Psychosomatische Institutsambulanzen (PsIA) ­ und (k)ein Ende. Ein guter Anfang, der nun weiterentwickelt werden will.

The objective of this paper is to describe the agreement from the perspective of the authors who, as experts for the Deutsche Krankenhausgesellschaft (DKG - German Hospital Federation), have accompanied the PsIA negotiations since 2013. It traces the development of the PsIA negotiations leading to the "Änderungsvereinbarungen zur Vereinbarung zu den Psychiatrischen Institutsambulanzen gemäß § 118 Abs. 2 SGB V" (amendment agreements to the Agreement concerning the Psychiatric Outpatient Departments according to § 118 Abs. 2 SGB V - German Social Security Statute Book) of October 2019 with its striking difficulties in view of partly diametrally opposed interests of the negotiating partners.

[Reorganization of the interdisciplinary emergency unit at the university clinic of Göttingen]. / Interdisziplinäre Notaufnahme - Das Göttinger Modell - mehr Effizienz, weniger Kosten.

Configuration of the interdisciplinary emergency unit within the university clinic of Göttingen was successfully reorganized during the past two years. All emergencies except traumatologic, gynecologic and pediatric emergencies are treated within this functional unit which is guided by the center of internal medicine. It is organized in a three shift operation manner over a period of 24 hours. Due to a close interdisciplinary collaboration between different departments patients receive optimal diagnostic and therapeutic treatment within a short period of time. To improve processes within the emergency department a series of measures were taken including the -establishment of an intermediate care unit for unstable patients, setting up of special diagnostic and therapeutic units for the acute coronary syndrome as well as stroke, implementation of standardized clinical pathways, establishment of an electronic data processing network in close communication with all diagnostic entities, introduction of a quality assurance system and reduction of medical costs. Reorganization measures lead to a substantial optimization and acceleration of emergency proceedings and thus, provides optimal patient care around the clock. In addition, medical costs could clearly be reduced at the interface between preclinical and clinical emergency medicine.

[Cardiological and psychosocial status of patients with malignant ventricular arrhythmias before implantation of a cardioverter defibrillator. First results from the German Austrian ICD Multicenter Study (GAIMS)]. / Kardiologische und psychosoziale Befunde bei Patienten mit malignen ventrikulären Herzrhythmusstörungen vor Implantation eines internen Defibrillators--Erste Ergebnisse aus der deutsch-österreichischen Multizenterstudie zu Krankheitserleben und -verlauf bei Patienten mit implantiertem Defibrillator.

In a prospective multicenter study of coping, subjective well-being and objective course of the disease we recruited patients with life-threatening cardiac arrhythmias awaiting the implantation of a cardioverter defibrillator. All patients received a semistructured interview and a number of well validated self-assessment questionnaires. In addition, detailed cardiological findings were documented. The present paper describes the study rationale and design as well as the main study hypotheses. In addition, we present representativity data for the inclusion sample and cross-sectional psychometric findings obtained before implantation of the device. The study sample consists of 286 patients with severe ventricular arrhythmias and is almost representative for all ICD recipients in the participating centers and ICD recipients in general. Despite their severe physical impairment, patients only showed moderate levels of psychological abnormalities. Only patients with severe heart failure or a history of repeated resuscitations showed elevated rates of anxiety or depression. However, there were relevant associations among the self-rating scales: Patients with abnormal anxiety or depression scores reported significantly elevated levels of physical complaints and depressive coping. They also showed low social support and an impaired quality of life. These cross-sectional findings add to the international literature on coping and well-being of patients with malignant cardiac arrhythmias. On the background of earlier research findings and clinical experience our results show high plausibility. Prospective changes over time in the different dimensions of psychosocial adjustment and their prognostic power for future quality of life and arrhythmic events will be reported separately.

[Time--the 4th dimision in medicine and psychotherapy]. / Zeit--die 4. Dimension in der Medizin und der Psychotherapie.

Time is presented as well in his historical meaning and as 4th dimension in its medical and psychotherapeutic context. In this medical and psychotherapeutic process it has an important function and is a variable of a process procedure. The difference between "kairos" = (the right point of time) and "chronos" = (the period of time) is historically meanful. The subjective experienced time is as well emphasized by the development of time in the relation to the development of the "self" as in the subjective experience of time in medical and psychotherapeutic situations. There are also changed conceptions and understandings of time running parallel to the development of nature sciences. The importance of time is explained for the medical practice and the meeting with the patient--especially for chronic diseases. The connection of confidence and time is particularly emphasized in the systemic approach.

Effect of depressive symptoms on survival after heart transplantation.

OBJECTIVE: This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated. METHOD: An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome. RESULTS: Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables. CONCLUSIONS: Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated.

[Psychiatric comorbidity in medical inpatients - prevalence and effect on the length of stay]. / Psychische Komorbidität bei internistischen Krankenhauspatienten - Prävalenz und Einfluss auf die Liegedauer -

In the course of a year the prevalence of psychiatric comorbidity as well as the effect of psychiatric comorbidity on the length of stay on two internal medical wards we investigated. When examined by separate methods, the prevalence of psychiatric comorbidity reached 36 % (ICD-10 diagnosis) in a sample of 511 medical inpatients of a university hospital. The study shows that patients with psychiatric comorbidity have a significantly longer length of stay - up to 8.2 days compared with inpatients with mere internal diagnosis. This association was not influenced by the length and the severity of the illness. The findings lead to the conclusion that psychiatric comorbidity is a central contributor to one of the most important factors of medical costs - the length of stay.