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  • 1
    Online Resource
    Online Resource
    Malperformance in Verbal Fluency and Delayed Recall as Cognitive Risk Factors for Impairment in Instrumental Activities of Daily Living
    S. Karger AG ; 2011
    In:  Dementia and Geriatric Cognitive Disorders Vol. 31, No. 1 ( 2011), p. 81-88
    Details
    In: Dementia and Geriatric Cognitive Disorders, S. Karger AG, Vol. 31, No. 1 ( 2011), p. 81-88
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. 〈 i 〉 Methods: 〈 /i 〉 Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. 〈 i 〉 Results: 〈 /i 〉 Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. 〈 i 〉 Conclusion: 〈 /i 〉 Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment.
    Type of Medium: Online Resource
    ISSN: 1420-8008 , 1421-9824
    URL: Article
    DOI: 10.1159/000323315
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482186-2
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  • 2
    Online Resource
    Online Resource
    Intensity of Treatment as Usual and Its Impact on the Effects of Face-to-Face and Internet-Based Psychotherapy for Depression: A Preregistered Meta-Analysis of Randomized Controlled Trials
    S. Karger AG ; 2022
    In:  Psychotherapy and Psychosomatics Vol. 91, No. 3 ( 2022), p. 200-209
    Details
    In: Psychotherapy and Psychosomatics, S. Karger AG, Vol. 91, No. 3 ( 2022), p. 200-209
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Treatment as usual (TAU) is the most frequently used control group in randomized trials of psychotherapy for depression. Concerns have been raised that the heterogeneity of treatments in TAU leads to biased estimates of psychotherapy efficacy and to an unclear difference between TAU and control groups like waiting list (WL). 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 We investigated the impact of control group intensity (i.e., amount and degree to which elements of common depression treatments are provided) on the effects of face-to-face and internet-based psychotherapy for depression. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We conducted a preregistered meta-analysis (www.osf.io/4mzyd). We included trials comparing psychotherapy with TAU or WL in patients with symptoms of unipolar depression. Six indicators were used to assess control group intensity. Primary outcome: Standardized mean difference (SMD) of psychotherapy and control in depressive symptoms at treatment termination. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We included 89 trials randomizing 14,474 patients to 113 psychotherapy conditions and 89 control groups (TAU in 42 trials, WL in 47 trials). Control group intensity predicted trial results in preregistered (one-sided 〈 i 〉 p 〈 /i 〉 s & #x3c; 0.042) and exploratory analyses. Psychotherapy effects were significantly smaller (one-sided 〈 i 〉 p 〈 /i 〉 = 0.002) in trials with higher intensity TAU (SMD = 0.324, CI 0.209 to 0.439) than in trials with lower intensity TAU (SMD = 0.628, CI 0.455 to 0.801). Psychotherapy effects against lower intensity TAU did not differ from effects against WL (two-sided 〈 i 〉 p 〈 /i 〉 = 0.663). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Our results suggest that variation in TAU intensity impacts the outcome of trials. More scrutiny in the design of control groups for clinical trials is recommended.
    Type of Medium: Online Resource
    ISSN: 0033-3190 , 1423-0348
    URL: Article
    DOI: 10.1159/000521951
    RVK:
    CU 5500
    RVK:
    XA 10000
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1472321-9
    SSG: 5,2
    SSG: 15,3
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  • 3
    Online Resource
    Online Resource
    Towards a Basic Endoscopic Assessment of Swallowing in Acute Stroke – Development and Evaluation of a Simple Dysphagia Score
    S. Karger AG ; 2008
    In:  Cerebrovascular Diseases Vol. 26, No. 1 ( 2008), p. 41-47
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 26, No. 1 ( 2008), p. 41-47
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 Dysphagia is an important complication of acute stroke with a reported incidence of up to 76%. The purpose of this investigation was to develop and to evaluate an endoscopic scoring system which has the potential to guide dysphagia management in acute stroke patients. 〈 i 〉 Methods: 〈 /i 〉 A fiberoptic endoscopic evaluation of swallowing (FEES) was carried out in 100 patients within 72 h of stroke onset. During endoscopic examination, the secretion status was evaluated, and the patient was successively given standard volumes of puree consistency, liquids and soft solid food. Penetration and aspiration was assessed using a 5-point scale. 〈 i 〉 Results: 〈 /i 〉 Nearly 80% of patients showed penetration or aspiration during FEES. These events occurred more frequently with liquids and soft solid food than with puree. Penetration or aspiration at any stage of examination predicted failure at the subsequent food consistency. Furthermore, key findings of endoscopic evaluation were predictive of the need for later orotracheal intubation. Based on these observations a score was developed that grades stroke-related dysphagia according to the risk of penetration or aspiration of the different food consistencies tested. Assessment of interrater reliability by means of 25 additional endoscopic examinations resulted in excellent agreement between three investigators, reflected by a ĸ coefficient of 0.89. 〈 i 〉 Conclusion: 〈 /i 〉 Stroke-related dysphagia may effectively be graded using a simple endoscopic scoring system. The usefulness of this screening protocol with respect to patient outcome and intercurrent complications has to be studied in prospective clinical trials.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000135652
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2008
    detail.hit.zdb_id: 1482069-9
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  • 4
    Online Resource
    Online Resource
    Intrauterine Exposure to Cigarette Smoke Is Associated with Increased Ghrelin Concentrations in Adulthood
    S. Karger AG ; 2014
    In:  Neuroendocrinology Vol. 99, No. 2 ( 2014), p. 123-129
    Details
    In: Neuroendocrinology, S. Karger AG, Vol. 99, No. 2 ( 2014), p. 123-129
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The appetite-stimulating hormone ghrelin is a fundamental regulator of human energy metabolism. A series of studies support the notion that long-term appetite and weight regulation may be already programmed in early life and it could be demonstrated that the intrauterine environment affects the ghrelin system of the offspring. Animal studies have also shown that intrauterine programming of orexigenic systems persists even until adolescence/adulthood. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We hypothesized that plasma ghrelin concentrations in adulthood may be associated with the intrauterine exposure to cigarette smoke. We examined this hypothesis in a sample of 19-year-olds followed up since birth in the framework of the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study of the long-term outcome of early risk factors. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 As a main finding, we found that ghrelin plasma concentrations in young adults who had been exposed to cigarette smoke in utero were significantly higher than in those without prenatal smoke exposure. Moreover, individuals with intrauterine nicotine exposure showed a significantly higher prevalence of own smoking habits and lower educational status compared to those in the group without exposure. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Smoking during pregnancy may be considered as an adverse intrauterine influence that may alter the endocrine-metabolic status of the offspring even until early adulthood.
    Type of Medium: Online Resource
    ISSN: 0028-3835 , 1423-0194
    URL: Article
    DOI: 10.1159/000363325
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1483028-0
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  • 5
    Online Resource
    Online Resource
    Left Ventricular Hypertrophy and Diastolic Dysfunction in Healthy Pregnant Women
    S. Karger AG ; 2002
    In:  Cardiology Vol. 97, No. 2 ( 2002), p. 73-78
    Details
    In: Cardiology, S. Karger AG, Vol. 97, No. 2 ( 2002), p. 73-78
    Abstract: 〈 i 〉 Objective: 〈 /i 〉 The purpose of this study was to examine which hemodynamic parameters change under the natural volume overload of pregnancy. 〈 i 〉 Study Design: 〈 /i 〉 46 healthy pregnant women were echocardiographically examined during the course of pregnancy. To evaluate left ventricular diastolic function, mitral inflow and pulmonary venous flow profiles were used. Fractional shortening and left ventricular muscle mass were calculated. 〈 i 〉 Results: 〈 /i 〉 In the course of pregnancy the left ventricular muscle mass index increased (from 66 ± 6 to 96 ± 9 g/m 〈 sup 〉 2 〈 /sup 〉 ), fractional shortening decreased (from 38 ± 4 to 32 ± 6%) and a disturbed diastolic relaxation pattern was documented. Eight weeks after delivery, all left ventricular systolic and diastolic functional parameters returned to normal values. 〈 i 〉 Conclusion: 〈 /i 〉 The natural volume overload in pregnancy leads to a reversible ‘physiological’ left ventricular hypertrophy, a short-term decrease in systolic function and a significant change in left ventricular diastolic function.
    Type of Medium: Online Resource
    ISSN: 0008-6312 , 1421-9751
    URL: Article
    DOI: 10.1159/000057675
    RVK:
    XA 36200
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2002
    detail.hit.zdb_id: 1482041-9
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  • 6
    Online Resource
    Online Resource
    Robot-Assisted Pancreatic Surgery: A Structured Approach to Standardization of a Program and of the Operation
    S. Karger AG ; 2020
    In:  Visceral Medicine Vol. 36, No. 2 ( 2020), p. 104-112
    Details
    In: Visceral Medicine, S. Karger AG, Vol. 36, No. 2 ( 2020), p. 104-112
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The use of robots in minimal invasive surgery has become increasingly common in recent years. 〈 b 〉 〈 i 〉 〈 /i 〉 〈 /b 〉 Robot-assisted pancreatoduodenectomy preponderates against a laparoscopic procedure especially due to the greater flexibility of instruments and therefore a better handling and a better angulation. Furthermore, there are benefits of enlarged 3-D visibility, software-based tremor control, and reduced physical exertion of the surgeon. 〈 b 〉 〈 i 〉 Methods and Results: 〈 /i 〉 〈 /b 〉 This review delivers a point-by-point approach to the setup of a robot-assisted pancreatic program and a detailed approach to robot-assisted pancreatoduodenectomy. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 In our standardized standard operating procedure approach we use 5 trocars, i.e., 4 robotic trocars and 1 assist trocar. We prefer the position of the robot ports in a straight horizontal line with a distance of 20 cm from the operational field. The operation is dissected into 11 standardized procedural steps as follows: (1) access to the pancreas and visualization, (2) extended Kocher manoeuvre, (3) lower rim and mesentericoportal axis, (4) upper rim and hepatoduodenal ligament, (5) dissection of the pancreatic neck, (6) mesenteric root and pars IV duodeni, (7) mesopancreas, (8) pancreatic anastomosis reconstruction, (9) bilioenteric anastomosis, (10) dudenojejunal anastomosis, and (11) drainage and closure. The setup of the pancreas program and the structured approach to complex pancreatic resections are elucidated. 〈 b 〉 〈 i 〉 Summary: 〈 /i 〉 〈 /b 〉 This review describes the approach to robot-assisted pancreatic surgery in a high-volume pancreas center on a structural and procedural level to support the establishment of such programs at other locations.
    Type of Medium: Online Resource
    ISSN: 2297-4725 , 2297-475X
    URL: Article
    DOI: 10.1159/000506909
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 2850734-4
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