La psicoterapia sulla strada verso l'accademizzazione?

Zusammenfassung: Bereits seit einigen Jahren fordert das Bundesministerium für Gesundheit in Deutschland eine Psychotherapie-Direktausbildung. Damit könnte Psychotherapie, vergleichbar mit Medizin oder Psychologie, studiert werden. In Österreich gibt es ähnliche Überlegungen. Der Artikel befasst sich mit der Frage, welche Vor- und Nachteile eine solche Akademisierung gegenüber der aktuellen Psychotherapieausbildung hätte. Sowohl für die aktuelle Psychotherapieausbildung als auch für die Akademisierung lassen sich Vor- und Nachteile anführen. Zudem muss der Begriff der Akademisierung klarifiziert werden. Welche Veränderungen auch kommen, für sie gelten die drei folgenden Anforderungen: Die Veränderungen sollten ausführlich und sachlich diskutiert werden, auf dem bisherigen Wissen aufbauen und entsprechend evaluiert sein oder werden. Schlüsselwörter: Psychotherapie, Psychotherapiewissenschaft, Psychotherapieforschung, AkademisierungSummary: For some years the German Federal Ministry of Health has been calling for psychotherapy training to be provided directly by universities. This would make it possible for psychotherapy to be studied at university, like medicine and psychology. In Austria thoughts are also following a similar trend. The article addresses the question as to the potential advantages and disadvantages of such an academisation of psychotherapy training as compared to the current training settings. Both the current form of training and the academisation have advantages and disadvantages. The concept of academisation also needs to be clarified. Whatever changes take place, the following three requirements apply: The changes should be discussed in detail and objectively, built on the knowledge accumulated to date and be or have been appropriately evaluated. Keywords: Psychotherapy, psychotherapeutic science, psychotherapy research, academisationRiassunto: Già da alcuni anni il Ministero tedesco per la salute chiede una formazione diretta in psicoterapia. Ciò consentirebbe di studiare psicoterapia in modo simile a quanto avviene per la medicina o la psicologia. Anche in Austria sono in atto riflessioni simili. L'articolo si occupa della domanda dei vantaggi e degli svantaggi che una tale accademizzazione avrebbe rispetto all'attuale formazione in psicoterapia. Sia per l'attuale formazione psicoterapeutica che per l'accademizzazione è possibile identificare vantaggi e svantaggi. Va inoltre chiarito il concetto di accademizzazione. Indipendentemente dall'evoluzione che seguirà, questi cambiamenti vanno 1) discussi dettagliatamente e oggettivamente, 2) devono basarsi sulle conoscenze attuali e 3) devono essere stati valutati o venir valutati sulla base di queste nozioni. Parole chiave: psicoterapia, scienze psicoterapeutiche, ricerca psicoterapeutica, accademizzazion

Concentrating on the Impact: Consequence-based Explanations in Recommender Systems

Recommender systems assist users in decision-making, where the presentation of recommended items and their explanations are critical factors for enhancing the overall user experience. Although various methods for generating explanations have been proposed, there is still room for improvement, particularly for users who lack expertise in a specific item domain. In this study, we introduce the novel concept of \textit{consequence-based explanations}, a type of explanation that emphasizes the individual impact of consuming a recommended item on the user, which makes the effect of following recommendations clearer. We conducted an online user study to examine our assumption about the appreciation of consequence-based explanations and their impacts on different explanation aims in recommender systems. Our findings highlight the importance of consequence-based explanations, which were well-received by users and effectively improved user satisfaction in recommender systems. These results provide valuable insights for designing engaging explanations that can enhance the overall user experience in decision-making.Comment: Preprint of the paper to be presented at IntRS'23: Joint Workshop on Interfaces and Human Decision Making for Recommender Systems, September 18, 2023, Singapore. paper will be published in the workshop proceeding

Examiner effect on the objective structured clinical exam – a study at five medical schools

Background: The Objective Structured Clinical Examination (OSCE) is increasingly used at medical schools to assess practical competencies. To compare the outcomes of students at different medical schools, we introduced standardized OSCE stations with identical checklists. Methods: We investigated examiner bias at standardized OSCE stations for knee- and shoulder-joint examinations, which were implemented into the surgical OSCE at five different medical schools. The checklists for the assessment consisted of part A for knowledge and performance of the skill and part B for communication and interaction with the patient. At each medical faculty, one reference examiner also scored independently to the local examiner. The scores from both examiners were compared and analysed for inter-rater reliability and correlation with the level of clinical experience. Possible gender bias was also evaluated. Results: In part A of the checklist, local examiners graded students higher compared to the reference examiner; in part B of the checklist, there was no trend to the findings. The inter-rater reliability was weak, and the scoring correlated only weakly with the examiner’s level of experience. Female examiners rated generally higher, but male examiners scored significantly higher if the examinee was female. Conclusions: These findings of examiner effects, even in standardized situations, may influence outcome even when students perform equally well. Examiners need to be made aware of these biases prior to examining

T cell stimulator cells, an efficient and versatile cellular system to assess the role of costimulatory ligands in the activation of human T cells.

It is well established that full activation of T cells requires the interaction of the TCR complex with the peptide-MHC complex (Signal 1) and additional signals (Signal 2). These second signals are generated by the interaction of costimulatory ligands expressed on antigen presenting cells with activating receptors on T cells. In addition, T cell responses are negatively regulated by inhibitory costimulatory pathways. Since professional antigen presenting cells (APC) harbour a plethora of stimulating and inhibitory surface molecules, the contribution of individual costimulatory molecules is difficult to assess on these cells. We have developed a system of stimulator cells that can give signal 1 to human T cells via a membrane bound anti-CD3 antibody fragment. By expressing human costimulatory ligands on these cells, their role in T cell activation processes can readily be analyzed. We demonstrate that T cell stimulator cells are excellent tools to study various aspects of human T cell costimulation, including the effects of immunomodulatory drugs or how costimulatory signals contribute to the in vitro expansion of T cells. T cell stimulator cells are especially suited for the functional evaluation of ligands that are implicated in costimulatory processes. In this study we have evaluated the role of the CD2 family member CD150 (SLAM) and the TNF family member TL1A (TNFSF15) in the activation of human T cells. Whereas our results do not point to a significant role of CD150 in T cell activation we found TL1A to potently costimulate human T cells. Taken together our results demonstrate that T cell stimulator cells are excellent tools to study various aspects of costimulatory processes

Sex‑Specifc Diferences in Mortality of Patients with a History of Bariatric Surgery: a Nation‑Wide Population‑Based Study

Purpose Bariatric surgery reduces mortality in patients with severe obesity and is predominantly performed in women. Therefore, an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria was performed. The focus was on deceased patients after bariatric surgery. Materials and Methods The Austrian health insurance funds cover about 98% of the Austrian population. Medical health claims data of all Austrians who underwent bariatric surgery from 01/2010 to 12/2018 were analyzed. In total, 19,901 patients with 107,806 observed years postoperative were eligible for this analysis. Comorbidities based on International Classification of Diseases (ICD)-codes and drug intake documented by Anatomical Therapeutical Chemical (ATC)-codes were analyzed in patients deceased and grouped according to clinically relevant obesity-associated comorbidities: diabetes mellitus (DM), cardiovascular disease (CV), psychiatric disorder (PSY), and malignancy (M). Results In total, 367 deaths were observed (1.8%) within the observation period from 01/2010 to 04/2020. The overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p < 0.001(Chi-squared)). Moreover, the 30-day mortality was 0.19% and sixfold higher in men compared to women (0.48 vs. 0.08%; p < 0.001). CV (82%) and PSY (55%) were the most common comorbidities in deceased patients with no sex-specific differences. Diabetes (38%) was more common in men (43 vs. 33%; p = 0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p = 0.025). Conclusion After bariatric surgery, short-term mortality as well as long-term mortality was higher in men compared to women. In deceased patients, diabetes was more common in men, whereas malignant diseases were more common in women.publishedVersio

Multimorbidity Patterns in the Elderly: A New Approach of Disease Clustering Identifies Complex Interrelations between Chronic Conditions

Objective: Multimorbidity is a common problem in the elderly that is significantly associated with higher mortality, increased disability and functional decline. Information about interactions of chronic diseases can help to facilitate diagnosis, amend prevention and enhance the patients ’ quality of life. The aim of this study was to increase the knowledge of specific processes of multimorbidity in an unselected elderly population by identifying patterns of statistically significantly associated comorbidity. Methods: Multimorbidity patterns were identified by exploratory tetrachoric factor analysis based on claims data of 63,104 males and 86,176 females in the age group 65+. Analyses were based on 46 diagnosis groups incorporating all ICD-10 diagnoses of chronic diseases with a prevalence $ 1%. Both genders were analyzed separately. Persons were assigned to multimorbidity patterns if they had at least three diagnosis groups with a factor loading of 0.25 on the corresponding pattern. Results: Three multimorbidity patterns were found: 1) cardiovascular/metabolic disorders [prevalence female: 30%; male: 39%], 2) anxiety/depression/somatoform disorders and pain [34%; 22%], and 3) neuropsychiatric disorders [6%; 0.8%]. The sampling adequacy was meritorious (Kaiser-Meyer-Olkin measure: 0.85 and 0.84, respectively) and the factors explained a large part of the variance (cumulative percent: 78 % and 75%, respectively). The patterns were largely age-dependent an

Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany

<p>Abstract</p> <p>Background</p> <p>Growing interest in multimorbidity is observable in industrialized countries. For Germany, the increasing attention still goes still hand in hand with a small number of studies on multimorbidity. The authors report the first results of a cross-sectional study on a large sample of policy holders (n = 123,224) of a statutory health insurance company operating nationwide. This is the first comprehensive study addressing multimorbidity on the basis of German claims data. The main research question was to find out which chronic diseases and disease combinations are specific to multimorbidity in the elderly.</p> <p>Methods</p> <p>The study is based on the claims data of all insured policy holders aged 65 and older (n = 123,224). Adjustment for age and gender was performed for the German population in 2004. A person was defined as multimorbid if she/he had at least 3 diagnoses out of a list of 46 chronic conditions in three or more quarters within the one-year observation period. Prevalences and risk-ratios were calculated for the multimorbid and non-multimorbid samples in order to identify diagnoses more specific to multimorbidity and to detect excess prevalences of multimorbidity patterns.</p> <p>Results</p> <p>62% of the sample was multimorbid. Women in general and patients receiving statutory nursing care due to disability are overrepresented in the multimorbid sample. Out of the possible 15,180 combinations of three chronic conditions, 15,024 (99%) were found in the database. Regardless of this wide variety of combinations, the most prevalent individual chronic conditions do also dominate the combinations: Triads of the six most prevalent individual chronic conditions (hypertension, lipid metabolism disorders, chronic low back pain, diabetes mellitus, osteoarthritis and chronic ischemic heart disease) span the disease spectrum of 42% of the multimorbid sample. Gender differences were minor. Observed-to-expected ratios were highest when purine/pyrimidine metabolism disorders/gout and osteoarthritis were part of the multimorbidity patterns.</p> <p>Conclusions</p> <p>The above list of dominating chronic conditions and their combinations could present a pragmatic start for the development of needed guidelines related to multimorbidity.</p