Organized complexity

Die Bedeutung der Beziehungsgestaltung im psychotherapeutischen Prozess hat sich in den letzten Jahren als zentral herausgestellt. So hat sich zum einen gezeigt, dass die psychotherapeutische Beziehung ein wichtiger Prädiktor für den Therapieerfolg darstellt. Auf der anderen Seite hat sich zudem gezeigt, dass es sich bei der zwischenmenschlichen Interaktion um ein komplexes dynamisches Muster handelt. Es erscheint daher adäquat, die Dynamik mittels einer fein aufgelösten Mikroprozessanalyse zu erfassen. Mit einer Frequenz von 10 Sekunden werden im Rahmen zweier Einzelfallanalysen interaktionell bedeutsame Pläne des Therapeuten und der Klientin kodiert. Da neuere systemtheoretische Konzeptionen Psychotherapie als das Bereitstellen von Möglichkeiten für Selbstorganisationsprozesse begreifen, sollen diese in den Datensätzen mit den Methoden der Chaosforschung sichtbar gemacht werden. Für die Analyse psychotherapeutischer Prozesse sind dabei besonders Bifurkationspunkte interessant, bei denen das System an der Grenze zu einem neuen Verhalten steht. Hier entscheidet dann die Aufnahmebereitschaft des Klienten, ob eine solche Grenze mutig überschritten wird und sich tatsächlich neue Muster etablieren.The basic importance of client-therapist-relationship in psychotherapy has often been stressed. At the one hand, the quality of this relationship has proved to be an important prediction of therapy outcome, at the other hand, the relationship itself has been perceived as a complex dynamic pattern of interpersonal interaction. It seems appropriate to investigate these dynamics by a highly specified microprocess analysis. Interactive plans of client and therapist have been coded by a sampling frequency of 10 seconds. Based on newer system-theories, psychotherapy can be taken as a process, which activates the self-organizing tendencies of clients. Using methods from chaos theory, self-organizing processes have been demonstrated for the two data sets. In order to get a deeper understanding of psychotherapeutic change processes bifurcation points, where a system balances on the border between an old and a new behaviour, have been the main subjects of investigation. It can be shown that the client’s openness is an important factor and key to influencing the outcome of a bifurcation, which can either be a bold step forward or a jump backwards

Bürgerschaftliches Engagement und soziale Ungleichheit. Eine Untersuchung auf Basis des European Social Survey

(no abstract available

Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: A study of intensive care units

Background: Hospitals face an increasing pressure towards efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). Purposes: Based on extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact. Methodology / Approach: A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire. Linear regression was employed to identify the effects of the predictor variables on error rate, as well as interaction effects between safety tools and safety climate. Findings: Higher workload has a detrimental effect on safety while safety climate - unlike the examined safety tools - has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant. Practice Implications: Increased workload and capacity utilization increase the occurrence of medical error; an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies

Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: A study of intensive care units

Background: Hospitals face an increasing pressure towards efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). Purposes: Based on extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact. Methodology / Approach: A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire. Linear regression was employed to identify the effects of the predictor variables on error rate, as well as interaction effects between safety tools and safety climate. Findings: Higher workload has a detrimental effect on safety while safety climate - unlike the examined safety tools - has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant. Practice Implications: Increased workload and capacity utilization increase the occurrence of medical error; an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies

Sudden Gains in Day-to-Day Change:Revealing Nonlinear Patterns of Individual Improvement in Depression

Item does not contain fulltextObjective: We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity and the relation of these patterns to treatment response. Method: Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, 1-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. Two-hundred and three cases had ICD-10 Symptom Rating (ISR) depression scores posttreatment: a score <= 1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory. Results: 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant 1-step trajectories and 25% of the linear cases. Sudden gains and nonspecific change trajectories were significantly more frequent for treatment responders. Conclusions: At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles.9 p

Critical Fluctuations as an Early-Warning Signal for Sudden Gains and Losses in Patients Receiving Psychotherapy for Mood Disorders

Whereas sudden gains and losses (large shifts in symptom severity) in patients receiving psychotherapy appear abrupt and hence may seem unexpected, hypotheses from complex-systems theory suggest that sudden gains and losses are actually preceded by certain early-warning signals (EWSs). We tested whether EWSs in patients' daily self-ratings of the psychotherapeutic process predicted future sudden gains and losses. Data were collected from 328 patients receiving psychotherapy for mood disorders who completed daily self-ratings about their therapeutic process using the Therapy Process Questionnaire (TPQ). Sudden gains and losses were classified from the Problem Intensity scale of the TPQ. The other items of the TPQ were used to compute the EWSs. EWSs predicted an increased probability for sudden gains and losses in a 4-day predictive window. These results show that EWSs can be used for real-time prediction of sudden gains and losses in clinical practice

Multi-Parameter Analysis of Biobanked Human Bone Marrow Stromal Cells Shows Little Influence for Donor Age and Mild Comorbidities on Phenotypic and Functional Properties

Heterogeneous populations of human bone marrow-derived stromal cells (BMSC) are among the most frequently tested cellular therapeutics for treating degenerative and immune disorders, which occur predominantly in the aging population. Currently, it is unclear whether advanced donor age and commonly associated comorbidities affect the properties of ex vivo-expanded BMSCs. Thus, we stratified cells from adult and elderly donors from our biobank (n = 10 and n = 13, mean age 38 and 72 years, respectively) and compared their phenotypic and functional performance, using multiple assays typically employed as minimal criteria for defining multipotent mesenchymal stromal cells (MSCs). We found that BMSCs from both cohorts meet the standard criteria for MSC, exhibiting similar morphology, growth kinetics, gene expression profiles, and pro-angiogenic and immunosuppressive potential and the capacity to differentiate toward adipogenic, chondrogenic, and osteogenic lineages. We found no substantial differences between cells from the adult and elderly cohorts. As positive controls, we studied the impact of in vitro aging and inflammatory cytokine stimulation. Both conditions clearly affected the cellular properties, independent of donor age. We conclude that in vitro aging rather than in vivo donor aging influences BMSC characteristics