16 research outputs found
Die Bedeutung einer Rehabilitationsmaßnahme nach Transkatheter-Aortenklappenersatz
HINTERGRUND:
Die Möglichkeit einer Rehabilitationsmaßnahme nach einem kardialen Akutereignis
oder einer Herzklappenimplantation ist in Deutschland sehr verbreitet. Der Nutzen
einer Rehabilitationsmaßnahme in Bezug auf körperliche Leistungsfähigkeit und Lebensqualität für die Patienten nach Transkatheter-Aortenklappenimplantation wurde in Studien gezeigt. Wissenschaftliche Daten zur Effektivität einer rehabilitativen Therapie auf kardiale Funktionsparameter im Langzeitverlauf und auf die Sechs-Monats-Letalität sind bislang nicht ausreichend belastbar. Zudem fehlt der Vergleich
zu Patienten, die keine Rehabilitation absolviert haben.
METHODIK:
Im Rahmen einer retrospektiven Longitudinalstudie wurden alle Patienten im Untersuchungszeitraum von Juli 2008 bis Januar 2016 ermittelt, bei denen im Herzzentrum Brandenburg eine transfemorale Aortenklappenimplantation bei hochgradiger Aortenklappenstenose durchgeführt wurde. Jeder Patient erhielt
die Möglichkeit, an einer dreiwöchigen Rehabilitation teilzunehmen. Die Analyse
erfolgte nach Unterscheidung zwischen den Patienten, die eine kardiologische Anschlussheilbehandlung, eine geriatrische Rehabilitation oder keine Rehabilitationsmaßnahme in Anspruch nahmen.
Alle Daten wurden durch Auswertung von Krankenakten und Entlassungsbriefen
aus den Rehabilitationseinrichtungen erhoben. Primärer Endpunkt war die Sechs-Monats-Letalität. Sekundäre Endpunkte umfassten unter anderem kardiale Funktionsparameter und der neurohumorale Marker NT-proBNP im zeitlichen Verlauf.
ERGEBNISSE:
Von den insgesamt 1056 untersuchten Patienten überlebten 1017 (96,3 %) bis zur Krankenhausentlassung und wurden in die Analyse eingeschlossen. 366 Patienten
(36,0 %) lehnten eine Rehabilitation ab. 435 (66,8 %) der verbliebenen 651 Patienten nahmen eine kardiologische Anschlussheilbehandlung in Anspruch. 213 Patienten
(33,2 %) entschieden sich für eine geriatrische Rehabilitation. Alle 1017 Patienten waren, mit Ausnahme einer Erkrankung mit Diabetes mellitus, hinsichtlich der
Demographie und der Komorbiditäten vergleichbar. Patienten mit Rehabilitationswunsch wiesen eine längere Krankenhausverweildauer (REHA-Gruppe: 7 Tage, Interquartilsabstand (IQR): 6-9) auf als Patienten ohne (Non-REHA-Gruppe:
6 Tage, IQR: 5-8), p < 0,001. Zudem zeigten diese Patienten zum Zeitpunkt der Entlassung aus dem Krankenhaus eine bessere systolische linksventrikuläre Ejektionsfraktion: REHA-Gruppe 54,2 %, Standardabweichung (SW) ± 11,1 %;
Non-REHA-Gruppe 52,5 % (SW ± 11,7 %) p < 0,031. Bei den Untersuchungen nach
sechs Monaten zeigten sich keine Unterschiede bezüglich der systolischen linksventrikulären Ejektionsfraktion oder des laborchemisch bestimmten NT-proBNP.
Patienten mit Rehabilitation wiesen eine niedrigere Sechs-Monats-Letalität auf als Patienten ohne Rehabilitationsmaßnahme: REHA-Gruppe 4,5 % vs. Non-REHA-Gruppe 10,4 % (adjustierte Odds Ratio 0,4; 95 % Konfidenzintervall: 0,23 – 0,70), p < 0,001. Insbesondere zeigte sich eine Reduktion der nicht-kardiovaskulär bedingten Mortalität: REHA-Gruppe 1,3 %, Non-REHA-Gruppe 4,8 % (OR 0,26; 95 % KI:0,10 – 0,65;
p < 0,002).
ZUSAMMENFASSUNG:
Eine Rehabilitationsmaßnahme verlängert nach TAVI das 6-Monats-Patientenüberleben. Für die Ursache des Rückgangs der nicht-kardiovaskulären Letalität bei Patienten mit erfolgter Rehabilitation empfehlen sich entsprechende weiterführende Untersuchungen.BACKGROUND:
The opportunity of rehabilitation after an acute event or valve implantation is very
common in Germany. The benefit of rehabilitation after transcatheter aortic valve
implantation (TAVI) in terms of physical performance and quality of life has been
proven. The impact of rehabilitation on cardiac function parameters in the long-term
course and on the six-month mortality has not been evaluated, yet.
METHODS:
In a retrospective longitudinal study with prospective follow-up, all patients undergoing
transfemoral aortic valve implantation at the Heart Center Brandenburg with severe
aortic valve stenosis were included in the study period from July 2008 to January 2016.
Each patient was given the opportunity to participate in a three-week rehabilitation
program. Logistic regression analysis was used to assess the relationship between
treatment modality and outcome according to whether patients received cardiac,
geriatric or no rehabilitation. All data were collected by evaluating hospital medical
records and discharge letters from the rehabilitation facilities. The primary endpoint
was six-month mortality. Secondary endpoints included cardiac function parameters
and the neurohumoral marker NT-proBNP over time.
RESULTS:
Of the total 1056 patients examined, 1017 (96.3 %) survived until hospital
discharge and were included in the analysis. 366 patients refused rehabilitation.
435 (66.8 %) of the remaining 651 patients received follow-up cardiological
treatment. 213 patients (33.2 %) opted for geriatric rehabilitation. Except for diabetes
mellitus, all 1017 patients were comparable in terms of demography and comorbidities.
Patients seeking rehabilitation had a longer hospital stay (REHA group 7 days IQR: 6-9)
compared to patients without (non-REHA group 6 days IQR: 5-8), p < 0.001.
In addition, these patients showed better systolic left ventricular ejection fraction at
discharge: REHA group 54.2 % (SD +/- 11.1 %), non-REHA group 52.5 % (+/- 11.7 %)
p < 0.031. Six-month follow-ups showed no differences in the systolic left ventricular
ejection fraction or the chemically determined NT-proBNP. Reduced six-month mortality was observed in patients with rehabilitation: REHA group
4.5 %, non-REHA group 10.4 % (OR 0.4, 95% CI: 0.23 - 0.70), p < 0.001. There was a
reduction in non-cardiovascular mortality: REHA group 1.3 %, non-REHA group 4.8 %
(OR 0.26, 95% CI: 0.10 - 0.65) p < 0.002.
SUMMARY:
A program of rehabilitation after TAVI has the potential to reduce 6-months mortality.
Future studies should focus on clarifying the cause of reduced non-cardiovascular
mortality in patients with successful rehabilitation. Risk factors for declining rehabilitation
programs should be identified
Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches
Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly
Investigating the effect of cognitive load on UX: A driving study
Cognitive load (CL) and user experience (UX) are understood to be critical in the automotive domain, little evaluation has taken place regarding the investigation of the effect of CL on UX in this domain. This position paper introduces a study plan and research goals that aim to investigate whether and how different levels of CL influence UX, using a driving simulator. Besides a discussion of theoretical background and related work, we present initial results regarding an appropriate experiment design and how to manipulate and measure these variables in our specific study context. The paper concludes with a summary and outlook on next steps
Impact of Rehabilitation on Outcomes after TAVI: A Preliminary Study
The benefit of rehabilitation in elderly patients undergoing transcatheter aortic valve implantation (TAVI) for treatment of severe aortic stenosis is unknown. The impact of declining rehabilitation programs on mortality has also not been described. In a longitudinal cohort study of 1056 patients undergoing elective TAVI between 2008 and 2016, logistic regression analysis was used to assess the relationship between treatment modality and outcome according to whether or not patients participated in a three-week rehabilitation program after TAVI. Subgroup analyses included patient outcome separated according to cardiac, geriatric, or no rehabilitation. A total of 1017 patients survived until hospital discharge (96.3%) and were offered rehabilitation, 366 patients (36.0%) declined to undergo rehabilitation, with the remaining patients undergoing either cardiac (n = 435; 42.8%) or geriatric rehabilitation (n = 216; 21.2%). Mortality at six months was lower for patients receiving rehabilitation compared with those who had not (adjusted odds ratio (OR): 0.49; 95% confidence interval (confidence interval [CI]: 0.25–0.94; p = 0.032). Sub-analysis showed the benefit of cardiac (adjusted OR: 0.31; 95% CI 0.14–0.71, p = 0.006), but not geriatric rehabilitation (adjusted OR 0.83; 95% CI 0.37–1.85, p = 0.65). A program of rehabilitation after TAVI has the potential to reduce mortality. Future studies should focus on health-orientated behavior and identifying risk factors for declining rehabilitation programs
Does the Argentine Tango Sustainably Improve Cancer-Associated Fatigue and Quality of Life in Breast Cancer Survivors?
Background: Chronic cancer-related fatigue is difficult to manage in breast cancer survivors. The tango trial showed that a six-week tango Argentino program was effective in reducing fatigue and improving quality of life, and here we investigated the sustainability of this tango program for breast cancer survivors. Methods: Stage I–III breast cancer survivors with increased fatigue symptoms were analyzed. The fifty participants in the tango trial were compared with a control cohort (n = 108) who did not participate in the tango program. Using the European Organization for Research and Treatment of Cancer Questionnaire C30 (EORTC-QLQ-C30) and the German version of the cancer fatigue scale (CFS-D) self-reported quality of life parameters were assessed and longitudinal changes, correlations, and association factors were calculated. Results: Significant improvements in fatigue (p = 0.006), physical functioning (p = 0.01), and diarrhea (p = 0.04) persisted in the 50 Tango participants at 6 months, but not in the control cohort. Twelve months after joining the tango program, increased fatigue was associated with reduced sporting activities (p = 0.0005), but this was not the case for tango dancing. Conclusions: The present results suggest that tango may be appropriate as a component of early supportive and follow-up care programs, to promote health-related quality of life and physical activity and also eventually to improve long-term clinical outcomes of breast cancer survivors. Trial registration: Trial registration numbers DRKS00013335 on 27 November 2017 and DRKS00021601 on 21 August 2020 retrospectively registered
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