[Chronic complex tinnitus: does day care unit-based short-term psychotherapy help?]. / Chronisch komplexer Tinnitus : Hilft eine teilstationäre Kurzzeitpsychotherapie?

BACKGROUND: Results of empirical research on the effectiveness of psychotherapeutic treatment of chronic complex tinnitus are still unclear and require further studies for clarification. OBJECTIVE: The objective of this study is to investigate the effectiveness of multimodal treatment of patients with chronic complex tinnitus in a day care unit setting. PATIENTS AND METHODS: In this prospective study, the effectiveness of an intense 5-day multimodal treatment delivered to 93 patients was assessed using a pre-post design. Tinnitus-specific effects were captured by the Mini-TQ-12 measurement instrument and psychiatric comorbidity assessed using the Brief Symptom Inventory (BSI). In statistical analyses, t-tests, χ(2) tests and Wilcoxon signed ranks tests were performed to determine statistical significance; effect sizes (ES) were calculated according to Cohen's d. RESULTS: The pre-post difference in Mini-TQ-12 was highly significant in t-test (p < 0.001); the ES was small (ES = 0.45). In BSI, the pre-post difference in the Global Severity Index (GSI) as a global measure was also highly significant in t-test (p < 0.001); ES was small (ES = 0.40). Nonparametric tests (Wilcoxon test) confirmed these results. CONCLUSION: This study demonstrates the statistically significant effectiveness of a multimodal therapeutic approach. Moreover, the results indicate that patients could benefit from more intensive therapeutic interventions.

[Effects of inpatient rehabilitation on long-term health-related quality of life in patients with cancer and rheumatoid arthritis: an analysis based on the classification of therapeutic procedures codes (KTL)]. / Einfluss stationärer Rehabilitationsleistungen auf die langfristige gesundheitsbezogene Lebensqualität von Patienten mit Krebs und rheumatoider Arthritis: eine KTL-Daten-Analyse.

OBJECTIVES: This explorative study investigated associations among the amount of different rehabilitative interventions, based on the classification of therapeutic procedures codes (KTL), and long-term health-related quality of life in patients with cancer or rheumatoid arthritis. METHODS: 3 therapeutic modules of rehabilitative interventions were defined on the basis of KTL codes: (i) somatic interventions, (ii) psychological interventions, and (iii) medical counselling. Based on a median-split, patients were classified in 2 groups with low vs. high amount of rehabilitative interventions. Health-related quality of life was assessed on admission, at discharge from rehabilitative stay, as well as 3 and 12 months after discharge using the SF-12 health survey. RESULTS: 166 patients with chronic arthritis and 159 patients with cancer undergoing inpatient rehabilitation were included in the analysis. Arthritis patients who received a high amount of somatic interventions showed a significant improvement in the SF-12 mental health component summary score up to 12 months after discharge (p<0.05). Cancer patients who received a high amount of psychological interventions showed higher SF-12 physical health component summary scores at 3 and 12 months follow-up (p<0.05). CONCLUSION: The results suggest differential relationships between amount of rehabilitative interventions and long-term rehabilitation outcome in 2 different disease groups. Routine classification of rehabilitative procedures (KTL) codes can be used for analysing dose-response relationships, although open questions remain concerning the validity of KTL codes.

Patient satisfaction during radiation therapy. Correlates and patient suggestions.

BACKGROUND: Assessing patient satisfaction might help to detect so far unknown patient needs and could contribute to quality assurance within the health care system. We evaluated patient satisfaction and its correlates in a consecutive sample of patients undergoing external beam radiation therapy. PATIENTS AND METHODS: Patient satisfaction was evaluated within a prospective study with two validated instruments (FPZ, ZUF-8) during the first week of radiation therapy in two university-based radiation oncology departments. RESULTS: A total of 273 patients could be analyzed. Most patients were irradiated for breast or urogenital cancer. Overall patient satisfaction was high (94.9-98.8%). The most important items for patient satisfaction included the following: "skills of physicians" followed by "physician contact with patients," "care," and "information" (Tab. 2). Neither center nor disease entity correlated with global patient satisfaction. Of the patients, 46% reported that they would have preferred additional information prior to the onset of radiotherapy. Patients who sought additional information reported a lower global patient satisfaction (p < 0.001). In multiple linear regression analysis, the need for more information, male gender, and a higher level of education were significant predictors for lower global patient satisfaction (Tab. 6). CONCLUSION: During the first week of radiation therapy, patients rate patient-physician interaction and communication on treatment and disease as important factors for their satisfaction. Supplying additional information to subsets of patients prior to starting radiotherapy might help to further improve satisfaction.

Routine psychosocial distress screening in radiotherapy: implementation and evaluation of a computerised procedure.

BACKGROUND: To implement distress screening in routine radiotherapy practice and to compare computerised and paper-and-pencil screening in terms of acceptability and utility. METHODS: We used the Stress Index RadioOncology (SIRO) for screening. In phase 1, 177 patients answered both a computerised and a paper version, and in phase 2, 273 patients filled out either the computerised or the paper assessment. Physicians received immediate feedback of the psycho-oncological results. Patients, nurses/radiographers (n=27) and physicians (n=15) evaluated the screening procedure. RESULTS: The agreement between the computerised and the paper assessment was high (intra-class correlation=0.92). Patients' satisfaction did not differ between the two administration modes. Nurses/radiographers rated the computerised assessment less time consuming (3.7 vs 18.5%), although the objective data did not reveal a difference in time demand. Physicians valued the psycho-oncological results as interesting and informative (46.7%). Patients and staff agreed that the distress screening did not lead to an increase in the discussion of psychosocial issues in clinician-patient encounters. CONCLUSION: The implementation of a distress screening was feasible and highly accepted, regardless of the administration mode. Communication trainings should be offered in order to increase the discussion of psychosocial topics in clinician-patient encounters.

[Quality of life and patient satisfaction after breast reconstruction]. / Lebensqualität und Zufriedenheit nach Brustrekonstruktion.

BACKGROUND: Nowadays, the array of methods for reconstruction of the female breast following mastectomy is vast. In this study, we investigate and compare quality of life after breast reconstruction and satisfaction with the results of two commonly used techniques (autologous tissue vs. expander/implant). METHODS: Ninety-one consecutive patients who underwent breast reconstruction at a German clinic between 1996 and 2001 were included in the study. Patient satisfaction and quality of life were assessed retrospectively using self-evaluation questionnaires. RESULTS: Patients were generally more satisfied with the outcome of the operation when autologous tissue was used. This was significant in the following areas: breast size, form, definition of the lower breast fold, softness of the breast, and symmetry of the breasts. In both groups the quality of life following breast reconstruction at least 2 years after the operation was equal to that of healthy women of the same age group. CONCLUSION: Although patients were more satisfied with the results of autologous breast reconstruction, procedure choice did not affect quality of life.

[Transsexuals' life satisfaction after gender transformation operations]. / Lebenszufriedenheit transsexueller Patienten nach geschlechtsangleichenden Operationen.

BACKGROUND: More and more frequently, the registration of life satisfaction is being used to evaluate different medical treatments. So far, there have been only few such surveys on transsexuals (TS). Therefore, the aim of this study was to evaluate the general and the health-related life satisfaction of transsexuals after gender transformation operations. PATIENTS AND METHODS: Forty patients took part in this German cross-sectional study. The Questions on Life Satisfaction Module (FLZ) and free questions on different aspects of the new gender identity were used as measuring instruments. RESULTS: Of the TS studied, 85-95% were "very satisfied" or "satisfied" with the results of their gender transformation operation in respect to gender identity. The TS were significantly less satisfied (P>0.001) in overall "general life satisfaction" than the general population. In overall FLZ scores for "health-related life satisfaction", no differences were seen. CONCLUSION: These data indicate a discrepancy between subjective satisfaction with new gender identity and current life situation, and they identify problems with life satisfaction.

Development and psychometric properties of a disease-specific quality of life questionnaire for adult patients with growth hormone deficiency.

BACKGROUND: Adults with growth hormone (GH) deficiency (GHD) may experience physical and psychological disturbances, which can affect their quality of life (QOL). OBJECTIVES: To develop and validate a disease-specific module from the previously published QOL measure Questions on Life Satisfaction Modules (QLS(M)): the QLS(M)-H that specifically addressed the needs of patients with hypopituitarism. A second aim was for the questionnaire to be applicable across different cultural backgrounds in order to evaluate the efficacy of therapy in large, international clinical trials, thus providing additional clinical endpoints for these studies. DESIGN: A preliminary German language version of the QLS(M)-H was developed from 26 semi-structured interviews of adults with GHD. The questionnaire was then independently translated into five other languages and applied in open, non-controlled, multicentre, longitudinal studies to patient (n=717) and normative populations (n=2700). METHODS: A revised, nine-item version of the questionnaire was developed, based on previously defined criteria, and was evaluated for reliability and validity. Sensitivity to detect changes after GH replacement was also assessed. RESULTS: The 16 items of the preliminary questionnaire were reduced to nine items on the basis of the correlation of items/factors from initial patient interviews. Psychometric analysis revealed the reliability of the nine-item scale. The Cronbach's alpha scores ranged from 0.81 to 0.89 and the test-retest correlations ranged from 0.76 to 0.88, all of which indicate reliability over time. Mean scores increased significantly during GH replacement therapy, with observed changes greater than those seen with the non-specific modules of the QLS(M), indicating the sensitivity of the scale. CONCLUSIONS: The QLS(M)-H questionnaire is concise, easy to complete, and can be effectively applied across different cultural backgrounds. Psychometric evaluation of the questionnaire reveals that it is a valid, reliable and sensitive tool useful for assessing impaired life satisfaction in adult patients with GHD and also for monitoring the efficacy of GH therapy.

[The quality-of-life questionnaire QLS-H: validation of the French language version of the questionnaire in patients with growth hormone deficiency and collection of reference data in the general population]. / Le questionnaire de qualité de vie QLS-H: validation de la version française chez les patients avec déficit en hormone de croissance et acquisition des valeurs de référence dans la population générale.

The QLS-H(c) (Questions on Life Satisfaction- Hypopituitarism) is new a quality of life (QoL) self-administered questionnaire addressing the complaints of adult patients with growth hormone deficiency. The French version of the QLS-H(c) (16 items) has been psychometrically evaluated during a randomized, open label study comparing two strategies of growth hormone (GH) replacement therapy. Seventy-three patients were included and received an 8-month GH replacement therapy. QoL was explored at baseline, 4 and 8 months using the QLS-H(c) questionnaire and the Nottingham Health Profile (NHP) reference scale. Acceptance of the QLS-H(c) was excellent as 92% of the questionnaires were suitable for analysis. All the items demonstrated good selectivity. The homogeneity of the questionnaire was confirmed (Cronbach's alpha, 0.87). The external validity construct was assessed and confirmed using the NHP scores. Sensitivity to change was confirmed. Following an 8-month replacement therapy, the perception of the QoL assessed with the QLS-H(c) questionnaire was significantly improved, irrespective to the treatment strategy. Finally, redundant items of the questionnaire were removed. As a result, the final version of the QLS-H(c) contained 9 items. In a parallel study, reference data of the QLS-H(c) (9 items) were collected from a representative sample of 989 subjects from the French population. With these reference ranges, algorithms to calculate Z scores adjusted for age and gender were developed as a measure for the deviation of patients' scores from those of the general population, and also to evaluate changes along time. In summary, the French version of the quality of life QLS-H(c) questionnaire is a relevant, validated investigational tool for the evaluation and follow-up of an adult patient with growth hormone deficiency.

Quality of life after severe hand injury.

This study explores the quality of life in 118 patients following severe and major hand injury with a Hand Injury Severity Score >50. Each patient answered five different validated outcome measures (DASH (Disability of the Arm, Shoulder, and Hand), FLZ(M) ('Fragen zur Lebenszufriedenheit'), HADS (Hospital Anxiety and Depression Score), BDDE-SR (Body Dysmorphic Disorder Examination-Self Report) and FBeK ('Fragebogen zur Beurteilung des eigenen Körpers'), which were incorporated into a single questionnaire. Each of these questionnaires covered one or more of the established quality-of-life domains. Patients with pain and pressure sensations were significantly less satisfied in life, showed lower levels of health satisfaction, had higher levels of anxiety and depression and showed higher body dysmorphic disorder levels (all p < 0.001). General life satisfaction in this hand-injury study group is highly dependent on the patients` satisfaction with their health and appearance as well as self-confidence. The quality-of-life outcomes improve with time, and despite evidence of continued impairment in the injured hand, the majority of patients had a normal quality of life.

Quality of life following aesthetic plastic surgery: a prospective study.

BACKGROUND: The objective of this study was the prospective evaluation of quality of life in patients undergoing aesthetic plastic surgery procedures. We examined pre- and postoperative changes in quality of life, and performed a comparison of our data with a representative random sample. METHOD: 228 patients agreed to participate in the present study. Measurements were taken preoperatively as well as 3 and 6 months postoperatively. One hundred and thirty two patients completed the three months postoperative evaluation (T1), 82 answered the 6 months follow-up evaluation (T2). The testing instrument included a standardised self-assessment test on satisfaction and quality of life (FLZ(M)), consisting of three modules: satisfaction with general life, health and appearance. Further, a postoperative complication questionnaire was used in order to evaluate the satisfaction with the surgical outcome and to estimate postoperative complications and side effects. RESULTS: Significantly increasing values in two aspects of quality of life were found: health and appearance. Whereas the positive influence on health is persistent, there is a diminishing influence of appearance 6 months postoperatively. Although higher values for some of the individual items of the FLZ(M) modules of the norm data were found in comparison to our study group, a general preoperative lower level of quality of life of the aesthetic surgery patients could not be confirmed. Over 84% were satisfied or very satisfied with the aesthetic result. 85% would undergo the same treatment again and 94% of the patients would further recommend their operation. More than half of the study group did not report a decrease in physical fitness or reduced social contacts in the direct postoperative period. CONCLUSION: Our study reveals that aesthetic plastic surgery increases most aspects of quality of life, especially regarding body satisfaction and health. It is very well tolerated by the patients and is therefore a recommended option.

[Quality of life with cystic fibrosis--aspects of age and gender]. / Alters- und geschlechtsbezogene Betrachtung der Lebensqualität bei Mukoviszidose.

BACKGROUND: Quality of life (QoL) becomes more important as primary criterion of quality management in time consuming therapy programs of chronic progressive diseases like cystic fibrosis (CF). Measuring weighted satisfaction of life allows to evaluate subjective aspects of health-related and general quality of life. PATIENTS/METHOD: QoL of 254 CF-patients (age 16-45 years, mean 29.4 years, mean FEV1 62.5 % of the predicted, mean BMI 20.5) was evaluated with the Questions on Life Satisfaction (FLZ(M)), a multi-dimensional QoL questionnaire. QoL results of patients are compared with the QoL of a healthy population. RESULTS: Subjective contentment in health-related life dimensions of German adolescents and adults with CF is significantly lower compared with healthy peers. Women with CF compensate their increased restriction in health-related dimensions by high satisfaction in the dimensions housing and partnership. Women with CF > 35 years have a risk for low life satisfaction, men of this age group are not restricted. CONCLUSIONS: Therapy programs should take into account the subjective perceived QoL. Routine monitoring of QoL can indicate patients with special needs.

Illness-related distress: does it mean the same for men and women? Gender aspects in cancer patients' distress and adjustment.

Gender differences were investigated in a sample of 149 married cancer patients (82 males, 67 females) undergoing outpatient chemotherapy. A cross-sectional design was used and evaluation included medical assessments and self-rating questionnaires. Tumour sites varied, and advanced stages of disease were predominant. Overall, the results suggest gender differences as well as some similarities. Although female patients reported symptoms and higher overall distress because of illness more frequently than male patients did, general satisfaction with life did not differ between genders, suggesting comparable adjustment. From the results of multivariate analyses physical impairment, such as older age, primarily explained female patients' distress, whereas men's distress was closely linked to their psychological condition. Men and women also differ in the way they make use of social support. Assessment of the distinctive aspects contributing to male and female cancer patients' distress could improve the provision of adequate support adapted to gender-specific requirements.

Measuring the quality of life: a comparison between physically and mentally chronically ill patients and healthy persons.

The FLZ seems to be a suitable method for reliably measuring the quality of life of healthy persons and of patients, as well as differentiating between persons and groups. The concept of weighting satisfaction with the individual importance of each of the items and of measuring several dimensions seems to make sense in view of the data. The modified version of the FLZ is currently being employed in various hospitals. The assessment of a larger normative sample is being planned. QL shall then be differentiated from the construct mood and be compared to objective data. In addition, the sensibility to change of the questionnaire shall be tested in a process analysis.

[Partnership and pregnancy conflict]. / Partnerschaft und Schwangerschaftskonflikt.

101 men and women with a current pregnancy decision-making conflict or abortion and 31 couples without such a problem were asked about their living conditions, their childhood and their relationship. As conditions for the crisis the financial situation of the pregnant woman and the emotional bond with the significant other could be identified. While the conflict can be predicted through the current situation, the decision whether to abort the child or not depends upon internal and more individual processes. Important parts of these processes are the general commitment of the involved man toward a relationship, the compatibility of a child with the professional situation of the pregnant women and their relationship with their own mother. The last issue is combined with the pregnant women's trust in her own motherly competence.

11-year follow-up study of resin-bonded fixed partial dentures.

The clinical performance of 325 resin-bonded fixed partial dentures (RBFPD) placed between 1984 and 1995 was reviewed. The primary indications of the 264 patients treated were trauma and aplasia. Two hundred eighty-three of the resin-bonded fixed partial dentures were primary restorations, and 42 of the restorations were secondary and tertiary after the loss of the primary resin-bonded fixed partial denture. Including the rebonded restorations, the survival rate calculated using the Kaplan-Meier method was 76% after 5 years and 60% after 10 years. Analysis of the data showed that casting alloy, pretreatment of the bonding surfaces, luting agent, and mobility of the abutment teeth were decisive prognostic factors for success. Base metal alloys, silicoating, mesh retention, and immobile abutments were positive factors. In contrast to other reports in the literature, retentive abutment preparation did not result in a higher survival rate than unprepared abutments. Small restorations in the bonding area did not affect the survival. No differences in survival rate were found for resin-bonded fixed partial dentures in the maxillae or mandible, or in the anterior and posterior regions. Multiunit resin-bonded fixed partial dentures had a smaller probability of survival than three-unit resin-bonded fixed partial dentures. Carious lesions were found on 4% of the abutment teeth.

Preprocessing in computed tomography picture analysis: a "bone-deleting" algorithm.

A procedure for automatic deletion of extracranial parts and bone in computed tomography (CT) pictures is presented. Such a procedure is a prerequisite for many types of quantitative image analysis. The algorithm can delineate complex bone contours and is completely independent of information outside the skull. Special options allow, in addition, the deletion of calcified parts of the brain and of some artifacts. The program is implemented in a general program system (PICPRO) developed for CT image analysis and picture manipulation.