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Ziel ist die Überprüfung der kurz- und mittelfristigen Wirksamkeit einer vorschulischen Förderung des Mengen- und Zahlenverständnisses bei Kindern mit einem Risiko für die Entwicklung einer Rechenstörung. Es wurden 32 Risikokinder mit einer Kombination aus den Förderprogrammen Mathematik im Vorschulalter und Mengen, zählen, Zahlen im letzten Kindergartenjahr von den Erzieherinnen trainiert und mit 38 untrainierten Risikokindern verglichen. Hinsichtlich der kurzfristigen Wirksamkeit zeigten sich positive Trainingseffekte auf die numerischen Leistungen im letzten Kindergartenjahr. Es ließen sich keine signifikanten mittelfristigen Trainingseffekte auf die Rechenleistungen im zweiten Halbjahr der 1. Klasse finden. Das eingesetzte vorschulische Präventionsprogramm leistete danach einen wichtigen Beitrag zur kurzfristigen Verbesserung der mathematischen Basiskompetenzen.
Hauptziel Adipositas ist eine der Hauptindikationen in der Kinder- und Jugend-Rehabilitation. Für ältere Jugendliche und junge Erwachsene fehlen altersspezifische Therapieangebote fast vollständig. Ziel war es die Wünsche bezüglich der Inhalte und Methoden einer „perfekten Therapie“ im Rahmen eines Rehabilitationsaufenthalts zu untersuchen.
Methode Im Rahmen der YOUTH-Studie wurden 147 adipöse Jugendliche und junge Erwachsene beiderlei Geschlechts (zwischen 15 und 21 Jahren) mithilfe eines standardisierten Fragebogens befragt.
Ergebnis Insgesamt zeigten sich relativ wenige alters- und geschlechtsspezifische Unterschiede. Interdisziplinär geleitete, koedukative Gruppen mit Elterneinbindung wurden gewünscht. Wichtige Themen waren gesunde Ernährung sowie psychosoziale Aspekte. Auch der Prävention von Rückfällen wurde eine hohe Relevanz zugeschrieben.
Schlussfolgerung Psychosoziale Aspekte und die Vorbereitung auf mögliche Rückfallsituationen sollten integraler Bestandteil der Therapie sein.
Introduction: Cardiac rehabilitation is designed for patients suffering from cardiovascular diseases or functional disabilities. The aim of a cardiac rehabilitation is to improve overall physical health, psychological well-being, physical function, the ability to participate in social life and help patients to change their habits. Regarding the heterogeneity of these aims measuring of the effect of cardiac rehabilitation is still a challenge. This study recommends a concept to assess the effects of cardiac rehabilitation regarding the individual change of relevant quality indicators.
Methods: With EVA-Reha; cardiac rehabilitation the Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey (MDK Rheinland-Pfalz) developed a software to collect data set including sociodemographic and diagnostic data and also the results of specific assessments. The project was funded by the Techniker Krankenkasse, Hamburg, and supported by participating rehabilitation centers. From 01. July 2010 to 30. June 2011 1309 patients (age 71.5 years, 76.1% men) from 13 rehabilitation centers were consecutively enrolled. 13 quality indicators in 3 scales were developed for evaluation of cardiac rehabilitation: 1) cardiovascular risk factors (blood pressure, LDL cholesterol, triglycerides), 2) exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure [NYHA classification], and angina pectoris [CCS classification]) and 3) subjective health (IRES-24: pain, somatic health, psychological wellbeing and depression as well as anxiety on the HADS). The study was prospective; data of patients were assessed at entry and discharge of rehabilitation. To measure the success of rehabilitation each parameter was graded in severity classes at entry and discharge. For each of the 13 quality indicators changes of severity class were rated in a rating matrix. For indicators without a requirement for medical care neither at entry nor at discharge no rating was performed.
Results: The grading into severity classes as well as the minimal important differences were given for the 13 quality indicators. The result of rehabilitation can be demonstrated in suitable form by means of rating of the 13 quality indicators according to a clinical population. The rating model differs well between clinically changed and unchanged patients for the quality indicators.
Conclusion: The result of cardiac rehabilitation can be assessed with 13 quality indicators measured at entry and discharge of the rehabilitation program. If a change into a more favorable category at the end of rehabilitation could be achieved it was counted as a success. The 13 quality indicators can be used to assess the individual result as well as the result of a population - e.g. all patients of a clinic in a specific time period. In addition, the assessment and rating of relevant quality indicators can be used for comparisons of rehabilitation centers.
Background: Post-activation potentiation (PAP) can elicit acute performance enhancements in variables of strength, power, and speed. However, it is unresolved whether the frequent integration of PAP eliciting conditioning activities in training (i.e., complex training) results in long-term adaptations. In this regard, it is of interest to know whether complex training results in larger performance enhancements as compared to more traditional and isolated training regimens (e. g., resistance training). Thus, this systematic literature review summarises the current state of the art regarding the effects of complex training on measures of strength, power, and speed in recreational, subelite, and elite athletes. Further, it provides information on training volume and intensities that proved to be effective.
Methods: Our literature search included the electronic databases Pubmed, SportDiscus, and Web of Science (1995 to September 2013). In total, 17 studies met the inclusionary criteria for review. Ten studies examined alternating complex training and 7 studies sequenced complex training.
Results: Our findings indicated small to large effects for both alternating complex training (countermovement jump height: +7.4 % [ESd = -0.43]; squat jump height: +9.8 % [ESd = -0.66]; sprint time: -2.4% [ESd = 0.63]) and sequenced complex training (countermovement jump height: +6.0 % [ESd = -0.83]; squat jump height: +11.9% [ESd = -0.97], sprint time: -0.7% [ESd = 0.52]) in measures of power and speed. As compared to more traditional training regimens, alternating and sequenced complex training showed only small effects in measures of strength, power, and speed. A more detailed analysis of alternating complex training revealed larger effects in countermovement jump height in recreational athletes (+9.7% [ESd = -0.57]) as compared to subelite and elite athletes (+2.7% [ESd = -0.15]). Based on the relevant and currently available literature, missing data (e.g., time for rest interval) and diverse information regarding training volume and intensity do not allow us to establish evidence-based dose-response relations for complex training.
Conclusion: Complex training represents an effective training regimen for athletes if the goal is to enhance strength, power, and speed. Studies with high methodological quality have to be conducted in the future to elucidate whether complex training is less, similar, or even more effective compared to more traditional training regimens. Finally, it should be clarified whether alternated and/or sequenced conditioning activities implemented in complex training actually elicit acute PAP effects.
Computer aided dosage management of phenprocoumon anticoagulation therapy Clinical validation
(2014)
A recently developed multiparameter computer-aided expert system (TheMa) for guiding anticoagulation with phenprocoumon (PPC) was validated by a prospective investigation in 22 patients. The PPC-INR-response curve resulting from physician guided dosage was compared to INR values calculated by "twin calculation" from TheMa recommended dosage. Additionally, TheMa was used to predict the optimal time to perform surgery or invasive procedures after interruption of anticogulation therapy. Results: Comparison of physician and TheMa guided anticoagulation showed almost identical accuracy by three quantitative measures: Polygon integration method (area around INR target) 616.17 vs. 607.86, INR hits in the target range 166 vs. 161, and TTR (time in therapeutic range) 63.91 vs. 62.40 %. After discontinuation of anticoagulation therapy, calculating the INR phase-out curve with TheMa INR prognosis of 1.8 was possible with a standard deviation of 0.50 +/- 0.59 days. Conclusion: Guiding anticoagulation with TheMa was as accurate as Physician guided therapy. After interruption of anticoagulant therapy, TheMa may be used for calculating the optimal time performing operations or initiating bridging therapy.
The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.
Tracheotomierte Patienten, die sowohl eine Dysphagie als auch respiratorische Defizite aufweisen, haben nach der Dekanülierung häufig Probleme, sich an die translaryngeale Atmung anzupassen. Wir entwickelten ein Dekanülierungsprotokoll für diese Patientengruppe, das optional in unser bestehendes Trachealkanülenmanagement integriert werden kann. Erfüllt ein Patient die hierfür definierten Kriterien, so erfolgt unter laryngoskopischer Kontrolle die Einlage eines Platzhalters, der bis zu 3 Tage in situ verbleibt. Während dieser Probedekanülierungsphase werden die respiratorischen Funktionen und das Speichelmanagement engmaschig überwacht. Auf der Grundlage dieser Evaluation wird dann die Entscheidung für oder gegen eine endgültige Dekanülierung getroffen. Wir stellen den Ablauf, die Kriterienkataloge und die Evaluationsparameter für diese Probedekanülierungsphase vor und illustrieren den Ablauf anhand von 2 Fallbeispielen.
Background: Therapeutic climbing exercises are employed for the treatment of shoulder-and knee-joint injuries. However, there is a void in the literature regarding muscle activation levels during the performance of these exercises. Thus, the purpose of this study was to investigate differences in muscle activation during therapeutic climbing exercises depending on the degree of task difficulty.
Participants/Material and Methods: A sample of 10 healthy subjects (sex: 4 females, 6 males; age: 27 +/- 3 years; climbing experience: 5 +/- 3 years) performed three shoulder girdle (i.e., wide shoulder pull, narrow shoulder pull, shoulder row) and two leg extensor (i.e., ascending frontal, ascending sidewards) exercises. Electromyographic (EMG) data were recorded on the right side for eleven muscles and then normalised using the maximum voluntary contractions for each muscle.
Results: With increasing task difficulty, muscle activity in all but one muscle (i.e., m. trapezius ascendens) increased significantly for the three shoulder girdle exercises. For the two leg extensor exercises, an increase in task difficulty produced a tendency towards yet not significantly higher muscle activity.
Conclusion: Shoulder row was the most effective therapeutic climbing exercise in the ability to activate muscles while showing the highest EMG signals. The absence of significant differences in muscle activity between the two leg extensor exercises indicates their equivalent use for muscle activation during therapy.
Background: The contractile history of a muscle or a muscle group can result in an acute enhancement of subsequent muscle force output. This phenomenon is referred to as postactivation potentiation (PAP) and it was frequently substantiated in original research manuscripts, systematic literature reviews, and meta-analyses. However, there is a lack in the literature regarding precise dose-response relations. This literature review describes the main determinants of PAP effects and additionally presents the state of the art regarding the acute effects of PAP protocols on measures of strength, power, and speed in subelite and elite athletes of different sport disciplines. Furthermore, an attempt is made to demonstrate evidence-based information concerning the design of effective PAP protocols.
Methods: Our literature search included the electronic databases Pubmed, SportDiscus, and Google Scholar (1995 - March 2013). In total, 23 studies met the inclusionary criteria for review.
Results: Findings from our literature review indicate that various conditioning activities produce acute PAP effects in subelite and particularly elite athletes. More specifically, conditioning activities that are characterised by multiple sets, moderate to high intensities (60 - 84 % of the one repetition maximum), and rest intervals of 7 - 10 min. following the conditioning activity have the potential to induce short-term improvements in muscle force output and sports performance.
Conclusion: It is recommended that subelite and particularly elite athletes from strength, power, and speed disciplines apply specifically tailored conditioning activities during the acute preparation process for competition to induce performance enhancing PAP effects.