bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radioiodtherapie beim differenzierten Schilddrüsenkarzinom
Authors: Eschner Wolfgang , Grünwald Frank , Lassmann Michael , Verburg Frederik , Luster Markus , Dietlein Markus 
Published: October 2018

ZusammenfassungDie Verfahrensanweisung zur Radioiodtherapie beim differenzierten Schilddrüsenkarzinom (Version 4) wurde von einer repräsentativen Expertengruppe im informellen Konsens verabschiedet und entspricht damit einer Leitlinie der ersten Stufe (S1) nach den Kriterien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Die Verfahrensanweisung ergänzt die S2-Leitlinie zur operativen Behandlung maligner Schilddrüsenerkrankungen um die nuklearmedizinischen Aspekte. Bezüglich der Indikationsstellung zur ablativen Radioiodtherapie beim kleinen papillären Schilddrüsenkarzinom und beim minimal invasiven follikulären Schilddrüsenkarzinom ohne Angioinvasion, bezüglich der empirischen Bemessung der 131I-Therapieaktivität sowie bezüglich der exogenen versus endogenen TSH-Stimulation bei der ablativen Radio-iodtherapie werden Handlungskorridore beschrieben. Der Text enthält die Auswertungen aus der National Cancer Database und der SEER-Database (jeweils USA), wonach die ablative Radioiodtherapie bereits in einer Niedrig-Risiko Konstellation die Überlebensrate verbessert. Der statistische Nachweis eines solchen Nutzens setzt ein nationales Krebsregister mit Langzeitdaten voraus.
The World Veterinary Orthopaedic Congress: “Synergy in Action”
Authors: Ehrhart Nicole , Kowaleski Mike , Van Ryssen Bernadette , Pozzi Antonio 
Published: October 2018

Syn-er-gy (noun) –the interaction of two elements that when combined produce a total effect that is greater than the sum of the individual elements; the working together of two things to produce a result greater than the sum of their individual effects.*
Systemic treatment of advanced differentiated and medullary thyroid cancer
Authors: Fassnacht M. , Mueller S. P. , Kreissl M. C. 
Published: October 2018

ZusammenfassungIn den vergangenen Jahren wurden drei neue Substanzen für die molekular gezielte Therapie des fortgeschrittenen und progredienten Schilddrüsenkarzinoms zugelassen: Vandetanib und Cabozantinib für das medulläre Schilddrüsenkarzinom sowie Sorafenib für das Radioiod-refraktäre differenzierte Schilddrüsenkarzinom. Die Selektion der Patienten durch ein interdisziplinäres Team sowie die Aufklärung der Patienten spielt eine wesentliche Rolle, wenn diese Behandlung in Betracht gezogen bzw. begonnen wird. Nur Patienten mit hoher Tumorlast und/oder symptomatischer bzw. progredienter Erkrankung, die lokalen Therapien nicht zugänglich ist, sollten behandelt werden. Um eine gute Lebensqualität zu erhalten, ist das Management der unerwünschten Arzneimittelwirkungen von größter Bedeutung. Aufgrund der Wirkweise der Tyrosinkinasehemmer ist der Verlauf der Tumormarker Calcitonin und Thyreoglobulin nur bedingt zur Beurteilung des Therapieansprechens und zum Follow-up geeignet, deshalb kommt der morphologischen und metabolischen Bildgebung besondere Bedeutung zu. Ein umschriebener oder geringer Progress sollte nicht unbedingt die Beendigung der Behandlung oder eine Therapieumstellung nach sich ziehen. In der nahen Zukunft werden weitere Substanzen verfügbar sein.
Molecular genetic markers for thyroid FNAB
Authors: Musholt P. B. , Musholt T. J. 
Published: October 2018

SummaryAim: Thyroid nodules > 1 cm are observed in about 12% of unselected adult employees aged 18–65 years screened by ultrasound scan (40). While intensive ultrasound screening leads to early detection of thyroid diseases, the determination of benign or malignant behaviour remains uncertain and may trigger anxieties in many patients and their physicians. A considerable number of thyroid resections are consecutively performed due to suspicion of malignancy in the detected nodes. Fine needle aspiration biopsy (FNAB) has been recommended for the assessment of thyroid nodules to facilitate detection of thyroid carcinomas but also to rule out malignancy and thereby avoid unnecessary thyroid resections. However, cytology results are dependent on experience of the respective cytologist and unfortunately inconclusive in many cases. Methods: Molecular genetic markers are already used nowadays to enhance sensitivity and specificity of FNAB cytology in some centers in Germany. The most clinically relevant molecular genetic markers as pre-operative diagnostic tools and the clinical implications for the intraoperative and postoperative management were reviewed. Results: Molecular genetic markers predominantly focus on the preoperative detection of thyroid malignancies rather than the exclusion of thyroid carcinomas. While some centers routinely assess FNABs, other centers concentrate on FNABs with cytology results of follicular neoplasia or suspicion of thyroid carcinoma. Predominantly mutations of BRAF, RET/PTC, RAS, and PAX8/PPARγ or expression of miRNAs are analyzed. However, only the detection of BRAF mutations predicts the presence of (papillary) thyroid malignancy with almost 98% probability, indicating necessity of oncologic thyroid resections irrespective of the cytology result. Other genetic alterations are associated with thyroid malignancy with varying frequency and achieve less impact on the clinical management. Conclusion: Molecular genetic analysis of FNABs is increasingly performed in Germany. Standardization, quality controls, and validation of various methods need to be implemented in the near future to be able to compare the results. With increasing knowledge about the impact of genetic alterations on the prognosis of thyroid carcinomas, recommendations have to be defined that may lead to individually optimized treatment strategies.
Combination of Pulmonary Embolism Rule-out Criteria and YEARS Algorithm in a European Cohort of Patients with Suspected Pulmonary Embolism
Authors: van der Pol L. , van der Hulle T. , Mairuhu A. , Huisman M. , Klok F. 
Published: October 2018

Background Both the YEARS algorithm and the pulmonary embolism (PE) rule-out criteria (PERC) were created to exclude PE with limited diagnostic tests. A diagnostic strategy combining both scores might save additional computed tomography pulmonary angiography (CTPA) scans, but they have never been evaluated in conjunction.
Aim The aim of this study was to determine the safety and efficiency of combining YEARS and PERC in a single diagnostic strategy for suspected PE.
Methods The PERC rule was assessed in 1,316 consecutive patients with suspected PE who were managed according to YEARS. We calculated the absolute difference (with 95% confidence interval [CI]) in failure rate and the number of ‘saved’ CTPAs for the scenario that PE would have been ruled out without CTPA in the absence of all PERC items.
Results Using the YEARS algorithm, PE was diagnosed in 189 patients (14%), 680 patients (52%) were managed without CTPA and the 3-month rate of venous thromboembolism in patients in whom PE was ruled out was 0.44% (95% CI: 0.19–1.0). Only 6 of 154 patients (3.9%; 95% CI: 1.4–8.2) with no YEARS items who were referred for CTPA would have been PERC negative, of whom none were diagnosed with PE at baseline or during follow-up (0%; 95% CI: 0–64). Applying PERC before YEARS in all patients would have led to a failure rate of 1.42% (95% CI: 0.87–2.3%), 0.98% (95% CI: 0.17–1.9) more than shown in patients managed by YEARS.
Conclusion Combining YEARS with PERC would have yielded only a modest improvement of efficiency in patients without a YEARS item and an unacceptable failure rate in patients with ≥ 1 YEARS item.
Failure to Provide Clinicians Useful IT Systems: Opportunities to Leapfrog Current Technologies
Authors: Silva J. S. , Bierstock S. , Douglas J. V. , Norcio A. F. , Chakraborty J. , Srini J. , Ball M. J. 
Published: October 2018

Summary

Objective:
To discuss why clinical information systems are failing.

Method:
Subjectively analyzing the development of clinical IT systems during the last decades.

Results and Conclusions:
The challenge is to anticipate what information clinicians need and then deliver it in a way that is tailored for their unique views. Clinicians need workstations that offer the highest level possible of user-determined flexibility and customization. We envision and outline a so-called point of care work station, automatically scaling to the display, hardware capacity, operating system, applications (local or distributed) the user needs and across diverse health IT systems.
Pervasive Healthcare
Authors: Wactlar H. , Saranummi N. 
Published: October 2018

Summary

Objective:
Introducing the Special Topic of Methods of Information in Medicine on pervasive healthcare, with selected papers from the Pervasive Healthcare Conference at Tampere, Finland, January 30 to February 1, 2008.

Methods:
Describing pervasive healthcare as field. Reporting about the content of the selected papers in this Special Topic. Developing and evaluating physiological measurement techniques, assistive care ambient notification and reminding systems, ambulatory monitoring, architectures and platforms for personalized home-health tele-monitoring, means of privacyprotecting health-sensitive information, and estab - lishing a clinical proof-of-concept methodology.

Results and Conclusions:
Pervasive healthcare is an emerging field with considerable technological breadth and expected strong impact for the quality and efficiency of healthcare in an aging society. However, this field is still a nascent one, with a good deal of exploratory research. There is also hypothesis-based and empirical research, which tests the assumptions or feasibility of a solution using clinical evidence, but most such trials at this time are preliminary and small. The emergence of a truly evidence-based outcomes assessment will take some time, but is in the making.
Let a Thousand Flowers Bloom: Transition towards Implementation of the IMIA Strategic Plan
Authors: Murray P. , Haux R. , Lorenzi N. 
Published: October 2018

Summary

Objective
: IMIA, the International Medical Informatics Association, has adopted the IMIA Strategic Plan, “Towards IMIA 2015”. In order to turn the vision into reality, we invite all members of IMIA, and others with an interest in our work, to engage in activities designed to achieve the key strategic goals of the plan.

Methods
: IMIA members and others are invited to study the IMIA Strategic Plan, and consider developing, or contributing to, proposals that can support the implementation of one or more parts of the Strategic Plan. IMIA has allocated a proportion of reserve funds for projectssupporting the implementation of the plan, and proposals can be submitted to the Interim Vice President for Strategic Planning Implementation.

Results and Conclusions
: Several projects are already being undertaken to support implementation of the IMIA Strategic Plan. IMIA looks forward to its members undertaking further projects, targeted at achieving its strategic goals and making the vision a reality by 2015.
Intelligent Data Analysis for Knowl edge Discovery, Patient Monitoring and Quality Assessment
Authors: Swift S. , Peek N. 
Published: October 2018

Summary
Objective: To introduce the focus theme of Methods of Information in Medicine on Intelligent Data Analysis for Knowledge Discovery, Patient Monitoring and Quality Assessment.
Methods: Based on two workshops on Intelligent Data Analysis in bioMedicine (IDAMAP) held in Washington, DC, USA (2010) and Bled, Slovenia (2011), six authors were invited to write full papers for the focus theme. Each paper was throughly reviewed by anonymous referees and revised one or more times by the authors.
Results: The selected papers cover four ongoing and emerging topics in Intelligent Data Analysis (IDA), being i) systems biology and metabolic pathway modelling; ii) gene expression data modelling; iii) signal processing from in-home monitoring systems; and iv) quality of care assessment. Each of these topics is discussed in detail to introduce the papers to the reader.
Conclusion: The development and application of IDA methods in biomedicine is an active area of research which continues to blend with other subfields of medical informatics. As data become increasingly ubiquitous in the biomedical domain, the demand for fast, smart and flexible data analysis methods is undiminished.
More than Four Decades of Medical Informatics Education for Medical Students in Germany
Authors: Hilgers R.-D. , Hofestädt R. , Knaup-Gregori P. , Ose C. , Timmer A. , Winter A. 
Published: October 2018

SummaryThe publication of German competency-based learning objectives “Medical Informatics” for undergraduate medical education gives reason to report on more publications of the German journal GMS Medical Informatics, Biometry and Epidemiology ( MIBE ) in Methods. The publications in focus deal with support of medical education by health and biomedical informatics, hospital information systems and their relation to medical devices, transinstitutional health information systems and the need of national eHealth strategies, epidemiological research on predicting high consumption of resources, and with the interaction of epidemiologists and medical statisticians in examining mortality risks in diabetes, in genome wide association studies and in dealing with limits and thresholds. This report is the beginning of an annual series intending to support better international cooperation to achieve good information as a basis for good medicine and good healthcare.
Introducing Kuhn et al.’s Paper“Informatics and Medicine: From Molecules to Populations” and Invited Papers on this Special Topic
Authors: Kulikowski C. A. 
Published: October 2018

Summary

Objective:
To introduce the paper by Kuhn et al. “Informatics and Medicine: From Molecules to Populations” and the papers that follow on this special topic in this issue of Methods of Information in Medicine, which opens a debate on the Kuhn et al. paper’s assertions by an international panel of invited researchers in biomedical informatics.

Method:
An introductory summary and comparative review of the Kuhn et al. paper and the debate papers, with some personal observations.

Results:
The Kuhn et al. paper makes a strong case for interdisciplinary education in biomedical informatics across institutions at the graduate level, which could be strengthened by analysis of previous relevant interdisciplinary experiences elsewhere, and the challenges they have faced, which point to more pervasive and earlier-stage needs for both education and practice bridging the research and healthcare communities.

Conclusions:
The experts debating the Kuhn et al. paper strongly and broadly support the key recommendation of developing graduate education in biomedical informatics in a more comprehensive way, yet at the same time make some incisive comments about the limitations of the “positivistic” and excessively technological orientation of the paper, which could benefit from greater attention to the narrative and care-giving aspects of health practice, with more emphasis on its human and social aspects.
Fibrinogen and Neopterin Is Associated with Future Myocardial Infarction and Total Mortality in Patients with Stable Coronary Artery Disease
Authors: Svingen Gard , Pedersen Eva , Seifert Reinhard , Kvaløy Jan , Midttun Øivind , Ueland Per , Nordrehaug Jan , Nygård Ottar , Nilsen Dennis , Mjelva Øistein 
Published: October 2018

AbstractSystemic fibrinogen and neopterin are related to inflammation. We investigated the prognostic utility and possible interactions of these biomarkers in stable coronary artery disease (SCAD) patients undergoing coronary angiography. We included 3,545 patients with suspected stable angina with a median follow-up of 7.3 and 10.2 years for incident acute myocardial infarction (AMI) and all-cause mortality, respectively. Prospective associations were explored by Cox regression. Potential effect modifications were investigated according to strata of fibrinogen, neopterin or high-sensitivity troponin T (hsTnT) below and above the median, as well as gender and smoking habits. During follow-up, 543 patients experienced an AMI and 769 patients died. In a multivariable model, the hazard ratios (HRs; 95% confidence interval [CI]) per 1 SD increase for fibrinogen in relation to these endpoints were 1.30 (1.20, 1.42; p < 0.001) and 1.22 (1.13, 1.31; p < 0.001), respectively. For neopterin, the HRs (95% CI) were 1.31 (1.23, 1.40; p < 0.001) and 1.24 (1.15, 1.34; p < 0.001), respectively. No significant interaction between fibrinogen and neopterin was observed. The prognostic utility of neopterin for incident AMI was improved in patients with an hsTnT above the median, for total mortality in non-smokers, and for both total mortality and AMI in females. In conclusion, both fibrinogen and neopterin were associated with future AMI and total mortality, but had low discriminatory impact. No interaction was observed between these two biomarkers. The prognostic utility of neopterin was improved in patients with hsTnT levels above the median, and in females and non-smokers.
Angiopoietin-2 and Survival in Peripheral Artery Disease Patients
Authors: Höbaus Clemens , Pesau Gerfried , Herz Carsten , Wrba Thomas , Koppensteiner Renate , Schernthaner Gerit-Holger 
Published: October 2018

AbstractSurvival of peripheral arterial disease (PAD) patients increased over the last decade due to increased use of secondary preventive medication and rapid revascularization of PAD patients. Angiogenetic markers such as vascular endothelial growth factor (VEGF), angiopoietin-2 (Ang-2) and its receptor Tie-2 might be useful markers to assess the residual risk for mortality in PAD patients. The aim of this study was to evaluate angiogenetic markers for the prediction of mortality in a PAD cohort. For this purpose, 366 patients (mean age: 69 ± 10 years) with PAD Fontaine stage I or II were included and followed up over a 5-year study period. Serum Ang-2, Tie-2 and VEGF levels were measured by bead-based multiplex assay. All-cause mortality and major cardiovascular events (MACE) including all-cause death, non-fatal stroke and non-fatal myocardial infarction were analysed by Kaplan–Meier and Cox regression analyses after 5 years. Ang-2 was associated with Tie-2 (R = 0.151, p = 0.006) and VEGF levels (R = 0.160, p = 0.002). However, only Ang-2 was linked to all all-cause mortality in PAD patients (hazard ratio [HR]: 1.55 [1.23–2.15], p = 0.008) even after adjustment for age and gender, haemoglobin A1c, low-density lipoprotein cholesterol, systolic blood pressure and glomerular filtration rate (HR: 1.44 [1.03–2.00], p = 0.032). Furthermore, an association of Ang-2 and MACE in PAD patients (HR: 1.36 (1.03–1.78), p = 0.028) was found. This result implies that Ang-2 might be used as an additional marker to stratify PAD patients to predict poor mid-term life expectancy.
Diagnosis and Treatment of Pulmonary Embolism in Challenging Populations
Authors: Werth Sebastian , Beyer-Westendorf Jan 
Published: October 2018

AbstractAlthough the diagnostic and therapeutic approach to pulmonary embolism (PE) has been considerably improved and standardized in recent years, special populations such as pregnant patients and those with impaired renal function or cancer still represent a clinical challenge and a detailed knowledge about the available diagnostic and therapeutic alternatives is mandatory to provide best evidence-based care for these difficult-to-treat patients. Although this review aimed to summarize the most important aspects in this field, the reader is referred to the original studies cited here and dedicated guideline and guidance documents for more detailed information.
Initial and Long-Term Treatment of Pulmonary Embolism: Current Approach and Future Perspectives
Authors: Ageno Walter , Donadini Marco 
Published: October 2018

AbstractPulmonary embolism is associated with variable risk of early mortality, ranging from less than 1% to more than 15%. Risk stratification, based on clinical variables and signs of right ventricular dysfunction, is crucial to decide the best management and treatment strategy. Home therapy may be an option for low-risk patients, whereas patients at intermediate risk need to be hospitalized and some of them, at intermediate high risk, may require more intensive monitoring to early detect signs of haemodynamic decompensation. The initial treatment is based on anticoagulants with rapid onset of action, either parenteral (heparin/fondaparinux) or oral (direct oral anticoagulants, DOACs). Thereafter, DOACs (or, if contraindicated, vitamin K antagonists) needs to be continued for at least 3 months. Beyond this period, an individual re-evaluation of the risk-to-benefit ratio of anticoagulation should be performed, based on several factors, including the type of index event, age, sex, D-dimer and residual venous obstruction. Possibly safer strategies can be offered to higher risk patients requiring extended duration of treatment, including the DOACs apixaban and rivaroxaban at reduced dose.
DOAC use in patients with chronic kidney disease
Authors: Kücükköylü S. , Rump L. C. 
Published: October 2018

SummaryDirect oral anticoagulants (DOACs) are increasingly prescribed substances in patients with indication for effective anticoagulation. Patients with chronic kidney disease (CKD) have a high burden of cardiovascular risk and are more likely to develop atrial fibrillation (AF) than patients without CKD. Patients with mild to moderate CKD benefit from DOACs, especially when having intolerance to vitamin K-antagonists (VKA). DOACs may in some cases be considered in patients with rare renal disease and hypercoagulabilic state. DOACs are to a large extent eliminated by renal excretion. Since prospective randomised data in CKD patients are sparse, the decision for anticoagulative therapy is challenging especially in patients with severe renal impairment. The direct factor Xa-inhibitors are approved for use even in patients with an estimated glomerular filtration rate (eGFR) between 15 and 30 ml/min. Careful monitoring of renal function on a regular basis is essential before initiation and after start of DOAC, especially for patients at risk for acute renal failure (elderly, diabetics, patients with preexisting kidney disease). None of the DOACs is approved in CKD patients with end-stage-renal-disease (ESRD) with or without dialysis. DOACs are not recommended for kidney transplant patients under immunosuppression with calcineurin inhibitors. In these patients conventional therapy with VKA is the only option, which has to be monitored closely since it has potential adverse effects.Nachdruck aus und zu zitieren als: Hämostaseologie 2017; 37: 286–294 https://doi.org/10.5482/HAMO-17-01-1657857