Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial.

BACKGROUND: In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. METHODS: The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. RESULTS: Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen's kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. CONCLUSIONS: While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.

Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial.

BACKGROUND: Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. OBJECTIVES: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched. METHODS: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. SETTING: Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. PARTICIPANTS: From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). INTERVENTION: The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. MEASUREMENTS: The MATE, the Client Socio-Demographic and Service Receipt Inventory--European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. RESULTS: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. CONCLUSIONS: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

The place of additional individual psychotherapy in the treatment of alcoholism: a randomized controlled study in nonresponders to anticraving medication-results of the PREDICT study.

BACKGROUND: Goal of the presented study is to evaluate whether alcohol-dependent patients given additional individual psychotherapy after a heavy relapse during pharmacotherapy remain abstinent for longer than those who continue with pharmacotherapy alone. METHODS: In a randomized, multicenter study, 109 alcohol-dependent patients who had suffered a heavy relapse either while receiving anticraving medication or placebo were randomized into 2 groups. One group received medication, medical management, and additional individual, disorder-specific, cognitive-behavioral psychotherapy, while the control group received medication and medical management only. Main outcome was defined as days until first heavy relapse. RESULTS: Fifty-four patients were randomized to the psychotherapy group, 55 to the control group. Intention-to-treat and completer analyses found no differences between groups, whereas as-treated analyses (patients who actually received psychotherapy compared with those who did not) found a significant effect of psychotherapy. CONCLUSIONS: Our data indicate that patients that are willing to attend psychotherapy benefit from receiving psychotherapy in addition to pharmacotherapy. We suggest that it may be beneficial to consider patients' preferences concerning psychotherapy at an earlier stage during treatment.

Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial.

BACKGROUND: Despite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients. METHODS: A total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio--Demographic and Service Receipt Inventory-European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview. DISCUSSION: This trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005035. Registered 03 June 2013.

Results of a double-blind, placebo-controlled pharmacotherapy trial in alcoholism conducted in Germany and comparison with the US COMBINE study.

The results of placebo-controlled trials (RCTs) with acamprosate or naltrexone vary substantially. Those differences have been attributed to differing patient characteristics, recruitment strategies, treatment settings and remuneration systems. We tested these assumptions by comparing a new double-blind, placebo-controlled randomized trial conducted in Germany (called PREDICT Study) with data from the US COMBINE Study. PREDICT was designed according to the protocol of the COMBINE Study. A total of 426 alcohol-dependent patients were compared to 459 COMBINE Study patients corresponding to the treatment cells in PREDICT. All patients received acamprosate, naltrexone or placebo for 3 months (PREDICT) or 4 months (COMBINE). Biweekly manualized 'medical management' to enhance compliance was delivered in both studies. Time until the first occurrence of heavy drinking was the main outcome measure. PREDICT found neither acamprosate nor naltrexone to supply any additional benefit compared with placebo, which is at variance with a positive naltrexone effect being reported in the COMBINE Study. A secondary comparison between both studies showed better overall treatment outcomes in PREDICT, although these patients had been more severely affected than their COMBINE counterparts. The divergence in results may be attributable to basic differences in the treatment environments (such as in-patient pre-treatment versus primary outpatient care). We suggest that identically designed RCTs conducted in different parts of the world may help improve the external validity of RCTs. This approach could be called 'comparative efficacy research'.

Efficacy of psychosocial interventions in men and women with sexual dysfunctions--a systematic review of controlled clinical trials: part 1-the efficacy of psychosocial interventions for male sexual dysfunction.

INTRODUCTION: As yet, a summary of research evidence concerning the efficacy of psychological treatment in male sexual dysfunction is lacking. AIM: Our systematic review gives an overview of the efficacy of psychosocial interventions in all male sexual dysfunctions. MAIN OUTCOME MEASURES: Main outcome measures included, for example, psychometrically validated scales, interviews, and clinical assessment by an independent rater. The efficacy of psychosocial interventions was measured, for example, by the frequency of and satisfaction with sexual activity and sexual functioning. METHODS: The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the man was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems [ICD10/-9]; Diagnostic and Statistical Manual of Mental Disorders [DSM-IV/-III-R]) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized controlled trials [RCTs] and controlled clinical trials [CCTs]). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance. RESULTS: We identified 19 RCTs and one CCT that investigated the efficacy in male sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Twelve out of 20 trials in men used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Overall, psychosocial interventions improved sexual functioning. While one study found that psychotherapy is superior to sildenafil, another study found the opposite. In men with premature ejaculation, behavioral techniques proved to be effective. A shortcoming was the rather low methodological quality of included studies. CONCLUSIONS: Most of the compared interventions proved to be similarly effective. Possibly, there are underlying constructs throughout all therapies that have an effect on the outcome.

Efficacy of psychosocial interventions in men and women with sexual dysfunctions--a systematic review of controlled clinical trials: part 2--the efficacy of psychosocial interventions for female sexual dysfunction.

INTRODUCTION: As yet, a summary of the research evidence concerning the efficacy of psychological treatment in female sexual dysfunction is lacking. Previous reviews were often nonsystematic or explored one specific sexual dysfunction. AIM: Our systematic review provides an overview of the efficacy of psychosocial interventions in all female sexual dysfunction. MAIN OUTCOME MEASURES: Main outcome measures included for example psychometrically validated scales, diary notes, interviews, and vulvar algesiometer. The efficacy of psychosocial interventions was measured for example by the frequency of and satisfaction with sexual activity and sexual functioning. Safety and acceptance were evaluated on the basis of adverse events and dropout rates. METHODS: The systematic literature search included electronic database search, handsearch, contact with experts, and an ancestry approach. Studies were included if the woman was given a formal diagnosis of a sexual dysfunction (International Statistical Classification of Diseases and Related Health Problems-ICD10/-9; Diagnostic and Statistical Manual of Mental Disorders-IV/-III-R) and when the intervention was psychosocial or psychotherapeutic. The control group included either another treatment or a waiting-list control group. The report of relevant outcomes was necessary for inclusion as well as the design of the study (randomized, controlled trials [RCTs] and controlled clinical trials). The assessment of methodological quality comprised aspects of randomization, blinding, incomplete outcome data, selective reporting, and allegiance. RESULTS: We identified 15 RCTs that investigated efficacy in female sexual dysfunction and two further studies that examined male and female sexual dysfunction together. Most trials explored sexual pain disorders. About half of all studies in women used either a concept derived from Masters and Johnson or a cognitive-behavioral treatment program. Both approaches showed significant improvements compared with a control group. Benefit was not always maintained over the (variable) follow-up period. CONCLUSIONS: Traditional sexual therapeutic concepts proved to be efficacious in the treatment of female sexual dysfunction. A shortcoming was the rather low methodological quality of included studies.

Management of sexual dysfunction due to antipsychotic drug therapy.

BACKGROUND: Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, retrograde ejaculation, sexual arousal, or overall sexual satisfaction. These are major aspects of tolerability and can highly affect patients' compliance. OBJECTIVES: To determine the effects of different strategies (e.g. dose reduction, drug holidays, adjunctive medication, switching to another drug) for treatment of sexual dysfunction due to antipsychotic therapy. SEARCH METHODS: An updated search was performed in the Cochrane Schizophrenia Group's Trials Register (3 May 2012) and the references of all identified studies for further trials. SELECTION CRITERIA: We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction. DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated random effects risk ratios (RR) with 95% confidence intervals (CI), for crossover trials we calculated Odds Ratios (OR) with 95% CI. For continuous data, we calculated mean differences (MD) on the basis of a random-effects model. We analysed cross-over trials under consideration of correlation of paired measures. MAIN RESULTS: Currently this review includes four pioneering studies (total n = 138 , duration two weeks to four months), two of which are cross-over trials. One trial reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n = 32, MD 3.20 95% CI 1.83 to 4.57), a greater mean duration of erections (n = 32, MD 1.18 95% CI 0.52 to 1.84) and frequency of satisfactory intercourse (n = 32, MD 2.84 95% CI 1.61 to 4.07). The second trial found no evidence for selegiline as symptomatic treatment for antipsychotic-induced sexual dysfunction compared with placebo (n = 10, MD change on Aizenberg's sexual functioning scale -0.40 95% CI -3.95 to 3.15). No evidence was found for switching to quetiapine from risperidone to improve sexual functioning (n = 36, MD -2.02 95% CI -5.79 to 1.75). One trial reported significant improvement in sexual functioning when participants switched from risperidone or an typical antipsychotic to olanzapine (n = 54, MD -0.80 95% CI -1.55 to -0.05). AUTHORS' CONCLUSIONS: We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.

[Helpful factors in day treatment for alcohol dependent patients--a qualitative narrative interview approach]. / Wirkfaktoren einer tagesklinischen Behandlung aus der Sicht alkoholabhängiger Patienten--eine qualitative narrative Interviewstudie.

Day treatment for alcohol dependent patients is still uncommon in Germany. The presented study aims to answer the question how patients experience this kind of treatment and which factors they perceive as important for their treatment success.7 interviews with alcohol-dependent patients were conducted. Data were analysed with qualitative methods and the help of a computer-supported coding system.We found several factors that are relevant for patients, especially important are factors concerning the therapeutical relationship as well as factors that are specific for day treatment.We can conclude that day treatment is seen as helpful to improve dependency symptoms by the patients.

Is one question enough to detect female sexual dysfunctions? A diagnostic accuracy study in 6,194 women.

INTRODUCTION: Literature shows that recognition of sexual dysfunctions in women is insufficient and existing instruments to aid detection are mostly too extensive to be used in routine practice. AIM: To develop a brief and accurate screening instrument to detect female sexual dysfunctions in routine care. METHODS: The initial item pool for the index test consisted of 15 items. In a 4-year period, a total of 12,957 persons filled out the test on a specifically designed web-site. Six thousand one hundred ninety-four complete data sets could be used for statistical analysis. The validated German version of the Female Sexual Function Index (FSFI-d) served as reference standard to estimate the accuracy of the screening test. In order to test several possible ways of combining items a multi-step procedure employing univariate analyses, multiple logistic regression, and classification and regression tree analysis was applied to a learning sample and cross-validated in a test sample. MAIN OUTCOME MEASURES: Diagnostic performance (sensitivity, specificity, positive and negative predictive value, accuracy, diagnostic odds ratio as well as adjusted odds ratio) of the items and resulting models to discriminate women with sexual dysfunction from those without were calculated. RESULTS: One dichotomous question for overall satisfaction proved to show high accuracy as a stand-alone instrument and played also a central role in multivariate models. It may be recommended as a one-question screening test (76.4% sensitivity and 76.5% specificity in the test sample). A hierarchical two-question test yielded higher sensitivity (93.5%) and lower specificity (60.1%). A slightly more extensive version consists of five questions (83.1% sensitivity and 81.2% specificity). CONCLUSIONS: Despite some methodological limitations of our study all developed tests showed acceptable to good diagnostic performance, all are very short and could therefore be easily implemented into routine care. Further tests of psychometric properties in other settings are needed.

Effect of sexual function on health-related quality of life mediated by depressive symptoms in cardiac rehabilitation. findings of the SPARK project in 493 patients.

INTRODUCTION: Empirical evidence suggests associations between cardiovascular diseases, sexual functioning, depressive symptoms, and quality of life. However, to date, the interrelation of these constructs has not been examined simultaneously in a structural analysis. AIM: To estimate the prevalence of sexual disorders and depressive symptoms and to examine the association between sexual disorders, depressive symptoms, and quality of life in patients in the rehabilitation of cardiovascular disorders. AIM: A postal survey in five German inpatient rehabilitation centers for cardiovascular diseases was conducted. Prevalence of sexual disorders and depressive symptoms were assessed using psychometrically sound instruments. To analyze complex associations, structural equation modeling was used. MAIN OUTCOME MEASURES: For epidemiological questions, proportions with 95% confidence intervals were calculated. The strength of association in structural equation models was expressed as a standardized regression coefficient. RESULTS: Data from 493 patients were analyzed (response rate 22.7%). At least moderate erectile dysfunction proved to be present in 20.3% of men. The prevalence of female sexual dysfunction lay at 43.1%. At least moderate depressive symptoms were present in 14.4% of men and 16.5% of women. A considerable association between sexual functioning and quality of life was found in both sexes, which was largely mediated by depressive symptoms. Major drawbacks of the study are imprecision of the estimates due to limited sample size and questionable generalizability of the findings due to possible self-selection bias. CONCLUSIONS: Considering the high prevalence of depressive symptoms and their role as a mediating factor between sexual functioning and quality of life, it is recommended to routinely screen for depression in men and women with cardiac disease.

Interrelationship of sildenafil treatment effects on the physiological and psychosocial aspects of erectile dysfunction of mixed or organic etiology.

INTRODUCTION: In a previous paper using mediation modeling, the direct and indirect effects of sildenafil on erection maintenance were demonstrated. OBJECTIVE: In an extension of this previous work, the historical psychosocial paradigm of ED, which focuses on performance anxiety, is tested by using mediation modeling to define the relationship of the physiological aspects (hardness and maintenance) and the associated psychosocial aspects (confidence, sexual relationship satisfaction, and performance anxiety) of ED. METHODS: Statistical mediation analysis using the following outcomes from a double-blind placebo-controlled trial of fixed-dose sildenafil 100 mg or 50 mg: Erection Hardness Score; the 15-item International Index of Erectile Function (IIEF), including item 4 (frequency of erection maintenance after penetration) and item 5 (difficulty of erection maintenance to intercourse completion); the Self-Esteem And Relationship questionnaire; and the question, "Do you feel anxious about your next attempt at sexual intercourse?" MAIN OUTCOME MEASURES: Estimated percentages of direct and indirect effects of sildenafil on psychosocial aspects of ED (95% confidence intervals). RESULTS: The model estimated that erection hardness mediated 43.7% (29.3%, 62.4%) of the effect of treatment onto confidence and 45.9% (32.2%, 61.8%) of the effect of treatment onto sexual relationship satisfaction, and that erection maintenance (using IIEF item 4 as a proxy) mediated 23.0% (10.1%, 39.1%) and 22.4% (10.1%, 36.5%), respectively. Similar results were obtained when IIEF item 5 was used as the proxy for measurement of maintenance. Of all possible paths to performance anxiety, only that from treatment via confidence was statistically significant, mediating an estimated 88.6% (55.5%, 146.2%; item 4 model) or 74.9% (47.0%, 121.0%; item 5 model) of the effect of treatment onto anxiety. The direct path to anxiety from treatment was not statistically significant. CONCLUSIONS: In men treated with sildenafil for ED, performance anxiety might be ameliorated by improved confidence. Improved confidence might be mainly mediated via increased erection hardness.

Understanding the effects of sildenafil treatment on erection maintenance and erection hardness.

INTRODUCTION: Erectile dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. Although intuitively related, the link between erection hardness and erection maintenance has not been formally established and quantified. AIM: To understand the components of erection maintenance through statistical modeling. METHODS: Data from a double-blind placebo-controlled trial of fixed-dose sildenafil (100 or 50 mg, 8 weeks) with open-label extension of flexible-dose sildenafil (100 and 50 mg, 4 weeks) were analyzed. Erection maintenance was assessed with item 4 (how often erection was maintained) or item 5 (difficulty in maintaining erection) of the International Index of Erectile Function (IIEF). Erection hardness was assessed with the Erection Hardness Score. MAIN OUTCOME MEASURES: Longitudinal modeling estimated mean treatment differences averaged over the double-blind phase for sildenafil 100 mg vs. placebo and 50 mg vs. placebo. Statistical mediation analysis was applied to partition the effect of sildenafil (pooled into one treatment group) on erection maintenance directly and indirectly through erection hardness. RESULTS: Longitudinal mean differences for sildenafil 100 and 50 mg vs. placebo were high (P < 0.0001 for each), with large standardized effect sizes (>0.8). Mediation modeling showed that sildenafil treatment affected maintenance directly as well as indirectly via erection hardness, when measured by IIEF item 4 (direct effect, 44.6%; indirect effect, 55.4%) or IIEF item 5 (direct effect, 56.9%; indirect effect, 43.1%). CONCLUSIONS: Sildenafil treatment significantly improved erection maintenance, a physiologic requirement for satisfactory sexual performance. According to our model, only approximately half of the effect of sildenafil on erection maintenance was estimated to be driven through direct effects. Rather, the effect of sildenafil on erection maintenance seems to be substantially driven by erection hardness. Therefore, achievement of optimal initial erection hardness appears to be an important treatment goal for enhancing erection maintenance and achieving successful ED treatment.

Association of sexual functioning and quality of partnership in patients in cardiovascular rehabilitation--a gender perspective.

INTRODUCTION: In the general population, studies indicate a strong association between sexual dysfunction and partnership quality. Despite a high prevalence of sexual problems in patients with cardiovascular diseases, this association has not yet been examined in this sample. AIM: The central task of this paper is to determine the association between sexual dysfunction and quality of partnership under a gender-specific view. METHODS: A written survey was handed out to all newly admitted patients in five participating inpatient rehabilitation centers for cardiovascular diseases in Germany. The survey included a gender-specific questionnaire to assess sexual functioning (International Index of Erectile Function for men, and Female Sexual Function Index for women), and a Partnership Questionnaire. MAIN OUTCOME MEASURES: Correlations were calculated between sexual function and relationship satisfaction, and differences between groups (cardiovascular diseased men and women with and without sexual problems) were tested using covariance analyses. RESULTS: Overall, 44.3% of 98 female participants and 52.7% of 395 male participants stated to have at least one sexual problem. Patients with sexual problems showed significantly more quarrelling (P = 0.001), significantly less tenderness (P < 0.001), communication (P < 0.001), as well as significantly lower overall quality of partnership (P < 0.001), compared with cardiac men and women without sexual problems. Suffering from a sexual problem impaired partnership quality for women to a significantly greater extent than for men. CONCLUSIONS: Possible shortcomings of our study are selection bias, i.e., it is unknown whether all newly admitted patients received the questionnaire by their physician, as well as an overall low response rate, probably because of the private character of questions. This study suggests for the first time that men and women who suffer from cardiovascular diseases and sexual problems show a significantly decreased partnership satisfaction compared with those without sexual dysfunction. Further longitudinal studies might confirm the causal nature of found correlations.

Integrated and independent learning of hand-related constituent sequences.

In almost all daily activities fingers of both hands are used in coordinated succession. The present experiments explored whether learning in such tasks pertains not only to the overall sequence spanning both hands but also to the constituent sequences of each hand. In a serial reaction time task, 2 repeating hand-related sequences were intertwined, so that actions of one hand alternated with actions of the other hand. Integrated learning of the overall sequence was weak when the constituent sequences were uncorrelated (Experiment 1) and massive when they were correlated (Experiment 2). Both experiments yielded evidence suggesting partly independent learning of the hand-related sequences. There were no reliable indications of intermanual transfer of this hand-related sequence knowledge. The findings suggest that after sufficient training of coordinated action sequences involving several limbs, a part of the acquired sequence knowledge begins to be represented in an effector-specific manner.

Meta-analysis: are 3 questions enough to detect unhealthy alcohol use?

BACKGROUND: Both the 10-item Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated 3-item version (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) are considered to detect unhealthy alcohol use accurately. PURPOSE: To examine whether the AUDIT-C is as accurate as the full AUDIT for detecting unhealthy alcohol use in adults. DATA SOURCES: MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, and BIOSIS Previews from 1998 to July 2008. STUDY SELECTION: Three independent reviewers selected studies that administered both the AUDIT and the AUDIT-C, applied a valid reference standard, avoided verification and incorporation bias, and reported relevant data. No language restrictions were applied. DATA EXTRACTION: Two reviewers extracted study characteristics and outcome data, which were cross-checked by a third reviewer. One reviewer assessed methodological quality with a standardized checklist. DATA SYNTHESIS: Fourteen studies were found. Most involved primary care patients in Europe and the United States. Sample sizes ranged between 112 and 13 438 patients, and sex and age distributions varied considerably. No statistically significant differences were found between the overall accuracy of the AUDIT and the AUDIT-C for detecting risky drinking, alcohol use disorders, or unhealthy alcohol use in primary care. Hierarchical summary receiver-operating characteristic curve analysis yielded pooled positive likelihood ratios of 6.62 for the AUDIT and 2.99 for the AUDIT-C, respectively, for detecting risky drinking; 4.03 and 3.82, respectively, for detecting any alcohol use disorder; and 4.82 and 3.91, respectively, for detecting risky drinking or any alcohol use disorder. Findings from a few studies on general population samples and inpatients suggested but did not prove that the AUDIT might be better than the AUDIT-C for identifying severe conditions, such as alcohol dependence. LIMITATION: Studies used different reference standards and had heterogeneous findings. CONCLUSION: Available evidence is inconclusive but suggests that the full AUDIT may be superior to the AUDIT-C for identifying unhealthy alcohol use in adults in some settings.

Acquisition of effector-specific and effector-independent components of sequencing skill.

In a serial reaction time task, participants practiced a repeating sequence with 1 hand. In interleaved blocks, they responded to random sequences with the other hand. Experiment 1 was composed of 5 sessions, each consisting of 30 blocks. Intermanual transfer, reflecting a hand-independent component of sequence knowledge, increased across session. A smaller but significant, nontransferable, and hand-specific component was evident in each session and did not increase with practice. Experiment 2 comprised only 1 session. Uninterrupted practice (no interleaved random blocks) improved hand-independent sequence learning in comparison with interrupted practice (as implemented in Experiment 1), whereas hand-specific sequence learning was unaffected by this between-subjects manipulation. These findings suggest separate mechanisms for effector-independent sequence learning and effector-specific acquisition of optimized response coarticulation.

[Alcohol use and consumption advice of medical students]. / Alkoholgebrauch und Konsumpermission bei Medizinstudenten.

BACKGROUND: An increased incidence of hazardous alcohol consumption in medical practitioners is widely discussed. We conducted a survey of 80 medical students with a standardized questionnaire in order to assess the impact of harmful drinking patterns on the ideas of recommendations about alcohol consumption intended for patients. The statistical analyses were descriptive and inferential. RESULTS: Only one of 80 medical students rated his own consumption as hazardous. The weekly alcohol median consumption was 30 g for women and 60 g for men. 24% of students answering the AUDIT-questionnaire were found to be in the at-risk consumption category. Every 10th student had more than 6 drinks once per week. The weekly estimated non-risk allowance for patients was 80 g of alcohol in women and 100 g for men. DISCUSSION: In contrast to the self rating we found a high percentage of hazardous drinking behaviour patterns when using standardized instruments. Compared to the WHO recommendations the students rated weekly alcohol consumption more strictly. This points both towards the need of preventive measures in this target group as well as the need to improve educative competency.

[Alcohol-specific psychotherapy (ASP) in practice--a survey of psychotherapists]. / Die Alkoholismusspezifische Psychotherapie (ASP) in der Praxis--eine Therapeutenbefragung.

BACKGROUND: Aim of this investigation was the therapists' subjective assessment of the Alcoholism Specific Psychotherapy (ASP) in practice. By means of a specifically designed questionnaire, we conducted a survey of 21 psychotherapists trained in the method, and performed a descriptive and qualitative analysis. RESULTS: Of the 21 therapists who participated in the survey, 13 in total used the complete ASP, and 14 parts thereof. Out of a mean of 12.7 (SD = 16.0) psychotherapies administered to alcohol dependents, 22 % were treated with ASP. Individual elements of ASP were implemented in 18 therapies of non alcohol dependent patients. The global rating of each of the four general aspects (ease of application, practical relevance, client acceptance and ASP in comparison to other manualized psychotherapies) was a median value of 3 on a 5 step rating scale, or "pretty satisfied". The application of the 20 modules varied from 19 to 94 %. 50 % rated ASP's degree of structure as "too much". DISCUSSION: The results of the survey show that ASP is rated largely positively, and used partially and selectively by most psychotherapists.

Effects of written information material on help-seeking behavior in patients with erectile dysfunction: a longitudinal study.

INTRODUCTION: Neither men with erectile dysfunction (ED) nor their physicians are willing to discuss sexual problem sufficiently. Written information material could facilitate a dialogue and encourage men to seek treatment. AIM: The central task of this article was to determine the effectiveness and acceptance of patient information material for sexual dysfunction. METHODS: Through an information campaign, men received informational material. Eight thousand men also received a first survey, which asked about the intention to seek treatment and to discuss the sexual problem with a physician or partner. A second follow-up questionnaire, 3-6 months after the first one, asked for the implementation of these intentions. Descriptive and regression-based analyses were applied. MAIN OUTCOME MEASURES: Help-seeking behavior, subjective assessment of change in disease severity and partnership quality, satisfaction. RESULTS: Four hundred forty-three men participated in both surveys. Nearly 90% of them became active after reading the information material. More than half talked with their partner (57.8%) and a physician (65%), and one-third sought treatment (31.8%). Especially discussing the problem with the partner and receiving treatment improved erectile functioning and led to an increase in the quality of partnership (P