Papers by Juliane Gartemann
Autoimmune Diseases, 2012
This systematic review assesses the current status of anti-cyclic citrullinated peptide (anti-CCP... more This systematic review assesses the current status of anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) tests in the diagnosis and prognosis of rheumatoid arthritis (RA). We reviewed publications on tests and biomarkers for early diagnosis of RA from English-language MEDLINE-indexed journals and non-MEDLINE-indexed sources. 85 publications were identified and reviewed, including 68 studies from MEDLINE and 17 non-MEDLINE sources. Anti-CCP2 assays provide improved sensitivity over anti-CCP assays and RF, but anti-CCP2 and RF assays in combination demonstrate a positive predictive value (PPV) nearing 100%, greater than the PPV of either of the tests alone. The combination also appears to be able to distinguish between patients whose disease course is expected to be more severe and both tests are incorporated in the 2010 ACR Rheumatoid Arthritis Classification Criteria. While the clinical value of anti-CCP tests has been established, differences in cut-off values, sensitivities and specificities exist between first-, second-and third-generation tests and harmonization efforts are under way. Anti-CCP and RF are clinically valuable biomarkers for the diagnosis and prognosis of RA patients. The combination of the two biomarkers in conjunction with other clinical measures is an important tool for the diagnosis and management of RA patients.
Autoimmune diseases, 2011
This systematic review assesses the current status of anti-cyclic citrullinated peptide (anti-CCP... more This systematic review assesses the current status of anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) tests in the diagnosis and prognosis of rheumatoid arthritis (RA). We reviewed publications on tests and biomarkers for early diagnosis of RA from English-language MEDLINE-indexed journals and non-MEDLINE-indexed sources. 85 publications were identified and reviewed, including 68 studies from MEDLINE and 17 non-MEDLINE sources. Anti-CCP2 assays provide improved sensitivity over anti-CCP assays and RF, but anti-CCP2 and RF assays in combination demonstrate a positive predictive value (PPV) nearing 100%, greater than the PPV of either of the tests alone. The combination also appears to be able to distinguish between patients whose disease course is expected to be more severe and both tests are incorporated in the 2010 ACR Rheumatoid Arthritis Classification Criteria. While the clinical value of anti-CCP tests has been established, differences in cut-off values,...
Value in Health, 2009
after adjusting for age, gender, gout treatment, comorbidities, and medication use. RESULTS: We i... more after adjusting for age, gender, gout treatment, comorbidities, and medication use. RESULTS: We identifi ed 4821 AMI cases of which 1410 were women. The adjusted odds ratio (OR [95% CI]) of AMI among women with gout was 1.62 (1.21-2.16), higher than the adjusted OR for men (1.12 [0.99-1.26]; p-value for interaction 0.01). When we combined both women and men in our analyses, we found an overall adjusted OR of 1.15 (1.06-1.25). CONCLUSIONS: Using population-based data, we found a 62% increased risk for AMI among elderly women with gout, and a 15% increased risk for elderly gout patients overall. The association between hyperuricemia, a known precursor to gout, and cardiovascular disease provides a potential explanation for our fi ndings. Gender differences in serum uric acid levels and metabolism may further explain the difference in risks between women and men. Findings provide support for the aggressive management of cardiovascular risk factors in gout patients. OBJECTIVES: In clinical studies, comorbidity measurement refers to assessment of total burden of illnesses across multiple health conditions unrelated to the patients' disease under study. In non-randomized clinical studies and epidemiology studies, adjustment for comorbidity is often undertaken to ensure outcomes are not directly affected by comorbidities. This analysis compared 3 measurements of comorbidities and their effects on physical function and quality of life with data from a randomized controlled trial of adalimumab in ankylosing spondylitis (AS). METHODS: Data were derived from the Adalimumab Trial Evaluating Long-Term Effi cacy and Safety in AS (ATLAS). Comorbidity indices at baseline were calculated as Chronic Disease Score (CDS), number of separate prescription medications (prescription count), and number of concurrent illnesses (concurrent illness count). Medications taken specifically for the treatment of AS were excluded from the CDS and prescription medication count calculations. Univariate associations between each of the 3 indices and a physical function index (SF-36 PCS) and AS disease-specifi c quality of life (ASQOL) at Week 12 were assessed. Correlations with each comorbidity measurement were ascertained. Model selection (Alkaike's Information Criterion [AIC]) was used to identify the best comorbidity measure for predicting SF-36 PCS and ASQOL. RESULTS: A total of 315 patients were included in the analysis. Their mean age was 42.2 years, and most were male (74.9%). At the univariate level, all 3 indices were signifi cant predictors of SF-36 PCS score (p 0.02), However, only CDS and prescription medication count were signifi cantly associated with ASQOL at Week 12. All 3 indices were well-correlated with each other (range 0.750-0.917). The AIC model demonstrated that CDS was the best predictor of SF-36 PCS and ASQOL. Prescription count was the second-best ranked measure for both outcomes. CONCLUSIONS: The CDS is a suitable measure for comorbidity adjustment in examining physical function and quality of life for AS patients.
Nursing in Critical Care, 2012
The cumulative time that critical care nurses spend implementing a tight glycaemic control (TGC) ... more The cumulative time that critical care nurses spend implementing a tight glycaemic control (TGC) protocol was estimated in a time-in-motion (TiM) study conducted in a hospital in the UK. TGC protocols were introduced to the critical care setting to reduce hyperglycaemic events in high-risk patients. The time burden to critical care nurses of implementing such protocols has not yet been studied in the UK. A prospective TiM pilot study was conducted in an eligible UK intensive care unit by four protocol-trained observers over five consecutive weekdays from 3 to 7 November 2008. Three nurses were also interviewed on site to gather their attitudes and perceptions about the benefits of and time associated with administering a TGC protocol. Independent observers shadowed nurses, observing when a blood glucose measurement was taken, when each predefined subtask was completed and the duration of each task. Semistructured interviews with nurses were conducted in-person and one-on-one by a trained study member. Considered together, the episodic median duration of all TGC activities was 6·65 min. Across a total shift, nurses devoted approximately 7% of their time to administering a TGC protocol. Nurses perceived that a TGC protocol is beneficial to patient safety and outcomes in a critical care setting but acknowledged that the tasks can be mildly to moderately tedious. This TiM analysis indicated that the additional responsibility of implementing a TGC protocol represents a substantive commitment of nursing time in a critical care setting. The episodic data of our pilot study in the UK contributes further evidence that TGC protocols may be arduous to maintain and constitute a substantial investment of nursing time.
BMC Health Services Research, 2015
Treatment for patients with breast cancer (BC) is guided by human epidermal growth factor recepto... more Treatment for patients with breast cancer (BC) is guided by human epidermal growth factor receptor 2 (HER2) status. The patient's HER2 status is assessed using US Food and Drug Administration-approved in vitro diagnostic (IVD) immunohistochemical (IHC) tests and laboratory-developed IVD tests. We analysed HER2 testing accuracy using data from the Nordic Immunohistochemistry Quality Control (NordiQC) HER2 IHC programme; results were used in an economic BC treatment model. Data were obtained from NordiQC HER2 BC surveys performed from 2008 to 2012. False-negative (FN) and false-positive (FP) rates for approved and laboratory-developed IVDs were used to estimate direct costs, loss of survival, productivity benefit and quality-adjusted life-years. In the absence of consistent and accessible clinical and economic data from countries participating in the NordiQC programme, United States productivity data, healthcare costs and patient numbers were used as a surrogate in order to estimate the potential impact of selecting an approved or laboratory-developed IVDs. In total, 1703 tests were performed. Pooled FN rates were 11 % for approved IVDs and 25 % for laboratory-developed IVDs; FP rates were 0 % and 5 %, respectively. Using these FP and FN rates in the economic model and applying them to the United States BC population, approved IVD tests would result in better clinical outcomes, i.e., better survival and fewer disease recurrences/progressions, and lower costs, i.e., total direct costs and lost productivity, versus laboratory-developed IVD tests. Every $1 saved by laboratories by using cheaper reagents could potentially result in approximately $6 additional costs to the healthcare system. The results of this analysis suggest that incorrect HER2 test results have far-reaching clinical and economic consequences.
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Papers by Juliane Gartemann