Psychoanalyse und Setting

Im Zusammenhang mit den aktuellen Diskussionen und den daraus folgenden Entscheidungen für die Weiterbildung zu PsychotherapeutInnen am PSZ, ist es das Anliegen der Autorin darzulegen, dass die Settingdichte in der psychoanalytischen Arbeit spezifische Folgen für die PatientInnen und AnalytikerInnen/PsychotherapeutInnen hat. Sie plädiert für die Wahrnehmung der Unterschiede zwischen hochfrequenten und niederfrequenten Arbeitsbedingungen, zeigt jedoch auf, dass sich daraus keine Unterschiede bezüglich der psychoanalytischen Selbsterfahrung als Basis für psychotherapeutische Arbeit folgern lassen

Pionierinnen im Dickicht der psychoanalytischen Weiblichkeitstheorien: Eine persönliche «tour d’horizon»

Die Position der Frauen in der Psychoanalyse ist vielfältig: Es gab die berühmten Patientinnen. Es gab die Pionierinnen, die in gesellschaftlich schwierigen Zeiten ihren Weg zur Psychoanalyse finden mussten, was oft mit dem Verzicht auf ein eigenes Familienleben verbunden war. Und Psychoanalytikerinnen spielten in der kritischen Auseinandersetzung um die Weiblichkeitstheorien Freuds in den 1920er und 1930er Jahren eine zentrale Rolle. Durch das Naziregime und seine Folgen wurde auch diese legendäre Debatte brutal unterbrochen. 40 Jahre danach, mit dem Erstarken der Frauenbewegung in den 1970er Jahren, wurde der Diskurs um die Weiblichkeitstheorien in der Psychoanalyse wieder aufgenommen und weiterentwickelt. 1971 bekamen auch die Schweizer Frauen das Stimm- und Wahlrecht, und ich begann am PSZ die psychoanalytische Ausbildung und ging auch an die berühmten Veranstaltungen der sogenannten «Plattform», einer Gruppe linker, institutionskritischer, vor allem junger KollegInnen, von denen sich die meisten in psychoanalytischer Ausbildung befanden oder sich für die Psychoanalyse interessierten. Freuds Konzepte der Triebentwicklung, zu der auch die Theorie des Penisneides und des Kastrationskomplexes der Frau gehörte, wurde damals nicht kritisch hinterfragt. Sie gehörten sozusagen zum undiskutierten gewachsenen Felsen der psychoanalytischen Theorie. Die bekannte argentinische Psychoanalytikerin Marie Langer war die erste Person, die am Seminar offen und deutlich diese Theorien in Frage stellte. Für mich bedeutete das eine Aufforderung (eine Erlaubnis?) zum Anders- und Weiterdenken. 1979/80 entstand eine erste Frauengruppe mit Goldy Parin. 1991 wurde der Arbeitskreis für feministische Psychoanalyse gegründet. Mit Psychoanalytikerinnen und psychoanalytisch orientierten Wissenschaftlerinnen aus Deutschland, Österreich und der Schweiz, die sich einmal im Jahr treffen, wird seitdem die Thematik erweitert und vertieft. Das kritische Bewusstsein um Weiblichkeits- und Genderthemen verankerte sich schliesslich auch im PSZ

Choir singing improves respiratory muscle strength and quality of life in patients with structural heart disease - HeartChoir: a randomised clinical trial

Most patients with reduced exercise capacity and acquired or congenital structural heart disease also have a reduced respiratory muscle strength. The aim of this pilot study was to investigate whether choir singing in combination with respiratory muscle training positively influences respiratory muscle strength, exercise capacity and quality of life in this population.; In this single-centre, randomised and open-label interventional study we compared respiratory muscle strength, exercise capacity and quality of life in patients with acquired or congenital structural heart disease who received either standard of care and a 12-week intervention (weekly choir rehearsal and daily breathing exercises) or standard of care alone. The primary endpoint was the difference in change in maximum inspiratory pressure (∆MIP%predicted). Secondary endpoints included the difference in change in maximum expiratory pressure (∆MEP%predicted), exercise capacity quantified as maximal oxygen uptake during exercise (∆MVO2%predicted) and quality of life quantified by the Minnesota living with heart failure questionnaire (∆MLHFQ score).; Overall 24 patients (mean age 65, standard deviation [SD] 19 years, 46% male) were randomised after exclusion. ∆MIP%predicted was significantly higher in the intervention group (∆MIP%predicted +14, SD 21% vs −14, SD 23%; p = 0.008) and quality of life improved significantly (∆MLHFQ score −5, SD 6 vs 3, SD 5; p = 0.006) after 12 weeks. ∆MEP%predicted and ∆MVO2%predicted did not differ between both groups (∆MEP%predicted −3, SD 26% vs −3, SD 16%; p = 1.0 and ∆MVO2%predicted 18, SD 12% vs 10, SD 15%; p = 0.2).; Choir singing in combination with respiratory muscle training improved respiratory muscle strength and quality of life in patients with structural heart disease and may therefore be valuable supplements in cardiac rehabilitation. (Clinical trial registration number: NCT03297918)

Prevalence of iron deficiency anemia and iron deficiency in a pediatric population with inflammatory bowel disease

OBJECTIVES: Iron deficiency is the most common cause of anemia in children with inflammatory bowel disease, although the real prevalence is unknown. Intravenous iron is suggested as the first line treatment. This study aims to determine the prevalence of iron deficiency anemia in children with inflammatory bowel disease followed in a Pediatric Gastroenterology Unit of a tertiary center and to evaluate this unit's experience with intravenous iron. MATERIALS AND METHODS: A retrospective cohort study was designed involving children with inflammatory bowel disease followed in that unit between January 2001 and April 2016. Laboratory results were collected at the moment of diagnosis, after one-year follow-up and prior each IV iron administration performed during the study period. Anemia was defined according to World Health Organization criteria and the iron deficiency was defined using recent guidelines. RESULTS: Were studied 69 patients 71% had CD and 29% UC. 50.7% were female. Mean patient age at diagnosis was 13.3 years (range 1--17 years). Prevalence of ID and IDA at diagnosis was 76.8% and 43.5%, respectively. After one year follow-up, those values decreased to 68.1% (p=.182) and 21.7% (p=.002), respectively. Hemoglobin significantly increased (p<.001). Intravenous iron was administered to 92.8% of patients. No adverse reactions were reported. CONCLUSIONS: Intravenous iron is the first line in the treatment of Iron deficiency anemia in Inflammatory Bowel disease and it is safe and effective. Persistent anemia and iron deficiency are common.info:eu-repo/semantics/publishedVersio

Nachruf auf Dr. med. Margret Tönnesmann

Nachruf auf Dr. med. Margret Tönnesman

The safety and efficacy of intravenous ferric carboxymaltose in anaemic patients undergoing haemodialysis: a multi-centre, open-label, clinical study

Background. Patients with chronic kidney disease (CKD) often present with iron depletion and iron deficiency anaemia (IDA) because of frequent blood (and iron) loss. Therapy consists of repletion of iron stores and intravenous (i.v.) iron has become the standard care in this setting. However, older i.v. iron preparations have their limitations. This study primarily investigated the safety, and also the efficacy, of ferric carboxymaltose (FCM), a next-generation i.v. iron formulation, given as a bolus–push injection in patients with CKD undergoing maintenance haemodialysis (HD)

Rationale and design of Ferinject® Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia

Iron deficiency (ID) and anaemia are common in patients with chronic heart failure (CHF). The presence of anaemia is associated with increased morbidity and mortality in CHF, and ID is a major reason for the development of anaemia. Preliminary studies using intravenous (i.v.) iron supplementation alone in patients with CHF and ID have shown improvements in symptom status. FAIR-HF (Clinical Trials.gov NCT00520780) was designed to determine the effect of i.v. iron repletion therapy using ferric carboxymaltose on self-reported patient global assessment (PGA) and New York Heart Association (NYHA) in patients with CHF and ID. This is a multi-centre, randomized, double-blind, placebo-controlled study recruiting ambulatory patients with symptomatic CHF with LVEF < 40% (NYHA II) or < 45% (NYHA III), ID [ferritin < 100 ng/mL or ferritin 100-300 ng/mL when transferrin saturation (TSAT) < 20%], and haemoglobin 9.5-13.5 g/dL. Patients were randomized in a 2:1 ratio to receive ferric carboxymaltose (Ferinject((R))) 200 mg iron i.v. or saline i.v. weekly until iron repletion (correction phase), then monthly until Week 24 (maintenance phase). Primary endpoints are (i) self-reported PGA at Week 24 and (ii) NYHA class at Week 24, adjusted for baseline NYHA class. This study will provide evidence on the efficacy and safety of iron repletion with ferric carboxymaltose in CHF patients with ID with and without anaemia

Open questions and misconceptions in the diagnosis and management of anemia in patients with gastrointestinal bleeding

Despite high prevalence of iron deficiency anemia (IDA) in patients with acute or chronic gastrointestinal bleeding (GIB), IDA and iron deficiency (ID) are frequently untreated. Reasons may be misconceptions about the impact and diagnosis of IDA and the efficacy of new treatments. Addressing these misconceptions, this article summarizes current evidence for better understanding and management of GIB-associated IDA. Despite only few controlled studies evaluated the efficacy of iron treatment in patients with GIB, there is consistent evidence suggesting that: (a) IDA should be diligently investigated, (b) effective treatment of ID/IDA improves outcomes such as health-related quality of life and can avoid severe cardiovascular consequences, and (c) intravenous iron should be considered as well-tolerated treatment in this setting. Overall, the misconceptions and practices outlined in this article should be replaced with strategies that are more in line with current guidelines and best practice in GIB and other underlying conditions of ID/IDA.A pesar de la alta prevalencia de anemia por déficit de hierro (ADH) en pacientes con hemorragia digestiva (HD) aguda o crónica, la ADH y el déficit de hierro (DH) son frecuentemente infratratados. Diversos conceptos erróneos sobre el impacto, el diagnóstico y la eficacia de los nuevos tratamientos de la ADH probablemente lo justifican. Para abordar estos errores conceptuales, este artículo resume la evidencia actual para una mejor comprensión y manejo de la ADH. A pesar de que existen pocos estudios controlados que hayan evaluado la eficacia del tratamiento con hierro en pacientes con HD, hay evidencia que sugiere que: (a) la ADH debe ser investigada diligentemente; (b) el tratamiento eficaz del DH/ADH mejora la calidad de vida relacionada con la salud y puede evitar relevantes complicaciones cardiovasculares, y (c) el hierro intravenoso debe ser considerado como un tratamiento bien tolerado en este contexto. En general, los conceptos erróneos y las prácticas inadecuadas descritas en este artículo deben ser reemplazados por estrategias que estén más en línea con las directrices actuales y buenas prácticas clínicas en HD y otras condiciones causantes del DH/ADHinfo:eu-repo/semantics/publishedVersio