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T Kaufmann

Publications and source records attributed to T Kaufmann.

At least 19 recordsLinked to original sources
PubMed2006

[The Gini coefficient. A numerical grading for the degree of standardization of surgical subspecialities].

BACKGROUND AND GOAL: General hospitals are under pressure especially under payment by DRGs (diagnosis related groups), therefore, a general trend for specialized surgical centers is obvious. For this reason knowledge of the level of standardization is important and allows strategical management of surgical subspecialties. MATERIALS AND METHODS: The Gini coefficient (GC, range: 0-1) is a measurement of the level of standardization when an economical ABC analysis is performed. Low GC values are typical for low levels of standardization. All surgical cases coded by ICD-9-CM in 1 of the 8 central operation rooms in a Swiss general teaching hospital over a period of 30 months were included. The database was analyzed by the ABC method. Due to the ABC analysis the GC for each speciality was specified. RESULTS AND DISCUSSIONS: In data period 1 a total of 11,573 and in data period 2 3,449 operations done by 7 specialities were evaluated. The GC for the Pareto distribution was 0.86. Neurosurgery had a value of only 0.34, which means that nearly every operation was unique. The highest level of standardization was reached by vascular surgery with a GC of 0.68. Compared with other industries the degree of standardization in our general hospital is low as measured by the GC. CONCLUSIONS: The GC is a valuable and objective measurement of the different procedures and standardization of surgery of given surgical subspecialties. It can be calculated from the operation room management (ORM) database and allows an objective analysis of the variety of surgical procedures per subspecialty. In this study the GC was implicated in an ORM setting for the first time.

Algorithms↗
PubMed2005

Comparison of methods to evaluate the energy supply in dairy herds.

Different methods to evaluate the nutritional and metabolic status in dairy herds are available. The aim of this study was to evaluate three different methods to assess the energy status of the herd: 1) the calculation of the energy balance of the herd with a new method based on the Swiss standard calculations, 2) the "efficiency of the feeding management" based on milk yield and milk protein content (%) obtained from DHI data, and 3) the percentage of cows per herd with an average milk yield (16-25 kg/day), but a low milk protein (< 3.2 %). The study included data from 47 farms enrolled in the herd reproduction survey program of the University of Berne, with a total of 653 cows included in one winter period. A correlation could only be seen between methods two and three. It is concluded that it is insufficient only to calculate the ration as an estimation of the energy status of the herd. A rough calculation of the ration is necessary to have an idea on the energy density. But the calculated ration seems to be considerably different from the amount of energy and nutrients of the diet finally absorbed by the cow. As the ingested ration is relevant for milk production and animal health, the relationship between milk yield and milk protein content as well as the percentage of cows with milk protein < 3.2% are considered to provide good information about the efficiency of the feeding management in dairy herds.

Animals↗
PubMed2001

Lesbian mothers' experiences of maternity care in the UK.

OBJECTIVE: to explore the maternity care experiences of a sample of lesbians in the UK in order to evaluate service delivery to this group. DESIGN: a descriptive study, using both qualitative and quantitative survey methods to elicit 'rich' accounts of women's experiences. PARTICIPANTS: a convenience sample of 50 women, reporting on a total of 65 pregnancies. FINDINGS: while participants were generally appreciative of the care they received, they also reported high levels of anxiety about the implications of disclosure, together with acute awareness of midwives' personal attitudes and prejudices. Their comments demonstrate the extent to which these issues may negatively impact on quality of care, and the study reveals examples of discomfort, inappropriate service delivery and even hostility. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: 'booking in' and antenatal education are identified as the two areas where service delivery is least effective in meeting the needs of this client group. Findings were used in drawing up the Royal College of Midwives' position paper on the care of lesbian mothers.

Attitude of Health Personnel↗
PubMed2000

On the decision of outpatient adenoidectomy and adenotonsillectomy in children.

OBJECTIVE: Outpatient tonsillectomy and/or adenoidectomy is the procedure of choice in the US, whereas in Europe, the transition from the traditional duration of hospital stay to same day discharge slowly increases. This trial was conducted to find factors, which influence surgery on an outpatient basis and to find possible positive and negative predictive conditions in patients. METHODS: Most trials, which argue for a same day discharge take the low percentage of postoperative hemorrhage into account. Hemorrhage, apnea and infections are complications and have to be distinguished from sequelae such as poor oral intake (with consecutive i.v. fluid supply), fever and protracted vomiting, that also should be considered as discharge criteria. Complications as well as sequelae were measured in 114 consecutive children, and the patients divided into an adenotonsillectomy group and an adenoidectomy group. RESULTS: Patients from both groups that underwent surgery because of severe obstructive symptoms had significantly more sequelae than those indicated because of chronic or recurrent infections. They could not have been discharged in an acceptable condition. Due to the fact that most children after adenoidectomy recovered well 8 h postoperatively, they could have been discharged on the same day. Children after adenotonsillectomy had significantly more sequelae. There was a tendency that adenotonsillectomy children with only mild obstructions could have been discharged either 8 or at least 24 h postoperatively. It still remains the surgeon's decision when a child can be discharged safely.

Adenoidectomy↗
PubMed2000

Bcl-2 is a monomeric protein: prevention of homodimerization by structural constraints.

The pro-apoptotic activity of the Bcl-2 family member Bax has been shown to be facilitated by homodimerization. However, it is unknown whether Bcl-2 or Bcl-x(L) have to homodimerize to protect cells from apoptosis. Here we show by co-immunoprecipitation and FPLC analyses that while Bax multimerizes and forms heterodimers with Bcl-2, there is no evidence for Bcl-2 homodimerization, even in conditions under which Bcl-2 protects cells from apoptosis. Immunofluorescence studies confirmed that Bax can attract active, soluble Bcl-2 to mitochondrial membranes, but that nuclear/ER membrane-bound Bcl-2 was incapable of dislocating soluble Bcl-2. The failure of Bcl-2 to homodimerize is due to structural constraints as versions of Bcl-2 deleted or mutated in the BH1 and BH2 domains effectively dimerized with wild-type Bcl-2 and were dislocated by Bcl-2 inside cells. These data indicate that naturally occurring Bcl-2 does not expose protein domains that mediate homodimerization and therefore most likely acts as a monomer to protect cells from apoptosis.

Animals↗
PubMed2000

Treatment of nonlaparotomized (clinical) stage I and II Hodgkin's disease patients by extended field and splenic irradiation.

PURPOSE: At the New York Presbyterian Hospital-Cornell Medical Center, patients with unequivocal clinical stage I and IIA Hodgkin's disease (HD) have been treated with mantle, splenic, and extended field radiation therapy (EFRT) (without surgical staging). A 24-year retrospective review was conducted to determine the effectiveness of our patient selection on the outcome of patients treated with this modality. METHODS AND MATERIALS: During the period 1971 to 1994, 94 patients with clinically staged HD, with favorable prognostic factors, were retrospectively reviewed. Patients with pathological or equivocal staging, "B" symptoms, bulk disease, history of previous chemotherapy, and/or Stage III or IV disease were excluded from our analysis. There were 27 Stage IA and 67 Stage IIA patients. All patients were treated to 3600 cGy with a 400 cGy boost to the involved field. The median follow-up was 52 months, mean of 62.1 months. RESULTS: Ten of 94 patients (10.5%) relapsed. Seven of the relapses were in the pelvis, one submandibularily, one in the tonsil, and one in the axilla. Nine of the relapses had nodular sclerosis histology, one had lymphocyte predominance, and none had mixed cellularity. The median time to relapse was 38 months; mean time 42. 3 months. All patients are alive, well and free of disease, including nine who received subsequent chemotherapy and one who underwent autotransplantation. CONCLUSIONS: Careful clinical staging of early, asymptomatic HD patients treated with mantle, splenic, and EFRT may obviate the need for exploratory laparotomy.

Adolescent↗
PubMed1999

Region-specific encoding of sensory and affective components of pain in the human brain: a positron emission tomography correlation analysis.

Brain imaging with positron emission tomography has identified some of the principal cerebral structures of a central network activated by pain. To discover whether the different cortical and subcortical areas process different components of the multidimensional nature of pain, we performed a regression analysis between noxious heat-related regional blood flow increases and experimental pain parameters reflecting detection of pain, encoding of pain intensity, as well as pain unpleasantness. The results of our activation study indicate that different functions in pain processing can be attributed to different brain regions; ie, the gating function reflected by the pain threshold appeared to be related to anterior cingulate cortex, the frontal inferior cortex, and the thalamus, the coding of pain intensity to the periventricular gray as well as to the posterior cingulate cortex, and the encoding of pain unpleasantness to the posterior sector of the anterior cingulate cortex.

Adult↗
PubMed1998

[Prediction of rehabilitation outcome after surgical interventions based on biochemical parameters: a new concept in mediator research].

The perioperative changes in epinephrin-, norepinephrine-, histamin-, C5a- and interleukin-6-levels were studied in 40 patients undergoing cholecystectomy for the diagnosis of acute cholecystitis. All relevant mediator levels could be determined in 38 patients. The outcome was not optimal in 16 of them (42%). In order to evaluate the predictive value of the mediators under investigation for the quality of the patients' outcome, a model based on the Bayes' theorem was developed. Using this model the outcome (optimal vs. not optimal) could be correctly predicted in 30 (79%) of our study patients. This kind of data analysis allows to define states of increased risk for a not optimal recovery based on biochemical parameters.

Acute Disease↗
PubMed1997

The human complement C9 gene: identification of two mutations causing deficiency and revision of the gene structure.

The ninth component of human complement (C9) is the last of the terminal complement components creating the membrane attack complex. C9 is a single-chain serum protein that is encoded by a gene located on chromosome 5p. Deficiency of terminal complement components is generally associated with recurrent neisseria infections. We studied a previously described Swiss family with inherited C9 deficiency. To identify the genetic basis of C9 deficiency, we developed an approach using exon-specific PCR and direct DNA sequencing. As a cause of C9 deficiency, we found two different point mutations, both generating TGA stop codons in the coding sequence. One mutation, a C to A exchange, was detected in exon 2 at cDNA position 166, the other, a C to T exchange, was located in exon 4 (cDNA position 464). In family studies of three first-degree relatives with heterozygous C9 deficiency, we demonstrated that the two mutations are segregating independently. Therefore, these mutations are sufficient to explain the complete deficiency of both the probands studied. DNA sequencing of the exon-intron junctions revealed a number of revisions regarding the boundaries between exons 4, 5, and 6 as well as between exons 10 and 11. No additional introns were detected in exons 6 and 10. Furthermore, DNA marker studies were conducted using known polymorphisms of the C6, C7, and C9 genes, confirming the linkage of the observed C9 mutations with defined haplotypes.

Base Sequence↗
PubMed1997

CODBLAM IV chemotherapy for large cell lymphoma: sequential use of infusional vincristine and bleomycin and "high dose" consolidation.

BACKGROUND: Based on prior results in large cell lymphoma (LCL) with COPBLAM (Cyclophosphamide, Oncovin, Prednisone, Bleomycin, Adriamycin, Matulane) I and COPBLAM III, CODBLAM (Cyclophosphamide, Oncovin, Dexamethasone, Bleomycin, Adriamycin, Matulane) IV was developed to intensify treatment further by utilizing four sequential cycles of infusional chemotherapy followed by high-dose chemotherapy and cycle active agents. METHODS: Sixty-one patients with LCL, mostly B-cell lymphoma, with 54% >60 years of age, were treated with daily continuous infusion of vincristine 1.0 mg/m2 days 1-2, bleomycin 4 mg/m2 i.v. push x 1 only followed by daily infusion 4 mg/m2 days 1-5, dexamethasone 10 mg/m2 days 1-5, procarbazine 100 mg/m2 orally days 1-5, doxorubicin 35 mg/m2 i.v. push day 1 (escalated), and cyclophosphamide 350 mg/m2 i.v. push day 1 (escalated), all given every 3 weeks for four cycles. After infusions, patients were restaged and treated with single courses of doxorubicin 90 mg/ m2 i.v. push followed at 3 weeks with cyclophosphamide 1500 mg/m2 i.v. push (both with concomitant vincristine 1 mg/m2 i.v. push and dexamethasone 10 mg/m2 p.o. daily for 5 days). Remaining treatment consisted of methotrexate 120 mg/m2 i.v. push with citrovorum rescue, cytarabine 250 mg/m2 i.v. push, and etoposide 100 mg/m2 i.v. infusion over 1 h, all given every 10 days for six cycles. RESULTS: The overall complete response (CR) rate was 88%. Of all patients, 36 (59%) are sustained disease free at a median follow-up time of 55 months. In patients age < or = 60 years, 89% achieved CR and 85% of patients age >60 years attained CR. CR was achieved in 83% of patients with constitutional B-type symptoms, 69% of patients with bulky adenopathy, and 86% of patients with immunoblastic histology. Toxicity was primarily pulmonary, occuring in 15% of patients. One toxic death was observed. CONCLUSIONS: Infusional CODBLAM IV may represent an effective and unique treatment for LCL.

Adult↗