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P Dirschedl

Publications and source records attributed to P Dirschedl.

At least 19 recordsLinked to original sources
PubMed2006

[Neonatal septicemia in the G-DRG system].

INTRODUCTION: The introduction of Diagnosis Related Groups in Germany (G-DRG) has brought forward the obligation for physicians to take into account an intricate system of medical, economical and legal implementations. Mistakes in the process of encoding the principal diagnosis or procedures may have financial consequences. Problems to determine the correct ICD-code will be most prominent for diseases with poorly defined or even inconsistent diagnostic criteria as is the case for neonatal septicemia. We decided to evaluate whether the introduction of G-DRG resulted in a change of frequency of the diagnosis "neonatal septicemia". METHODS: We analysed data derived from the quality assurance program "Neonatalerhebung" in the state of Baden-Württemberg during the years of 2001 through 2004, i. e., 2 years before and 2 years during the introduction of G-DRG. During this period an annual number of 12,316 up to 13,172 newborns were admitted to the participating hospitals. RESULTS: The mean number of diagnoses per patient increased from 2.2 to 3.8. The frequency of the diagnosis of septicemia remained constant. The percentage of newborns receiving antibiotic therapy did not change. The ratio of cases with "septicemia yes" over "antibiotics yes" did not change. Although it is difficult to determine the diagnosis of neonatal septicemia and in spite of the economic implications of this diagnosis, no change in the frequency of this diagnosis occurred during the introduction of DRG. CONCLUSIONS: Assuming that the participating hospitals used an identical database for the quality assurance program "Neonatalerhebung" and for accounting, we conclude that the DRG system is stable with respect to neonatal septicemia.

Diagnosis-Related Groups↗
PubMed2004

mdclust--exploratory microarray analysis by multidimensional clustering.

MOTIVATION: Unsupervised clustering of microarray data may detect potentially important, but not obvious characteristics of samples, for instance subgroups of diagnoses with distinct gene profiles or systematic errors in experimentation. RESULTS: Multidimensional clustering (mdclust) is a method, which identifies sets of sample clusters and associated genes. It applies iteratively two-means clustering and score-based gene selection. For any phenotype variable best matching sets of clusters can be selected. This provides a method to identify gene-phenotype associations, suited even for settings with a large number of phenotype variables. An optional model based discriminant step may reduce further the number of selected genes.

Cluster Analysis↗
PubMed2003

Determinants and prognoses of locoregional and distant progression in breast cancer.

PURPOSE: To describe locoregional and distant progression in a population-based breast cancer sample. METHODS AND MATERIALS: Between 1978 and 1998, the Munich Cancer Registry evaluated 14,429 patients. The mean follow-up of survivors was 8.3 years. Metastases (MET), local recurrence (LR), and lymph node recurrence (LNR) were considered as outcome measures. The prognostic factor for, and effects of, LR and MET were assessed multivariately by the Cox and dynamic Aalen models. RESULTS: The LR and MET rate increased with increasing tumor size, with the latter described by pT category. Distant MET occurred earlier than local progression. MET was recorded even earlier for MET alone. The mean time from diagnosis to MET for MET and LR was 54.9, 43.4, 29.4, and 24.7 months and for MET only was 36.5, 31.0, 22.6, and 12.9 months for pT1, pT2, pT3, and pT4, respectively. After MET, survival varied only slightly by pT stage; after LR, a more favorable prognosis, especially for pT1 and pT2, was evident. The prognosis after MET depended mainly on the MET location; 50% of patients with cerebral or nervous system MET survived <1 year and 50% of those with skeletal MET survived >2 years. In the Cox model, the relative risk of LR for MET was 3.0. In the Aalen model, after 30 months, when the hazard rates of MET began to decline, there was still an excess risk of MET after LR. CONCLUSION: This disease description highlights the importance of long-term observational studies. Empiric evidence that LR is both an indicator for, and in part a cause of, MET has been provided. In the future, the MET location should be reported. Variations in guidelines or health care systems that influence the time to MET and survival after MET through different diagnostic procedures should also be considered.

Adult↗
PubMed2003

[Model project on coding accuracy].

First experiences with the external evaluation of coding accuracy in view of the German DRG-System are reported. 387 randomised inpatient cases of three departments of a municipal hospital were evaluated. 1.648 diagnosis codes and 946 procedure codes were evaluated with complete clinical data. Before and after correction by the reviewers the cases were grouped (AR-DRG 4.1) and the casemix index of the sample was calculated. 45.9% to 56.7% of primary diagnosis in the department samples were rated as correct. 25.2% to 37.5% of secondary diagnosis were rated as correct, 8.3% to 14.2% were corrected and 49.2% to 60.5% were rated as not relevant with regard to the German coding standards. 7.2% to 22.7% of secondary diagnosis had to be completed in the data. Evaluation of procedure codes resulted in 54.2% to 65.7% accepted codes, 5.9% to 12.1% corrected codes and 23.1% to 39.9% not accepted with regard to the German coding standards. 30.8% to 37.0% of procedure codes had to be completed in the data. After review, remarkable shift in DRGs was seen and casemix index increased 6.9% in average (0.25-12.1%). General and department-specific implications for improvement of coding accuracy could be evaluated. Consequences of potential coding errors in a prospective payment system on DRG basis were seen under conditions of daily hospital practice. External evaluation of coding accuracy used in this study could be the methodological basis for further investigations on this topic.

Diagnosis-Related Groups↗
PubMed2001

[Quality project in invasive/interventional cardiology].

With installing a new catheterization laboratory, a quality project with focus on indications for invasive/interventional procedures was implemented. Health insurance companies as budget holders were involved in the project, external control is accomplished by their medical service (MDK). The focus on indications is new, since most approaches in this area deal with structure and/or process quality. The actual concept of this quality project makes medical performance transparent with regard to adequate indication as the first and important step to excellent quality of results. Further, the concept contains a rational approach to the controversial discussion about the increasing frequency of catheter-based coronary interventions.

Angioplasty, Balloon, Coronary↗
PubMed2000

Altered genotoxicity in mucosal cells of head and neck cancer patients due to environmental pollutants.

The complexity of carcinogenesis in squamous cell cancer (SCC) of the upper aerodigestive tract requires examining environmental risk factors, including mutagen sensitivities to xenobiotics. Three environmental, occupational, and habitual pollutants - dibutylphthalate (DBP), diisobutylphthalate (DiBP), and N'nitrosodiethylamine (NDELA) - were submitted to genotoxicity testing on mucosal biopsy specimens of tumor and nontumor patients in vitro. The single-cell microgel electrophoresis (Comet) assay was applied to detect DNA strand breaks in human epithelial cells of the pharynx and larynx from nontumor patients, patients with SCC of the oropharynx and patients with SCC of the larynx. Genotoxicity was found for DBP, DiBP, and NDELA in cells derived from nontumor and tumor patients. With respect to phthalates, Olive tail moment (OTM) levels were higher in patients with SCC of the oropharynx and SCC of the larynx (P < 0.01), the latter showing even more pronounced genotoxicity for DiBP. Testing epithelial cells of the patients with either oropharyngeal or laryngeal SCC for NDELA demonstrated results similar to the nontumor patients. Present findings indicate heterogeneous mutagen sensitivities to some but not all xenobiotics.

Adolescent↗
PubMed1999

Analysis of time-dependent covariates in failure time data.

In failure time analyses, time-dependent covariates are only rarely used. In some clinical studies, however, consideration of available covariate information over time could be relevant to understanding complex disease processes. We propose the time-dependent Cox model and the linear model of Aalen as two possible approaches for such time-dependent survival analyses. The approaches are illustrated with the data of the Stanford Heart Transplantation Study and a study of malignant glioma. Differences between these models and the baseline analysis are discussed.

Adult↗
PubMed1998

Procalcitonin: a new marker for diagnosis of acute rejection and bacterial infection in patients after heart and lung transplantation.

UNLABELLED: The aim of the study was to investigate the reliability of procalcitonin (PCT), a new potential marker for detection of bacterial, fungal and protozoal infections, in order to differentiate these from viral infections and early rejections in heart, heart-lung and lung transplanted patients. PCT is a propeptide of calcitonin with unknown origin which is not detectable in plasma of healthy subjects. It increases rapidly and significantly under severe microbial infections. METHODS: PCT plasma levels were measured using an immuno-luminescence assay. C-reactive protein and white blood cells were quantified to validate the PCT values. RESULTS: Increased levels of PCT were found in all transplant patients with bacterial, fungal and protozoal infections. The magnitude of the values were clearly associated with the severity of the infection. Trauma of operation or inflammatory events such as viral infections and rejections did not trigger PCT-production. The release of PCT did not depend on the type of pathogens even though Aspergillum resulted in the highest levels measured. Sensitivity, specificity and prognostic value of PCT for systemic infections were higher than of the other parameters investigated. CONCLUSION: PCT is a highly specific analyte which shows significant diagnostic validities when nonviral infections are compared with rejection episodes. PCT discriminates between inflammatory events such as rejection or viral infections and nonviral-infections including bacterial, fungal and protozoal infections. The half-life of PCT is 24 h indicating clearly a competent antibiotic treatment. Unnecessary antibiotic therapy can be avoided due to the early exclusion of bacterial and fungal infections.

Adolescent↗
PubMed1997

Maternal smoking during pregnancy and lactation increases the risk for atopic eczema in the offspring.

BACKGROUND: Maternal smoking during pregnancy has been shown to lead to immunologic changes in the offspring. However, little is known about the influence of this exposure on atopic manifestations. OBJECTIVE: Our purpose was to investigate the influence of air pollutants on manifestations of atopy in preschool children. METHODS: Unselected cohorts of a total of 678 5- to 6-year-old preschool children (350 boys, 328 girls) were investigated in areas with different degrees of air pollution in Bavaria. Data on the history of atopic diseases and other relevant factors were obtained by questionnaire. A skin-prick test was performed with common aeroallergens. Manifestation of atopy was defined as personal history of atopic disease or positive prick test to either grass pollen, house dust mite, or cat and analyzed multivariately. RESULTS: Of all children, 38.9% exhibited at least one manifestation of atopy. Atopic eczema was reported in 7.9% to 15.5%, hayfever in 4.1% to 25.6%, and asthma in 3.0% to 8.1%. Of the mothers, 12.6% smoked during pregnancy or lactation or both. Analysis of the manifestation of atopy including sex, location, nitrogen oxide and sulfur dioxide exposure and maternal smoking as covariates revealed an influence of the maternal smoking during pregnancy/lactation. Of children whose mothers had smoked during pregnancy/lactation, 52.2% exhibited manifestations of atopy in contrast to 35.7% of children of nonsmoking mothers (p < 0.044). A history of atopic eczema was the only component of the variable "manifestation of atopy" that was significantly associated with maternal smoking during pregnancy and lactation. A causal interpretation of this finding, however, was not supported by a follow-up study. CONCLUSION: Maternal smoking during pregnancy or lactation or both might play a role in the development of atopic eczema and should be avoided.

Allergens↗
PubMed1996

[Validity of telephone ECG multichannel transmission].

Transtelephonic ECG transmission is an established monitoring system for cardiac patients in many countries around the world with the exception of Germany. This study reports first experiences with a multichannel ECG system using nine leads. This system allows to analyze ECG for ischemic events in addition to cardiac arrhythmias. In this study the reliability of a modified lead registration procedure of the telephonic ECG system David 9 (MAP, München) was compared to conventional 12-lead ECG recording (Mingograph 7, Siemens) in 225 consecutive patients. Comparison was performed using the arm electrodes of the telephonic ECG system (Tel. ECG) within the armpit (group I) or at the wrists (group II). Placing the electrodes at the wrists improved sensitivity and specificity of electrocardiograpic abnormalities to conventional 12 lead ECG (Conv. ECG). Specificity for detection of anterior myocardial infarction was 0.95 (Tel. ECG vs. Conv. ECG), specificity was 1.0. For infero-posterior infarction these relations were 0.94 and 1.0 respectively. ST-segment changes have been detected in the Tel. ECG with 0.93 and 0.89 for specificity and sensitivity. The numbers of arrhythmia analysis were 1.0 and 0.7 for all rhythm disturbances. Detection of atrial fibrillation was less reliable due to short recording time and low amplitude of the transmitted signal. Specificity and sensitivity for detection of ventricular arrhythmias were 1.0 and 0.89. Optimizing the placement of arm electrodes to the wrist instead of armpits as done up to now improved the reliability of the telephonic transmitted ECG. This telephonic ECG system then enables a reliable registration of ischemic and arrhythmic events.

Aged↗
PubMed1995

Unconjugated secondary bile acids in the serum of patients with colorectal adenomas.

A positive association between deoxcholic acid (DCA) in the serum and colorectal adenomas, the precursors of colorectal cancer has recently been found, which supported the hypothesis of a pathogenic role of DCA in colonic carcinogenesis. This approach was based on the hypothesis that DCA formed in the colon is absorbed into the portal venous blood and exhibits a constant spillover to the systemic circulation. To further substantiate this hypothesis this study investigated whether in the serum of adenoma patients DCA was higher in the unconjugated fraction, which originates directly from the colon. DCA was found to be 2.8-fold higher in the unconjugated fraction of patients with colorectal adenomas than in controls (0.89 v 0.32 mumol/l, p < 0.0025), 1.9-fold in the total DCA fraction (1.89 v 0.95 mumol/l, p < 0.0001), and 1.4-fold in the conjugated fraction (0.67 v 0.47 mumol/l, p < 0.05). It was further found that the bacterial isomerisation product 3 beta-DCA was twofold higher in the unconjugated fraction of adenoma patients than in controls (0.08 v 0.04 mumol/l, p = 0.27), 1.8-fold in the total iso-DCA fraction (0.11 v 0.06 mumol/l, p < 0.05), and 1.5-fold in the conjugated iso-DCA fraction (0.03 v 0.02 mumol/l, p = 0.68). The data suggest that the positive association between the serum DCA concentration and colorectal adenoma as described previously results from the DCA fraction that is absorbed from the colon. This further supports a pathogenic role of DCA in the carcinogenesis of colorectal cancer.

Adenoma↗
PubMed1995

Two-year follow-up of duodenal ulcer patients treated with omeprazole and amoxicillin.

The present study evaluated the time in remission during a 2-year follow-up after eradication of Helicobacter pylori (HP) in patients with an HP-associated duodenal ulcer (DU). HP was eradicated by combined treatment with high-dose omeprazole (2 x 40 mg) and amoxicillin (2 x 1,000 mg; n = 27) administered for 10 days (OME + AMX); alternatively, patients were treated with omeprazole monotherapy (OME) using the same dosage (n = 25). During the 2-year follow-up period endoscopy including histological examination was performed after 1 and 2 years or whenever symptoms compatible with ulcer relapse occurred. HP eradication was achieved in 82% of the OME + AMX group, but in 0% of the OME group. The cumulative DU relapse rates were 0% after 1 year and 7% after 2 years in 22 patients who became HP-negative. Both HP-negative patients who relapsed in the 2nd year of follow-up were HP-positive again at the time of relapse. Of the 5 patients who were not eradicated after OME + AMX therapy, 2 relapsed within the 1st year (40%) and another 2 within the 2nd year (80%). In the OME group the cumulative relapse rates within 1 and 2 years of follow-up were 52 and 76%, respectively. The results further confirm that eradication of HP with combined OME + AMX treatment leads to a distinct decrease in DU relapse rates and thus may cure DU disease. Long-term eradication with combined OME + AMX treatment is possible, and the rate of reinfection with HP is low (4.5%/year).

Amoxicillin↗
PubMed1994

Estimation of gestational age by transvaginal sonographic measurement of greatest embryonic length in dated human embryos.

A prospective descriptive study was carried out to establish reference values for gestational age assessment in the first trimester by measuring embryonic length in dated human embryos, by using transvaginal ultrasound. In 160 pregnant women who had undergone assisted reproductive procedures, 139 singleton embryos and 46 embryos from 21 multiple pregnancies were studied between the 35th and 98th day after the last menstrual period. Transvaginal ultrasound examination, including inspection of embryonic structures and measurement of greatest embryonic length (L), was performed in these women. Estimation of gestational age (t) by measurement of L in singletons is best described by the equation t = 35.72 + 1.082L(1)/(2) + 1.472L - 0.09749L(3)/(2). Mean 95% confidence interval and 95% prediction interval were 4.3 and 9.3 days, respectively. There was no significant change in the estimation curve when multiple measurements in singletons were taken nor when embryos from multiple pregnancies were measured. Accuracy of embryonic age estimation from a single measurement of greatest embryonic length was evaluated.

Journal Article↗
PubMed1994

Effect of shock waves and cisplatin on cisplatin-sensitive and -resistant rodent tumors in vivo.

The effect of a combination of shock waves with cisplatin was examined in vivo with subcutaneously implanted amelanotic melanomas (A-Mel 3) in Syrian golden hamsters and cisplatin-sensitive or cisplatin-resistant fibrosarcoma (SSK2/0 and SSK2/R2) in C3H mice. In all 3 tumor models, 4 treatment modalities were compared: control, cisplatin treatment, shock waves and the combination of shock waves and cisplatin. Shock waves significantly delayed tumor growth in all 3 tumor models when compared to the respective control group. Cisplatin alone delayed the growth of A-Mel 3 and SSK2/0, whereas SSK2/R2 remained uninfluenced by the drug. In all 3 tumor models the combined treatment with shock waves and cisplatin additively and significantly delayed tumor growth. In A-Mel-3-bearing animals the combined treatment significantly increased survival time. The growth of SSK2/0 and SSK2/R2 tumors was delayed to a similar extent by the combined treatment modality as compared to shock-wave treatment alone. This indicates that the cisplatin resistance of SSK2/R2 tumors has been overcome by the simultaneous shock wave treatment. An increased intracellular cisplatin accumulation in the tumors due to shock wave exposure is suggested as the mechanism of interaction between shock waves and cisplatin.

Animals↗
PubMed1994

Embryonic heart rate in dated human embryos.

Using simultaneous B-mode and time-motion transvaginal ultrasonography we measured embryonic heart rate (EHR) in dated human embryos during the first trimester in a prospective study. In 160 pregnant women who had undergone assisted reproductive procedures, 139 singleton embryos and 46 embryos from 21 multiple pregnancies were studied between the 37th and 98th postmenstrual day. Because multiple measurements in one embryo at different ages were possible, a total of 348 measurements were taken. EHR in dated human embryos shows an increase up to 63 postmenstrual days or 22 mm greatest length. Thereafter a steady decrease of EHR was noted. Maximal EHR is reached when morphological development of the embryonic heart is completed. Furthermore, we examined 27 embryos with low EHR compared with greatest embryonic length. All of these ended in missed abortion within the embryonic period. According to our data the increase of EHR parallels the morphological development of the embryonic heart. Decline of EHR afterwards is interpreted as a functional adaption to muscular development of the heart.

Female↗
PubMed1994

Variation of serum bile acids in patients with colorectal adenomas during a one-year follow-up.

We were recently able to show that patients with colorectal adenomas have an increased serum level of the secondary bile acid deoxycholic acid [Bayerdörffer et al.: Gastroenterology 1993; 104:145-151]. The course of individual serum bile acids was followed for 1 year in a random subgroup of these patients. The individual serum bile acids of 39 patients, 10 men with adenoma, 12 men without adenoma, 8 women with adenoma, and 9 women without adenoma, were determined at 6-month intervals by gas liquid chromatography (GC). The mean individual differences in serum bile acids between baseline and 6-month follow-up and baseline and 12-month follow-up ranged from +19 to -15 nmol/l in men with adenoma, and from +66 to -64 nmol/l in men without adenoma. In women, the ranges were +73 to -74 nmol/l in those with adenoma and +33 to -81 nmol/l in those without adenoma. The variations of the relative percentages of the individual bile acids in the three investigations were lower than those of the absolute values. The differences between the baseline, the 6-month, and the 12-month follow-up were not significant for the major bile acids deoxycholic acid, chenodeoxycholic acid and cholic acid. The main finding, namely an increase in the serum levels and the relative proportion of deoxycholic acid in men with colorectal adenomas remained unchanged throughout the follow-up. The data indicate that measurement of the bile acid pattern by GC is a useful and reproducible parameter in investigating the role of secondary bile acids in the pathogenesis of colorectal cancer.

Adenoma↗
PubMed1994

[Exercise tests in spirometry].

Actual situation: There is a great variety of exercise programs (formerly called protocols) used in daily routine and general practice. Exercise programs vary with increments, step-duration, speed and grade, although standard recommendations have been published recently. In the USA, the Bruce program is widely accepted, although some criticism has been published. Comparing different exercise programs it is obvious, that maximal values (VO2, heart rate etc.) are only moderately affected by the program, but submaximal values are strongly influenced by the methodological procedure. Advantages and disadvantages of the different exercise testing procedures will be presented. As we need some standardized exercise programs to avoid "free-style ergometry", recommendations may be based on the following assumptions: Exercise testing should not be too short nor too long (10-12 min total test time), work rate increments should be intermediate (adapted to physical fitness), work rate steps should be about 2 min or an individualized ramp test should be used. Exercise test programs have to be selected according to the patient's fitness, to the disease or function to be studied, and to the laboratory setting. Standardization is strongly recommended.

Exercise Test↗