Validierung der deutschen Version des Reizdarmfragebogens

Validierung der deutschen Version des Reizdarmfragebogens Hintergrund: Derzeit liegt in deutscher Sprache kein Fragebogen zur Erfassung der Symptombelastung bei Patienten mit Reizdarmsyndrom vor. Im englischsprachigen Raum steht ein solches Diagnostikum mit der Gastrointestinal Symptom Rating Scale- Irritable Bowel Syndrome (GSRS- IBS) zur Verfügung. Ziel dieser Studie ist die Entwicklung und Validierung der deutschen Version der GSRS-IBS, um diese Lücke zu schließen. Methodik: In die Studie wurden 372 Patienten eingeschlossen. Diese Probanden füllten die übersetzte Version des GSRS-IBS aus. Zur externen Validierung wurden zusätzlich Fragebögen zur Erfassung allgemeiner Körperbeschwerden (GBB-24) sowie von Angst und Depressivität (HADS-D) eingesetzt. Untersucht wurden drei Patientenstichproben (Patienten mit Reizdarmsyndrom, CED oder Psychosomatischen Erkrankungen) sowie eine Kontrollgruppe ohne Darmerkrankungen. Zur Prüfung der faktoriellen Struktur des Fragebogens wurde eine Hauptachsenanalyse mit obliquer Rotation (Oblimin) durchgeführt. Die psychometrischen Eigenschaften des Fragebogens wurden anhand von internen Konsistenzen (Cronbachs α), Itemschwierigkeiten und Trennschärfen beurteilt. Zur Überprüfung der Konstruktvalidität wurden Korrelationen zwischen dem Reizdarmfragebogen (RDF), der HADS-D und dem GBB-24 betrachtet. Ergebnisse: Die 5-faktorielle Struktur des englischsprachigen Fragebogens konnte weitgehend bestätigt werden. Die Faktorenanalyse in der Reizdarmstichprobe ergab eine 4-faktorielle Lösung, wobei die in der englischen Version gefundenen Faktoren Obstipation und Völlegefühl in der deutschsprachigen Variante einen gemeinsamen Faktor bildeten. Die Zuordnung der Items zu den Faktoren stimmt in weiten Teilen mit den Ergebnissen in der englischsprachigen Stichprobe überein. Bei Betrachtung des Gesamtwerts des Reizdarmfragebogens konnte man, wie erwartet, einen im Vergleich zu den übrigen Gruppen signifikant höheren Wert in der Reizdarmstichprobe erkennen. Bezüglich der Itemschwierigkeiten bewegte sich die Mehrzahl der Items im mittleren Bereich. Allerdings gab es auch eher leichte bzw. schwierige Items, was für eine gute Differenzierung des Fragebogens spricht. Die korrigierten Item-Skala-Korrelationen und die Reliabilitätsanalyse fielen sehr zufriedenstellend aus. Die Korrelationen zwischen dem Reizdarmfragebogen und der HADS-D sowie dem GBB-24 stützen die Konstruktvalidität des Verfahrens. Es zeigten sich in der Gesamtstichprobe hohe Korrelationen zwischen dem RDF und der Skala Magenbeschwerden des GBB-24 und mittlere Korrelationen mit den Skalen Angst und Depressivität der HADS-D. Interessant ist hier, dass in der Reizdarmstichprobe keine signifikante Korrelationen zwischen dem RDF und der HADS-D zu finden waren. Schlussfolgerung: Der Reizdarmfragebogen ist ein effizientes, valides und reliables Instrument zur Erfassung der Symptombelastung bei Reizdarmpatienten.Validation German version Irritable Bowel Syndrome Specific Symptom Questionnaire Background: According to the current scientific stand, there is no such questionnaire designated in Germany that records the symptom distress in patients with irritable bowel syndrome. Since 2003 there has been “Gastrointestinal Symptom Rating Scale- Irritable Bowel Syndrome (GSRS-IBS) by Wiklund specified for the English speaking countries. The aim of this study is the validation of the GSRS-IBS in the German version. Methods: The study includes 372 patients. All probands filled in the Reizdarmfragebogen, the GBB-24, and the HADS-D (a German Version of HADS). All patients were split into four categories. These four classes include the type of patients with irritable bowels syndrome, those with chronic inflammatory bowel diseases, and those with psychosomatic disorders. The fourth group used as a control group includes orthopedic patients and students. In order to analyze the factorial structure of the questionnaire, we used a principal axis analysis with oblique rotation (Oblimin). To show the psychometrically qualities of the Reizdarmfragebogen, we took a look at internal consistencies (Cronbachs α), the item difficulties, and the item-total correlations. The construct validity was verified by the correlation of the RDF, the HADS-D, and the GBB-24. Results: The factorial structure of the German data is rather similar to the structure found in the English sample. Just looking at the irritable bowel syndrome sample, we found a 4-factor-solution. The factors constipation and fullness, which were separated in the English version, only constitute one factor in the German sample. The factor loadings are roughly the same as in the English version. If you look at the aggregate value of the Reizdarmfragebogen, we could show a significant higher score in the group of the irritable bowel syndrome patients. During the statistic calculation of the item difficulty, we could demonstrate that most of the items show a medium difficulty, some are easy and others hard. This shows the excellent differentiation of the RDF. The item total-correlation and the reliability analysis were satisfactory. Considering the correlations between the RDF, the HADS-D, and the GBB-24, we found significant correlations between the RDF scores and the subscale stomach complains of the GBB-24. Moreover, there were medium correlations in the total sample between the RDF scores and anxiety and depression assessed by the HADS-D. Interestingly, there was no significant correlation between the HADS-D-subscales and the RDF score in the RDS subsample - a result which supports the bio-psycho-social model of RDS. Summary: The RDF is an efficient, valid, and reliable questionnaire to capture the symptom distress in patients with irritable bowel syndrome

Design and validation of a German version of the GSRS-IBS - an analysis of its psychometric quality and factorial structure

Background: Currently, a suitable questionnaire in German language is not available to monitor the progression and evaluate the severity of irritable bowel syndrome (IBS). Therefore, this study aimed to translate the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) into German and to evaluate its psychometric qualities and factorial structure. Methods: This study is based on a total sample of 372 participants [62.6% female, mean age = 41 years (SD = 17 years)]. 17.5% of the participants had a diagnosis of IBS, 19.9% were receiving treatment for chronic inflammatory bowel disease, 12.1% of the participants were recruited from a psychosomatic clinic, and 50.5% belonged to a control group. All participants completed the German version of GSRS-IBS (called Reizdarm-Fragebogen, RDF), as well as the Gießen Subjective Complaints List (GBB-24) and the Hospital Anxiety and Depression Scale - German version (HADS-D). Results: The internal consistency of the RDF total scale was at least satisfactory in all subsamples (Cronbach’s Alpha between .77 and .92), and for all subscales (Cronbach’s Alpha between .79 and .91). The item difficulties (between .25 and .73) and the item-total correlations (between .48 and .83) were equally satisfactory. Principal axis analysis revealed a four-factorial structure of the RDF items, which mainly resembled the structure of the English original. Convergent validity was established based on substantial and significant correlations with the stomach-complaint scale of the GBB-24 (r = .71; p < .01) and the anxiety (r = .42; p < .01) and depression scales (r = .43; p < .01) of the HADS-D. Conclusion: The German version of the GSRS-IBS RDF proves to be an effective, reliable, and valid questionnaire for the assessment of symptom severity in IBS, which can be used in clinical practice as well as in clinical studies

Comparative analysis of high-sensitivity cardiac troponin I and T for their association with coronary computed tomography-assessed calcium scoring represented by the Agatston score

Background: This study evaluates the association between high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) and coronary calcium concentration (CAC) detected by coronary computed tomography (CCT) and evaluated with the Agatston score in patients with suspected coronary artery disease (CAD). Methods: Patients undergoing CCT during routine clinical care were enrolled prospectively. CCT was indicated for patients with a low to intermediate pretest probability for CAD. Within 24 h of CCT examination, peripheral blood samples were taken to measure cardiac biomarkers hs-cTnI and hs-cTnT. Results: A total of 76 patients were enrolled including 38% without detectable CAC, 36% with an Agatston score from 1 to 100, 17% from 101 to 400, and 9% with values ≥ 400. hs-cTnI was increasing alongside Agatston score and was able to differentiate between different groups of Agatston scores. Both hs-cTn discriminated values greater than 100 (hs-cTnI, AUC = 0.663; p = 0.032; hs-cTnT, AUC = 0.650; p = 0.048). In univariate and multivariate logistic regression models, hs-cTnT and hs-cTnI were significantly associated with increased Agatston scores. Patients with hs-cTnT ≥ 0.02 µg/l and hs-cTnI ≥ 5.5 ng/l were more likely to reveal values ≥ 400 (hs-cTnT; OR = 13.4; 95% CI 1.545–116.233; p = 0.019; hs-cTnI; OR = 8.8; 95% CI 1.183–65.475; p = 0.034). Conclusion: The present study shows that the Agatston score was significantly correlated with hs cardiac troponins, both in univariable and multivariable linear regression models. Hs-cTnI is able to discriminate between different Agatston values. The present results might reveal potential cut-off values for hs cardiac troponins regarding different Agatston values. Trial registration Cardiovascular Imaging and Biomarker Analyses (CIBER), NCT03074253 https://clinicaltrials.gov/ct2/show/record/NCT0307425

Risk factor paradox: No prognostic impact of arterial hypertension and smoking in patients with ventricular tachyarrhythmias

Background: Data regarding the outcome of patients with ventricular tachyarrhythmias related to arterial hypertension (AHT) and smoking is limited. The study sought to assess the prognostic impact of AHT and smoking on survival in patients presenting with ventricular tachyarrhythmias. Methods: All consecutive patients surviving ventricular tachycardia (VT) and ventricular fibrillation (VF) upon admission to the University Medical Center Mannheim (UMM), Germany from 2002 to 2016 were included and stratified according to AHT and smoking by propensity score matching. The primary prognostic endpoint was all-cause mortality at 30 months.Results: A total of 988 AHT-matched patients (494 each, with and without AHT) and a total of 872 smoking-matched patients (436 each, with and without smoking) were included. The rates of VT and VF were similar in both groups (VT: AHT 60% vs. no AHT 60%; smokers 61% vs. non-smokers 62%; VF: AHT 35% vs. no AHT 38%; smokers 39% vs. non-smokers 38%). Neither AHT nor smoking were associated with the primary endpoint of long-term all-cause mortality at 30 months (long-term mortality rates: AHT/no AHT, 26% vs. 28%; log-rank p = 0.525; smoking/non-smoking, 22% vs. 25%; log-rank p = 0.683).Conclusions: Paradoxically, neither AHT nor smoking were associated with differences of long-term all-cause mortality in patients presenting with ventricular tachyarrhythmias

Type 2 diabetes is independently associated with all-cause mortality secondary to ventricular tachyarrhythmias

Objectives: The study sought to assess the prognostic impact of type 2 diabetes in patients presenting with ventricular tachyarrhythmias on admission. Background: Data regarding the prognostic outcome of diabetics presenting with ventricular tachyarrhythmias is limited. Methods: A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with type 2 diabetes (diabetics) were compared to non-diabetics applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint of long-term all-cause mortality at 2 years. Secondary prognostic endpoints were cardiac death at 24 h, in-hospital death at index, all-cause mortality at 30 days, all-cause mortality in patients surviving index hospitalization at 2 years (i.e. “after discharge”) and rehospitalization due to recurrent ventricular tachyarrhythmias at 2 years. Results: In 2411 unmatched high-risk patients with ventricular tachyarrhythmias, diabetes was present in 25% compared to non-diabetics (75%). Rates of VT (57% vs. 56%) and VF (43% vs. 44%) were comparable in both groups. Multivariable Cox regression models revealed diabetics associated with the primary endpoint of long-term all-cause mortality at 2 years (HR = 1.513; p = 0.001), which was still proven after propensity score matching (46% vs. 33%, log rank p = 0.001; HR = 1.525; p = 0.001). The rates of secondary endpoints were higher for in-hospital death at index, all-cause mortality at 30 days, as well as after discharge, but not for cardiac death at 24 h or rehospitalization due to recurrent ventricular tachyarrhythmias. Conclusion: Presence of type 2 diabetes is independently associated with an increase of all-cause mortality in patients presenting with ventricular tachyarrhythmias on admission

Prognostic impact of age and gender on patients with electrical storm

Background: Electrical storm (ES) is a severe and life-threatening heart rhythm disorder. Age and male gender have been identified as independent risk factors for cardiovascular diseases. However, data regarding the prognostic impact of age and gender on ES patients is limited. Methods: The present study included retrospectively consecutive patients presenting with ES from 2002 to 2016. Patients 67 years old or older were compared to patients younger than 67, males were also compared to females. Receiver operating characteristic analyses were performed to find the optimum age cut-off value. The primary endpoint was all-cause mortality at 3 years. The secondary endpoints were in-hospital mortality, rehospitalization rates, electrical storm recurrences (ES-R), and major adverse cardiac events (MACE) at 3 years. Results: Eighty-seven ES patients with implantable cardioverter-defibrillators were included. Age ≥ 67 years was associated with increased all-cause mortality at 3 years (48% vs. 20%, hazard ratio = 3.046; 95% confidence interval 1.316–7.051; p = 0.008; log-rank p = 0.006). MACE, in-hospital mortality, rehospitalization rates, and ES-R were not affected by age. Even after multivariate adjustment, age ≥ 67 years was associated with increased long-term mortality at 3 years, besides left ventricular ejection fraction < 35%. In contrast, gender was not associated with the primary and secondary endpoints. Conclusions: Patients 67 years old and older presenting with ES are associated with poor long-term prognosis at 3 years. Increased long-term mortality was still evident after multivariate adjustment. In contrast, gender was not associated with the primary and secondary endpoints

Technik hilft in der Rehabilitation - mit dem Lokomat lernen Patienten wieder zu gehen

In Deutschland sind etwa 1000 Menschen pro Jahr von einer neu auftretenden Querschnittlähmung betroffen. Die häufigsten Ursachen sind Erkrankungen wie Tumore oder Unfälle. Das Querschnittzentrum der Universität Heidelberg in Schlierbach ist auf Patienten mit Schädigungen des Rückenmarks spezialisiert. Bei einer inkompletten Lähmung kann ein individuelles Trainingsprogramm erhebliche Verbesserung bringen. Das Uniklinikum Heidelberg setzt dazu unter anderem den selbst mitentwickelten „Lokomaten“ ein