What contributes most to the SPPB and its subscores in hospitalized geriatric patients: an ICF model-based approach.

BACKGROUND: Mobility deficits are highly prevalent among geriatric patients and have serious impact on quality of life, hospitalizations, and mortality. This study aims to capture predictors of mobility deficits in hospitalized geriatric patients using the International Classification of Functioning, Disability and Health (ICF) model as a framework. METHODS: Data were obtained from n = 397 patients (78 ± 7 years, 15 ± 7 ICD-11 diagnoses) on a geriatric ward at time of admission. Mobility was assessed using the Short Physical Performance Battery (SPPB) total score and gait, static balance and transfer subscores. Parameters from an extensive assessment including medical history, neuropsychological and motor examination, and questionnaires were assigned to the five components of the ICF model. Spearman's Correlation and multiple linear regression analyses were calculated to identify predictors for the SPPB total score and subscores. RESULTS: Use of walking aid, fear of falling (FOF, but not occurrence of previous falls), participation in society, ADL and grip strength were strongly associated with the SPPB total score and all subscores (p < .001). FOF and grip strength were significant predictors for the SPPB total score as well as for gait and transfer subscores. FOF also showed a strong association with the static balance subscore. The clinical parameters of the ICF model could only partially explain the variance in the SPPB total score (24%) and subscores (12-23%), with no parameter from the activities and participation component being significantly predictive. CONCLUSIONS: FOF and reduced grip strength are associated with mobility deficits in a hospitalized geriatric cohort. Further research should focus on interventions to reduce FOF and increase muscle strength in geriatric patients. Moreover, there is a need for ICF-based assessments instruments (especially in the activities and participation components) that allow a holistic view on mobility and further daily life-relevant health aspects in geriatric patients.

Motor, cognitive and mobility deficits in 1000 geriatric patients: protocol of a quantitative observational study before and after routine clinical geriatric treatment - the ComOn-study.

BACKGROUND: Motor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany). METHODS: This is a prospective, explorative observational multi-center study. In addition to the comprehensive geriatric assessment, quantitative measures of reduced mobility and motor and cognitive deficits are performed before and after a two week's inpatient stay. Components of the assessment are mobile technology-based assessments of gait, balance and transfer performance, neuropsychological tests, frailty, sarcopenia, autonomic dysfunction and sensation, and questionnaires to assess behavioral deficits, activities of daily living, quality of life, fear of falling and dysphagia. Structural MRI and an unsupervised 24/7 home assessment of mobility are performed in a subgroup of participants. The study will also investigate the minimal clinically relevant change of the investigated parameters. DISCUSSION: This study will help form a better understanding of symptoms and their complex interactions and treatment effects in a large geriatric cohort.

Neurogeriatrics-a vision for improved care and research for geriatric patients with predominating neurological disabilities.

Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson's disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.

Diagnosis and treatment of cognitive impairment.

As a result of the aging population dementia is a growing challenge, especially in healthcare. Nevertheless, cognitive disorders are often not systematically evaluated, especially during hospital stays for other reasons; however, cognitive impairment is associated with a number of geriatric syndromes, including falls, delirium, dysphagia and lack of adherence to treatment plans. This article considers the current state of diagnosis and treatment of dementia. Non-pharmacological therapeutic approaches as well as current and future pharmacological treatment options are discussed. The drugs of choice for the symptomatic treatment of cognitive deficits in Alzheimer's disease and Parkinson-associated dementia are cholinesterase inhibitors and memantine; there is no specific pharmacological treatment for other types of dementia. Prevention and treatment of cardiovascular risk factors can potentially retard the progression of possibly all forms of dementia.

Functional movement disorders in neurogeriatric inpatients : Underdiagnosed, often comorbid to neurodegenerative disorders and treatable.

BACKGROUND: The proportion of patients with functional movement disorders (FMD) is particularly high in neurology clinics. Treatment options have not been consistently developed, not well evaluated and not validated. This article presents the preliminary data on the prevalence and treatment response of patients with FMD who were treated within the framework of an early rehabilitative geriatric complex treatment at a university hospital for neurology. METHODS: From July 2017 to November 2018 the prevalence, demographic and clinical parameters, and response to treatment of FMD patients were documented and compared to non-FMD patients treated at the neurogeriatric ward of the University Hospital Schleswig-Holstein, in Kiel. Clinical endpoints were the Short Physical Performance Battery (SPPB) for mobility and the Barthel index for instrumented activity of daily life (iADL). RESULTS: The prevalence of FMD was 11% (19/175) and predominantly observed in women (74%). Of the FMD patients nine also had a diagnosis of either idiopathic Parkinson's disease (N = 7), dementia with Lewy bodies (N = 1) or progressive supranuclear palsy (N = 1). At admission, neither the SPPB nor the iADL differed significantly between FMD and non-FMD patients. The treatment response was comparable between the groups: SPPB change was +0.3±1.8 (mean, standard deviation) in FMD and +0.4±1.9 in non-FMD patients (p = 0.83). The iADL change was +19±15 in FMD and +18±17 in non-FMD (p = 0.83). CONCLUSION: The prevalence of FMD was unexpectedly high in the neurogeriatric ward of a German university hospital. There were comparable impairments and responses to multidisciplinary treatment in mobility and iADL between FMD and non-FMD geriatric patients, suggesting that specific and informed treatment provided by a multidisciplinary geriatric team is effective in geriatric FMD patients. Further studies of this underdiagnosed disorder in older age are warranted.

[Comparison of Two Umbilicoplasty Techniques in 72 Patients after Breast Reconstruction with a Free DIEP Flap] / Vergleich zweier Techniken der Umbilikoplastik bei 72 Patientinnen nach Brustrekonstruktion mit freier DIEP-Lappenplastik.

INTRODUCTION: The appearance of the umbilicus after DIEP flap surgery or abdominoplasty plays an important role in aesthetic perception (1). Although the umbilicus has no function, there is no doubt about the importance of its shape for the self-esteem of patients, especially after breast cancer (2). In the present study, we compared two of the preferred techniques described in the literature on 72 patients in terms of aesthetic outcome, complications and sensitivity: the caudal flap (domed shape) and the oval shape of the umbilicus. PATIENTS AND METHODS: Seventy-two patients who underwent a DIEP flap for breast reconstruction between January 2016 and July 2018 were retrospectively included in this study. Two techniques for umbilical reconstruction were compared: the transverse oval shape of the umbilicus and umbilicoplasty using a caudal flap, which results in a dome shape of the umbilicus. To compare the aesthetic results, an evaluation by the patients and an assessment by three independent plastic surgeons were carried out at least 6 months postoperatively. Patients and surgeons were asked to rate the general appearance of the umbilicus, including scarring and shape, on a scale from 1 to 6 (1=very good, 2=good, 3=fair, 4=sufficient, 5=poor, 6=insufficient). Furthermore, the occurrence of wound healing disorders was examined, and patients were asked about the sensitivity of the umbilicus. RESULTS: Both techniques showed similar degrees of aesthetic satisfaction (p=0,49) as part of the patients' self-assessment. The plastic surgeons gave the caudal flap technique a significantly better rating than the umbilicus with a transverse oval shape (p=0,042). More wound healing disorders occurred in the caudal lobule (11,1%) compared with the transverse oval umbilicus. However, this was not significant (p=0,16). A surgical revision was not necessary. The caudal flap umbilicus showed a tendency to improved sensitivity (60 vs. 45%), but this was not significant (p=0,19). CONCLUSION: Patient satisfaction showed similar results for the two methods of umbilicoplasty. On average, both techniques were given a good rating for their results. However, surgeons rated the caudal flap umbilicoplasty as more aesthetically pleasing.

Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors.

BACKGROUND: Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF. METHODS: For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models. RESULTS: The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: ß = -0.28, P = 0.09; discharge: ß = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: ß = -0.15, P = 0.10; discharge: ß = -0.15, P = 0.19). CONCLUSIONS: This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.

[How well are patients informed on the websites of German university breast centres about the possibilities of breast reconstruction?] / Wie gut werden Patientinnen auf Internetseiten von deutschen universitären Brustzentren über die Möglichkeiten der Brustrekonstruktion informiert?

INTRODUCTION: In recent decades, the internet has become one of the most important sources of information for patients. How substantial are the possibilities to find out about breast reconstruction on the homepages of university hospitals in Germany? Is there information about plastic surgery with its spectrum of modern reconstructive possibilities? METHODS: A total of 35 homepages of university breast centres in Germany was analysed for the indication of cooperation with a plastic surgeon or a department for plastic surgery and their links, with information on reconstructive possibilities such as implant reconstruction, autologous soft tissue reconstruction with pedicled and free flaps as well as lipofilling. RESULTS: A plastic surgeon or a cooperating department is mentioned on 49 % of the homepages. Of those homepages, 20 % contain a direct link. 91 % of the homepages describe the possibility of breast reconstruction in general, 80 % of the websites the use of autologous tissue. In 51 % of the cases, a free tissue transfer is mentioned, whereas only 23 % describe the procedures like DIEP flap, TMG, or I-GAP in more detail. Only two centres use detailed illustrations. Six websites (17 %) describe reconstruction by pedicled TRAM flap only. Breast reconstruction with a silicone implant is mentioned on 71 % of the websites. The possibility of lipofilling is discussed in 31 %. DISCUSSION: About half of the websites of university breast centres do not show any cooperation with a plastic surgeon. There are significant gaps in the information on free tissue transfer for breast reconstruction.

[Adequate Antibiotic Prophylaxis and Therapy of Periprosthetic Infections of the Breast - Review of 468 Consecutive Implant Removals]. / Gezielte Antibiotika-Prophylaxe und Therapie periprothetischer Infektionen der Brust ­ Erfahrungen aus 468 konsekutiven Implantatentfernungen.

Background Periprosthetic infections are feared complications in aesthetic as well as in reconstructive breast surgery. The purpose of our study was to evaluate our institution's specific culture data and to identify most common organisms and suitable antibiotics for prophylaxis and first line treatment in implant-based breast surgery. Patients and Methods We analyzed all patients with a change or removal of breast implants in the period from 01.01.2012 to 31.12.2015 retrospectively. Based on the medical records, the surgical indications were identified and specifically analyzed for signs of infection and capsular fibrosis. In addition, we assessed all microbiological data of these interventions. Results 468 implant removals or exchanges were performed in 360 patients. Microbiological smears were gathered from 169 patients (249 implants). Bacteria were cultured from 23 implants (21 patients). In 6 additional implants (four patients) a periprosthetic infection was present, without pathogen detection. In most cases, advanced capsular fibrosis was the reason for implant exchange. In 17 smears bacterial detection was carried out despite absence of clinical signs of infection. In 17 cases coagulase-negative staphylococci were detected. In 4 Staphylococcus aureus, and once each E. coli, Morganella morganii and Proprionibacterium acnes (one double infection). All pathogens were sensitive to piperacillin/tazobactam and vancomycin. One resistancy was seen to cefuroxime and amoxicillin/clavulanic acid, and 2 to gentamicin, ciprofloxacin and clindamycin. Conclusion In the majority of cases, pathogen detection was an incidental finding, while capsular contracture caused surgical revision. Pathogens and resistance patterns found in this study differed from the majority of international publications. In our institution, Cefuroxime and amoxicillin/clavulanic acid have been proven to be a reasonable choice for prevention and treatment of periprosthetic infections. Especially in fulminant infections piperacillin/tazobactam would be our choice for initial treatment, until the specific antibiogram is available.

The effect of a bacterial contamination on the formation of capsular contracture with polyurethane breast implants in comparison with textured silicone implants: an animal study.

INTRODUCTION: One of the most common complications following breast augmentation is capsular contracture. The subclinical infection of the implant is often considered to be one of the main risk factors. It is believed that polyurethane (PU) implants, because of their larger foam-like surface, have lower capsular contracture rates due to better tissue integration. It remains unclear if bacterial contamination and biofilm formation result in higher capsular contracture rates under the condition of the increased surface of PU implants compared to textured silicone-gel implants. The effect of this bacterial contamination was examined in an animal-based study. METHODS: A total of 80 mini implants (40 textured silicone-gel implants and 40 PU implants) were implanted in the dorsum of female Wistar rats. In each group, 20 implants were inoculated before implantation with a standard amount of Staphylococcus epidermidis. Capsules and implants were explanted after 60 days, followed by double-blind histological, immunohistochemical, and microbiological examinations. RESULTS: Macroscopic separation of the total capsule in the textured implant group was possible whereas the growth of surrounding tissue into the foam structure of PU implants made separation in that group difficult. After contamination, a thicker capsule could be observed in both groups without significant differences. Histologically, capsules around PU implants showed significantly lower expression of parallel myofibrils. We were able to describe a significant higher infiltration with inflammatory cells in capsules around PU implants both with and without contamination. Microbiological investigations revealed positive growth of S. epidermidis around one PU implant without related signs of capsular contracture. DISCUSSION: This study demonstrates that aside from the surface of silicone implants, bacterial contamination has major impact on the architecture of capsule formation. In our study, we were able to demonstrate that bacterial contamination leads to a thicker capsule and an increased tissue reaction with a higher amount of inflammatory cells. However, a resulting bacterial infection was only demonstrated in one case and had an insignificant influence on capsule architecture. The observed inflammatory reaction around PU implants was observed as a nonbacterial, granulomatose foreign body reaction. EBM RATING: Level I: Evidence obtained from at least one properly designed randomized controlled trial.

The central-pedicled intracorial skin-flap technique for reconstruction of the nipple-areola complex (NAC).

Nipple-areola complex (NAC) reconstruction tends to be the final phase of post-mastectomy reconstruction for many cancer patients, as it transforms the amorphous breast mound into a more aesthetically realistic breast. A variety of local-flap based techniques have been reported. In this paper we will describe a cantral-pedicled intracorial skin flap technique. Review of 12 patients showed aesthetic pleasing NAC and durable long-term results of nipple projection.

Accidental inclusions following blast injury in esthetical zones: ablation by a hydrosurgery system.

In case of blast injuries, traumatic tattoos can result from accidental inclusions of intradermal pigmented particles. To avoid these tattoos, especially in esthetical areas like the head and neck region and the hands, the primary goal in our treatment is to remove all particles and foreign bodies. Superficial foreign bodies can easily be removed by brushes or dermabrasion. Deeper lesions are a challenge for plastic surgeons, because they are not so easily removed. Ablation by a water jet surgical tool, the Versajet-system (Smith & Nephew Inc, Andover, MA), enables the removal of nearly all particles and foreign bodies, which sustained a blast injury of the face or the hands. Aim of this paper is to describe the method of using this hydrosurgery system in blast injuries in esthetical zones and its advantages by presenting cases of two patients of us.