A New Tool to Assess Quality of Life in Patients with Idiopathic Pulmonary Fibrosis or Non-specific Interstitial Pneumonia.

BACKGROUND: Quality of life (QoL) is significantly impaired in patients with pulmonary fibrosis, however reliable tools to assess QoL issues specific for this group of patients are still missing. We thus aimed to develop a new questionnaire called "Quality of life in patients with idiopathic pulmonary fibrosis" (QPF) to measure QoL in patients with fibrotic idiopathic interstitial pneumonias (IIP). METHODS: An item pool was created on the basis of a German expert group with support of patients suffering from pulmonary fibrosis. In a 1st step, this version of the questionnaire was completed by 52 patients with idiopathic pulmonary fibrosis (IPF) or non-specific interstitial pneumonia (NSIP). Following this, an item- and an exploratory factor analysis was carried out and a 2nd version created. In a multicenter validation study in a one-group pre-post design, the questionnaire was filled in by 200 patients with IIP (IPF = 190, iNSIP = 10) at 2 time points with an interval of 6 months. Cross-validation was carried out with the St. Georges Respiratory Questionnaire (SGRQ). RESULTS: The mean age of the patients was 71.0 years (50-90 years), 82.5 % were male. Item analysis revealed that most of Cronbach alpha and selectivity values of QPF-scales could be considered as sufficient (e. g. QPF-scale "condition" [alpha = 0.827], "impairment" [alpha = 0.882]). At scale level, there were significant differences in terms of a deterioration or improvement in the QPF-condition and QPF-breathlessness scales and also in the SGRQ-activity scale. Analysis of construct validation of QPF and SGRQ showed moderate correlations between both questionnaires. A deterioration in health status from the patient's and doctor's perspective was seen in the scales "impairment", "shortness of breath" and "health status" of the QPF. The QPF was able to detect a change in the patient's mood ("condition" scale) in the course of treatment. CONCLUSION: This newly developed questionnaire maps the special needs of the patients well. The QPF is suitable for screening of quality of life as well as for supplementing the medical history and for monitoring the course of disease in fibrotic IIPs.

[The neuropsychological principles of psychotherapy]. / Neuropsychologische Grundlagen der Psychotherapie.

Recent advances achieved in the field of clinical neuro(bio-)psychology have been varied and impressive. Together with the related social and psychosocial aspects, they contribute to and enrich the development of new options in diagnosis and psychotherapy. Important research results are discussed here based on the examples of depression, Alzheimer's disease and self-injury, which profit greatly from neuropsychological research, especially through early detection of symptoms and prevention.

[Mental disorders in adolescence: current trends in therapy]. / Psychische Störungen im Jugendalter: Aktuelle Therapietrends.

On the basis of the high prevalence for behavioural problems and mental disorders in adolescence and its persistence into adulthood it is tested whether and based upon which emphasis this topic is considered in the recent discussion on psychotherapy. Therefore, a bibliometric analysis is given that summarizes the issue in the 2011 and 2012 volumes of representative German child and adolescent psychological and psychiatric journals. The focus lies on conduct disorder, depression, deliberate self-harm, dissociative disorder, and post traumatic stress disorder.

[Risk and opportunities for children in problem families]. / Risiken und Chancen für Kinder in belasteten Familien.

Against the background of high prevalence of behavioral problems and mental disorders in childhood and adolescence and its persistence into adulthood, the research about risk and protective factors within the family context is highly relevant. We surveyed publications of leading journals. A bibliometric analysis of major German psychological and psychiatric journals over the years 2009/10 is presented. The focus is on psycho-social causes and developmental models as well as assessment and intervention with families of adversity.

Patient satisfaction with different asthma-training variants.

OBJECTIVE: Information on patient satisfaction with professional health care delivery in asthmatics is rare, and the question as to how asthma education programmes affect such satisfaction has not yet been addressed. METHODS: This multi-centre study investigated three different variants of an asthma education programme for adults. Patients participated either in variant B (basic training with teacher-directed presentation, two 90 min sessions), variant C (comprehensive training, four sessions), variant D (including additional psychological components, minimum five sessions), or variant E (equivalent to B in outpatient context). At the end of the training the perceived satisfaction with the programme and reported personal benefit were assessed by means of a new inventory that was developed. RESULTS: The sample comprised N = 320 patients (n = 244 inpatients and n = 76 outpatients) ranging in age from 18 to 80 years (M = 46.3 years). The average total score for educational satisfaction of all participants was 8.0 (maximum score = 10). Choice of topics was judged particularly positive (M = 8.58), followed by the structure of training/setting-conditions (M = 8.0). The perceived personal benefit from the training was evaluated less positively (M = 7.32). When comparing the programme variants, patients' average satisfaction tends to increase with the extent and intensity of the training offered. Outpatients showed significantly less satisfaction in contrast to inpatients. Inpatients' satisfaction with the three variants increased with extensiveness and intensity of the training, while the contrast of between-group comparisons (B-C, B-D and C-D) was significant. CONCLUSION: Assessment of the patient's view of health care services should complement standardised evaluation methods, especially in multi-intervention rehabilitation programmes. PRACTICE IMPLICATIONS: Rehabilitation-specific diagnostic measures should be developed and validated in order to better assess patients' satisfaction and training efficacy from the patient's perspective. Further study is recommended on how far individualised training measures might increase subjective benefit.

Development and evaluation of a cancer-related fatigue patient education program: protocol of a randomized controlled trial.

BACKGROUND: Cancer-related fatigue (CRF) and its impact on patients' quality of life has been an increasing subject of research. However, in Germany there is a lack of evidence-based interventions consistent with the multidimensional character of fatigue. The objective of this study is to develop and evaluate a self-management program for disease-free cancer patients to cope with CRF. METHODS: Based on evidence extracted from a literature review, a curriculum for the self-management program was elaborated. The curriculum was reviewed and validated by an interdisciplinary expert group and the training-modules will be pretested with a small number of participants and discussed in terms of feasibility and acceptance.To determine the efficacy of the program a randomised controlled trial will be carried out: 300 patients will be recruited from oncological practices in Bremen, Germany, and will be allocated to intervention or control group. The intervention group participates in the program, whereas the control group receives standard care and the opportunity to take part in the program after the end of the follow-up (waiting control group). Primary outcome measure is the level of fatigue, secondary outcome measures are quality of life, depression, anxiety, self-efficacy and physical activity. Data will be collected before randomisation, after intervention, and after a follow-up of 6 months. DISCUSSION: Because there are no comparable self-management programs for cancer survivors with fatigue, the development of the curriculum has been complex; therefore, the critical appraisal by the experts was an important step to validate the program and their contributions have been integrated into the curriculum. The experts appreciated the program as filling a gap in outpatient cancer care.If the results of the evaluation prove to be satisfactory, the outpatient care of cancer patients can be broadened and supplemented. TRIAL REGISTRATION: ClinicalTrials NCT00552552.

A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial.

OBJECTIVE: To evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors. METHODS: In ten German centres, 261 patients with cancer-related fatigue were randomly assigned to a patient education program consisting of 6 sessions à 90 min or standard care. The primary outcome measure was cancer-related fatigue. Data were analysed using analysis of variance (ANOVA) with repeated measures. RESULTS: Patients in the intervention group showed statistically significant reduction in cancer-related fatigue (F = 76.510, p < 0.001, η(2) = 0.248). Secondary outcomes also showed significant improvements in all measures, including quality of life (F = 29.607, p < 0.001, η(2) = 0.113), general self-efficacy (F = 27.680, p < 0.001, η(2) = 0.107), exercise self-efficacy (F = 49.230, p < 0.001, η(2) = 0.175), physical activity (F = 8.036, p < 0.001, η(2) = 0.033), anxiety (F = 33.194, p < 0.001, η(2) = 0.125), depression (F = 24.604, p < 0.001, η(2) = 0.096), and fatigue knowledge (F = 55.157, p < 0.001, η(2) = 0.192). CONCLUSION: The program was effective in reducing perceived fatigue as well as further outcomes. PRACTICE IMPLICATIONS: This newly developed education program has the potential to fill a gap in the care of cancer survivors. The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group.

[Chronic fatigue in cancer patients]. / Chronische Fatigue bei Krebspatienten.

BACKGROUND: Due to improvements in long-term survival in cancer patients, emphasis is increasingly placed on chronic symptoms such as cancer-related fatigue in patients after completion of cancer treatment. Fatigue prevalence in these patients ranges from 17% to 56%. However, there is a lack of complex treatments that take the multifactorial character of fatigue causation into account. PATIENTS AND METHODS: Based on a needs analysis, a patient education program was developed and evaluated. The study aimed at cancer patients after completion of the cancer treatment who suffer from chronic fatigue. The self-management program FIBS consists of six modules. Information about fatigue and behavioural therapy orientated strategies and exercises are included. Patients who attended the program were highly satisfied. They were satisfied with the selected topics at an average of 84.0%, and with the conditions at 84.25%. 95.8% of the patients achieved a subjectively perceived personal benefit, on average 8.14 of 12 possible points. The overall patient education satisfaction scored 78.72%. CONCLUSION: The newly developed self-management program closes a gap in health care of cancer patients with chronic fatigue for whom there are hardly any intervention options to date. The program is characterised by target group-specific contents and methods and a high satisfaction of the patients.