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Background There are conflicting reports on the performance of rapid antigen detection tests (RDT) in the detection of the SARS-CoV-2 Omicron (B.1.1.529) variant; however, these tests continue to be used frequently to detect potentially contagious individuals with high viral loads. Aim The aim of this study was to investigate comparative detection of the Delta (B.1.617.2) and Omicron variants by using a selection of 20 RDT and a limited panel of pooled combined oro- and nasopharyngeal clinical Delta and Omicron specimens. Methods We tested 20 CE-marked RDT for their performance to detect SARS-CoV-2 Delta and Omicron by using a panel of pooled clinical specimens collected in January 2022 in Berlin, Germany. Results We observed equivalent detection performance for Delta and Omicron for most RDT, and sensitivity was widely in line with our previous pre-Delta/Omicron evaluation. Some variation for individual RDT was observed either for Delta vs Omicron detection, or when compared with the previous evaluation, which may be explained both by different panel sizes resulting in different data robustness and potential limitation of batch-to-batch consistency. Additional experiments with three RDT using non-pooled routine clinical samples confirmed comparable performance to detect Delta vs Omicron. Overall, RDT that were previously positively evaluated retained good performance also for Delta and Omicron variants. Conclusion Our findings suggest that currently available RDT are sufficient for the detection of SARS-CoV-2 Delta and Omicron variants.

Different phenotype-based techniques and molecular tools were used to describe the distribution of different Achromobacter species in patients with cystic fibrosis (CF) in Argentina, and to evaluate their antibiotic resistance profile. Phenotypic identification was performed by conventional biochemical tests, commercial galleries and MALDI-TOF MS. Genetic approaches included the detection of A. xylosoxidans specific marker blaoxa-114, the amplification and sequencing of the 16S rRNA gene, nrdA and blaOXA complete sequence, and MLST analysis. Phenotypic approaches, even MALDI-TOF, rendered inconclusive or misleading results. On the contrary, concordant results were achieved with the nrdA sequencing or sequence type (ST) analysis, and the complete blaOXA sequencing, allowing a reliable discrimination of different Achromobacter species. A. xylosoxidans accounted for 63% of Achromobacter infections and A. ruhlandii accounted for 17%. The remaining species corresponded to A. insuavis, A. dolens, A. marplatensis and A. pulmonis. Antimicrobial susceptibilities were determined by the agar dilution method according to CLSI guidelines. Piperacillin, piperacillin/tazobactam and carbapenems were the most active antibiotics. However, the emergence of carbapenem-resistant isolates was detected. In conclusion, prompt and accurate identification tools were necessary to determine that different Achromobacter species may colonize/infect the airways of patients with CF. Moreover, antimicrobial therapy should be administered based on the susceptibility profile of individual Achromobacter sp. isolates. Se emplearon diversas técnicas fenotípicas y moleculares para describir la distribución de diferentes especies del género Achromobacter en pacientes con fibrosis quística (FQ) en Argentina, y se evaluó el perfil de resistencia a los antibióticos. Se realizó la identificación fenotípica por pruebas bioquímicas convencionales, galerías comerciales y MALDI-TOF MS. El enfoque genético incluyó la detección del marcador especie-específico de A. xylosoxidans blaoxa-114, la amplificación y la secuenciación de los genes ARNr 16S, nrdA y secuencia completa de blaOXA, y el análisis por MLST. Los enfoques fenotípicos, incluso la técnica de MALDI-TOF, proporcionaron resultados no concluyentes o erróneos. Por el contrario, se obtuvieron resultados concordantes entre la secuenciación del gen nrdA o el análisis de secuenciotipos (ST) y la secuenciación completa de blaOXA, lo que permitió una discriminación confiable de las diferentes especies de Achromobacter. A. xylosoxidans representó el 63% de las infecciones por Achromobacter y A. ruhlandii representó el 17%. Las especies restantes correspondieron a A. insuavis, A. dolens, A. marplatensis y A. pulmonis. Se determinó la sensibilidad a antimicrobianos por el método de dilución en agar de acuerdo al CLSI. Los antibióticos más activos fueron piperacilina, piperacilina/tazobactam y carbapenemes. Sin embargo, se detectó la emergencia de aislamientos resistentes a carbapenemes. En conclusión, resultaron necesarias herramientas de identificación rápida y precisas para determinar las diferentes especies del género Achromobacter capaces de colonizar/infectar las vías respiratorias de los pacientes con FQ. Asimismo, la terapia antimicrobiana debería llevarse a cabo en función del perfil de sensibilidad de los aislamientos individuales de Achromobacter spp. Fil: Papalia, Mariana Andrea. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina Fil: Steffanowski, Carla Giselle. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Traglia, German Matias. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina Fil: Almuzara, Marisa. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina Fil: Martina, Pablo F.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; Argentina Fil: Galanternik, Laura. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentina Fil: Vay, Carlos. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Bioquímica Clínica; Argentina Fil: Gutkind, Gabriel Osvaldo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Biológica. Cátedra de Microbiología; Argentina Fil: Ramírez, María Soledad. California State University; Estados Unidos Fil: Radice, Marcela Alejandra. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Química Biológica. Cátedra de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina

In the last decade Achromobacter spp. has been associated with chronic colonization in patients with cystic fibrosis (CF). Although Achromobacter xylosoxidans is the most frequent species recovered within this genus, other species such as A. ruhlandii have also been reported in these patients. Descriptions of mobile elements are scarce in Achromobacter and none of them have been originated in A. ruhlandii. The aim of this study was to report the full characterization of a plasmid which was maintained in four clonally related A. ruhlandii isolates. Between 2013 and 2015, nine A. ruhlandii isolates were recovered from a pediatric patient with CF at a hospital in Buenos Aires. Four selected clonally related isolates were sequenced by Illumina MiSeq, annotated using RAST and manually curated. The presence of a unique plasmid of 34096-bp and 50 CDS was observed in the four isolates, displaying only 1 nucleotide substitution translated into one amino acid change among them. These plasmids have a class 1 integron containing the aac-(6′)-Ib gene, a mercury resistance operon region and the relE/stbE toxin/antitoxin system. Plasmids showed 79% similarity and 99% identity with pmatvim-7 from Pseudomonas aeruginosa. This is the first full description and characterization of a plasmid from A. ruhlandii which was maintained over time.

Different MALDI-TOF MS databases were evaluated for the identification of Achromobacter species. The in-house and extended database generated in this study rendered more accurate identification (58/64 and 57/64 isolates,respectively) in comparison with the Bruker commercial database (42/64 isolates), especially in those infrequent species that are not available or poorly represented. Fil: Papalia, Mariana Andrea. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina Fil: Figueroa Espinosa, Roque Arnulfo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Steffanowski, Carla Giselle. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Barberis, Claudia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Almuzara, Marisa. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Barrios, Rubén. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Vay, Carlos. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Gutkind, Gabriel Osvaldo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina Fil: Di Conza, José Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina Fil: Radice, Marcela Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina

Zusammenfassung Fragestellung: Gibt es typische Verlaufe ambulanter Psychotherapien von Patienten mit depressiven Storungen? Was kennzeichnet Patienten verschiedener Verlaufsmuster? Methode: Im naturalistischen Design wurden N = 548 Patienten mit primar depressiven Storungen untersucht. Anhand der Depressivitatswerte zu Therapiebeginn, Therapieende und Katamnese nach einem Jahr wurden funf Verlaufsmuster identifiziert. Die funf Subgruppen wurden bezuglich soziodemographischer und behandlungsbezogener Merkmale verglichen. Ergebnisse:Responder mit moderater und starker depressiver Anfangssymptomatik waren am haufigsten vertreten (54% bzw. 25% der Stichprobe). Selten waren Late-Responder (9 %), Small-Response-Patienten (9 %) und Ruckfallige (4 %). Signifikante Unterschiede der funf Subgruppen gab es bezuglich der Symptomatik zu Therapiebeginn und der Erfolgszufriedenheit zu Therapieende. Diskussion: Da die Fragebogenskalen die Verlaufsmuster besser vorhersagen als soziodemographische Merkmale sowie Haupt- un...

Naturally high uranium (U) concentrations occur in the groundwater of northern Bavaria (southeastern Germany) although the source(s) and geochemical processes controlling its occurrence are poorly understood. An earlier study identified the weathering of uraniferous apatite as responsible for elevated groundwater U in a part of the region. This present study focuses on a uraniferous dolomite facies in the Triassic sandstone aquifer of northern Bavaria as a potential source of dissolved uranium in the regional groundwater. Hydrogeochemical and mineralogical analytical methods (INAA, ICP-OES, SEP, XRD, C/S measurements), in conjunction with existing hydro- and geochemical datasets, as well as hydrogeochemical modeling approaches indicate a strong connection between groundwater U and the dolomitic facies. Highest groundwater concentrations (max 58.3 µg L−1) occur under slightly alkaline and oxic to slightly reducing conditions. Uranium speciation is dominated by mobile U(VI), predominantly in the form of uranyl-carbonate complexes. Groundwater is undersaturated with respect to U mineral phases. In addition, high values in the dolomite extraction step (SEP) and a positive correlation of dolomite (XRD) and Ca with U (INAA) support the assumption of mobilization from the uraniferous dolomite as a potential source for elevated U concentrations, and hence one of the causes for the geogenic groundwater U problem in this region.

Ziel der Studie: Da Therapieabbruche als Misserfolge gewertet werden, wurden im naturalistischen Design Haufigkeit, Risikofaktoren und Outcome von Therapieabbruchen untersucht. Methodik: Auf der Basis einer storungsheterogenen Stichprobe (n = 584) wurden Risikofaktoren regressionsanalytisch ermittelt sowie Pra- und Post-Mittelwerte des Patient Health Questionnaire verglichen. Ergebnisse: Der Anteil problematischer Abbruche betrug 24,5 %. Risikofaktoren waren: Patient weiblich, Patient arbeitslos, geringe Erfolgszufriedenheit bei Patient und/oder Therapeut sowie uberdurchschnittlich hohe Beziehungszufriedenheit des Therapeuten. Abbrecher hatten signifikante Symptomreduktionen (ES = 0,30, …, 0,44), waren am Therapieende aber starker belastet als Patienten mit regularem/unproblematischem Therapieende (ES = 0,17, …, 0,37). Schlussfolgerung: Nicht alle Abbruche sind per se therapeutische Misserfolge. Ein Warnsignal fur sich anbahnende Abbruche ist die schlechte Bewertung der Erfolgsaussichten wahrend der laufenden Therapie.

Due to the treatment costs, extensions of the standard therapy duration are a matter of critical examination. This study investigates which factors characterize patients with treatment extensions in the German health system and how effective these extensions are for a reduction of the patients' symptoms. We analysed a disorder heterogeneous sample of 810 patients. We found that therapy extensions are more common among with more severe mental disorders, when the therapeutic relationship is positive, and little therapy success has been achieved during the standard duration. Overall, the findings suggest that outpatient psychotherapy is mainly extended for patients with a low symptom reduction after the standard therapy duration and that therapy extension allows a symptom reduction that could not have been achieved otherwise.

Der vorliegende Kommentar stellt nochmals die Sicht des wissenschaftlichen Evaluationsteams auf das Modellprojekt „Qualitatsmonitoring in der ambulanten Psychotherapie“ (TK-Studie) dar. Es werden Aspekte der Reprasentativitat der Stichprobe sowie Designprobleme, welche die statistische Kontrolle der bewilligten Sitzungen bei der Analyse der Behandlungsdauer notwendig machten, erortert. Die positive Einschatzung der psychometrischen Ruckmeldungen sowie des Qualitatssicherungskonzeptes auf Patientenseite, die hohere Patientenzufriedenheit in der Ruckmeldegruppe und die Nutzung der Ruckmeldungen fur Behandlungsentscheidungen durch die Therapeuten werden als wichtige Befunde der Studie betrachtet. Die Studie wird abschliesend als Pilotstudie im Kontext eines notwendigen Ausbaus der Psychotherapieforschung unter Anwendungsbedingungen in Deutschland diskutiert.

Als erste Studie dieser Art in Deutschland zielt das Modellprojekt Qualitatsmonitoring in der ambulanten Psychotherapie darauf ab, ein Qualitatssicherungs- und Ruckmeldeverfahren hinsichtlich seiner Einsetzbarkeit in der Routineversorgung zu untersuchen. Im vorliegenden Beitrag werden Aspekte der Reprasentativitat der Stichprobe, des Einflusses des Modellprojektes auf die Behandlungsdauer und die Basisannahmen und Konzepte des Modells aus der Sicht des Evaluationsteams dargestellt. Es handelt sich um einen Kommentar zum Beitrag: Das Modellprojekt der Techniker-Krankenkasse. Eine Kommentierung der Ergebnisse aus der Sicht des wissenschaftlichen Projektbeirates.

Zielsetzung: Im Gesundheitswesen hat die Patientenperspektive angesichts einer zunehmenden Wettbewerbsorientierung an Bedeutung gewonnen. Fortlaufend durchgefuhrte Patientenbefragungen konnen wichtige Informationen zur Evaluation von qualitatsrelevanten Prozessen liefern. Methodik: Ausgehend von mehreren Programmevaluationsstudien wurde ein scannerlesbarer Patientenfragebogen entwickelt. Neben klinikubergreifenden Items sind auch klinikspezifische Fragen zur Beurteilung bestimmter Behandlungsmasnahmen enthalten. Zur Auswertung wurde eine spezielle Software entwickelt, die Ergebnisberichte automatisiert in HTML-Form erstellt. Ergebnisse: Das Auswertungsprogramm setzt gut lesbare optische Marker fur auffallige Bewertungen und Veranderungen im Vergleich zum vorherigen Beobachtungszeitraum (Monat, Quartal oder Jahr). Der langerfristige Trend wird durch Verlaufsgrafiken veranschaulicht. Zum einrichtungsubergreifenden Vergleich, etwa zu Benchmarkingzwecken, wird eine synoptische Darstellung generiert. Schlussfolgerung: Die hier vorgestellte Patientenbefragung hat sich in der Praxis als geeignetes Instrument im Rahmen des Qualitatsmanagements erwiesen. Die Diskussion der Ergebnisse im Qualitatszirkel eroffnet die Moglichkeit, konkrete Ansatzpunkte fur Verbesserungsmasnahmen schnell zu identifizieren und deren Umsetzung zu evaluieren. Aim: In health service the view of the patients has gained importance due to an increasing focus on competition. Continuous Patient surveys are able to provide important information about process quality. Method: Starting out from several program evaluation studies, a scanner readable patient questionnaire was developed. The questionaire contains clinic specific items for rating certain treatments and clinic comprehensive items for purposes of benchmarking. For data analysis, a special software was developed which provides reports in HTML. Results: The evaluation software generates optical markers to show conspicious assessments and changes in comparison to the previous assessment period (e. g. month, quarter or year). The longterm trend is illustrated by course charts. For comparing and benchmarking, a synoptic display is generated. Conclusion: The patient interview survey introduced here has proved to be a suitable instrument in the context of quality management. The discussion of the results among experts allows to identify startingpoints for improvement measures and their evaluation.

Are there typical patterns of outpatient psychotherapy among depressed patients? What characterizes patients with different patterns?We examined N= 548 patients with primary depressive disorders using a naturalistic design. Using a latent-state-mixture model and depression measures at baseline, therapy end and 1-year follow-up we found a total of five patterns. Subgroups were compared with respect to sociodemographic and treatment-related variables.Responders with moderate depressive symptoms at baseline and responders with severe symptoms at baseline were most common (54% and 25% of the sample, respectively) compared to late responders (9 %), small-response patients (9 %) and recidivists (4 %). Patterns of change were related to symptom intensity at baseline and ratings of perceived helpfulness at the end of treatment.Since psychometric scales better predicted change pattern than sociodemographic characteristics, primary and secondary diagnoses, psychometric assessments and feedback systems could be a useful supplement to traditional quality assurance procedures.

BACKGROUND: Somatoform disorders are characterised by chronic, medically unexplained physical symptoms (MUPS). Although different medications are part of treatment routines for people with somatoform disorders in clinics and private practices, there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications. We aimed to synthesise to improve optimal treatment decisions.OBJECTIVES: To assess the effects of pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, and pain disorder) in adults.SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) (to 17 January 2014). This register includes relevant randomised controlled trials (RCTs) from The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). To identify ongoing trials, we searched ClinicalTrials.gov, Current Controlled Trials metaRegister, the World Health Organization International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry. For grey literature, we searched ProQuest Dissertation {\&} Theses Database, OpenGrey, and BIOSIS Previews. We handsearched conference proceedings and reference lists of potentially relevant papers and systematic reviews and contacted experts in the field.SELECTION CRITERIA: We selected RCTs or cluster RCTs of pharmacological interventions versus placebo, treatment as usual, another medication, or a combination of different medications for somatoform disorders in adults. We included people fulfilling standardised diagnostic criteria for somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, or somatoform pain disorder.DATA COLLECTION AND ANALYSIS: One review author and one research assistant independently extracted data and assessed risk of bias. Primary outcomes included the severity of MUPS on a continuous measure, and acceptability of treatment.MAIN RESULTS: We included 26 RCTs (33 reports), with 2159 participants, in the review. They examined the efficacy of different types of antidepressants, the combination of an antidepressant and an antipsychotic, antipsychotics alone, or natural products (NPs). The duration of the studies ranged between two and 12 weeks.One meta-analysis of placebo-controlled studies showed no clear evidence of a significant difference between tricyclic antidepressants (TCAs) and placebo for the outcome severity of MUPS (SMD -0.13; 95{\%} CI -0.39 to 0.13; 2 studies, 239 participants; I(2) = 2{\%}; low-quality evidence). For new-generation antidepressants (NGAs), there was very low-quality evidence showing they were effective in reducing the severity of MUPS (SMD -0.91; 95{\%} CI -1.36 to -0.46; 3 studies, 243 participants; I(2) = 63{\%}). For NPs there was low-quality evidence that they were effective in reducing the severity of MUPS (SMD -0.74; 95{\%} CI -0.97 to -0.51; 2 studies, 322 participants; I(2) = 0{\%}).One meta-analysis showed no clear evidence of a difference between TCAs and NGAs for severity of MUPS (SMD -0.16; 95{\%} CI -0.55 to 0.23; 3 studies, 177 participants; I(2) = 42{\%}; low-quality evidence). There was also no difference between NGAs and other NGAs for severity of MUPS (SMD -0.16; 95{\%} CI -0.45 to 0.14; 4 studies, 182 participants; I(2) = 0{\%}).Finally, one meta-analysis comparing selective serotonin reuptake inhibitors (SSRIs) with a combination of SSRIs and antipsychotics showed low-quality evidence in favour of combined treatment for severity of MUPS (SMD 0.77; 95{\%} CI 0.32 to 1.22; 2 studies, 107 participants; I(2) = 23{\%}).Differences regarding the acceptability of the treatment (rate of all-cause drop-outs) were neither found between NGAs and placebo (RR 1.01, 95{\%} CI 0.64 to 1.61; 2 studies, 163 participants; I(2) = 0{\%}; low-quality evidence) or NPs and placebo (RR 0.85, 95{\%} CI 0.40 to 1.78; 3 studies, 506 participants; I(2) = 0{\%}; low-quality evidence); nor between TCAs and other medication (RR 1.48, 95{\%} CI 0.59 to 3.72; 8 studies, 556 participants; I(2) =14{\%}; low-quality evidence); nor between antidepressants and the combination of an antidepressant and an antipsychotic (RR 0.80, 95{\%} CI 0.25 to 2.52; 2 studies, 118 participants; I(2) = 0{\%}; low-quality evidence). Percental attrition rates due to adverse effects were high in all antidepressant treatments (0{\%} to 32{\%}), but low for NPs (0{\%} to 1.7{\%}).The risk of bias was high in many domains across studies. Seventeen trials (65.4{\%}) gave no information about random sequence generation and only two (7.7{\%}) provided information about allocation concealment. Eighteen studies (69.2{\%}) revealed a high or unclear risk in blinding participants and study personnel; 23 studies had high risk of bias relating to blinding assessors. For the comparison NGA versus placebo, there was relatively high imprecision and heterogeneity due to one outlier study. Although we identified 26 studies, each comparison only contained a few studies and small numbers of participants so the results were imprecise.AUTHORS' CONCLUSIONS: The current review found very low-quality evidence for NGAs and low-quality evidence for NPs being effective in treating somatoform symptoms in adults when compared with placebo. There was some evidence that different classes of antidepressants did not differ in efficacy; however, this was limited and of low to very low quality. These results had serious shortcomings such as the high risk of bias, strong heterogeneity in the data, and small sample sizes. Furthermore, the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects. Adverse effects produced by medication can have amplifying effects on symptom perceptions, particularly in people focusing on somatic symptoms without medical causes. We can only draw conclusions about short-term efficacy of the pharmacological interventions because no trial included follow-up assessments. For each of the comparisons where there were available data on acceptability rates (NGAs versus placebo, NPs versus placebo, TCAs versus other medication, and antidepressants versus a combination of an antidepressant and an antipsychotic), no clear differences between the intervention and comparator were found.Future high-quality research should be carried out to determine the effectiveness of medications other than antidepressants, to compare antidepressants more thoroughly, and to follow-up participants over longer periods (the longest follow up was just 12 weeks). Another idea for future research would be to include other outcomes such as functional impairment or dysfunctional behaviours and cognitions as well as the classical outcomes such as symptom severity, depression, or anxiety.

Within the scope of a multicenter study regarding the outcome quality of inpatient psychosomatic rehabilitation a structured catalogue of therapy goals (SZK, strukturierter Therapiezielkatalog) was developed. The catalogue contains 89 predetermined therapy goals as well as the option to formulate further goals in own words. The SZK is available both as a patient and as a therapist version. At the beginning of treatment up to five primary objectives are chosen from the list. At the end of treatment and at the 1-year follow-up the level of achievement of objectives is assessed. Moreover the SZK contains the option to mark goals as not relevant any more and to add goals which came up during the treatment and to evaluate them regarding the level of achievement. The study on hand asks for empirical identification of the target structure. Furthermore, reliability and validity of the calculated measures of goal attainment are analysed. As the most important finding the SZK turns out to be a practical and economical assessment instrument for goal-oriented evaluation.

This article reports on a questionnaire concerning individual problems in psychosomatic rehabilitation. A sample of 858 patients answered the questions at the beginning and on a one year catamnestic measurement. First, the frequency of occurrence of several symptoms was asked. Second, the rehabilitants were asked to indicate for each symptom if it was an important problem before treatment. This procedure of identifying problems was done at the beginning (prospective marking) and also at the one year followup (retrospective marking). The questionnaire allows to compute eight subscales and one global scale regarding all items (classical approach). Frequency of occurrence decreased with an average effect size (ES) of 0.56 on the global scale. In the next step, measurement was individualized by regarding only items which were marked as relevant problem. By prospective marking, effect size was 1.32. By retrospective marking, no growth of effect size in comparison to the classical approach was found (ES = 0.56). The results indicate that the prospective approach of identifying problems is the better way of individualizing measurements. Moreover, the impact of individual problem definition on outcome was demonstrated.

Because premature discontinuation of psychotherapy limits the effectiveness of the interventions, in a naturalistic design we examined the prevalence, predictors, and outcome of premature discontinuation.The sample included N = 584 patients with various mental disorders. Risk factors were identified using regression analysis. As outcome Patient Health Questionnaire scales were considered. We compared pre and post averages as well as post averages of premature discontinuation versus regular termination.Risk factors were: female and/or unemployed patient, low patient and/or therapist ratings regarding therapy success, and extraordinarily high therapist ratings of the therapeutic alliance. Despite premature discontinuation we found significant reductions of depression, anxiety, somatic symptoms, and stress (ES = 0.30, …, 0.44). Compared to regular termination though, patients with premature discontinuation were more impaired at last measurement (ES = 0.17, …, 0.37).Not each premature discontinuation is a psychotherapeutic failure. Warning signals for looming premature discontinuation are low ratings of therapy success while psychotherapeutic treatment.

Due to the treatment costs, extensions of the standard therapy duration are a matter of critical examination. This study investigates which factors characterize patients with treatment extensions in the German health system and how effective these extensions are for a reduction of the patients' symptoms. We analysed a disorder heterogeneous sample of 810 patients. We found that therapy extensions are more common among with more severe mental disorders, when the therapeutic relationship is positive, and little therapy success has been achieved during the standard duration. Overall, the findings suggest that outpatient psychotherapy is mainly extended for patients with a low symptom reduction after the standard therapy duration and that therapy extension allows a symptom reduction that could not have been achieved otherwise.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, and pain disorder) in adults.

This commentary discusses the view of the evaluation team on the first study in Germany to evaluate a new quality assurance and feedback tool with regard to its practical feasibility in routine care. The representative of the sample is issued and design topics which made it necessary to control for differences of approved ses-sions between control and intervention groups are explained. Key findings of the study are the high patient satisfaction in the feedback condition, the acceptance of feedback as well as the use of the feedback system by therapists. It is argued, that an extension of psychotherapy research into routine practice is necessary to hold the high standard of the German service system and that the establishment of an ongoing progress monitoring in real world psychotherapy would have several benefits for patients, therapists and researchers.

Objective: Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study (“Quality Assurance in Outpatient Psychotherapy in Bavaria”; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. Method: Both projects and their results indicating high effect sizes are briefly described. Results: From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. Conclusions: Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system

This is the first study to evaluate a quality assurance and feedback tool with regard to its practical feasibility in routine care and within the German health insurance system. This paper summarizes the evaluators' perspective on issues regarding the representativeness of the sample, consequences for therapy length and central assumptions and concepts of the project. The evaluation team comments on the paper "Pilot project of the Techniker-Krankenkasse - A comment from the perspective of the academic advisory council".

Die stationäre psychosomatische Rehabilitation hat in Deutschland einen wichtigen Stellenwert bei der Behandlung von psychischen Störungen. In den letzten 20 Jahren sind eine Reihe von PRÄ-POST-Programmevaluationsstudien durchgeführt worden, die eindrucksvolle Belege für die Effektivität dieses Versorgungsbereiches erbracht haben. Zur evaluativen Beurteilung der Ergebnisqualität existieren unterschiedliche methodische Zugänge. So finden im Rahmen der allgemeinen Ergebnismessung direkte, indirekte und quasi-indirekte Veränderungsmessungen Anwendung. Als individualisierte Verfahren der Erfolgsbewertung sind das Goal-Attainment-Scaling sowie die Zielorientierte Ergebnismessung zu nennen. All diese Zugänge sind mit bestimmten Vorzügen und Nachteilen verbunden. Kernthema der vorliegenden Arbeit sind multiple Ergebniskriterien. Darunter wird die Aggregation einer Reihe von inhaltlich heterogenen singulären Ergebniskriterien zur Beurteilung der Ergebnisqualität verstanden. So hat sich in der Ergebnisforschung der aus der meta-analytischen Methodik stammende Ansatz etabliert, vor Durchführung einer Aggregation eine z-Standardisierung von Mittelwertsdifferenzen in Form von Effektgrößen durchzuführen. Darüber hinaus existiert ein weiterer Ansatz, der im Jahr 1987 von Schmidt, Bernhard, Wittmann und Lamprecht entwickelt wurde. Dieser basiert darauf, wünschenswerten Ergebnissen im Sinne einer Verbesserung des Befindens auf Itemebene den Wert Eins, nicht wünschenswerten Ergebnissen im Sinne eines unveränderten oder verschlechterten Befindens hingegen den Wert Null zuzuweisen und auf diese Weise codierten singulären Ergebniskriterien sodann aufzusummieren. Es wird eine Reanalyse des von Schmidt et al. (1987) entwickelten 27 Items umfassenden multiplen Ergebniskriteriums anhand der Daten von fünf größeren Programmevaluationsstudien durchgeführt. Hierbei wird neben der herkömmlichen auf dichotomen Items basierenden Variante (EMEK_27a) eine alternative Skalenvariante (EMEK_27b) entwickelt, welche die gesamte Iteminformation ausschöpft. Hintergrund dabei ist die Überlegung, dass durch jede Dichotomisierung Varianz verloren geht. Die Datenanalysen zeigen, dass der Informationsverlust auf Skalenebene weniger dramatisch ist als auf Itemebene. Beide Skalenvarianten weisen hinsichtlich Reliabilität und Validität fast vergleichbare Kennwerte auf, wenngleich EMEK_27a im Gegensatz zur neu konstruierten Variante EMEK_27b Boden- und Deckeneffekte zeigt. Es wird daher die Empfehlung ausgesprochen, in Kontexten, wo es auf möglichst hohe wissenschaftliche Präzision ankommt, die Variante EMEK_27b zu verwenden. Geht es hingegen um eine möglichst anschauliche Vermittlung der Ergebnisse in die Praxis, so ist die herkömmliche Variante EMEK_27a statistisch wenig geschulten Gesprächspartnern in der Praxis sogar eher vermittelbar. Ungelöst bleibt bei allen Varianten der Veränderungsmessung das methodische Problem der fehlenden Berücksichtigung des Ausgangszustandes der Patienten zu Beginn der Behandlung. So kann die Information „unverändert“ (entspricht einem Nulleffekt) zweierlei beinhalten: die Beibehaltung eines ungünstigen Zustandes oder aber die Beibehaltung eines günstigen Zustandes. So wird bei einer ausschließlichen Betrachtung von Prä-Post-Effektgrößen oder direkten Veränderungsmaßen der präventive Gedanke einer Beibehaltung von erwünschten Zuständen durch die herkömmliche Methodik der Ergebnismessung nur unzureichend berücksichtigt, was nicht im Sinne einer fairen Evaluation ist. Zwar wurden in der Vergangenheit mathematische Korrekturverfahren und individualisierte Ansätze zur Ergebnismessung vorgeschlagen, die jedoch zu anderweitigen methodischen Problemen führen wie mangelnde Vergleichbarkeit der berechneten Kennwerte, Selektion von Extremgruppen sowie ungelöste Fragen hinsichtlich der Reliabilität. Es wird daher eine innovative Strategie zur Bewertung der Ergebnisqualität vorgeschlagen, indem ein neues Composit-Kriterium gebildet wird, das sich aus z-standardisierten Status- und Veränderungsinformationen zusammensetzt. Mehrere singuläre Composit-Ergebniskriterien lassen sich durch Summenbildung zu multiplen Ergebniskriterien aufaggregieren. Eine erste Erprobung liefert Anhaltspunkte dafür, dass das Composit-Kriterium eine sehr differenzierte Bewertung der Ergebnisqualität ermöglicht, die mit den zur Validierung herangezogenen Maßen im Einklang steht. Insbesondere die bei der klassischen indirekten Veränderungsmessung häufig zu beobachtende negative Korrelation zwischen Ausgangs- und Differenzwerten, die zu dem unerwünschten statistischen Phänomen der Regression zur Mitte und damit zu einer Verzerrung der Ergebnisse führt, tritt hier nicht auf. Darüber hinaus zeigt das neue Composit-Kriterium ausgezeichnete statistische Kennwerte und Verteilungseigenschaften, die denen herkömmlicher Prä-Post-Effektgrößen in nichts nachstehen.

Within the scope of a multicenter study regarding the outcome quality of inpatient psychosomatic rehabilitation a structured catalogue of therapy goals (SZK, strukturierter Therapiezielkatalog) was developed. The catalogue contains 89 predetermined therapy goals as well as the option to formulate further goals in own words. The SZK is available both as a patient and as a therapist version. At the beginning of treatment up to five primary objectives are chosen from the list. At the end of treatment and at the 1-year follow-up the level of achievement of objectives is assessed. Moreover the SZK contains the option to mark goals as not relevant any more and to add goals which came up during the treatment and to evaluate them regarding the level of achievement. The study on hand asks for empirical identification of the target structure. Furthermore, reliability and validity of the calculated measures of goal attainment are analysed. As the most important finding the SZK turns out to be a practical and economical assessment instrument for goal-oriented evaluation.

This article reports on a questionnaire concerning individual problems in psychosomatic rehabilitation. A sample of 858 patients answered the questions at the beginning and on a one year catamnestic measurement. First, the frequency of occurrence of several symptoms was asked. Second, the rehabilitants were asked to indicate for each symptom if it was an important problem before treatment. This procedure of identifying problems was done at the beginning (prospective marking) and also at the one year follow up (retrospective marking). The questionnaire allows to compute eight subscales and one global scale regarding all items (classical approach). Frequency of occurrence decreased with an average effect size (ES) of 0.56 on the global scale. In the next step, measurement was individualized by regarding only items which were marked as relevant problem. By prospective marking, effect size was 1.32. By retrospective marking, no growth of effect size in comparison to the classical approach was found (ES = 0.56). The results indicate that the prospective approach of identifying problems is the better way of individualizing measurements. Moreover, the impact of individual problem definition on outcome was demonstrated.