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In internal medicine German authors tend to publish randomized controlled trials (RCTs) with non-significant findings in German journals, RCTs with significant findings in international journals. In the neurosciences a similar trend was seen but the findings were not statistically significant. The reason for this inconclusive finding might be the low number of RCTs published in German.
Despite good clinical evidence, depot antipsychotics are only seldom prescribed to patients with first episode schizophrenia. The present study aims at investigating psychiatrists’ reasons for this reservation.
We surveyed 198 psychiatrists on their attitude toward offering depot treatment to first episode patients (FEP). Participants scored the extent of influence of individual factors on their decision on a seven-point-scale, additional data on their prescription practice and estimation of the relapse risk of FEP were collected.
Psychiatrists reported that only three out of 12 factors were of influence. These were the limited availability of different second generation antipsychotic depot drugs, the frequent rejection of the depot offer by the patients and the patients’ skepticism based on the lack in experience of a relapse.
There is actually little specific reason for not prescribing depot to FEP according to the current survey. For those factors being reported to be of influence, psychoeducation, including profound information on depot treatment, the development of additional SGA depot drugs and the standard offer of depot treatment to all FEP in a shared-decision-making may be considered.
Studies on the frequency of caregiver involvement in representative inpatient samples are scarce. The aim of our study was to conduct a representative survey on caregiver involvement in routine inpatient care involving all three parties (patients, caregivers, psychiatrists). Therefore, we performed face-to-face interviews consisting of open-ended questions to gain a deeper understanding of when and how caregivers are involved in care treatment and to identify which topics are mainly discussed.
This cross-sectional survey included inpatients from 55 acute psychiatric wards across ten psychiatric hospitals, their treating psychiatrists and, when possible, their caregivers. In total, we performed semi-structured face-to-face interviews with 247 patients, their treating psychiatrists and 94 informal caregivers. Each psychiatrist named the next two to three patients to be discharged. After a patient had given informed consent, the interview was performed by a researcher. In addition, the psychiatrist and, when possible, the primary caregiver identified by the patient, were also interviewed.
It was perceived by both patients and psychiatrists that contact between caregiver and psychiatrist had taken place in one-third of the patient cases. Predictors for psychiatrist-caregiver-contact were revealed in the patient's diagnosis (schizophrenia), a lower history of inpatient stays, and the respective hospital. According to psychiatrists the most frequent subjects of discussion with caregivers involved therapeutic issues and organisational and social-psychiatric topics (e.g. work, living and social support). Patients and caregivers stated that psychiatric treatment and the diagnostic classification of the mental illness were the most frequent topics of conversation. For all three groups, the most often cited reason for missed caregiver involvement was the subjective perception that a caregiver was not in fact needed.
Whether or not caregivers were contacted and involved during an inpatient stay strongly depended on the individual hospital. The frequency of involvement of caregivers can certainly be increased by changing processes and structures in hospitals. All three parties (patients, caregivers and psychiatrists) most often stated that the caregiver was not involved in the treatment because they thought it was unnecessary. Evidence demonstrates the positive effect of caregivers' involvement on the therapeutic process but also on the well-being of the caregiver, therefore it is necessary to increase awareness of this evidence among all three interest groups.
Although shared decision-making (SDM) has the potential to improve health outcomes, psychiatrists often exclude patients with more severe mental illnesses or more acute conditions from participation in treatment decisions. This study examines whether SDM is facilitated by an approach which is specifically adapted to the needs of acutely ill patients (SDM-PLUS).
The study is a multi-centre, cluster-randomised, non-blinded, controlled trial of SDM-PLUS in 12 acute psychiatric wards of five psychiatric hospitals addressing inpatients with schizophrenia or schizoaffective disorder. All patients fulfilling the inclusion criteria were consecutively recruited for the trial at the time of their admission to the ward. Treatment teams of intervention wards were trained in the SDM-PLUS approach through participation in two half-day workshops. Patients on intervention wards received group training in SDM. Staff (and patients) of the control wards acted under ‘treatment as usual’ conditions. The primary outcome parameter was the patients' perceived involvement in decision-making at 3 weeks after study enrolment, analysed using a random-effects linear regression model.
In total, 161 participants each were recruited in the intervention and control group. SDM-PLUS led to higher perceived involvement in decision-making (primary outcome, analysed patients n = 257, mean group difference 16.5, 95% CI 9.0–24.0, p = 0.002, adjusted for baseline differences: β 17.3, 95% CI 10.8–23.6, p = 0.0004). In addition, intervention group patients exhibited better therapeutic alliance, treatment satisfaction and self-rated medication compliance during inpatient stay. There were, however, no significant improvements in adherence and rehospitalisation rates in the 6- and 12-month follow-up.
Despite limitations in patient recruitment, the SDM-PLUS trial has shown that the adoption of behavioural approaches (e.g. motivational interviewing) for SDM may yield a successful application to mental health. The authors recommend strategies to ensure effects are not lost at the interface between in- and outpatient treatment.
Trial registration: The trial was registered at Deutsches Register Klinischer Studien (DRKS00010880).
Classical Wolf-Rayet stars are evolved, hydrogen depleted massive stars that exhibit strong mass-loss. In theory, these stars can form either by intrinsic mass loss (stellar winds or eruptions), or via mass-removal in binaries. The Wolf-Rayet stars in the Magellanic Clouds are often thought to have originated through binary interaction due to the low ambient metallicity and, correspondingly, reduced wind mass-loss. We performed a complete spectral analysis of all known WR binaries of the nitrogen sequence in the Small and Large Magellanic Clouds, as well as additional orbital analyses, and constrained the evolutionary histories of these stars. We find that the bulk of Wolf-Rayet stars are luminous enough to be explained by single-star evolution. In contrast to prediction, we do not find clear evidence for a large population of low-luminosity Wolf-Rayet stars that could only form via binary interaction, suggesting a discrepancy between predictions and observations.
The purpose of this study was to describe disaster preparedness strategies and behaviors among rural families who have children with special health care needs and to examine the effect of self-efficacy and response-efficacy on disaster preparedness.
Data for this study were drawn from the baseline surveys of 287 rural families with children with special health care needs who were part of a randomized controlled trial examining the impact of an intervention on disaster preparedness. Distributions of child, parent, and family characteristics were examined by preparedness. Linear regression models were built to examine the impact of self-efficacy and response-efficacy on level of disaster preparedness.
Disaster preparedness (overall, emergency plan, discussion/practice, and supplies) was low (40.9-69.7%) among study families. Disaster preparedness was found to increase with each unit increase in the level of self-efficacy and family resilience sources across all 4 categories of preparedness.
Disaster preparedness among rural families with children with special health care needs is low, which is concerning because these children may have increased vulnerability to adverse outcomes compared to the general population. Results suggest that increasing the levels of self-efficacy and family resilience sources may increase disaster preparedness. (Disaster Med Public Health Preparedness. 2016;10:225–232)
Migratory fishes are natural wonders. For many people, the term migratory fish evokes images of salmon audaciously jumping at waterfalls as they return to their own riverine birthplace to spawn after years of growth in the ocean, but freshwater fishes actually show a broad spectrum of migration strategies. Migratory fishes include small species – three-spined sticklebacks that spawn in coastal streams around the northern Pacific and gobies that move from the ocean into tropical island streams by climbing waterfalls (McDowall, 1988) – as well as some of the largest freshwater fishes in the world, such as the Mekong dog-eating catfish and the Chinese paddlefish (Stone, 2007). Aside from migratory habits, these species have few shared characteristics; they encompass numerous evolutionary lineages, enormous differences in life history, and every possible direction and distance of migration. Biologists treat migratory freshwater fishes as a functional group because their life-history strategy revolves around long-distance movement between ecosystems in a perilous quest to take advantage of both high-quality breeding sites and bountiful feeding areas. As humans have physically blocked fish migrations, degraded breeding and feeding grounds and relentlessly harvested migrants for their flesh and roe, many populations have declined or been extirpated. This chapter will provide an overview of fundamental and applied research that is helping to guide efforts to conserve migratory freshwater fishes.
For practical purposes, we define migratory behaviour as the synchronized movement of a substantial proportion of a population between distinct habitats, which is repeated through time within or across generations. Modern definitions of fish migrations typically recognise both the adaptive benefits of migrating and individual variation in executing the general strategy (see McDowall, 1988; Lucas & Baras, 2001). Not every individual must move, the timing may vary somewhat from year to year, and the motive for migrating may include seeking refuge from harsh conditions in addition to breeding and feeding. Nonetheless, in most cases, migration is critical to individual fitness and population persistence because it enables specialised use of different habitats for growth and reproduction. Where their migration routes are blocked or key habitats are lost, migratory fishes often suffer rapid and catastrophic losses.
Human appropriation and degradation of the Earth's freshwater ecosystems (Vörösmarty et al., 2010; Carpenter et al., 2011) have transformed this reliance on multiple habitats into a detriment for many migratory fishes.
Phonological alternations in homorganic nasal–stop sequences provide a continuing topic of investigation for phonologists and phoneticians alike. Surveys like Herbert (1986), Rosenthal (1989), Steriade (1993) and Hyman (2001) demonstrate that cross-linguistically the most common process is for the postnasal stop to become voiced, as captured by Pater’s (1999) markedness constraint *NT. However, as observed since Hyman (2001), *NT alone does not account for all postnasal patterns of laryngeal alternation. In this paper, we focus on three problematic patterns. First, in some languages with a two-way laryngeal contrast, voiceless stops are aspirated postnasally, i.e. the contrast between NT and ND is enhanced, not neutralized. Second, in some languages with a three-way laryngeal contrast, the voicing contrast is maintained postnasally, while the aspiration contrast neutralizes in favour of aspiration. Third, in other languages with a three-way laryngeal contrast we find the opposite postnasal aspiration neutralization: aspiration is lost. We argue that an analysis based on perceptual cues provides the best account for this range of alternations. It demonstrates the crucial role of perceptual cues and laryngeal contrasts in a particular language while fitting the range of patterns into an Optimality Theoretic factorial typology that covers a wider range of postnasal laryngeal alternations than previous analyses.
The B fields in OB stars (BOB) survey is an ESO large programme collecting spectropolarimetric observations for a large number of early-type stars in order to study the occurrence rate, properties, and ultimately the origin of magnetic fields in massive stars. As of July 2014, a total of 98 objects were observed over 20 nights with FORS2 and HARPSpol. Our preliminary results indicate that the fraction of magnetic OB stars with an organised, detectable field is low. This conclusion, now independently reached by two different surveys, has profound implications for any theoretical model attempting to explain the field formation in these objects. We discuss in this contribution some important issues addressed by our observations (e.g., the lower bound of the field strength) and the discovery of some remarkable objects.
To study whether employees who disclose a psychiatric diagnosis, such as depression risk stigmatisation and discrimination at the workplace.
Randomised experimental study with 748 managers from German companies incorporating four case vignettes displaying an employee with different ‘diagnoses’ (depression, burnout, private crisis and thyroid dysfunction), but identical unspecific complaints. Main outcome measures were the managers' attitudes and their impact on stigmatisation with respect to job performance.
In nearly all aspects of job performance, the diagnosis depression (psychiatric disorder) was seen as more critical than the diagnosis of a thyroid dysfunction (somatic disease). The diagnosis ‘burnout’ did not prove to be less stigmatising than ‘depression’. Likewise ‘private crisis’ was rated less favourably than thyroid dysfunction.
Therefore, employees have to evaluate if they disclose their psychiatric disorder or if they conceal it as a somatic illness.
The development of infrared observational facilities has revealed a number of massive stars in obscured environments throughout the Milky Way and beyond. The determination of their stellar and wind properties from infrared diagnostics is thus required to take full advantage of the wealth of observations available in the near and mid infrared. However, the task is challenging. This session addressed some of the problems encountered and showed the limitations and successes of infrared studies of massive stars.
Recent studies have claimed the existence of very massive stars (VMS) up to 300 M⊙ in the local Universe. As this finding may represent a paradigm shift for the canonical stellar upper-mass limit of 150 M⊙, it is timely to discuss the status of the data, as well as the far-reaching implications of such objects. We held a Joint Discussion at the General Assembly in Beijing to discuss (i) the determination of the current masses of the most massive stars, (ii) the formation of VMS, (iii) their mass loss, and (iv) their evolution and final fate. The prime aim was to reach broad consensus between observers and theorists on how to identify and quantify the dominant physical processes.
Diagnostic errors can have tremendous consequences because they can result in a fatal chain of wrong decisions. Experts assume that physicians' desire to confirm a preliminary diagnosis while failing to seek contradictory evidence is an important reason for wrong diagnoses. This tendency is called ‘confirmation bias’.
To study whether psychiatrists and medical students are prone to confirmation bias and whether confirmation bias leads to poor diagnostic accuracy in psychiatry, we presented an experimental decision task to 75 psychiatrists and 75 medical students.
A total of 13% of psychiatrists and 25% of students showed confirmation bias when searching for new information after having made a preliminary diagnosis. Participants conducting a confirmatory information search were significantly less likely to make the correct diagnosis compared to participants searching in a disconfirmatory or balanced way [multiple logistic regression: odds ratio (OR) 7.3, 95% confidence interval (CI) 2.53–21.22, p<0.001; OR 3.2, 95% CI 1.23–8.56, p=0.02]. Psychiatrists conducting a confirmatory search made a wrong diagnosis in 70% of the cases compared to 27% or 47% for a disconfirmatory or balanced information search (students: 63, 26 and 27%). Participants choosing the wrong diagnosis also prescribed different treatment options compared with participants choosing the correct diagnosis.
Confirmatory information search harbors the risk of wrong diagnostic decisions. Psychiatrists should be aware of confirmation bias and instructed in techniques to reduce bias.
En medicina interna, los autores alemanes tienden a publicar los ensayos controlados distribuidos al azar (ECDA) con hallazgos no significativos en revistas alemanas y los ECDA con hallazgos significativos en revistas internacionales. En las neurociencias, se vio una tendencia similar, pero los hallazgos no eran estadísticamente significativos. La razón para este hallazgo no concluyente podría ser el bajo número de ECDA publicados en lengua alemana.
Background and objective: Spinal cord stimulation has been used successfully for many years in the management of neuropathic pain. Nociceptive pathways are closely integrated into many autonomic reflexes. The aim was to test the hypothesis that pain relief caused by spinal cord stimulation is related to changes in peripheral skin blood flow.
Methods: Twelve patients with spinal cord stimulators implanted as a treatment for neuropathic pain were entered into the study. Laser Doppler perfusion scanning was used as a direct method for selective measurement of changes in skin (peripheral) blood flow. Measurements were taken before and after the onset of spinal cord stimulation over the site of its sensory projection. The degree of pain relief due to spinal cord stimulation and the skin temperature of each patient were also recorded.
Results: Apart from one patient, spinal cord stimulation did not change skin blood flow in a statistically significant manner.
Conclusions: Pain relief due to spinal cord stimulation is not related to changes of skin blood flow.
We have used fluctuation electron microscopy (FEM) to measure nanoscale mediumrange order in amorphous Al92Sm8. Samples of this amorphous alloy formed by rapid quenching (melt-spinning) show a high density of pure Al nanocrystals (>1020 m-3) after low temperature (< 250 °C) devitrification. In samples amorphized by deformation (cold-rolling), primary Al-crystallization does not occur. This difference in devitrification behavior suggests an underlying structural difference in the amorphous state. FEM is a quantitative microscopy technique for determining nanoscale medium-range order in amorphous materials. Our measurements show that amorphous alloys formed by melt-spinning and cold-rolling have significant structural differences, and that annealing melt-spun alloy under conditions previously shown to modify the devitrification thermodynamics also changes the medium-range structure.