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Borken, Germany

Norman K.,Charite - Medical University of Berlin | Wirth R.,St. Marien Hospital Borken | Wirth R.,IBA University | Neubauer M.,Charite - Medical University of Berlin | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2015

Objectives: We investigated the impact of low phase angle (PhA) values on muscle strength, quality of life, symptom severity, and 1-year mortality in older cancer patients. Design: Prospective study with 1-year follow-up. Participants: Cancer patients aged >60years. Methods: PhA was derived from whole body impedance analysis. The fifth percentile of age-, sex-, and body mass index-stratified reference values were used as cut-off. Quality of life was determined with the European Organization of Research and Treatment in Cancer questionnaire, reflecting both several function scales and symptom severity. Muscle strength was assessed by hand grip strength, knee extension strength, and peak expiratory flow. Results: 433 cancer patients, aged 60-95years, were recruited. Patients with low PhA (n=197) exhibited decreased muscle strength compared with patients with normal PhA (hand grip strength: 22±8.6 vs 28.9±8.9kg, knee extension strength: 20.8±11.8 vs 28.1±14.9kg, and peak expiratory flow: 301.1±118 vs 401.7±142.6L/min, P<.001). Physical function, global health status, and role function from the European Organization of Research and Treatment in Cancer questionnaire were reduced, and most symptoms (fatigue, anorexia, pain, and dyspnea) increased in patients with low PhA (P<.001). In a risk-factor adjusted regression analysis, PhA emerged as independent predictor of physical function (ß:-0.538, P=023), hand grip strength (ß:-4.684, P<.0001), knee extension strength (ß:-4.548, P=035), and peak expiratory flow (ß:-66.836, P<.0001). Low PhA moreover predicted 1-year mortality in the Cox proportional hazards regression model, whereas grip strength was no longer significant. Conclusions: PhA below the fifth reference percentile is highly predictive of decreased muscle strength, impaired quality of life, and increased mortality in old patients with cancer and should be evaluated in routine assessment. © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Source


Norman K.,Charite - Medical University of Berlin | Wirth R.,St. Marien Hospital Borken | Neubauer M.,Charite - Medical University of Berlin | Eckardt R.,Charite - Medical University of Berlin | Stobaus N.,Charite - Medical University of Berlin
Journal of the American Medical Directors Association | Year: 2015

OBJECTIVES: We investigated the impact of low phase angle (PhA) values on muscle strength, quality of life, symptom severity, and 1-year mortality in older cancer patients.DESIGN: Prospective study with 1-year follow-up.PARTICIPANTS: Cancer patients aged >60 years.METHODS: PhA was derived from whole body impedance analysis. The fifth percentile of age-, sex-, and body mass index-stratified reference values were used as cut-off. Quality of life was determined with the European Organization of Research and Treatment in Cancer questionnaire, reflecting both several function scales and symptom severity. Muscle strength was assessed by hand grip strength, knee extension strength, and peak expiratory flow.RESULTS: 433 cancer patients, aged 60-95 years, were recruited. Patients with low PhA (n = 197) exhibited decreased muscle strength compared with patients with normal PhA (hand grip strength: 22 ± 8.6 vs 28.9 ± 8.9 kg, knee extension strength: 20.8 ± 11.8 vs 28.1 ± 14.9 kg, and peak expiratory flow: 301.1 ± 118 vs 401.7 ± 142.6 L/min, P < .001). Physical function, global health status, and role function from the European Organization of Research and Treatment in Cancer questionnaire were reduced, and most symptoms (fatigue, anorexia, pain, and dyspnea) increased in patients with low PhA (P < .001). In a risk-factor adjusted regression analysis, PhA emerged as independent predictor of physical function (ß:-0.538, P = .023), hand grip strength (ß:-4.684, P < .0001), knee extension strength (ß:-4.548, P = .035), and peak expiratory flow (ß:-66.836, P < .0001). Low PhA moreover predicted 1-year mortality in the Cox proportional hazards regression model, whereas grip strength was no longer significant.CONCLUSIONS: PhA below the fifth reference percentile is highly predictive of decreased muscle strength, impaired quality of life, and increased mortality in old patients with cancer and should be evaluated in routine assessment. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved. Source


Wirth R.,St. Marien Hospital Borken | Wirth R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg
Gerontology | Year: 2012

Background: The estimated life expectancy of older persons is an important component of medical decision-making. To date, no data are available on the accuracy of health care professionals in estimating the remaining life expectancy of older subjects. Methods: A survey estimating the mean remaining life expectancy of Germans of both sexes at the ages of 0, 70, 80 and 90 years was performed from September to November 2010. Results: Two hundred and six health care professionals underestimated the mean remaining life expectancy of older persons by 10%, on average, and with great variance (SD = 34%). Medical doctors, especially those not specialized in geriatrics, estimated worst. Conclusions: Underestimation of the remaining life expectancy of older people is prevalent in health care professionals and may lead to patients being managed inappropriately. This underscores the need for further studies and better training on this issue in health care education. Copyright © 2011 S. Karger AG, Basel. Source


Wirth R.,St. Marien Hospital Borken | Bauer J.M.,Friedrich - Alexander - University, Erlangen - Nuremberg | Willschrei H.P.,St. Marienhospital Orsoy | Volkert D.,Friedrich - Alexander - University, Erlangen - Nuremberg | Sieber C.C.,Friedrich - Alexander - University, Erlangen - Nuremberg
Gerontology | Year: 2010

Background: Despite extensive discussion about percutaneous endoscopic gastrostomy (PEG) in nursing home residents, no prevalence data exist in most countries. Objective: This study aimed to determine the prevalence of PEG in German nursing homes, as well as nursing home characteristics that may influence this prevalence. Additionally, we documented the timing of PEG insertion, whether pre- or post-admission to the nursing home, and the proportion of residents receiving oral nutrition in addition to tube feeds. Methods: A 26-item questionnaire was sent to 6,995 German nursing homes. Responses were anonymous. Results: Of the 6,995 questionnaires sent out, 807 (11.5%) were completed and returned. Of the 66,507 total residents in the responding nursing homes, there were 4,390 residents with PEG (6.6%). The median PEG prevalence was 5.6% (5th-95th percentile 1.0-16.3%). Of all PEGs inserted, 55.3% were inserted before and 44.7% were inserted after nursing home admission. Oral beverage intake in addition to tube feeding was reported in 48.8% of residents with a PEG, and 43.5% of patients also received solid food. There were no significant differences in PEG prevalence between the federal states of Germany. The location (rural vs. urban) of the nursing home, its proprietor and food delivery method had no significant influence on PEG prevalence. With regard only to PEG tubes inserted after nursing home admission, all the factors stated above showed no significant influence on PEG prevalence. Weak positive correlations between PEG prevalence and the size of the nursing home as well as the number of total and certified nursing staff per resident could be detected, reflecting the heavy burden of care associated with residents requiring artificial nutrition. Conclusions: Compared to other countries, Germany can be assumed to have an average PEG prevalence in nursing home residents. No specific nursing home characteristics could be identified that affect PEG prevalence. Copyright © 2009 S. Karger AG, Basel. Source


Linder R.,Wissenschaftliches Institute Der Tk For Nutzen Und Effizienz Im Gesundheitswesen Wineg | Muller H.,Wissenschaftliches Institute Der Tk For Nutzen Und Effizienz Im Gesundheitswesen Wineg | Grenz-Farenholtz B.,Wissenschaftliches Institute Der Tk For Nutzen Und Effizienz Im Gesundheitswesen Wineg | Wagner C.,Wissenschaftliches Institute Der Tk For Nutzen Und Effizienz Im Gesundheitswesen Wineg | And 2 more authors.
BMC Musculoskeletal Disorders | Year: 2012

Background: The statutory health insurance system embodies a large amount of data on the treatments of their members. Depending on joint, prosthesis type, patient activity and comorbidity, knee and hip replacements can last up to 20 years. Based on statutory health insurance data the main object of this analysis was to investigate how high the early revision rate of replacements actually is. Methods. The number of replacements in the years 2005 and 2006 has been extracted from the TK database for hip (OPS-Code 5-820, n = 20,875), knee (OPS 5-822, n = 13,466), upper limbs (OPS 5-824, n = 901), and lower limbs (OPS 5-826) replacements. This data has then been related to each consecutive operation (i. e. change or excision of joint endoprosthesis) over a joint-specific observation period of two years. Results: In 3.7% of the cases joint replacements stood for less than 2 years (hip 3.5%, knee 3.8%, upper limbs 6.5%, and lower limbs 5.5%). There is a significantly positive correlation between the treatment data of the hospitals and the outcome as to low rates of reoperations at early stages. The main reason for short lifetime (76 - 81%) is mechanical failure. Conclusion: The percentage of joint endoprostheses with significantly short lifetimes has been unexpectedly high. The de facto lifetimes of joint endoprostheses thus often do not match the manufacturers' information. The authors strongly support the idea of a national endoprosthesis register as such a register could give detailed information on.firstly whether these deficits are due to material defects, osteolysis or dislocation and.secondly which products are mainly affected. © 2012 Linder et al.; licensee BioMed Central Ltd. Source

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