Biomedical subjects

Martin Posch

Publications and source records attributed to Martin Posch.

6 recordsLinked to original sources

PubMed2003

Quality of life in patients with non-metastatic differentiated thyroid cancer under thyroxine supplementation therapy.

GOALS: When thyroid and other cancers are "cured" it is often assumed that the patients are able to resume their normal lives. This was a cross-sectional study to evaluate health-related quality of life (HRQOL) and to identify rehabilitation needs of patients with non-metastatic thyroid cancer under thyroxine supplementation therapy. PATIENTS AND METHODS: Included in the study were 150 consecutive patients with differentiated thyroid cancer (age 52 +/- 14 years, range 25-83 years; male/female 39/111). All patients had a history of total thyroidectomy followed by radioiodine ablation, were free of metastatic disease and under levothyroxine treatment. The mean period since the diagnosis of thyroid cancer was 5.5 +/- 6 years (range 0-23 years). Health-related quality of life was evaluated using the SF-36 Health Survey. The findings were compared with sex- and age-matched reference values. RESULTS: "Role-emotional" and "Vitality" were significantly lower ( P<0.001 and P<0.005, respectively) in the group as a whole ( n = 150). In the subgroup of patients with a recent (less than 1 year) diagnosis of thyroid cancer ( n = 51), however, the following subscales were significantly lower: "Mental Health" ( P<0.01), "Role-emotional" ( P<0.001), "Role-physical" ( P<0.005), "Social functioning" ( P<0.005) and "Vitality" ( P<0.001). Multiple regression analysis identified a significant positive correlation between "Mental Health", "Physical functioning", "Vitality", "Role-emotional" and "Social functioning" with the time since initial diagnosis, and there was also a positive correlation between "Physical functioning", "Bodily pain" and "Role-emotional" with male gender. CONCLUSIONS: These findings indicate that "Vitality", "Role-physical", "Mental Health", "Role-emotional" and "Social functioning" are significantly impaired during the first year after diagnosis. Thereafter, quality of life improves correlating with the time since initial diagnosis. However, "Vitality" and "Role-emotional" remain permanently impaired in thyroid cancer patients. A multidisciplinary rehabilitation concept should include psychological support and an early start to exercise to improve physical performance of these patients leading to better HRQOL and to help them fulfill their social role earlier.

Adult↗

PubMed2003

Issues in designing flexible trials.

We outline the general framework of adaptive combination tests and discuss their relationship to flexible group sequential designs. An important field of applications is sample size reassessment. We discuss reassessment rules based on conditional power arguments using either the observed or the prefixed effect size. These rules tend to lead to large expected sample sizes for small actual effects. However, the application of a maximal bound for the second stage sample size leads to more favourable properties. Additionally, we consider an optimized reassessment rule in terms of expected sample sizes. Since the adaptive design does not use the classical test statistics for some types of sample size reassessments, the adaptive test may reject the null hypothesis while the classical one-sample test does not. We characterize sample size reassessment rules, where such inconsistencies are avoided. Finally, the extension of flexibility to the number of stages is explored. In the first interim analysis a second interim analysis is only planned if the chance to achieve a decision there is high. This leads to savings in the average number of interim analysis performed, without paying a noticeable price in terms of expected sample size.

Clinical Trials as Topic↗

PubMed2003

Factors that influence the duration of splint wear in peripheral nerve lesions.

OBJECTIVE: To assess the weekly frequency and overall duration of wear for splints used to treat peripheral nerve lesions and factors that possibly influence splint wear. DESIGN: A total of 78 patients (23 women, 55 men) who had been treated with a hand splint for peripheral nerve palsy were interviewed by telephone, based on a preformulated questionnaire. The duration of wear, reasons for terminating use, the effect of the splint, the patients' assessment of splint treatment, the patients' instruction, and the patients' level of education were recorded. Survival analysis for the entire period of wear and logistic regressions to determine factors that influence splint wear were performed. Comparison of effect scores between lesions in the dominant those in the nondominant hand were carried out with a test. RESULTS: The median duration of wear was 6 mo for daytime and 4 mo for nighttime splints. Daytime splints were worn by 85% and nighttime splints by 84% of patients for 5-7 days per week. The reported effect of the splint was the only significant factor that influenced the frequency of wear. The splint was reported to be significantly more effective in the dominant hand than in the nondominant hand. Numerically, radial nerve lesions and cock-up wrist splints were most common. CONCLUSION: Regular splint wear was registered in the majority of patients and was positively influenced by a good effect of the splint, which was reported to be better in the dominant hand.

Adult↗

PubMed2002

[Optimizing electrotherapy--a comparative study of 3 different currents].

Neuromuscular electrical stimulation can be used to increase strength of skeletal muscle. In neuromuscular electrical stimulation of innervated skeletal muscle, the application of the highest possible intensities of electricity is an important determinant of therapeutic success with regard to strength training. The therapeutic goal of "strengthening muscles" is opposed to the side effect of discomfort through the application of electricity. The aim of the present study was to compare three forms of electric current with respect to subjective tolerance and maximum achievable muscular strength. Twenty-nine healthy male volunteers were included in a single-blind study in which three forms of electric current were applied in a randomized fashion. The following types were compared: a short monophasic form, a biphasic form that was twice as long in terms of impulse duration, and a long monophasic form with an equal impulse duration than tht of the biphasic form and with an impulse form that corresponded to the short monophasic current. Stimulation was administered via surface electrodes placed on the knee extensors in the lower extremity on the right side. The intensity of the current was increased to the individual limit of tolerance or to a maximum of 100 mA. The main target parameter used to determine the success of treatment was the maximum electrically induced strength as a percentage of maximal voluntary contraction. The short monophasic form of electricity was associated with much less discomfort than the long monophasic and biphasic forms (p < 0.0001, p = 0.0062). Furthermore, the biphasic form was better tolerated (and therefore had a larger therapeutic range of application) than the long monophasic form (p = 0.041). The biphasic and long monophasic forms produced higher values for maximum electrically induced strength than did the short monophasic form (p = 0.0001, p = 0.0010). To summarize: the biphasic form had a larger range of therapeutic application than the long monophasic form. Furthermore, the biphasic form produced 40% more electrically induced strength than the short monophasic one. It may be concluded that, in terms of therapeutic application, the biphasic form of electric current is superior to the monophasic forms described in the present study.

Adult↗

PubMed2002

Reliability of EMG time-frequency measures of fatigue during repetitive lifting.

PURPOSE: To test the short-term and long-term reliability of time-frequency electromyographic (EMG) measures of fatigue during repetitive dynamic lifting and compare it with the reliability of median frequency (MF) EMG measures of fatigue during static lifting. METHODS: Fourteen' healthy male subjects (26 +/- 5 years) repetitively (12 lifts/min) lifted and lowered a box (29 x 25 x 23 cm, 13 kg) for 4.5 min during 3 different tests on 2 different days. EMG data and the biomechanics of motion were recorded. Before and after dynamic lifting, static maximum lifting tests were performed. At the end of each of the two sessions, subjects performed a static lift at 80% of their maximum lifting force for 30 s. RESULTS: Significant fatigue-related changes were observed during the lifting exercise via EMG time-frequency analysis at the paravertebral L5, L2, T10, and vastus lateralis (VL) electrode sites. Two parameters for assessing fatigue during dynamic contractions [i.e., the Instantaneous Median Frequency (IMDF) and its time dependent change] were shown to be reproducible both in the short-term (2 h) and long-term (2 wk). The corresponding ICCs reflecting the reproducibility of values between sessions were 96.9% (L5), 98.1% (L2), 90.1% (T10), 96.4% (UT), 98.0% (GM), 89.5% (VL), and 99.0% (BF), respectively. For most EMG recording sites, the reliability of the IMDF measures was not dependent upon the postural strategy that the subject used to accomplish the lifting task or on the subject's strength as measured via the static maximum lifting test. A comparison between the ICC values of the IMDF measures and those of the parameters utilized to assess fatigue during static sustained lifts [i.e., the Median Frequency (MDF) and its change during the test] revealed equally good reproducibility for most EMG recording sites. The respective ICC values that took into account time dependent trends for the IMDF parameter were 87.1% (L5), 62.4% (L2), 90.1% (T10), 0% (UT), 72.7% (GM), 45.4% (VL), and 100% (BF), and for the MDF parameter 94.9% (L5), 73.0% (L2), 80.9% (T10), 100% (UT), 89% (GM), 91.7% (VL), and 90.9% (BF), respectively. CONCLUSIONS: The time-frequency approach allows one to derive EMG spectral parameters that can be used to monitor muscle fatigue during dynamic real-world tasks such as lifting.

Adult↗

PubMedDate not supplied

Impact of pneumococcal vaccination on morbidity and mortality of geriatric patients: a case-controlled study.

BACKGROUND: Infections due to Streptococcus pneumoniae are the major cause of adult community-acquired pneumonia, especially in elderly persons with chronic medical conditions. Despite their well-documented efficacy against bacteraemic disease and deaths in the elderly population, pneumococcal polysaccharide vaccines are still very much underused. OBJECTIVE: A retrospective, case-controlled study was performed to investigate the impact of vaccination with a polysaccharide pneumococcal vaccine, together with other risk factors, on the incidence of pneumonia and deaths in patients in a long-stay geriatric hospital. METHODS: Subjects were 1,077 residents in a long-stay geriatric hospital in Vienna, Austria, including 359 patients diagnosed as having pneumonia during the period from July 1996 to October 1998 and 718 control subjects. Two controls resident in the hospital during the same time period were matched for each case according to demographic characteristics, chronic illness, and duration of stay in the geriatric ward. The vaccination status was established for all subjects. A logistic regression analysis was performed to assess the efficacy of vaccination and the impact of other cofactors on disease and death. RESULTS: In cases and controls, 514 (47.7%) had received a pneumococcal vaccine within 2 years prior to the study. There were no differences in demographic characteristics, underlying medical conditions, or duration of stay in the hospital between vaccinated and non-vaccinated patients. In patients diagnosed with pneumonia, 66% were unvaccinated. Logistic regression analysis showed that vaccination significantly decreased the risk of pneumonia (odds ratio 0.279; p < 0.0001). Of the cofactors tested, only gender (lower risk in males) and diabetes mellitus (higher risk) had any impact on disease risk and vaccine efficacy. There appeared to be a highly significant effect of vaccination, reducing the risk of all deaths (odds ratio 0.269; p < 0.0001) and deaths due to pneumonia (odds ratio 0.331; p < 0.0001). CONCLUSION: This study showed that vaccination with a polysaccharide pneumococcal vaccine is effective in all groups of geriatric subjects and has a consequential value for health and well-being of elderly institutionalized patients.

Aged↗