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Biomedical subjects

G Bosch

Publications and source records attributed to G Bosch.

At least 19 recordsLinked to original sources
PubMed1992

[Follow-up options in institutional protection--"patient careers" in a comprehensive community psychiatric care system].

The recommendations for the reorganization of German psychiatry were associated with the expectation that institutional protection can be reduced in a comprehensive community care system on the longterm basis and that a stabilization can be achieved during treatment with a minimum share in full and partial hospitalization. To test this assumption we studied the institutional pathways of 136 chronic, mainly schizophrenic patients within the comprehensive care system of the Department of Social Psychiatry over two years. A cluster analysis of sequence and intensity of institutional care showed three major types of use of the system: as a rehabilitation system, as an alternative and flexible care system, and as a traditional "dual-care-system". These patterns of institutional pathways were analyzed regarding predictors from patient's history. Consequences are discussed concerning further development of community mental health, coordination of services and continuity of care.

Adult↗
PubMed1991

A novel process for anaerobic composting of municipal solid waste.

A novel process has been developed and evaluated in a pilot-scale program for conversion of the biodegradable fraction of municipal solid waste (MSW) to methane via anaerobic composting. The sequential batch anaerobic composting (SEBAC) process employs leachate management to provide organisms, moisture, and nutrients required for rapid conversion of MSW and removal of inhibitory fermentation products during start-up. The biodegradable organic materials are converted to methane and carbon dioxide in 21-42 d, rather than the years required in landfills.

Anaerobiosis↗
PubMed1990

[Rehabilitation in a community psychiatric service facility--success and failure during a one year period].

Rehabilitation outcome was examined within a social psychiatric model institution including several partial hospitalization programmes and various outpatient services. After a one-year period the treatment success was measured by objective criteria in 166 consecutively admitted patients, most of them diagnosed as schizophrenics. 75% showed improvements in terms of reduced institutional protection and a more independent living situation. Vocational rehabilitation was successful in 47%. There was no significant correlation between these outcome measures. A poor outcome was found in a group of patients who had received a comparatively high rate of therapeutic activities and was classified by sociodemographic variables. Consequences concerning the therapeutic approach in community mental health services and its evaluation are shown.

Adult↗
PubMed1990

[Social workers and physicians--partners in social psychiatry? Assumptions and reality in a social psychiatry model institution].

With the reform of psychiatric and psychosocial care services, new professional groups, apart from the traditionally medical professions, have increasingly found their way into everyday therapy. Social workers in particular have gained significance in complementary fields of treatment. An empirical survey of the everyday situation in a comprehensive community mental health service system focusing on the therapist-couple "physician" and "social worker" collaborating to guarantee continuity of care for long-term treatment, yielded three results: 1. The dual-therapistsystem was convincingly effective for nearly half of the total number of patients; the other patients were attended generally by one therapist, while the second therapist took an active part in treatment only sporadically. 2. Analysis considering the two professional groups involved showed a significant pre-dominance of the physicians, both on a qualitative basis in their function as being the primary therapist as well as in strictly quantitative terms concerning the relations of all therapeutic activities. 3. A comparison of two extreme groups "doctor-patients" and "social worker-patient" revealed significant differences in features of their respective social and clinical case histories. In the course of treatment we found a rapid focusing on and acceptance of the medical therapeut. These results, which also reflect the conflict between social psychiatric claims and everyday reality, are discussed with regard to the self-perception of the professional groups involved and the practice of our department and the cooperative institutions, as well as the expectations of the patients and their relatives, and finally with reference to the various exclusively medical-oriented treatment models which still dominate contemporary psychiatric praxis.

Adult↗
PubMed1989

[Reduction of complete inpatient treatment by a system of partial hospitalization, ambulatory and complementary services].

This study aimed at investigating whether psychiatric care and especially partial hospitalisation programmes would achieve a reduction in time and cost of inpatient care. Frequency and duration of hospital treatments were studied in chronic psychotic patients (mean duration of illness = 8.7 years) before and after admission to a comprehensive community care system. The system includes partial hospitalisation programmes, out-patient care and various community services. Frequency and duration of hospital treatments were found to be lowered to less than 50%. However, since there were long periods of partial hospitalisation in addition to in-patient treatment, the remaining time of out-patient care was reduced. This result can be found mainly during the first year after admission and applies in particular to elderly and particularly chronic patients. In discussing the findings, treatment costs were also considered.

Adult↗
PubMed1987

[Younger psychiatric patients in homes for the aged and nursing homes].

All 77 residents aged under 65 in geriatric nursing homes and homes for the elderly in the Berlin (W) district of Charlottenburg were assessed in regard to mental illness and impairment. Additionally, data were collected covering psychopathology, clinical and personal data, medical and social care as well as the extent of contacts to nonresidents and institutional setting. 85% of these younger residents-8% of the total residential population-proved to be mentally ill. Primarily, they suffered from addiction, schizophrenia or mental retardation. Projecting our results to the total residential population of Berlin living in such homes, 728 younger mentally ill or retarded patients or 0,5%o of the population aged under 65 would live in such institutions. These residents had histories of unfavorable living conditions and a long psychiatric case history with frequent hospitalization. Distinct differences in regard to patient data as well as settings were found among public, welfare and private institutions. Results are discussed and arguments for improving care of this population are presented.

Adult↗
PubMed1986

[Patient flow in a social psychiatric treatment model].

The Department of Social Psychiatry at the Free University of Berlin offers a mode of treatment that comprises semi-inpatient, complementary and outpatient treatment in close cooperation with facilities for full inpatient treatment. This relatively comprehensive system is examined for its patient flow. The authors observed over a period of three years to what extent patient flow followed lines as recommended in literature for step-by-step rehabilitation and flexible retransfer. Furthermore the differences in utilising the system by first admissions and readmissions to the Department are described.

Affective Disorders, Psychotic↗
PubMed1985

[Treatment conditions and discharge from the viewpoint of the therapist and patient--on the follow-up of former patients of a social psychiatric model institution].

An interview conducted with former patients verified whether or not the reasons for being discharged from hospital coincided with those of the therapists. There was only agreement in approximately 50% of the cases according to whether the patients demanded to be released or whether their discharge was ordered by the hospital. Agreement was found to be greater particularly in cases where further treatment was not considered to be necessary by the patients and where patients were assigned to medical treatment elsewhere. There was more agreement in cases where further care was regarded as not necessary by both--therapists and patients. Patients who believed that they themselves had terminated treatment judged the hospital in a more negative light, as was to be expected. Agreement was high between therapists and patient regarding the treatment which was conducted afterwards. In this case medical records transpired to be very reliable. The question why a model setting, which aims at a high consensus among the medical staff and patients, attains only limited agreement on the reasons and necessity for discharge from hospital, is discussed.

Follow-Up Studies↗
PubMed1984

Reconstruction of the nipple: a new technique.

We propose a simple one-stage procedure for nipple reconstruction. The fundamental basis, the technique itself, and the results obtained demonstrate that a single-flap reconstruction achieves a nipple that will keep its shape 15 months later.

Breast↗
PubMed1975

[Zur beruflichen Rehabilitation schizophrener Patienten].

The article reports on the results of vocational rehabilitation efforts in 399 schizophrenic patients. The criterion for assessing the rehabilitation outcome was a regular job for at least three months after discharge from the hospital - which was achieved in 51% of the schizophrenics as compared to 63% of the control group. In the majority of cases good rehabilitation results could be achieved only by placement in a job which, compared with the previous position, required less skills. In analysing the rehabilitation success in its relation to different variables it was noted that the diagnostic assignment to paranoid types of schizophrenia was positive whereas the opposite was found in the cases of hebephrenic courses and defective conditions. As a rule, better success could be achieved with older patients, which is attributed to vocational stabilisation before the onset of the disease. More effective than the correlation with diagnostic and psychopathological data was the examination of the relationship between success and the variables 1) social background and 2) attitudes. Very negative factors turned out to be social origin and milieu conditions, economic and family situations, the states of unemployment at the time before admission and an insufficient adjustment to the training programme. No correlation could be found between success and a longer history of employment. Social isolation could be largely eliminated through the therapeutic family milieu offering identification possibilities. In addition, the study revealed the importance of a continuous psychosocial follow-up care.

Adaptation, Psychological↗