oalib

Publish in OALib Journal

ISSN: 2333-9721

APC: Only $99

Submit

Any time

2015 ( 9 )

2014 ( 18 )

2013 ( 32 )

2012 ( 28 )

Custom range...

Search Results: 1 - 10 of 182 matches for " Sibylle Kozek-Langenecker "
All listed articles are free for downloading (OA Articles)
Page 1 /182
Display every page Item
Emotional or evidence-based medicine: is there a moral tragedy in haemostatic therapy?
Sibylle Kozek-Langenecker, Benny S?rensen, John Hess, Donat R Spahn
Critical Care , 2011, DOI: 10.1186/cc10583
Abstract: Proposing cryoprecipitate as an alternative source of fibrinogen is irrelevant in most European countries, where cryoprecipitate is not used due to safety concerns [3]. Cryoprecipitate is no longer regarded as appropriate therapy for hereditary bleeding disorders in Europe, the United States or the United Kingdom, and hence its administration for acquired coagulopathies represents a double standard [4].Fibrinogen concentrate was first licensed in Brazil in 1963. Over 3 million grams have been used since 1985, mainly in countries where fibrinogen concentrate has approval for acquired bleeding. In Germany, Austria and Switzerland, fibrinogen concentrate represents the standard of care in most hospitals; it is typically used as the first-line haemostatic intervention. Restricting use of fibrinogen concentrate to clinical trials as suggested by Stanworth and Hunt seems absurd - consistent application of this principle would abolish the use of all blood-bank products.If there is a moral tragedy, it is the acceptance of fresh frozen plasma and cryoprecipitate in practice despite the absence of evidence to confirm efficacy [3,5].SKL has received travel reimbursement and speakers fees for lecturing from Biotest, Octapharma, Baxter and CSL Behring; travel reimbursement and honoraria for consulting at a Biotest advisory board; and an unrestricted educational grant for the e-learning, 'perioperativebleeding', from CSL Behring. BS has participated in advisory boards and/or received speaker honoraria from Novo Nordisk, Baxter, CSL Behring, Bayer, Pentapharm and Biovitrum. The Haemostasis Research Unit receives unrestricted research support from Novo Nordisk, Grifols, CSL Behring, LFB, Baxter, Bayer and Octapharma. JRH received a travel reimbursement and honorarium for consulting with CSL Behring. DRS's academic department receives grant support from CSL Behring and Vifor SA (no grant numbers are attributed). DRS was chairman of the ABC Faculty and a member of the ABC Trauma Facu
Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review
Sibylle Kozek-Langenecker, Benny S?rensen, John R Hess, Donat R Spahn
Critical Care , 2011, DOI: 10.1186/cc10488
Abstract: Studies reporting the outcome (blood loss, transfusion requirement, length of stay, survival and plasma fibrinogen level) of FFP or fibrinogen concentrate administration to patients in a perioperative or massive trauma setting were identified in electronic databases (1995 to 2010). Studies were included regardless of type, patient age, sample size or duration of patient follow-up. Studies of patients with congenital clotting factor deficiencies or other haematological disorders were excluded. Studies were assessed for eligibility, and data were extracted and tabulated.Ninety-one eligible studies (70 FFP and 21 fibrinogen concentrate) reported outcomes of interest. Few were high-quality prospective studies. Evidence for the efficacy of FFP was inconsistent across all assessed outcomes. Overall, FFP showed a positive effect for 28% of outcomes and a negative effect for 22% of outcomes. There was limited evidence that FFP reduced mortality: 50% of outcomes associated FFP with reduced mortality (typically trauma and/or massive bleeding), and 20% were associated with increased mortality (typically surgical and/or nonmassive bleeding). Five studies reported the outcome of fibrinogen concentrate versus a comparator. The evidence was consistently positive (70% of all outcomes), with no negative effects reported (0% of all outcomes). Fibrinogen concentrate was compared directly with FFP in three high-quality studies and was found to be superior for > 50% of outcomes in terms of reducing blood loss, allogeneic transfusion requirements, length of intensive care unit and hospital stay and increasing plasma fibrinogen levels. We found no fibrinogen concentrate comparator studies in patients with haemorrhage due to massive trauma, although efficacy across all assessed outcomes was reported in a number of noncomparator trauma studies.The weight of evidence does not appear to support the clinical effectiveness of FFP for surgical and/or massive trauma patients and suggests it can b
Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM?)-guided administration of fibrinogen concentrate and prothrombin complex concentrate
Herbert Sch?chl, Ulrike Nienaber, Georg Hofer, Wolfgang Voelckel, Csilla Jambor, Gisela Scharbert, Sibylle Kozek-Langenecker, Cristina Solomon
Critical Care , 2010, DOI: 10.1186/cc8948
Abstract: This retrospective analysis included trauma patients who received ≥ 5 units of red blood cell concentrate within 24 hours. Coagulation management was guided by thromboelastometry (ROTEM?). Fibrinogen concentrate was given as first-line haemostatic therapy when maximum clot firmness (MCF) measured by FibTEM (fibrin-based test) was <10 mm. Prothrombin complex concentrate (PCC) was given in case of recent coumarin intake or clotting time measured by extrinsic activation test (EXTEM) >1.5 times normal. Lack of improvement in EXTEM MCF after fibrinogen concentrate administration was an indication for platelet concentrate. The observed mortality was compared with the mortality predicted by the trauma injury severity score (TRISS) and by the revised injury severity classification (RISC) score.Of 131 patients included, 128 received fibrinogen concentrate as first-line therapy, 98 additionally received PCC, while 3 patients with recent coumarin intake received only PCC. Twelve patients received FFP and 29 received platelet concentrate. The observed mortality was 24.4%, lower than the TRISS mortality of 33.7% (P = 0.032) and the RISC mortality of 28.7% (P > 0.05). After excluding 17 patients with traumatic brain injury, the difference in mortality was 14% observed versus 27.8% predicted by TRISS (P = 0.0018) and 24.3% predicted by RISC (P = 0.014).ROTEM?-guided haemostatic therapy, with fibrinogen concentrate as first-line haemostatic therapy and additional PCC, was goal-directed and fast. A favourable survival rate was observed. Prospective, randomized trials to investigate this therapeutic alternative further appear warranted.Coagulopathy has been shown to be present in approximately 25 to 35% of all trauma patients on admission to the emergency room (ER) [1,2]. This represents a serious problem for major trauma patients and accounts for 40% of all trauma-related deaths [3]. Coagulopathy forces a strategy of early and rapid haemostatic treatment to prevent exsanguination. F
Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study
Peter Faybik, Andreas Bacher, Sibylle A Kozek-Langenecker, Heinz Steltzer, Claus Krenn, Sandra Unger, Hubert Hetz
Critical Care , 2005, DOI: 10.1186/cc3985
Abstract: We studied 61 MARS treatments in 33 patients with acute liver failure (n = 15), acute-on-chronic liver failure (n = 8), sepsis (n = 5), liver graft dysfunction (n = 3), and cholestasis (n = 2). Standard coagulation tests, standard thromboelastography (TEG), and heparinase-modified and abciximab-fab-modified TEG were performed immediately before and 30 minutes after commencement of MARS, and after the end of MARS treatment. Prostaglandin I2 was administered extracorporeally to all patients; 17 patients additionally received unfractioned heparin.Three moderate bleeding complications in three patients, requiring three to four units of packed red blood cells, were observed. All were sufficiently managed without interrupting MARS treatment. Although there was a significant decrease in platelet counts (median, 9 G/l; range, -40 to 145 G/l) and fibrinogen concentration (median, 15 mg/dl; range, -119 to 185 mg/dl) with a consecutive increase in thrombin time, the platelet function, as assessed by abciximab-fab-modified TEG, remained stable. MARS did not enhance fibrinolysis.MARS treatment appears to be well tolerated during marked coagulopathy due to liver failure. Although MARS leads to a further decrease in platelet count and fibrinogen concentration, platelet function, measured as the contribution of the platelets to the clot firmness in TEG, remains stable. According to TEG-based results, MARS does not enhance fibrinolysis.The molecular adsorbent recirculating system (MARS) has been developed and successfully used in patients with liver failure to replace excretory liver function and detoxification. MARS is based on principles of albumin dialysis, and was shown to significantly improve hepatic encephalopathy, cerebral blood flow, renal function, and systemic hemodynamics [1-3]. It has further been shown that plasma concentrations of ammonia and many albumin-bound molecules, such as bilirubin, decreased during MARS therapy [4,5]. Nevertheless, improved outcome has been d
A balanced view of balanced solutions
Bertrand Guidet, Neil Soni, Giorgio Rocca, Sibylle Kozek, Beno?t Vallet, Djillali Annane, Mike James
Critical Care , 2010, DOI: 10.1186/cc9230
Abstract: Normal saline solution has been used for over 50 years in a multitude of clinical situations as an intraoperative, resuscitation and maintenance fluid therapy. Neither normal nor physiological, however, saline solution is still a standard against which other solutions are measured. Much attention has been given recently to so-called balanced solutions such as Ringer's lactate, and more recent derivatives. Colloids prepared in balanced electrolyte solutions have also been developed, alongside colloids in isotonic saline.As one might expect, excessive use of saline has been observed to result in hyperchloraemic acidosis - which has been identified as a potential side effect of saline-based solutions. There is debate about the morbidity associated with this condition, although some consider the associated morbidity is probably low. It has been suggested that the use of balanced solutions may avoid this effect.This acidosis effect was reviewed and highlighted in the British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients [1]. These guidelines clearly recommend the use of balanced crystalloids rather than saline - but they make no specific recommendations regarding colloids, implying that they could be either standard or balanced. The publication of these guidelines has provoked strong reactions. In a British Medical Journal editorial, Liu and Finfer comment: 'Although administration of normal saline can cause hyperchloraemic acidosis, we do not know whether this is harmful to patients. Adopting this guideline is unlikely to harm patients, but may not have any tangible benefit' [2].Others have reviewed the physiological effects of acidosis. Handy and Soni noted that 'There is little evidence that in 50 years of normal saline usage, there has been significant morbidity from the use of this fluid' [3]. Liu and Finfer continue: 'The danger in providing consensus guidelines endorsed by specialist societies is that clinicians may feel pressured t
Identification and Inversion of Magnetic Hysteresis for Sinusoidal Magnetization
Martin Kozek,Bernhard Gross
International Journal of Online Engineering (iJOE) , 2005,
Abstract: The sinusoidal magnetization of a sample material is difficult to achieve, since the magnetic hysteresis poses a strong non-linearity. In order to find the proper input voltage, a feed-forward strategy with a hysteresis model identification and inversion is proposed. The classical Preisach model in the Everett formulation is used for this purpose and eddy current effects are also included. A new heuristic inversion offering equal performance but avoiding a time-consuming identification procedure is also proposed. After an initial identification procedure the model, its inverse, the heuristic inversion, and the proper input voltages for a desired sinusoidal magnetization are computed. The resulting application achieves accurate results, is easy to use, supplies the user with transparent and clear information, and adds the flexibility for automation or remote control.
The role of the self-concept in the relationship of menstrual symptom attitudes and negative mood  [PDF]
Sibylle Peterse, Tilman Eckloff
Health (Health) , 2011, DOI: 10.4236/health.2011.36056
Abstract: Background: A relationship between symptom attitudes and negative affect has consistently been found in a range of different symptom domains. Little is known, however, about the role of different aspects of the self in this relationship. We explored the mediating role of interferences of symptom with the self-concept in the association of menstrual symptom attitudes and depressive mood. Methods: Eighty-one women completed an online survey on menstrual symptom attitudes, perceived interferences of symptoms with various self-aspects and negative mood states. We tested our hypothesis in a mediation analysis. Results: We found a complete mediation of the relationship of symptom attitudes and depressive mood by interferences of symptoms with self-aspects. However, interferences with self-aspects did not play a role in the association of anxious mood and symptom report. Conclusion: The self-concept should receive greater attention in research on symptom attitudes and psychological well-being. This would be particularly important in research on medically unexplained symptom report.
Dynamic Activity-Related Incentives for Physical Activity  [PDF]
Julia Schuler, Sibylle Brunner
Advances in Physical Education (APE) , 2012, DOI: 10.4236/ape.2012.21001
Abstract: The present studies adopted the theoretical framework of activity- and purpose-related incentives (Rheinberg, 2008) to explain the maintenance of physical activity. We hypothesized that activity-related incentives (e.g., “fun”) increase more than purpose-related incentives (e.g., “health”) between the initiation and maintenance phase of physical activity. Additionally, change in activity-related incentives was hypothesized to be a better predictor of maintenance of physical activity than change in purpose-related incentives. Two correlative field studies with rehabilitation patients (Study 1) and Nordic Walkers (Study 2) were conducted to test the hypotheses. Participants’ incentives of physical activity were measured at the beginning of exercising and two weeks (Study 1; T2) and three months (Study 2; T2) later. At T2, participants were asked for their current physical activity. Both studies showed a greater change of activity-related incentives than purpose-related incentives. Furthermore, change in activity-related incentives was more predictive of the maintenance of physical activity than change in purpose-related incentives. The results showed the important role of activity-related incentives in maintenance of physical activity. The theoretical contribution to physical activity maintenance research and practical implications for health promotion programs were discussed.
A Pilot Study on the New USDA Meal Pattern for School Breakfast in a Sample of First-Grade Students  [PDF]
Noelle Carr, Sibylle Kranz
Food and Nutrition Sciences (FNS) , 2012, DOI: 10.4236/fns.2012.39175
Abstract: Background: The United States Department of Agriculture (USDA) recently modified the school breakfast program (SBP) to improve children’s nutrition. Based on the new patterns, schools must offer larger amounts of fruits, grains, and proteins/meats to children; the amounts of fluid foods (milk and juice) remained the same. This study examined the effect of the new food pattern on student’s consumption and food cost. Methods: The amounts and cost of foods served and wasted for one week in first grade students attending two elementary schools (n = 812) were measured. One school received the current SBP pattern (control breakfast, average number of students attending breakfast n = 81), the other school’s breakfast reflected the proposed changes (test breakfast, n = 82). To test the hypothesis that the test breakfast leads to significantly increased food cost and food waste compared to the control breakfast, the weekly average amount of the served solid and fluid foods (grams and milliliters) as well as their waste were compared between the two groups using paired student’s t-test in STATA 11 (significance at p-value < 0.05). Results: Data confirmed the hypothesis in that the test breakfast was associated with significantly higher food cost (by approximately $100/week) and solid food waste but there was no change in milk and juice consumption. Conclusions: This exploratory study indicates that a significant portion of the additional foods served to first-graders to improve their nutritional status were not consumed but wasted. Further studies in larger samples and including students from all grades are needed to examine this issue fully.
Does sequential augmenting of the simple linear heteroscedastic regression reduce variances of the Ordinary Least Squares?
Andrzej S. Kozek,Brian Jersky
Statistics , 2013,
Abstract: If uncorrelated random variables have a common expected value and decreasing variances then the variance of a sample mean is decreasing with the number of observations. Unfortunately, this natural and desirable Variance Reduction Property (VRP) by augmenting data is not automatically inherited by Ordinary Least Squares (OLS) estimators of parameters. In the paper we find conditions for the OLS to have the VRP. In the case of a straight line regression we show that the OLS estimators of intercept and slope have the VRP if the design points are increasing. This also holds true for alternating two-point experimental designs. The obtained results are useful in the cases where it is known that variances of the subsequent observations are non-increasing, but the ratios of the decrease are not available to use sub-optimal or optimal Weighted Least Squares estimators.
Page 1 /182
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.