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Schultheis M, Grabbe S, Staubach P, Hennig K, Mauch M, Burckhardt M, Langer G, Heise M, Zamsheva M, Schollenberger L, Strobel A. Drivers of disease severity and burden of hidradenitis suppurativa: a cross-sectional analysis on 553 German patients. Int J Dermatol 2024; 63:188-195. [PMID: 37919257 DOI: 10.1111/ijd.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions with an age peak at around 40 years and an estimated prevalence of 1%. Nodules and abscesses can develop into fistules and scarring, which cause severe pain. HS is a progressive, life-defining disease that leads to physical limitations, inability to work, and social isolation. There is still little data on the drivers of disease severity and burden. METHOD The cross-sectional study is based on the baseline data of 553 participants of the health care research project "EsmAiL," which was carried out as a multicenter randomized controlled trial. It included adult HS-patients presenting with at least three inflammatory lesions and at least a moderate impact on quality of life. RESULTS Disease activity increases with age. Men are more severely affected than women but feel less burdened. Obesity negatively influences disease activity and disease burden. Affected individuals have a higher level of education than the age adjusted population, but the unemployment rate is significantly higher. Disease activity significantly reduces quality of life and promotes depression and anxiety. CONCLUSIONS HS is a severe and debilitating dermatosis. As a result of the well-established factors involved, HS requires a multi-causal approach to management, in addition to medical and surgical treatment. This must take into account all available therapeutic options, as well as patient education to reduce risk factors and pain, and psychological support. HS requires interdisciplinary and multi-professional care. To prevent disease progression, a structured treatment plan is needed.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marcus Heise
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lukas Schollenberger
- Interdisciplinary Center for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Alexandra Strobel
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Krajewski PK, Strobel A, Schultheis M, Staubach P, Grabbe S, Hennig K, Matusiak L, von Stebut E, Garcovich S, Bayer H, Heise M, Kirschner U, Nikolakis G, Szepietowski JC. Hidradenitis Suppurativa Is Associated with Severe Sexual Impairment. Dermatology 2024; 240:205-215. [PMID: 38190809 DOI: 10.1159/000536128] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit, often affecting and deforming intimate regions. HS is associated with severe pain, pruritus, and constant, purulent, malodorous discharge expected to impair sexual health of patients. METHODS We performed a cross-sectional, multicentric study involving 199 German patients from the health services research project "Epidemiology and Care in Acne inversa (EpiCAi)." The sexual health, HS severity, and quality of life of the studied group were evaluated using a specially designed questionnaire. RESULTS Regardless of gender, HS has an enormous impact on patients' sexual health. The patients scored, on average, 28.8 ± 5.3 points on the Relation and Sexuality Scale (RSS). Multiple linear regression revealed that females and patients with Hurley III stage had higher sexual dysfunction (p = 0.012). Sexual dysfunction is associated with pain (β = 0.25), the number of active lesions, the affected areas (β = 0.14), and psychosocial aspects, including low quality of life (β = 0.404), stigmatization (β = 0.411), depression (β = 0.413), and anxiety (β = 0.300). Patients already see a substantial decrease in sexual frequency in the early stages of HS, while functional impairment and fear increase with the severity of the disease. CONCLUSION Sexual health and management of its dysfunctions should be part of a holistic approach to HS patients.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Hans Bayer
- Dermatology Outpatient Office Hautmedizin Bad Soden, Bad Soden, Germany
| | - Marcus Heise
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute for Health- and Nursing Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Heise M, Staubach P, Nikolakis G, Schollenberger L, Mauch M, Burckhardt M, Zamsheva M, Strobel A, Langer G, Bechara F, Kirschner U, Hennig K, Kunte C, Goebeler M, Podda M, Grabbe S, Schultheis M. A center-based, ambulatory care concept for hidradenitis suppurativa improves patient outcomes and is also cost-effectiveness. J DERMATOL TREAT 2023; 34:2284105. [PMID: 38010850 DOI: 10.1080/09546634.2023.2284105] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. METHODS EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). RESULTS Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. CONCLUSION Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.
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Affiliation(s)
- Marcus Heise
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Georgios Nikolakis
- Department of Dermatology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- School of Business and Health, Baden-Wuerttemberg Cooperative State University, Stuttgart, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Falk Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
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Schultheis M, Staubach P, Nikolakis G, Schollenberger L, Mauch M, Burckhardt M, Heise M, Zamsheva M, Strobel A, Langer G, Bechara F, Kirschner U, Hennig K, Kunte C, Goebeler M, Grabbe S. A centre-based ambulatory care concept for hidradenitis suppurativa improves disease activity, disease burden and patient satisfaction: results from the randomized controlled EsmAiL trial. Br J Dermatol 2023; 189:170-179. [PMID: 37132470 DOI: 10.1093/bjd/ljad135] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions that occurs in young women, in particular, and affects approximately 1% of the population. Outpatient care is often inadequate and usually cannot prevent progression. OBJECTIVES To evaluate in the EsmAiL ('Evaluation eines strukturierten und leitlinienbasierten multmodalen Versorgungskonzepts für Menschen mit Akne inversa') trial whether an innovative care concept can decrease disease activity and burden, and improve patient satisfaction. METHODS EsmAiL was conducted as a two-arm, multicentre, prospective, randomized controlled trial that included 553 adults with HS. Inclusion criteria were a minimum of three inflammatory lesions and at least a moderate impact of the disease on quality of life. The control group (CG) remained under standard care, while patients in the intervention group (IG) were treated according to a trial-specific, multimodal concept. The primary endpoint was the absolute change in International Hidradenitis Suppurativa Severity Score System (IHS4). RESULTS In total, 274 patients were randomized to the IG and 279 to the CG. Altogether, 377 attended the final assessment after 12 months of intervention. Participants in the IG (n = 203) achieved a mean improvement in IHS4 of 9.3 points, while the average decrease in IHS4 in patients in the CG (n = 174) was 5.7 points (P = 0.003). Patients treated under the new care concept also reported a statistically significantly higher decrease in pain, Dermatology Life Quality Index and Hospital Anxiety and Depression Scale scores compared with those in the CG (P < 0.001). Patient satisfaction was also statistically significantly higher in the IG compared with the CG (P < 0.001). CONCLUSIONS The establishment of standardized treatment algorithms in so-called 'acne inversa centres' in the ambulatory setting has a substantial, positive impact on the course of HS and significantly improves patient satisfaction.
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Affiliation(s)
| | | | - Georgios Nikolakis
- Department of Dermatology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Marcus Heise
- Institute for Health and Nursing Science
- Institute of General Practice and Family Medicine
- Profile Centre of Health Sciences Halle
| | - Marina Zamsheva
- Institute for Health and Nursing Science
- Profile Centre of Health Sciences Halle
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Profile Centre of Health Sciences Halle
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gero Langer
- Institute for Health and Nursing Science
- Profile Centre of Health Sciences Halle
| | - Falk Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | | | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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Schultheis M, Grabbe S, Staubach P, Hennig K, Mauch M, Burckhardt M, Langer G, Heise M, Zamsheva M, Strobel A. Clinical Features of Persons Suffering from Acne Inversa. Dtsch Arztebl Int 2023; 120:345-346. [PMID: 37482806 PMCID: PMC10408280 DOI: 10.3238/arztebl.m2023.0008] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/07/2022] [Accepted: 01/12/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz
| | - Petra Staubach
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz
| | - Katharina Hennig
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz
| | | | - Marion Burckhardt
- German Wound Healing Society, Gießen
- School of Business and Health, Baden-Wuerttemberg Cooperative State University (DHBW) Stuttgart
| | - Gero Langer
- Institute of Health and Nursing Sciences, German Center for Evidence-based Nursing, Martin Luther University Halle-Wittenberg
- Profilzentrum Gesundheitswissenschaften, Medical Faculty of Martin Luther University Halle-Wittenberg
| | - Marcus Heise
- Institute of Health and Nursing Sciences, German Center for Evidence-based Nursing, Martin Luther University Halle-Wittenberg
- Institute of General Practice, Medical Faculty of Martin Luther University Halle-Wittenberg
- Profilzentrum Gesundheitswissenschaften, Medical Faculty of Martin Luther University Halle-Wittenberg
| | - Marina Zamsheva
- Institute of Health and Nursing Sciences, German Center for Evidence-based Nursing, Martin Luther University Halle-Wittenberg
- Institute of Medical Epidemiology, Biometry, and Informatics,Medical Faculty of Martin Luther University Halle-Wittenberg
- Profilzentrum Gesundheitswissenschaften, Medical Faculty of Martin Luther University Halle-Wittenberg
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biometry, and Informatics,Medical Faculty of Martin Luther University Halle-Wittenberg
- Profilzentrum Gesundheitswissenschaften, Medical Faculty of Martin Luther University Halle-Wittenberg
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Oehme R, Sandholzer-Yilmaz AS, Heise M, Frese T, Fankhaenel T. Utilization of point-of-care tests among general practitioners, a cross-sectional study. BMC Prim Care 2022; 23:41. [PMID: 35264103 PMCID: PMC8906527 DOI: 10.1186/s12875-022-01643-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
Background Point-of-care testing (POCT) has numerous potential benefits to improve health care service, especially in resource-limited settings. We aim to identify which POC-tests (POCTs) of laboratory parameters are known, employed, and rated as useful by general practitioners (GPs). Methods A questionnaire with 27 POCTs was posted to a random selection of GPs (n = 451) in Saxony, Germany. Results A total of 208 GPs replied (response rate 46.1%). Out of 27 POCTs, each GP knew an average of 20.3 as laboratory parameters and 9.2 as POCTs. Urine test strips (99.0%), blood glucose test (98.1%), and Troponin I/T (86.4%) were the best-known, followed by INR/Quick (82.5%), Microalbumin (79.1%), and D-dimer (78.6%) POCTs. Yet, solely 0 to 13 POC tests were actually used (mean value 4.6). Urine test strips were employed most frequently (97.6%), followed by blood glucose test (94.7%), Troponin I/T (57.8%), Microalbumin (57.3%), and INR/Quick POCTs (41.7%). Heart fatty binding protein (H-FABP), Syphilis, Coeliac disease, and Malaria appeared as the least frequently used POCTs. The majority of the GPs declared 14 of the 27 POCTs to be useful. Discussion/conclusion The most recurrently employed POCTs are those for diagnosing or monitoring diabetes mellitus, ensued by POCTs addressing acute cardiovascular diseases (Troponin I/T, D-dimer) or monitoring the therapy of infectious diseases or the anticoagulant therapy. POCTs most often rated as useful by GPs are also widely known and frequently used. Nonetheless, the majority of GPs rate only a very limited number of POCTs as useful. Frequent concerns might be low economic benefit, over-reliance, and test accuracy coming along with the complex implementation of the tests requiring technical skills, accurate storage, and the correct interpretation of test results. Trial registration In accordance with the (Model) Professional Code for Physicians in Germany, neither human body materials nor data that can be assigned to a specific human being are used in our study. A declaration of no objection from the Ethics Committee of the Martin-Luther University Halle-Wittenberg (Medical Faculty) confirms no professional or ethical concerns due to completely anonymized data collection and analysis. Our study was therefore not registered in a corresponding registry. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01643-9.
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Heise M, Heidemann C, Baumert J, Du Y, Frese T, Avetisyan M, Weise S. Structured diabetes self-management education and its association with perceived diabetes knowledge, information, and disease distress: Results of a nationwide population-based study. Prim Care Diabetes 2022; 16:387-394. [PMID: 35400607 DOI: 10.1016/j.pcd.2022.03.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate, how participation in structured diabetes self-management education (DSME) programs is associated with perceived level of knowledge about diabetes, information needs, information sources and disease distress. METHODS We included 796 ever- and 277 never-DSME participants of the population-based survey "Disease knowledge and information needs - Diabetes mellitus (2017)" from Germany. Data on perceived level of diabetes knowledge (12 items), information needs (11 items), information sources (13 items) and disease distress (2 indices) were collected. Multiple logistic regression analyses were used to examine the association of DSME-participation with these outcomes. RESULTS DSME-participants showed a higher level of diabetes knowledge compared to never-DSME participants, particularly in aspects concerning diabetes in general (odds ratio 2.53; 95% confidence intervals 1.48-4.33), treatment (2.41; 1.36-4.26), acute complications (1.91; 1.07-3.41) and diabetes in everyday life (1.83; 1.04-3.22). DSME-participants showed higher information needs regarding late complications (1.51; 1.04-2.18) and acute complications (1.71; 1.71-2.48) than DSME never participants. DSME-participants more frequently consulted diabetologists (5.54; 3.56-8.60) and diabetes care specialists (5.62; 3.61-8.75) as information sources. DSME participation was not associated with disease distress. CONCLUSION DSME is a valuable tool for improving individual knowledge about diabetes. However, DSME should focus more on psychosocial aspects to reduce the disease burden.
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Affiliation(s)
- M Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - C Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - J Baumert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - Y Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, General-Paper-Str. 62-66, 12101 Berlin, Germany.
| | - T Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - M Avetisyan
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - S Weise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
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Carmienke S, Fink A, Baumert J, Heidemann C, Du Y, Frese T, Heise M. Participation in structured diabetes self-management education programs and its associations with self-management behaviour - a nationwide population-based study. Patient Educ Couns 2022; 105:843-850. [PMID: 34272129 DOI: 10.1016/j.pec.2021.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the relationship between participation in structured diabetes self-management education programs (DSME) and self-management behaviour (SMB) in routine care. METHODS The study included 864 ever- and 515 never-DSME participants from the population-based survey German Health Update (GEDA) 2014/2015. SMB and clinical care variables were: Following a diet plan, keeping a diabetes diary, holding a diabetes pass, self-monitoring of blood glucose (SMBG), foot self-examination (FSE), retinopathy screening, haemoglobin A1c (HbA1c) measurement and examination of the feet by clinicians (FEC). We conducted logistic regression analyses for association of DSME-participation with SMB, adjusting for various variables. RESULTS DSME-participation was significantly associated with SMB including following a diet plan (OR 1.88 [95% CI 1.21-2.92]), keeping a diabetes journal (OR 3.83 [2.74-5.36]), holding a diabetes health passport (OR 6.11 [4.40-8.48]), SMBG (OR 2.96 [2.20-3.98]) and FSE (OR 2.64 [2.01-3.47]) as well as retinopathy screening (OR 3.30 [2.31-4.70]), HbA1c measurement (OR 2.58 [1.88-3.52]), and FEC (OR 3.68 [2.76-4.89]) after adjusting for confounders. CONCLUSION DSME-participation is associated with higher frequencies of various SMB and clinical care variables in routine care. Never-DSME attenders are more likely not to receive retinopathy screening, FEC and HbA1c measurements as recommended. PRACTICE IMPLICATIONS Clinicians should refer diabetes patients to a DSME and ensure a regular follow up for never-DSME attenders.
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Affiliation(s)
- Solveig Carmienke
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
| | - Jens Baumert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Christin Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Yong Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany.
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Thiel C, Richter C, Samos FAZ, Heise M, Frese T, Fankhaenel T. Pushing occupational rehabilitation - implementation of a therapy diary in the outpatient aftercare of psychosomatic rehabilitation may promote the occupational reintegration process: a survey of therapists and patients. J Occup Med Toxicol 2021; 16:15. [PMID: 33882961 PMCID: PMC8059245 DOI: 10.1186/s12995-021-00306-2] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Treatment results achieved after fulfilling an inpatient psychosomatic rehabilitation are often not permanent. Additional participation in outpatient rehabilitation aftercare may reduce the risk of recurrent disorders and support a successful reentry to working life. A therapy diary should accompany the aftercare and bring about the self-reflection process of psychosomatic rehabilitates, which could reduce recurrent disease progressions and support the recovery process as a whole. The study focuses on the evaluation of the effectiveness and implementation potentialities of a therapy diary in outpatient rehabilitation aftercare. Methods In a qualitative study, seven therapists for outpatient rehabilitation aftercare in Central Germany and eleven outpatient psychosomatic rehabilitation patients were interrogated using partially standardized, guideline-based expert interviews. The data evaluation is based on the Qualitative Content Analysis according to Mayring. Results The results show that an accompanying use of a therapy diary during the outpatient rehabilitation aftercare enables an intense commitment through own thoughts and feelings. By writing down thoughts, emotions, dysfunctional behaviors in problematic situations, great successes are experienced. Through this initiated self-reflection process, the rehabilitant gains a better knowledge of one’s behavior in dealing with oneself and the environment and thereby, whenever necessary, learns to create new ways of acting. Conclusions The voluntary use of the therapy diary in the outpatient rehabilitation aftercare could assist the therapy process and henceforward the recovery of the rehabilitants, and also increase the prospect of successful occupational rehabilitation.
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Affiliation(s)
- Carolin Thiel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany. .,SRH Hochschule für Gesundheit GmbH, University of Applied Health Sciences, Campus Gera, Neue Straße 28-30, Gera, Germany.
| | - Cynthia Richter
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Franziska-Antonia Zora Samos
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Thomas Fankhaenel
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany.,SRH Hochschule für Gesundheit GmbH, University of Applied Health Sciences, Campus Gera, Neue Straße 28-30, Gera, Germany
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10
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Heise M, Fink A, Baumert J, Heidemann C, Du Y, Frese T, Carmienke S. Patterns and associated factors of diabetes self-management: Results of a latent class analysis in a German population-based study. PLoS One 2021; 16:e0248992. [PMID: 33740024 PMCID: PMC7978380 DOI: 10.1371/journal.pone.0248992] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Few studies on diabetes self-management considered the patterns and relationships of different self-management behaviours (SMB). The aims of the present study are 1) to identify patterns of SMB among persons with diabetes, 2) to identify sociodemographic and disease-related predictors of SMB among persons with diabetes. RESEARCH DESIGN AND METHODS The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female; 56.0% male) with diabetes (type I and II) from the population-based study German Health Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to distinguish different patterns of self-management behaviours among persons with diabetes. The assessment of SMB was based on seven self-reported activities by respondents (dietary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-management behaviour. RESULTS Latent class analysis suggested a distinction between three patterns of SMB. Based on modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes self-management with above-average frequency in all seven indicators of SMB. 32.1% showed a nonadherent pattern with a below-average commitment in all seven forms of SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet nonadherent with regard to all other forms of SMB. In multivariable regression analyses, participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage points), followed by attentiveness towards one's personal health (31.0 percentage points). Respondents with a duration of illness of less than 10 years (19.5 percentage points), employed respondents (7.5 percentage points), as well as respondents with a high socioeconomic status (24.7 percentage points) were more likely to show suboptimal forms of diabetes self-management. DISCUSSION In the present nationwide population-based study, a large proportion of persons with diabetes showed suboptimal self-management behaviour. Participation in a DSME program was the strongest predictor of good self-management. Results underline the need for continual and consistent health education for patients with diabetes.
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Affiliation(s)
- Marcus Heise
- Institute of General Practice and Family Medicine, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Astrid Fink
- Institute of Medical Sociology, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Solveig Carmienke
- Institute of General Practice and Family Medicine, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany
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11
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Klement A, Ibs T, Longard S, Klinkhart C, Frese T, Heise M. "Corona-Debriefing": concept and pilot testing of a 90-minute workshop for undergraduate-education and specialist-training in family medicine. GMS J Med Educ 2020; 37:Doc95. [PMID: 33364374 PMCID: PMC7740013 DOI: 10.3205/zma001388] [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] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
Background: The corona pandemic is changing the framework conditions for medical studies and continuing education as well as the work with patients and within teams. Systematic reflection and communication about experiences and ways of dealing with them forms the basis for successful learning in and out of the crisis. Therefore, we designed a 90-minute workshop "Corona-Debriefing" for students and physicians in specialist-training in family medicine (ÄiW) using three successive moderated interaction phases: Questionnaire survey via tele-dialogue voting (TED) with immediate presentation of results and discussion, moderated experience reports on the categories risk/assessment/support/coping and finally moderated group discussions in small groups to collect "best practice" examples of crisis management. Objective: We tested "Corona-Debriefing" as a pilot test with 48 participants (TN) in July 2020 (30 present, 14 online) in order to assess mental stress and risk perception of participants plus formative/brief summative evaluation of the workshop. Methods: The PHQ-4 with its subscales GAD-2 (anxiety) and PHQ-2 (depression) was used to assess mental stress; risk assessments were made by means of self-constructed 5-point Likert-scales for the dimensions person/society/health/economy. A formative evaluation was carried out by means of a questionnaire at the end of the event; the brief summative assessment was asked for by means of a school grading scale. Results: 37 complete TED questionnaires and 22 evaluations were obtained. TN showed a low personal risk assessment, but considerable fears about social and economic developments. Needs are seen mainly in improvements regarding organization, protective equipment and technical communication (e.g. official recommendations for action). The workshop was rated "good" or "very good" in 95% of the evaluations. Criticism was directed at the limited time available, the narrowing of topics by moderators and the desire for (even) more room for the exchange of personal experiences. Conclusion: The workshop "Corona-Debriefing" is a relatively easy way to use crisis experiences for learning processes. "Corona-Debriefing" can be used by changing the focus of moderation in various courses, years or fields of study, whereby the participants' own personal and clinical crisis experiences remain a prerequisite for a meaningful "debriefing".
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Affiliation(s)
- Andreas Klement
- Universität Halle-Wittenberg, Institut für Allgemeinmedizin, KOMPAS: Kompetenzzentrum für die Weiterbildung in der Allgemeinmedizin Sachsen-Anhalt, Halle/Saale, Germany
| | - Torben Ibs
- Universität Halle-Wittenberg, Institut für Allgemeinmedizin, KOMPAS: Kompetenzzentrum für die Weiterbildung in der Allgemeinmedizin Sachsen-Anhalt, Halle/Saale, Germany
| | - Sebastian Longard
- Universität Halle-Wittenberg, Institut für Allgemeinmedizin, KOMPAS: Kompetenzzentrum für die Weiterbildung in der Allgemeinmedizin Sachsen-Anhalt, Halle/Saale, Germany
| | - Catarina Klinkhart
- Universität Halle-Wittenberg, Institut für Allgemeinmedizin, KOMPAS: Kompetenzzentrum für die Weiterbildung in der Allgemeinmedizin Sachsen-Anhalt, Halle/Saale, Germany
| | - Thomas Frese
- Universität Halle-Wittenberg, Institut für Allgemeinmedizin, KOMPAS: Kompetenzzentrum für die Weiterbildung in der Allgemeinmedizin Sachsen-Anhalt, Halle/Saale, Germany
| | - Marcus Heise
- Universität Halle-Wittenberg, Institut für Allgemeinmedizin, KOMPAS: Kompetenzzentrum für die Weiterbildung in der Allgemeinmedizin Sachsen-Anhalt, Halle/Saale, Germany
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12
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Köhler S, Heise M, Abendroth J, Sommer S, Frese T. Subjektiv erlebte Arbeitsbelastung in der Weiterbildung Allgemeinmedizin und Anforderungen an ein Kompetenzzentrum – eine Querschnittsstudie aus Sachsen-Anhalt. Gesundheitswesen 2020; 82:801-807. [DOI: 10.1055/a-0905-2921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Ziel der Studie Das Erwartungsbild von ÄrztInnen in Weiterbildung (ÄiW) an Kompetenzzentren ist in Teilen noch unklar. Vergangene Studien zeigten, dass sich hohe Arbeitsbelastung und Stressempfinden negativ auf die psychische Gesundheit auswirken und junge ÄrztInnen ab dem Berufseinstieg begleiten. Gibt es bei ÄiW im Fach Allgemeinmedizin Unterschiede im subjektiven Arbeitsbelastungsempfinden im stationären und ambulanten Bereich? Wie wirkt sich eine hohe subjektive Arbeitsbelastung auf Bedürfnisse/Wünsche der ÄiW an die Kompetenzzentren aus?
Methodik Design: Querschnittserhebung März - Juni 2017 in Sachsen-Anhalt, Stichprobe: alle bei der KOSTA registrierte ÄiWs (n=221) Messinstrument: Selbst entwickelter Fragebogen (Wünsche an ein Kompetenzzentrum, Soziodemographie, Weiterbildungsbiografie, Evaluation bisheriger Weiterbildung im ambulanten und stationären Bereich, Fragebogen zur Erfassung beruflicher Gratifikationskrisen (ERI).
Ergebnisse Insgesamt gingen 73 Antworten der ÄiWs ein (33,0%). Alle 73 Antworten wurden in der Analyse berücksichtigt. Auf einem Mittelwertindex von 1 (minimale Stressverausgabung) bis 4 (maximale Stressverausgabung) wurde eine höhere Arbeitsbelastung im stationären Weiterbildungssektor (MW stationär: 2,8 vs. ambulant: 2,1; p<0,01) angegeben. Die subjektive Arbeitsbelastung stieg signifikant mit dem Ausmaß der geleisteten Überstunden an (stationär: η²=18,3%, p=0,02; ambulant: η²=28,3%, p<0,01). Überdurchschnittlich Belastete äußerten tendenziell häufiger Bedarf nach lückenloser Weiterbildungsplanung (Prozentsatzdifferenz d%=0,31), nach Betreuung durch einen Mentor (d%=0,15) und informellem Austausch mit KollegInnen (d%=0,19). Das durch die ÄiWs empfundene Belastungsniveau erwies sich dagegen als unabhängig von personenbezogenen und demografischen Merkmalen.
Schlussfolgerung Der Betreuungsbedarf von ÄiW durch Weiterbildungsmanager und Mentoren wird durch ein erhöhtes Belastungsniveau gesteigert. Dies muss bedacht werden, um für jeden ÄiW einen individuellen Beratungsansatz bieten zu können.
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Affiliation(s)
- Sophie Köhler
- Medizinische Fakultät, Institut für Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle
| | - Marcus Heise
- Medizinische Fakultät, Institut für Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle
| | - Jens Abendroth
- Medizinische Fakultät, Institut für Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle
| | - Susanne Sommer
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg Fachbereich Medizin, Marburg
| | - Thomas Frese
- Medizinische Fakultät, Institut für Allgemeinmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle
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Carmienke S, Baumert J, Gabrys L, Heise M, Frese T, Heidemann C, Fink A. Participation in structured diabetes mellitus self-management education program and association with lifestyle behavior: results from a population-based study. BMJ Open Diabetes Res Care 2020; 8:e001066. [PMID: 32205327 PMCID: PMC7206925 DOI: 10.1136/bmjdrc-2019-001066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/12/2020] [Accepted: 02/26/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Whether participation in structured diabetes self-management education programs (DSME) for participants with diabetes mellitus is associated with a healthy lifestyle in routine care apart from randomized-controlled studies remains unclear and is this studies' research question. RESEARCH DESIGN AND METHODS We identified 1300 persons with diabetes mellitus drawn from the cross-sectional population-based analysis German Health Update 2014/2015 (GEDA 2014/2015), which integrated the modules of the European Health Interview Survey (EHIS) wave 2. Of those, 816 were ever-DSME participants and 484 never-participants. We conducted multivariable weighted logistic regression analyses for lifestyle differences comparing ever-DSME and never-DSME participants. Lifestyle was defined by physical activity (PA), current smoking, fruit/vegetable consumption and body mass index (BMI). Age, sex, socioeconomic status, living together, limitation due to health problems for at least for 6 months, self-efficacy and attention to one's health were included as confounders in the regression models. RESULTS Ever-DSME participants engaged significantly more often in cycling at least 1 day per week (OR 1.62, 95% CI: 1.15-2.30) and performed significantly more often aerobic endurance training of 150 min per week (including walking: OR 1.42, 95% CI: 1.03-1.94, without walking: OR 1.48, 95% CI: 1.08-2.03) compared with never-DSME participants. Ever-DSME participants were significantly more often ex-smoker compared with never-DSME participants (OR 1.39, 95% CI: 1.03-1.88). DSME attendance was not significantly associated with current smoking, BMI and fruit or vegetable consumption. CONCLUSION DSME participation is associated with a moderately healthier lifestyle particularly for PA even in routine healthcare. Study results emphasize the importance of a broadly dissemination of DSME access for nationwide diabetes healthcare. Future studies should adjust for DSME participation when investigating lifestyle in persons with diabetes.
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Affiliation(s)
- Solveig Carmienke
- Institute for General Practice and Family Medicine, Medical Faculty of Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Lars Gabrys
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
- Fachhochschule für Sport und Management Potsdam, Potsdam, Germany
| | - Marcus Heise
- Institute for General Practice and Family Medicine, Medical Faculty of Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Thomas Frese
- Institute for General Practice and Family Medicine, Medical Faculty of Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Martin-Luther-Universitat Halle-Wittenberg, Halle, Germany
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14
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Schmid GL, Kühnast B, Heise M, Deutsch T, Frese T. Ultrasonography in assessing suspected bone fractures: a cross-sectional survey amongst German general practitioners. BMC Fam Pract 2020; 21:9. [PMID: 31931750 PMCID: PMC6958739 DOI: 10.1186/s12875-020-1078-5] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022]
Abstract
Background Over the last two decades, ultrasonography (US) has been shown to be an accurate tool for the diagnosis of suspected bone fractures; however, the integration of this application of US into routine care and outpatient settings needs to be explored. In this study, we surveyed German general practitioners (GPs) to assess their knowledge, attitudes, and utilization of US for the diagnosis of suspected fractures. Methods Notification of the study, a self-designed questionnaire, and a reminder were mailed to 600 randomly selected GPs in Saxony and Saxony-Anhalt. Results The response rate was 47.7% (n = 286), and respondents did not differ from the population of all GPs in respect to sex and practice type. Among GPs surveyed, 48.6% used an US device in their practice. On average, GPs diagnosed six patients with suspected fractures per month, yet only 39.3% knew about the possibility of ultrasonographic fracture diagnosis, and only 4.3% of GPs using US applied it for this purpose. Among participants, 71.9% believed that US is inferior to conventional X-rays for the diagnosis of bony injuries. Users of US were better informed of and more commonly used US for fracture diagnosis compared to non-users. Conclusion The need to rule out possible fractures frequently arises in general practice, and US devices are broadly available. Further efforts are needed to improve the knowledge and attitudes of GPs regarding the accuracy of US for fracture diagnosis. Multicenter controlled trials could explore the safety, usefulness, and effectiveness of this still seldom used diagnostic approach for suspected fractures.
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Affiliation(s)
- Gordian Lukas Schmid
- Department of General Practice, Medical Faculty of the University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Deutschland. .,Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Beatrice Kühnast
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Tobias Deutsch
- Department of General Practice, Medical Faculty of the University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Deutschland
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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15
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Zänker S, Scholz G, Heise M, Emmerling F, Kemnitz E. New 2D layered structures with direct fluorine–metal bonds: MF(CH 3COO) (M: Sr, Ba, Pb). CrystEngComm 2020. [DOI: 10.1039/d0ce00287a] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
New coordination polymers with 2D network structures with fluorine directly coordinated to the metal ion were prepared both via mechanochemical synthesis and fluorolytic sol–gel synthesis.
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Affiliation(s)
- S. Zänker
- Humboldt-Universität zu Berlin
- Department of Chemistry
- D-12489 Berlin
- Germany
- Federal Institute for Materials Research and Testing (BAM)
| | - G. Scholz
- Humboldt-Universität zu Berlin
- Department of Chemistry
- D-12489 Berlin
- Germany
| | - M. Heise
- Humboldt-Universität zu Berlin
- Department of Chemistry
- D-12489 Berlin
- Germany
| | - F. Emmerling
- Humboldt-Universität zu Berlin
- Department of Chemistry
- D-12489 Berlin
- Germany
- Federal Institute for Materials Research and Testing (BAM)
| | - E. Kemnitz
- Humboldt-Universität zu Berlin
- Department of Chemistry
- D-12489 Berlin
- Germany
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16
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Kötter T, Fuchs S, Heise M, Riemenschneider H, Sanftenberg L, Vajda C, Voigt K. What keeps medical students healthy and well? A systematic review of observational studies on protective factors for health and well-being during medical education. BMC Med Educ 2019; 19:94. [PMID: 30935393 PMCID: PMC6444449 DOI: 10.1186/s12909-019-1532-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/25/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Despite the growing evidence of a negative impact of medical school on students' health and well-being, little is known about protective factors for staying healthy and well during medical education. Therefore, a systematic review of peer-reviewed studies aiming to identify such predictors was conducted. METHODS Medline, Embase, and PsychInfo were systematically searched by using preselected MeSH terms to identify English- and German-language peer-reviewed articles (observational studies) examining predictors for medical students' health and well-being, published between January 2001 and April 2018. Two authors independently selected abstracts reporting predictors for medical students' health and well-being. Further, two authors extracted information from the identified studies, needed for methodological quality assessment of the studies, as well as for comprehensive description of identified predictors. RESULTS From 5013 hits in the database search, six observational studies met the inclusion criteria and were included in the final analysis. These studies were of heterogeneous design and quality. They featured a wide variety of health and well-being related outcomes and of its predictors. Lower levels of perceived stress, as well as lower levels of neuroticism were found to predict better health-related outcomes. CONCLUSIONS Further research, by using harmonized tools for the assessment of outcomes, as well as predictors, is needed to determine what keeps students healthy and well during medical education. Identifying protective factors is an essential prerequisite for the design of evidence-based health-promoting interventions.
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Affiliation(s)
- Thomas Kötter
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Stephan Fuchs
- Institute of General Practice & Family Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Marcus Heise
- Institute of General Practice & Family Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Henna Riemenschneider
- Department of General Practice, Carl Gustav Carus Faculty of Medicine, Dresden, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Christian Vajda
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Karen Voigt
- Department of General Practice, Carl Gustav Carus Faculty of Medicine, Dresden, Germany
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Gudo ES, Ali S, António VS, Chelene IR, Chongo I, Demanou M, Falk K, Guiliche OC, Heinrich N, Monteiro V, Muianga AF, Oludele J, Mula F, Mutuku F, Amade N, Alho P, Betsem E, Chimbuinhe Z, Cristovam AJ, Galano G, Gessain A, Harris E, Heise M, Inalda F, Jala I, Jaszi E, King C, Kitron U, Kümmerer BM, LaBeaud AD, Lagerqvist N, Malai G, Mazelier M, Mendes S, Mukoko D, Ndenga B, Njouom R, Pinto G, Tivane A, Vu DM, Vulule J. Seroepidemiological Studies of Arboviruses in Africa. Adv Exp Med Biol 2018; 1062:361-371. [PMID: 29845545 DOI: 10.1007/978-981-10-8727-1_25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
The literature on sero-epidemiological studies of flaviviral infections in the African continent is quite scarce. Much of the viral epidemiology studies have been focussing on diseases such as HIV/AIDS because of their sheer magnitude and impact on the lives of people in the various affected countries. Increasingly disease outbreaks caused by arboviruses such as the recent cases of chikungunya virus, dengue virus and yellow fever virus have prompted renewed interest in studying these viruses. International agencies from the US, several EU nations and China are starting to build collaborations to build capacity in many African countries together with established institutions to conduct these studies. The Tofo Advanced Study Week (TASW) was established to bring the best scientists from the world to the tiny seaside town of Praia do Tofo to rub shoulders with African virologists and discuss cutting-edge science and listen to the work of researchers in the field. In 2015 the 1st TASW focussed on Ebola virus. The collections of abstracts from participants at the 2nd TASW which focused on Dengue and Zika virus as well as presentations on other arboviruses are collated in this chapter.
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Affiliation(s)
| | - S Ali
- National Institute of Health, Maputo, Mozambique
| | - V S António
- National Institute of Health, Maputo, Mozambique
| | - I R Chelene
- National Institute of Health, Maputo, Mozambique
| | - I Chongo
- National Institute of Health, Maputo, Mozambique
| | - M Demanou
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon.
| | - K Falk
- The Public Health Agency of Sweden and Karolinska Institute, Solna, Sweden.
| | - O C Guiliche
- National Institute of Health, Maputo, Mozambique
| | - N Heinrich
- Infectious Diseases & Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
| | - V Monteiro
- National Institute of Health, Maputo, Mozambique
| | - A F Muianga
- National Institute of Health, Maputo, Mozambique
| | - J Oludele
- National Institute of Health, Maputo, Mozambique
| | - F Mula
- National Institute of Health, Maputo, Mozambique
| | - F Mutuku
- Technical University of Mombasa, Mombasa, Kenya.
| | - N Amade
- National Institute of Health, Maputo, Mozambique
| | - P Alho
- National Institute of Health, Maputo, Mozambique
| | - E Betsem
- Faculté de médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroon
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
| | | | | | - G Galano
- Pemba Provincial Hospital, Pemba, Mozambique
| | - A Gessain
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
| | - E Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - M Heise
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - F Inalda
- National Institute of Health, Maputo, Mozambique
| | - I Jala
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
- Tropical Disease Research Center (TDRC), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - E Jaszi
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - C King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - U Kitron
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - B M Kümmerer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - A D LaBeaud
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - N Lagerqvist
- The Public Health Agency of Sweden and Karolinska Institute, Solna, Sweden
| | - G Malai
- Polana Caniço General Hospital Mozambique, Maputo, Mozambique
| | - M Mazelier
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
| | - S Mendes
- Nampula Central Hospital, Nampula, Mozambique
| | - D Mukoko
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - B Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - R Njouom
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
| | - G Pinto
- National Institute of Health, Maputo, Mozambique
| | - A Tivane
- National Institute of Health, Maputo, Mozambique
| | - D M Vu
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - J Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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18
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Abstract
ZusammenfassungTrotz einer gut etablierten Dokumentation in der Qualitätssicherung der Akutbehandlung beim Krankheitsbild Schlaganfall sind Daten zur Lebensund Versorgungssituation betroffener Patienten im weiteren Verlauf nach Entlassung aus der Akuttherapie nur spärlich vorhanden. Im Qualitätssicherungsprojekt Schlaganfall Nordwestdeutschland wurde eine fragebogenbasierte Erhebung drei Monate nach Entlassung aus dem akut behandelnden Krankenhaus durchgeführt. Ziel der Studie war die Erhebung der Lebensund Versorgungssituation einschließlich der Re-Insulthäufigkeit, der Mortalität und der funktionellen Leistungsfähigkeit. 3 632 Patienten nahmen an der Follow-up-Untersuchung teil, davon hatten etwa zwei Drittel die Diagnose eines ischämischen Insultes und etwa 20% eine TIA. Die Mortalität im Zeitraum zwischen Entlassung und Follow-up lag bei 5,0% und die Re-Insulthäufigkeit bei 3,5%. Standardisierte Nachbefragung von Schlaganfallpatienten liefern wichtige Informationen zum weiteren Krankheitsverlauf, die auch für die akut behandelnde Klinik wertvolle Hinweise enthalten.
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19
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Samos FA, Heise M, Fuchs S, Mittmann S, Bauer A, Klement A. Pilot phase evaluation of the elective general practice class: results of student surveys of the first two years. GMS J Med Educ 2017; 34:Doc4. [PMID: 28293671 PMCID: PMC5327659 DOI: 10.3205/zma001081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 10/05/2016] [Accepted: 11/09/2016] [Indexed: 05/28/2023]
Abstract
Background: Primary health care in rural regions is currently undergoing a global crisis in respect of the next generation of practitioners. National and international recommendations advise placing greater emphasis upon practical skills and competences in medical studies. It is also in the interest of training the next generation to include mentoring and longitudinal integration of contact to teaching practices for general medicine in an early stage. Consequently, the General Practice Class (KAM) was introduced in Halle in 2011 as an elective with 20 individually mentored students per year, beginning with the first subject-related semester. We are now reporting on the results of the evaluation for the first two years. Method: A standardised online survey was carried out with all students who took part in the KAM in the two years 2011 and 2012 (N=38). For both years the survey was made at the end of the first summer semester on the basis of an adapted version of the Heidelberger Inventar zur Lehrevaluation (Heidelberg Inventory for the Evaluation of Teaching, HILVE-II) and the Berliner Evaluationsinstrument für selbsteingeschätzte, studentische Kompetenzen (Berlin Evaluation Instrument for the self-assessment of student competences, BEvaKomp). Furthermore, each year the preference for the choice of specialty and location of a medical practice was queried. Predictors for the preference of the chosen specialty and the location of a medical practice were estimated by binary logistic regression analysis. Via univariate evaluations the number of students who reported an increase in knowledge in different areas of competence as a result of the KAM was counted. Correlations between the intention to remain in the KAM and the quality of teaching were evaluated on the basis of bivariate correlations. Results: 48% of the students agreed partly or fully that the KAM seminars enhanced their specialist competence. This individual acquiring of competence in the model project represented a significant predictor for the preferred choice of the area (OR 7.98; 95% CI [1.27-50.27], p=0.027). Students who assessed the commitment (r=0.504), support (r=0.526) and interaction management (r=0.529) of the mentors positively were more likely inclined to continue their participation in the KAM. Conclusion: The successful conveyance of care-relevant competences to students proved to be an important predictor in our project for the preference of the specialty general practice. This requires that the medical mentors are suitably trained and that the students are specifically prepared for practical experience.
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Affiliation(s)
- Franziska-Antonia Samos
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Marcus Heise
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Stephan Fuchs
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Susanne Mittmann
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Alexander Bauer
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
| | - Andreas Klement
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of General Practice and Family Medicine, Halle (Saale), Germany
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20
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Yiş U, Uyanık G, Rosendahl D, Çarman K, Bayram E, Heise M, Cömertpay G, Kurul S. Clinical, radiological, and genetic survey of patients with muscle–eye–brain disease caused by mutations in POMGNT1. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.288] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Bunse J, Heise M. [Rare differential diagnosis of inguinal pain and swelling in women]. Chirurg 2016; 87:973-975. [PMID: 27299752 DOI: 10.1007/s00104-016-0219-9] [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: 10/21/2022]
Affiliation(s)
- J Bunse
- Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Deutschland.
| | - M Heise
- Sana Klinikum Lichtenberg, Fanningerstr. 32, 10365, Berlin, Deutschland
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22
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Abstract
Liver transplantation is the treatment of choice for acute hepatic failure or endstage liver disease. Long-time outcome following liver transplantation has been increased as a result of improvements in surgical technique, perioperative management, organ procurement and immunuosuppression. Differences in liver disease, access and allocation to liver transplantation as outcome due to gender have been reported. This review highlights the important differences in the field of liver transplantation.
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Affiliation(s)
- M Heise
- Klinik und Poliklinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Deutschland
| | - H Lang
- Klinik und Poliklinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Deutschland
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23
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Lachmann N, Czarnecki K, Brennig S, Phaltane R, Heise M, Heinz N, Kempf H, Dilloo D, Kaever V, Schambach A, Heuser M, Moritz T. Deoxycytidine-kinase knockdown as a novel myeloprotective strategy in the context of fludarabine, cytarabine or cladribine therapy. Leukemia 2015; 29:2266-9. [PMID: 25921248 DOI: 10.1038/leu.2015.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- N Lachmann
- Reprogramming and Gene Therapy Group, REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - K Czarnecki
- Reprogramming and Gene Therapy Group, REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - S Brennig
- Reprogramming and Gene Therapy Group, REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - R Phaltane
- Reprogramming and Gene Therapy Group, REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - M Heise
- Reprogramming and Gene Therapy Group, REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - N Heinz
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - H Kempf
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - D Dilloo
- Department of Pediatric Hematology and Oncology, Center for Child and Adolescent Medicine, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - V Kaever
- Institute of Pharmacology, Research Core Unit Metabolomics, Hannover Medical School, Hannover, Germany
| | - A Schambach
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - T Moritz
- Reprogramming and Gene Therapy Group, REBIRTH Cluster of Excellence, Hannover Medical School, Hannover, Germany.,Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
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24
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Weiler N, Thrun I, Eberlin M, Foltys D, Heise M, Hoppe-Lotichius M, Zimmermann T, Kraemer I, Otto G. Tacrolimus effects and side effects after liver transplantation: is there a difference between immediate and extended release? Transplant Proc 2014; 45:2321-5. [PMID: 23953543 DOI: 10.1016/j.transproceed.2013.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/19/2012] [Accepted: 03/06/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Immunosuppressive therapy after orthotopic liver transplantation (OLT) requires a high degree of patient compliance to guarantee safety and avoid side effects. In 2007, prolonged-release tacrolimus was launched in Europe to improve compliance. In this prospective observational crossover single-center trial, we analyzed effects and side effects of prolonged-release tacrolimus in OLT patients. METHODS LT patients at our center were included if they were older than l8 years of age, had had the procedure at least 6 months prior, and were outpatients currently on twice-daily tacrolimus. Patients were observed for 6 months before switching to once-daily tacrolimus. Patient history, clinical examination, and laboratory examinations were recorded on inclusion as well as after 3, 6, 9, 12, and 18 months. RESULTS The rates of rejection, hypertension, hypercholesterolemia, and diabetes mellitus were compared during twice-daily and once-daily tacrolimus. Similarly, laboratory parameters were identical during both periods with the exception of glycated hemoglobin, which was significantly elevated under once-daily tacrolimus (P = .00l). CONCLUSION Converting patients to extended-release tacrolimus with was safe in terms of rejection, hypertension, and hypercholesterolemia as well as renal and liver functions. Further investigations concerning pharmacokinetics and glucose metabolism will be needed to evaluate prolonged-release tacrolimus.
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Affiliation(s)
- N Weiler
- Department of Transplantation, Hepatobiliary and Pancreatic Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
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25
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Viljoen N, Heise M, Burt F. DNA-launched sindbis virus based replicon encoding the yellow fever virus ED-lll protein. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1309] [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: 10/25/2022] Open
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Abstract
INTRODUCTION Right-sided hepatectomy including segment 1 and right trisectionectomy are typical approaches to surgical treatment of hilar cholangiocarcinoma. In this study we have compared the oncological capacity of this approach to left-sided hepatectomy. PATIENTS AND PROCEDURES: In 223 patients referred to our institution 150 hepatic resections were performed: 14 hilar resections, 68 right and 68 left hepatectomies. RESULTS Survival after curative (R0) and palliative surgery was significantly superior to that in patient with exploration or no surgery at all (p < 0.0001). 5- and 10-year survival after right versus left hepatectomy was 29 and 22 % versus 21 and 7 % (p = 0.204). If hospital mortality was eliminated, survival after right hepatectomy was marginally significantly superior to that after left-sided hepatectomy (p = 0.041). Hospital mortality was 13 % after right compared to 4 % after left hepatectomy (p = 0.069). The R situation was of prognostic importance following right and the N situation after left hepatectomy (p = 0.038 and 0.01, respectively). Vascular resection - in right-sided procedures performed as "hilar en bloc resection" - did not influence the outcome. CONCLUSIONS Low perioperative mortality after left-sided resection and, obviously, inferior oncological radicality are features of left hepatectomy. These features do not detract from the importance of left hepatectomy which is an indispensable approach to surgically treated patients with hilar cholangiocarcinoma.
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Affiliation(s)
- G Otto
- Abteilung für Transplantation und Hepatopankreobiliäre Chirurgie, Universitätsmedizin Mainz, Deutschland.
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27
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Carbajo-Pescador S, Steinmetz C, Kashyap A, Lorenz S, Mauriz JL, Heise M, Galle PR, González-Gallego J, Strand S. Melatonin induces transcriptional regulation of Bim by FoxO3a in HepG2 cells. Br J Cancer 2012; 108:442-9. [PMID: 23257900 PMCID: PMC3566813 DOI: 10.1038/bjc.2012.563] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Melatonin induces apoptosis in many different cancer cell lines, including hepatocellular carcinoma cells. However, the responsible pathways have not been clearly elucidated. A member of the forkhead transcription factors' family, FoxO3a, has been implicated in the expression of the proapoptotic protein Bim (a Bcl-2-interacting mediator of cell death). In this study, we used human HepG2 liver cancer cells as an in vitro model to investigate whether melatonin treatment induces Bim through regulation by the transcription factor FoxO3a. Methods: Cytotoxicity of melatonin was compared in HepG2 hepatoblastoma cells and primary human hepatocytes. Proapoptotic Bim expression was analysed by reverse transcriptase–polymerase chain reaction and western blot. Reporter gene assays and chromatin immunoprecipitation assays were performed to analyse whether FoxO3a transactivates the Bim promoter. Small interfering RNA (siRNA) was used to study the role of FoxO3a in Bim expression. Immunofluorescence was performed to analyse FoxO3a localisation in HepG2 cells. Results: Melatonin treatment induces apoptosis in HepG2 cells, but not in primary human hepatocytes. The proapoptotic effect was mediated by increased expression of the BH3-only protein Bim. During melatonin treatment, we observed increased transcriptional activity of the forkhead-responsive element and could demonstrate that FoxO3a binds to a specific sequence within the Bim promoter. Furthermore, melatonin reduced phosphorylation of FoxO3a at Thr32 and Ser253, and induced its increased nuclear localisation. Moreover, silencing experiments with FoxO3a siRNA prevented Bim upregulation. Conclusion: This study shows that melatonin can induce apoptosis in HepG2 hepatocarcinoma cells through the upregulation of proapoptotic Bim mediated by nuclear translocation and activation of the transcription factor FoxO3a.
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Affiliation(s)
- S Carbajo-Pescador
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) and Institute of Biomedicine, University of León, León, Spain
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28
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Abshagen J, von Stamm J, Heise M, Will C, Pfister G. Localized modulation of rotating waves in Taylor-Couette flow. Phys Rev E Stat Nonlin Soft Matter Phys 2012; 85:056307. [PMID: 23004862 DOI: 10.1103/physreve.85.056307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Indexed: 06/01/2023]
Abstract
We report the results of an experimental study on the multiplicity of states in Taylor-Couette flow as a result of axial localization of azimuthally rotating waves. Localized states have been found to appear hysteretically from time-dependent Taylor-Couette flow at Reynolds numbers significantly above the onset of wavy Taylor vortices. These localized states have the shape of a modulated rotating wave and differ significantly from global modulated wavy Taylor vortex states in their spatial characteristics. Axial localization of rotating waves is accompanied with a significant increase in size of the underlying pair of Taylor vortices. Our work reveals that localization provides a mechanism for the appearance of multiple time-dependent states in Taylor-Couette flow.
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Affiliation(s)
- J Abshagen
- Institute of Experimental and Applied Physics, University of Kiel, Germany.
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29
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Rauchfuss F, Breuer M, Dittmar Y, Heise M, Bossert T, Hekmat K, Settmacher U. Implantation of the liver during reperfusion of the heart in combined heart-liver transplantation: own experience and review of the literature. Transplant Proc 2012; 43:2707-13. [PMID: 21911150 DOI: 10.1016/j.transproceed.2011.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 04/19/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND There are only a few reports about combined heart-liver transplantations. The surgical techniques differ widely, ranging from sequential implantation of the organs to simultaneous transplantations. We report our experience with simultaneous, combined heart-liver transplantations without using a veno-venous bypass demonstrating that this is a feasible surgical technique. METHODS Since 2005, we performed 4 combined heart-liver transplantations by implanting the liver during the reperfusion period of the newly implanted heart. We retrospectively reviewed patient clinical data and outcomes. RESULTS The mean operative time was 534 ± 247 minutes and the ischemia times for heart and liver were 190 ± 72 minutes (cold ischemia time for the heart), 98 ± 96 minutes (warm ischemia time for the heart), 349 ± 101 minutes (cold ischemia time for the liver), and 36.25 ± 3.5 minutes (warm ischemia time for the liver). Three patients were discharged from the hospital after an uneventful clinical course. One patient died due to multi-organ failure during the intensive care unit stay on the 23rd postoperative day. CONCLUSION We suggest that combined, simultaneous heart-liver transplantation without veno-venous bypass is a feasible surgical technique.
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Affiliation(s)
- F Rauchfuss
- Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University Jena, Jena, Germany.
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30
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Foltys D, Kaths J, Zimmermann T, Heise M, Hoppe-Lotichius M, Otto G. Ten Years of Simultaneous Pancreas-Kidney Transplantation: A Retrospective Single-Center Analysis of Prospectively Obtained Data. Transplant Proc 2011; 43:3267-9. [DOI: 10.1016/j.transproceed.2011.09.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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31
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Foltys D, Zimmermann T, Heise M, Kaths M, Lautem A, Wisser G, Weiler N, Hoppe-Lotichius M, Hansen T, Otto G. Liver transplantation for hepatocellular carcinoma--is there a risk of recurrence caused by intraoperative blood salvage autotransfusion? ACTA ACUST UNITED AC 2011; 47:182-7. [PMID: 21986299 DOI: 10.1159/000330746] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/28/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIMS The use of intraoperative blood salvage autotransfusion (IBSA) during surgical approaches may contribute to tumour cell dissemination. Therefore, IBSA should be avoided in cases of malignancy. However, the risks of IBSA might be acceptable in liver transplantation (LT) for selected small hepatocellular carcinoma (HCC). METHODS In total, 136 recipients of LT with histologically proven HCC in the explanted liver were included in this analysis. With regard to tumour recurrence, 40 patients receiving IBSA despite HCC (IBSA group) were compared to 96 patients without IBSA (non-IBSA group). RESULTS Milan criteria as assessed in the explanted liver were fulfilled in 24 of 40 IBSA patients and 58 of 96 non-IBSA patients (p = 0.85). Five of 40 patients in the IBSA group and 18 of 96 patients in the non-IBSA group experienced tumour recurrence (p = 0.29). In spite the theoretical risk of tumour cell dissemination, the recurrence rate was not increased in the IBSA group. CONCLUSION Our results indicate that IBSA does not modify the risk of HCC recurrence. Therefore, in highly selected HCC patients undergoing LT, the use of IBSA appears to be justified.
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Affiliation(s)
- D Foltys
- Department of Transplantation and Hepatobiliary Surgery, University Medical Centre, Johannes Gutenberg University, Mainz, Germany.
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32
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Cirak S, Ölmez A, Karasoy H, Bakouche B, Heise M, Muntoni F, Winkler J, Topaloglu H, Uyanik G. P34 Clinical phenotype and novel mutations in Alsin related motorneuron disease. Neuromuscul Disord 2011. [DOI: 10.1016/s0960-8966(11)70053-0] [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: 11/16/2022]
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33
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Abstract
Hepatocellular carcinoma and cholangiocarcinoma are relatively rare tumors of the gastrointestinal tract in western Europe but their incidence has been increased in recent years. Newly diagnosed intrahepatic lesions or intrahepatic cholestasis require extensive laboratory tests and imaging studies in order to confirm the diagnosis of hepatocellular carcinoma, intrahepatic or extrahepatic cholangiocarcinoma. The treatment options range from liver resection or liver transplantation to conservative measures (in cases of non-resectable lesions). This review article aims to provide an overview on the diagnostic options and the subsequent treatment.
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Affiliation(s)
- F Rauchfuss
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Friedrich-Schiller-Universität Jena, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland.
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34
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Ruth I, Heise M, Foltys DB, Otto G. LIVER TRANSPLANT IN RECIPIENTS OVER 65 YEARS OF AGE: A JUSTIFIED TREND? Transplantation 2010. [DOI: 10.1097/00007890-201007272-01595] [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: 11/25/2022]
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35
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Abstract
INTRODUCTION Due to the current profound lack of suitable donor organs, transplant centers are increasingly forced to accept so-called marginal organs. One criterion for marginal donors is the donor age >65 years. We have presented herein the impact of higher donor age on graft and patient survival. PATIENTS AND METHODS Since 2004, 230 liver transplantations have been performed at our center, including 54 donor organs (23.5%) from individuals >65 years of age. We performed a retrospective analysis of recipient and graft survivals. RESULTS The overall 1-year mortality was 22.2% (12/54) among recipients of organs from older donors versus 19.5% among recipients whose donors were <65 years. When donor organs were grouped according to age, the 1-year mortality in patients receiving organs from donors aged 65-69 years was 30% (6/20); 70-74 years, 29.4% (5/17); and donors >75 years, 5.9% (1/17). There was no significant correlation between mortality rate and the number of additional criteria of a marginal donor organ. DISCUSSION The current lack of donor organs forces transplant centers to accept organs from older individuals; increasingly older patients are being recruited for the donor pool. Our results showed that older organs may be transplanted with acceptable outcomes. This observation was consistent with data from the current literature. It should be emphasized, however, that caution is advised when considering the acceptance of older organs for patients with hepatitis C-related cirrhosis.
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Affiliation(s)
- F Rauchfuss
- Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University, Jena, Germany.
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Altmeyer S, Hoffmann C, Heise M, Abshagen J, Pinter A, Lücke M, Pfister G. End wall effects on the transitions between Taylor vortices and spiral vortices. Phys Rev E Stat Nonlin Soft Matter Phys 2010; 81:066313. [PMID: 20866528 DOI: 10.1103/physreve.81.066313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 05/06/2010] [Indexed: 05/29/2023]
Abstract
We present numerical simulations as well as experimental results concerning transitions between Taylor vortices and spiral vortices in the Taylor-Couette system with rigid, nonrotating lids at the cylinder ends. These transitions are performed by wavy structures appearing via a secondary bifurcation out of Taylor vortices and spirals, respectively. In the presence of these axial end walls, pure spiral solutions do not occur as for axially periodic boundary conditions but are substituted by primary bifurcating, stable wavy spiral structures. Similarly to the periodic system, we found a transition from Taylor vortices to wavy spirals mediated by so-called wavy Taylor vortices and, on the other hand, a transition from wavy spirals to Taylor vortices triggered by a propagating defect. We furthermore observed and investigated the primary bifurcation of wavy spirals out of the basic circular Couette flow with Ekman vortices at the cylinder ends.
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Affiliation(s)
- S Altmeyer
- Institut für Theoretische Physik, Universität des Saarlandes, D-66123 Saarbrücken, Germany
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Hoffmann C, Heise M, Altmeyer S, Abshagen J, Pinter A, Pfister G, Lücke M. Nonlinear defects separating spiral waves in Taylor-Couette flow. Phys Rev E 2010; 80:066308. [PMID: 20365268 DOI: 10.1103/physreve.80.066308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Indexed: 11/06/2022]
Abstract
Stable domain walls which are realized by a defect between oppositely traveling spiral waves in a pattern-forming hydrodynamic system, i.e., Taylor-Couette flow, are studied numerically as well as experimentally. A nonlinear mode coupling resulting from the nonlinearities in the underlying momentum balance is found to be essential for the stability of the defects. These nonlinearly driven defects separate spiral domains and act either as a phase generating or annihilating defect. Specific phase differences of either 0 or pi between the participating traveling waves are a characteristic feature of this defect. The influence of a symmetry breaking externally imposed flow on the spiral domains and the defects is studied. The numerical and experimental results are in excellent agreement.
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Affiliation(s)
- Ch Hoffmann
- Institut für Theoretische Physik, Universität des Saarlandes, Saarbrücken, Germany.
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Johnston S, Trudeau M, Rubin S, Little S, Heise M, Durante M, Salazar V, Richie M, Cristofanilli M. 380 A novel skin assessment tool for inflammatory breast cancer (IBC). EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70406-7] [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] Open
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Foltys D, Linkermann A, Heumann A, Hoppe-Lotichius M, Heise M, Schad A, Schneider J, Bender K, Schmid M, Mauer D, Peixoto N, Otto G. Organ recipients suffering from undifferentiated neuroendocrine small-cell carcinoma of donor origin: a case report. Transplant Proc 2010; 41:2639-42. [PMID: 19715991 DOI: 10.1016/j.transproceed.2009.06.026] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Transmission of donor-derived cancer by organ transplantation is rare, but the risk has been increasing due to the aging donor pool. Undifferentiated neuroendocrine small-cell carcinoma is an aggressive tumor with the tendency to spread. Herein we have demonstrated different approaches to treat organ recipients with transmitted tumors. METHODS AND RESULTS Grafts were retrieved from a decreased donor without any history of previous diseases. Autopsy was not performed after donation. The recipient of the liver graft presented with suspected nodules on routine abdominal ultrasound. After computed tomography (CT) scan, biopsy confirmed the diagnosis of a small-cell carcinoma. Donor origin was unequivocally identified by DNA fingerprinting. Despite chemotherapy the patient died 7 months after orthotopic liver transplantation (OLT). All involved transplantation centers were informed immediately following diagnosis. The male kidney recipient underwent detailed diagnostic work-up to exclude tumor transmission. One year after transplantation, liver metastases caused by a histologically proven small-cell carcinoma from the same donor were apparent. Chemotherapy was immediately started and the graft was removed. Despite continued treatment the tumor progressed and the patient died after repeated intestinal complications. The pathological examination of the explanted second kidney graft did not show any tumor infiltration. CONCLUSION Therapeutic regimens in recipients suffering from donor-derived carcinoma differ depending on the transplanted organ. Graft removal of non-life-sustaining organs and discontinuation of immunosuppressive medication should result in complete tumor rejection. Minimizing the risk of tumor transmission, a CT scan might be advisable in donors of more advanced age.
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Affiliation(s)
- D Foltys
- Department of Transplantation and Hepatobiliary Surgery, Johannes Gutenberg-University, Mainz, Germany.
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Leonhardt S, Heller T, Heise M. Neuronale Netze zur nichtinvasiven Blutzuckermessung. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1998.43.s1.584b] [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: 11/15/2022]
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Heise M, Hochstrate K, Abshagen J, Pfister G. Spirals vortices in Taylor-Couette flow with rotating endwalls. Phys Rev E Stat Nonlin Soft Matter Phys 2009; 80:045301. [PMID: 19905382 DOI: 10.1103/physreve.80.045301] [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] [Received: 06/19/2009] [Indexed: 05/28/2023]
Abstract
A Hopf bifurcation with translational invariance has been widely considered as an appropriate model for the appearance of spiral vortices in counter-rotating Taylor-Couette flow. Our experimental work demonstrates that flow conditions close to the axial boundaries are responsible for the type of bifurcation scenario, i.e., either asymmetric pure traveling waves or more complex behavior, such as defect states or symmetric mixed states appearing from a Hopf bifurcation. The measurements were performed in the first Taylor-Couette experiment with independently rotating endwalls confining the system in axial direction. The rotation rate of the (synchronous) endwalls is found to be an essential control parameter for the spatial amplitude distribution of the traveling waves and also reflects symmetry of the corresponding flow pattern appearing from the Hopf bifurcation.
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Affiliation(s)
- M Heise
- Institute of Experimental and Applied Physics, University of Kiel, Kiel, Germany.
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Krüger U, Heise M, Rückert R, Scholz H. Die Prognose eines peripheren Gefäßbypasses in Korrelation zur Phasenverschiebung zwischen Druck und Fluß. BIOMED ENG-BIOMED TE 2009. [DOI: 10.1515/bmte.1996.41.s1.120] [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: 11/15/2022]
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Zimmermann T, Otto C, Hoppe-Lotichius M, Biesterfeld S, Lautem A, Knaak M, Zimmermann A, Barreiros A, Heise M, Schattenberg J, Sprinzl M, Galle P, Otto G, Schuchmann M. Risk Factors in Patients With Rapid Recurrent Hepatitis C Virus–Related Cirrhosis Within 1 Year After Liver Transplantation. Transplant Proc 2009; 41:2549-56. [DOI: 10.1016/j.transproceed.2009.06.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Dittmar Y, Voigt R, Heise M, Rabsch A, Jandt K, Settmacher U. [Indications and results of palliative gastric resection in advanced gastric carcinoma]. Zentralbl Chir 2009; 134:77-82. [PMID: 19242887 DOI: 10.1055/s-0028-1098793] [Citation(s) in RCA: 4] [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: 10/21/2022]
Abstract
BACKGROUND Gastric carcinoma is often diagnosed at UICC stage 3 b or 4. R0 resection can be achieved only in very few such cases. Even for these patients the 5-year survival rate is less than 5 %. Surgical palliation is traditionally reserved for the treatment of severe tumour complications not responding to other forms of treatment. PATIENTS AND METHODS We report on 21 patients who underwent palliative resection for gastric carcinoma at our institution between 2004 and 2007. Ten of these were assigned to palliative surgical treatment pre-operatively while this choice was made for 11 patients on the grounds of the intra-operative findings. We performed 17 gastrectomies, 3 proximal gastric resections and one distal gastric resection. RESULTS It has been shown that the patients have an improved overall survival time as compared to patients who received non-surgical treatment. The perioperative risk was reasonable when patients were carefully selected. Median survival for resected patients was 16 months. 80 % of patients were alive after 6 months and approximately 60 % of patients were alive after 12 months. The perioperative mortality was 0 % with a mean hospital stay of 12 days. All patients were discharged home with proper bowel passage and analgesia as individually required. CONCLUSIONS We are convinced that palliative gastric resection provides a pronounced survival benefit over any other palliative treatment options. Patients also have an improved quality of life.
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Affiliation(s)
- Y Dittmar
- Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Universitätsklinikum Jena, Germany
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Schwarting S, Hübers U, Heise M, Schlieper J, Hauschild A. Positionspapier der DGZS zur Anwendung von Protrusionsschienen bei Erwachsenen mit schlafbezogenen Atmungsstörungen. Pneumologie 2008. [DOI: 10.1055/s-0028-1083134] [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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Foltys D, Moench C, Burck I, Hoppe-Lotichius M, Schad A, Teufel A, Heise M, Otto G. Der solid pseudopapilläre Pankreastumor (SPT) – eine seltene Raumforderung der Bauchspeicheldrüse. Z Gastroenterol 2008; 46:689-94. [DOI: 10.1055/s-2008-1027318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Muranyi P, Wunderlich J, Heise M. Influence of relative gas humidity on the inactivation efficiency of a low temperature gas plasma. J Appl Microbiol 2008; 104:1659-66. [DOI: 10.1111/j.1365-2672.2007.03691.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
We present a type of spiral vortex state that appears from a supercritical Hopf bifurcation below the linear instability of circular Couette flow in a Taylor-Couette system with rigid end plates. These spirals have been found experimentally as well as numerically as "pure" states but also coexist with "classical" spirals (or axially standing waves for smaller systems) which typically appear from linear instability in counterrotating Taylor-Couette flow. These spiral states have an axial distribution of the strongly localized amplitude in the vicinity of the rigid end plates that confine the system in the axial direction. Furthermore, they show significantly different oscillation frequencies compared to the critical spiral frequencies. Despite the localization of the amplitude near the ends, the states appear as global states with spirals that propagate either toward the middle from each end of the system or vice versa. In contrast to classical spirals, these states exhibit a spatial or a spatiotemporal reflection symmetry.
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Affiliation(s)
- M Heise
- Institute of Experimental and Applied Physics, University of Kiel, 24098 Kiel, Germany
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Heise M, Hoffmann C, Abshagen J, Pinter A, Pfister G, Lücke M. Stabilization of domain walls between traveling waves by nonlinear mode coupling in Taylor-Couette flow. Phys Rev Lett 2008; 100:064501. [PMID: 18352477 DOI: 10.1103/physrevlett.100.064501] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Indexed: 05/26/2023]
Abstract
We present a new mechanism that allows the stable existence of domain walls between oppositely traveling waves in pattern-forming systems far from onset. It involves a nonlinear mode coupling that results directly from the nonlinearities in the underlying momentum balance. Our work provides the first observation and explanation of such strongly nonlinearly driven domain walls that separate structured states by a phase generating or annihilating defect. Furthermore, the influence of a symmetry breaking externally imposed flow on the wave domains and the domain walls is studied. The results are obtained for vortex waves in the Taylor-Couette system by combining numerical simulations of the full Navier-Stokes equations and experimental measurements.
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Affiliation(s)
- M Heise
- Institut für Experimentelle und Angewandte Physik, Universität Kiel, D-24098 Kiel, Germany
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