Publications by authors named "Marco Meyer"

23 Publications

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[Acceptance of video consultation among patients with inflammatory rheumatic diseases depends on gender and location-Results of an online survey among patients and physicians].

Z Rheumatol 2021 Aug 27. Epub 2021 Aug 27.

Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland.

Introduction: In order to successfully integrate telemedicine into the daily routine of rheumatology, both the patient's and the physician's perspective are important. For this purpose, a detailed study by means of a web-based survey was conducted by the Working Group Young Rheumatology (AGJR) of the German Society for Rheumatology (DGRh) and the German Rheumatism League National Association. By means of subgroup analysis of the data regarding video consultation, the aim was now to find out which requirements and wishes patients and physicians have for video consultations.

Methods: The prospective survey was distributed via social media, QR code and email. Descriptive statistics and regression analysis related to video consultation were performed and correlations were shown.

Results: The data indicated positive attitudes toward video consultation on the part of both patients (n = 299) and rheumatologists (n = 129). A correlation between age and positive opinion of the video consultation was found among the patients (r = 0.161, p = 0.006), especially among female patients a positive approval of the video consultation was found with increasing age (r = 0.244, p < 0.001 to male patients: r = -0.190, p = 0.145). Regarding the travelling time to the treating rheumatologist, male patients found the video consultation more attractive with increasing travelling time (r = 0.229, p = 0.078). With respect to the wishes of patients and physicians, video consultation should be used primarily for follow-up or emergency appointments. Video consultation for initial appointments, on the other hand, was very rarely mentioned.

Conclusion: During the COVID 19 pandemic, video consultation was increasingly popular among rheumatology patients as well as among rheumatologists.
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http://dx.doi.org/10.1007/s00393-021-01052-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391858PMC
August 2021

The Development and Validation of the Epistemic Vice Scale.

Rev Philos Psychol 2021 Jun 25:1-28. Epub 2021 Jun 25.

Faculty of Philosophy, Macquarie University, Sydney, Australia.

This paper presents two studies on the development and validation of a ten-item scale of epistemic vice and the relationship between epistemic vice and misinformation and fake news. Epistemic vices have been defined as character traits that interfere with acquiring, maintaining, and transmitting knowledge. Examples of epistemic vice are gullibility and indifference to knowledge. It has been hypothesized that epistemically vicious people are especially susceptible to misinformation and conspiracy theories. We conducted one exploratory and one confirmatory observational survey study on Amazon Mechanical Turk among people living in the United States (total  = 1737). We show that two psychological traits underlie the range of epistemic vices that we investigated: indifference to truth and rigidity. Indifference manifests itself in a lack of motivation to find the truth. Rigidity manifests itself in being insensitive to evidence. We develop a scale to measure epistemic vice with the subscales indifference and rigidity. The Epistemic Vice Scale is internally consistent; has good convergent, divergent, and discriminant validity; and is strongly associated with the endorsement of misinformation and conspiracy theories. Epistemic vice explains additional variance in the endorsement of misinformation and conspiracy theories over and above demographic and related psychological concepts and shows medium to large effect sizes across outcome measures. We demonstrate that epistemic vice differs from existing psychological constructs, and show that the scale can explain individual differences in dealing with misinformation and conspiracy theories. We conclude that epistemic vice might contribute to "postfactive" ways of thinking.

Supplementary Information: The online version contains supplementary material available at 10.1007/s13164-021-00562-5.
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http://dx.doi.org/10.1007/s13164-021-00562-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8231755PMC
June 2021

Improved Balance and Gait Ability and Basic Activities of Daily Living after Comprehensive Geriatric Care in Frail Older Patients with Fractures.

Healthcare (Basel) 2021 May 11;9(5). Epub 2021 May 11.

Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling, 57074 Siegen, Germany.

(1) Purpose: Comprehensive geriatric care (CGC) is a multidisciplinary treatment approach for elderly patients. We aimed to investigate outcomes in fracture patients who had been treated using this approach in a large geriatric unit. (2) Methods: This observational cohort study assessed the gait function (using the Tinetti Balance and Gait Test (TBGT)) and basic activities of daily living (ADL) (using the Barthel index (BI)) before and after CGC and compared the results. Baseline data, walking ability assessments (Timed Up and Go, TUG), and cognitive status (mini mental status examination, MMSE) were also analyzed in the subgroup of patients with versus without fractures. (3) Results: Out of 1263 hospitalized patients, 1099 received CGC (median age: 83.1 years (IQR: 79.0-87.8 years); 64.1% were female). TBGT improvement was observed in 90.7% and BI increased in 82.7% of fracture patients. A TBGT improvement of >5 was noted in 47.3% and was associated with female sex, a lower BI at admission (median: 40 versus 45; = 0.010), and poorer mobility on admission (TUG: median 5 versus 4; = 0.001). An improvement in BI of ≥15 was observed in 63.0% of the cases, and was associated with a better cognitive status (MMSE: median 25 versus 18; = 0.001) and inversely associated with diabetes mellitus and a previous stroke. (4) Conclusion: CGC in specialized geriatric units improves the balance and gait and the basic ADL in geriatric patients. After fracture, female patients are more likely to experience improvements in gait and balance, while patients with better cognitive condition are more likely to experience improvements in ADL.
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http://dx.doi.org/10.3390/healthcare9050560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151142PMC
May 2021

Digital rheumatology in the era of COVID-19: results of a national patient and physician survey.

RMD Open 2021 02;7(1)

Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany

Objective: To analyse the impact of the COVID-19 pandemic on rheumatic patients' and rheumatologists' usage, preferences and perception of digital health applications (DHAs).

Methods: A web-based national survey was developed by the Working Group Young Rheumatology of the German Society for Rheumatology and the German League against Rheumatism. The prospective survey was distributed via social media (Twitter, Instagram and Facebook), QR code and email. Descriptive statistics were calculated, and regression analyses were performed to show correlations.

Results: We analysed the responses of 299 patients and 129 rheumatologists. Most patients (74%) and rheumatologists (76%) believed that DHAs are useful in the management of rheumatic and musculoskeletal diseases (RMDs) and felt confident in their own usage thereof (90%; 86%). 38% of patients and 71% of rheumatologists reported that their attitude had changed positively towards DHAs and that their usage had increased due to COVID-19 (29%; 48%). The majority in both groups agreed on implementing virtual visits for follow-up appointments in stable disease conditions. The most reported advantages of DHAs were usage independent of time and place (76.6%; 77.5%). The main barriers were a lack of information on suitable, available DHAs (58.5%; 41.9%), poor usability (42.1% of patients) and a lack of evidence supporting the effectiveness of DHAs (23.2% of rheumatologists). Only a minority (<10% in both groups) believed that digitalisation has a negative impact on the patient-doctor relationship.

Conclusion: The COVID-19 pandemic instigated an increase in patients' and rheumatologists' acceptance and usage of DHAs, possibly introducing a permanent paradigm shift in the management of RMDs.
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http://dx.doi.org/10.1136/rmdopen-2020-001548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907631PMC
February 2021

Desymmetrizing Heteroleptic [Cu(P^P)(N^N)][PF] Compounds: Effects on Structural and Photophysical Properties, and Solution Dynamic Behavior.

Molecules 2020 Dec 29;26(1). Epub 2020 Dec 29.

Department of Chemistry, University of Basel, BPR 1096, Mattenstrasse 24a, CH-4058 Basel, Switzerland.

The preparation, characterization and electrochemical and photophysical properties of a series of desymmetrized heteroleptic [Cu(P^P)(N^N)][PF] compounds are reported. The complexes incorporate the chelating P^P ligands bis(2-(diphenylphosphanyl)phenyl)ether (POP) and (9,9-dimethyl-9-xanthene-4,5-diyl)bis(diphenylphosphane) (xantphos), and 6-substituted 2,2'-bipyridine (bpy) derivatives with functional groups attached by -(CH)- spacers: 6-(2,2'-bipyridin-6-yl)hexanoic acid (), 6-(5-phenylpentyl)-2,2'-bipyridine () and 6-[2-(4-phenyl-1-1,2,3,triazol-1-yl)ethyl]-2,2'-bipyridine (). [Cu(POP)()][PF], [Cu(xantphos)()][PF], [Cu(POP)()][PF], [Cu(xantphos)()][PF], and [Cu(xantphos)()][PF] have been characterized in solution using multinuclear NMR spectroscopy, and the single crystal structure of [Cu(xantphos)()][PF]0.5EtO was determined. The conformation of the 6-[2-(4-phenyl-1-1,2,3,triazol-1-yl)ethyl]-substituent in the [Cu(xantphos)()] cation is such that the α- and β-CH units reside in the xanthene 'bowl' of the xantphos ligand. The 6-substituent desymmetrizes the structure of the [Cu(P^P)(N^N)] cation and this has consequences for the interpretation of the solution NMR spectra of the five complexes. The NOESY spectra and EXSY cross-peaks provide insight into the dynamic processes operating in the different compounds. For powdered samples, emission maxima are in the range 542-555 nm and photoluminescence quantum yields (PLQYs) lie in the range 13-28%, and a comparison of PLQYs and decay lifetimes with those of [Cu(xantphos)(6-Mebpy)][PF] indicate that the introduction of the 6-substituent is not detrimental in terms of the photophysical properties.
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http://dx.doi.org/10.3390/molecules26010125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796056PMC
December 2020

Severity assessment in mice subjected to carbon tetrachloride.

Sci Rep 2020 09 25;10(1):15790. Epub 2020 Sep 25.

Institute for Laboratory Animal Science and Experimental Surgery, Faculty of Medicine, RWTH, Aachen International University, Aachen, Germany.

The Directive 2010/63 EU requires classifying burden and severity in all procedures using laboratory animals. This study evaluated the severity of liver fibrosis induction by intraperitoneal carbon tetrachloride (CCl) injections in mice. 29 male C57BL/6N mice were treated three times per week for 4 weeks with an intraperitoneal injection (50 µl) of either 0.6 ml/kg body weight CCl-vehicle solution, germ oil (vehicle-control) or handling only. Severity assessment was performed using serum analysis, behavioral tests (open field test, rotarod, burrowing and nesting behavior), fecal corticosterone metabolite (FCM) measurement, and survival. The most significant group differences were noticed in the second week of treatment when the highest AST (1463 ± 1404 vs. 123.8 ± 93 U/L, p < 0.0001) and nesting values were measured. In addition, respective animals showed lower moving distances (4622 ± 1577 vs. 6157 ± 2060 cm, p < 0.01) and velocity in the Open field, identified as main factors in principal component analysis (PCA). Overall, a 50% survival rate was observed within the treatment group, in which the open field performance was a good tracer parameter for survival. In summary, this study demonstrates the feasibility of assessing severity in mice using behavioral tests and highlight the open field test as a possible threshold parameter for risk assessment of mortality.
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http://dx.doi.org/10.1038/s41598-020-72801-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519684PMC
September 2020

Evaluation of a new wireless technique for continuous electroencephalography monitoring in neurological intensive care patients.

J Clin Monit Comput 2021 Aug 2;35(4):765-770. Epub 2020 Jun 2.

Department of Anesthesiology, Johannes Gutenberg Universitaet, Universitaetsmedizin Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.

A novel wireless eight-channel electroencephalography (EEG) headset specially developed for ICUs was tested in regard of comparability with standard 10/20 EEG systems. The continuous EEG (cEEG) derivations via CerebAir EEG headset (Nihon Kohden Europe, Rosbach, Germany) and internationally standardized 10/20 reference EEGs as the diagnostic standard were performed in a mixed collective on a neurointensive care unit (neuro-ICU). The derivations were verified for comparability in detection of EEG background activity, epileptiform discharges, and seizure patterns. Fifty-two patients with vigilance reduction following serious neurological or metabolic diseases were included, and both methods were applied and further analyzed in 47. EEG background activity matched in 24 of 45 patients (53%; p = 0.126), epileptiform discharges matched in 32 (68%) patients (p = 0.162), and seizure activity matched in 98%. Overall, in 89% of the patients, cEEG detected the same or additional ICU-relevant EEG patterns. The tested wireless cEEG headset is a useful monitoring tool in patients with consciousness disorders. The present study indicates that long-term measurements with the wireless eight-channel cEEG lead to a higher seizure and epileptiform discharge detection compared to intermittent 10/20 EEG derivations in the ICU setting.
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http://dx.doi.org/10.1007/s10877-020-00533-8DOI Listing
August 2021

Epileptic seizure discharges in patients after open chamber cardiac surgery-a prospective prevalence pilot study using continuous electroencephalography.

Intensive Care Med 2020 Jul 13;46(7):1418-1424. Epub 2020 May 13.

Heart and Brain Research Group, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.

Purpose: Patients undergoing cardiac surgery often develop delirium which increases the risk of postoperative morbidity and leads to a reduced quality of life. Retrospective studies show a higher incidence of delirium in patients with seizures. However, these studies do not systematically detect subclinical seizures, so the incidence of seizures after cardiac surgery remains speculative. The objective of this study is to determine the prevalence of electrographic seizures after elective open-chamber cardiac surgery.

Methods: This prospective, blinded, monocentric, observational study investigated patients scheduled for elective open-chamber valve reconstruction or replacement. Anaesthesia, surgery and postoperative treatment were standardized and not influenced by the presented observation. After surgery, all patients arrived at the ICU, and EEG monitoring started within the first hour. EEG recording was continuously performed for up to 24 h, and the results were independently analysed by two blinded EEG board-certified neurologists.

Results: 100 patients were included. Abnormal EEG patterns were present in 33% of patients, and 9% of all patients showed electrographic seizures. The main EEG activity at the beginning of each recording was suppressed or showed a burst-suppression pattern, and at the end of recording, all patients had an alpha/theta rhythm. An association between electrographic seizures and delirium was found (p < 0.01).

Conclusion: This study reveals a surprisingly high incidence of abnormal EEG patterns and electrographic seizures in patients undergoing open-chamber cardiac surgery. As electrographic seizures are associated with the incidence of delirium, this finding is a relevant phenomenon in the post-cardiac surgery ICU population.
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http://dx.doi.org/10.1007/s00134-020-06073-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334279PMC
July 2020

Flexible endoscopic evaluation of swallowing (FEES) to determine neurological intensive care patients' oral diet.

Int J Speech Lang Pathol 2021 Feb 3;23(1):83-91. Epub 2020 Apr 3.

Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.

Purpose: Dysphagia is common in critically ill neurological patients and is associated with a high mortality and morbidity. Data on the usefulness of flexible endoscopic examination of swallowing (FEES) in neurological intensive care unit (ICU) patients are lacking, raising the need for evaluation.

Method: FEES was performed in neurological intensive care patients suspected of dysphagia. We correlated findings with baseline data, disability status, pneumonia and duration of hospitalisation, as well as a need for mechanical ventilation or tracheotomy.

Result: This analysis consisted of 125 patients with suspected dysphagia. Most of the patients (81; 64,8%) suffered from acute stroke. Dysphagia was diagnosed using FEES in 90 patients (72%). FEES results led to dietary modifications in 80 patients (64%). The outcome at discharge was worse in dysphagic stroke patients diagnosed by FEES as compared to non-dysphagic stroke patients ( = 0.009). Patients without oral diet had higher need for intubation ( = 0.007), tracheotomy ( = 0.032) and higher mortality ( < 0.001) in comparison to patients with at least small amounts of oral intake.

Conclusion: As the clinical assessment of the patients often classified the dysphagia incorrectly, the broad use of FEES in ICU patients might help to adequately adjust patients' oral diet. This knowledge might contribute to lower mortality and morbidity.
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http://dx.doi.org/10.1080/17549507.2020.1744727DOI Listing
February 2021

Tocilizumab treatment for polyarteritis nodosa.

Rheumatology (Oxford) 2020 Oct;59(10):e63-e65

Department of Rheumatology, Clinical Immunology and Nephrology, Asklepios Klinik Altona, Hamburg, Klinikum Bad Bramstedt, Germany.

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http://dx.doi.org/10.1093/rheumatology/keaa079DOI Listing
October 2020

Impaired Cerebrovascular Autoregulation in Large Vessel Occlusive Stroke after Successful Mechanical Thrombectomy: A Prospective Cohort Study.

J Stroke Cerebrovasc Dis 2020 Mar 3;29(3):104596. Epub 2020 Jan 3.

Department of Anesthesiology, Johannes Gutenberg-University, University medical hospital Mainz, Mainz, Germany.

Introduction: Successful thrombectomy improves morbidity and mortality after stroke. The present prospective, observational cohort study investigated a potential correlation between the successful restoration of tissue perfusion by mechanical thrombectomy and intact cerebrovascular autoregulation (CA).

Objective: Status of CA in patients with large vessel occlusive stroke after thrombectomy.

Methods: After thrombectomy CA was measured using transcranial Doppler ultrasound. For this purpose a moving correlation index (Mxa) based on spontaneous arterial blood pressure fluctuations and corresponding cerebral blood flow velocity changes was calculated. CA impairment was defined by Mxa values more than .3.

Results: Twenty patients with an acute occlusion of the middle cerebral artery or distal internal carotid artery were included. A successful recanalization of the occluded vessel via interventional thrombectomy was achieved in 10 of these patients (successful recanalization group), while in 10 patients mechanical recanalization failed or could not be applied (no recanalization group). Mean Mxa at stroke side was .58 ± .21 Table 2a in patients with successful intervention. At the unaffected hemisphere Mxa was .50 ± .20 Table 2a in successful recanalization group and .45 ± .24 Table 2b in no recanalization group without statistically significant differences. Based on the previously defined Mxa cut off more than .3, CA impairment was observable in all successful recanalized patients and in 8 of 10 patients with unsuccessful interventional treatment.

Conclusions: These results suggest that brain perfusion may be affected due to impaired CA even after successful mechanical thrombectomy. Therefore, a tight blood pressure management is of great importance in post-thrombectomy stroke treatment to avoid cerebral hypo- and hyperperfusion.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.104596DOI Listing
March 2020

Small behavioral adaptations enable more effective prey capture by producing 3D-structured spider threads.

Sci Rep 2019 11 21;9(1):17273. Epub 2019 Nov 21.

Institute of Biology II, RWTH Aachen University, Aachen, Germany.

Spiders are known for producing specialized fibers. The radial orb-web, for example, contains tough silk used for the web frame and the capture spiral consists of elastic silk, able to stretch when prey impacts the web. In concert, silk proteins and web geometry affects the spider's ability to capture prey. Both factors have received considerable research attention, but next to no attention has been paid to the influence of fiber processing on web performance. Cribellate spiders produce a complex fiber alignment as their capture threads. With a temporally controlled spinneret movement, they connect different fibers at specific points to each other. One of the most complex capture threads is produced by the southern house spider, Kukulcania hibernalis (Filistatidae). In contrast to the so far characterized linear threads of other cribellate spiders, K. hibernalis spins capture threads in a zigzag pattern due to a slightly altered spinneret movement. The resulting more complex fiber alignment increased the thread's overall ability to restrain prey, probably by increasing the adhesion area as well as its extensibility. Kukulcania hibernalis' cribellate silk perfectly illustrates the impact of small behavioral differences on the thread assembly and, thus, of silk functionality.
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http://dx.doi.org/10.1038/s41598-019-53764-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6872738PMC
November 2019

Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study.

BMC Neurol 2019 Nov 12;19(1):282. Epub 2019 Nov 12.

Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.

Background: Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients.

Methods: The FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. The study was designed as a cross-sectional hospital-based registry.

Results: We investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage. Oropharyngeal dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6-17] vs. 7 [4-12], p = .013; median mRS 5 [IQR 4-5] vs. 4 [IQR 3-5], p = .012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p = .107). FEES examinations revealed that only 30.9% of the patients had an oral diet appropriate for their swallowing abilities. A change of oral diet was associated with a better outcome at discharge (mRS; p = .006), less need of mechanical ventilation (p = .028), shorter period of hospitalisation (p = .044), and lower rates of pneumonia (p = .007) and mortality (p = .011).

Conclusion: Due to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre. FEES in acute stroke patients helps to adjust the oral diet for the vast majority of stroke patients (69.1%) based on their swallowing abilities, potentially avoiding severe complications.
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http://dx.doi.org/10.1186/s12883-019-1499-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852733PMC
November 2019

Positive Effect of Steroids in Posterior Reversible Encephalopathy Syndrome.

Case Rep Neurol 2019 May-Aug;11(2):173-177. Epub 2019 May 21.

Department of Geriatrics, Jung-Stilling Hospital Siegen, Siegen, Germany.

We present a case of posterior reversible encephalopathy syndrome with severe clinical manifestation. Apart from initial aphasia, hemiparesis, and a generalized seizure, the patient had a prolonged loss of consciousness. Although blood pressure was normalized, the clinical status deteriorated continuously. After adding steroids to the therapy, the patient recovered rapidly, suggesting that this could have been a useful therapeutic approach. Even the vasogenic edema in the cerebral magnetic resonance imaging disappeared shortly within 6 days.
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http://dx.doi.org/10.1159/000500410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738275PMC
May 2019

German Mobile Apps in Rheumatology: Review and Analysis Using the Mobile Application Rating Scale (MARS).

JMIR Mhealth Uhealth 2019 08 5;7(8):e14991. Epub 2019 Aug 5.

Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.

Background: Chronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety.

Objective: The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists.

Methods: The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers.

Results: In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms.

Conclusions: To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital.
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http://dx.doi.org/10.2196/14991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699116PMC
August 2019

Assessment of Cardiac Involvement in Fabry Disease (FD) with Native T1 Mapping.

Rofo 2019 Oct 12;191(10):932-939. Epub 2019 Feb 12.

Neurology, Justus-Liebig-University, Giessen, Germany.

Purpose:  Fabry disease (FD) is an X-linked multi-organ disorder of lysosomal metabolism with cardiac disease being the leading cause of death. Identifying early FD-specific pathologies is important in the context of maximum therapeutic benefit in these stages. Therefore, the aim of this study was to investigate the value of quantitative cardiac T1 mapping as a potential disease-specific surrogate.

Methods:  16 consecutive FD patients (9 female, 7 male; median age: 54 years, IQR 17) and 16 control patients (9 female, 7 male; median age: 52 years, IQR 20) were investigated at 1.5 Tesla. Native T1 mapping was performed using a modified look locker inversion recovery sequence (MOLLI) and native T1 times were measured within the septal myocardium at the midventricular short-axis section. Also functional parameters, left ventricular morphology, presence of late-gadolinium enhancement, cTnI- and Lyso-Gb3-Levels were evaluated.

Results:  The median native septal T1 time for FD was 889.0 ms and 950.6 ms for controls (p < 0.003). LGE and positive cTnI values (0.26 ± 0.21) were present in 5 FD patients (31.25 %), and left ventricular hypertrophy (LVH) was present in 4 FD patients (25.00 %). The 4 cTnI and 8 Lyso-Gb3 positive FD patients had significantly lower native T1 values (p < 0.05, respectively p < 0.01). Assuming a T1 cut-off value of 900 ms for the identification of increased cardiac lipid deposit, 9 patients with FD (56.25 %) had pathologic values (4 patients cTnI and 8 patients Lyso-Gb3 positive). Moreover, native septal T1 showed a good negative correlation to Lyso-Gb3 (r = - 0.582; p = 0.018).

Conclusion:  A pathologic cardiac native T1 time obviously reflects cardiac involvement in the scope of FD at tissue level. In the future native T1 mapping as an imaging biomarker might allow identification of early stages of cardiac involvement in FD before morphological changes are obvious.

Key Points:   · Native T1 values are significantly decreased in Fabry disease.. · Native T1 shows promising correlation to cardiac and Fabry-specific biomarkers.. · Native T1 mapping might have great potential for early disease detection and therapy monitoring..

Citation Format: · Roller FC, Fuest S, Meyer M et al. Assessment of Cardiac Involvement in Fabry Disease (FD) with Native T1 Mapping. Fortschr Röntgenstr 2019; 191: 932 - 939.
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http://dx.doi.org/10.1055/a-0836-2723DOI Listing
October 2019

Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students.

BMC Med Educ 2018 Jul 3;18(1):157. Epub 2018 Jul 3.

Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Universitätsklinikum Hamburg-Eppendorf III. Medizinische Klinik Martinistr. 52, D-20246, Hamburg, Germany.

Background: Verbal and non-verbal aspects of communication as well as empathy are known to have an important impact on the medical encounter. The aim of the study was to analyze how well final year undergraduate medical students use skills of verbal and non-verbal communication during history-taking and whether these aspects of communication correlate with empathy and gender.

Methods: During a three steps performance assessment simulating the first day of a resident 30 medical final year students took histories of five simulated patients resulting in 150 videos of physician-patient encounters. These videos were analyzed by external rating with a newly developed observation scale for the verbal and non-verbal communication and with the validated CARE-questionnaire for empathy. One-way ANOVA, t-tests and bivariate correlations were used for statistical analyses.

Results: Female students showed signicantly higher scores for verbal communication in the case of a female patient with abdominal pain (p < 0.05), while male students started the conversations significantly more often with an open question (p < 0.05) and interrupted the patients significantly later in two cases than female students (p < 0.05). The number of W-questions asked by all students was significantly higher in the case of the female patient with abdominal pain (p < 0.05) and this patient was interrupted after the beginning of the interview significantly earlier than the patients in the other four cases (p < 0.001). Female students reached significantly higher scores for non-verbal communication in two cases (p < 0.05) and showed significantly more empathy than male students in the case of the female patient with abdominal pain (p < 0.05). In general, non-verbal communication correlated significantly with verbal communication and with empathy while verbal communication showed no significant correlation with empathy.

Conclusions: Undergraduate medical students display differentiated communication behaviour with respect to verbal and non-verbal aspects of communication and empathy in a performance assessment and special differences could be detected between male and female students. These results suggest that explicit communication training and feedback might be necessary to raise students' awareness for the different aspects of communication and their interaction.
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http://dx.doi.org/10.1186/s12909-018-1260-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029273PMC
July 2018

What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study.

BMJ Open 2018 03 6;8(3):e019016. Epub 2018 Mar 6.

Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.

Objectives: Fibre-endoscopic evaluation of swallowing (FEES) to detect dysphagia is gaining more and more importance as a diagnostic tool. Therefore, we have investigated the impact of FEES in neurological patients in a clinical setting.

Design: Cross-sectional hospital-based registry.

Setting: Primary acute care in a neurological department of a German university hospital.

Participants: 241patients with various neurological diseases who underwent FEES procedure.

Primary And Secondary Outcome Measures: Dysphagia and related comorbidities.

Results: 267 FEES were performed in 241 patients with various neurological diagnoses. Dysphagia was diagnosed in 68.9% of the patients. In only 33.1% of the patients, appropriate oral diet was chosen prior to FEES. A relevant dysphagia occurred more often in patients with structural brain lesions (83.1% vs 65.3%, P=0.001), patients with dysphagia had a longer hospitalisation (median 18 (IQR 12-30) vs 15 days (IQR 9.75-22.75), P=0.005) and had a higher mortality (8.4% vs 1.3%, P=0.041). When the oral diet was changed, we observed a lower pneumonia rate (36% vs 50%, P=0.051) and a lower mortality (3.7% vs 11.3%, P=0.043) in comparison to no change of oral diet. A restriction of oral diet was identified more often in older patients (median 75 years (IQR 66.3-82 years) vs median 72 years (IQR 60-79 years), P=0.01) and in patients with structural brain lesions (86.8% vs 73.1%, P=0.05).

Conclusion: On clinical investigation, dysphagia was misjudged for the majority of the patients. FEES might help to compensate this drawback, revising the diet regime in nearly 70% of the patients.
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http://dx.doi.org/10.1136/bmjopen-2017-019016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855308PMC
March 2018

One decade of oral anticoagulation in stroke patients: Results from a large country-wide hospital-based registry.

Int J Stroke 2018 04 27;13(3):308-312. Epub 2017 Sep 27.

5 Institute of quality assurance Hesse, Eschborn/Frankfurt, Germany.

Background New evidence regarding stroke prevention in atrial fibrillation has been published. Implementing knowledge into clinical practice remains challenging. Aims To investigate oral anticoagulants in stroke patients documented in a nationwide registry. Methods The database is an obligatory federal-state-wide hospital-based registry that covers more than 95% of all ischemic strokes, transient ischemic attacks and intracerebral hemorrhages in a community of more than six million inhabitants (Hesse/Germany). We analyzed oral anticoagulants prescribed on discharge in patients with stroke or transient ischemic attack during 2006-2015. Results From 2006 to 2015, we annually selected median 20,895 patients. From 2006 to 2015, the proportion of patients treated with oral anticoagulants increased (9.8% to 24%). The annual proportion of patients with atrial fibrillation remained constant (median: 23%). In atrial fibrillation patients treated with oral anticoagulants, the age increased (median 2008/2009: 76.9 years vs. 2014/2015 79.4 years). The percentage of treated individuals in atrial fibrillation increased dramatically (2006: 30.1% to 2015: 74.5%); in 2015, 30.8% of these patients received vitamin K antagonists and 70.2% new oral anticoagulants. Independent factors associated with new oral anticoagulants therapy were a previous medication with new oral anticoagulants and a treatment on stroke unit. Between new oral anticoagulants- and vitamin K antagonists-treated patients (2015), no differences in age were noted (both mean: 79.4 years). Conclusions The new oral anticoagulants availability enhanced a general trend treating more target patients with oral anticoagulants.
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http://dx.doi.org/10.1177/1747493017733928DOI Listing
April 2018

Troglitazone treatment increases protein kinase B phosphorylation in skeletal muscle of normoglycemic subjects at risk for the development of type 2 diabetes.

Diabetes 2002 Sep;51(9):2691-7

Medizinische Klinik 1, Medizinische Universität zu Lübeck, Lübeck, Germany.

We investigated whether the effect of troglitazone on glucose disposal is associated with altered insulin signaling. Nondiabetic first-degree relatives of type 2 diabetic patients (age 30 +/- 2 years, BMI 30 +/- 1 kg/m(2); n = 20) were randomized in a double-blind manner to 3 months of troglitazone (200 mg/day) or placebo treatment. Before and after treatment, 3-h euglycemic-hyperinsulinemic glucose clamps (40 mU. m(-2). min(-1)) were performed, and muscle biopsies were obtained immediately before and after the clamps. In the biopsies, insulin receptor kinase (IRK) activity, insulin receptor substrate (IRS)-1-associated phosphatidylinositol 3-kinase (PI3K) activity, Ser(473) and Thr(308) phosphorylation of protein kinase B (PKB), and protein expression of IRS-1, IRS-2, phosphoinositol-dependent kinase-1 (PDK-1), PKB, and GLUT-4 were determined. After troglitazone treatment, insulin-stimulated glucose disposal was increased compared with pretreatment and placebo (279 +/- 37 vs. 211 +/- 26 and 200 +/- 25 mg. m(-2). min(-1); both P < 0.05). IRK and PI3K activities were not altered by troglitazone, but PKB Ser(473) phosphorylation was enhanced compared with pretreatment and placebo at the clamp insulin level (138 +/- 36 vs. 77 +/- 16 and 55 +/- 13 internal standard units; both P < 0.05) and with pretreatment at the basal level (31 +/- 9 vs. 14 +/- 4 internal standard units; P < 0.05). PKB Thr(308) phosphorylation also tended to be higher, but this was not statistically significant. Troglitazone did not alter insulin receptor number or IRS-1, IRS-2, PKB, PDK-1, or GLUT-4 protein expression. We conclude that increased PKB phosphorylation may contribute to the insulin-sensitizing effects of thiazolidinediones in human skeletal muscle.
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http://dx.doi.org/10.2337/diabetes.51.9.2691DOI Listing
September 2002

Atypical beta-adrenergic effects on insulin signaling and action in beta(3)-adrenoceptor-deficient brown adipocytes.

Am J Physiol Endocrinol Metab 2002 Jul;283(1):E146-53

Department of Internal Medicine I, Medical University of Lübeck, 23538 Lübeck, Germany.

Cross talk between adrenergic and insulin signaling systems may represent a fundamental molecular basis of insulin resistance. We have characterized a newly established beta(3)-adrenoceptor-deficient (beta(3)-KO) brown adipocyte cell line and have used it to selectively investigate the potential role of novel-state and typical beta-adrenoceptors (beta-AR) on insulin signaling and action. The novel-state beta(1)-AR agonist CGP-12177 strongly induced uncoupling protein-1 in beta(3)-KO brown adipocytes as opposed to the beta(3)-selective agonist CL-316,243. Furthermore, CGP-12177 potently reduced insulin-induced glucose uptake and glycogen synthesis. Neither the selective beta(1)- and beta(2)-antagonists metoprolol and ICI-118,551 nor the nonselective antagonist propranolol blocked these effects. The classical beta(1)-AR agonist dobutamine and the beta(2)-AR agonist clenbuterol also considerably diminished insulin-induced glucose uptake. In contrast to CGP-12177 treatment, these negative effects were completely abrogated by metoprolol and ICI-118,551. Stimulation with CGP-12177 did not impair insulin receptor kinase activity but decreased insulin receptor substrate-1 binding to phosphatidylinositol (PI) 3-kinase and activation of protein kinase B. Thus the present study characterizes a novel cell system to selectively analyze molecular and functional interactions between novel and classical beta-adrenoceptor types with insulin action. Furthermore, it indicates insulin receptor-independent, but PI 3-kinase-dependent, potent negative effects of the novel beta(1)-adrenoceptor state on diverse biological end points of insulin action.
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http://dx.doi.org/10.1152/ajpendo.00531.2001DOI Listing
July 2002
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