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.
The purpose of this article is to analyze the ways of organizing work to "earn a living" in public spaces of workers of the popular economy (E.P onwards) in the capital city of Santiago del Estero ...since 2021. That is, to characterize the activities of obtaining resources and ways of obtaining money, to describe the practices linked to social reproduction and to inquire about the meanings given to the work of selling in public spaces at present. To do this, we resort to the socialization of an ethnographic experience that describes the historically established practices of street vending or fixed stalls in the area of the city's Park and Waterfront. That is, we want to put in tension the dimensions involved in "making a living" for a group of workers organized in the popular economy. The street is undoubtedly a space of domination that systematically produces and reproduces a class structure when it comes to accessing, circulating and inhabiting the different work situations in the cities. In line with the thematic call of the dossier, we propose to recover the notion of "the street" as a multiple and intersectional place that becomes a central dimension to understand the ways of work organization, the obtaining of money, the meanings attributed to street vending, etc. In this way, we make use of the tools provided by ethnography in order to make the nature of economic life and social relations more complex, based on the testimonies and experiences of workers.
O objetivo deste artigo é analisar as formas como os trabalhadores da economia popular (E.P, doravante) da capital Santiago del Estero organizam o seu trabalho para "ganhar a vida" em espaços públicos a partir do ano 2021. Ou seja, caraterizar as actividades de obtenção de recursos e as formas de obtenção de dinheiro, descrever as práticas ligadas à reprodução social e investigar os significados atribuídos ao trabalho de venda no espaço público na atualidade. Para isso, recorremos à socialização de uma experiência etnográfica que descreve as práticas historicamente estabelecidas de venda ambulante ou de bancas fixas na área do Parque e da Orla da cidade. Em outras palavras, queremos estressaras dimensões do "ganhar a vida" de um grupo de trabalhadores organizados na economia popular. A rua é, sem dúvida, um espaço de dominação que produz e reproduz sistematicamente uma estrutura de classe no acesso, circulação e habitação das diferentes situações de trabalho nas cidades. De acordo com a chamada temática do dossier, propomos recuperar a noção de "rua" como um lugar múltiplo e interseccional que se torna uma dimensão central para compreender as formas de organização do trabalho, a obtenção de dinheiro, os significados atribuídos à venda ambulante. Deste modo, utilizamos as ferramentas da etnografia para complexificar a natureza da vida económica e das relações sociais, a partir dos testemunhos e experiências dos trabalhadores.
Este artículo analiza los modos de organización del trabajo para “ganarse la vida” en espacios públicos de trabajadores/as de la economía popular de la ciudad capital de Santiago del Estero (Argentina) a partir del año 2021. Busca caracterizar las actividades de obtención de recursos y formas de obtención de dinero, describir las prácticas vinculadas con la reproducción social e indagar sobre los significados otorgados al trabajo de la venta en espacios públicos en la actualidad. Para ello, recurre a la socialización de una experiencia etnográfica que describe las prácticas históricamente establecidas en la venta ambulante o de puestos fijos en la zona del Parque y Costanera de la ciudad. Pretende poner en tensión las dimensiones que conlleva “ganarse la vida” para un grupo de trabajadores/as organizados/as en la economía popular. La calle sin duda resulta un espacio de dominación que produce y reproduce sistemáticamente una estructura clasista a la hora de acceder, circular y habitar las diversas situaciones de trabajo en las ciudades. Propone recuperar la noción de “la calle” como un lugar múltiple e interseccional, que se transforma en una dimensión central para comprender los modos de organización del trabajo, la obtención de dinero, los significados atribuidos a la venta ambulante. De esta manera, se vale de las herramientas que brinda la etnografía para complejizar la naturaleza de la vida económica y las relaciones sociales a partir de testimonios y vivencias de trabajadores.
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.
Um zu evaluieren, ob das neue Einsatzmittel Gemeindenotfallsanitäter (G-NFS) den Rettungsdienst bei der Versorgung niedrigprioritärer Notfälle entlastet, wurden im Rahmen eines ...Innovationsfondsprojekts auch die hausärztliche und die Patient*innenperspektive mittels schriftlicher Befragung erhoben. Die Rekrutierung zur Studienteilnahme gestaltete sich jedoch schwierig. Mit dieser Studie soll untersucht werden, warum sich die G-NFS gegen eine Aufklärung zur Studienteilnahme entschieden und welche Maßnahmen erforderlich wären, um zukünftig mehr Notfallpatient*innen in Erhebungen einschließen zu können.
Retrospektive Analyse der im Erhebungszeitraum 01.04.2021 bis 30.06.2022 von den G-NFS dokumentierten Angaben zu Patientencharakteristika, durchgeführten Maßnahmen und Empfehlungen sowie zu den Gründen für die Ablehnung zur Studienteilnahme.
Es konnten 5.395 G-NFS-Einsatzprotokolle, die Angaben zur Nicht-Teilnahmefähigkeit beinhalteten, in die Auswertung eingeschlossen werden. Das Durchschnittsalter der Patient*innen betrug 62,4 Jahre (SD 22,7), und 50,2% waren weiblich. Als nicht dringlich zu versorgen wurden 57,4% der Fälle kategorisiert, die Nachalarmierung eines weiteren Rettungsmittels erfolgte in 35,2% der Fälle. Bei 404 (7,5%) Fällen lag eine wiederholte Inanspruchnahme und bei 1.120 (20,8%) Fällen Fremdsprachlichkeit vor, 1.012 (18,8%) Fälle lehnten die Studienteilnahme ab und 2.975 (55,1%) Fälle waren aus Sicht der G-NFS nicht teilnahmefähig. Als Gründe für die Nicht-Teilnahmefähigkeit aus Sicht der G-NFS wurden neurokognitive Einschränkungen (35%), Akut-/Notfall (26,5%), Beeinträchtigungen der psychischen Gesundheit (10,3%) und Substanzmissbrauch (6,5%) beschrieben.
Die Ergebnisse zeigen, dass aus Sicht der G-NFS über die Hälfte der Patient*innen aus unterschiedlichen Gründen nicht in der Lage war, an einer schriftlichen Befragung teilzunehmen, obwohl keine Behandlungsdringlichkeit vorlag. Ein hoher Versorgungsbedarf und das komplexe Einwilligungsverfahren könnten dafür ursächlich sein. Zusätzlich sind weitere Ressourcen für eine bedarfsgerechte Versorgung dieser Patient*innen erforderlich, um die Notfallversorgung zu entlasten. Weitere Untersuchungen sind notwendig, um festzustellen, welche Einwilligungsverfahren geeignet sind, um diesen Patient*innen die Teilnahme an Studien zu erleichtern.
In order to evaluate whether the new rescue means “community emergency paramedics” (Gemeindenotfallsanitäter G-NFS) relieves the emergency medical service (EMS) in the care of low-priority emergencies, the perspective of general practitioners and patients was also surveyed in a written questionnaire as part of an innovation fund project. Recruitment for participation in the study proved to be difficult. The aim of this study is to evaluate why the G-NFS decided against providing information on study participation and what measures would be necessary to include more emergency patients in surveys in the future.
Retrospective analysis of the assignment protocols from April 1, 2021 to June 30, 2022. In addition to patient characteristics, data on treatments, interventions and recommendations to patients as well as reasons for non-participation in the patient survey were collected.
5,395 G-NFS protocols that contained information on non-participation were included in the analysis. The average age of the patients was 62.4 years (SD 22.7), and 50.2% were female. 57.4% of the cases were categorised as non-urgent, and 35.2% of the cases required an additional ambulance to be alerted. 404 (7.5%) patients used the EMS more than once, 1,120 (20.8%) did not have sufficient language skills, 1,012 (18.8%) patients declined study participation, and 2,975 (55.1%) patients were not able to participate according to the G-NFS assessment. Dementia/neurocognitive impairment (35%), acute/emergency situation (26.5%), mental health impairment (10.3%), and substance abuse (6.5%) were given as reasons for non-participation from the G-NFS perspective.
The results show that more than half of the patients were unable to take part in a written survey for various reasons, even though there was no need for urgent care. This could be due to a high demand for care and the complex consent procedure. In addition, further resources are required to provide needs-based care for these patients in order to relieve the burden on emergency medical care. Over half of the patients were unable to take part in a written survey for various reasons. Further research is needed to determine what consent procedures are appropriate to facilitate patients’ study participation.
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