From research to practice: Implementing an experimental home treatment model into routine mental health care

Background In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. Methods We compared patients who received HT during the RCT study phase with patients who received the same HT service after it had become part of routine mental health services in the same catchment area. Sociodemographic and clinical characteristics as well as service use (HT and hospital bed days) were compared between the RCT and the subsequent routine care study period. Results Compared to patients who received HT during the RCT, routine care HT patients were more often living with others, less often admitted compulsorily, more often diagnosed with anxiety and stress-related disorders (ICD-10 F4) and less often diagnosed with schizophrenia spectrum disorders (F2). When compared to patients who were exclusively treated on hospital wards, involvement of the HT team in patients’ care was associated with a clear-cut reduction of hospital bed days both during the RCT and under routine care conditions. However, unlike during the RCT study period, involvement of HT was associated with longer overall treatment episodes (inpatient + HT days) under routine care conditions. Conclusions HT seems to reduce the use of hospital bed days even under routine care conditions but is at risk of producing longer overall acute treatment episodes

Facharztweiterbildung Psychiatrie und Psychotherapie: Problemorientiertes Lernen - Evaluation eines Modellprojekts

Zusammenfassung: Die Betonung individueller Lernbedürfnisse, der Fähigkeit zur Lösung komplexer klinischer Probleme sowie einer von interkollegialer Kommunikation geprägten professionellen Grundhaltung durch das problemorientierte Lernen (POL) spricht für dessen Eignung als didaktisches Format in der Facharztweiterbildung. Dennoch wurde es bisher selten hierfür eingesetzt. Im Rahmen dieses Modellprojektes wurde das POL in das Kurrikulum der strukturierten Facharztweiterbildung Psychiatrie und Psychotherapie aufgenommen und über einen Zeitraum von 12Monaten mittels strukturierter Fragebögen evaluiert. Es fanden im Evaluationszeitraum 41POL-Kurse statt, an denen insgesamt 447 Assistenzärzte teilnahmen. Die Teilnehmer und die Tutoren bewerteten 19 von 21 erfragten Aspekten der POL-Kurse als gut bis sehr gut (Mittelwert auf einer 5-stufigen Likert-Skala >4). Insgesamt wurde das POL als besonders geeignet für die Weiterbildung eingeschätzt (Teilnehmer 4,5±0,8; Tutoren 5,0±0,2). Die Ergebnisse dieses Modellprojekts sprechen für die Eignung des POL als Teil eines vielfältigen Weiterbildungsangebots, um den Praxisbezug und die Anwendbarkeit des Wissens im klinischen Alltag zu stärke

Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: A longitudinal study

The relationship between acute stress disorder (ASD), posttraumatic stress disorder symptoms (PTSD), and chronic pain was investigated in a longitudinal study of injured accident victims (N = 323, 64.7% men). Assessments took place 5 days (T1), 6 (T2) months, and 12 (T3) months postaccident. Relations between pain and posttraumatic stress symptoms were tested by structural equation modeling. Subjects diagnosed with full or subsyndromal PTSD at T2 and at T3 (14 and 19%) reported significantly higher pain intensity. Cross-lagged panel analysis yielded a mutual maintenance of pain intensity and ASD or PTSD symptoms across T2. Across the second half year, PTSD symptoms impacted significantly on pain but not vice versa. Clinicians need to pay careful attention to PTSD symptoms in accident survivors suffering from chronic pain

Genome-wide association study for 13 udder traits from linear type classification in cattle

Udder conformation traits are known to correlate with the incidence of clinical mastitis and the length of productive life. The results of a genome-wide association study based on imputed high-density genotypes of 1,637 -Brown Swiss sires and de-regressed breeding values for 13 udder traits are presented here. For seven traits significant signals could be observed in five regions on BTA3, BTA5, BTA6, BTA17, and BTA25. For fore udder length and teats diameter significant SNPs were found in a known region around 90 Mb on BTA6. For the trait rear udder height significant SNPs are positioned in the coding region of the SNX29gene. Several significant SNPs around 62 Mb on BTA17 are associated with the traits rear udder width, frontteat placement and rear teat placement. The function of potential candidate genes and the influence of substructure will be addressed as next steps

Psychotherapie für alle?: Zur Indikation für psychotherapeutische Behandlungen

Zusammenfassung: Hintergrund: Die Wirksamkeit der Psychotherapie zur Behandlung der meisten psychischen Störungen ist empirisch sehr überzeugend belegt. Es gibt aber weltweit bei weitem nicht genügend Therapeuten, um alle Menschen mit psychischen Erkrankungen angemessen psychotherapeutisch behandeln zu können. Fragestellung und Methodik: Es werden Überlegungen zu der Frage dargestellt, welche Krankheiten, Störungen oder Probleme generell psychotherapeutisch behandelt werden sollen, wer diese Behandlungen am besten durchführt und wie die Dissemination evidenzbasierter Ansätze trotz knapper Ressourcen verbessert werden kann. Ergebnisse: Je schwerer eine Gesundheitsstörung ausgeprägt ist, umso höher ist in aller Regel auch der therapeutische Nutzen einer Intervention. Das gilt auch für die Psychotherapie. Aber gerade die schwer kranken Menschen werden heute oft nicht mit wirksamen psychotherapeutischen Interventionen behandelt. Ein Grund hierfür ist, dass es wenig validierte Therapiekonzepte für multimorbide Patienten mit psychischen und somatischen Erkrankungen gibt. Ein weiterer Grund besteht darin, dass deren Behandlung ein spezifisches medizinisches Wissen sowie weitere spezielle Fähigkeiten und Erfahrungen erfordert, die bei weitem nicht alle Psychotherapeuten besitzen. Schlussfolgerungen: Die Indikation zur Psychotherapie soll immer sorgsam, mit Augenmaß, unter Berücksichtigung der verfügbaren wissenschaftlichen Evidenz und klinischer Erfahrungswerte gestellt werden. Zukünftig sollten sich die Ausbildung von Psychotherapeuten, die wissenschaftlichen Untersuchungen von Psychotherapien und die klinischen Angebote verstärkt auf Patienten mit schweren psychischen Störungen und/oder mit psychischen und somatischen Komorbiditäten konzentrieren

The long-term prediction of return to work following serious accidental injuries: A follow up study

Background Considerable indirect costs are incurred by time taken off work following accidental injuries. The aim of this study was to predict return to work following serious accidental injuries. Method 121 severely injured patients were included in the study. Complete follow-up data were available for 85 patients. Two weeks post trauma (T1), patients rated their appraisal of the injury severity and their ability to cope with the injury and its job-related consequences. Time off work was assessed at one (T2) and three years (T3) post accident. The main outcome was the number of days of sick leave taken due to the accidental injury. Results The patients' appraisals a) of the injury severity and b) of their coping abilities regarding the accidental injury and its job-related consequences were significant predictors of the number of sick-leave days taken. Injury severity (ISS), type of accident, age and gender did not contribute significantly to the prediction. Conclusions Return to work in the long term is best predicted by the patients' own appraisal of both their injury severity and the ability to cope with the accidental injury

Measuring and modelling the isotopic composition of soil respiration: insights from a grassland tracer experiment

The carbon isotopic composition (δ<sup>13</sup>C) of CO<sub>2</sub> efflux (δ<sup>13</sup>C<sub>efflux</sub>) from soil is generally interpreted to represent the actual isotopic composition of the respiratory source (δ<sup>13</sup>C<sub>Rs</sub>). However, soils contain a large CO<sub>2</sub> pool in air-filled pores. This pool receives CO<sub>2</sub> from belowground respiration and exchanges CO<sub>2</sub> with the atmosphere (via diffusion and advection) and the soil liquid phase (via dissolution). Natural or artificial modification of δ<sup>13</sup>C of atmospheric CO<sub>2</sub> (δ<sup>13</sup>C<sub>atm</sub>) or δ<sup>13</sup>C<sub>Rs</sub> causes isotopic disequilibria in the soil-atmosphere system. Such disequilibria generate divergence of δ<sup>13</sup>C<sub>efflux</sub> from δ<sup>13</sup>C<sub>Rs</sub> (termed "disequilibrium effect"). <br><br> Here, we use a soil CO<sub>2</sub> transport model and data from a <sup>13</sup>CO<sub>2</sub>/<sup>12</sup>CO<sub>2</sub> tracer experiment to quantify the disequilibrium between δ<sup>13</sup>C<sub>efflux</sub> and δ<sup>13</sup>C<sub>Rs</sub> in ecosystem respiration. The model accounted for diffusion of CO<sub>2</sub> in soil air, advection of soil air, dissolution of CO<sub>2</sub> in soil water, and belowground and aboveground respiration of both <sup>12</sup>CO<sub>2</sub> and <sup>13</sup>CO<sub>2</sub> isotopologues. The tracer data were obtained in a grassland ecosystem exposed to a δ<sup>13</sup>C<sub>atm</sub> of −46.9 ‰ during daytime for 2 weeks. Nighttime δ<sup>13</sup>C<sub>efflux</sub> from the ecosystem was estimated with three independent methods: a laboratory-based cuvette system, in-situ steady-state open chambers, and in-situ closed chambers. <br><br> Earlier work has shown that the δ<sup>13</sup>C<sub>efflux</sub> measurements of the laboratory-based and steady-state systems were consistent, and likely reflected δ<sup>13</sup>C<sub>Rs</sub>. Conversely, the δ<sup>13</sup>C<sub>efflux</sub> measured using the closed chamber technique differed from these by −11.2 ‰. Most of this disequilibrium effect (9.5 ‰) was predicted by the CO<sub>2</sub> transport model. Isotopic disequilibria in the soil-chamber system were introduced by changing δ<sup>13</sup>C<sub>atm</sub> in the chamber headspace at the onset of the measurements. When dissolution was excluded, the simulated disequilibrium effect was only 3.6 ‰. Dissolution delayed the isotopic equilibration between soil CO<sub>2</sub> and the atmosphere, as the storage capacity for labelled CO<sub>2</sub> in water-filled soil pores was 18 times that of soil air. <br><br> These mechanisms are potentially relevant for many studies of δ<sup>13</sup>C<sub>Rs</sub> in soils and ecosystems, including FACE experiments and chamber studies in natural conditions. Isotopic disequilibria in the soil-atmosphere system may result from temporal variation in δ<sup>13</sup>C<sub>Rs</sub> or diurnal changes in the mole fraction and δ<sup>13</sup>C of atmospheric CO<sub>2</sub>. Dissolution effects are most important under alkaline conditions

Strategic responses to global challenges: The case of European banking, 1973–2000

In applying a strategy, structure, ownership and performance (SSOP) framework to three major clearing banks (ABN AMRO, UBS, Barclays), this article debates whether the conclusions generated by Whittington and Mayer about European manufacturing industry can be applied to the financial services sector. While European integration plays a key role in determining strategy, it is clear that global factors were far more important in determining management actions, leading to significant differences in structural adaptation. The article also debates whether this has led to improved performance, given the problems experienced with both geographical dispersion and diversification, bringing into question the quality of decision-making over the long term