Reablement - relevant factors for implementation: an exploratory sequential mixed-methods study design.

BACKGROUND: Reablement is a multi-professional and internationally established home-based health care service for mainly older people with the aim to reduce the need for long-term care and to promote self-determination. However, it is unknown which factors would facilitate the implementation of reablement in health care services. Therefore, the aim of this work was to identify relevant factors for the implementation process and to elucidate their importance based on the perspectives of experts. METHODS: Within an exploratory sequential mixed-methods design, a literature search followed by framework analysis was carried out using the five domains of the Consolidated Framework of Implementation Research (CFIR) to collect potentially relevant factors for implementation of reablement. A survey was then drawn up encompassing the factors identified. Within the survey international reablement - experts were asked to rate the relevance of these factors . RESULTS: The literature search identified 58 publications that served as sources for the framework analysis, where 40 potentially relevant factors were clustered into the five CFIR domains. These 40 factors were rated by experts in an online-survey. Based on the analysis of survey-data, 35 factors were considered as relevant for implementation of reablement services. The CFIR-domain characteristics of individuals, including teamwork and communication skills, was seen as most relevant. CONCLUSIONS: The implementation of reablement services is complex and requires the consideration of numerous factors, especially regarding the CFIR-domain characteristics of individuals. From the perspective of the survey´s participants one important factor of a successful implementation was the engagement of the persons involved. It requires team members with a strong, shared vision. Communication skills are highly important to promote teamwork and intensive training is needed to establish these skills. Further research on the implementation of reablement services is essential to realize its full potential.

Transoral laser microsurgery for T1b glottic cancer: review of 51 cases.

For the treatment of T1b glottic carcinoma, different treatment options, such as transoral laser microsurgery, open surgical techniques, and primary radiotherapy, are under discussion. In this context, the aim of the present study was to describe oncologic results and complication rates of transoral laser microsurgery in treatment of T1b glottic carcinoma. This is a retrospective unicenter chart review of patients treated at an academic tertiary referral center between 1986 and 2006. Fifty-one previously untreated T1b cases were exclusively treated by transoral laser microsurgery and included into this study, 47 were male, and 4 were female. The main outcome measures included local control rate and complications, overall, disease specific, and recurrence-free survival. The median follow-up period was 98 months. The 5-year local control rate was 90.2%; larynx preservation rate was 92.2%. No intra- or postoperative complications, such as wound infections, postoperative bleeding, hematoma, edema, and fistula development, were observed. A single patient required revision surgery due to synechia. Five-year survival rates were: overall 84.7%, disease specific 97.7%, and recurrence free 72.4%. Our data support the conclusion that transoral laser microsurgery is a considerable treatment option in T1b glottic carcinoma. The oncologic outcome was at least comparable to other treatment options, while the perioperative morbidity and complication rate were lower.

(Chemo)radiotherapy after laser microsurgery and selective neck dissection for pN2 head and neck cancer.

This study analyzed the efficacy of transoral laser microsurgery and postoperative (chemo) radiotherapy (CRT) for head and neck squamous cell carcinoma. Between 1987 and 2007, 318 patients with pN2 neck disease were included. Seventy-three patients received laser resection and neck dissection alone, 154 postoperative radiotherapy, and 91 postoperative (C)RT. Mean follow-up was 58.2 ± 51.2 months, and locoregional control was significantly better after postoperative (C)RT (surgery alone: 42 %, radiotherapy: 57 %, CRT: 59 %; p < 0.01). Postoperative (C)RT did not have a significant impact on disease-specific survival (DSS) (surgery alone: 55 %, radiotherapy alone: 60 %, CRT: 64 %; p = 0.36). Fifty-seven patients (17.92 %) developed distant metastases, and 39 patients (12.26 %) presented with secondary malignancies, with no significant differences found between the treatment groups. Postoperative (C)RT significantly improved locoregional control, but had no significant effect on DSS because of high rates of secondary malignancies and distant metastases. Reduced radicality in combination with an effective screening might improve prognosis and quality of life of these patients.

On the rotational equations of motion in rigid body dynamics when using Euler parameters.

Many models of three-dimensional rigid body dynamics employ Euler parameters as rotational coordinates. Since the four Euler parameters are not independent, one has to consider the quaternion constraint in the equations of motion. This is usually done by the Lagrange multiplier technique. In the present paper, various forms of the rotational equations of motion will be derived, and it will be shown that they can be transformed into each other. Special attention is hereby given to the value of the Lagrange multiplier and the complexity of terms representing the inertia forces. Particular attention is also paid to the rotational generalized external force vector, which is not unique when using Euler parameters as rotational coordinates.

Organ preservation in T4a laryngeal cancer: is transoral laser microsurgery an option?

The main objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of T4a laryngeal cancer and to report the oncological and functional outcomes. This is a retrospective case-series study, held in a single-institute, academic tertiary referral center. Seventy-nine patients with previously untreated T4a glottic (n = 31, 39 %) or supraglottic laryngeal carcinoma (n = 48, 61 %) were included in this study. Five patients (6 %) were treated exclusively by TLM, 16 (20 %) had TLM and unilateral neck dissection, 27 (35 %) had TLM and bilateral neck dissection. Adjuvant (chemo)radiotherapy was additionally administered in 26 (33 %) cases following TLM and neck dissection, and in 5 (6 %) cases after TLM without neck dissection. The main outcome measures included organ preservation, local control, functional outcome, overall, recurrence-free, and disease-specific survival. The median follow-up period was 49 months, 5 year organ preservation rate and local control rate were 80.0 and 67.2 %, 5 year overall, recurrence-free and disease-specific survival were 55.8, 61.9 and 71.8 %. The 5 year overall survival rates were 62.5 % in pN0 cases and 57.2 % in cases with pN-positive neck disease. With respect to survival, these results are comparable to total laryngectomy, while being superior to primary (chemo)radiotherapy. TLM results in a low morbidity, rapid recovery and good function and can be a valid option for organ preserving surgery of pT4a glottic and supraglottic cancer.

Oncologic and functional results after transoral laser microsurgery of tongue base carcinoma.

The objective of the study was to determine the oncological and functional results in patients after excision of tongue base carcinoma by transoral laser microsurgery. A retrospective unicenter study performed between 1986 and 2007. 82 patients with previously untreated squamous cell carcinoma of the tongue base (T1-4, N0-2, M0) underwent transoral laser surgery with curative intent. Stage distribution was as follows: stage I, 1 case (1 %): stage II, 6 cases (7 %): stage III, 14 cases (17 %): stage IV 61 cases (75 %). Main outcome measures are local control rate, overall survival, recurrence-free survival, complications, and feeding tube dependence. The results were Kaplan-Meier 5-year local control rate for all patients was 84 %. T-stage-related local control rate after 5 years was 94 % for stage I-II, 78 % for stage III and 81 % for stage IV. 5-year overall survival and recurrence-free survival were 59 and 69 %, respectively. UICC stage-related overall survival and recurrence-free survival were 70 and 86 % for stage I-II, 44 and 54 % for stage III and 58 and 69 % for stage IV. Postoperative bleeding at the primary tumor site occurred in 9 patients (11 %). Gastrostomy tubes remained in place permanently in 5 patients (6 %). Primary transoral laser microsurgery of tongue base carcinoma offers convincing oncological and functional results comparable to other treatment modalities, e.g., radio(chemo)therapy but has lower rates of morbidity.

Results of transoral laser microsurgery for supraglottic carcinoma in 277 patients.

The objective of the study was to evaluate the oncological and functional results of transoral laser microsurgery (TLM) in patients with supraglottic laryngeal squamous cell carcinoma. Between June 1980 and December 2006, 277 patients with squamous cell supraglottic carcinoma of all stages were treated by primary carbon dioxide laser microsurgery. All treatments were performed with curative intention. The goal was the complete tumor removal with preservation of functionally important structures of the larynx. The administered treatment was exclusively TLM with or without selective or modified radical neck dissection in 215 cases (78 %); TLM with postoperative radiotherapy was performed in 62 cases (22 %). Data were analyzed using the Kaplan-Meier method. The median follow-up was 65 months. We achieved a 5-year local control rate of 85% for pT1/pT2, 82% for pT3, and 76% for pT4. The 5-year overall, recurrence-free and disease-specific survival rates for stages I and II were 76, 81, and 92%, for stages III and IVa 59, 65, and 81%, respectively. With respect to local control and survival, these results are comparable with the results achieved by conventional partial and total resection of the larynx, while being superior to primary (chemo)radiotherapy. Transoral laser microsurgery results in a low morbidity, rapid recovery, and superior function compared with standard therapy.

Results of transoral laser microsurgery in 102 patients with squamous cell carcinoma of the tonsil.

The objective of this study is to assess the feasibility of transoral laser microsurgery (TLM) in the treatment of squamous cell cancer of the tonsil and to report the oncological and functional outcomes, using retrospective chart review in the setting of single-institute, academic tertiary referral center. Between October 1987 and December 2006, 102 patients were eligible for this study, mostly suffering from advanced disease: 13% presented with stage I and II (UICC/AJCC 2002) tumors and 87% with stages III and IVa. The median follow-up was 63 months. All patients were treated by TLM with (or without) neck dissection (95%) and with (66%) postoperative radiotherapy. Overall survival, recurrence-free survival, disease-free survival, local control and loco-regional control were analyzed as end points. Rate of tracheotomies, postoperative complications and swallowing function were also analyzed. 5-year Kaplan-Meier local and loco-regional control was 78% for pT1 and pT2 and 75 % for pT3 and pT4a tumors. 5-year Kaplan-Meier disease-free survival, recurrence-free survival, and overall survival and was 74, 64 and 59% for stage I and II, 68, 60 and 56 % for stage III and IVa, respectively. Our data supports the conclusion, that TLM should be considered as a therapeutic option for the treatment of cancer of the tonsil. The oncological and functional results are comparable to any other treatment regimen, while the morbidity and complications tend to be lower.

Assessing psychological variables on mobile devices: an introduction to the experience sampling app ESM-Quest.

The use of the Experience Sampling Method (ESM), which involves repeated assessments in people's daily lives, has increased in popularity in psychology and associated disciplines in recent years. A rather challenging aspect of ESM is its technical implementation. In this paper, after briefly introducing the history of ESM and the main reasons for its current popularity, we outline the ESM-Quest experience sampling app which is currently being developed at the University of Vienna. ESM-Quest runs on different operating systems, specifically on mobile devices such as smartphones and tablets running either iOS or Android. An internet connection is not necessary during the assessment. Compared to most other ESM apps, ESM-Quest allows event-based random sampling, which is very helpful when assessments need to be collected within specific situations. Currently, ESM-Quest is being utilized at the University of Vienna and will be made available for research groups worldwide upon request. We introduce the technical aspects of ESM-Quest and provide examples of analyses on ESM data collected through this app, such as examining fluctuations in constructs within individuals. Finally, we outline potential next steps in ESM research.

Redundancy of minimal weight expansions in Pisot bases.

Motivated by multiplication algorithms based on redundant number representations, we study representations of an integer n as a sum n=∑kεkUk, where the digits εk are taken from a finite alphabet Σ and (Uk)k is a linear recurrent sequence of Pisot type with U0=1. The most prominent example of a base sequence (Uk)k is the sequence of Fibonacci numbers. We prove that the representations of minimal weight ∑k|εk| are recognised by a finite automaton and obtain an asymptotic formula for the average number of representations of minimal weight. Furthermore, we relate the maximal number of representations of a given integer to the joint spectral radius of a certain set of matrices.

Temporal patterns of roe deer traffic accidents: Effects of season, daytime and lunar phase.

Wildlife-related accidents, especially deer-vehicle accidents, pose a serious problem for road safety and animal protection in many countries. Knowledge of spatial and temporal patterns of deer-vehicle accidents is inevitable for accident analysis and mitigation efforts with temporal deer-vehicle accident data being much more difficult to obtain in sufficient data quality. We described the temporal patterns of roe deer (Capreolus capreolus) roadkills occurring in the period 2002-2006 in southeastern Austria. Using a comprehensive dataset, consisting of 11.771 data points, we examined the influence of different time units (i.e. season, month, day of week, day of year), illumination categories (coarse and fine temporal resolution) and lunar phases on deer-vehicle accidents by performing linear and generalized additive models. Thereby, we identified peak accident periods within the analyzed time units. Highest frequencies of deer-vehicle accidents occurred in November, May and October, on Fridays, and during nights. Relationships between lunar phases and roe deer-vehicle accidents were analysed, providing evidence for high frequencies of deer-vehicle accidents during full moon phases. We suggest that deer-vehicle accidents are dependent both on human activity in traffic and wildlife activity, which is in turn affected by phenology, intra- and interspecific competition, climatic and astronomical events. Our results highlight, that short-term mitigation measures (e.g. traffic controls and speed limits) can be highly effective to reduce deer-vehicle accidents, but should be flexibly adapted to specific temporal periods.

Organ function and quality of life after transoral laser microsurgery and adjuvant radiotherapy for locally advanced laryngeal cancer.

BACKGROUND AND PURPOSE: Transoral laser microsurgery (TLM) and adjuvant radiotherapy are an established therapy regimen for locally advanced laryngeal cancer at our institution. Aim of the present study was to assess value of quality of life (QoL) data with special regard to organ function under consideration of treatment efficacy in patients with locally advanced laryngeal cancer treated with larynx-preserving TLM and adjuvant radiotherapy. PATIENTS AND METHODS: From 1994 to 2006, 39 patients (ten UICC stage III, 29 UICC stage IVA/B) with locally advanced laryngeal carcinomas were treated with TLM and adjuvant radiotherapy. Data concerning treatment efficacy, QoL (using the VHI [Voice Handicap Index], the EORTC QLQ-C30 and QLQ-H&N35 questionnaires) and organ function (respiration, deglutition, voice quality) were obtained for ten patients still alive after long-term follow-up. Correlations were determined using the Spearman rank test. RESULTS: After a median follow-up of 80.8 months, the 5-year overall survival rate was 46.8% and the locoregional control rate 76.5%, respectively. The larynx preservation rate was 89.7% for all patients and 100% for patients still alive after follow-up. Despite some verifiable problems in respiration, speech and swallowing, patients showed a subjectively good QoL. CONCLUSION: TLM and adjuvant radiotherapy is a curative option for patients with locally advanced laryngeal cancer and an alternative to radical surgery. Even if functional deficits are unavoidable in the treatment of locally advanced laryngeal carcinomas, larynx preservation is associated with a subjectively good QoL.

Transoral laser microsurgery for treatment of oropharyngeal cancer in 368 patients.

BACKGROUND: Oncological and functional outcome of transoral laser microsurgery (TLM) for primary treatment of oropharyngeal cancer was examined using a multimodal treatment concept. METHODS: A total of 368 patients with oropharyngeal squamous cell carcinoma (pT1-4, pN0-2, M0) underwent TLM +/- neck dissection (85%), +/- (chemo)radiotherapy (57%). The majority of patients had advanced stage III and IVa disease (79%). RESULTS: Five-year Kaplan-Meier estimates for local control were 83.5% for pT1, 74.1% for pT2, 77.3% for pT3, and 76.0% for pT4a tumors. Five-year estimates of overall, disease-specific, and recurrence-free survival for stage I were 76.0%, 92.8%, and 69.1%; for stage II 71.1%, 85.7%, and 49.6%; for stage III 61.7%, 72.5%, and 58.8%; and for stage IVa 57.3%, 73.7%, and 63.9%, respectively. Postoperative (chemo)radiotherapy improved the outcome for advanced disease. p16-positive tumors had superior survival estimates. Overall, 93.5% maintained regular oral nutrition without feeding tube dependency. CONCLUSION: Primary TLM in multimodal concepts of treatment offers good oncologic outcome even for advanced-stage oropharyngeal cancer.

Organ preserving transoral laser microsurgery for cancer of the hypopharynx.

OBJECTIVE: To assess the feasibility of transoral laser microsurgery (TLM) in the treatment of hypopharyngeal cancer, with a special focus on piriform sinus carcinomas, and to report the oncologic and functional outcomes. STUDY DESIGN: Prospective case-series study at a single institute, an academic tertiary referral center. METHODS: A total of 172 patients with previously untreated squamous cell carcinoma of the hypopharynx were eligible for this study (1986-2003). The piriform sinus was the most common localization (n = 150). Patients with simultaneous second primaries, distant metastases, or N3 neck disease and cancers of the category pT4b were excluded. Fifteen percent of the patients had stages I and II (according to guidelines from the Union Internationale Contre le Cancer 2002/American Joint Commission on Cancer, 2002), and 85% had stages III and IVa. The median follow-up period was 45 months. All patients (n = 172) were treated by TLM, mainly by selective neck dissection (93%) and/or postoperative radiotherapy (52%). Overall survival, recurrence-free survival, organ preservation, and local control were analyzed as end points. Rate of tracheotomies, postoperative complications, and swallowing function (feeding tube dependency) were also analyzed. RESULTS: : Five-year Kaplan-Meier local control was 84% for pT1; 70% for pT2; 75% for pT3; and 57% for pT4a. Five-year Kaplan-Meier recurrence-free survival was 73% for stages I and II, 59% for stage III, and 47% for stage IVa. The whole group of 172 hypopharyngeal cancer patients was analyzed, with an additional special focus on the homogenous group of piriform sinus carcinomas (n = 150). CONCLUSIONS: Our data support the conclusion that TLM is a valid option to standard radical surgery or standard conservation treatment. Oncologic and functional results compare favorably, while morbidity and complication rates tend to be lower.

The discrete adjoint method for parameter identification in multibody system dynamics.

The adjoint method is an elegant approach for the computation of the gradient of a cost function to identify a set of parameters. An additional set of differential equations has to be solved to compute the adjoint variables, which are further used for the gradient computation. However, the accuracy of the numerical solution of the adjoint differential equation has a great impact on the gradient. Hence, an alternative approach is the discrete adjoint method, where the adjoint differential equations are replaced by algebraic equations. Therefore, a finite difference scheme is constructed for the adjoint system directly from the numerical time integration method. The method provides the exact gradient of the discretized cost function subjected to the discretized equations of motion.

A frequency domain approach for parameter identification in multibody dynamics.

The adjoint method shows an efficient way to incorporate inverse dynamics to engineering multibody applications, as, e.g., parameter identification. In case of the identification of parameters in oscillating multibody systems, a combination of Fourier analysis and the adjoint method is an obvious and promising approach. The present paper shows the adjoint method including adjoint Fourier coefficients for the parameter identification of the amplitude response of oscillations. Two examples show the potential and efficiency of the proposed method in multibody dynamics.

Impact of re-resection for inadequate margins on the prognosis of upper aerodigestive tract cancer treated by laser microsurgery.

OBJECTIVES: Positive or uncertain surgical margins left untreated have a distinct prognostic relevance in squamous cell carcinoma of the upper aerodigestive tract. An advantage of transoral laser microsurgery is that it can be easily repeated if inadequate resection margins are found postoperatively. The present study investigates the impact of laser surgical reresection on the outcome of patients. STUDY DESIGN: The authors conducted a retrospective unicenter study. METHODS: A review of 1,467 patients with squamous cell carcinoma of the upper aerodigestive tract who were initially treated by transoral laser microsurgery with curative intent between August 1986 and December 2002 was conducted. Locoregional control as well as TNM adjusted and overall survival were analyzed using the Kaplan-Meier method. RESULTS: Three hundred eighty-six patients have required reresection to obtain clear surgical margins, in 70 of whom residual carcinoma has been detected in revision specimens. Patients without need for revision and those in whom revision specimens were found tumor-free had an almost identical locoregional control (P = .4611). In patients with positive revision specimens, however, locoregional control was significantly worsened (P = .0058). Neither the need for reresection nor the detection of further tumor tissue in revision specimens affected TNM adjusted or overall survival. CONCLUSIONS: Survival of patients was similar whether clear resection margins were reached within the first surgical step or with revision surgery. However, patients in whom reresection specimens contained residual carcinoma had an increased risk of locoregional failure and should undergo a further reresection or at least a very close follow up.

Transoral laser microsurgery for advanced laryngeal cancer.

OBJECTIVE: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of advanced laryngeal cancer. DESIGN: Prospective case series study. SETTING: Multi-institution (academic, tertiary referral centers). PATIENTS: A total of 117 patients with pathologically confirmed T2 to T4 lesions, stage III or stage IV, glottic or supraglottic carcinoma of the larynx were treated with TLM from 1997 to 2004. All patients had a minimum follow-up period of 2 years. INTERVENTIONS: Transoral laser microsurgery in 117 patients, neck dissection in 91 patients, and adjuvant radiotherapy in 45 patients. MAIN OUTCOME MEASURES: End points analyzed included laryngeal preservation, overall survival, disease-free survival, local control, locoregional control, and distant metastases. Postoperative complications, tracheotomy rate, and feeding-tube dependence were also examined. RESULTS: The median follow-up period among surviving patients was 5 years. At 2 years, the percentage of patients with an intact larynx after treatment was 92%. The 2-year local control and locoregional control rates were 82% and 77%, respectively. The 2-year disease-free and overall survival rates were 68% and 75%, respectively. The 5-year Kaplan-Meier estimates were local control, 74%; locoregional, control, 68%; disease-free survival, 58%; overall survival, 55%; and distant metastases, 14%. Four patients (3%) experienced treatment-related deaths. Seven patients (6%) experienced a postoperative hemorrhage. Of those patients with organ preservation and no disease recurrence, 2 patients (3%) were tracheotomy dependent, and 4 patients (7%) were feeding-tube dependent. CONCLUSIONS: In patients with advanced laryngeal cancer, TLM with or without radiotherapy is a valid treatment strategy for organ preservation. Furthermore, low morbidity and mortality and excellent oncologic and functional outcomes make TLM an attractive therapeutic option.

Optimal input design for multibody systems by using an extended adjoint approach.

We present a method for optimizing inputs of multibody systems for a subsequently performed parameter identification. Herein, optimality with respect to identifiability is attained by maximizing the information content in measurements described by the Fisher information matrix. For solving the resulting optimization problem, the adjoint system of the sensitivity differential equation system is employed. The proposed approach combines these two well-established methods and can be applied to multibody systems in a systematic, automated manner. Furthermore, additional optimization goals can be added and used to find inputs satisfying, for example, end conditions or state constraints.

Transoral laser microsurgery for treatment for hypopharyngeal cancer in 211 patients.

BACKGROUND: The oncologic and functional outcome of transoral laser microsurgery (TLM) for primary treatment of hypopharyngeal cancer was examined in a multimodal treatment concept. METHODS: Two hundred eleven patients with squamous cell carcinoma (SCC) of the hypopharynx (pT1-4a, pN0-2, M0) were treated by TLM +/- neck dissection (88%) +/- (chemo)radiotherapy ([C]RT; 51%). The majority of cases were advanced stages III and IVa (85%). RESULTS: The 5-year Kaplan-Meier estimates for local control after TLM were pT category-related 88.1%, 74.8%, 77.3%, and 61.8% for pT1-4a tumors. The 5-year estimates of overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) for early stages I and II were 68.2%, 96.7%, and 74.6%, respectively; for stage III they were 65.9%, 83.8%, and 56.4%, respectively; and the rates for stage IVa were 44.5%, 60.7%, and 50.3%, respectively. Overall, 95.7% of the patients maintained regular oral nutrition without feeding tube dependency. CONCLUSION: Primary TLM in multimodal concepts of treatment (+/- neck dissection, +/- [C]RT) offers favorable oncologic results as compared with other therapeutic regimes.