GesundEuropan Campus Rottal-Inn
Digital Health Revolution: Has the Future of Medicine Arrived Yet?
7th IEEE International Conference on e-Health and Bioengineering (EHB): Smarter technology for a better health, Iași, Romania
Mareike Hechinger, A. Kobleder
Förderung der Adhärenz kardiologischer Rehabilitation
Cochrane Pflege Corner. Krankenpflege, vol. 8, pp. 36-37
Die kardiologische Rehabilitationist eine Komponente zur Unterstützung von Patientinnen und Patienten bei der Erholung nach koronaren Ereignissen und zielt darauf ab, die Wahrscheinlichkeit für weitere Erkrankungen zu senken. Die Anzahl Teilnehmender an Rehabilitationsprogrammen ist aber oft gering und teilnehmende Personen halten sich mitunter nicht an das empfohlene Programm. Mit diesem Cochrane Review wird ein bereits bestehender Review aus dem Jahr 2013 aktualisiert. Die Wissenschaftlerinnen und Wissenschaftler suchten in den Datenbanken MEDLINE, EMBASE, CI-NAHL und PsycINFO. Zudem wurden die Datenbanken des Central Register of Controlled Trials (CENTRAL) und die Conference Proceedings on Web of Science (ISI Proceedings) durchsucht. Um auf weitere Studien aufmerksam zu werden, wurden auch die Datenbanken des National Health Service (NHS) und des Centre for Reviews and Dissemination (CRD) berücksichtigt. Neben der Suche in Datenbanken wurden die Referenzlisten eingeschlossener Studien nachweiteren relevanten Studien durch-gesehen. Es gab keine Einschrän-kung hinsichtlich der Sprache.Eingeschlossen wurden randomi-sierte kontrollierte Studien (RCT’s),Quasi-RCT’sund Crossover-Stu-dien. Personen über 18 JahremitMyokardinfarkt, Koronararterien-bypass-Operation, perkutanertransluminaler Koronarangioplastie (PTCA), Herzversagen, Angina oder anderen koronaren Herzerkrankungen galten als relevante Population, sofern sie berechtigt und geeignet waren, an einer kardialen Rehabilitation teilzunehmen. Zur Messung der Adhärenz wurden solche Teilnehmende als relevant angesehen, die bereits zugestimmt hatten, an einer Rehabilitation teilzunehmen. Ausgeschlos-sen wurden Personen mit Herztransplantation oder Herzschrittmachern bzw. Studien mit Interventionen, die lediglich pharmakologische Behandlungen betrafen.
A. Kobleder, N. Nikolic, Mareike Hechinger, K. Denhaerynck, M. Hampl, M. Müller, B. Senn
Perceived Health-Related Quality of Life in Women with Vulvar Neoplasia: A Cross Sectional Study
International Journal of Gynecological Cancer, vol. 26, no. 7, pp. 1313-1319
Objective The aim of the study was to determine health-related quality of life (HRQoL) of women with surgically treated vulvar intraepithelial neoplasia (VIN) and vulvar cancer (VC) during the first week after hospital discharge. Further objectives were to investigate differences between women with VIN and VC as well as to examine whether correlations exist between women’s symptom experience and HRQoL.
Methods This cross-sectional study was conducted in 8 hospitals in Germany and Switzerland. Women with VIN and VC rated HRQoL with the validated German Short-Form 36. Differences between HRQoL in women with VIN and VC were tested with Wilcoxon rank-sum score. The WOMen with vulvAr Neoplasia (WOMAN) - Patient reported Outcome (PRO) self-report instrument was used to measure women’s symptom experience. Correlations between symptoms and HRQoL were calculated using Spearman correlation coefficient.
Results Women with VIN and VC (n = 65) reported lower HRQoL in physical aspects (Physical Component Summary [PCS], 34.9) than that in mental aspects (Mental Component Summary, 40.5). Women with VC had lower HRQoL than women with VIN, as manifested by significant differences concerning the dimensions of “physical functioning” and “role-physical.” “Difficulties in daily life” as a distressing symptom correlated with MCS and PCS. Wound-related symptoms correlated with PCS and psychosocial symptoms/issues with MCS.
Conclusions Analysis showed that women with vulvar neoplasia reported lower HRQoL in the physical and mental dimensions 1 week after discharge than comparable studies referring to months or years after surgery. Health-related quality of life is influenced by physical impairment because physical symptoms are prevalent 1 week after discharge. Patient education should focus on symptom management in an early postsurgical phase to enhance women’s HRQoL.
A. Fringer, Mareike Hechinger, F. Wolfensberger, R. Steiner, W. Schnepp
Transitions as experienced by persons in palliative care circumstances and their families - a qualitative meta-synthesis
BMC Palliative Care, vol. 17, no. Article number 22, pp. 1-15
Background When receiving palliative care, patients and their families experience altered life situations in which they must negotiate challenges in daily life, increased care and new roles. With limited time, they also experience emotional changes that relate to their uncertain future. Transitions experienced in such situations are often studied by focusing on individual aspects, which are synthesized in the following study. The aim was to conduct a qualitative meta-synthesis to explore the experiences patients and their families gain during transitions in palliative care circumstances.
Methods A qualitative meta-synthesis was conducted following an inductive approach as proposed by Sandelowski and Barroso. Inclusion criteria were studies with adult persons in palliative situations and articles published in English or German. Relevant articles were identified by researching the Pubmed and Cinahl databases, as well as by hand searches in journals and reference lists for the period 2000–2015. The findings of each study were analyzed using initial coding, followed by axial and selective coding in this order. Consequently, a conceptual model was derived from the categories.
Results In total 2225 articles were identified in the literature search. Finally, 14 studies were included after the selection process. The central phenomenon observed among palliative care patients and their families was maintaining normality during transitions. Transitions are initially experienced unconsciously until a crisis occurs and responsive actions are necessary, which encourages patients and families to perceive the situation consciously and develop strategies for its negotiation. Patients remain caught between hopelessness and valuing their remaining time alive. As the illness progresses, informal caregivers reprioritize and balance their roles, and after death, family members inevitably find themselves in changed roles.
Conclusions In palliative care situations, transitions are experienced differently by patients and their families in a constant phenomenon that oscillates between unconscious and conscious perceptions of transitions. The derived conceptual model offers an additional perspective to existing models and helps to clarify the phenomenon in practical settings. The study promotes a differentiated conceptual view of transitions and emphasizes patients’ and families’ perspectives.
Mareike Hechinger, A. Büscher
Pflegerische Beziehung im ambulanten Pflegesetting
QuPuG - Journal für Qualitative Forschung in Pflege- und Gesundheitswissenschaft, vol. 6, no. 2, pp. 82-91
Die Beziehungsgestaltung zwischen Pflegenden und pflegebedürftigen Menschen ist ein wichtiger Aspekt der ambulanten Pflege, der bislang kaum erforscht ist. In einer qualitativen Studie wurde die pflegerische Beziehungsgestaltung im deutschen, ambulanten Pflegesetting untersucht. Die Studie orientierte sich an den Prinzipien der Grounded-Theory nach Strauss und Corbin. Acht Interviews mit beruflich Pflegenden und 24 teilnehmende Beobachtungen wurden durchgeführt. Dem Ergebnis zufolge investieren Pflegende zu Beginn in den Beziehungsaufbau, um einen Zugang zum Gegenüber zu erhalten und förderliche sowie hinderliche Einflussfaktoren auf die Beziehung auszubalancieren. Die Ausrichtung der Beziehung auf dieser Ebene ist funktional in enger Anlehnung an pflegerische Tätigkeiten. Ausgehend von einem erfolgreichen Beziehungsaufbau auf der funktionalen Ebene können Pflegende optional die Beziehung auf einer menschlich-privaten Ebene gestalten. Diese ist geprägt von Reziprozität, dem Zeigen von Gefühlen und verstärktem Sich privat involvieren. Die Ergebnisse zeigen, dass es einer Sensibilisierung der Pflegepraxis für Beziehungsentwicklung bedarf. Es gilt, bereits in der Ausbildung Fähigkeiten zur Reflexion und Abgrenzung zu fördern, damit Pflegende Beziehungen bewusst gestalten lernen.
Mareike Hechinger, H. Mayer, A. Fringer
Kenneth Gergen’s concept of multi-being: an application to the nurse-patient relationship
Medicine, Health Care and Philosophy, vol. 22, no. Published: 15 April 2019, pp. 599-611
The nurse–patient relationship is of great significance for both nurses and patients. The purpose of this article is to gain an understanding of how the individual is constituted through a focus on the execution of the patient’s and nurse’s role in the joint relationship. The article represents a social-constructionist consideration using Kenneth Gergen’s concept of multi-being. Gergen’s notions of the self as a multi-being focuses on the individual’s relational character through former relationships and social interactions. Gergen’s concept is applied onto nurses and patients as individuals to gain an understanding of the broader institutional and social context of each role and their interactions within the nurse–patient relationship. The article focuses on the nurse–patient relationship in general with regard to specific challenges in the home care setting. Various demands and experiences from a myriad of past relationships merge as potential actions for nurses and patients during the forming of a relationship. Nurses as multi-beings see themselves confronted with guidelines and legal conditions, their own as well as the patients’ expectations and the actual possible forming of a relationship in the light of daily nursing care. Patients as multi-beings experience an extended social environment that comprises the nurse–patient relationship while simultaneously having to cope with illness and increasing care dependency within their own homes. Discrepancies can be observed in the relationship with regard to the inherent human qualities, the demands of forming a relationship, and the actual relationship arising due to framework conditions.
GesundEuropan Campus Rottal-Inn
T. Lorenz, Vlaskamp, B. N. S., Anna-Maria Kasparbauer, A. Mörtl, S. Hirche
Dyadic Movement Synchronization While Performing Incongruent Trajectories Requires Mutual Adaptation
Frontiers in Human Neuroscience, no. June
Unintentional movement synchronization is often emerging between interacting humans. In the present study, we investigate the extent to which the incongruence of movement trajectories has an influence on unintentional dyadic movement synchronization. During a target-directed tapping task, a participant repetitively moved between two targets in front of another participant who performed the same task in parallel but independently. When the movement path of one participant was changed by placing an obstacle between the targets, the degree of their unintentional movement synchronization was measured. Movement synchronization was observed despite of their substantially different movement trajectories. A deeper investigation of the participant's unintentional behavior shows, that although the actor who cleared the obstacle puts unintentional effort in establishing synchrony by increasing movement velocity—the other actor also unintentionally adjusted his/her behavior by increasing dwell times. Results are discussed in the light of joint action, movement interference and obstacle avoidance behavior.
GesundEuropan Campus Rottal-Inn
T. Talanow, Anna-Maria Kasparbauer, J. Lippold, B. Weber, U. Ettinger
Neural Correlates of Proactive and Reactive Inhibition of Saccadic Eye Movements
Brain Imaging and Behavior, vol. 14, pp. 72-88
Although research on goal-directed, proactive inhibitory control (IC) and stimulus-driven, reactive IC is growing, no previous study has compared proactive IC in conditions of uncertainty with regard to upcoming inhibition to conditions of certain upcoming IC. Therefore, we investigated effects of certainty and uncertainty on behavior and blood oxygen level dependent (BOLD) signal in proactive and reactive IC. In two studies, healthy adults performed saccadic go/no-go and prosaccade/antisaccade tasks. The certainty manipulation had a highly significant behavioral effect in both studies, with inhibitory control being more successful under certain than uncertain conditions on both tasks (p ≤ 0.001). Saccadic go responses were significantly less efficient under conditions of uncertainty than certain responding (p < 0.001). Event-related functional magnetic resonance imaging (fMRI) (one study) revealed a dissociation of certainty- and uncertainty-related proactive inhibitory neural correlates in the go/no-go task, with lateral and medial prefrontal and occipital cortex showing stronger deactivations during uncertainty than during certain upcoming inhibition, and lateral parietal cortex being activated more strongly during certain upcoming inhibition than uncertainty or certain upcoming responding. In the antisaccade task, proactive BOLD effects arose due to stronger deactivations in uncertain response conditions of both tasks and before certain prosaccades than antisaccades. Reactive inhibition-related BOLD increases occurred in inferior parietal cortex and supramarginal gyrus (SMG) in the go/no-go task only. Proactive IC may imply focusing attention on the external environment for encoding salient or alerting events as well as inhibitory mechanisms that reduce potentially distracting neural processes. SMG and inferior parietal cortex may play an important role in both proactive and reactive IC of saccades.
GesundEuropan Campus Rottal-Inn
Anna-Maria Kasparbauer, D. Rujescu, M. Riedel, O. Pogarell, A. Costa, T. Meindl, C. La Fougère, U. Ettinger
Methylphenidate Effects on Brain Activity as a Function of SLC6A3 Genotype and Striatal Dopamine Transporter Availability
Neuropsychopharmacology, vol. 40, pp. 736-745
We pharmacologically challenged catecholamine reuptake, using methylphenidate, to investigate its effects on brain activity during a motor response inhibition task as a function of the 3′-UTR variable number of tandem repeats (VNTR) polymorphism of the dopamine transporter (DAT) gene (SLC6A3) and the availability of DATs in the striatum. We measured the cerebral hemodynamic response of 50 healthy males during a Go/No-Go task, a measure of cognitive control, under the influence of 40 mg methylphenidate and placebo using 3T functional magnetic resonance imaging. Subjects were grouped into 9-repeat (9R) carriers and 10/10 homozygotes on the basis of the SLC6A3 VNTR. During successful no-go trials compared with oddball trials, methylphenidate induced an increase of blood oxygen level-dependent (BOLD) signal for carriers of the SLC6A3 9R allele but a decrease in 10/10 homozygotes in a thalamocortical network. The same pattern was observed in caudate and inferior frontal gyrus when successful no-go trials were compared with successful go trials. We additionally investigated in a subset of 35 participants whether baseline striatal DAT availability, ascertained with 123I-FP-CIT single photon emission computed tomography, predicted the amount of methylphenidate-induced change in hemodynamic response or behavior. Striatal DAT availability was nominally greater in 9R carriers compared with 10/10 homozygotes (d=0.40), in line with meta-analyses, but did not predict BOLD or behavioral changes following MPH administration. We conclude that the effects of acute MPH administration on brain activation are dependent on DAT genotype, with 9R carriers showing enhanced BOLD following administration of a prodopaminergic compound.
GesundEuropan Campus Rottal-Inn
Anna-Maria Kasparbauer, N. Merten, D. Aichert, N. Wöstmann, T. Meindl, D. Rujescu, U. Ettinger
Association of COMT and SLC6A3 Polymorphisms With Impulsivity, Response Inhibition and Brain Function
Cortex, vol. 71, no. October, pp. 219-231
Evidence of the genetic correlates of inhibitory control is scant. Two previously studied dopamine-related polymorphisms, COMT rs4680 and the SLC6A3 3′ UTR 40-base-pair VNTR (rs28363170), have been associated with response inhibition, however with inconsistent findings. Here, we investigated the influence of these two polymorphisms in a large healthy adult sample (N = 515) on a response inhibition battery including the antisaccade, stop-signal, go/no-go and Stroop tasks as well as a psychometric measure of impulsivity (Barratt Impulsiveness Scale) (Experiment 1). Additionally, a subsample (N = 144) was studied while performing the go/no-go, stop-signal and antisaccade tasks in 3T fMRI (Experiment 2). In Experiment 1, we did not find any significant associations of COMT or SLC6A3 with inhibitory performance or impulsivity. In Experiment 2, no association of COMT with BOLD was found. However, there were consistent main effects of SLC6A3 genotype in all inhibitory contrasts: Homozygosity of the 10R allele was associated with greater fronto–striatal BOLD response than genotypes with at least one 9R allele. These findings are consistent with meta-analyses showing that the 10R allele is associated with reduced striatal dopamine transporter expression, which in animal studies has been found to lead to increased extracellular dopamine levels. Our study thus supports the involvement of striatal dopamine in the neural mechanisms of cognitive control, in particular response inhibition.
GesundEuropan Campus Rottal-Inn
I. Meyhöfer, M. Steffens, E. Faiola, Anna-Maria Kasparbauer, V. Kumari, U. Ettinger
Combining two model systems of psychosis: The effects of schizotypy and sleep deprivation on oculomotor control and psychotomimetic states
Psychophysiology, vol. 54, no. 11, pp. 1755-1769
Model systems of psychosis, such as schizotypy or sleep deprivation, are valuable in informing our understanding of the etiology of the disorder and aiding the development of new treatments. Schizophrenia patients, high schizotypes, and sleep‐deprived subjects are known to share deficits in oculomotor biomarkers. Here, we aimed to further validate the schizotypy and sleep deprivation models and investigated, for the first time, their interactive effects on smooth pursuit eye movements (SPEM), prosaccades, antisaccades, predictive saccades, and measures of psychotomimetic states, anxiety, depression, and stress. To do so, n = 19 controls and n = 17 high positive schizotypes were examined after both a normal sleep night and 24 h of sleep deprivation. Schizotypes displayed higher SPEM global position error, catch‐up saccade amplitude, and increased psychotomimetic states. Sleep deprivation impaired SPEM, prosaccade, antisaccade, and predictive saccade performance and increased levels of psychotomimetic experiences. Additionally, sleep deprivation reduced SPEM gain in schizotypes but not controls. We conclude that oculomotor impairments are observed in relation to schizotypy and following sleep deprivation, supporting their utility as biomarkers in model systems of psychosis. The combination of these models with oculomotor biomarkers may be particularly fruitful in assisting the development of new antipsychotic or pro‐cognitive drugs.
GesundEuropan Campus Rottal-Inn
M. Steffens, B. Becker, C. Neumann, Anna-Maria Kasparbauer, I. Meyhöfer, B. Weber, M. Mehta, R. Hurlemann, U. Ettinger
Effects of Ketamine on Brain Function During Smooth Pursuit Eye Movements
Human Brain Mapping, vol. 37, no. 11, pp. 4047-4060
The uncompetitive NMDA receptor antagonist ketamine has been proposed to model symptoms of psychosis. Smooth pursuit eye movements (SPEM) are an established biomarker of schizophrenia. SPEM performance has been shown to be impaired in the schizophrenia spectrum and during ketamine administration in healthy volunteers. However, the neural mechanisms mediating SPEM impairments during ketamine administration are unknown. In a counter‐balanced, placebo‐controlled, double‐blind, within‐subjects design, 27 healthy participants received intravenous racemic ketamine (100 ng/mL target plasma concentration) on one of two assessment days and placebo (intravenous saline) on the other. Participants performed a block‐design SPEM task during functional magnetic resonance imaging (fMRI) at 3 Tesla field strength. Self‐ratings of psychosis‐like experiences were obtained using the Psychotomimetic States Inventory (PSI). Ketamine administration induced psychosis‐like symptoms, during ketamine infusion, participants showed increased ratings on the PSI dimensions cognitive disorganization, delusional thinking, perceptual distortion and mania. Ketamine led to robust deficits in SPEM performance, which were accompanied by reduced blood oxygen level dependent (BOLD) signal in the SPEM network including primary visual cortex, area V5 and the right frontal eye field (FEF), compared to placebo. A measure of connectivity with V5 and FEF as seed regions, however, was not significantly affected by ketamine. These results are similar to the deviations found in schizophrenia patients. Our findings support the role of glutamate dysfunction in impaired smooth pursuit performance and the use of ketamine as a pharmacological model of psychosis, especially when combined with oculomotor biomarkers.
GesundEuropan Campus Rottal-Inn
Anna-Maria Kasparbauer, I. Meyhöfer, M. Steffens, B. Weber, M. Aydine, V. Kumari, R. Hurlemann, U. Ettinger
Neural Effects of Methylphenidate and Nicotine During Smooth Pursuit Eye Movements
NeuroImage, vol. 141, no. November, pp. 52-59
Nicotine and methylphenidate are putative cognitive enhancers in healthy and patient populations. Although they stimulate different neurotransmitter systems, they have been shown to enhance performance on overlapping measures of attention. So far, there has been no direct comparison of the effects of these two stimulants on behavioural performance or brain function in healthy humans. Here, we directly compare the two compounds using a well-established oculomotor biomarker in order to explore common and distinct behavioural and neural effects.
Eighty-two healthy male non-smokers performed a smooth pursuit eye movement task while lying in an fMRI scanner. In a between-subjects, double-blind design, subjects either received placebo (placebo patch and capsule), nicotine (7 mg nicotine patch and placebo capsule), or methylphenidate (placebo patch and 40 mg methylphenidate capsule).
There were no significant drug effects on behavioural measures. At the neural level, methylphenidate elicited higher activation in left frontal eye field compared to nicotine, with an intermediate response under placebo.
The reduced activation of task-related regions under nicotine could be associated with more efficient neural processing, while increased hemodynamic response under methylphenidate is interpretable as enhanced processing of task-relevant networks. Together, these findings suggest dissociable neural effects of these putative cognitive enhancers.