TY - JOUR A1 - Zetzl, Teresa A1 - Schuler, Michael A1 - Renner, Agnes A1 - Jentschke, Elisabeth A1 - van Oorschot, Birgitt T1 - Yoga intervention and reminder e-mails for reducing cancer-related fatigue - a study protocol of a randomized controlled trial JF - BMC Psychology N2 - Background Almost 90% of cancer patients suffer from symptoms of fatigue during treatment. Supporting treatments are increasingly used to alleviate the burden of fatigue. This study examines the short-term and long-term effects of yoga on fatigue and the effect of weekly reminder e-mails on exercise frequency and fatigue symptoms. Methods The aim of the first part of the study will evaluate the effectiveness of yoga for cancer patients with mixed diagnoses reporting fatigue. We will randomly allocate 128 patients to an intervention group (N = 64) receiving yoga and a wait-list control group (N = 64) receiving yoga 9 weeks later. The yoga therapy will be performed in weekly sessions of 60 min each for 8 weeks. The primary outcome will be self-reported fatigue symptoms. In the second part of the study, the effectiveness of reminder e-mails with regard to the exercise frequency and self-reported fatigue symptoms will be evaluated. A randomized allocated group of the participants (“email”) receives weekly reminder e-mails, the other group does not. Data will be assessed using questionnaires the beginning and after yoga therapy as well as after 6  months. Discussion Support of patients suffering from fatigue is an important goal in cancer patients care. If yoga therapy will reduce fatigue, this type of therapy may be introduced into routine practice. If the reminder e-mails prove to be helpful, new offers for patients may also develop from this. KW - Cancer KW - Fatigue KW - Yoga KW - Reminder e-mails KW - Supportive therapy Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202268 VL - 7 ER - TY - JOUR A1 - Yurdadogan, Tino A1 - Malsch, Carolin A1 - Kotseva, Kornelia A1 - Wood, David A1 - Leyh, Rainer A1 - Ertl, Georg A1 - Karmann, Wolfgang A1 - Müller-Scholden, Lara A1 - Morbach, Caroline A1 - Breuning, Margret A1 - Wagner, Martin A1 - Gelbrich, Götz A1 - Bots, Michiel L. A1 - Heuschmann, Peter U. A1 - Störk, Stefan T1 - Functional versus morphological assessment of vascular age in patients with coronary heart disease JF - Scientific Reports N2 - Communicating cardiovascular risk based on individual vascular age (VA) is a well acknowledged concept in patient education and disease prevention. VA may be derived functionally, e.g. by measurement of pulse wave velocity (PWV), or morphologically, e.g. by assessment of carotid intima-media thickness (cIMT). The purpose of this study was to investigate whether both approaches produce similar results. Within the context of the German subset of the EUROASPIRE IV survey, 501 patients with coronary heart disease underwent (a) oscillometric PWV measurement at the aortic, carotid-femoral and brachial-ankle site (PWVao, PWVcf, PWVba) and derivation of the aortic augmentation index (AIao); (b) bilateral cIMT assessment by high-resolution ultrasound at three sites (common, bulb, internal). Respective VA was calculated using published equations. According to VA derived from PWV, most patients exhibited values below chronological age indicating a counterintuitive healthier-than-anticipated vascular status: for VA(PWVao) in 68% of patients; for VA\(_{AIao}\) in 52% of patients. By contrast, VA derived from cIMT delivered opposite results: e.g. according to VA\(_{total-cIMT}\) accelerated vascular aging in 75% of patients. To strengthen the concept of VA, further efforts are needed to better standardise the current approaches to estimate VA and, thereby, to improve comparability and clinical utility. KW - arterial stiffening KW - atherosclerosis KW - calcification KW - carotid artery disease Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265810 VL - 11 IS - 1 ER - TY - THES A1 - Yurdadogan, Tino T1 - Endorganschaden und Gefäßalter bei Patienten mit koronarer Herzkrankheit T1 - End organ damage and vascular age in patients with coronary artery disease N2 - Die nicht-invasive Gefäßdiagnostik stellt einen wichtigen Pfeiler in der Prävention von Herz-Kreislauferkrankungen dar. Während lange Zeit die sonographische Messung der cIMT, als morphologisches Korrelat der Gefäßalterung, als Goldstandard galt, ist in den letzten Jahren in Gestalt der Pulswellenanalyse/PWV-Messung eine Technik weiterentwickelt worden, die, als funktionelles Korrelat der Gefäßalterung, aufgrund der leichteren Durchführbarkeit und geringerer Untersucherabhängigkeit und Kosten vielversprechend ist. So erlaubt die Messung der Pulswelle mittels gewöhnlicher Blutdruckmanschetten, genau wie die cIMT, die Berechnung des individuellen Gefäßalters und die Diagnostik für das Vorliegen eines Endorganschadens der Blutgefäße. Um die Messergebnisse der beiden Untersuchungen miteinander zu vergleichen, wurden beide in der EUROASPIRE-IV Studie an Patienten mit koronarer Herzkrankheit durchgeführt. Die Auswertung der Messergebnisse der mit dem Vascular Explorer durchgeführten Pulswellenanalyse/PWV-Messung ergab überraschenderweise, dass die Mehrheit der herzkranken Patienten weder eine vaskuläre Voralterung noch einen Endorganschaden der Blutgefäße aufweisen. Im Falle der cIMT-Messung war Gegenteiliges der Fall, was trotz der medikamentösen Therapie der Patienten so zu erwarten war. Weiterhin zeigte sich lediglich eine geringe Korrelation zwischen den Messergebnissen beider Untersuchungen. Die Determinanten der einzelnen Messwerte aus cIMT und Pulswellenanalyse/PWV-Messung waren deckungsgleich mit den in der Literatur beschriebenen Faktoren, wenn auch viele der sonst signifikanten Regressoren das Signifikanzniveau in unserer Auswertung nicht unterschritten. Eine Limitation der funktionellen Gefäßdiagnostik liegt derzeit darin, dass die Messergebnisse stark von dem verwendeten Messgerät abhängen. Es liegen noch zu wenig Vergleichsstudien vor, um die Messergebnisse, speziell von neueren Geräten wie dem Vascular Explorer, auf andere zu übertragen. Bei der Berechnung des Gefäßalters sollten daher optimalerweise gerätespezifische Normwerte vorliegen, was beim Vascular Explorer nicht der Fall ist. Gleiches gilt für die Verwendung des PWVcf-Grenzwerts für die Diagnose eines Endorganschadens der Blutgefäße. Analog hat auch die Messung der cIMT gewisse Einschränkungen. So wäre eine weitere Standardisierung der Messorte (A. carotis communis vs Bulbus vs A. carotis interna), zwischen denen sich die durchschnittliche cIMT erheblich unterscheidet, sowie der Messparameter (Minimal- vs Maximal- vs Mittelwert) wünschenswert. Die universelle Anwendung eines cIMT-Grenzwerts zur Diagnose eines Endorganschadens der Blutgefäße ist daher kritisch zu sehen. Dies zeigt sich auch darin, dass in den neuesten Leitlinien der bislang geltende Grenzwert angezweifelt und kein aktuell gültiger Grenzwert mehr genannt wird. Wir interpretieren unsere Ergebnisse dahingehend, dass unsere Messung der cIMT die zu erwartende pathologische Gefäßalterung bei Patienten mit koronarer Herzkrankheit besser widerspiegelt als die Messung der Pulswelle mit dem Vascular Explorer. Welche der beiden Untersuchungen hinsichtlich der prognostischen Wertigkeit überlegen ist, muss im Rahmen von Längsschnittstudien geklärt werden. N2 - Non-invasive vascular diagnostics play an important role in the prevention of cardiovascular diseases. For a long time, sonographic measurement of the cIMT was considered the gold standard. Yet, by continually developing the PWA/PWV measurement, a promising technique is available, that is easy to handle and has better inter-examiner reproducibility at lower costs. Just like the cIMT examination, recording and analysing the pulse wave via blood pressure cuffs allows the determination of the individual vascular age and to diagnose end organ damage of the arteries. In order to compare the results of both examinations, they were performed during the EUROASPIRE IV-study in patients with coronary artery disease. Despite being under medication, we expected to find early vascular aging in most patients. Surprisingly, according to the results of the PWA/PWV measurement with the Vascular Explorer device, most of the study population neither showed early vascular aging nor met the criteria for end organ damage of the arteries. cIMT measurements delivered the opposite results. Moreover, we found only poor correlation between the measured values of both examinations. Regression analysis yielded determinants of cIMT and PWA/PWV measurement, which were largely congruent with those described in literature. The most apparent weakness of evaluating the vascular status by means of PWA/PWV measurement lies in the poor inter-device comparability. Due to a lack of comparative studies with large sample sizes, measured values of different devices are currently not transferable. Nonetheless, reference values used for vascular age determination with the Vascular Explorer are available in a study using a different device. Furthermore, the PWV threshold for diagnosing end organ damage is applied regardless of the technique/device used for measurement, although an adjustment is urgently needed. Similarly, the cIMT measurement has certain limitations as efforts can still be made to better standardise examination protocols (e.g. sites of measurement (Common Carotid Artery vs Bulb vs Internal Carotid artery), obtained values (minimum vs maximum vs mean)). The formerly valid cIMT threshold is currently being called into question by the latest guidelines, as there is evidence of its underestimation. Ultimately, cIMT measurement better reflects the expected early vascular aging in patients with coronary artery disease than PWA/PWV measurement with the Vascular Explorer. However, longitudinal studies are necessary to further evaluate the prognostic value of both examinations. KW - Arteriosklerose KW - Pulswelle KW - Koronare Herzkrankheit KW - Endorganschaden KW - Gefäßalter KW - Carotis Intima Media Dicke Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218469 ER - TY - JOUR A1 - Winter, Michael A1 - Pryss, Rüdiger A1 - Probst, Thomas A1 - Reichert, Manfred T1 - Towards the applicability of measuring the electrodermal activity in the context of process model comprehension: feasibility study JF - Sensors N2 - Process model comprehension is essential in order to understand the five Ws (i.e., who, what, where, when, and why) pertaining to the processes of organizations. However, research in this context showed that a proper comprehension of process models often poses a challenge in practice. For this reason, a vast body of research exists studying the factors having an influence on process model comprehension. In order to point research towards a neuro-centric perspective in this context, the paper at hand evaluates the appropriateness of measuring the electrodermal activity (EDA) during the comprehension of process models. Therefore, a preliminary test run and a feasibility study were conducted relying on an EDA and physical activity sensor to record the EDA during process model comprehension. The insights obtained from the feasibility study demonstrated that process model comprehension leads to an increased activity in the EDA. Furthermore, EDA-related results indicated significantly that participants were confronted with a higher cognitive load during the comprehension of complex process models. In addition, the experiences and limitations we learned in measuring the EDA during the comprehension of process models are discussed in this paper. In conclusion, the feasibility study demonstrated that the measurement of the EDA could be an appropriate method to obtain new insights into process model comprehension. KW - process model KW - process model comprehension KW - electrodermal activity KW - sensor Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-211276 SN - 1424-8220 VL - 20 IS - 16 ER - TY - JOUR A1 - Winter, Michael A1 - Pryss, Rüdiger A1 - Probst, Thomas A1 - Reichert, Manfred T1 - Applying Eye Movement Modeling Examples to guide novices' attention in the comprehension of process models JF - Brain Sciences N2 - Process models are crucial artifacts in many domains, and hence, their proper comprehension is of importance. Process models mediate a plethora of aspects that are needed to be comprehended correctly. Novices especially face difficulties in the comprehension of process models, since the correct comprehension of such models requires process modeling expertise and visual observation capabilities to interpret these models correctly. Research from other domains demonstrated that the visual observation capabilities of experts can be conveyed to novices. In order to evaluate the latter in the context of process model comprehension, this paper presents the results from ongoing research, in which gaze data from experts are used as Eye Movement Modeling Examples (EMMEs) to convey visual observation capabilities to novices. Compared to prior results, the application of EMMEs improves process model comprehension significantly for novices. Novices achieved in some cases similar performances in process model comprehension to experts. The study's insights highlight the positive effect of EMMEs on fostering the comprehension of process models. KW - Business Process Models KW - Process Model Comprehension KW - Eye Movement Modeling Examples KW - eye tracking KW - human-centered design KW - cognition Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-222966 SN - 2076-3425 VL - 11 IS - 1 ER - TY - JOUR A1 - Willeke, Kristina A1 - Janson, Patrick A1 - Zink, Katharina A1 - Stupp, Carolin A1 - Kittel-Schneider, Sarah A1 - Berghöfer, Anne A1 - Ewert, Thomas A1 - King, Ryan A1 - Heuschmann, Peter U. A1 - Zapf, Andreas A1 - Wildner, Manfred A1 - Keil, Thomas T1 - Occurrence of mental illness and mental health risks among the self-employed: a systematic review JF - International Journal of Environmental Research and Public Health N2 - We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed. KW - incidence KW - mental disorders KW - mental health KW - mental illness KW - prevalence KW - self-employed KW - small business KW - systematic review Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-245085 SN - 1660-4601 VL - 18 IS - 16 ER - TY - JOUR A1 - Wiedmann, Silke A1 - Heuschmann, Peter U. A1 - Hillmann, Steffi A1 - Busse, Otto A1 - Wiethoelter, Horst A1 - Walter, Georg M. A1 - Seidel, Guenter A1 - Misselwitz, Bjoern A1 - Janssen, Alfred A1 - Berger, Klaus A1 - Burmeister, Christoph A1 - Matthias, Christine A1 - Kolominsky-Rabas, Peter A1 - Hermanek, Peter T1 - The Quality of Acute Stroke Care-an Analysis of Evidence-Based Indicators in 260 000 Patients JF - Deutsches Ärzteblatt International N2 - Background: Stroke patients should be cared for in accordance with evidence-based guidelines. The extent of implementation of guidelines for the acute care of stroke patients in Germany has been unclear to date. Methods: The regional quality assurance projects that cooperate in the framework of the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall-Register, ADSR) collected data on the care of stroke patients in 627 hospitals in 2012. The quality of the acute hospital care of patients with stroke or transient ischemic attack (TIA) was assessed on the basis of 15 standardized, evidence-based quality indicators and compared across the nine participating regional quality assurance projects. Results: Data were obtained on more than 260 000 patients nationwide. Intravenous thrombolysis was performed in 59.7% of eligible ischemic stroke patients patients (range among participating projects, 49.7-63.6%). Dysphagia screening was documented in 86.2% (range, 74.8-93.1%). For the following indicators, the defined targets were not reached for all of Germany: antiaggregation within 48 hours, 93.4% (range, 86.6-96.4%); anticoagulation for atrial fibrillation, 77.6% (range, 72.4-80.1%); standardized dysphagia screening, 86.2% (range, 74.8-93.1%); oral and written information of the patients or their relatives, 86.1% (range, 75.4-91.5%). The rate of patients examined or treated by a speech therapist was in the target range. Conclusion: The defined targets were reached for most of the quality indicators. Some indicators, however, varied widely across regional quality assurance projects. This implies that the standardization of care for stroke patients in Germany has not yet been fully achieved. KW - Hesse KW - study-group ADSR KW - ischemic-stroke KW - Germany KW - implementation KW - rehabilitation Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-114747 SN - 1866-0452 VL - 111 IS - 45 ER - TY - JOUR A1 - Wiedmann, Silke A1 - Heuschmann, Peter U. A1 - Hermanek, Peter T1 - In reply: The quality of acute stroke treatment-an analysis of evidence-based indicators in 260 000 patients JF - Deutsches Aerzteblatt International N2 - No abstract available. KW - acute stroke KW - treatment Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-148666 VL - 112 ER - TY - JOUR A1 - Wetzel, Britta A1 - Pryss, Rüdiger A1 - Baumeister, Harald A1 - Edler, Johanna-Sophie A1 - Gonçalves, Ana Sofia Oliveira A1 - Cohrdes, Caroline T1 - “How come you don’t call me?” Smartphone communication app usage as an indicator of loneliness and social well-being across the adult lifespan during the COVID-19 pandemic JF - International Journal of Environmental Research and Public Health N2 - Loneliness and lack of social well-being are associated with adverse health outcomes and have increased during the COVID-19 pandemic. Smartphone communication data have been suggested to help monitor loneliness, but this requires further evidence. We investigated the informative value of smartphone communication app data for predicting subjective loneliness and social well-being in a sample of 364 participants ranging from 18 to 78 years of age (52.2% female; mean age = 42.54, SD = 13.22) derived from the CORONA HEALTH APP study from July to December 2020 in Germany. The participants experienced relatively high levels of loneliness and low social well-being during the time period characterized by the COVID-19 pandemic. Apart from positive associations with phone call use times, smartphone communication app use was associated with social well-being and loneliness only when considering the age of participants. Younger participants with higher use times tended to report less social well-being and higher loneliness, while the opposite association was found for older adults. Thus, the informative value of smartphone communication use time was rather small and became evident only in consideration of age. The results highlight the need for further investigations and the need to address several limitations in order to draw conclusions at the population level. KW - loneliness KW - social well-being KW - passive data KW - app KW - smartphone communication KW - COVID-19 KW - social media use KW - age differences KW - public mental health KW - mental health monitoring Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241033 SN - 1660-4601 VL - 18 IS - 12 ER - TY - JOUR A1 - Weiß, Martin A1 - Gründahl, Marthe A1 - Deckert, Jürgen A1 - Eichner, Felizitas A. A1 - Kohls, Mirjam A1 - Störk, Stefan A1 - Heuschmann, Peter U. A1 - Hein, Grit T1 - Differential network interactions between psychosocial factors, mental health, and health-related quality of life in women and men JF - Scientific Reports N2 - Psychosocial factors affect mental health and health-related quality of life (HRQL) in a complex manner, yet gender differences in these interactions remain poorly understood. We investigated whether psychosocial factors such as social support and personal and work-related concerns impact mental health and HRQL differentially in women and men during the first year of the COVID-19 pandemic. Between June and October 2020, the first part of a COVID-19-specific program was conducted within the “Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB)” cohort study, a representative age- and gender-stratified sample of the general population of Würzburg, Germany. Using psychometric networks, we first established the complex relations between personal social support, personal and work-related concerns, and their interactions with anxiety, depression, and HRQL. Second, we tested for gender differences by comparing expected influence, edge weight differences, and stability of the networks. The network comparison revealed a significant difference in the overall network structure. The male (N = 1370) but not the female network (N = 1520) showed a positive link between work-related concern and anxiety. In both networks, anxiety was the most central variable. These findings provide further evidence that the complex interplay of psychosocial factors with mental health and HRQL decisively depends on gender. Our results are relevant for the development of gender-specific interventions to increase resilience in times of pandemic crisis. KW - anxiety KW - depression KW - human behaviour KW - quality of life Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357858 VL - 13 ER - TY - THES A1 - Wahl, Valerie Elisabeth T1 - Empfehlungen zu Lebensstilveränderungen und deren Umsetzung nach einem koronaren Ereignis - Ergebnisse der EUROASPIRE IV-Studie im Raum Würzburg T1 - Recommendations on lifestyle changes and their implementation after a coronary event – Results from the EUROASPIRE IV survey in the Würzburg region N2 - Die koronare Herzkrankheit ist weltweit die häufigste Todesursache und belastet die Gesellschaft durch Therapien und Arbeitsausfälle mit hohen Kosten. Die Europäischen Gesellschaft für Kardiologie empfiehlt in den Leitlinien zur Sekundärprävention der koronaren Herzkrankheit verschiedene Lebensstiländerungen. In der vorliegenden Arbeit wurde untersucht, wie häufig diese Empfehlungen tatsächlich gegeben werden, ob diese von den Patienten umgesetzt werden und welche Faktoren den Erhalt der Empfehlung bzw. die Umsetzung beeinflussen. Hierzu wurden 536 Probanden mit bekannter KHK aus dem Raum Würzburg im Rahmen der multizentrischen Querschnittsstudie EUROASPIRE IV befragt und untersucht. Es konnte gezeigt werden, dass die Empfehlungen insgesamt viel zu selten gegeben werden. Als positiver Einflussfaktor für den Erhalt einer Empfehlung konnte die Teilnahme an einem Rehabilitationsprogramm identifiziert werden. Die Wahrscheinlichkeit, die Empfehlungen zu erhalten, sank zudem mit zunehmendem Alter bei Erstdiagnose der KHK. Diese Erkenntnisse können in Zukunft dabei helfen, die Aufklärung über die Risikofaktoren insgesamt und besonders bei älteren Menschen zu intensivieren. Sie untermauern zudem die große Bedeutung eines Rehabilitationsprogrammes bei der Informationsvermittlung. Auch die Umsetzung der empfohlenen Lebensstilveränderungen erfolgte nicht in zufriedenstellender Häufigkeit. Für die Beendigung des Rauchens konnte die Teilnahme an einem Rehabilitationsprogramm als größter Einflussfaktor ermittelt werden. Die Wahrscheinlichkeit, dass die verschiedenen Maßnahmen zu Lebensstilveränderungen umgesetzt werden, war beim weiblichen Geschlecht deutlich höher als beim männlichen. Die Umsetzung wurde zudem dadurch beeinflusst, ob der Patient vorher die entsprechende Empfehlung erhalten hatte. Die Daten zeigen somit auch bei der Umsetzung der Maßnahmen die Bedeutung von Rehabilitationsprogrammen, besonders für Raucher, und verdeutlichen, dass vor allem bei Männern weitere Anreize geschaffen werden müssen, damit diese die Empfehlungen zur Lebensstiländerung auch umsetzen. Dass viel mehr Probanden die Maßnahmen umgesetzt haben, wenn sie vorher die entsprechende Empfehlung erhalten haben, unterstreicht die außerordentliche Wichtigkeit der umfassenden Aufklärung des Patienten über die existentiellen Chancen eines Lebensstilwandels. N2 - Coronary heart disease (CHD) is the leading cause of death worldwide and is a burden for the society with high costs through therapies and absenteeisms. The European Society of Cardiology recommends various lifestyle changes in their guidelines on cardiovascular disease prevention. The present work investigates the frequency of recommendations given by physicians, the implementation by the patients and the factors affecting both the receipt and the implementation of these recommendations. Therefore, 536 participants with a known CHD in the Würzburg region were interviewed and examined within the German subset of the multicenter cross-sectional EUROASPIRE IV survey. The results showed that recommendations are given infrequently. The attendance of a rehabilitation program was determined as a positive factor for the receipt of a recommendation. With increasing age at initial diagnosis of CHD, the receipt of a recommendation was less likely. These findings may help intensify the education about the risk factors overall and particularly for older people. Furthermore, the findings corroborate the importance of a rehabilitation program to impart information about lifestyle changes. The recommended lifestyle changes were also implemented infrequently. As the primary factor to stop smoking, the attendance of a rehabilitation program was identified. The implementation of various lifestyle changes was more likely in female than in male patients. Moreover, the receipt of a recommendation affected the implementation. The importance of rehabilitation programs for the implementation of lifestyle changes is shown particularly for current smokers. Male patients must be further incentivised to implement the recommended lifestyle changes. The exceptional importance of comprehensive education about the existential opportunities of lifestyle changes is underlined by the fact that significantly more patients implemented lifestyle changes after a given recommendation. KW - Koronare Herzkrankheit KW - Sekundärprävention KW - Lebensstilveränderung Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200203 ER - TY - JOUR A1 - Wagner, Martin A1 - Wanner, Christoph A1 - Schich, Martin A1 - Kotseva, Kornelia A1 - Wood, David A1 - Hartmann, Katrin A1 - Fette, Georg A1 - Rücker, Viktoria A1 - Oezkur, Mehmet A1 - Störk, Stefan A1 - Heuschmann, Peter U. T1 - Patient’s and physician’s awareness of kidney disease in coronary heart disease patients – a cross-sectional analysis of the German subset of the EUROASPIRE IV survey JF - BMC Nephrology N2 - Background Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician’s awareness of kidney disease of patients hospitalized for CHD and also the patient’s awareness of CKD in a study visit following hospital discharge. Methods All serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFR\(_{CKD-EPI}\) < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician’s awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician. Results Of the 536 patients, 32% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22%, and 72% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35% had impaired kidney function. Of 158 patients with kidney disease, 54 (34%) were aware of CKD. Determinants of patient’s awareness were severity of CKD (OR\(_{eGFR}\) 0.94; 95%CI 0.92–0.96), obesity (OR 1.97; 1.07–3.64), history of heart failure (OR 1.99; 1.00–3.97), and mentioning of kidney disease in the index event’s hospital discharge letter (OR 5.51; 2.35–12.9). Conclusions Although CKD is frequent in CHD, only one third of patients is aware of this condition. Patient’s awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician’s awareness for kidney dysfunction may improve patient’s awareness of CKD. KW - coronary heart disease KW - ICD-coding of CKD KW - chronic kidney disease KW - patients’ awareness KW - physicians’ awareness KW - EUROASPIRE survey Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-158387 VL - 18 IS - 321 ER - TY - JOUR A1 - Wagner, Martin A1 - Ashby, Damien R. A1 - Kurtz, Caroline A1 - Alam, Ahsan A1 - Busbridge, Mark A1 - Raff, Ulrike A1 - Zimmermann, Josef A1 - Heuschmann, Peter U. A1 - Wanner, Christoph A1 - Schramm, Lothar T1 - Hepcidin-25 in diabetic chronic kidney disease is predictive for mortality and progression to end stage renal disease JF - PLoS One N2 - Background Anemia is common and is associated with impaired clinical outcomes in diabetic chronic kidney disease (CKD). It may be explained by reduced erythropoietin (EPO) synthesis, but recent data suggest that EPO-resistance and diminished iron availability due to inflammation contribute significantly. In this cohort study, we evaluated the impact of hepcidin-25—the key hormone of iron-metabolism—on clinical outcomes in diabetic patients with CKD along with endogenous EPO levels. Methods 249 diabetic patients with CKD of any stage, excluding end-stage renal disease (ESRD), were enrolled (2003–2005), if they were not on EPO-stimulating agent and iron therapy. Hepcidin-25 levels were measured by radioimmunoassay. The association of hepcidin-25 at baseline with clinical variables was investigated using linear regression models. All-cause mortality and a composite endpoint of CKD progression (ESRD or doubling of serum creatinine) were analyzed by Cox proportional hazards models. Results Patients (age 67 yrs, 53% male, GFR 51 ml/min, hemoglobin 131 g/L, EPO 13.5 U/L, hepcidin-25 62.0 ng/ml) were followed for a median time of 4.2 yrs. Forty-nine patients died (19.7%) and forty (16.1%) patients reached the composite endpoint. Elevated hepcidin levels were independently associated with higher ferritin-levels, lower EPO-levels and impaired kidney function (all p<0.05). Hepcidin was related to mortality, along with its interaction with EPO, older age, greater proteinuria and elevated CRP (all p<0.05). Hepcidin was also predictive for progression of CKD, aside from baseline GFR, proteinuria, low albumin- and hemoglobin-levels and a history of CVD (all p<0.05). Conclusions We found hepcidin-25 to be associated with EPO and impaired kidney function in diabetic CKD. Elevated hepcidin-25 and EPO-levels were independent predictors of mortality, while hepcidin-25 was also predictive for progression of CKD. Both hepcidin-25 and EPO may represent important prognostic factors of clinical outcome and have the potential to further define “high risk” populations in CKD. KW - diabetes mellitus KW - inflammation KW - type 2 diabetes KW - hemoglobin KW - chronic kidney disease KW - anemia KW - ferritin KW - proteinuria Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125514 VL - 10 IS - 4 ER - TY - THES A1 - Wagner, Martin T1 - Chronic Kidney Disease as an Important Co-morbid Condition in Coronary Heart Disease Patients T1 - Chronische Nierenerkrankung als bedeutender Risikofaktor bei Patienten mit koronarer Herzkrankheit N2 - In patients with coronary heart disease (CHD) the control of the modifiable “traditional” cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, achieving/maintaining normal body weight and smoking cessation is of major importance to improve prognosis. Guideline recommendations for secondary CHD prevention include specific treatment targets for blood pressure, lipid levels, and markers of glucose metabolism for both younger and older patients. Chronic kidney disease (CKD) has been identified as a “non-traditional” risk factor for worse outcome in CHD patients, as it is associated with a markedly increased risk for subsequent CV events and mortality. The specific objectives of the current thesis-project are to investigate (a) the quality of care in a recent sample of German CHD patients and to investigate variation of risk factor control between younger and elder patients (≤70 versus >70 years), (b) to analyze the prevalence of CKD across Europe in stable CHD patients in the outpatient setting and during a hospital stay for CHD, (c) to investigate the level of awareness of CKD in German CHD patients and their treating physicians. Data from the European-wide EUROASPIRE IV study were used that include data on 7998 CHD patients in the ambulatory setting (study visit) and during a hospital stay for CHD (index). The German EUROASPIRE IV study center in Würzburg recruited 536 patients in 2012-2013. Risk factor control was compared against the current recommendations of the European Society of Cardiology. CKD was described by stages of glomerular filtration rate (eGFR) and albuminuria. German patients were asked in an additional kidney specific module whether they have ever been told by a physician about renal impairment. The fact that CKD or acute kidney injury (AKI) was mentioned in prominent parts of the hospital discharge letter as well as correct ICD-coding of CKD or AKI served as a proxy for physician’s awareness of CKD. The majority of German CHD patients was treated with the recommended drug therapies including e.g. β-blockers, anti-platelets and statins. However, treatment targets for blood pressure and LDL-cholesterol levels were not achieved in many patients (45% and 53%, respectively) and glycemic control in diabetic CHD patients with HbA1-levels <7% was insufficient (61%). A minority of patients reported on current smoking (10%), but unhealthy life-styles e.g. overweight/obesity (85%/37%) were frequent. Patterns of care differed between younger and older CHD patients while older patients were less likely to receive the recommended medical CHD-therapy, were more likely to have uncontrolled blood pressure and also to be diabetic. However, a greater proportion of diabetic patients >70 years was achieving the HbA1c target, and less elder patients were current smokers or were obese. About 17% of patients on average had CKD (eGFR< 60 ml/min/1.73m²) in the entire European sample at the study visit, and an additional 10% had albuminuria despite preserved eGFR, with considerable variation among countries. Impaired kidney function was observed in every fifth patient admitted for CHD in the entire European dataset of the EUROASPIRE IV study. Of the German CHD patients with CKD at the study visit, only a third were aware of their renal impairment. A minority of these patients was being seen by nephrologists, however, with a higher likelihood of CKD awareness and specialist care in more advanced stages of CKD. About a third of patients admitted for CHD showed either CKD or AKI during the hospital stay, but the discharge letter mentioned chronic or acute kidney disease only in every fifth of these patients. In contrast, correct ICD coding of CKD or AKI was more complete, but still suboptimal. In summary, quality of secondary prevention in German CHD patients indicates considerably room for improvement, with life-style modifications may become an even greater factor in prevention campaigns than medical treatment into certain target ranges. Preventive therapies should also consider different needs in older individuals acknowledging physical and mental potential, other comorbidities and drug-interactions with co-medication. CKD is common in CHD patients, not only in the elderly. Since CHD and CKD affect each other and impact on worse prognosis of each other, raising the awareness of CKD among patients and physicians and considering CKD in medical therapy may improve prognosis and slow disease progression of CHD as well as CKD. N2 - Bei Patienten mit koronarer Herzkrankheit (KHK) ist die Behandlung der „klassischen“ kardiovaskulären Risikofaktoren wie Bluthochdruck, Hypercholesterinämie, Diabetes, ein normales Körpergewicht sowie der Nikotinverzicht von Bedeutung, um die Prognose zu verbessern. Leitlinien empfehlen in der Sekundärprävention spezifische Behandlungsziele für Bluthochdruck, Hypercholesterinämie und Diabetes. Die chronische Niereninsuffizienz (NI) stellt einen „nicht-klassischen“ Risikofaktor für eine schlechtere Prognose bei KHK-Patienten dar und ist assoziiert mit einem erhöhten Risiko für eine Progression der KHK und kardiovaskuläre Mortalität. Die Studienziele der vorgelegten Arbeit beinhalten (a) die Umsetzung der KHK-Leitlinien in einem deutschen Kollektiv von Patienten inklusive der Unterschiede in der Versorgung zwischen Jüngeren und älteren Patienten (≤70 / >70 Jahre). Zudem (b) wird die Prävalenz der NI in stabilen ambulanten Verhältnissen und ebenso während eines Krankenhausaufenthaltes aufgrund eines KHK-Ereignisses in 24 Europäischen Ländern inklusive Deutschland untersucht. Schließlich (c) wird am deutschen Studienzentrum das Bewusstsein („Awareness“) für Nierenerkrankungen sowohl bei den Patienten als auch den behandelnden Ärzten analysiert. Es wurden die Daten der europaweiten EUROASPIRE IV Studie verwendet, für die zwischen 2012 und 2013 insgesamt 7998 KHK Patienten rekrutiert wurden. Sie enthält Informationen aus einem ambulanten Studienbesuch und aus einem Krankenhausaufenthalt aufgrund eines KHK-Ereignisses (Index). Am deutschen Studienzentrum in Würzburg wurden 536 Patienten eingeschlossen und die Qualität der Risikofaktorkontrolle nach den Empfehlungen der Europäischen Gesellschaft für Kardiologie untersucht. Chronische NI wurde in Stadien eingeteilt anhand von glomerulärer Filtrationsrate (eGFR) und Albuminurie. Zudem Am deutschen EUROASPIRE IV Studienzentrum wurden die Patienten zudem in einem zusätzlichen „Nieren-spezifischen Modul“ befragt, ob sie jemals von einem Arzt hinsichtlich einer Nierenerkrankung aufgeklärt wurden. Um das Bewusstsein für Nierenerkrankungen bei Ärzten einzuschätzen, wurde untersucht, ob akute oder chronische Nierenfunktionseinschränkungen im Arztbrief des Index-Aufenthaltes erwähnt wurden, und ob Nierenerkrankungen adäquat ICD-codiert waren. Die Mehrheit der deutschen KHK-Patienten wurde mit den empfohlenen Präparaten β-Blocker, Aspirin und Statinen behandelt, allerdings wurden die Ziel-/Grenzwerte für Blutdruck und Cholesterin oftmals nicht erreicht (45% bzw. 53%), ebenso wie die Blutzuckerkontrolle bei diabetischen Patienten (39%). Nur wenige Patienten waren aktive Raucher (10%), aber viele waren übergewichtig (85%) oder adipös (37%). Ältere Patienten erhielten seltener die empfohlenen Präparate und waren häufiger hypertensiv oder Diabetiker. Allerdings zeigten sich diabetische Patienten >70 Jahre besser kontrolliert und ältere Patienten waren seltener Raucher oder übergewichtig. Im Durchschnitt hatten 17% der KHK Patienten – mit großer Variation innerhalb der teilnehmenden Staaten – im EUROASPIRE IV Gesamtkollektiv eine chronische NI (eGFR <60 ml/min/1.73m²) und zusätzliche 10% hatten Albuminurie bei erhaltener eGFR. Eine eingeschränkte Nierenfunktion zeigte sich auch in jedem fünften Patienten bei Krankenhausaufnahme für das Index Ereignis im EUROASPIRE IV Gesamtkollektiv. Von den deutschen Patienten mit chronischer NI gab nur ein Drittel an, von ihrer Nierenfunktionseinschränkung zu wissen. Nur wenige dieser Patienten wurden von einem Nephrologen behandelt, wobei Patienten mit fortgeschrittener NI sich sowohl häufiger ihrer NI bewusst waren als auch von Spezialisten behandelt wurden. Im Index-Krankenhausaufenthalt hatte ein Drittel der Patienten wenigstens einen Hinweis auf eine entweder chronisch oder akut eingeschränkte Nierenfunktion. Lediglich in einem Fünftel war diese Diagnose im Entlassungsbrief erwähnt, während die Codierung nach Entlassung zwar vollständiger, aber immer noch lückenhaft war. Die Qualität der Sekundärprävention in deutschen KHK-Patienten lässt weiterhin beträchtlichen Raum für Verbesserung. Hierbei erscheinen die Veränderung im Lebensstil weitaus zielführender zu sein als die medikamentöse Therapie in definierte Zielbereiche. Die medizinische Therapie und die Herangehensweise an Verhaltensänderungen muss insbesondere bei älteren Patienten an die besondere Bedürfnisse dieser Patientengruppe angepasst werden. Chronische NI ist häufig bei KHK Patienten anzutreffen, nicht nur bei älteren Studienteilnehmern. KHK und chronische NI beeinflussen sich und die Prognose des jeweils anderen gegenseitig, sodass eine Steigerung des Bewusstseins für Nierenerkrankungen sowohl bei Patienten als auch bei Ärzten, und die Anpassung der Behandlungsstrategie womöglich zu einer Verbesserung der Prognose und zur Verlangsamung des Fortschreitens beider Erkrankungen, KHK und NI führen. KW - koronare Herzerkrankung KW - Sekundärprävention KW - Chronische Nierenerkrankung KW - coronary heart disease KW - secondary prevention KW - chronic kidney disease Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175498 ER - TY - THES A1 - von der Heide, Julia Magdalena T1 - Ist eine Berechnung der Geometrie der Halswirbelkörper anhand ihrer Morphologie im Kindesalter und somit eine Individualisierung der CVM-Methode möglich? T1 - Is it possible to calculate the geometry of the cervical vertebral bodies based on their morphology in childhood and thus individualize the CVM method? N2 - Ziel der vorliegenden Studie war es zu untersuchen, ob anhand geometrischer Merkmale der HWK im Kindesalter eine sichere individuelle Vorhersage der Morphologie der HWK zum Ende der Entwicklung möglich ist. Hierdurch könnte eine Individualisierung der CVM-Methode und somit eine Einschätzung des bereits verstrichenen Wachstums erfolgen. Zu diesem Zweck wurden insgesamt 1377 FRS-Aufnahmen von 267 Patienten – 110 weibliche und 157 männliche – aus dem Archiv der Poliklinik für Kieferorthopädie des Universitätsklinikums Würzburg digitalisiert und untersucht. Die HWK wurden im Programm OnyxCeph (Herst.: Image Instruments GmbH) quantifiziert und die berechneten Werte mit der Software SPSS statistisch ausgewertet. Mittels linearer Regressionen wurde versucht, anhand der Morphologie der Wirbelkörper vor dem puberalen Wachstumsschub auf die Geometrie der HWK im Erwachsenenalter zu schließen. Zur Illustrierung wurden Streudiagramm und die dazugehörigen Abfolgen von Röntgenbildern dargestellt. Eine Schätzung der Geometrie der HWK im Erwachsenenalter würde bei den separat betrachteten Parametern und bei einer gemeinsamen Betrachtung der Parameter kaum zu korrekten Einschätzungen führen. Die Streudiagramme mit den Bilderabfolgen stützen diese These ebenfalls und illustrieren die mögliche Fehleinschätzung der Geometrie. Die Ergebnisse der Studie zeigen erneut, dass die Geometrie der HWK im Erwachsenenalter sehr variabel ist, wie komplex die Entwicklung der HWK ist und dass anhand ihrer Geometrie im Kindesalter keine sichere Einschätzung der skelettalen Reife möglich ist. Eine Individualisierung der CVM-Methode ist anhand der in dieser Studie untersuchten Parameter nicht möglich. Somit lässt sich schlussfolgern, dass die CVM-Methode nicht als alleinige Methode zur präzisen skelettalen Alterseinschätzung verlässlich genutzt werden kann, sondern für eine sichere Beurteilung weitere Reifeindikatoren hinzugezogen werden sollten. Allerdings sollten hierzu zusätzliche radiologische Untersuchungen, wie beispielsweise die Handröntgenaufnahme, nur dann durchgeführt werden, wenn diese dem ALARA-Prinzip entsprechen. N2 - The aim of the present study was to investigate whether a reliable individual prediction of the morphology of the cervical vertebral bodies at the end of development is possible based on their geometric features in childhood. This could allow the CVM method to be individualized and thus an assessment of the growth that has already occurred. For this purpose, a total of 1377 FRS images of 267 patients - 110 female and 157 male - from the archive of the Department of Orthodontics at the University Hospital of Würzburg were digitized and examined. The cervical vertebrae were quantified using the OnyxCeph program and the calculated values were statistically evaluated using the SPSS software. Through linear regressions an attempt was made to use the morphology of the cervical vertebral bodies before the pubertal growth spurt to draw conclusions about the geometry of the cervical vertebrae in adulthood. A scatter diagram and the associated sequences of X-ray images were displayed to illustrate this. An estimate of the geometry of the cervical vertebral bodies in adulthood would hardly lead to correct assessments wheter the parameters were considered separately or together. The scatter diagrams with the image sequences also support this thesis and illustrate the possible misjudgement of the geometry. The results of the study show once again the geometrical variability and the complexity of the development of the cervical vertebral bodies, which makes it impossible to give a reliable assessment of skeletal maturity based on its geometry in childhood. It is not possible to individualize the CVM method based on the parameters examined in this study. It can therefore be concluded that the CVM method cannot be used reliably as the sole method for precise skeletal age assessment, but that further maturity indicators should be involved for a reliable assessment. However, additional radiological examinations, such as hand X-rays, should only be carried out if they comply with the ALARA principle. KW - Skelett KW - CVM-Methode KW - Altersbestimmung Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-360753 ER - TY - JOUR A1 - Vollmuth, Christoph A1 - Muljukov, Olga A1 - Abu-Mugheisib, Mazen A1 - Angermeier, Anselm A1 - Barlinn, Jessica A1 - Busetto, Loraine A1 - Grau, Armin J. A1 - Günther, Albrecht A1 - Gumbinger, Christoph A1 - Hubert, Nikolai A1 - Hüttemann, Katrin A1 - Klingner, Carsten A1 - Naumann, Markus A1 - Palm, Frederick A1 - Remi, Jan A1 - Rücker, Viktoria A1 - Schessl, Joachim A1 - Schlachetzki, Felix A1 - Schuppner, Ramona A1 - Schwab, Stefan A1 - Schwartz, Andreas A1 - Trommer, Adrian A1 - Urbanek, Christian A1 - Volbers, Bastian A1 - Weber, Joachim A1 - Wojciechowski, Claudia A1 - Worthmann, Hans A1 - Zickler, Philipp A1 - Heuschmann, Peter U. A1 - Haeusler, Karl Georg A1 - Hubert, Gordian Jan T1 - Impact of the coronavirus disease 2019 pandemic on stroke teleconsultations in Germany in the first half of 2020 JF - European Journal of Neurology N2 - Background and purpose The effects of the coronavirus disease 2019 (COVID-19) pandemic on telemedical care have not been described on a national level. Thus, we investigated the medical stroke treatment situation before, during, and after the first lockdown in Germany. Methods In this nationwide, multicenter study, data from 14 telemedical networks including 31 network centers and 155 spoke hospitals covering large parts of Germany were analyzed regarding patients' characteristics, stroke type/severity, and acute stroke treatment. A survey focusing on potential shortcomings of in-hospital and (telemedical) stroke care during the pandemic was conducted. Results Between January 2018 and June 2020, 67,033 telemedical consultations and 38,895 telemedical stroke consultations were conducted. A significant decline of telemedical (p < 0.001) and telemedical stroke consultations (p < 0.001) during the lockdown in March/April 2020 and a reciprocal increase after relaxation of COVID-19 measures in May/June 2020 were observed. Compared to 2018–2019, neither stroke patients' age (p = 0.38), gender (p = 0.44), nor severity of ischemic stroke (p = 0.32) differed in March/April 2020. Whereas the proportion of ischemic stroke patients for whom endovascular treatment (14.3% vs. 14.6%; p = 0.85) was recommended remained stable, there was a nonsignificant trend toward a lower proportion of recommendation of intravenous thrombolysis during the lockdown (19.0% vs. 22.1%; p = 0.052). Despite the majority of participating network centers treating patients with COVID-19, there were no relevant shortcomings reported regarding in-hospital stroke treatment or telemedical stroke care. Conclusions Telemedical stroke care in Germany was able to provide full service despite the COVID-19 pandemic, but telemedical consultations declined abruptly during the lockdown period and normalized after relaxation of COVID-19 measures in Germany. KW - COVID-19 KW - SARS-CoV- 2 KW - stroke KW - telemedicine KW - survey Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259396 VL - 28 IS - 10 ER - TY - JOUR A1 - Unnikrishnan, Vishnu A1 - Schleicher, Miro A1 - Shah, Yash A1 - Jamaludeen, Noor A1 - Pryss, Ruediger A1 - Schobel, Johannes A1 - Kraft, Robin A1 - Schlee, Winfried A1 - Spiliopoulou, Myra T1 - The effect of non-personalised tips on the continued use of self-monitoring mHealth applications JF - Brain Sciences N2 - Chronic tinnitus, the perception of a phantom sound in the absence of corresponding stimulus, is a condition known to affect patients' quality of life. Recent advances in mHealth have enabled patients to maintain a ‘disease journal’ of ecologically-valid momentary assessments, improving patients' own awareness of their disease while also providing clinicians valuable data for research. In this study, we investigate the effect of non-personalised tips on patients' perception of tinnitus, and on their continued use of the application. The data collected from the study involved three groups of patients that used the app for 16 weeks. Groups A & Y were exposed to feedback from the start of the study, while group B only received tips for the second half of the study. Groups A and Y were run by different supervisors and also differed in the number of hospital visits during the study. Users of Group A and B underwent assessment at baseline, mid-study, post-study and follow-up, while users of group Y were only assessed at baseline and post-study. It is seen that the users in group B use the app for longer, and also more often during the day. The answers of the users to the Ecological Momentary Assessments are seen to form clusters where the degree to which the tinnitus distress depends on tinnitus loudness varies. Additionally, cluster-level models were able to predict new unseen data with better accuracy than a single global model. This strengthens the argument that the discovered clusters really do reflect underlying patterns in disease expression. KW - tinnitus KW - ecological momentary assessments KW - physician feedback KW - mHealth KW - self-monitoring KW - non-personalised tips Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219435 SN - 2076-3425 VL - 10 IS - 12 ER - TY - JOUR A1 - Ungethüm, K. A1 - Wiedmann, S. A1 - Wagner, M. A1 - Leyh, R. A1 - Ertl, G. A1 - Frantz, S. A1 - Geisler, T. A1 - Karmann, W. A1 - Prondzinsky, R. A1 - Herdeg, C. A1 - Noutsias, M. A1 - Ludwig, T. A1 - Käs, J. A1 - Klocke, B. A1 - Krapp, J. A1 - Wood, D. A1 - Kotseva, K. A1 - Störk, S. A1 - Heuschmann, P. U. T1 - Secondary prevention in diabetic and nondiabetic coronary heart disease patients: insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys JF - Clinical Research in Cardiology N2 - Background Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012–13; and EA-V, 2016–17) in Germany. Methods The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V). Results 384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%). Conclusion Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients. KW - coronary heart disease KW - diabetes mellitus KW - secondary prevention KW - EUROASPIRE Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324037 VL - 112 IS - 2 ER - TY - JOUR A1 - Tütüncü, Serdar A1 - Olma, Manuel A1 - Kunze, Claudia A1 - Dietzel, Joanna A1 - Schurig, Johannes A1 - Fiessler, Cornelia A1 - Malsch, Carolin A1 - Haas, Tobias Eberhard A1 - Dimitrijeski, Boris A1 - Doehner, Wolfram A1 - Hagemann, Georg A1 - Hamilton, Frank A1 - Honermann, Martin A1 - Jungehulsing, Gerhard Jan A1 - Kauert, Andreas A1 - Koennecke, Hans-Christian A1 - Mackert, Bruno-Marcel A1 - Nabavi, Darius A1 - Nolte, Christian H. A1 - Reis, Joschua Mirko A1 - Schmehl, Ingo A1 - Sparenberg, Paul A1 - Stingele, Robert A1 - Völzke, Enrico A1 - Waldschmidt, Carolin A1 - Zeise-Wehry, Daniel A1 - Heuschmann, Peter U. A1 - Endress, Matthias A1 - Haeusler, Karl Georg T1 - Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry JF - Journal of Neurology N2 - Aims We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. Methods The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. Results At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28-2.84, P < 0.01]. Conclusion At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge. KW - NOAC KW - ischemic stroke KW - atrial fibrillation KW - under-dosing Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266969 SN - 1432-1459 VL - 269 IS - 1 ER - TY - JOUR A1 - Tütüncü, Serdar A1 - Olma, Manuel C. A1 - Kunze, Claudia A1 - Krämer, Michael A1 - Dietzel, Joanna A1 - Schurig, Johannes A1 - Filser, Paula A1 - Pfeilschifter, Waltraud A1 - Hamann, Gerhard F. A1 - Büttner, Thomas A1 - Heuschmann, Peter U. A1 - Kirchhof, Paulus A1 - Laufs, Ulrich A1 - Nabavi, Darius G. A1 - Röther, Joachim A1 - Thomalla, Götz A1 - Veltkamp, Roland A1 - Eckardt, Kai‐Uwe A1 - Haeusler, Karl Georg A1 - Endres, Matthias T1 - Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack JF - European Journal of Neurology N2 - 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. KW - kidney function KW - prognosis KW - stroke Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-287271 VL - 29 IS - 9 SP - 2716 EP - 2724 ER -