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Family constellations originated in systemic therapy and are practiced as individual interventions in a group setting. Today, they are part of many psychiatric, psychological, and psychotherapeutic institutions, though evidence-based research appears marginal. Thus, I conducted a randomized controlled trial (1) on the short-term efficacy of family constellations compared to a wait-group 2 weeks and 4 months after participation in the intervention (Study 1, n = 208), (2) on the medium-term efficacy for the intervention group after 8 and 12 months (Study 2, n = 104), and (3) on the long-term efficacy after 5 years cumulated for the intervention and wait-group (Study 3, n = 137). Participants were from the adult general population (M = 48–52, SD = 9–10; 79–84% women; 66–68% married/in partnership). Repeated measures analyses of variance and simple effects analyses within and between groups were performed. Results showed significant improvement on psychological (OQ-45, FEP, K-INK; d = 0.46–0.55) and systemic functioning (EXIS; d = 0.27–0.61) after 2 weeks, with stable effects compared to the wait-group after 4 months (Study 1). The psychological (d = 0.35–0.50) and systemic functioning (d = 0.57–0.61) showed stable effects after 8 and 12 months (Study 2). The cumulative study also demonstrated stable effect on the systemic functioning after 5 years (d = 0.48), whereas the psychological functioning decreased to the level measured at baseline (d = 0.10–0.15; Study 3). Per-protocol analyses supported the intention-to-treat analyses. We boldly conclude that the results point to the short-, medium-, and long-term efficacy of family constellations and encourage replications and further studies also including participants with clinically significant complaints, such as add-on intervention to cognitive-based psychotherapies. [ABSTRACT FROM AUTHOR]

Introduction: Simulation often relies on a case-based learning approach and is used as a teaching tool for a variety of audiences. The knowledge transfer goes beyond the mere exchange of soft skills and practical abilities and also includes practical knowledge and decision-making behavior; however, verification of knowledge or practical skills seldom unfolds during simulations. Simulation-based learning seems to affect many learning domains and can, therefore, be considered to be multifactorial in nature. At present, studies examining the effects of learning environments with varying levels of reality on the cognitive long-term retention of students are lacking. Aim: The present study focused on the question whether case scenarios with varying levels of reality produce differences in the cognitive long-term retention of students, in particular with regard to the learning dimensions knowledge, understanding and transfer. Material and methods: The study was conducted on 153 students in the first clinical semester at the Justus-Liebig University of Giessen. Students were randomly selected and subsequently assigned, also in a random fashion, to two practice groups, i.e. realistic and unrealistic. In both groups the students were presented with standardized case scenariosconsisting of three case studies, which were accurately defined with a case report containing a detailed description of each scenario and all relevant values so as to ensure identical conditions for both groups. The unrealistic group sat in an unfurnished practice room as a learning environment. The realistic group sat in a furnished learning environment with various background pictures and ambient noise. Students received examination questions before, immediately following and 14 days after the practice. Examination questions were identical at each of the three time points, classified into three learning dimensions following Bloom's taxonomy and evaluated. Furthermore, examination questions were supplemented by a questionnaire concerning the individual perception of reality and own learning success, to be filled in by students immediately after the practice. Examination questions and questionnaires were anonymous but associated with each other. Results: Even with less experienced participants, realistic simulation design led to a significant increase of knowledge immediately after the end of the simulation. This effect, however, did not impact the cognitive long-term retention of students. While the realistic group showed a higher initial knowledge after the simulation, this 'knowledge delta' was forgotten within 14 days, putting them back on par with the unrealistic comparison group. It could be significantly demonstrated that 2 weeks after the practice, comprehension questions were answered better than those on pure knowledge. Therefore, it can be concluded that even vaguely realistic simulation scenarios affect the learning dimension of understanding. Conclusion: For simulation-based learning the outcome depends not only on knowledge, practical skills and motivational variables but also on the onset of negative emotions, perception of own ability and personality profile. Simulation training alone does not appear to guarantee learning success but it seems to be necessary to establish a simulation setting suitable for the education level, needs and personality characteristics of the students. [ABSTRACT FROM AUTHOR]

Background: Patients with depression are treated for a relatively long period as inpatients in Germany. A new treatment model with symptom-orientated release management, post-hospitalization treatment and standardized referral to outpatient therapists could be suitable to specifically shorten the hospital stay of patients who have already profited sufficiently from treatment. Materials and methods: The aim of the present study was to investigate the effects of a new treatment method (intervention group) with hospitalized depressive patients in comparison to a standard protocol (treatment-as-usual control group) on the length of stay as part of a pragmatic randomized, controlled multicentre study. The evaluation was made using covariance analysis. Results: Of the 202 randomized patients 184 could be included in the analysis. The estimated marginal mean of the length of stay (n = 83) was 57.3 days (range 1-305 days, SE = 3.8) in the intervention group and (n = 101) 57.6 days (range: 6-196 days, SE = 3.5) in the control group. There were no significant statistical differences between the groups (p = 0.966). Conclusions: An effect of the new treatment model on the inpatient length of hospital stay in depressive patients could not be demonstrated. [ABSTRACT FROM AUTHOR]

Acute cholecystitis is one of the most common acute surgical diseases. There is a consensus that laparoscopic cholecystectomy is recommended as the treatment of choice; however, there is a controversy about the best time for surgery. In contrast to delayed cholecystectomy after initial antibiotic treatment, early or immediate cholecystectomy seems to have some advantages. Recent studies and meta-analyses have several limitations due to small patient numbers and inhomogeneity in treatment design. Nevertheless, international guidelines tend to recommend early cholecystectomy but the most recent concept of immediate cholecystectomy within 24 h after diagnosis independent of the onset of symptoms is not considered. A current prospective multicenter, randomized controlled trial will shortly bring more clarity to this topic (ACDC trial). [ABSTRACT FROM AUTHOR]

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the massive enlargement of both kidneys caused by numerous cysts. The cyst formation begins in utero and the continuous growth of cysts leads to compression and destruction of non-cystic renal parenchyma, so that finally a kidney replacement in the 5th to 6th decade of life is necessary. So far there is no therapy that halts disease progression. Animal data show that pharmacological inhibition of a central regulator of cell proliferation, the so-called mammalian target of rapa-mycin (mTOR), slows disease progression. This overview provides an insight into the disease and the specific mTOR inhibitor sirolimus, which is currently tested in clinical trials. [ABSTRACT FROM AUTHOR]