TY - JOUR A1 - Weck, Florian A1 - Junga, Yvonne Marie A1 - Kliegl, Reinhold A1 - Hahn, Daniela A1 - Brucker, Katharina A1 - Witthöft, Michael T1 - Effects of competence feedback on therapist competence and patient outcome BT - a randomized controlled trial JF - Journal of consulting and clinical psychology N2 - Objective: Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome. Method: Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions. Results: (a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy. Conclusion: Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome. What is the public health significance of this article? This study suggests the substantial value of systematic competence feedback for improving therapist competence in the psychotherapy of depression. No significant effect of competence feedback on the reduction of reported depressive symptoms was found. KW - feedback KW - outcome KW - major depression KW - therapeutic alliance KW - therapeutic KW - competencies Y1 - 2021 U6 - https://doi.org/10.1037/ccp0000686 SN - 0022-006X SN - 1939-2117 VL - 89 IS - 11 SP - 885 EP - 897 PB - American Psychological Association CY - Washington ER - TY - JOUR A1 - Salzwedel, Annett A1 - Haubold, Kathrin A1 - Barnack, Beate A1 - Reibis, Rona Katharina A1 - Völler, Heinz T1 - Indikatoren der Ergebnisqualität kardiologischer Rehabilitation Ergebnisse einer Delphi-Befragung von Mitgliedern der Deutschen Gesellschaft für Prävention und Rehabilitation von Herz- und Kreislauferkrankungen e. V. (DGPR) JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Ziel der Studie Die vorliegende Untersuchung beinhaltete die explorative Erfassung potenzieller Indikatoren der Ergebnisqualität der kardiologischen Rehabilitation (CR) für Patienten unter 65 Jahren. Methoden In einer 4-stufigen webbasierten Delphi-Befragung (04-07/2016) von in der CR tätigen Ärzten[2] , Psychologen und Sport-/Physiotherapeuten wurden Parameter der körperlichen Leistungsfähigkeit, der Sozialmedizin, der subjektiven Gesundheit und kardiovaskuläre Risikofaktoren hinsichtlich ihrer Eignung als Qualitätsindikator bewertet. Ergebnisse Von 44 vorgegebenen wie auch von den Teilnehmern vorgeschlagenen Parametern wurden 21 Parameter (48%), die Hälfte davon psychosoziale Faktoren, als potenzielle Qualitätsindikatoren ausgewählt, wobei lediglich für das Rauchverhalten, den Blutdruck, das LDL-Cholesterin und die max. Belastbarkeit im Belastungs-EKG ein Konsens (Zustimmung>75% der Befragten) erzielt wurde. Schlussfolgerung Die Wahl der Qualitätsindikatoren durch die Experten erfolgte mehrheitlich mit nur geringer Einigkeit. Eine klinische und wissenschaftliche Evaluierung der gewählten Parameter ist daher zwingend erforderlich. N2 - Objective The present investigation aimed an explorative acquisition of potential performance measures for quantifying the quality of cardiac rehabilitation (CR) for patients under 65 years of age. Methods A 4-level web based Delphi survey of physicians, psychologists, and sports or physiotherapists in CR was conducted from April to July in 2016. The experts assessed several parameters of physical performance, social medicine, subjective health and cardiovascular risk factors regarding their suitability as performance measures of CR. Results Of the 44 predetermined as well as by the participants proposed parameters, 21 parameters (48%) were selected as potential performance measures. Half of these were psychosocial factors. Merely, smoking habits, blood pressure, LDL-cholesterol and maximum capacity on exercise-ECG achieved a consensus (agreement>75% of the respondents). Conclusions The experts’ choice of performance measures was little consistent. Therefore, a clinical investigation and scientific evaluation of the predefined parameters is essential. T2 - Quality Performance Measures in Cardiac RehabilitationResults of a Delphi Survey of Members of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR) KW - cardiac rehabilitation KW - quality assurance KW - performance measures KW - outcome KW - expert survey KW - kardiologische Rehabilitation KW - Qualitätsindikatoren KW - Ergebnisqualität KW - Rehabilitationserfolg KW - Expertenbefragung Y1 - 2018 U6 - https://doi.org/10.1055/s-0044-101048 SN - 0034-3536 SN - 1439-1309 VL - 58 IS - 1 SP - 31 EP - 38 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Liang, Xu-Jing A1 - Huang, Si-Min A1 - Li, Jian-Ping A1 - Zhu, Xian-Nv A1 - Lu, Yong-Ping A1 - Hocher, Berthold A1 - Chen, You-Peng T1 - Hepatic impairment induced by scrub typhus is associated with new onset of renal dysfunction JF - Clinical laboratory : the peer reviewed journal for clinical laboratories and laboratories related to blood transfusion N2 - Background: Scrub typhus is a potentially fatal infectious disease caused by Orientia tsutsugamushi. There is little attention given to hepatic impairment in the adults with scrub typhus. This study investigated the incidence and the prognostic implications of hepatic impairment in patients with scrub typhus. Methods: We retrospectively reviewed a total of 143 adult patients with scrub typhus who were admitted between January 1999 and December 2010 in Guangdong province, China. The patients were divided into three groups, e.g., normal, mild, and moderate to severe groups based on the elevated serum ALT and/or total bilirubin levels. Furthermore, clinical characteristics and prognosis of the patient groups were compared. Results: 109 patients (76.2%) had abnormal liver function. Among the patients with hepatic impairment 45 cases (31.4%), 54 cases (37.8%), and 10 cases (7.0%) had mild, moderate, and severe hepatic damage, respectively. The moderate to severe hepatic impairment group had higher levels of serum creatinine compared with that of normal hepatic function. The incidence of new onset of renal dysfunction - defined as peak serum creatinine >= 176 mu mol/L during hospital stay with no evidence of renal disease prior hospitalization - was 0% in the mild hepatic impairment group, 8.9% in the moderate hepatic impairment group, and 21.9% in the severe hepatic impairment group, (p = 0.005 for trend). Additionally, the patients with hepatic impairment (n = 109) had higher incidences of episodes of thrombocytopenia (45.9% vs. 8.82%, p < 0.001), hypoalbuminemia (50.5% vs. 11.8%, p < 0.001), new onset of renal dysfunction (16.5% vs. 0.0%, p = 0.011), and electrocardiogram abnormality (28.4% vs. 8.82%, p = 0.019) than the patients without hepatic impairment. Conclusions: The degree of hepatic impairment induced by scrub typhus is associated with new onset of renal dysfunction. KW - hepatic impairment KW - renal dysfunction KW - complication KW - outcome KW - scrub typhus Y1 - 2014 U6 - https://doi.org/10.7754/Clin.Lab.2013.121203 SN - 1433-6510 VL - 60 IS - 1 SP - 63 EP - 68 PB - Clin Lab Publ., Verl. Klinisches Labor CY - Heidelberg ER - TY - JOUR A1 - Roehrig, B. A1 - Nosper, M. A1 - Linck-Eleftheriadis, S. A1 - Strandt, G. A1 - Salzwedel, Annett A1 - Völler, Heinz T1 - Method of the assessment of patients Outcome in cardiac rehabilitation by means of quality indicators - a description of the method JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Introduction: Cardiac rehabilitation is designed for patients suffering from cardiovascular diseases or functional disabilities. The aim of a cardiac rehabilitation is to improve overall physical health, psychological well-being, physical function, the ability to participate in social life and help patients to change their habits. Regarding the heterogeneity of these aims measuring of the effect of cardiac rehabilitation is still a challenge. This study recommends a concept to assess the effects of cardiac rehabilitation regarding the individual change of relevant quality indicators. Methods: With EVA-Reha; cardiac rehabilitation the Medical Advisory Service of Statutory Health Insurance Funds in Rhineland-Palatinate, Alzey (MDK Rheinland-Pfalz) developed a software to collect data set including sociodemographic and diagnostic data and also the results of specific assessments. The project was funded by the Techniker Krankenkasse, Hamburg, and supported by participating rehabilitation centers. From 01. July 2010 to 30. June 2011 1309 patients (age 71.5 years, 76.1% men) from 13 rehabilitation centers were consecutively enrolled. 13 quality indicators in 3 scales were developed for evaluation of cardiac rehabilitation: 1) cardiovascular risk factors (blood pressure, LDL cholesterol, triglycerides), 2) exercise capacity (resting heart rate, maximal exercise capacity, maximal walking distance, heart failure [NYHA classification], and angina pectoris [CCS classification]) and 3) subjective health (IRES-24: pain, somatic health, psychological wellbeing and depression as well as anxiety on the HADS). The study was prospective; data of patients were assessed at entry and discharge of rehabilitation. To measure the success of rehabilitation each parameter was graded in severity classes at entry and discharge. For each of the 13 quality indicators changes of severity class were rated in a rating matrix. For indicators without a requirement for medical care neither at entry nor at discharge no rating was performed. Results: The grading into severity classes as well as the minimal important differences were given for the 13 quality indicators. The result of rehabilitation can be demonstrated in suitable form by means of rating of the 13 quality indicators according to a clinical population. The rating model differs well between clinically changed and unchanged patients for the quality indicators. Conclusion: The result of cardiac rehabilitation can be assessed with 13 quality indicators measured at entry and discharge of the rehabilitation program. If a change into a more favorable category at the end of rehabilitation could be achieved it was counted as a success. The 13 quality indicators can be used to assess the individual result as well as the result of a population - e.g. all patients of a clinic in a specific time period. In addition, the assessment and rating of relevant quality indicators can be used for comparisons of rehabilitation centers. KW - cardiac rehabilitation KW - quality indicator KW - outcome KW - success KW - quality management Y1 - 2014 U6 - https://doi.org/10.1055/s-0033-1341457 SN - 0034-3536 SN - 1439-1309 VL - 53 IS - 1 SP - 31 EP - 37 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Chaudhary, Tanja A1 - Walch, Elisabeth A1 - Herold, Birgit A1 - Metze, B. A1 - Lejeune, A. A1 - Burkhardt, F. A1 - Buehrer, C. T1 - Predictive and concurrent validity of standardized neurodevelopmental examinations by the griffiths scales and bayley scales of infant development II JF - Klinische Pädiatrie : clinical research and practice in pediatrics N2 - Background: Standardized examinations of preterm infants are used to identify candidates for early intervention. We aimed to assess the predictive power and concurrent validity of the mental development index of the Bayley scales of infant development II (Bayley MDI) and the Griffiths scales developmental quotient (Griffiths DQ) in healthy term and preterm infants < 1 500 g birth weight without major perinatal complications. Methods: 137 Infants (89 term, 48 preterm) were examined by both tests at a corrected age of 6, 12, and 22 months, and 114 went on to undergo Bayley assessments at 39 months. Results: There were significant correlations between Bayley and Griffiths results at 6, 12, and 22 months (r = 0.530, 0.714, and 0.833, respectively, p < 0.001) but Bland Altman plots revealed major systematic bias at 6 months (Griffiths > Bayley, mean differences 14.3 +/- 9.8) and 22 months (Bayley > Griffiths, mean difference 5.2 +/- 13.9) and wide 95% limits of agreement at 6, 12 and 22 months (35.9%, 40.0%, and 52.4%, respectively). The agreement for a presumptive diagnosis of developmental impairment in the group of preterm infants between Bayley examinations obtained at 39 months corrected age (reference) and previous examinations was poor at 6, 12, and 22 months for both Bayley and Griffiths (Cohen's kappa for Griffiths: 0.225, 0.192, 0.369; for Bayley: 0.121, 0.316, 0.369, respectively). Conclusion: Caution should be exercised when interpreting results from standardized neurodevelopmental examinations obtained during the first 2 years of life in comparatively well preterm infants. KW - very low birth weight infant KW - outcome KW - neurodevelopmental impairment Y1 - 2013 U6 - https://doi.org/10.1055/s-0032-1331169 SN - 0300-8630 VL - 225 IS - 1 SP - 8 EP - 12 PB - Thieme CY - Stuttgart ER -