Treatment escalation in patients not responding to pharmacotherapy, psychotherapy, and electro-convulsive therapy: experiences from a novel regimen using intravenous S-ketamine as add-on therapy in treatment-resistant depression.

A lack of response despite maximum therapy is common in patients fulfilling criteria of treatment-resistant depression. Therefore, innovative strategies for treatment escalation are warranted. Here, we report the clinical experiences associated with a novel therapeutic regimen combining electroconvulsive therapy and repeated intravenous S-ketamine treatment in three patients. The combined therapy was feasible and had no serious side effects. All patients responded to the new treatment option. The augmentative effect of sub-anesthetic S-ketamine on ECT is discussed.

"PERLE bedside-examination-course for candidates in state examination" - Developing a training program for the third part of medical state examination (oral examination with practical skills).

INTRODUCTION: In preparation for the state examination, many students have open questions and a need for advice. Tutors of the Skills Lab PERLE-"Praxis ERfahren und Lernen" (experiencing and learning practical skills) have developed a new course concept to provide support and practical assistance for the examinees. OBJECTIVES: The course aims to familiarize the students with the exam situation in order to gain more confidence. This enables the students to experience a confrontation with the specific situation of the exam in a protected environment. Furthermore, soft skills are utilized and trained. Concept of the course: The course was inspired by the OSCE-model (Objective Structured Clinical Examination), an example for case-based learning and controlling. Acquired knowledge can be revised and extended through the case studies. Experienced tutors provide assistance in discipline-specific competencies, and help in organizational issues such as dress code and behaviour. Evaluation of the course: An evaluation was conducted by the attending participants after every course. Based on this assessment, the course is constantly being developed. In March, April and October 2015 six courses, with a total of 84 participants, took place. Overall 76 completed questionnaires (91%) were analysed. DISCUSSION: Strengths of the course are a good tutor-participants-ratio with 1:4 (1 Tutor provides guidance for 4 participants), the interactivity of the course, and the high flexibility in responding to the group's needs. Weaknesses are the tight schedule, and the currently not yet performed evaluation before and after the course. CONCLUSION: In terms of "best practise", this article shows an example of how to offer low-cost and low-threshold preparation for the state examination.