R Willers

Heinrich-Heine-Universität Düsseldorf, Düsseldorf, North Rhine-Westphalia, Germany

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Publications (119)396.85 Total impact

  • 11/2015; 2(1):e000113-e000113. DOI:10.1136/lupus-2015-000113
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    ABSTRACT: Background Medical adherence is an important factor influencing therapeutic success. In the majority the lack of adherence remains unrecognised and/or is misinterpreted as non- respectively not adequate response. In Germany and several other countries medical costs are paid by a social health insurance system. Therefore, a lack of adherence with disposal of the unused drugs has a prejudicial effect on national economies. Objectives Our objective was to investigate the frequency and influencing factors of low adherence in lupus patients in Germany. Methods The LuLa-Study is a longitudinal cross-sectional survey of the German LE self-help community on a multitude of LE associated factors. It is being conducted annually by means of a self-reported questionnaire since 2001. Amongst others health-related quality of life is measured by the Short-Form-12 (SF-12) with its mental (MCS) and physical component summary (PCS), damage by using the “Brief Index of Lupus Damage” (BILD) and disease activity using the “Systemic Lupus Activity Questionnaire” (SLAQ). In 2012 we included additional questions concerning medical adherence (using the four item Morisky Medication Adherence Scale; MMAS-4) as well as satisfaction (numeric-rating-scale; 0-10) concerning their lupus medication (i. a. antimalarials, glucocorticoids, immunosuppressive agents). Results In 2012 we received 579 questionnaires. The MMAS-4 was completed by 458 participants. 81 individuals did not currently take any lupus medication and in 40 cases the MMAS-4 was incomplete and therefore omitted. 62.7% showed a high, 32.5% a moderate and 4.8% a low adherence. Increasing age (p<0.001), lower physical functioning (p=0.030; SF-12 PCS), a better mental status (p=0.011; SF-12 MCS), and accumulated damage (p<0.001; BILD) went along with a better reported adherence. Other factors lacked significant differences between the low, medium and high adherence groups like disease activity, disease duration, number of lupus-specific drugs (range 1-5), intensity of lupus therapy (symptomatic, immunomodulatory, immunosuppressive), overall number of medications (including medication for comorbidities; range 1-12), and satisfaction with lupus specific drugs. In participants using azathioprine (n=96) or ciclosporine (n=15) a high adherence was reported more frequently (72% resp. 73%) than in users of mycophenolic acid (n=72; 61%), methotrexate (n=49; 57%) or antimalarials (n=252; 58%). Conclusions Our reported adherence rates lie within the large range reported by the review of Costedoat-Chalumeau et al [1]. We disclose several aspects that need to be taken into account when evaluating and initiating a therapy in patients with lupus. Especially in younger patients and those with a worse mental status lower medical adherence should be considered. The choice of the medical agent might have an additional negative impact on patients' adherence. When initiating a therapy, potential obstacles should be addressed and discussed openly between patients and physicians. Thus, individual therapy planning may contribute to improved adherence and thus produce the best possible outcome. References Acknowledgements The LuLa-study is supported by unrestricted grants from GlaxoSmithKline and UCB Pharma. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):782.3-783. DOI:10.1136/annrheumdis-2015-eular.2822 · 10.38 Impact Factor
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    ABSTRACT: Fragestellung. Unser Ziel war die Beurteilung der Mikrovaskularisation und des antiangiogenetischen Effektes einer Thalidomidtherapie mittels dynamischer kontrastverstärkter MRT (d-MRT) bei unterschiedlichen hämatologischen Erkrankungen. Methodik. Bei 20 Normalpersonen, 20 Patienten mit Myelodysplastischen Syndromen (MDS), 10 Patienten mit Osteomyelofibrose (OMF) und 10 Patienten mit Multiplem Myelom (MM) wurde eine schnelle Gradientenechosequenz (Turbo fast low angle shot 2D) mit pumpengesteuerter Gd-DTPA-Applikation vor und bei 18 davon durchschnittlich 4,3 Monate nach Therapiebeginn mit Thalidomid durchgeführt. Zwei Perfusionsparameter (Amplitude und Austauschratenkonstante) wurden berechnet und es erfolgten ein statistischer Vergleich der Werte zwischen Probanden und Patienten sowie eine Korrelation der klinischen Verlaufsparameter der Patienten mit den d-MRT-Ergebnissen. Ergebnisse. Bei den Patienten wurden im Vergleich zu den Normalpersonen durchschnittlich höhere Amplituden (Normalpersonen 14,4±5,2; MDS 24,8±8,1; OMF 35,9±4,3; MM 23,4±3,6) und Austauschratenkonstanten (Normalpersonen 0,124±0,042; MDS 0,136±0,036; OMF 0,144±0,068; MM 0,131±0,034) gemessen. Bei 14 von 18 im Verlauf untersuchten Patienten konnte eine signifikante (p<0,005) Reduktion der Perfusionsparameter in der d-MRT unter Thalidomidtherapie nachgewiesen werden. Klinisch zeigten sämtliche dieser Patienten eine Krankheitsremission. Schlussfolgerungen. Bei den untersuchten hämatologischen Erkrankungen liegen im Vergleich zu Normalpersonen signifikant höhere d-MRT-Perfusionsparameter der Lendenwirbelsäule vor. Unter antiangiogenetischer Therapie mit Thalidomid kommt es im Falle eines Therapieansprechens zum Abfall dieser Werte. Purpose. The aim of the study was to measure microcirculation parameters by dynamic contrast-enhanced MRI (d-MRI) and to evaluate the anti-angiogentic effects during treatment with thalidomide in different hematologic malignancies. Methods. In 20 healthy normal persons, 20 patients with myelodysplastic syndromes (MDS), 10 patients with multiple myeloma (MM) and 10 with myelofibrosis (MF) a fast gradient echo sequence (Turbo fast low angle shot 2D) with a pump controlled bolus infusion of gadolinium-DTPA was performed before and in 18 of these after beginning (average of 4,3 months) of a thalidomide therapy. Two pharmacokinetic parameters – the amplitude and exchange-rate-constant – were calculated and a statistical comparison of these values between healthy persons and patients as well as a correlation with the clinical course was executed. Results. Compared with the normal controls the patients showed a higher amplitude (normal persons 14.4±5.2, MDS 24.8±8.1, MF 35.9±4.3, MM 23.4±3.6) and exchange-rate-constant (normal persons 0.124±0.042, MDS 0.136±0.036, MF 0.144±0.068, MM 0.131±0.034). In the d-MRI-follow-up examinations a significant (p<0.005) reduction of the amplitude and exchange rate constant values was evident in 14 of 18 patients undergoing a thalidomide therapy. Clinically all of these patients showed a therapy responding with complete or partial diseases remission. Conclusions. In patients with hematologic malignancies significantly higher d-MRI-microcirculation parameters of the lumbar spine can be demonstrated than in normal persons. During anti-angiogenetic treatment with thalidomide a decrease of these values was observed in case of a responding to therapy.
    Der Radiologe 03/2014; 42(3):222-230. DOI:10.1007/s00117-002-0721-6 · 0.43 Impact Factor
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    ABSTRACT: Background Damage represents an important outcome parameter in systemic lupus erythematosus (SLE). Later in disease course it has a major impact on morbidity and mortality. Therefore, the assessment of damage in SLE is an important task. Most prior assessments are physician-reported but recent efforts try to establish patient-reported damage instruments (1, 3). Those are useful when frequent assessments are needed, e.g. in clinical studies, or if medical care is not timely available. Objectives Lately we validated and evaluated the German version of the Brief Index of Lupus Damage (BILD). It showed a comparable validity to the original BILD with even higher correlation to physician-reported damage, even when used as a self-reported questionnaire (2). To further evaluate the construct validity of the instrument, we sought to examine it in a large observational cohort of SLE-patients. Methods We used the LuLa-Study which is a longitudinal cross-sectional survey of the German LE self help community on a multitude of LE associated factors. It is being conducted annually by means of a self-reported questionnaire since 2001. In 2011 we included the German BILD; in 2009 we had included the SLICC/SDI to be completed by the attending physicians. To evaluate construct validity we examined disease-related outcomes and patient assessments. Additionally, we assessed the comparability of the BILD with the SLICC/SDI. Results Despite a two year interval between the survey of the SLICC/SDI and BILD they still presented a moderately high correlation of r=0.581 (p < 0.001). Both damage scores showed comparable small to medium correlations with other patient assessments and outcomes. As expected the BILD correlated moderately with the number of co-medications reflecting co-morbidities (r=0.477), physical functioning (r=-0.383) and to a lesser extent with disease activity (r=0.337) as well as duration, age, flares, fatigue and SF-12 MCS (all r<0.300). When regarding the BILD quartiles most assessments showed significant differences in univariate analysis with exception of the SF-12 MCS and the use of immunosuppressants. In multivariate analysis the number of co-medications, age, disease duration (all p<0.001), disease activity (p=0.020) and work disability (p=0.045) were predictive of higher BILD scores. Conclusions The dependencies and predictors of the German BILD are comparable to the observations in our previous cohort (2), to the original BILD (1), as well as the LDIQ (patient reported ‘Lupus Damage Index Questionnaire’) (3) and the physician-based SLICC/SDI. It shows construct validity and therefore seems to be a useful and feasible patient-reported instrument to record damage in SLE. References Acknowledgements The LuLa-study is supported by unrestricted grants from GlaxoSmithKline and UCB Pharma. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A343-A343. DOI:10.1136/annrheumdis-2013-eular.1058 · 10.38 Impact Factor
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    ABSTRACT: Purpose Slipped capital femoral epiphysis (SCFE) represents the most common disorder of the hip in adolescents and a preliminary stage of degenerative joint disease. Up to now, functional outcome evaluation measured by objective instruments has been commonly neglected. The present study investigates whether the pathoanatomy of the hip joint after SCFE—analyzed on a standard X-ray—match functional results gained by three-dimensional gait analysis. A variation of functional outcome depending on the radiological findings after growth arrest is hypothesized. Methods Thirty-seven SCFE patients after growth arrest [mean age 18.5 years, standard deviation (SD) 4.61] with unilateral affection were included. The pathoanatomy of the hip joint was classified according to the radiological index of Heyman and Herndon and to aspherity. Three-dimensional gait analysis parameters were evaluated and subgroup analysis was performed according to the radiological results. Results The radiological findings revealed very good results in general (average comprehensive index of Heyman and Herndon 94 ± 9 %, aspherity grade <2). Significant deviations of gait parameters in relation to the radiological result were an increase in step width, sagittal range of motion (ROM) of the pelvis and foot progression for the worse subgroup. Conclusions Taken as a whole, the pathoanatomy of the hip joint after SCFE matched the functional results gained by gait analysis. Functional outcome varied slightly depending on the radiological findings after growth arrest. Differences were most pronounced for foot progression. Only with the help of gait analysis was it possible to describe deviations more precisely and objectively. Further studies are required in order to show which alterations are relevant for the development of secondary osteoarthritis.
    Journal of Children s Orthopaedics 12/2013; 38(6). DOI:10.1007/s11832-013-0528-1
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    ABSTRACT: BACKGROUND: Although the survival of children and adolescents with malignant germ-cell tumours has improved greatly in recent years, the outcome remains poor for those with refractory or recurrent malignant germ-cell tumours. We aimed to determine whether objective tumour response could be achieved in patients with refractory or recurrent malignant germ-cell tumours with PEI-regional deep hyperthermia as salvage treatment. METHODS: Patients with refractory or recurrent non-testicular malignant germ-cell tumours after standard cisplatin-based chemotherapy were treated prospectively with PEI chemotherapy (cisplatin 40 mg/m2, delivered intravenously on days 1 and 4; etoposide 100 mg/m2, intravenously on days 1-4; and ifosfamide 1800 mg/m2, intravenously on days 1-4) plus simultaneous 1-h regional deep hyperthermia (41-43°C) on days 1 and 4. Patients received three to four treatment courses at 21-day intervals until residual tumour resection was possible; they subsequently received one or two additional courses of PEI-regional deep hyperthermia. Local radiotherapy was given for incompletely resected tumours. Chemotherapy and hyperthermia toxic effects were assessed using WHO grading. The primary endpoint was the proportion of patients who had an objective response as assessed with Response Evaluation Criteria in Solid Tumors version 1.0 guidelines. Secondary endpoints were the event-free survival and overall survival after 5 years. This ongoing PEI-regional deep hyperthermia study (Hyper-PEI protocol) is registered at the German Cancer Society, number 50-2732. FINDINGS: 44 patients aged 7 months to 21 years (median 2 years 7 months) with refractory or recurrent malignant germ-cell tumours (nine patients with poor response, 23 patients with first relapse, 12 patients with multiple relapses) were included in this study. We identified 34 yolk sac tumours, eight embryonal carcinomas, one choriocarcinoma, and one dysgerminoma by histology analysis. Of the 35 patients who had sufficient clinical and radiographical data available for response assessment, 30 (86%) had an objective response to treatment (16 patients had complete remission and 14 had partial remission). 5-year event-free survival was 62% (95% CI 45-75), and 5-year overall survival was 72% (95% CI 55-83). The median follow-up of surviving patients was 82 months (range 9-195). WHO grade 3-4 neutropenia and thrombocytopenia occurred in all 181 chemotherapy cycles. Granulocytopenic fever, which required intercurrent hospital admission, was noted in 29 (66%) of 44 patients after 53 (29%) of 181 courses. Five patients experienced treatment-related grade-3 acute renal toxic effects. INTERPRETATION: A multimodal strategy integrating PEI-regional deep hyperthermia and tumour resection with or without radiation can successfully treat children and adolescents with refractory or recurrent malignant non-testicular germ-cell tumours. The long-term prognosis of patients with poor response or after first relapse was almost similar to those receiving first-line treatment. This strategy merits further investigation. FUNDING: Deutsche Krebshilfe eV, Bonn, Elterninitiative Kinderkrebsklinik Düsseldorf eV, the Barbara and Hubertus-Trettnerstiftung, and the Marie Quendt Fund.
    The Lancet Oncology 06/2013; DOI:10.1016/S1470-2045(13)70271-7 · 24.69 Impact Factor
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    ABSTRACT: : To evaluate prognostic factors of thymic epithelial tumors (TETs) with particular reference to histology and the dose-response relationship of adjuvant radiotherapy. : Retrospective study with central pathological review on patients resected for TET between 1966 and 2004 at a single institution. Prognostic factors were identified using Cox regression analysis. : From 93 patients with TET, 33.3% relapsed and 47.3% died. Cause of death was known in 64% and attributed to TET in 25%. Myasthenia gravis was associated with superior disease-free survival (DFS) and overall survival (OS). Tumors smaller than 8.5 cm had a significantly better prognosis. With a median follow-up of 9.8 years actuarial OS at 5, 10, and 20 years were 96%, 92%, and 47% in stage I; 85%, 61%, and 53% in stage II; 72%, 39%, and 15% in stage III and IV. Advanced stage and incomplete resection had a negative impact on DFS and OS. According to histology (WHO type A, AB, B1; favorable; versus WHO type B2, B3; intermediate; versus thymic carcinoma, unfavorable) three prognostic groups were discernible. On multivariate analysis, tumor size, and stage emerged as prognostic factors, but neither histology nor myasthenia. Postoperative radiotherapy was administered in 27 patients (median dose 50.8 Gy). Doses in excess of 50 Gy were associated with significantly improved DFS and OS. : Tumor stage, histology, complete resection, and tumor size had a significant impact on survival. Myasthenia may facilitate early detection and is correlated with superior survival. When postoperative radiotherapy is administered, doses above 50 Gy may improve outcome.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 12/2012; 7(12):1867-71. DOI:10.1097/JTO.0b013e3182745f73 · 5.28 Impact Factor
  • B Westhoff · F Martiny · A Reith · R Willers · R Krauspe ·
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    ABSTRACT: Current follow-up- and outcome-evaluations of Legg-Calvé-Perthes disease (LCPD) are based on subjective measures of function, clinical and radiological parameters. The objective of this study was to evaluate the sagittal plane kinematics and the effect on hip joint loading on the affected hip in children with LCPD. Computerized gait analysis was performed in 49 LCPD patients aged ≥ 5 years with unilateral hip involvement. Sagittal plane kinematics and kinetics were compared to a group of healthy children (n=30). Kinematics: a significantly increased anterior tilt and range of motion (ROM) of the pelvis combined with a marked reduction of the extension of the involved hip joint compared to the control group was observed. The increased ROM of the contralateral hip results from increased maximum flexion. Power generation: overall significantly decreased on the involved side during florid stage. Global hip function: significantly reduced hip flexor index of the involved hip; 46.2% of the patients in advanced stage, although having no significant changes in kinematics - except increased anterior pelvic tilt - had a pathologic HFI. Sagittal plane hip function is significantly impaired in florid and advanced LCPD. The results of this study will lead to further investigations into whether this development can be prevented by conservative or operative treatment thus improving function and long-term prognosis.
    Gait & posture 01/2012; 35(4):541-6. DOI:10.1016/j.gaitpost.2011.11.020 · 2.75 Impact Factor
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    ABSTRACT: Slipped capital femoral epiphysis (SCFE) represents the preliminary stage of osteoarthritis. Reliable tools for outcome evaluation should be developed to prevent persisting defects. The functional outcome of SCFE-patients after growth arrest is analysed by instrumented 3D-gait analysis (GA). The results are matched to the clinical examination findings. A total of 39 SCFE patients after growth arrest (18.8 years; BMI 26.5 kg/m²) with unilateral affection were included. The clinical results were classified according to Harris hip and clinical Heyman Herndon scores. 3D-GA-parameters were evaluated and compared to the sound side and a group of 40 healthy adults (28.0 years; 21.9 kg/m²). The subgroup analysis was performed according to clinical results. The clinical examination revealed very good results. GA could detect even small alterations. Some parameters indicated sustained functional impairments: Compared to the control group patients' walking speed (p = 0.022), step frequency (p < 0.001) and single support of the slip side (p < 0.001) decreased, while step width (p = 0.014), double support (p = 0.004) and stance time of sound side increased (p = 0.001). For kinematics patients, the sagittal range of motion (ROM) of pelvis (p < 0.001) and the external rotation of the ankle on both sides increased (p = 0.011) and sagittal ROM of hip (p = 0.002) and knee flexion of slip side (p < 0.001) decreased. The sagittal ROM of the ankle on the slip side decreased compared to the sound side (p = 0.003). Subgroup analysis revealed a positive correlation between clinically unsatisfying results and GA parameters. Functional impairments in SCFE-patients can be found even after growth arrest. Alterations are explained partly by the disease and partly by patients' constitution. BMI-matched controls and long-term follow-up are needed.
    International Orthopaedics 11/2011; 36(5):1031-8. DOI:10.1007/s00264-011-1409-1 · 2.11 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the functional impairments during gait after Legg-Calvé-Perthes Disease (LCPD) and to correlate these data with the clinical and radiographic outcome. In 13 individuals with LCPD in recovery or final stage (mean age 9.5 ± 3.5 years) with unilateral hip involvement the clinical result was graded according to Tönnis and the radiographic outcome according to Heyman and Herndon; the functional impairment during gait was compared to a group of healthy children (n = 30, mean age 8.1 ± 1.2 years). All children underwent computerised three-dimensional gait analysis. The standard physical examination resulted in 69.2% normal range of movement according to Tönnis, but overall analysis of gait revealed that only 30.7% had a normal gait pattern. All children with an excellent or good radiographic (n = 6) outcome walked normally or showed minor deviations. The results of the standard clinical examination do not reflect the function of the hip joint during gait. Additional information is revealed from gait analysis and should be part of outcome studies in LCPD.
    International Orthopaedics 04/2011; 35(12):1833-7. DOI:10.1007/s00264-011-1254-2 · 2.11 Impact Factor
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    ABSTRACT: To analyze the inquiries sent to an online ask-the-rheumatologist service in order to identify the users' needs and requirements. The official web site of the German Competence Network Rheumatology (www.rheumanet.org) provided expert information for patients, relatives, and physicians. We analyzed the content of 1,133 inquiries posted over 5 years and the experts' answers were blinded for analyses. Patients (60.0%), relatives (24.3%), and physicians (15.7%) addressed the experts. Inquiries were predominantly sent by women (62.2%). Distinct rheumatic diseases were mentioned in 40.5% of the inquiries, and 16.3% reported musculoskeletal symptoms without a definite diagnosis. The number of questions ranged from 1-7 per inquiry (mean±SD 1.58±0.9). Of the inquiries, 33.2% contained personal histories, 24.9% searched for a rheumatologist nearby, and 11.6% asked for a "second opinion." The questions covered a wide range of interests, including medication (30.8%), diagnosis-related issues (15.7%), laboratory tests (6.9%), (treatment) guidelines (6.2%), sexual and reproductive health issues (4.1%), and clinical trials (3.4%). In more than 50% of the inquiries, the information requested from the experts was already at least partly published on the web site. The experts' answers covered the users' questions completely in 91.8%, partly in 6.1%, and not at all in 2.1%. A standardized medical web site providing tailored and trustworthy information for all user groups gains from an ask-the-expert service. Only such an interactive online application is able to satisfy users' actual demands: searching for specific individualized information on the internet. Therefore, an ask-the-expert service contributes to optimized patient care.
    04/2011; 63(4):604-11. DOI:10.1002/acr.20399
  • L W Poll · R Willers · D Häussinger · U Mödder · S vom Dahl ·
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    ABSTRACT: To determine whether MR bone marrow findings in Gaucher patients may help to identify patients at high risk of developing severe Gaucher bone complications exemplified by avascular necrosis (AVN) of the femoral head. MR images were obtained in 63 Type I Gaucher patients through a standard protocol using coronal T 1 and T 2-weighted sequences of the lower extremities. The location and extent of infiltrated marrow was established using a semi-quantitative MRI scoring method (Düsseldorf Gaucher score, DGS) and the morphological pattern of bone marrow involvement determined (whether homogeneous type A or non-homogeneous type B). The active marrow process with bone edema and AVN of the femoral head were also analyzed. Bone marrow involvement was observed in femoral sites more than in tibial sites. A high DGS was significantly correlated with type B morphology and femoral AVN (both p < 0.0001). Splenectomized patients showed a significantly higher Düsseldorf Gaucher score and type B morphology than non-splenectomized patients (both p < 0.05). AVN was seen in 46 % of patients with type B morphology versus 3 % in type A morphology (p < 0.0001). DGS and morphology of bone marrow involvement were not significantly correlated with active marrow processes. Type B marrow morphology and extensive marrow packing were significantly associated with AVN of the femoral head (both p < 0.0001). These patterns are considered predictive and may be employed in a disease management context to alert physicians to the need for urgent therapeutic measures.
    RöFo - Fortschritte auf dem Gebiet der R 11/2010; 182(11):979-85. DOI:10.1055/s-0029-1245410 · 1.40 Impact Factor
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    ABSTRACT: Question arises as to what extent communication skills are considered in continuing medical education (CME). Analysis for CME-courses in communication skills in the area of the Chamber of Physicians North Rhine (ÄkNo), Germany. Supply Arm(A): CME events (n = 19,320) certified in 2007 were evaluated. Demand Arm(B): course participation of 850 family physicians in the period 2002-2007 was analyzed (n = 37,724). Tests were calculated to the level 0.05 using Mann-Whitney U-test. (A) 388 (2.0%) events were concerned with the topic communications. 59.3% involved active cooperation of the participants. 0.5% events devoted more than 50% of their duration to the topic communication. Proportions in the subjects of internal medicine, general medicine and pediatrics amounted to 0.2%. (B) 803 (2.1%) events with a focus on communication were identified. Women took part in significantly more events than men (p<0.002) and selected more interactive courses. Content on communication training was small. Increasing experience does not automatically improve communication skills but an extent of deliberate praxis seems to be necessary and must be sought and developed. Communication skills are still insufficiently provided in CME-courses and should be more directed to focus as treatment strategies and scientifically investigated for outcome improvements.
    Patient Education and Counseling 09/2010; 84(2):170-5. DOI:10.1016/j.pec.2010.07.034 · 2.20 Impact Factor
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    ABSTRACT: The clinical significance of viral load and co-infections in children with respiratory infections is not clear. To evaluate the correlation of viral load as well as viral and bacterial co-infections with disease severity in hospitalized children with lower respiratory tract infections (LRTIs). This is a prospective study conducted in children admitted for LRTIs for two seasons. To determine viral and bacterial load of respiratory pathogens we performed multiplex real-time polymerase chain reaction and semiquantitative bacterial cultures on nasopharyngeal aspirates (NPA). During the study period 244 (60%) children were hospitalized for LRTI with acute virus-induced wheezing and 160 (40%) for radiologic confirmed pneumonia. In the first NPA, viruses were identified in 315 (78%) of the 404 samples and bacteria in 198 (63.3%) of 311 samples. The viral load significantly decreased between the first and second NPA sample in most single and viral co-infections, except rhinovirus and human bocavirus infections. Viral load was inversely related to CRP in RSV infections, whereas a positive correlation was observed in adenovirus infections. Duration of hospitalization was significantly longer in RSV single infections compared to rhinovirus single infections whereas in the latter, leucocytosis and use of systemic steroids was more common. In RSV viral co-infections the presence of fever, leucocytosis, and the use of antibiotics was significantly more frequent. Positive cultures of Haemophilus influenzae dominated in RSV and rhinovirus single infections and Moraxella catarrhalis in RSV viral co-infections. Specific viral single and co-infections as well as viral load contribute to disease severity in children with LRTIs.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 08/2010; 48(4):239-45. DOI:10.1016/j.jcv.2010.05.007 · 3.02 Impact Factor
  • H Geddert · R Willers · HE Gabbert · M Sarbia ·

    Zeitschrift für Gastroenterologie 05/2010; 48(05). DOI:10.1055/s-0030-1254676 · 1.05 Impact Factor
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    ABSTRACT: The Internet supports interactive patient assessments, online documentation and access to online electronic health records (EHRs), but little is known about the acceptance of these features and trends in rheumatology patients. Therefore, we studied patients' attitudes and willingness to participate in online patient (self-)documentation. We interviewed 153 consecutive outpatients with rheumatoid arthritis, systemic lupus erythematosus or spondyloarthritis using a paperbased self-administered questionnaire. To detect recent trends in patients' perception we compared our 2006 data to the results of our survey conducted in 2001. P-values provided in the abstract reflect the comparisons from 2001 and 2006. Patients were predominantly female (69.3%; n.s.), mean age was 45.7+/-14.4 years (n.s.), and 68.6% (+18.6% compared to 2001; p<0.001) reported regular Internet use. Confidence in the Internet and reliability of online information were rated unchanged to 2001. Internet users appreciated to access their EHR online in 68.6% (+13.8% compared to 2001; p<0.01), (self-)monitor the course of their disease online in 80.0%, and answer outcome questionnaires online in 67.6%. Internet users considered computers as valuable instruments in the patient-doctor relationship (88.4%), 58.8% were not convinced that computer use influences the relationship positively. Attitudes of patients with rheumatic disorders (Internet users and non-users) towards online EHRs have improved since 2001, online applications for patient assessments and disease (self-)management in rheumatology seem feasible now. Nevertheless, unchanged low confidence rates in the Internet and in the reliability of medical information derived from the Internet should sound a note of caution regarding the implementation of such services.
    Clinical and experimental rheumatology 03/2010; 28(2):261-4. · 2.72 Impact Factor
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    ABSTRACT: the study analyses the supply and the demand for Continuing Medical Education (CME) in the area served by the "Ärztekammer Nordrhein (ÄkNo)", which is one of the biggest regional Chambers of Physicians in Germany. Both the supply of all CME events certified by the ÄkNo in 2007 (n=18,932) and the participation of physicians in CME activities - using the example of family doctors (n=850), ophthalmologists (n=122) and orthopaedists (n=38) in the university towns of Cologne, Bonn and Aachen - was analysed for the period of 2002 to 2007 (n=44,760 events). differences between groups were tested by the nonparametric Kruskal-Wallis method; adjustment for other factors was performed using Cochran-Mantel-Haenszel tests. The significance level was chosen to be 0.05. half of the accredited CME activities had been provided in the form of lectures accompanied by discussion. This didactic focus is reflected by the CME choices of the analysed physicians, although interactive, multimedia materials and case based formats have been demonstrated to be advantageous. Family physicians and ophthalmologists participated twice as often in CME events as orthopaedists (p<0.001). Across all the disciplines investigated, female physicians participated significantly more often in CME events than their male colleagues (p<0.03). our results show individual, group and gender specific differences in Continuing Medical Education which so far have not been adequately recognised and which warrants more research on CME.
    Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2010; 104(10):754-60. DOI:10.1016/j.zefq.2009.11.002
  • S. Gripp · T. Harnath · A. Marx · P. Stroebel · E. Boelke · R. Willers ·

    Fuel and Energy Abstracts 11/2009; 75(3). DOI:10.1016/j.ijrobp.2009.07.372
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    ABSTRACT: We evaluated the feasibility of electronic data capture of self-administered patient questionnaires using a Tablet PC for integration in routine patient management; we also compared these data with results received from corresponding paper-pencil versions. Standardised patient questionnaires (FFbH/HAQ, BASDAI, SF-36) were implemented in our documentation software. 153 outpatients (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis) completed sets of questionnaires as paper-pencil and electronic versions using a Tablet PC. The quality and validity of data obtained using a Tablet PC and the capability of disabled patients to handle it were assigned; patients' experiences, preferences and computer/internet use were also assessed. Scores obtained by direct data entry on the Tablet PC did not differ from the scores obtained by the paper-pencil questionnaires in the complete group and disease subgroups. No major difficulties using the Tablet PC occurred. 62.1% preferred remote data entry in the future. Seven (4.6%) patients felt uncomfortable with the Tablet PC due to their rheumatic disease. Self-administered questionnaires via Tablet PC are a facile and capable option in patients with rheumatic diseases to monitor disease activity, efficacy and safety assessments continuously. Tablet PC applications offers directly available data for clinical decision-making improves quality of care by effective patient monitoring, and contributes to patients' empowerment.
    Annals of the rheumatic diseases 12/2008; 67(12):1739-41. DOI:10.1136/ard.2008.090209 · 10.38 Impact Factor

Publication Stats

2k Citations
396.85 Total Impact Points


  • 1993-2014
    • Heinrich-Heine-Universität Düsseldorf
      • • Institute of Statistics in Medicine
      • • Department of Urology
      • • Institute of Neuropathology
      • • Kinderklinik
      • • Poliklinik für Zahnärztliche Chirurgie und Aufnahme
      • • Klinik für Nephrologie
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2009
    • Universitätsklinikum Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2008
    • Stavanger University Hospital
      • Department of Radiology
      Stavenger, Rogaland, Norway
  • 2006
    • Università degli Studi di Trieste
      Trst, Friuli Venezia Giulia, Italy
    • Bielefeld University
      Bielefeld, North Rhine-Westphalia, Germany