61 Medizin und Gesundheit
Filtern
Dokumenttyp
- Wissenschaftlicher Artikel (Fachzeitschriften) (37) (entfernen)
Sprache
- Englisch (37)
Volltext vorhanden
- ja (37)
Gehört zur Bibliographie
- nein (37)
Schlagworte
- Rückenschmerz (11)
- Physikalische Therapie (5)
- Maschinelles Lernen (4)
- low back pain (4)
- stratified care (4)
- Elektrode (3)
- Intervention <Medizin> (3)
- Jugend (3)
- Sport (3)
- Sportler (3)
- back pain (3)
- sports (3)
- Übung (3)
- Alkoholmissbrauch (2)
- Bewegungsapparat (2)
- Convolutional Neural Network (2)
- Flüssigkristalline Polymere (2)
- Gesundheitswesen (2)
- Hirnstimulation (2)
- Kreuzschmerz (2)
- Leistungssportler (2)
- Nigeria (2)
- Parkinson-Krankheit (2)
- Prävention (2)
- Rehabilitation (2)
- Sportverletzung (2)
- Therapie (2)
- alcohol (2)
- deep brain stimulation (2)
- electrode model (2)
- exercise (2)
- health services research (2)
- internet (2)
- machine learning (2)
- perturbation (2)
- physiotherapy (2)
- psychometrics (2)
- rehabilitation (2)
- ultrasound (2)
- young people (2)
- Anomalie <Medizin> (1)
- Anomalieerkennung (1)
- Apoptosis (1)
- Apotheke (1)
- App <Programm> (1)
- Astrozyt (1)
- Bewegung (1)
- Bewegungsstörung (1)
- Bilderkennung (1)
- Bildgebendes Verfahren (1)
- Bindegewebe (1)
- Biofeedback-Therapie (1)
- CNN (1)
- Chronischer Schmerz (1)
- DNN (1)
- Deep learning (1)
- Delphi survey (1)
- Demenz (1)
- Depression (1)
- Deutschland (1)
- Dienstleistung (1)
- Dynamometer (1)
- E-Health (1)
- EHR (1)
- EMG (1)
- Einzelhandel (1)
- Electronic Commerce (1)
- Elektrokortikogramm (1)
- Elektromyographie (1)
- Elektronische Patientenakte (1)
- Elektrophysiologie (1)
- Ellbogengelenk (1)
- Epidemiologie (1)
- Essenzieller Tremor (1)
- Forschung (1)
- Gesundheitspolitik (1)
- Gesundheitsökonomie (1)
- Gyrus temporalis (1)
- Haltung (1)
- Handy (1)
- Hemisphäre <Anatomie> (1)
- Herzmuskelkrankheit (1)
- Hirnareal (1)
- Hüftgelenkprothese (1)
- ICU (1)
- Intensivpflege (1)
- Intensivstation (1)
- Internet (1)
- Kniegelenk (1)
- Kniegelenkprothese (1)
- Kommunikation (1)
- Krankengymnastik (1)
- Künstliche Beatmung (1)
- Künstliche Intelligenz (1)
- LBP (1)
- Laborparameter (1)
- Laser-Rastermikroskopie (1)
- Leistung (1)
- Linke Hemisphäre (1)
- Läsion (1)
- Magnetische Stimulation (1)
- Medizinische Ausbildung (1)
- Medizinische Informatik (1)
- MiSpEx (1)
- Musculus biceps brachii (1)
- Muskel-Skelett-Erkrankung (1)
- Muskelkater (1)
- Myalgie (1)
- Nachsorge (1)
- Nervenkrankheit (1)
- Neuronales Netz (1)
- Petri nets (1)
- Pflegepersonal (1)
- Physiotherapeut (1)
- Primäre Gesundheitsversorgung (1)
- Psychometrie (1)
- Public Health (1)
- Raucherentwöhnung (1)
- Rekursives neuronales Netz (1)
- Ressourcen am Arbeitsplatz (1)
- Risikofaktor (1)
- Rotatorenmanschette (1)
- Rumpf (1)
- STarT back tool (1)
- STarT-Back approach (1)
- Schlaganfall (1)
- Schmerz (1)
- Schultergelenk (1)
- Schädigung (1)
- Sensomotorik (1)
- Sensor (1)
- Soziale Norm (1)
- Sozialmedizin (1)
- Stabilisierung (1)
- Stress (1)
- Stressbewältigung (1)
- Stressor (1)
- Student (1)
- Studium (1)
- Substantia alba (1)
- Telemedizin (1)
- Test (1)
- Training (1)
- Trainingsprogramm (1)
- Transkranielle magnetische Stimulation (1)
- Ultraschall (1)
- Unique Selling Proposition (1)
- Universität (1)
- VLSM (1)
- VentAI (1)
- Vibroarthrographie (1)
- Work-Life-Balance (1)
- Zentralnervensystem (1)
- adolescent athletes (1)
- aftercare (1)
- anomaly detection (1)
- apoptosis (1)
- arithmetic fact retrieval (1)
- artificial intelligence (1)
- astrocytes (1)
- biceps brachii (1)
- charge storage capacity (CSCc) (1)
- chronic low back pain (1)
- chronic non-specific low back pain (1)
- clinical decision making (1)
- complaints (1)
- complex prognostic factors (1)
- connective tissue (1)
- connectivity (1)
- convolutional neural networks (1)
- core (1)
- cortical electrical stimulation (1)
- cortical stimulation (1)
- critical care (1)
- critically-ill patient (1)
- curriculum (1)
- curved trajectory (1)
- deep learning (1)
- dementia (1)
- diagnostics imaging (1)
- disability (1)
- disconnectome (1)
- doctor of physical therapy (1)
- dynamic postural control test (1)
- education (1)
- electrocorticogram (1)
- electrode impedance (1)
- electrode reconstruction (1)
- electroplating (1)
- epidemiology (1)
- evaluation (1)
- exercise therapy (1)
- exergame (1)
- health policy (1)
- health services administration & management (1)
- health technologies (1)
- home-based (1)
- image recognition (1)
- implementation strategies (1)
- in vivo two-photon laser-scanning microscopy (1)
- in-store health services (1)
- injury prevention program (IPP) (1)
- injury prevention programs (IPP) (1)
- instability (1)
- intensive care (1)
- interpretability (1)
- knee joint sound (1)
- lab values (1)
- lesion mapping (1)
- lightGBM (1)
- liquid crystal polymer electrodes (1)
- medical consumables (1)
- medical economics (1)
- medical informatics (1)
- mobile phone (1)
- modeling (1)
- morphology (1)
- motor control exercises (1)
- movement disorders (1)
- muscle damage (1)
- muscle fatiguing exercise (1)
- muscle pain (1)
- musculoskeletal care (1)
- musculoskeletal disorder (1)
- musculoskeletal system (1)
- necroptosis (1)
- neuron-glia interaction (1)
- non-specifc (1)
- nursing staff (1)
- one-legged stance test (1)
- optimization (1)
- output impedance (1)
- overhead athlete (1)
- overuse injuries (1)
- pain intensity (1)
- patient reported outcomes (1)
- patient-reported outcomes (1)
- patients' perceptions (1)
- performance (1)
- pharmaceutical services (1)
- physical therapy (1)
- platinum (1)
- primary health care (1)
- problem drinking (1)
- prognosis (1)
- public health (1)
- pulsed current (1)
- qualitative research (1)
- questionnaire (1)
- reinforcement learning algorithm (1)
- responsiveness (1)
- retail clinics (1)
- retail pharmacies (1)
- risk factors (1)
- rotator cuff (1)
- sensorimotor training (1)
- septic cardiomyopathy (1)
- small data (1)
- smoking cessation (1)
- social medicine (1)
- social norms (1)
- spectral estimation (1)
- sports-related injuries (1)
- stabilization exercise (1)
- star excursion balance test (1)
- static postural control test (1)
- stimulator characterization (1)
- stimulator model (1)
- stratification (1)
- stress (1)
- students (1)
- symptoms (1)
- targeted treatment (1)
- telerehabilitation (1)
- text messaging (1)
- time series classification (1)
- tobacco (1)
- total hip replacement (1)
- total knee replacement (1)
- training intervention (1)
- tremor (1)
- trunk stability (1)
- unstable resistance training (1)
- usability (1)
- ventilation (1)
- vibroarthrography (1)
- warm-up exercise (1)
- water pipe (1)
- wearable motion sensors (1)
- web (1)
- workplace stressors (1)
- Überlastungsschaden (1)
- Übungsprogramm (1)
Institut
Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients’ perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was ‘treatment-success’, with subthemes of ‘assessment and treatment planning’, ‘acceptance of the questionnaire’ and ‘contextual factors’. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient ‘buy in’ is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems.
Deep brain stimulation (DBS) is an established therapy for movement disorders such as in Parkinson's disease (PD) and essential tremor (ET). Adjusting the stimulation parameters, however, is a labour-intensive process and often requires several patient visits. Physicians prefer objective tools to improve (or maintain) the performance in DBS. Wearable motion sensors (WMS) are able to detect some manifestations of pathological signs, such as tremor in PD. However, the interpretation of sensor data is often highly technical and methods to visualise tremor data of patients undergoing DBS in a clinical setting are lacking. This work aims to visualise the dynamics of tremor responses to DBS parameter changes with WMS while patients performing clinical hand movements. To this end, we attended DBS programming sessions of two patients with the aim to visualise certain aspects of the clinical examination. PD tremor and ET were effectively quantified by acceleration amplitude and frequency. Tremor dynamics were analysed and visualised based on setpoints, movement transitions and stability aspects. These methods have not yet been employed and examples demonstrate how tremor dynamics can be visualised with simple analysis techniques. We therefore provide a base for future research work on visualisation tools in order to assist clinicians who frequently encounter patients for DBS therapy. This could lead to benefits in terms of enhanced evaluation of treatment efficacy in the future.
Background: Deficiency in musculoskeletal imaging (MI) education will pose a great challenge to physiotherapists in clinical decision making in this era of first-contact physiotherapy practices in many developed and developing countries. This study evaluated the nature and the level of MI training received by physiotherapists who graduate from Nigerian universities.
Methods: An online version of the previously validated Physiotherapist Musculoskeletal Imaging Profiling Questionnaire (PMIPQ) was administered to all eligible physiotherapists identified through the database of the Medical Rehabilitation Therapist Board of Nigeria. Data were obtained on demographics, nature, and level of training on MI procedures using the PMIPQ. Logistic regression, Friedman’s analysis of variance (ANOVA) and Kruskal-Wallis tests were used for the statistical analysis of collected data.
Results: The results (n = 400) showed that only 10.0% of the respondents had a stand-alone entry-level course in MI, 92.8% did not have any MI placement during their clinical internship, and 67.3% had never attended a MI workshop. There was a significant difference in the level of training received across MI procedures [χ2 (15) = 1285.899; p = 0.001]. However, there was no significant difference in the level of MI training across institutions of entry-level programme (p = 0.36). The study participants with transitional Doctor of Physiotherapy education were better trained in MI than their counterparts with a bachelor’s degree only (p = 0.047).
Conclusions: Most physiotherapy programmes in Nigeria did not include a specific MI module; imaging instructions were mainly provided through clinical science courses. The overall self-reported level of MI training among the respondents was deficient. It is recommended that stand-alone MI education should be introduced in the early part of the entry-level physiotherapy curriculum.
Background: High numbers of consumable medical materials (eg, sterile needles and swabs) are used during the daily routine of intensive care units (ICUs) worldwide. Although medical consumables largely contribute to total ICU hospital expenditure, many hospitals do not track the individual use of materials. Current tracking solutions meeting the specific requirements of the medical environment, like barcodes or radio frequency identification, require specialized material preparation and high infrastructure investment. This impedes the accurate prediction of consumption, leads to high storage maintenance costs caused by large inventories, and hinders scientific work due to inaccurate documentation. Thus, new cost-effective and contactless methods for object detection are urgently needed.
Objective: The goal of this work was to develop and evaluate a contactless visual recognition system for tracking medical consumable materials in ICUs using a deep learning approach on a distributed client-server architecture.
Methods: We developed Consumabot, a novel client-server optical recognition system for medical consumables, based on the convolutional neural network model MobileNet implemented in Tensorflow. The software was designed to run on single-board computer platforms as a detection unit. The system was trained to recognize 20 different materials in the ICU, while 100 sample images of each consumable material were provided. We assessed the top-1 recognition rates in the context of different real-world ICU settings: materials presented to the system without visual obstruction, 50% covered materials, and scenarios of multiple items. We further performed an analysis of variance with repeated measures to quantify the effect of adverse real-world circumstances.
Results: Consumabot reached a >99% reliability of recognition after about 60 steps of training and 150 steps of validation. A desirable low cross entropy of <0.03 was reached for the training set after about 100 iteration steps and after 170 steps for the validation set. The system showed a high top-1 mean recognition accuracy in a real-world scenario of 0.85 (SD 0.11) for objects presented to the system without visual obstruction. Recognition accuracy was lower, but still acceptable, in scenarios where the objects were 50% covered (P<.001; mean recognition accuracy 0.71; SD 0.13) or multiple objects of the target group were present (P=.01; mean recognition accuracy 0.78; SD 0.11), compared to a nonobstructed view. The approach met the criteria of absence of explicit labeling (eg, barcodes, radio frequency labeling) while maintaining a high standard for quality and hygiene with minimal consumption of resources (eg, cost, time, training, and computational power).
Conclusions: Using a convolutional neural network architecture, Consumabot consistently achieved good results in the classification of consumables and thus is a feasible way to recognize and register medical consumables directly to a hospital’s electronic health record. The system shows limitations when the materials are partially covered, therefore identifying characteristics of the consumables are not presented to the system. Further development of the assessment in different medical circumstances is needed.
Aim: The aim of the study was to identify common orthopedic sports injury profiles in adolescent elite athletes with respect to age, sex, and anthropometrics.
Methods: A retrospective data analysis of 718 orthopedic presentations among 381 adolescent elite athletes from 16 different sports to a sports medical department was performed. Recorded data of history and clinical examination included area, cause and structure of acute and overuse injuries. Injury-events were analyzed in the whole cohort and stratified by age (11–14/15–17 years) and sex. Group differences were tested by chi-squared-tests. Logistic regression analysis was applied examining the influence of factors age, sex, and body mass index (BMI) on the outcome variables area and structure (α = 0.05).
Results: Higher proportions of injury-events were reported for females (60%) and athletes of the older age group (66%) than males and younger athletes. The most frequently injured area was the lower extremity (47%) followed by the spine (30.5%) and the upper extremity (12.5%). Acute injuries were mainly located at the lower extremity (74.5%), while overuse injuries were predominantly observed at the lower extremity (41%) as well as the spine (36.5%). Joints (34%), muscles (22%), and tendons (21.5%) were found to be the most often affected structures. The injured structures were different between the age groups (p = 0.022), with the older age group presenting three times more frequent with ligament pathology events (5.5%/2%) and less frequent with bony problems (11%/20.5%) than athletes of the younger age group. The injured area differed between the sexes (p = 0.005), with males having fewer spine injury-events (25.5%/34%) but more upper extremity injuries (18%/9%) than females. Regression analysis showed statistically significant influence for BMI (p = 0.002) and age (p = 0.015) on structure, whereas the area was significantly influenced by sex (p = 0.005).
Conclusion: Events of soft-tissue overuse injuries are the most common reasons resulting in orthopedic presentations of adolescent elite athletes. Mostly, the lower extremity and the spine are affected, while sex and age characteristics on affected area and structure must be considered. Therefore, prevention strategies addressing the injury-event profiles should already be implemented in early adolescence taking age, sex as well as injury entity into account.
Introduction: Injury prevention programs (IPPs) are an inherent part of training in recreational and professional sports. Providing performance-enhancing benefits in addition to injury prevention may help adjust coaches and athletes’ attitudes towards implementation of injury prevention into daily routine. Conventional thinking by players and coaches alike seems to suggest that IPPs need to be specific to one’s sport to allow for performance enhancement. The systematic literature review aims to firstly determine the IPPs nature of exercises and whether they are specific to the sport or based on general conditioning. Secondly, can they demonstrate whether general, sports-specific or even mixed IPPs improve key performance indicators with the aim to better facilitate long-term implementation of these programs?
Methods: PubMed and Web of Science were electronically searched throughout March 2018. The inclusion criteria were randomized control trials, publication dates between Jan 2006 and Feb 2018, athletes (11–45 years), injury prevention programs and included predefined performance measures that could be categorized into balance, power, strength, speed/agility and endurance. The methodological quality of included articles was assessed with the Cochrane Collaboration assessment tools.
Results: Of 6619 initial findings, 22 studies met the inclusion criteria. In addition, reference lists unearthed a further 6 studies, making a total of 28. Nine studies used sports specific IPPs, eleven general and eight mixed prevention strategies. Overall, general programs ranged from 29–57% in their effectiveness across performance outcomes. Mixed IPPs improved in 80% balance outcomes but only 20–44% in others. Sports-specific programs led to larger scale improvements in balance (66%), power (83%), strength (75%), and speed/agility (62%).
Conclusion: Sports-specific IPPs have the strongest influence on most performance indices based on the significant improvement versus control groups. Other factors such as intensity, technical execution and compliance should be accounted for in future investigations in addition to exercise modality.
Background: Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.
Objective: The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.
Methods: From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.
Results: Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.
Conclusions: The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.
Background: To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated.
Methods: Using Zelen’s design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff’s Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool).
Results: Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline.
Conclusions: After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it.
Background: Stratified care is an up-to-date treatment approach suggested for patients with back pain in several guidelines. A comprehensively studied stratification instrument is the STarT Back Tool (SBT). It was developed to stratify patients with back pain into three subgroups, according to their risk of persistent disabling symptoms. The primary aim was to analyse the disability differences in patients with back pain 12 months after inclusion according to the subgroups determined at baseline using the German version of the SBT (STarT-G). Moreover, the potential to improve prognosis for disability by adding further predictor variables, an analysis for differences in pain intensity according to the STarT-Classification, and discriminative ability were investigated.
Methods: Data from the control group of a randomized controlled trial were analysed. Trial participants were members of a private medical insurance with a minimum age of 18 and indicated as having persistent back pain. Measurements were made for the risk of back pain chronification using the STarT-G, disability (as primary outcome) and back pain intensity with the Chronic Pain Grade Scale (CPGS), health-related quality of life with the SF-12, psychological distress with the Patient Health Questionnaire-4 (PHQ-4) and physical activity. Analysis of variance (ANOVA), multiple linear regression, and area under the curve (AUC) analysis were conducted.
Results: The mean age of the 294 participants was 53.5 (SD 8.7) years, and 38% were female. The ANOVA for disability and pain showed significant differences (p < 0.01) among the risk groups at 12 months. Post hoc Tukey tests revealed significant differences among all three risk groups for every comparison for both outcomes. AUC for STarT-G’s ability to discriminate reference standard ‘cases’ for chronic pain status at 12 months was 0.79. A prognostic model including the STarT-Classification, the variables global health, and disability at baseline explained 45% of the variance in disability at 12 months.
Conclusions: Disability differences in patients with back pain after a period of 12 months are in accordance with the subgroups determined using the STarT-G at baseline. Results should be confirmed in a study developed with the primary aim to investigate those differences.
Deep brain stimulation (DBS) is a neurosurgical intervention where electrodes are permanently implanted into the brain in order to modulate pathologic neural activity. The post-operative reconstruction of the DBS electrodes is important for an efficient stimulation parameter tuning. A major limitation of existing approaches for electrode reconstruction from post-operative imaging that prevents the clinical routine use is that they are manual or semi-automatic, and thus both time-consuming and subjective. Moreover, the existing methods rely on a simplified model of a straight line electrode trajectory, rather than the more realistic curved trajectory. The main contribution of this paper is that for the first time we present a highly accurate and fully automated method for electrode reconstruction that considers curved trajectories. The robustness of our proposed method is demonstrated using a multi-center clinical dataset consisting of N = 44 electrodes. In all cases the electrode trajectories were successfully identified and reconstructed. In addition, the accuracy is demonstrated quantitatively using a high-accuracy phantom with known ground truth. In the phantom experiment, the method could detect individual electrode contacts with high accuracy and the trajectory reconstruction reached an error level below 100 μm (0.046 ± 0.025 mm). An implementation of the method is made publicly available such that it can directly be used by researchers or clinicians. This constitutes an important step towards future integration of lead reconstruction into standard clinical care.
Static (one-legged stance) and dynamic (star excursion balance) postural control tests were performed by 14 adolescent athletes with and 17 without back pain to determine reproducibility. The total displacement, mediolateral and anterior-posterior displacements of the centre of pressure in mm for the static, and the normalized and composite reach distances for the dynamic tests were analysed. Intraclass correlation coefficients, 95% confidence intervals, and a Bland-Altman analysis were calculated for reproducibility. Intraclass correlation coefficients for subjects with (0.54 to 0.65), (0.61 to 0.69) and without (0.45 to 0.49), (0.52 to 0.60) back pain were obtained on the static test for right and left legs, respectively. Likewise, (0.79 to 0.88), (0.75 to 0.93) for subjects with and (0.61 to 0.82), (0.60 to 0.85) for those without back pain were obtained on the dynamic test for the right and left legs, respectively. Systematic bias was not observed between test and retest of subjects on both static and dynamic tests. The one-legged stance and star excursion balance tests have fair to excellent reliabilities on measures of postural control in adolescent athletes with and without back pain. They can be used as measures of postural control in adolescent athletes with and without back pain.
Introduction: Annually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs’ components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes.
Methods: PubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006–Dec 2017, athletes (11–45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools.
Results: Of the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed.
Conclusion: The general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.
Life-threatening cardiomyopathy is a severe, but common, complication associated with severe trauma or sepsis. Several signaling pathways involved in apoptosis and necroptosis are linked to trauma- or sepsis-associated cardiomyopathy. However, the underling causative factors are still debatable. Heparan sulfate (HS) fragments belong to the class of danger/damage-associated molecular patterns liberated from endothelial-bound proteoglycans by heparanase during tissue injury associated with trauma or sepsis. We hypothesized that HS induces apoptosis or necroptosis in murine cardiomyocytes. By using a novel Medical-In silico approach that combines conventional cell culture experiments with machine learning algorithms, we aimed to reduce a significant part of the expensive and time-consuming cell culture experiments and data generation by using computational intelligence (refinement and replacement). Cardiomyocytes exposed to HS showed an activation of the intrinsic apoptosis signal pathway via cytochrome C and the activation of caspase 3 (both p < 0.001). Notably, the exposure of HS resulted in the induction of necroptosis by tumor necrosis factor α and receptor interaction protein 3 (p < 0.05; p < 0.01) and, hence, an increased level of necrotic cardiomyocytes. In conclusion, using this novel Medical-In silico approach, our data suggest (i) that HS induces necroptosis in cardiomyocytes by phosphorylation (activation) of receptor-interacting protein 3, (ii) that HS is a therapeutic target in trauma- or sepsis-associated cardiomyopathy, and (iii) indicate that this proof-of-concept is a first step toward simulating the extent of activated components in the pro-apoptotic pathway induced by HS with only a small data set gained from the in vitro experiments by using machine learning algorithms.
Background: The STarT-Back-Approach (STarT: Subgroups for Targeted Treatment) was developed in the UK and has demonstrated clinical and cost effectiveness. Based on the results of a brief questionnaire, patients with low back pain are stratified into three treatment groups. Since the organisation of physiotherapy differs between Germany and the UK, the aim of this study is to explore German physiotherapists’ views and perceptions about implementing the STarT-Back-Approach.
Methods: Three two-hour think-tank workshops with physiotherapists were conducted. Focus groups, using a semi-structured interview guideline, followed a presentation of the STarT-Back-Approach, with discussions audio recorded, transcribed and qualitatively analysed using content analysis.
Results: Nineteen physiotherapists participated (15 female, mean age 41.2 (SD 8.6) years). Three main themes emerged, each with multiple subthemes: 1) the intervention (15 subthemes), 2) the healthcare context (26 subthemes) and 3) individual characteristics (8 subthemes). Therapists’ perceptions of the extent to which the STarT-Back intervention would require changes to their normal clinical practice varied considerably. They felt that within their current healthcare context, there were significant financial disincentives that would discourage German physiotherapists from providing the STarT-Back treatment pathways, such as the early discharge of low-risk patients with supported self-management materials. They also discussed the need for appropriate standardised graduate and post-graduate skills training for German physiotherapists to treat high-risk patients with a combined physical and psychological approach (e.g., communication skills).
Conclusions: Whilst many German physiotherapists are positive about the STarT-Back-Approach, there are a number of substantial barriers to implementing the matched treatment pathways in Germany. These include financial disincentives within the healthcare system to early discharge of low-risk patients. Therapists also highlighted the need for solutions in respect of scalable physiotherapy training to gain skills in combined physical and psychological approaches.
Electrical stimulation is used for example to treat neuronal disorders and depression with deep brain stimulation or transcranial electrical stimulation. Depending on the application, different electrodes are used and thus different electrical characteristics exist, which have to be handled by the stimulator. Without a measuring device the user would have to rely on the stimulator being able to deliver the needed stimulation signal. Therefore, the objective of this paper is to present a method to increase the level of confidence with characterization and modelling of the electrical behavior by using the example of one channel of our stimulation device for experimental use. In several simulation studies with an electrode model with values in a typical range for cortical applications the influence of the load onto the stimulator and the possibility to pre-estimate measuring signals in complex networks are shown.
Background: Problem drinking, particularly risky single-occasion drinking is widespread among adolescents and young adults in most Western countries. Mobile phone text messaging allows a proactive and cost-effective delivery of short messages at any time and place and allows the delivery of individualised information at times when young people typically drink alcohol. The main objective of the planned study is to test the efficacy of a combined web- and text messaging-based intervention to reduce problem drinking in young people with heterogeneous educational level.
Methods/Design: A two-arm cluster-randomised controlled trial with one follow-up assessment after 6 months will be conducted to test the efficacy of the intervention in comparison to assessment only. The fully-automated intervention program will provide an online feedback based on the social norms approach as well as individually tailored mobile phone text messages to stimulate (1) positive outcome expectations to drink within low-risk limits, (2) self-efficacy to resist alcohol and (3) planning processes to translate intentions to resist alcohol into action. Program participants will receive up to two weekly text messages over a time period of 3 months. Study participants will be 934 students from approximately 93 upper secondary and vocational schools in Switzerland. Main outcome criterion will be risky single-occasion drinking in the past 30 days preceding the follow-up assessment.
Discussion: This is the first study testing the efficacy of a combined web- and text messaging-based intervention to reduce problem drinking in young people. Given that this intervention approach proves to be effective, it could be easily implemented in various settings, and it could reach large numbers of young people in a cost-effective way.
Background: Tobacco smoking prevalence continues to be high, particularly among adolescents and young adults with lower educational levels, and is therefore a serious public health problem. Tobacco smoking and problem drinking often co-occur and relapses after successful smoking cessation are often associated with alcohol use. This study aims at testing the efficacy of an integrated smoking cessation and alcohol intervention by comparing it to a smoking cessation only intervention for young people, delivered via the Internet and mobile phone.
Methods/Design: A two-arm cluster-randomised controlled trial with one follow-up assessment after 6 months will be conducted. Participants in the integrated intervention group will: (1) receive individually tailored web-based feedback on their drinking behaviour based on age and gender norms, (2) receive individually tailored mobile phone text messages to promote drinking within low-risk limits over a 3-month period, (3) receive individually tailored mobile phone text messages to support smoking cessation for 3 months, and (4) be offered the option of registering for a more intensive program that provides strategies for smoking cessation centred around a self-defined quit date. Participants in the smoking cessation only intervention group will only receive components (3) and (4). Study participants will be 1350 students who smoke tobacco daily/occasionally, from vocational schools in Switzerland. Main outcome criteria are 7-day point prevalence smoking abstinence and cigarette consumption assessed at the 6-month follow up.
Discussion: This is the first study testing a fully automated intervention for smoking cessation that simultaneously addresses alcohol use and interrelations between tobacco and alcohol use. The integrated intervention can be easily implemented in various settings and could be used with large groups of young people in a cost-effective way.