PerBrain: a multimodal approach to personalized tracking of evolving state-of-consciousness in brain-injured patients: protocol of an international, multicentric, observational study.

BACKGROUND: Disorders of consciousness (DoC) are severe neurological conditions in which consciousness is impaired to various degrees. They are caused by injury or malfunction of neural systems regulating arousal and awareness. Over the last decades, major efforts in improving and individualizing diagnostic and prognostic accuracy for patients affected by DoC have been made, mainly focusing on introducing multimodal assessments to complement behavioral examination. The present EU-funded multicentric research project "PerBrain" is aimed at developing an individualized diagnostic hierarchical pathway guided by both behavior and multimodal neurodiagnostics for DoC patients. METHODS: In this project, each enrolled patient undergoes repetitive behavioral, clinical, and neurodiagnostic assessments according to a patient-tailored multi-layer workflow. Multimodal diagnostic acquisitions using state-of-the-art techniques at different stages of the patients' clinical evolution are performed. The techniques applied comprise well-established behavioral scales, innovative neurophysiological techniques (such as quantitative electroencephalography and transcranial magnetic stimulation combined with electroencephalography), structural and resting-state functional magnetic resonance imaging, and measurements of physiological activity (i.e. nasal airflow respiration). In addition, the well-being and treatment decision attitudes of patients' informal caregivers (primarily family members) are investigated. Patient and caregiver assessments are performed at multiple time points within one year after acquired brain injury, starting at the acute disease phase. DISCUSSION: Accurate classification and outcome prediction of DoC are of crucial importance for affected patients as well as their caregivers, as individual rehabilitation strategies and treatment decisions are critically dependent on the latter. The PerBrain project aims at optimizing individual DoC diagnosis and accuracy of outcome prediction by integrating data from the suggested multimodal examination methods into a personalized hierarchical diagnosis and prognosis procedure. Using the parallel tracking of both patients' neurological status and their caregivers' mental situation, well-being, and treatment decision attitudes from the acute to the chronic phase of the disease and across different countries, this project aims at significantly contributing to the current clinical routine of DoC patients and their family members. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04798456 . Registered 15 March 2021 - Retrospectively registered.

Health-related quality of life and functional impairment in acute vestibular disorders.

BACKGROUND AND PURPOSE: Acute vestibular symptoms have a profound impact on patients' well-being. In this study, health-related quality of life (HRQoL) and functional impairment were investigated prospectively in patients with different peripheral and central vestibular disorders during the acute symptomatic stage to decipher the most relevant underlying factors. METHODS: In all, 175 patients with acute vestibular disorders were categorized as central vestibular (CV, n = 40), peripheral vestibular (PV, n = 68) and episodic vestibular disorders (EV, n = 67). All patients completed scores to quantify generic HRQoL (European Quality of Life Score Five Dimensions Five Levels, EQ-5D-5L) and disease-specific HRQoL (Dizziness Handicap Inventory, DHI). Vestibular-ocular motor signs were assessed by video-oculography, vestibular-spinal control by posturography and verticality perception by measurement of subjective visual vertical. RESULTS: Patients with PV had a poorer HRQoL compared to patients with CV and EV (EQ-5D-5L/DHI: PV, 0.53 ± 0.31/56.1 ± 19.7; CV, 0.66 ± 0.28/43.3 ± 24.0; EV, 0.75 ± 0.24/46.7 ± 21.4). After adjusting for age, gender, cardiovascular risk factors and non-vestibular brainstem/cerebellar dysfunction patients with PV persisted to have poorer generic and disease-specific HRQoL (EQ-5D-5L -0.17, DHI +11.2) than patients with CV. Horizontal spontaneous nystagmus was a highly relevant factor for subgroup differences in EQ-5D-5L and DHI, whilst vertical spontaneous nystagmus, subjective visual vertical and sway path were not. EQ-5D-5L decreased significantly with more intense horizontal subjective visual vertical in CV (rho = -0.57) and PV (rho = -0.5) but not EV (rho = -0.13). CONCLUSIONS: Patients with PV have the highest functional impairment of all patients with acute vestibular disorders. Vestibular-ocular motor disturbance in the yaw plane has more impact than vestibular-spinal or vestibular-perceptive asymmetry in the roll and pitch plane, suggesting that horizontal visual stability is the most critical for HRQoL.

Sustainable bioenergy for climate mitigation: developing drought-tolerant trees and grasses.

BACKGROUND AND AIMS: Bioenergy crops are central to climate mitigation strategies that utilize biogenic carbon, such as BECCS (bioenergy with carbon capture and storage), alongside the use of biomass for heat, power, liquid fuels and, in the future, biorefining to chemicals. Several promising lignocellulosic crops are emerging that have no food role - fast-growing trees and grasses - but are well suited as bioenergy feedstocks, including Populus, Salix, Arundo, Miscanthus, Panicum and Sorghum. SCOPE: These promising crops remain largely undomesticated and, until recently, have had limited germplasm resources. In order to avoid competition with food crops for land and nature conservation, it is likely that future bioenergy crops will be grown on marginal land that is not needed for food production and is of poor quality and subject to drought stress. Thus, here we define an ideotype for drought tolerance that will enable biomass production to be maintained in the face of moderate drought stress. This includes traits that can readily be measured in wide populations of several hundred unique genotypes for genome-wide association studies, alongside traits that are informative but can only easily be assessed in limited numbers or training populations that may be more suitable for genomic selection. Phenotyping, not genotyping, is now the major bottleneck for progress, since in all lignocellulosic crops studied extensive use has been made of next-generation sequencing such that several thousand markers are now available and populations are emerging that will enable rapid progress for drought-tolerance breeding. The emergence of novel technologies for targeted genotyping by sequencing are particularly welcome. Genome editing has already been demonstrated for Populus and offers significant potential for rapid deployment of drought-tolerant crops through manipulation of ABA receptors, as demonstrated in Arabidopsis, with other gene targets yet to be tested. CONCLUSIONS: Bioenergy is predicted to be the fastest-developing renewable energy over the coming decade and significant investment over the past decade has been made in developing genomic resources and in collecting wild germplasm from within the natural ranges of several tree and grass crops. Harnessing these resources for climate-resilient crops for the future remains a challenge but one that is likely to be successful.

Sarcopenia is associated with disability status-results from the KORA-Age study.

We estimated the prevalence of sarcopenia and its impact on disability in older people. Sarcopenia was found to contribute to higher disability scores. However, our study was not able to show any influence of sarcopenia on the rate of functional decline. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not. INTRODUCTION: The objectives of this study using data from a population-based cohort were to estimate the prevalence of sarcopenia in older people in Germany and to test the hypothesis that sarcopenia is associated with disability in older adults. METHODS: Cross-sectional (n = 927) and longitudinal analyses (n = 859) of participants aged ≥65 years at baseline from southern Germany enrolled in the Cooperative Health Research in the Region Augsburg (KORA)-Age study (2009-2012). Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm which includes the presence of both low muscle mass and low muscle function (strength or performance). Disability status was measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI). The presence of disability was defined as HAQ-DI >0. Directed acyclic graphs (DAGs) were constructed to identify potential confounders. The effect of sarcopenia on disability was analyzed using linear mixed effect models with disability values as a continuous outcome. RESULTS: The overall prevalence of sarcopenia was 5.7% (men 4.0%, women 7.5%) and increased with age. The 3-year incidence of disability was 32.7%. After adjustment for potential confounders, presence of sarcopenia was significantly associated with higher disability scores (0.142 [confidence interval 0.029-0.254]). CONCLUSION: The prevalence of sarcopenia is consistent with estimates from other European studies using this algorithm. Our results suggest that sarcopenia can contribute to higher disability scores in older adults. However, our study was not able to show any influence of sarcopenia on the rate of functional decline using the EWGSOP diagnostic algorithm for sarcopenia. This directs attention to an accurate diagnosis of sarcopenia as the onset may be influenced, but its rate may not.

Country-specific and individual determinants of dizziness in Europe: results from the Survey of Health Ageing and Retirement in Europe (SHARE).

OBJECTIVES: Dizziness is one of the most common complaints amongst older persons and has relevant consequences for functioning. However, the epidemiological findings on dizziness are scarce and inconsistent and prevalence varies considerably among existing studies. Hence the objective of this study is to compare the prevalence of dizziness in persons aged 50 years or older across several European countries. The specific aim was to identify country- and person-specific determinants associated with a higher risk. STUDY DESIGN: Cross-sectional study. METHODS: Data from the Survey of Health Ageing and Retirement in Europe project, covering 20 countries were analysed. Micro-data on more than 69,000 persons aged 50+ years and additional macro-data on economic inequality, climate and urbanisation were included. We applied multilevel models to examine the impact of country-50 years or older specific determinants as well as individual characteristics on prevalence of dizziness. RESULTS: We found a total of 12.4% of the participants in our sample were troubled by dizziness in the last 6 months. Prevalence ranged from 6.5% to 23.4%. In multilevel analysis several determinants on the country (higher proportion of urban population) and on the individual level (female gender, living alone, old age, poor education, presence of comorbidities, depressive symptoms, sensory problems, lack of physical activities) were identified. CONCLUSIONS: In conclusion dizziness is a common complaint amongst older Europeans that needs more attention. Further studies should investigate the prevalence, determinants and management of defined vestibular and non-vestibular causes of dizziness across Europe.

Impact of joint contracture on older persons in a geriatric setting: A cross-sectional study.

BACKGROUND: Joint contractures are a common phenomenon in older persons and are assessed by measuring the range of motion; however, little is known about the impact of joint contractures on activities of daily living (ADL). OBJECTIVES: The aim of the study was to identify problems related to joint contracture of older persons in a geriatric setting using the international classification of functioning, disability and health (ICF) as a framework. MATERIAL AND METHODS: A cross-sectional study was conducted between February and July 2013 in nursing homes (n=11) and geriatric rehabilitation hospitals (n=3) in North Rhine-Westphalia, Germany. The study population included persons aged ≥65 years with at least one diagnosis of joint contracture. If the participant was unable to adequately answer the best informed next of kin or staff nurse acted as a proxy. A questionnaire with 124 ICF categories was completed through face-to-face interviews with the participants. RESULTS: A total of 149 participants were included in the study. The mean age was 77.6±6.9 years and 69.8% were women. Problems in climbing (94.0%), walking long distances (92.6%) and kneeling (92.6%) were most frequently identified. The most often identified facilitators in environmental factors were health services, systems and policies (93.2%), whereas the leading barrier was climate (30.3%). CONCLUSION: Joint contractures have a huge impact on functioning and social participation and particularly on personal mobility. From the nursing and rehabilitation perspective, assessments should not only measure joint mobility but also determine and quantify the consequences of contractures on ADL.

How much does it hurt to be lonely? Mental and physical differences between older men and women in the KORA-Age Study.

OBJECTIVE: Loneliness has a deep impact on quality of life in older people. Findings on sex-specific differences on the experience of loneliness remain sparse. This study compared the intensity of and factors associated with loneliness between men and women. METHODS: Analyses are based on the 2008/2009 data of the KORA-Age Study, comprising 4127 participants in the age range of 64-94 years. An age-stratified random subsample of 1079 subjects participated in a face-to-face interview. Loneliness was measured by using a short German version of the UCLA-Loneliness-Scale (12 items, Likert scaled, ranging from 0 to 36 points). Multiple logistic regression analysis was conducted to analyze the associations of socio-demographic, physical, and psychological factors with loneliness. RESULTS: The mean level of loneliness did not significantly differ between men (17.0 ± 4.5) and women (17.5 ± 5.1). However, among the oldest old (≥85 years), loneliness was higher in women (p value = 0.047). Depression, low satisfaction with life, and low resilience were associated significantly with loneliness, which was more pronounced in men. Living alone was not associated with loneliness, whereas lower social network was associated with a three time higher risk for feeling lonely in both men and women. CONCLUSIONS: The extent of loneliness was equally distributed between men and women, although women were more disadvantaged regarding living arrangements as well as physical and mental health. However, loneliness was stronger associated with adverse mental health conditions in men. These findings should be considered when developing intervention strategies to reduce loneliness.

[Living conditions: stumbling block or path to successful ageing? Results of the Augsburg regional conference "Living environment, age and health"]. / Wohnumfeld - Stolperstein oder Weg zum gesunden Altern? Ergebnisse der Augsburger Regionalkonferenz "Wohnumfeld, Alter und Gesundheit".

In addition to good medical care, living environment is of central importance in encouraging social participation among older people. Therefore, municipalities should prioritise the age-appropriate design of living environments. Results of the KORA Age study were presented at the regional conference "Living environment, age and health" in the Augsburg town hall on October 1, 2013. The results on participation and living environment were discussed with local policy makers and senior citizens' representatives from Augsburg and two surrounding regions. The study examined the impact of living environment on participation using two different approaches: qualitative findings from focus group discussions and quantitative findings based on telephone interviews and the use of a geographic information system. The results were complemented by contributions from a regional and national perspective. It was stressed in the closing discussion that a senior-friendly living environment can only be created by using a broad range of different measures. On the one hand physical barriers need to be removed, while at the same time the sense of community, neighborhood cohesion and solidarity should be encouraged further.

Refining the hospitalization rate: A mixed methods approach to differentiate primary COVID-19 from incidental cases.

Purpose: Until now, the Hospitalization Rate (HR) served as an indicator (among others) for the COVID-19 associated healthcare burden. To ensure that the HR accomplishes its full potential, hospitalizations caused by COVID-19 (primary cases) and hospitalizations of patients with incidental positive SARS-CoV-2 test results (incidental cases) must be differentiated. The aim of this study was to synthesize the existing evidence on differentiation criteria between hospitalizations of primary cases and incidental cases. Methods: An online survey of the members of the German Network University Medicine (NUM) was conducted. Additionally, senior clinicians with expertise in COVID-19 care were invited for qualitative, semi-structured interviews. Furthermore, a rapid literature review was undertaken on publications between 03/2020 and 12/2022. Results: In the online survey (n=30, response rate 56%), pneumonia and acute upper respiratory tract infections were the most indicative diagnoses for a primary case. In contrast, malignant neoplasms and acute myocardial infarctions were most likely to be associated with incidental cases. According to the experts (n=6), the diagnosis, ward, and type of admission (emergency or elective), low oxygen saturation, need for supplemental oxygen, and initiation of COVID-19 therapy point to a primary case. The literature review found that respiratory syndromes and symptoms, oxygen support, and elevated levels of inflammatory markers were associated with primary cases. Conclusion: There are parameters for the differentiation of primary from incidental cases to improve the objective of the HR. Ultimately, an updated HR has the potential to serve as a more accurate indicator of the COVID-19 associated healthcare burden.

Costs and resource utilization patterns in surgical site infections: a pre-COVID-19 perspective from France, Germany, Spain, and the UK.

BACKGROUND: Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus. AIM: To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe. METHODS: The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls. FINDINGS: In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis. CONCLUSION: The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.

Guard cell anion channel SLAC1 is regulated by CDPK protein kinases with distinct Ca2+ affinities.

In response to drought stress, the phytohormone abscisic acid (ABA) induces stomatal closure. Thereby the stress hormone activates guard cell anion channels in a calcium-dependent, as well as -independent, manner. Open stomata 1 protein kinase (OST1) and ABI1 protein phosphatase (ABA insensitive 1) represent key components of calcium-independent ABA signaling. Recently, the guard cell anion channel SLAC1 was identified. When expressed heterologously SLAC1 remained electrically silent. Upon coexpression with Ca(2+)-independent OST1, however, SLAC1 anion channels appear activated in an ABI1-dependent manner. Mutants lacking distinct calcium-dependent protein kinases (CPKs) appeared impaired in ABA stimulation of guard cell ion channels, too. To study SLAC1 activation via the calcium-dependent ABA pathway, we studied the SLAC1 response to CPKs in the Xenopus laevis oocyte system. Split YFP-based protein-protein interaction assays, using SLAC1 as the bait, identified guard cell expressed CPK21 and 23 as major interacting partners. Upon coexpression of SLAC1 with CPK21 and 23, anion currents document SLAC1 stimulation by these guard cell protein kinases. Ca(2+)-sensitive activation of SLAC1, however, could be assigned to the CPK21 pathway only because CPK23 turned out to be rather Ca(2+)-insensitive. In line with activation by OST1, CPK activation of the guard cell anion channel was suppressed by ABI1. Thus the CPK and OST1 branch of ABA signal transduction in guard cells seem to converge on the level of SLAC1 under the control of the ABI1/ABA-receptor complex.

[Data for epidemiological research on ageing in Germany. Opportunities and limitations of existing datasets: results of the second workshop of the working group Epidemiology of Ageing within the German Society for Epidemiology (DGEpi)]. / Daten für die epidemiologische Altersforschung. Möglichkeiten und Grenzen vorhandener Datensätze. Ergebnisse des 2. Workshops der Arbeitsgruppe Epidemiologie des Alterns der Deutschen Gesellschaft für Epidemiologie (DGEpi).

Due to the increasing proportion of older people in the general population epidemiologists are interested in identifying which factors determine healthy ageing. For this reason within the German Society for Epidemiology we founded the working group 'Epidemiology of Ageing' in 2011. The working group organised a workshop to present useful datasets on ageing in Germany for epidemiological research. Those presented included: Study of Health in Pomerania (SHIP) The German Ageing Survey (DEAS) Surveys from the Robert Koch Institute: German Health Interview and Examination Survey for Adults (DEGS) and the German Health Update (GEDA) The German Socio-Economic Panel Study (SOEP) Cooperative Health Research in the Region of Augsburg (KORA-Age) Survey of Health, Ageing and Retirement in Europe (SHARE) Germany Claims data from statutory health insurance agencies Presentations contained a brief description of the datasets, methodologies, age-related themes, their strengths and limitations as well as their availability for secondary analysis. All presented datasets can be used for longitudinal analyses and are available to the scientific community.

The DizzyQuest: relation between self-reported hearing loss, tinnitus and objective hearing thresholds in patients with Meniere's disease.

BACKGROUND: Combining a mobile application-based vestibular diary called the DizzyQuest and an iPad-based hearing test enables evaluation of the relationship between experienced neuro-otological symptoms and hearing thresholds in daily life setting. The aim was to investigate the relationship between self-reported hearing symptoms and hearing thresholds in patients with Meniere's disease (MD), using the DizzyQuest and the iPad-based hearing test simultaneously. METHODS: The DizzyQuest was administered for 3 weeks in 21 patients. Using the experience-sampling-method (ESM), it assessed hearing loss and tinnitus severity for both ears separately. Each day after the DizzyQuest, an iPad-based hearing test was used to measure hearing thresholds. A mixed model regression analysis was performed to investigate relationships between hearing thresholds and self-reported hearing loss and tinnitus severity. RESULTS: Fifteen patients were included. Overall, pure-tone averages (PTAs) were not correlated with self-reported hearing loss severity and tinnitus. Individual differences in PTA results between both ears did not significantly influence the difference in self-reported hearing loss severity between both ears. Self-reported hearing loss and tinnitus scores were significantly higher in ears that corresponded with audiometric criteria of MD (p < 0.001). Self-reported tinnitus severity significantly increased with self-reported hearing loss severity in affected (p = 0.011) and unaffected ears (p < 0.001). CONCLUSION: Combining the DizzyQuest and iPad-based hearing test, facilitated assessment of self-reported hearing loss and tinnitus severity and their relationship with hearing thresholds, in a daily life setting. This study illustrated the importance of investigating neuro-otological symptoms at an individual level, using multiple measurements. ESM strategies like the DizzyQuest should therefore be considered in neuro-otological research.

[Interventions by clinical pharmacists on surgical wards - impact on antibiotic therapy]. / Interventionen eines Apothekers auf chirurgischen Normalstationen - Auswirkungen auf die Antibiotikatherapie.

BACKGROUND: Antibiotics are undeniably beneficial. However, inappropriate or incorrect use puts patients at risk for avoidable adverse drug reactions, promotes emergence of resistance and potentially increases overall health-care costs. The objective of this study was to assess the impact of pharmaceutical consulting on the quality and costs of antibiotic use in surgical wards. PATIENTS AND METHODS: From February 2007 to February 2008 a total of 638 patients were enrolled in the controlled intervention study. Within the control period (n = 317) the current pattern of anti-biotic use was monitored without intervening, in the intervention period (n = 321) the pharmacist gave advice with regard to optimised antibiotic therapy. RESULTS: In 216 patients 331 antibiotic-related problems were identified; 232 interventions resulted in a modification of therapy (acceptance 70 %). The most common interventions were those regarding the duration of therapy and the choice of agent. The intervention with the greatest acceptance (91 %) was dosing recommendations. The pharmaceutical intervention resulted in a shorter duration of therapy (9.9 vs. 11.2 days, p < 0.001) and an increased adherence to the surgical department's guidelines (64 % vs. 71 %, p = 0.03). Intravenous therapy was switched to oral therapy earlier and more often (p = 0.006). As a result, the total cost for intravenous antibiotics decreased from € 96 500.- to € 81 600.- (p = 0.001). Dosage recommendations (e. g. in impaired organ function) or information on interaction and side effects increased drug -safety. CONCLUSION: Using the example of antibiotic therapy we showed that pharmaceutical counselling on surgical wards influences various aspects of antibiotic therapy, increases drug safety and reduces cost by having an effect on duration of therapy and timely switch from intravenous to oral preparations.

[Multimorbidity and successful aging: the population-based KORA-Age study]. / Multimorbidität und erfolgreiches Altern: Ein Blick auf die Bevölkerung im Rahmen der KORA-Age-Studie.

BACKGROUND: The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public. PATIENTS AND METHODS: In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics. RESULTS: A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%). CONCLUSION: The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.

[Using the international classification of functioning, disability and health (ICF) in trauma care]. / Anwendung der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) in der Traumatologie.

The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive and structured treatment management and outcome evaluation in trauma care based on specific ICF core sets and the ICF-based Rehab-CYCLE. The Rehab-CYCLE allows the problem-based assessment of functioning in a multi-professional team under physician-guidance and the definition of long-term, intervention and cycle goals. Defined intervention goals are assigned to the appropriate intervention principles and techniques as well as the specific evaluation instruments. Together with the patient additional intervention goals are identified, intervention principals adapted and the further treatment setting planned based on a multi-professional outcome evaluation. The standardized documentation is reported multi-professionally on the ICF assessment sheet which reflects the patient perspective with all their problems and needs as well as the perspective of the treatment team.

[Introduction to the international classification of functioning, disability and health (ICF)]. / Einführung in die International Classification of Functioning, Disability and Health (ICF).

The WHO International Classification of Functioning, Disability and Health (ICF) allows a standardized description of functioning and disability based on individual and contextual factors. The ICF adopts a biopsychosocial model of disability and functioning and is complementary to the ICD-10 (International Classification of Diseases). For its implementation in clinical practice ICF-based instruments, such as the ICF core sets were developed in a standardized scientific process. These consist of the ICF categories which are most relevant for patients with specific diseases or in specific health care situations. In trauma care the ICF and ICF core sets can be applied in defined health problems and treatment situations for documentation of functioning, structured planning and implementation of interventions as well as outcome assessment.

[Systematic review of measurement instruments and concepts used for functioning outcome in multiple trauma]. / Outcomes der Funktionsfähigkeit bei Polytrauma : Messinstrumente und Konzepte, ein systematischer Review.

Multiple trauma and injuries are the main causes for mortality and long term disability in the younger population under 50 years old. Monitoring patient-relevant long term consequences after an acute event is therefore of high importance. However, there is no systematic overview on the assessment instruments and their concepts used to monitor long term outcome of multiple trauma. The International Classification of Functioning, Disability and Health (ICF) is a framework to standardize and compare assessment instruments. We conducted a systematic search of the electronic databases Medline and Embase covering the years 2000 to 2006 and data on utilized instruments were extracted from the retrieved studies. The corresponding concepts were identified and coded using the ICF. A total of 117 studies with 112 instruments were included and 1,032 different concepts were extracted of which 93% could be coded. This review confirms the heterogeneity and complexity of the problems encountered after multiple trauma. A homogeneous concept for assessment of long term outcome is warranted.

Introducing the DizzyQuest: an app-based diary for vestibular disorders.

BACKGROUND: Most questionnaires currently used for assessing symptomatology of vestibular disorders are retrospective, inducing recall bias and lowering ecological validity. An app-based diary, administered multiple times in daily life, could increase the accuracy and ecological validity of symptom measurement. The objective of this study was to introduce a new experience sampling method (ESM) based vestibular diary app (DizzyQuest), evaluate response rates, and to provide examples of DizzyQuest outcome measures which can be used in future research. METHODS: Sixty-three patients diagnosed with a vestibular disorder were included. The DizzyQuest consisted of four questionnaires. The morning- and evening-questionnaires were administered once each day, the within-day-questionnaire 10 times a day using a semi-random time schedule, and the attack questionnaire could be completed after the occurrence of a vertigo or dizziness attack. Data were collected for 4 weeks. Response rates and loss-to-follow-up were determined. Reported symptoms in the within-day-questionnaire were compared within and between patients and subgroups of patients with different vestibular disorders. RESULTS: Fifty-one patients completed the study period. Average response rates were significantly higher than the desired response rate of > 50% (p < 0.001). The attack-questionnaire was used 159 times. A variety of neuro-otological symptoms and different disease profiles were demonstrated between patients and subgroups of patients with different vestibular disorders. CONCLUSION: The DizzyQuest is able to capture vestibular symptoms within their psychosocial context in daily life, with little recall bias and high ecological validity. The DizzyQuest reached the desired response rates and showed different disease profiles between subgroups of patients with different vestibular disorders. This is the first time ESM was used to assess daily symptoms and quality of life in vestibular disorders, showing that it might be a useful tool in this population.