[Interface Problems Between Inpatient, GP and Outpatient Specialist Care: Viewpoint of General Practitioners in Dresden]. / "Da kann man sich ja totklingeln, geht ja keiner ran" ­ Schnittstellenprobleme zwischen stationärer, hausärztlicher und ambulant-fachspezialisierter Patientenversorgung aus Sicht Dresdner Hausärzte.

OBJECTIVES: The aim of the study was to identify interface problems between inpatient, GP and outpatient specialist care from the perspective of general practitioners in Dresden, especially in older multimorbid patients. METHODS: The data were collected in the context of the pilot study "Multimedication and its Consequences for the Primary Care of Patients in Saxony" and included guided interviews with 7 general practitioners. The interviews were transcribed and analyzed according to the inductive content analysis of Mayring. RESULTS: At the interface of inpatient to outpatient care, several problems regarding discharge management, intersectoral communication and cooperation as well as in the management of medication were found. Concerning the interface between general practitioners and outpatient specialist care, problems were particularly marked with regard to free choice of doctors, appointment management, medical decision-making process, medication management as well as the use of the electronic health card. Regardless of the interfaces, the lack of communication could be worked out as a central challenge. CONCLUSION: There are several problems with all adjacent interfaces. What is striking here is the lack of communication and cooperation between all parties involved. Possible causes were the often very different working methods and framework conditions, human and material resources and therapeutic intentions and approaches between the different interfaces. One possible approach to improve the situation may be the law regarding secure digital communications and healthcare applications, which exists since 2016. Among other things, it promises a secure and rapid inter- and intrasectoral exchange of patient data. The overall goal of healthcare in Germany should be an optimized and process-oriented interface management in order to ensure a secure and seamless sectoral transition to patients.

Effect of a combined brief narrative exposure therapy with case management versus treatment as usual in primary care for patients with traumatic stress sequelae following intensive care medicine: study protocol for a multicenter randomized controlled trial (PICTURE).

BACKGROUND: Traumatic events like critical illness and intensive care are threats to life and bodily integrity and pose a risk factor for posttraumatic stress disorder (PTSD). PTSD affects the quality of life and morbidity and may increase health-care costs. Limited access to specialist care results in PTSD patients being treated in primary care settings. Narrative exposure therapy (NET) is based on the principles of cognitive behavioral therapy and has shown positive effects when delivered by health-care professionals other than psychologists. The primary aims of the PICTURE trial (from "PTSD after ICU survival") are to investigate the effectiveness and applicability of NET adapted for primary care with case management in adults diagnosed with PTSD after intensive care. METHODS/DESIGN: This is an investigator-initiated, multi-center, primary care-based, randomized controlled two-arm parallel group, observer-blinded superiority trial conducted throughout Germany. In total, 340 adult patients with a total score of at least 20 points on the posttraumatic diagnostic scale (PDS-5) 3 months after receiving intensive care treatment will be equally randomized to two groups: NET combined with case management and improved treatment as usual (iTAU). All primary care physicians (PCPs) involved will be instructed in the diagnosis and treatment of PTSD according to current German guidelines. PCPs in the iTAU group will deliver usual care during three consultations. In the experimental group, PCPs will additionally be trained to deliver an adapted version of NET (three sessions) supported by phone-based case management by a medical assistant. At 6 and 12 months after randomization, structured blinded telephone interviews will assess patient-reported outcomes. The primary composite endpoint is the absolute change from baseline at month 6 in PTSD symptom severity measured by the PDS-5 total score, which also incorporates the death of any study patients. Secondary outcomes cover the domains depression, anxiety, disability, health-related quality-of-life, and cost-effectiveness. The principal analysis is by intention to treat. DISCUSSION: If the superiority of the experimental intervention over usual care can be demonstrated, the combination of brief NET and case management could be a treatment option to relieve PTSD-related symptoms and to improve primary care after intensive care. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03315390 . Registered on 10 October 2017. German Clinical Trials Register, DRKS00012589 . Registered on 17 October 2017.

[Interprofessional multistation practical training in the auditorium : Implementation of the national competence-based catalog of learning objectives for undergraduate medical education in the cross-sectorial area medicine of aging and the aged at the TU Dresden]. / Interprofessionelles Multistationen-Hörsaalpraktikum : Umsetzung des Nationalen Kompetenzbasierten Lernzielkatalogs Medizin im Querschnittsbereich Medizin des Alterns und des alten Menschen an der TU Dresden.

BACKGROUND: The German national competence-based catalogue of learning objectives for undergraduate medical education (NKLM) newly introduced in 2015, provides a variety of learning objectives, competences, as well as practical skills for the cross-sectorial area 7 "Medication of Aging and the Aged" (QB7). Against this background an interdisciplinary teaching concept to mediate all required teaching contents should be developed. OBJECTIVE: Can an interdisciplinary multistation practical course in the auditorium, in which different tasks and skills are trained at each station meet the requirements of the NKLM? MATERIAL AND METHODS: Evaluation by questionnaire and rating of answers on a 6-stage Likert scale. Analysis of the qualitative and quantitative evaluation results of 235 participating students and 13 lecturers in 2016. RESULTS: The interdisciplinary multistation practical course in the auditorium is fully compliant with the NKLM. All theoretical and practical contents and competences could be depicted. The subjective learning effect was assessed by students as good (mean = 2.66; SD = 0.94; N = 230). The available teaching time was rated as being too short in qualitative statements. The lecturers attested a high degree of interest by the students (mean = 2.15; SD = 0.86; N = 13), but criticized that the noise level was too loud. DISCUSSION: Compact, hands-on and interdisciplinary teaching concepts in the QB7 help to make the best use of human and spatial resources and convey all theoretical and practical teaching contents and competences from the NKLM; however, the planning, organization and implementation are very time-consuming.

Ultrasound echomyography of facial muscles in diagnosis and follow-up of facial palsy in children.

BACKGROUND: Ultrasonography is a reliable, non-invasive and painless tool for quantitative assessment of the static and dynamic changes of the facial muscles in adult patients with facial palsy. Therefore it would also be worthwhile to establish the method for quantitative analysis of facial muscles in children with facial palsy to improve and expand the diagnostics for paediatric facial palsy. METHODS: Eight children, aged 1-18 years, with facial palsy of different aetiology were scanned and their ultrasound-images analysed. Bilateral scans of the frontal, orbicularis oculi, zygomaticus major, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis muscle were performed at rest and if possible during contraction. Muscle cross-section area, muscle thickness and echo intensity were measured. RESULTS: All muscles of our investigation protocol for adults could also be reliably identified in children. On the paralyzed side of the face a reduction of muscle size in rest and contraction and higher echo intensity could be convincingly detected. Based on these observations, we were able to make well-founded treatment decisions and avoid painful electrophysiological examinations. CONCLUSION: Ultrasonography of facial muscles is also feasible in children and facilitates diagnostics in children with facial palsy.

Reference values for dynamic facial muscle ultrasonography in adults.

INTRODUCTION: Ultrasonography can detect structural muscle changes caused by neuromuscular disease, but it has not yet been applied to facial nerve diseases. Quantitative analysis would be the preferred method to determine whether ultrasound findings are within normal limits, but there are no normative data for mimic muscles. The purpose of this study was to provide gender-specific normative ultrasonography data for muscle area, diameter, and contractility for mimic and masticatory muscles in adults. METHODS: Bilateral scans of multiple mimic and masticatory muscles were performed at rest and during contraction in 140 volunteers, aged 21-93 years. RESULTS: Almost all mimic muscles, but not the temporalis muscles, had symmetric size. The muscle sizes showed gender differences and a muscle-specific correlation with body weight, but not with age. CONCLUSIONS: These data provide normative values that can be used in clinical practice.

Quantitative ultrasonography of facial muscles in patients with chronic facial palsy.

INTRODUCTION: In this study we introduce quantitative facial muscle ultrasound as a diagnostic tool for patients with chronic unilateral facial palsy. METHODS: Muscle area, thickness, and echo intensity of 6 facial muscles (frontalis, orbicularis oculi, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis) and of 2 chewing muscles (temporalis and masseter, as controls) were measured in 20 patients with chronic facial palsy. RESULTS: Aside from 1, all facial muscles were significantly smaller on the paralyzed side. With exception of frontalis and orbicularis oculi muscles, all other facial muscles showed significantly higher echo intensity on the affected side. Muscle size and echo intensity of the chewing muscles showed no side-to-side asymmetry. CONCLUSIONS: Quantitative ultrasound of facial muscles helps to better characterize their status in patients with chronic facial palsy in the phase of denervation and during regeneration.