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Objective: The problematic use of computer games was included in the DSM-5 and in the ICD-11. Initial research revealed associa- tions between problematic gaming (PG) and quality of life (QoL). However, clarification is needed concerning which dimensions of the multidi- mensional construct QoL are particularly relevant for PG. Method: To answer this question empirically, we asked 503 parents (mean age: 47.63 years) to rate their 503 children (average age: 14.60 years) regarding QoL and PG, using validated questionnaires on parental assessments of adolescent PG and health-related QoL to collect the data. Correlation analyses were calculated to determine bivariate relations, and a multiple linear regression was used to conduct a multivariable analysis. Results: In the bivariate analyses, a higher severity of PG was associated with a lower health-related QoL in all five surveyed dimensions. In the multivariable model (corrected R2 = 0.35), we observed statistically significant associations between higher severity of PG and male sex and lower age of the adolescent as well as lower QoL in the dimensions of physical well-being and school environment. Conclusions: According to the findings of the present study, physical well-being and school environment should be especially focused on in preventive approaches against the development of PG in youth.
Objective: Despite increased awareness of the serious epilepsy complication sudden unexpected death in epilepsy (SUDEP), a substantial population of people with epilepsy (PWE) remain poorly informed. Physicians indicate concern that SUDEP information may adversely affect patients' health and quality of life. We examined SUDEP awareness and the immediate and long-term effects of providing SUDEP information to PWE.
Methods: Baseline knowledge and behaviors among PWE and behavioral adjustments following the provision of SUDEP information were evaluated in a prospective, multicenter survey using the following validated scales: Neurological Disorders Depression Inventory for Epilepsy for depression symptoms, the EuroQoL five-dimension scale for health-related quality of life (HRQoL), a visual analog scale for overall health, the revised Epilepsy Stigma Scale for perceived stigma, and the Seizure Worry Scale for seizure-related worries. The prospective study collected data through semiquantitative interviews before (baseline), immediately after, and 3 months after the provision of SUDEP information.
Results: In total, 236 participants (mean age = 39.3 years, range = 18-77 years, 51.7% women) were enrolled, and 205 (86.9%) completed long-term, 3-month follow-up. One patient died from SUDEP before follow-up. No worsening symptoms from baseline to 3-month follow-up were observed on any scale. At baseline, 27.5% of participants were aware of SUDEP. More than 85% of participants were satisfied with receiving SUDEP information. Three quarters of participants were not concerned by the information, and >80% of participants recommended the provision of SUDEP information to all PWE. Although most patients reported no behavioral adjustments, 24.8% reported strong behavioral adjustments at 3-month follow-up.
Significance: The provision of SUDEP information has no adverse effects on overall health, HRQoL, depressive symptoms, stigma, or seizure worry among PWE, who appreciate receiving information. SUDEP information provision might improve compliance among PWE and reduce but not eliminate the increased mortality risk.
Menschen mit Epilepsie (engl. PWE) haben im Vergleich zur Allgemeinbevölkerung ein erhöhtes Risiko, vorzeitig zu versterben. Der plötzliche, unerwartete Tod bei Epilepsie (engl. Sudden Unexpected Death in Epilepsy, kurz SUDEP) stellt die häufigste epilepsiebedingte Todesursache dar. Obwohl das Thema in Fachkreisen zunehmende Aufmerksamkeit erfährt, die Empfehlung zur SUDEP Aufklärung zunehmend in nationalen Leitlinien aufgenommen wird, und der Patientenwunsch nach einer generellen SUDEP Aufklärung in verschiedenen Studien gezeigt werden konnte, besteht weiterhin ein Informationsdefizit unter PWE. Ursache hierfür scheint insbesondere die Sorge der behandelnden Neurolog*innen zu sein, Menschen mit Epilepsie übermäßig emotional zu belasten und ihre Lebensqualität zu mindern. Diese Studie untersucht sowohl das Vorwissen über SUDEP als auch unmittelbare sowie langfristige Auswirkungen einer SUDEP Aufklärung auf Erwachsene mit Epilepsie. Ziel ist mögliche negative Auswirkungen der Aufklärung sowie Auswirkungen auf das Verhalten aufzudecken. Aus diesem Zweck wählten wir ein prospektives, multizentrisches, longitudinales Studiendesign. Die Daten wurden in halbquantitativen Interviews vor (vor der Aufklärung), unmittelbar nach (nach der Aufklärung) und drei Monate nach (3-Monats Follow-up) der SUDEP Aufklärung erhoben. Um die direkte Vergleichbarkeit zwischen den Zeitpunkten zu ermöglichen wurden folgende validierte Instrumente verwendet: das Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) zur Erfassung depressiver Symptome, der EuroQoL (EQ-5D) zur Erfassung der gesundheitsbezogenen Lebensqualität (HRQoL), eine visuelle Analogskala (VAS) zur Erfassung des allgemeinen Gesundheitszustandes, die revised Epilepsy Stigma Scale (rESS) zur Erfassung der wahrgenommenen Stigmatisierung und die Seizure Worry Scale zur Erfassung anfallsbezogener Sorgen. Insgesamt wurden 236 Teilnehmende (Durchschnittsalter: 39,3 Jahre, Spannweite: 18-77 Jahre, 51,7 % Frauen) in die Studie eingeschlossen. 205 (86,9 %) der Teilnehmenden konnten erneut im Langzeit Follow-up nach drei Monaten befragt werden. Eine der Teilnehmenden verstarb im Zeitraum des Follow-ups an SUDEP. Keines der validierten Instrumente zeigte zwischen den Zeitpunkten vor der Aufklärung und dem 3-Monats Follow-up eine Verschlechterung. Vor der Aufklärung hatten nur 27,5 % der Teilnehmenden von SUDEP gehört, und nur 9,3 % gaben an, diese Informationen von ihrer bzw. ihrem Neurolog*in erhalten zu haben. Nach der Aufklärung gaben mehr als 85 % der Teilnehmenden an, mit der SUDEP Aufklärung zufrieden oder sehr zufrieden zu sein. Drei Viertel der Teilnehmenden gaben an, durch die Aufklärung nicht oder überhaupt nicht belastet zu sein. Mehr als 80 % der Teilnehmenden befürworteten eine generelle SUDEP Aufklärung für alle Menschen mit Epilepsie. Bei dem 3-Monats Follow-up gab die Mehrheit der Teilnehmenden an, keine Verhaltensänderung vorgenommen zu haben, 24,8 % berichteten jedoch von starken Verhaltensänderungen.
Unsere Studie zeigt, dass eine SUDEP Aufklärung keine negativen Auswirkungen auf den allgemeinen Gesundheitszustand, die HRQoL, depressive Symptome, krankheitsbezogene Stigmatisierung oder Sorgen vor Anfällen hat. Insgesamt zeigte sich eine hohe Zustimmung zur SUDEP Aufklärung. Eine generelle SUDEP Aufklärung könnte sich zudem positiv auf die Compliance auswirken und das Mortalitätsrisiko senken. Eine SUDEP Aufklärung bietet allerdings keinen sicheren Schutz vor SUDEP.
Objective: To determine the impact of an exercise-based prehabilitation (EBPrehab) program on preand postoperative exercise capacity, functional capacity (FC) and quality of life (QoL) in patients awaiting elective coronary artery bypass graft surgery (CABG).
Design: A two-group randomized controlled trail.
Setting: Ambulatory prehabilitation.
Subjects: Overall 230 preoperative elective CABG-surgery patients were randomly assigned to an intervention (IG, n=88; n=27 withdrew after randomization) or control group (CG, n=115).
Intervention: IG: two-week EBPrehab including supervised aerobic exercise. CG: usual care.
Main measures: At baseline (T1), one day before surgery (T2), at the beginning (T3) and at the end of cardiac rehabilitation (T4) the following measurements were performed: cardiopulmonary exercise test, six-minute walk test (6MWT), Timed-Up-and-Go Test (TUG) and QoL (MacNew questionnaire).
Results: A total of 171 patients (IG, n=81; CG, n=90) completed the study. During EBPrehab no complications occurred. Preoperatively FC (6MWTIG: 443.0±80.1m to 493.5±75.5m, P=0.003; TUGIG: 6.9±2.0 s to 6.1±1.8 s, P=0.018) and QoL (IG: 5.1±0.9 to 5.4±0.9, P<0.001) improved significantly more in IG compared to CG. Similar effects were observed postoperatively in FC (6MWDIG: Δ-64.7m, pT1–T3=0.013; Δ+47.2m, pT1–T4<0.001; TUGIG: Δ+1.4s, pT1–T3=0.003).
Conclusions: A short-term EBPrehab is effective to improve perioperative FC and preoperative QoL in patients with stable coronary artery disease awaiting CABG-surgery.
Background: The treatment of severely injured patients, especially in older age, is complex, and based on strict guidelines. Methods: We conducted a retrospective study by analyzing our internal registry for mortality risk factors in deceased trauma patients. All patients that were admitted to the trauma bay of our level-1-trauma center from 2014 to 2018, and that died during the in-hospital treatment, were included. The aim of this study was to carry out a quality assurance concerning the initial care of severely injured patients. Results: In the 5-year period, 135 trauma patients died. The median (IQR) age was 69 (38–83) years, 71% were male, and the median (IQR) Injury Severity Score (ISS) was 25 (17–34) points. Overall, 41% of the patients suffered from severe traumatic brain injuries (TBI) (AIShead ≥ 4 points). For 12.7%, therapy was finally limited owing to an existing patient’s decree; in 64.9% with an uncertain prognosis, a ‘therapia minima’ was established in consensus with the relatives. Conclusion: Although the mortality rate was primarily related to the severity of the injury, a significant number of deaths were not exclusively due to medical reasons, but also to a self-determined limitation of therapy for severely injured geriatric patients. The conscientious documentation concerning the will of the patient is increasingly important in supporting medical decisions.
Introduction: Cancer patients tend to prefer oral instead of parenteral chemotherapy. To date, there is little evidence on the medication adherence in cancer patients. We investigated medication adherence to tyrosine kinase inhibitors in patients suffering from non-small cell lung cancer. Methods: Tyrosine kinase inhibitor adherence was measured electronically by MEMS® (medication event monitoring system) over at least six months. Adherence rates were calculated in terms of Dosing Compliance, Timing Compliance, Taking Compliance, and Drug Holidays. Patients were dichotomized as adherent when Dosing Compliance and Timing Compliance were ≥80%, Taking Compliance ranged between 90 and 110%, and <1 Drug Holiday was registered. Quality of life was assessed by two questionnaires (EORTC QLQ-C30 version 3.0, EORTC QLQ-LC13) at three time points. Adverse drug events were reported via patient diaries. Results: Out of 32 patients enrolled, data from 23 patients were evaluable. Median Dosing Compliance, Taking Compliance, and Timing Compliance adherence rates of tyrosine kinase inhibitor intake amounted to 100%, 98%, and 99%, respectively; Drug Holidays were observed in three patients. Four patients were dichotomized as non-adherent. Three of them had a twice-daily tyrosine kinase inhibitor regimen. Median quality of life scores amounted to 67 (max. 100) and remained unchanged over the study period. Fatigue and rash were the most frequently reported adverse drug events. Conclusion: Medication adherence of non-small cell lung cancer patients treated with tyrosine kinase inhibitors was extraordinarily high and is likely to support the effectiveness of tyrosine kinase inhibitor treatment and a good quality of life over a long period of time. Adherence facilitating information and education is especially relevant for patients taking tyrosine kinase inhibitors in a twice-daily regimen.
Objectives: Gliomas are often diagnosed due to epileptic seizures as well as neurocognitive deficits. First treatment choice for patients with gliomas in speech-related areas is awake surgery, which aims at maximizing tumor resection while preserving or improving patient’s neurological status. The present study aimed at evaluating neurocognitive functioning and occurrence of epileptic seizures in patients suffering from gliomas located in language-related areas before and after awake surgery as well as during their follow up course of disease.
Materials and Methods: In this prospective study we included patients who underwent awake surgery for glioma in the inferior frontal gyrus, superior temporal gyrus, or anterior temporal lobe. Preoperatively, as well as in the short-term (median 4.1 months, IQR 2.1-6.0) and long-term (median 18.3 months, IQR 12.3-36.6) postoperative course, neurocognitive functioning, neurologic status, the occurrence of epileptic seizures and number of antiepileptic drugs were recorded.
Results: Between 09/2012 and 09/2019, a total of 27 glioma patients, aged 36.1 ± 11.8 years, were included. Tumor resection was complete in 15, subtotal in 6 and partial in 6 patients, respectively. While preoperatively impairment in at least one neurocognitive domain was found in 37.0% of patients, postoperatively, in the short-term, 36.4% of patients presented a significant deterioration in word fluency (p=0.009) and 34.8% of patients in executive functions (p=0.049). Over the long-term, scores improved to preoperative baseline levels. The number of patients with mood disturbances significantly declined from 66.7% to 34.8% after surgery (p=0.03). Regarding seizures, these were present in 18 (66.7%) patients prior to surgery. Postoperatively, 22 (81.5%) patients were treated with antiepileptic drugs with all patients presenting seizure-freedom.
Conclusions: In patients suffering from gliomas in eloquent areas, the combination of awake surgery, regular neurocognitive assessment - considering individual patients´ functional outcome and rehabilitation needs – and the individual adjustment of antiepileptic therapy results in excellent patient outcome in the long-term course.
Background: Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue-penetration and with a low thermal burden to the surface of the skin. wIRA is able to improve essential and energetically meaningful factors of wound healing by thermal and non-thermal effects.
Aim of the study: prospective study (primarily planned randomised, controlled, blinded, de facto with one exception only one cohort possible) using wIRA in the treatment of patients with recalcitrant chronic venous stasis ulcers of the lower legs with thermographic follow-up.
Methods: 10 patients (5 males, 5 females, median age 62 years) with 11 recalcitrant chronic venous stasis ulcers of the lower legs were treated with water-filtered infrared-A and visible light irradiation (wIRA(+VIS), Hydrosun® radiator type 501, 10 mm water cuvette, water-filtered spectrum 550–1400 nm) or visible light irradiation (VIS; only possible in one patient). The uncovered wounds of the patients were irradiated two to five times per week for 30 minutes at a standard distance of 25 cm (approximately 140 mW/cm2 wIRA and approximately 45 mW/cm2 VIS). Treatment continued for a period of up to 2 months (typically until closure or nearly closure of the ulcer). The main variable of interest was “percent change of ulcer size over time” including complete wound closure. Additional variables of interest were thermographic image analysis, patient’s feeling of pain in the wound, amount of pain medication, assessment of the effect of the irradiation (by patient and by clinical investigator), assessment of feeling of the wound area (by patient), assessment of wound healing (by clinical investigator) and assessment of the cosmetic state (by patient and by clinical investigator). For these assessments visual analogue scales (VAS) were used.
Results: The study showed a complete or nearly complete healing of lower leg ulcers in 7 patients and a clear reduction of ulcer size in another 2 of 10 patients, a clear reduction of pain and pain medication consumption (e.g. from 15 to 0 pain tablets per day), and a normalization of the thermographic image (before the beginning of the therapy typically hyperthermic rim of the ulcer with relative hypothermic ulcer base, up to 4.5°C temperature difference). In one patient the therapy of an ulcer of one leg was performed with the fully active radiator (wIRA(+VIS)), while the therapy of an ulcer of the other leg was made with a control group radiator (only VIS without wIRA), showing a clear difference in favour of the wIRA treatment. All mentioned VAS ratings improved remarkably during the period of irradiation treatment, representing an increased quality of life. Failures of complete or nearly complete wound healing were seen only in patients with arterial insufficiency, in smokers or in patients who did not have venous compression garment therapy.
Discussion and conclusions: wIRA can alleviate pain considerably (with an impressive decrease of the consumption of analgesics) and accelerate wound healing or improve a stagnating wound healing process and diminish an elevated wound exudation and inflammation both in acute and in chronic wounds (in this study shown in chronic venous stasis ulcers of the lower legs) and in problem wounds including infected wounds. In chronic recalcitrant wounds complete healing is achieved, which was not reached before. Other studies have shown that even without a disturbance of wound healing an acute wound healing process can be improved (e.g. reduced pain) by wIRA.
wIRA is a contact-free, easily used and pleasantly felt procedure without consumption of material with a good penetration effect, which is similar to solar heat radiation on the surface of the earth in moderate climatic zones. Wound healing and infection defence (e.g. granulocyte function including antibacterial oxygen radical formation of the granulocytes) are critically dependent on a sufficient energy supply (and on sufficient oxygen). The good clinical effect of wIRA on wounds and also on problem wounds and wound infections can be explained by the improvement of both the energy supply and the oxygen supply (e.g. for the granulocyte function). wIRA causes as a thermal effect in the tissue an improvement in three decisive factors: tissue oxygen partial pressure, tissue temperature and tissue blood flow. Besides this non-thermal effects of infrared-A by direct stimulation of cells and cellular structures with reactions of the cells have also been described. It is concluded that wIRA can be used to improve wound healing, to reduce pain, exudation, and inflammation and to increase quality of life.
In dieser Studie wurden Patienten untersucht, die einen malignen Hirninfarkt erlitten hatten und mit Hilfe der dekompressiven Hemikraniektomie behandelt wurden. Es wurden die funktionelle Beeinträchtigung, die Körperbehinderung und die Lebensqualität untersucht. Die Patienten wurden sechs Monate nach dem Ereignis kontaktiert, um eine Nachuntersuchung durchzuführen. Dabei wurden die Patienten bezüglich ihrer Beeinträchtigung, Körperbehinderung und Lebensqualität beurteilt. Die Studie beinhaltete 36 Patienten. Daraus resultiert eine Überlebensrate von 64%. Bei 10 Patienten wurde die Beeinträchtigung mit dem Barthel Index mit 50 Punkten beurteilt. In drei Fällen betrug der BI 90 Punkte. Die Mehrheit der Patienten (12) zeigte ernste Beeinträchtigungen (BI<50). Die Behinderung korrelierte negativ mit dem Patientenalter. 16 Patienten waren nicht in der Lage zu gehen und benötigten bei der täglichen Arbeit Hilfe, was einen mRS von 4 oder 5 Punkten entspricht. Keiner der Patienten erreichte einen unabhängigen Status. Patienten, die eine höhere BI-Punktezahl hatten, waren signifikant jünger, hatten weniger schwere Beeinträchtigungen bei der Krankenhausaufnahme, wurden kürzer mechanisch ventiliert und verließen die Intensivstation früher. Die Schwere der Angst oder der Depression korrelierte dabei signifikant mit der Schwere der Behinderung. Die dekompressive Hemikraniektomie verbessert die Überlebensrate dramatisch, reduziert aber nicht die Größe des Infarktvolumens. Die Mehrzahl der Patienten wurde durch den Infarkt deutlich in ihrem Leben beeinträchtigt. Insgesamt ist die Lebensqualität reduziert.
Purpose: DINO and DACOTA were prospective, noninterventional studies assessing the health status and quality of life of patients with COPD newly treated with roflumilast 500 µg once-daily add-on therapy.
Patients and methods: Patients were evaluated over 6 months. Clinical COPD questionnaire (CCQ) and COPD assessment test (CAT) scores were recorded at baseline and after 3 and 6 months. In DACOTA, post-bronchodilator FEV1 was recorded at each time point.
Results: Of 5,462 and 3,645 patients recruited into DINO and DACOTA, respectively, 3,274 patients in DINO and 916 patients in DACOTA completed the 6-month visit. Almost all patients had severe or very severe airway obstruction; mean baseline CCQ total score was 3.9 in DINO and 3.7 in DACOTA. Overall, 33.8% of patients in DACOTA and 30.6% in DINO discontinued treatment prematurely. Significant and clinically relevant improvements in CCQ total scores were observed in both studies (mean change from baseline of 1.36 in DINO and 0.91 in DACOTA at Month 6 [all P<0.001]). Changes in CAT total score from baseline to Month 6 indicated that the average clinical impact of COPD was reduced from a severe (score: 21–30) to a moderate (score: 11–20) impairment. In DACOTA, mean change in post-bronchodilator FEV1 was 202 mL (P<0.001). Diarrhea, nausea, and weight decrease were the most frequently reported adverse drug reactions.
Conclusion: In real-life clinical practice, roflumilast treatment as an add-on therapy is associated with clinically relevant improvements in health status and quality of life.