Hematoma expansion (HE) is the most important therapeutic target during acute care of patients with intracerebral hemorrhage (ICH). Imaging biomarkers such as non-contrast CT (NCCT) markers have been ...associated with increasing risk for HE. The aim of the present study was to evaluate the influence of NCCT markers with functional long-term outcome and with HE in patients with deep (basal ganglia and thalamus) ICH who represent an important subgroup of patients at the highest risk for functional deterioration with HE due to the eloquence of the affected brain region.
From our prospective institutional database, all patients maximally treated with deep ICH were included and retrospectively analyzed. NCCT markers were recorded at diagnostic imaging, ICH volume characteristics were volumetrically evaluated, and all patients received follow-up imaging within 0-48 h. We explored associations of NCCT makers with unfavorable functional outcome, defined as modified Rankin scale 4-6, after 12 months and with HE. Bias and confounding were addressed by multivariable regression modeling.
In 322 patients with deep ICH, NCCT markers were distributed as follows: irregular shape: 69.6%, heterogenous density: 55.9%, hypodensities: 52.5%, island sign: 19.3%, black hole sign: 11.5%, and blend sign: 4.7%. Upon multivariable regression analyses, independent associations were documented with the functional outcome for irregular shape (aOR: 2.73, 95%CI: 1.42-5.22,
= 0.002), heterogenous density (aOR: 2.62, 95%CI: 1.40-4.90,
= 0.003) and island sign (aOR: 2.54, 95%CI: 1.05-6.14,
= 0.038), and with HE for heterogenous density (aOR: 5.01, 95%CI: 1.93-13.05,
= 0.001) and hypodensities (aOR: 3.75, 95%CI: 1.63-8.62,
= 0.002).
NCCT markers are frequent in deep ICH patients and provide important clinical implications. Specifically, markers defined by diverging intra-hematomal densities provided associations with a 5-times higher risk for HE and a 2.5-times higher likelihood for unfavorable functional long-term outcome. Hence, these markers allow the identification of patients with deep ICH at high risk for clinical deterioration due to HE.
Purpose This study aims to address customer focus as an important component of total quality management (TQM) and explore the key drivers of member satisfaction in tennis clubs via a novel ...theory-based member satisfaction index (MSI) model with high explanatory and predictive power. Furthermore, the study aims to investigate the relationship between satisfaction and behavioral intentions (willingness to stay; WTS) with consideration of the mediating effect of identification with the club. Design/methodology/approach This study uses variance-based partial least squares structural equation modeling (PLS-SEM) to estimate the MSI model, which was tested in a leading tennis club in Germany ( n = 185). Findings The results reveal that club atmosphere, club facilities and the price/quality ratio of the membership fee are the most important drivers of member satisfaction in tennis clubs. Member satisfaction has a large influence on the WTS of tennis club members. Identification with the club, when included as a mediator in the model, increases the variance explained in WTS considerably. Research limitations/implications The small sample limits the generalizability of findings, and further research is recommended. Practical implications The MSI model is a useful benchmark tool for club managers who want to quantify the satisfaction and WTS of their club members. In addition, because of the integrated formative measurement models, the PLS-SEM results show which indicators can be used to positively impact satisfaction with each of the service quality dimensions, overall member satisfaction and WTS. The most important of these results are discussed in an importance-performance map analysis. Originality/value The MSI model is a multi-attribute index model through which members' evaluations of various dimensions of service and value are derived through multivariable linear function with each dimension weighted according to its importance in one holistic model. The model shows the strong impact of satisfaction on WTS of sports club members and reveals that findings of previous research on the relationship between fan and spectator identification and loyalty are transferable to sports club members. The MSI represents a new contribution to the literature; it was applied here to tennis clubs but is also suitable for application to other sports clubs.
OBJECTIVETo determine the influence of intracerebral hemorrhage (ICH) location and volume and hematoma surface on perihemorrhagic edema evolution.
METHODSPatients with ICH of the prospective ...Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage (UKER-ICH) cohort study (NCT03183167) between 2010 and 2013 were analyzed. Hematoma and edema volume during hospital stay were volumetrically assessed, and time course of edema evolution and peak edema correlated to hematoma volume, location, and surface to verify the strength of the parameters on edema evolution.
RESULTSOverall, 300 patients with supratentorial ICH were analyzed. Peak edema showed a high correlation with hematoma surface (R = 0.864, p < 0.001) rather than with hematoma volumes, regardless of hematoma location. Smaller hematomas with a higher ratio of hematoma surface to volume showed exponentially higher relative edema (R = 0.755, p < 0.001). Multivariable logistic regression analysis revealed a cutoff ICH volume of 30 mL, beyond which an increase of total mass lesion volume (combined volume of hematoma and edema) was not associated with worse functional outcome. Specifically, peak edema was associated with worse functional outcome in ICH <30 mL (odds ratio OR 2.63, 95% confidence interval CI 1.68–4.12, p < 0.001), contrary to ICH ≥30 mL (OR 1.20, 95% CI 0.88–1.63, p = 0.247). There were no significant differences between patients with lobar and those with deep ICH after adjustment for hematoma volumes.
CONCLUSIONSPeak perihemorrhagic edema, although influencing mortality, is not associated with worse functional outcomes in ICH volumes >30 mL. Although hematoma volume correlates with peak edema extent, hematoma surface is the major parameter for edema evolution. The effect of edema on functional outcome is therefore more pronounced in smaller and irregularly shaped hematomas, and these patients may particularly benefit from edema-modifying therapies.
For the visualisation of the intraocular space it is essential to illuminate the inside of the eye. One illumination approach is diaphanoscopy, in which the light of an extraocular source is ...transmitted through the tissue layers of the eyewall. The transmission properties of these tissues and their irradiation load depend on applied diaphanoscope contact pressure. However, excessive illumination can lead to irreversible photochemical and thermal damage to the retina. In diaphanoscopic illumination, the retina is particularly at risk due to its proximity to the light source. Therefore, the photochemical and thermal retinal hazards, resulting from direct transmitted light through the eyewall, are determined for different applied pressures of the diaphanoscope on the eye (15, 65 and 115 kPa). The study is performed on porcine eyes with different pigmentation. So, the difference in intraocular irradiance, photochemical and thermal hazards, as well as the maximal exposure time is also examined for different pigmentations. For less pigmented eyes the irradiance inside the eye, the photochemical and the thermal hazard are higher than for higher pigmented eyes. The values also become significantly higher for increasing applied pressure with the diaphanoscope but do not exceed given limits in the standard DIN EN ISO 15004-2: 2014.
Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based ...study.
The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (
= 5,275) were invited to screening with Pap smear, liquid-based cytology (LBC, ThinPrep), and HPV testing (Hybrid Capture2, HC2). Screen-positive participants ASC-US+ or high-risk HC2 (hrHC2) and a random 5% sample of screen-negatives were referred to colposcopy.
HPV genotyping was conducted by GP5+/6+ PCR-EIA with reverse line blotting. Sensitivity, specificity (adjusted for verification bias), and potential harms, including number of colposcopies needed to detect 1 precancerous lesion (NNC), were calculated.
In 2,627 screened women, cytological sensitivities (Pap, LBC: 47%) were lower than HC2 (95%) and PCR (79%) for CIN2+. Cotesting demonstrated higher sensitivities (HC2 cotesting: 99%; PCR cotesting: 84%), but at the cost of lower specificities (92%-95%) compared with HPV stand-alone (HC2: 95%; PCR: 94%) and cytology (97% or 99%). Cotesting versus HPV stand-alone showed equivalent relative sensitivity HC2: 1.06, 95% confidence interval (CI), 1.00-1.21; PCR: 1.07, 95% CI, 1.00-1.27. Relative specificity of Pap cotesting with either HPV test was inferior to stand-alone HPV. LBC cotesting demonstrated equivalent specificity (both tests: 0.99, 95% CI, 0.99-1.00). NNC was highest for Pap cotesting.
Cotesting offers no benefit in detection over stand-alone HPV testing, resulting in more false positive results and colposcopy referrals.
HPV stand-alone screening offers a better balance of benefits and harms than cotesting.
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This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in ...December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V., AGUB).
This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated.
The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary incontinence are discussed.
Abstract
Aim
This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091)
was ...published in December 2021. This guideline combines and summarizes earlier guidelines such as “Female stress urinary incontinence,” “Female urge incontinence” and “Use of Ultrasonography
in Urogynecological Diagnostics” for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und
Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V.,
AGUB).
Methods
This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the
Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline “Urinary Incontinence in Adults” published by the European Association of
Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated.
Recommendations
The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of
female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary
incontinence are discussed.
Zusammenfassung
Ziel
Im Dezember 2021 erschien die völlig überarbeitete interdisziplinäre S2k-Leitlinie für die Diagnostik, Therapie und Nachsorge der Patientinnen mit einer Harninkontinenz
(AWMF-Registernummer: 015-091) und fasst erstmals die früheren Leitlinien „Belastungsinkontinenz der Frau“, „Dranginkontinenz der Frau“ und die Leitlinie „Sonographie im Rahmen der
urogynäkologischen Diagnostik“ zusammen. Die Koordination erfolgte durch die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) und der Arbeitsgemeinschaft für Urogynäkologie und
plastische Beckenbodenrekonstruktion e. V. (AGUB).
Methoden
Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Professionen im Auftrag der Leitlinienkommission der DGGG, OEGGG
und SGGG entwickelt. Grundlage der vorliegenden Leitlinie ist die aktuelle Leitlinienversion „Urinary Incontinence in Adults“ der European Association of Urologie (EAU); zusätzlich wurden
landesspezifische Punkte für das deutsche bzw. das österreichische und das Gesundheitswesen der Schweiz berücksichtigt.
Empfehlungen
Die Kurzversion dieser Leitlinie beinhaltet Empfehlungen und Statements zur Epidemiologie, Ätiologie, Klassifikation, Symptomatik, Diagnostik und Therapie von
Patientinnen mit einer Harninkontinenz. Spezifische Lösungsansätze für Diagnostik und konservative und medikamentöse Therapien werden für die unkomplizierte und komplizierte Harninkontinenz
diskutiert.
Abstract
Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091)
was ...published in December 2021. This guideline combines and summarizes earlier guidelines such as “Female stress urinary incontinence,” “Female urge incontinence” and “Use of Ultrasonography
in Urogynecological Diagnostics” for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und
Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V.,
AGUB).
Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the
Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline “Urinary Incontinence in Adults” published by the European Association of
Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated.
Recommendations The short version of this guideline consists of recommendations and statements on the surgical treatment of female patients with stress urinary incontinence and urge
incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of
iatrogenic urogenital fistula are presented.
Zusammenfassung
Ziel Im Dezember 2021 erschien die völlig überarbeitete interdisziplinäre S2k-Leitlinie für die Diagnostik, Therapie und Nachsorge der Patientinnen mit einer Harninkontinenz
(AWMF-Registernummer: 015-091) und fasst erstmals die früheren Leitlinien „Belastungsinkontinenz der Frau“, „Dranginkontinenz der Frau“ und die Leitlinie „Sonographie im Rahmen der
urogynäkologischen Diagnostik“ zusammen. Die Koordination erfolgte durch die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) und der Arbeitsgemeinschaft für Urogynäkologie und
plastische Beckenbodenrekonstruktion e. V. (AGUB).
Methoden Diese S2k-Leitlinie wurde durch einen strukturierten Konsens von repräsentativen Mitgliedern verschiedener Professionen im Auftrag der Leitlinienkommission der DGGG, OEGGG
und SGGG entwickelt. Grundlage der vorliegenden Leitlinie ist die aktuelle Leitlinienversion „Urinary Incontinence in Adults“ der European Association of Urologie (EAU), zusätzlich wurden
landesspezifische Punkte für das deutsche bzw. das österreichische und das Gesundheitswesen der Schweiz berücksichtigt.
Empfehlungen Die Kurzversion dieser Leitlinie beinhaltet Empfehlungen und Statements zur operativen Therapie von Patientinnen mit einer Belastungsharninkontinenz und
Dranginkontinenz. Spezifische Lösungsansätze für Diagnostik und Therapie werden für die unkomplizierte und komplizierte Harninkontinenz diskutiert. Ebenso werden Diagnostik und operative
Therapie der iatrogen bedingten urogenitalen Fisteln ausgewiesen.
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