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1.
BMC Med Res Methodol ; 18(1): 23, 2018 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-29439652

RESUMO

BACKGROUND: Standard survival analysis fails to give insight into what happens to a patient after a first outcome event (like first relapse of a disease). Multi-state models are a useful tool for analyzing survival data when different treatments and results (intermediate events) can occur. Aim of this study was to implement a multi-state model on data of patients with rectal cancer to illustrate the advantages of multi-state analysis in comparison to standard survival analysis. METHODS: We re-analyzed data from the RCT FOGT-2 study by using a multi-state model. Based on the results we defined a high and low risk reference patient. Using dynamic prediction, we estimated how the survival probability changes as more information about the clinical history of the patient becomes available. RESULTS: A patient with stage UICC IIIc (vs UICC II) has a higher risk to develop distant metastasis (DM) or both DM and local recurrence (LR) if he/she discontinues chemotherapy within 6 months or between 6 and 12 months, as well as after the completion of 12 months CTx with HR 3.55 (p = 0.026), 5.33 (p = 0.001) and 3.37 (p < 0.001), respectively. He/she also has a higher risk to die after the development of DM (HR 1.72, p = 0.023). Anterior resection vs. abdominoperineal amputation means 63% risk reduction to develop DM or both DM and LR (HR 0.37, p = 0.003) after discontinuation of chemotherapy between 6 and 12 months. After development of LR, a woman has a 4.62 times higher risk to die (p = 0.006). A high risk reference patient has an estimated 43% 5-year survival probability at start of CTx, whereas for a low risk patient this is 79%. After the development of DM 1 year later, the high risk patient has an estimated 5-year survival probability of 11% and the low risk patient one of 21%. CONCLUSIONS: Multi-state models help to gain additional insight into the complex events after start of treatment. Dynamic prediction shows how survival probabilities change by progression of the clinical history.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Avaliação de Resultados em Cuidados de Saúde/métodos , Neoplasias Retais/tratamento farmacológico , Medição de Risco/métodos , Adulto , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Medição de Risco/estatística & dados numéricos , Fatores de Risco
2.
Herz ; 43(4): 325-337, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28451702

RESUMO

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has emerged as the procedure of choice for patients with severe aortic stenosis (AS) and high perioperative risk. We performed a meta-analysis to compare the mortality related to TAVR with medical therapy (MT) and surgical aortic valve replacement (SAVR). METHODS: A systematic literature search was conducted by two independent investigators from the database inception to 30 December 2014. Relative risk (RR) and odds ratio (OR) were calculated and graphically displayed in forest plots. We used I 2 for heterogeneity (meta-regression) and Egger's regression test of asymmetry (funnel plots). RESULTS: We included 24 studies (n = 19 observational studies; n = 5 randomized controlled trials), with a total of 7356 patients in this meta-analysis. Mean age had a substantial negative impact on the long-term survival of AS patients (OR = 1.544; 95% CI: 1.25-1.90). Compared with MT, TAVR showed a statistically significant benefit for all-cause mortality at 12 months (OR = 0.68; 95% CI: 0.49-0.95). Both TAVR and SAVR were associated with better outcomes compared with MT. TAVR showed lower all-cause mortality over SAVR at 12 months (OR = 0.81; 95% CI: 0.68-0.97). The comparison between SAVR and TAVR at 2 years revealed no significant difference (OR = 1.09; 95% CI: 1.01-1.17). CONCLUSION: In AS, both TAVR and SAVR provide a superior prognosis to MT and, therefore, MT is not the preferred treatment option for AS. Furthermore, our data show that TAVR is associated with lower mortality at 12 months compared with SAVR. Further studies are warranted to compare the long-term outcome of TAVR versus SAVR beyond a 2-year follow-up period.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Intervenção Coronária Percutânea , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica , Estenose da Valva Aórtica/terapia , Feminino , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
3.
Eur J Clin Microbiol Infect Dis ; 36(3): 565-573, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27838792

RESUMO

Influenza virus infections (IVI) may pose a vital threat to immunocompromised patients such as those suffering from malignancies, but specific data on epidemiology and outcome in these patients are scarce. In this study, we collected data on patients with active cancer or with a history of cancer, presenting with documented IVI in eight centres in Germany. Two hundred and three patients were identified, suffering from haematological malignancies or solid tumours; 109 (54 %) patients had active malignant disease. Influenza A was detected in 155 (77 %) and Influenza B in 46 (23 %) of patients (genera not determined in two patients). Clinical symptoms were consistent with upper respiratory tract infection in 55/203 (27 %), influenza-like illness in 82/203 (40 %), and pneumonia in 67/203 (33 %). Anti-viral treatment with oseltamivir was received by 116/195 (59 %). Superinfections occurred in 37/203 (18 %), and admission on an intensive care unit was required in 26/203 (13 %). Seventeen patients (9 %) died. Independent risk factors for death were delayed diagnosis of IVI and bacterial or fungal superinfection, but not underlying malignancy or ongoing immunosuppression. In conclusion, patients with IVI show high rates of pneumonia and mortality. Early and rapid diagnosis is essential. The high rate of pneumonia and superinfections should be taken into account when managing IVI in these patients.


Assuntos
Influenza Humana/epidemiologia , Influenza Humana/patologia , Neoplasias/complicações , Idoso , Antivirais/uso terapêutico , Cuidados Críticos , Feminino , Alemanha/epidemiologia , Humanos , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/mortalidade , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Fatores de Risco , Sociedades , Superinfecção/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
4.
Eur Arch Otorhinolaryngol ; 274(3): 1345-1349, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27858146

RESUMO

The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire reports subjective hearing impairments in four typical conditions. We investigated the association between the frequency-specific probability of hearing loss and scores from the unaided APHAB (APHABu) to determine whether the APHABu could be useful in primary diagnoses of hearing loss, in addition to pure tone and speech audiometry. This retrospective study included database records from 6558 patients (average age 69.0 years). We employed a multivariate generalised linear mixed model to analyse the probabilities of hearing losses (severity range 20-75 dB, evaluated in 5-dB steps), measured at different frequencies (0.5, 1.0, 2.0, 4.0, and 8.0 kHz), for nearly all combinations of APHABu subscale scores (subscale scores from 20 to 80%, evaluated in steps of 5%). We calculated the probability of hearing loss for 28,561 different combinations of APHABu subscale scores (results available online). In general, the probability of hearing loss was positively associated with the combined APHABu score (i.e. increasing probability with increasing scores). However, this association was negative at one frequency (8 kHz). The highest probabilities were for a hearing loss of 45 dB at test frequency 2.0 kHz, but with a wide spreading. We showed that the APHABu subscale scores were associated with the probability of hearing loss measured with audiometry. This information could enrich the expert's evaluation of the subject's hearing loss, and it might help resolve suspicious cases of aggravation. The 0.5 and 8.0 kHz frequencies influenced hearing loss less than the frequencies in-between, and 2.0 kHz was most influential on intermediate degree hearing loss (around 45 dB), which corresponded to the frequency-dependence of speech intelligibility measured with speech audiometry.


Assuntos
Limiar Auditivo , Perda Auditiva/diagnóstico , Inquéritos e Questionários , Idoso , Audiometria , Feminino , Humanos , Masculino , Probabilidade , Estudos Retrospectivos
5.
Eur Arch Otorhinolaryngol ; 274(10): 3593-3598, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28756570

RESUMO

Subjective hearing loss in hearing-impaired patients can be assessed by inventory questionnaires. The abbreviated profile of hearing aid benefit (APHAB) measures subjective hearing loss in four typical hearing situations (subscales). It is used to fit hearing aids in patients with statutory insurance in Germany. In addition, the unaided APHAB (APHABu) can be used as a primary diagnostic instrument in audiology. There are no published data regarding the sensitivity and specificity of the unaided APHABu. Therefore, we investigated these parameters for detecting hearing loss of at least 25 dB at any frequency between 0.5 and 8.0 kHz. We used the APHABu to determine hearing loss in 245 subjects aged 50 years and older without any reported disease of the ears. Due to incomplete answering of the APHAB form, 55 subjects have been excluded. We also measured the pure-tone thresholds by air conduction for all octave frequencies between 0.5 and 8 kHz. Receiver operating characteristic (ROC) curves and the Youden Index were used to determine the diagnostic value of the APHABu, particularly sensitivity and specificity, in three different ways: (1) separately for ease of communication (ECu), background noise (BNu), and hearing with reverberation (RVu) subscales; (2) with the mean value of ECu, BNu, and RVu; and (3) with a logistic regression model. The area under the ROC curve was lower for BN only (0.83) and nearly equal for all other methods (0.87-0.89). Depending on how we performed the analyses, the sensitivity of the APHABu was 0.70-0.84 (single subscales), 0.76 (mean value of ECu, BNu, and RVu), or 0.85 (logistic regression model). The specificity was 0.79-0.95. The use of single APHABu subscales for determining the sensitivity and specificity of the APHABu due to confusing results. In comparison, the use of the mean value of ECu, BNu, and RVu and the use of the logistic regression model due to equal values in the ROC curves but a higher sensitivity in the logistic regression model. Therefore, we would recommend the last method for determining the sensitivity and specificity of the APHABu.


Assuntos
Auxiliares de Audição/normas , Perda Auditiva , Idoso , Atitude Frente a Saúde , Feminino , Alemanha , Perda Auditiva/diagnóstico , Perda Auditiva/psicologia , Testes Auditivos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Sensibilidade e Especificidade , Inquéritos e Questionários
6.
Laryngorhinootologie ; 96(8): 519-521, 2017 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-28850992

RESUMO

The BEMED study (BMJ 2016; 352: DOI 10.1136) was designed as multi-centric, double-blind, plaebo-controlled study in patients with Menière's disease. It should compare a low-level (2 × 24 mg/d) vs. high-level (3 × 48 mg/d) betahstine intake vs. placebo. The primary endpoint was the "number of vertigo attacks lasting longer than 20 min as documented in a patient's diary". The main finding of the study was that betahistine did not significantly better reduced the number of vertigo attacks than placebo. Therefore, the BEMED study should be critically discussed in the present paper.


Assuntos
beta-Histina/uso terapêutico , Doença de Meniere/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Alemanha , Humanos , Masculino , Doença de Meniere/classificação , Doença de Meniere/diagnóstico , Pessoa de Meia-Idade , Adulto Jovem
7.
Acta Anaesthesiol Scand ; 60(10): 1404-1414, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27578364

RESUMO

BACKGROUND: Post-operative delirium and post-operative cognitive dysfunction (POCD) are both common but it has not been clarified how closely they are associated. We aimed to assess the possible relationship in a secondary analysis of data from the 'Surgery Depth of anaesthesia and Cognitive outcome'- study. METHODS: We included patients aged ≥ 60 years undergoing non-cardiac surgery planned for longer than 60 min. Delirium was assessed according to the Diagnostic and Statistical Manual of Mental Disorders IV criteria in the post-anaesthesia care unit (PACU) as well as within the first week after surgery. Cognitive function was assessed with a neuropsychological test battery. Multivariable analysis of POCD was performed with consideration of predisposing and precipitating factors. RESULTS: Of 1277 randomized patients, 850 (66.6%) had complete data. Delirium was found in 270 patients (32.9% of 850). We detected POCD in 162 (20.9% of 776) at 1 week and in 52 (9.4% of 553) at 3 months. In multivariable analysis (n = 808), delirium had no overall effect on POCD (P = 0.30). Patients with no delirium in PACU but with postoperative delirium within 7 days had an increased risk of POCD at 3 months (OR = 2.56 (95%-confidence interval: 1.07-6.16), P = 0.035). No significant association was found for the other subgroups. CONCLUSIONS: There is no clear evidence that postoperative delirium is independently associated with POCD up to 3 months.


Assuntos
Disfunção Cognitiva/etiologia , Delírio/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada
8.
Eur Arch Otorhinolaryngol ; 273(11): 3587-3593, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26975446

RESUMO

Hearing loss can be measured by pure-tone and speech audiometry. The subjective hearing impairment can be assessed using questionnaires. The APHAB determines this for four typical hearing situations. It has not been researched previously whether a particular frequency-specific hearing loss leads to a particular unaided APHAB score in one of the subscales or not. Clarification could be helpful using the unaided APHAB as an instrument for primary diagnostics of hearing loss independently of whether hearing aids were subsequently fitted or not. A total of 4546 records from a database were analysed; the average age of the subjects was 69.3 years. Using a multivariant mixed linear model, a possible correlation was examined between a frequency-specific hearing loss (0.5-8.0 kHz) and particular unaided APHAB scores for its subscales. Furthermore, it was determined whether the subject's gender has a corresponding impact. There was no evidence of gender-specific dependence of the unaided APHAB scores. For the EC scale frequencies above 0.5 kHz, for the RV scale all frequencies and for the AV scale the frequencies at 1.0 and 2.0 kHz showed a significant correlation between hearing loss and the APHAB score. For each decibel of hearing loss there was an average rise in the APHAB score for the EC and RV scale of approximately 0.2 percentage points and an average decrease in the AV scale of 0.1 percentage points for each frequency. For the BN scale there was no evidence of this kind of correlation. The very varied possibility between individuals compensating for hearing loss in situations with background noises could be that there is no correlation between frequency-specific hearing loss and an associated unaided APHAB score. The described frequency-specific influence of hearing loss to the EC and RV score could be explained by fewer compensating possibilities for the patients in these specific hearing situations than for the BN scale described. Using the unaided APHAB form in primary diagnostics of hearing impairment is helpful for understanding individual problems.


Assuntos
Auxiliares de Audição , Perda Auditiva/diagnóstico , Inquéritos e Questionários , Idoso , Audiometria de Tons Puros , Limiar Auditivo , Feminino , Humanos , Modelos Lineares , Masculino , Fatores Sexuais
9.
Laryngorhinootologie ; 95(9): 620-6, 2016 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-26669582

RESUMO

BACKGROUND: This is the first population-based analysis of inpatient salivary gland surgery across Germany. METHODS: Nationwide Diagnosis-Related Groups (DRG) statistics for 2007 to 2011 were analyzed regarding indications for salivary gland surgery based on ICD-10 codes. Age specific surgery rates were calculated for both sexes. RESULTS: Inpatient salivary gland surgical rates in 2007-2011 amounted for incisions (OPS [Classification of Operations and Procedures] code 5-260) 1.43 per 100 000 population, for excisions (5-261) 2.06 per 100 000, for salivary gland resections (5-262) 2.06 per 100 000, and for external incisions (5-270) 0.43 per 100 000. Regarding the mentioned four OPS codes, the surgical rates for benign tumors accounted to 10.08 per 100 000, for sialadenitis (without sialoliths) to 4.00 per 100 000, for malignant tumors to 3.90 per 100 000, and for sialolithiasis to 2.09 per 100 000. The increase of surgical rates from 2007 to 2011 was significant for malignant and benign tumors as well as for salivary stones. The surgical rates were highest for patients>60 years. DISCUSSION: Especially surgery for malignant tumors was more frequent than expected. In spite of the introduction of minimal invasive technique the rates for salivary gland resections in case of sialadenitis or sialolithiasis still seem to be high.


Assuntos
Cálculos das Glândulas Salivares/cirurgia , Glândulas Salivares/cirurgia , Feminino , Alemanha , Humanos , Pacientes Internados , Masculino , Sialadenite
10.
Laryngorhinootologie ; 95(8): 540-5, 2016 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-27064271

RESUMO

BACKGROUND: Questionnaires as the APHAB (Abbreviated Profile of Hearing Aid Benefit) are besides pure-tone and speech-audiometry the third method of diagnostics in audiology. Up to now there has been no research on the influence of individual hearing loss, represented by standard audiograms, on the scores of the unaided APHAB (APHABu) done with a big number of subjects. This study will investigate whether there does exist such a relationship or not. METHODS: A total of 2 745 records provided by a database were analysed. First, the subjects' audiograms (air conduction) were allocated to 7 standardised audiogram types. By using a multivariant mixed linear model a potential connection was examined between these standard audiograms and particular APHABu scores for its four subscales: EC - ease of communication, BN - background noise, RV - reverberation, AV - aversiveness of sounds. RESULTS: There was no evidence for a dependency between any type of hearing loss dependence and unaided APHAB-scores. The values on the EC-scale vary between 49.8 and 58.0, on the BN-scale between 45.3 and 46.6, on the RV-scale between 44.4 and 52.4, and on the AV-scale between 47.6 and 50.1. DISCUSSION: This result confirms earlier studies with other questionnaires. Therefore, the APHABu can be used as an initial instrument for the diagnostics of individual hearing loss independently on whether hearing aids will be fitted subsequently or not.


Assuntos
Auxiliares de Audição , Perda Auditiva , Testes Auditivos , Surdez , Humanos , Ruído , Percepção da Fala , Inquéritos e Questionários
11.
Am J Transplant ; 15(4): 1091-100, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25736912

RESUMO

Tailoring treatment by patient strata based on the risk of disease progression and treatment toxicity might improve outcomes of patients with posttransplant lymphoproliferative disorder (PTLD). We analysed the cohort of 70 patients treated in the international, multicenter phase II PTLD-1 trial (NCT01458548) to identify such factors. Of the previously published scoring systems in PTLD, the international prognostic index (IPI), the PTLD prognostic index and the Ghobrial score were predictive for overall survival. None of the scoring systems had a considerable effect on the risk for disease progression. Age and ECOG performance status were the baseline variables with the highest prognostic impact in the different scoring systems. Baseline variables not included in the scoring systems that had an impact on overall survival and disease progression were the type of transplant and the response to rituximab at interim staging. Thoracic organ transplant recipients who did not respond to rituximab monotherapy were at particularly high risk for death from disease progression with subsequent CHOP-based chemotherapy. Patients in complete remission after four courses of rituximab and patients in partial remission with low-risk IPI had a low risk of disease progression. We speculate that chemotherapy might not be necessary in this patient cohort.


Assuntos
Antígenos CD20/imunologia , Linfócitos B/imunologia , Transtornos Linfoproliferativos/tratamento farmacológico , Rituximab/uso terapêutico , Humanos , Transtornos Linfoproliferativos/imunologia , Transtornos Linfoproliferativos/patologia , Pessoa de Meia-Idade , Prognóstico
12.
Eur Arch Otorhinolaryngol ; 272(9): 2135-42, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24740734

RESUMO

The Freiburger Speech Test (FST) has been the gold standard in speech testing by word recognition score in Germany for many years. Recently, it has been demonstrated that for an amount of 104 test-persons there is no significant deviation within the lists. The objective of this study was to determine the percentiles of the distinct measuring situations in quiet and with noise (e.g. applied in hearing aid fitting) and the average benefit using hearing aids. In this prospective study, 623 patients with SNHL and equipped with hearing aids for at least 3 months have been investigated by means of the Freiburger monosyllabic test (FBE) without and with hearing aids and in quiet or with noise (CCITT noise, 65/60 dB signal-noise ratio) in free field conditions at 65 dB to determine the ratio of intelligibility. To investigate the different diagnostic conditions a linear mixed model was applied. The dependent binary variable corresponds to the number of understood syllables. The average age of all subjects was about 72.6 years. The average rate of understanding in the FBE without hearing aids and in quiet was 38.5 %, with hearing aids and in quiet 67.7 %, without hearing aids and with noise 22.4 %, and with hearing aids and with noise 39.8 %. All results were presented with the depending confidence intervals. The extent of hearing loss and the quality of hearing aid fitting can be successfully measured using the FST in quiet and with background noise (CCITT noise). In quiet, an average hearing improving gain of 29.2 % points and with noise a gain of 17.4 % points could be estimated with a successful hearing aid fitting.


Assuntos
Auxiliares de Audição , Perda Auditiva Neurossensorial/terapia , Ruído , Idoso , Idoso de 80 Anos ou mais , Audiometria da Fala , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Percepção da Fala
13.
HNO ; 62(10): 735-45, 2014 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-25231698

RESUMO

A specific quality assurance questionnaire concerned with the provision of hearing aids was introduced that assesses elements of patient satisfaction within Germany's statutory healthcare system. A questionnaire-based assessment is now relevant for all physicians involved in the care of statutorily insured patients in Germany. The APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire is the most widely used. The APHAB assesses several different situations: the normal hearing situation, hearing in noise, comprehension of speech in situations of echo or reverberation and hearing in loud situations. The APHAB questionnaire-based patient evaluation of the benefit of hearing aids represents the third pillar of audiological diagnostics, alongside classical pure-tone and speech audiometry. The objective of the APHAB database is to allow evaluation of individual patient data on the basis of a larger volume of data.


Assuntos
Bases de Dados como Assunto/organização & administração , Auxiliares de Audição/normas , Perda Auditiva/reabilitação , Programas Nacionais de Saúde , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde/normas , Inquéritos e Questionários , Audiometria de Tons Puros/normas , Audiometria da Fala/normas , Limiar Auditivo , Compreensão , Registros Eletrônicos de Saúde , Alemanha , Perda Auditiva/diagnóstico , Humanos , Mascaramento Perceptivo , Percepção da Fala
14.
HNO ; 61(7): 586-91, 2013 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-23076435

RESUMO

BACKGROUND: The Freiburg speech test has been the gold standard in speech audiometry in Germany for many years. Previously, however, this test had not been evaluated in assessing the effectiveness of a hearing aid in background noise. Furthermore, the validity of particular word lists used in the test has been questioned repeatedly in the past, due to a suspected higher variation within these lists as compared to the other word list used. PATIENTS AND METHODS: In this prospective study, two groups of subjects [normal hearing control subjects and patients with SNHL (sensorineural hearing loss) that had been fitted with hearing aid] were examined. In a first group, 113 control subjects with normal age- and gender-related pure tone thresholds were assessed by means of the Freiburg monosyllabic test under free-field conditions at 65 dB. The second group comprised 104 patients that had been fitted with hearing aids at least 3 months previously to treat their SNHL. Members of the SNHL group were assessed by means of the Freiburg monosyllabic test both with and without hearing aids, and in the presence or absence of background noise (CCITT-noise; 65/60 dB signal-noise ratio, in accordance with the Comité Consultatif International Téléphonique et Télégraphique), under free-field conditions at 65 dB. RESULTS: The first (control) group exhibited no gender-related differences in the Freiburg test results. In a few instances, inter-individual variability of responses was observed, although the reasons for this remain to be clarified. Within the second (patient) group, the Freiburg test results under the four different measurement conditions differed significantly from each other (p>0.05). This group exhibited a high degree of inter-individual variability between responses. In light of this, no significant differences in outcome could be assigned to the different word lists employed in the Freiburg speech test. CONCLUSION: The Freiburg monosyllabic test is able to assess the extent of hearing loss, as well as the effectiveness of a fitted hearing aid, in the presence or absence of background-noise (CCITT-noise). The present study could not evidence statistically significant differences in outcome when using the different word lists in this test battery.


Assuntos
Audiometria da Fala/métodos , Audiometria da Fala/estatística & dados numéricos , Correção de Deficiência Auditiva/estatística & dados numéricos , Auxiliares de Audição/estatística & dados numéricos , Transtornos da Audição/diagnóstico , Transtornos da Audição/epidemiologia , Ruído , Adulto , Correção de Deficiência Auditiva/instrumentação , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Razão Sinal-Ruído , Resultado do Tratamento
15.
Laryngorhinootologie ; 92(12): 815-22, 2013 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-24037501

RESUMO

BACKGROUND: Progredient hearing loss is a common symptom, which is hard to detect early. This study presents an assessment to face this problem. METHODS: 1,159 subjects between the age of 50 and 75 have been investigated by a 12 question profile about their hearing in different situations. The answers have been rated by weighted points and compared with the pure-tone audiogram of the subjects. RESULTS: 6 of the 12 questions were suitable to detect a hearing loss of 25 dB in one of the 4 frequencies 0,5-1-2-4 kHz. For subjects under age of 60 a cutoff value of 3, for subjects aged 60 years or older a cutoff value of 2 points could be set for the 6 questions including "Mini-Audio-Test" (MAT). DISCUSSION: The "Mini-Audio-Test" is able to detect a hearing loss of 25 dB at least in one of the 4 frequencies by a sensitivity of 78%, 95% confidence interval (71,8%, 83,2%), for the younger group of subjects and by 69%, 95% confidence interval (66,0%, 72,6%), for the older one. Subjects with a pathological score should be examined by an ENT-physician.


Assuntos
Programas de Rastreamento/métodos , Presbiacusia/diagnóstico , Inquéritos e Questionários , Idoso , Audiometria de Tons Puros , Estudos Transversais , Diagnóstico Precoce , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Presbiacusia/epidemiologia , Estudos Prospectivos , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes
16.
Ann Oncol ; 23(11): 2827-2834, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22734012

RESUMO

BACKGROUND: This prospective multicentre phase II trial assessed the feasibility and efficacy of perioperative chemotherapy with docetaxel, cisplatin and capecitabine (DCX) in patients with gastro-oesophageal adenocarcinoma. METHODS: Patients with curatively resectable adenocarcinoma of the stomach, the gastro-oesophageal junction or the lower third of the oesophagus were enrolled. Patients received docetaxel 75 mg/m(2) plus cisplatin 60 mg/m(2) (day 1), followed by oral capecitabine 1875 mg/m(2) divided into two doses (days 1-14) every 3 weeks. There were three cycles preoperatively and three cycles postoperatively. The primary end point was the R0 resection rate. RESULTS: Fifty-one patients were recruited and assessed for feasibility and efficacy. 94.1% of patients received all three planned cycles preoperatively, and 52.9% received three cycles postoperatively. The R0 resection rate was 90.2%. 13.7% of patients showed complete pathological remission (pCR). Toxicity was acceptably tolerable. Without prophylactic granulocyte colony-stimulating factor administration, neutropenic fever developed in 21.5% of patients preoperatively (grade 3 or 4) and in 11.1% of patients postoperatively. CONCLUSIONS: DCX is a safe and feasible perioperative regimen in the treatment of gastro-oesophageal adenocarcinoma with a high percentage of cycles delivered pre- and postoperatively, compared with standard practice. The high efficacy in terms of R0 resection rate and pCR is very promising.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Junção Esofagogástrica , Neoplasias Gástricas/tratamento farmacológico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Capecitabina , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Cisplatino/uso terapêutico , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Docetaxel , Esquema de Medicação , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Fluoruracila/análogos & derivados , Fluoruracila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxoides/administração & dosagem , Taxoides/efeitos adversos , Taxoides/uso terapêutico , Resultado do Tratamento
17.
Eur Radiol ; 22(1): 59-72, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21845461

RESUMO

OBJECTIVES: To obtain an overview of the current clinical practice of cardiac computed tomography (CT). METHODS: A 32-item questionnaire was mailed to a total of 750 providers of cardiac CT in 57 countries. RESULTS: A total of 169 questionnaires from 38 countries were available for analysis (23%). Most CT systems used (94%, 207/221) were of the latest generation (64-row or dual-source CT). The most common indications for cardiac CT was exclusion of coronary artery disease (97%, 164/169). Most centres used beta blockade (91%, 151/166) and sublingual nitroglycerine (80%, 134/168). A median slice thickness of 0.625 mm with a 0.5-mm increment and an 18-cm reconstruction field of view was used. Interpretation was most often done using source images in orthogonal planes (92%, 155/169). Ninety percent of sites routinely evaluate extracardiac structures on a large (70%) or cardiac field of view (20%). Radiology sites were significantly more interested in jointly performing cardiac CT together with cardiology than cardiologists. The mean examination time was 18.6 ± 8.4 min, and reading took on average 28.7 ± 17.8 min. CONCLUSIONS: Cardiac CT has rapidly become established in clinical practice, and there is emerging consensus regarding indications, conduct of the acquisition, and reading.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Nitroglicerina/administração & dosagem , Padrões de Prática Médica , Tomografia Computadorizada por Raios X , Vasodilatadores/administração & dosagem , Cardiologia , Angiografia Coronária/métodos , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Interpretação de Imagem Assistida por Computador , Guias de Prática Clínica como Assunto , Doses de Radiação , Inquéritos e Questionários
18.
Ann Rheum Dis ; 69(1): 34-8, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19126560

RESUMO

OBJECTIVE: Ankylosing spondylitis (AS) and periodontal disease (PD) are characterised by dysregulation of the host inflammatory response, resulting in soft and hard connective tissue destruction. AS has been related to other inflammatory diseases, however, there is a paucity of data on whether AS is associated with inflammatory PD. METHODS: The association between AS and PD was examined in 48 patients with AS and 48 healthy controls, matched for age and gender. AS was diagnosed according to the modified New York criteria. Periodontal examination included probing pocket depth (PPD), clinical attachment loss (CAL), plaque index (PI) and bleeding on probing (BOP). Potential risk factors of PD such as smoking, low education, alcohol consumption, body mass index (BMI), as well as chronic diseases associated with PD and AS were assessed through questionnaires. RESULTS: In stepwise logistic regression, including AS status, age, gender, education, smoking, alcohol consumption and BMI, only AS status, age and education remained significant predictors of PD. Patients with AS had significant 6.81-fold increased odds (95% CI 1.96 to 23.67) of PD (defined as mean attachment loss >3 mm) compared to controls. The strength of the association was attenuated but remained statistically significant after further adjustment for plaque accumulation (odds ratio (OR) 5.48, 95% CI 1.37 to 22.00). CONCLUSIONS: The present study shows that patients with AS have a significantly higher risk of PD, strongly suggesting the need for close collaboration between rheumatologists, periodontists and dental hygienists when treating patients with AS.


Assuntos
Periodontite Crônica/etiologia , Espondilite Anquilosante/complicações , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/efeitos adversos , Índice de Massa Corporal , Periodontite Crônica/diagnóstico , Escolaridade , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/efeitos adversos
19.
Int J Clin Pharmacol Ther ; 48(12): 791-7, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21084034

RESUMO

OBJECTIVE: Pharmacokinetics of 4-methyl-amino-antipyrine (MAA), the active metabolite of the nonsteroidal anti-inflammatory agent dipyrone, whose time course correlates to the therapeutic effect of the drug, are studied. STUDY DESIGN AND SETTING: 153 patients hospitalized in the Department of Medicine at the Hadassah University Hospital, Jerusalem, Israel. INTERVENTION: Patients receiving dipyrone for the treatment of fever or pain were asked to participate in the study. Pharmacokinetics and statistical analysis: Using the population approach based on a formerly developed experimental model, the relationships between pharmacokinetic parameters and demographic and physiological covariates are explored. RESULTS: The results of the analysis show considerable variability in pharmacokinetics across the study population, and a significant decrease in clearance with age. CONCLUSION: A population pharmacokinetic analysis of MAA, the active product of dipyrone, reveals that age is a significant predictor of MAA disposition. Covariates that measure hepatic and renal function do not appear to be good predictors of the rate of MAA disposition.


Assuntos
Anti-Inflamatórios não Esteroides/farmacocinética , Dipirona/farmacocinética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Intensive Care Med ; 46(8): 1552-1562, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32572531

RESUMO

PURPOSE: To investigate the global burden of sepsis in hospitalized adults by updating and expanding a systematic review and meta-analysis and to compare findings with recent Institute for Health Metrics and Evaluation (IHME) sepsis estimates. METHODS: Thirteen electronic databases were searched for studies on population-level sepsis incidence defined according to clinical criteria (Sepsis-1, -2: severe sepsis criteria, or sepsis-3: sepsis criteria) or relevant ICD-codes. The search of the original systematic review was updated for studies published 05/2015-02/2019 and complemented by a search targeting low- or middle-income-country (LMIC) studies published 01/1979-02/2019. We performed a random-effects meta-analysis with incidence of hospital- and ICU-treated sepsis and proportion of deaths among these sepsis cases as outcomes. RESULTS: Of 4746 results, 28 met the inclusion criteria. 21 studies contributed data for the meta-analysis and were pooled with 30 studies from the original meta-analysis. Pooled incidence was 189 [95% CI 133, 267] hospital-treated sepsis cases per 100,000 person-years. An estimated 26.7% [22.9, 30.7] of sepsis patients died. Estimated incidence of ICU-treated sepsis was 58 [42, 81] per 100,000 person-years, of which 41.9% [95% CI 36.2, 47.7] died prior to hospital discharge. There was a considerably higher incidence of hospital-treated sepsis observed after 2008 (+ 46% compared to the overall time frame). CONCLUSIONS: Compared to results from the IHME study, we found an approximately 50% lower incidence of hospital-treated sepsis. The majority of studies included were based on administrative data, thus limiting our ability to assess temporal trends and regional differences. The incidence of sepsis remains unknown for the vast majority of LMICs, highlighting the urgent need for improved epidemiological sepsis surveillance.


Assuntos
Sepse , Adulto , Hospitais , Humanos , Incidência , Unidades de Terapia Intensiva , Sepse/epidemiologia
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