Qualitätsindikatoren in der Praxis

Hintergrund: Zur Erfassung der psychiatrischen Versorgungsqualität bedarf es geeigneter Qualitätsindikatoren. Diese sollten neben der klinischen Relevanz die Perspektiven von Behandler und Patienten berücksichtigen, verschiedene Dimensionen der Behandlung abdecken und sich auf veränderbare Versorgungsaspekte beziehen. Ziel der Studie war die Entwicklung und Erprobung von Qualitätsindikatoren zur Erfassung von Prozess- und Ergebnisqualität in der stationären Depressionsbehandlung. Diese Indikatoren wurden für den systematischen Qualitätsvergleich zwischen den Kliniken (Benchmarking) genutzt. Methode: Eine Multicenter-Studie wurde von Oktober 2001 bis April 2004 in 10 psychiatrisch-psychotherapeutischen Kliniken durchgeführt. Ergebnisse: Die Behandlung von über 2000 depressiven Patienten wurde mittels BADO dokumentiert, die depressionsspezifisch modifiziert wurde. Die Ergebnisse für verschiedene Qualitätsindikatoren werden dargestellt und diese bezüglich Relevanz, Praktikabilität und Validität für die stationäre Depressionsbehandlung beurteilt. Diskussion: Die Ergebnisse bestätigen die in der Literatur diskutierten methodischen Schwierigkeiten von Qualitätsindikatoren. Für die stationäre Depressionsbehandlung werden sinnvolle Qualitätsindikatoren empfohlen. Ein Ausblick über den Nutzen der Qualitätsindikatoren und eines Krankenhausvergleichs wird gegeben.

EarthCARE Aerosol and Cloud Layer and Column Products

We introduce the development of EarthCARE Level 2 layer products derived from profile measurements of the high-spectral-resolution lidar ATLID and column products obtained from combined information of ATLID and the Multi-Spectral Imager (MSI). Layer products include cloud top height as well as aerosol layer boundaries and mean optical properties along the satellite nadir track. Synergistic column products comprise cloud top height, Ångström exponent, and aerosol type both along-track and across the MSI swath.

[Psychiatric emergencies]

Psychiatric emergencies present a frequent and interdisciplinary challenge. Clinical diagnosis and management are complicated by the acuity, and the patient's compliance is often limited by the illness. Psychiatric emergencies include states of acute agitation, suicidality, delirium, stupor, and drug-induced emergencies. Sometimes interventions such as conversational contact, responding empathically to patients, or "talking down" are sufficient. If pharmacotherapy is necessary, benzodiazepines and antipsychotic drugs are the primary agents of choice.

[DGPPN recommendations on quality indicators for schizophrenia]

BACKGROUND

In Germany, several quality indicators have been proposed for the measurement of quality of mental healthcare. Some of these quality indicators have been tested in feasibility studies. The German Association for Psychiatry and Psychotherapy (DGPPN) established the "Task Force Quality Indicators (QI)" that, based on previous experience in the development and pilot testing of indicators, considered the further development and practical realization of QI for schizophrenia.

AIM

The aim was to select a set of QI for schizophrenia that can also be applied to other diagnoses or used in generic measurements. Another goal was to focus on high feasibility of indicators.

METHODS

In a multistage selection process, the DGPPN Task Force selected QI that focus on essential quality aspects from an inventory of 161 existing QI developed by national and international research groups. Indicators were adapted in consultation with the "trialogic forum" of the DGPPN.

RESULTS

The DGPPN proposes the following ten indicators for quality measurement in mental healthcare for schizophrenia: QI1 Long-term treatment/Monitoring of side effects, QI2 Seclusion and restraint, QI3 Number of suicides, QI4 Psychoeducational-oriented intervention for significant others, QI5 Timely beginning of outpatient treatment after discharge from inpatient treatment, QI6 Aggression management - inpatient treatment, QI7 Diagnostic procedures/Physical examination, QI8 Antipsychotic polypharmacy, QI9 Rehabilitation/Vocational rehabilitation, QI10 Diagnostic procedures/Psychosocial functioning.

DISCUSSION

Most of our proposed QI have to be measured by means of additional data documentation. Based on prior experience in the pilot testing of QI, the DGPPN estimates that the additional efforts in data documentation would be manageable, but have to be refinanced. The indicators will be tested in feasibility studies in different mental healthcare hospitals in Germany.

Internal structure and phase transition behavior of stimuli-responsive microgels in PEG melts

In this work we investigated the behaviour of stimuli-responsive poly(N-vinylcaprolactam) (PVCL) microgels in poly(ethylene glycol) (PEGs) with a linear architecture. We performed small-angle neutron scattering (SANS) experiments at two different microgel concentrations and various temperatures. The results were compared with those on PVCL microgels in water. PVCL in PEG (molecular weight M_W = 2 kg mol^-1) exhibits a volume phase transition temperature (VPTT) at a temperature between 160 and 180 °C. The diameter of the swollen microgel is only slightly smaller than in water. Furthermore, with increasing molecular weight of the surrounding polymer matrices fewer chains penetrate the microgel particles. In agreement with that, we identify a decreasing diameter with increasing molecular weight. In the short chain polymers up to M_W = 3 kg mol^-1, PVCL is well dispersed in the matrices with only minor signatures of agglomeration. For the well dispersed systems, we find unperturbed chain conformation of the PEG. Our results clearly show that the miscibility of PVCL and PEG disappears in a molecular weight range of 3 to 10 kg mol^-1.

Dissecting the actin cortex density and membrane-cortex distance in living cells by super-resolution microscopy

Nanoscale spacing between the plasma membrane and the underlying cortical actin cytoskeleton profoundly modulates cellular morphology, mechanics, and function. Measuring this distance has been a key challenge in cell biology. Current methods for dissecting the nanoscale spacing either limit themselves to complex survey design using fixed samples or rely on diffraction-limited fluorescence imaging whose spatial resolution is insufficient to quantify distances on the nanoscale. Using dual-color super-resolution STED (stimulated-emission-depletion) microscopy, we here overcome this challenge and accurately measure the density distribution of the cortical actin cytoskeleton and the distance between the actin cortex and the membrane in live Jurkat T-cells. We found an asymmetric cortical actin density distribution with a mean width of 230 (+105/-125) nm. The spatial distances measured between the maximum density peaks of the cortex and the membrane were bi-modally distributed with mean values of 50  ±  15 nm and 120  ±  40 nm, respectively. Taken together with the finite width of the cortex, our results suggest that in some regions the cortical actin is closer than 10 nm to the membrane and a maximum of 20 nm in others.

kW-class direct diode laser for sheet metal cutting based on DWDM of pump modules by use of ultra-steep dielectric filters

A direct diode laser was built with > 800 W output power at 940 nm to 980 nm. The radiation is coupled into a 100 µm fiber and the NA ex fiber is 0.17. The laser system is based on pump modules that are wavelength stabilized by VBGs. Dense and coarse wavelength multiplexing are realized with commercially available ultra-steep dielectric filters. The electro-optical efficiency is above 30%. Based on a detailed analysis of losses, an improved e-o-efficiency in the range of 40% to 45% is expected in the near future. System performance and reliability were demonstrated with sheet metal cutting tests on stainless steel with a thickness of 4.2 mm.

Evaluation of the 'Jumping to conclusions' bias in different subgroups of the at-risk mental state: from cognitive basic symptoms to UHR criteria

BACKGROUND

Patients with psychosis display the so-called 'Jumping to Conclusions' bias (JTC) - a tendency for hasty decision-making in probabilistic reasoning tasks. So far, only a few studies have evaluated the JTC bias in 'at-risk mental state' (ARMS) patients, specifically in ARMS samples fulfilling 'ultra-high risk' (UHR) criteria, thus not allowing for comparisons between different ARMS subgroups.

METHOD

In the framework of the PREVENT (secondary prevention of schizophrenia) study, a JTC task was applied to 188 patients either fulfilling UHR criteria or presenting with cognitive basic symptoms (BS). Similar data were available for 30 healthy control participants matched for age, gender, education and premorbid verbal intelligence. ARMS patients were identified by the Structured Interview for Prodromal Symptoms (SIPS) and the Schizophrenia Proneness Instrument - Adult Version (SPI-A).

RESULTS

The mean number of draws to decision (DTD) significantly differed between ARM -subgroups: UHR patients made significantly less draws to make a decision than ARMS patients with only cognitive BS. Furthermore, UHR patients tended to fulfil behavioural criteria for JTC more often than BS patients. In a secondary analysis, ARMS patients were much hastier in their decision-making than controls. In patients, DTD was moderately associated with positive and negative symptoms as well as disorganization and excitement.

CONCLUSIONS

Our data indicate an enhanced JTC bias in the UHR group compared to ARMS patients with only cognitive BS. This underscores the importance of reasoning deficits within cognitive theories of the developing psychosis. Interactions with the liability to psychotic transitions and therapeutic interventions should be unravelled in longitudinal studies.

[Gender-inclusive care of victims of violence : The model project "Gender Gewaltkonzept" at the University Hospital Aachen]

Violence is a topic of great social relevance, frequently causing tremendous health consequences for those affected and high consequential costs for health care and the national economy. The established consulting and assistance services are usually restricted to offers for ambulant supply, mainly from private agencies or societies. As a result, there is no identification and care for patients who have experienced violence and who are treated in hospital. Another deficiency is the identification and care of male victims of violence. Despite wide-ranging offers of assistance, only very few gender-specific consulting and support services have been available to date.Therefore, the model project "Gender Gewaltkonzept" was initiated at Aachen University Hospital to assess the prevalence of violence and the potential consequences of the violence experienced on the patients' health. In addition, we investigated whether males and females are in need of different supply requirements.Based on the results of the project "Gender Gewaltkonzept" so far, and on prevalence estimates proving that there is a high rate of violent experiences in both males and females, this overview is aimed at presenting the aid and protection concepts available for victims of violence, in addition to the existing deficiencies of the care system. We present approaches to resolving these deficiencies to be able to establish all-encompassing gender-appropriate support for victims of violence.