Richard Klaghofer

University Hospital Zürich, Zürich, Zurich, Switzerland

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Publications (161)411.93 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that online self-help-intervention decoupling (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial (RCT) design, including diagnostic interviews by phone, a 6-month follow-up, and email support. Methods: For this RCT, 105 adults with TTM were recruited online and randomly allocated to either DC (n=55) or PMR (n=50). The intervention lasted four weeks, with severity of TTM assessed at three time-points (pre-intervention, immediately post-intervention, and at 6-months follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). Both intention-to-treat (ITT) and completer analyses were conducted. Results: ITT analysis demonstrated highly-significant and comparable symptom reduction (MGH-HPS) in both the DC and PMR groups (p<0.001, partial η2=0.31) that persisted through six months of follow-up. Participants’ subjective appraisals favoured DC in some areas (e.g., greater satisfaction with DC than PMR). Completer analyses demonstrated the same pattern as ITT analysis. Conclusions: Despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short internet-based interventions like DC and PMR potentially help patients with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted.
    Psychotherapy and Psychosomatics 07/2015; accepted. · 9.37 Impact Factor
  • Journal of psychosomatic research 06/2015; 78(6):623-624. DOI:10.1016/j.jpsychores.2015.03.119 · 2.84 Impact Factor
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    ABSTRACT: The aim of the study was to determine if Sonoclot with its sensitive glass bead-activated, viscoelastic test can predict postoperative bleeding in patients undergoing cardiac surgery at predefined time points. A prospective, observational clinical study. A teaching hospital, single center. Consecutive patients undergoing cardiac surgery (N = 300). Besides routine laboratory coagulation studies and heparin management with standard (kaolin) activated clotting time, additional native blood samples were analyzed on a Sonoclot using glass bead-activated tests. Glass bead-activated clotting time, clot rate, and platelet function were recorded immediately before anesthesia induction and at the end of surgery after heparin reversal but before chest closure. Primary outcome was postoperative blood loss (chest tube drainage at 4, 8, and 12 hours postoperatively). Secondary outcome parameters were transfusion requirements, need for surgical re-exploration, time of mechanical ventilation, length of intensive care unit and hospital stay, and hospital morbidity and mortality. Patients were categorized into "bleeders" and "nonbleeders." Patient characteristics, operations, preoperative standard laboratory parameters, and procedural times were comparable between bleeders and nonbleeders except for sex and age. Bleeders had higher rates of transfusions, surgical re-explorations, and complications. Only glass bead measurements by Sonoclot after heparin reversal before chest closure but not preoperatively were predictive for increased postoperative bleeding. Sonoclot with its glass bead-activated tests may predict the risk for postoperative bleeding in patients undergoing cardiac surgery at the end of surgery after heparin reversal but before chest closure. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Cardiothoracic and Vascular Anesthesia 01/2015; DOI:10.1053/j.jvca.2015.01.015 · 1.48 Impact Factor
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    ABSTRACT: Current guidelines suggest a fasting time of 2 h for clear fluids, which is often exceeded in clinical practice, leading to discomfort, dehydration and stressful anaesthesia induction to patients, especially in the paediatric population. Shorter fluid fasting might be a strategy to improve patient comfort but has not been investigated yet. This prospective clinical trial compares gastric pH and residual volume after 1 vs 2 h of preoperative clear fluid fasting. Children (1-16 yr, ASA I or II) undergoing elective procedures in general anaesthesia requiring tracheal intubation were randomized into group A with 60 min or B with 120 min preoperative clear fluid fasting. To determine gastric pH and residual volume, the gastric content was sampled in supine, left and right lateral patient position using an oro-gastric tube after intubation. Data are median (interquartile range) for group A or B (P<0.05). In total, 131 children aged 1.01-16.23 yr were included; gastric pH was determined in 120 cases. Patient characteristic data were similar between the two groups, except for gender (46/33 males in group A/B; P=0.02). Despite significantly shorter fasting times for clear fluids in group A compared with group B (76/136 min; P<0.001), no significant difference was observed regarding gastric pH [1.43 (1.30-1.56)/1.44 (1.29-1.68), P=0.66] or residual volume [0.43 (0.21-0.84)/0.46 (0.19-0.78) ml kg(-1), P=0.47]. One hour clear fluid fasting does not alter gastric pH or residual volume significantly compared with 2 h fasting. The study was approved by the local ethics committee (KEK-ZH-Nr. 2011-0034) and registered with ClinicalTrials.gov (NCT01516775). © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    BJA British Journal of Anaesthesia 12/2014; 114(3). DOI:10.1093/bja/aeu399 · 4.35 Impact Factor
  • S Buehrer, R Klaghofer, M Weiss, A Schmitz
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    ABSTRACT: Negative behavioral changes after anesthesia in children are common. The Post Hospitalization Behavior Questionnaire (PHBQ) was particularly developed and has been widely used in English-speaking countries to investigate such behavioral changes. The PHBQ consists of 27 questions related to behavioral features observed by parents after anesthesia or hospitalization, each involving comparison with their baseline status. A comparable diagnostic tool in German should be established. The PHBQ was translated into German using a well defined back-translation method. A 3-point Likert scale was used to categorize behavioral features as less than, equal to or more than baseline. Overall 600 questionnaires were given out at children's hospital discharge, following surgical or medical procedures or examinations with or without concurrent anesthesia or deep sedation. After questionnaires were returned, factor and item analysis was conducted. Cronbach's alpha was calculated to determine internal consistency as a measure of reliability. In total, 155 returned and completed questionnaires were assessed, with patients' age ranging from 1.1 to 15.9 (median 5.7) years and length of hospitalization between 1 to 15 (median 2.5) days. The German translation of the PHBQ has a factorial structure that is similar to the English version, and its psychometric properties are also similar. After analysis of the main components and consideration of the Scree plot, either 6 or 7 factors were indicated. Analogously to the original version, we chose 6 factors, which explain 58% of variance. Items were not identically assigned to factors as with the original version, and terms used to describe the factors were slightly adapted. Reliability was adequate, with Cronbach's alpha for the 6 factors being between 0.6 and 0.82 (for total scale: Cronbach's alpha = 0.89, compared to 0.82 for the original version). Children younger than 5 years showed more negative behavioral changes than older children. There were no gender differences. With the German translation of the PHBQ presented here an instrument is available to detect negative behavioral changes after anesthesia in children among German speaking populations. The translation is comparable to the English version with minor differences concerning its factorial structure, which may be due to the predominant role of anxiety in all items. Like the original, this questionnaire does not per se discriminate between anesthesia and hospitalization induced behavioral changes. However, the German translation of the PHBQ is a questionnaire that is feasible for clinical routine and scientific settings and can be easily and quickly completed by caregivers.
    Der Anaesthesist 12/2014; · 0.74 Impact Factor
  • S. Buehrer, R. Klaghofer, M. Weiss, A. Schmitz
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    ABSTRACT: Hintergrund Verhaltensauffälligkeiten nach Anästhesien bei Kindern sind häufig und wurden im englischsprachigen Raum insbesondere mithilfe des Post Hospitalization Behavior Questionnaire (PHBQ) untersucht. Ziel der Arbeit Ein vergleichbares deutschsprachiges Instrument soll erstellt und evaluiert werden. Material und Methoden Der PHBQ wurde mithilfe der Rückübersetzungsmethode ins Deutsche übersetzt. Die Stichprobe umfasste 155 Kinder und Jugendliche im Alter von 1,1 bis 15,9 Jahren nach einem ambulanten oder stationären Krankenhausaufenthalt mit oder ohne operativen oder diagnostischen Eingriff in Narkose oder Sedation. Die ausgefüllten Fragebogen wurden einer Faktoren- und „Item“-Analyse unterzogen. Ergebnisse Die faktorielle Struktur und die psychometrischen Eigenschaften des deutschsprachigen PHBQ sind grundsätzlich vergleichbar mit der englischen Originalversion. Die Reliabilität war adäquat mit einem Cronbachs α von 0,89 für die Gesamtskala bzw. 0,60–0,82 für die Einzelfaktoren. Kinder mit einem Alter unter 5 Jahren zeigten häufiger Verhaltensauffälligkeiten als die älteren Kinder. Ein Geschlechtsunterschied wurde nicht gefunden. Schlussfolgerung Mit der vorliegenden Übersetzung des PHBQ steht nun ein deutschsprachiges Instrument zur Verfügung, das mit dem englischsprachigen Original vergleichbar und geeignet ist, Verhaltensauffälligkeiten nach Anästhesien bei Kindern zu untersuchen.
    Der Anaesthesist 12/2014; 64(2). DOI:10.1007/s00101-014-2400-1 · 0.74 Impact Factor
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    ABSTRACT: Purpose: To examine the impact of both the patient’s and partner’s potential resources (sense of coherence (SOC), post-traumatic growth (PTG)), relationship quality (RQ)) and stressors (anxiety, depression, physical complaints) on depression and quality of life (QOL) in couples facing cancer. Patients and Methods: Questionnaires rating anxiety, depression, quality of life, SOC, PTG, RQ and physical complaints were completed by 207 couples facing different cancer types and stages. Hierarchical multiple regression models were used to assess the individuals and combined influences of patient and partner variables. Results: Partners’ depression scores and RQ accounted for 23.7% of the variance in patient depression; 39.9% was explained by the degree of a patient’s own anxiety, physical complaints, SOC and PTG. In turn, a patient’s depression and RQ accounted for 24.7% of the variance in their partner’s depression, with 44.2% of such variance explained by the partner’s own ratings of anxiety and physical complaints. Assessing QOL, a partner’s depression and RQ accounted for 21.7% of the variance in patient QOL, with 45.8% of such variance explained by the patient’s own depression, physical complaints and SOC. In partners, the patient’s depression and RQ accounted for 13.1% of the variance in QOL, with 44.8% explained by the degree of the partner’s own depression, physical complaints and SOC. Conclusions: These findings support a couples-centered approach to psycho-oncological counseling and treatment. Particularly in depressed couples with low resilience, couples therapy or counseling should be considered because of the mutual adverse impact of depression on QOL in such couples.
    Psycho-Oncology 09/2014; ahead of print. DOI:10.1002/pon.3662 · 4.04 Impact Factor
  • Journal of Psychosomatic Research 06/2014; 76(6):514. DOI:10.1016/j.jpsychores.2014.03.080 · 2.84 Impact Factor
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    ABSTRACT: Previous research on trichotillomania (TTM) has demonstrated an emotion regulation function of hair pulling behavior. One condition that can impede the regulation of emotions is alexithymia. The present study aimed to explore the relationship between the degree of alexithymia and the severity of hair pulling behavior in individuals with TTM. Multiple strategies were used to recruit a sample of 105 participants via the internet. All participants were diagnosed with TTM by an experienced clinician via a subsequent phone-interview. Multiple linear regression analysis was performed to test the potential predictive value of the different facets of alexithymia (20-item Toronto Alexithymia Scale) on the severity of TTM (Massachusetts General Hospital Hair-Pulling Scale). Both the difficulty in identifying feelings (DIF) facet of alexithymia (p = 0.045) and depression (p = 0.049) were significant predictors of the severity of TTM. In conclusion, alexithymia seems to play a role in hair pulling behavior in individuals with TTM. However, the significant association was small in terms of the overall variance explained, thus warranting further research. If replicated in prospective studies, then these results indicate that therapeutic approaches aimed at supporting patients in recognizing and differentiating feelings might be useful for the treatment of TTM.
    Psychiatry Research 05/2014; accepted 2014-03-24(1-2). DOI:10.1016/j.psychres.2014.03.029 · 2.68 Impact Factor
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    ABSTRACT: A rating scale for thirst and hunger was evaluated as a noninvasive, simple and commonly available tool to estimate preanesthetic gastric volume, a surrogate parameter for the risk of perioperative pulmonary aspiration, in healthy volunteer school age children. Numeric scales with scores from 0 to 10 combined with smileys to rate thirst and hunger were analyzed and compared with residual gastric volumes as measured by magnetic resonance imaging and fasting times in three settings: before and for 2 h after drinking clear fluid (group A, 7 ml/kg), before and for 4 vs 6 h after a light breakfast followed by clear fluid (7 ml/kg) after 2 vs 4 h (crossover, group B), and before and for 1 h after drinking clear fluid (crossover, group C, 7 vs 3 ml/kg). In 30 children aged 6.4-12.8 (median 9.8) years, participating on 1-5 (median two) study days, 496 sets of scores and gastric volumes were determined. Large inter- and intra-individual variations were seen at baseline and in response to fluid and food intake. Significant correlations were found between hunger and thirst ratings in all groups, with children generally being more hungry than thirsty. Correlations between scores and duration of fasting or gastric residual volumes were poor to moderate. Receiver operating characteristic (ROC) analysis revealed that thirst and hunger rating scales cannot predict gastric content. Hunger and thirst scores vary considerably inter- and intra-individually and cannot predict gastric volume, nor do they correlate with fasting times in school age children.
    Pediatric Anesthesia 03/2014; 24(3):309-15. DOI:10.1111/pan.12276 · 1.74 Impact Factor
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    ABSTRACT: The benefit of the post-anaesthesia care unit (PACU) with respect to an early detection of postoperative complications is beyond dispute. From a patient perspective, prevention and optimal management of pain, nausea and vomiting (PONV) are also of utmost importance. The aims of the study were therefore to prospectively measure pain and PONV on arrival to the PACU and before discharge and to determine the relationship of pain and PONV to the length of stay in the PACU. Postoperative pain was assessed over 30 months using a numeric rating scale on admittance to the PACU and before discharge; in addition, PONV was recorded. Statistical analysis was done considering gender, age, American Society of Anesthesiologists (ASA) classification, surgical speciality, anaesthesia technique, duration of anaesthesia, intensity of nursing and length of stay. Data of 12,179 patients were available for analysis. The average length of stay in the PACU was 5.7 ± 5.9 h, whereas regular PACU patients stayed for 3.2 ± 1.9 h and more complex IMC patients stayed for 15.1 ± 6.0 h. On admittance, 27% of patients were in pain and the number decreased to 13% before discharge; 3% experienced PONV. Risk factors for increased pain determined by multivariate analysis were female gender; higher ASA classification; general, cardiac and orthopaedic surgery and prolonged case duration. In more complex IMC patients, pain scores were higher on arrival but dropped to similar levels before discharge compared to regular PACU patients. Female gender and postoperative pain were risk factors for postoperative vomiting. Pain and PONV on arrival correlated with length of stay in the PACU. Pain- or PONV-free patients stayed almost half of the time in the PACU compared to patients with severe pain or vomiting on arrival. The majority of PACU patients had good pain control, both on admittance and before discharge, and the overall incidence of PONV was low. Managing patients in the PACU could achieve a significant reduction of pain and PONV. The level of pain and presence of PONV on admittance to the PACU correlate with and act as predictors for increased length of PACU stay.
    01/2014; 3(1):10. DOI:10.1186/s13741-014-0010-8
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    ABSTRACT: While there is a considerable amount of literature addressing consequences of trauma in veterans and holocaust survivors, war and postwar civilian populations, particularly children, are still understudied. Evidence regarding intergenerational effects of trauma in families is inconsistent. To shed light on intergenerational aspects of trauma-related mental health problems among families 11 years after the Kosovo war. In a cross-sectional study, a paired sample of 51 randomly selected triplets (school-aged child, mother, father, N=153) of Kosovar families was investigated with regard to trauma exposure, posttraumatic stress (UCLA Posttraumatic Diagnostic Scale), anxiety (Spence Children's Anxiety Scale, Hopkins Symptom Checklist-25), and depressive symptoms (Depressionsinventar für Kinder und Jugendliche [DIKJ; depression inventory for children and adolescents], Hopkins Symptom Checklist-25). Considerable trauma exposure and high prevalence rates of clinically relevant posttraumatic stress, anxiety, and depressive symptoms were found in both parents and children. While strong correlations were found between children's depressive symptoms and paternal posttraumatic stress, anxiety and depressive symptoms, maternal symptoms did not correlate with their children's. In multiple regression analyses, only posttraumatic stress symptoms of fathers were significantly related with children's depressive symptoms. Eleven years after the Kosovo war, the presence of posttraumatic stress, anxiety, and depressive symptoms in civilian adults and their children is still substantial. As symptoms of parents and children are associated, mental health problems of close ones should be actively screened and accounted for in comprehensive treatment plans, using a systemic approach. Future research should include longitudinal studies conducting multivariate analyses with larger sample sizes in order to investigate indicators, causal and resilience factors.
    European Journal of Psychotraumatology 08/2013; 4. DOI:10.3402/ejpt.v4i0.21060 · 2.40 Impact Factor
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    ABSTRACT: Objective: Concomitant skin conditions may be neglected in internal medicine patients due to lack of knowledge or resources. Thus, we investigated the prevalence of undiagnosed skin conditions in this population. Methods: 200 patients in a university medical center's internal medicine division were examined clinically for dermatoses and quality of life in a prospective, 2-month, single-center study. Results: All patients had several dermatological problems (mean per patient: 13; range: 3-25). There was no relationship between the patient's main medical problem and the number or nature of dermatological conditions. Most patients (84%) requested treatment for their skin condition during hospitalization, especially for xerosis (76%), warts (69%), seborrheic eczema (67%) and onychorrhexis (53%) but not for asymptomatic dermatoses. The impairment in skin-related quality of life was mild but significant, with a mean ± SD Dermatology Life Quality Index of 3 ± 4 (p < 0.001), and global quality of life impairment was severe (p < 0.001). Conclusions: Inpatients suffered from many different, mostly age-related, skin conditions that remained undiagnosed. When prompted, however, patients requested treatment, particularly for symptomatic dermatological conditions such as xerosis, revealing an unmet need that needs to be addressed by qualified evaluation and care.
    Dermatology 09/2012; 225(2). DOI:10.1159/000342177 · 1.69 Impact Factor
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    ABSTRACT: Long term longitudinal data are scarce on epidemiological characteristics and patient outcomes in patients on maintenance dialysis, especially in Switzerland. We examined changes in epidemiology of patients undergoing renal replacement therapy by either hemodialysis or peritoneal dialysis over four decades. Single center retrospective study including all patients which initiated dialysis treatment for ESRD between 1970 and 2008. Analyses were performed for subgroups according to dialysis vintage, based on stratification into quartiles of date of first treatment. A multivariate model predicting death and survival time, using time-dependent Cox regression, was developed. 964 patients were investigated. Incident mean age progressively increased from 48 ± 14 to 64 ± 15 years from 1st to 4th quartile (p < 0.001), with a concomitant decrease in 3- and 5-year survival from 72.2 to 67.7%, and 64.1 to 54.8%, respectively. Nevertheless, live span continuously increased from 57 ± 13 to 74 ± 11 years (p < 0.001). Patients transplanted at least once were significantly younger at dialysis initiation, with significantly better survival, however, shortened live span vs. individuals remaining on dialysis. Among age at time of initiating dialysis therapy, sex, dialysis modality and transplant status, only transplant status is a significant independent covariate predicting death (HR: 0.10 for transplanted vs. non-transplanted patients, p = 0.001). Dialysis vintage was associated with better survival during the second vs. the first quartile (p = 0.026). We document an increase of a predominantly elderly incident and prevalent dialysis population, with progressively shortened survival after initiation of renal replacement over four decades, and, nevertheless, a prolonged lifespan. Analysis of the data is limited by lack of information on comorbidity in the study population. Survival in patients on renal replacement therapy seems to be affected not only by medical and technical advances in dialysis therapy, but may mostly reflect progressively lower mortality of individuals with cardiovascular and metabolic complications, as well as a policy of accepting older and polymorbid patients for dialysis in more recent times. This is relevant to make demographic predictions in face of the ESRD epidemic nephrologists and policy makers are facing in industrialized countries.
    BMC Nephrology 07/2012; 13:52. DOI:10.1186/1471-2369-13-52 · 1.52 Impact Factor
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    ABSTRACT: A transplant represents a decisive event for patients and their caregivers. This article deals with the attitudes patients and their spouses have towards the transplantation. In a cross-sectional study, 121 patients and their spouses were surveyed by questionnaire after a heart, lung, liver or kidney transplant. Attitudes were assessed by means of semantic differentials. Based on the results, an 'Attitudes towards Transplantation' Scale was developed. Sense of coherence (SOC-13), quality of life (Sf-36), quality of the relationship (RAS), burnout (BM) and the patient's emotional response to the transplant (TxEQ-D) were additional psychosocial variables measured in order to assess the association between the attitudes and psychosocial characteristics of transplant patients and their spouses. The majority of patients and their spouses reported positive attitudes towards the transplant, including the attitudes towards medication, their perceived self and fate of being a transplant patient or spouse. Patients and spouses, however, had a negative attitude towards the transplantation in terms of stress and anxiety. Patients reported greater emotional stress from the transplant and rated their post-transplant perceived fate more negatively than their spouses. Attitudes towards the transplant were significantly associated with the sense of coherence and the quality of relationship. The attitudes of patients and spouses to different aspects of the transplant itself and to being a transplant patient or spouse should be deliberately reconsidered and facilitated in the psychosocial counselling with regard to the comprehensibility, manageability and meaningfulness of the transplant experience as well as to potential conflicts in the partnership.
    Schweizerische medizinische Wochenschrift 06/2012; 142:w13595. DOI:10.4414/smw.2012.13595 · 1.88 Impact Factor
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    ABSTRACT: Medication non-adherence is a common problem in organ transplantation patients with severe consequences for the patients' health. This study aimed at examining the determinants of intention formation and adherence behavior based on the Theory of Planned Behavior (TPB). Moreover, to account for the role of patients' partners, provided social support by partners was included. Here, support provided by female partners was hypothesized to be more effective than support provided by male partners. This cross-sectional study comprised 121 heart, liver, lung, and kidney transplant recipients (n=81 men; mean age=54.32, SD=13.32) and their partners (mean age=51.99, SD=13.67). Patients completed a questionnaire with TPB variables and a validated measure of self-reported adherence. Partners reported their provided social support with regard to medication adherence of the patients. For the prediction of intention to adhere to medication, the non-significant main effect of provided social support was qualified by partners' gender: Support provided by women was positively related to patients' intention to adhere, whereas support provided by men was slightly negatively related to the intention to adhere in their female spouses. Intentions in turn emerged together with relationship quality as the most important predictor of adherence behavior. The beneficial effects of support provided by women could be replicated within the framework of the TPB in the context of organ transplantation. Interventions should focus on increasing the effectiveness of support provision of male partners and on promoting relationship quality.
    Journal of psychosomatic research 03/2012; 72(3):214-9. DOI:10.1016/j.jpsychores.2011.10.008 · 2.84 Impact Factor
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    ABSTRACT: Cross-sectional gastric antral area (GAA) measurements by ultrasonography (US) have been proposed for preoperative assessment of gastric volume in adults but not been validated in children. This study investigates whether in children gastric volumes can be predicted by US performed in different patient positions. Gastric fluid and air volumes were examined by magnetic resonance imaging before or up to 120 min after ingestion of 7 ml·kg(-1) diluted raspberry syrup in healthy volunteers who had fasted overnight. GAA was measured with US three times each in supine (SUP), elevated 45° degree supine (E45) and right decubital (RDC) position using imaging planes defined by vascular landmarks. Correlation coefficients (Pearson) between GAA and gastric volumes were calculated and Bland-Altman analysis performed. Sixteen children aged from 6.4 to 12.8 (9.2) years were included in 23 examinations: 6 after overnight fasting, 3 directly after, and 14 with a delay of 74 ± 35 min after fluid intake. GAA was 221 ± 116, 218 ± 112, and 347 ± 188 mm(2) for SUP, E45, and RDC position, respectively. The best correlation between body weight corrected total gastric/gastric fluid volume (TGV(w)/GFV(w)) with GAA was found for RDC position (R = 0.79; P < 0.01/R = 0.78; P < 0.01). Bias and precision of calculated and measured GFV(w) was 0 ± 2.8 ml·kg(-1). Correlations between GAA and TGV(w) or GFV(w) in children are best in the RDC position, but not sufficient to predict GFV(w) with a given GAA. Interpretation of isolated GAA values may be misleading.
    Pediatric Anesthesia 02/2012; 22(2):144-9. DOI:10.1111/j.1460-9592.2011.03718.x · 1.74 Impact Factor
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    ABSTRACT: Gastric emptying in the first 2 h after 7 ml kg(-1) of sugared clear fluid has recently been investigated in healthy children using magnetic resonance imaging (MRI). This study aims to compare gastric volume and emptying half-life during 1 h after 3 or 7 ml kg(-1) sugared clear fluid intake. Fourteen healthy volunteer children aged 11.1 (8.2-12.5) yr were investigated prospectively after administration of 3 and 7 ml kg(-1) diluted raspberry syrup in a randomized order, after overnight fasting (baseline). Gastric content volume (GCV(w)) was assessed with a 1.5 Tesla MRI scanner in a blinded fashion. Data are presented as median (range) and compared using the Wilcoxon test. Baseline GCV(w) was 0.39 (0.04-1.00) and 0.34 (0.07-0.75) before intake of 3 and 7 ml kg(-1) syrup, respectively (P=0.93). GCV(w) was 0.45 (0.04-1.55)/1.33 (0.30-2.60) ml kg(-1) 60 min after ingestion of 3/7 ml kg(-1) syrup (P=0.002). Thus GCV(w) had declined to baseline after 3 ml kg(-1) (P=0.39) but not after 7 ml kg(-1) (P=0.001) within 60 min. T(1/2) was 20 (10-62)/27 (13-43) min (P=0.73) after 3/7 ml kg(-1). In healthy volunteer children, residual GCV(w) 1 h after intake of 3 ml kg(-1) syrup is significantly smaller than that after 7 ml kg(-1) and within the range of baseline.
    BJA British Journal of Anaesthesia 01/2012; 108(4):644-7. DOI:10.1093/bja/aer497 · 4.35 Impact Factor
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    ABSTRACT: Objective: While a number of studies have dealt with the psychosocial consequences of transplantation for patients, we know comparatively little about the strains faced by their spouses. The present study investigates the psychosocial health of transplant patients and their spouses, as well as the link between these groups’ physical and psychosocial status, on the one hand, and their degree of burnout and level of life satisfaction on the other. Design: In a cross-sectional study, 121 patients and their spouses are surveyed by questionnaire following heart, lung, liver, or kidney transplant. Methods: The psychosocial parameters investigated in both patients and spouses are sense of coherence, quality of life, quality of the relationship, life satisfaction, and burnout. Results: Patients rate the quality of the relationship higher than their partners do, and they are more satisfied with the relationship than their spouses are (p < .001). Regression analyses show that patients’ life satisfaction is associated with quality of the relationship. Evidence of a full burnout syndrome can be found in three of the patients and two of the spouses. Burnout in the case of both patients and their partners is associated with limitations in one’s own sense of coherence and in one’s mental and physical health (multiple R2 = 0.79 for patients and 0.76 for spouses). Conclusion: Because of the importance of the couple’s relationship, psychosocial counseling should pay more attention to relationship satisfaction. Psychotherapeutic techniques should be used to improve the sense of coherence in both patient and spouse.
    Swiss Journal of Psychology 01/2012; 71(3):125-134. DOI:10.1024/1421-0185/a000079 · 0.57 Impact Factor

Publication Stats

3k Citations
411.93 Total Impact Points

Institutions

  • 2002–2014
    • University Hospital Zürich
      Zürich, Zurich, Switzerland
  • 1998–2014
    • University of Zurich
      • • Klinik für Psychiatrie und Psychotherapie
      • • Internal Medicine Unit
      • • Institut für Anästhesiologie
      Zürich, Zurich, Switzerland
    • West Middlesex University Hospital NHS Trust
      TW9, England, United Kingdom
  • 2012
    • Stadtspital Waid
      Zürich, Zurich, Switzerland
  • 2005–2007
    • University of California, San Francisco
      • Department of Anesthesia and Perioperative Care
      San Francisco, CA, United States
  • 2002–2005
    • Triemli City Hospital
      Zürich, Zurich, Switzerland
  • 2002–2003
    • Psychiatrische Universitätsklinik Zürich
      Zürich, Zurich, Switzerland
  • 2000
    • Zürcher Höhenklinik Wald
      Zürich, Zurich, Switzerland