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Biomedical subjects

C W Wallesch

Publications and source records attributed to C W Wallesch.

At least 19 recordsLinked to original sources
PubMed2006

Prognosis and prognostic factors in ADL-dependent stroke patients during their first in-patient rehabilitation--a prospective multicentre study.

PURPOSE: This prospective longitudinal study aimed at a description of ADL-functioning and at an analysis, which clinical instruments predict independency 6 months after discharge from in-patient rehabilitation following disabling first stroke. METHOD: A total of 147 patients with disabling first stroke were recruited from three neurological rehabilitation centres. They were assessed during their first in-patient rehabilitation with the NIH Stroke Scale, Hemispheric Stroke Scale (HSS), Activity Index, Barthel Index, Neurobehavioural Rating Scale, Cornell Depression Scale, and the prognostic prediction of the rehabilitation neurologist. The 6 months outcome was established with the Nottingham Extended ADL Scale (NEADL) and by the legal dependency status. RESULTS: The best prediction of 6 months outcome as measured by the NEADL was obtained by the HSS and a multivariate model that also included the physician's prognostic prediction, both early in rehabilitation and at discharge. The dependency status was best predicted by the HSS and patient's sex. CONCLUSION: Clinical scales performed during rehabilitation such as the HSS are valid for prediction of ADL-dependency 6 months after discharge.

Activities of Daily Living↗
PubMed2006

A longitudinal study of health-related quality of life of first stroke survivors' close relatives.

BACKGROUND AND PURPOSE: Mental and social burdens of stroke patients' relatives have been investigated repeatedly, but there is little information about their quality of life (QoL). The purpose of the study was to describe the health-related QoL of stroke patients' relatives at 3 points in time after the stroke. METHOD: Sixty-four closest relatives of patients suffering from a disabling stroke were questioned at admission to inpatient rehabilitation as well as 6 months and 1 year after discharge with the SF36 (short form 36-item questionnaire) and about probable covariates. RESULTS: During inpatient rehabilitation relatives' perception of their physical role as well as of all mental health scales was significantly lower than the normative data. We found improvements in all scales except physical functioning between inpatient rehabilitation and 6 months after discharge. Deteriorations between 6 months and 1 year occurred in physical functioning, role physical, social functioning, role emotional and mental health. CONCLUSIONS: Changes in perceived health-related QoL indicate that relatives go through different stages while coping with the chronic illness of their family member during rehabilitation and in the first year after discharge. These findings may aid support and counseling.

Adaptation, Psychological↗
PubMed2006

Release of glial fibrillary acidic protein is related to the neurovascular status in acute ischemic stroke.

This study aimed at an analysis of glial fibrillary acidic protein (GFAP) in acute ischemic stroke, its association with the neurovascular status and its potential value as monitoring parameter. In 53 consecutive patients, serial venous blood samples were taken on admission, 6, 12, 18, 24, 48, 72, 96, and 120 h after stroke onset. The neurovascular status was assessed by repetitive extracranial and transcranial duplex sonography. Neurologic deficits were quantified by the National Institutes of Health stroke scale, and functional outcome was assessed with the modified Rankin Scale. Mean GFAP values were elevated from admission on with highest levels 48 h after stroke onset. GFAP release was highly correlated with severity of neurologic deficits and infarct volume. In patients with persistent middle cerebral artery occlusion, GFAP increased significantly compared with patients with normal sonographic findings (P = 0.019) and recanalization after thrombolysis resulted in a significant reduced increase (P = 0.038). GFAP concentrations were associated with the functional outcome after 3 months. Release kinetics of GFAP are associated with patients clinical deficits and infarct volume, depend on the neurovascular status on admission and on early recanalization after thrombolysis, and may be used as an additional predictor of the early course and functional outcome.

Aged↗
PubMed2005

[Physicians' attitudes concerning guidelines. An empirical survey in neurologic clinics].

BACKGROUND: Guidelines gain importance for medical services. Their perception and use by physicians does not only rely on their attitudes towards guidelines, but also on other parameters of influence. PURPOSE: to assess hospital physicians's attitudes concerning clinical guidelines and physician- and hospital- related factors of influence. METHODS: multicenter survey with 99 junior and senior registrars from 30 departments of neurology (taking regional random samples). RESULTS: A majority of physicians regarded guidelines as a means of quality improvement and medical education. However, there were no generally positive or negative attitudes, but the physicians differentiated between the individual and the health system level. These patterns of attitudes did not depend upon aspects of the respective departments (such as size, internal guidelines, access to sources of information) and did not vary significantly between hospitals. Instead, there was a marked influence of personality traits on individual opinions concerning guideline utility. Senior registrars, less team-oriented physicians, younger physicians and the more prestige-motivated expressed positive attitudes. On the other hand, a sceptical and more negative attitude was found with professionals who expressed strong team orientation and scientific interest. CONCLUSIONS: The overall positive attitude is probably related to the identification of guideline users with their authors and also to the their present status as non-binding recommendations. The independence of attitudes from hospital characteristics, especially the existence of internal guidelines, may indicate either voluntary guideline use or rather a low impact of guidelines as management instruments or frequently used tools. The potential of guidelines for medical education does not seem to be fully utilised.

Attitude of Health Personnel↗
PubMed2004

Transient focal ischemia in rat brain differentially regulates mRNA expression of protease-activated receptors 1 to 4.

Degeneration or survival of cerebral tissue after ischemic injury depends on the source, intensity, and duration of the insult. In the model of focal ischemia, reduced blood flow results in a cascade of pathophysiologic events, including inflammation, excitotoxicity, and platelet activation at the site of injury. One serine protease that is associated closely with and produced in response to central nervous system (CNS) injury is thrombin. Thrombin enters the injury cascade in brain either via a compromised blood-brain barrier or possibly from endogenous prothrombin. Thrombin mediates its action through the protease-activated receptor family (PAR-1, -3, and -4). PARs belong to the superfamily of G protein-coupled receptors with a 7-transmembrane domain structure and are activated by proteolytic cleavage of their N-terminus. We showed that thrombin can be neuroprotective or deleterious when present at different concentrations before and during oxygen-glucose deprivation, an in vitro model of ischemia. We examined the change in mRNA expression levels of PAR-1 to 4 as a result of transient focal ischemia in rat brain, induced by microinjection of endothelin near the middle cerebral artery. Using semiquantitative reverse transcription-polymerase chain reaction (RT-PCR) analysis, after ischemic insult on the ipsilesional side, PAR-1 was found to be downregulated significantly, whereas PAR-2 mRNA levels decreased only moderately. PAR-3 was upregulated transiently and then downregulated, and PAR-4 mRNA levels showed the most striking (2.5-fold) increase 12 hr after ischemia, in the injured side. In the contralateral hemisphere, mRNA expression was also affected, where decreased mRNA levels were observed for PAR-1, -2, and -3, whereas PAR-4 levels were reduced only after 7 days. Taken together, these data suggest involvement of the thrombin receptors PAR-1, PAR-3, and PAR-4 in the pathophysiology of brain ischemia.

Animals↗
PubMed2004

Sudden progression of a glioblastoma in partial remission?

There are only sparse data on viral CNS infections in patients with malignant glioma. We report a case of fatal herpes encephalitis in a patient with glioblastoma in partial remission and provide a short review of the literature.

Brain Neoplasms↗
PubMed2003

Physicians' preferences and expectations in traumatic brain injury rehabilitation--results of a case-based questionnaire survey.

PURPOSE: Analysis of medical decisions in the differential allocation of traumatic brain injury (TBI) rehabilitation programmes. METHOD: Medical specialists routinely involved in the treatment and rehabilitation of TBI patients from acute hospitals, rehabilitation centres, and the Medical Services of the Workers' Pension Insurance of Sachsen-Anhalt and Mecklenburg-Vorpommern were included in a systematic survey, in which they had to give their opinions on the individually optimal rehabilitation setting and therapies and probable outcome on the basis of case vignettes. These specialists are crucial for decision-making in rehabilitation resource allocation. RESULTS: Both allocation and prognosis depended mainly on patient characteristics. In a mixed logistic regression model, which takes into account that: (a) patient and physician characteristics may influence each other; and (b) that expert assessments might be correlated, setting preferences were related to chronicity and degree of motor and cognitive impairment, but also to the institutional background of the reviewer. Neuropsychological therapy dominated intervention recommendations, followed by physio- and occupational therapy. A comparatively great demand of psychotherapy and medicosocial assessment was recognized. Preferred rehabilitation setting did not influence the physicians' subjective prognosis. Older, chronic and motorically impaired patients were considered to profit less from rehabilitation. Physician characteristics and recommendations of either rehabilitation setting or therapies did not influence prognostic expectations. CONCLUSIONS: Physician characteristics influenced setting preferences. Preferences for type of treatment and ADL-prognosis depended on patients' variables only. Expected effects of rehabilitation were independent on rehabilitation setting and kinds of treatment.

Activities of Daily Living↗
PubMed2002

Physicians' preferences and expectations in stroke rehabilitation--results of a case-based questionnaire survey.

PURPOSE: Analysis of medical decisions in the differential allocation of stroke rehabilitation programmes. METHOD: Medical specialists routinely involved in the treatment and rehabilitation of stroke patients from acute hospitals, rehabilitation centres, and the Medical Services of the Workers' Pension Funds of Sachsen-Anhalt and Mecklenburg-Vorpommern were included in a systematic survey, in which they had to give their opinions on the individually optimal rehabilitation setting and therapies and probable outcome on the basis of case vignettes. These specialists are crucial for decision-making in rehabilitation resource allocation. RESULTS: Both allocation and prognosis did not depend only on patient but also on physician characteristics. Neurologists tended to prefer outpatient rehabilitation and expected a greater effect of rehabilitation upon ADL-function than specialists from other professions. Preferred rehabilitation setting did not influence the physicians' subjective prognosis. For patients who qualified both for in- and outpatient rehabilitation, the two settings, therapeutic potentials were considered to be equivalent. CONCLUSIONS: Differences in setting and treatment preferences between experts concerning optimal treatment cannot be resolved on the basis of available evidence. Further data are required that allow to decide which type of rehabilitation is best suited for a given patient.

Adult↗
PubMed2002

[Peer review of routine clinical case reports - an instrument of quality management? Results of a pilot investigation].

A scoring system for quality assessment of neurological routine case reports was developed in cooperation with the Quality Management Commission of the German Neurological Society (DGN). Five clinical departments of neurology submitted eight anonymized reports for each of seven tracer diagnoses (CNS hemorrhage, ischemic infarction in the anterior circulation, epilepsy, Parkinsonism, bacterial CNS infection, multiple sclerosis (initial diagnosis), polyneuropathy) which were reviewed by two neurologists from different departments. The reports reflect differences between departments concerning certain procedures, especially technical investigations and the use of standardized scores. Interrater reliability was low. However, there were significant and meaningful differences between departments, which can be used for quality improvement. The approach can be recommended for use in peer audits between hospitals.

Benchmarking↗
PubMed2002

Cessation of embolic signals after antithrombotic prevention is related to reduced risk of recurrent arterioembolic transient ischaemic attack and stroke.

OBJECTIVES: To evaluate the reduction of embolic signals after the initiation of an antithrombotic secondary prevention in patients with recent arterioembolic stroke and to determine the predictive value of decreased microembolism on the risk of early stroke recurrence. METHODS: Eighty six consecutive patients (55 men, 31 women; mean age 60.6 years) with a non-disabling arterioembolic ischaemic event in the anterior circulation within the last 30 days and a medium grade or high grade stenosis (> or =50%) of the ipsilateral carotid or middle cerebral artery underwent 1 hour transcranial Doppler monitoring as part of the admission examinations. Antithrombotic secondary prevention was started after completion of admission. Patients in whom embolic signals were detected underwent a second monitoring within 4 days (mean time 1.8 days). All patients were followed up prospectively to evaluate the relation between presence and persistence of embolic signals and the risk of recurrent transient ischaemic attack (TIA) and stroke within the next 6 weeks. RESULTS: In 44 patients, embolic signals were detected at admission, a mean 5.4 days (range 0 to 21 days) after the initial event. Twenty five were positive for embolic signals also at the second monitoring, in 19 signals had ceased. Forty two patients without embolic signals at admission served as controls. During follow up, six ischaemic events (two stroke, three TIA, one amaurosis fugax) occurred in 25 patients with persisting embolic signals but none in 19 patients in whom signals had ceased by the second monitoring. One patient in the control group had a TIA. The incidence of a recurrent event was 0.45 per 30 patient-days if embolic signals persisted compared with 0.015 if signals could not be detected or had ceased. Persistence of embolic signals was an independent predictor of a recurrent TIA or stroke (adjusted odds ratio 37.0; 95% confidence interval (95% CI) 3.5 to 333; p<0.003). Cessation and decrease of embolic signals was associated with the administration of antiplatelet agents but not with anticoagulation with intravenous heparin (p<0.001). CONCLUSIONS: Rapid cessation of embolic signals detected in patients with recently symptomatic arterial stenosis decreases increased risk of an early ischaemic recurrence. Effect of antithrombotic agents on embolic signals might serve as a marker for their efficacy on preventing stroke recurrence.

Aged↗
PubMed2001

Physicians' estimates of rehabilitation requirements after stroke and traumatic brain injury--a questionnaire survey in East Germany.

PURPOSE: The provision of rehabilitation services is organized differently in Germany than most other countries, with large indication-specific in-patient centres. This study is aimed at the rehabilitative knowledge of physicians who initiate and conduct rehabilitation in Germany. METHODS: Medical specialists routinely involved in the treatment and rehabilitation of patients with stroke and traumatic brain injury (TBI) from acute hospitals, rehabilitation centres, and the Medical Services of the Workers' Pension Funds of Sachsen-Anhalt and Mecklenburg-Vorpommern were included in a systematic questionnaire survey aiming at the rehabilitation requirements of patients under their care or evaluation. These specialists are crucial for decision-making in rehabilitation ressource allocation. RESULTS: According to these experts, rehabilitation requirements for stroke and TBI patients are dominated by deficits in motor functions and daily-living. They are aware that TBI rehabilitation includes a greater focus on memory functions, problem-solving and attention, and in stroke on language functions. According to the surveyed specialists, the present system of medical rehabilitation in Germany covers the requirements of stroke and TBI patients only partially. Deficits are identified in out-patient and day clinic rehabilitation. CONCLUSIONS: Although the knowledge of rehabilitation requirements is adequate in general, its large ranges reflect the necessity for further analysis. The opinions of the surveyed specialists reflect their respective professional setting. Advantages and disadvantages of the German system require further investigation.

Activities of Daily Living↗
PubMed2001

Sex differences in length of survival with malignant astrocytoma, but not with glioblastoma.

In a retrospective analysis based on a malignant glioma databank, we describe effects of age, sex and diagnosis upon survival in patients with malignant cerebral glioma with a pre-treatment Karnofsky-index of 60 or more. All patients had been treated with 55-60Gy radiotherapy and nitrosurea-based adjuvant chemotherapy. We found an age-dependent sex effect upon survival in grade III astrocytoma patients, but not with glioblastoma.

Adult↗
PubMed2001

[Coping in patients with malignant glioma in the course of radiation therapy].

UNLABELLED: Twenty-one patients with malignant glioma were interviewed in the course of radiation therapy (before start, in the middle and at the end of treatment and six weeks later). We used the "Freiburger Fragebogen zur Krankheitsverarbeitung (FKV)", an assessment of coping strategies, the "State-Trait-Anxiety-Inventory (STAI)", the "Beck-Depression-Scale (BDI)", and the QLQ-C 30 questionnaire of the EORTC. RESULTS: The coping strategies of our patients are comparable with other cancer patients. They are mainly characterized by "self-encouragement", "compliance" and "trust in the treating physician". Anxiety was low and showed no significant changes. Depressivity was higher than in the normal population, however, it also showed no significant changes in the course of therapy. Quality of life scores remained constant, despite an increase of fatigue. In our patients with malignant glioma, the influence of radiation on coping, anxiety, depression and quality of life seems insignificant in comparison to that of the diagnosis of cancer.

Adaptation, Psychological↗