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Biomedical subjects

K Berger

Publications and source records attributed to K Berger.

At least 37 records · Page 2Linked to original sources
PubMed2004

Determinants of IV heparin treatment in patients with ischemic stroke.

Management of acute ischemic stroke with IV unfractionated heparin is subject to debate. The authors evaluated patient-related and institutional factors influencing its use in 42 hospitals. Cardioembolic stroke type, carotid stenosis, atrial fibrillation, and treatment in stroke units or intensive care units significantly increased the probability of use. However, there are large unexplained variations in IV heparin use among hospitals.

Acute Disease↗
PubMed2004

Quantitative proteome analysis in benign thyroid nodular disease using the fluorescent ruthenium II tris(bathophenanthroline disulfonate) stain.

Thyroid tumorigenesis involves qualitative and quantitative changes in protein expression, which can be comprehensively studied by proteome analysis. However, one of the technical bottlenecks of proteomics remains a reliable, sensitive and inexpensive method for quantification of differentially expressed proteins. This is due to the limited linear range of most available protein stains, i.e. silver and Coomassie blue, and high costs of commercially available fluorescent stains. In this paper we describe our experience with a lab-made ruthenium based fluorescent stain (ruthenium II tris(bathophenanthroline disulfonate) (RuBPs)) to perform proteome analysis of nodular thyroid disease. We first compared the properties of RuBPs with two highly sensitive protein stains: (1) silver staining and (2) the commercially available fluorescent dye Sypro Ruby. We show that in addition to its highly sensitive staining capabilities similar to Sypro Ruby and silver (2 ng), RuBPs offers several advantages such as a broad dynamic range (similar to Sypro Ruby and 500 times broader than the dynamic range of silver stain), low costs ( 0.03 per gel) and excellent compatibility with mass spectrometry. We then applied the inexpensive RuBPs stain to 2D gels (pH 4-7) of four benign thyroid nodules and normal thyroid tissue. We were able to detect approximately 1800 protein spots/gel in our thyroid samples. Quantitative changes in protein expression levels of at least 20-42 proteins were noted in the benign nodules compared with the normal thyroid tissue of the same patient. Differentially expressed spots were further characterised by nano-LC-FTICR and MALDI-TOF mass spectrometry. In summary we demonstrate, that the novel fluorescent ruthenium II tris(bathophenanthroline disulfonate) stain is a highly sensitive, reliable and inexpensive tool for quantitative proteome analysis in thyroid nodular disease.

Dextrans↗
PubMed2004

Protease inhibitors in spontaneous cervical artery dissections.

BACKGROUND AND PURPOSE: Observations in patients with arterial aneurysms, fibromuscular dysplasia, and spontaneous cervical artery dissection (sCAD) indicate that protease inhibitor deficiency might boost the enzymatic destruction of arterial tissue and increase the risk of these arterial wall diseases. Here we present the first large investigation of the protease inhibitor hypothesis in patients with sCAD. METHODS: Eighty patients with sCAD were compared with 80 age- and sex-matched healthy individuals. Alpha1-antitrypsin (alpha1-AT) and alpha2-macroglobulin (alpha2-MG) levels, and alpha1-AT genotypes were assessed and compared between groups. RESULTS: alpha1-AT and alpha2-MG levels as well as alpha1-AT genotypes did not differ significantly between patients and controls. The frequency of Z alleles in the patient group was higher than in the control group and than in other cohorts from Europe; however, the difference remained nonsignificant. All patients with Z alleles had internal carotid artery dissections. CONCLUSIONS: Overall, this data does not support the hypothesis that protease inhibitor levels or alpha1-AT genotypes play an important role in the etiology of sCAD. The present data does not exclude that the Pi-Z allele might have an influence on subgroups of sCAD, such as internal carotid artery dissections.

Adult↗
PubMed2004

[Factors influencing duration of hospitalization after stroke in Germany].

BACKGROUND: In Germany up-to-date data within community settings about factors influencing length of stay in acute hospitals are lacking. We, therefore, identified predictors for length of stay in acute hospital after ischemic stroke in a pooled analysis of large German stroke registers. METHODS: Ischemic stroke patients admitted to hospitals cooperating within the German Stroke Registers Study Group (ADSR) between January 1, 2000 and December 31, 2000 were analysed. The influence of patients' demographic and clinical characteristics as well as the characteristics of the treating hospitals on length of stay were analysed by multivariate linear regression. RESULTS: Overall, 13 440 patients after ischemic stroke were included in the analyses. Their mean age was 70 years, 53 % were men. Median length of stay in acute hospitals was 12 days. In multivariate analyses younger age, an increasing number of co-morbidities, and an increasing number of neurological deficits were identified as predictors of prolonged stay in hospital. Patients were more likely to stay longer in an acute hospital if they were to be discharged to a rehabilitation unit or to a nursing home. Length of stay was independently decreased for patients treated in hospitals providing acute stroke unit services and for hospitals treating more than 250 stroke patients per year. CONCLUSION: In addition to patients' demographic and clinical characteristics, length of stay in hospital was influenced by the hospitals' characteristics. Especially the volume of treated patients and the organisation of services within the hospital may play the key role.

Age Factors↗
PubMed2004

The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in German cancer centers.

BACKGROUND: Delayed chemotherapy-induced nausea and vomiting (CINV) remains a major adverse effect of cancer chemotherapy. We assessed, under current practice patterns, the occurrence and impact on healthcare resource utilization of CINV in patients receiving emetogenic chemotherapy. An additional aim of this study was to estimate costs imputable to CINV in the German healthcare environment. MATERIALS AND METHODS: This prospective, multi-center, cross-sectional cost-of-illness study was conducted in three hospitals and in three office-based facilities in Germany. Consecutive patients undergoing emetogenic chemotherapy (levels 4 or 5 according to Hesketh classification of emetogenicity) were enrolled. Data were obtained from preplanned chart reviews and from self-administered patient questionnaires. Analysis of direct costs was performed from the perspectives of third party payer (statutory sick fund), provider (hospital) and patients. Indirect costs were assessed on the basis of paid workdays lost. RESULTS: During the 5-day observation period, 134 of 208 chemotherapy cycles observed (64.4%) were associated with at least one episode of nausea or vomiting. More patients experienced delayed than acute CINV (60.7% versus 32.8%), and more patients reported nausea than vomiting (62.5% versus 26.0%). A total of 68 patients (32.6%) utilized healthcare resources due to CINV. The most frequently used resources were rescue medications and outpatient hospital and office physician visits. Only one patient required hospitalization and only three patients lost workdays due to CINV. Average costs imputable to CINV per patient (with or without CINV) per treatment cycle incurred by third party payers and hospital providers were Euro 49 and Euro 48, respectively. Patient or treatment characteristics that were associated with high costs imputable to CINV were as follows: cisplatin-containing regimen; experience of emesis; and presence of delayed CINV. CONCLUSIONS: A substantial proportion of patients continue to experience CINV. This entails not only clinical but also economic consequences, and highlights a continuing need for improved utilization of existing antiemetic agents and for new, more efficacious treatments. The greatest improvements in patient care and potential for cost offset may be realized by preventing delayed CINV.

Antiemetics↗
PubMed2003

[Influence of institutional factors in neurological, medical and geriatric departments on length of stay in patients with stroke].

BACKGROUND: Length of hospital stay (LOS) is determined not only by medical procedures or complications but also by institutional factors. We examined the influence of various institutional factors in neurological, medical and geriatric departments on LOS in patients with ischemic stroke. METHODS: We used data of 12,410 patients from the Westphalian Stroke Register for the years 2000 and 2001. Forty-two centres including 24 neurological, 13 medical and five geriatric departments participated in the register. The register is based on a standardized data assessment, including patient-related sociodemographic and clinical items, diagnostic and treatment procedures, complications, and status at discharge. RESULTS: 7855 patients with ischemic stroke from 37 centres (median age: 73 years, 51 % female) were included in the analysis. In neurological departments, the LOS decreased with increasing numbers of stroke patients treated per centre and year, presence of a stroke unit or a rehabilitation unit. Conversely, the ratio beds to number of physicians was positively associated with LOS. In geriatric departments, a significant decrease in LOS with an increasing number of stroke cases and availability of a rehabilitation unit was also observed. In departments of medicine, no significant influence on LOS was found for the institutional factors analysed. CONCLUSIONS: Institutional factors have a significant influence on LOS in patients with stroke. In this analysis, the influence varied between the different medical specialties. Institutional factors gain importance in the management of stroke patients, when Diagnosis Related Groups (DRG) are introduced.

Aged↗
PubMed2003

[Costs and cost-effectiveness of Eptifibatide in the treatment of coronary ischemic syndromes. An analysis based on the PURSUIT study].

AIMS: We analyzed whether using Eptifibatide plus heparin compared to heparin alone in patients with acute coronary ischemic syndromes is cost saving and/or cost-effective from the perspective of German hospitals. Our analysis is based on the clinical results of the PURSUIT study. MATERIALS AND METHODS: We conducted an incremental cost-consequence and cost-effectiveness analysis from the perspective of the admitting hospital. Costs refer to the initial hospitalization following the event. Incremental drug costs are based on a 72 hour infusion of Eptifibatide. Additional costs are analyzed as resulting from the management of complicating myocardial infarctions, including incremental days on the general ward or intensive care unit as well as necessary revascularization procedures. All costs are expressed in EURO (EUR). The estimated costs of managing ischemic complications are based on typical patterns seen in German hospitals. Our estimation of the life-years saved by using Eptifibatide is based on the DEALE method. All calculations are standardized to a hypothetical cohort of 100 treated patients. RESULTS: There are 0.064 saved life-years per patient. Cost-effectiveness of Eptifibatide is EUR 14,464 per life-year saved. CONCLUSION: Eptifibatide is cost-effective compared to other therapies in the treatment of acute coronary ischemic syndromes. The additional costs of using this substance should be reimbursed to the hospitals.

Angina, Unstable↗
PubMed2003

Polymorphisms of the alpha-synuclein promoter: expression analyses and association studies in Parkinson's disease.

Mutations of the alpha-synuclein gene have shown to be relevant in some rare families with autosomal dominant Parkinson's disease (PD). Furthermore, alpha-synuclein protein is a major component of the Lewy bodies also in sporadic PD patients. Increased levels of wildtype alpha-synuclein in the cell leads to increased intracellular hydrogen peroxide levels and causes death of dopaminergic neurons in rat primary culture. Subsequently, oxidative stress has been directly linked with alpha-synuclein aggregation in vitro. This raises the question whether increased alpha-synuclein expression might be linked to higher susceptibility to PD and whether alpha-synuclein promoter polymorphisms are associated with PD. Here, two polymorphisms (-116C>G and -668T>C) of the alpha-synuclein promoter defining four haplotypes have been characterized in 315 German PD patients. The influence of the four haplotypes on gene expression was studied by CAT reporter gene assays in neuronal SK-N-AS cells. The -668C/-116G haplotype revealed significant higher CAT expression than the -668T/-116G or the -668T/-116C haplotype, respectively. Although the -668C/-116G haplotype was more common in PD patients, this difference was not significant.

Aged↗
PubMed2003

Modulation of disease risk according to a cathepsin D / apolipoprotein E genotype in Parkinson's disease.

Aspartyl protease Cathepsin D (CTSD) has been suggested to play a role in the pathogenesis of sporadic Alzheimer's disease (AD) due to interference with protein degradation mechanisms. A C224T (A38V) polymorphism in exon 2 of the CTSD gene is reported to be associated with an increased risk for AD. The partially overlapping pathology between AD and Parkinson's disease (PD) led us to investigate the role of this polymorphism in PD. Using association studies in 457 German PD patients and 340 controls we found no evidence for direct association between the CTSD genotype and PD. However, stratification for the apolipoprotein E (APOE) epsilon4 allele suggests a protective effect of the CTSD T-allele in PD (OR = 0.24, p = 0.002). Our findings suggest interference of CTSD and APOE polymorphisms in the pathogenesis of PD, in the sense of modulating disease risk.

Aged↗
PubMed2003

Economics of prophylactic treatment.

Clinical studies have shown significant improvement in outcomes with the use of prophylactic treatment, as well as apparent gains in health-related quality of life. Given the high cost and still limited availability of factor concentrates, physicians, insurers and governments require cost-effectiveness data to evaluate competing treatments (eg prophylactic vs. on-demand treatment) and to set priorities within the context of each country's financial resources. To date, the few published studies of the cost-effectiveness of haemophilia prophylaxis have generally focused on the reduction in frequency of bleedings as an intermediate outcome, and not on long-term health outcomes, such as the development of arthropathy and its social and economic costs. Since all prophylactic measures are investments for the future, long-term economic consequences need to be carefully studied and evaluated.

Cost of Illness↗
PubMed2003

[Cost-utility analysis of contrast-enhanced MR angiography with automated table-translation for diagnosis and therapy planning in patients with peripheral vascular disease].

PURPOSE: To analyze the cost-utility of contrast-enhanced MR angiography (ceMRA) in the diagnosis and the planning of surgical or interventional treatment in patients with peripheral arterial occlusive disease. MATERIALS AND METHODS: Additional costs and incremental costs per quality-adjusted life-year for ceMRA were calculated by a decision model. The costs of ceMRA and conventional angiography were compared. Treatment was either surgery or PTA. A retrospective analysis of 24 patients provided the data for the diagnostic accuracy of ceMRA. The data about quality of life assessment were taken from the literature. Costs were calculated in Euro using the current fee schedule. The influence of the individual parameters on the model was estimated from a sensitivity analysis. RESULTS: Per quality-adjusted life-year, ceMRA added euro; 24,408.60 in cases undergoing radiologic intervention and euro; 24,191.32 in cases treated surgically. CONCLUSION: Despite its high costs, ceMRA is an effective diagnostic procedure considering patient benefits. Additional costs do not exceed an acceptable range.

Adult↗
PubMed2003

Cost of illness of atopic asthma and seasonal allergic rhinitis in Germany: 1-yr retrospective study.

The purpose of this study was to evaluate the cost of illness of moderate-to-severe atopic asthma and/or seasonal allergic rhinitis (SAR) in Germany from the perspective of third-party payers (TPP) and patients. Five-hundred patients (276 children/adolescents) with moderate-to-severe asthma and/or SAR were included in this cross-sectional study. Information was collected using a specific patient questionnaire and the abstraction of patient records. Overall, annual costs per patient increased with the severity of atopic asthma and if it was associated with SAR. The average annual cost of SAR was Euro1,089 per child/adolescent and Euro1,543 per adult. Annual costs of severe asthma plus SAR increased to Euro7,928 per child/adolescent and to Euro9,287 per adult. For TPPs, the main cost drivers were medication, hospitalisation, and rehabilitation. The most significant costs for patients were household modifications. For children/adolescents, 60-78% of the expenditures were direct costs, while in adults, 58% of expenditures were indirect costs. It was also observed that patients with moderate and severe asthma used inhaled corticosteroids less frequently than recommended by treatment guidelines. In summary, the total cost for patients increases with the severity of atopic asthma and/or seasonal allergic rhinitis and indirect costs represent a large proportion of the total cost.

Adolescent↗
PubMed2002

[Subjective need for help and objectified geriatric assess. Comparison of the Halberstädter Gerontologic Study and the Augsburger Senior Study].

The Halberstadt Geriatric Study and the Augsburg Senior Citizens Study contain common elements of geriatric assessment (self-assessment of functional dependence, objective evaluation of the functional status). In our cross-sectional investigation, the objective was to examine associations between functional dependence and functional tests and to investigate whether association patterns differed between the surveyed groups. The prospective Halberstadt study began in the German Democratic Republic in 1983 within the framework of a vocational examination before employees entered retirement. In 1995 the study was reactivated; 367 survivors answered a postal questionnaire of which 167 persons took part in a test battery including performance and psychometric tests. The 214 Augsburg test persons had already taken part in the MONICA survey (monitoring of trends and determinants of cardiovascular disease). In 1997 they were assessed in a follow-up study, the aim being to determine the functional status of an elderly cohort through interviews and functional tests. In both studies functional dependence was defined by the (I)ADL concept [(instrumental) activities of daily living]. The participants' functional status was determined with the help of performance tests such as foot tapping and cognitive tests such as the Mini-Mental State Examination. Additionally, medical diagnoses and the use of medical facilities were investigated. The presence of functional dependence was consistently and predominantly significantly associated with the functional status assessed by performance tests. These results were largely confirmed by a logistic regression model. Our results show that even in populations with a different socialization, performance tests are stable indicators of functional dependence and should therefore be incorporated in geriatric assessment programs. The introduction of a standardized assessment program with subsequent intervention measures could lead to a delay of functional dependence and need of care and reduce costs in the health care system.

Activities of Daily Living↗
PubMed2002

Evaluation of healthcare utilization and health status of patients with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus.

OBJECTIVE: To assess the effects on motor functioning, health status and direct medical costs of high-frequency stimulation of the subthalamic nucleus (DBS-STN) in patients with idiopathic Parkinson's disease (PD). In addition, the cost-effectiveness of DBS-STN vs. drug treatment was investigated. METHODS: 16 consecutive patients with PD from two centers (Düsseldorf/Cologne; Kiel) treated by DBS-STN were prospectively evaluated. Clinical evaluations were done at baseline and 1, 3, 6, 12 months following surgery by means of the Unified Parkinson's disease Rating Scale (UPDRS). Health status of PD patients was assessed using the Sickness Impact Profile (SIP) at baseline and 6 months following surgery. Relevant economic data were taken from the medical records and costs (1999) were derived from different German medical economic resources. Costs were determined from the perspective of the health care provider. RESULTS: Following DBS-STN UPDRS scores (subscores and sum score) as well as health status improved considerably in PD patients. The overall SIP score and the physical dimension score (p < 0.009) were significantly different (p < 0.01) six month after surgery compared with baseline values. Mean costs of DM 40,020 (US dollars 20,810, EURO 20,410, GB pounds 12,810) per patient were spent during the 12 month observation period for in-patient and out-patient care. These expenses included already the costs for the electronic device for bilateral stimulation. Following DBS-STN medication was considerably reduced. Mean daily drug costs at baseline were DM 46.7+/-21.8 (US dollars 24, EURO 24, GB pounds 15) and DM 18.3+/-17.7 (US dollars 10, EURO 9, GB pounds 6) at 12 months following DBS-STN. Accounting for the decreased drug consumption, total annual costs amounted to DM 31,400 (US dollars 16,330, EURO 16,010, GB pounds 10,050). Further, we estimated the incremental cost effectiveness as DBS-STN had higher costs but was more effective than baseline treatment. The incremental total cost-effectiveness ratio for DBS-STN was DM 1.800 (US dollars 940, EURO 920, GB pounds 580) for one point decrease of the UPDRS. CONCLUSION: DBS-STN is an effective treatment that considerably alleviates the severity of signs and symptoms and improves the health status of patients with PD. Compared with drug treatment, however, the expenditures associated with DBS-STN are increased when only direct medical costs are considered in a one year horizon. However, on a long-term basis costs will decrease considerably because of the reduction of the drug expenditure and improved functioning in all activities of daily living. To adequately evaluate the cost-effectiveness of DBS-STN compared with standard drug regimen for PD it is necessary to include direct, indirect and intangible costs on a long-term basis and under standardized circumstances.

Aged↗
PubMed2002

Clinical outcomes and resource utilization associated with haemophilia care in Europe.

We conducted a multicentre, cross- sectional study of 1042 haemophilia subjects across Europe to compare various health outcomes associated with on-demand vs. prophylactic factor-substitution therapy. Demographic, medical history, and healthcare resource utilization data were analysed along with the number of bleeding events over the past 6 months. Treatment-cost data were also examined to provide preliminary information for future economic studies. A logistic regression analysis, controlling for other statistically significant covariates, showed that patients treated on demand were 3.4 times more likely to have had a joint bleed over the previous 6 months than those treated with prophylaxis. Multiple regression analyses further confirmed these findings, because on-demand subjects had, on average, 5.15 more joint bleeds over the reporting period than patients treated with prophylaxis. Notably, these findings were even more dramatic for younger haemophilia patients when our study sample was stratified by age. Due to the high cost of factor replacement, healthcare costs were significantly higher for subjects treated prophylactically. While hospital costs for prophylaxis subjects were, on average, lower, statistically significant cost savings for prophylactic subjects were not noted. These results suggest that clinicians and health policy decision-makers should consider the advantages of prophylactic therapy for haemophilia patients in formulating treatment protocols and allocating health resources.

Age Factors↗
PubMed2002

Linking medicine and economics: health economics and quality of life in haemophilia care.

Scarce resources in healthcare are a fact of life everywhere. Providing optimal healthcare for haemophilia means delivering the best possible clinical outcomes at an acceptable total cost, however that is defined by individual societies. Health economics helps us to do this. So far, economic evaluation has enhanced our understanding of some of the economic implications of haemophilia and has provided some guidance on the way forward to optimize efficient allocation of resources for this condition. Further advances and consensus on evaluation methods and standards for the economics of haemophilia are required, however. This need will continue in the face of new, more sophisticated and therefore more costly haemophilia therapies.

Economics, Medical↗
PubMed2001

The estimated economic burden of genital herpes in the United States. An analysis using two costing approaches.

BACKGROUND: Only limited data exist on the costs of genital herpes (GH) in the USA. We estimated the economic burden of GH in the USA using two different costing approaches. METHODS: The first approach was a cross-sectional survey of a sample of primary and secondary care physicians, analyzing health care resource utilization. The second approach was based on the analysis of a large administrative claims data set. Both approaches were used to generate the number of patients with symptomatic GH seeking medical treatment, the average medical expenditures and estimated national costs. Costs were valued from a societal and a third party payer's perspective in 1996 US dollars. RESULTS: In the cross-sectional study, based on an estimated 3.1 million symptomatic episodes per year in the USA, the annual direct medical costs were estimated at a maximum of $984 million. Of these costs, 49.7% were caused by drug expenditures, 47.7% by outpatient medical care and 2.6% by hospital costs. Indirect costs accounted for further $214 million. The analysis of 1,565 GH cases from the claims database yielded a minimum national estimate of $283 million direct medical costs. CONCLUSIONS: GH appears to be an important public health problem from the health economic point of view. The observed difference in direct medical costs may be explained with the influence of compliance to treatment and possible undersampling of subpopulations in the claims data set. The present study demonstrates the validity of using different approaches in estimating the economic burden of a specific disease to the health care system.

Cost of Illness↗