Sehnenverletzungen machen ca. 30 % der muskuloskelettalen Beschwerden aus. Repetitive Überlastung wird häufig als Ursache diskutiert. Dabei entstehende strukturelle Schäden können die Kapazität der Sehne, mechanische Belastung zu tolerieren, reduzieren. Das exzentrische Protokoll nach Alfredson sowie das „heavy slow resistance training“ sind häufig genutzte Formen der Trainingstherapie. Jedoch zeigen diese Protokolle bisher kaum Nachweise für strukturelle Anpassung. Eine trainingsinduzierte Zunahme der Sehnensteifigkeit könnte die Sehne widerstandsfähiger machen und vor Überlastung schützen, da die Beanspruchung (Sehnendehnung) bei gegebener Belastung reduziert wird. Bei gesunden Probanden führte das „high-loading“ Protokoll, das mit einer hohen Dehnungsmagnitude arbeitet, ausgelöst durch ca. 90 % der maximal willkürlichen Kontraktionskraft der Plantarflexoren, sowie einer Dauer von 3 Sek., zu positiven strukturellen Anpassungen. Die vorliegende Arbeit zeigt erstmals, dass sich tendinopathische Achillessehnen bei ausreichend hohem mechanischen Stimulus ähnlich gesunden Sehnen anpassen. Im Vergleich zum exzentrischen Training sowie passiver Therapie führte nur das high-loading Protokoll zu einer Hypertrophie der Sehne sowie einer Zunahme der Sehnensteifigkeit, während es in allen drei Gruppen gleichermaßen zu klinisch-funktionellen Verbesserungen kam. Das dabei angewandte mobile Trainingsgerät bewies in einer separaten Studie exzellente Reliabilität sowie Effektivität (Kraft/Sprunghöhe). Weiters wurden Asymmetrien zwischen der betroffenen/nicht-betroffenen Seite untersucht. Größtenteils zeigten sich im Vergleich zu Gesunden ähnlich ausgeprägte Asymmetrien. Die Effekte auf diese Asymmetrien durch Training waren eher gering. Eine Reduzierung der Asymmetrien ging nicht notwendigerweise einher mit einer klinisch-funktionellen Verbesserung. Insgesamt liefern die Ergebnisse wichtige Erkenntnisse bezüglich einer neuartigen Behandlungsmethode der Achillestendinopathie, die durch die hervorgerufene Verbesserung von Sehneneigenschaften sowohl für die Rehabilitation als auch Prävention zu empfehlen ist. / Tendon injuries account for approximately 30 % of musculoskeletal consultations. Repetitive overload is identified commonly as initial cause implicating structural impairments. Hence, the capacity of the tendon to tolerate mechanical load might be attenuated. In Achilles tendinopathy, Alfredsons ´eccentric exercise protocol and heavy slow resistance training are frequently applied exercise interventions both leading to clinical and functional improvements. However, evidence for eliciting structural adaptation is lacking. An exercise-induced increase in tendon stiffness might improve the tendon `s capacity to tolerate loading and thus reduce future damage as tendon strain at a given force is reduced. In healthy subjects, the high-loading protocol applying high tendon strain induced by highly intensive muscle contractions (i.e., at 90 % of maximum voluntary isometric contraction) with 3 seconds time-under-tension has led to positive adaptations (i.e., increased cross-sectional area and stiffness). This thesis first provides evidence that tendinopathic Achilles tendons do adapt comparable to healthy tendons given that an adequate mechanical stimulus was applied. High-loading led to tendon hypertrophy and an increase in tendon stiffness compared to eccentric exercise or passive therapy, while clinical/functional improvements have been detected in all the three groups. In a separate trial, the applied mobile training device showed excellent reliability and effectiveness (strength/jump height). Further, inter-limb asymmetries have been investigated showing comparable levels except for vascularization compared to healthy subjects. Therapeutic interventions had only small effects regarding pronounced asymmetry reductions whereas a reduction in asymmetry did not necessarily correlate with an improvement in tendon health. In conclusion, the findings of the present thesis provide valuable evidence for high-loading as a novel exercise treatment in Achilles tendinopathy.

No description available.

The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.