[Postoperative management following decompressive hemicraniectomy for malignant middle cerebral artery infarction-A German nationwide survey study]. / Postoperatives Management nach dekompressiver Hemikraniektomie bei malignem Mediainfarkt ­ eine deutschlandweite Umfragestudie.

BACKGROUND: Malignant middle cerebral artery infarction is a potentially life-threatening disease. Decompressive hemicraniectomy constitutes an evidence-based treatment practice, especially in patients under 60 years of age; however, recommendations with respect to postoperative management and particularly duration of postoperative sedation lack standardization. OBJECTIVE: This survey study aimed to analyze the current situation of patients with malignant middle cerebral artery infarction following hemicraniectomy in the neurointensive care setting. MATERIAL AND METHODS: From 20 September 2021 to 31 October 2021, 43 members of the initiative of German neurointensive trial engagement (IGNITE) network were invited to participate in a standardized anonymous online survey. Descriptive data analysis was performed. RESULTS: Out of 43 centers 29 (67.4%) participated in the survey, including 24 university hospitals. Of the hospitals 21 have their own neurological intensive care unit. While 23.1% favored a standardized approach regarding postoperative sedation, the majority utilized individual criteria (e.g., intracranial pressure increase, weaning parameters, complications) to assess the need and duration. The timing of targeted extubation varied widely between hospitals (≤ 24 h 19.2%, ≤ 3 days in 30.8%, ≤ 5 days in 19.2%, > 5 days in 15.4%). Early tracheotomy (≤ 7 days) is performed in 19.2% and 80.8% of the centers aim for tracheotomy within 14 days. Hyperosmolar treatment is used on a regular basis in 53.9% and 22 centers (84.6%) agreed to participate in a clinical trial addressing the duration of postoperative sedation and ventilation. CONCLUSION: The results of this nationwide survey among neurointensive care units in Germany reflect a remarkable heterogeneity in the treatment practices of patients with malignant middle cerebral artery infarction undergoing hemicraniectomy, especially with respect to the duration of postoperative sedation and ventilation. A randomized trial in this matter seems warranted.

Effects of different exercise intensity on bone mineral density in adults: a comparative systematic review and meta-analysis.

PURPOSE: The primary objective of the present systematic review and meta-analysis was to determine the effect of differing exercise intensity on (areal) bone mineral density (BMD) at lumbar spine and hip in adults by a comparative meta-analysis. METHODS: A systematic review of the literature according to the PRISMA statement included: (a) exercise trials, (b) with ≥two study arms that compared different exercise intensities, (c) intervention ≥6 months, (d) BMD assessments at lumbar spine (LS) or hip. Five electronic databases were scanned without language restrictions up to July 2021. The present analysis of exercise intensity was conducted as a mixed-effect meta-analysis and applied "type of exercise" and "study duration" as moderator in subgroup analyses. Outcome measures were standardized mean differences (SMD) for BMD changes at the LS, and hip. RESULTS: Eleven exercise studies with 26 study arms were included. Although the effect of high-intensity exercise was more pronounced on LS-BMD (SMD: 0.19, 95%-CI: 0.61 to -0.23) and hip-ROI (0.17, 0.38 to -0.04), we did not observe significant differences between the groups (LS-BMD: p=0.373 and hip-BMD: p=0.109). We observed a substantial level of heterogeneity between the trials for LS- but not for hip-BMD. Applying "type of exercise" and "study duration" as moderators did not significantly modify the differences between low and high exercise intensity on BMD at LS or hip. CONCLUSION: There is insufficient evidence for a superior effect of high-intensity exercise on areal BMD at lumbar spine and hip in people aged 50 years and older. Varying exercise intensity with periods of lower exercise intensity intermitted by higher intensity might be a promising option to address the issue of exercise intensities in intervention studies.

Effects of dynamic resistance exercise on bone mineral density in postmenopausal women: a systematic review and meta-analysis with special emphasis on exercise parameters.

This systematic review and meta-analysis set out to determine the effect of dynamic resistance exercise (DRT) on areal bone mineral density (aBMD) in postmenopausal women and derive evidence-based recommendations for optimized training protocols. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) of isolated DRT with at least one exercise and one control group, (c) with intervention durations ≥ 6 months, (d) aBMD assessments at lumbar spine or proximal femur, (e) in cohorts of postmenopausal women. We searched eight electronic databases up to March 2019 without language restrictions. The meta-analysis was performed using a random-effects model. Standardized mean differences (SMD) for BMD changes at lumbar spine (LS), femoral neck (FN), and total hip (TH) were defined as outcome measures. Moderators of the exercise effects, i.e., "intervention length," "type of DRT," "training frequency," "exercise intensity," and "exercise volume," were addressed by sub-group analyses. The study was registered in the international prospective register of systematic reviews (PROSPERO) under ID: CRD42018095097. Seventeen articles with 20 exercise and 18 control groups were eligible. SMD average is 0.54 (95% CI 0.22-0.87) for LS-BMD, 0.22 (0.07-0.38) for FN-BMD, and 0.48 (0.22-0.75) for TH-BMD changes (all p ≤ 0.015). While sub-group analysis for FN-BMD revealed no differences within categories of moderators, lower training frequency (< 2 sessions/week) resulted in significantly higher BMD changes at LS and TH compared to higher training frequency (≥ 2 sessions/week). Additionally, free weight training was significantly superior to DRT devices for improving TH-BMD. This work provided further evidence for significant, albeit only low-moderate, effects of DRT on LS-, FN-, and TH-BMD. Unfortunately, sub-analysis results did not allow meaningful exercise recommendations to be derived. This systematic review and meta-analysis observed a significant low-moderate effect of dynamic resistance exercise on bone mineral density changes in postmenopausal women. However, sub-group analyses focusing on exercise characteristics found no results that enable the derivation of meaningful exercise recommendations in the area of exercise and osteoporosis prevention or therapy.

Longitudinal Changes in Muscle Mass and Function in Older Men at Increased Risk for Sarcopenia - The FrOST-Study.

BACKGROUND: Declines in muscle mass and function are inevitable developments of the advanced aging process. Corresponding dimensions of longitudinal changes in at-risk populations are still scarce although clinically relevant. The present study monitored changes in morphologic and functional sarcopenia criteria related to sarcopenia in older men with low muscle mass over a period of 24 months. OBJECTIVES: The main objective of the present study was to determine whether changes in muscle mass and function were comparable across the body. Our hypothesis was that both (1) fat free mass (FFM) and (2) function decline at a significantly higher rate in the lower versus the upper extremities. DESIGN: We conducted an observational study of 24 months. SETTING: Community dwelling men living in the area of Northern Bavaria were initially included in the Franconian Sarcopenic Obesity (FranSO) study by the Institute of Medical Physics University of Erlangen-Nürnberg, Germany. PARTICIPANTS: One hundred and seventy-seven (177) men (77.5±4.5 years) within the lowest skeletal muscle mass index (SMI) quartile of the FranSO study were included in the present 24 month analysis. MEASUREMENTS: Fat free mass (direct-segmental, multi-frequency Bio-Impedance-Analysis (DSM-BIA)), handgrip strength (hand-dynamometer) and 10-m habitual gait velocity (photo sensors) were assessed at baseline and 24-month follow-up. RESULTS: Lower extremity fat free mass (LEFFM: -2.0±2.4%), handgrip strength (-12.8±11.0%) and gait velocity (-3.5±9.0%) declined significantly (p<.001) during the follow-up period, while upper extremity FFM was maintained unchanged (UEFFM: 0.1±3.1%). Changes in LEFFM were significantly higher (p<.001) compared with UEFFM, however contrary to our expectation the decline in handgrip strength representing upper extremity muscle function was 3.7-fold higher (p<.001) than the decline in gait velocity. CONCLUSION: Medical experts involved in diagnosis, monitoring and management of sarcopenia should consider that parameters constituting morphologic and functional sarcopenia criteria feature different rates of decline during the aging process.

A novel Dance Dance Revolution (DDR) system for in-home training of stepping ability: basic parameters of system use by older adults.

OBJECTIVE: This series of studies was conducted to develop and establish characteristics of exercise videogame play in older adults. The videogame was a modified version of the popular Dance Dance Revolution (DDR; Konomi). METHODS: Participants aged ≥70 were asked to make simple step movements in response to vertically drifting arrows presented on a video screen. Step responses were detected by a modified USB DDR mat, and characteristics of stepping performance such as step timing, percentage of missed target steps and percentage of correct steps were recorded by purpose-built software. Drift speed and step rate of visual stimuli were modified to increase task difficulty. RESULTS: Significant linear relationships between stepping performance and stimulus characteristics were observed. Performance of older adults decreased as stimulus speed and step rate were increased. Optimal step performance occurred for a stimulus speed of 17° of visual angle per second and a step rate of one step every 2 s. At fast drift speeds (up to 35°/s), participants were more than 200 ms too slow in coordinating their steps with the visual stimulus. Younger adults were better able to perform the stepping task across a wider range of drift speeds than older adults. CONCLUSION: The findings suggest that older adults are able to interact with video games based upon DDR but that stepping performance is determined by characteristics of game play such as arrow drift speed and step rate. These novel "exergames" suggest a low-cost method by which older adults can be engaged in exercises that challenge balance and which can be conducted in their own homes.

Use of virtual reality technique for the training of motor control in the elderly. Some theoretical considerations.

Virtual augmented exercise, an emerging technology that can help to promote physical activity and combine the strengths of indoor and outdoor exercise, has recently been proposed as having the potential to increase exercise behavior in older adults. By creating a strong presence in a virtual, interactive environment, distraction can be taken to greater levels while maintaining the benefits of indoor exercises which may result in a shift from negative to positive thoughts about exercise. Recent findings on young participants show that virtual reality training enhances mood, thus, increasing enjoyment and energy. For older adults virtual, interactive environments can influence postural control and fall events by stimulating the sensory cues that are responsible in maintaining balance and orientation. However, the potential of virtual reality training has yet to be explored for older adults. This manuscript describes the potential of dance pad training protocols in the elderly and reports on the theoretical rationale of combining physical game-like exercises with sensory and cognitive challenges in a virtual environment.

A preference-based index for the SF-12.

BACKGROUND: The SF-12 is a widely used generic measure of subjective health. As the scoring algorithms of the SF-12 do not include preference values, different approaches to assign a preference-based index are available that should be tested regarding their feasibility and validity. OBJECTIVES: To develop a concept for a preference-based index for the SF-12 on the basis of multi-attribute decision analysis and to perform initial tests of its feasibility and validity in an empirical study. METHODS: A multi-attribute preference function for the SF-12 was developed, estimated and tested for validity. Two mail surveys (n = 100, 200) and an interview (n = 72) were conducted with women who had an operation for breast cancer. Visual analogue scale (VAS) and standard gamble (SG) measures elicited preference-based valuations. RESULTS: Eight attributes were identified in the SF-12. Validity tests showed an average difference of 8 VAS score points between directly measured and predicted values for given health states. CONCLUSION: The initial results show that this approach might allow the direct assignment of a preference-based valuation to the SF-12. The quality of the psychometric features of the multi-attribute value function is encouraging. Future studies should test this concept more extensively, especially by determining parameters for a representative sample of the general population and by comparing performance with other approaches to value the SF-12.

Health values and prospect theory: a comment.

In a recent volume of Medical Decision Making, Treadwell and Lenert stated that under prospect theory, community members compared with patients underestimate the utility of health improvements. In this comment, the authors show that this statement holds only for a subset of possible preference functions. Furthermore, the authors provide arguments that, in general, the rater's current health state is not the appropriate reference level if applying prospect theory to health valuations.