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 - Forchert, Leandra A1 - Potapova, Ekaterina A1 - Panetta, Valentina A1 - Dramburg, Stephanie A1 - Perna, Serena A1 - Posa, Daniela A1 - Resch‐Marat, Yvonne A1 - Lupinek, Christian A1 - Rohrbach, Alexander A1 - Grabenhenrich, Linus A1 - Icke, Katja A1 - Bauer, Carl‐Peter A1 - Hoffman, Ute A1 - Forster, Johannes A1 - Zepp, Fred A1 - Schuster, Antje A1 - Wahn, Ulrich A1 - Keil, Thomas A1 - Lau, Susanne A1 - Vrtala, Susanne A1 - Valenta, Rudolf A1 - Matricardi, Paolo Maria T1 - Der p 23‐specific IgE response throughout childhood and its association with allergic disease: A birth cohort study JF - Pediatric Allergy and Immunology N2 - 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. KW - asthma KW - birth cohort KW - childhood KW - Der p 23 KW - house dust mite allergy KW - IgE Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-287181 VL - 33 IS - 7 ER - TY - JOUR A1 - Mehdi, Muntazir A1 - Dode, Albi A1 - Pryss, Rüdiger A1 - Schlee, Winfried A1 - Reichert, Manfred A1 - Hauck, Franz J. T1 - Contemporary review of smartphone apps for tinnitus management and treatment JF - Brain Sciences N2 - Tinnitus is a complex and heterogeneous psycho-physiological disorder responsible for causing a phantom ringing or buzzing sound albeit the absence of an external sound source. It has a direct influence on affecting the quality of life of its sufferers. Despite being around for a while, there has not been a cure for tinnitus, and the usual course of action for its treatment involves use of tinnitus retaining and sound therapy, or Cognitive Behavioral Therapy (CBT). One positive aspect about these therapies is that they can be administered face-to-face as well as delivered via internet or smartphone. Smartphones are especially helpful as they are highly personalized devices, and offer a well-established ecosystem of apps, accessible via respective marketplaces of differing mobile platforms. Note that current therapeutic treatments such as CBT have shown to be effective in suppressing the tinnitus symptoms when administered face-to-face, their effectiveness when being delivered using smartphones is not known so far. A quick search on the prominent market places of popular mobile platforms (Android and iOS) yielded roughly 250 smartphone apps offering tinnitus-related therapies and tinnitus management. As this number is expected to steadily increase due to high interest in smartphone app development, a contemporary review of such apps is crucial. In this paper, we aim to review scientific studies validating the smartphone apps, particularly to test their effectiveness in tinnitus management and treatment. We use the PRISMA guidelines for identification of studies on major scientific literature sources and delineate the outcomes of identified studies. KW - mobile health KW - healthcare KW - mobile apps KW - tinnitus therapy KW - cbt KW - self help KW - tinnitus research Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219367 SN - 2076-3425 VL - 10 IS - 11 ER - TY - JOUR A1 - Schlee, Winfried A1 - Neff, Patrick A1 - Simoes, Jorge A1 - Langguth, Berthold A1 - Schoisswohl, Stefan A1 - Steinberger, Heidi A1 - Norman, Marie A1 - Spiliopoulou, Myra A1 - Schobel, Johannes A1 - Hannemann, Ronny A1 - Pryss, Rüdiger T1 - Smartphone-guided educational counseling and self-help for chronic tinnitus JF - Journal of Clinical Medicine N2 - 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. KW - tinnitus KW - self-help KW - ecological momentary assessment KW - ehealth KW - smart-phone KW - intervention Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-267295 SN - 2077-0383 VL - 11 IS - 7 ER - TY - JOUR A1 - Fricke, Julia A1 - Ávila, Gabriela A1 - Keller, Theresa A1 - Weller, Karsten A1 - Lau, Susanne A1 - Maurer, Marcus A1 - Zuberbier, Torsten A1 - Keil, Thomas T1 - Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta‐analysis JF - Allergy N2 - Background and objectives: Urticaria is a frequent skin condition, but reliable prevalence estimates from population studies particularly of the chronic form are scarce. The objective of this study was to systematically evaluate and summarize the prevalence of chronic urticaria by evaluating population‐based studies worldwide. Methods: We performed a systematic search in PUBMED and EMBASE for population‐based studies of cross‐sectional or cohort design and studies based on health insurance/system databases. Risk of bias was assessed using a specific tool for prevalence studies. For meta‐analysis, we used a random effects model. Results: Eighteen studies were included in the systematic evaluation and 11 in the meta‐analysis including data from over 86 000 000 participants. Risk of bias was mainly moderate, whereas the statistical heterogeneity (I\(^{2}\)) between the studies was high. Asian studies combined showed a higher point prevalence of chronic urticaria (1.4%, 95%‐CI 0.5‐2.9) than those from Europe (0.5%, 0.2‐1.0) and Northern American (0.1%, 0.1‐0.1). Women were slightly more affected than men, whereas in children < 15 years we did not find a sex‐specific difference in the prevalence. The four studies that examined time trends indicated an increasing prevalence of chronic urticaria over time. Conclusions: On a global level, the prevalence of chronic urticaria showed considerable regional differences. There is a need to obtain more sex‐specific population‐based and standardized international data particularly for children and adolescents, different chronic urticaria subtypes and potential risk and protective factors. KW - chronic urticaria KW - meta‐analysis KW - prevalence KW - sex differences KW - systematic review Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213700 VL - 75 IS - 2 SP - 423 EP - 432 ER - TY - JOUR A1 - Tiffe, Theresa A1 - Morbach, Caroline A1 - Rücker, Viktoria A1 - Gelbrich, Götz A1 - Wagner, Martin A1 - Faller, Hermann A1 - Störk, Stefan A1 - Heuschmann, Peter U. T1 - Impact of patient beliefs on blood pressure control in the general population: findings from the population-based STAAB cohort study JF - International Journal of Hypertension N2 - Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of Würzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences. KW - hypertension Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200992 VL - 2019 ER - TY - JOUR A1 - Edelmann, Frank A1 - Musial-Bright, Lindy A1 - Gelbrich, Goetz A1 - Trippel, Tobias A1 - Radenovic, Sara A1 - Wachter, Rolf A1 - Inkrot, Simone A1 - Loncar, Goran A1 - Tahirovic, Elvis A1 - Celic, Vera A1 - Veskovic, Jovan A1 - Zdravkovic, Marija A1 - Lainscak, Mitja A1 - Apostolović, Svetlana A1 - Neskovic, Aleksandar N. A1 - Pieske, Burkert A1 - Düngen, Hans-Dirk T1 - Tolerability and feasibility of beta-blocker titration in HFpEF versus HFrEF: Insights from the CIBIS-ELD trial JF - JACC: Heart Failure N2 - OBJECTIVES: This study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction. BACKGROUND: Broad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain. METHODS: In the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro-B-type natriuretic peptide). RESULTS: For both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23% vs. HFrEF: 34%, p < 0.001). Mean E/e' and left atrial volume index did not change in either group, although E/A increased in HFpEF. CONCLUSIONS: BB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and Left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure HF] Patients: A Randomised, Double-Blind Multicentre Study CIBIS-ELD]; ISRCTN34827306). KW - beta-blockers KW - heart failure KW - HFpEF KW - HFrEF KW - tolerability Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-191022 VL - 4 IS - 2 ER - TY - JOUR A1 - Barbieri, Flavia L. A1 - Gardon, Jacques A1 - Ruiz-Castell, María A1 - Paco V., Pamela A1 - Muckelbauer, Rebecca A1 - Casiot, Corinne A1 - Freydier, Rémi A1 - Duprey, Jean-Louis A1 - Chen, Chih-Mei A1 - Müller-Nordhorn, Jacqueline A1 - Keil, Thomas T1 - Toxic trace elements in maternal and cord blood and social determinants in a Bolivian mining city JF - International Journal of Environmental Health Research N2 - This study assessed lead, arsenic, and antimony in maternal and cord blood, and associations between maternal concentrations and social determinants in the Bolivian mining city of Oruro using the baseline assessment of the ToxBol/Mine-Nino birth cohort. We recruited 467 pregnant women, collecting venous blood and sociodemographic information as well as placental cord blood at birth. Metallic/semimetallic trace elements were measured using inductively coupled plasma mass spectrometry. Lead medians in maternal and cord blood were significantly correlated (Spearman coefficient=0.59; p<0.001; 19.35 and 13.50 μg/L, respectively). Arsenic concentrations were above detection limit (3.30 μg/L) in 17.9% of maternal and 34.6% of cord blood samples. They were not associated (Fischer's p=0.72). Antimony medians in maternal and cord blood were weakly correlated (Spearman coefficient=0.15; p<0.03; 9.00 and 8.62 μg/L, respectively). Higher concentrations of toxic elements in maternal blood were associated with maternal smoking, low educational level, and partner involved in mining. KW - environmental exposure KW - metallic trace elements KW - maternal exposure KW - prenatal exposure KW - risk factors Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-190703 VL - 26 IS - 2 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 - THES A1 - Riegler, Christoph Paul T1 - Eine deutschsprachige Variante des Functioning Assessment Short Test (FAST): Übereinstimmung zwischen Selbsteinschätzung und Fremdeinschätzung T1 - A German variant of the Functioning Assessment Short Test (FAST): Agreement of self-assessment with external assessment N2 - Die Erhebung der alltäglichen Funktionsfähigkeit mithilfe von Skalen zu instrumentellen Aktivitäten des täglichen 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 für ein geriatrisches Patientenkollektiv entwickelt wurden, haben sie wichtige Schwächen in der Anwendung bei jüngeren Patientengruppen (insbesondere die fehlende Erfassung beruflicher Funktionsfähigkeit). Aus diesem Grund wurde im Rahmen der vorliegenden Arbeit mit dem Functioning Assessment Short Test (FAST) ein bereits in mehreren Sprachen validiertes, für erwachsene Patienten jedweden Alters konzipiertes Instrument mit sehr guten psychometrischen Kennwerten ins Deutsche übertragen und hinsichtlich Validität und Reliabilität untersucht. Die deutschsprachige Variante des FAST wurde durch standardisierte vorwärts-rückwärts-Übersetzung aus dem Englischen erstellt und ist als Selbstausfüllerfragebogen konzipiert. Die Skala enthält 23 ordinal skalierte Einzelitems, aus denen sich ein Summenscore berechnen lässt, wobei höhere Werte für eine schlechtere alltägliche Funktionsfähigkeit stehen. Der Fragebogen wurde zwischen 2017 und 2018 an insgesamt 120 Teilnehmern in Würzburg und Münster getestet, von denen 60 aus bevölkerungsbasierten Kohortenstudien stammten und je 30 Patienten aufgrund eines ischämischen Schlaganfalls oder einer akuten Depression stationär behandelt wurden. Als Maß für die Reliabilität des Instrumentes wurde die Übereinstimmung zwischen Selbst- und Fremdeinschätzung der alltäglichen Funktionsfähigkeit (Fremdeinschätzung durch Angehörige der Teilnehmer bzw. behandelnde Ärzte / Psychologen) mithilfe des FAST gewählt. Die Validität der Skala wurde durch die Messung von Korrelationen des FAST Summenscores mit gängigen Skalen zu Depressivität (PHQ-D-9, CES-D), Angstsymptomatik (PHQ-GAD-7), gesundheitsbezogener Lebensqualität (SF-12, EQ-5D) und kognitiver Leistungsfähigkeit (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 Reliabilitätsanalyse zeigte für die Probanden aus der Allgemeinbevölkerung ein moderates (ICC 0.50 (95%-CI 0.64 – 0.54), für die Patienten mit akutem ischämischem Schlaganfall ein gutes (ICC 0.65 (95%-CI 0.55 – 0.75) und für die stationär behandelten Patienten mit Depression ein schlechtes Ergebnis (ICC 0.11 (95%-CI 0.02 – 0.20). Hinsichtlich der Konstruktvalidität zeigte sich in der bevölkerungsbasierten 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 Rückenschmerz signifikante Prädiktoren für den FAST Summenscore. In der multivariablen Analyse verblieben SF-12 und chronischer Rückenschmerz als signifikante Einflussfaktoren. In der Stichprobe von Patienten mit akutem ischämischem 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 Allgemeinbevölkerung und bei Patienten mit akutem ischämischem Schlaganfall, während die Ergebnisse bei stationär behandelten Patienten mit Depression schlecht waren. Aufgrund der kleinen Fallzahl der untersuchten Stichproben und des fehlenden Assessment von Test-Retest-Reliabilität sollten vor der breiten Anwendung des FAST im deutschsprachigen Raum weitere psychometrische Prüfungen des Instruments erfolgen. N2 - Assessment of functional impairment via IADL scales is crucial in determining the individual and social consequences of clinical and subclinical diseases. There is only a limited number of validated IADL scales in the German-speaking area. Since all these scales were developed to assess functional impairment in geriatric patients, they possess relevant weaknesses when assessing younger individuals, such as a lack of questions on occupational functioning. Therefore, we created a German variant of the Functioning Assessment Short Test (FAST); an IADL scale that has been validated in various languages with excellent psychometric properties and is applicable to patients of all ages. The German variant of the FAST was developed following a standardized forward-backward translation protocol and is designed as a selfadministered questionnaire. The scale contains 23 ordinal-scaled items of which a sum score can be calculated, whereat higher values on the scale account for more difficulties in activities of daily living. Between 2015 and 2016, 120 participants were enrolled and assessed with the FAST questionnaire in Würzburg and Münster. Sixty patients were derived from two ongoing population-based studies, while 30 participants were inpatients treated for depression and 30 participants were inpatients admitted to a neurological clinic due to acute ischemic stroke. To assess reliability of the FAST scale, the agreement between self-assessment and external assessment by relatives (in participants from the general population and stroke patients) or treating physicians / psychologists (in patients treated for acute depression) was calculated. Validity was assessed by conducting correlations with established scales of depression (PHQD- 9, CES-D), anxiety (PHQ-GAD-7), health-related quality of life (SF-12, VAS from EQ-5D) and cognitive functioning (MOCA). Furthermore, uni- and multivariable regression analyses were conducted using the aforementioned scales together with relevant diagnoses from the participants record to identify predictors of higher values of the FAST scale. Reliability was moderate for patients form the general population (ICC 0.50 (95%-CI 0.64 – 0.54), good for inpatients admitted for acute ischemic stroke (ICC 0.65 (95%-CI 0.55 – 0.75) and poor for inpatients admitted for acute depression (ICC 0.11 (95%-CI 0.02 – 0.20). Regarding construct validity, a significant correlation of the FAST scale with PHQ-D-9, CESD, PHQ-GAD-7 and the mental component of the SF-12 was found in patients derived from the general population. In univariable regression analysis the PHQ-D-9, the PHQ-GAD-7, the mental component of the SF-12 and the presence of chronic back pain explained variance of the FAST scale. In multivariable regression, chronic back pain together with SF-12 remained significant predictors. In the sample of patients treated for acute ischemic stroke, a significant negative correlation between FAST score and MOCA score was detected. In conclusion, the German variant of the FAST yielded moderate to good psychometric properties in the general population and patients treated for acute ischemic stroke, while reliability was poor in inpatients with acute depression. Due to the small sample size and the lack of assessment of test-retest-reliability, the German variant of the FAST should be tested in a larger sample before the scale can be broadly used in research and clinical practice. KW - Functioning Assessment Short Test KW - Instrumental Activities of Daily Living KW - Fragebogen KW - alltägliche Funktionsfähigkeit KW - instrumentelle Aktivitäten des täglichen Lebens Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288931 ER - TY - JOUR A1 - Bolm, Louisa A1 - Zemskov, Sergii A1 - Zeller, Maria A1 - Baba, Taisuke A1 - Roldan, Jorge A1 - Harrison, Jon M. A1 - Petruch, Natalie A1 - Sato, Hiroki A1 - Petrova, Ekaterina A1 - Lapshyn, Hryhoriy A1 - Braun, Ruediger A1 - Honselmann, Kim C. A1 - Hummel, Richard A1 - Dronov, Oleksii A1 - Kirichenko, Alexander V. A1 - Klinkhammer-Schalke, Monika A1 - Kleihues-van Tol, Kees A1 - Zeissig, Sylke R. A1 - Rades, Dirk A1 - Keck, Tobias A1 - Fernandez-del Castillo, Carlos A1 - Wellner, Ulrich F. A1 - Wegner, Rodney E. T1 - 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) JF - Cancers N2 - (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. KW - pancreatic cancer KW - perioperative therapy KW - neoadjuvant therapy KW - pancreatic surgery Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262174 SN - 2072-6694 VL - 14 IS - 4 ER - TY - THES A1 - Sahiti, Floran T1 - Myocardial Work – Application and Clinical Characterization of a New Echocardiographic Tool T1 - Myocardial Work – Anwendung und klinische Charakterisierung einer neuen Echokardiographie-basierten Methode N2 - 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 Würzburg, 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 Würzburg, 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. N2 - 2 Zusammenfassung Die linksventrikuläre (LV) Ejektionsfraktion (EF) und der Global Longitudinal Strain (GLS) sind die am häufigsten verwendeten Maße der LV-Funktion. Sie sind jedoch stark von den jeweiligen Belastungsbedingungen abhängig, da eine höhere Nachlast zu einer geringeren systolischen Deformation und somit zu einer niedrigeren LVEF und GLS führt, trotz einer vermutlich unveränderten myokardialen Kontraktionsstärke. Intrakardiale Druck-Volumen-Schleifenmessungen stellen den Referenzstandard zur Beurteilung der LV-Funktion dar, da hiermit auch die umfassende Berücksichtigung der Lastbedingungen (Vorlast, Nachlast) möglich ist. Dieses Verfahren lässt sich jedoch aufgrund des invasiven Charakters nur schwer in Follow-up Untersuchungen oder großen Studienpopulationen einsetzen. Angelehnt an die Prinzipien dieser invasiven Technik, wurde vor kurzem das neuartige Konzept der Echokardiographie-abgeleiteten Beurteilung der Myokardarbeit (MyW) entwickelt. Dieser Ansatz wertet Druck-Strain-Schleifen aus und berücksichtigt den Einfluss der Nachlast, so dass MyW als weniger lastabhängig gilt verglichen mit LVEF und GLS. Die Analyse von MyW könnte deshalb eine wertvolle Alternative sein, um den o.g. Herausforderungen zu begegnen. Die Methode lässt sich in großen Stichproben, ggf. auch wiederholt, einsetzen. Die hier vorgelegte Dissertation befasst sich mit der Anwendung und klinischen Charakterisierung von MyW, einer innovativen echokardiographischen Methode. Der Fokus lag auf vier Themenbereichen: (a) Festlegung von Referenzwerten für MyW-Indizes, d. h. Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) und Global Work Efficiency (GWE); wir adressierten einen breiten Altersbereich und quantifizierten die Assoziation der MyW-Indizes mit Alter, Geschlecht und weiteren klinischen und echokardiographischen Parametern bei kardiovaskulär gesunden Normalpersonen. (b) Untersuchung des Einflusses kardiovaskulärer Risikofaktoren auf die MyW-Indizes und die Charakterisierung einer subklinischen LV-Verschlechterung in der Allgemeinbevölkerung. (c) Bewertung der Assoziation der MyW-Indizes mit der LV-Geometrie, insbesondere der LV-Masse und der LV-Dimensionen. (d) Bewertung der Dynamik der MyW-Indizes im Krankenhaus bei Patienten, die wegen akuter Herzinsuffizienz (AHF) ins Krankenhaus aufgenommen wurden. Im Rahmen der hier vorgelegten Dissertation wurden die Daten zweier größerer Kohorten herangezogen: Die bevölkerungsbasierte STAAB-Kohortenstudie rekrutierte und phänotypisierte prospektiv eine repräsentative Stichprobe (5.000 Personen) der Allgemeinbevölkerung der Stadt Würzburg im Alter von 30-79 Jahren, die zum Zeitpunkt des Einschlusses keine vorbeschriebene Herzinsuffizienz hatten. Wir konzentrierten uns auf die erste Hälfte der Studienstichprobe (n=2473 Personen), welche die erwarteten Stratifizierung bezüglich Alter und Geschlecht erfüllten. Das Acute Heart Failure (AHF) Register ist ein klinisches Register zur Rekrutierung und Phänotypisierung von konsekutiven Patienten, die wegen akut dekompensierter Herzinsuffizienz in die Medizinische Klinik I des Universitätsklinikums Würzburg aufgenommen wurden. Ziel dieser Studie ist es, das pathophysiologische Verständnis insbesondere in Bezug auf die Frühphase nach einer kardialen Dekompensation zu verbessern und damit die gezielte Diagnostik und Therapie von Patienten mit AHF zu verbessern. Wir fokussierten hier auf Patienten, bei denen im Krankenhaus zwei Echokardiogramme durchgeführt wurden: früh nach Aufnahme ins Krankenhaus und kurz vor der Entlassung. Die wichtigsten Erkenntnisse der hier vorgelegten Dissertation sind: Aus den Daten der STAAB-Kohortenstudie wurden Referenzwerte für MyW-Indizes etabliert, die auf Auswertungen von insgesamt 779 gesunden Normalpersonen (mittleres Alter 49 ± 10 Jahre, 59% Frauen) mit Sinusrhythmus beruhen. Diese Probanden wiesen gemäß der Ergebnisse einer umfangreichen Eingangsuntersuchung keine kardiovaskulären Risikofaktoren oder Erkrankungen auf und zeigten echokardiographisch keinen Hinweis auf eine LV-Klappenerkrankung. Mit der Ausnahme von GWI fanden sich keine Assoziationen der MyW-Indizes mit dem Geschlecht. Darüber hinaus zeigte sich eine Altersabhängigkeit der MyW-Indizes. Bis zum Alter von 45 Jahren wies MyW stabile Werte auf, jenseits des 45. Lebensjahres jedoch eine Aufwärtsverschiebung: dabei war eine zunehmend höhere Altersdekade mit mehr GWW bzw. weniger GWE verbunden. Die MyW-Indizes korrelierten nur schwach mit üblichen echokardiographischen Parametern, was darauf hindeuten könnte, dass MyW zusätzliche Informationen jenseits klinisch etablierter Variablen beitragen kann. Weitere Analysen aus der STAAB-Kohortenstudie trugen zu einem besseren Verständnis des Einflusses kardiovaskulärer Risikofaktoren auf die MyW-Indizes und der Assoziation der LV-Geometrie mit der LV-Leistung bei. Wir zeigten, dass kardiovaskuläre Risikofaktoren sich selektiv auf GCW und GWW auswirken. Hypertonie beeinträchtigte die Arbeit des Myokards zutiefst, insbesondere durch die Erhöhung sowohl des GCW als auch des GWW. Der LV arbeitet demnach bei Hypertonie auf einem höheren Energieniveau – jedoch mit geringerer Effizienz. Andere klassische kardiovaskuläre Risikofaktoren (Diabetes mellitus, Adipositas, Dyslipidämie, Rauchen), wirkten sich unabhängig vom Blutdruck durchweg negativ auf GCW aus, zeigten jedoch keinen Einfluss auf GWW. Darüber hinaus wirkten sich alle kardiovaskulären Risikofaktoren nachteilig auf GWE aus. Jede Abweichung von einem normalen LV-Geometrie Profil war mit Änderungen der MyW verbunden. Bemerkenswert war, dass MyW empfindlich auf frühe Veränderungen der LV-Masse und -Dimensionen reagierte. Personen mit arterieller Hypertonie aber noch normaler LV-Geometrie zeigten ein myokardiales Arbeitsmuster, das ansonsten typischerweise bei LV-Hypertrophie zu finden ist. Somit könnte dieses Muster als frühes Zeichen einer Myokardschädigung bei hypertensiver Herzerkrankung dienen und bei der Risikostratifizierung und Primärprävention helfen. Aus dem AHF-Register wählten wir Personen mit seriellen Echokardiogrammen im Krankenhaus aus und beschrieben Veränderungen der myokardialen Leistung während der Rekompensationsphase beschrieben. Als Surrogat einer Rekompensation zogen wir während der Hospitalisierung sinkende Spiegel von N-terminalem pro-natriuretischem Peptid (NT-proBNP) heran. Bei Patienten mit reduzierter Ejektonfraktion (HFrEF) waren fallende NT-proBNP Werte (i. S. einer erfolgreichen Rekompensation) mit einer Verbesserung von GCW und GWI und konsekutiv auch von GWE verbunden. Im Gegensatz dazu gab es bei Patienten, die eine erhaltene Ejektonfraktionsfraktion aufwiesen (HFpEF), keine signifikante Veränderung von GCW und GWI. Eine erfolglose Rekompensation, d. h. keine Veränderung oder ein potenzieller Anstieg von NT-proBNP, war jedoch mit einem Anstieg von GWW verbunden. Wir interpretierten dies als unterschiedliche myokardiale Reaktion auf De- und Rekompensation in Abhängigkeit vom Herzinsuffizienz-Phänotyp. Darüber hinaus war GWW als Surrogat eines unangemessenen LV-Energieverbrauchs bei allen Patienten mit AHF erhöht (im Vergleich zu Referenzwerten) und korrelierte mit keinem der konventionellen Marker. In einer explorativen Analyse war GWW ein starker Prädiktor für das Risiko, im Verlauf der nächsten sechs Monaten nach Krankenhausentlassung zu sterben oder erneut hospitalisiert zu werden. Damit könnte die GWW zusätzliche Informationen enthalten, die über die konventionellen Marker für den Schweregrad der Herzinsuffizienz hinausgehen. KW - Myocardial Work KW - Echocardiography KW - Heart Failure KW - Hypertension KW - STAAB Cohort Study KW - Wasted Work KW - Cardiac Efficiency KW - Herzinsuffizienz KW - Echokardiographie KW - myokardiale Arbeit KW - LV Function Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-282261 ER - TY - JOUR A1 - Rücker, Viktoria A1 - Keil, Ulrich A1 - Fitzgerald, Anthony P A1 - Malzahn, Uwe A1 - Prugger, Christof A1 - Ertl, Georg A1 - Heuschmann, Peter U A1 - Neuhauser, Hannelore T1 - Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts JF - PLoS ONE N2 - Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008–11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40–65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk. KW - fatal cardiovascular disease KW - SCORE KW - Germany Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-166804 VL - 11 IS - 9 ER - TY - JOUR A1 - Elhfnawy, Ahmed Mohamed A1 - Heuschmann, Peter U. A1 - Pham, Mirko A1 - Volkmann, Jens A1 - Fluri, Felix T1 - Stenosis length and degree interact with the risk of cerebrovascular events related to internal carotid artery stenosis JF - Frontiers in Neurology N2 - Background and Purpose: Internal carotid artery stenosis (ICAS)≥70% is a leading cause of ischemic cerebrovascular events (ICVEs). However, a considerable percentage of stroke survivors with symptomatic ICAS (sICAS) have <70% stenosis with a vulnerable plaque. Whether the length of ICAS is associated with high risk of ICVEs is poorly investigated. Our main aim was to investigate the relation between the length of ICAS and the development of ICVEs. Methods: In a retrospective cross-sectional study, we identified 95 arteries with sICAS and another 64 with asymptomatic internal carotid artery stenosis (aICAS) among 121 patients with ICVEs. The degree and length of ICAS as well as plaque echolucency were assessed on ultrasound scans. Results: A statistically significant inverse correlation between the ultrasound-measured length and degree of ICAS was detected for sICAS≥70% (Spearman correlation coefficient ρ = –0.57, p < 0.001, n = 51) but neither for sICAS<70% (ρ = 0.15, p = 0.45, n = 27) nor for aICAS (ρ = 0.07, p = 0.64, n = 54). The median (IQR) length for sICAS<70% and ≥70% was 17 (15–20) and 15 (12–19) mm (p = 0.06), respectively, while that for sICAS<90% and sICAS 90% was 18 (15–21) and 13 (10–16) mm, respectively (p < 0.001). Among patients with ICAS <70%, a cut-off length of ≥16 mm was found for sICAS rather than aICAS with a sensitivity and specificity of 74.1% and 51.1%, respectively. Irrespective of the stenotic degree, plaques of the sICAS compared to aICAS were significantly more often echolucent (43.2 vs. 24.6%, p = 0.02). Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICAS≥70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICAS≥70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results. KW - ischemic stroke KW - carotid stenosis KW - carotid atherosclerosis KW - length of stenosis KW - degree of stenosis KW - carotid ultrasound KW - outcome Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196225 SN - 1664-2295 VL - 10 IS - 317 ER - TY - JOUR A1 - Hillmann, Steffi A1 - Wiedmann, Silke A1 - Rücker, Viktoria A1 - Berger, Klaus A1 - Nabavi, Darius A1 - Bruder, Ingo A1 - Koennecke, Hans-Christian A1 - Seidel, Günter A1 - Misselwitz, Björn A1 - Janssen, Alfred A1 - Burmeister, Christoph A1 - Matthis, Christine A1 - Busse, Otto A1 - Hermanek, Peter A1 - Heuschmann, Peter Ulrich T1 - Stroke unit care in Germany: the German stroke registers study group (ADSR) JF - BMC Neurology N2 - Background: Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care. Methods: Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators. Results: In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago. Conclusions: Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low. KW - stroke register KW - stroke unit care KW - quality of health care KW - quality indicators Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159447 VL - 17 IS - 49 ER - TY - JOUR A1 - Bening, Constanze A1 - Hamouda, Khaled A1 - Oezkur, Mehmet A1 - Schimmer, Christoph A1 - Schade, Ina A1 - Gorski, Armin A1 - Aleksic, Ivan A1 - Leyh, Rainer T1 - Rapid deployment valve system shortens operative times for aortic valve replacement through right anterior minithoracotomy JF - Journal of Cardiothoracic Surgery N2 - Background: There is growing evidence from the literature that right anterior minithoracotomy aortic valve replacement (RAT-AVR) improves clinical outcome. However, increased cross clamp time is the strongest argument for surgeons not performing RAT-AVR. Rapid deployment aortic valve systems have the potential to decrease cross-clamp time and ease this procedure. We assessed clinical outcome of rapid deployment and conventional valves through RAT. Methods: Sixty-eight patients (mean age 76 ± 6 years, 32% females) underwent RAT-AVR between 9/2013 and 7/2015. According to the valve type implanted the patients were divided into two groups. In 43 patients (R-group; mean age 74.1 ± 6.6 years) a rapid deployment valve system (Edwards Intuity, Edwards Lifesciences Corp; Irvine, Calif) and in 25 patients (C-group; mean age 74.2 ± 6.6 years) a conventional stented biological aortic valve was implanted. Results: Aortic cross-clamp (42.1 ± 12 min vs. 68.3 ± 20.3 min; p < 0.001) and bypass time (80.4 ± 39.3 min vs. 106.6 ± 23.2 min; p = 0.001) were shorter in the rapid deployment group (R-group). We observed no differences in clinical outcome. Postoperative gradients (R-group: max gradient, 14.3 ± 8 mmHg vs. 15.5 ± 5 mmHg (C-group), mean gradient, 9.2 ± 1.7 mmHg (R-group) vs. 9.1 ± 2.3 mmHg (C-group) revealed no differences. However, larger prostheses were implanted in C-group (25 mm; IQR 23–27 mm vs. 23 mm; IQR 21–25; p = 0.009). Conclusions: Our data suggest that the rapid deployment aortic valve system reduced cross clamp and bypass time in patients undergoing RAT-AVR with similar hemodynamics as with larger size stented prosthesis. However, larger studies and long-term follow-up are mandatory to confirm our findings. KW - aortic valve replacement KW - minimally invasive surgery KW - heart valve prosthesis KW - biological rapid deployment aortic valve Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159439 VL - 12 IS - 27 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 - Kammerer, Klaus A1 - Göster, Manuel A1 - Reichert, Manfred A1 - Pryss, Rüdiger T1 - Ambalytics: a scalable and distributed system architecture concept for bibliometric network analyses JF - Future Internet N2 - A deep understanding about a field of research is valuable for academic researchers. In addition to technical knowledge, this includes knowledge about subareas, open research questions, and social communities (networks) of individuals and organizations within a given field. With bibliometric analyses, researchers can acquire quantitatively valuable knowledge about a research area by using bibliographic information on academic publications provided by bibliographic data providers. Bibliometric analyses include the calculation of bibliometric networks to describe affiliations or similarities of bibliometric entities (e.g., authors) and group them into clusters representing subareas or communities. Calculating and visualizing bibliometric networks is a nontrivial and time-consuming data science task that requires highly skilled individuals. In addition to domain knowledge, researchers must often provide statistical knowledge and programming skills or use software tools having limited functionality and usability. In this paper, we present the ambalytics bibliometric platform, which reduces the complexity of bibliometric network analysis and the visualization of results. It accompanies users through the process of bibliometric analysis and eliminates the need for individuals to have programming skills and statistical knowledge, while preserving advanced functionality, such as algorithm parameterization, for experts. As a proof-of-concept, and as an example of bibliometric analyses outcomes, the calculation of research fronts networks based on a hybrid similarity approach is shown. Being designed to scale, ambalytics makes use of distributed systems concepts and technologies. It is based on the microservice architecture concept and uses the Kubernetes framework for orchestration. This paper presents the initial building block of a comprehensive bibliometric analysis platform called ambalytics, which aims at a high usability for users as well as scalability. KW - system architecture design KW - bibliometric analysis KW - community detection Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-244916 SN - 1999-5903 VL - 13 IS - 8 ER - TY - JOUR A1 - Parisi, Sandra A1 - Lehner, Nina A1 - Schrader, Hanna A1 - Kierer, Leonard A1 - Fleischer, Anna A1 - Miljukov, Olga A1 - Borgulya, Gabor A1 - Rüter, Gernot A1 - Viniol, Annika A1 - Gágyor, Ildikó T1 - Experiencing COVID-19, home isolation and primary health care: A mixed-methods study JF - Frontiers in Public Health N2 - Objectives Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). Methods A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. Results A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Conclusions Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers. KW - COVID-19 KW - patients' experience KW - illness experience KW - mixed methods KW - general practice KW - home isolation KW - Germany KW - telehealth Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301498 SN - 2296-2565 VL - 10 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 - Stangl, Stephanie T1 - Versorgung von Patientinnen und Patienten mit Brustkrebs in einer überwiegend ländlich geprägten Region T1 - Provision of breast cancer care in a mainly rural area N2 - Für die Diagnose und Therapie von Brustkrebs existiert die nationale evidenz- und konsensbasierte S3-Leitlinie. Die klinischen Krebsregister stellen sektor- und facharztübergreifende Diagnose- und Therapiedaten zur Qualitätssicherung bereit. Bislang fehlen jedoch Daten bezüglich patient-reported outcome measures (PROMs). Aufgrund des demographischen Wandels werden Brustkrebserkrankungen vor allem in ländlichen Regionen weiter zunehmen, weshalb Versorgungsstrukturen für alle Patientinnen erreichbar sein sollten. Es wurde ein patientenorientiertes Registerkonzept (Breast Cancer Care for patients with metastatic disease (BRE-4-MED)) für 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 Primär- und Sekundärdaten 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 stärksten war dieser Zusammenhang in grenznahen Regionen ausgeprägt. Die vorliegende Arbeit zeigt Chancen für eine patientenorientierte, qualitätsgesicherte Brustkrebsversorgung unabhängig vom Wohnort auf. N2 - For the diagnosis and treatment of breast cancer evidence- and consensus-based recommendations are provided by the national S3-guideline. The comprehensive clinical cancer registries provide intersectoral and multispecialty data on diagnosis and therapy for quality assurance. However, information on patient-reported outcome measures (PROMs) are still lacking. With demographic change, breast cancer will continue to increase, especially in rural areas. Therefore, care structures should be accessible to all patients. A patient-centered registry concept (Breast Cancer Care for patients with metastatic disease (BRE-4-MED)) has been developed for metastatic breast cancer. The concept was tested in a pilot study utilizing predefined feasibility criteria. Bavaria-wide accessibility to breast cancer-specific care structures was studied using a Geographic Information System (GIS) analysis. Guideline recommendations and results of the BRE-4-MED pilot study were used to identify relevant care structures. Thirty-one patients (96.8% female) from four certified breast centers of Mainfranken participated. The results of the pilot study show that the integration of primary and secondary data from different sources into a central database is feasible and the underlying organizational processes (e.g., data linkage with the cancer registry, central follow-up survey) worked out. The results of the accessibility analysis show that women from urban regions had a higher chance of reaching selected care structures than women from rural regions. This relationship was most pronounced for border-close areas. This thesis highlights opportunities for patient-centered and quality-assured breast cancer care regardless of patients’ residence. KW - Brustkrebs KW - Klinischer Behandlungspfad KW - Patientenorientierte Medizin KW - Ländlicher Raum KW - Qualitätssicherung KW - Versorgungsqualität KW - Leitlinien KW - Patienten-orientierte Versorgung Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-282474 ER - TY - THES A1 - Müller-Scholden, Lara T1 - Einfluss spezifischer kardiovaskulärer Risikofaktoren und ihrer Kombination auf die Karotis-Intima-Media-Dicke und Erstellung von Normwerten – Ergebnisse der STAAB Kohortenstudie T1 - Impact of particular Cardiovascular Risk Factors and their combination on Carotid-Intima-Media-Thickness (CIMT) and Development of Reference Values among Healthy Adults – Findings from the STAAB cohort study N2 - Primary prevention in cardiovascular diseases is becoming more and more important as they are still the number one cause of morbidity and mortality in industrialized countries. Many cardiovascular events may even occur in clinically asymptomatic patients. The atherosclerosis as underlying pathogenesis is increasingly well understood and risk factors with a harmful influence are identified. However, by measuring the carotid-intima-media-thickness (CIMT) via B-mode ultrasound there is a widely accepted, safe, noninvasive, sensitive and reproducible technique to assess subclinical vascular diseases. The CIMT is established as a surrogate marker for atherosclerosis and its increase is associated with the presence of cardiovascular risk factors. The basic prerequisite for further risk stratification, according to the level of arteriosclerosis represented by the CIMT, is to define gender-, age- and region-specific reference values. The latest version of the international guidelines for cardiovascular risk prediction do no longer recommend the use of CIMT for cardiovascular risk prediction in the general population. This may be attributed to the fact, that the experts refer to studies in which only the measurement of a single segment was considered. Thus the aim of the present study was to assess a potential segment-specific impact of particular cardiovascular risk factors on the CIMT. Furthermore the goal was to evaluate the relevance of the existing models for risk prediction and to discuss the current recommendations for the use of CIMT. Additionally, reference values were developed from data of a representative group of the general population of Würzburg and the reproducibility of the data collection was examined. Subjects derived from the population-based STAAB (Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression) cohort study, that included people of the general population of Würzburg aged 30 to 79 years [12]. CIMT was measured on the far wall of both sides in three different predefined locations: common carotid artery (CCA), bulb, and internal carotid artery (ICA). Diabetes, dyslipidemia, hypertension, smoking and obesity were considered as risk factors. In multivariable logistic regression analysis, odds ratios of risk factors per location were estimated for the endpoint of individual age- and sex-adjusted 75th percentile of CIMT. These thresholds were derived from the standard values of the general population. An apparently healthy subpopulation was formed to generate these reference values, which consists only of people that did not exhibit any of the above mentioned risk factors or manifest cardiovascular diseases. 2492 subjects were included in the analysis. Segment-specific CIMT was highest in the bulb, followed by CCA, and lowest in the ICA. The reproducibility between the investigators was overall weaker than in comparable studies, therefore a potential improvement of the training protocol for inexperienced persons was assumed. Moreover, the results of the reproducibility analysis illustrate the need for a standardized, internationally recognized protocol for the training of CIMT investigators and an exact measurement protocol. The reference values of the apparently healthy population were consistent with values from other authors collected in a comparable way and formed the basis for further investigations. CIMT increases with age and independently with the number of risk factors. Dyslipidemia, hypertension, and smoking were associated with higher CIMT, but diabetes and obesity were not (OR (95% CI) between 1.28 (0.98 - 1.65), ACC, and 1.86 (1.53 - 2.27), bulb). We observed no segment-specific association between the three different locations and risk factors, except for a possible interaction between smoking and ICA. As no segment-specific association between cardiovascular risk factors and CIMT became evident, one simple measurement of one location may suffice to assess the cardiovascular risk of an individual. In addition, the identified risk factors are reflected in the current models for risk prediction and prevention, so that the added value of the use of CIMT in the general population loses importance. N2 - Kardiovaskuläre Erkrankungen sind unverändert die häufigste Ursache für Morbidität und Mortalität in den Industrienationen [1]. Die Risikoprädiktion und -prävention dieser Erkrankungen ist von großer Bedeutung, unter anderem deswegen weil primäre Ereignisse bei bis dato asymptomatischen Personen auftreten können [2]. Die zugrundeliegende Pathogenese, die Arteriosklerose, ist immer besser erforscht und zugleich sind Risikofaktoren identifiziert, die einen schädlichen Einfluss haben [3, 4]. Durch die Messung der Karotis-Intima-Media-Dicke (Carotid-Intima-Media-Thickness, CIMT) mittels B-Mode Ultraschall steht eine weit verbreitete, sichere und anerkannte Methode zur Verfügung, mit der bereits subklinische Formen der Arteriosklerose erfasst werden können [5]. Die CIMT ist als Surrogatparameter für eine generalisierte Arteriosklerose im gesamten Gefäßsystem etabliert und ihre Zunahme wird mit dem Vorliegen von kardiovaskulären Risikofaktoren assoziiert [6-8]. In der Risikoprädiktion mit Hilfe der CIMT bilden geschlechts-, alters- und regionalspezifische Normwerte die Basis [5]. Die aktuellen internationalen Leitlinien empfehlen in ihren neusten Fassungen, nicht mehr die CIMT zur kardiovaskulären Risikoprädiktion in der Allgemeinbevölkerung einzusetzen [1, 9]. Die Experten berufen sich auf Studien, in denen lediglich ein singuläres Messsegment betrachtet wurde [1, 9-11]. Das Ziel der vorliegenden Arbeit war es den Einfluss spezifischer kardiovaskulärer Risikofaktoren auf die verschiedenen Segmente der A. carotis zu erfassen und – davon ausgehend – den Stellenwert der vorhandenen Modelle zur Risikoprädiktion zu evaluieren. Des Weiteren wurden Normwerte aus einer repräsentativen Gruppe der Würzburger Allgemeinbevölkerung gebildet und die Reproduzierbarkeit der Ultraschalluntersuchung im Bereich der Halsschlagader überprüft. Den Berechnungen liegen Daten der STAAB-Kohortenstudie (Häufigkeit und Einflussfaktoren auf frühe STAdien A und B der Herzinsuffizienz in der Bevölkerung) zugrunde, einer große Bevölkerungsstudie, die seit 2015 Daten der Würzburger Bevölkerung erhebt [12]. Es wurden Probanden zwischen mit einem Alter zwischen 30 und 79 Jahren eingeschlossen. Die CIMT wurde auf beiden Seiten des Halses auf der schallkopffernen Seite an drei vorab definierten Lokalisationen des Gefäßes, der A. carotis communis (ACC), dem Bulbus und der A. carotis interna (ACI), vermessen. Es wurden die fünf Risikofaktoren Diabetes mellitus, Dyslipidämie, Hypertonie, Rauchen und Übergewicht berücksichtigt. Mittels einer logistischen Regression wurde der spezifische Einfluss dieser Faktoren auf die individuelle, alters- und geschlechtsbasierte 75. Perzentile der CIMT in den einzelnen Lokalisationen betrachtet. Diese Grenzwerte stammten aus den eigens erstellten Normwerten für die Allgemeinbevölkerung. Es wurde eine „gesunde“ Subpopulation zur Erstellung dieser Normwerte gebildet, die keine der oben genannten Risikofaktoren sowie keine manifesten kardiovaskulären Erkrankungen aufwiesen. Die Auswertung umfasste die Daten von insgesamt 2492 Probanden. Die segmentspezifische CIMT war am größten im Bereich Bulbus, gefolgt von der ACC und der ACI. Männer hatten höhere Wanddickenwerte und mehr Risikofaktoren als Frauen. Die Reproduzierbarkeit zwischen den einzelnen Untersuchern war insgesamt moderat bis stark. Im Vergleich zu anderen Studien zeigte sich jedoch insgesamt eine schwächere Übereinstimmung, so dass von einer potentiellen Verbesserung des Schulungsprotokolls für unerfahrene Personen ausgegangen wird. Die Ergebnisse der Reproduzierbarkeitsanalyse verdeutlichen den Bedarf eines standardisierten, international anerkannten Protokolls zur Schulung von Untersuchern der CIMT und eines exakten Messprotokolls [5, 13]. Die erhobenen Normwerte der „Gesunden“ zeigten eine Konsistenz mit verschiedenen, auf vergleichbare Weise erhobenen Werten und bildeten die Basis für die weiteren Untersuchungen. Die CIMT nahm mit dem Alter und – unabhängig davon – ebenfalls mit der Anzahl an Risikofaktoren zu. Die Faktoren Dyslipidämie, Rauchen und Hypertonie hatten einen statistisch signifikanten Einfluss für das Überschreiten des Grenzwertes der 75. Perzentile (OR (95 % KI) zwischen 1,28 (0,98 – 1,65), ACC, und 1,86 (1,53 – 2,27), Bulbus) [14]. Die Faktoren Diabetes mellitus und Übergewicht zeigten im verwendeten Modell keinen Effekt auf die CIMT. Insgesamt konnte, bis auf eine mögliche Interaktion zwischen dem Risikofaktor Rauchen und der ACI, kein segmentspezifischer Effekt beobachtet werden [14]. Daraus resultierend wurde die Hypothese aufgestellt, dass zur Erfassung des kardiovaskulären Risikos einer Person die Messung eines singulären Segments möglicherweise ausreicht [14]. Dies stärkt die neusten Empfehlungen der Leitlinien, die sich auf Studien berufen, welche eben nur ein Segment betrachteten. Die identifizierten Risikofaktoren spiegeln sich darüber hinaus in den gängigen Modellen zur Risikoprädiktion und -prävention wider. Demnach gerät der Einsatz der CIMT zur Bestimmung des individuellen Risikos von Personen der Allgemeinbevölkerung in den Hintergrund [15]. KW - Arteriosklerose KW - Karotis-Intima-Media-Dicke KW - Risikofaktoren Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220292 ER - TY - JOUR A1 - Malsch, Carolin A1 - Liman, Thomas A1 - Wiedmann, Silke A1 - Siegerink, Bob A1 - Georgakis, Marios K. A1 - Tiedt, Steffen A1 - Endres, Matthias A1 - Heuschmann, Peter U. T1 - Outcome after stroke attributable to baseline factors—the PROSpective Cohort with Incident Stroke (PROSCIS) JF - PLoS ONE N2 - Background The impact of risk factors on poor outcome after ischemic stroke is well known, but estimating the amount of poor outcome attributable to single factors is challenging in presence of multimorbidity. We aim to compare population attributable risk estimates obtained from different statistical approaches regarding their consistency. We use a real-life data set from the PROSCIS study to identify predictors for mortality and functional impairment one year after first-ever ischemic stroke and quantify their contribution to poor outcome using population attributable risks. Methods The PROSpective Cohort with Incident Stroke (PROSCIS) is a prospective observational hospital-based cohort study of patients after first-ever stroke conducted independently in Berlin (PROSCIS-B) and Munich (PROSCIS-M). The association of baseline factors with poor outcome one year after stroke in PROSCIS-B was analysed using multiple logistic regression analysis and population attributable risks were calculated, which were estimated using sequential population attributable risk based on a multiple generalized additive regression model, doubly robust estimation, as well as using average sequential population attributable risk. Findings were reproduced in an independent validation sample from PROSCIS-M. Results Out of 507 patients with available outcome information after 12 months in PROSCIS-B, 20.5% suffered from poor outcome. Factors associated with poor outcome were age, pre-stroke physical disability, stroke severity (NIHSS), education, and diabetes mellitus. The order of risk factors ranked by magnitudes of population attributable risk was almost similar for all methods, but population attributable risk estimates varied markedly between the methods. In PROSCIS-M, incidence of poor outcome and distribution of baseline parameters were comparable. The multiple logistic regression model could be reproduced for all predictors, except pre-stroke physical disability. Similar to PROSCIS-B, the order of risk factors ranked by magnitudes of population attributable risk was almost similar for all methods, but magnitudes of population attributable risk differed markedly between the methods. Conclusions Ranking of risk factors by population impact is not affected by the different statistical approaches. Thus, for a rational decision on which risk factor to target in disease interventions, population attributable risk is a supportive tool. However, population attributable risk estimates are difficult to interpret and are not comparable when they origin from studies applying different methodology. The predictors for poor outcome identified in PROSCIS-B have a relevant impact on mortality and functional impairment one year after first-ever ischemic stroke. KW - ischemic stroke KW - stroke KW - physical activity KW - diabetes mellitus KW - regression analysis KW - hemorrhagic stroke KW - atrial fibrillation KW - hypertension Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177342 VL - 13 IS - 9 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 - THES A1 - Fischer, Miriam Yvonne T1 - Sind Halswirbel zur Alters- und Reifeschätzung in der Medizin geeignet? T1 - Are cervical vertebrae suitable for age estimation? N2 - Über die Bedeutung der Halswirbelmethode zur skelettalen Reifebestimmung ist man sich in Fachkreisen uneins. Bislang veröffentlichte Arbeiten setzen sich zumeist mit dem im prä-und peripuberalen Wachstumsabschnitt auseinander. Ziel dieser Studie wares, die Anwendbarkeit der CVM-Methode im Erwachsenenalter zu untersuchen. Dazu wurden insgesamt 420 Fernröntgenseitenaufnahmen des Universitätsklinikums Würzburg herangezogen und digitalisiert. Darunter befanden sich 320 Probanden, die das 20. Lebensjahr bereits überschritten haben, sowie 100 Kinder im Alter von 8-10 Jahren als Vergleichsgruppe. Anschließend wurden die Röntgenbilder durch das Programm Onyx-Ceph 3 TMdigital analysiert. Es wurden relevante Strukturen der Halswirbelkörper durch den Beobachter markiert und die benötigten Strecken und Winkel berechnet. Zur Überprüfung des Intrabeobachterfehlers bei der Punktierung wurden 50 zufällig ausgewählte Aufnahmenim Abstand von zwei Wochen erneut punktiert.Alle Aufnahmen wurden zudem durch einen Beobachter nach den CVM-Klassifizierungen von Hassel und Farman sowie Baccetti et al.bewertet. Nach zwei Wochen wurde dieser Vorgang erneut wiederholt. Die Ergebnisse dieser Studie zeigen, dass ausgereifte Halswirbelkörper deutlich von der vorgegebenen Form nach den finalen Reifestadien nach Baccetti et al.sowie Hassel und Farman abweichen. Die Konkavitäten der basalen Wirbelbegrenzung fallen flacher aus als in der bisherigen Literatur angenommen (149° -156°). Dieses Merkmal ist bei Frauen tendenziell stärker ausgeprägt. Darüber hinaus konnte festgestellt werden, dass ausgereifte Halswirbelkörper zumeist quadratischer Form sind (Höhen-Breiten-Verhältnis von 0,93 -0,99). Die Messungen ergaben ebenfalls, dass beide superioren Winkel durchschnittlichnicht das Kriterium des rechten Winkels erfüllen und somit keine eindeutig rechteckige Form gebildet wird. 80Die Auswertung der Vergleichsgruppe von 8-10Jährigen zeigte deutliche Überschneidungen einzelner Merkmale. Vor allem am anterior-superior und posterior-superioren Winkel konnte eine große Übereinstimmung der Werte der Adulten mit den der Kinder festgestellt werden. Auch die inferioren Konkavitäten an C2 und C3 sowie das anterior-posteriore Höhenverhältnis zeigten maßgebliche Überschneidungen der Werte beider Gruppen. Es kann also geschlussfolgert werden, dass die Form der Wirbelkörper kein verlässlicher Parameter bei der Bestimmung der skelettalen Reife ist. Diese Ergebnisse konnten bereits in der internationalen Fachzeitschrift „Journal of Forensic Odonto-Stomatology“ publiziert werden [49].Die visuelle Analyse wird zusätzlich dadurch erschwert, dass die Stadien oftmals nicht deutlich voneinander abgrenzbar sind, sondern regelrecht ineinander übergehen. Diese Grenzfälle führten zu einer nicht ausreichenden Intrabeobachterreliabilität, was auf eine unzureichende Verlässlichkeit der oben genannten Klassifikationen schließen lässt.Im Vergleich zu bisherigen Methoden kann die Bestimmung der skelettalen Reife nach der Halswirbelmethode durch die hohe Varianz in der Anatomie nicht eindeutigerfolgen.Somit sollte die CVM-Methode nicht als alleiniges Mittel bei der Bestimmung der skelettalen Reife genutzt werden, sondern eher zur Stützung bereits bewährter Methoden. Es sollte über eine zukünftige Klassifizierung diskutiert werden, die diese anatomischen Varianzen vor allem in den Endstadien berücksichtigt. N2 - BACKGROUND: The ability of cervical vertebrae (CV) staging to contribute in forensic age estimation is being discussed controversially. The large variability of CV geometries in the end stage of development might be the reason for not reaching a performance competitive to hand or third molar methods. Here we study the geometry of adult CV and demonstrate that the description of their “typical” appearance is often not met. METHODS: Lateral cephalograms from clinical routine of 320 subjects aged 20 years or above (median 24 years, 52% female) were evaluated. The criteria for the end stage of CV development (Hassel-Farman, Baccetti) were examined by assessing them in terms of metric measurements: (1) rectangular shape of C3/C4, (2) at least one of the height-width ratios of C3/C4 >1 (both not <1), (3) significant concavities at the inferior margin of C2, C3 and C4. Metric data of the adults were also compared to those of 100 children aged 8-10 years (50% female). RESULTS: Adult CV often violated the criteria of rectangular shape (44% C3, 36% C4), of height-width ratio (16% C3, 35% C4) and inferior concavity (10% C2, 10% C3, 19% C4). All of the criteria for adult CV were fulfilled in only 24% of the subjects (95%CI 19-28%). The variability of measures of the CV shapes was large; e.g., the 95% reference ranges for the height-width ratios were 0.81-1.19 (C3) and 0.77-1.14 (C4). There was a material overlap of ranges of CV measures of adults and children. CONCLUSION: While hand bones and teeth have well-defined appearances in the end stage of development, adult CV have a large biological variance of shapes; it is hard to define their “typical” appearance. Moreover, measures of CV geometry do not strictly separate adults from children. These facts might reason the limited usefulness of CV in age estimation. KW - Skelett KW - Reifeschätzung KW - Halswirbelmethode KW - Altersbestimmung Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214294 ER - TY - JOUR A1 - Roßberg, Siri A1 - Keller, Theresa A1 - Icke, Katja A1 - Siedmann, Valentina A1 - Lau, Imke A1 - Keil, Thomas A1 - Lau, Susanne T1 - Orally applied bacterial lysate in infants at risk for atopy does not prevent atopic dermatitis, allergic rhinitis, asthma or allergic sensitization at school age: Follow‐up of a randomized trial JF - Allergy N2 - Background The allergy preventive effects of gut immune modulation by bacterial compounds are still not fully understood. Objective We sought to evaluate the effect of bacterial lysate applied orally from the second until seventh months of life on the prevalence of allergic diseases at school age. Methods In a randomized, placebo‐controlled trial, 606 newborns with at least one allergic parent received orally a bacterial lysate consisting of heat‐killed Gram‐negative Escherichia coli Symbio and Gram‐positive Enterococcus faecalis Symbio or placebo from week 5 until the end of month 7. A total of 402 children were followed until school age (6‐11 years) for the assessment of current atopic dermatitis (AD), allergic rhinitis (AR), asthma and sensitization against aeroallergens. Results AD was diagnosed in 11.0% (22/200) of children in the active and in 10.4% (21/202) of children in the placebo group. AR was diagnosed in 35% (70/200) of children in the active and in 38.1% (77/202) children in the placebo group. Asthma was diagnosed in 9% (18/199) of children in the active and in 6.6% (13/197) of children in the placebo group. Sensitization occurred in 46.5% (66/142) of participants in the active and 51.7% (76/147) in the placebo group. Conclusion An oral bacterial lysate of heat‐killed Gram‐negative Escherichia coli and Gram‐positive Enterococcus faecalis applied during the first 7 months of life did not influence the development of AD, asthma and AR at school age. KW - asthma KW - atopic dermatitis KW - prevention KW - rhinitis Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213456 VL - 75 IS - 8 SP - 2020 EP - 2025 ER - TY - JOUR A1 - Oezkur, Mehmet A1 - Magyar, Atilla A1 - Thomas, Phillip A1 - Reif, Andreas A1 - Störk, Stefan A1 - Heuschmann, Peter U. A1 - Leyh, Rainer G. A1 - Wagner, Martin T1 - The COMT-polymorphism is not associated with the incidence of acute kidney injury after cardiac surgery - a prospective cohort study JF - BMC Nephrology N2 - Background: The Catechol-O-methyltransferase (COMT) represents the key enzyme in catecholamine degradation. Recent studies suggest that the COMT rs4680 polymorphism is associated with the response to endogenous and exogenous catecholamines. There are, however, conflicting data regarding the COMT Met/Met phenotype being associated with an increased risk of acute kidney injury (AKI) after cardiac surgery. The aim of the current study is to prospectively investigate the impact of the COMT rs4680 polymorphism on the incidence of AKI in patients undergoing cardiac surgery. Methods: In this prospective single center cohort study consecutive patients hospitalized for elective cardiac surgery including cardiopulmonary-bypass (CPB) were screened for participation. Demographic clinical data, blood, urine and tissue samples were collected at predefined time points throughout the clinical stay. AKI was defined according to recent recommendations of the Kidney Disease Improving Global Outcome (KDIGO) group. Genetic analysis was performed after patient enrolment was completed. Results: Between April and December 2014, 150 patients were recruited. The COMT genotypes were distributed as follows: Val/Met 48.7%, Met/Met 29.3%, Val/Val 21.3%. No significant differences were found for demography, comorbidities, or operative strategy according to the underlying COMT genotype. AKI occurred in 35 patients (23.5%) of the total cohort, and no differences were evident between the COMT genotypes (20.5% Met/Met, 24.7% Val/Met, 25.0% Val/Val, p = 0.66). There were also no differences in the post-operative period, including ICU or in-hospital stay. Conclusions: We did not find statistically significant variations in the risk for postoperative AKI, length of ICU or in-hospital stay according to the underlying COMT genotype. KW - AKI KW - COMT KW - cardiac surgery KW - KDIGO Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175529 VL - 19 IS - 34 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 - Schlagenhauf, Ulrich A1 - Rehder, Juliane A1 - Gelbrich, Götz A1 - Jockel‐Schneider, Yvonne T1 - Consumption of Lactobacillus reuteri‐containing lozenges improves periodontal health in navy sailors at sea: A randomized controlled trial JF - Journal of Periodontology N2 - Background The objective of this trial was to evaluate whether the regular consumption of probiotics may improve the known deterioration of periodontal health in navy sailors during deployments at sea. Methods 72 healthy sailors of a naval ship on a practicing mission at sea were recruited and randomly provided with a blinded supply of lozenges to be consumed twice daily for the following 42 days containing either the probiotic strains Lactobacillus reuteri (DSM 17938 and L. reuteri (ATTC PTA 5289) (test n = 36) or no probiotics (placebo n = 36). At baseline, at day 14 and day 42 bleeding on probing (primary outcome), gingival index, plaque control record, probing attachment level, and probing pocket depth were assessed at the Ramfjord teeth. Results At baseline there were no significant differences between the groups. At day 14 and day 42 test group scores of all assessed parameters were significantly improved (P < 0.001) compared to baseline and to the placebo group which by contrast showed a significant (P < 0.001) deterioration of all parameters at the end of the study. Conclusions The consumption of probiotic L. reuteri‐lozenges is an efficacious measure to improve and maintain periodontal health in situations with waning efficacy of personal oral hygiene. KW - gingivitis KW - oral hygiene KW - probiotics Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215577 VL - 91 IS - 10 SP - 1328 EP - 1338 ER - TY - JOUR A1 - Schwaab, Bernhard A1 - Bjarnason-Wehrens, Birna A1 - Meng, Karin A1 - Albus, Christian A1 - Salzwedel, Annett A1 - Schmid, Jean-Paul A1 - Benzer, Werner A1 - Metz, Matthes A1 - Jensen, Katrin A1 - Rauch, Bernhard A1 - Bönner, Gerd A1 - Brzoska, Patrick A1 - Buhr-Schinner, Heike A1 - Charrier, Albrecht A1 - Cordes, Carsten A1 - Dörr, Gesine A1 - Eichler, Sarah A1 - Exner, Anne-Kathrin A1 - Fromm, Bernd A1 - Gielen, Stephan A1 - Glatz, Johannes A1 - Gohlke, Helmut A1 - Grilli, Maurizio A1 - Gysan, Detlef A1 - Härtel, Ursula A1 - Hahmann, Harry A1 - Herrmann-Lingen, Christoph A1 - Karger, Gabriele A1 - Karoff, Marthin A1 - Kiwus, Ulrich A1 - Knoglinger, Ernst A1 - Krusch, Christian-Wolfgang A1 - Langheim, Eike A1 - Mann, Johannes A1 - Max, Regina A1 - Metzendorf, Maria-Inti A1 - Nebel, Roland A1 - Niebauer, Josef A1 - Predel, Hans-Georg A1 - Preßler, Axel A1 - Razum, Oliver A1 - Reiss, Nils A1 - Saure, Daniel A1 - von Schacky, Clemens A1 - Schütt, Morten A1 - Schultz, Konrad A1 - Skoda, Eva-Maria A1 - Steube, Diethard A1 - Streibelt, Marco A1 - Stüttgen, Martin A1 - Stüttgen, Michaela A1 - Teufel, Martin A1 - Tschanz, Hansueli A1 - Völler, Heinz A1 - Vogel, Heiner A1 - Westphal, Ronja T1 - Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — part 2 JF - Journal of Clinical Medicine N2 - Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively. KW - cardiac rehabilitation KW - scientific guidelines KW - secondary prevention KW - physical activity KW - exercise training KW - psychological interventions KW - education KW - gender KW - frailty KW - migration KW - old patients KW - young patients KW - tele-medicine KW - home-based-rehabilitation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-242645 SN - 2077-0383 VL - 10 IS - 14 ER - TY - JOUR A1 - Krist, Lilian A1 - Dornquast, Christina A1 - Reinhold, Thomas A1 - Becher, Heiko A1 - Jöckel, Karl-Heinz A1 - Schmidt, Börge A1 - Schramm, Sara A1 - Icke, Katja A1 - Danquah, Ina A1 - Willich, Stefan N. A1 - Keil, Thomas A1 - Brand, Tilman T1 - Association of acculturation status with longitudinal changes in health-related quality of life — results from a cohort study of adults with Turkish origin in Germany JF - International Journal of Environmental Research and Public Health N2 - Health-related quality of life (HRQL) among migrant populations can be associated with acculturation (i.e., the process of adopting, acquiring and adjusting to a new cultural environment). Since there is a lack of longitudinal studies, we aimed to describe HRQL changes among adults of Turkish descent living in Berlin and Essen, Germany, and their association with acculturation. Participants of a population-based study were recruited in 2012–2013 and reinvited six years later to complete a questionnaire. Acculturation was assessed at baseline using the Frankfurt acculturation scale (integration, assimilation, separation and marginalization). HRQL was assessed at baseline (SF-8) and at follow-up (SF-12) resulting in a physical (PCS) and mental (MCS) sum score. Associations with acculturation and HRQL were analyzed with linear regression models using a time-by-acculturation status interaction term. In the study 330 persons were included (65% women, mean age ± standard deviation 43.3 ± 11.8 years). Over the 6 years, MCS decreased, while PCS remained stable. While cross-sectional analyses showed associations of acculturation status with both MCS and PCS, temporal changes including the time interaction term did not reveal associations of baseline acculturation status with HRQL. When investigating HRQL in acculturation, more longitudinal studies are needed to take changes in both HRQL and acculturation status into account. KW - health-related quality of life KW - HRQL KW - acculturation KW - Turkish KW - migrants Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234068 SN - 1660-4601 VL - 18 IS - 6 ER - TY - JOUR A1 - Kraft, Robin A1 - Reichert, Manfred A1 - Pryss, Rüdiger T1 - Towards the interpretation of sound measurements from smartphones collected with mobile crowdsensing in the healthcare domain: an experiment with Android devices JF - Sensors N2 - The ubiquity of mobile devices fosters the combined use of ecological momentary assessments (EMA) and mobile crowdsensing (MCS) in the field of healthcare. This combination not only allows researchers to collect ecologically valid data, but also to use smartphone sensors to capture the context in which these data are collected. The TrackYourTinnitus (TYT) platform uses EMA to track users' individual subjective tinnitus perception and MCS to capture an objective environmental sound level while the EMA questionnaire is filled in. However, the sound level data cannot be used directly among the different smartphones used by TYT users, since uncalibrated raw values are stored. This work describes an approach towards making these values comparable. In the described setting, the evaluation of sensor measurements from different smartphone users becomes increasingly prevalent. Therefore, the shown approach can be also considered as a more general solution as it not only shows how it helped to interpret TYT sound level data, but may also stimulate other researchers, especially those who need to interpret sensor data in a similar setting. Altogether, the approach will show that measuring sound levels with mobile devices is possible in healthcare scenarios, but there are many challenges to ensuring that the measured values are interpretable. KW - mHealth KW - crowdsensing KW - tinnitus KW - noise measurement KW - environmental sound Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252246 SN - 1424-8220 VL - 22 IS - 1 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 -