"Kundenzufriedenheit" bei ambulanten Pflegedienstleistern: Bestandsaufnahme und Vorschläge für ein stresstheoretisch fundiertes Messinstrument

Der Artikel gibt einen Überblick zum Stand der Forschung zur Qualitätssicherung in der ambulanten Pflege. Es werden Erfahrungen und Instrumente zur Messung von Patientenzufriedenheit referiert. Die unzureichende theoretische Fundierung der meisten Messinstrumente wird als Manko herausgestellt. Aufbauend auf stresstheoretischen Überlegungen werden Vorschläge zur Fundierung eines neuen Instrumentes unterbreitet. Grundlage ist das transaktionale Modell von Lazarus und Launier. Zusätzlich werden theoretische Überlegungen zu den Facetten des Konstruktes entwickelt. Es folgen Beispiele zur Operationalisierung. Ein Fazit sowie ein Ausblick auf geplante Vorhaben bilden den Schluss des Artikels.This report deals with quality assurance in ambulant care. Experiences are discussed and instruments for the measurement of patient satisfaction are presented. Most of the instruments lack a theoretical basis. Therefore stress theories are suggested as theoretical background for the measurement of the construct. The further argumentation is based on a transactional perspective. Additionally facets and components of the construct are developed. The report finishes with examples for the operationalization, a final conclusion and an outlook an future plans

Investigations of the Oligocene-Miocene opening of the Ligurian Basin using refraction seismic data

The Ligurian Basin is located north-west of Corsica at the transition from the western Alpine orogen to the Apennine system. The Back-arc basin was generated by the southeast trench retreat of the Apennines-Calabrian subduction zone. The opening took place from late Oligocene to Miocene. While the extension led to extreme continental thinning and un-roofing of mantle material little is known about the style of back-arc rifting. To shed light on the present day crustal and lithospheric architecture of the Ligurian Basin, active seismic data have been recorded on short period ocean bottom seismometers in the framework of SPP2017 4D-MB, the German component of AlpArray. An amphibious refraction seismic profile was shot across the Ligurian Basin in an E-W direction from the Gulf of Lion to Corsica. The profile extends onshore Corsica to image the necking zone of continental thinning. The majority of the refraction seismic data show mantle phases at offsets up to 70 km. The arrivals of seismic phases were picked and inverted in a travel time tomography. The results show a crust-mantle boundary in the central basin at ~12 km depth below sea surface. The mantle shows rather high velocities >7.8 km/s. The crust-mantle boundary deepens from ~12 km to ~18 km within 25 - 30 km towards Corsica. The results do not map an axial valley as expected for oceanic spreading. However, an extremely thinned continental crust indicates a long lasting rifting process that possibly does not initiated oceanic spreading before the opening of the Ligurian Basin stopped

Quantitative assessment of the asphericity of pretherapeutic FDG uptake as an independent predictor of outcome in NSCLC

Background The aim of the present study was to evaluate the predictive value of a novel quantitative measure for the spatial heterogeneity of FDG uptake, the asphericity (ASP) in patients with non-small cell lung cancer (NSCLC). Methods FDG-PET/CT had been performed in 60 patients (15 women, 45 men; median age, 65.5 years) with newly diagnosed NSCLC prior to therapy. The FDG-PET image of the primary tumor was segmented using the ROVER 3D segmentation tool based on thresholding at the volume-reproducing intensity threshold after subtraction of local background. ASP was defined as the relative deviation of the tumor’s shape from a sphere. Univariate and multivariate Cox regression as well as Kaplan-Meier (KM) analysis and log-rank test with respect to overall (OAS) and progression-free survival (PFS) were performed for clinical variables, SUVmax/mean, metabolically active tumor volume (MTV), total lesion glycolysis (TLG), ASP and “solidity”, another measure of shape irregularity. Results ASP, solidity and “primary surgical treatment” were significant independent predictors of PFS in multivariate Cox regression with binarized parameters (HR, 3.66; p < 0.001, HR, 2.11; p = 0.05 and HR, 2.09; p = 0.05), ASP and “primary surgical treatment” of OAS (HR, 3.19; p = 0.02 and HR, 3.78; p = 0.01, respectively). None of the other semi-quantitative PET parameters showed significant predictive value with respect to OAS or PFS. Kaplan-Meier analysis revealed a probability of 2-year PFS of 52% in patients with low ASP compared to 12% in patients with high ASP (p < 0.001). Furthermore, it showed a higher OAS rate in the case of low versus high ASP (1-year-OAS, 91% vs. 67%: p = 0.02). Conclusions The novel parameter asphericity of pretherapeutic FDG uptake seems to provide better prognostic value for PFS and OAS in NCSLC compared to SUV, metabolic tumor volume, total lesion glycolysis and solidity

From gradual spreading to catastrophic collapse - Reconstruction of the 1888 Ritter Island volcanic sector collapse from high-resolution 3D seismic data

Volcanic island flank collapses have the potential to trigger devastating tsunamis threatening coastal communities and infrastructure. The 1888 sector collapse of Ritter Island, Papua New Guinea (in the following called Ritter) is the most voluminous volcanic island flank collapse in historic times. The associated tsunami had run-up heights of more than 20 m on the neighboring islands and reached settlements 600 km away from its source. This event provides an opportunity to advance our understanding of volcanic landslide-tsunami hazards. Here, we present a detailed reconstruction of the 1888 Ritter sector collapse based on high-resolution 2D and 3D seismic and bathymetric data covering the failed volcanic edifice and the associated mass-movement deposits. The 3D seismic data reveal that the catastrophic collapse of Ritter occurred in two phases: (1) Ritter was first affected by deep-seated, gradual spreading over a long time period, which is manifest in pronounced compressional deformation within the volcanic edifice and the adjacent seafloor sediments. A scoria cone at the foot of Ritter acted as a buttress, influencing the displacement and deformation of the western flank of the volcano and causing shearing within the volcanic edifice. (2) During the final, catastrophic phase of the collapse, about 2.4 km³ of Ritter disintegrated almost entirely and travelled as a highly energetic mass flow, which incised the underlying sediment. The irregular topography west of Ritter is a product of both compressional deformation and erosion. A crater-like depression underlying the recent volcanic cone and eyewitness accounts suggest that an explosion may have accompanied the catastrophic collapse. Our findings demonstrate that volcanic sector collapses may transform from slow gravitational deformation to catastrophic collapse. Understanding the processes involved in such a transformation is crucial for assessing the hazard potential of other volcanoes with slowly deforming flanks such as Mt. Etna or Kilauea

RV SONNE 252 Cruise Report / Fahrtbericht, Yokohama : 05.11.2016 - Nouméa : 18.12.2016. SO252 : RITTER ISLAND Tsunami potential of volcanic flank collapses

Large volcanic debris flows associated with volcanic island flank collapses may cause devastating tsunamis as they enter the ocean. Computer simulations show that the largest of these volcanic debris flows on oceanic islands such as Hawaii or the Canaries can cause ocean-wide tsunamis (Løvholt et al., 2008; Waythomas et al., 2009). However, the magnitude of these tsunamis is subject to on-going debate as it depends particularly on landslide transport and emplacement processes (Harbitz et al. 2013). A robust understanding of these factors is thus essential in order to assess the hazard of volcanic flank collapses. Recent studies have shown that emplacement processes are far more complex than assumed previously. With a collapsed volume of about 5 km3 the 1888 Ritter Island flank collapse is the largest in historic times and represents an ideal natural laboratory for several reasons: (I) The collapse is comparatively young and the marine deposits are clearly visible, (II) the pre-collapse shape of the island is historically documented and (III) eyewitness reports documenting tsunami arrival times, run-up heights and inundation levels on neighboring islands are available. We propose to collect bathymetric, high resolution 2D and 3D seismic data as well as seafloor samples from the submarine deposits off Ritter Island to learn about the mobility and emplacement dynamics of the 1888 flank collapse landslide. A comparison to similar studies from other volcanic islands will provide an improved understanding of emplacement processes of volcanic island landslides and their overall tsunamigenic potential. In addition, a detailed knowledge of the 1888 landslide processes in combination with tsunami constraints from eyewitness reports provides a unique possibility to determine the landslide velocity, which can then be used in subsequent hazard analyses for ocean islands.peer-reviewe

Extremely thinned continental crust underneath the Ligurian Basin?

The Ligurian Basin is situated at the transition from the western Alpine orogeny to the Apennine system, an area where a change in subduction polarity is observed. The back-arc basin was generated by the southeast trench retreat of the Apennines-Calabrian subduction zone. The opening took place from late Oligocene to Miocene. While the extension led to continental thinning and subsidence, oceanic spreading with unroofing of mantle material was proposed for the late opening period, 21-16 Ma. To shed light on the present day crustal and lithospheric architecture of the Ligurian Basin, active and passive seismic data have been recorded on ocean bottom seismometers of a long-term network consisting of 29 broad-band stations, installed from June 2017 to February 2018 in the framework of SPP2017 4D-MB, the German component of AlpArray. Two refraction seismic profiles were shot to serve two aspects: (1) Determine the orientation of the horizontal components of the long-term instruments and (2) estimate the velocity distribution of the upper lithosphere, to provide a velocity model for the passive seismic data analysis. Good quality data have been recorded, regional and teleseismic events as well as active shots could be detected by the network stations. The majority of the refraction seismic data show mantle phases at offsets up to 70 km and a very prominent wide-angle reflection originating at the crust mantle boundary. Its features share a number of characteristics (i.e. offset range, continuity) generally associated with continental settings rather than mimicking seafloor spreading lithosphere emplaced in back-arc basins. Based on traveltime tomography along the refraction lines, the crust-mantle boundary is determined at ~9.5 km depth below seafloor. The acoustic basement is difficult to map seismically. The transition to the crystalline basement is indicated at a depth of ~6.5 km below seafloor. The absolute seismic velocities can be interpreted as hyper-extended continental crust or serpentinised mantle. The thick sedimentary coverage allows for long lasting extension of the crust. The crustal portion interpreted from the seismic velocities thickens towards the north which is in good agreement with the anti-clockwise rotation of the Corsica-Sardinia block and an associated gradual opening of the Ligurian Basin

Comparative efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus Supportive Psychotherapy for early onset chronic depression: design and rationale of a multisite randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Effective treatment strategies for chronic depression are urgently needed since it is not only a common and particularly disabling disorder, but is also considered treatment resistant by most clinicians. There are only a few studies on chronic depression indicating that traditional psycho- and pharmacological interventions are not as effective as in acute, episodic depression. Current medications are no more effective than those introduced 50 years ago whereas the only psychotherapy developed specifically for the subgroup of chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), faired well in one large trial. However, CBASP has never been directly compared to a non-specific control treatment.</p> <p>Methods/Design</p> <p>The present article describes the study protocol of a multisite parallel-group randomized controlled trial in Germany. The purpose of the study is to estimate the efficacy of CBASP compared to supportive psychotherapy in 268 non-medicated early-onset chronically depressed outpatients. The intervention includes 20 weeks of acute treatment with 24 individual sessions followed by 28 weeks of continuation treatment with another 8 sessions. Depressive symptoms are evaluated 20 weeks after randomisation by means of the 24-item Hamilton Rating Scale of Depression (HRSD). Secondary endpoints are depressive symptoms after 12 and 48 weeks, and remission after 12, 20, and 48 weeks. Primary outcome will be analysed using analysis of covariance (ANCOVA) controlled for pre-treatment scores and site. Analyses of continuous secondary variables will be performed using linear mixed models. For remission rates, chi-squared tests and logistic regression will be applied.</p> <p>Discussion</p> <p>The study evaluates the comparative effects of a disorder-specific psychotherapy and a well designed non-specific psychological approach in the acute and continuation treatment phase in a large sample of early-onset chronically depressed patients.</p> <p>Trial registration</p> <p>ClinicalTrials.gov (<a href="http://www.clinicaltrials.gov/ct2/show/NCT00970437">NCT00970437</a>).</p

Decline in the number of patients with meningitis in German hospitals during the COVID-19 pandemic

BACKGROUND AND OBJECTIVES: In 2020, a wide range of hygiene measures was implemented to mitigate infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In consequence, pulmonary infections due to other respiratory pathogens also decreased. Here, we evaluated the number of bacterial and viral meningitis and encephalitis cases during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In a multicentre retrospective analysis of data from January 2016 until December 2020, numbers of patients diagnosed with bacterial meningitis and other types of CNS infections (such as viral meningitis and encephalitis) at 26 German hospitals were studied. Furthermore, the number of common meningitis-preceding ear-nose-throat infections (sinusitis, mastoiditis and otitis media) was evaluated. RESULTS: Compared to the previous years, the total number of patients diagnosed with pneumococcal meningitis was reduced (n = 64 patients/year in 2020 vs. n = 87 to 120 patients/year between 2016 and 2019, all p < 0.05). Additionally, the total number of patients diagnosed with otolaryngological infections was significantly lower (n = 1181 patients/year in 2020 vs. n = 1525 to 1754 patients/year between 2016 and 2019, all p < 0.001). We also observed a decline in viral meningitis and especially enterovirus meningitis (n = 25 patients/year in 2020 vs. n = 97 to 181 patients/year between 2016 and 2019, all p < 0.001). DISCUSSION: This multicentre retrospective analysis demonstrates a decline in the number of patients treated for viral and pneumococcal meningitis as well as otolaryngological infections in 2020 compared to previous years. Since the latter often precedes pneumococcal meningitis, this may point to the significance of the direct spread of pneumococci from an otolaryngological focus such as mastoiditis to the brain as one important pathophysiological route in the development of pneumococcal meningitis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-022-11034-w