Multimediales Lernen in der medizinischen Ausbildung: Möglichkeiten, Nutzung, Grenzen

Multimediales Lernen gewinnt in der medizinischen Ausbildung zunehmend an Bedeutung. Eine Analyse vorhandener Lernprogramme auf CD-ROM und im Internet zeigt, dass das aktuelle Angebot breit und vielfältig ist. Jedoch gibt es auch Reserven, beispielsweise hinsichtlich der Interaktivität und der Interdisziplinarität der Lernsysteme. Im Rahmen einer Befragung von Studierenden der Medizin wurde deutlich, dass Lernprogramme auf CD-ROM insgesamt nur selten, im Internet so gut wie gar nicht genutzt werden. Neben der Einstellung der Studierenden zum multimedialen Lernen scheinen dabei insbesondere praktische Probleme mit der geringen Nutzung in Zusammenhang zu stehen. Ein entscheidendes Hindernis ist die fehlende Information über entsprechende Angebote. Nur ein kleiner Teil der Studenten weiß über Lernprogramme durch Lehrende. Dies hängt nach den Ergebnissen der hier vorgestellten Dozentenbefragung unter anderem damit zusammen, dass eine Vielzahl der Lehrenden keine Lernprogramme kennt. Kennen die Dozenten jedoch Lernprogramme, dann empfehlen sie diese in der Regel auch ihren Studierenden. Hauptgrund für die Nichtempfehlung von multimedialen Lernangeboten trotz deren Kenntnis ist nach Meinung der Dozenten vor allem die fehlenden Vorteile vieler Lernprogramme gegenüber "klassischen" Lernmaterialien wie z.B. Büchern. Eine Befragung von Lernprogramm-Entwicklern und Lehrenden zeigt darüber hinaus, dass bei der Entwicklung von Lernprogrammen und deren Nutzung durch die Studierenden zahlreiche Probleme auftreten. Zum einen ist zur Erstellung ein erheblicher finanzieller und personeller Aufwand nötig. Entscheidend ist zudem, dass die Prüfungsrelevanz der multimedialen Angebote oftmals nicht gegeben ist, die Programme also an den Bedürfnissen der Studierenden vorbeigehen. Weiterhin führt die mangelnde Implementierung bzw. curriculare Einbindung der Lernprogramme häufig dazu, dass die Nutzung der entsprechenden Angebote hinter den Erwartungen zurück bleibt. Eng damit verbunden ist auch das Problem der fehlenden Nachhaltigkeit vieler Projekte, das die langfristige Nutzung der entwickelten Lernsysteme erschwert. Ber der künftigen Entwicklung und dem Einsatz medizinischer Lernprogramme sind diese Probleme zu berücksichtigen und langfristige Konzepte der Universitäten und Hochschulen zur nachhaltigen Nutzung erforderlich

Prospective Associations of Lifetime Post-traumatic Stress Disorder and Birth-Related Traumatization With Maternal and Infant Outcomes

Objective: Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes. Methods: In the prospective-longitudinal Maternal in Relation to Infants' Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations. Results: A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birth-related traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems. Conclusion: Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted. Implications: Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.Peer Reviewe

study protocol for a randomised-controlled trial

Introduction: As a consequence of sepsis and intensive care, considerable proportions of patients but also of their spouses develop a post-traumatic stress disorder (PTSD). However, only a very small number receive psychotherapeutic treatment. Internet-based cognitive–behavioural writing therapy (IB-CBWT) has proven to be an effective treatment option for PTSD. It seems to fit the specific needs of this cohort and to overcome treatment barriers. Aim of the REPAIR trial is to examine the efficacy, safety and applicability of IB-CBWT for PTSD in patients and their spouses after intensive care for sepsis. Methods and analysis: Participants will be assigned randomly either to a treatment or a wait-list (WL) control group. The treatment group receives IB-CBWT for PTSD, actively involving the partners of the participants. IB-CBWT will be guided by a therapist and comprises two written assignments per week over a 5 week period. After completing the assignments, the participants obtain individual responses from the therapist. Participants of the WL control group will receive treatment after a waiting period of 5 weeks. The primary outcome is PTSD symptom severity in self-rated PTSD Checklist for Diagnostic and Statistical Manual Fifth Edition at the end of treatment and waiting time, respectively. Secondary outcomes are remission of PTSD, depression, anxiety, and somatisation measured by the Brief Symptom Inventory-18, marital satisfaction measured by the Relationship Assessment Scale, health-related quality of life measured by the EQ-5D-5L, and the feasibility of IB-CBWT for this cohort (ie, dropout rate). Statistical analysis will be performed according to the intent-to-treat principle. Ethics and dissemination: The study is conducted according to the principles of Good Clinical Practice and has been approved by the ethics committee of the Friedrich-Schiller University Jena, Germany. Results will be disseminated at scientific conferences, published in peer-reviewed journals, and provided to consumers of healthcare. Trial registration number: Pre-results, DRKS00010676

Internet-based cognitive-behavioural writing therapy for reducing post-traumatic stress after severe sepsis in patients and their spouses (REPAIR): results of a randomised-controlled trial

Objectives To investigate the efficacy, safety and applicability of internet-based, therapist-led partner-assisted cognitive-behavioural writing therapy (iCBT) for post-traumatic stress disorder (PTSD) symptoms after intensive care for sepsis in patients and their spouses compared with a waitlist (WL) control group. Design Randomised-controlled, parallel group, open-label, superiority trial with concealed allocation. Setting Internet-based intervention in Germany; location-independent via web-portal. Participants Patients after intensive care for sepsis and their spouses of whom at least one had a presumptive PTSD diagnosis (PTSD-Checklist (PCL-5)≥33). Initially planned sample size: 98 dyads. Interventions ICBT group: 10 writing assignments over a 5-week period; WL control group: 5-week waiting period. Primary and secondary outcome measures Primary outcome: pre–post change in PTSD symptom severity (PCL-5). Secondary outcomes: remission of PTSD, depression, anxiety and somatisation, relationship satisfaction, health-related quality of life, premature termination of treatment. Outcomes measures were applied pre and post treatment and at 3, 6 and 12 months follow-up. Results Twenty-five dyads representing 34 participants with a presumptive PTSD diagnosis were randomised and analysed (ITT principle). There was no evidence for a difference in PCL-5 pre–post change for iCBT compared with WL (mean difference −0.96, 95% CI (−5.88 to 3.97), p=0.703). No adverse events were reported. Participants confirmed the applicability of iCBT. Conclusions ICBT was applied to reduce PTSD symptoms after intensive care for sepsis, for the first time addressing both patients and their spouses. It was applicable and safe in the given population. There was no evidence for the efficacy of iCBT on PTSD symptom severity. Due to the small sample size our findings remain preliminary but can guide further research, which is needed to determine if modified approaches to post-intensive care PTSD may be more effective

Psychological interventions for acute pain after open heart surgery (Protocol)

The objectives are as follows: To assess the efficacy of psychological interventions as an adjunct to standard surgical care compared to standard surgical care or attention control in adults undergoing open heart surgery

The RIPI-f (Reporting Integrity of Psychological Interventions delivered face-to-face) checklist was developed to guide reporting of treatment integrity in face-to-face psychological interventions.

Objectives: Intervention integrity is the degree to which the study intervention is delivered as intended. This article presents the RIPI-f checklist (Reporting Integrity of Psychological Interventions delivered face-to-face) and summarizes its development methods. RIPI-f proposes guidance for reporting intervention integrity in evaluative studies of face-to-face psychological interventions. Study Design and Setting: We followed established procedures for developing reporting guidelines. We examined 56 documents (reporting guidelines, bias tools, and methodological guidance) for relevant aspects of face-to-face psychological intervention integrity. Eighty four items were identified and grouped as per the template for intervention description and replication (TIDieR) domains. Twenty nine experts from psychology and medicine and other scholars rated the relevance of each item in a single-round Delphi survey.Amultidisciplinary panel of 11 experts discussed the survey results in three online consensus meetings and drafted the final version of the checklist. Results: We propose RIPI-f, a checklist with 50 items. Our checklist enhances TIDieR with important extensions, such as therapeutic alliance, provider’s allegiance, and the adherence of providers and participants. Conclusion: RIPI-f can improve the reporting of face-to-face psychological interventions. The tool can help authors, researchers, systematic reviewers, and guideline developers. We suggest using RIPI-f alongside other reporting guidelines.post-print504 K

The RIPI-f (Reporting Integrity of Psychological Interventions delivered face-to-face) checklist was developed to guide reporting of treatment integrity in face-to-face psychological interventions

Objective: Intervention integrity is the degree to which the study intervention is delivered as intended. This article presents the RIPI-f checklist (Reporting Integrity of Psychological Interventions delivered face-to-face) and summarizes its development methods. RIPI-f proposes guidance for reporting intervention integrity in evaluative studies of face-to-face psychological interventions. Study design and setting: We followed established procedures for developing reporting guidelines. We examined 56 documents (reporting guidelines, bias tools, and methodological guidance) for relevant aspects of face-to-face psychological intervention integrity. Eighty-four items were identified and grouped according to the template for intervention description and replication (TIDieR) domains. Twenty-nine experts from psychology and medicine and other scholars rated the relevance of each item in a single-round Delphi survey. A multidisciplinary panel of 11 experts discussed the survey results in three online consensus meetings and drafted the final version of the checklist. Results: We propose RIPI-f, a checklist with 50 items. Our checklist enhances TIDieR with important extensions, such as therapeutic alliance, provider's allegiance, and the adherence of providers and participants. Conclusion: RIPI-f can improve the reporting of face-to-face psychological interventions. The tool can help authors, researchers, systematic reviewers, and guideline developers. We suggest using RIPI-f alongside other reporting guidelines

Influence and participation of young adults who have an intellectual disability, in the local community's social arenas and democratic processes

To achieve citizenship, all citizens need to be able to make their voices heard. Policy and practice in the welfare society stress that all citizens should be included, but in reality, young adults who have intellectual disabilities (ID) are often excluded. The overall aim of the thesis was to study how young adults who have ID acquired citizenship. The specific aims were also to study how young adults who have ID experienced influence and participation in a municipality's leisure activities, cultural activities, and democratic processes.  The theories used were theories of citizenship, participation, and situated learning.  The study was conducted as participatory action research by seven co-researchers and staff. The action Influence Café was organized as a meeting place on three occasions. To support dialogues with the co-researchers, the method Talking Mats was used during the individual interviews, while during the focus group interviews, photographs were used. The co-researchers were seven young adults aged between 16 to 30 years of age who have ID. Five staff from the municipal organization constituted a project group. The co-researchers took part in two single interviews each, three focus group interviews, and three actions. The staff from the municipality took part in a focus group interview and a survey. Field notes were taken during the action process.  The results showed that young adults who have ID experienced exclusion in leisure, culture, and democracy activities and had difficulties gaining influence as citizens. When staff from the municipality were given a method and the opportunity to reflect on involving young adults who have ID in decision making, a change in their attitudes towards a more inclusive direction could be achieved. Conversely, when young adults who have ID were allowed to express their thoughts, they experienced a sense of impact on the organization in the municipality. The results indicate that a shift needs to take place, away from the lack of knowledge and abilities of young adults who have ID, towards the knowledge deficits and normative beliefs of those around them. A conclusion that can be drawn from the study is that empowerment and the ability to influence society can be created if young adults who have ID are made visible and begin to be seen as a resource; and thereby they can be allowed to take their place as citizens. Young adults who have ID can participate as co-researchers if the right adaptations are made. To enable influence and participation for young adults who have ID in leisure, cultural, and democracy activities, staff need to have knowledge about prevailing norms, ID, and how an adaptation of activities can take place. The Influence Café method can contribute to increased influence and increased participation in municipal activities for young adults who have ID. The Talking Mats can be used as a method for interviews, but adaptations of the method need to be made based on the design of the study. In future research, more studies need to be based on the theory of situated learning where young adults who have an ID get the opportunity to cooperate with staff in focus on adaptation and knowledge building.