BDH-Klinik Elzach

In patients with coronary artery disease and concomitant asymptomatic severe carotid stenosis, combined simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEA) has been widely performed despite lack of evidence from randomized trials. We recently showed that the risk of stroke or death within 30 days was higher following CABG+CEA compared with CABG alone. Here, we report long-term outcomes following CABG with versus without CEA. The CABACS (Coronary Artery Bypass Graft Surgery in Patients With Asymptomatic Carotid Stenosis Study) is a randomized, controlled, multicenter, open trial. Patients with asymptomatic severe (≥70%) carotid stenosis undergoing CABG were allocated either CABG+CEA or CABG alone, and follow-up was 5 years. Major secondary end points included nonfatal stroke or death, any death and any nonfatal stroke. Due to low recruitment, the study was stopped prematurely after randomization of 127 patients in 17 centers. By 5 years, the rate of stroke or death did not significantly differ between groups (CABG+CEA 40.6% [95% CI, 0.285-0.536], CABG alone 35.0% [95% CI, 0.231-0.484]; P=0.58). Higher albeit statistically nonsignificant rates of nonfatal strokes occurred at any time following CABG+CEA versus CABG alone (1 year: 19.3% versus 7.1%, P=0.09; 5 years: 29.4% versus 18.8%, P=0.25). All-cause mortality up to 5 years was similar in both groups (CABG+CEA: 25.4% versus CABG alone: 23.3%, hazard ratio, 1.148 [95% CI, 0.560-2.353]; P=0.71). Subgroup analyses did not reveal any significant effect of age, sex, preoperative modified Rankin Scale and center on outcome events. During 5-years follow-up, combined simultaneous CABG+CEA was associated with a higher albeit statistically nonsignificant rate of stroke or death compared with CABG alone. This was mainly due to a nonsignificantly higher perioperative risk following CABG+CEA. Since the power of our study was not sufficient, no significant effect of either procedure could be observed at any time during follow-up. URL: http://www.controlled-trials.com; Unique identifier: ISRCTN13486906.

Evaluations of cases of a neurological early rehabilitation clinic carried out by the medical services of health insurances (2018) are described and analyzed. More than a quarter of the 1098 cases were evaluated. Examinations focused on hours of ventilation, unnecessary hospitalization, intensity of nursing and features of the definition of early neurological rehabilitation. Strategies to minimize are errors described.

In Kap. 2 schildern wir die ersten Eindrucke eines Auslanders unmittelbar nach seiner Ankunft in China. Die schwierige Verstandigung sorgt zwar zunachst fur ein Gefuhl der Hilflosigkeit, aber ein herzlicher Empfang und der Ausblick auf interessante Entdeckungen lassen die Vorfreude auf eine spannende Zeit steigen. Wahrend die grosen, internationalen Metropolen Schanghai und Beijing einiges fur Auslander bieten, ist in den Stadten der zweiten und dritten Ordnung die englische Sprache weniger verbreitet. Entscheidend fur das erfolgreiche Leben und Wirken eines Auslanders in China ist daher die Auswahl des Ubersetzers. Mandarin, als Hauptdialekt der chinesischen Sprache, ist schwierig zu erlernen. Auserdem sind lokale Dialekte weitverbreitet, die sich vom Mandarin stark unterscheiden. Die chinesische Sprache ist im Allgemeinen sehr vieldeutig, oft erschliest sich der Sinn eines Satzes nur im Kontext. In diesem zweiten Kapitel zeigen wir nicht nur, wie man in China kompetente Ubersetzer aussucht, sondern erlautern auch einige wesentliche Besonderheiten in der Kultur und im sozialen Umgang. Wir gehen in diesem Zusammenhang besonders auf die Beziehungspflege in China ein. Zu Themen des Alltags wie der Fortbewegung geben wir ebenso Empfehlungen wie fur die vielen Moglichkeiten der Freizeitgestaltung. Dazu gehort auch ein soziales Engagement in der chinesischen Gesellschaft, was wir an einem Beispiel verdeutlichen.

BackgroundEvaluation of functional status is difficult in neurological and neurosurgical early rehabilitation patients. The Early Rehabilitation Index (ERI) was introduced in Germany over 20 years ago, but since then validation studies are lacking. The ERI (range −325 to 0 points) includes highly relevant items including the necessity of intermittent mechanical ventilation or tracheostomy.MethodsThe present paper analyzed data from a German multi-center study, enrolling 754 neurological early rehabilitation patients. Together with ERI, Barthel Index (BI), Glasgow Coma Scale (GCS), Glasgow Outcome Score Extended, Coma Remission Scale (CRS), Functional Ambulation Categories and length of stay were obtained.ResultsERI showed significant improvements from admission to discharge (p < 0.001). In addition, there were significant correlations of the ERI upon admission and at discharge with BI, CRS and GCS.ConclusionsEvaluation of our study data suggest that the ERI may be used as a valid assessment instrument for neurological and neurosurgical early rehabilitation patients.

In Germany, neurological-neurosurgical early rehabilitation is well established in the treatment of severe neurological diseases. To develop quality standards, knowledge of the current rehabilitation course is required. Aretrospective analysis was performed on the course of rehabilitation from patients in anearly neurological/neurosurgical rehabilitation program in 16centers from 10German states. The odds for agood or poor outcome were investigated using amultivariate logistic regression model. Seven hundred and fifty-four patients were included in the study. The average age of the patients was 68 ±15years. Of the patients studied, 26 % were on mechanical ventilation commencing their neurological rehabilitation. The average duration of stay was 56 ±51days. Weaning rate from mechanical ventilation was 65 % and the rate of weaning from tracheal cannula was 54 %. Mean improvement in the Barthel Index of 17 points, significant reduction of dysphagia (from 62 to 30 %) and depended walking (from 99 to 82 %), and the achievement of phaseC (the next stage of rehabilitation) in 38 % can still be counted as signs of successful rehabilitation. During their course of stay, near 10 % of the patients died. Of these, 67 % received solely palliative care. In the multivariate logistic models, the absence of the factor "necessity for mechanical ventilation on admission" (odds ratio 0.61; 95 % confidence interval (CI): 0.42…0.89) increased the chance for good outcome and the presence of this factor the risk of dying with an odds ratio of 8.07 (95 % CI: 4.54-14.34). In spite of the severity of neurological deficits, significant functional progress has been made. These results could be interpret as positive proof of the efficacy of neurological/neurosurgical early rehabilitation programs.

In den letzten Jahren hat sich die Phase B der neurologischen Frührehabilitation als intensivmedizinische Weiterbehandlung von beatmeten Patienten, die aufgrund neurologischer Erkrankungen, Komplikationen und Komorbiditäten erschwert von der Ventilation zu entwöhnen sind, in vielen Bundesländern nahezu flächendeckend etabliert [1]. Der Anteil in die Phase B beatmet aufgenommener Patienten liegt in Kliniken, die Weaning anbieten, zwischen 10 und 20 % [2]. Bei etwa zwei Drittel der Patienten ist das Weaning erfolgreich [3].

Post-traumatic growth (PTG) is the experience of positive changes that can follow a traumatic event. The current study examined the factorial as well as the discriminant validity of the German version of the Post-traumatic Growth Inventory (PTGI-G) in stroke patients. A total of 188 adult stroke patients (63.3% male; median age 69 years) completed the PTGI-G and the German version of the Hospital Anxiety and Depression Scale (HADS-D) at the end of their inpatient rehabilitation. Confirmatory factor analyses indicate an acceptable model fit of both the original five-factor solution as well as a second-order factor model of the PTGI-G (CFI > .95; RMSEA < .01). Small and non-significant correlations between the PTGI-G subscales and the depression scale of the HADS-D support the discriminant validity of the PTGI-G. The PTGI-G appears to be a valid tool in the context of stroke research.