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155. Symptom Burden before and after Dialysis Initiation in Older Patients

Author

de Rooij, Esther N.M., Meuleman, Yvette, de Fijter, Johan W., Jager, Kitty J., Chesnaye, Nicholas C., Evans, Marie, Caskey, Fergus J., Torino, Claudia, Porto, Gaetana, Szymczak, Maciej, Drechsler, Christiane, Wanner, Christoph, Dekker, Friedo W., Hoogeveen, Ellen K., Schneider, Andreas, Torp, Anke, Iwig, Beate, Perras, Boris, Marx, Christian, Drechsler, Christiane, Blaser, Christof, Wanner, Christoph, Emde, Claudia, Krieter, Detlef, Fuchs, Dunja, Irmler, Ellen, Platen, Eva, Schmidt-Gürtler, Hans, Schlee, Hendrik, Naujoks, Holger, Schlee, Ines, Cäsar, Sabine, Beige, Joachim, Röthele, Jochen, Mazur, Justyna, Hahn, Kai, Blouin, Katja, Neumeier, Katrin, Anding-Rost, Kirsten, Schramm, Lothar, Hopf, Monika, Wuttke, Nadja, Frischmuth, Nikolaus, Ichtiaris, Pawlos, Kirste, Petra, Schulz, Petra, Aign, Sabine, Biribauer, Sandra, Manan, Sherin, Röser, Silke, Heidenreich, Stefan, Palm, Stephanie, Schwedler, Susanne, Delrieux, Sylke, Renker, Sylvia, Schättel, Sylvia, Stephan, Theresa, Schmiedeke, Thomas, Weinreich, Thomas, Leimbach, Til, Stövesand, Torsten, Bahner, Udo, Seeger, Wolfgang, Cupisti, Adamasco, Sagliocca, Adelia, Ferraro, Alberto, Mele, Alessandra, Naticchia, Alessandro, Còsaro, Alex, Ranghino, Andrea, Stucchi, Andrea, Pignataro, Angelo, De Blasio, Antonella, Pani, Antonello, Tsalouichos, Aris, Antonio, Bellasi, Di Iorio, Biagio Raffaele, Alessandra, Butti, Abaterusso, Cataldo, Somma, Chiara, D’alessandro, Claudia, Torino, Claudia, Zullo, Claudia, Pozzi, Claudio, Bergamo, Daniela, Ciurlino, Daniele, Motta, Daria, Russo, Domenico, Favaro, Enrico, Vigotti, Federica, Ansali, Ferruccio, Conte, Ferruccio, Cianciotta, Francesca, Giacchino, Francesca, Cappellaio, Francesco, Pizzarelli, Francesco, Greco, Gaetano, Porto, Gaetana, Bigatti, Giada, Marinangeli, Giancarlo, Cabiddu, Gianfranca, Fumagalli, Giordano, Caloro, Giorgia, Piccoli, Giorgina, Capasso, Giovanbattista, Gambaro, Giovanni, Tognarelli, Giuliana, Bonforte, Giuseppe, Conte, Giuseppe, Toscano, Giuseppe, Del Rosso, Goffredo, Capizzi, Irene, Baragetti, Ivano, Oldrizzi, Lamberto, Gesualdo, Loreto, Biancone, Luigi, Magnano, Manuela, Ricardi, Marco, Di Bari, Maria, Laudato, Maria, Sirico, Maria Luisa, Ferraresi, Martina, Provenzano, Michele, Malaguti, Moreno, Palmieri, Nicola, Murrone, Paola, Cirillo, Pietro, Dattolo, Pietro, Acampora, Pina, Nigro, Rita, Boero, Roberto, Scarpioni, Roberto, Sicoli, Rosa, Malandra, Rosella, Savoldi, Silvana, Bertoli, Silvio, Borrelli, Silvio, Maxia, Stefania, Maffei, Stefano, Mangano, Stefano, Cicchetti, Teresa, Rappa, Tiziana, Palazzo, Valentina, De Simone, Walter, Schrander, Anita, van Dam, Bastiaan, Siegert, Carl, Gaillard, Carlo, Beerenhout, Charles, Verburgh, Cornelis, Janmaat, Cynthia, Hoogeveen, Ellen, Hoorn, Ewout, Dekker, Friedo, Boots, Johannes, Boom, Henk, Eijgenraam, Jan-Willem, Kooman, Jeroen, Rotmans, Joris, Jager, Kitty, Vogt, Liffert, Raasveld, Maarten, Vervloet, Marc, van Buren, Marjolijn, van Diepen, Merel, Chesnaye, Nicholas, Leurs, Paul, Voskamp, Pauline, Blankestijn, Peter, van Esch, Sadie, Boorsma, Siska, Berger, Stefan, Konings, Constantijn, Aydin, Zeynep, Musiała, Aleksandra, Szymczak, Anna, Olczyk, Ewelina, Augustyniak-Bartosik, Hanna, Miśkowiec-Wiśniewska, Ilona, Manitius, Jacek, Pondel, Joanna, Jędrzejak, Kamila, Nowańska, Katarzyna, Nowak, Łukasz, Szymczak, Maciej, Durlik, Magdalena, Dorota, Szyszkowska, Nieszporek, Teresa, Heleniak, Zbigniew, Jonsson, Andreas, Blom, Anna-Lena, Rogland, Björn, Wallquist, Carin, Vargas, Denes, Dimény, Emöke, Sundelin, Fredrik, Uhlin, Fredrik, Welander, Gunilla, Hernandez, Isabel Bascaran, Gröntoft, Knut-Christian, Stendahl, Maria, Svensson, Maria, Evans, Marie, Heimburger, Olof, Kashioulis, Pavlos, Melander, Stefan, Almquist, Tora, Jensen, Ulrika, Woodman, Alistair, McKeever, Anna, Ullah, Asad, McLaren, Barbara, Harron, Camille, Barrett, Carla, O'Toole, Charlotte, Summersgill, Christina, Geddes, Colin, Glowski, Deborah, McGlynn, Deborah, Sands, Dympna, Caskey, Fergus, Roy, Geena, Hirst, Gillian, King, Hayley, McNally, Helen, Masri-Senghor, Houda, Murtagh, Hugh, Rayner, Hugh, Turner, Jane, Wilcox, Joanne, Berdeprado, Jocelyn, Wong, Jonathan, Banda, Joyce, Jones, Kirsteen, Haydock, Lesley, Wilkinson, Lily, Carmody, Margaret, Weetman, Maria, Joinson, Martin, Dutton, Mary, Matthews, Michael, Morgan, Neal, Bleakley, Nina, Cockwell, Paul, Roderick, Paul, Mason, Phil, Kalra, Philip, Sajith, Rincy, Chapman, Sally, Navjee, Santee, Crosbie, Sarah, Brown, Sharon, Tickle, Sheila, Mathavakkannan, Suresh, and Kuan, Ying more...

Published
2022
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156. Translation of Collaborative Dementia Care Management into Different Healthcare Settings: Study Protocol for a Multicenter Implementation Trial (DCM:IMPact)

Author

Platen, Moritz, Hoffmann, Wolfgang, Rädke, Anika, Scharf, Annelie, Mohr, Wiebke, Mühlichen, Franka, and Michalowsky, Bernhard

Abstract

Background: Collaborative care models for people living with dementia (PwD) have been developed and evaluated, demonstrating safety, efficacy, and cost-effectiveness. However, these studies are based on heterogeneous study populations and primary care settings, limiting the generalizability of the results. Therefore, this study aims to implement and evaluate collaborative care across various healthcare settings and patient populations.Objective: To describe the study design of this multicenter implementation trial.Methods: This single-arm, multicenter, longitudinal implementation study will be conducted in five different healthcare settings, including 1) physicians’ networks, 2) dementia networks, 3) counselling centers, 4) hospitals, and 5) ambulatory care services. Eligibility criteria are: having a formal dementia diagnosis or having been screened positive for dementia and living community-dwelling. The staff of each healthcare setting identifies patients, informs them about the study, and invites them to participate. Participants will receive a baseline assessment followed by collaborative individualized dementia care management, comprising proven safe, effective, and cost-effective modules. Over six months, specially-qualified nurses will assess patients’ unmet needs, transfer them to individualized care plans, and address them, cooperating with various healthcare providers. A follow-up assessment is conducted six months after baseline. Approximately 60–100 PwD per setting per year are expected to participate. Differences across settings will be assessed regarding acceptability, demand, implementation success and barriers, efficacy, and cost-effectiveness.Results: We expect that acceptability, demand, implementation success and barriers, efficacy, and cost-effectiveness will vary by patients’ sociodemographic and clinical characteristics and unmet needs in each setting.Conclusion: The results will provide evidence highlighting differences in the implementation of collaborative care in various healthcare settings and demonstrating the settings with the highest need, best conditions for a successful implementation, and highest (cost-)effectiveness, as well as the population group that benefits most from collaborative care.Trial registration: German Clinical Trials Register: DRKS00025074. Registered 16 April 2021-retrospectively registered. more...

Published
2022
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157. Association Between Low- and High-Value Medication and Hospital Referrals by General Practitioners in Patients Living with Dementia

Author

Michalowsky, Bernhard, Platen, Moritz, Bohlken, Jens, and Kostev, Karel

Abstract

Background: Previous studies revealed that low-value medication (LvM), drugs that provide little or no benefit but have the potential to cause harm, are associated with hospitalizations in dementia. Recommended medications, referred to as high-value medication (HvM), can be used alternately. However, the effect of LvM and HvM on hospitalizations is uncertain.Objective: To determine the prevalence of LvM and HvM in hospitalized and non-hospitalized patients living with dementia (PwD) and the odds for hospital referrals in PwD receiving LvM or HvM.Methods: The analysis was based on 47,446 PwD who visited a general practitioner practice between 2017 and 2019. Different guidelines were used to elicit LvM and HvM, resulting in 185 LvM and HvM related recommendations. Of these, 117 recommendations (83 for LvM, 34 for HvM) were categorized into thirteen therapy classes. The association of hospital referrals issued by general practitioners and receiving LvM or HvM was assessed using multiple logistic regression models.Results: 20.4% of PWD received LvM. Most frequently prescribed LvM were non-recommended sedatives and hypnotics, analgesics, and antidepressants. Recommended HvM were 3.4 (69.9%) more frequently prescribed than LvM. Most commonly prescribed HvM were recommended antihypertensives, antiplatelet agents, and antiarrhythmics. Both receiving LvM and receiving HvM were associated with higher odds for hospital referrals. When receiving LvM were compared to HvM, no significant differences could be found in hospital referrals.Conclusion: LvM is highly prevalent but did not cause more likely hospital referrals than HvM. Further research should focus on acute hospitalizations, not only on planned hospital referrals. more...

Published
2022
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180. Correspondence Prescriptions for Potentially Inappropriate Medication (PIM): Prevalence and Rank List of the Most Common Active Substances.

Author

Wohlgemuth, A., Michalowsky, B., Hoffmann, W., Platen, M., Engeli, S., Wucherer, D., and Ittermann, T.

Abstract

The term "potentially inadequate medication" (PIM) describes medications or active substances that should not be prescribed to older persons because of their adverse effects profile. Such relative contraindications should always be considered in the overall context and in view of comorbidities and further medications. The PRISCUS 2.0 list was published recently--a revised version of a PIM list for the German pharmaceutical market (1). When considering the number of older patients in the healthcare system for whom these medications may pose risks, this topic is more topical than ever. Thus far only few published data exist on the prevalence of PIMs and their development as well as on the PIM substances most commonly prescribed in primary care in Germany. [ABSTRACT FROM AUTHOR] more...

Published
2024
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183. Phosphorus recovery by re-dissolution from activated sludge – effects of carbon source and supplementation level revisitedElectronic supplementary information (ESI) available. See DOI: https://doi.org/10.1039/d2ew00356b

Author

Anders, Annika, Weigand, Harald, and Platen, Harald

Abstract

Municipal sewage sludge is a sink for wastewater-borne phosphorus (P) and a source for P recovery. Many wastewater treatment plants (WWTPs) employ the enhanced biological P removal (EBPR) which relies on the ability of polyphosphate accumulating organisms (PAOs) to store P in the biomass. Inversion of EBPR may provide a tool for on-site P recovery from activated sludge (AS). Key features of anaerobic P release and the metabolism of acclimated PAOs are well known from laboratory experiments. However, uncertainty persists regarding the behavior of non-acclimated sludge which hampers the practical implementation of P recovery. In this light, we revisited the effects of volatile fatty acid supplementation (formate, acetate, propionate, and butyrate) on the anaerobic P re-dissolution from non-acclimated AS of a full-scale WWTP. All supplementations induced P re-dissolution but the highest re-dissolution was observed with acetate (1.54–1.68 mmol P L−1) with a Pyield/VFAconsumedratio of 0.45. For AS with 6.3 gTSSL−1, a supplementation level of 200 mg L−1acetate was most efficient. Recovery amounted to 21–24% of total P within 300 min. Surprisingly, P re-dissolution continued even after acetate had been fully consumed. From the energetic viewpoint, this seems contradictory. Therefore, we integrated the process stoichiometry with known metabolic pathways accounting for the main electron, energy, carbon and P flows for the acetate-induced P re-dissolution. Results show that induction of anaerobiosis in AS from the EBPR process is, indeed, a viable technical option for P recovery. Yet, efficiency needs to be improved since P re-dissolution was either limited by acetate uptake capacity or by available polyphosphate. more...

Published
2022
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192. Psychosocial subgroups in high-performance athletes with low back pain: eustress-endurance is most frequent, distress-endurance most problematic!

Author

Titze, Christina, Fett, Daniela, Trompeter, Katharina, Platen, Petra, Gajsar, Hannah, and Hasenbring, Monika I.

Abstract

Objectives: In non-athletes, fear-avoidance and endurance-related pain responses appear to influence the development and maintenance of low back pain (LBP). The avoidance-endurance model (AEM) postulates three dysfunctional pain response patterns that are associated with poorer pain outcomes. Whether comparable relationships are present in athletes is currently unclear. This cross-sectional case-control study explored frequencies and behavioral validity of the AEM-based patterns in athletes with and without LBP, as well as their outcome-based validity in athletes with LBP. Methods: Based on the Avoidance-Endurance Fast-Screen, 438 (57.1% female) young adult high-performance athletes with and 335 (45.4% female) without LBP were categorized as showing a "distress-endurance" (DER), "eustress-endurance" (EER), "fear-avoidance" (FAR) or "adaptive" (AR) pattern. Results: Of the athletes with LBP, 9.8% were categorized as FAR, 20.1% as DER, 47.0% as EER, and 23.1% as AR; of the athletes without LBP, 10.4% were categorized as FAR, 14.3% as DER, 47.2% as EER, and 28.1% as AR. DER and EER reported more pronounced endurance- and less pronounced avoidance-related pain responses than FAR, and vice versa. DER further reported the highest training frequency. In athletes with LBP, all dysfunctional groups reported higher LBP intensity, with FAR and DER displaying higher disability scores than AR. Conclusions: The results indicate that also in athletes, patterns of endurance- and fear-avoidance-related pain responses appear dysfunctional with respect to LBP. While EER occurred most often, DER seems most problematic. Implications: Endurance-related pain responses that might be necessary during painful exercise should therefore be inspected carefully when shown in response to clinical pain. [ABSTRACT FROM AUTHOR] more...

Published
2021
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194. Medicine in Spine Exercise [MiSpEx] – a national research network to evaluate back pain

Author

Mayer, F, primary, Arampatzis, A, additional, Banzer, W, additional, Beck, H, additional, Brüggemann, G-P, additional, Hasenbring, M, additional, Kellmann, M, additional, Kleinert, J, additional, Schiltenwolf, M, additional, Schmidt, H, additional, Schneider, C, additional, Stengel, D, additional, Wippert, P-M, additional, and Platen, P, additional more...

Published
2018
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196. Impact of Low‐value Medications in Dementia on Patient‐reported Health‐related Quality of Life, Hospitalizations, and Direct Health Care Costs.

Author

Platen, Moritz, Flessa, Steffen, Teipel, Stefan, Raedke, Anika, Scharf, Annelie, Mohr, Wiebke, Buchholz, Maresa, Hoffmann, Wolfgang, and Michalowsky, Bernhard

Abstract

Background: Persons living with dementia (PwD) are commonly affected by low‐value medications (Lvm), i.e., medications unlikely to benefit patients but to cause harm. Lvm in PwD have been associated with negative physical, psychological, and financial outcomes. However, longitudinal effects have not yet been evaluated. Therefore, we aimed to analyze the impact of Lvm on patient‐centered outcomes among PwD over 24 months. Method: This longitudinal analysis was based on 352 community‐dwelling PwD. Data were assessed at baseline and after 12 and 24 months. Medications that were explicitly not recommended were used to identify Lvm dichotomously (yes/no) and cumulatively (once, over one or two years). The 12‐Item Short‐Form Health Survey assessed patients' health‐related quality of life (HRQoL). Hospitalizations were assessed retrospectively for 12 months. Health care costs were monetarized by standardized unit costs. Multiple panel‐specific regression models were applied to analyze the impact of Lvm on HRQoL, hospitalizations and costs. Result: Over 24 months, 182 PwD (52%) received Lvm at least once and 56 (16%) continuously. The Lvm prevalence decreased from 36% (CI95% 30.8% – 40.8%) at baseline to 29% (CI95% 24.2% – 33.7%) two years later. Treating PwD with Lvm significantly increased the risk of hospitalization by 58% (CI95% 1.14 OR – 2.19 OR; p = 0.006), increased health care costs by €5,359 (CI95% ‐790€ – 11,508€; p = 0.088), and reduced patients' HRQoL (b = ‐1.81; CI95% ‐3.00 – ‐0.63; p = 0.003). HRQoL declined more strongly the longer that Lvm was received, whereas hospitalizations and health care costs were substantially affected by short‐term Lvm use, indicated by an increased hospitalization risk due to receiving Lvm over one year of 178% (CI95% 1.32 OR – 5.86 OR; p = 0.007) and costs for receiving Lvm once of €8,939 (CI95% €‐590€ – €18,469; p = 0.066). Conclusion: More than every second PwD received Lvm once, up to 12 months or continuously over 24 months, negatively impacting patient‐reported HRQoL, hospitalizations, and costs. While continuous Lvm intake decreased patients' HRQoL, receiving Lvm in the short term was relevant regarding further increases in hospitalizations and costs. Innovative approaches are needed to encourage prescribers to avoid and replace Lvm in dementia care. [ABSTRACT FROM AUTHOR] more...

Published
2023
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198. Kidney Failure Prediction Models: A Comprehensive External Validation Study in Patients with Advanced CKD

Author

Ramspek, Chava L., Evans, Marie, Wanner, Christoph, Drechsler, Christiane, Chesnaye, Nicholas C., Szymczak, Maciej, Krajewska, Magdalena, Torino, Claudia, Porto, Gaetana, Hayward, Samantha, Caskey, Fergus, Dekker, Friedo W., Jager, Kitty J., van Diepen, Merel, Cupisti, Adamasco, Sagliocca, Adelia, Ferraro, Alberto, Musiała, Aleksandra, Mele, Alessandra, Naticchia, Alessandro, Còsaro, Alex, Woodman, Alistair, Ranghino, Andrea, Stucchi, Andrea, Jonsson, Andreas, Schneider, Andreas, Pignataro, Angelo, Schrander, Anita, Torp, Anke, McKeever, Anna, Szymczak, Anna, Blom, Anna-Lena, De Blasio, Antonella, Pani, Antonello, Tsalouichos, Aris, Ullah, Asad, McLaren, Barbara, van Dam, Bastiaan, Iwig, Beate, Antonio, Bellasi, Di Iorio, Biagio Raffaele, Rogland, Björn, Perras, Boris, Alessandra, Butti, Harron, Camille, Wallquist, Carin, Siegert, Carl, Barrett, Carla, Gaillard, Carlo, Garofalo, Carlo, Abaterusso, Cataldo, Beerenhout, Charles, O’Toole, Charlotte, Somma, Chiara, Marx, Christian, Summersgill, Christina, Blaser, Christof, D’alessandro, Claudia, Emde, Claudia, Zullo, Claudia, Pozzi, Claudio, Geddes, Colin, Verburgh, Cornelis, Bergamo, Daniela, Ciurlino, Daniele, Motta, Daria, Glowski, Deborah, McGlynn, Deborah, Vargas, Denes, Krieter, Detlef, Russo, Domenico, Fuchs, Dunja, Sands, Dympna, Hoogeveen, Ellen, Irmler, Ellen, Dimény, Emöke, Favaro, Enrico, Platen, Eva, Olczyk, Ewelina, Hoorn, Ewout, Vigotti, Federica, Ansali, Ferruccio, Conte, Ferruccio, Cianciotta, Francesca, Giacchino, Francesca, Cappellaio, Francesco, Pizzarelli, Francesco, Sundelin, Fredrik, Uhlin, Fredrik, Greco, Gaetano, Roy, Geena, Porto, Gaetana, Bigatti, Giada, Marinangeli, Giancarlo, Cabiddu, Gianfranca, Hirst, Gillian, Fumagalli, Giordano, Caloro, Giorgia, Piccoli, Giorgina, Capasso, Giovanbattista, Gambaro, Giovanni, Tognarelli, Giuliana, Bonforte, Giuseppe, Conte, Giuseppe, Toscano, Giuseppe, Del Rosso, Goffredo, Welander, Gunilla, Augustyniak-Bartosik, Hanna, Boots, Hans, Schmidt-Gürtler, Hans, King, Hayley, McNally, Helen, Schlee, Hendrik, Boom, Henk, Naujoks, Holger, Masri-Senghor, Houda, Murtagh, Hugh, Rayner, Hugh, Miśkowiec-Wiśniewska, Ilona, Schlee, Ines, Capizzi, Irene, Bascaran Hernandez, Isabel, Baragetti, Ivano, Manitius, Jacek, Turner, Jane, Eijgenraam, Jan-Willem, Kooman, Jeroen, Beige, Joachim, Pondel, Joanna, Wilcox, Joanne, Berdeprado, Jocelyn, Röthele, Jochen, Wong, Jonathan, Rotmans, Joris, Banda, Joyce, Mazur, Justyna, Hahn, Kai, Jędrzejak, Kamila, Nowańska, Katarzyna, Blouin, Katja, Neumeier, Katrin, Jones, Kirsteen, Anding-Rost, Kirsten, Gröntoft, Knut-Christian, Oldrizzi, Lamberto, Haydock, Lesley, Vogt, Liffert, Wilkinson, Lily, Gesualdo, Loreto, Schramm, Lothar, Biancone, Luigi, Nowak, Łukasz, Raasveld, Maarten, Durlik, Magdalena, Magnano, Manuela, Vervloet, Marc, Ricardi, Marco, Carmody, Margaret, Di Bari, Maria, Laudato, Maria, Luisa Sirico, Maria, Stendahl, Maria, Svensson, Maria, Weetman, Maria, van Buren, Marjolijn, Joinson, Martin, Ferraresi, Martina, Dutton, Mary, van Diepen, Merel, Matthews, Michael, Provenzano, Michele, Hopf, Monika, Malaguti, Moreno, Wuttke, Nadja, Morgan, Neal, Palmieri, Nicola, Frischmuth, Nikolaus, Bleakley, Nina, Murrone, Paola, Cockwell, Paul, Leurs, Paul, Roderick, Paul, Voskamp, Pauline, Kashioulis, Pavlos, Ichtiaris, Pawlos, Blankestijn, Peter, Kirste, Petra, Schulz, Petra, Mason, Phil, Kalra, Philip, Cirillo, Pietro, Dattolo, Pietro, Acampora, Pina, Sajith, Rincy, Nigro, Rita, Boero, Roberto, Scarpioni, Roberto, Sicoli, Rosa, Malandra, Rosella, Aign, Sabine, Cäsar, Sabine, van Esch, Sadie, Chapman, Sally, Biribauer, Sandra, Navjee, Santee, Crosbie, Sarah, Brown, Sharon, Tickle, Sheila, Manan, Sherin, Röser, Silke, Savoldi, Silvana, Bertoli, Silvio, Borrelli, Silvio, Boorsma, Siska, Heidenreich, Stefan, Melander, Stefan, Maxia, Stefania, Maffei, Stefano, Mangano, Stefano, Palm, Stephanie, Konings, Stijn, Mathavakkannan, Suresh, Schwedler, Susanne, Delrieux, Sylke, Renker, Sylvia, Schättel, Sylvia, Dorota, Szyszkowska, Cicchetti, Teresa, Nieszporek, Teresa, Stephan, Theresa, Schmiedeke, Thomas, Weinreich, Thomas, Leimbach, Til, Rappa, Tiziana, Almquist, Tora, Stövesand, Torsten, Bahner, Udo, Jensen, Ulrika, Palazzo, Valentina, De Simone, Walter, Seeger, Wolfgang, Kuan, Ying, Heleniak, Zbigniew, and Aydin, Zeynep more...

Published
2021
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199. Automated Positive End-Expiratory Pressure Titration during Mechanical Ventilation

Author

Platen, Philip von, Pomprapa, Anake, Lohse, Arnhold, Leonhardt, Steffen, Pickerodt, Philipp A., Russ, Martin, Taher, Mahdi, Boerger, Emilia, Francis, Roland C.E., and Walter, Marian

Abstract

Optimizing the positive end-expiratory pressure remains challenging for any clinician treating a patient with acute respiratory distress syndrome. This paper presents an approach to automate a PEEP titration maneuver and identify the best PEEP according to maximal compliance. The respiratory system was modeled by a single-compartment model, and parameters were estimated using multiple linear regression. A classifier identified the best PEEP using the scaled relative change in compliance between PEEP levels based on empirical data from previous manual PEEP titrations. An experimental system allows the in vivo testing of the automated PEEP titration, including additional safety measures. The complete system was tested in a single animal experiment and correctly identified the best PEEP. The introduced system is a step closer towards an automated, standardized PEEP optimization and closed-loop control of mechanical ventilation. more...

Published
2021
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200. Nine typical injury patterns in German professional male football (soccer): a systematic visual video analysis of 345 match injuries

Author

Klein, Christian, Luig, Patrick, Henke, Thomas, Bloch, Hendrik, and Platen, Petra

Abstract

AimWe aimed to systematically analyse the videos of acute injuries in professional men’s football and describe typical injury patterns.MethodsInjuries were registered with the German statutory accident insurance for professional athletes as part of occupational accident reporting. Following each season (2014–2017), video footage of the two highest divisions in German male football was searched for moderate and severe acute match injuries. Two raters then independently assessed the injuries for: game situation, player and opponent behaviour, referee decision, and injury mechanisms.ResultsThe total data set included 7493 acute injuries. Of these, 857 (11%) were moderate or severe match injuries. The video search yielded 345 (40%) clearly identifiable injuries and of those 170 (49%) were contact injuries. We describe nine typical injury patterns: one each for head and shoulder injuries, two for thigh and ankle, and three for knee injuries. The nine patterns are called: (1) Head-to-head injury. (2) Collision-and-fall shoulder injury. (3) Sprinter’s thigh injury. (4) Perturbation-and-strain thigh injury. (5) Tackle knee injury. (6) Tackle-and-twist knee injury. (7) Non-contact knee injury. (8) Attacked ankle injury. (9) Collision-and-twist ankle injury. Thigh injuries occurred primarily in non-contact situations (44/81), mostly while the player was sprinting (23/44). Knee injuries were often caused by direct external impact (49/84)—mainly suffered by the tackler during a tackle (17/49).ConclusionThe nine common injury patterns in football differed substantially in their mechanisms and causes. more...

Published
2021
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