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  • 1
    Electronic Resource
    Electronic Resource
    Use of biomarkers for alcohol use disorders in clinical practice (2003)
    Oxford, UK : Blackwell Publishing Ltd.
    Addiction 98 (2003), S. 0 
    Details
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Background  Biomedical markers may provide additive objective information in screening and confirmation of acute or recent consumption, intoxication, relapse, heavy drinking, hazardous/harmful use/abuse and dependence and alcohol use related organ dysfunction (alcohol use-related disorders: AUDs).Aims  To review the use of biomarkers in clinical practice to detect AUDs.Findings  About one-fifth of the patients seen in clinical practice have AUDs, which offer a variety of treatment options if diagnosed. The diagnosis of AUDs relies on clinical and alcohol-related history, physical examination, questionnaires and laboratory values. No clinical available laboratory test [e.g. for acute abuse: alcohol in blood or breath; for chronic alcohol abuse: γ-glutamyl transferase (GGT), mean corpuscular volume (MCV), carbohydrate-deficient transferrin (CDT)] is reliable enough on its own to support a diagnosis of alcohol dependence, harmful use or abuse. Sensitivities, specificities and the predictive values may vary considerably according to patient and control group characteristics (e.g. gender, age or related comorbidity). In patient groups with limited cooperation markers may be helpful when considering treatment options.Conclusions  More research is needed to determine the value of markers (single or combined, with questionnaires) in the context of clinical decision-making algorithms in defined settings and with defined dichotomous outcome variables.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1359-6357.2003.00587.x
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Author's response to Caan (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Addiction biology 1 (1996), S. 0 
    Details
    ISSN: 1369-1600
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1369-1600.1996.tb00031.x
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    β-Carbolines in chronic alcoholics following trauma (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Addiction biology 1 (1996), S. 0 
    Details
    ISSN: 1369-1600
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In our society every second polytraumatized patient is a chronic alcoholic. A patient's alcohol-related history is often unavailable and laboratory markers are not sensitive or specific enough to detect alcohol-dependent patients who are at risk of developing alcohol withdrawal syndrome (AWS) during their post-traumatic intensive care unit (ICU) stay. Previously, it has been found that plasma levels of norharman are elevated in chronic alcoholics. We investigated whether β-carbolines, i.e. harman and norharman levels, could identify chronic alcoholics following trauma and whether possible changes during ICU stay could serve as a predictor of deterioration of clinical status. Sixty polytraumatized patients were transferred to the ICU following admission to the emergency room and subsequent surgery. Chronic alcoholics were included only if they met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use and their daily ethanol intake was ≥ 60 g. Harman and norharman levels were assayed on admission and on days 2, 4, 7 and 14 in the ICU. Harman and norharman levels were determined by high pressure liquid chromatography. Elevated norharman levels were found in chronic alcoholics (n = 35) on admission to the hospital and remained significantly elevated during their ICU stay. The area under the curves (AUC) showed that norharman was comparable to carbohydrate-deficient transferrin (CDT) and superior to conventional laboratory markers in detecting chronic alcoholics. Seventeen chronic alcoholics developed AWS; 16 of these patients experienced hallucinations or delirium. Norharman levels were significantly increased on days 2 and 4 in the ICU in patients who developed AWS compared with those who did not. An increase in norharman levels preceded hallucinations or delirium with a median period of approximately 3 days. The findings that elevated norharman levels are found in chronic alcoholics, that the AUC was in the range of CDT on admission and that norharman levels remained elevated during the ICU stay, support the view that norharman is a specific marker for alcoholism in traumatized patients. Since norharman levels increased prior to the onset of hallucinations and delirium it seems reasonable to investigate further the potential role of norharman as a possible substance which triggers AWS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1080/1355621961000124726
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    β-Carbolines in alcohol-dependent intensive care patients during prophylactics and therapy of alcohol withdrawal syndrome (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Addiction biology 3 (1998), S. 0 
    Details
    ISSN: 1369-1600
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The primary aim of this study was to investigate whether the naturally occurring beta-carbolines norharman and harman differed between alcohol-dependent patients who developed alcohol withdrawal syndrome (AWS) and those who did not. The secondary aim was to determine whether different treatment regimens influenced the levels of the beta-carbolines. Thirty chronic alcoholics with carcinoma of the upper digestive tract were included in this study. They were prophylactically treated by two different medical regimens: flunitrazepam and clonidine (FNZ regimen) and gamma-hydroxybutyrate and clonidine (GHB regimen). Patients exceeding the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar) score of 20 were assigned to the AWS therapy group and received haloperidol in addition to their prevous prophylactic treatment. Patients without AWS remained in the prophylactic group. From days 1–4 of the intensive care unit (ICU) stay norharman, but not harman, was increased in the AWS therapy group. In the FNZ regimen, six of 16 patients (38%) and in the GHB regimen, nine of 14 patients (64%) developed AWS (p= 0.14). Norharman levels did not differ between the two regimens. However, harman levels were increased in the GHB treated regimen on days 1, 2 and 4 following admission to the ICU and correlated with the severity of alcohol withdrawal syndrome. As norharman was elevated in the therapeutically treated ICU patients, this marker appears to be involved in the pathogenesis of AWS. As harman was elevated before and during hallucinations on the GHB regimen, it seems reasonable to carry out further investigations into the potential role of harman as a hallucinatory substance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1080/13556219872092
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Different dosages of dobutamine in septic shock patients: determining oxygen consumption with a metabolic monitor integrated in a ventilator (2000)
    Springer
    Intensive care medicine 26 (2000), S. 1740-1746 
    Details
    ISSN: 1432-1238
    Keywords: Dobutamine Indirect calorimetry Oxygen consumption Oxygen delivery Sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Objective: Oxygen consumption (VO2) obtained from respiratory gases by indirect calorimetry (VO2,IC) with a metabolic monitor integrated in a ventilator were to be compared to VO2 obtained by the Fick principle (VO2,Fick ) in septic patients following an increase in oxygen delivery (DO2) induced by positive inotropic support. Design: Prospective clinical study. Setting: University Hospital, Surgical Intensive Care Unit (ICU). Patients: Thirty patients suffering from sepsis. Interventions: DO2 was increased by dobutamine infusion, starting with an initial dosage of 5 µg·kg·min, increased to a maximum of 10 µg·kg·min. Measurements and main results: Dobutamine infusion induced a dosage-related increase in DO2 (from 577±192 to 752±202 ml·min·m2, p〈0.01), which was associated with a statistically significant increase in VO2,IC (from 173±30 to 188±28 ml·min·m2, p〈0.01) and in VO2,Fick (from 140±25 to 156±24 ml·min·m2, p〈0.01). The comparison between VO2,IC and VO2,Fick revealed differences (bias and precision – 33±32 ml·min·m2). Conclusions: With a metabolic monitor integrated in a ventilator it was possible to carry out continuous monitoring of calorimetric data under clinical conditions. In contrast to previous studies using indirect calorimetry, this study showed a moderate correlation between VO2 and DO2 in septic patients using either method. The clinical relevance of this finding requires further investigation. Different factors (e. g. injectant temperature, pulmonary VO2) produced substantial differences between VO2,IC and VO2,Fick as previously shown.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340000635
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    Paper (German National Licenses)
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  • 6
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    Robust Allocation of Operating Rooms with Lognormal case Durations (2016)
    Details
    Publication Date: 2020-08-05
    Description: The problem of allocating operating rooms (OR) to surgical cases is a challenging task, involving both combinatorial aspects and uncertainty handling. In this article, we formulate this problem as a job shop scheduling problem, in which the job durations follow a lognormal distribution. We propose to use a cutting-plane approach to solve a robust version of this optimization problem. To this end, we develop an algorithm based on fixed-point iterations to solve the subproblems that identify worst-case scenarios and generate cut inequalities. The procedure is illustrated with numerical experiments based on real data from a major hospital in Berlin.
    Language: English
    Type: reportzib , doc-type:preprint
    Format: application/pdf
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    OPUS
  • 7
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    Makespan and Tardiness in Activity Networks with Lognormal Activity Durations (2016)
    Details
    Publication Date: 2020-08-05
    Description: We propose an algorithm to approximate the distribution of the completion time (makespan) and the tardiness costs of a project, when durations are lognormally distributed. This problem arises naturally for the optimization of surgery scheduling, where it is very common to assume lognormal procedure times. We present an analogous of Clark's formulas to compute the moments of the maximum of a set of lognormal variables. Then, we use moment matching formulas to approximate the earliest starting time of each activity of the project by a shifted lognormal variable. This approach can be seen as a lognormal variant of a state-of-the-art method used for the statistical static timing analysis (SSTA) of digital circuits. We carried out numerical experiments with instances based on real data from the application to surgery scheduling. We obtained very promising results, especially for the approximation of the mean overtime in operating rooms, for which our algorithm yields results of a similar quality to Monte-Carlo simulations requiring an amount of computing time several orders of magnitude larger.
    Language: English
    Type: reportzib , doc-type:preprint
    Format: application/pdf
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    OPUS
  • 8
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    Robust Allocation of Operating Rooms: a Cutting Plane Approach to handle Lognormal Case Durations (2018)
    Details
    Publication Date: 2021-01-22
    Description: The problem of allocating operating rooms (OR) to surgical cases is a challenging task, involving both combinatorial aspects and uncertainty handling. We formulate this problem as a parallel machines scheduling problem, in which job durations follow a lognormal distribution, and a fixed assignment of jobs to machines must be computed. We propose a cutting-plane approach to solve the robust counterpart of this optimization problem. To this end, we develop an algorithm based on fixed-point iterations that identifies worst-case scenarios and generates cut inequalities. The main result of this article uses Hilbert's projective geometry to prove the convergence of this procedure under mild conditions. We also propose two exact solution methods for a similar problem, but with a polyhedral uncertainty set, for which only approximation approaches were known. Our model can be extended to balance the load over several planning periods in a rolling horizon. We present extensive numerical experiments for instances based on real data from a major hospital in Berlin. In particular, we find that: (i) our approach performs well compared to a previous model that ignored the distribution of case durations; (ii) compared to an alternative stochastic programming approach, robust optimization yields solutions that are more robust against uncertainty, at a small price in terms of average cost; (iii) the \emph{longest expected processing time first} (LEPT) heuristic performs well and efficiently protects against extreme scenarios, but only if a good prediction model for the durations is available. Finally, we draw a number of managerial implications from these observations.
    Language: English
    Type: article , doc-type:article
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    OPUS
  • 9
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    Robust Allocation of Operating Rooms: a Cutting Plane Approach to handle Lognormal Case Durations (2016)
    Details
    Publication Date: 2020-08-05
    Description: The problem of allocating operating rooms (OR) to surgical cases is a challenging task, involving both combinatorial aspects and uncertainty handling. We formulate this problem as a parallel machines scheduling problem, in which job durations follow a lognormal distribution, and a fixed assignment of jobs to machines must be computed. We propose a cutting-plane approach to solve the robust counterpart of this optimization problem. To this end, we develop an algorithm based on fixed-point iterations that identifies worst-case scenarios and generates cut inequalities. The main result of this article uses Hilbert's projective geometry to prove the convergence of this procedure under mild conditions. We also propose two exact solution methods for a similar problem, but with a polyhedral uncertainty set, for which only approximation approaches were known. Our model can be extended to balance the load over several planning periods in a rolling horizon. We present extensive numerical experiments for instances based on real data from a major hospital in Berlin. In particular, we find that: (i) our approach performs well compared to a previous model that ignored the distribution of case durations; (ii) compared to an alternative stochastic programming approach, robust optimization yields solutions that are more robust against uncertainty, at a small price in terms of average cost; (iii) the \emph{longest expected processing time first} (LEPT) heuristic performs well and efficiently protects against extreme scenarios, but only if a good prediction model for the durations is available. Finally, we draw a number of managerial implications from these observations.
    Language: English
    Type: reportzib , doc-type:preprint
    Format: application/pdf
    Format: application/pdf
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    OPUS
  • 10
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    Associations of postoperative mortality with the time of day, week and year (2018)
    Details
    Publication Date: 2023-07-17
    Language: English
    Type: article , doc-type:article
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    OPUS
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