The Potential of Cardiac Markers to Improve Patient Management
B-type natriuretic peptide (BNP) is a quantitative marker for heart failure. The use of BNP in patients with dyspnea has consistently shown to improve patient management and reduce treatment cost. Additional indications with the potential to improve patient management include treatment monitoring in acute and chronic heart failure, pulmonary embolism, and coronary artery disease.
Das Bundesministerium für Verkehr, Bau und Stadtentwicklung hat am 22. Februar 2008 einen Referentenentwurf zur Novellierung des Raumordnungsgesetzes vorgelegt. Der Entwurf übernimmt weitgehend die etablierten Instrumente des gegenwärtigen Raumordnungsrechts und entwickelt diese zum Teil weiter. Der Entwurf verfolgt den Anspruch, durch das Bundesgesetz nur das Erforderliche zu regeln und den Länden Spielräume zur Ausgestaltung zu überlassen.
Carolin Hildebrandt, Lisa Müller, Christian Heisse and Christian Raschner
Core muscle imbalances and weak trunk strength are relevant for injury prevention and performance. Information regarding core strength requirements and ideal flexion/extension ratios in alpine skiing is limited. We aimed to compare trunk strength capacities in elite alpine skiers with those of a matched control group. The concentric maximal trunk flexion and extension of 109 elite skiers and 47 active controls were measured at 150°/s in a ballistic mode using the CON-TREX® TP 1000 test system. The relative flexion peak torque was higher in male ski racers (p = 0.003; 2.44 ± 0.30 Nm/kg) than in the controls (2.32 ± 0.42 Nm/kg). The relative peak torque for extension was 4.53 ± 0.65 Nm/kg in ski racers and 4.11 ± 0.52 Nm/kg in the controls (p = 0.001). Female athletes were significantly stronger in both, relative flexion force (p = 0.006; skiers 2.05 ± 0.22 Nm/kg; controls 1.74 ± 0.28 Nm/kg) and relative extension force (p = 0.001; skiers 3.55 ± 0.53 Nm/kg; controls 3.14 ± 0.48 Nm/kg). No significant differences were found in the ratios of flexion to extension forces in females and males. Ski racers are engaged in extensive strength training for both leg and trunk muscles, which explains the higher peak values. Both groups indicated a low ratio from 0.54-0.59, which represents high trunk extensor muscles strength relative to flexor muscles.
The civil economy approach is an attempt to reconcile economic market interactions with the normative standards of traditional virtue ethics. We analyze critically some of its main elements with a special focus on the concept of reciprocity, which plays a central role in the whole approach. Its strengths include, among others, virtue orientation, emphasis on happiness rather than utility, and in particular the notion of reciprocity. However, we argue that this concept of reciprocity would on average not be incentive compatible, and from a methodological point of view, the implied hypothesis of a homo reciprocans is not a viable alternative to the standard model of homo oeconomicus. We also consider that the approach is not entirely new, as it shares many characteristics with the social market economy conception.
Christian Müller, Sindy Lautenschläger and Sebastian Voigt-Radloff
In Germany, four to five million community-dwelling people aged 65 years or older fall every year. The presented potential analysis evaluates the potential of occupational therapy-led physical exercise programs and home environment adaptations to reduce the frequency of falling and as well as intrinsic and extrinsic risk factors for falling of older people living at home.
The potential analysis was compiled according to a method guideline (p.11-22) available as follows: http://www.cochrane. de/news/leitfaden-f%C3%BCr-gesundheitsfachberufe-mai-2013. The research question of fall prevention was considered as very relevant for health care and specified according to the PICOS-system. A Cochrane review was systematically searched and the body of evidence was assessed using the GRADE-system. In addition, studies after the search period of the Cochrane review were identified using the search strategy of this review. Both the studies within and after the review were assessed regarding their transferability to the German health care context.
Corpus of evidence
A Cochrane review from 2012 revealed that occupational therapy-led physical exercise programs reduced the frequency of falling of older people living at home (7 studies, 951 participants, 0.68 RaR; 95%-KI [0.58-0.80]), the number of fallers (6 studies, 714 participants, 0.78 RaR, 95%-KI [0.64-0.94]) and the fractures (6 studies, 810 participants, 0.34 RaR, 95%-KI [0.18-0.63]). Further studies showed that home environment adaptation programs significantly reduced the number of falls (4 studies, 1443 participants, 0.69 RaR, 95%-KI [0.55-0.86]) and the number of fallers (5 studies, 1153 participants, 0.79 RaR, 95%-KI [0.70-0.91]). However, direct implementation into the German healthcare context is not recommendable.
Implication for research
It is recommended (1) to manualise identified home environment adaptation programmes for the German healthcare context and (2) to pilot-test the physical exercise programmes ‘LiFE’ with regard to theoretical framework, acceptance, applicability and feasibility and to examine both interventions as part of a feasibility study. If this trial results in a feasible treatment programme well accepted by patients and their treating occupational therapists, a large-scaled randomized clinical trial in terms of comparative effectiveness research may follow.
Christian Müller, Janine Puls, Sindy Lautenschläger, Astrid Stephan and Gabriele Meyer
The transition from home care to nursing home care is a significant event in the life of a person with dementia and also for informal caregiver, who deal with many crises and changes.
To describe a protocol for a systematic review based on the `‘PRISMA-P 2015 statement`. We will carry out this review firstly to identify interventions that support people with dementia and their informal caregivers in the transition from home care to nursing home care, secondly to synthesise the available evidence for the efficacy of identified interventions, and thirdly to examine whether the identified interventions have been systematically developed, evaluated and implemented according to the MRC framework.
This systematic review will be conducted according to the recommendations specified in the Cochrane Handbook for Intervention Reviews; reporting will follow the PRISMA statement.
The search strategy covers six electronic bibliographic databases, Google Scholar and ALOIS. In addition, backward citation tracking will be applied. The protocol includes decisions made on the research questions, inclusion/exclusion criteria, search methods, study selection, data extraction, assessment of risk of bias, data synthesis and plans for dissemination and funding.
This systematic review will summarise the body of evidence of interventions supporting people with dementia and their informal caregivers during the transition from home care to nursing home care.
This review protocol has been registered on the Prospective Register of Systematic Reviews (PROSPERO 2015: CRD42015019839).
Arndt-Christian Müller, Johannes Mischinger, Theodor Klotz, Bernd Gagel, Gregor Habl, Gencay Hatiboglu and Michael Pinkawa
The aim of the study was to reach a consensus on indication and application of a hydrogel spacer based on multicentre experience and give new users important information to shorten the learning curve for this innovative technique.
The interdisciplinary meeting was attended by radiation oncologists and urologists, each with experience of 23 – 138 hydrogel injections (SpaceOAR®) in prostate cancer patients before dose-escalated radiotherapy. User experience was discussed and questions were defined to comprise practical information relevant for successful hydrogel injection and treatment. Answers to the defined key questions were generated. Hydrogel-associated side effects were collected to estimate the percentage, treatment and prognosis of potential risks.
The main indication for hydrogel application was dose-escalated radiotherapy for histologically confirmed low or intermediate risk prostate cancer. It was not recommended in locally advanced prostate cancer. The injection or implantation was performed under transrectal ultrasound guidance via the transperineal approach after prior hydrodissection. The rate of injection-related G2-toxicity was 2% (n = 5) in a total of 258 hydrogel applications. The most frequent complication (n = 4) was rectal wall penetration, diagnosed at different intervals after hydrogel injection and treated conservatively.
A consensus was reached on the application of a hydrogel spacer. Current experience demonstrated feasibility, which could promote initiation of this method in more centres to reduce radiation-related gastrointestinal toxicity of dose-escalated IGRT. However, a very low rate of a potential serious adverse event could not be excluded. Therefore, the application should carefully be discussed with the patient and be balanced against potential benefits.
Anna Iacoi, Alexander Brobeil, Malena Götte, Christian Enzensberger, Vera Müller, Stefan Gattenlöhner and Roland Axt-Fliedner
Pulmonary capillary haemangiomatosis (PCH) is a rare disorder of the lung, well described in adult literature. PCH is characterized by capillary proliferation, infiltrating the interstitium and alveolar walls. This leads to development of respiratory distress and to end-stage pulmonary hypertension. Mostly young adults are affected. The affection of newborn is described in less than ten cases in literature in the past forty years. PCH is a mostly deadly ending disease. We present a preterm born infant with antepartal diagnosed hydrops fetalis, who died 30 minutes after birth. Autopsy revealed PCH as lethal reason and not cardial disease as presumed before.