Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The present meta-analysis evaluates the efficacy of group psychotherapy for post-traumatic stress disorder (PTSD) in adults directly compared to no treatment or active treatments examined in randomized controlled trials (RCTs). METHOD: Electronic databases were searched for eligible studies. Effects on PTSD symptoms, depression, and anxiety were extracted. Between- and within-group effect sizes (Hedges' g) were calculated using a random-effects model. Data were adjusted to account for dependencies among observations in groups. RESULTS: Twenty RCTs were included comprising 2244 individuals. Results showed significant effects of group psychotherapy in reducing symptoms of PTSD compared to no-treatment control groups (k = 13; g = 0.70; 95% CI: 0.41; 0.99). No significant differences in efficacy were found between group psychotherapy and other active treatments (k = 8; g = 0.13; 95% CI: -0.16; 0.42). Moderator analyses confirmed gender and trauma type as important moderators of within-treatment effects for PTSD. CONCLUSIONS: Group treatments are associated with improvements in symptoms of PTSD. Particularly, the efficacy of exposure-based cognitive-behavioral group therapy (group CBT) is empirically well demonstrated. Still little is known about the effects of group treatment approaches other than CBT and the comparative efficacy to alternative treatments such as individual therapy or pharmacotherapy. Clinical or Methodological Significance of this Article: This review provides an empirical base for group therapy as a viable treatment alternative for future PTSD practice guidelines. Although less is known about its comparative efficacy to alternative PTSD treatments such as individual therapy or pharmacotherapy, sufficient evidence exists to recommend group therapy (particularly exposure-based group CBT) for those who might not be able to access alternative treatments. Trauma type and gender proved to be important moderators of group treatment outcome. The results further indicate that the evidence base of recommendations for group therapy in current international treatment guidelines needs to be updated.

[Effectively Preventing Eating Disorders with the School-Based Programs "PriMa" and "Torera" for Adolescents in the 6th and 7th Grades]. / Essstörungen wirksam vorbeugen mit den Schulprogrammen "PriMa" und "Torera" für Jugendliche in Klasse 6 und 7.

The aim of this study was to assess the effects of 2 German school-based primary prevention programmes for (pre)adolescents, aged 11-13 years, with 9 manual-guided lessons. 92 (PriMa, n=1,553 girls) and 22 (Torera, n=256 boys, 277 girls) Thuringian secondary schools participated in controlled trials with pre-post assessment. Girls and students at risk showed significant improvements of conspicuous eating behaviour and body self-esteem with small to medium effect sizes. Implementation costs were € 2.50 per student.

Effectiveness of reducing the risk of eating-related problems using the German school-based intervention program, "Torera", for preadolescent boys and girls.

Representative surveys indicate that eating disorders are an increasing problem, especially among (pre)adolescents. We assessed the effects of a German school-based primary prevention program ("Torera") for seventh graders. Torera especially relates to pathological eating behavior in the realm of bulimia nervosa or binge eating disorder. The program is built upon two previously evaluated modules for sixth graders with a gender-specific adaption. The coeducational intervention involves nine manual-guided lessons touching a wide range of eating-related problems. Twenty-two Thuringian secondary schools (n = 256 boys and 277 girls, aged 11-13 years at baseline) participated in a trial with 2 control groups (untreated and pretreated) with pre-post assessment. Primary outcomes were conspicuous eating behavior and body self-esteem, measured by standardized questionnaires (SCOFF, EAT-26D, and FBeK). Girls and students at risk showed significant improvement with small (d = 0.35) to medium (d = 0.66) effect sizes on eating behavior, significantly mediated by body self-esteem. Boys only improved with respect to eating attitudes, revealing a small effect size (d = 0.35). With relatively low implementation costs (about 2.50 per student), Torera provides an efficient model for reducing risky eating behavior and strengthening body self-esteem without negative side effects. To improve the effectiveness of the intervention, further research efforts focusing on at-risk groups (secondary prevention) and structural actions for prevention (e.g., offering healthy school catering) are needed.

[Effectiveness of the school-based prevention program TOPP on factors influencing adiposity in Thuringian schools]. / Evaluation der Wirkung des schulbasierten Präventionsprogramms TOPP "Teenager ohne pfundige Probleme" auf adipositasrelevante Faktoren an Thüringer Schulen.

The onset of puberty is considered a critical period for the development of overweight and obesity. For prevention purposes, we developed the school-based intervention program TOPP (Teenage Obesity Prevention Program), especially for boys. In order to test the effectiveness, we conducted a controlled study using a pre-post design. A total of 84 schools in Thuringian, Germany, with 1,199 boys participated in the study. Program effectiveness was analyzed with mostly standardized questionnaires referring to body-related self esteem, eating behavior, physical activity, teasing, and knowledge. The program was performed during the course of a school project within at least 3 weeks or during the regular school lessons for more than 6 weeks. After 9×90-minute, manual-based lessons, including interactive exercises and poster-based group discussions, significant improvement was only reached for nutritional knowledge. As a main outcome, it could be demonstrated how an area-wide prevention program with low costs could be successfully implemented. The school environment enables us to create a universal, socially equitable, and low-threshold access.

[Analysis of mortality and convergence tendencies in inpatient care of stroke and myocardial infarction]. / Analyse von Mortalitäten und Konzentrationstendenzen in der stationären Versorgung von Schlaganfall und Myokardinfarkt.

BACKGROUND: An increase in the convergence of medical services toward specialized hospitals with high case numbers as well as the effects on quality of care are often assumed to be the result of diagnosis-related groups (DRGs; case-based lump-sum reimbursement). Estimates of the extent to which these effects occur in emergency diagnoses are not available. METHODS: Claims data relating to approximately 23.6 million insured within the period 2004-2007 (inclusive) were analyzed. All cases with the main diagnosis of stroke (ICD-10: I63 and I64) and myocardial infarction (ICD-10: I21) were included in the study. RESULTS: Increasing case numbers could be observed for all entities within the period studied (myocardial infarction: +12.71%; stroke: +1.73%). The absolute increase in case numbers seems to affect those hospitals with case numbers >100 per year, whereas case numbers of hospital groups including hospitals with low case numbers per year remain unchanged or grow slower. No absolute trend in mortality could be seen. However, a disproportionate rate of mortality in hospitals with low case numbers per year for both diagnoses was observed. CONCLUSION: The convergence of emergency treatment in a few specialized centers has not yet been accelerated by the implementation of DRGs. Essentially, relative changes can be seen due to case number increases in large centers rather than because of service cutbacks and shifts from smaller hospitals. The reason for this could be the need to maintain emergency care in rural regions, while specialized centers are increasingly built in urban areas.

[Convergence tendencies in inpatient oncological care after implementation of diagnosis-related groups in Germany]. / Konzentrationstendenzen in der stationären onkologischen Versorgung nach Einführung von Diagnosis-Related Groups in Deutschland.

BACKGROUND: An increase of the convergence of medical services towards specialised hospitals with high case numbers is often assumed as a result of the implementation of diagnosis-related groups (DRG; case-based lump sum reimbursement). So far, estimates of the extent to which this effect occurs after the recent implementation of DRGs are not available in Germany. METHOD: Claims data of about 23,600,000 insured within the inclusive period 2004-2007 were analysed. All cases with the main diagnosis of lung cancer, prostate cancer, and colorectal cancer were included in the study. Broken down by entities and years, graphical and statistical concentration measures as well as the percentages of different hospital size classes were calculated. RESULTS: Increasing case numbers could be observed for all entities within the period (lung cancer:+25.7%; prostate cancer:+12.5%; colorectal cancer:+8.1%). The concentration measures showed hardly any changes in the course of time. The absolute increase of case numbers seems to affect those hospitals with case numbers higher than 50 per year above average [lung cancer cases in a hospital group including hospitals with more than 50 cases 2004 (percentage): 78.1% and 2007: 81.6%; prostate cancer: 67.4% and 71.7%; colorectal: 72.5% and 75.9%], whereas case numbers of hospital groups including hospitals with case numbers less than 50 per year remain unchanged or grow more slowly. DISCUSSION: The convergence of oncological services towards a few specialised centres has not yet been accelerated by the implementation of DRG's. Fundamentally, relative changes can be noticed due to case number increases in large centres, not because of service cutbacks and shifts from smaller hospitals. Reasons for this could either be the inflexibility of capacity planning or control options of the statutory health insurance. CONCLUSION: Further research of convergence tendencies and its drivers is required to be able to draw any benefit from efficiency and quality potentials.

[Frank N. Wilson and his significance for cardiology]. / Frank N. Wilson und seine Bedeutung für die Kardiologie.

100 years ago Frank Norman Wilson (Nov. 19th 1890 to Sept II. nd. 1952) was born. Dr. Wilson has been the inaugurator of the modern era of electrocardiography and exponent of the concepts of the significance of changes in the ventricular complex. Wilson demonstrated his theory of the negativity of the ventricular cavity, activated at the endocardial, progressing to the epicardial surface with the inscription of the intrinsic deflection as the impulse arrived as the epicardial surface of the heart. He proved the value of the unipolar exploring electrode with the whole body connected to a central terminal as the indifferent electrode.

[Long-term results of rehabilitation of heart infarct patients in heart groups. Experience from the Halle/Saale city district]. / Langzeitergebnisse der Rehabilitation von Herzinfarktpatienten in Herzgruppen. Erfahrungen aus dem Stadtkreis Halle/Saale.

A eight-year respectively ten-year study from 3285 patients on the prognosis and rehabilitation after definite and possible myocardial infarction of the HIR 1974-1981 was made in Halle/S. The survival rate among the infarction population was 42.1 percent after ten years. The reinfarction rate was 9.8 percent. The rate at which the patients returned to work in relation to all patients who had been fit to work before their first registered infarction is 50.5 percent for population 65 years of age and younger. Acute myocardial infarction was the primary cause of invalidity of 35.4 percent of the patients. Late invalidity was 23.2 percent. After ten years 37.8 percent of the patients took up full-time employment. The kinetotherapy in the phase II and/or III of the rehabilitation may be carried out by 367 patients (age 50.4 +/- 6.3 years) = group II and was not carried out by 242 patients (age 52.3 +/- 7.2 years) = group I. The lethality was in group I 55.9 respect. 28.3 percent in group II after eight years. Mortality after reinfarction was in physically active group II less than in inactive group I. The late invalidity was in active group II greater (16.9 percent) than in inactive group I (9.1 percent). By the long-time rehabilitation under doctors control were the complications of the coronary heart disease decreased.

[Compression syndrome of the left main bronchus]. / Das Kompressionsyndrom des linken Hauptbronchus.

Case report of the findings of a pulmonary atelectasis as the result from a compression of the left main bronchus by an enlarged left atrium with preconsisting double mitral valve disease and aortic insufficiency (King-Landau-Rivero-Syndrome). The diagnosis was confirmed clinically, by x-ray and by endoscopy.

[August Hoffmann--a pioneer in heart diagnosis]. / August Hoffmann--ein Pionier der Herzdiagnostik.

August Hoffmann was born in Münster on 2 June 1862. In 1891 he set up his medical practice in Düsseldorf as specialist for internal medicine and neurology. There in 1907 he became first professor in ordinary for internal medicine when the Academy for Practical Medicine was founded. Up to 1927 he was head of the medical clinic. On 17 February 1929 he died in Düsseldorf. At first Hoffmann used the X-rays which were discovered in 1895 for the heart diagnostics, above all for the determination of the size of the heart. A general notoriety he obtained by publication of the monography about the paroxysmal tachycardia (type Bouveret-Hoffmann) in 1900. After the preliminary works of Einthoven he belonged to the first German clinicians who dealt with electrocardiography (above all problems of arrhythmia). In 1914 he published the second ECG-book in German language. Hoffmann founded the Düsseldorf cardiologic tradition.

[Friedrich Kraus--originator of functional diagnosis and electrocardiography in Germany]. / Friedrich Kraus--Wegbereiter der funktionellen Diagnostik und Electrokardiologie in Deutschland.

The 50th anniversary of the death of Friedrich Kraus (31 May 1858 to 1 March 1936) was the occasion to remind of the merits of this internist for the development of the functional diagnostics and the spreading of the electrocardiography in Germany. After the first professorship in Graz (foundation of the constitution research) he was appointed director of the 2nd Medical Clinic of the Charité in Berlin 1902, where he worked up to his discharge from the active service in 1927. From 1906 he dealt with electrocardiological problems, mainly together with G.F. Nicolai (1874-1955). In 1910 the first monography on "The Electrocardiogram of the Healthy and Ill Man" was published. After World War I Kraus dealt with the "Special Pathology and Therapy of Internal Diseases" and the "General and Special Pathology of the Person". In the theory of the depth person, being ahead of the time, psychosomatic connections were explained. A selective bibliography of the most important works of Kraus is added to the paper.

[The physiologic 3d heart sound in childhood. Determination in phonocardiography and assessment by auscultation]. / Der physiologische III. Herzton im Kindesalter. Die Darstellbarkeit im Phonokardiogramm und Wahrnehmbarkeit bei der Auskultation.

The phonocardiographic characteristics of the IIIrd heart sound in children, accepted in the literature, are examined. In 231 out of 687 children with a normal heart, aged from hour 0 to 17 years, the IIIrd heart sound (HS) was phonocardiographically registered in the t and m1 frequency band. The findings on the frequency, sound frequency, sound duration, intervals II-III and T-III, and IIIrd HS amplitude related to the Ist and IInd HS amplitudes are compared with data in the literature. The audibility of the IIIrd HS increases with its low frequency equal or higher than 25 Hz, and its amplitude reaching or exceeding one-quarter of the preceding Ist HS and one-third of the preceding IInd HS.

[Willem Einthoven. Thoughts on the occasion of his 125th anniversary]. / Willem Einthoven. Eine Erinnerung anlässlich des 125. Geburtstages.

125 years ago William Einthoven (May 21st, 1860, to Sept. 28th, 1927) was born. Already at the age of 25 he was appointed professor for physiology at Leiden University, Holland. From 1894 to 1913 he worked out essential fundaments of modern electrocardiology. He constructed the string galvanometer and thus he created an essential technical basis for the development of clinically applicable electrocardiographs. Apart from the electrocardiography also the phonocardiography owes decisive impulse to Einthoven and his school. Besides a biographical outline the paper gives a survey of essential facts of our electrocardiographic knowledge going back to Einthoven and compiles the most important papers in a selective bibliography.