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Biomedical subjects

A Aeschlimann

Publications and source records attributed to A Aeschlimann.

At least 19 recordsLinked to original sources
PubMed2006

Predictors for response to rehabilitation in patients with hip or knee osteoarthritis: a comparison of logistic regression models with three different definitions of responder.

OBJECTIVE: To identify pre-treatment predictors of who will benefit from a 3-4-week comprehensive rehabilitation intervention in patients with osteoarthritis (OA) of the knee or hip. METHODS: A prospective cohort study with assessments at admission to the clinic and after 6 months was conducted. Two hundred and fifty patients from the rehabilitation clinic Rehaclinic Zurzach, Switzerland, were included. Three different measures of response to a 3-4-week comprehensive rehabilitation intervention were used: one indirect measure (minimal clinically important difference (MCID) in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) global score=18% improvement), one direct measure (transition question) and a combination of both criteria. Responders were predicted by a sequential logistic regression analysis with nine personal variables, five lifestyle risk factors, seven psychological status variables and the WOMAC global baseline score. RESULTS: The set of statistically significant predictors was dependent on the definition of response. The comparison of predictors that were statistically significant in any of the prediction models showed similar odds ratios (ORs) for the majority of predictors across three regression models with the different response definitions as dependent variable. Female gender, absence of depressive symptoms (dep), history of complementary medicine (cm) and low comorbidity (com) were the most stable predictors and had ORs above 2.0 (female) and above 1.5 (dep, cm, com) across the three regression models with different response definitions. CONCLUSION: A set of predictors for the outcome of rehabilitation in patients with OA was identified. If these predictors could be confirmed in future research, this knowledge might help to adopt and individualize the treatment of patients who are, at present, less likely to respond.

Aged↗
PubMed2006

Analgesic action of acetaminophen in symptomatic osteoarthritis of the knee.

OBJECTIVES: The study was designed to investigate the analgesic effects and mechanisms of acetaminophen (paracetamol) in symptomatic osteoarthritis (OA) of the knee. METHODS: Twenty patients with symptomatic OA were randomly allocated to two groups treated with either acetaminophen or rofecoxib for 3 months. Visits and measurements were scheduled upon entry (T0), at month 1 (T1) and at month 3 (T3). The intensity of joint pain was evaluated with a 100-mm visual analogue scale (VAS). The physical function of the affected knee was evaluated with a questionnaire comparable to the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Levels of serotonin, substance P (SP) and beta-endorphin (BEND) were determined with commercial enzyme-linked immunoassay kits. The expression of kappa opioid receptor (KOR) in peripheral mononuclear blood cells (PBMCs) was quantified by real-time PCR. RESULTS: Both acetaminophen and rofecoxib relieved pain considerably but with different kinetics, and affected different biomarkers. Rofecoxib appeared to be more efficient, reducing pain intensity by 56% at T1 (P<0.01), whereas acetaminophen reduced it by only 29%. Physical function improved in both groups by T3. Correlated with the pain relief, acetaminophen significantly reduced plasma BEND levels, whereas rofecoxib did not do so. In both groups plasma SP levels were elevated compared with T0. A reduction in serum serotonin was detected in the rofecoxib group at T1 (P=0.004) but had recovered at T3. No changes in KOR mRNA in PBMCs were observed in either group. CONCLUSIONS: There is a correlation between reduction in circulating BEND and OA pain relief in patients treated with acetaminophen.

Acetaminophen↗
PubMed2004

Inpatient rehabilitation for hip or knee osteoarthritis: 2 year follow up study.

OBJECTIVE: To examine the course of pain, physical function, and other health dimensions after a comprehensive inpatient rehabilitation intervention in patients with osteoarthritis (OA) of the hip or knee. METHODS: An observational, prospective cohort study with assessments at baseline (entry into clinic), 1 (discharge from inpatient rehabilitation), 3, 6, 9, 12, and 24 months after baseline. Consecutively referred patients to an inpatient rehabilitation centre fulfilling the inclusion criteria were studied. 3-4 week comprehensive rehabilitation intervention, including strengthening exercise, flexibility training, endurance training, relaxation strategies, and consultations for preventive measures, was carried out. Individual home rehabilitation programmes were taught. Generic health status was measured using the SF-36, condition specific health was measured with the WOMAC questionnaire. Effects were analysed with sensitivity statistics (effect size, ES) and non-parametric tests. RESULTS: Data from 128 patients with complete follow up data were analysed. Both pain and physical function improved moderately (WOMAC pain: ES = 0.56, WOMAC function ES = 0.44) until discharge. Although the effect in pain reduction remained significant by month 24 (WOMAC: ES = 0.26), physical function deteriorated close to baseline values after 12 months. CONCLUSIONS: Comprehensive inpatient rehabilitation of patients with OA of the hip or knee may improve pain and physical function in the mid-term, and pain in the long term.

Aged↗
PubMed2004

Self assessment in continuous professional development: a valuable tool for individual physicians and scientific societies.

OBJECTIVES: To assess the appreciation of self assessment (SA) by multiple choice question (MCQ) tests during continuous professional development (CPD) meetings and to evaluate the attitude towards the option of recertification. METHODS: A questionnaire was completed at a meeting of the Swiss Societies of Rheumatology and Physical Medicine and Rehabilitation in 2003 (response rate 94.9% (223/235)). RESULTS: 60.9% of members found SA useful to assess rheumatological knowledge by MCQ tests; 71.3% thought it motivating to receive an anonymous feedback; 47.2% wanted an additional individualised feedback; 70.8% asked for SA to be continued every 2 years during CPD sessions; 26.3% favoured the option of recertification with identical standards to the Swiss certifying examination in rheumatology. Physicians in private practice less often chose the option of recertification than physicians employed by hospitals (OR = 2.09, 95% CI 1.03 to 4.18). No correlations between the type and duration of specialisation, personal reading time, frequency of attendance at CPD meetings, sex of the members, and the choices made were found. CONCLUSIONS: SA by MCQ tests during CPD meetings is highly accepted by Swiss rheumatologists. This reliable, valid, and economic method of learning needs assessment enables individual physicians and scientific societies to plan educational with specific goals in mind.

Attitude of Health Personnel↗
PubMed2002

[Are inpatient rehabilitation or ambulatory physical therapy of patients with musculoskeletal problems effective and are patients referred to proper treatment?].

The aim of the present study was to investigate the effectiveness of an inpatient rehabilitation program and outpatient physiotherapy, respectively. Moreover, we wanted to know whether the referral to these two treatment paths was appropriate with regard to the patient's initial health status. According to the referring physician's indication patients with health problems in the cervical, lumbar spine, arm or leg were treated by an inpatient rehabilitation program or by outpatient physiotherapy. These two consecutively recruited patient cohorts were then compared. Those patients treated by the inpatient rehabilitation program differed from the outpatient group with regard to the initial health status and to age. Patients with musculoskeletal problems, who underwent an inpatient rehabilitation program, showed a significantly worse health and functional status than the outpatient group. Therefore, it can be concluded that the indication towards inpatient rehabilitation or outpatient physiotherapy was correctly given by the referring physicians. Patients treated by outpatient physiotherapy did also show a reduced health and functional status in comparison to the average population. Both types of treatment led to statistically significant and clinically relevant improvement of both the health and functional status in all patient groups.

Adult↗
PubMed2002

Distribution, density and migration dynamics of Ixodes ricinus in an area of the Jurassic mountains of Switzerland.

In an area of the Jurassic mountains of Switzerland ecological aspects of the tick species Ixodes ricinus were studied. In particular, the influence of temperature, humidity and vegetation parameters on tick density and distribution were investigated several times in six different habitat types. This was carried out on two scales; on a small scale, within a habitat type and on a larger scale, where all six habitat types were included. By a marking experiment, aspects of the migration dynamics of the ticks were studied. The densities of the six habitat types differed significantly in most of the cases. An analysis of the distribution pattern within a habitat type showed a contagious distribution mostly for the forests and the forest edge, whereas a random distribution was found as well, mainly for the meadows. But these distribution patterns tend towards randomness with time. On a small scale none of the factors showed an influence on tick distribution, therefore the most important factor on this scale might be the hosts of Ixodes ricinus. On a larger scale, temperature and humidity do in some cases influence tick densities. The marking experiment suggests an extremely high turnover of the ticks in an area with an average host density, probably due to passive transportation by hosts and to activation of resting individuals.

Altitude↗
PubMed2001

Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities.

OBJECTIVE: To discuss the concepts of the minimal clinically important difference (MCID) and the smallest detectable difference (SDD) and to examine their relation to required sample sizes for future studies using concrete data of the condition-specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the generic Medical Outcomes Study 36-Item Short Form (SF-36) in patients with osteoarthritis of the lower extremities undergoing a comprehensive inpatient rehabilitation intervention. METHODS: SDD and MCID were determined in a prospective study of 122 patients before a comprehensive inpatient rehabilitation intervention and at the 3-month followup. MCID was assessed by the transition method. Required SDD and sample sizes were determined by applying normal approximation and taking into account the calculation of power. RESULTS: In the WOMAC sections the SDD and MCID ranged from 0.51 to 1.33 points (scale 0 to 10), and in the SF-36 sections the SDD and MCID ranged from 2.0 to 7.8 points (scale 0 to 100). Both questionnaires showed 2 moderately responsive sections that led to required sample sizes of 40 to 325 per treatment arm for a clinical study with unpaired data or total for paired followup data. CONCLUSION: In rehabilitation intervention, effects larger than 12% of baseline score (6% of maximal score) can be attained and detected as MCID by the transition method in both the WOMAC and the SF-36. Effects of this size lead to reasonable sample sizes for future studies lying below n = 300. The same holds true for moderately responsive questionnaire sections with effect sizes higher than 0.25. When designing studies, assumed effects below the MCID may be detectable but are clinically meaningless.

Aged↗
PubMed2001

Multiple choice question quiz: a valid test for needs assessment in CME in rheumatology and for self assessment.

Drawing from experience in Switzerland, a test of 60 multiple choice questions covering the entire area of rheumatology was constructed and used at the international symposium of rheumatology, EULAR, Geneva 1998. It was introduced as a multiple choice question game, the language was English, and the level of acceptance was very high. Language posed only occasional problems. The reliability of the test for internal consistency was high (Cronbach alpha 0.852). One of the main target groups, the private practitioners, was the largest group of rheumatologists (nearly 50%). Evaluative statements of the participants indicate that it was a highly relevant test for rheumatology. This test is a valuable way for needs assessment in continuing medical education and for self assessment. Importantly, it has been shown that such a test can be conducted at an international level.

Analysis of Variance↗
PubMed2001

Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention.

OBJECTIVE: To compare the responsiveness of the condition-specific Western Ontario and McMaster Universities osteoarthritis (OA) index (WOMAC) and the generic Short Form-36 (SF-36) in patients with OA of the legs undergoing a comprehensive inpatient rehabilitation intervention. METHODS: A prospective follow up study of consecutively referred inpatients of a rehabilitation clinic was made. The patients included fulfilled the American College of Rheumatology criteria for knee or hip OA and underwent both passive and, particularly, active physical therapy for three to four weeks. Responsiveness assessment was performed using the standardised response mean (SRM), effect size, and Guyatt's responsiveness statistic between admission and discharge (end of rehabilitation) and then again between admission and three months later. For pain and function the SRMs were stratified by sex and OA joint. Effects were tested by the t test and SRMs of different scales were compared by the jack knife test. RESULTS: At the three month follow up, complete data were obtained for 223 patients. In general, the three responsiveness statistics showed a similar order of responsiveness. For both instruments, the pain scales were more responsive than the function scales. The responsiveness of the pain scale of both instruments was comparable (SRM=0.723 for WOMAC and SRM=0.528 for SF-36 at the end of rehabilitation; SRM=0.377 for WOMAC and SRM=0.468 for SF-36 at the three month follow up). In the measurement of function, the WOMAC was significantly more responsive than the SF-36 (SRMs, end of rehabilitation: 0.628 v 0.249; three month follow up: 0.235 v -0.001). Responsiveness tended to be higher in women and in knee OA than in men and hip OA. CONCLUSIONS: Both instruments, the WOMAC and the SF-36, capture improvement in pain in patients undergoing comprehensive inpatient rehabilitation intervention. Functional improvement can be detected better by the WOMAC than by the SF-36. All the other scales of both instruments were more weakly responsive.

Adult↗
PubMed2000

[Vasculitis and mononeuritis multiplex].

In 1991, a 67 year old patient, suffering from an adenocarcinoma of the colon, had to undergo hemicolectomy. In the five following years, isolated metastases developed in the liver and have been surgically removed. In 1997, acute mononeuritis multiplex appeared and nerve biopsy revealed vasculitis. There were no signs of inflammatory rheumatic illness, collagenosis, cryglobulinemia, infection or hypersensitivity to medication. We have therefore postulated a relation between the vasculitis and the malignancy. Tumorous relapse could however not be detected at that time. Under immunosuppressive therapy, the neurological deficiencies receded partially, though the carcinoma of the colon reappeared with systemic metastases in the wake of the vasculitis. Diagnostic measures and the relationship between malignancy and vasculitis are discussed.

Adenocarcinoma↗
PubMed1999

A new look at the Western Ontario and McMaster Universities Osteoarthritis Index using Rasch analysis.

OBJECTIVE: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a valid and widely used instrument for the assessment of osteoarthritis patients. We examined whether applying Rasch analysis, a new item-response theory, supports its metric properties. METHODS: The metric properties were examined in a cohort of patients with osteoarthritis of the hip or knee. In an exploratory approach, a validated German version of the WOMAC was analyzed using Rasch analysis for its unidimensionality and construct definition. RESULTS: One hundred fifty-eight patients were included in the study. The 3 WOMAC domains--pain, stiffness, and physical function--were unidimensional when examined separately. In an analysis including all items, the stiffness items did not fit the model. This indicates that they are distinct from the pain and function items. Item difficulty analyses revealed redundancy between corresponding pain and function items addressing the same task (e.g., "pain while standing upright" and "difficulty while standing"). CONCLUSION: Applying Rasch analysis to the 3 WOMAC domains confirms their unidimensionality. However, the pain and function items seem to represent the same construct. Thus, it may be possible to simplify these domains to avoid redundancy. The impact of reducing items must nevertheless be examined.

Activities of Daily Living↗
PubMed1998

Still's disease in children and adults: a distinct pattern of acute-phase proteins.

Crossed affinoimmunoelectrophoresis with Con A as a ligand was used to examine the microheterogeneity of alpha1-acid glycoprotein (AGP) and alpha1-antichymotrypsin (ACT) in sera of patients with child-onset and adult-onset Still's disease. The reactivity of both proteins was increased in sera of adults and decreased in sera of children with active disease, when compared with normal values. We also found statistically significant differences in serum concentration of ACT and ferritin in both diseases. This result suggests different pathogenic mechanisms of Still's disease in children and adults. Serum concentration of ferritin and ACT could be of value as a combined marker for the adult, but not the juvenile form of Still's disease.

Adolescent↗
PubMed1998

Longitudinal study of Lyme borreliosis in a high risk population in Switzerland.

Orienteers from all parts of Switzerland (n = 416) were included in a longitudinal study for Lyme borreliosis. In spring 1986, the seroprevalence was 28.1%. At the beginning of the study, 84.3% of orienteers reported a history of tick bite, and 3.8% reported a past history of Lyme borreliosis. During the first (spring 1986-autumn 1986), second (autumn 1986-spring 1987) and third (spring 1987-autumn 1987) period, rates of seroconversion were 0.6%, 2.7% and 2.1% respectively. During the first and second period, clinical incidence were 1.0% and 0.25% respectively. No active Lyme borreliosis was detected during the third period. Among orienteers who seroconverted during the study (n = 16), only two developed clinical symptoms. Hence, Borrelia burgdorferi infection is often asymptomatic.

Adult↗
PubMed1997

Population genetic structure of Ixodes ricinus in Switzerland from allozymic data: no evidence of divergence between nearby sites.

Ixodes ricinus is a vector and reservoir of numerous infectious agents, especially Borrelia burgdorferi, the agent of Lyme disease. In Switzerland, its ecology and physiology have been well studied. Moreover, the foci of some infectious agents transmitted by this tick are identified. They can display relatively to extremely small geographical size depending on the diseases considered. In order to understand how the gene flows occur and to characterise the genetic structure of Ixodes ricinus populations, we used an indirect method based on genetic markers: allozymes. The sampling was carried out in 5 localities. Eighteen loci were analysed and 2 appeared polymorphic. This shows the low allozymic variability displayed by Ixodes ricinus. Based on these 2 loci, the populations appeared panmictic in Switzerland. This may be explained by the wide range of vertebrate species this tick can infest, especially birds. However, the result is surprising if we consider the extreme localisation of the foci of some infectious agents. We conclude that more powerful genetic markers could be used in order to better understand the epidemiology of tick-borne diseases in Switzerland.

Alleles↗
PubMed1996

[Current didactic concepts--243 participants evaluate Rheuma 2000].

The Swiss League against Rheumatic diseases in collaboration with rheumatologists organized a special educational program for general practitioners. An evaluation questionnaire was filled in by 238 of the 243 participants. With an average value of 4.57 points out of possible 5.0 the new educational concept was very successful. The interactive learning process in small groups seems to be a good alternative to formal lectures.

Education, Medical, Continuing↗
PubMed1996

Ticks of domestic animals in the Macedonia region of Greece.

A study was carried out on ticks of domestic animals in the Macedonia region of Greece. During 1983-1986, 11,620 tick specimens, belonging to 18 species and subspecies, were collected from cattle, sheep, goats and dogs, in 64 localities throughout Macedonia. Rhipicephalus bursa, the most common tick, and Hyalomma marginatum marginatum occurred in all bioclimatic zones, as well as the two one-host ticks, Boophilus annulatus and H. detritum scupense, which were present in fewer localities. R. turanicus, R. sanguineus, Ixodes gibbosus and H. anatolicum excavatum occurred essentially in the mesomediterranean bioclimatic zone. I. ricinus, Dermacentor marginatus and Haemaphysalis ticks (Hm. inermis, Hm. punctata, Hm. sulcata, Hm. parva) were found frequently in the biotopes of the attenuated mesomediterranean and submediterranean bioclimates. Rhipicephalus adults and the two-host Hyalomma ticks were active in the spring-summer period. Ixodes spp., Haemaphysalis spp., D. marginatus, as well as H. detritum scupense and the immature stages of R. bursa appeared during autumn and winter. Hyalomma and Boophilus ticks fed mainly on cattle. R. sanguineus almost exclusively parasitized dogs, which were also the only hosts from which I. hexagonus has been collected. The infestations were generally weak or moderate. Few heavy infestations were observed on cattle, especially in autumn. Most of the tick species showed a strong preference for some particular sites on the vertebrate body. This predilection could vary according to the host species.

Animals↗