Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study.

PURPOSE: To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. METHODS: The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. RESULTS: SPPB (median [interquartile range] 4.0 [2.8-5.0] pt. vs. 5.0 [3.0-6.3] pt.), step count (516 [89-1806] steps vs. 1111 [228-3291] steps), and LSA-IS total score (10.5 [6.0-15.0] pt. vs. 16.3 [12.0-24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003-0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. CONCLUSION: AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients' locomotor capacity.

Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial.

BACKGROUND: Training effects reported for stepping exergames on stepping performances in older adults often based on not comprehensively validated outcomes measures, and follow-up data on their sustainability are lacking. The aim of this study is to evaluate the effectiveness and sustainability of a motor-cognitive stepping exergame training on the stepping performance in older adults. METHODS: Fifty-eight older adults (78.3 ± 6.5 years) participated in the randomized controlled trial with a 10-week intervention and 10-week follow-up period. The intervention group (IG: n = 29) took part in a once-weekly exercise program including strength and balance exercises supplemented with an additional stepping exergame training. The control group (CG: n = 29) only performed the strength and balance exercises. Outcome measures included stepping reaction times (SRTs) and games scores for individual stepping exergame levels and for the overall exergame performance, as measured by an assessment strategy previously validated in older adults. RESULTS: SRTs and/or games scores for 7 out of 10 levels and the overall exergame performance significantly improved in the IG compared to the CG during the intervention (p ≤ 0.001-0.039, η p 2 = 0.090-0.445). Training gains were sustained for 2 levels and for the overall exergame performance (p = 0.017-0.033, η p 2 = 0.127-0.193). CONCLUSION: The study demonstrates that the additional stepping exergame training effectively and sustainably improves the performance in complex motor-cognitive stepping exergame tasks in older adults, which can be relevant for preventing falls. Future research is needed to evaluate the effectiveness of such training on reducing the number of falls. TRIAL REGISTRATION: ISRCTN registry, ISRCTN14855620, 06/06/2019 (retrospectively registered).

Attachment, Growth, and Detachment of Human Mesenchymal Stem Cells in a Chemically Defined Medium.

The manufacture of human mesenchymal stem cells (hMSCs) for clinical applications requires an appropriate growth surface and an optimized, preferably chemically defined medium (CDM) for expansion. We investigated a new protein/peptide-free CDM that supports the adhesion, growth, and detachment of an immortalized hMSC line (hMSC-TERT) as well as primary cells derived from bone marrow (bm-hMSCs) and adipose tissue (ad-hMSCs). We observed the rapid attachment and spreading of hMSC-TERT cells and ad-hMSCs in CDM concomitant with the expression of integrin and actin fibers. Cell spreading was promoted by coating the growth surface with collagen type IV and fibronectin. The growth of hMSC-TERT cells was similar in CDM and serum-containing medium whereas the lag phase of bm-hMSCs was prolonged in CDM. FGF-2 or surface coating with collagen type IV promoted the growth of bm-hMSCs, but laminin had no effect. All three cell types retained their trilineage differentiation capability in CDM and were detached by several enzymes (but not collagenase in the case of hMSC-TERT cells). The medium and coating did not affect detachment efficiency but influenced cell survival after detachment. CDM combined with cell-specific surface coatings and/or FGF-2 supplements is therefore as effective as serum-containing medium for the manufacture of different hMSC types.

[Patient Groups with Different Risk Profiles for Irregular Drop-Out from Forensic Psychiatry (§â€Š64 StGB)]. / Patientengruppen mit unterschiedlichem Risikoprofil für eine vorzeitige Erledigung des Maßregelvollzugs (§â€Š64 StGB).

OBJECTIVE: About 50 - 70 % of the patients with substance abuse disorders who are mandated to forensic treatment according to the section 64 of the German penal code are discharged from treatment irregularly. Previous research identified a number of potential risk factors for irregular treatment dropout. Systematic assessment of risks factors and their consideration for treatment planning may help to improve treatment retention. Therefore, the aim of this study was to identify groups of patients with a comparable risk profile for treatment dropout. METHODS: From 2007 - 2012, patients entering forensic treatment completed the MATE-Crimi and a sociodemographic questionnaire. RESULTS: From 431 patients entering forensic treatment, 357 patients agreed to participate. Of the 357 included patients 35.9 % had completed the forensic treatment irregular. Using cox regression, young age, low treatment motivation and a primary criminal behaviour with the substance use as a consequence of criminal behaviour were identified as risk factors for early drop-out. A subsequent analysis of latent classes using these variables resulted in three classes. CONCLUSIONS: Our study revealed a small number of risk factors being relevant for treatment drop-out. Furthermore, we identified three groups of patients with different risk profiles. Next steps include the development of treatment pathways for these patient groups.