Klaus Schmierer

Publications (48) View all

• Source

  Available from: Christo Albor

  Conference Proceeding: Creating a multiple sclerosis population dataset in East London as an example of changing the way routine patient data is used

  Christo Albor, Oliver Richards, Arief Gunawan, Ben Turner, Sreeram Ramagopalan, Charles Gutteridge, Kambiz Boomla, Klaus Schmierer
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  ABSTRACT: Aim To create an efficient point-of-care system of collecting, coding, updating and extracting clinical data for the development of a cohort dataset of people with multiple sclerosis (MS) in East London. Background Few geographically-linked datasets of people with multiple sclerosis exist in the UK. The development of these datasets would aid in generating etiological hypotheses, comparing disease progression between treatment regimes, and recruiting clinical trial participants. Methods Identifying cases: Based on existing patient lists at The Royal London Hospital (RLH), a list of patients was created on ‘Cerner Millennium Software’ (CRS). Phase 1 of coding clinical data: Scanned clinical letters are manually searched to populate key variables. Missing data are highlighted on the clinical interface of CRS for the attention of clinicians. Phase 2 of coding clinical data: When patients come for clinical appointments, clinicians complete missing items directly. Results 812 MS patients have been identified and matched with demographic data. So far, clinical data of 91 patients have been coded in Phase 1, and 21 have reached Phase 2. Demographic findings: The mean age of the 812 MS patients is 45 years. 64% are White, 10% South Asian, 9% Black, and 2% Mixed. Clinical findings: From 91 patients at Phase 1 62 have relapsing remitting, 16 secondary progressive, 6 primary progressive and 3 as yet unspecified forms of MS. The median age at onset for women was 31, and for men it was 34. Conclusion We have developed a method of dynamically collecting, coding, updating and extracting clinical data within CRS, the clinical recording system used for day-to-day patient care at the RLH. Our continued development of the cohort will enable hypothesis-driven analyses. Our method can be scaled up or down and applied to many diseases, especially those of a chronic nature requiring regular follow-up.
  Evidence Live 2013; 03/2013
• Article: What went wrong? The flawed concept of cerebrospinal venous insufficiency.

  José M Valdueza, Florian Doepp, Stephan J Schreiber, Bob W van Oosten, Klaus Schmierer, Friedemann Paul, Mike P Wattjes
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  ABSTRACT: In 2006, Zamboni reintroduced the concept that chronic impaired venous outflow of the central nervous system is associated with multiple sclerosis (MS), coining the term of chronic cerebrospinal venous insufficiency ('CCSVI'). The diagnosis of 'CCSVI' is based on sonographic criteria, which he found exclusively fulfilled in MS. The concept proposes that chronic venous outflow failure is associated with venous reflux and congestion and leads to iron deposition, thereby inducing neuroinflammation and degeneration. The revival of this concept has generated major interest in media and patient groups, mainly driven by the hope that endovascular treatment of 'CCSVI' could alleviate MS. Many investigators tried to replicate Zamboni's results with duplex sonography, magnetic resonance imaging, and catheter angiography. The data obtained here do generally not support the 'CCSVI' concept. Moreover, there are no methodologically adequate studies to prove or disprove beneficial effects of endovascular treatment in MS. This review not only gives a comprehensive overview of the methodological flaws and pathophysiologic implausibility of the 'CCSVI' concept, but also summarizes the multimodality diagnostic validation studies and open-label trials of endovascular treatment. In our view, there is currently no basis to diagnose or treat 'CCSVI' in the care of MS patients, outside of the setting of scientific research.Journal of Cerebral Blood Flow & Metabolism advance online publication, 27 February 2013; doi:10.1038/jcbfm.2013.31.
  Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism 02/2013; · 5.46 Impact Factor
• Article: ADvanced IMage Algebra (ADIMA): a novel method for depicting multiple sclerosis lesion heterogeneity, as demonstrated by quantitative MRI.

  Marios C Yiannakas, Daniel J Tozer, Klaus Schmierer, Declan T Chard, Valerie M Anderson, Daniel R Altmann, David H Miller, Claudia Am Wheeler-Kingshott
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  ABSTRACT: BACKGROUND: There are modest correlations between multiple sclerosis (MS) disability and white matter lesion (WML) volumes, as measured by T2-weighted (T2w) magnetic resonance imaging (MRI) scans (T2-WML). This may partly reflect pathological heterogeneity in WMLs, which is not apparent on T2w scans. OBJECTIVE: To determine if ADvanced IMage Algebra (ADIMA), a novel MRI post-processing method, can reveal WML heterogeneity from proton-density weighted (PDw) and T2w images. METHODS: We obtained conventional PDw and T2w images from 10 patients with relapsing-remitting MS (RRMS) and ADIMA images were calculated from these. We classified all WML into bright (ADIMA-b) and dark (ADIMA-d) sub-regions, which were segmented. We obtained conventional T2-WML and T1-WML volumes for comparison, as well as the following quantitative magnetic resonance parameters: magnetisation transfer ratio (MTR), T1 and T2. Also, we assessed the reproducibility of the segmentation for ADIMA-b, ADIMA-d and T2-WML. RESULTS: Our study's ADIMA-derived volumes correlated with conventional lesion volumes (p < 0.05). ADIMA-b exhibited higher T1 and T2, and lower MTR than the T2-WML (p < 0.001). Despite the similarity in T1 values between ADIMA-b and T1-WML, these regions were only partly overlapping with each other. ADIMA-d exhibited quantitative characteristics similar to T2-WML; however, they were only partly overlapping. Mean intra- and inter-observer coefficients of variation for ADIMA-b, ADIMA-d and T2-WML volumes were all < 6 % and < 10 %, respectively. CONCLUSION: ADIMA enabled the simple classification of WML into two groups having different quantitative magnetic resonance properties, which can be reproducibly distinguished.
  Multiple Sclerosis 10/2012; · 4.26 Impact Factor
• Article: Imaging of Demyelination and Remyelination in Multiple Sclerosis

  D L Arnold, C M Dalton, K Schmierer, G B Pike, D H Miller
  Myelin Repair and Neuroprotection in Multiple Sclerosis. 01/2013;
• Article: Imaging of Demyelination and Remyelination in Multiple Sclerosis

  D.L. Arnold, C.M. Dalton, K. Schmierer, G.B. Pike, D.H. Miller
  Myelin Repair and Neuroprotection in Multiple Sclerosis. 01/2013;