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Meyer-Moock S.,University of Greifswald | Feng Y.-S.,University of Greifswald | Maeurer M.,Caritas Krankenhaus | Dippel F.-W.,University of Leipzig | Kohlmann T.,University of Greifswald
BMC Neurology | Year: 2014

Background: There are a number of instruments that describe severity and progression of multiple sclerosis and they are increasingly used as endpoints to assess the effectiveness of therapeutic interventions. We examined to what extent the psychometric properties of two accepted instruments - EDSS and MSFC - meet methodological standards and the value they have in clinical trials.Methods: We conducted a systematic literature search in relevant databases [MEDLINE (PubMed), ISI Web of Science, EMBASE, PsycINFO & PSYNDEX, CINAHL] yielding 3,860 results. Relevant full-text publications were identified using abstract and then full-text reviews, and the literature was reviewed.Results: For evaluation of psychometric properties (validity, reliability, sensitivity of change) of EDSS and MSFC, 120 relevant full-text publications were identified, 54 of them assessed the EDSS, 26 the MSFC and 40 included both instruments. The EDSS has some documented weaknesses in reliability and sensitivity to change. The main limitations of the MSFC are learning effects and the z-scores method used to calculate the total score. However, the methodological criterion of validity applies sufficiently for both instruments.For use in clinical studies, we found the EDSS to be preferred as a primary and secondary outcome measure in recent studies (50 EDSS, 9 MSFC).Conclusions: Recognizing their strengths and weaknesses, both EDSS and MSFC are suitable to detect the effectiveness of clinical interventions and to monitor disease progression. Almost all publications identify the EDSS as the most widely used tool to measure disease outcomes in clinical trials. Despite some limitations, both instruments are accepted as endpoints and neither are discussed as surrogate parameters in identified publications. A great advantage of the EDSS is its international acceptance (e.g. by EMA) as a primary endpoint in clinical trials and its broad use in trials, enabling cross-study comparisons. © 2014 Meyer-Moock et al.; licensee BioMed Central Ltd.

Braden B.,John Radcliffe Hospital | Dietrich C.F.,Caritas Krankenhaus
Medical Ultrasonography | Year: 2011

Transabdominal ultrasound is clinically useful in detecting Crohn's disease (initial diagnosis) by evaluating bowel wall thickness and surrounding structures including periintestinal inflammatory reaction, extent and localization of involved bowel segments and detection of extraluminal complications such as fistula, abscesses, carcinoma and ileus. Transabdominal ultrasound presently is accepted as a clinically important first line tool in assessing patients with Crohn's disease irrespective of their clinical symptoms and/or disease activity. It helps to better characterize the disease course in individual patients and can guide therapeutic decisions. In this review the current literature will be analysed.

Dietrich C.F.,Caritas Krankenhaus | Cui X.-W.,Caritas Krankenhaus | Ignee A.,Caritas Krankenhaus | Hocke M.,Hospital Meiningen | Hirche T.O.,German Clinic for Diagnosics
Ultrasound in Medicine and Biology | Year: 2015

The value of ultrasound techniques in examination of the pleurae and lungs has been underestimated over recent decades. One explanation for this is the assumption that the ventilated lungs and the bones of the rib cage constitute impermeable obstacles to ultrasound. However, a variety of pathologies of the chest wall, pleurae and lungs result in altered tissue composition, providing substantially increased access and visibility for ultrasound examination. It is a great benefit that the pleurae and lungs can be non-invasively imaged repeatedly without discomfort or radiation exposure for the patient. Ultrasound is thus particularly valuable in follow-up of disease, differential diagnosis and detection of complications. Diagnostic and therapeutic interventions in patients with pathologic pleural and pulmonary findings can tolerably be performed under real-time ultrasound guidance. In this article, an updated overview is given presenting not only the benefits and indications, but also the limitations of pleural and pulmonary ultrasound. © 2015 World Federation for Ultrasound in Medicine & Biology.

Dietrich C.F.,Caritas Krankenhaus | Ignee A.,Caritas Krankenhaus | Greis C.,Bracco Imaging Deutschland | Cui X.W.,Caritas Krankenhaus | Schreiber-Dietrich D.G.,Caritas Krankenhaus
Ultraschall in der Medizin | Year: 2014

Ultrasound technology is always connected to possible artefacts. Since introduction of ultrasound technology the knowledge of those artifacts is eminent to avoid misinterpretations. It is important to know that with the introduction of new ultrasound technology the possibility of artifacts are rising.Whereas artefacts initially were limited to B-mode sonography, every technological step (colour Doppler sonography, contrast enhanced sonography) comes with a range of new artefacts. This article is written to explain the technological basics of ultrasound artefacts and provide the reader with examples in daily practice and how to avoid them. © Georg Thieme Verlag KG Stuttgart New York.

Buchhorn R.,Caritas Krankenhaus | Christian W.,Caritas Krankenhaus
Cardiology in the Young | Year: 2014

Objectives Potential side effects of stimulants for attention deficit disorder are in the focus of scientific discussions, intensified by the higher number of prescriptions. Children with known arrhythmias or other severe cardiac problems should not receive stimulants because of their sympathomimetic effects. Methods This is a retrospective analysis of 24-hour Holter electrocardiograms from 100 consecutive children with attention deficit disorder from January, 2006 to April, 2012. Results In all, nine children had significant ventricular arrhythmia (mean age 11.4 ± 3.1 years, 77% male, 77% received methylphenidate). All these children had ventricular parasystole-four of them with an accelerated idioventricular rhythm. A significant circadian rhythm of premature ventricular contractions in seven children and the effect of standing and exercise clearly indicate the influence of the autonomic nervous system. In these children, hourly analysis of circadian rhythm within a 24-hour period showed a highly significant correlation between premature ventricular contractions and the vagal tone indicated by the heart rate variability parameter RMSSD (r =-0.83; p < 0.001). Ventricular arrhythmia was unaffected in seven children who received methylphenidate before diagnosis and decreased during metoprolol treatment in two children. Conclusion By Holter electrocardiogram analysis, we observed a remarkably high incidence of ventricular parasystole and accelerated idioventricular rhythm in nine of 100 children with attention deficit disorder, which depends on autonomic imbalance and not on stimulant treatment. © 2013 Cambridge University Press.

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