Growth curves of common factors in psychotherapy: Multilevel growth modelling and outcome analysis.

OBJECTIVE A large body of literature discusses change mechanisms underlying psychotherapy with an emphasis on common factors. The present study examined how different comprehensive common factors change over the course of therapy and whether this change was associated with clinical outcome at discharge. METHOD Three hundred forty-eight adults (mean age = 32.1, SD = 10.6; 64% female) attended a standardized 14-week day-clinic psychotherapy program. They provided longitudinal data on common factors based on weekly assessments. Additionally, pre- and post-assessment questionnaires on clinical outcome were completed. Using multilevel modelling, we predicted common factors by time (week in therapy). Multiple linear regression models tested the association between changes in common factors and clinical outcome. RESULTS The common factor 'Therapeutic Alliance' was best fitted by linear growth models, whereas models for the common factors 'Coping', 'Cognitive Integration' and 'Affective Processing' indicated logarithmic changes over time. 'Coping', that is change in patients' ability to cope with their individual problems, was most closely linked with outcome. CONCLUSIONS The present study provides evidence for the changeability of common factors over the course of therapy as well as their specific contributions to psychotherapeutic progress

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

Purpose: Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods. Methods: A hybrid approach is currently an accepted alternative to conventional surgery. Renal and/or visceral revascularisation enables subsequent stent-graft placement into the visceral portion of the aorta. Results: Knowledge of the surgical procedure and a precise assessment of the vascular morphology are crucial for pre-procedural planning and for detection of post-procedural complications. Multi-detector computed tomography angiography (MDCTA) combined with two- and three-dimensional (2D and 3D) rendering is useful for pre-interventional planning and for the detection of post-procedural complications. Three-dimensional rendering allows proper anatomical analyses, influencing interventional strategies and resulting in a better outcome. Conclusions: With the knowledge of procedure-specific MDCTA findings in various vascular conditions, the radiologist and surgeon are able to perform an efficient pre-interventional planning and follow-up examination. Based on our experience with this novel technique of combined open and endovascular aortic aneurysm treatment, this pictorial review illustrates procedure-specific imaging findings, including common and rare complications, with respect to 2D and 3D post-processing technique

Maximum Diameter Measurements of Aortic Aneurysms on Axial CT Images After Endovascular Aneurysm Repair: Sufficient for Follow-up?

Purpose: To assess the accuracy of maximum diameter measurements of aortic aneurysms after endovascular aneurysm repair (EVAR) on axial computed tomographic (CT) images in comparison to maximum diameter measurements perpendicular to the intravascular centerline for follow-up by using three-dimensional (3D) volume measurements as the reference standard. Materials and Methods: Forty-nine consecutive patients (73±7.5years, range 51-88years), who underwent EVAR of an infrarenal aortic aneurysm were retrospectively included. Two blinded readers twice independently measured the maximum aneurysm diameter on axial CT images performed at discharge, and at 1 and 2years after intervention. The maximum diameter perpendicular to the centerline was automatically measured. Volumes of the aortic aneurysms were calculated by dedicated semiautomated 3D segmentation software (3surgery, 3mensio, the Netherlands). Changes in diameter of 0.5cm and in volume of 10% were considered clinically significant. Intra- and interobserver agreements were calculated by intraclass correlations (ICC) in a random effects analysis of variance. The two unidimensional measurement methods were correlated to the reference standard. Results: Intra- and interobserver agreements for maximum aneurysm diameter measurements were excellent (ICC=0.98 and ICC=0.96, respectively). There was an excellent correlation between maximum aneurysm diameters measured on axial CT images and 3D volume measurements (r=0.93, P<0.001) as well as between maximum diameter measurements perpendicular to the centerline and 3D volume measurements (r=0.93, P<0.001). Conclusion: Measurements of maximum aneurysm diameters on axial CT images are an accurate, reliable, and robust method for follow-up after EVAR and can be used in daily routin

Long-term Survival After Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysms

Pla general interior de l'estació de Roquetes Andana central de 8m. d'ample, 100m de llargada i a 50m profunditat, amb bancs de pedra de color blanc en el centre

Emergency stent-graft placement for hemorrhage control in acute thoracic aortic rupture

Objective: To report mid-term results of stent-graft (SG) implantation in acute thoracic aortic rupture as alternative to conventional open surgery with its associated high morbidity and mortality rates. Methods: Out of a series of 69 patients undergoing thoracic aortic SG implantation since 1998, 24 (mean age 57±19 years, range 20-85-years-old) patients were treated on an emergency basis for hemorrhage control. The indication for SG placement was acute traumatic aortic rupture in 15 patients, type B dissection with contained rupture in 3 patients, penetrating aortic ulcer with periaortic hematoma in 3 patients, and thoracic aortic aneurysm rupture in 3 patients. Preoperative assessment was done by computed tomography (CT) scanning and echography. Patients were treated in the angiography suite by implantation of Excluder (n=18), Talent (n=4), Corvita (n=1), and Vanguard (n=1) self-expanding grafts. Local anesthesia was the most frequently used anaesthesiologic technique. Results: Technical success rate of SG deployment was 100%. The early postoperative mortality was 12.5% (3 of 24). One patient suffered temporary paraplegia (4%). There was no intervention-related mortality during the mean follow-up of 34.1 months. Two secondary endoleaks were successfully treated with additional SG placement at 2 and 12 months postoperative, respectively. Conclusions: Emergency SG repair to control hemorrhage in patients with an acute thoracic aortic rupture is a less-invasive attractive and rational treatment option, especially if associated lesions or co-morbidity may interfere with the surgical outcome. Long-term follow-up results will be helpful to clarify procedure durability bounded by material failure and postoperative aneurysm or aortic wall remodellin

Maximum diameter measurements of aortic aneurysms on axial CT images after endovascular aneurysm repair: sufficient for follow-up?

PURPOSE: To assess the accuracy of maximum diameter measurements of aortic aneurysms after endovascular aneurysm repair (EVAR) on axial computed tomographic (CT) images in comparison to maximum diameter measurements perpendicular to the intravascular centerline for follow-up by using three-dimensional (3D) volume measurements as the reference standard. MATERIALS AND METHODS: Forty-nine consecutive patients (73 ± 7.5 years, range 51-88 years), who underwent EVAR of an infrarenal aortic aneurysm were retrospectively included. Two blinded readers twice independently measured the maximum aneurysm diameter on axial CT images performed at discharge, and at 1 and 2 years after intervention. The maximum diameter perpendicular to the centerline was automatically measured. Volumes of the aortic aneurysms were calculated by dedicated semiautomated 3D segmentation software (3surgery, 3mensio, the Netherlands). Changes in diameter of 0.5 cm and in volume of 10% were considered clinically significant. Intra- and interobserver agreements were calculated by intraclass correlations (ICC) in a random effects analysis of variance. The two unidimensional measurement methods were correlated to the reference standard. RESULTS: Intra- and interobserver agreements for maximum aneurysm diameter measurements were excellent (ICC = 0.98 and ICC = 0.96, respectively). There was an excellent correlation between maximum aneurysm diameters measured on axial CT images and 3D volume measurements (r = 0.93, P < 0.001) as well as between maximum diameter measurements perpendicular to the centerline and 3D volume measurements (r = 0.93, P < 0.001). CONCLUSION: Measurements of maximum aneurysm diameters on axial CT images are an accurate, reliable, and robust method for follow-up after EVAR and can be used in daily routine

Classes of common factors of psychotherapy and their associations with therapy techniques

Theoretischer Hintergrund: Bis heute wird die Frage, welche Faktoren für die Wirkung von Psychotherapie verantwortlich sind, kontrovers diskutiert. Im Zentrum dieser Diskussion stehen zwei vermeintlich gegensätzliche Wirkmodelle – das Modell spezifisch wirksamer Therapietechniken und das allgemeine Wirkfaktorenmodell. Allgemeine Wirkfaktoren und Therapietechniken sind konzeptuell jedoch auf unterschiedlichen Ebenen des Psychotherapieprozesses angesiedelt. An Stelle der Entweder-oder-Debatte sollte deshalb die Analyse ihres Zusammenwirkens in den Vordergrund rücken. Fragestellung: Mit Hilfe von Expertenratings wurde untersucht, ob sich verschiedene allgemeine Wirkfaktoren durch typische Zusammenhänge mit bestimmten Therapietechniken zu übergeordneten Klassen zusammenfassen lassen. Methode: 68 deutschsprachige Psychotherapieexperten schätzten in einer internetbasierten Umfrage ein, mit wel- chen spezifischen Therapietechniken verschiedene allgemeine Wirkfaktoren zusammenhängen. Mittels Faktorenanalyse wurde dann ge- prüft, welche Klassen von allgemeinen Wirkfaktoren sich durch bestimmte Muster von Technikzusammenhängen abbilden. Durch eine hierarchische Regressionsanalyse wurden zudem die Stärke und Richtung der Zusammenhänge zwischen einzelnen Wirkfaktorenklassen und den verschiedenen Techniken untersucht. Ergebnisse: Die Faktorenanalyse zeigt, dass den Zusammenhängen zwischen allgemeinen Wirkfaktoren und Techniken eine vierdimensionale Struktur unterliegt. Die vier Klassen von allgemeinen Wirkfaktoren hängen jeweils mit einer bestimmten Gruppe von Therapietechniken zusammen. Schlussfolgerungen: Die Vielzahl allgemeiner Wirkfaktoren lässt sich mittels ihrer Operationalisierung durch Therapietechniken zusammenfassen.Background: There is considerable disagreement as to what makes psychotherapy effective. The controversy about the comparative efficacy of different modalities of psychotherapy has generated two different major perspectives: the specific ingredients assumption and the common factors model. However, conceptual considerations suggest a synergistic view of common factors and specific techniques. Objective: Based on ratings of 68 German-speaking psychotherapy experts we examined whether the different common factors can be summarized among superordinate classes according to their associations with specific techniques. Method: Psychotherapy experts rated the degree of associations between various common factors and techniques in a web-based survey. A factor analysis was performed to analyze the dimensional structure of common factors, which underlies the rated associations between common factors and specific techniques. In addition, the strength, the direction, and the technical patterns of the different classes of common factors were analyzed by regression analysis. Results: The factor analysis revealed that common factors can be described by a four-dimensional structure. The four classes of common factors are characterized by a set of specifically associated techniques. Conclusion: The multitude of common factors can be reduced by a technique-related operationalization

Psychotherapie bei schizophrenen Psychosen Rolle, Ziele und Wirksamkeit

Das Recovery-Konzept, das heute die Zielvorgaben der Behandlung und Rehabilitation schizophrener Erkrankungen bestimmt, bietet nicht nur ein konzeptuell begründetes Therapierationale für symptom- und problemorientierte psychotherapeutische Interventionen. Mit der Thematisierung des subjektiven Anpassungsprozesses, den schizophren Erkrankte im Hinblick auf die Überwindung ihrer Selbststigmatisierung, die Entwicklung eines positiven Selbstwerts und die Rückgewinnung einer möglichst selbstbestimmten Lebensführung zu leisten haben, wird die Rolle der Psychotherapie bei schizophrenen Psychosen erheblich erweitert

Wirkfaktoren der Psychotherapie – eine Übersicht und Standortbestimmung

Zusammenfassung.Psychotherapie wirkt. Wie, ist weitgehend unklar. Vor dem Hintergrund der Kontroverse über die unterschiedliche Wirksamkeit verschiedener Psychotherapieansätze haben sich zwei gegensätzliche Vorstellungen darüber entwickelt, was Psychotherapie wirksam macht: Vertreter der Sichtweise, dass zwischen verschiedenen Psychotherapierichtungen nur geringe Wirkunterschiede bestehen, führen die Wirksamkeit von Psychotherapie auf allgemeine Wirkfaktoren zurück. Befürworter empirisch fundierter Psychotherapieansätze gehen dagegen von verfahren- oder störungsspezifischen Wirkfaktoren aus. Mit dem Wirkfaktorenbegriff sowie der dichotomen Gegenüberstellung der zwei Arten von Wirkfaktoren sind jedoch eine Reihe terminologischer und konzeptueller Schwierigkeiten verbunden: Es liegt keine klare und einheitliche Definition des Wirkfaktorenbegriffs vor; Wirkfaktoren können außerdem verschiedensten Ebenen des Therapieprozesses zugeordnet werden. Die begrifflichen Unklarheiten, das Ebenenproblem sowie die Befundlage stellen die Dichotomie in Frage. Konzeptuell angemessener erscheint eine Perspektive, die spezifische und allgemeine Wirkfaktoren in ihrer synergistischen Wirkung sowie ihrem Zusammenspiel mit Störungsparametern und individuellen Patientenmerkmalen betrachtet. </jats:p