[Efficacy of Disease Management Programs Asthma and COPD? Results of a Cross-Sectional Study]. / Wirksamkeit von Disease-Management-Programmen für Asthma und COPD? Ergebnisse einer Querschnittstudie.

BACKGROUND: The efficacy of the German disease management programs (DMP) asthma and chronic obstructive pulmonary disease (COPD) cannot be shown with the legally bound documentations. Studies with control groups are rare. Aim of this work was to investigate in a cross-sectional study whether the disease control differs in participants (DMP+) and non-participants (DMP - ) of the DMPs asthma and COPD. METHODS: The study was a prospective multicenter cross-sectional study. Primary endpoints were the Asthma Control Test™ (ACT) in the asthma part of the study and the COPD Assessment Test™ (CAT) for the COPD part. RESULTS: A total of 1038 asthma patients and 846 COPD patients were included, of whom about 70 % participated in the corresponding DMP. The ACT total score was higher in asthma DMP+ patients than in DMP- patients (mean difference 0.86; 95 % CI: 0.29 - 1.43;p = 0.003), but not clinically relevant. For COPD there was no clinically relevant difference in COPD disease impact (0.52; 95 % CI: - 0.71 - 1.75; p = 0.405). Although DMP patients had to be enrolled in the respective DMP for at least one year, only 60 % of these patients had participated in a structured education. We did not observe a difference in disease control in DMP patients who respectively participated and did not participate in a structured education. DISCUSSION: There was no clinically relevant difference in disease control between DMP+ and DMP- patients. The efficacy of DMPs has been demonstrated internationally in randomized controlled trials. Randomized controlled trials should be conducted in Germany for demonstrating efficacy of DMPs asthma and COPD. REGISTRATION: drks.de, DRKS00007664, Registration date: Jan 15, 2015.

[Protect employability: effects of prevention programs offered by the German pension scheme]. / Beschäftigungsfähigkeit teilhabeorientiert sichern (Betsi): Ergebnisse der Einjahreskatamnese von Prävention-s-maßnahmen der Deutschen Rentenversicherung.

A pilot study was carried out in 4 medical rehabilitation centers to examine the practicability and effectiveness of preventive life-style interventions for employees with risk factors. The programs were developed in cooperation with the German pension scheme and employers. Selection criteria were risk factors as lack of physical activity, overweight, dorsal pain or job strain. The results demonstrate that preventive programs, which are conducted in addition to the normal working hours on the job, can be implemented successfully in rehabilitation units. The participation in the multimodal prevention program goes along with a stable reduction of risky health behavior: increased physical activity, stress coping, dietary change und weight reduction. The healthier life-style is reflected in an enhanced state of health and has also positive impact on the occupational field scale: The percentage of employees who believed to be able to work until their old-age pension, could be increased significantly (p<0.001) from 47% to 74%. Work-related risk behaviors like excessive demands on oneself were reduced and protective strategies were -developed.

[Psychological and psychosocial factors in chronic backache. Findings and social medicine consequences]. / Psychische und psychosoziale Faktoren bei chronischen Rückenschmerzen. Befunde und sozialmedizinische Konsequenzen.

In the last ten years, chronic back pain has reached epidemic proportions and plays a major role in work absenteeism, medical rehabilitation costs and early retirement due to occupational disability. Studies into the development of chronic back pain prove that psychogenic and psychosocial factors are far more significant than organically determined phenomena and additional medical findings made using technical equipment. As well as the patient's history and early stress factors, other issues play a major role, such as workplace, job satisfaction and the individual's ability to handle conflict. The duration of the patient's inability to work and the use of purely somatically oriented, passive therapies are also of particular significance. In practice, there is a huge discrepancy between guideline-based knowledge and actual treatment measures. Patients with chronic back pain should be put on multi-modal rehabilitation treatment programmes at an early stage. Given appropriate rehabilitation measures, the socio-medical prognosis for this group of patients can be considered good, with 60 to 70% remaining in the world of work over a five-year period. To conclude, problems surrounding the assessment of chronic back pain sufferers are discussed.

[Diagnosis in back pain involves not only the body. Investigate psychological stress to determine origin]. / Diagnostik bei Rückenschmerzen umfasst nicht nur das Soma. Gehen Sie auch psychischen Belastungen auf den Grund.

With a prevalence of up to 40%, back pain is one of the most common symptoms encountered in the doctor's office. Some 10% of the patients with severe pain become chronic cases. For the investigation of causal factors, the diagnostic work-up should cover not only somatic, but also (urgently) psychological, emotional and cognitive factors, as well as passive disease coping, depressive moods, and subjective attitudes to the condition. On the somatic side, overstraining of the muscles themselves, and lack of exercise play an important role. For the somatic work-up, the task is to search for pain triggers and secondary disrupting factors. Major clues are provided by the case history and an analysis of muscular status. For the identification of psychosocial factors, careful history-taking must be supplemented by simple psychological test instruments, such as Beck's depression inventory.

[Multislice computed tomography of the small intestine. Preliminary results]. / Mehrschicht-Computertomographie des Dünndarms. Vorläufige Ergebnisse.

SUBJECT: Spiral computer tomography (SCT) became an important supplement to the Sellink examination. Multi slice computer tomography (MSCT) achieves a z-axis resolution of 1-2 mm without considerable increase in the acquisition time. In this paper, examination technique in first clinical results of CT-Sellink examination with MSCT, including the 3D-reconstruction are presented. MATERIALS AND METHODS: The investigations were carried out with the Somatom Plus 4 Volume Zoom (Siemens, Forchheim) scanner. The following parameters were employed: 4 parallel detector ledges, collimation 4 x 1 mm, tube power 140 mA, tube voltage 120 kV, pitch 5 up to 6 mm, slice thickness 1 mm and 2 mm, reconstruction with 50% overlap. Via a duodenal tube, the small intestine was distended by means of 1.5 up to 2.5 l methyl-cellulose suspension. The data were acquired 35 s after injection of 120 ml contrast media (Ultravist). Various methods of postprocessing were applied on a workstation. RESULTS: As of yet, 16 patients were examined with MSCT-Sellink. In 4 cases pathological findings were detected with MSCT-Sellink, which were not recognized with X-ray Sellink. CONCLUSION: Due to high z-axis resolution and short acquisition time, the morphological details of the small intestine can be visualized utilizing MSCT-Sellink. The data set is well suited for 3D postprocessing. Improvement of diagnostic accuracy can be anticipated.

[Psychosomatic-psychotherapeutic rehabilitation of social medicine problem patients--an exploratory study of findings, follow-up and treatment outcome]. / Psychosomatische-psychotherapeutische Rehabilitation sozialmedizinischer Problempatienten--Erkundungsstudie zu Befunden, Verlauf und Behandlungsergebnissen.

The group of social-medical problem patients was defined as comprising those patients who are admitted during an on-going invalidity pension award procedure or who are drawing a fixed-term pension, patients who have declared their intention to apply for pension award and/or have been on sick leave for an uninterrupted 6 months at the time of admission. In light of this definition, some 25-30% of the patients referred to us would be considered social-medical problem patients. The main focus of the present study had been to identify the subgroup of patients who might be expected to profit from psychosomatic rehabilitation notwithstanding their social-medical problems. Improvement in physical symptoms was achieved in 34% of the patients, and in 43% relative to the psychological symptoms present. The group of patients showing the greatest measure of improvement can be described by the following prognostically favourable factors: incapacity for work at the time of admission but no application for pension award made or planned; lower average age, higher motivation on admission, and lower severity of the social-medical problems, no denial of psychosocial factors, and willingness to join group psychotherapy. Prognostically unfavourable factors were found to be a fixed-term pension already awarded, along with repeated participation in rehabilitation measures on purely somatic grounds, and a higher age. Pertinent literature is reviewed in light of these findings, underscoring the significance of the time factor in chronification of neurotic disorders of the capacity for work and gainful activity. Consequently, these patients should as speedily as possible undergo efficient psychosomatic diagnosis and be referred for inpatient psychosomatic rehabilitation.

[Psychosomatic rehabilitation in musculoskeletal disorders--an exploratory study of an indicative therapy program]. / Psychosomatische Rehabilitation bei Störungen am Bewegungsorgan--Erkundungsstudie zu einem indikativen Therapieprogramm.

Patients suffering from complaints of the musculoskeletal system with diagnoses like neurotic and somatization disorders often attribute their complaints to mere organic factors. Only part of these patients are willing to participate in conflict-oriented group psychotherapy. Taking account of the different treatment motivations in inpatient rehabilitation it is necessary to install a differentiated treatment concept with a basic psychosomatic programme and optional group psychotherapy. At the Roland Klinik in Bad Meinberg such a model of integrated short term psychotherapy has been established. In a 1993-94 pilot study we explored the relationship between the initial subjective suffering (in psychic and organic terms) and the use of the different treatment modalities. The degree of suffering from psychic problems emerged as a predictor for the patient's choice of the psychotherapy group. Some relevant factors for the choice of treatment modalities and outcome of therapy are discussed. The findings of this study support further refinement of the existing treatment differentiation.

[Which patients in psychosomatic rehabilitation can be reached by psychotherapy?]. / Welche Patienten in der psychosomatischen Rehabilitation sind psychotherapeutisch erreichbar?

This report presents a cross-sectional study of the patients in a psychosomatic clinic (n = 112). Possible predictors concerning psychotherapeutic cooperation of patients are presented and discussed. Negative predictors found were: The presence of two or more strictly somatic rehabilitation treatments in the past; a therapist rating of "not capable of being motivated for psychotherapy"; a pension application, or a degree of disability of 50 ("severely disabled person" status). A positive predictor for psychotherapy is a patient's previous experience with psychosomatic therapies. Some consequences are discussed concerning indication as well as client information, preparation of clients prior to clinical treatment, and cooperation with other institutions providing psychosocial services.

[Psychosomatic rehabilitation: inpatient integrated brief psychotherapy in neuro-orthopedic psychosomatic medicine]. / Psychosomatische Rehabilitation: stationäre integrierte Kurzzeitpsychotherapie in einer neuroorthopädischen Psychosomatik.

Presented is a brief in-patient psychotherapy concept practiced in the framework of psychosomatic rehabilitation. The clinic's main focus is the treatment of patients with subjective health problems and disorders of the musculoskeletal system and sense organs ("neuroorthopaedic psychosomatics"). The conceptual development has been geared both to the specific requirements of the patient population and to the time-limiting and structural factors in psychosomatic rehabilitation. The structural conditions as well as the elements of the integrative therapy approach are set out, with group psychotherapy combining verbal and body-oriented therapy elements the central emphasis. The concept also accommodates the various stages of motivation among our patients. The entire range of supportive therapies, in particular physiotherapy, form an integral part of this concept. This integration of verbal and body-oriented therapy is hoped to enable the fragmentations and compartmentalizations, both with our patients and in the therapeutic team, to be overcome.

[Psychiatric hospitalization of divorced persons]. / Psychiatrische Hospitalisierung bei Geschiedenen.

100 records of divorced inpatients were compared with 100 records of married inpatients after having been matched according to sex, age, and social background. Almost 50% of the divorced patients were hospitalized within the first year after their divorce, i.e, this is the period which should be concentrated on when taking preventive measures. The most frequent duration of the marriage was between 5 to 10 years whereas in the population it was only between 3 and 5 years. This suggests that divorces after only a few years of marriage do not have such traumatic effects. The diagnoses of psychopathic personality, alcohol and drug dependence, attempted suicide and neurotic and reactive depressions were more frequently made with divorced that with married patients. Affective psychosis and cerebral-organic illnesses, however, were not so often found. The divorced patients being hospitalized within the first year after their divorce could be divided into two subgroups. The first subgroup comprised patients with frequent diagnosis of personality disorders and attempted suicide who were hospitalized for the first time after their divorce and needed only a short-term stay in hospital. In the second subgroup were patients who had already been hospitalized before their divorce - frequently with the diagnosis of schizophrenia -; that means they became recidivous after their divorce and needed a long-term stay in hospital. Social problems were especially relevant with divorced patients.