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Biomedical subjects

U Koch

Publications and source records attributed to U Koch.

216 records · Page 12Linked to original sources
PubMedDate not supplied

[Evaluation of outpatient rehabilitation: goals, conceptual framework and study design of a health and pension insurance joint research project].

In Germany the statutory health and pension insurance schemes are the main providers of medical rehabilitation, the majority of rehabilitation measures being given in an inpatient setting. Over the last few years, the health and pension insurance schemes have strengthened the extension of outpatient rehabilitation, and have funded a comprehensive evaluation study in this context. In this evaluation study outpatient rehabilitation in centres with different conceptual backgrounds is compared with inpatient rehabilitation in rehab clinics, indications considered being cardiology and orthopaedics. Overall, 14 rehab centres and more than 2000 patients were included in the project. The patients were interviewed and medically examined before and after the measure. A follow-up was done after six and twelve months. In addition to the rehabilitants themselves, the rehab centre physicians as well as the office-practice physicians were interviewed about the outcome of the rehab measure. One year after rehabilitation, data were collected from the relevant health and pension insurance funds concerning the benefits the patients had received. Due to the study's non-experimental design, validity of the results is confined to rehabilitants participating on an outpatient basis and who had been found medically suited for this type of rehabilitation, were capable of travelling to the rehab centre on their own within less than 45 minutes and had voluntarily opted for the outpatient setting. The findings of the study show that outpatient rehabilitants' motivation and expectations differ from those found in inpatient rehabilitation. The health economics analysis performed is restricted to the costs involved in the rehabilitation measure as such as well as the health-related benefits provided to the rehabilitants in the twelve-month study period. The issue of whether increasing outpatient rehab measures will lead to decreasing costs in the rehab system as a whole had not been considered in the framework of this project.

Ambulatory Care↗
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[1-Year follow-up of inpatient treatment in a psychosomatic rehabilitation clinic with either a psychoanalytic or behavior therapy oriented treatment].

In a naturalistic setting, we studied the long-term effects of an inpatient treatment program at a psychosomatic rehabilitation clinic, where patients were assigned to a department with either a psychoanalytic or behavior therapeutic orientated treatment after one week of comprehensive diagnosis. The study is based on a self-developed questionnaire which gathers retrospective information in a broad spectrum of problem areas at the point of admittance and release (t0 and t1) as well as current assessments one year following treatment (t2). Additionally, a symptom checklist (Giessener Beschwerdebogen) and a questionnaire assessing depression (Allgemeine Depressionsskala) were prospectively employed at t0 and t2. We asked a consecutive sample of 376 patients to participate, of which 56% answered at t2. Despite limitations of the internal and external validity of the study, we were able to show that substantial improvements are maintained following treatment for both therapies at one-year follow-up, whereas only small difference are found between the outcomes of the two different schools implemented in the clinic.

Adult↗
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[Current trends in medical rehabilitation and their significance for the field of psychosomatic rehabilitation].

At present the process of serious restructuring can be observed in the system of medical rehabilitation in Germany. This paper focuses on recently initiated innovations and their consequences for psychosomatic rehabilitation. The patient's access to a psychosomatic rehabilitation system is analysed and examined to what extent innovations increase early detection of patients with psychosomatic disorders. Regarding the structure of psychosomatic rehabilitative offers, the initiated innovations such as an increase of flexibility, better transition and improvement of inpatient rehabilitative offers are described and discussed. Finally, the development of quality improvement programs and rehabilitation research in the field of psychosomatic rehabilitation is presented. Although many changes have taken place up to now, further relevant modifications in psychosomatic rehabilitation are predicted by the authors.

Ambulatory Care↗
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[Quality assurance in the field of psychosomatic rehabilitation].

Since the mid 1990s, the statutory pension insurance agencies have developed and begun to implement a broad program for quality management in the field of medical rehabilitation. A total of 942 rehabilitation clinics from all areas of indication, including the field of psychosomatic rehabilitation, are currently participating in the program. In its first program point, the 5-point program deals with the collection and analysis of structural and conceptual aspects. Program point 2 deals with the documentation of therapy plans for the primary treatment groups; in program point 3, clinical documentations are used for a quality screening (peer review procedure), and in point four, patient satisfaction and treatment results will be evaluated by patient interviews. The analysis of inadequacies performed within these program points will be returned to the clinics by means of an information system. Thus, the clinics receive information on the conditions in their own clinics against the backdrop of results from clinics with similar structures. The quality problems which are identified, will be dealt with in the framework of quality circles (program point 5). This article describes and discusses the specifications of the quality assurance program for the field of psychosomatic rehabilitation.

Germany↗
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[Analysis of premature termination in inpatient psychosomatic rehabilitation based on epidemiologic data from two hospital companies].

Premature termination of inpatient psychotherapy can have multiple, mostly negative, effects for patients, therapists, clinics, insurance companies, and employers, but research regarding inpatient settings is still deficient. The analysis of two sets of data of four different rehabilitation clinics from two different hospital companies (2699 and 2215 patients, respectively), aimed at possible predictors and outcomes of premature termination. We found ratios of premature termination of 8.3% and 14.7%, respectively. Especially young patients under 30 years of age and patients with eating and personality disorders were more likely to terminate inpatient treatment prematurely. Treatment outcome as rated by therapists was in significantly fewer cases among premature terminators than among successful terminators improved. The results seem to indicate, that assignment to inpatient psychotherapy can be optimized. For a better understanding of the process of premature termination more theory guided prospective and followup studies are necessary.

Adult↗
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[Differential indications for ambulatory group therapy of obesity--exemplified by "interdisciplinary therapy of obesity"].

The article deals with reflections about the differential indication for out-patient group therapy treatment of patients suffering from a considerable overweight by the example of the "Interdisciplinary therapy of obesity". First the conception of the "Interdisciplinary therapy of obesity" is presented. Within the context of evaluation of the therapy program, especially the results of a long-term follow-up study and the special conditions for severely obese people are dealt with. Empirical results and clinical experiences build the foundations to work out differential indication criteria like therapy motivation, degree of overweight and degree of psychological strain. On this basis modifications of the therapy program are suggested in the form of three different kinds of treatment, taking into account the clinically different groups of obese people.

Adolescent↗
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Chemoprophylaxis with erythromycin stearate or amoxycillin in patients with chronic bronchitis--effects on cellular and humoral immune functions.

Twenty-six patients aged between 27 and 71 years with chronic bronchitis were divided into a control group of 6 and two groups of 10 patients each who received either erythromycin stearate or amoxycillin 1500 mg/d for 2 weeks and 1000 mg/d for 12 weeks thereafter. Immunological function tests were performed before starting chemotherapy and thereafter at 2 weeks and 14 weeks. Clinical evaluations and lung function tests showed no significant changes in any of the groups during the study period. In the control group no changes in cellular and humoral immune functions were noted. In the group receiving amoxycillin decreased responses of lymphocytes to the mitogen phytohaemagglutinin were observed after 14 days. In the erythromycin-treated group, increased polymorphonuclear leucocyte (PMNL) motility and mitogen-induced transformation were observed at 14 days but these increases were not statistically significant. In this group the markedly depressed PMNL migration found in 3 individuals before treatment improved considerably. These results indicate that chemotherapy and chemoprophylaxis with either amoxycillin or erythromycin stearate do not compromise the host immunodefences.

Adult↗
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[Disability and attitude to preventive measures in patients with acute and chronic diseases of the musculoskeletal system].

The steady increase in the number of patients with musculoskeletal disorders has increased correspondingly the importance of prevention and health promotion in this area. Under the new health reform laws for health promotion we developed a concept of health counselling for persons suffering from acute or chronic musculoskeletal (rheumatic) disorders. In the context of the formative evaluation we surveyed in 1992 the insured persons via a questionnaire classifying them into three different groups of healthy persons and persons with acute and chronic complaints (criterion: accumulated days of work absenteeism). We asked the patients about frequency of rheumatic complaints, subjective and functional injuries. We also investigated the attitudes towards preventive interventions. Parameters like days of work absenteeism and cluster of diagnosis from the database of the health insurance company complete the subjective data.

Adult↗
PubMedDate not supplied

[Implementation and evaluation of an ambulatory exercise therapy based rehabilitation program for breast cancer patients].

Physical exercise does not only have positive effects on physical fitness but also on mental health. However, there has been little empirical study on effects of rehabilitation programmes based on physical exercise in cancer patients. We conducted a study to examine the interrelation between the participation of breast cancer patients in an exercise rehabilitation training and aspects of quality of life and physical fitness. 28 patients with not metastasized mamma carcinoma participated in a structured exercise rehabilitation program twice a week for ten weeks. Before and after the intervention the patients were asked to fill in questionnaires to assess their quality of life. At the same instants they underwent physical examination and a bicycle ergometry as well as a blood drawing. The training was aimed at changes at the social, emotional, as well as the motor physical level. Pre-post comparisons demonstrated an improvement in quality of life, such as decreased levels of depression and anxiety. Furthermore the women proved to show an obvious increase in physical fitness. Present results support an implementation of an exercise rehabilitation training for breast cancer outpatients.

Adaptation, Psychological↗
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[Need for psycho-oncologic management in Germany--a comparison of present status and future needs].

A comparison of acute care, inpatient rehabilitation and outpatient aftercare in Germany reveals significant differences in the quality and spreading of psychosocial services for cancer patients. Planning psychosocial care for cancer patients, we have to consider patients' need for psychosocial care as well as the health professionals' estimation of patients' needs and the demand for health care services. Analyses of patients' requirements have shown that the needs which patients defined themselves differ from the needs estimated by experts. Therefore, decisions made in health care must be based on systematic data acquired by various approaches. Within the frame of evaluation performed in the research program "Rehabilitation of Cancer Patients" funded by the German Ministry of Research (the former BMFT), data from two studies are presented investigating the need for psychosocial care in oncology using two different approaches. In one study we investigated the status quo of psychosocial care for cancer patients in acute hospitals (n = 585) and rehabilitation centers (n = 42). By use of the Delphi technique, the second study focuses on an analysis of patients' need estimated by health professionals (n = 34). Comparing both studies, deficits in psychosocial care for cancer patients were found especially in acute hospitals and outpatient aftercare services. Methodological problems of the two approaches are discussed and further research strategies are suggested.

Adaptation, Psychological↗