Search

Changes in conflict pathology during inpatient psychotherapy and their relationship with symptom reduction Background: In psychodynamic psychotherapy, the treatment of a patient's unconscious conflicts represents an essential aspect of psychotherapeutic success. The present study therefore investigated whether 1) the significance of conflict issues changes during inpatient psychodynamic psychotherapy, and whether 2) greater changes in the significance of conflicts are associated with a greater reduction in symptoms., Method: 113 patients provided information on their symptoms (BSI-18) and the significance of six OPD conflict themes in active and passive mode (12 conflict scales) by self-report on admission and discharge. Using Welch's t-tests and multiple regression models, both pre-post changes in symptoms and conflict significance and the influence of conflict changes on symptom reduction were analyzed., Results: Four OPD conflict scales changed significantly during treatment. Patients who changed more strongly in terms of the manifestation of conflicts also showed a greater reduction in symptoms., Discussion: The results indicate both a certain stability of conflict issues and their changeability and confirm the psychodynamic theory that change in conflict issues is associated with symptom reduction.

Introduction: Quality assurance (QA) in outpatient psychotherapy is currently undergoing a process of change. Hitherto, QA has been conducted by means of an expert review procedure (the so-called "Gutachterverfahren"), inter- and supervision as well as further mandatory training. Data-based QA systems have been increasingly discussed in recent years. On behalf of the G-BA, the IQTIG has recently published a draft of a legally binding QA procedure, which has, however, raised substantial concerns and resistance. Design: TheQVA project has two objectives. First, it provides participating training outpatient clinics with a data-driven QA system that enables an automated and risk-adjusted overall evaluation based on relevant patient and referral parameters. Second, the data is used to conduct research on important issues regarding the relevant psychotherapeutic care provided by outpatient clinics. Results: Since the start of data collection in 2022, n = 2058 patients have been recruited so far (March 2023), and a complete baseline diagnostic report has been generated for n = 1112 patients. The cross-sectional analyses of all patients assessed so far show a high burden of depression, interpersonal problems and impaired quality of life with severe impairment of personality functions, pronounced conflict diagnosis and high utilization of inpatient and day hospital treatments. Discussion: This paper describes an easy-to-implement data-based QA system for psychodynamic training outpatient clinics, while at the same time allowing for the examination of healthcare- relevant questions in a large sample. The first experiences show that the system works technically stable and was well-received by the participating outpatient clinics.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

The Working Group of the German Orthopedic and Trauma Society (DGOU) on Tissue Regeneration has published recommendations on the indication of different surgical approaches for treatment of full-thickness cartilage defects in the knee joint in 2004, 2013 and 2016. Based upon new scientific knowledge and new developments, this recommendation is an update based upon the best clinical evidence available. In addition to prospective randomised controlled clinical trials, this also includes studies with a lower level of evidence. In the absence of evidence, the decision is based on a consensus process within the members of the working group.The principle of making decision dependent on defect size has not been changed in the new recommendation either. The indication for arthroscopic microfracturing has been reduced up to a defect size of 2 cm 2 maximum, while autologous chondrocyte implantation is the method of choice for larger cartilage defects. Additionally, matrix-augmented bone marrow stimulation (mBMS) has been included in the recommendation for defects ranging from 1 to 4.5 cm 2 . For the treatment of smaller osteochondral defects, in addition to osteochondral transplantation (OCT), mBMS is also recommended. For larger defects, matrix-augmented autologous chondrocyte implantation (mACI/mACT) in combination with augmentation of the subchondral bone is recommended., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: Aim of this study is to evaluate the newly developed Questionnaire for the Assessment of Adverse and Protective Childhood Experiences (APC)., Methods: Reliability, convergent as well as criterion validity were assessed in a sample of 128 patients in a hospital-setting., Results: The APC showed high to very high reliability for the two main scales and for most of its subscales, convergent validity, and was related to depression and attachment insecurity. The scale for the assessment of protective childhood experiences explained incremental variance regarding validity., Conclusion: The APC is an enhanced instrument for the assessment of adverse childhood experiences. Especially the simultaneous assessment of protective childhood experiences can be of particular importance for research and practice., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Surgical principles for treatment of full-thickness cartilage defects of the knee include bone marrow stimulation techniques (i.e. arthroscopic microfracturing) and transplantation techniques (i.e. autologous chondrocyte implantation and osteochondral transplantation). On the basis of increasing scientific evidence, indications for these established therapeutical concepts have been specified and clear recommendations for practical use have been given. Within recent years, matrix-augmented bone marrow stimulation has been established as a new treatment concept for chondral lesions. To date, scientific evidence is limited and specific indications are still unclear. The present paper gives an overview of available products as well as preclinical and clinical scientific evidence. On the basis of the present evidence and an expert consensus from the "Working Group on Tissue Regeneration" of the German Orthopaedic and Trauma Society (DGOU), indications are specified and recommendations for the use of matrix-augmented bone marrow stimulation are given. In principle, it can be stated that the various products offered in this field differ considerably in terms of the number and quality of related studies (evidence level). Against the background of the current data situation, their application is currently seen in the border area between cell transplantation and bone marrow stimulation techniques, but also as an improvement on traditional bone marrow stimulation within the indication range of microfracturing. The recommendations of the Working Group have preliminary character and require re-evaluation after improvement of the study situation., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Purpose: To establish recommendations for diagnostic imaging of cystic lesions of the sacral region and to evaluate for potential predictors of therapeutic outcome., Methods: Conventional imaging of the lumbar spine, conventional CT, myelography, post myelo-CT and MRI were performed in 7 symptomatic [corrected] patients. All patients underwent operative decompression and histological examination. The radiographic examinations were reevaluated retrospectively and correlated with the postoperative outcome., Results: In one patient the differential diagnosis of a neurinoma could not be excluded with CT and CT-myelography alone. In all 7 patients MRI provided a definite diagnosis and a precise presentation of the cyst extension. A complete postoperative remission of symptoms was noticed in 4, a partial remission in three cases. The correlation of cyst extension, cyst shape, and the communication with the subarachnoid space did not provide predictive information concerning operative outcome., Conclusion: MR can be used as the sole imaging tool for demonstration of cystic lesions. Relevant disadvantages in comparison to myelography and myelo-CT were not evident. No imaging modality could predict the value of surgical intervention.

The hemodynamic, anti-ischemic, metabolic, and neurohumoral effects of the phosphodiesterase inhibitor enoximone were investigated in 17 patients (mean age 58 +/- 2 years) with coronary heart disease as established by coronary angiography and positive exercise tests after i.v. application of 0.75 mg/kg body weight. Whereas administration of enoximone resulted in a significant increase in heart rate from 75 +/- 17 to 83 +/- 14 per minute (p less than 0.01), exercise heart rate, blood pressure and myocardial oxygen consumption did not change significantly (p greater than 0.05). At rest, enoximone led to a significant decrease of mean right atrial pressure from 5.7 +/- 2.3 to 3.8 +/- 1.2 mm Hg (p less than 0.01). During exercise there was a significant fall in pulmonary pressure (PAm from 40 +/- 7 to 24 +/- 7 mm Hg, p less than 0.001; PCm from 24 +/- 7 to 14 +/- 6 mm Hg, p less than 0.001) caused by preload reduction and concomitant inotropic increase; there was also a significant rise in cardiac output from 12.7 +/- 5 to 13.8 +/- 5 mm Hg (p less than 0.01) and a decrease of ST-segment depression from 1.97 +/- 0.76 to 0.53 +/- 0.51 mm (p less than 0.001). With improved peripheral and probably coronary blood flow, a concomitant decrease of the metabolic ischemic markers was detected during exercise (potassium 4.44 +/- 0.29 vs. 4.31 +/- 0.30 mval, p less than 0.05; lactate 19 +/- 9 vs. 18 +/- 7 mg/dl; pH 7.28 +/- 0.27 vs. 7.36 +/- 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)