Neuausrichtung von Versorgung und Finanzierung Der Pflege-Report, der in Buchform und als Open-Access-Publikation erscheint, nimmt jährlich relevante Themen der Versorgung von Pflegebedürftigen unter ...die Lupe. Als Schwerpunkt des Jahres 2020 werden zentrale Reformbereiche der heutigen Leistungs-, Steuerungs- und Finanzierungsstrukturen aufgegriffen und diskutiert Aus dem Inhalt 15 Fachbeiträge beleuchten die Ursachen der nötigen Reformen, diskutieren hierbei bestehende Herausforderungen und zeigen Lösungswege im Einzelnen auf, u. a. Historie und internationaler Vergleich Bedarfslagen von ambulant Pflegebedürftigen und ihren pflegenden Angehörigen sowie deren finanzielle und zeitliche Belastungen Möglichkeiten und Grenzen einer Leistungsdefinition und individuellen Leistungsbemessung im Kontext Langzeitpflege Steuerungsfragen an der Schnittstelle „Prävention und Rehabilitation und Pflege“, Steuerung durch Care- und Case-Management, kommunale Steuerung von individuellen Pflegeleistungen und Grenzen vertragswettbewerblicher Steuerung Pflegefinanzierung in regionaler Perspektive, Stärkung solidarischer Finanzierungselemente sowie ergänzende private Vorsorge Zudem präsentiert der Pflege-Report empirische Analysen zur Pflegebedürftigkeit in Deutschland sowie zur Inanspruchnahme verschiedener Pflegeformen. Ein besonderer Fokus gilt der gesundheitlichen Versorgung in der ambulanten Pflege und im Pflegeheim.
Objective
First, to investigate how psychotherapists and patients experience the change from in‐person to remote psychotherapy or vice versa during COVID‐19 regarding the therapeutic interventions ...used. Second, to explore the influence of therapeutic orientations on therapeutic interventions in in‐person versus remote psychotherapy.
Method
Psychotherapists (N = 217) from Austria were recruited, who in turn recruited their patients (N = 133). The therapeutic orientation of the therapists was psychodynamic (22.6%), humanistic (46.1%), systemic (20.7%) or behavioural (10.6%). All the data were collected remotely via online surveys. Therapists and patients completed two versions of the ‘Multitheoretical List of Therapeutic Interventions’ (MULTI‐30) (version 1: in‐person; version 2: remote) to investigate differences between in‐person and remote psychotherapy in the following therapeutic interventions: psychodynamic, common factors, person‐centred, process‐experiential, interpersonal, cognitive, behavioural and dialectical‐behavioural.
Results
Therapists rated all examined therapeutic interventions as more typical for in‐person than for remote psychotherapy. For patients, three therapeutic interventions (psychodynamic, process‐experiential, cognitive interventions) were more typical for in‐person than for remote psychotherapy after correcting for multiple testing. For two therapeutic interventions (behavioural, dialectical‐behavioural), differences between the four therapeutic orientations were more consistent for in‐person than for remote psychotherapy.
Conclusions
Therapeutic interventions differed between in‐person and remote psychotherapy and differences between therapeutic orientations in behavioural‐oriented interventions become indistinct in remote psychotherapy.
O melhor amigo do camelô Thiago José Silva
Plural,
12/2023, Letnik:
30, Številka:
2
Journal Article
Recenzirano
Odprti dostop
A presente pesquisa descreve, a partir de uma investigação etnográfica, a relação estabelecida entre o comércio ambulante e o mercado ilegal de agiotagem e seus impactos em virtude do processo de ...formalização dessa primeira atividade econômica. Percebe-se, por meio da observação participante, que os laços construídos entre camelôs e agiotas se mantém à revelia dos estatutos jurídicos desses interlocutores, o qual a lógica que move essa relação se dá por meio da pessoalidade desses sujeitos e da postura dos ambulantes em assimilar o dinheiro emprestado pela agiotagem como um recurso específico para “girar a mercadoria”. Essas caracterizações feitas pelos interlocutores geram garantias específicas na dinâmica desse mercado, na qual a relação entre legal e ilegal se retroalimenta. Conclui-se portanto, o processo de formalização, ao contrário das expectativas governamentais, gera uma maior demanda pelo mercado ilegal de agiotagem.
To explore how mental health professionals address spiritual care for outpatients in weekly multidisciplinary care meetings (MDM), and to explore the barriers and facilitators in the ways health ...professionals address spiritual care in those meetings.
Two teams of mental health professionals providing care for psychiatric outpatients are included. Qualitative data were collected from audio recordings of multidisciplinary meetings and from focus-group interviews afterwards. Data were analysed using ‘open coding’.
Spiritual care was not frequently addressed mostly due to the requirements of the health insurance reimbursement system. Aspects of spirituality addressed in these meetings pertained mainly to meaningful daily activities. Addressing spiritual care was facilitated, on the other hand, by a holistic focus on health and recovery-oriented care.
In ambulatory mental healthcare spirituality is sparsely addressed and, when addressed, few aspects of spirituality come into view. Facilitating healthcare professionals’ awareness of their clinical perspective is an essential step to improve spiritual care for psychiatric outpatients.
Major depressive disorder (MDD) is a highly prevalent and disabling disorder. This study examines two psychotherapy methods for MDD, behavioral activation (BA), and metacognitive therapy (MCT), when ...applied as outpatient treatments to severely affected patients.
The study was conducted in a tertiary outpatient treatment center. Patients with a primary diagnosis of MDD (N = 122) were included in the intention-to-treat sample (55.7% female, mean age 41.9 years). Participants received one individual and one group session weekly for 6 months (M). Assessments took place at baseline, pretreatment, mid-treatment (3 M), post-treatment (6 M), and follow-up (12 M). The primary outcome was depressive symptomatology assessed by the Hamilton Rating Scale for Depression at 12 M follow-up. Secondary outcomes included general symptom severity, psychosocial functioning, and quality of life.
Linear mixed models indicated a change in depressive symptoms (F(2, 83.495) = 12.253, p < 0.001) but no between-group effect (F(1, 97.352) = 0.183, p = 0.670). Within-group effect sizes were medium for MCT (post-treatment: d = 0.610; follow-up: d = 0.692) and small to medium for BA (post-treatment: d = 0.636, follow-up: d = 0.326). In secondary outcomes, there were improvements (p ≤ 0.040) with medium to large within-group effect sizes (d ≥ 0.501) but no between-group effects (p ≥ 0.304). Response and remission rates did not differ between conditions at follow-up (response MCT: 12.9%, BA: 13.3%, remission MCT: 9.7%, BA: 10.0%). The deterioration rate was lower in MCT than in BA (χ21 = 5.466, p = 0.019, NTT = 7.4).
Both MCT and BA showed symptom reductions. Remission and response rates were lower than in previous studies, highlighting the need for further improvements in adapting/implementing treatments for severely affected patients with MDD.
Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The ...aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community‐based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (ORs). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self‐harm behaviour (OR 7.9) and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5) and self‐harm behaviour (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail.
Jedes Jahr erleiden 270.000 Menschen in Deutschland einen Schlaganfall. In vielen Fällen können die betroffenen Personen wieder nach Hause zurückkehren und ihr Leben fortführen, benötigen dabei aber ...ambulante Pflege- und Therapiemaßnahmen. Gerade in ländlichen Regionen bringt dies erhebliche Herausforderungen mit sich, denen sich neue Technologien und die Digitalisierung entgegenstellen. Die Beiträger*innen des Bandes diskutieren erste Ergebnisse des Projekts »DeinHaus 4.0 Oberpfalz« aus interdisziplinärer Sicht, bei dem die Möglichkeit des Einsatzes von Telepräsenzrobotern zur Unterstützung ambulanter Pflege- und Therapiemaßnahmen untersucht wird.
Machine learning (ML) may help to predict successful psychotherapy outcomes and to identify relevant predictors of success. So far, ML applications are scant in psychotherapy research and they are ...typically based on small samples or focused on specific diagnoses. In this study, we predict successful therapy outcomes with ML in a heterogeneous sample in routine outpatient care. We trained established ML models (decision trees and ensembles of them) with routinely collected clinical baseline information from n = 685 outpatients to predict a successful outcome of cognitive behavioral therapy. Treatment success was defined as clinically significant change (CSC) on the Brief-Symptom-Checklist (reached by 326 patients; 48%). The best performing model (Gradient Boosting Machines) achieved a balanced accuracy of 69% (p < .001) on unseen validation data. Out of 383 variables, we identified the 16 most important predictors, which were still able to predict CSC with 67% balanced accuracy. Our study demonstrates that ML models built on data, which is typically available at the outset of therapy, can predict whether an individual will substantially benefit from the intervention. Some of the predictors were theoretically expected (e.g., level of functioning), but others need further validation (e.g., somatization). From a theoretical and practical perspective, ML is clearly an attractive addition to more established psychotherapy research methodology.
•At psychotherapy outset, it is non-trivial to predict which patients will benefit.•Machine Learning (ML) is a promising addition to psychotherapy research.•ML models can predict treatment outcome in routine outpatient care.•The best performing ML model achieved a balanced accuracy of 69%.•16 Most important predictors are sufficient; they inform future research.
Gait impairments in persons with multiple sclerosis (pwMS) leading to decreased ambulation and reduced walking endurance remain poorly understood. Our objective was to assess gait asymmetry (GA) and ...bilateral coordination of gait (BCG), among pwMS during the six-minute walk test (6MWT), and determine their association with disease severity. We recruited 92 pwMS (age: 46.6 ± 7.9; 83% females) with a range of clinical disability, who completed the 6MWT wearing gait analysis system. GA was assessed by comparing left and right swing times, and BCG was assessed by the phase coordination index (PCI). Several functional and subjective gait assessments were performed. Results show that gait is more asymmetric and less coordinated as the disease progresses (p < 0.0001). Participants with mild MS showed significantly better BCG as reflected by lower PCI values in comparison to the other two MS severity groups (severe: p = 0.001, moderate: p = 0.02). GA and PCI also deteriorated significantly each minute during the 6MWT (p < 0.0001). GA and PCI (i.e., BCG) show weaker associations with clinical MS status than associations observed between functional and subjective gait assessments and MS status. Similar to other neurological cohorts, GA and PCI may be important parameters to assess and target in interventions among pwMS.
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