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2. Selection effects may account for better outcomes of the German Disease Management Program for type 2 diabetes

Author

van den Bussche Hendrik, Wegscheider Karl, Treszl András, von Leitner Eike-Christin, Gedrose Benjamin, Küver Claudia, Schäfer Ingmar, and Kaduszkiewicz Hanna

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background The nationwide German disease management program (DMP) for type 2 diabetes was introduced in 2003. Meanwhile, results from evaluation studies were published, but possible baseline differences between DMP and usual-care patients have not been examined. The objective of our study was therefore to find out if patient characteristics as socio-demographic variables, cardiovascular risk profile or motivation for life style changes influence the chance of being enrolled in the German DMP for type 2 diabetes and may therefore account for outcome differences between DMP and usual-care patients. Methods Case control study comparing DMP patients with usual-care patients at baseline and follow up; mean follow-up period of 36 ± 14 months. We used chart review data from 51 GP surgeries. Participants were 586 DMP and 250 usual-care patients with type 2 diabetes randomly selected by chart registry. Data were analysed by multivariate logistic and linear regression analyses. Significance levels were p ≤ 0.05. Results There was a better chance for enrolment if patients a) had a lower risk status for diabetes complications, i.e. non-smoking (odds ratio of 1.97, 95% confidence interval of 1.11 to 3.48) and lower systolic blood pressure (1.79 for 120 mmHg vs. 160 mmHg, 1.15 to 2.81); b) had higher activity rates, i.e. were practicing blood glucose self-monitoring (1.67, 1.03 to 2.76) and had been prescribed a diabetes patient education before enrolment (2.32, 1.29 to 4.19) c) were treated with oral medication (2.17, 1.35 to 3.49) and d) had a higher GP-rated motivation for diabetes education (4.55 for high motivation vs. low motivation, 2.21 to 9.36). Conclusions At baseline, future DMP patients had a lower risk for diabetes complications, were treated more intensively and were more active and motivated in managing their disease than usual-care patients. This finding a) points to the problem that the German DMP may not reach the higher risk patients and b) selection bias may impair the assessment of differences in outcome quality between enrolled and usual-care patients. Suggestions for dealing with this bias in evaluation studies are being made.

Published
2010
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3. Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke

Author

Schröder, Julian, Cheng, Bastian, Ebinger, Martin, Köhrmann, Martin, Wu, Ona, Kang, Dong-Wha, Liebeskind, David S, Tourdias, Thomas, Singer, Oliver C, Christensen, Soren, Campbell, Bruce, Luby, Marie, Warach, Steven, Fiehler, Jens, Fiebach, Jochen B, Gerloff, Christian, Thomalla, Götz, Albers, Gregory, Davis, Stephen, Donnan, Geoffrey, Fisher, Marc, Furlan, Anthony, Grotta, James, Hacke, Werner, Kidwell, Chelsea, Koroshetz, Walter, Lees, Kennedy R, Lev, Michael, Sorensen, A Gregory, Thijs, Vincent, Wardlaw, Joanna, Wintermark, Max, Hao, Qing, Kim, Jong S, Breuer, Lorenz, Treszl, Andras, Forkert, Nils D, Galinovic, Ivana, Rosenkranz, Michael, Engelhorn, Tobias, Endres, Matthias, and Dousset, Vincent

Subjects
Neurosciences, Stroke, Clinical Research, Brain Disorders, Biomedical Imaging, Aged, Diffusion Magnetic Resonance Imaging, Female, Humans, Infarction, Middle Cerebral Artery, Male, Middle Aged, Tomography, X-Ray Computed, brain ischemia, diffusion magnetic resonance imaging, magnetic resonance imaging, middle cerebral artery, neuroimaging, severity of illness index, stroke, STIR and VISTA Imaging Investigators, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery
Abstract

Background and purposeAlberta Stroke Program Early Computed Tomographic Score (ASPECTS) has been used to estimate diffusion-weighted imaging (DWI) lesion volume in acute stroke. We aimed to assess correlations of DWI-ASPECTS with lesion volume in different middle cerebral artery (MCA) subregions and reproduce existing ASPECTS thresholds of a malignant profile defined by lesion volume ≥100 mL.MethodsWe analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluid-attenuated inversion recovery in acute stroke. DWI-ASPECTS and lesion volume were calculated. The population was divided into subgroups based on lesion localization (superficial MCA territory, deep MCA territory, or both). Correlation of ASPECTS and infarct volume was calculated, and receiver-operating characteristics curve analysis was performed to identify the optimal ASPECTS threshold for ≥100-mL lesion volume.ResultsA total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (r=-0.78; P

Published
2014

5. Evaluating the effects of Picture Exchange Communication System ® mediator training via telehealth using behavioral skills training and general case training

Author

Alyssa Treszl, Paige O'Neill, and Julie Koudys

Subjects
Applied psychology, Telehealth, medicine.disease, Training (civil), Psychiatry and Mental health, Clinical Psychology, Skills training, Arts and Humanities (miscellaneous), Picture exchange communication system, Generalization (learning), Developmental and Educational Psychology, Parent training, medicine, Autism, Psychology
Published
2021

7. A Single Nucleotide Polymorphism near the CYP17A1 Gene Is Associated with Left Ventricular Mass in Hypertensive Patients under Pharmacotherapy

Author

Matthias Huber, Susanne Lezius, Rona Reibis, Andras Treszl, Dorota Kujawinska, Stefanie Jakob, Karl Wegscheider, Heinz Völler, and Reinhold Kreutz

Subjects
clinical study, genetics, heart, hypertension, cytochrome P450 17A1 (Cyp17A1), Biology (General), QH301-705.5, Chemistry, QD1-999
Abstract

Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 ± 9.8 years, 83% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) ≥40% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7%) and myocardial infarction (n = 545; 54.1%) with a mean LVEF of 59.9% ± 9.3%. The mean left ventricular mass index (LVMI) was 52.1 ± 21.2 g/m2.7 and 485 (48.2%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7% increase in LVMI (95% CI: 1%–12%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.

Published
2015
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12. A Randomized Controlled Trial of a Novel Self-Help Technique for Impulse Control Disorders: A Study on Nail-Biting

Author

Moritz, Steffen, Treszl, Andras, and Rufer, Michael

Abstract

Nail-biting is currently classified as an impulse control disorder not otherwise specified. Although seldom targeted as a primary symptom, nail-biting is often associated with somatic complications and decreased quality of life. The present study assessed the effectiveness of an innovative self-help technique, titled decoupling (DC). DC aims at attenuating pathological nail-biting by performing motor sequences that decouple and rearrange the behavioral elements involved in the habit. A total of 72 participants with excessive nail-biting were recruited via specialized self-help forums and were randomized to either DC or progressive muscle relaxation (PMR) groups after baseline assessment. Four weeks later, participants underwent a similar assessment as before and were asked to rate the effectiveness of the intervention. The primary outcome parameter was the Massachusetts General Hospital Scale (MGH) adapted. Relative to the PMR group, the DC group showed significant progress in withstanding the urge to bite their nails. Furthermore, they appraised the appearance of their nails as considerably less compromised at the end of the treatment relative to participants undergoing PMR. At statistical trend level, the DC group showed a significantly greater decline on the adapted MGH relative to PMR. Despite methodological limitations, the present study asserts that the effectiveness of DC, previously shown for trichotillomania, extends to nail-biting. (Contains 2 tables and 2 figures.)

Published
2011
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21. DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4·5 h of symptom onset (PRE-FLAIR): a multicentre observational study

Author

Thomalla, Götz, Cheng, Bastian, Ebinger, Martin, Hao, Qing, Tourdias, Thomas, Wu, Ona, Kim, Jong S, Breuer, Lorenz, Singer, Oliver C, Warach, Steven, Christensen, Soren, Treszl, Andras, Forkert, Nils D, Galinovic, Ivana, Rosenkranz, Michael, Engelhorn, Tobias, Köhrmann, Martin, Endres, Matthias, Kang, Dong-Wha, Dousset, Vincent, Sorensen, A Gregory, Liebeskind, David S, Fiebach, Jochen B, Fiehler, Jens, and Gerloff, Christian

Published
2011
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24. Real-world outcomes of endovascular treatment in a non-selected population with peripheral artery disease – prospective study with 2-year follow-up

Author

Ulrich Hoffmann, Hans-Joachim Lau, David Hardung, Karl Wegscheider, Klaus Amendt, Lothar Heuser, András Treszl, Thomas Pfannebecker, Karl-Ludwig Schulte, Thomas Weiss, Christiane Tiefenbacher, and Gunnar Tepe

Subjects
Male, medicine.medical_specialty, Percutaneous, Multivariate analysis, Arterial disease, medicine.medical_treatment, Population, Disease, Peripheral Arterial Disease, Quality of life, Angioplasty, medicine, Humans, Popliteal Artery, Prospective Studies, education, Prospective cohort study, Vascular Patency, education.field_of_study, business.industry, Surgery, Femoral Artery, Treatment Outcome, Quality of Life, Female, Stents, Cardiology and Cardiovascular Medicine, business, Angioplasty, Balloon, Follow-Up Studies
Abstract

Summary. Background: The study aimed to evaluate the outcomes of percutaneous transluminal angioplasty (PTA) in lower-extremity peripheral artery disease (PAD) patients. Patients and methods: A multi-centre, observational study was performed with 32 German and Austrian centres contributing data to the PTA registry. Data of 1,781 patients with lower-leg and pelvic PAD who were suitable for endovascular PTA treatment were contributed from participating centres. Data from 1,533 patients are reported here (1,055 male and 478 female). This study did not have exclusion criteria. Quality of life (QOL) questionnaire (EQ-5D) scores, Rutherford classification, mortality, patency rate and details of major adverse cardiovascular events were collected at 6-, 12-, 18-, and 24-month follow ups. Results: PTA with/without stenting achieved 90.3 %, 86.5 %, 82.7 %, and 71.9 % technical success (recanalisation achieving ≥ 70 % patency, no evidence of embolisation, recoiling or dissection) in iliac, femoral, popliteal, and below-the-knee arteries, respectively. Procedural/postprocedural complications occurred in 142 (9.3 %, 1 death) and 74 (4.8 %) patients. QOL, mobility, self-care, activity, and pain/discomfort scores improved (p

Published
2019

38. German Multicenter Real-World Registry of Stenting for Superficial Femoral Artery Disease: Clinical Results and Predictive Factors for Revascularization

Author

Krankenberg, Hans, Tübler, Thilo, Sixt, Sebastian, Fischer, Matthias, Schmiedel, Rainer, Schulte, Karl-Ludwig, Balzer, Jörn O., Kieback, Arne, Fiehn, Eduard, Wittenberg, Günther, Ali, Tammam, Tiefenbacher, Christiane, Jahnke, Thomas, Steinkamp, Hermann J., Wegscheider, Karl, Treszl, András, Ingwersen, Maja, and Zeller, Thomas

Published
2014
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46. Quantitative Measurements of Relative Fluid-Attenuated Inversion Recovery (FLAIR) Signal Intensities in Acute Stroke for the Prediction of Time from Symptom Onset

Author

Cheng, Bastian, Brinkmann, Mathias, Forkert, Nils D, Treszl, Andras, Ebinger, Martin, Köhrmann, Martin, Wu, Ona, Kang, Dong-Wha, Liebeskind, David S, Tourdias, Thomas, Singer, Oliver C, Christensen, Soren, Luby, Marie, Warach, Steven, Fiehler, Jens, Fiebach, Jochen B, Gerloff, Christian, and Thomalla, Götz

Published
2013
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