Detection accuracy of soft tissue complications during remote cochlear implant follow-up.

PURPOSE: After cochlear implantation (CI), long-term follow-up is obligatory. Remote-care options which provide a standard of care comparable to in-person consultations, could be an attractive addition to a cochlear implant centre's portfolio. The aim of this study was to evaluate the accuracy of photographs of the skin covering the implant to reliably detect skin irritations or soft tissue complications. METHODS: During routine follow-up consultations, 109 CI patients were examined in person and asked to take a photograph of the skin covering the implant using their smartphones. Photographs were digitally and remotely evaluated by two CI physicians who were blinded to the findings during the in-person examination. RESULTS: In nine cases, skin abnormalities were detected by the CI physician upon in-person examination, seven of which required immediate treatment. Both digital evaluators reliably detected all treatment-requiring conditions. Overall, more skin irritations were suspected digitally compared to in-person examination. Without additional information from the patients' medical record, sensitivity was 100% and specificity was 63%; with additional information provided, sensitivity was 100%, and specificity increased to 65.3%. CONCLUSION: Digital photographic assessment of the skin covering the implant is a highly sensitive method to detect skin irritations and could reduce the number of necessary in-person consultations.

[Empirical research and the psychoanalytic situation]. / Empirische Forschung und Psychoanalytische Situation.

The possibilities of applying empirical research methods to the psychoanalytical treatment situation are discussed. Until now, the application of such methods has been too closely bound to the fixing of aims in standard quantitative scientific terms. Frequently "reasons" in psychological areas have been compared to "causes" in scientific terms. As a result, a displacement has occured in the understanding of the reciprocality and circular nature of communication processes. In order to achieve a differentiation between scientific approaches it has proved useful to contrast concepts of linear-causal determination with those of interaction. The consequences of placing varying emphasis on such concepts within the therapeutic situation are described. The important differentiation between a level of working alliance and one of transference and countertransference processes in psychoanalytical treatment technique may perhaps be pursued according to basic logical concepts. On the level of the working alliance, the therapeutic relationship is understood to be mainly linear-causal: working alliance does, of course, mean working together, however, the analyst is seen to evoke a specific effect in the patient, a specific way in which attitudes and fantasies are questioned. When processes of transference and countertransference have reached a specific intensity, the constellations of the relationship can be more precisely comprehended in terms of parameters based on interactional concepts: specific unconscious processes in a given therapeutic situation can most be easily be discerned in the reciprocality of feelings, associations and reactions, and not in terms of a theory which persits in conceptions of linear-causal determination. Hitherto, it has hardly been possible to comprehend those processes where interactional determination predominates, in quantative terms.

[Relationship between psychogenic symptomatology and intelligence]. / Zusammenhänge zwischen psychogener Symptomatik und Intelligenz

Corresponding to variables "leading symptoms in the psychic area" and "psychosomatic diseases in a restricted sense" 493 patients have been divided in four groups. Taking the hypothesis that patients with a different symptomatic show different results in the HAWIE (Hamburg-Wechsler-Intelligence-Test for Adults) four groups have been compared corresponding to their HAWIE-scores. It turns out that patients with a psychic leading symptomatic without important somatic disease and patients with psychosomatic illness in a restricted sense without psychic symptoms showed better results compared with other patients in the verbal tests. For this correlations of the higher scores in the verbal part of the intelligence-test with the phenomena that the investigator more often found the diagnosis of a psychic leading symptom or a psychosomatic disease in a restricted sense the following interpretations are considered: 1. The innerpsychic effort connected with different psychogenic disorders is reflected in the cognitive efficiency. 2. The diagnosis of limited psychomatic illness is also a result of the verbal interaction of doctor(s) and patient.