TY - JOUR A1 - Oezkur, Mehmet A1 - Wagner, Martin A1 - Weismann, Dirk A1 - Krannich, Jens Holger A1 - Schimmer, Christoph A1 - Riegler, Christoph A1 - Rücker, Victoria A1 - Leyh, Rainer A1 - Heuschmann, Peter U. T1 - Chronic hyperglycemia is associated with acute kidney injury in patients undergoing CABG surgery – a cohort study JF - BMC Cardiovascular Disorders N2 - Background Chronic hyperglycemia (CHG) with HbA1c as an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting surgery (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG impacting short-and long-term outcomes. We investigated the association between CHG and postoperative incidence of AKI in CABG patients with and without history of diabetes mellitus (DM). Methods This cohort study consecutively enrolled patients undergoing CABG in 2009 at the department for cardiovascular surgery. CHG was defined as HbA1c ≥ 6.0 %. Patients with advanced chronic kidney disease (CKD) were excluded. The incidence of postoperative AKI and its association with CHG was analyzed by univariate and multivariate logistic regression modeling. Results Three-hundred-seven patients were analyzed. The incidence of AKI was 48.2 %. Patients with CHG (n = 165) were more likely to be female and had greater waist circumference as well as other comorbid conditions, such as smoking, history of DM, CKD, hypertension, pulmonary hypertension, and chronic obstructive pulmonary disease (all p ≤ 0.05). Preoperative eGFR, atrial fibrillation (AF), history of DM and CHG were associated with an increased risk of postoperative AKI in univariate analyses. In multivariate modelling, history of DM as well as preoperative eGFR and AF lost significance, while age, CHG and prolonged OP duration (p < 0.05) were independently associated with postoperative AKI. Conclusions Our results suggest that CHG defined on a single measurement of HbA1c ≥ 6.0 % was associated with the incidence of AKI after CABG. This finding might implicate that treatment decisions, including the selection of operative strategies, could be based on HbA1c measurement rather than on a recorded history of diabetes. Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125224 VL - 15 IS - 41 ER - TY - JOUR A1 - Magg, Barbara A1 - Riegler, Christoph A1 - Wiedmann, Silke A1 - Heuschmann, Peter A1 - Sommer, Claudia A1 - Üçeyler, Nurcan T1 - Self-administered version of the Fabry-associated pain questionnaire for adult patients JF - Orphanet Journal of Rare Diseases N2 - Background Fabry-associated pain may be the first symptom of Fabry disease (FD) and presents with a unique phenotype including mostly acral burning triggerable pain attacks, evoked pain, pain crises, and permanent pain. We recently developed and validated the first Fabry Pain Questionnaire (FPQ) for adult patients. Here we report on the validation of the self-administered version of the FPQ that no longer requires a face-to-face interview but can be filled in by the patients themselves allowing more flexible data collection. Methods At our Würzburg Fabry Center for Interdisciplinary Treatment, Germany, we have developed the self-administered version of the FPQ by adapting the questionnaire to a self-report version. To do this, consecutive Fabry patients with current or past pain history (n = 56) were first interviewed face-to-face. Two weeks later patients’ self-reported questionnaire results were collected by mail (n = 55). We validated the self-administered version of the FPQ by assessing the inter-rater reliability agreement of scores obtained by supervised administration and self-administration of the FPQ. Results The FPQ contains 15 questions on the different pain phenotypes, on pain development during life with and without therapy, and on impairment due to pain. Statistical analysis showed that the majority of questions were answered in high agreement in both sessions with a mean AC1-statistic of 0.857 for 55 nominal-scaled items and a mean ICC of 0.587 for 9 scores. Conclusions This self-administered version of the first pain questionnaire for adult Fabry patients is a useful tool to assess Fabry-associated pain without a time-consuming face-to-face interview but via a self-reporting survey allowing more flexible usage. KW - Fabry disease KW - Fabry-associated pain KW - pain questionnaire Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-145294 VL - 10 IS - 113 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 -