Beziehungs- und Kommunikationskonzept der Kreditierung

Zusammenfassung: Hintergrund: Die Qualität der therapeutischen Beziehung ist wesentlich für den Therapieerfolg. Wie eine Allianz entsteht, wird mit dem Konzept der Kreditierung als therapeutische Haltung des Zutrauens und Zumutens von Entwicklungspotenzial beleuchtet. Material und Methoden: Die qualitative Kreditierungsanalyse untersucht in Therapietranskripten, wie der initiale "Kredit" für eine Therapie als Grundlage des Arbeitsbündnisses gebildet und im Verlauf verhandelt wird. Dies wird an Beispielen aus der Kurztherapie der Patientin ElsaD. illustriert. Ergebnisse: Obwohl Therapiemodelle und -ziele zwischen ElsaD. und der Therapeutin offen ausgehandelt werden, kommt keine explizite Einigung im Sinne eines Pakts zustande. Der Kredit der Therapeutin bleibt unbeantwortet. Schlussfolgerung: Das Forschungsinstrument erfasst deskriptiv wichtige Aspekte der hilfreichen Beziehung und therapeutischen Allian

The Hidden Face of Nitrogen Oxides Species: From Toxic Effects to Potential Cure?

Nitrogen oxide (NOx) species represent ones of the most threatening air pollutants due to their prevalence and harmful impact on the environment and human health. The term NOx gathers mainly nitric oxide (NO) and nitrogen dioxide (NO2), mostly produced by anthropogenic activities such as transport and industries. Several cellular constituents were already described as NOx targets. These include membranes, proteins, respiratory chain enzymes, lipids, and DNA. Such damages lead to pathologies of lungs, cardiovascular system, and skin because these organs represent the first barrier toward the environment. On the other hand, NOx is also naturally synthetized by several organisms, playing a mediator role in essential cellular functions. However, few data are yet available on NOx activity toward microorganisms. Here, we review data concerning the double face of NOx, including their use in the medical field against pathogens’ infections that highlight the versatility of these compounds

Non-Motor Symptoms in Patients Suffering from Motor Neuron Diseases.

The recently postulated "disease spreading hypothesis" has gained much attention, especially for Parkinson's disease (PD). The various non-motor symptoms (NMS) in neurodegenerative diseases would be much better explained by this hypothesis than by the degeneration of disease-specific cell populations. Motor neuron disease (MND) is primarily known as a group of diseases with a selective loss of motor function. However, recent evidence suggests disease spreading into non-motor brain regions also in MND. The aim of this study was to comprehensively detect NMS in patients suffering from MND. We used a self-rating questionnaire including 30 different items of gastrointestinal, autonomic, neuropsychiatric, and sleep complaints [NMS questionnaire (NMSQuest)], which is an established tool in PD patients. 90 MND patients were included and compared to 96 controls. In total, MND patients reported significantly higher NMS scores (median: 7 points) in comparison to controls (median: 4 points). Dribbling, impaired taste/smelling, impaired swallowing, weight loss, loss of interest, sad/blues, falling, and insomnia were significantly more prevalent in MND patients compared to controls. Interestingly, excessive sweating was more reported in the MND group. Correlation analysis revealed an increase of total NMS score with disease progression. NMS in MND patients seemed to increase with disease progression, which would fit with the recently postulated "disease spreading hypothesis." The total NMS score in the MND group significantly exceeded the score for the control group, but only 8 of the 30 single complaints of the NMSQuest were significantly more often reported by MND patients. Dribbling, impaired swallowing, weight loss, and falling could primarily be connected to motor neuron degeneration and declared as motor symptoms in MND.S

Perturbation of Lytic and Latent Gammaherpesvirus Infection in the Absence of the Inhibitory Receptor CEACAM1

Control of gammaherpesvirus infections requires a complex, well orchestrated immune response regulated by positive and negative co-signaling molecules. While the impact of co-stimulatory molecules has been addressed in various studies, the role of co-inhibitory receptors has not been tested. The ITIM-bearing CEACAM1 is an inhibitory receptor expressed by a variety of immune cells, including B, T and NK cells. Using Ceacam1−/− mice, we analyzed the in vivo function of CEACAM1 during acute and latent murine gammaherpesvirus 68 (MHV-68) infection. During acute lytic replication, we observed lower virus titers in the lungs of Ceacam1−/− mice than in WT mice. In contrast, during latency amplification, Ceacam1−/− mice displayed increased splenomegaly and a higher latent viral load in the spleen. Analysis of the immune response revealed increased virus-specific antibody levels in Ceacam1−/− mice, while the magnitude of the T cell-mediated antiviral immune response was reduced. These findings suggest that inhibitory receptors can modulate the efficacy of immune responses against gammaherpesvirus infections

A Multicenter Screening Study

Background In cystic fibrosis, highly variable glucose tolerance is suspected. However, no study provided within-patient coefficients of variation. The main objective of this short report was to evaluate within-patient variability of oral glucose tolerance. Methods In total, 4,643 standardized oral glucose tolerance tests of 1,128 cystic fibrosis patients (median age at first test: 15.5 [11.5; 21.5] years, 48.8% females) were studied. Patients included were clinically stable, non-pregnant, and had at least two oral glucose tolerance tests, with no prior lung transplantation or systemic steroid therapy. Transition frequency from any one test to the subsequent test was analyzed and within-patient coefficients of variation were calculated for fasting and two hour blood glucose values. All statistical analysis was implemented with SAS 9.4. Results A diabetic glucose tolerance was confirmed in 41.2% by the subsequent test. A regression to normal glucose tolerance at the subsequent test was observed in 21.7% and to impaired fasting glucose, impaired glucose tolerance or both in 15.2%, 12.0% or 9.9%. The average within-patient coefficient of variation for fasting blood glucose was 11.1% and for two hour blood glucose 25.3%. Conclusion In the cystic fibrosis patients studied, a highly variable glucose tolerance was observed. Compared to the general population, variability of two hour blood glucose was 1.5 to 1.8-fold higher

Sprachförderung im Vorschulalter: Evaluation dreier Sprachförderkonzepte

'In Deutschland lebende Kinder mit Migrationshintergrund und mangelnder Sprachkompetenz können Bildungschancen häufig nur unzureichend nutzen. Um diesen sprachlichen Defiziten frühzeitig zu begegnen, werden Sprachfördermaßnahmen bereits im Elementarbereich durchgeführt. Die Wirksamkeit solcher Sprachfördermaßnahmen wurde bisher allerdings selten überprüft. Die Landesstiftung Baden-Württemberg hat mit der hier vorgestellten Studie EVAS die Effektivität von durch die Landesstiftung geförderten gezielten Sprachfördermaßnahmen im Vergleich zu unspezifischen Förderaktivitäten im Kindergarten evaluieren lassen. Zusätzlich wurden in dieser Studie die Sprachleistungen geförderter Kinder mit denjenigen von Kindern ohne Förderbedarf verglichen (N=490). Die Ergebnisse der Studie zeigen, dass unmittelbare Effekte der spezifischen Sprachfördermaßnahmen ausbleiben. Dieser unerwartete Befund legt nahe, die Bedingungen erfolgreicher Sprachförderung zu diskutieren und abzuwägen.' (Autorenreferat)'Children with an immigrant background and a lack of language proficiency living in Germany frequently fail to benefit from educational opportunities. To cope with these language impairments at an early stage, language programs are already implemented in preschool. The effectiveness of these programs, though, has rarely been evaluated. On behalf of the 'Landesstiftung Baden-Württemberg', the efficiency of specific language programs sponsored by the 'Landesstiftung' in comparison to unspecific supportive measures at preschool level was evaluated as part of the EVAS longitudinal study. Additionally, the language proficiency of children participating in a specific language program was compared to that of children without language difficulties (N=490). The results of the study show that there are no significant effects immediately after the completion of the specific language development measures. Due to these unexpected outcomes, conditions for successful supportive measures have to be discussed and reconsidered.' (author's abstract)

Model-Based Meta-Analysis of Relapsing Mouse Model Studies from the Critical Path to Tuberculosis Drug Regimens Initiative Database

Tuberculosis (TB), the disease caused by Mycobacterium tuberculosis (Mtb), remains a leading infectious disease-related cause of death worldwide, necessitating the development of new and improved treatment regimens. Nonclinical evaluation of candidate drug combinations via the relapsing mouse model (RMM) is an important step in regimen development, through which candidate regimens that provide the greatest decrease in the probability of relapse following treatment in mice may be identified for further development. Although RMM studies are a critical tool to evaluate regimen efficacy, making comprehensive “apples to apples” comparisons of regimen performance in the RMM has been a challenge in large part due to the need to evaluate and adjust for variability across studies arising from differences in design and execution. To address this knowledge gap, we performed a model-based meta-analysis on data for 17 unique regimens obtained from a total of 1592 mice across 28 RMM studies. Specifically, a mixed-effects logistic regression model was developed that described the treatment duration-dependent probability of relapse for each regimen and identified relevant covariates contributing to interstudy variability. Using the model, covariate-normalized metrics of interest, namely, treatment duration required to reach 50% and 10% relapse probability, were derived and used to compare relative regimen performance. Overall, the model-based meta-analysis approach presented herein enabled cross-study comparison of efficacy in the RMM and provided a framework whereby data from emerging studies may be analyzed in the context of historical data to aid in selecting candidate drug combinations for clinical evaluation as TB drug regimens