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Auzanneau M, Eckert AJ, Fritsche A, Heni M, Icks A, Mueller-Stierlin AS, Dugic A, Risse A, Lanzinger S, Holl RW. Diabetes in all hospitalized cases in Germany 2015-2019 and impact of the first COVID-19 year 2020. Endocr Connect 2023; 12:EC-22-0475. [PMID: 36811912 PMCID: PMC10083653 DOI: 10.1530/ec-22-0475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To analyze the proportion of diabetes among all hospitalized cases in Germany between 2015 and 2020. METHODS Using the nationwide Diagnosis-Related-Groups statistics, we identified among all inpatient cases aged ≥ 20 years all types of diabetes in the main or secondary diagnoses based on ICD-10 codes, as well all COVID-19 diagnoses for 2020. RESULTS From 2015 to 2019, the proportion of cases with diabetes among all hospitalizations increased from 18.3% (3.01 of 16.45 million) to 18.5% (3.07 of 16.64 million). Although the total number of hospitalizations decreased in 2020, the proportion of cases with diabetes increased to 18.8% (2.73 of 14.50 million). The proportion of COVID-19 diagnosis was higher in cases with diabetes than in those without in all sex and age subgroups. The relative risk (RR) for a COVID-19 diagnosis in cases with vs without diabetes was highest in age group 40-49 years (RR in females: 1.51; in males: 1.41). CONCLUSIONS The prevalence of diabetes in the hospital is twice as high as the prevalence in the general population and has increased further with the COVID-19 pandemic, underscoring the increased morbidity in this high-risk patient group. This study provides essential information that should help to better estimate the need for diabetological expertise in inpatient care settings.
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Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, ZIBMT, Medical Faculty of Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Correspondence should be addressed to M Auzanneau:
| | - Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, Medical Faculty of Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Andreas Fritsche
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Internal Medicine IV, University Hospital Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Martin Heni
- Institute of Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- Division of Endocrinology and Diabetology, Department of Internal Medicine 1, University Hospital Ulm, Ulm, Germany
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Centre for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Annabel S Mueller-Stierlin
- Department of General Practice and Primary Care, University Hospital Ulm, Um, Germany
- Department of Psychiatry and Psychotherapy II, University Hospital Ulm, Um, Germany
| | - Ana Dugic
- Department of Gastroenterology, Klinikum Bayreuth, Medizincampus Oberfranken der Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Bayreuth, Germany
| | - Alexander Risse
- Diabetes Center at Sophie-Charlotte-Platz, Diabetes Foot Unit, Berlin, Germany
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Medical Faculty of Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Medical Faculty of Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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Morbach S, Eckhard M, Lobmann R, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetic Foot Syndrome. Exp Clin Endocrinol Diabetes 2023; 131:84-93. [PMID: 36720238 DOI: 10.1055/a-1946-3838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Stephan Morbach
- Department of Diabetology and Angiology, Marienkrankenhaus gGmbH, Soest, Germany
| | - Michael Eckhard
- University Diabetes Center and Interdisciplinary Diabetic Foot Center of Central Hessen, University Hospital Giessen and Marburg GmbH, Location: Giessen and GZW Diabetes Clinic Bad Nauheim, Germany
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Location: Bad Cannstatt, Germany
| | - Eckhard Müller
- Practice for Diabetology and Nephrology, KfH Kidney Center, Bernkastel-Kues, Germany
| | | | | | - Gerhard Rümenapf
- Upper Rhine Vascular Center, Department of Vascular Surgery, Diakonissen-Stiftungs-Hospital, Speyer, Germany
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3
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Morbach S, Eckhard M, Lobmann R, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1904-7527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stephan Morbach
- Abteilung für Diabetologie und Angiologie, Marienkrankenhaus gGmbH, Soest, Deutschland
| | - Michael Eckhard
- Universitäres Diabeteszentrum und Interdisziplinäres Zentrum Diabetischer Fuß Mittelhessen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen und GZW Diabetesklinik Bad Nauheim, Deutschland
| | - Ralf Lobmann
- Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum Stuttgart, Standort Bad Cannstatt, Deutschland
| | - Eckhard Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH-Nierenzentrum, Bernkastel-Kues, Deutschland
| | | | - Alexander Risse
- Diabeteszentrum am Sophie-Charlotte-Platz, Berlin, Deutschland
| | - Gerhard Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer, Deutschland
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4
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Morbach S, Eckhard M, Lobmann R, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1515-9222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephan Morbach
- Abteilung für Diabetologie und Angiologie, Marienkrankenhaus gGmbH, Soest
| | - Michael Eckhard
- Universitäres Diabeteszentrum und Interdisziplinäres Zentrum Diabetischer Fuß Mittelhessen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen und GZW Diabetesklinik Bad Nauheim
| | - Ralf Lobmann
- Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum Stuttgart, Standort Bad Cannstatt
| | - Eckhard Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH-Nierenzentrum, Bernkastel-Kues
| | | | | | - Gerhard Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
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5
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Reinboldt-Jockenhöfer F, Babadagi Z, Hoppe HD, Risse A, Rammos C, Cyrek A, Blome C, Benson S, Dissemond J. Association of wound genesis on varying aspects of health-related quality of life in patients with different types of chronic wounds: Results of a cross-sectional multicentre study. Int Wound J 2021; 18:432-439. [PMID: 33398926 PMCID: PMC8273619 DOI: 10.1111/iwj.13543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 01/06/2023] Open
Abstract
Patients with chronic wounds are significantly impaired in their health‐related quality of life (HRQoL). The validated Wound‐QoL questionnaire allows assessing the impact of chronic wounds on different aspects of HRQoL including physical, psychological, and everyday life‐related impairments. The aim of our study was to investigate associations of these HRQoL dimensions with age, sex, and particularly wound genesis. In this retrospective, cross‐sectional, multicentre study, Wound‐QoL questionnaires from clinical routine of patients with venous leg ulcers, arterial leg ulcers, mixed leg ulcers, and diabetic foot ulcers (DFU) were evaluated. Effects of wound genesis, sex, and age were assessed with analysis of variance as well as correlation and multiple linear regression analyses. The completed questionnaires of 381 patients (f = 152/m = 229; mean age 68.9) were included. The wound genesis groups showed significantly different distributions of age and sex. We also found significant differences between those groups in everyday life‐related QoL, with the greatest impairments in patients with DFU. Physical QoL scores showed significant differences between men and women depending on diagnosis group: in patients with venous leg ulcers, women had greater impairment of physical QoL than men. Independent of the underlying diagnosis, women had significantly higher scores in the psychological subscale as well as in the Wound‐QoL sum scale. Within the subgroup of arterial leg ulcer patients, overall HRQoL sum score was significantly worse in older patients. Regression analyses supported negative effects of DFU diagnosis and female sex on HRQoL. Our data offer evidence that HRQoL shows clinically relevant differences between patients with chronic wounds of different genesis. Moreover, our data revealed that HRQoL is associated with age and sex, which should be considered when treating the patient groups. In order to be able to capture these important aspects and to offer individualised and patient‐oriented treatments, the Wound‐QoL should be implemented as a quick and uncomplicated standard instrument in daily routine. Patients with chronic wounds are significantly impaired in their health‐related quality of life. Validated Wound‐QoL questionnaire is a quick and easy‐to‐use instrument for daily practice. Wound‐related quality of life shows clinically relevant differences between patients with chronic wounds of different genesis. Wound‐related quality of life is associated with age and sex, which should be considered when treating these patient groups. Health‐related quality of life should be regularly objectified in all patients with chronic wounds with a validated measuring instrument.
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Affiliation(s)
- Finja Reinboldt-Jockenhöfer
- Department of Dermatology, Venereology and Allergology, Initiative Chronische Wunden (ICW) e.V, University Hospital of Essen, Germany
| | | | | | - Alexander Risse
- Department of Diabetology, Klinikum Dortmund, Dortmund, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Germany
| | - Anna Cyrek
- Division of Vascular and Endovascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing, German Center for Health Services Research in Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, Initiative Chronische Wunden (ICW) e.V, University Hospital of Essen, Germany
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Morbach S, Lobmann R, Eckhard M, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetic Foot Syndrome. Exp Clin Endocrinol Diabetes 2020; 129:S82-S90. [PMID: 33352597 DOI: 10.1055/a-1284-6412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Stephan Morbach
- Department of Diabetology and Angiology, Marienkrankenhaus gGmbH, Soest, Germany
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Bad Cannstatt, Germany
| | - Michael Eckhard
- University Diabetes Center and Interdisciplinary Diabetic Foot Center of Central Hesse, University Hospital Giessen and Marburg GmbH, Giessen site and GZW Diabetes Clinic Bad Nauheim, Germany
| | - Eckhard Müller
- Practice for Diabetology and Nephrology, KfH kidney center, Bernkastel-Kues, Germany
| | - Heinrich Reike
- Department of Internal Medicine, Mariannen-Hospital, Werl, Germany
| | - Alexander Risse
- Diabetes Center, Department of Internal Medicine North, Dortmund, Germany
| | - Gerhard Rümenapf
- Upper Rhine Vascular Center, Department of Vascular Surgery, Diakonissen Stiftungs Hospital, Speyer, Germany
| | - Maximilian Spraul
- Diabetes Center Rheine, Department of Internal Medicine III (Mathias Hospital and Jacobi Hospital), Rheine, Germany
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Affiliation(s)
- Stephan Morbach
- Abteilung für Diabetologie und Angiologie, Marienkrankenhaus gGmbH, Soest
| | - Ralf Lobmann
- Klinik für Endokrinologie, Diabetologie und Geriatrie, Klinikum Stuttgart, Standort Bad Cannstatt
| | - Michael Eckhard
- Universitäres Diabeteszentrum und Interdisziplinäres Zentrum Diabetischer Fuß Mittelhessen, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen und GZW Diabetesklinik Bad Nauheim
| | - Eckhard Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH-Nierenzentrum, Bernkastel-Kues
| | | | | | - Gerhard Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - Maximilian Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Hodeck K, Tittel SR, Dreyhaupt I, Beer R, Petermann S, Risse A, Weyer M, Hake K, Schiel R, Holl RW. Charakteristika von Diabetespatienten mit und ohne Pflegebedürftigkeit. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1207-9645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ZusammenfassungIm Rahmen der vorliegenden multizentrischen Auswertung mit 6.424 Pflegepatienten unter 500.973 Menschen mit Diabetes aus dem DPV-Register wird die Erkrankungssituation der Pflegebedürftigen im Vergleich zu Patienten ohne Pflegebedürftigkeit, differenziert nach Altersgruppen und Diabetestyp, dargestellt.15 % der Pflegebedürftigen haben einen Typ-1-Diabetes, darunter fallen 99,0 % der Kinder, 9,5 % der 18- bis 75-Jährigen und 2,4 % der über 75-Jährigen. Pflegebedürftigkeit ist bei Erwachsenen und Senioren insbesondere mit den Krankheitsbildern Demenz, Depression, Herzinsuffizienz, Durchblutungsstörungen der Hirngefäße/Schlaganfall sowie mit dem diabetischen Fußsyndrom/Amputationen assoziiert. In der diabetologischen Therapie des Typ-2-DM wird bei 77 % der Pflegebedürftigen und damit deutlich häufiger als in der Vergleichsgruppe mit 55 % Insulin eingesetzt. Trotz höherer HbA1c-Werte und höherer Nüchternglukose als bei Typ-2-Patienten ohne Pflege treten unter Pflegebedürftigen gleichzeitig signifikant häufiger Hypoglykämien mit und ohne Koma auf. Stoffwechselbedingte Entgleisungen führten bei 15 % der Pflegepatienten mit Typ-2-DM gegenüber nur 6 % der Menschen mit Typ-2-DM ohne Pflegebedarf zu Klinikaufnahmen.Im Rahmen der Versorgung sollte verstärkt auf die Vermeidung von Stoffwechselentgleisungen geachtet und präventiv auf einen späteren Eintritt der assoziierten Krankheitsbilder hingewirkt werden. Die Versorgungsstrukturen sollten regional auf die Begleitung der Betroffenen spezialisiert werden. In der Aus- und Weiterbildung von Pflegepersonal und Ärzten sollten die Besonderheiten von jungen und alten Menschen mit Typ-1- und Typ-2-Diabetes stärker beachtet werden.
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Affiliation(s)
- Katja Hodeck
- Institut für Innovatives Gesundheitsmanagement GmbH, Berlin
| | - Sascha R. Tittel
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm und Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg
| | - Ines Dreyhaupt
- Kreisklinik Trostberg, Kliniken Südostbayern AG, Traunstein
| | - Renate Beer
- Diabetesberatung, HELIOS Klinikum Hildesheim
| | | | | | - Marc Weyer
- Innere Medizin, DRK Kamillus Klinik, Asbach
| | - Kathrin Hake
- Klinik für Kinder- und Jugendmedizin, MediClin Müritz-Klinikum, Waren
| | - Ralf Schiel
- MEDIGREIF Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Haus Gothensee, Ostseebad Heringsdorf
| | - Reinhard W. Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm und Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg
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Affiliation(s)
- Stephan Morbach
- Abteilung für Diabetologie und Angiologie, Marienkrankenhaus gGmbH, Soest
| | - Ralf Lobmann
- Klinik für Endokrinologie, Diabetologie und Geriatrie, Krankenhaus Bad Cannstatt, Klinikum Stuttgart
| | - Michael Eckhard
- Universitäres Diabeteszentrum und Interdisziplinäres Zentrum Diabetischer Fuß Mittelhessen, Med. Klinik und Poliklinik III, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Eckhard Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH-Nierenzentrum, Bernkastel-Kues
| | | | | | - Gerhard Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - Maximilian Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Petrak F, Albus C, Grewe P, Dieris-Hirche J, Paust R, Risse A, Röhrig B, Meier JJ. Erwiderung zum Leserbrief „Adhärenz: Wer wie an was?“ von Dr. med. Bernd Kalvelage (Diabetologie 2019; 14: 365–366; DOI https://doi.org/10.1055/a-0969-0728). DIABETOL STOFFWECHS 2019. [DOI: 10.1055/a-0969-0913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Frank Petrak
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum (FP: ORCID identifier: 0000-0001-5985-5845)
- Zentrum für Psychotherapie, Wiesbaden
| | - Christian Albus
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinik Köln
| | - Petra Grewe
- Praxis für Psychologische Psychotherapie Petra Grewe, Dortmund
| | - Jan Dieris-Hirche
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum (FP: ORCID identifier: 0000-0001-5985-5845)
| | - Rainer Paust
- Institut für Psychosoziale Medizin, Elisabeth-Krankenhaus Essen
| | | | - Bonnie Röhrig
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum (FP: ORCID identifier: 0000-0001-5985-5845)
| | - Juris J. Meier
- Diabeteszentrum Bochum/Hattingen, Katholisches Klinikum Bochum, Ruhr-Universität Bochum
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Morbach S, Lobmann R, Eckhard M, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/a-0598-3040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Stephan Morbach
- Abteilung für Diabetologie und Angiologie, Marienkrankenhaus gGmbH, Soest
| | - Ralf Lobmann
- Klinik für Endokrinologie, Diabetologie und Geriatrie, Krankenhaus Bad-Cannstatt, Klinikum Stuttgart
| | - Michael Eckhard
- Universitäres Diabeteszentrum und Interdisziplinäres Zentrum Diabetischer Fuß Mittelhessen, Med. Klinik und Poliklinik III, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen
| | - Eckhard Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH Nierenzentrum, Bernkastel-Kues
| | | | | | - Gerhard Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - Maximilian Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Haep A, Murday S, Risse A, Nashan D, Ständer HF. [Charcot foot masked by erysipelas and peripheral arterial disease]. Hautarzt 2017; 69:316-320. [PMID: 29184984 DOI: 10.1007/s00105-017-4085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Charcot foot is also known as Charcot disease or Charcot arthropathy. The associated aseptic destruction of the bones and joints of the foot results due to peripheral neuropathy accompanied by impaired pain perception, impaired vasomotricity with increased vasodilation, and an unequal weight distribution. Because it is frequently diagnosed late and, thus, incorrectly treated, serious complications often result. An 86-year-old man in poor health was diagnosed with erysipelas of the right foot. The foot was glossy and edematously swollen, showing necrosis of the distal phalanx of the third toe. The patient experienced pain after a walking distance of approximately 20 m. In addition to erysipelas, confirmed neuropathic arthropathy and radiological indicators for Charcot foot established peripheral artery disease (PAD) as a third diagnosis. Despite multiple systemic antibiotic therapies, there was a progressive disease pattern marked by increasing inflammation parameters with an increasing decline of the patient's overall health. The patient suffered severe deterioration in spite of vascular surgical measures, ultimately leading to his death. In the present case, the indicators and respective confirmation of the three overlapping diagnoses erysipelas, Charcot foot and PAD are elaborated.
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Affiliation(s)
- A Haep
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland.
| | - S Murday
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland
| | - A Risse
- Diabeteszentrum, Klinikzentrum Nord, Klinikum Dortmund gGmbH, Münsterstr. 240, 44145, Dortmund, Deutschland
| | - D Nashan
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland
| | - H F Ständer
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland.,Dermatologie Bad Bentheim, Praxis im Paulinenkrankenhaus, Paulinenweg 1, 48455, Bad Bentheim, Deutschland
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13
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Affiliation(s)
- Stephan Morbach
- Marienkrankenhaus gGmbH, Abteilung für Diabetologie und Angiologie, Soest
| | - Eckhard Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH Nierenzentrum, Bernkastel-Kues
| | | | | | - Gerhard Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - Maximilian Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Morbach S, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0042-115201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Morbach
- Marienkrankenhaus gGmbH, Abteilung für Diabetologie und Angiologie, Soest
| | - E. Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH Nierenzentrum, Bernkastel-Kues
| | - H. Reike
- Innere Abteilung, Mariannen-Hospital Werl
| | - A. Risse
- Diabetologie, Medizinische Klinik Nord, Dortmund
| | - G. Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - M. Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Risse A. Referat – Dänische Daten zeigen einen Rückgang von Amputationen. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Morbach S, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1553564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Morbach
- Marienkrankenhaus gGmbH, Abteilung für Diabetologie und Angiologie, Soest
| | - E. Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH Nierenzentrum, Bernkastel-Kues
| | - H. Reike
- Innere Abteilung, Mariannen-Hospital Werl
| | - A. Risse
- Diabetologie, Medizinische Klinik Nord, Dortmund
| | - G. Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - M. Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Schwandt A, Köppen S, Ebner S, Zimny S, Risse A, Bergis D, Dapp A, Jehle PM, Wietholtz H, Holl RW. Ergebnisse einer multizentrischen Studie mit 222.078 Typ-2-Diabetespatienten aus der DPV-Datenbank: Psoriasis bei 232 Patienten mit Typ-2-Diabetes trägt zu einer hohen Rate an Depression bei. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Risse A, Dissemond J, Engels G, Glau S, Hochlenert D, Jecht M, Kersken J, Kramer A, Kröger K, Landgraf R, Lobmann R, May M, Mohrmann M, Morbach S, Pralle K, Reuter HM, Storck M, Tonn C, Trocha A, Wozniak G. Diabetisches-Fuß-Syndrom-Register. Diabetologe 2015. [DOI: 10.1007/s11428-014-1285-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- J. Dissemond
- Professor, Department for Dermatology, Venerology and Allergology, University School of Medicine, Essen, Germany
| | - K. Kröger
- Professor, Clinic Director, Department for Vascular Medicine, HELIOS Clinic, Krefeld, Germany
| | - M. Storck
- Professor Clinic Director, Department for Vascular and Thoracic Surgery, Municipal Hospital Karlsruhe, Academic Teaching Hospital Univ. Freiburg, Germany
| | - A. Risse
- Clinic-Center North, Center for Diabetes, Dortmund, Germany
| | - P. Engels
- EngelsConsult, Bergisch Gladbach, Germany
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Morbach S, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0034-1385402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S. Morbach
- Marienkrankenhaus gGmbH, Abteilung für Diabetologie und Angiologie, Soest
| | - E. Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH Nierenzentrum, Bernkastel-Kues
| | - H. Reike
- Innere Abteilung, Mariannen-Hospital Werl
| | - A. Risse
- Diabetologie, Medizinische Klinik Nord, Dortmund
| | - G. Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - M. Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III, (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Schwandt A, Bergis D, Dapp A, Ebner S, Jehle PM, Köppen S, Risse A, Zimny S, Holl RW. Psoriasis and Diabetes: A Multicenter Study in 222078 Type 2 Diabetes Patients Reveals High Levels of Depression. J Diabetes Res 2015; 2015:792968. [PMID: 26357664 PMCID: PMC4556326 DOI: 10.1155/2015/792968] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/01/2015] [Accepted: 07/22/2015] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the association between psoriasis and disease outcome in type 2 diabetes (T2D). METHODS 222078 T2D patients (≥10 years old) from the prospective, multicenter diabetes patient registry were analyzed. Specific search items were used to identify psoriasis patients. Multiple regression models were fitted and adjusted for demographic confounder. RESULTS 232 T2D patients had comorbid psoriasis. After adjusting psoriasis patients revealed a higher BMI (31.8 [31.0; 32.6] versus 30.6 [30.5; 30.6] kg/m2, p = 0.004) and HbA1c (64.8 [62.1; 67.6] versus 59.0 [58.9; 59.1] mmol/mol, p < 0.0001). Insulin was used more frequently (62.3 [55.7; 68.5] versus 50.9 [50.7; 51.1] %, p = 0.001), only OAD/GLP-1 was similar, and nonpharmacological treatment was less common (13.3 [9.5; 18.3] versus 21.9 [21.7; 22.1] %, p = 0.002). Severe hypoglycemia (0.31 [0.238; 0.399] versus 0.06 [0.057; 0.060] events per patient-year, p < 0.0001), hypertension (86.1 [81.1; 90.0] versus 68.0 [67.8; 68.2] %, p < 0.0001), and thyroid disease (14.0 [10.1; 19.2] versus 4.6 [4.5; 4.7] %, p < 0.0001) were more prevalent. Depression occurred more often (10.5 [7.1; 15.2] versus 2.8 [2.7; 2.8] %, p < 0.0001). CONCLUSIONS Clinical diabetes characteristics in psoriasis T2D patients were clearly worse compared to patients without psoriasis. Comorbid conditions and depression were more prevalent, and more intensive diabetes therapy was required.
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Affiliation(s)
- Anke Schwandt
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, German Center for Diabetes Research (DZD), University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- *Anke Schwandt:
| | - Dominik Bergis
- Division of Endocrinology & Metabolism, Department of Internal Medicine I, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Albrecht Dapp
- Medical Clinic, Health Center Spaichingen, Diabetes Center, Hospital District Tuttlingen, Robert Koch Straße 31, 78549 Spaichingen, Germany
| | - Stefan Ebner
- 2nd Department of Internal Medicine, General Hospital Linz, Krankenhausstraße 9, 4021 Linz, Austria
| | - Peter M. Jehle
- Department of Internal Medicine, Academic Hospital Paul Gerhardt Stift, Martin Luther University of Halle-Wittenberg, Paul-Gerhardt-Straße 42-45, 06886 Lutherstadt Wittenberg, Germany
| | - Stefan Köppen
- 2nd Department of Internal Medicine, Clinical Center HELIOS Hildesheim, Senator-Braun-Allee 33, 31135 Hildesheim, Germany
| | - Alexander Risse
- Department of Diabetes, Clinical Center Dortmund GmbH, Beurhausstraße 40, 44137 Dortmund, Germany
| | - Stefan Zimny
- Department of General Internal Medicine, Endocrinology and Diabetes, HELIOS Clinic Schwerin, Wismarsche Straße 393-397, 19049 Schwerin, Germany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, German Center for Diabetes Research (DZD), University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany
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Affiliation(s)
- S Morbach
- Marienkrankenhaus gGmbH, Abteilung für Diabetologie und Angiologie, Soest
| | - E Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH Nierenzentrum, Bernkastel-Kues
| | - H Reike
- Innere Abteilung, Mariannen-Hospital Werl
| | - A Risse
- Diabetologie, Medizinische Klinik Nord, Dortmund
| | - G Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - M Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III, (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Affiliation(s)
- S. Morbach
- Marienkrankenhaus gGmbH, Abteilung für Diabetologie und Angiologie, Soest
| | - E. Müller
- Schwerpunktpraxis für Diabetologie und Nephrologie, KfH Nierenzentrum, Bernkastel-Kues
| | - H. Reike
- Innere Abteilung, Mariannen-Hospital Werl
| | - A. Risse
- Diabetologie, Medizinische Klinik Nord, Dortmund
| | - G. Rümenapf
- Oberrheinisches Gefäßzentrum, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Speyer
| | - M. Spraul
- Diabetes-Zentrum Rheine, Medizinische Klinik III, (Mathias-Spital und Jakobi-Krankenhaus), Rheine
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Kroger K, Storck M, Risse A. [Innovative wound care--new studies to increase evidence]. MMW Fortschr Med 2013; 155 Suppl 2:51-55. [PMID: 24930322 DOI: 10.1007/s15006-013-1054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Today numerous products for wound care are available. A research-based evidence on which the clinician can base its selection, is still missing. In the guidelines randomized controlled trials (RCTs) have been left out. METHOD In the overview three current RCT with products for the treatment of chronically venous ulcers will be presented. RESULTS AND CONCLUSIONS The pre-mentioned studies show, that it is possible to provide a basis for evidence-based treatment in wound healing. The effective value ofa wound treatment based on the costs and benefits must be defined by the health system. But products, for which data from randomized trials exist, should be evaluated in a different way to products, for which there are no such data.
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Molz E, Risse A, Welp-Overmann U, Jockenhoevel F, Bollen M, Badenhoop K, Holl RW. Herzinfarkt- und Schlaganfallrisiko bei 102.339 DM-Typ-2-Patienten der Diabetes-Patienten-Verlaufsdokumentation (DPV): Wer ist gefährdet? DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Risse A, Holl R, Fach EM, Hungele A. Häufigkeit und Schwere des Diabetischen Fuß-Syndrom (DFS) bei 120293 Menschen mit Typ1- oder Typ2 Diabetes mellitus. Eine multizentrische Auswertung des DPV-Datensatzes 2005–2010. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1280947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dissemond J, Assadian O, Gerber V, Kingsley A, Kramer A, Leaper DJ, Mosti G, Piatkowski de Grzymala A, Riepe G, Risse A, Romanelli M, Strohal R, Traber J, Vasel-Biergans A, Wild T, Eberlein T. Classification of wounds at risk and their antimicrobial treatment with polihexanide: a practice-oriented expert recommendation. Skin Pharmacol Physiol 2011; 24:245-55. [PMID: 21508658 DOI: 10.1159/000327210] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Currently, there are no generally accepted definitions for wounds at risk of infection. In clinical practice, too many chronic wounds are regarded as being at risk of infection, and therefore many topical antimicrobials - in terms of frequency and duration of use - are applied to wounds. Based on expert discussion and current knowledge, a clinical assessment score was developed. The objective of this wounds at risk (W.A.R.) score is to allow decision-making on the indication for the use of antiseptics on the basis of polihexanide. The proposed clinical classification of W.A.R. shall facilitate the decision for wound antisepsis and allow an appropriate general treatment regimen with the focus on the prevention of wound infection. The W.A.R. score is based on a clinically oriented risk assessment using concrete patient circumstances. The indication for the use of antiseptics results from the addition of differently weighted risk causes, for which points are assigned. Antimicrobial treatment is justified in the case of 3 or more points.
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Affiliation(s)
- J Dissemond
- Department of Dermatology, Universitätsklinikum Essen, Germany
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Morbach S, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diagnostik, Therapie, Verlaufskontrolle und Prävention des diabetischen Fußsyndroms. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1224622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Morbach S, Müller E, Reike H, Risse A, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1004682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Risse A. [The diabetic foot syndrome - an interdisciplinary challenge]. Hamostaseologie 2007; 27:117-22. [PMID: 17479175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Therapy and diagnosis of the diabetic foot syndrome are almost standardized, all procedures are well established. There are no challenges in technical dimensions. But the rate of major amputations remains unacceptably high in Germany. Because there are other causes than lack of medical knowledge, this review describes the somatologic, psychiatric, and philosophic perspectives of the problem.
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Affiliation(s)
- A Risse
- Diabeteszentrum Nord, Medizinische Klinik Nord, Dortmund.
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Risse A. Das diabetische Fußsyndrom. Hamostaseologie 2007. [DOI: 10.1055/s-0037-1617161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
ZusammenfassungDas diabetische Fußsyndrom bietet keine Herausforderung in technischer oder medizinischer Hinsicht, wohl aber enorme, bisher nicht überwundene organisatorische Schwierigkeiten der interdisziplinären Kooperation. Die unverändert hohe Zahl von Majoramputationen beim diabetischen Fuß- Syndrom bleibt ein ungelöstes Problem im deutschen Gesundheitswesen. Der Artikel beleuchtet die Ursachen unter somatologischen, psychiatrischen und philosophischen Aspekten.
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Morbach S, Müller E, Reike H, Risse A, Spraul M. Diabetisches Fußsyndrom. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-941468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Harrasser A, Rakovac I, Seereiner S, Beck P, Risse A, Jecht M, Pieber TR. Änderung des Benutzerverhaltens nach Einführung eines Web-basierten Informationssystems für Qualitätsmanagement. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-944085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Falcke H, Apel WD, Badea AF, Bähren L, Bekk K, Bercuci A, Bertaina M, Biermann PL, Blümer J, Bozdog H, Brancus IM, Buitink S, Brüggemann M, Buchholz P, Butcher H, Chiavassa A, Daumiller K, de Bruyn AG, de Vos CM, Di Pierro F, Doll P, Engel R, Gemmeke H, Ghia PL, Glasstetter R, Grupen C, Haungs A, Heck D, Hörandel JR, Horneffer A, Huege T, Kampert KH, Kant GW, Klein U, Kolotaev Y, Koopman Y, Krömer O, Kuijpers J, Lafebre S, Maier G, Mathes HJ, Mayer HJ, Milke J, Mitrica B, Morello C, Navarra G, Nehls S, Nigl A, Obenland R, Oehlschläger J, Ostapchenko S, Over S, Pepping HJ, Petcu M, Petrovic J, Plewnia S, Rebel H, Risse A, Roth M, Schieler H, Schoonderbeek G, Sima O, Stümpert M, Toma G, Trinchero GC, Ulrich H, Valchierotti S, van Buren J, van Cappellen W, Walkowiak W, Weindl A, Wijnholds S, Wochele J, Zabierowski J, Zensus JA, Zimmermann D. Detection and imaging of atmospheric radio flashes from cosmic ray air showers. Nature 2005; 435:313-6. [PMID: 15902250 DOI: 10.1038/nature03614] [Citation(s) in RCA: 256] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 04/04/2005] [Indexed: 11/09/2022]
Abstract
The nature of ultrahigh-energy cosmic rays (UHECRs) at energies >10(20) eV remains a mystery. They are likely to be of extragalactic origin, but should be absorbed within approximately 50 Mpc through interactions with the cosmic microwave background. As there are no sufficiently powerful accelerators within this distance from the Galaxy, explanations for UHECRs range from unusual astrophysical sources to exotic string physics. Also unclear is whether UHECRs consist of protons, heavy nuclei, neutrinos or gamma-rays. To resolve these questions, larger detectors with higher duty cycles and which combine multiple detection techniques are needed. Radio emission from UHECRs, on the other hand, is unaffected by attenuation, has a high duty cycle, gives calorimetric measurements and provides high directional accuracy. Here we report the detection of radio flashes from cosmic-ray air showers using low-cost digital radio receivers. We show that the radiation can be understood in terms of the geosynchrotron effect. Our results show that it should be possible to determine the nature and composition of UHECRs with combined radio and particle detectors, and to detect the ultrahigh-energy neutrinos expected from flavour mixing.
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Affiliation(s)
- H Falcke
- Max-Planck-Institut für Radioastronomie, 53121 Bonn, Germany.
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Rakovac I, Gfrerer RJ, Habacher W, Seereiner S, Beck P, Risse A, Bauer B, Pieber TR. Screening of depression in patients with diabetes mellitus. Diabetologia 2004; 47:1469-70. [PMID: 15278278 DOI: 10.1007/s00125-004-1467-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 06/22/2004] [Indexed: 11/29/2022]
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Hunger-Dathe W, Braun A, Müller UA, Schiel R, Femerling M, Risse A. Insulin Pump Therapy in Patients with Type 1 Diabetes Mellitus: Results of the Nationwide Quality Circle in Germany (ASD) 1999 - 2000. Exp Clin Endocrinol Diabetes 2003; 111:428-34. [PMID: 14614650 DOI: 10.1055/s-2003-44290] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Only a few specialised centres in Germany initiated insulin pump therapy before 1990. Initiation of pump therapy involves the participation in a structured treatment and teaching programme (TTP). During the last decade insulin pump therapy has been widely used. The impact of this decentralisation on the quality of care is still unknown. The aim of this trial was both to evaluate the outcome of insulin pump therapy outside specialised centres and to identify features that might be associated with persistently increased HbA1 c levels. PATIENTS AND METHODS 250 patients with type 1 diabetes mellitus (age 36.0 +/- 13.1 years; diabetes duration 16.1 +/- 9.9 years), who were on continuous subcutaneous insulin infusion (CSII) therapy during 1999 - 2000, were individually included in the study. Second examination was performed one year after participation in the in-patient TTP for insulin pump therapy. Patients were recruited from 21 member institutions of the Working Group for Structured Diabetes Therapy of the German Diabetes Association. Further details were sought by questionnaire on those patients with persistently increased HbA1c (> 1.7 fold of mean normal range.) RESULTS One year after participation in the TTP for CSII relative HbA1c (original value/mean normal of the local method [Müller et al., 1999]) decreased from 1.51 (0.9 - 3.2) to 1.44 (0.9 - 3.6) (p < 0.0001), severe hypoglycaemia from 0.46 to 0.12/patient/year (p < 0.001), severe ketoacidosis from 0.08 to 0.05/patients/year (p = 0.003) and hospitalisation from 5.2 to 3.1 days/patient/year (p = 0.002). In 43/207 (17%) the incidence of severe hypoglycaemia was unchanged (before 0.12 and after TTP 0.14/patients/year), there was slight increase in severe ketoacidosis (before 0.15; after TTP 0.23/patients/year) and hospitalisation days were unchanged (before 4.5; after TTP 4.4 days/patients/year). The following factors were associated with adverse outcomes: psychological problems including eating disorders and alcohol abuse (28%), lack of interest in self-management (28%) and social problems (11%). In 28% there was no follow-up treatment by diabetologists specialised in pump therapy. CONCLUSION The benefits of insulin pump therapy are improvement of HbA1c, reduction of hypoglycaemia, ketoacidosis and hospitalisation days as well as improved flexibility. It is possible to draw up a list of clinical criteria and service requirements, which are likely to reduce failures.
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Affiliation(s)
- W Hunger-Dathe
- Department of Internal Medicine II, Medical School, Friedrich-Schiller-University of Jena, Jena, Germany.
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Müller UA, Femerling M, Risse A, Schumann M, Use G, Jörgens V, Berger M. [Self-treatment instruction of patients with type 1 diabetes. Report from hospitals belonging to Working Group for Structured Diabetes Therapy (ASD) in Germany 1998]. Med Klin (Munich) 2000; 95:359-68. [PMID: 10943096 DOI: 10.1007/s000630050013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Intensified insulin therapy is the therapy of choice for patients with diabetes Type I. Intensified insulin therapy includes an basis-bolus insulin injection regimen or continuous subcutaneous insulin infusion, several times daily blood glucose self-monitoring, self-adaptation of insulin dosages by the patients themselves and a far-reaching liberalization of nutrition. The patients learn self management of diabetes therapy in a structured treatment and teaching program. The effectivity of this program is evaluated in the routine care. PATIENTS AND METHOD A peer-review quality circle was formed as an official working group of the German Diabetes Association based on the formation of a working group (Arbeitsgemeinschaft für Strukturierte Diabetestherapie [ASD]) of presently 135 general internal medicine departments from city, country and university hospitals throughout the country. The group attempted to document and to improve the quality of structure and process of Type-I diabetes care in its participating institutions by a system of peer supervision. Systematic follow-up examinations of 50 consecutive Type-I diabetic patients 12 to 15 months after participation in the program confirm the outcome quality. The working group meets every year to discuss the results non anonymously. A PC-system (DIQUAL) was developed for collecting, checking and pooling of the outcome data. RESULTS From 1992 a representative sample of 6.555 patients with Type-I diabetes was examined. At the first time in 1998 the outcome results of 1.789 patients were analyzed depending on the therapeutic goals. In patients with a high initial HbA1c (> or = 8%) an improvement from 9.8 to 8.0% was reached going together with a reduction of severe hypoglycemia from 0.23 to 0.13/patient/year. In patients with an acceptable initial HbA1c (< 8%) the frequency of severe hypoglycemia could be reduced from 0.65 to 0.24/patient/year without any deterioration in metabolic control. Furthermore the incidence of ketoacidosis with hospitalization and the inpatient days were reduced significantly. CONCLUSION A substantial improvement of HbA1c and reduction of acute complications, especially of severe hypoglycemia in patients with Type-I diabetes were reached by participation in a structured teaching and treatment programme in clinical routine care.
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Affiliation(s)
- U A Müller
- Klinik für Innere Medizin II, Friedrich-Schiller-Universität Jena.
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Affiliation(s)
- A Risse
- Medizinische Klinik Nord, Städtische Kliniken, Dortmund
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Bültmann M, Streich R, Risse A, Falke KJ, Pappert D. [Postoperative analgesia in children after hernioplasty. Wound infiltration with different concentrations of bupivacaine: a pilot study]. Anaesthesist 1999; 48:439-43. [PMID: 10467476 DOI: 10.1007/s001010050727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
UNLABELLED Wound instillation seems to be an easy and preferable way to achieve postoperative analgesia in pediatric hernioplasty. This prospective, randomized and double-blinded pilot-study was initiated to gain preliminary information in order to define the appropriate concentration of local anaesthetic for efficient posthernioplastic analgesia. METHOD 29 children aged 3.1 to 13.7 (5.25 (3.8-8.2) years were randomly assigned to receive either 0.2 ml/kg bupivacaine 0.125% (n = 10), bupivacaine 0.25% (n = 10) or bupivacaine 0.5% (n = 9). The local anesthetic (LA) was instillated intraoperatively before wound closure above the external oblique muscle and below Scarpa's fascia. After entering the post-anesthetic care unit (PACU) pain was assessed by a trained nurse using the linear analogue pain scale (LAPS) in intervals of 15 min. Patients were observed in the PACU for 30-60 min. Pain was further evaluated for 5.5(3-6) h in the ward every hour. In day-only patients the parents were contacted 24 h postoperatively to obtain additional information. RESULTS From the beginning of the observation period the 0.5% group tended to have less pain than the others in the PACU. The 0.125% and 0.25% group required earlier supplementary analgetics. In addition, the 0.5% group needed once (1/9) supplementary analgesics; the 0.25% group five times (5/10) and the 0.125% group six times (6/10). None of these results is statistically significant, though they appear to be clinically relevant. DISCUSSION Wound instillation with 0.2 ml of bupivacaine 0.5% seems to be easy to perform, safe and efficient in controlling posthernioplastic pain. Because of the small numbers of patients included however, no statistically significant differences were observed between the groups. Neither in the LAPS on arrival and observation at the PACU nor in the need for supplementary analgesics. Despite lacking significance the clinical impression suggests a difference to be validated by larger studies. Our data implies that wound instillation with 0.2 ml/kg bupivacaine 0.5% should be regarded for routine usage.
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Affiliation(s)
- M Bültmann
- Klinik für Anästhesiologie und operative Intensivmedizin Charité, medizinische Fakultät, Humboldt Universität Berlin
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Wagner A, Risse A, Brill HL, Wienhausen-Wilke V, Rottmann M, Sondern K, Angelkort B. Therapy of severe diabetic ketoacidosis. Zero-mortality under very-low-dose insulin application. Diabetes Care 1999; 22:674-7. [PMID: 10332664 DOI: 10.2337/diacare.22.5.674] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Despite modern concepts in therapy by low-dose insulin application and better care in intensive care units (ICUs), there still is a mortality of 5-10% for severe diabetic ketoacidosis (DKA). The aim of this study was to develop a therapy concept to reduce complications and mortality in DKA. RESEARCH DESIGN AND METHODS From 1986 to 1997, 114 consecutive patients (mean [range]; age 34 [11-74] years) with type 1 diabetes suffering from severe DKA were treated on ICUs and investigated in a retrospective and prospective study. The following are the criteria for admission onto ICUs: < 7.20 pH level, > 300 mg/dl blood glucose, less than -12 mmol/l base excess, or < 300 mg/dl blood glucose plus severe symptoms (i.e., coma). We treated patients according to the following concepts: very-low-dose insulin application by a basal insulin infusion of 1 U/h (0.5-4.0 U/h i.v.), maximal decrease of blood glucose level by 50 mg. dl-1. h-1, slow-motion reequilibration by fluid substitution of 1,000 ml/h (Ringer-Lactate, NaCl 0.9% or half-electrolyte fluids) in the first 4 h, potassium replacement and heparin (500-1,000 U/h i.v.). RESULTS When patients were admitted to ICU, we found the following parameters: mean (range); 609.0 (86.0-1,428.0) mg/dl blood glucose level; 7.13 (6.53-7.36) pH level; and -19.7 (-41.2 to -7.0) mmol/l base excess. After 12 h of treatment, we reached the following parameters: mean values; 251 mg/dl blood glucose level, 7.31 pH level, and -9.37 mmol/l base excess level. All patients survived without any lasting deficiencies or fatal complications. CONCLUSIONS Very-low-dose insulin application and slow-motion reequilibration plus monitored substitution of electrolytes are the basic strategies in the treatment of severe DKA. In our view, small doses of infused insulin are the main reason for the safe results of this therapy program.
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Affiliation(s)
- A Wagner
- Medizinische Klinik Nord, Dortmund, Germany.
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Müller UA, Femerling M, Reinauer KM, Risse A, Voss M, Jörgens V, Berger M, Mühlhauser I. Intensified treatment and education of type 1 diabetes as clinical routine. A nationwide quality-circle experience in Germany. ASD (the Working Group on Structured Diabetes Therapy of the German Diabetes Association). Diabetes Care 1999; 22 Suppl 2:B29-34. [PMID: 10097896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This contribution describes the nationwide implementation of an intensive treatment and education program for type 1 diabetic patients in the clinical routine of the German health care system. Based on the formation of a working group (Arbeitsgemeinschaft Strukturierte Diabetestherapie [ASD]) of presently 57 general internal medicine departments, mainly from secondary and tertiary care levels in city and country hospitals throughout the country, a peer-review quality circle was formed as an official working group of the German Diabetes Association. The participating institutions performed a structured program of intensive treatment and education in all type 1 diabetic patients referred to them on a routine basis. The program includes multiple daily insulin injections or continuous subcutaneous insulin infusion, several times daily blood glucose self-monitoring and self-adaptation of insulin dosages and other aspects of treatment by the patients, and a far-reaching liberalization of the nutrition regimen. The group has attempted to document and to improve the quality of the structure and process of type 1 diabetes care in its participating institutions by a system of peer supervision. Furthermore, all member institutions volunteered to collect outcome data based on systematic 1-1.3 years' follow-up examinations of consecutive type 1 diabetic patients. For the 1997 evaluation of 1,103 type 1 diabetic patients, significant decreases of GHb levels and of incidence rates of severe hypoglycemia (from 0.35 to 0.16 cases per patient-year) and ketoacidosis (from 0.08 to 0.02 cases per patient-year) are presented. The ASD quality circle represents a model to improve principal aspects of type 1 diabetes care on a nationwide basis.
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Affiliation(s)
- U A Müller
- Department of Medicine II, Friedrich-Schiller University Jena, Germany
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Risse A. [Didactic concepts of diabetes counseling and education]. Z Gastroenterol 1996; 34 Suppl 2:66-8. [PMID: 8767429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A Risse
- Medizinische Klinik Nord/Städt. Kliniken Dortmund
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Leplow B, Lamparter U, Risse A, Wassilev SW. [Post-herpetic neuralgia: clinical predictors and psychopathologic findings]. Nervenarzt 1990; 61:46-51. [PMID: 2308660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
48 patients, who had had acute Herpes zoster were screened for a retrospective investigation concerning the development of post-herpetic neuralgia. Subjects with and without neuralgia were compared with respect to medical, demographic and psychological variables. Nine patients were excluded from the investigation because of reported pain, which was not due to Herpes zoster. From the 39 subjects who remained in the analysis, 59% had postherpetic neuralgia for at least three months, and 28% for more than a year. No medical or demographic risk factor was sufficient for a prediction of the pain group. By applying objective criteria to psychometric test protocols, an index was constructed which differed between the groups. The pain-group showed a higher frequency of psychopathological impairment than those without post-herpetic neuralgia. However, the psychopathology was not consistently related to the length of neuralgia or the intensity of persistent pain.
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Affiliation(s)
- B Leplow
- Institut für Psychologie, Christian-Albrechts-Universität, Kiel
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Risse A, Krull F. [Headache in early syphilis--a case report]. Z Gesamte Inn Med 1987; 42:280-2. [PMID: 3630274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A 16-year-old girl fell ill with headache of uncertain etiology. Some weeks later an exanthem led to the diagnosis of lues. Characteristic changes in serum and liquor parameters were found. Hearing disorder and choked disc improved during the therapy with penicillin. The rare picture of early luetic meningitis remains important for the differential diagnosis of headache.
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Krull F, Risse A. [A case of malignant neuroleptic syndrome with rhabdomyolysis and a therapeutic trial using physostigmine]. Fortschr Neurol Psychiatr 1986; 54:398-401. [PMID: 2880787 DOI: 10.1055/s-2007-1001945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report the case of a 22-year-old schizophrenic patient who developed a neuroleptic malignant syndrome under treatment with Benperidol, Levomepromazin and Biperiden. Clinical signs were: fever, rigidity, altered consciousness and rhabdomyolysis of hip-abductors. Intravenous injection of physostigmine led to clearing of consciousness, whereas there seemed to be no impact on fever and rigidity.
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