Agaplesion Frankfurter Diakonie Kliniken

Dementia care has several shortcomings: lack of guideline based early diagnoses and interventions concerning effective outpatient crisis intervention, regional multiprofessional networking and care givers support. To meet these challenges, the DemStepCare project is composed of a need-driven, staged treatment approach. GPs and case managers direct a regional dementia care network to provide counseling, case management, out-patient crisis intervention and care givers support. Qualitative survey results of the care giver perspective show positive aspects and further potential for improvement of the care services.

Knee arthroplasty is one of the most frequently performed operations in Germany, with approximately 170000 procedures per year. It is therefore essential that physicians should adhere to an appropriate, and patient-centered indication process. The updated guideline indication criteria for knee arthroplasty (EKIT-Knee) contain recommendations, which are based on current evidence and agreed upon by a broad consensus panel. For practical use, the checklist has also been updated.For this guideline update, a systematic literature research was conducted in order to analyse (inter-)national guidelines and systematic reviews focusing on osteoarthritis of the knee and knee arthroplasty, to answer clinically relevant questions on diagnostic, predictors of outcome, risk factors and contraindications.Knee arthroplasty should solely be performed in patients with radiologically proven moderate or severe osteoarthritis of the knee (Kellgren-Lawrence grade 3 or 4), after previous non-surgical treatment for at least three months, in patients with high subjective burden with regard to knee-related complaints and after exclusion of possible contraindications (infection, comorbidities, BMI ≥40kg/m2). Modifiable risk factors (such as smoking, diabetes mellitus, anaemia) should be addressed and optimised in advance. After meeting current guideline indications, a shared decision-making process between patients and surgeons is recommended, in order to maintain high quality surgical management of patients with osteoarthritis of the knee.The update of the S2k-guideline was expanded to include unicondylar knee arthroplasty, the preoperative optimisation of modifiable risk factors was added and the main indication criteria were specified.

Post-bariatric surgical procedures in patients after massive weight loss (MWL) are often associated with elevated minor and major complications (17-55%). If there is additionally a long history of hydradenitis suppurativa (HS) in the lower abdomen and groin area, complications of infection can appear in all patients. Differentiated pre-, peri- and postoperative therapy regime is then indicated.From 2010 to 2021, a total of 12 (66.6% women, 33.3% men) consecutive patients underwent conventional (Pittsburg rating scale [PRS]: Grade 2) or fleur-de-lis abdominoplasty (PRS: Grade 3) after massive weight loss. All patients simultaneously suffered long term HS in the lower abdomen and groin area (Hurley classification Grade 2: n=10, Grade 3: n=2). The prevalence in our study was 1.09%.Postoperative minor and major complications (follow-up 12 months) are determined and correlated with risk factors (e.g. age, method of weight loss, nicotine abuse…).Mean age was 45.2 years (±10.3), mean BMI pre-operative 33.24kg/m2 (±8.7), the mean decrease in BMI was 19.01kg/m2 (±5.9) and the maximum BMI before weight loss 52.25kg/m2. The mean duration of the suppurative hydradenitis was 31.5 years and n=2 (17.0%) had current medical therapy against this. All patients showed further locations of the HS in other parts of the body and 66.6% had had surgical procedures because of the HS. 42.0% had nicotine abuse. The mean operation time was 98 minutes and the mean resection weight was 2210 grams. The overall complication rate was n=10 (83.0%), and the rate of major complications n=8 (66.4%) with surgical intervention in full anaesthesia. No patient had an infected haematoma, abscess or acute bleeding in the first 24 hours postoperatively.The antibiotic regime prevented the expected soft tissue infection in all patients. Inspection of the abdomen and groin area 4 weeks before surgery is recommended, in order to start preoperative therapy for the HS.

Abstract: Background: We examine the potential of behavioral activation by wearable devices in inpatients with late-life depression (LLD). Methods: In randomized order, 17 inpatients with LLD wore a GPS watch that either allowed monitoring their activity level or had a disabled activity display. The patients answered questionnaires repeatedly in addition to completing an ambulatory assessment of biopsychological stress. Results: Acceptance and satisfaction were high. We found short-term differential effects of the randomization order, with patients first in the control group being more active but also more stressed. A high number of missing values limits the informative value of ambulatory assessment. Conclusions: The intervention was feasible and well accepted. However, the effect of continuous feedback on activity levels in a crossover design needs to be critically reassessed.

Implantable cardioverter defibrillators (ICDs) offer effective therapy for the prevention of sudden cardiac death (SCD) due to ventricular arrhythmias. However, inappropriate shocks have detrimental effects on survival and quality of life. The addition of hemodynamic monitoring may be useful in discriminating clinically important ventricular arrhythmias. In this study, we assess the ability of laser Doppler flowmetry to assess the hemodynamic effect of paced atrial and ventricular arrhythmias using mean arterial blood pressure as the reference. In this acute human study in patients undergoing an elective electrophysiological study, laser Doppler flowmetry, arterial blood pressure, and surface ECG were acquired during high-rate atrial and ventricular pacing to simulate supraventricular and ventricular tachycardias. Arterial blood pressure and laser Doppler flow signals correlated well during atrial and ventricular pacing (rho = 0.694, p<.001). The hemodynamic impairment detected by both methods was greater during ventricular pacing than atrial pacing (-1.0% vs. 19.0%, p<.001). Laser Doppler flowmetry performed better than rate alone to identify hemodynamic impairments. In this acute study, laser Doppler flowmetry tissue perfusion served as a good surrogate measure for arterial pressure, which could be incorporated into future ICDs.

The overall survival of patients with advanced and refractory oesophageal squamous cell carcinoma, mostly aged 65 years and older, is poor. Treatment with PD-1 antibodies showed improved progression-free survival and overall survival. We assessed the safety and efficacy of combined nivolumab and ipilimumab therapy in this population. This multicentre, open-label, phase 2 trial done in 32 sites in Germany included patients aged 65 years and older with oesophageal squamous cell carcinoma and disease progression or recurrence following first-line therapy. Patients were treated with nivolumab (240 mg fixed dose once every 2 weeks, intravenously) in the safety run-in phase and continued with nivolumab and ipilimumab (nivolumab 240 mg fixed dose once every 2 weeks and ipilimumab 1 mg/kg once every 6 weeks, intravenously). The primary endpoint was overall survival, which was compared with a historical cohort receiving standard chemotherapy in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03416244. Between March 2, 2018, and Aug 20, 2020, we screened 75 patients with advanced oesophageal squamous cell carcinoma. We enrolled 66 patients (50 [76%] men and 16 [24%] women; median age 70·5 years [IQR 67·0-76·0]), 44 (67%) of whom received combined nivolumab and ipilimumab therapy and 22 (33%) received nivolumab alone. Median overall survival time at the prespecified data cutoff was 7·2 months (95% CI 5·7-12·4) and significantly higher than in a historical cohort receiving standard chemotherapy (p=0·0063). The most common treatment-related adverse events were fatigue (12 [29%] of 42), nausea (11 [26%]), and diarrhoea (ten [24%]). Grade 3-5 treatment-related adverse events occurred in 13 (20%) of 66 patients. Treatment-related death occurred in one patient with bronchiolitis obliterans while on nivolumab and ipilimumab treatment. Patients aged at least 65 years, with advanced oesophageal squamous cell carcinoma might benefit from combined nivolumab and ipilimumab therapy in second-line treatment. Bristol Myers Squibb.