritz-Haber-Institut der Max-Planck-Gesellschaft, Faradayweg 4-6, 14195 Berlin, Germany
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37
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Kim M, Bertram M, Pollmann M, von Oertzen A, Mikhailov AS, Rotermund HH, Ertl G. Controlling Chemical Turbulence by Global Delayed Feedback: Pattern Formation in Catalytic CO Oxidation on Pt(110). Science 2001; 292:1357-60. [PMID: 11359007 DOI: 10.1126/science.1059478] [Citation(s) in RCA: 198] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Control of spatiotemporal chaos is one of the central problems of nonlinear dynamics. We report on suppression of chemical turbulence by global delayed feedback using, as an example, catalytic carbon monoxide oxidation on a platinum (110) single-crystal surface and carbon monoxide partial pressure as the controlled feedback variable. When feedback intensity was increased, spiral-wave turbulence was transformed into new intermittent chaotic regimes with cascades of reproducing and annihilating local structures on the background of uniform oscillations. The global feedback further led to the development of cluster patterns and standing waves and to the stabilization of uniform oscillations. These findings are reproduced by theoretical simulations.
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Affiliation(s)
- M Kim
- Abteilung Physikalische Chemie, Fritz-Haber-Institut der Max-Planck-Gesellschaft, Faradayweg 4-6, 14195 Berlin, Germany
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Asmus F, Zimprich A, Naumann M, Berg D, Bertram M, Ceballos-Baumann A, Pruszak-Seel R, Kabus C, Dichgans M, Fuchs S, Müller-Myhsok B, Gasser T. Inherited Myoclonus-dystonia syndrome: narrowing the 7q21-q31 locus in German families. Ann Neurol 2001; 49:121-4. [PMID: 11198282 DOI: 10.1002/1531-8249(200101)49:1<121::aid-ana20>3.0.co;2-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [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: 11/10/2022]
Abstract
Genetic studies were performed in four German families with autosomal dominant myodonus-dystonia syndrome. Mutations in the D2 dopamine receptor gene, which have been implicated in this disorder, were excluded in all four families by linkage analysis and direct sequencing. All four families supported linkage to the second reported locus on chromosome 7q21 with a combined maximum multipoint lod score of 5.99. The observation of key recombinations in one family refined the disease locus to a 7.2 cM region flanked by the markers D7S652 and D7S2480.
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Affiliation(s)
- F Asmus
- Neurologische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München, Germany
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Bertram M. INSIGHT and NORDIL. International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment. Nordic Diltiazem Study. Lancet 2000; 356:1926; author reply 1928-9. [PMID: 11130403 DOI: 10.1016/s0140-6736(05)73474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/25/2022]
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Abstract
Repeated cranial computerized tomography scan examination in patients with elevated intracranial pressure is time consuming and requires patient transportation. We prospectively evaluated the diagnostic value of transcranial duplex sonography as a bedside tool for detection of the mass effect after space-occupying ischemic stroke and brain haemorrhage and for evaluating the width and dislocation of the ventricular system and the dislocation of brain mid-line structures. We used transcranial duplex sonography in 21 consecutive patients with space-occupying ischemic middle cerebral artery infarction and brain haemorrhage. The transcranial duplex sonography examinations were performed within 2 h before or after corresponding follow-up cranial computerized tomography scans. We measured the third ventricular width as a parameter for infratentorial and the mid-line shift for supratentorial space-occupying effect. In all patients, mid-line structures could be identified by transcranial duplex sonography. Significant third ventricular dilation was found subsequently in most patients with infratentorial mass effect, and mid-line shift occurred in all patients with supratentorial space-occupying lesions, respectively. The mean difference (absolute values) between transcranial duplex sonography and cranial computerized tomography measurements was 0.8 mm for the ventricular width (standard deviation 1 mm) and 1.1 mm for the mid-line shift (standard deviation: 1.46 mm), with a tendency for these parameters to be underestimated at higher values using transcranial duplex sonography. The linear correlation coefficients were R = 0.97 and R = 0.94, respectively. Transcranial duplex sonography appears to be a sufficiently reliable bedside method for evaluating the width and the lateral displacement of the third ventricle, as validated by cranial computerized tomography scan. Thus, it may be suitable for monitoring the space-occupying effect of both supra- and infratentorial strokes during treatment on critical care and stroke units.
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Affiliation(s)
- M Bertram
- Department of Neurology, University of Heidelberg INF 400, Heidelberg 69120, Germany
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Lin AL, Hagberg A, Ardelea A, Bertram M, Swinney HL, Meron E. Four-phase patterns in forced oscillatory systems. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 2000; 62:3790-3798. [PMID: 11088896 DOI: 10.1103/physreve.62.3790] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2000] [Indexed: 05/23/2023]
Abstract
We investigate pattern formation in self-oscillating systems forced by an external periodic perturbation. Experimental observations and numerical studies of reaction-diffusion systems and an analysis of an amplitude equation are presented. The oscillations in each of these systems entrain to rational multiples of the perturbation frequency for certain values of the forcing frequency and amplitude. We focus on the subharmonic resonant case where the system locks at one-fourth the driving frequency, and four-phase rotating spiral patterns are observed at low forcing amplitudes. The spiral patterns are studied using an amplitude equation for periodically forced oscillating systems. The analysis predicts a bifurcation (with increasing forcing) from rotating four-phase spirals to standing two-phase patterns. This bifurcation is also found in periodically forced reaction-diffusion equations, the FitzHugh-Nagumo and Brusselator models, even far from the onset of oscillations where the amplitude equation analysis is not strictly valid. In a Belousov-Zhabotinsky chemical system periodically forced with light we also observe four-phase rotating spiral wave patterns. However, we have not observed the transition to standing two-phase patterns, possibly because with increasing light intensity the reaction kinetics become excitable rather than oscillatory.
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Affiliation(s)
- AL Lin
- Center for Nonlinear Dynamics and Department of Physics, The University of Texas at Austin, Austin, Texas 78712, USA
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Abstract
OBJECTIVES To test the hypothesis that serum procalcitonin (PCT) levels are elevated in patients with bacterial meningitis and remain within normal limits in patients with abacterial meningitis. DESIGN Prospective case series. SETTING Tertiary care center. PATIENTS A total of 30 patients (13 men and 17 women) with a mean age of 52 yrs, having acute bacterial (n = 16) or abacterial (n = 14) meningitis. INTERVENTIONS Blood and cerebrospinal fluid samples. MEASUREMENTS AND MAIN RESULTS Patients with abacterial meningitis were younger and had a shorter hospital stay. Of 16 patients with bacterial meningitis, 14 were in a septic condition at admission, but only 5 of 14 patients with abacterial meningitis were in a septic condition at admission. At discharge, 12 patients were without symptoms, 9 patients were moderately disabled, and 9 were severely disabled. No patient died. At admission, PCT, C-reactive protein, white blood cell and cerebrospinal fluid leukocyte counts, and cerebrospinal fluid protein and lactate levels were higher and the serum/cerebrospinal fluid glucose quotient was lower in patients with bacterial meningitis as compared with those with abacterial meningitis (p < .001). PCT was the variable with the highest specificity for bacterial infections (100%), but there were false-negative findings in five patients with bacterial meningitis (a sensitivity of 69%). Persistently elevated or increasing PCT levels after 2 days were associated with an unfavorable clinical course. CONCLUSIONS Our results indicate that PCT is a useful additional variable for distinguishing bacterial from abacterial meningitis. In patients with abacterial meningitis, PCT levels do not increase even in cases of viral sepsis. Elevated PCT levels indicate a bacterial origin with high specificity, but false-negative results can occur.
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Affiliation(s)
- S Schwarz
- Department of Neurology, University of Heidelberg, Germany
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Lin AL, Bertram M, Martinez K, Swinney HL, Ardelea A, Carey GF. Resonant phase patterns in a reaction-diffusion system. Phys Rev Lett 2000; 84:4240-4243. [PMID: 10990655 DOI: 10.1103/physrevlett.84.4240] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/1999] [Indexed: 05/23/2023]
Abstract
Resonance regions similar to the Arnol'd tongues found in single oscillator frequency locking are observed in experiments using a spatially extended periodically forced Belousov-Zhabotinsky system. We identify six distinct 2:1 subharmonic resonant patterns and describe them in terms of the position-dependent phase and magnitude of the oscillations. Some experimentally observed features are also found in numerical studies of a forced Brusselator reaction-diffusion model.
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Affiliation(s)
- AL Lin
- Center for Nonlinear Dynamics and Department of Physics, The University of Texas at Austin, Austin, Texas 78712, USA
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Bertram M, Bonsanto M, Hacke W, Schwab S. Managing the therapeutic dilemma: patients with spontaneous intracerebral hemorrhage and urgent need for anticoagulation. J Neurol 2000; 247:209-14. [PMID: 10787117 DOI: 10.1007/s004150050565] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.4] [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: 10/28/2022]
Abstract
Physicians face a therapeutic dilemma in patients with acute hemorrhagic stroke requiring long-term, high-intensity anticoagulants because this treatment increases the risk of intracranial hemorrhage (ICH) 8- to 11-fold. We retrospectively studied 15 patients with ICH which occurred under anticoagulation with phenprocoumon, with an international norrmalized ratio (INR) of 2.5-6.5 on admission. Hemispheric, thalamic, cerebellar, intraventricular, or subarachnoid hemorrhage without aneurysm occurred. Absolute indications for anticoagulation were double, mitral, or aortic valve replacement, combined mitral valve failure with atrial fibrillation and atrial enlargement, internal carotid artery-jugular vein graft, frequently recurring deep vein thrombosis with risk of pulmonary embolism, and severe nontreatable ischemic heart disease. As soon as the diagnosis of ICH was established, INR normalization was attempted in all patients by administration of prothrombin complex, fresh frozen plasma, or vitamin K. After giving phenprocoumon antagonists (and neurosurgical therapy in four patients) heparin administration was started. Nine patients received full-dose intravenous and six low-dose subcutaneous heparin. The following observations were made: (a) All patients with effective, full-dose heparin treatment with a 1.5- to 2-fold elevation in partial thromboplastin time after normalization of the INR were discharged without complication. (b) Three of four of the patients with only incomplete correction of the INR (> 1.35) experienced relevant rebleeding within 3 days (all patients with an INR higher than 1.5), two of whom were on full-dose heparin. (c) Three of seven of the patients with normalized INR and without significant PTT elevation developed severe cerebral embolism. Although our data are based on a retrospective analysis, they support treatment with intravenous heparin (partial thromboplastin time 1.5-2 times baseline value) after normalization of the INR in patients with an ICH and an urgent need for anticoagulation.
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Affiliation(s)
- M Bertram
- Department of Neurology, University of Heidelberg, Germany
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Harden RN, Bruehl S, Galer BS, Saltz S, Bertram M, Backonja M, Gayles R, Rudin N, Bhugra MK, Stanton-Hicks M. Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive? Pain 1999; 83:211-9. [PMID: 10534592 DOI: 10.1016/s0304-3959(99)00104-9] [Citation(s) in RCA: 277] [Impact Index Per Article: 11.1] [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: 10/17/2022]
Abstract
This is a multisite study examining the internal validity and comprehensiveness of the International Association for the Study of Pain (IASP) diagnostic criteria for Complex Regional Pain Syndrome (CRPS). A standardized sign/symptom checklist was used in patient evaluations to obtain data on CRPS-related signs and symptoms in a series of 123 patients meeting IASP criteria for CRPS. Principal components factor analysis (PCA) was used to detect statistical groupings of signs/symptoms (factors). CRPS signs and symptoms grouped together statistically in a manner somewhat different than in current IASP/CRPS criteria. As in current criteria, a separate pain/sensation criterion was supported. However, unlike in current criteria, PCA indicated that vasomotor symptoms form a factor distinct from a sudomotor/edema factor. Changes in range of motion, motor dysfunction, and trophic changes, which are not included in the IASP criteria, formed a distinct fourth factor. Scores on the pain/sensation factor correlated positively with pain duration (P<0. 001), but there was a negative correlation between the sudomotor/edema factor scores and pain duration (P<0.05). The motor/trophic factor predicted positive responses to sympathetic block (P<0.05). These results suggest that the internal validity of the IASP/CRPS criteria could be improved by separating vasomotor signs/symptoms (e.g. temperature and skin color asymmetry) from those reflecting sudomotor dysfunction (e.g. sweating changes) and edema. Results also indicate motor and trophic changes may be an important and distinct component of CRPS which is not currently incorporated in the IASP criteria. An experimental revision of CRPS diagnostic criteria for research purposes is proposed. Implications for diagnostic sensitivity and specificity are discussed.
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Affiliation(s)
- R N Harden
- Center for Pain Studies, Room 1190, Rehabilitation Institute of Chicago, 345 E. Superior St., Chicago, IL 60611, USA
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Steiner T, Hennes HJ, Ringleb P, Bertram M, Hacke W. Zeitbasiertes Management des akuten Schlaganfalls. Notf Rett Med 1999. [DOI: 10.1007/s100490050168] [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: 10/28/2022]
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Abstract
Conventional therapies for raised intracranial pressure (ICP) frequently are not effective. We report a patient with raised ICP following a large hemispheric stroke. After conventional therapies had failed, indomethacin was repeatedly administered. After bolus infusion (50 mg), the ICP fell by a mean of 8.1 mm Hg, and the mean arterial blood pressure increased by a mean of 7.1 mm Hg, leading to a mean increase in the cerebral perfusion pressure by 15.3 mm Hg. After 1 h, the ICP had returned to baseline values after most infusions. Continuous infusion of indomethacin was not effective. We conclude that indomethacin may reduce elevated ICP over a short time in patients with ischemic brain edema even after conventional therapy has failed.
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Affiliation(s)
- S Schwarz
- Department of Neurology, University of Heidelberg, Heidelberg,
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Schwab S, Schwarz S, Bertram M, Spranger M, Hacke W. [Moderate hypothermia for the treatment of malignant middle cerebral artery infarct]. Nervenarzt 1999; 70:539-46. [PMID: 10412699 DOI: 10.1007/s001150050477] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Moderate hypothermia was induced in 30 patients with malignant middle cerebral artery (MCA) territory infarction. Patients were kept at 33 degrees C body-core temperature for 48 to 72 h, and ICP, CPP, and brain temperature were monitored. Outcome at 4 weeks and at 3 months after the stroke as well as side effects of moderate hypothermia were analysed. Mortality of malignant MCA infarction could be reduced from 80% in historical controls, to 43% (13/30) under hypothermia. During hypothermia elevated ICP values could be significantly reduced. Herniation due to a secondary rise of ICP after rewarming was the cause of death in all 13 patients. The most frequent complication of moderate hypothermia was pneumonia in 12 of the 30 patients (40%). Other severe side effects of hypothermia could not be detected. Moderate hypothermia may improve clinical outcome in patients with malignant MCA infarction.
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Affiliation(s)
- S Schwab
- Neurologische Klinik, Universität Heidelberg
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Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, Gayles R, Rudin N, Bhugra MK, Stanton-Hicks M. External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria. International Association for the Study of Pain. Pain 1999; 81:147-54. [PMID: 10353502 DOI: 10.1016/s0304-3959(99)00011-1] [Citation(s) in RCA: 458] [Impact Index Per Article: 18.3] [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: 02/08/2023]
Abstract
Recent work in our research consortium has raised internal validity concerns regarding the current IASP criteria for Complex Regional Pain Syndrome (CRPS), suggesting problems with inadequate sensitivity and specificity. The current study explored the external validity of these IASP criteria for CRPS. A standardized evaluation of signs and symptoms of CRPS was conducted by study physicians in 117 patients meeting IASP criteria for CRPS, and 43 patients experiencing neuropathic pain with established non-CRPS etiology (e.g. diabetic neuropathy, post-herpetic neuralgia). Multiple discriminant function analyses were used to test the ability of the IASP diagnostic criteria and decision rules, as well as proposed research modifications of these criteria, to discriminate between CRPS patients and those experiencing non-CRPS neuropathic pain. Current IASP criteria and decision rules (e.g. signs or symptoms of edema, or color changes or sweating changes satisfy criterion 3) discriminated significantly between groups (P < 0.001). However, although sensitivity was quite high (0.98), specificity was poor (0.36), and a positive diagnosis of CRPS was likely to be correct in as few as 40% of cases. Empirically-based research modifications to the criteria, which are more comprehensive and require presence of signs and symptoms, were also tested. These modified criteria were also able to discriminate significantly, between the CRPS and non-CRPS groups (P < 0.001). A decision rule, requiring at least two sign categories and four symptom categories to be positive optimized diagnostic efficiency, with a diagnosis of CRPS likely to be accurate in up to 84% of cases, and a diagnosis of non-CRPS neuropathic pain likely to be accurate in up to 88% of cases. These results indicate that the current IASP criteria for CRPS have inadequate specificity and are likely to lead to overdiagnosis. Proposed modifications to these criteria substantially improve their external validity and merit further evaluation.
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Affiliation(s)
- S Bruehl
- Center for Pain Studies, Rehabilitation Institute of Chicago, IL 60611, USA
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