193 results on '"N Timmesfeld"'
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2. 4 Wochen, 8 Sitzungen: Therapeutische Ansätze zur Gestaltung eines beziehungsorientierten und motivierenden Online-Beratungssettings für Betroffene einer Internetnutzungsstörung
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B Geisler, B te Wildt, L Bottel, M Pape, K Wölfling, P Henningsen, N Timmesfeld, A Neumann, R Beckers, S Herpertz, and J Dieris-Hirche
- Published
- 2022
3. Infrastrukturen für das 'neue Öl': Datenquellen, -fluss und -linkage für ein effektive(re)s Pandemiemanagement in Deutschland
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I Meyer, HH Diebner, K Scholz, R Denz, P Ihle, and N Timmesfeld
- Published
- 2022
4. Definition of DLPFC and M1 according to anatomical landmarks for navigated brain stimulation: Inter-rater reliability, accuracy, and influence of gender and age.
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V. Mylius, S. S. Ayache, R. Ahdab, W. H. Farhat, H. G. Zouari, Marcus Belke, P. Brugières, E. Wehrmann, K. Krakow, N. Timmesfeld, S. Schmidt, Wolfgang H. Oertel, Susanne Knake, and Jean-Pascal Lefaucheur
- Published
- 2013
- Full Text
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5. Musiktherapie in der Schwangerschaft: Systematisches Review zur Vorbereitung eines Langzeit-Projektes zur Verbesserung von maternaler Stressresilienz und kindlichem Outcome durch kreative Projekte
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J Maul, S Behnam, N Timmesfeld, and B Arabin
- Published
- 2021
6. Multivariate Analysen über den Einfluss von Body Mass Index und Gewichtszunahme der Mutter auf das maternale und neonatale Outcome bei Zwillingsschwangerschaften
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J Schubert, N Timmesfeld, K Noever, and B Arabin
- Published
- 2021
7. 385O Automated detection of microsatellite status in early colon cancer (CC) using artificial intelligence (AI) integrated infrared (IR) imaging on unstained samples from the AIO ColoPredictPlus 2.0 (CPP) registry study
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Anke Reinacher-Schick, Dirk Arnold, Klaus Gerwert, C. Sternemann, Frederik Großerüschkamp, A-L. Kraeft, Axel Mosig, Celine Lugnier, N. Timmesfeld, D. Schuhmacher, O. Overheu, L. Mueller, Hendrik Jütte, Inke Sabine Feder, Waldemar Uhl, Christian Teschendorf, S.M. Schörner, Andrea Tannapfel, and S. Wisser
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Oncology ,medicine.medical_specialty ,business.industry ,Colorectal cancer ,Internal medicine ,Registry study ,Medicine ,Microsatellite ,Hematology ,business ,medicine.disease - Published
- 2021
8. Verlauf von maternalem body mass index und maternaler Gewichtszunahme, sowie maternalem und kindlichem Outcome bei Zwillingsschwangerschaften zwischen 2000 und 2015
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J Schubert, N Timmesfeld, K Noever, and B Arabin
- Published
- 2020
9. Vermeidung der Konsequenzen von schwangerschaftsassoziierter Adipositas bei Mutter und Kind – Ein systematisches Review mit Metaanalyse nach strengen modernen Qualitätskriterien
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S Behnam, B Arabin, and N Timmesfeld
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- 2020
10. Vermeidung der Konsequenzen von schwangerschaftsassoziierter Adipositas bei Mutter und Kind: Ein systematisches Review mit Metaanalyse nach strengen modernen Qualitätskriterien, Registrierung: PROSPERO CRD42018089009
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Birgit Arabin, S Behnam, and N Timmesfeld
- Published
- 2019
11. The relationship between initial closed reduction and the surgical reconstruction of the radiocarpal joint line in distal radial fractures
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Philipp Lechler, M. Frink, M. Börsch, Christoph Kolja Boese, Tim Schwarting, and N. Timmesfeld
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Male ,Wrist Joint ,medicine.medical_specialty ,medicine.medical_treatment ,Radiography ,Radial fractures ,Fracture Fixation, Internal ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Germany ,Joint line ,Bone plate ,Humans ,Medicine ,Internal fixation ,030212 general & internal medicine ,Range of Motion, Articular ,Hospitals, Teaching ,Retrospective Studies ,General Environmental Science ,Fracture Healing ,Orthodontics ,030222 orthopedics ,business.industry ,Recovery of Function ,Middle Aged ,Articular surface ,Biomechanical Phenomena ,Surgery ,body regions ,Treatment Outcome ,General Earth and Planetary Sciences ,Female ,Research questions ,Radius Fractures ,business ,Bone Plates - Abstract
Introduction Whilst initial closed reduction followed by definitive open fixation is widely applied in the treatment of distal radial fractures, the effect of the closed reduction on the reconstruction of the articular surface remains unclear. Our research questions were: (1) Does closed reduction followed by surgical fixation reconstruct palmar tilt and radial inclination? (2) Does closed reduction influence the surgically reconstructed palmar tilt and radial inclination? Methods Palmar tilt and radiocarpal inclination of 425 patients were measured at admission, following initial closed reduction and after surgical reconstruction. Results Closed reduction increased palmar tilt by 12.1° and radial inclination by 2.7°. Open surgical reduction further corrected palmar tilt by 17.88° and radial inclination by 3.5°. Whilst there was no association between postoperative palmar tilt and initially achieved closed reduction, a significant association between radial inclination following closed reduction and surgical fixation was found. Conclusion Our retrospective study challenges the existence of a relationship between the initial closed reduction and the reconstruction of the anatomic joint line in surgically treated distal radial fractures.
- Published
- 2016
12. 409P Causes of mortality in elderly UICC stage III colon cancer (CC) patients (pts.) - Tumor related death and competing risks from the Colopredict Plus (CPP) registry
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Inke Sabine Feder, Ulrich Kaiser, Stefanie Nöpel-Dünnebacke, Aristoteles Giagounidis, Christian Teschendorf, U. Graeven, Anke Reinacher-Schick, S. Hollerbach, L. Engel, H. Böhner, Andrea Tannapfel, D. Collette, Dirk Arnold, H-R. Bruch, Frank Hartmann, Renate Klaassen-Mielke, A-L. Kraeft, N. Timmesfeld, and Lothar Müller
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Oncology ,medicine.medical_specialty ,business.industry ,Colorectal cancer ,Internal medicine ,Medicine ,Hematology ,business ,medicine.disease ,Competing risks ,Uicc stage - Published
- 2020
13. Breast Microcalcifications as Type Descriptors to Stratify risk of Malignancy: a Systematic Review and Meta-Analysis of 10665 Cases with Special Focus on Round/Punctate Microcalcifications
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Marga B. Rominger, C. Wisgickl, and N. Timmesfeld
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medicine.medical_specialty ,Biopsy ,Breast Neoplasms ,Malignancy ,Predictive Value of Tests ,Carcinoma ,Humans ,Medicine ,Mammography ,Radiology, Nuclear Medicine and imaging ,Breast ,Probability ,medicine.diagnostic_test ,business.industry ,Carcinoma, Ductal, Breast ,Calcinosis ,medicine.disease ,Confidence interval ,Carcinoma, Intraductal, Noninfiltrating ,Cross-Sectional Studies ,Logistic Models ,Predictive value of tests ,Meta-analysis ,Female ,Microcalcification ,Radiology ,medicine.symptom ,business - Abstract
Purpose: To use a systematic review and meta-analysis to determine the predictive value of five suspicious type descriptors of microcalcifications, with special focus on round/punctate microcalcifications because of controversy. Materials and Methods: We performed a literature search using three databases and one search engine. We screened citations for malignancy rates of type descriptors. We regarded malignancy rates below 2 % (BI-RADS 3) and above 95 % (BI-RADS 5) as clinically significant threshold values for suspicion (BI-RADS 4). Results: Forty studies from 14 countries with a total of 10,665 microcalcification lesions were included. The pooled malignancy rates were: coarse heterogeneous, 13 % (95 % confidence interval (95 %-CI): 7 – 20 %); amorphous or indistinct, 27 % (95 %-CI: 21 – 33 %); pleomorphic, 50 % (95 %-CI: 43 – 58 %); linear, 78 % (95 %-CI: 68 – 86 %). The pooled malignancy rate of all round/punctate microcalcifications was 9 % (95 %-CI: 6 – 13 %), for the subgroup follow-up it was 0,5 % (95 %-CI: 0.08 – 2.57 %), and with histological verification it was 14 % (95 %-CI: 11 – 19 %). Woman selection and consideration of additional suspicious image findings were reasons for between-study heterogeneity. Addition of ACR distribution descriptors diversified risk stratification, but did not alter BI-RADS assessment category. Conclusion: All suspicious type descriptors including round/punctate microcalcifications as well as combinations of type with suspicious distribution descriptors fell into BI-RADS assessment category 4. Exclusion of suspicious adjunct factors can direct clustered, round/punctate microcalcifications to a lower BI-RADS assessment category.
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- 2012
14. Aktueller Stand der Behandlung des FAI in Deutschland
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S. Lakemeier, J. Görlich, N. Timmesfeld, T. J. Heyse, M. D. Schofer, and S. Fuchs-Winkelmann
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medicine.medical_specialty ,business.industry ,Orthopedic surgery ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,Hip arthroscopy ,business ,medicine.disease ,Nationwide survey ,Femoroacetabular impingement - Abstract
AIM Femoroacetabular impingement (FAI) is a recently proposed mechanical concept for the development of osteoarthritis of the hip. Aim of this nationwide survey is the description of the current status of diagnostics and therapy of FAI in Germany. MATERIAL AND METHODS All orthopedic and traumatological hospitals listed in the "list of German hospitals 2006" were invited via e-mail to take part in this anonymous survey. RESULTS The questionnaire was answered by 682 departments (50.5 %). 98 (14.3 %) of these departments treated FAI in 2007. CONCLUSION In Germany, diagnostics and treatment of FAI were performed inconsistently in a small number of specialized hospitals.
- Published
- 2011
15. Verletzungsarten und Verletzungshäufigkeiten beim Cable-Wakeboard: eine prospektive saisonbegleitende Studie
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S. Fuchs-Winkelmann, T. Patzer, M. D. Schofer, N. Timmesfeld, and S. A. Hrabal
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Summer season ,medicine.medical_specialty ,Pediatrics ,business.industry ,Incidence (epidemiology) ,Medicine ,Orthopedics and Sports Medicine ,Mean age ,business ,Prospective cohort study ,Surgery - Abstract
UNLABELLED Cable-wakeboarding has become more and more popular in the last years in Germany and worldwide as well. The mechanism, frequency and severity of injuries is still unclear and not described in the literature yet. Thus to compare the injuries of cable-wakeboarding with similar sports we decided to perform this prospective study during a six months summer season. The study included 122 actives with a mean age of 25 years (15 - 42, +/- 5.876), 81,1 % male, sending an online questionnaire to us every month. 98 % of the participants suffered 277 injuries during 8647 hours of activity, 108 (39 % 12 / 1000 h) had to be treated medically. We found out most frequently mild injuries (61 % 19.5 / 1000 h), 15 % very severe injuries (4.8 / 1000 h), 14 % severe injuries (4.5 / 1000 h) and 10 % medium-severe injuries (3.2 / 1000 h). Injuries of the knee and the shoulder dominated in more than 20 % each with more than 70 % distorsions and contusions. CONCLUSION Cable-wakeboarding is not more dangerous in regard to injuries than similar trendy sports even though the rate of mild injuries not treated medically is quite higher.
- Published
- 2009
16. Entwicklung der operativen Versorgung des malignen Melanoms in den letzten 30 Jahren am Beispiel der Marburger Universitätshautklinik
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N Timmesfeld, A Weidemann, and W Pfützner
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Dermatology - Abstract
Fragestellung: Die Inzidenz des malignen Melanoms hat zugenommen. Da die Primartherapie des malignen Melanoms die operative Behandlung darstellt und sich das therapeutische Management kontinuierlich weiter entwickelt hat, stellt sich die Frage, inwiefern sich die Anforderungen an die Melanomchirurgie im Verlauf der letzten Jahrzehnte verandert haben. Methoden: Um dieser Frage nachzugehen, wurde exemplarisch an der Marburger Universitatshautklinik die im Zeitraum von 1985 – 2010 durchgefuhrten dermatochirurgischen Melanomeingriffe hinsichtlich verschiedener Parameter evaluiert. Ergebnisse: Es zeigte sich, dass im Zeitraum der untersuchten 25 Jahre eine deutliche Zunahme operativer Eingriffe bei Melanompatienten zu verzeichnen war. Zwar betraf dies alle Alterskollektive, allerdings war der prozentuale Anstieg bei hoheren Altersgruppen deutlich starker ausgepragt, am hochsten bei den uber 70-jahrigen Patienten. Etwa ¾ aller Operationsverfahren waren Dehnungsplastiken, die anderen Defektverschlusse stellten komplexe Plastiken oder Hauttransplantate dar, wobei letztere im zeitlichen Verlauf deutlich abgenommen haben, moglicherweise auch bedingt durch reduzierte Sicherheitsabstande. Zugenommen hat dagegen der Anteil der Metastasenchirurgie, was auch Ausdruck einer langeren Lebenserwartung von Melanompatienten sein konnte. Schlussfolgerungen: Zusammenfassend lasst sich feststellen, dass sowohl der quantitative Umfang als auch das Spektrum dermatochirurgischer Massnahmen eine deutliche Ausweitung erfahren hat. Die zunehmende operative Behandlung alterer Menschen mit Melanomen stellt dabei eine zusatzliche Herausforderung fur die Dermatochirurgie dar.
- Published
- 2015
17. Effects of standardized acoustic stimulation in premature infants: a randomized controlled trial
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Michael Zemlin, F Dorn, Lori J. Wirth, N Timmesfeld, M Wege, Stefan Gorbey, Rolf F. Maier, and Björn Lemmer
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Male ,medicine.medical_specialty ,Evening ,Respiratory rate ,Stimulation ,Gestational Age ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Respiratory Rate ,law ,Heart Rate ,030225 pediatrics ,Heart rate ,medicine ,Humans ,030212 general & internal medicine ,Neonatology ,Monitoring, Physiologic ,Obstetrics ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Treatment Outcome ,Acoustic Stimulation ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,business ,Infant, Premature - Abstract
The objective of this study was to investigate the effects of recorded lullabies and taped maternal voice in premature infants. Sixty-two preterm infants in a stable condition with 30
- Published
- 2015
18. Focused intraoperative transthoracic echocardiography by anesthesiologists: a feasibility study
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T, Kratz, M, Campo Dell'Orto, M, Exner, N, Timmesfeld, M, Zoremba, H, Wulf, and T, Steinfeldt
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Adult ,Male ,Cardiovascular Diseases ,Echocardiography ,Monitoring, Intraoperative ,Hemodynamics ,Feasibility Studies ,Humans ,Female ,Prospective Studies ,Middle Aged ,Aged ,Anesthesiologists - Abstract
Focused transthoracic echocardiography (TTE) is frequently used perioperatively for hemodynamic monitoring and diagnosis of cardiovascular instability, but less commonly intraoperatively.To evaluate the feasibility of intraoperative TTE, we enrolled 222 anesthetised patients from August to November 2012 into a prospective observational study. 162 patients underwent TTE examination according to the Focused Assessed Transthoracic Echocardiography (FATE) protocol after positioning and draping for surgery. Sixty additional hemodynamically unstable subjects were examined during anesthesia and surgery. The imaging quality of four FATE views was rated on a scale from 1 (impossible) to 5 (perfect). TTE was assessed as applicable, if at least two of the four basic FATE views were graded 4 or 5, or three views were assessed as grade 3.Imaging quality was unacceptable in 20 patients, resulting in a feasibility rate of 91% (97.5%-CI 0.86-1, P=0.01). TTE was feasible in hemodynamically unstable subjects (91.7%; 97.5%-CI 0.82-1.0), in orthopedic and trauma patients (95% respectively, [97.5%-CI 0.83-1]) and in abdominal surgery (78%).TTE can be applied in the operating theatre during surgery, although its use during abdominal surgery is somewhat limited.
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- 2014
19. IVIg-Erhaltungstherapie bei Myasthenia gravis – eine RCT-Fallzahlsimulation
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M. Seipelt, Norbert Sommer, H Kurz, F Seitz, A Spengler, B. Tackenberg, W. H. Oertel, Christian Eienbröker, and N Timmesfeld
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Physiology (medical) ,Neurology (clinical) - Published
- 2014
20. Adrenal incidentaloma and subclinical Cushing's syndrome: a longitudinal follow-up by endoscopic ultrasound (EUS)
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N Timmesfeld, M Collienne, and Peter H. Kann
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Endoscopic ultrasound ,medicine.medical_specialty ,S syndrome ,medicine.diagnostic_test ,business.industry ,Endocrinology, Diabetes and Metabolism ,General Medicine ,Endocrinology ,Internal Medicine ,medicine ,Radiology ,Adrenal incidentaloma ,business ,Subclinical infection - Published
- 2014
21. [Characteristics in treatment of the hip in patients with Down syndrome]
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C-D, Peterlein, M, Schiel, N, Timmesfeld, M D, Schofer, O, Eberhardt, T, Wirth, and F F, Fernandez
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Adult ,Joint Instability ,Male ,Adolescent ,Incidence ,Infant ,Plastic Surgery Procedures ,Arthroplasty ,Osteotomy ,Young Adult ,Treatment Outcome ,Risk Factors ,Child, Preschool ,Germany ,Hip Dislocation ,Humans ,Female ,Hip Joint ,Down Syndrome ,Child ,Retrospective Studies - Abstract
The treatment of hip instability in patients with Down syndrome is challenging. We have performed different pelvic osteotomies and corrections at the proximal femur for this indication. This retrospective study was conducted to evaluate the clinical and radiological outcome of each intervention.All in all, 166 patients with Down syndrome were treated at our orthopaedic department in the observation period. Problems related to the hip joint were diagnosed in 63 of those patients. Only patients who underwent surgery were included in this study. The charts and X-rays of these 31 patients were evaluated with respect to the following parameters: incidence of the hip problem, concomitant diseases, temporal progress, kind of operation method and date, duration of stay in the hospital, after-care, follow-on surgery related to complications, AC angle, CE angle, ACM angle, CCD angle, index of migration according to Reimers, classification of Bauer and Kerschbauer and general morphology of the femoral head. The group was compared with an age-matched group of 21 patients with hip dysplasia. Those patients underwent the same sort of operation in the same year.In the Morbus Down group, we performed surgery for preservation of the hip in 49 cases. This included 13 osteotomies according to Chiari, 11 triple osteotomies according to Tönnis, 10 corrections by femoral varus derotation osteotomy, 8 pelvic osteotomies according to Pemberton, 5 pelvic osteotomies according to Salter and 2 open reductions of the hip. With respect to the moment of surgery, we detected three peaks of age. There was no difference in course of disease and quantity of complications between the groups. Satisfactory results concerning clinical and radiological outcome were achieved predominantly by complete redirectional acetabular osteotomies. Half of the patients who were solely treated by femoral varus derotation osteotomy needed follow-on surgery in the form of pelvic osteotomy. Comparison of preoperative and postoperative range of motion of the hip joint between groups detected capsular insufficiency, increased ligamentous laxity and muscular hypotonia in patients with Down syndrome. Comparison of pelvic radiographs demonstrated significant improvement concerning measured angles in both groups. Preoperative values with respect to AC angle and CE angle were demonstrated to be lower in the hip dysplasia group (p 0.01); whereas values for ACM angle were comparable between groups.Hypermobility and secondary dislocation of the hip joint is a common problem in patients with Down syndrome, which often requires surgical intervention at an early stage. According to our data and clinical results we suggest a complete redirectional acetabular osteotomy in combination with capsular plication for treatment of this challenging condition.
- Published
- 2013
22. Fusion Imaging (CEUS/CE-CT or CEUS/CE-MRI), a clinical investigation tool for comparing different contrast enhanced (CE) imaging procedures, is able to uncover investigation limitations and has influence on important clinical decisions
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C. Löser, N Timmesfeld, J Neebe, HP Weskott, and M. Höpfner
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Image fusion ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Imaging Procedures ,Breathing problems ,Clinical investigation ,Ct scanners ,medicine ,Contrast (vision) ,Radiology, Nuclear Medicine and imaging ,Statistical analysis ,Radiology ,business ,Prospective cohort study ,media_common - Abstract
Purpose: Fusion imaging – a tool to visualize different imaging procedures simultaneously – is capable of comparing focal liver lesions. Evaluation of lesions and their localization were prospectively investigated. Material and methods: 150 in- and out-patients with focal liver lesions were enrolled in an ethical approved prospective study, where fusion imaging was used to compare findings with CEUS and CE-CT or CE-MRI. Equipment: LOGIQ E9 (GE Healthcare, Milwaukee, Il, USA) C1 – 5 or L9 probe; MRT (1.5 – 3T (Siemens) and CT (1 – 64 (Siemens/GE/Philips) slice scanners, most of them performed as 3 phase investigation, if no contraindications against contrast agents were present. Results: In all patients fusion process was performed even when one of the image techniques suffered under its typical shortcomings or artifacts, e.g. steatosis/obesity or breathing problems. Mismatching results were investigated for the influence on clinical decisions using a descriptive statistical analysis. Mismatching lesions were seen in 42.2%. Reducing these differences to clinical important decisions, patients with diagnostic findings like metastases or other malignant disorders were discordant in 24.5%. Reasons for misdiagnosing lesions in US were tiny lesions (4 – 12 mm) near or at liver surface or near ligaments in 3.9%. Lesions overseen on CT or MRI were 3 – 29 mm in size. Differences in applied CT scanners (1 – 64 slices) didn't seem to be a relevant reason to explain mismatching results. Conclusion: Fusion-Imaging is able to show detailed differences in number and localization of focal liver lesions and has influence on important clinical decisions in 24% of the investigated patients. Discussion: Explanations for these differences – physical and/or pathophysiological – are necessary to improve diagnostic decision-making in the future and further to decide about “gold-standard” of detection of liver lesions. Time of contrast phase and different latephase behavior of applied contrast agents are possible factors that may have influence on detection of metastases.
- Published
- 2013
23. Comorbid psychiatric disorders in female adolescents with first-onset anorexia nervosa
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K, Bühren, R, Schwarte, F, Fluck, N, Timmesfeld, M, Krei, K, Egberts, E, Pfeiffer, C, Fleischhaker, C, Wewetzer, and B, Herpertz-Dahlmann
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Anorexia Nervosa ,Adolescent ,Depression ,Mental Disorders ,Comorbidity ,Body Mass Index ,Suicidal Ideation ,Diagnostic and Statistical Manual of Mental Disorders ,Feeding and Eating Disorders ,Suicide ,Prevalence ,Humans ,Female ,Self-Injurious Behavior - Abstract
Patients with anorexia nervosa (AN) exhibit high rates of psychiatric comorbidity. To disentangle the effects of duration of illness on comorbid psychiatric symptoms, we investigated the rates of comorbid psychiatric disorders, suicidality and self-harm behaviour in adolescent patients with a first onset of AN.In adolescent females (n = 148) with a first onset of AN, body mass index, psychiatric comorbidity (according to DSM-IV), depressive symptoms, suicidality and self-injurious behaviour were assessed.Seventy patients (47.3%) met the criteria for at least one comorbid psychiatric disorder. The binge-purging subtype was associated with increased rates of psychiatric comorbidity, suicidality and self-injurious behaviour. The severity of eating disorder-specific psychopathology influenced current psychiatric comorbidity and suicidal ideation.Prevalence rates of comorbid psychiatric disorders and suicidal ideation are considerably lower among adolescents with AN compared with adults. An early and careful assessment, along with adequate treatment of the eating disorder, might prevent the development of severe psychiatric comorbidities.
- Published
- 2013
24. [Measurement on printed paper strips or on the ultrasound device with computer assistance - which technique is more accurate in paediatric hip ultrasound?]
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C-D, Peterlein, K-F, Schüttler, N, Timmesfeld, S, Lakemeier, C, Görg, S, Fuchs-Winkelmann, and M, Schofer
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Equipment Failure Analysis ,Male ,Arthrometry, Articular ,Image Interpretation, Computer-Assisted ,Infant, Newborn ,Humans ,Reproducibility of Results ,Hip Joint ,Single-Blind Method ,Equipment Design ,Range of Motion, Articular ,Sensitivity and Specificity ,Ultrasonography - Abstract
Two different measurement techniques of ultrasonograms of the infant hip were evaluated with respect to reproducibility of the Graf classification and variation of α- and β-angles.In a cross-sectional, blinded study, the hips of 207 consecutive newborn babies (101 male; 106 female) were sonographically screened at an average of 2.64 days after birth. Each hip was measured twice by three investigators with different levels of experience - a paediatric orthopaedic surgeon, a senior surgeon and a trained medical student. A mobile ultrasound system (SONOLINE G60S®, Siemens, Erlangen, Germany), equipped with a 7.5 MHz linear transducer, was used. Both hip joints were measured twice by all three investigators. The measurement was performed 6-8 weeks later in a blinded manner. The sonograms were initially printed out on high-quality paper strips and measured by pencil, ruler and goniometer. Finally, each investigator evaluated the same sonograms computer-assisted, using the trackball and dashboard of the ultrasound system.Concerning intraobserver reliability, we observed a significant reduction of variation both for α- and β-angles in favour of the classic measurement on printed strips (p0.05). The interobserver calculation also detected a trend for higher angle variation when the angles were measured electronically. The reproducibility of Graf classification was not influenced by the kind of measurement technique. The outcome was not affected by investigator's level of experience (p0.05).This study demonstrated considerable advantages for the classic measurement of paediatric hip ultrasonograms with pencil and goniometer on printed paper strips compared to computer-aided measurement concerning variation of α- and β-angles.
- Published
- 2012
25. [Current Diagnostics and Treatment of FAI in Germany]
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S, Lakemeier, T J, Heyse, J, Görlich, N, Timmesfeld, S, Fuchs-Winkelmann, and M D, Schofer
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Adult ,Male ,Postoperative Care ,Internet ,Middle Aged ,Health Surveys ,Osteoarthritis, Hip ,Hospitalization ,Arthroscopy ,Cross-Sectional Studies ,Germany ,Surveys and Questionnaires ,Femoracetabular Impingement ,Humans ,Minimally Invasive Surgical Procedures ,Female ,Aged - Abstract
Femoroacetabular impingement (FAI) is a recently proposed mechanical concept for the development of osteoarthritis of the hip. Aim of this nationwide survey is the description of the current status of diagnostics and therapy of FAI in Germany.All orthopedic and traumatological hospitals listed in the "list of German hospitals 2006" were invited via e-mail to take part in this anonymous survey.The questionnaire was answered by 682 departments (50.5 %). 98 (14.3 %) of these departments treated FAI in 2007.In Germany, diagnostics and treatment of FAI were performed inconsistently in a small number of specialized hospitals.
- Published
- 2011
26. Retracted: Cable wakeboarding, a new trendy sport: analysis of injuries with regard to injury prevention
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T. Patzer, S. A. Hrabal, M. D. Schofer, S. Fuchs-Winkelmann, and N. Timmesfeld
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medicine.medical_specialty ,Epidemiologic study ,Medical treatment ,business.industry ,Human factors and ergonomics ,Poison control ,Physical Therapy, Sports Therapy and Rehabilitation ,Suicide prevention ,Occupational safety and health ,Summer season ,Injury prevention ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,business - Abstract
Cable wakeboarding has enjoyed an increasing popularity worldwide over the past years. The aim was to analyze the data gained in a prospective Descriptive Epidemiologic Study during a 6-month summer season in order to propose preventive methods with the goal of reducing injury severity and frequency. The study included 122 participants with a mean age of 25 years (15-42; +/-5.88, 81% male) having regularly submitted a monthly, online questionnaire. Ninety-eight percent of the participants sustained 277 injuries over 8647 h of activity, 108 (39%; 12/1000 h) had to be treated medically. The most common form of injuries were mild injuries (61%; 19.5/1000 h), 15% were very severe (4.8/1000 h), 14% were severe (4.5/1000 h) and 10% were medium-severe (3.2/1000 h). More than 20% of injuries were to the knee and shoulder with >70% being distorsions and contusions. Severe injuries were mostly observed during rotational jumps. Injury prevention in cable wakeboarding has to address the training of jumps and tricks and the construction of obstacles and ramps. Cable wakeboarding is not more dangerous when comparing rates of injury of similar and related popular sports, even though the rate of mild injuries not requiring medical treatment is somewhat higher. Language: en
- Published
- 2010
27. [Parental enquiries before frequenting the outpatient paediatric orthopaedic consultation--focus Internet]
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C-D, Peterlein, M D, Schofer, L C, Guntermann, N, Timmesfeld, S, Fuchs-Winkelmann, and J, Schmitt
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Adult ,Male ,Parents ,Internet ,Foot Deformities, Congenital ,Cerebral Palsy ,Information Storage and Retrieval ,Hospitals, University ,Clubfoot ,Self-Help Groups ,Orthopedics ,Scoliosis ,Germany ,Surveys and Questionnaires ,Utilization Review ,Humans ,Female ,Computer Literacy ,Gait ,Health Education ,Hip Dislocation, Congenital ,Referral and Consultation - Abstract
Every day several million people are seeking for answers to medical problems via the internet. In particular parents, whose children are affected by systemic diseases, orthopaedic defective positions, anomalies or deformities, use the internet to increase their knowledge. Concerning this situation there is a lack of studies in the current literature.We investigated parental preparation to the outpatient paediatric orthopaedic consultation at our University Hospital with respect to internet enquiries or further sources of information using a standardised questionnaire. We assessed age and educational background of the parents, local hardware equipment and general habits of internet use. In particular, we retrieved parental use of search machines (e.g., Google.de, Yahoo.de), general medical websites (e.g., netdoktor.de) and websites from self-help groups (e.g., klumpfusskinder.de).In total, 288 out of 300 questionnaires (96%) were evaluated. More than half of the parents (57%) were over 35 years of age and 78% were women. 82% of the study population had access to the internet at home and 70% used the internet regularly. More than 80% obtained information about the orthopaedic diseases of their child beforehand. Age and educational background of the parents were not significantly correlated with the extent of enquiries (p0.05). 90% of the parents, using the internet as source of information, frequented internet search machines; approximately one third used general medical websites. In particular in clubfeet we observed a highly significant (p0.001) tendency of parents to frequent websites from self-help groups. 60% of the study population assessed the internet information as useful; 92% will frequent the internet as source of information again. One third of the respondents is going to discuss the obtained internet information with the physician.The internet is an important source of information for parents in the field of paediatric orthopaedics. Treating physicians will be increasingly confronted with the results of parental internet enquiries.
- Published
- 2010
28. [Anterior shoulder instability--the current situation]
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M D, Schofer, A, Diehl, C, Theisen, N, Timmesfeld, T J, Heyse, S, Fuchs-Winkelmann, and T, Efe
- Subjects
Health Facility Size ,Joint Instability ,Reoperation ,Data Collection ,Shoulder Dislocation ,Combined Modality Therapy ,Arthroscopy ,Outcome and Process Assessment, Health Care ,Postoperative Complications ,Hospital Bed Capacity ,Germany ,Surveys and Questionnaires ,Utilization Review ,Secondary Prevention ,Humans ,Surgery Department, Hospital - Abstract
The aim of the study was to survey the current state of the conservative and operative treatment of anterior shoulder instability and its rehabilitation in German hospitals.A previously evaluated online questionnaire was sent out to all German hospitals with orthopaedic or trauma surgery departments. The Federal Statistical Office's hospital list was the basis for the selection of hospitals. The questions referred to the year 2007. The survey, including 3 reminders, was conducted over 3 months. The questionnaire consisted of 6 response categories: always (100%), almost always (99-81%), predominantly (80-51%), rarely (50-21%), almost never (20-1%) and never (0%).The response rate was 41% and 67% of these had carried out shoulder stabilisations. In total, 99.2% of the 67% were evaluable. The proportion of shoulder surgery was 8.4% of the total number of operations. Shoulder stabilisations represented 10.6% of these operations. A specialised shoulder department existed in 22.9%. Conservative treatment was carried out with an immobilisation of the arm "predominantly", "almost always" and "always" for internal rotation in 70.8% and in 23.4% for external rotation. The shoulders were "predominantly", "almost always" and "always" stabilised in an arthroscopic technique in 68.2% and in an open one in 31.8% of the clinics. With 92.9%, the Bankart repair was the most common operation. Shoulder instability was principally treated with the arthroscopic technique, regardless of the care level and department and is considered the best surgical technique. Physiotherapy was prescribed "always" and "almost always" in 99.3%. The rate of reluxation after conservative treatment was estimated at 35.5%, after operative open anterior shoulder stabilisation at 9.1% and after arthroscopic shoulder stabilization at 10.6%. Nevertheless, 49.4% of respondents expected the best results after arthroscopic treatment. Participants, who mainly applied the arthroscopic technique, expected a lower rate of reluxation in comparison to other techniques (p0.001).The operative shoulder stabilisation is most frequently carried out as arthroscopic Bankart repair. A standardised, subsequent treatment is well established.
- Published
- 2010
29. [Incidence and mechanism of injuries in cable-wakeboarding: a prospective study]
- Author
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T, Patzer, S A, Hrabal, N, Timmesfeld, S, Fuchs-Winkelmann, and M D, Schofer
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Adult ,Male ,Risk Factors ,Incidence ,Athletic Injuries ,Humans ,Female ,Comorbidity ,Knee Injuries ,Wounds, Nonpenetrating ,Lacerations ,Risk Assessment - Abstract
Cable-wakeboarding has become more and more popular in the last years in Germany and worldwide as well. The mechanism, frequency and severity of injuries is still unclear and not described in the literature yet. Thus to compare the injuries of cable-wakeboarding with similar sports we decided to perform this prospective study during a six months summer season. The study included 122 actives with a mean age of 25 years (15 - 42, +/- 5.876), 81,1 % male, sending an online questionnaire to us every month. 98 % of the participants suffered 277 injuries during 8647 hours of activity, 108 (39 % 12 / 1000 h) had to be treated medically. We found out most frequently mild injuries (61 % 19.5 / 1000 h), 15 % very severe injuries (4.8 / 1000 h), 14 % severe injuries (4.5 / 1000 h) and 10 % medium-severe injuries (3.2 / 1000 h). Injuries of the knee and the shoulder dominated in more than 20 % each with more than 70 % distorsions and contusions.Cable-wakeboarding is not more dangerous in regard to injuries than similar trendy sports even though the rate of mild injuries not treated medically is quite higher.
- Published
- 2009
30. [Operative and follow-up treatment of rotator cuff tears--the current situation]
- Author
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M D, Schofer, M, Quante, C-D, Peterlein, N, Timmesfeld, K, Phan, and S, Fuchs-Winkelmann
- Subjects
Adult ,Male ,Postoperative Care ,Tenodesis ,Middle Aged ,Decompression, Surgical ,Rotator Cuff Injuries ,Arthroscopy ,Benchmarking ,Rotator Cuff ,Cross-Sectional Studies ,Shoulder Impingement Syndrome ,Tendon Injuries ,Germany ,Health Care Surveys ,Utilization Review ,Critical Pathways ,Humans ,Minimally Invasive Surgical Procedures ,Female ,Follow-Up Studies - Abstract
The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals.An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office.44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments.Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.
- Published
- 2009
31. Low-frequency rTMS of the vertex in the prophylactic treatment of migraine
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Felix Rosenow, Janine Reis, Wolfgang H. Oertel, A Haag, Veit Mylius, K. Schepelmann, J Hötzel, Michael Teepker, and N Timmesfeld
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Adult ,Male ,Migraine Disorders ,medicine.medical_treatment ,Analgesic ,Placebo ,behavioral disciplines and activities ,Placebos ,Young Adult ,Physiology (medical) ,medicine ,Humans ,Single-Blind Method ,Young adult ,business.industry ,Therapeutic effect ,General Medicine ,Middle Aged ,medicine.disease ,Transcranial Magnetic Stimulation ,Clinical trial ,Transcranial magnetic stimulation ,Treatment Outcome ,Migraine ,Anesthesia ,Neuropathic pain ,Female ,Neurology (clinical) ,business ,Prophylactic treatment ,Blinded study - Abstract
High-frequency repetitive transcranial magnetic stimulation (rTMS) increases and low-frequency rTMS decreases neural excitability. Clinically, rTMS shows beneficial effects in the treatment of neurological and psychiatric disorders. Furthermore, chronic and neuropathic pain has been shown to respond to rTMS treatment. A small pilot study revealed prophylactic effects of high-frequency rTMS in migraine. As there is evidence of neuronal hyperexcitability in migraine, we conducted a placebo-controlled, blinded study to evaluate the therapeutic effects of low-frequency rTMS in migraine. The primary end-point was defined as a reduction of migraine attacks compared with placebo, secondary outcomes were a reduction in the total number of days with headache, hours with headache, pain intensity and a decrease of analgesic intake for migraine. Twenty-seven migraineurs completed the study and were treated with rTMS on five consecutive days. For the verum group, two trains of 500 pulses with a frequency of 1 Hz were applied over vertex with a round coil. For the treatment of the placebo group, a figure-of-eight sham coil was used. A significant decrease of migraine attacks could be observed in the verum group. However, when comparing these effects with placebo, no significance was evident. The same was true concerning secondary outcome measures with regard to days with migraine and total hours with migraine. No effects were evident for pain intensity and use of analgesics. The rTMS treatment was tolerated well. rTMS stimulation over vertex with 1 Hz was not effective in migraine prophylaxis when compared with placebo. The positive effects regarding migraine attacks, days and total hours with migraine in the verum group are encouraging and indicate that further research on this topic is warranted.
- Published
- 2008
32. CD44: survival and metastasis in chondrosarcoma
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J. Wapelhorst, Susanne Fuchs-Winkelmann, Dominik Malcherczyk, Juergen R J Paletta, R. Moll, Thomas J. Heyse, Markus D. Schofer, and N. Timmesfeld
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Adult ,Male ,musculoskeletal diseases ,Pathology ,medicine.medical_specialty ,Adolescent ,Biomedical Engineering ,Chondrosarcoma ,Myxoid chondrosarcoma ,Disease-Free Survival ,Metastasis ,Young Adult ,Rheumatology ,medicine ,Humans ,Protein Isoforms ,Orthopedics and Sports Medicine ,Neoplasm Metastasis ,CD44 ,Grading (tumors) ,Aged ,Aged, 80 and over ,Prognostic factor ,biology ,Proportional hazards model ,business.industry ,Middle Aged ,medicine.disease ,musculoskeletal system ,Immunohistochemistry ,Grading ,Hyaluronan Receptors ,biology.protein ,Female ,Neoplasm Recurrence, Local ,business ,Clear cell - Abstract
Summary Objective Recent studies have shown abnormal expression of CD44s and some of its isoforms in many human malignancies, but little is known about the presence of CD44 in chondrosarcoma. In this study the expression of CD44s and two variant isoforms was evaluated. It was assumed that abnormalities in these receptor proteins may be associated with clinical outcome of the patients. Method Thirty paraffin-embedded chondrosarcoma samples were immunostained with monoclonal antibodies for CD44s, CD44v5 and CD44v6. Two independent examiners who were unaware of the clinical status of the patients evaluated the immunohistochemical results. The percentage of CD44-positive cells was scored semiquantitatively. A rate of higher than 10% was considered as overexpression. Results Among the 30 patients (median age 50 years) there were 22 conventional chondrosarcomas, two dedifferentiated chondrosarcomas, two extraskeletal chondrosarcomas, and one periostal, mesenchymal, clear cell and myxoid chondrosarcoma each. In the immunochemistry staining overexpression (>10% of cells) of CD44s was shown in 56.7% (17 of 30), of CD44v5 in 43.3% (13 of 30) and of CD44v6 in 6.7% (two of 30) of the tumors. Four grade III chondrosarcomas (80%) and 10 (71.4%) grade II chondrosarcomas showed overexpression for CD44s, whereas CD44s was overexpressed in only three (27.3%) grade I chondrosarcomas. Cox regression suggests overexpression of CD44s to be an additional prognostic marker for chondroid bone tumors independent of grading and other covariates. Conclusions Overexpression of CD44s correlated significantly with metastatic potential and with poorer survival in patients with chondrosarcoma. CD44s might be an independent additional marker, but small sample size remains to be considered.
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33. Comparing outcomes of patients with early active rheumatoid arthritis initially treated on an inpatient or outpatient basis: a posthoc analysis of the CORRA trial.
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Mai A, Krause D, Klaassen-Mielke R, Meiszl K, Timmesfeld N, Baraliakos X, and Braun J
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- Humans, Male, Female, Middle Aged, Treatment Outcome, Aged, Glucocorticoids therapeutic use, Glucocorticoids administration & dosage, Adult, Hospitalization statistics & numerical data, Severity of Illness Index, Germany epidemiology, Remission Induction, Arthritis, Rheumatoid drug therapy, Outpatients, Inpatients, Antirheumatic Agents therapeutic use
- Abstract
Objective: Treatment strategies of patients with active rheumatoid arthritis (RA) vary within and between countries. While most patients in Germany are treated on an outpatient basis, some are hospitalised (inpatients). In the recently published randomised CORRA (CORRA, CORticoid bridging in Rheumatoid Arthritis) trial, we studied two 12 week glucocorticoid (GC) bridging strategies in patients with early RA comparing high or low GC doses with placebo, followed by an extension phase of 9 months. Here, in this posthoc analysis, we compared 12 week outcomes of patients according to their initial treatment as inpatients or outpatients., Methods: Inpatients initially spent 2-5 days (short-term) or 14 days (long-term) in one tertiary rheumatology hospital. Outpatients were mostly treated in rheumatology practices. There was no randomisation regarding the initial treatment strategy. The main endpoint of this posthoc analysis was Clinical Disease Activity Index (CDAI) remission at weeks 4, 8 and 12., Results: Data of 280 outpatients and 95 inpatients could be analysed. Inpatients were more often male, had less cardiovascular comorbidity, but higher baseline CDAI scores and more symptoms of depression compared with outpatients. At weeks 8 and 12, CDAI remission was more frequently observed in inpatients (week 8: 24.7 vs 14.9%; week 12: 30.5 vs 17.3%). These results were confirmed in a multivariable model: OR=2.43 (1.06; 5.55); p=0.035, and OR=2.91 (1.37; 6.14); p=0.005, respectively., Conclusion: In early active RA, initial inpatient treatment was associated with higher CDAI remission rates at weeks 8 and 12. This may be due to the initially more intense hospital care., Competing Interests: Competing interests: Professor Dr Xenofon Baraliakos received consulting fees, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer and UCB. He is an editorial board member of the Annals of Rheumatic Diseases, is currently ASAS President and EULAR President-elect. All other authors have nothing to declare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
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34. Move-PCD-a multi-center longitudinal randomized controlled superiority trial on the effect of a 6-month individualized supported physical activity (PA) program on quality of life (QoL) in children, adolescents, and adults with primary ciliary dyskinesia.
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Hoffmann AT, Mai A, Baum K, Schlegtendal A, Maier C, Stein J, Tokic M, Dillenhöfer S, Lücke T, Timmesfeld N, and Brinkmann F
- Subjects
- Humans, Adolescent, Child, Young Adult, Adult, Middle Aged, Male, Female, Exercise, Longitudinal Studies, Exercise Therapy methods, Equivalence Trials as Topic, Treatment Outcome, Time Factors, Randomized Controlled Trials as Topic, Surveys and Questionnaires, Ciliary Motility Disorders therapy, Kartagener Syndrome therapy, Kartagener Syndrome physiopathology, Quality of Life, Multicenter Studies as Topic
- Abstract
Background: Primary ciliary dyskinesia (PCD) is a rare genetical disease with malfunction of the motile cilia leading to impaired muco-ciliary clearance in the respiratory tract. There is no cure for PCD, only supportive therapy aimed at minimizing the progression of the disease and improving the patient's quality of life (QoL). Physical activity (PA) is one of these recommended supportive therapies for people with PCD (pwPCD). However, there is no scientific evidence to support this recommendation. In addition, regular medical advice to increase PA remains largely ineffective in pwPCD., Methods: To test the main hypothesis, that an individualized and supported PA program leads to a better QoL 6 months after randomization (QoL-PCD questionnaire) compared to usual recommendation in pwPCD, 158 pwPCD aged 7 to 55 years are to be included in this multi-center randomized controlled trial (RCT). After the screening visit, a 1:1 randomization stratified by age group and FEV1 will be performed. A QoL-PCD questionnaire, motor test, and lung function will be carried out at regular intervals in both groups. PA is recorded in both groups using activity trackers during the study period. The main aim of the trial is to estimate the difference in the change of QoL between the groups after 6 months. Therefore, our full analysis set consists of all randomized patients and analysis is performed using the intention-to-treat principle. Statistical software R ( http://www.r-project.org ) is used. Ethical approvement without any reservations: RUB Bochum Ethics Committee (No. 23-7938; December 4, 2023). Recruitment start: March 2024., Discussion: Limitations result from the rarity of PCD with its broad disease spectrum and the large age range. These are reduced by stratified randomization and the measurement of the individual change in QoL as primary endpoint. In our view, only a PA program tailored to individual needs with close contact to trainers offers the chance to meet personal needs of pwPCD and to establish PA as a pillar of therapy in the long term. The study protocol explains all procedures and methods of recruitment, implementation of the study visits and intervention, measures for patient and data safety, and for minimizing risks and bias., Trial Registration: German Clinical Trials Register (DRKS) 00033030. Registered on December 7, 2023. Update 10 July 2024. STUDY PROTOCOL VERSION 10: Version 1.2; 12 June 2024., (© 2024. The Author(s).)
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- 2024
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35. Investigating the structure of disordered eating symptoms in adult men: A network analysis.
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Eschrich RL, Halbeisen G, Steins-Loeber S, Timmesfeld N, and Paslakis G
- Abstract
Objective: Eating disorders (EDs) increasingly emerge as a health risk in men, but there is concern that men's symptoms go unnoticed due to stereotypical perceptions and gender-related differences in symptom presentation. Novel assessments focused particularly on attitudes and behaviours towards increasing muscle size and definition. Using network analysis, this study aimed to corroborate and extend previous findings on disordered eating presentation in men by examining the role of muscularity concerns among an extended range of disordered eating symptoms., Method: N = 294 adult men (18 years or older) completed muscularity-related and disordered eating assessments, among which we included assessments for orthorexic eating and Avoidant/Restrictive Food Intake Disorder for the first time. We selected symptoms empirically, estimated a regularised network, identified symptom communities, evaluated network loadings and bridge centrality estimates, and compared network structures between different groups of participants., Results: We identified five symptom communities related to muscularity-related concerns, features of core ED psychopathology, and selective eating. Symptoms regarding ruminating about healthy eating, guilt for unhealthy eating, weight overvaluation, concerns about muscularity, and selective eating emerged as highly central., Discussion: The results largely corroborate previous observations but suggest that muscle-building behaviours are part of a broader cluster of male body shaping and rule-based dieting behaviours., (© 2024 The Author(s). European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)
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- 2024
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36. Natural and hybrid immunity after SARS-CoV-2 infection in children and adolescents.
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Rothoeft T, Maier C, Talarico A, Hoffmann A, Schlegtendal A, Lange B, Petersmann A, Denz R, Timmesfeld N, Toepfner N, Vidal-Blanco E, Pfaender S, Lücke T, and Brinkmann F
- Subjects
- Humans, Adolescent, Child, Male, Female, Child, Preschool, COVID-19 Vaccines immunology, Immunity, Innate, Coronavirus Nucleocapsid Proteins immunology, COVID-19 immunology, Antibodies, Neutralizing blood, Antibodies, Neutralizing immunology, Antibodies, Viral blood, SARS-CoV-2 immunology, Spike Glycoprotein, Coronavirus immunology, Immunity, Humoral, Immunity, Cellular
- Abstract
Purpose: In contrast to adults, immune protection against SARS-CoV-2 in children and adolescents with natural or hybrid immunity is still poorly understood. The aim of this study was to analyze different immune compartments in different age groups and whether humoral immune reactions correlate with a cellular immune response., Methods: 72 children and adolescents with a preceding SARS-CoV-2 infection were recruited. 37 were vaccinated with an RNA vaccine (BNT162b2). Humoral immunity was analyzed 3-26 months (median 10 months) after infection by measuring Spike protein (S), nucleocapsid (NCP), and neutralizing antibodies (nAB). Cellular immunity was analyzed using a SARS-CoV-2-specific interferon-γ release assay (IGRA)., Results: All children and adolescents had S antibodies; titers were higher in those with hybrid immunity (14,900 BAU/ml vs. 2118 BAU/ml). NCP antibodies were detectable in > 90%. Neutralizing antibodies (nAB) were more frequently detected (90%) with higher titers (1914 RLU) in adolescents with hybrid immunity than in children with natural immunity (62.5%, 476 RLU). Children with natural immunity were less likely to have reactive IGRAs (43.8%) than adolescents with hybrid immunity (85%). The amount of interferon-γ released by T cells was comparable in natural and hybrid immunity., Conclusion: Spike antibodies are the most reliable markers to monitor an immune reaction against SARS-CoV-2. High antibody titers of spike antibodies and nAB correlated with cellular immunity, a phenomenon found only in adolescents with hybrid immunity. Hybrid immunity is associated with markedly higher antibody titers and a higher probability of a cellular immune response than a natural immunity., (© 2024. The Author(s).)
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- 2024
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37. An open-label, randomized controlled trial to assess a ketogenic diet in critically ill patients with sepsis.
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Rahmel T, Effinger D, Bracht T, Griep L, Koos B, Sitek B, Hübner M, Hirschberger S, Basten J, Timmesfeld N, Adamzik M, and Kreth S
- Subjects
- Humans, Male, Female, Middle Aged, 3-Hydroxybutyric Acid blood, Adult, Aged, Ketosis, Treatment Outcome, Diet, Ketogenic, Critical Illness, Sepsis diet therapy, Sepsis blood
- Abstract
Patients with sepsis experience metabolic and immunologic dysfunction that may be amplified by standard carbohydrate-based nutrition. A ketogenic diet (KD) may offer an immunologically advantageous alternative, although clinical evidence is limited. We conducted a single-center, open-label, randomized controlled trial to assess whether a KD could induce stable ketosis in critically ill patients with sepsis. Secondary outcomes included assessment of feasibility and safety of KD, as well as explorative analysis of clinical and immunological characteristics. Forty critically ill adults were randomized to either a ketogenic or standard high-carbohydrate diet. Stable ketosis was achieved in all KD patients, with significant increases in β-hydroxybutyrate levels compared with controls [mean difference 1.4 milimoles per liter; 95% confidence interval (CI): 1.0 to 1.8; P < 0.001). No major adverse events or harmful metabolic side effects (acidosis, dysglycemia, or dyslipidemia) were observed. After day 4, none of the patients in the KD group required insulin treatment, whereas in the control group, insulin dependency ranged between 35% and 60% ( P = 0.009). There were no differences in 30-day survival, but ventilation-free [incidence rate ratio (IRR) 1.7; 95% CI: 1.5 to 2.1; P < 0.001], vasopressor-free (IRR 1.7; 95% CI: 1.5 to 2.0; P < 0.001), dialysis-free (IRR 1.5; 95% CI: 1.3 to 1.8; P < 0.001), and intensive care unit-free days (IRR 1.7; 95% CI: 1.4 to 2.1; P < 0.001) were higher in the ketogenic group. Next-generation sequencing of CD4
+ /CD8+ T cells and protein analyses showed reduced immune dysregulation, with decreased gene expression of T-cell activation and signaling markers and lower pro-inflammatory cytokine secretion. This trial demonstrated the safe induction of a stable ketogenic state in sepsis, warranting larger trials to investigate potential benefits in sepsis-related organ dysfunction.- Published
- 2024
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38. Collaborative advance care planning in palliative care: a randomised controlled trial.
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Seifart C, Koch M, Herzog S, Leppin N, Nagelschmidt K, Riera Knorrenschild J, Timmesfeld N, Denz R, Seifart U, Rief W, and Von Blanckenburg P
- Abstract
Objective: An effective tool for establishing concordant end-of-life (EOL) care in patients with cancer is advance care planning (ACP). However, various barriers, including psychological obstacles, hamper the access to ACP. Therefore, a new conceptual model combining a psycho-oncological approach with structured ACP was developed. The effectiveness and efficiency of this new concept of collaborative ACP (col-ACP) is evaluated in the present randomised controlled trial in patients with palliative cancer., Methods: 277 patients with palliative cancer and their relatives were randomised into three groups (1) collaborative ACP (col-ACP) consisting of a psycho-oncological approach addressing barriers to EOL conversations followed by a standardised ACP procedure, (2) supportive intervention (active control) and (3) standard medical care., Results: Patients in the col-ACP group completed advance directives (p<0.01) and healthcare proxies (p<0.01) significantly more often. Additionally, they felt better planned ahead for their future treatment (p<0.01) and were significantly more confident that their relatives were aware of their treatment wishes (p=0.03). In fact, their goals of care were known and highly fulfilled. However, patients' and caregivers' quality of life, patients' stress, depression and peace did not differ between the groups., Conclusions: The new, well-received, concept of col-ACP improves readiness and access to ACP and results in more consistent EOL care. Further, even if no direct influence on quality of life could be proven, it supports patients in planning their treatment, making autonomous decisions and regaining self-efficacy in the face of life-limiting cancer. Therefore, a closer interlocking and information exchange between psycho-oncological and ACP services seems to be reasonable., Trial Registration Number: NCT03387436., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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39. Neonatal B-Cell Levels and Infant Health in Newborns Potentially Exposed to Anti-CD20 Monoclonal Antibodies During Pregnancy or Lactation.
- Author
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Schwake C, Steinle J, Thiel S, Timmesfeld N, Haben S, Ayzenberg I, Gold R, and Hellwig K
- Subjects
- Humans, Female, Pregnancy, Infant, Newborn, Retrospective Studies, Male, Adult, Infant Health, Prenatal Exposure Delayed Effects immunology, Prenatal Exposure Delayed Effects chemically induced, Antigens, CD19 immunology, Lymphocyte Count, Rituximab adverse effects, Rituximab administration & dosage, Rituximab pharmacology, Immunologic Factors adverse effects, Immunologic Factors administration & dosage, Immunologic Factors pharmacology, Infant, B-Lymphocytes immunology, B-Lymphocytes drug effects, Lactation immunology, Antigens, CD20 immunology
- Abstract
Objectives: To report CD19
+ B-cell counts and possible adverse effects on infants of mothers exposed to anti-CD20 mAbs ≤6 months before/during pregnancy or lactation., Methods: We conducted a retrospective study using data from the German nationwide neuroimmunologic pregnancy registry. Inclusion criteria involved infants whose mothers received anti-CD20 mAbs ≤6 months before/during pregnancy or lactation, with ≥1 postnatal CD19+ B-cell count. Main outcomes were absolute and relative CD19+ B-cell counts. Comparison with reference values was performed conservatively in a subgroup with maternal exposure ≤3 months before/during pregnancy. Additional outcomes included pregnancy results, severe infections, and lymphocyte counts., Results: The cohort comprised 49 infants (F:M 25:24) exposed to anti-CD20 mAbs ≤6 months before/during pregnancy or lactation. CD19+ B-cell and lymphocyte counts in 40 infants with maternal exposure ≤3 months before/during pregnancy were comparable with normative values. Only 2 cases of complete CD19+ B-cell depletion occurred after second-trimester and third-trimester ocrelizumab exposure, with repopulation observed within 2 months. Exclusive lactation exposure had no significant effect on infants' absolute CD19+ B-cell counts., Discussion: Administering anti-CD20 mAbs before or at the pregnancy onset, or during lactation, seems safe without significant impact on infant B-cell development. However, second-trimester or third-trimester exposure can cause CD19+ B-cell depletion due to placental transfer, necessitating monitoring and postponing live vaccines.- Published
- 2024
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40. Evaluation of a non-auditory neurocognitive test battery in hearing-impaired according to age.
- Author
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Götze L, Sheikh F, Haubitz I, Falkenstein M, Timmesfeld N, and Völter C
- Subjects
- Humans, Aged, Male, Female, Middle Aged, Aged, 80 and over, Cognitive Dysfunction diagnosis, Cognitive Dysfunction etiology, Cognitive Dysfunction psychology, Age Factors, Hearing Loss psychology, Hearing Loss diagnosis, Neuropsychological Tests
- Abstract
Purpose: Due to the demographic shift, the number of older people suffering from hearing loss and from cognitive impairment increases. Both are closely related and hard to differentiate as most standard cognitive test batteries are auditory-based and hearing-impaired individuals perform worse also in non-auditory test batteries. Therefore, reference data for hearing-impaired are mandatory., Methods: The computer-based battery ALAcog assesses multiple cognitive domains, such as attention, (delayed) memory, working memory, inhibition, processing speed, mental flexibility and verbal fluency. A data set of 201 bilaterally hearing-impaired subjects aged ≥ 50 (mean 66.6 (SD 9.07)) was analysed. The LMS method, estimated curves for the 10th, 25th, 50th, 75th and 90th percentile were calculated, and classified according to age, starting from the age of 50., Results: Cognitive function shows a decline in all subtests as people age, except for verbal fluency, which remains almost stable over age. The greatest declines were seen in recall and delayed recall and in mental flexibility. Age and hearing ability did not correlate (p = 0.68). However, as people age, inter-subject variability of cognitive test results increases. This was especially the case for inhibition. Cognitive function was not correlated with hearing ability (each p ≥ 0.13)., Conclusion: The present results make an approach to establish reference data for a comprehensive non-auditory test battery in a large sample of elderly hearing-impaired people which can be used as a simple tool to better contextualise cognitive performance beyond mean and median scores., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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41. Cervical pessary to prevent preterm birth and poor neonatal outcome: An integrity meta-analysis of randomized controlled trials focusing on adherence to the European Medical Device Regulation.
- Author
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Kyvernitakis I, Baschat AA, Malan M, Rath W, Berger R, Henrich W, Schleussner E, Yousefi B, Timmesfeld N, and Maul H
- Subjects
- Humans, Female, Pregnancy, Infant, Newborn, Pregnancy, Twin, Guideline Adherence statistics & numerical data, Pregnancy Outcome, Europe, Pessaries, Premature Birth prevention & control, Randomized Controlled Trials as Topic
- Abstract
Background: Findings from randomized trials (RCTs) on cervical pessary treatment to prevent spontaneous preterm birth are inconsistent., Objectives: Our hypothesis suggests that adhering to the European Medical Device Regulation (MDR) and following the instructions for use are essential prerequisites for successful therapy. Conversely, the non-adherence to these guidelines will probably contribute to its failure., Search Strategy and Selection Criteria: Based on validated criteria from integrity assessments we performed a systematic review identifying 14 RCTs evaluating the effect of cervical pessaries., Data Collection and Analysis: We analyzed the implications of 14 criteria each accounting for 0-2 points of a score reflecting the clinical evaluation plan (CEP) as proposed by the MDR to evaluate the risk-benefit ratio of medical devices., Main Results: Seven RCTs in each singleton and twin pregnancies (5193 "cases") were included, detecting a high heterogeneity within control groups (I
2 = 85% and 87%, respectively, P < 0.01). The CEP score varied from 11 to 26 points for all studies. The most common reasons for low scores and potential data compromise were poor recruitment rates, no (completed) power analysis, and no pre-registration, but mainly non-adherence to technical, biological, and clinical equivalence to the instructions for use as required by the MDR. All trials with score values greater than 20 had applied audit procedures. Within this group we found significantly reduced rates of spontaneous preterm birth at less than 34 weeks within the pessary group in singleton (odds ratio 0.28; 95% confidence interval 0.12-0.65) and twin pregnancies (odds ratio 0.30; 95% confidence interval 0.13-0.67). Similarly, there was a significant reduction in the composite poor neonatal outcome in singleton (odds ratio 0.25; 95% confidence interval 0.10-0.61) and twin pregnancies (odds ratio 0.54; 95% confidence interval 0.35-0.82) after a pessary as compared with controls., Conclusion: Non-audited RCTs and meta-analyses mixing studies of different clinical quality as pre-defined by a CEP and the MDR pose the risk for erroneous conclusions., (© 2023 International Federation of Gynecology and Obstetrics.)- Published
- 2024
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42. Digital Medication Management in Polypharmacy.
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Brünn R, Basten J, Lemke D, Piotrowski A, Söling S, Surmann B, Greiner W, Grandt D, Kellermann-Mühlhoff P, Harder S, Glasziou P, Perera R, Köberlein-Neu J, Ihle P, van den Akker M, Timmesfeld N, and Muth C
- Subjects
- Humans, Germany, Female, Male, Aged, Middle Aged, Inappropriate Prescribing statistics & numerical data, Inappropriate Prescribing prevention & control, Primary Health Care statistics & numerical data, Aged, 80 and over, COVID-19 mortality, Adult, SARS-CoV-2, Polypharmacy, Decision Support Systems, Clinical statistics & numerical data, Hospitalization statistics & numerical data
- Abstract
Background: Inappropriate drug prescriptions for patients with polypharmacy can have avoidable adverse consequences. We studied the effects of a clinical decision-support system (CDSS) for medication management on hospitalizations and mortality., Methods: This stepped-wedge, cluster-randomized, controlled trial involved an open cohort of adult patients with polypharmacy in primary care practices (=clusters) in Westphalia-Lippe, Germany. During the period of the intervention, their medication lists were checked annually using the CDSS. The CDSS warns against inappropriate prescriptions on the basis of patient-related health insurance data. The combined primary endpoint consisted of overall mortality and hospitalization for any reason. The secondary endpoints were mortality, hospitalizations, and high-risk prescription. We analyzed the quarterly health insurance data of the intention- to-treat population with a mixed logistic model taking account of clustering and repeated measurements. Sensitivity analyses addressed effects of the COVID-19 pandemic and other effects., Results: 688 primary care practices were randomized, and data were obtained on 42 700 patients over 391 994 quarter years. No significant reduction was found in either the primary endpoint (odds ratio [OR] 1.00; 95% confidence interval [0.95; 1.04]; p = 0.8716) or the secondary endpoints (hospitalizations: OR 1.00 [0.95; 1.05]; mortality: OR 1.04 [0.92; 1.17]; high-risk prescription: OR 0.98 [0.92; 1.04])., Conclusion: The planned analyses did not reveal any significant effect of the intervention. Pandemicadjusted analyses yielded evidence that the mortality of adult patients with polypharmacy might potentially be lowered by the CDSS. Controlled trials with appropriate follow-up are needed to prove that a CDSS has significant effects on mortality in patients with polypharmacy.
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- 2024
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43. Prevalence of infectious diseases, immunity to vaccine-preventable diseases and chronic medical conditions among Ukrainian refugees in Germany - A cross sectional study from the German Network University Medicine (NUM).
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Brinkmann F, Friedrichs A, Behrens GM, Behrens P, Berner R, Caliebe A, Denkinger CM, Giesbrecht K, Gussew A, Hoffmann AT, Hojenski L, Hovardovska O, Dopfer-Jablonka A, Kaasch AJ, Kobbe R, Kraus M, Lindner A, Maier C, Mitrov L, Nauck M, de Miranda SN, Scherer M, Schmiedel Y, Stahl D, Timmesfeld N, Toepfner N, Vehreschild J, Wohlgemuth WA, Petersmann A, and Vehreschild MJGT
- Subjects
- Adolescent, Adult, Child, Female, Humans, Male, Cross-Sectional Studies, Germany epidemiology, Prevalence, Universities, Communicable Diseases epidemiology, Eastern European People, Refugees, Tuberculosis epidemiology, Tuberculosis prevention & control, Vaccine-Preventable Diseases
- Abstract
Background: Vulnerability to infectious diseases in refugees is dependent on country of origin, flight routes, and conditions. Information on specific medical needs of different groups of refugees is lacking. We assessed the prevalence of infectious diseases, immunity to vaccine-preventable diseases, and chronic medical conditions in children, adolescents, and adult refugees from Ukraine who arrived in Germany in 2022., Methods: Using different media, we recruited Ukrainian refugees at 13 sites between 9-12/2022. An antigen test for acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection, serologies for a range of vaccine-preventable diseases, as well as interferon gamma release assays (IGRAs) for tuberculosis (TB), and SARS-CoV-2 were performed. We assessed personal and family history of chronic medical conditions, infectious diseases, vaccination status, and conditions during migration., Results: Overall, 1793 refugees (1401 adults and 392 children/adolescents) were included. Most participants were females (n = 1307; 72·3%) and from Eastern or Southern Ukraine. TB IGRA was positive in 13% (n = 184) of the adults and in 2% (n = 7) of the children. Serology-based immunological response was insufficient in approximately 21% (360/1793) of the participants for measles, 32% (572/1793) for diphtheria, and 74% (1289/1793) for hepatitis B., Conclusions: We show evidence of low serological response to vaccine-preventable infections and increased LTBI prevalence in Ukrainian refugees. These findings should be integrated into guidelines for screening and treatment of infectious diseases in migrants and refugees in Germany and Europe. Furthermore, low immunity for vaccine-preventable diseases in Ukrainians independent of their refugee status, calls for tailor-made communication efforts., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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44. [Positive experiences of specialist assistants and physicians with respect to the delegation research project StaerkeR : Evaluation of the training and experiences within the framework of this project].
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Mai A, Abrantes Diaz S, Stein M, Denz R, Klaaßen-Mielke R, Timmesfeld N, Krause D, and Braun J
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- Humans, Rheumatologists, Rheumatology education
- Abstract
Introduction: The delegation of medical services to rheumatology assistants (RFA) has proven to be safe and effective in the evaluation of the research project "StaerkeR". Afterwards, the experiences of the participating RFAs and rheumatologists with delegation were surveyed and discussed within the framework of an opinion research project., Methods: At the end of the project, the participating RFAs and rheumatologists were surveyed via an online questionnaire (quantitative analysis) (21 questions for physicians and 44 questions for RFAs). In addition, focus group meetings were held for the RFAs, which were led by a moderator and a secretary. The results of the focus group sessions (qualitative analyses) were analyzed according to the structured method of Kuckartz., Results: All 31 RFAs and 25 rheumatologists involved in the project participated in the online surveys and 9 RFAs took part in the 2 focus groups. In the online surveys, both the RFAs and the rheumatologists gave predominantly good to very good ratings with respect to RFA training, the implementation of delegation in the practices and outpatient clinics, the role of the RFAs and the overall evaluation of the delegation concept. In the focus group discussions, many possible limitations regarding acceptance and implementation of the delegation concept were mentioned., Conclusion: The delegation of medical tasks to RFAs is a concept that is positively assessed and highly accepted by both sides, the rheumatologists and the RFAs. In a comparison between the individual practices and hospital outpatient departments, there is still a clear heterogeneity with respect to the willingness and logistical possibilities in the implementation of the delegation concept., (© 2022. The Author(s).)
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- 2024
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45. Early postpartum treatment strategies and early postpartum relapses in women with active multiple sclerosis.
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Haben S, Ciplea AI, Tokic M, Timmesfeld N, Thiel S, Gold R, Langer-Gould AM, and Hellwig K
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- Pregnancy, Female, Humans, Natalizumab therapeutic use, Cohort Studies, Fingolimod Hydrochloride therapeutic use, Postpartum Period, Recurrence, Immunosuppressive Agents, Multiple Sclerosis drug therapy, Multiple Sclerosis, Relapsing-Remitting drug therapy
- Abstract
Background: Relapse risk after delivery is increased in women with active multiple sclerosis (MS), the best strategy to reduce it is unknown. We aimed to assess the association of four different postpartum strategies with relapses during the first 6 months post partum., Methods: This cohort study includes data prospectively collected through structured telephone interviews from the German Multiple Sclerosis and Pregnancy Registry. Pregnancies with active MS (fingolimod or natalizumab treatment OR relapse within 1 year before pregnancy) and postpartum follow-up of ≥6 months were included. We compared four strategies: (1) intention to breastfeed exclusively without disease-modifying therapy (DMT) (exclusive breast feeding ≥2 months or switching to non-exclusive/weaning within 2 weeks after a relapse during the first 2 months), (2) early treatment with natalizumab/fingolimod and (3) other DMT initiated within 6 weeks post partum before a relapse. If women did not or only partially breastfed, or started DMT≤6 weeks after delivery after a relapse or later, we assumed (4) no-DMT-no-exclusive- breastfeeding-strategy. Main outcome was time to postpartum MS relapses., Results: In 867 women with 911 pregnancies, most (n=416) intended to breastfeed exclusively or had no-DMT-no-exclusive-breastfeeding-strategy (n=290); fewer started fingolimod (n=38), natalizumab (n=74) or another DMT (n=93) early. Recurrent time-to-event analysis showed a statistically significant reduction in relapse hazard only with the natalizumab/fingolimod-strategy as of months 3-4 post partum compared with intention-to-breastfeed-exclusively-strategy. The very early relapse risk was highest in no-DMT-no-exclusive-breastfeeding-strategy., Conclusion: In active MS, an early postpartum treatment strategy should be determined well before delivery. Natalizumab/fingolimod-strategy reduced postpartum relapse hazard from month 3, but none diminished the early postpartum relapse hazard., Competing Interests: Competing interests: AIC: received speaker honoraria from Bayer Healthcare, Biogen and Teva and sponsorship for congress participation and travel grants from Teva; MT: is employed in a project funded by a grant from the Innovation Fund of the Federal Joint Committee, NT: has received a grant from the Innovation Fund of the Federal Joint Committee; ST: received speakers honoraria from Bayer Healthcare and Biogen as well as payment for manuscript writing from HEXAL AG; RG: has received speaker honoraria and research support from Bayer-Schering Healthcare, Biogen-Idec Germany, Chugai, Eisai, Merck Serono, Nikkiso Pharma, Novartis, Roche, Sanofi-Genzyme, and TEVA, has received consulting honoraria from CSL Behring, Baxter, Janssen and Talecris and has stock options in Bayer, Merck and Roche; KH: has received speaker honoraria and research support from Bayer, Biogen, Merck, Novartis, Sanofi-Genzyme, Roche and Teva, has received support for congress participation from Bayer, Biogen, Merck, Roche, Sanofi Genzyme and Teva, and has served on scientific advisory boards for Bayer, Biogen, Sanofi, Teva, Roche, Novartis, Merck., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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46. The effect of a visuospatial interference intervention on posttraumatic intrusions: a cross-over randomized controlled trial.
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Kehyayan A, Thiel JP, Unterberg K, Salja V, Meyer-Wehrmann S, Holmes EA, Matura JM, Dieris-Hirche J, Timmesfeld N, Herpertz S, Axmacher N, and Kessler H
- Subjects
- Humans, Cognition, Cross-Over Studies, Stress Disorders, Post-Traumatic therapy, Video Games
- Abstract
Background : Intrusive memories form a core symptom of Posttraumatic Stress Disorder (PTSD). Based on concepts of visuospatial interference and memory-updating accounts, technological innovations aim to attenuate such intrusions using visuospatial interventions. Objective : This study aims to test the effect of a visuospatial Tetris -based intervention versus a verbal condition ( Wiki ) and a never-targeted control ( no intervention ) on intrusion frequency. Method : A randomized crossover trial was conducted including N = 38 PTSD patients who had at least 3 distinct intrusive memories of trauma. After both 2 weeks (intervention 1) and 4 weeks (intervention 2), one of the three memories was randomly selected and either the visuospatial intervention (memory reminder of a traumatic memory + Tetris ) or verbal condition (reading a Wikipedia article + answering questions) was performed on their first memory in randomized order. In the week 4 session, the patient conducted the other intervention condition on their second memory (crossover). The third memory was never targeted ( no intervention ). Daily occurrence of intrusions over 8 weeks was collected using a diary and analysed using mixed Poisson regression models. Results : Overall, there was no significant reduction in intrusion frequency from either intervention compared to each other, and to no intervention control (relative risk Tetris / Wiki : 0.947; p = .31; relative risk no intervention / Tetris : 1.060; p = .15; relative risk no intervention / Wiki : 1.004; p = .92). Conclusions : There was no effect of either intervention on intrusions when administered in a crossover design where participants received both interventions. Design shortcomings and consequences for future studies are discussed.
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- 2024
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47. Health Economic Evaluation of an Online-Based Motivational Program to Reduce Problematic Media Use and Promote Treatment Motivation for Internet Use Disorder-Results of the OMPRIS Study.
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Niemann A, Hillerich V, Wasem J, Dieris-Hirche J, Bottel L, Pape M, Herpertz S, Timmesfeld N, Basten J, Te Wildt BT, Wölfling K, Beckers R, Henningsen P, Neusser S, and Neumann A
- Subjects
- Adult, Female, Humans, Male, Cost-Benefit Analysis, Internet, Prospective Studies, Surveys and Questionnaires, Internet Use, Motivation, Internet Addiction Disorder economics, Internet Addiction Disorder psychology, Internet Addiction Disorder therapy
- Abstract
Internet Use Disorders (IUD) have a relevant effect on national economies. In the randomized, controlled, multicenter, prospective, and single-blinded OMPRIS study (pre-registration number DRKS00019925; Innovation Fund of the Joint Federal Committee of Germany, grant number 01VSF18043), a four-week online program to reduce media addiction symptoms, was evaluated for cost-effectiveness. The intervention group (IG) was compared to a waiting control group (WCG) from German statutory health insurance (SHI) and a societal perspective. Resource use, namely indirect and direct (non) medical costs, was assessed by a standardized questionnaire at baseline and after the intervention. Additionally, intervention costs were calculated. Determining the Reliable Change Index (RCI) based on the primary outcome, assessed by the "Scale for the Assessment of Internet and Computer Game Addiction" (AICA-S), individuals with and without reliable change (RC) were distinguished. The incremental cost-effectiveness ratio was calculated using the difference-in-difference approach. There were 169 (IG n = 81, WCG n = 88) persons included in the analysis. The mean age was 31.9 (SD 12.1) years. A total of 75.1% were male, and 1.8% diverse. A total of 65% (IG) and 27% (WCG) had an RC. The cost per person with RC was about EUR 860 (SHI) and EUR 1110 (society). The intervention leads to an improvement of media addiction symptoms at moderate additional costs.
- Published
- 2023
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48. Cancer advance care planning: development of a screening tool.
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Berlin P, Göggelmann L, Herzog S, Pedrosa Carrasco AJ, Hauck J, Timmesfeld N, Kruse J, Rief W, Riera Knorrenschild J, von Blanckenburg P, and Seifart C
- Abstract
Objectives: Advance care discussions are a useful communication tools for medical preferences and beneficial for shared decision-making processes in hospital settings. The present study developed the first screening tool for need for advance care planning (ACP)., Methods: In phase 1 (n=92), items were evaluated using feasibility analysis and item reduction. In phase 2 (n=201), reduced screening items were analysed for predictive value of need for ACP. Statistical analysis included receiver-operating characteristics analysis (area under the curve>0.80), optimal cut-off based on sensitivity and specificity, interpretation of OR and construct validity using correlation with death anxiety, communication avoidance within families and trust based on the relationship with the treating physician., Results: Participants in both phases were approximately 60 years old with non-curative prognosis. After item reduction, predictive values of four possible items with good item difficulty and discrimination were compared for mild, moderate and great levels of death anxiety. A two-item combination of I am burdened by thoughts of an unfavourable course of the disease and I am burdened by the feeling of being ill-prepared for the end of life showed best prediction of death anxiety and communication avoidance. Clinical cut-off at sum-score ≥6 was of high sensitivity (95%) and specificity (81%). Previous use of social support and readiness for ACP was related to higher chance of interest in ACP., Conclusion: Screening for need of ACP is possible with two objective items and one subjective item. Positive screening therefore indicates when to offer ACP discussions and provides routine estimation of ACP need in clinical practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
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49. Pediatric multi-drug-resistant tuberculosis in Germany - diagnostic and therapeutic challenges of an "orphan disease".
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Schäfer HL, Barker M, Follmann P, Günther A, Hörning A, Kaiser-Labusch P, Kerzel S, Maier C, Roth S, Schmidt C, Schütz K, Stehling F, Struffert M, Timmesfeld N, Vöhringer P, and Brinkmann F
- Subjects
- Humans, Child, Retrospective Studies, Case-Control Studies, Risk Factors, Rare Diseases, Antitubercular Agents therapeutic use, Tuberculosis, Multidrug-Resistant diagnosis, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant epidemiology, Tuberculosis drug therapy
- Abstract
Delay in diagnosing multidrug-resistant tuberculosis (MDR-pTB) in children prolongs time to effective treatment. Data on risk factors for pediatric MDR from low-incidence countries are scarce. Retrospective nationwide case-control study to analyze MDR-pTB cases in Germany between 2010 and 2020 in comparison to a drug-susceptible (DS)-pTB group. We included 52 MDR cases (24 tuberculosis (TB), 28 TB infection (TBI); mean age 7.3 years) and 56 DS cases (31 TB, 26 TBI; mean age 7.9 years). Groups were similar for sex, household size, and migration background. Compared to the DS group, more children with MDR were born in the Commonwealth of Independent States (CIS) (22% MDR-pTB vs. 13% DS-pTB, n.s.) and had more MDR index cases (94% MDR-pTB, 5% DS-pTB, p < 0.001). The interval between first healthcare contact and initiation of effective therapy was significantly longer in MDR-pTB (47 days) than in DS-pTB (11 days, p < 0.001), correlating with disease progression. Treatment for MDR-pTB was successful in 74%, but 22% experienced long-term adverse effects (e.g., hepatopathy, hearing loss)., Conclusions: Close contact to MDR cases or birth in MDR-TB-high-incidence countries are risk factors for MDR-pTB. Early identification of potential MDR index cases by contact investigation, and susceptibility testing in children from high-burden MDR-TB countries are essential for timely diagnosis and treatment, reducing the severity of disease and treatment side effects., Trial Registration: Deutsches Register Klinischer Studien ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023817 ), DRKS00023817, 2020-09-08., What Is Known: •Management of children with MDR-TB remains challenging due to difficulties in diagnosing MDR-TB (lack of information on MDR index case, lack of microbiological confirmation in paucibacillary disease). •Choice of treatment regimen and monitoring of side effects., What Is New: •Children with an MDR-TB index or born in a MDR-TB-high-incidence country are at higher risk of developing MDR-TB in a low incidence country. •The time lag to initiate treatment in MDR-TB is longer than in DS-TB and MDR-TB treatment involves a higher risk of adverse effects in longer treatment regimens especially with injectables., (© 2023. The Author(s).)
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- 2023
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50. Efficacy of a short-term webcam-based telemedicine treatment of internet use disorders (OMPRIS): a multicentre, prospective, single-blind, randomised, clinical trial.
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Dieris-Hirche J, Bottel L, Basten J, Pape M, Timmesfeld N, Te Wildt BT, Geisler BL, Wölfling K, Henningsen P, Beutel M, Neumann A, Niemann A, Beckers R, and Herpertz S
- Abstract
Background: Evidence-based treatments for internet use disorders (IUDs) are limited, and online therapy approaches are poorly studied. We investigated the efficacy of a manualised therapist-guided online intervention (OMPRIS) to reduce IUD symptoms and improve psychological well-being., Methods: In this multicentre, two-arm, single-blinded trial, individuals ≥16 years suffering from IUD symptoms were recruited in Germany from August 16, 2020, to March 11, 2022, through media advertisements and healthcare providers. Participants were randomly allocated by sequential balancing randomisation (1:1) to either the manualised webcam-based OMPRIS intervention or a waitlist control (WLC) group. OMPRIS provided strategies from motivational interviewing, behavioural therapy, and social counselling. The primary outcome at the end of treatment was a reduction in IUD symptoms as measured by the Assessment of Internet and Computer Scale (AICA-S). Follow-up assessments were conducted at 6 weeks and 6 months. Analyses were performed in the intention-to-treat population. This trial was registered (German Clinical Trial Register, DRKS00019925) and has been completed., Findings: A total of 180 individuals were randomly assigned to the OMPRIS intervention (n = 89) or WLC (n = 91) arm. After treatment, 81 (91.0%) participants in the OMPRIS intervention group and 88 (96.7%) in the WLC group completed the outcome assessment. The ANCOVA model showed that OMPRIS participants had a significantly greater reduction in AICA-S scores from baseline (mean score 12.1 [SD 4.6]) to post-treatment (6.8 [5.2]) than those in the WLC group (from 12.6 [5.1] to 11.0 [5.4]; estimated mean difference -3.9; [95% CI -5.2 to -2.6]; p < 0.0001; d = 0.92). No adverse events were reported to the trial team., Interpretation: Webcam-based OMPRIS therapy was effective and superior to waiting list conditions in reducing IUD symptoms. Webcam-based, specialised online therapy thus increases IUD treatment options., Funding: German Innovation Fund of Germany's Federal Joint Committee (G-BA), grant number 01VSF18043., Competing Interests: RB reports that he is CEO (employed) of the Competence Centre of Healthcare Telematics (ZTG Zentrum für Telematik und Telemedizin GmbH). The shareholders of ZTG are various representative bodies of care providers and cost bearers in the German healthcare system. The ZTG receives institutional funding from the state of North Rhine-Westphalia, Germany. Furthermore, RB reports that he is an honorary member of the board of directors of the German Society for Telemedicine (Deutsche Gesellschaft für Telemedizin e.V.). LB reports that she is on the executive board of the Association of Media Addiction Germany (Fachverband Medienabhängigkeit e.V.), which is committed to creating a network of researchers and practitioners in the German-speaking region within the framework of a large-scale cooperation to deal with internet addictions and gaming disorder. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 The Author(s).)
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- 2023
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