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Book ; Thesis: Seroepidemiologische Untersuchung über das Vorkommen von humanen Zystizerkose- und Toxoplasmoseinfektionen in La Paz, Bolivien

Castellanos, Ixchel

1995

Author's details	vorgelegt von Ixchel Castellanos
Language	German
Size	VIII, 172 Bl. : graph. Darst.
Edition	[Mikrofiche-Ausg.]
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Göttingen, Univ., Diss., 1996
Note	Mikrofiche-Ausg.: 2 Mikrofiches : 24x
HBZ-ID	HT008877585
Database	Catalogue ZB MED Medicine, Health

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Article: Ethical conflicts associated with COVID-19 pandemic, triage and frailty-unexpected positive disease progression in a 90-year-old patient: A case report.

Wehrfritz, Andreas / Schmidt, Joachim / Bremer, Frank / Lang, Anne-Katharina / Welzer, Jacob / Castellanos, Ixchel

Clinical case reports

2023 Volume 11, Issue 7, Page(s) e7710

Abstract: During the COVID 19 pandemic, advanced age, scoring systems, and a shortage of ICU beds were used as cut-offs for ICU admission. This case report describes the epicrisis of an elderly patient who was almost mistakenly not treated in an ICU. ...

Abstract	During the COVID 19 pandemic, advanced age, scoring systems, and a shortage of ICU beds were used as cut-offs for ICU admission. This case report describes the epicrisis of an elderly patient who was almost mistakenly not treated in an ICU.
Language	English
Publishing date	2023-07-18
Publishing country	England
Document type	Case Reports
ZDB-ID	2740234-4
ISSN	2050-0904
ISSN	2050-0904
DOI	10.1002/ccr3.7710
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Article ; Online: β-(1→3)-D-glucan- and mannan-guided early termination of antifungal therapy in ICU patients: a randomized controlled study.

Erb, Timothy / Mihai, Sidonia / Strauß, Richard / Herbst, Larissa / Castellanos, Ixchel / Diesch, Katharina / Cipa, Franziska / Bihlmaier, Karl / Lang, Anne-Katharina / Ganslmayer, Marion / Willam, Carsten / Bremer, Frank / Fürst, Julia / Beyer, Christian / Bogdan, Christian / Rath, Anca / Held, Jürgen

Antimicrobial agents and chemotherapy

2023 Volume 67, Issue 11, Page(s) e0072523

Abstract: ... ...

Abstract	Candida
MeSH term(s)	Adult ; Humans ; Antifungal Agents/therapeutic use ; Mannans ; Glucans ; Prospective Studies ; beta-Glucans ; Candidiasis, Invasive/drug therapy ; Intensive Care Units ; Biomarkers
Chemical Substances	Antifungal Agents ; Mannans ; Glucans ; beta-Glucans ; Biomarkers
Language	English
Publishing date	2023-10-12
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	217602-6
ISSN	1098-6596 ; 0066-4804
ISSN (online)	1098-6596
ISSN	0066-4804
DOI	10.1128/aac.00725-23
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Article: Standards-Based Procedural Phenotyping: The Arden Syntax on i2b2.

Mate, Sebastian / Castellanos, Ixchel / Ganslandt, Thomas / Prokosch, Hans-Ulrich / Kraus, Stefan

Studies in health technology and informatics

2017 Volume 243, Page(s) 37–41

Abstract: Phenotyping, or the identification of patient cohorts, is a recurring challenge in medical informatics. While there are open source tools such as i2b2 that address this problem by providing user-friendly querying interfaces, these platforms lack semantic ...

Abstract	Phenotyping, or the identification of patient cohorts, is a recurring challenge in medical informatics. While there are open source tools such as i2b2 that address this problem by providing user-friendly querying interfaces, these platforms lack semantic expressiveness to model complex phenotyping algorithms. The Arden Syntax provides procedural programming language construct, designed specifically for medical decision support and knowledge transfer. In this work, we investigate how language constructs of the Arden Syntax can be used for generic phenotyping. We implemented a prototypical tool to integrate i2b2 with an open source Arden execution environment. To demonstrate the applicability of our approach, we used the tool together with an Arden-based phenotyping algorithm to derive statistics about ICU-acquired hypernatremia. Finally, we discuss how the combination of i2b2's user-friendly cohort pre-selection and Arden's procedural expressiveness could benefit phenotyping.
Language	English
Publishing date	2017
Publishing country	Netherlands
Document type	Journal Article
ISSN	0926-9630
ISSN	0926-9630
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Article: Requirements Analysis for a Clinical Decision Support System Aiming at Improving the Artificial Nutrition of Critically Ill Patients.

Schüttler, Christina / Hinderer, Marc / Kraus, Stefan / Lang, Anne-Katharina / Prokosch, Hans-Ulrich / Castellanos, Ixchel

Studies in health technology and informatics

2017 Volume 243, Page(s) 137–141

Abstract: Background: Nutrition support is an important aspect regarding the care of critically ill patients. Malnutrition affects the recovery process negatively. However, the impact on the clinical outcome is often underestimated in complex clinical settings ... ...

Abstract	Background: Nutrition support is an important aspect regarding the care of critically ill patients. Malnutrition affects the recovery process negatively. However, the impact on the clinical outcome is often underestimated in complex clinical settings due to several factors hindering optimization of nutrition. Objective: To identify the requirements for a clinical decision support system that enables the medical staff to improve its patients' nutritional status. Methods: A literature review and interviews with two senior physicians were conducted to refine the requirements for the support system as well as to determine the inclusion criteria for a subsequent intervention study. Results: The analysis resulted in: (i) the identification of 4 measurement parameters for the assessment of the nutrition status; (ii) the graphical layout in adherence to the standards-based implementation approach for the creation of multi-patient dashboards; (iii) the definition of the study group. The nutrition dashboard will be implemented and integrated based on the set requirements, followed by an intervention study evaluating the dashboard's efficacy.
Language	English
Publishing date	2017
Publishing country	Netherlands
Document type	Journal Article
ISSN	0926-9630
ISSN	0926-9630
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Article ; Online: A method for the graphical modeling of relative temporal constraints.

Mate, Sebastian / Bürkle, Thomas / Kapsner, Lorenz A / Toddenroth, Dennis / Kampf, Marvin O / Sedlmayr, Martin / Castellanos, Ixchel / Prokosch, Hans-Ulrich / Kraus, Stefan

Journal of biomedical informatics

2019 Volume 100, Page(s) 103314

Abstract: Searching for patient cohorts in electronic patient data often requires the definition of temporal constraints between the selection criteria. However, beyond a certain degree of temporal complexity, the non-graphical, form-based approaches implemented ... ...

Abstract	Searching for patient cohorts in electronic patient data often requires the definition of temporal constraints between the selection criteria. However, beyond a certain degree of temporal complexity, the non-graphical, form-based approaches implemented in current translational research platforms may be limited when modeling such constraints. In our opinion, there is a need for an easily accessible and implementable, fully graphical method for creating temporal queries. We aim to respond to this challenge with a new graphical notation. Based on Allen's time interval algebra, it allows for modeling temporal queries by arranging simple horizontal bars depicting symbolic time intervals. To make our approach applicable to complex temporal patterns, we apply two extensions: with duration intervals, we enable the inference about relative temporal distances between patient events, and with time interval modifiers, we support counting and excluding patient events, as well as constraining numeric values. We describe how to generate database queries from this notation. We provide a prototypical implementation, consisting of a temporal query modeling frontend and an experimental backend that connects to an i2b2 system. We evaluate our modeling approach on the MIMIC-III database to demonstrate that it can be used for modeling typical temporal phenotyping queries.
MeSH term(s)	Algorithms ; Computer Graphics ; Computer Simulation ; Databases, Factual ; Humans ; Information Storage and Retrieval ; Time
Language	English
Publishing date	2019-10-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2057141-0
ISSN	1532-0480 ; 1532-0464
ISSN (online)	1532-0480
ISSN	1532-0464
DOI	10.1016/j.jbi.2019.103314
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Article ; Online: Disseminated Multifocal Intracerebral Bleeding Events in Three Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation As Rescue Therapy.

Bihlmaier, Karl / Coras, Roland / Willam, Carsten / Grampp, Steffen / Jabari, Samir / Eichhorn, Philip / Haller, Florian / Kuramatsu, Joji / Schwab, Stefan / Castellanos, Ixchel / Birkholz, Torsten / Schüttler, Jürgen / Altmeppen, Jürgen / Schiffer, Mario / Herbst, Larissa

Critical care explorations

2020 Volume 2, Issue 9, Page(s) e0218

Abstract: Objectives: To describe three coronavirus disease 2019 patients suffering from acute respiratory distress syndrome under venovenous extracorporeal membrane oxygenation therapy and tight anticoagulation monitoring presenting a novel pattern of multifocal ...

Abstract	Objectives: To describe three coronavirus disease 2019 patients suffering from acute respiratory distress syndrome under venovenous extracorporeal membrane oxygenation therapy and tight anticoagulation monitoring presenting a novel pattern of multifocal brain hemorrhage in various degrees in all cerebral and cerebellar lobes. Design: Clinical observation of three patients. Post mortem examinations. Setting: Two ICUs at the University Hospital Erlangen. Patients: Three patients (medium age 56.6 yr, two male with hypertension and diabetes, one female with no medical history) developed severe acute respiratory distress syndrome on the basis of a severe acute respiratory syndrome coronavirus 2 infection. All required mechanical ventilation and venovenous extracorporeal membrane oxygenation support. Interventions: Clinical observation, CT, data extraction from electronic medical records, and post mortem examinations. Main results: We report on an unusual multifocal bleeding pattern in the white matter in three cases with severe acute respiratory distress syndrome due to coronavirus disease 2019 undergoing venovenous extracorporeal membrane oxygenation therapy. Bleeding pattern with consecutive herniation was found in CT scans as well as in neuropathologic post mortem examinations. Frequency for this unusual brain hemorrhage in coronavirus disease 2019 patients with extracorporeal membrane oxygenation therapy at our hospital is currently 50%, whereas bleeding events in extracorporeal membrane oxygenation patients generally occur at 10-15%. Conclusions: Multifocality and high frequency of the unusual white matter hemorrhage pattern suggest a coherence to coronavirus disease 2019. Neuropathological analyses showed circumscribed thrombotic cerebrovascular occlusions, which eventually led to microvascular and later on macrovascular disseminated bleeding events. However, signs of cerebrovascular inflammation could not be detected. Polymerase chain reaction analyses of brain tissue or cerebrospinal fluid remained negative. Increased susceptibility for fatal bleeding events should be taken into consideration in terms of systemic anticoagulation strategies in coronavirus disease 2019.
Keywords	covid19
Language	English
Publishing date	2020-09-15
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000218
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Article ; Online: Does introduction of a Patient Data Management System (PDMS) improve the financial situation of an intensive care unit?

Castellanos, Ixchel / Schüttler, Jürgen / Prokosch, Hans-Ulrich / Bürkle, Thomas

BMC medical informatics and decision making

2013 Volume 13, Page(s) 107

Abstract: Background: Patient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation. These systems are costly and raise the question if ... ...

Abstract	Background: Patient Data Management Systems (PDMS) support clinical documentation at the bedside and have demonstrated effects on completeness of patient charting and the time spent on documentation. These systems are costly and raise the question if such a major investment pays off. We tried to answer the following questions: How do costs and revenues of an intensive care unit develop before and after introduction of a PDMS? Can higher revenues be obtained with improved PDMS documentation? Can we present cost savings attributable to the PDMS? Methods: Retrospective analysis of cost and reimbursement data of a 25 bed Intensive Care Unit at a German University Hospital, three years before (2004-2006) and three years after (2007-2009) PDMS implementation. Results: Costs and revenues increased continuously over the years. The profit of the investigated ICU was fluctuating over the years and seemingly depending on other factors as well. We found a small increase in profit in the year after the introduction of the PDMS, but not in the following years. Profit per case peaked at 1039 € in 2007, but dropped subsequently to 639 € per case. We found no clear evidence for cost savings after the PDMS introduction. Our cautious calculation did not consider additional labour costs for IT staff needed for system maintenance. Conclusions: The introduction of a PDMS has probably minimal or no effect on reimbursement. In our case the observed increase in profit was too small to amortize the total investment for PDMS implementation.This may add some counterweight to the literature, where expectations for tools such as the PDMS can be quite unreasonable.
MeSH term(s)	Costs and Cost Analysis/economics ; Costs and Cost Analysis/standards ; Database Management Systems/economics ; Database Management Systems/standards ; Database Management Systems/statistics & numerical data ; Electronic Health Records/economics ; Electronic Health Records/standards ; Electronic Health Records/statistics & numerical data ; Germany ; Humans ; Intensive Care Units/economics ; Intensive Care Units/standards ; Intensive Care Units/statistics & numerical data ; Retrospective Studies
Language	English
Publishing date	2013-09-16
Publishing country	England
Document type	Journal Article ; Observational Study
ISSN	1472-6947
ISSN (online)	1472-6947
DOI	10.1186/1472-6947-13-107
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Article ; Online: Using Arden Syntax for the creation of a multi-patient surveillance dashboard.

Kraus, Stefan / Drescher, Caroline / Sedlmayr, Martin / Castellanos, Ixchel / Prokosch, Hans-Ulrich / Toddenroth, Dennis

Artificial intelligence in medicine

2015 Volume 92, Page(s) 88–94

Abstract: Objective: Most practically deployed Arden-Syntax-based clinical decision support (CDS) modules process data from individual patients. The specification of Arden Syntax, however, would in principle also support multi-patient CDS. The patient data ... ...

Abstract	Objective: Most practically deployed Arden-Syntax-based clinical decision support (CDS) modules process data from individual patients. The specification of Arden Syntax, however, would in principle also support multi-patient CDS. The patient data management system (PDMS) at our local intensive care units does not natively support patient overviews from customizable CDS routines, but local physicians indicated a demand for multi-patient tabular overviews of important clinical parameters such as key laboratory measurements. As our PDMS installation provides Arden Syntax support, we set out to explore the capability of Arden Syntax for multi-patient CDS by implementing a prototypical dashboard for visualizing laboratory findings from patient sets. Methods and material: Our implementation leveraged the object data type, supported by later versions of Arden, which turned out to be serviceable for representing complex input data from several patients. For our prototype, we designed a modularized architecture that separates the definition of technical operations, in particular the control of the patient context, from the actual clinical knowledge. Individual Medical Logic Modules (MLMs) for processing single patient attributes could then be developed according to well-tried Arden Syntax conventions. Results: We successfully implemented a working dashboard prototype entirely in Arden Syntax. The architecture consists of a controller MLM to handle the patient context, a presenter MLM to generate a dashboard view, and a set of traditional MLMs containing the clinical decision logic. Our prototype could be integrated into the graphical user interface of the local PDMS. We observed that with realistic input data the average execution time of about 200ms for generating dashboard views attained applicable performance. Conclusion: Our study demonstrated the general feasibility of creating multi-patient CDS routines in Arden Syntax. We believe that our prototypical dashboard also suggests that such implementations can be relatively easy, and may simultaneously hold promise for sharing dashboards between institutions and reusing elementary components for additional dashboards.
MeSH term(s)	Artificial Intelligence ; Decision Support Systems, Clinical/organization & administration ; Decision Support Systems, Clinical/standards ; Expert Systems ; Hospital Information Systems/organization & administration ; Hospital Information Systems/standards ; Humans ; Medical Informatics ; Programming Languages ; Tertiary Care Centers
Language	English
Publishing date	2015-10-09
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	645179-2
ISSN	1873-2860 ; 0933-3657
ISSN (online)	1873-2860
ISSN	0933-3657
DOI	10.1016/j.artmed.2015.09.009
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Article ; Online: Increased Rate of Poor Laryngoscopic Views in Patients Scheduled for Cardiac Surgery Versus Patients Scheduled for General Surgery: A Propensity Score-Based Analysis of 21,561 Cases.

Heinrich, Sebastian / Ackermann, Andreas / Prottengeier, Johannes / Castellanos, Ixchel / Schmidt, Joachim / Schüttler, Jürgen

Journal of cardiothoracic and vascular anesthesia

2015 Volume 29, Issue 6, Page(s) 1537–1543

Abstract: Objectives: Former analyses reported an increased rate of poor direct laryngoscopy view in cardiac surgery patients; however, these findings frequently could be attributed to confounding patient characteristics. In most of the reported cardiac surgery ... ...

Abstract	Objectives: Former analyses reported an increased rate of poor direct laryngoscopy view in cardiac surgery patients; however, these findings frequently could be attributed to confounding patient characteristics. In most of the reported cardiac surgery cohorts, the rate of well-known risk factors for poor direct laryngoscopy view such as male sex, obesity, or older age, were increased compared with the control groups. Especially in the ongoing debate on anesthesia staff qualification for cardiac interventions outside the operating room a detailed and stratified risk analysis seems necessary. Design: Retrospective, anonymous, propensity score-based, matched-pair analysis. Setting: Single-center study in a university hospital. Participants: No active participants. Retrospective, anonymous chart analysis. Interventions: The anesthesia records of patients undergoing cardiac surgery in a period of 6 consecutive years were analyzed retrospectively. The results were compared with those of a control group of patients who underwent general surgery. Poor laryngoscopic view was defined as Cormack and Lehane classification grade 3 or 4. Measurements and main results: The records of 21,561 general anesthesia procedures were reviewed for the study. The incidence of poor direct laryngoscopic views in patients scheduled for cardiac surgery was significantly increased compared with those of the general surgery cohort (7% v 4.2%). Using propensity score-based matched-pair analysis, equal subgroups were generated of each surgical department, with 2,946 patients showing identical demographic characteristics. After stratifying for demographic characteristics, the rate of poor direct laryngoscopy view remained statistically significantly higher in the cardiac surgery group (7.5% v 5.7%). Conclusions: Even with stratification for demographic risk factors, cardiac surgery patients showed a significantly higher rate of poor direct laryngoscopic view compared with general surgery patients. These results should be taken into account for human resource management and distribution of difficult airway equipment, especially when cardiac interventional programs are implemented in remote hospital locations.
MeSH term(s)	Aged ; Anesthesia, General/adverse effects ; Anesthesia, General/trends ; Appointments and Schedules ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/trends ; Female ; Humans ; Laryngoscopy/adverse effects ; Laryngoscopy/trends ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies ; Surgical Procedures, Operative/adverse effects ; Surgical Procedures, Operative/trends
Language	English
Publishing date	2015-12
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2015.04.027
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