Evaluation des Nationalen Aktionsplans der Bundesregierung zur Umsetzung der UN-Behindertenrechtskonvention: Abschlussbericht

Mit dem im Juni 2011 vom Bundeskabinett beschlossenen Nationalen Aktionsplan (NAP) zur Umsetzung der UN-Behindertenrechtskonvention (UN-BRK) wurde erstmals eine behindertenpolitische Gesamtstrategie verabschiedet, die politikfeldübergreifend die Ziele und Maßnahmen zur Umsetzung der Konvention auf Bundesebene zusammenführt. Im vorliegenden Gutachten werden sowohl die inhaltliche Ausgestaltung des NAP - d.h. sein konzeptioneller Aufbau und die enthaltenen Maßnahmen - als auch die Rolle der verschiedenen Akteure sowie die Prozesse während der Entwicklung und bisherigen Umsetzung des NAP im Kontext der Anforderungen der UN-BRK untersucht. Das Gutachten beschäftigt sich zudem mit der Frage, inwiefern das Thema Wirkungsanalyse im gegenwärtigen NAP bereits verankert ist und umgesetzt wird

Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial

Purpose!#!Supporting the provision of intensive care medicine through telehealth potentially improves process quality. This may improve patient recovery and long-term outcomes. We investigated the effectiveness of a multifaceted telemedical programme on the adherence to German quality indicators (QIs) in a regional network of intensive care units (ICUs) in Germany.!##!Methods!#!We conducted an investigator-initiated, large-scale, open-label, stepped-wedge cluster randomised controlled trial enrolling adult ICU patients with an expected ICU stay of ≥ 24 h. Twelve ICU clusters in Berlin and Brandenburg were randomly assigned to three sequence groups to transition from control (standard care) to the intervention condition (telemedicine). The quality improvement intervention consisted of daily telemedical rounds guided by eight German acute ICU care QIs and expert consultations. Co-primary effectiveness outcomes were patient-specific daily adherence (fulfilled yes/no) to QIs, assessed by a central end point adjudication committee. Analyses used mixed-effects logistic modelling adjusted for time. This study is completed and registered with ClinicalTrials.gov (NCT03671447).!##!Results!#!Between September 4, 2018, and March 31, 2020, 1463 patients (414 treated on control, 1049 on intervention condition) were enrolled at ten clusters, resulting in 14,783 evaluated days. Two randomised clusters recruited no patients (one withdrew informed consent; one dropped out). The intervention, as implemented, significantly increased QI performance for 'sedation, analgesia and delirium' (adjusted odds ratio (99.375% confidence interval [CI]) 5.328, 3.395-8.358), 'ventilation' (OR 2.248, 1.198-4.217), 'weaning from ventilation' (OR 9.049, 2.707-30.247), 'infection management' (OR 4.397, 1.482-13.037), 'enteral nutrition' (OR 1.579, 1.032-2.416), 'patient and family communication' (OR 6.787, 3.976-11.589), and 'early mobilisation' (OR 3.161, 2.160-4.624). No evidence for a difference in adherence to 'daily multi-professional and interdisciplinary clinical visits' between both conditions was found (OR 1.606, 0.780-3.309). Temporal trends related and unrelated to the intervention were detected. 149 patients died during their index ICU stay (45 treated on control, 104 on intervention condition).!##!Conclusion!#!A telemedical quality improvement program increased adherence to seven evidence-based German performance indicators in acute ICU care. These results need further confirmation in a broader setting of regional, non-academic community hospitals and other healthcare systems

Impact of mindfulness training and emotional regulation on anxiety, depression and treatment adherence in adolescents.

El estudio buscó identificar el impacto del entrenamiento en habilidades de atención plena y regulación emocional sobre la ansiedad, depresión y adherencia al tratamiento en adolescentes en psicoterapia en la Pontificia Universidad Javeriana. Evidenciando la ansiedad y la depresión como los trastornos más prevalentes en adolescentes (OMS,2023) y la adherencia al tratamiento como una problemática frente a la eficacia terapéutica (Gearing et al., 2012). Utilizando un diseño de caso único con reversión de tratamientos múltiples en dos participantes. Se evaluaron reevaluación cognitiva, supresión emocional, uso de habilidades de regulación emocional y de atención plena mediante un registro diario, el FFMQ, el DERS, el DASS-21 y un cuestionario de validez social. La intervención mostró un impacto significativo en las habilidades de regulación emocional y, en un participante, en la conciencia plena. Se observó una diminución de depresión en ambos participantes y de la ansiedad en uno.The aim of this study was to identify the impact of training in mindfulness and emotion regulation skills on anxiety, depression, and treatment adherence in adolescents participating in psychotherapy at Pontificia Universidad Javeriana. A single-case design with multiple treatment reversal was used in two participants. A baseline record was conducted, followed by an intervention in mindfulness, another baseline, an intervention in mindfulness with emotion regulation, and finally a follow-up. A daily record was applied to assess cognitive reappraisal, emotional suppression, use of emotion regulation skills, and use of mindfulness skills. Additionally, the FFMQ, DERS, and DASS-21 were administered in the pretest, second baseline, posttest, and follow-up, along with a social validity questionnaire. The intervention had a direct and significant impact on emotion regulation skills, and in one participant, on mindfulness skills. A significant reduction in depression was observed in both clients and in anxiety in one of them. The results support the study hypothesis but highlighted the need to include more family-level interventions.Magíster en Psicología ClínicaMaestrí

Impacto de una estrategia de intervención en las estrategias de comunicación y regulación emocional de familias.

El presente proyecto busca identificar el impacto de una intervención especifica de terapia de tercera generación sobre las estrategias de regulación emocional y de comunicación en integrantes de una familia, es un diseño de caso único. Inicialmente se abarca el registro de la linea base de las estrategias de comunicación y de regulación emocional de los familiares y posteriormente se inicia la intervención con estrategias de terapias de tercera generación registrando las conductas problemáticas de la linea base y evidenciando si hay cambios

The reliability of a restraint sensor system for the computer-supported detection of spinal stabilizing muscle deficiencies

Background: The presence of muscular deficiency seems to be a major cause of back pain that requires counteractions. Considering that the autochthonous back muscles, responsible for straightening and stabilizing the spine, cannot be activated voluntarily, they can be strengthened only through specific training. The computer-supported test and training system (CTT) Centaur (BfMC GmbH, Leipzig, SN, Germany) seems well suited for this purpose. To show its potential as a reliable diagnostic and training tool, this study aimed to evaluate the test-retest reliability of this 3D spatial rotation device. Methods: A prospective pilot study was conducted in 20 healthy volunteers of both sexes. For test-retest reliability analysis, three measurements were performed with a two-day interval between each measurement. Each measurement consisted of a one-minute endurance test performed in eight different positions (transverse plane). During the test, the subject was tilted by 90° in the sagittal plane from a neutral, upright position. Meanwhile, the subject's level of upper body stabilization along the body axis was assessed. All trunk movements (momentum values) were quantified by a multicomponent force sensor and standardized relative to the subject's upper body mass. The range of motion was assessed by 95% confidence ellipse analysis. Here, all position-specific confidence ellipses for each measurement were merged to a summarized quantity. Finally, ICC analysis using a single-rating, absolute agreement, two-way mixed-effects model and a Bland-Altman plot was performed to determine the reliability. Results: Considering all measurements (t1, t2, t3), the ICC for reliability evaluation was 0.805, and the corresponding 95% confidence interval (CI) was [0.643, 0.910]. Moreover, the Bland-Altman plots for all three pairs of time points did not show significant differences. Conclusion: This study concludes that the CTT Centaur shows good test-retest reliability, indicating it can be used in clinical practice in the future

Fortalecimiento del tejido social y del empoderamiento de la acción social y política de los representantes de la mesa de participación de víctimas del municipio de Gachancipá

37 páginasEsta investigación acción participativa se realizó con tres de los integrantes de la mesa de participación -MP- de víctimas de gachancipá y una integrante de la comunidad víctima del municipio. Se tiene en cuenta que Gachancipá ha sido un municipio receptor registrándose en el período de 2014 hasta 2018, 795 personas recibidas a causa del desplazamiento forzado. Asimismo, a partir de la revisión teórica se evidencia la ausencia de artículos encontrados que se centren en esta comunidad, la falta de visibilización y trabajo para la reparación y no repetición. Ante esto se construyen 5 talleres, que basados en herramientas de la psicología social y comunitaria, se encaminan a cumplir el objetivo de fortalecer el tejido social de los representantes de la MP de víctimas del municipio de Gachancipá identificando estrategias de fortalecimiento y empoderamiento de acción social y política. En los resultados se realiza la red temática, donde se establecen siete temas globales que surgen del tema central: Empoderamiento y Acción social y política como líderes. En relación a estos se identifican 13 temas organizadores y 12 básicos. Ante esta problemática, el presente proyecto resalta la importancia trabajar en canales que faciliten el acceso a la información y al conocimiento, que apoyarán también los procesos de empoderamiento comunitario, ya que mediante el fortalecimiento de las concepciones de formas de poder se podrá establecer una base sólida para la posterior acción social y política.PsicologíaPsicólog

The reliability of a restraint sensor system for the computer-supported detection of spinal stabilizing muscle deficiencies

Background!#!The presence of muscular deficiency seems to be a major cause of back pain that requires counteractions. Considering that the autochthonous back muscles, responsible for straightening and stabilizing the spine, cannot be activated voluntarily, they can be strengthened only through specific training. The computer-supported test and training system (CTT) Centaur (BfMC GmbH, Leipzig, SN, Germany) seems well suited for this purpose. To show its potential as a reliable diagnostic and training tool, this study aimed to evaluate the test-retest reliability of this 3D spatial rotation device.!##!Methods!#!A prospective pilot study was conducted in 20 healthy volunteers of both sexes. For test-retest reliability analysis, three measurements were performed with a two-day interval between each measurement. Each measurement consisted of a one-minute endurance test performed in eight different positions (transverse plane). During the test, the subject was tilted by 90° in the sagittal plane from a neutral, upright position. Meanwhile, the subject's level of upper body stabilization along the body axis was assessed. All trunk movements (momentum values) were quantified by a multicomponent force sensor and standardized relative to the subject's upper body mass. The range of motion was assessed by 95% confidence ellipse analysis. Here, all position-specific confidence ellipses for each measurement were merged to a summarized quantity. Finally, ICC analysis using a single-rating, absolute agreement, two-way mixed-effects model and a Bland-Altman plot was performed to determine the reliability.!##!Results!#!Considering all measurements (t1, t2, t3), the ICC for reliability evaluation was 0.805, and the corresponding 95% confidence interval (CI) was [0.643, 0.910]. Moreover, the Bland-Altman plots for all three pairs of time points did not show significant differences.!##!Conclusion!#!This study concludes that the CTT Centaur shows good test-retest reliability, indicating it can be used in clinical practice in the future

The reliability of a restraint sensor system for the computer-supported detection of spinal stabilizing muscle deficiencies

Background: The presence of muscular deficiency seems to be a major cause of back pain that requires counteractions. Considering that the autochthonous back muscles, responsible for straightening and stabilizing the spine, cannot be activated voluntarily, they can be strengthened only through specific training. The computer-supported test and training system (CTT) Centaur (BfMC GmbH, Leipzig, SN, Germany) seems well suited for this purpose. To show its potential as a reliable diagnostic and training tool, this study aimed to evaluate the test-retest reliability of this 3D spatial rotation device. Methods: A prospective pilot study was conducted in 20 healthy volunteers of both sexes. For test-retest reliability analysis, three measurements were performed with a two-day interval between each measurement. Each measurement consisted of a one-minute endurance test performed in eight different positions (transverse plane). During the test, the subject was tilted by 90° in the sagittal plane from a neutral, upright position. Meanwhile, the subject's level of upper body stabilization along the body axis was assessed. All trunk movements (momentum values) were quantified by a multicomponent force sensor and standardized relative to the subject's upper body mass. The range of motion was assessed by 95% confidence ellipse analysis. Here, all position-specific confidence ellipses for each measurement were merged to a summarized quantity. Finally, ICC analysis using a single-rating, absolute agreement, two-way mixed-effects model and a Bland-Altman plot was performed to determine the reliability. Results: Considering all measurements (t1, t2, t3), the ICC for reliability evaluation was 0.805, and the corresponding 95% confidence interval (CI) was [0.643, 0.910]. Moreover, the Bland-Altman plots for all three pairs of time points did not show significant differences. Conclusion: This study concludes that the CTT Centaur shows good test-retest reliability, indicating it can be used in clinical practice in the future

The reliability of a restraint sensor system for the computer-supported detection of spinal stabilizing muscle deficiencies

Background: The presence of muscular deficiency seems to be a major cause of back pain that requires counteractions. Considering that the autochthonous back muscles, responsible for straightening and stabilizing the spine, cannot be activated voluntarily, they can be strengthened only through specific training. The computer-supported test and training system (CTT) Centaur (BfMC GmbH, Leipzig, SN, Germany) seems well suited for this purpose. To show its potential as a reliable diagnostic and training tool, this study aimed to evaluate the test-retest reliability of this 3D spatial rotation device. Methods: A prospective pilot study was conducted in 20 healthy volunteers of both sexes. For test-retest reliability analysis, three measurements were performed with a two-day interval between each measurement. Each measurement consisted of a one-minute endurance test performed in eight different positions (transverse plane). During the test, the subject was tilted by 90° in the sagittal plane from a neutral, upright position. Meanwhile, the subject's level of upper body stabilization along the body axis was assessed. All trunk movements (momentum values) were quantified by a multicomponent force sensor and standardized relative to the subject's upper body mass. The range of motion was assessed by 95% confidence ellipse analysis. Here, all position-specific confidence ellipses for each measurement were merged to a summarized quantity. Finally, ICC analysis using a single-rating, absolute agreement, two-way mixed-effects model and a Bland-Altman plot was performed to determine the reliability. Results: Considering all measurements (t1, t2, t3), the ICC for reliability evaluation was 0.805, and the corresponding 95% confidence interval (CI) was [0.643, 0.910]. Moreover, the Bland-Altman plots for all three pairs of time points did not show significant differences. Conclusion: This study concludes that the CTT Centaur shows good test-retest reliability, indicating it can be used in clinical practice in the future

Atraumatic femoral head necrosis: a biomechanical, histological and radiological examination compared to primary hip osteoarthritis

Introduction!#!Atraumatic necrosis of the femoral head (AFHN) is a common disease with an incidence of 5000-7000 middle-aged adults in Germany. There is no uniform consensus in the literature regarding the configuration of the bone in AFHN. The clinical picture of our patients varies from very hard bone, especially in idiopathic findings, and rather soft bone in cortisone-induced necrosis. A better understanding of the underlying process could be decisive for establishing a morphology-dependent approach. The aim of this study is the closer examination of the condition of the bone in the AFHN compared to the primary hip osteo arthritis (PHOA).!##!Materials and methods!#!The preparations were obtained as part of elective endoprosthetic treatment of the hip joint. Immediately after sample collection, thin-slice CT of the preserved femoral heads was performed to determine the exact density of the bone in the necrosis zone. Reconstruction was done in 0.8-1 mm layers in two directions, coronary and axial, starting from the femoral neck axis. Density of the femoral heads was determined by grey value analysis. The value in Hounsfield units per sample head was averaged from three individual measurements to minimize fluctuations. For biomechanical and histomorphological evaluation, the samples were extracted in the load bearing zone perpendicular to the surface of the femoral head. Group-dependent statistical evaluation was performed using single factor variance analysis (ANOVA).!##!Results!#!A total of 41 patients with a mean age of 64.44 years were included. The mean bone density of the AFHN samples, at 1.432 g/cm!##!Conclusions!#!The present study (NCT, evidence level II) shows that AFHN has a very well detectable higher bone density compared to PHOA. However, neither biomechanical stress tests nor histomorphological evaluation did show any significant difference between the groups. The results allow the conclusion that there is no 'soft' necrosis at all in the AFHN group