@phdthesis{Goettler2022, author = {G{\"o}ttler, David Johannes}, title = {Smoking cessation patterns in patients with established coronary heart disease}, doi = {10.25972/OPUS-22395}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-223955}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Background Tobacco smoking is accountable for more than one in ten deaths in patients with cardiovascular disease. Thus, smoking cessation has a high priority in secondary prevention of coronary heart disease (CHD). The present study meant to assess smoking cessation patterns, identify parameters associated with smoking cessation and investigate personal reasons to change or maintain smoking habits in patients with established CHD. Methods Quality of CHD care was surveyed in 24 European countries in 2012/13 by the fourth European Survey of Cardiovascular Disease Prevention and Diabetes. Patients 18 to 79 years of age at the date of the CHD index event hospitalized due to first or recurrent diagnosis of coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction or acute myocardial ischemia without infarction (troponin negative) were included. Smoking status and clinical parameters were iteratively obtained a) at the cardiovascular disease index event by medical record abstraction, b) during a face-to-face interview 6 to 36 months after the index event (i.e. baseline visit) and c) by telephone-based follow-up interview two years after the baseline visit. Parameters associated with smoking status at the time of follow-up interview were identified by logistic regression analysis. Personal reasons to change or maintain smoking habits were assessed in a qualitative interview and analyzed by qualitative content analysis. Results One hundred and four of 469 (22.2\%) participants had been classified current smokers at the index event and were available for follow-up interview. After a median observation period of 3.5 years (quartiles 3.0, 4.1), 65 of 104 participants (62.5\%) were classified quitters at the time of follow-up interview. There was a tendency of diabetes being more prevalent in quitters vs non-quitters (37.5\% vs 20.5\%, p=0.07). Higher education level (15.4\% vs 33.3\%, p=0.03) and depressed mood (17.2\% vs 35.9\%, p=0.03) were less frequent in quitters vs non-quitters. Quitters more frequently participated in cardiac rehabilitation programs (83.1\% vs 48.7\%, p<0.001). Cardiac rehabilitation appeared as factor associated with smoking cessation in multivariable logistic regression analysis (OR 5.19, 95\%CI 1.87 to 14.46, p=0.002). Persistent smokers at telephone-based follow-up interview reported on addiction as wells as relaxation and pleasure as reasons to continue their habit. Those current and former smokers who relapsed at least once after a quitting attempt, stated future health hazards as their main reason to undertake quitting attempts. Prevalent factors leading to relapse were influence by their social network and stress. Successful quitters at follow-up interview referred to smoking-related harm done to their health having had been their major reason to quit. Interpretation Participating in a cardiac rehabilitation program was strongly associated with smoking cessation after a cardiovascular disease index event. Smoking cessation counseling and relapse prophylaxis may include alternatives for the pleasant aspects of smoking and incorporate effective strategies to resist relapse.}, subject = {Tabakkonsum}, language = {en} } @article{HebestreitZeidlerSchippersetal.2022, author = {Hebestreit, Helge and Zeidler, Cornelia and Schippers, Christopher and de Zwaan, Martina and Deckert, J{\"u}rgen and Heuschmann, Peter and Krauth, Christian and Bullinger, Monika and Berger, Alexandra and Berneburg, Mark and Brandstetter, Lilly and Deibele, Anna and Dieris-Hirche, Jan and Graessner, Holm and G{\"u}ndel, Harald and Herpertz, Stephan and Heuft, Gereon and Lapstich, Anne-Marie and L{\"u}cke, Thomas and Maisch, Tim and Mundlos, Christine and Petermann-Meyer, Andrea and M{\"u}ller, Susanne and Ott, Stephan and Pfister, Lisa and Quitmann, Julia and Romanos, Marcel and Rutsch, Frank and Schaubert, Kristina and Schubert, Katharina and Schulz, J{\"o}rg B. and Schweiger, Susann and T{\"u}scher, Oliver and Ungeth{\"u}m, Kathrin and Wagner, Thomas O. F. and Haas, Kirsten}, title = {Dual guidance structure for evaluation of patients with unclear diagnosis in centers for rare diseases (ZSE-DUO): study protocol for a controlled multi-center cohort study}, series = {Orphanet Journal of Rare Diseases}, volume = {17}, journal = {Orphanet Journal of Rare Diseases}, number = {1}, doi = {10.1186/s13023-022-02176-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300440}, year = {2022}, abstract = {Background In individuals suffering from a rare disease the diagnostic process and the confirmation of a final diagnosis often extends over many years. Factors contributing to delayed diagnosis include health care professionals' limited knowledge of rare diseases and frequent (co-)occurrence of mental disorders that may complicate and delay the diagnostic process. The ZSE-DUO study aims to assess the benefits of a combination of a physician focusing on somatic aspects with a mental health expert working side by side as a tandem in the diagnostic process. Study design This multi-center, prospective controlled study has a two-phase cohort design. Methods Two cohorts of 682 patients each are sequentially recruited from 11 university-based German Centers for Rare Diseases (CRD): the standard care cohort (control, somatic expertise only) and the innovative care cohort (experimental, combined somatic and mental health expertise). Individuals aged 12 years and older presenting with symptoms and signs which are not explained by current diagnoses will be included. Data will be collected prior to the first visit to the CRD's outpatient clinic (T0), at the first visit (T1) and 12 months thereafter (T2). Outcomes Primary outcome is the percentage of patients with one or more confirmed diagnoses covering the symptomatic spectrum presented. Sample size is calculated to detect a 10 percent increase from 30\% in standard care to 40\% in the innovative dual expert cohort. Secondary outcomes are (a) time to diagnosis/diagnoses explaining the symptomatology; (b) proportion of patients successfully referred from CRD to standard care; (c) costs of diagnosis including incremental cost effectiveness ratios; (d) predictive value of screening instruments administered at T0 to identify patients with mental disorders; (e) patients' quality of life and evaluation of care; and f) physicians' satisfaction with the innovative care approach. Conclusions This is the first multi-center study to investigate the effects of a mental health specialist working in tandem with a somatic expert physician in CRDs. If this innovative approach proves successful, it will be made available on a larger scale nationally and promoted internationally. In the best case, ZSE-DUO can significantly shorten the time to diagnosis for a suspected rare disease.}, language = {en} } @article{BuergerEmserSeideletal.2022, author = {Buerger, Arne and Emser, Theresa and Seidel, Alexandra and Scheiner, Christin and von Schoenfeld, Cornelia and Ruecker, Viktoria and Heuschmann, Peter U. and Romanos, Marcel}, title = {DUDE - a universal prevention program for non-suicidal self-injurious behavior in adolescence based on effective emotion regulation: study protocol of a cluster-randomized controlled trial}, series = {Trials}, volume = {23}, journal = {Trials}, doi = {10.1186/s13063-021-05973-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265874}, year = {2022}, abstract = {Background Non-suicidal self-injury (NSSI) has become a substantial public health problem. NSSI is a high-risk marker for the development and persistence of mental health problems, shows high rates of morbidity and mortality, and causes substantial health care costs. Thus, there is an urgent need for action to develop universal prevention programs for NSSI before adolescents begin to show this dangerous behavior. Currently, however, universal prevention programs are lacking. Methods The main objective of the present study is to evaluate a newly developed universal prevention program ("DUDE - Du und deine Emotionen / You and your emotions"), based on a skills-based approach in schools, in 3200 young adolescents (age 11-14 years). The effectiveness of DUDE will be investigated in a cluster-randomized controlled trial (RCT) in schools (N = 16). All groups will receive a minimal intervention called "Stress-free through the school day" as a mental health literacy program to prevent burnout in school. The treatment group (N = 1600; 8 schools) will additionally undergo the universal prevention program DUDE and will be divided into treatment group 1 (DUDE conducted by trained clinical psychologists; N = 800; 4 schools) and treatment group 2 (DUDE conducted by trained teachers; N = 800; 4 schools). The active control group (N = 1600; 8 schools) will only receive the mental health literacy prevention. Besides baseline assessment (T0), measurements will occur at the end of the treatment (T1) and at 6- (T2) and 12-month (T3) follow-up evaluations. The main outcome is the occurrence of NSSI within the last 6 months assessed by a short version of the Deliberate Self-Harm Inventory (DSHI-9) at the 1-year follow-up (primary endpoint; T3). Secondary outcomes are emotion regulation, suicidality, health-related quality of life, self-esteem, and comorbid psychopathology and willingness to change. Discussion DUDE is tailored to diminish the incidence of NSSI and to prevent its possible long-term consequences (e.g., suicidality) in adolescents. It is easy to access in the school environment. Furthermore, DUDE is a comprehensive approach to improve mental health via improved emotion regulation.}, language = {en} } @article{MontellanoKluterRueckeretal.2022, author = {Montellano, Felipe A. and Kluter, Elisabeth J. and R{\"u}cker, Viktoria and Ungeth{\"u}m, Kathrin and Mackenrodt, Daniel and Wiedmann, Silke and Dege, Tassilo and Quilitzsch, Anika and Morbach, Caroline and Frantz, Stefan and St{\"o}rk, Stefan and Haeusler, Karl Georg and Kleinschnitz, Christoph and Heuschmann, Peter U.}, title = {Cardiac dysfunction and high-sensitive C-reactive protein are associated with troponin T elevation in ischemic stroke: insights from the SICFAIL study}, series = {BMC Neurology}, volume = {22}, journal = {BMC Neurology}, number = {1}, doi = {10.1186/s12883-022-03017-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300119}, year = {2022}, abstract = {Background Troponin elevation is common in ischemic stroke (IS) patients. The pathomechanisms involved are incompletely understood and comprise coronary and non-coronary causes, e.g. autonomic dysfunction. We investigated determinants of troponin elevation in acute IS patients including markers of autonomic dysfunction, assessed by heart rate variability (HRV) time domain variables. Methods Data were collected within the Stroke Induced Cardiac FAILure (SICFAIL) cohort study. IS patients admitted to the Department of Neurology, W{\"u}rzburg University Hospital, underwent baseline investigation including cardiac history, physical examination, echocardiography, and blood sampling. Four HRV time domain variables were calculated in patients undergoing electrocardiographic Holter monitoring. Multivariable logistic regression with corresponding odds ratios (OR) and 95\% confidence intervals (CI) was used to investigate the determinants of high-sensitive troponin T (hs-TnT) levels ≥14 ng/L. Results We report results from 543 IS patients recruited between 01/2014-02/2017. Of those, 203 (37\%) had hs-TnT ≥14 ng/L, which was independently associated with older age (OR per year 1.05; 95\% CI 1.02-1.08), male sex (OR 2.65; 95\% CI 1.54-4.58), decreasing estimated glomerular filtration rate (OR per 10 mL/min/1.73 m2 0.71; 95\% CI 0.61-0.84), systolic dysfunction (OR 2.79; 95\% CI 1.22-6.37), diastolic dysfunction (OR 2.29; 95\% CI 1.29-4.02), atrial fibrillation (OR 2.30; 95\% CI 1.25-4.23), and increasing levels of C-reactive protein (OR 1.48 per log unit; 95\% CI 1.22-1.79). We did not identify an independent association of troponin elevation with the investigated HRV variables. Conclusion Cardiac dysfunction and elevated C-reactive protein, but not a reduced HRV as surrogate of autonomic dysfunction, were associated with increased hs-TnT levels in IS patients independent of established cardiovascular risk factors.}, language = {en} } @article{MartinMauerMalzahnetal.2022, author = {Martin, Eva and Mauer, Isabell and Malzahn, Uwe and Heuschmann, Peter Ulrich and Goebeler, Matthias and Benoit, Sandrine}, title = {Comorbid diseases among bullous pemphigoid patients in Germany: new insights from a case-control study}, series = {Journal der Deutschen Dermatologischen Gesellschaft}, volume = {20}, journal = {Journal der Deutschen Dermatologischen Gesellschaft}, number = {6}, doi = {10.1111/ddg.14738}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318395}, pages = {798 -- 805}, year = {2022}, abstract = {Background and objectives Bullous pemphigoid (BP) is associated with neuropsychiatric disorders. Other comorbid diseases are discussed controversially. We evaluated the prevalence of comorbidity in BP patients in a representative area of Germany. Patients and methods Medical files of all BP patients treated at the Department of Dermatology, University Hospital W{\"u}rzburg, Germany, between June 2002 and May 2013 were retrospectively reviewed. Bullous pemphigoid was diagnosed based on established criteria. For each patient, two controls were individually matched. Records were evaluated for age, sex, laboratory values, concomitant medication and comorbidity. Conditional logistic regression, multivariable regression analysis and complex regression models were performed to compare results. Results 300 BP patients were identified and compared to 583 controls. Bullous pemphigoid was associated with neuropsychiatric disorders as well as laboratory abnormalities including leukocytosis and eosinophilia. Importantly, a highly significant association of BP with anemia (OR 2.127; 95 \% CI 1.532-2.953) and renal impairment (OR 2.218; 95 \% CI 1.643-2.993) was identified. No association was found with malignancy and arterial hypertension. Conclusions Our data revealed an increased frequency of anemia and renal impairment in BP patients. In accordance with previous studies the strong association for neuropsychiatric disorders was confirmed (p < 0.0005).}, language = {en} } @article{HasenpuschMatterneTischeretal.2022, author = {Hasenpusch, Claudia and Matterne, Uwe and Tischer, Christina and Hrudey, Ilona and Apfelbacher, Christian}, title = {Development and content validation of a comprehensive health literacy survey instrument for use in individuals with asthma during the COVID-19 pandemic}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, number = {4}, issn = {1660-4601}, doi = {10.3390/ijerph19041923}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-262146}, year = {2022}, abstract = {Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0\%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.}, language = {en} } @phdthesis{JiruHillmann2022, author = {Jir{\`u}-Hillmann, Steffi}, title = {Schlaganfallversorgung: Europ{\"a}ische, deutsche und regionale Perspektiven}, doi = {10.25972/OPUS-26144}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261445}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Seit Mitte der 1990er Jahre wurden nationale und regionale Schlaganfallregister in Europa etabliert, die Auskunft {\"u}ber die Versorgungsqualit{\"a}t von Schlaganfallpatienten geben. Bislang lagen nur wenige Daten zu zeitlichen Trends der akuten Schlaganfallversorgung vor. Diese sind jedoch essentiell, um beispielsweise Zusammenh{\"a}nge zwischen der Einf{\"u}hrung potentiell qualit{\"a}tsverbessernder Maßnahmen und der Entwicklung der Versorgungsqualit{\"a}t feststellen zu k{\"o}nnen. Die Behandlung von Schlaganfallpatienten auf Stroke Units ist aufgrund der eindeutigen Evidenz aus randomisierten- und Beobachtungsstudien zum Standard geworden. Bislang war unklar, ob demografische und klinische Charakteristika die direkte Aufnahme auf eine Stroke Unit beeinflussen. Zudem war nicht bekannt, ob und wenn ja, in welchem Ausmaß strukturelle Kriterien und der Anteil der Patienten, der auf eine Stroke Unit aufgenommen wurde, die Qualit{\"a}t der Stroke Unit Versorgung beeinflussen. Im Anschluss an die Akutbehandlung im Krankenhaus bzw. nach geeigneten Rehabilitationsmaßnahmen {\"u}bernehmen pflegende Angeh{\"o}rige h{\"a}ufig die Versorgung der Schlaganfallpatienten im h{\"a}uslichen Umfeld. Die aktuelle Situation der pflegenden Angeh{\"o}rigen von Schlaganfallpatienten in Deutschland ist bisher jedoch nur unzureichend evaluiert. In der vorliegenden Dissertation wurden zun{\"a}chst im Rahmen des „European Implementation Score"-Projektes zeitliche Trends der Qualit{\"a}t der akuten Schlaganfallversorgung in f{\"u}nf nationalen europ{\"a}ischen Schlaganfallregistern aus Deutschland, England/Wales/Nordirland, Polen, Schottland und Schweden nach zuvor definierten evidenzbasierten Qualit{\"a}tsindikatoren berechnet. Im zweiten Schritt wurde anhand von Daten der Arbeitsgemeinschaft Deutscher Schlaganfall Register (ADSR) evaluiert, ob demografische und klinische Patientencharakteristika die direkte Aufnahme auf eine Stroke Unit in Deutschland beeinflussen. Weiterhin wurde der Einfluss struktureller Charakteristika auf die Erf{\"u}llung von 11 evidenzbasierter Qualit{\"a}tsindikatoren in Krankenh{\"a}usern, die {\"u}ber eine regionale oder {\"u}berregionale Stroke Unit verf{\"u}gen, untersucht. Abschließend wurden im Rahmen des regionalen Telemedizinnetzwerkes TRANSIT-Stroke demografische und klinische Charakteristika von Schlaganfallpatienten, die 3 Monate nach dem Schlaganfall mit dem Erhalt von Pflege durch einen Angeh{\"o}rigen assoziiert waren, identifiziert. Zus{\"a}tzlich wurden mit standardisierten Erhebungsinstrumenten positive und negative Erfahrungen der Pflege eines Schlaganfallpatienten sowie die selbsteingesch{\"a}tzte Belastung (deutsche Version des Caregiver Reaction Assessment und Self-Rated Burden Scale) ausgewertet sowie Faktoren, die mit den Pflegeerfahrungen und Belastungen assoziiert sind, evaluiert. Auf europ{\"a}ischer Ebene konnten wir einen Zusammenhang zwischen der Einf{\"u}hrung eines neuen Qualit{\"a}tsindikators und der Verbesserung der Qualit{\"a}t beobachten. Dies galt insbesondere f{\"u}r die erstmalige Einf{\"u}hrung des Qualit{\"a}tsindikators Dysphagiescreening im deutschen -(2006) und schwedischen Schlaganfallregister (2007). Somit gibt es Hinweise darauf, dass das Monitoring der Qualit{\"a}t der Schlaganfallversorgung zu Qualit{\"a}tsverbesserungen bzw. auch zu einer vollst{\"a}ndigeren Dokumentation f{\"u}hrt. Insgesamt konnten wir ein qualitativ hohes Niveau der akuten Schlaganfallversorgung auf Stroke Units in Deutschland gem{\"a}ß evidenzbasierter Qualit{\"a}tsindikatoren feststellen. Patienten mit einem isch{\"a}mischen Schlaganfall, die am Wochenende aufgenommen wurden (p<0,0001), innerhalb von 3 Stunden nach Symptombeginn im Krankenhaus aufgenommen wurden (p<0,0001), hypertensiv waren (p<0,0001), unter einer Hyperlipid{\"a}mie (p<0,0001) litten, wurden mit einer h{\"o}heren Wahrscheinlichkeit auf einer Stroke Unit aufgenommen. Dagegen hatten Patienten mit einem schwereren Schlaganfall (NIHSS>15) eine geringere Chance, auf einer Stroke Unit aufgenommen zu werden (p<0,0001). Der Einfluss struktureller Charakteristika auf die Qualit{\"a}t der Stroke Unit Versorgung war gering. Eine Verbesserung der Qualit{\"a}t k{\"o}nnte noch durch einen h{\"o}heren Anteil der auf einer Stroke Unit aufgenommenen Patienten erreicht werden. Im Rahmen der Nachbefragung von Patienten im regionalen Telemedizinnetzwerk TRANSIT-Stroke stellten Frauen mit 70,1\% den gr{\"o}ßten Anteil der pflegenden Angeh{\"o}rigen dar. 74,4\% der pflegenden Angeh{\"o}rigen war {\"a}lter als 55 Jahre. In univariablen und multivariablen logistischen Regressionsanalysen waren ein hohes Alter, ein niedriger Barthel-Index bei Entlassung sowie das Vorliegen von Diabetes signifikant mit einer h{\"o}heren Wahrscheinlichkeit assoziiert, Pflege von einem Angeh{\"o}rigen zu erhalten. Der Großteil der pflegenden Angeh{\"o}rigen m{\"o}chte den Angeh{\"o}rigen pflegen und ist gleichzeitig dem Risiko gesundheitlicher Probleme ausgesetzt. Circa ein F{\"u}nftel der pflegenden Angeh{\"o}rigen berichtete finanzielle Belastungen aufgrund der Pflegesituation. Depressive Symptome der Patienten waren mit einer h{\"o}heren Belastung der pflegenden Angeh{\"o}rigen hinsichtlich der selbsteingesch{\"a}tzten Belastung und den positiven und negativen Erfahrungen assoziiert. J{\"u}ngere, m{\"a}nnliche Schlaganfallpatienten, mit einem milderen Schlaganfall, die mit einer Partnerin oder Ehepartnerin zusammenleben, scheinen sich oft nicht bewusst zu sein, dass sie Pflege erhalten. M{\"o}glich ist hier, dass sie die Unterst{\"u}tzung und Pflege als „normal" betrachten, w{\"a}hrend der Partner bzw. die Partnerin dies als tats{\"a}chliche Pflege wertet. Schlaganfallregister eignen sich, um die Qualit{\"a}t der Akutversorgung im Zeitverlauf zu monitorieren und Zusammenh{\"a}nge zwischen der Einf{\"u}hrung potentiell qualit{\"a}tsverbessernder Maßnahmen und der tats{\"a}chlichen Qualit{\"a}t darstellen zu k{\"o}nnen. Die Qualit{\"a}t der Stroke Unit Versorgung in Deutschland ist auf einem hohen Niveau. Eine Verbesserung der Qualit{\"a}t k{\"o}nnte noch durch einen h{\"o}heren Anteil der auf einer Stroke Unit aufgenommenen Patienten erreicht werden. Ein Großteil der Schlaganfallpatienten lebt im Anschluss an die Akutversorgung im h{\"a}uslichen Umfeld, in dem pflegende Angeh{\"o}rige eine wichtige Rolle bei der Versorgung spielen. Pflegenden Angeh{\"o}rigen ist ihre Aufgabe wichtig, sind jedoch aufgrund der Pflege zugleich Belastungen hinsichtlich ihrer Gesundheit, der Gestaltung ihres t{\"a}glichen Zeitplans und der Finanzen ausgesetzt.}, subject = {Schlaganfall}, language = {de} } @article{AllgaierSchleeProbstetal.2022, author = {Allgaier, Johannes and Schlee, Winfried and Probst, Thomas and Pryss, R{\"u}diger}, title = {Prediction of tinnitus perception based on daily life mHealth data using country origin and season}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {15}, issn = {2077-0383}, doi = {10.3390/jcm11154270}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-281812}, year = {2022}, abstract = {Tinnitus is an auditory phantom perception without external sound stimuli. This chronic perception can severely affect quality of life. Because tinnitus symptoms are highly heterogeneous, multimodal data analyses are increasingly used to gain new insights. MHealth data sources, with their particular focus on country- and season-specific differences, can provide a promising avenue for new insights. Therefore, we examined data from the TrackYourTinnitus (TYT) mHealth platform to create symptom profiles of TYT users. We used gradient boosting engines to classify momentary tinnitus and regress tinnitus loudness, using country of origin and season as features. At the daily assessment level, tinnitus loudness can be regressed with a mean absolute error rate of 7.9\% points. In turn, momentary tinnitus can be classified with an F1 score of 93.79\%. Both results indicate differences in the tinnitus of TYT users with respect to season and country of origin. The significance of the features was evaluated using statistical and explainable machine learning methods. It was further shown that tinnitus varies with temperature in certain countries. The results presented show that season and country of origin appear to be valuable features when combined with longitudinal mHealth data at the level of daily assessment.}, language = {en} } @article{ForchertPotapovaPanettaetal.2022, author = {Forchert, Leandra and Potapova, Ekaterina and Panetta, Valentina and Dramburg, Stephanie and Perna, Serena and Posa, Daniela and Resch-Marat, Yvonne and Lupinek, Christian and Rohrbach, Alexander and Grabenhenrich, Linus and Icke, Katja and Bauer, Carl-Peter and Hoffman, Ute and Forster, Johannes and Zepp, Fred and Schuster, Antje and Wahn, Ulrich and Keil, Thomas and Lau, Susanne and Vrtala, Susanne and Valenta, Rudolf and Matricardi, Paolo Maria}, title = {Der p 23-specific IgE response throughout childhood and its association with allergic disease: A birth cohort study}, series = {Pediatric Allergy and Immunology}, volume = {33}, journal = {Pediatric Allergy and Immunology}, number = {7}, doi = {10.1111/pai.13829}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-287181}, year = {2022}, abstract = {Background The Dermatophagoides pteronyssinus molecule Der p 23 is a major allergen whose clinical relevance has been shown in cross-sectional studies. We longitudinally analysed the trajectory of Der p 23-specific IgE antibody (sIgE) levels throughout childhood and youth, their early-life determinants and their clinical relevance for allergic rhinitis and asthma. Methods We obtained sera and clinical data of 191 participants of the German Multicentre Allergy Study, a prospective birth cohort. Serum samples from birth to 20 years of age with sIgE reactivity to Der p 23 in a customised semiquantitative microarray were newly analysed with a singleplex quantitative assay. Early mite exposure was assessed by measuring the average content of Der p 1 in house dust at 6 and 18 months. Results Der p 23-sIgE levels were detected at least once in 97/191 participants (51\%). Prevalence of Der p 23 sensitisation and mean sIgE levels increased until age 10 years, plateaued until age 13 years and were lowest at age 20 years. Asthma, allergic rhinitis (AR) and atopic dermatitis (AD) were more prevalent in Der p 23-sensitised children, including those with monomolecular but persistent sensitisation (11/97, 11\%). A higher exposure to mites in infancy and occurrence of AD before 5 years of age preceded the onset of Der p 23 sensitisation, which in turn preceded a higher incidence of asthma. Conclusions Der p 23 sensitisation peaks in late childhood and then decreases. It is preceded by early mite exposure and AD. Asthma and AR can occur in patients persistently sensitised to Der p 23 as the only mite allergen, suggesting the inclusion of molecular testing of Der p 23-sIgE for subjects with clinical suspicion of HDM allergy but without sIgE to other major D.pt. allergens.}, language = {en} } @article{SchleeNeffSimoesetal.2022, author = {Schlee, Winfried and Neff, Patrick and Simoes, Jorge and Langguth, Berthold and Schoisswohl, Stefan and Steinberger, Heidi and Norman, Marie and Spiliopoulou, Myra and Schobel, Johannes and Hannemann, Ronny and Pryss, R{\"u}diger}, title = {Smartphone-guided educational counseling and self-help for chronic tinnitus}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {7}, issn = {2077-0383}, doi = {10.3390/jcm11071825}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-267295}, year = {2022}, abstract = {Tinnitus is an auditory phantom perception in the ears or head in the absence of a corresponding external stimulus. There is currently no effective treatment available that reliably reduces tinnitus. Educational counseling is a treatment approach that aims to educate patients and inform them about possible coping strategies. For this feasibility study, we implemented educational material and self-help advice in a smartphone app. Participants used the educational smartphone app unsupervised during their daily routine over a period of four months. Comparing the tinnitus outcome measures before and after smartphone-guided treatment, we measured changes in tinnitus-related distress, but not in tinnitus loudness. Improvements on the Tinnitus Severity numeric rating scale reached an effect size of 0.408, while the improvements on the Tinnitus Handicap Inventory (THI) were much smaller with an effect size of 0.168. An analysis of user behavior showed that frequent and intensive use of the app is a crucial factor for treatment success: participants that used the app more often and interacted with the app intensively reported a stronger improvement in the tinnitus. Between study allocation and final assessment, 26 of 52 participants dropped out of the study. Reasons for the dropouts and lessons for future studies are discussed in this paper.}, language = {en} } @phdthesis{Riegler2022, author = {Riegler, Christoph Paul}, title = {Eine deutschsprachige Variante des Functioning Assessment Short Test (FAST): {\"U}bereinstimmung zwischen Selbsteinsch{\"a}tzung und Fremdeinsch{\"a}tzung}, doi = {10.25972/OPUS-28893}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-288931}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Die Erhebung der allt{\"a}glichen Funktionsf{\"a}higkeit mithilfe von Skalen zu instrumentellen Aktivit{\"a}ten des t{\"a}glichen Lebens (IADL) ist essenziell zur Erfassung der individuellen und gesellschaftlichen Konsequenzen von klinischen und subklinischen Erkrankungen. Im deutschsprachigen Raum existieren jedoch nur wenige validierte Instrumente zur Erfassung von IADL. Da all diese Skalen f{\"u}r ein geriatrisches Patientenkollektiv entwickelt wurden, haben sie wichtige Schw{\"a}chen in der Anwendung bei j{\"u}ngeren Patientengruppen (insbesondere die fehlende Erfassung beruflicher Funktionsf{\"a}higkeit). Aus diesem Grund wurde im Rahmen der vorliegenden Arbeit mit dem Functioning Assessment Short Test (FAST) ein bereits in mehreren Sprachen validiertes, f{\"u}r erwachsene Patienten jedweden Alters konzipiertes Instrument mit sehr guten psychometrischen Kennwerten ins Deutsche {\"u}bertragen und hinsichtlich Validit{\"a}t und Reliabilit{\"a}t untersucht. Die deutschsprachige Variante des FAST wurde durch standardisierte vorw{\"a}rts-r{\"u}ckw{\"a}rts-{\"U}bersetzung aus dem Englischen erstellt und ist als Selbstausf{\"u}llerfragebogen konzipiert. Die Skala enth{\"a}lt 23 ordinal skalierte Einzelitems, aus denen sich ein Summenscore berechnen l{\"a}sst, wobei h{\"o}here Werte f{\"u}r eine schlechtere allt{\"a}gliche Funktionsf{\"a}higkeit stehen. Der Fragebogen wurde zwischen 2017 und 2018 an insgesamt 120 Teilnehmern in W{\"u}rzburg und M{\"u}nster getestet, von denen 60 aus bev{\"o}lkerungsbasierten Kohortenstudien stammten und je 30 Patienten aufgrund eines isch{\"a}mischen Schlaganfalls oder einer akuten Depression station{\"a}r behandelt wurden. Als Maß f{\"u}r die Reliabilit{\"a}t des Instrumentes wurde die {\"U}bereinstimmung zwischen Selbst- und Fremdeinsch{\"a}tzung der allt{\"a}glichen Funktionsf{\"a}higkeit (Fremdeinsch{\"a}tzung durch Angeh{\"o}rige der Teilnehmer bzw. behandelnde {\"A}rzte / Psychologen) mithilfe des FAST gew{\"a}hlt. Die Validit{\"a}t der Skala wurde durch die Messung von Korrelationen des FAST Summenscores mit g{\"a}ngigen Skalen zu Depressivit{\"a}t (PHQ-D-9, CES-D), Angstsymptomatik (PHQ-GAD-7), gesundheitsbezogener Lebensqualit{\"a}t (SF-12, EQ-5D) und kognitiver Leistungsf{\"a}higkeit (MOCA) erhoben. Daneben erfolgte eine uni- und multivariate Regression zur Erhebung des Einflusses der o.g. Skalen und relevanter Vorerkrankungen auf den Summenscore des FAST. Die Reliabilit{\"a}tsanalyse zeigte f{\"u}r die Probanden aus der Allgemeinbev{\"o}lkerung ein moderates (ICC 0.50 (95\%-CI 0.64 - 0.54), f{\"u}r die Patienten mit akutem isch{\"a}mischem Schlaganfall ein gutes (ICC 0.65 (95\%-CI 0.55 - 0.75) und f{\"u}r die station{\"a}r behandelten Patienten mit Depression ein schlechtes Ergebnis (ICC 0.11 (95\%-CI 0.02 - 0.20). Hinsichtlich der Konstruktvalidit{\"a}t zeigte sich in der bev{\"o}lkerungsbasierten Stichprobe eine signifikante Korrelation des FAST Summenscores mit PHQ-D-9, CES-D, PHQ-GAD-7 und psychischer Summenskala der SF-12. In der univariablen Regression waren PHQ-D9, PHQ-GAD-7, psychische Summenskala des SF-12 und das Vorliegen von chronischem R{\"u}ckenschmerz signifikante Pr{\"a}diktoren f{\"u}r den FAST Summenscore. In der multivariablen Analyse verblieben SF-12 und chronischer R{\"u}ckenschmerz als signifikante Einflussfaktoren. In der Stichprobe von Patienten mit akutem isch{\"a}mischem Schlaganfall zeigte sich eine signifikante, negative Korrelation des FAST Summenscores mit dem MOCA. Zusammenfassend zeigte die deutschsprachige Variante des FAST moderate bis gute psychometrische Kennwerte in der Allgemeinbev{\"o}lkerung und bei Patienten mit akutem isch{\"a}mischem Schlaganfall, w{\"a}hrend die Ergebnisse bei station{\"a}r behandelten Patienten mit Depression schlecht waren. Aufgrund der kleinen Fallzahl der untersuchten Stichproben und des fehlenden Assessment von Test-Retest-Reliabilit{\"a}t sollten vor der breiten Anwendung des FAST im deutschsprachigen Raum weitere psychometrische Pr{\"u}fungen des Instruments erfolgen.}, language = {de} } @article{BolmZemskovZelleretal.2022, author = {Bolm, Louisa and Zemskov, Sergii and Zeller, Maria and Baba, Taisuke and Roldan, Jorge and Harrison, Jon M. and Petruch, Natalie and Sato, Hiroki and Petrova, Ekaterina and Lapshyn, Hryhoriy and Braun, Ruediger and Honselmann, Kim C. and Hummel, Richard and Dronov, Oleksii and Kirichenko, Alexander V. and Klinkhammer-Schalke, Monika and Kleihues-van Tol, Kees and Zeissig, Sylke R. and Rades, Dirk and Keck, Tobias and Fernandez-del Castillo, Carlos and Wellner, Ulrich F. and Wegner, Rodney E.}, title = {Concepts and outcomes of perioperative therapy in stage IA-III pancreatic cancer — a cross-validation of the National Cancer Database (NCDB) and the German Cancer Registry Group of the Society of German Tumor Centers (GCRG/ADT)}, series = {Cancers}, volume = {14}, journal = {Cancers}, number = {4}, issn = {2072-6694}, doi = {10.3390/cancers14040868}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-262174}, year = {2022}, abstract = {(1) Background: The aim of this study is to assess perioperative therapy in stage IA-III pancreatic cancer cross-validating the German Cancer Registry Group of the Society of German Tumor Centers — Network for Care, Quality, and Research in Oncology, Berlin (GCRG/ADT) and the National Cancer Database (NCDB). (2) Methods: Patients with clinical stage IA-III PDAC undergoing surgery alone (OP), neoadjuvant therapy (TX) + surgery (neo + OP), surgery+adjuvantTX (OP + adj) and neoadjuvantTX + surgery + adjuvantTX (neo + OP + adj) were identified. Baseline characteristics, histopathological parameters, and overall survival (OS) were evaluated. (3) Results: 1392 patients from the GCRG/ADT and 29,081 patients from the NCDB were included. Patient selection and strategies of perioperative therapy remained consistent across the registries for stage IA-III pancreatic cancer. Combined neo + OP + adj was associated with prolonged OS as compared to neo + OP alone (17.8 m vs. 21.3 m, p = 0.012) across all stages in the GCRG/ADT registry. Similarly, OS with neo + OP + adj was improved as compared to neo + OP in the NCDB registry (26.4 m vs. 35.4 m, p < 0.001). (4) Conclusion: The cross-validation study demonstrated similar concepts and patient selection criteria of perioperative therapy across clinical stages of PDAC. Neoadjuvant therapy combined with adjuvant therapy is associated with improved overall survival as compared to either therapy alone.}, language = {en} } @phdthesis{Sahiti2022, author = {Sahiti, Floran}, title = {Myocardial Work - Application and Clinical Characterization of a New Echocardiographic Tool}, doi = {10.25972/OPUS-28226}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282261}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {1 Summary Left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) are the most commonly used measures of LV function. Yet, they are highly dependent on loading conditions since higher afterload yields lower systolic deformation and thereby a lower LVEF and GLS - despite presumably unchanged LV myocardial contractile strength. Invasive pressure-volume loop measurements represent the reference standard to assess LV function, also considering loading conditions. However, this procedure cannot be used in serial investigations or large sample populations due to its invasive nature. The novel concept of echocardiography-derived assessment of myocardial work (MyW) is based on LV pressure-strain loops, may be a valuable alternative to overcome these challenges, and may also be used with relative ease in large populations. As MyW also accounts for afterload, it is considered less load-dependent than LVEF and GLS. The current PhD work addresses the application and clinical characterization of MyW, an innovative echocardiographic tool. As the method is new, we focused on four main topics: (a) To establish reference values for MyW indices, i.e., Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE); we addressed a wide age range and evaluated the association of MyW indices with age, sex and other clinical and echocardiography parameters in apparently cardiovascular healthy individuals. (b) To investigate the impact of cardiovascular (CV) risk factors on MyW indices and characterize the severity of subclinical LV deterioration in the general population. (c) To assess the association of the LV geometry, i.e., LV mass and dimensions, with MyW indices. (d) To evaluate in-hospital dynamics of MyW indices in patients hospitalized for acute heart failure (AHF). For the PhD thesis, we could make use of two larger cohorts: The STAAB population-based cohort study prospectively recruited and phenotyped a representative sample (5,000 individuals) of the general population of the City of W{\"u}rzburg, aged 30-79 years and free from symptomatic heart failure at the time of inclusion. We focused on the first half of the study sample (n=2473 individuals), which fulfilled the anticipated strata regarding age and sex. The Acute Heart Failure (AHF) Registry is a prospective clinical registry recruiting and phenotyping consecutive patients admitted for decompensated AHF to the Department of Medicine I, University Hospital W{\"u}rzburg, and observing the natural course of the disease. The AHF Registry focuses on the pathophysiological understanding, particularly in relation to the early phase after cardiac decompensation, with the aim to improve diagnosis and better-tailored treatment of patients with AHF. For the current study, we concentrated on patients who provided pairs of echocardiograms acquired early after index hospital admission and prior to discharge. The main findings of the PhD thesis were: From the STAAB cohort study, we determined the feasibility of large-scale MyW derivation and the accuracy of the method. We established reference values for MyW indices based on 779 analyzable, apparently healthy participants (mean age 49 ± 10 years, 59\% women), who were in sinus rhythm, free from CV risk factors or CV disease, and had no significant LV valve disease. Apart from GWI, there were no associations of other MyW indices with sex. Further, we found a disparate association with age, where MyW showed stable values until the age of 45 years, with an upward shift occurring beyond the age of 45. A higher age decade was associated with higher GWW and lower GWE, respectively. MyW indices only correlated weakly with common echocardiographic parameters, suggesting that MyW may add incremental information to clinically established parameters. Further analyses from the STAAB cohort study contributed to a better understanding of the impact of CV risk factors on MyW indices and the association of LV geometry with LV performance. We demonstrated that CV risk factors impacted selectively on GCW and GWW. Hypertension appears to profoundly compromise the work of the myocardium, in particular, by increasing both GCW and GWW. The LV in hypertension seems to operate at a higher energy level yet lower efficiency. Other classical CV risk factors (Diabetes mellitus, Obesity, Dyslipidemia, Smoking) - independent of blood pressure - impacted consistently and adversely on GCW but did not affect GWW. Further, all CV risk factors affected GWE adversely. We observed that any deviation from a normal LV geometric profile was associated with alterations on MyW. Of note, MyW was sensitive to early changes in LV mass and dimensions. Individuals with normal LV geometry yet established arterial hypertension exhibited a MyW pattern that is typically found in LV hypertrophy. Therefore, such a pattern might serve as an early sign of myocardial damage in hypertensive heart disease and might aid in risk stratification and primary prevention. From the AHF Registry, we selected individuals with serial in-hospital echocardiograms and described in-hospital changes in myocardial performance during recompensation. In patients presenting with a reduced ejection fraction (HFrEF), decreasing N-terminal pro-natriuretic peptide (NT-proBNP) levels as a surrogate of successful recompensation were associated with an improvement in GCW and GWI and consecutively in GWE. In contrast, in patients presenting with a preserved ejection fraction (HFpEF), there was no significant change in GCW and GWI. However, unsuccessful recompensation, i.e., no change or an increase in NT-proBNP levels, was associated with an increase in GWW. This suggests a differential myocardial response to de- and recompensation depending on the HF phenotype. Further, GWW as a surrogate of inappropriate LV energy consumption was elevated in all patients with AHF (compared to reference values) and was not associated with conventional markers as LVEF or NT-proBNP. In an exploratory analysis, GWW predicted the risk of death or rehospitalization within six months after discharge. Hence, GWW might carry incremental information beyond conventional markers of HF severity.}, language = {en} } @phdthesis{Stangl2022, author = {Stangl, Stephanie}, title = {Versorgung von Patientinnen und Patienten mit Brustkrebs in einer {\"u}berwiegend l{\"a}ndlich gepr{\"a}gten Region}, doi = {10.25972/OPUS-28247}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-282474}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {F{\"u}r die Diagnose und Therapie von Brustkrebs existiert die nationale evidenz- und konsensbasierte S3-Leitlinie. Die klinischen Krebsregister stellen sektor- und facharzt{\"u}bergreifende Diagnose- und Therapiedaten zur Qualit{\"a}tssicherung bereit. Bislang fehlen jedoch Daten bez{\"u}glich patient-reported outcome measures (PROMs). Aufgrund des demographischen Wandels werden Brustkrebserkrankungen vor allem in l{\"a}ndlichen Regionen weiter zunehmen, weshalb Versorgungsstrukturen f{\"u}r alle Patientinnen erreichbar sein sollten. Es wurde ein patientenorientiertes Registerkonzept (Breast Cancer Care for patients with metastatic disease (BRE-4-MED)) f{\"u}r den metastasierten Brustkrebs entwickelt und hinsichtlich vordefinierter Machbarkeitskriterien pilotiert. An der BRE-4-MED-Pilotstudie nahmen 31 Patientinnen (96.8\% weiblich) teil. Die bayernweite Erreichbarkeit zu brustkrebsspezifischen Versorgungsstrukturen wurde mithilfe einer Geographic Information System (GIS)-Analyse untersucht. Anhand von Leitlinienempfehlungen und Ergebnissen der BRE-4-MED-Pilotstudie wurden relevante Versorgungsstrukturen identifiziert. Die Ergebnisse der Pilotstudie zeigen, dass die Integration von Prim{\"a}r- und Sekund{\"a}rdaten aus verschiedenen Quellen in ein zentrales Studienregister machbar ist und die erforderlichen organisatorischen Prozesse (z. B. data linkage mit Krebsregister) funktionieren. Die Ergebnisse der Erreichbarkeitsanalyse verdeutlichen, dass es keine bayernweite Erreichbarkeit zu brustkrebsspezifischen Versorgungsstrukturen gibt. Am st{\"a}rksten war dieser Zusammenhang in grenznahen Regionen ausgepr{\"a}gt. Die vorliegende Arbeit zeigt Chancen f{\"u}r eine patientenorientierte, qualit{\"a}tsgesicherte Brustkrebsversorgung unabh{\"a}ngig vom Wohnort auf.}, subject = {Brustkrebs}, language = {de} } @article{SahitiMorbachCejkaetal.2022, author = {Sahiti, Floran and Morbach, Caroline and Cejka, Vladimir and Tiffe, Theresa and Wagner, Martin and Eichner, Felizitas A. and Gelbrich, G{\"o}tz and Heuschmann, Peter U. and St{\"o}rk, Stefan}, title = {Impact of cardiovascular risk factors on myocardial work-insights from the STAAB cohort study}, series = {Journal of Human Hypertension}, volume = {36}, journal = {Journal of Human Hypertension}, number = {3}, issn = {1476-5527}, doi = {10.1038/s41371-021-00509-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-271770}, pages = {235-245}, year = {2022}, abstract = {Myocardial work is a new echocardiography-based diagnostic tool, which allows to quantify left ventricular performance based on pressure-strain loops, and has been validated against invasively derived pressure-volume measurements. Myocardial work is described by its components (global constructive work [GCW], global wasted work [GWW]) and indices (global work index [GWI], global work efficiency [GWE]). Applying this innovative concept, we characterized the prevalence and severity of subclinical left ventricular compromise in the general population and estimated its association with cardiovascular (CV) risk factors. Within the Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study we comprehensively phenotyped a representative sample of the population of W{\"u}rzburg, Germany, aged 30-79 years. Indices of myocardial work were determined in 1929 individuals (49.3\% female, mean age 54 ± 12 years). In multivariable analysis, hypertension was associated with a mild increase in GCW, but a profound increase in GWW, resulting in higher GWI and lower GWE. All other CV risk factors were associated with lower GCW and GWI, but not with GWW. The association of hypertension and obesity with GWI was stronger in women. We conclude that traditional CV risk factors impact selectively and gender-specifically on left ventricular myocardial performance, independent of systolic blood pressure. Quantifying active systolic and diastolic compromise by derivation of myocardial work advances our understanding of pathophysiological processes in health and cardiac disease.}, language = {en} } @article{SommerAmrBavendieketal.2022, author = {Sommer, Kim K. and Amr, Ali and Bavendiek, Udo and Beierle, Felix and Brunecker, Peter and Dathe, Henning and Eils, J{\"u}rgen and Ertl, Maximilian and Fette, Georg and Gietzelt, Matthias and Heidecker, Bettina and Hellenkamp, Kristian and Heuschmann, Peter and Hoos, Jennifer D. E. and Keszty{\"u}s, Tibor and Kerwagen, Fabian and Kindermann, Aljoscha and Krefting, Dagmar and Landmesser, Ulf and Marschollek, Michael and Meder, Benjamin and Merzweiler, Angela and Prasser, Fabian and Pryss, R{\"u}diger and Richter, Jendrik and Schneider, Philipp and St{\"o}rk, Stefan and Dieterich, Christoph}, title = {Structured, harmonized, and interoperable integration of clinical routine data to compute heart failure risk scores}, series = {Life}, volume = {12}, journal = {Life}, number = {5}, issn = {2075-1729}, doi = {10.3390/life12050749}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-275239}, year = {2022}, abstract = {Risk prediction in patients with heart failure (HF) is essential to improve the tailoring of preventive, diagnostic, and therapeutic strategies for the individual patient, and effectively use health care resources. Risk scores derived from controlled clinical studies can be used to calculate the risk of mortality and HF hospitalizations. However, these scores are poorly implemented into routine care, predominantly because their calculation requires considerable efforts in practice and necessary data often are not available in an interoperable format. In this work, we demonstrate the feasibility of a multi-site solution to derive and calculate two exemplary HF scores from clinical routine data (MAGGIC score with six continuous and eight categorical variables; Barcelona Bio-HF score with five continuous and six categorical variables). Within HiGHmed, a German Medical Informatics Initiative consortium, we implemented an interoperable solution, collecting a harmonized HF-phenotypic core data set (CDS) within the openEHR framework. Our approach minimizes the need for manual data entry by automatically retrieving data from primary systems. We show, across five participating medical centers, that the implemented structures to execute dedicated data queries, followed by harmonized data processing and score calculation, work well in practice. In summary, we demonstrated the feasibility of clinical routine data usage across multiple partner sites to compute HF risk scores. This solution can be extended to a large spectrum of applications in clinical care.}, language = {en} } @article{JirůHillmannGabrielSchuleretal.2022, author = {J{\´i}rů-Hillmann, Steffi and Gabriel, Katharina M. A. and Schuler, Michael and Wiedmann, Silke and M{\"u}hler, Johannes and D{\"o}tter, Klaus and Soda, Hassan and Rascher, Alexandra and Benesch, Sonka and Kraft, Peter and Pfau, Mathias and Stenzel, Joachim and von Nippold, Karin and Benghebrid, Mohamed and Schulte, Kerstin and Meinck, Ralf and Volkmann, Jens and Haeusler, Karl Georg and Heuschmann, Peter U.}, title = {Experiences of family caregivers 3-months after stroke: results of the prospective trans-regional network for stroke intervention with telemedicine registry (TRANSIT-Stroke)}, series = {BMC Geriatrics}, volume = {22}, journal = {BMC Geriatrics}, doi = {10.1186/s12877-022-02919-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313330}, year = {2022}, abstract = {Background Long-term support of stroke patients living at home is often delivered by family caregivers (FC). We identified characteristics of stroke patients being associated with receiving care by a FC 3-months (3 M) after stroke, assessed positive and negative experiences and individual burden of FC caring for stroke patients and determined factors associated with caregiving experiences and burden of FC 3 M after stroke. Methods Data were collected within TRANSIT-Stroke, a regional telemedical stroke-network comprising 12 hospitals in Germany. Patients with stroke/TIA providing informed consent were followed up 3 M after the index event. The postal patient-questionnaire was accompanied by an anonymous questionnaire for FC comprising information on positive and negative experiences of FC as well as on burden of caregiving operationalized by the Caregiver Reaction Assessment and a self-rated burden-scale, respectively. Multivariable logistic and linear regression analyses were performed. Results Between 01/2016 and 06/2019, 3532 patients provided baseline and 3 M-follow-up- data and 1044 FC responded to questionnaires regarding positive and negative caregiving experiences and caregiving burden. 74.4\% of FC were older than 55 years, 70.1\% were women and 67.5\% were spouses. Older age, diabetes and lower Barthel-Index in patients were significantly associated with a higher probability of receiving care by a FC at 3 M. Positive experiences of FC comprised the importance (81.5\%) and the privilege (70.0\%) of caring for their relative; negative experiences of FC included financial difficulties associated with caregiving (20.4\%). Median overall self-rated burden was 30 (IQR: 0-50; range 0-100). Older age of stroke patients was associated with a lower caregiver burden, whereas younger age of FC led to higher burden. More than half of the stroke patients in whom a FC questionnaire was completed did self-report that they are not being cared by a FC. This stroke patient group tended to be younger, more often male with less severe stroke and less comorbidities who lived more often with a partner. Conclusions The majority of caregivers wanted to care for their relatives but experienced burden at the same time. Elderly patients, patients with a lower Barthel Index at discharge and diabetes are at higher risk of needing care by a family caregiver. Trial registration The study was registered at "German Clinical Trial Register": DRKS00011696. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML\&TRIAL_ID=DRKS00011696}, language = {en} } @article{HessMengSchulteetal.2022, author = {Heß, Verena and Meng, Karin and Schulte, Thomas and Neuderth, Silke and Bengel, J{\"u}rgen and Faller, Hermann and Schuler, Michael}, title = {Decreased mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs: A longitudinal analysis}, series = {Psycho-Oncology}, volume = {31}, journal = {Psycho-Oncology}, number = {5}, doi = {10.1002/pon.5856}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-257662}, pages = {725-734}, year = {2022}, abstract = {Background Cancer patients' mental health and quality of life can be improved through professional support according to their needs. In previous analyses of the UNSAID study, we showed that a relevant proportion of cancer patients did not express their needs during the admission interview of inpatient rehabilitation. We now examine trajectories of mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs. Methods We enrolled 449 patients with breast, prostate, and colon cancer at beginning (T0) and end (T1) of a 3-week inpatient rehabilitation and 3 (T2) and 9 (T3) months after discharge. We explored depression (PHQ-2), anxiety (GAD-2), emotional functioning (EORTC QLQ-C30), fear of progression (FoP-Q-SF), and global quality of life (EORTC QLQ-C30) using structuring equation models. Furthermore, we evaluated self-reports about expressing needs and utilization of professional help at follow-up. Results Patients with unexpressed needs (24.3\%, n = 107) showed decreased mental health compared to other patients (e.g., depression: d T0 = 0.32, d T1-T3 = 0.39). They showed a significant decline in global quality of life at discharge and follow-up (d = 0.28). Furthermore, they had a higher need for support (Cramer's V T2 = 0.10, T3 = 0.15), talked less about their needs (Cramer's V T2 = 0.18), and made less use of different health care services at follow-up. Conclusion Unexpressed needs in cancer patients may be a risk factor for decreased mental health, quality of life, and non-utilization of professional help in the long term. Further research should clarify causal relationships and focus on this specific group of patients to improve cancer care.}, language = {en} } @article{TuetuencueOlmaKunzeetal.2022, author = {T{\"u}t{\"u}nc{\"u}, Serdar and Olma, Manuel C. and Kunze, Claudia and Kr{\"a}mer, Michael and Dietzel, Joanna and Schurig, Johannes and Filser, Paula and Pfeilschifter, Waltraud and Hamann, Gerhard F. and B{\"u}ttner, Thomas and Heuschmann, Peter U. and Kirchhof, Paulus and Laufs, Ulrich and Nabavi, Darius G. and R{\"o}ther, Joachim and Thomalla, G{\"o}tz and Veltkamp, Roland and Eckardt, Kai-Uwe and Haeusler, Karl Georg and Endres, Matthias}, title = {Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack}, series = {European Journal of Neurology}, volume = {29}, journal = {European Journal of Neurology}, number = {9}, doi = {10.1111/ene.15431}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-287271}, pages = {2716 -- 2724}, year = {2022}, abstract = {Background and purpose Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction. Methods The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD-EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m\(^{2}\). eGFR dynamics were classified based on two in-hospital values as "stable normal" (≥60 ml/min/1.73 m\(^{2}\)), "increasing" (by at least 15\% from baseline, second value ≥ 60 ml/min/1.73 m\(^{2}\)), "decreasing" (by at least 15\% from baseline of ≥60 ml/min/1.73 m\(^{2}\)), and "stable decreased" (<60 ml/min/1.73 m\(^{2}\)). The composite endpoint (stroke, major bleeding, myocardial infarction, all-cause death) was assessed after 24 months. We estimated hazard ratios in confounder-adjusted models. Results Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m\(^{2}\) at baseline (hazard ratio [HR] = 2.2, 95\% confidence interval [CI] = 1.40-3.54) as well as decreasing (HR = 1.79, 95\% CI = 1.07-2.99) and stable decreased eGFR (HR = 1.64, 95\% CI = 1.20-2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95\% CI = 1.51-6.10) and decreasing eGFR were associated with all-cause death (HR = 3.12, 95\% CI = 1.63-5.98). Conclusions In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.}, language = {en} } @article{JansonWillekeZaibertetal.2022, author = {Janson, Patrick and Willeke, Kristina and Zaibert, Lisa and Budnick, Andrea and Bergh{\"o}fer, Anne and Kittel-Schneider, Sarah and Heuschmann, Peter U. and Zapf, Andreas and Wildner, Manfred and Stupp, Carolin and Keil, Thomas}, title = {Mortality, morbidity and health-related outcomes in informal caregivers compared to non-caregivers: a systematic review}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, number = {10}, issn = {1660-4601}, doi = {10.3390/ijerph19105864}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-275219}, year = {2022}, abstract = {A systematic overview of mental and physical disorders of informal caregivers based on population-based studies with good methodological quality is lacking. Therefore, our aim was to systematically summarize mortality, incidence, and prevalence estimates of chronic diseases in informal caregivers compared to non-caregivers. Following PRISMA recommendations, we searched major healthcare databases (CINAHL, MEDLINE and Web of Science) systematically for relevant studies published in the last 10 years (without language restrictions) (PROSPERO registration number: CRD42020200314). We included only observational cross-sectional and cohort studies with low risk of bias (risk scores 0-2 out of max 8) that reported the prevalence, incidence, odds ratio (OR), hazard ratio (HR), mean- or sum-scores for health-related outcomes in informal caregivers and non-caregivers. For a thorough methodological quality assessment, we used a validated checklist. The synthesis of the results was conducted by grouping outcomes. We included 22 studies, which came predominately from the USA and Europe. Informal caregivers had a significantly lower mortality than non-caregivers. Regarding chronic morbidity outcomes, the results from a large longitudinal German health-insurance evaluation showed increased and statistically significant incidences of severe stress, adjustment disorders, depression, diseases of the spine and pain conditions among informal caregivers compared to non-caregivers. In cross-sectional evaluations, informal caregiving seemed to be associated with a higher occurrence of depression and of anxiety (ranging from 4 to 51\% and 2 to 38\%, respectively), pain, hypertension, diabetes and reduced quality of life. Results from our systematic review suggest that informal caregiving may be associated with several mental and physical disorders. However, these results need to be interpreted with caution, as the cross-sectional studies cannot determine temporal relationships. The lower mortality rates compared to non-caregivers may be due to a healthy-carer bias in longitudinal observational studies; however, these and other potential benefits of informal caregiving deserve further attention by researchers.}, language = {en} }