Publications by authors named "Henning Krampe"

47 Publications

Compliance with COVID-19 public health guidelines: an attitude-behaviour gap bridged by personal concern and distance to conspiracy ideation.

Psychol Health 2021 Sep 28:1-22. Epub 2021 Sep 28.

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Objective: This study examined predictors of compliance with public health guidelines to curb transmission of COVID-19.

Design: Applying an exploratory longitudinal design, participants ( = 431) from Germany and Austria completed surveys in April/May 2020 (T1) and July/August 2020 (T2).

Measures: Three outcome measures operationalised compliance with public health guidelines at T2: self-reported adherence (behavioural), agreement and opposition (attitudinal). At T1, demographics, perceived distress (PHQ-4, crisis of meaning), resources (self-control, meaningfulness), locus of control, conspiracy mentality and social media use were assessed. At T2, situational variables were added (person at risk, infection of close person, fear of infection, COVID-19 stress). Temporal shifts from T1 to T2 were examined as complementary information.

Results: An attitude-behaviour gap at T2 was identified, as agreement with and opposition to the guidelines were only modestly correlated with adherence to them. Measures of personal concern (fear of infection, person at risk) were associated with both adherence and positive attitudes towards the measures. COVID-19 stress and conspiracy mentality predicted negative attitudes, but not adherence. Age predicted adherence positively, social media use negatively.

Conclusion: The findings support the significance of personal concern for compliance with public health guidelines and suggest a critical impact of social media use and conspiracy mentality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08870446.2021.1974861DOI Listing
September 2021

Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives.

J Clin Med 2021 Aug 31;10(17). Epub 2021 Aug 31.

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.

The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm10173928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432195PMC
August 2021

Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey.

BMC Psychiatry 2021 09 6;21(1):437. Epub 2021 Sep 6.

Social Sciences, MF Norwegian School of Theology, Religion and Society, Oslo, Norway.

Background: An internal locus of control (LoC I) refers to the belief that the outcome of events in one's life is contingent upon one's actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one's life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic.

Methods: This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS.

Results: The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress.

Conclusions: The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12888-021-03418-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419811PMC
September 2021

Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings - Results of an expert consensus and feasibility field test.

J Intensive Care Soc 2021 May 14;22(2):159-174. Epub 2020 May 14.

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Background: There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care.

Methods: We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n = 5; n = 5; n = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal.

Results: We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale - revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)).

Conclusions: We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS.

Trial Registration: This study was registered at ClinicalTrials.gov (Identifier: NCT04175236; first posted 22 November 2019).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1751143720923597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120565PMC
May 2021

Sense of coherence, mental well-being and perceived preoperative hospital and surgery related stress in surgical patients with malignant, benign, and no neoplasms.

BMC Psychiatry 2020 11 27;20(1):567. Epub 2020 Nov 27.

Institute of Psychology, University of Innsbruck, Innsbruck, Austria.

Background: This prospective, cross-sectional, observational study examined associations between sense of coherence (SOC), mental well-being, and perceived preoperative hospital and surgery related stress of surgical patients with malignant, benign, and no neoplasms. The objective was to assess a putative association between SOC and preoperative stress, and to test for a statistical mediation by mental well-being.

Method: The sample consisted of 4918 patients from diverse surgical fields, of which 945 had malignant neoplasms, 333 benign neoplasms, and 3640 no neoplasms. For each subsample, we conducted simple mediation analyses to test an indirect effect of SOC on preoperative stress mediated by mental well-being. The models were adjusted for age, gender, and essential medical factors.

Results: Patient groups did not differ significantly regarding degrees of SOC and mental well-being (SOC, M [SD]: 12.31 [2.59], 12.02 [2.62], 12.18 [2.57]; mental well-being M [SD]: 59.26 [24.05], 56.89 [22.67], 57.31 [22.87], in patients with malignant, benign, and without neoplasms, respectively). Patients without neoplasms reported significantly lower stress (4.19 [2.86], M [SD]) than those with benign (5.02 [3.03], M [SD]) and malignant neoplasms (4.99 [2.93], M [SD]). In all three mediation models, SOC had significant direct effects on stress, with higher SOC being associated with lower stress (- 0.3170 [0.0407], - 0.3484 [0.0752], - 0.2919 [0.0206]; c' [SE], p < 0.001 in patients with malignant, benign, and without neoplasms, respectively). In patients with malignant neoplasms and without neoplasms, SOC showed small indirect effects on stress that were statistically mediated by well-being. Higher SOC was related to higher well-being, which in turn was related to lower stress. In patients with benign neoplasms, however, no significant indirect effects of SOC were found.

Conclusions: SOC was directly associated with lower perceived hospital and surgery related stress, over and above the direct and mediation effects of mental well-being. Because the data are cross-sectional, conclusions implying causality cannot be drawn. Nevertheless, they indicate important relationships that can inform treatment approaches to reduce elevated preoperative stress by specifically addressing low SOC.

Trial Registration: clinicaltrials.gov Identifier: NCT01357694 . Registered 18 May 2011.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12888-020-02953-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693497PMC
November 2020

Meaning in Life and Self-Control Buffer Stress in Times of COVID-19: Moderating and Mediating Effects With Regard to Mental Distress.

Front Psychiatry 2020 23;11:582352. Epub 2020 Sep 23.

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Background: As evidenced by several studies, mental distress increased substantially during the COVID-19 pandemic. In this period, citizens were asked to exercise a high degree of self-control with regard to personal and social health behavior. At the same time, we witnessed an increase of prosocial acts and shared creative expressions, which are known to serve as sources of meaning. Meaning in life and self-control are acknowledged psychological resources. Especially in times of crisis, meaning in life has been shown to be a crucial factor for resilience and coping. However, threatening and stressful situations can also jeopardize existential security and trigger crises of meaning. The present study aimed to document levels of acute COVID-19 stress and general mental distress in Germany and Austria during the lockdown and in the weeks thereafter. In order to identify potential risk factors related to demographics and living conditions, their associations with COVID-19 stress were analyzed exploratively. The primary objective of the study, however, was to investigate the buffering effect of two psychological resources-meaningfulness and self-control-with regard to the relation between acute COVID-19 stress and general mental distress. Finally, a potential aggravation of mental distress due to the occurrence of crises of meaning was examined.

Method: A cross-sectional survey was conducted online during lockdown (survey group 1) and the subsequent weeks characterized by eased restrictions (survey group 2). A total of N = 1,538 German-speaking participants completed a questionnaire battery including a novel measure of acute COVID-19 stress, meaningfulness and crisis of meaning (SoMe), self-control (SCS-KD), and a screening of general mental distress, measured by core symptoms of depression and anxiety (PHQ-4). In a first step, associations between living conditions, demographics, and COVID-19 stress were explored. Second, a moderation and a mediation model were tested. Meaningfulness, a measure of presence of meaning in life, as well as self-control were proposed to serve as buffers in a time of crisis, thus moderating the relation between acute COVID-19 stress and general mental distress (double moderation). Crisis of meaning, operationalizing an experienced lack of meaning in life, was proposed to mediate the relationship between acute COVID-19 stress and general mental distress, with an assumed moderation of the association between COVID-19 stress and crisis of meaning by survey group (lockdown versus eased restrictions after lockdown), and a hypothesized moderation of the link between crisis of meaning and general mental distress by self-control (dual moderated mediation).

Results: COVID-19 stress was slightly right-skewed. Scores were higher during lockdown than in the weeks thereafter. The rate of clinically significant general mental distress was high, exceeding prevalence rates from both the general population and clinical samples of the time before the pandemic. In the weeks following the lockdown (group 2), general mental distress and crisis of meaning were significantly higher than during lockdown (group 1), whereas meaningfulness and self-control were significantly lower. Demographically, age had the strongest association with COVID-19 stress, with older participants perceiving less acute stress (r = -.21). People who were partnered or married suffered less from COVID-19 stress (η2 = .01). Living alone (η2 = .006), living in a room versus a flat or house (η2 = .008), and being unemployed due to the pandemic (η2 = .008) were related to higher experience of COVID-19 stress. COVID-19 stress and general mental distress were strongly related (r = .53). Both meaningfulness and self-control were negatively associated with general mental distress (r = -.40 and -.36, respectively). They also moderated the relationship between COVID-19 stress and general mental distress: When meaningfulness was high, high COVID-19 stress was related to substantially lower PHQ-4 scores than when meaningfulness was low. The same held for self-control: High scores of self-control were associated with lower PHQ-4 scores especially when COVID-19 stress was high. Crisis of meaning mediated the relationship between COVID-19 stress and PHQ-4. There was a higher likelihood of crises of meaning occurring when COVID-19 stress was high; crisis of meaning, in turn, was associated with general mental distress. Survey group moderated the first path of this mediation, i.e., the relationship between COVID-19 stress and crisis of meaning: High scores of COVID-19 stress were associated more strongly with crisis of meaning in the second survey group (after the lockdown). Self-control moderated the second path, i.e., the relationship between crisis of meaning and PHQ-4: When a crisis of meaning was present, self-control could buffer its effect on general mental distress.

Conclusions: Also in the present study among German-speaking participants, general mental distress was high. Scores were higher after than during the lockdown, indicating an ongoing destabilization for a significant part of the population. People who saw a meaning in their lives and who were capable of self-control reported substantially less mental distress. Meaningfulness and self-control also served as buffers between COVID-19 stress and general mental distress: When COVID-19 stress was high, the presence of meaningfulness and self-control accounted for lower general mental distress. Moreover, people who suffered strongly from COVID-19 stress were more likely to develop a crisis of meaning which, in turn, was associated with higher general mental distress. This suggests that ongoing anxiety and depression might (also) be based on existential struggles. Again here, self-control buffered the impact of crisis of meaning on general mental health. We conclude from these findings that public health policies can support citizens in coping with large-scale crises by enabling experiences of meaningfulness, e.g., through transparent and reliable modes of communicating goals and necessary intermediate steps. Moreover, health professionals are well advised to invite individuals to confront existential questions and struggles, and to encourage them to exercise self-control. The latter can be boosted by keeping higher-order goals salient-which again is inherently linked to an understanding of their meaning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyt.2020.582352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538834PMC
September 2020

Cross-Sectional and Longitudinal Construct Validity of the Generic KINDL-A(dult)B(rief) Questionnaire in Adults with Thrombophilia or with Hereditary and Acquired Bleeding Disorders.

Acta Haematol 2021 5;144(2):166-175. Epub 2020 Jun 5.

Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany,

Background/aims: The newly adapted generic KINDL-A(dult)B(rief) questionnaire showed satisfactory cross-sectional psychometric properties in adults with bleeding disorders or thrombophilia. This investigation aimed to evaluate its cross-sectional and longitudinal construct validity.

Methods: After ethical committee approval and written informed consent, 335 patients (mean age 51.8 ± 16.6 years, 60% women) with either predominant thrombophilia (n = 260) or predominant bleeding disorders (n = 75) participated. At baseline, patients answered the KINDL-AB, the MOS 36-item Short-Form Health Survey (SF-36), and the EQ-5D-3L. A subgroup of 117 patients repeated the questionnaire after a median follow-up of 2.6 years (range: 0.4-3.5). A priori hypotheses were evaluated regarding convergent correlations between KINDL-AB overall well-being and specific subscales, EQ-5D-3L index values (EQ-IV), EQ-5D visual analog scale (EQ-VAS), and SF-36 subscales.

Results: Contrary to hypothesis, baseline correlations between the KINDL-AB and EQ-IV/EQ-VAS were all moderate while, as hypothesized, several KINDL-AB subscales and SF-36 subscales correlated strongly. At follow-up, no significant changes in all three instruments occurred. Correlations between instruments over the follow-up were mostly moderate and partially strong. Contrary to hypothesis but consistent with no significant changes in health-related quality of life, convergent correlations between changes in KINDL-AB overall well-being, physical and psychological well-being, and EQ-IV/EQ-VAS were all weak.

Conclusions: While repeated measures of KINDL-AB showed moderate to strong correlations, changes in KINDL-AB overall well-being and subscales correlated more weakly than expected with changes involving two established instruments of generic health status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000507602DOI Listing
April 2021

Improvements in Patient Monitoring in the Intensive Care Unit: Survey Study.

J Med Internet Res 2020 06 19;22(6):e19091. Epub 2020 Jun 19.

Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Background: Due to demographic change and, more recently, coronavirus disease (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be due to the lack of user involvement in research and development.

Objective: This study focused on the satisfaction of ICU staff with current patient monitoring and their suggestions for future improvements. We aimed to identify aspects of monitoring that interrupt patient care, display devices for remote monitoring, use cases for artificial intelligence (AI), and whether ICU staff members are willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further aimed to identify differences in the responses of different professional groups.

Methods: This survey study was performed with ICU staff from 4 ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire, by analyzing a preceding qualitative interview study with ICU staff, about the clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and chi-square tests to compare the distributions of item responses of the professional groups.

Results: In total, 86 of the 270 ICU physicians and nurses completed the survey questionnaire. The majority stated they felt confident using the patient monitoring equipment, but that high rates of false-positive alarms and the many sensor cables interrupted patient care. Regarding future improvements, respondents asked for wireless sensors, a reduction in the number of false-positive alarms, and hospital standard operating procedures for alarm management. Responses to the display devices proposed for remote patient monitoring were divided. Most respondents indicated it would be useful for earlier alerting or when they were responsible for multiple wards. AI for ICUs would be useful for early detection of complications and an increased risk of mortality; in addition, the AI could propose guidelines for therapy and diagnostics. Transparency, interoperability, usability, and staff training were essential to promote the use of AI. The majority wanted to learn more about new technologies for the ICU and required more time for learning. Physicians had fewer reservations than nurses about AI-based intelligent alarm management and using mobile phones for remote monitoring.

Conclusions: This survey study of ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm standard operating procedures, introducing wireless sensors, preparing for the use of AI, and enhancing the digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine.

Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/19091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307326PMC
June 2020

Guideline-conform translation and cultural adaptation of the Addenbrooke's Cognitive Examination III into German.

Ger Med Sci 2020 6;18:Doc04. Epub 2020 Apr 6.

Department for Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Age-related disorders, such as dementia, significantly contribute to the global burden of disease. Adequate screening in the primary care setting is critical for early detection and proper management. The Addenbrooke's Cognitive Examination III (ACE-III) is an open-source neuropsychological test with superior diagnostic quality in comparison to the Mini-Mental State Examination (MMSE). Our aim was to perform a guideline-conform English-German translation and cultural adaptation of the ACE-III in order to enable implementation in German-speaking countries. The translation and cultural adaptation were performed in accordance with the "Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures" from the International Society for Pharmacoeconomics and Outcome Research (ISPOR) (Wild et al. 2005). Four separate English-German translations were compiled into one German consensus translation, which was then translated back into English and compared to the original English version. After comparison, the German consensus translation was revised with emphasis on the identified differences between the English original version and the English translated version. This revised German consensus translation was subsequently evaluated for clinical applicability on a 5-point scale (0 - not applicable; 5 - applicable without any restrictions) by 20 practitioners experienced in the field of neuropsychological testing, using an anonymized, paper-based 22-item survey. Nineteen of the 20 practitioners (95.0%) rated the German ACE-III translation as overall applicable. The median rating was 4.0 [IQR (4.0/5.0)]. When evaluating survey items assessing the applicability of the individual 19 subtests of the ACE-III, all of them (100%) were rated as applicable with a median rating of 4.5 [IQR (4.1/4.9)]. The German ACE-III translation in its current form is generally applicable and can be utilized for clinical and scientific purposes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3205/000280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174851PMC
September 2021

Stability of neuropsychological test performance in older adults serving as normative controls for a study on postoperative cognitive dysfunction.

BMC Res Notes 2020 Feb 4;13(1):55. Epub 2020 Feb 4.

Department of Anesthesiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.

Objective: Studies of postoperative cognitive dysfunction (POCD) rely on repeat neuropsychological testing. The stability of the applied instruments, which are affected by natural variability in performance and measurement imprecision, is often unclear. We determined the stability of a neuropsychological test battery using a sample of older adults from the general population. Forty-five participants aged 65 to 89 years performed six computerized and non-computerized neuropsychological tests at baseline and again at 7 day and 3 months follow-up sessions. Mean scores on each test were compared across time points using repeated measures analyses of variance (ANOVA) with pairwise comparison. Two-way mixed effects, absolute agreement analyses of variance intra-class correlation coefficients (ICC) determined test-retest reliability.

Results: All tests had moderate to excellent test-retest reliability during 7-day (ICC range 0.63 to 0.94; all p < 0.01) and 3-month intervals (ICC range 0.60 to 0.92; all p < 0.01) though confidence intervals of ICC estimates were large throughout. Practice effects apparent at 7 days eased off by 3 months. No substantial differences between computerized and non-computerized tests were observed. We conclude that the present six-test neuropsychological test battery is appropriate for use in POCD research though small sample size of our study needs to be recognized as a limitation. Trial registration ClinicalTrials.gov Identifier NCT02265263 (15th October 2014).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13104-020-4919-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001199PMC
February 2020

Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study.

JMIR Med Inform 2019 Apr 30;7(2):e13064. Epub 2019 Apr 30.

Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany.

Background: In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients' health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s.

Objective: The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring.

Methods: This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff-5 physicians, 6 nurses, and 4 respiratory therapists-were recorded, transcribed, and analyzed using the grounded theory approach.

Results: Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies.

Conclusions: This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite.

Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/13064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658223PMC
April 2019

Social Relationship Factors, Preoperative Depression, and Hospital Length of Stay in Surgical Patients.

Int J Behav Med 2018 Dec;25(6):658-668

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.

Purpose: The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields.

Method: Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure.

Results: Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS.

Conclusion: Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes.

Trial Registration: NCT01357694.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12529-018-9738-8DOI Listing
December 2018

Psychometric Properties of a Modified KINDL-R Questionnaire for Adolescents and Adults, and Construction of a Brief Version, the KINDL-A(dult)B(rief) Questionnaire, KINDL-AB.

Acta Haematol 2018 13;140(1):1-9. Epub 2018 Jul 13.

Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany.

Background/aims: The generic quality of life KINDL-R -questionnaire is validated for use in children/adolescents ≤16 years. The aim of this cross-sectional investigation was to modify the KINDL-R questionnaire for use in adults and to validate its psychometric properties.

Methods: Five items of the KINDL-R questionnaire were adapted and the newly developed KINDL-A(dult) questionnaire administered to 255 patients with hereditary and acquired bleeding disorders (mean age 53 years). Its internal consistency and convergent and divergent construct validity were investigated and confirmatory factor analysis was used to evaluate the latent factor structure.

Results: The KINDL-A questionnaire showed satisfactory reliability, varying construct validity, but inconclusive factor structure. The KINDL-AB(rief) was developed by removing half of the items and combining 2 sub-axes. This led to factor loadings between 0.62 and 0.91 and increased overall fit (Goodness of fit > 0.8 and Root Mean Square Error of Approximation, RMSEA, < 0.08). Results were validated in 966 healthy blood donors (mean age 38 years). In this group, the KINDL-AB questionnaire showed factor loadings between 0.43 and 0.77, Goodness of fit > 0.95 and RMSEA < 0.05.

Conclusions: The new KINDL-AB suggests sufficient to good psychometric properties in adult patients with hereditary and acquired bleeding disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000490408DOI Listing
June 2019

Psychometric Properties of a Modified KINDL-R Questionnaire for Adolescents and Adults, and Construction of a Brief Version, the KINDL-A(dult)B(rief) Questionnaire, KINDL-AB.

Acta Haematol 2018 13;140(1):1-9. Epub 2018 Jul 13.

Institute for Clinical Chemistry and Coagulation Center, University Hospital Schleswig Holstein, Lübeck/Kiel, Germany.

Background/aims: The generic quality of life KINDL-R -questionnaire is validated for use in children/adolescents ≤16 years. The aim of this cross-sectional investigation was to modify the KINDL-R questionnaire for use in adults and to validate its psychometric properties.

Methods: Five items of the KINDL-R questionnaire were adapted and the newly developed KINDL-A(dult) questionnaire administered to 255 patients with hereditary and acquired bleeding disorders (mean age 53 years). Its internal consistency and convergent and divergent construct validity were investigated and confirmatory factor analysis was used to evaluate the latent factor structure.

Results: The KINDL-A questionnaire showed satisfactory reliability, varying construct validity, but inconclusive factor structure. The KINDL-AB(rief) was developed by removing half of the items and combining 2 sub-axes. This led to factor loadings between 0.62 and 0.91 and increased overall fit (Goodness of fit > 0.8 and Root Mean Square Error of Approximation, RMSEA, < 0.08). Results were validated in 966 healthy blood donors (mean age 38 years). In this group, the KINDL-AB questionnaire showed factor loadings between 0.43 and 0.77, Goodness of fit > 0.95 and RMSEA < 0.05.

Conclusions: The new KINDL-AB suggests sufficient to good psychometric properties in adult patients with hereditary and acquired bleeding disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000490408DOI Listing
June 2019

Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial.

BMC Psychiatry 2017 12 29;17(1):417. Epub 2017 Dec 29.

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.

Background: Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care.

Methods: The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only.

Results: Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness.

Conclusions: Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change.

Trial Registration: clinicaltrials.gov Identifier: NCT01357694.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12888-017-1579-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747166PMC
December 2017

Prospective clinical observational study evaluating gender-associated differences of preoperative pain intensity.

Medicine (Baltimore) 2016 Jul;95(27):e4077

Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Hospital Wolfenbuettel gGmbH, Wolfenbuettel Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospital Waldfriede, Berlin Department of Biostatistics, Clinical Research Unit, Berlin Institute of Health, Charité- Universitaetsmedizin Berlin, Germany.

Previous studies reported conflicting results concerning different pain perceptions of men and women. Recent research found higher pain levels in men after major surgery, contrasted by women after minor procedures. This trial investigates differences in self-reported preoperative pain intensity between genders before surgery.Patients were enrolled in 2011 and 2012 presenting for preoperative evaluation at the anesthesiological assessment clinic at Charité University hospital. Out of 5102 patients completing a computer-assisted self-assessment, 3042 surgical patients with any preoperative pain were included into this prospective observational clinical study. Preoperative pain intensity (0-100 VAS, visual analog scale) was evaluated integrating psychological cofactors into analysis.Women reported higher preoperative pain intensity than men with median VAS scores of 30 (25th-75th percentiles: 10-52) versus 21 (10-46) (P < 0.001). Adjusted multiple regression analysis showed that female gender remained statistically significantly associated with higher pain intensity (P < 0.001). Gender differences were consistent across several subgroups especially with varying patterns in elderly. Women scheduled for minor and moderate surgical procedures showed largest differences in overall pain compared to men.This large clinical study observed significantly higher preoperative pain intensity in female surgical patients. This gender difference was larger in the elderly potentially contradicting the current hypothesis of a primary sex-hormone derived effect. The observed variability in specific patient subgroups may help to explain heterogeneous findings of previous studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000004077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058824PMC
July 2016

Effects of an Innovative Psychotherapy Program for Surgical Patients: Bridging Intervention in Anesthesiology--A Randomized Controlled Trial.

Anesthesiology 2015 Jul;123(1):148-59

From the Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Berlin, Germany (L.F.K., C.D.S., A.-L.S., E.W.-G., F.B., T.N., S.T., A.L., B.N., H.K.); Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin, Berlin, Germany (N.R.-S.); Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany (H.G., E.B.); Institute of Medical Biometry, Campus Charité Mitte, Charité-Universitätsmedizin, Berlin, Germany, and Sostana GmbH, Berlin, Germany (K.-D.W.); and Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany (E.B.).

Background: The stepped care program Bridging Intervention in Anesthesiology (BRIA) aims at motivating and supporting surgical patients with comorbid mental disorders to engage in psychosocial mental healthcare options. This study examined the efficacy of BRIA.

Methods: This randomized, parallel-group, open-label, controlled trial was conducted in the preoperative anesthesiological assessment clinics and surgical wards of a large university hospital in Germany. A total of 220 surgical patients with comorbid mental disorders were randomized by using the computer-generated lists to one of two intervention groups: BRIA psychotherapy sessions up to 3 months postoperatively (BRIA) versus no psychotherapy/computerized brief written advice (BWA) only. Primary outcome was participation in psychosocial mental healthcare options at month 6. Secondary outcome was change of self-reported general psychological distress (Global Severity Index of the Brief Symptom Inventory) between baseline and month 6.

Results: At 6-month follow-up, the rate of patients who engaged in psychosocial mental healthcare options was 30% (33 of 110) in BRIA compared with 11.8% (13 of 110) in BWA (P = 0.001). Number needed to treat and relative risk reduction were 6 (95% CI, 4 to 13) and 0.21 (0.09 to 0.31), respectively. In BRIA, Global Severity Index decreased between baseline and month 6 (P < 0.001), whereas it did not change significantly in BWA (P = 0.197).

Conclusions: Among surgical patients with comorbid mental disorders, BRIA results in an increased engagement in subsequent therapy options and a decrease of general psychological distress. These data suggest that it is reasonable to integrate innovative psychotherapy programs into the context of interdisciplinary surgical care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ALN.0000000000000685DOI Listing
July 2015

Pharmacotherapy in pain patients with substance abuse.

J Pain Palliat Care Pharmacother 2015 Mar 2;29(1):59-60. Epub 2015 Feb 2.

Drs. Michael Schäfer, Claudia Denke, Henning Krampe, and Claudia Spies are from the Department of Anaesthesiology and Intensive Care at Charité Universitätsmedizin, Campus Virchow Klinikum and Campus Mitte , Berlin , Germany.

Definitions and difficulties relating to managing acute and chronic pain in patients with current or past substance abuse disorders are discussed. Problems with too rapid discontinuation of drugs are described. An interdisciplinary approach involving pain specialists, substance abuse clinicians and mental health professional is advocated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/15360288.2014.1003677DOI Listing
March 2015

Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study.

Eur J Anaesthesiol 2015 Mar;32(3):147-51

From the Department of Anaesthesiology and Surgical Intensive Care Medicine, Campus-Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany *Both Tanja Drews and Martin Franck contributed equally.

Background: Posttraumatic stress disorder (PTSD) may appear after hospitalisation for surgery with general anaesthesia in elderly patients. Prevalence and risk factors in this setting are unknown. Postoperative delirium could be a risk factor.

Objective: The purpose of this study was to identify the prevalence of, and risk factors for, PTSD 3 months after surgery with general anaesthesia in elderly patients.

Design: A prospective, clinical observational study.

Setting: This study was carried out between March 2009 and May 2010 in a German university hospital in Berlin and was part of a larger study focusing on depth of anaesthesia.

Patients:

Inclusion Criteria: at least 60 years of age; noncardiac surgery with general anaesthesia.

Exclusion Criteria: impaired preoperative cognitive function [mini-mental state examination (MMSE) score <24]; expected surgery time less than 1 h; nonproficiency in the German language.

Interventions: None.

Main Outcome Measures: Screening for PTSD 3 months after surgery using the screening instrument Post-Traumatic Stress Syndrome 14-Questions Inventory Score (PTSS-14). The following risk factors for PTSD 3 months after surgery were tested: age; American Society of Anesthesiologists physical status; sex; duration of anaesthesia; postoperative delirium; PTSS-14 score 7 days after surgery; postoperative vomiting and nausea; postoperative pain; and preoperative depression.

Statistics: Univariate statistical analysis was performed with Fisher's exact test and Spearman correlation. A backward logistic regression was performed.

Results: A total of 559 out of 1277 patients were included. Sixty-six patients (12%) were identified with PTSD 3 months after surgery. Seventy-seven patients (14%) were identified with postoperative delirium. Independent associated factors in the backward logistic regression were postoperative delirium (risk factor) and preoperative depression (protective factor).

Conclusion: The prevalence of PTSD 3 months after surgery in elderly patients was high using the screening instrument PTSS-14. Postoperative delirium is a risk factor for PTSD 3 months after surgery.

Trial Registration: ISRCTN Register: 36437985. http://www.controlled-trials.com/ISRCTN36437985/
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/EJA.0000000000000107DOI Listing
March 2015

Does research into medical education on tobacco and alcohol get the respect it deserves?

Addiction 2014 Feb 24;109(2):173-4. Epub 2013 Oct 24.

Department of Cardiology and Pneumology, University Hospital Göttingen, Robert-Koch-Straße 40, D-37075, Göttingen, Germany; Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.

Implementation of effective clinical interventions as part of routine medical care to combat problem drinking and tobacco use is recognized to be low. Insufficient training is an important barrier preventing physicians from delivering interventions recommended in current guidelines. High-impact medical journals publish almost nothing on how to address this. If they start to take an interest perhaps we will see more progress and many thousands of lives saved at minimal cost.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/add.12357DOI Listing
February 2014

German medical students' beliefs about the effectiveness of different methods of stopping smoking.

Nicotine Tob Res 2013 Nov 26;15(11):1892-901. Epub 2013 Jun 26.

Department of Cardiology and Pneumology, University Medical Centre Göttingen, Georg-August-University Göttingen, Göttingen, Germany;

Introduction: In many countries, smoking cessation interventions are not routinely delivered as recommended in national and international guidelines. This may be because of incorrect beliefs about their effectiveness. This study assessed which cessation methods are believed to be effective by medical students in different years of undergraduate education as well as predictors of correct beliefs about effectiveness.

Methods: In this cross-sectional study, undergraduate students from 27 German medical schools were invited to complete a survey addressing demographic characteristics, smoking status, self-rated knowledge of health consequences, and treatment options for smoking and beliefs about the effectiveness of 8 different methods to achieve long-term smoking cessation. Predictors of beliefs were identified by means of multilevel modeling.

Results: A total of 19,526 students completed the survey. Students greatly overestimated the effectiveness of unaided quitting, and differences between years of undergraduate education were small. In the final year, 51% of students wrongly believed that willpower alone was more effective than a comprehensive group cessation program, including nicotine replacement therapy. Multilevel modeling revealed that having never smoked, supporting public smoking bans, and recalling theoretical training in smoking cessation were associated with correct beliefs.

Conclusions: A considerable proportion of German medical students believe that willpower alone is more effective than comprehensive treatment programs to support a quit attempt.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ntr/ntt078DOI Listing
November 2013

German medical students' beliefs about how best to treat alcohol use disorder.

Eur Addict Res 2013 15;19(5):245-51. Epub 2013 Feb 15.

Department of Anesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.

Background/aims: A minority of German medical students believe they know how to support smokers willing to quit. This paper examined whether the same would be true for treating alcohol use disorder (AUD), and individual factors associated with incorrect beliefs about the effectiveness of methods to treat AUD.

Methods: In this cross-sectional study, 19,526 undergraduate students from 27 German medical schools completed a survey addressing beliefs about the effectiveness of different methods of overcoming AUD. Beliefs about AUD treatment effectiveness were compared across the 5 years of undergraduate education and predictors identified by means of multiple linear regression.

Results: Even in the fifth year, 28.1% (95% CI: 26.5-29.7) of students believed that willpower alone was more effective for overcoming AUD than a comprehensive treatment program. The only significant predictor of this belief was a similar belief for stopping smoking.

Conclusion: Our results indicate that a considerable proportion of German medical students overestimate the effectiveness of willpower to treat smoking and AUD. The addictive nature of these disorders needs to be stressed during undergraduate medical education to ensure that future physicians will be able and motivated to support patients in their quit attempts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000346672DOI Listing
May 2014

Persistence of psychological distress in surgical patients with interest in psychotherapy: results of a 6-month follow-up.

PLoS One 2012 5;7(12):e51167. Epub 2012 Dec 5.

Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.

Objectives: This prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy.

Methods: A total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis.

Results: 16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p's between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA's controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress.

Conclusion: In surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0051167PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3515556PMC
May 2013

German medical students lack knowledge of how to treat smoking and problem drinking.

Addiction 2012 Oct 3;107(10):1878-82. Epub 2012 May 3.

Department of Cardiology and Pneumology, University Hospital Göttingen, Göttingen, Germany, German.

Aim: To assess the extent of undergraduate medical training on alcohol use disorders (AUD) and smoking, and medical students' perceived knowledge regarding consequences of, and treatment options for, these disorders compared with other chronic conditions.

Design: Cross-sectional survey assessing teaching and perceived knowledge of health consequences and treatment options for AUD and smoking compared with diabetes and hypertension.

Setting: Medical schools in Germany.

Participants: Twenty-five of 36 medical school offices (response rate 69.4%) and 19 526 of 39 358 students from 27 medical schools (response rate 49.6%).

Measurement: Medical schools were asked to provide information on curricular coverage of the four conditions. Students reported their year of study and perceived knowledge about the consequences of all four disorders and perceived knowledge of treatment options.

Findings: Courses time-tabled approximately half as many teaching hours on AUD and tobacco as on diabetes or hypertension. Final-year students reported high levels of knowledge of consequences of all four conditions and how to treat diabetes and hypertension, but only 20% believed they knew how to treat alcohol use disorders or smoking.

Conclusions: Curriculum coverage in German medical schools of alcohol use disorders and smoking is half that of diabetes and hypertension, and in the final year of their undergraduate training most students reported inadequate knowledge of how to intervene to address them.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1360-0443.2012.03907.xDOI Listing
October 2012

[Web-based for preanesthesia evaluation record: a structured, evidence-based patient interview to assess the anesthesiological risk profile].

Anasthesiol Intensivmed Notfallmed Schmerzther 2011 Oct 21;46(10):694-8. Epub 2011 Oct 21.

Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité- Universitätsmedizin Berlin, Campus Mitte und Campus Virchow Klinikum.

At present, providers at an Anesthesia Preoperative Evaluation Clinic (APEC) may have difficulties in gaining access to relevant clinical information, including external medical records, surgical dictations etc. This common occurence makes obtaining an informed consent by the patient after a complete pre-anesthetic assessment difficult. This form of patient information is subject to wide interindividual variations and, thus, represents a challenge for quality assurance. Insufficient or not completed pre-anesthetic assessments can lead to an untimely termination of an elective procedure.A web-based pre-anesthetic evaluation record moves the time point of the first contact to well before the day of admission. The current pre-anesthesia evaluation record is replaced by a structured interview in the form of a complex of questions in a specific hierarchy taking guidelines, standard operating procedures (SOP) and evidence-based medicine (EBM) into consideration. The answers to the complex of questions are then classified according to agreed criteria and possible scoring systems of relevant classifications. The endpoints result in procedural recommendations not only for the informing anesthesiologist but also for the patient. The standardized risk criteria can be used as core process indicators to check the process quality of the anesthesiological risk evaluation. Short-notice cancellations of elective operations due to incomplete premedication procedures will then be avoided with the help of such structured and evidence-based patient interviews with detailed assessment of the anesthesiological risk profile.The web-based anesthesia evaluation record (WAR) corresponds with the recommendations of the DGAI to carry out the staged information in analogy to the staged information of Weissauer. The basic practice is not changed by WACH. By means of WACH, the time point of the first contact with anesthesia is moved forward and occurs within a different framework. WACH has potential advantages for both patient and anesthesiologist, not least due to a higher patient safety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0031-1291948DOI Listing
October 2011

[Computerized anesthesia awareness - optimization of processes for planning anesthesia].

Anasthesiol Intensivmed Notfallmed Schmerzther 2011 Oct 21;46(10):E1-6. Epub 2011 Oct 21.

Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité- Universitätsmedizin Berlin, Campus Mitte und Campus Virchow Klinikum.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0031-1291949DOI Listing
October 2011

Prediction of the risk of comorbid alcoholism in schizophrenia by interaction of common genetic variants in the corticotropin-releasing factor system.

Arch Gen Psychiatry 2011 Dec 1;68(12):1247-56. Epub 2011 Aug 1.

Division of Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany.

Context: Stress plays a major role in the development of comorbid alcohol use disorder (AUD). In turn, AUD worsens the outcome of psychiatric patients with respect to global disease severity, social situation, and socioeconomic burden. Prediction of persons at risk for AUD is crucial for future preventive and therapeutic strategies.

Objective: To investigate whether genetic variants of the corticotropin-releasing factor system or their interaction influence the risk of developing AUD in chronic disease populations.

Design: Genotype analysis comprising selected single-nucleotide polymorphisms within the CRHR1 and CRHBP genes in patients with schizophrenia and in a nonschizophrenic psychiatric disease control sample should allow the extraction of predictors of comorbid AUD. Gene expression (messenger RNA) analysis in peripheral blood mononuclear cells was performed to gain the first mechanistic insight.

Setting: An ideal setup for this study was the Göttingen Research Association for Schizophrenia Data Collection of schizophrenic patients, specifically intended to enable association of genetic information with quantifiable phenotypes in a phenotype-based genetic association study. Patients  A total of 1037 schizophrenic patients (Göttingen Research Association for Schizophrenia sample), 80 nonschizophrenic psychiatric disease controls as a small replicate sample, and a case-control study including 1141 healthy subjects.

Main Outcome Measures: Association of CRHR1 and CRHBP genotypes with the following: (1) AUD; (2) a newly developed alcoholism severity score comprising 5 AUD-relevant variables; and (3) quantitative CRHR1 and CRHBP messenger RNA expression.

Results: An interaction of CRHR1 rs110402 and CRHBP rs3811939 predicts high risk of comorbid AUD in schizophrenic patients (odds ratio = 2.27; 95% confidence interval, 1.56-3.30; P < .001) as well as psychiatric disease controls (odds ratio = 4.02; 95% confidence interval, 0.95-17.05; P = .06) and leads to the highest CRHR1/CRHBP messenger RNA ratio (P = .02; dysbalanced stress axis).

Conclusions: The high predictive value of a genetic interaction within the stress axis for the risk of comorbid AUD may be used for novel preventive and individualized therapeutic approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archgenpsychiatry.2011.100DOI Listing
December 2011

Depression and essential health risk factors in surgical patients in the preoperative anaesthesiological assessment clinic.

Eur J Anaesthesiol 2011 Oct;28(10):733-41

Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany.

Background And Objective: Depression is common in patients with medical illness. However, little is known about frequency and clinical relevance of preoperative depression in surgical patients. The objective of this study was to investigate the frequency of depression, essential health risk factors and hospital length of stay (LOS) of patients in preoperative anaesthesiological assessment.

Methods: Patients were consecutively screened in the preoperative anaesthesiological assessment clinics. In total, 5429 patients gave written informed consent to perform a computerised self-assessment of lifestyle factors, including alcohol use, tobacco smoking, weight, physical status, physical exercise, sleeping disturbance, subjective health and sense of coherence (SOC). Depression was defined by a WHO-5 well-being score of 13 or less. LOS was obtained from the electronic patient management system.

Results: A clinically relevant depressive state was found in 29.7% of the patients. Patients with depression had a median LOS of 6.0 days as compared to patients with positive well-being who had a LOS of 4.8 days (P < 0.001). Worse subjective health, less physical exercise and experience of SOC, as well as more severe sleeping disturbances were independently and significantly associated with depression (P < 0.001).

Conclusion: Clinically significant depressive states are frequent conditions in surgical patients of preoperative anaesthesiological assessment and are associated with an increased LOS. Different clinical pathways delivering adequate preoperative information according to the needs, considering subjective health and SOC of the patient as well as avoiding immobilisation and sleep disturbances during hospital stay should be considered. Long-term treatment programmes including brief intervention in the hospital and an outpatient concept should be offered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/EJA.0b013e3283478361DOI Listing
October 2011

Supervised disulfiram in the treatment of alcohol use disorder: a commentary.

Alcohol Clin Exp Res 2011 Oct 13;35(10):1732-6. Epub 2011 May 13.

Background: This commentary discusses the systematic review "The efficacy of disulfiram for the treatment of alcohol use disorder (AUD)" by Jørgensen and colleagues (2011, Alcohol Clin Exp Res DOI: 10.1111/j.1530-0277.2011.01523.x). The main focus of the commentary is on long-term effects, long-term use, and psychotherapeutic application of supervised disulfiram.

Methods: A brief qualitative overview is given of previous and recent clinical studies on disulfiram in alcoholism treatment.

Results: The alcohol deterrent disulfiram is an effective pharmacological adjunct to the treatment of AUD when it is administered as supervised low-dose disulfiram and is integrated in comprehensive biopsychosocial alcoholism therapy. However, the assumed underlying psychological effects of psychotherapeutic disulfiram application have never been properly investigated. Prospective long-term follow-up studies are rare and suggest that long-term effects of disulfiram are associated with long-term use and/or integration of the medication in cognitive behavior therapy.

Conclusions: Evidence from decades of research suggests psychological effects as principal mode of action of supervised disulfiram. Future randomized controlled trials are needed that investigate psychological actions and long-term outcomes of this alcohol deterrent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1530-0277.2011.01519.xDOI Listing
October 2011

[The Post-Traumatic Stress Syndrome 14-Questions Inventory (PTSS-14) - Translation of the UK-PTSS-14 and validation of the German version].

Anasthesiol Intensivmed Notfallmed Schmerzther 2010 Nov 30;45(11-12):688-95. Epub 2010 Nov 30.

Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin.

Background: Hospitalization may represent a stressor that can lead to Posttraumatic stress disorder (PTSD).

Methods: Translation of the UK-PTSS-14, conducted in accordance with ISPOR principles and validation with the PDS (86 patients).

Results: The ROC analysis showed that the German version of PTSS-14 is a valid instrument with high sensitivity (82%) and specificity (92%) with the optimum cut-off point at 40 points. The translation process was authorized by the author of the UK-PTSS-14.

Conclusion: The validated German version of PTSS-14 is now ready for use as an efficient and reliable screening-tool for PTSD in a clinical setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0030-1268870DOI Listing
November 2010
-->