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1.
Neuropsychol Rehabil ; 32(1): 131-147, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32851896

RESUMEN

MS related fatigue might be related to autonomous nervous system (ANS) dysfunctions or to inflammation related vagal (hyper-) activation. Consequently, influencing ANS status may lead to relieve of fatigue. We used two opposite biofeedback interventions to either increase sympathetic ("self-alert training", SAT) or parasympathetic activation ("progressive muscle relaxation", PMR). We recorded fatigue status of patients before and after a challenging vigilance task, their behavioural performance on this task, their skin conductance response (SCR), and parameters indicating parasympathetic activity concerning heart rate variability (HRV). We repeated these recordings after the biofeedback training sessions. Patients of the SAT group were able to learn to increase their SCR voluntarily. Patients of the PMR group showed increasing parameters indicating parasympathetic modulation of the HRV. The vigilance task increased their feeling of fatigue. However, there was no effect of biofeedback training on either fatigue status or performance on the vigilance task. Our results show that MS patients can learn to change voluntarily their ANS activity using biofeedback instructions based on SCR and this can be used in future studies to test the postulated link between ANS and fatigue. However, in this experimental intervention we were unable to document a relation between ANS activity and fatigue.Trial registration: ClinicalTrials.gov identifier: NCT03268187.


Asunto(s)
Biorretroalimentación Psicológica , Fatiga , Fatiga/etiología , Fatiga/terapia , Frecuencia Cardíaca , Humanos , Vigilia
2.
Z Evid Fortbild Qual Gesundhwes ; 110-111: 54-9, 2016.
Artículo en Alemán | MEDLINE | ID: mdl-26875036

RESUMEN

Regarding the effectiveness of disease management programs (DMPs) in Germany, several studies have been published on the DMP for type 2 diabetes. This pilot study provides methodological insights into evaluating the DMP for coronary heart disease (CHD), which currently includes 1.7 million participants, and reveals trends in healthcare outcomes for mortality, guideline adherent prescribing and costs. Major methodological challenges that need to be considered for the development of an appropriate matching method for this indication have been identified. The results show positive trends in favor of the DMP regarding mortality, costs and medication according to guidelines. A matching design is applicable to the CHD indication; the knowledge gained regarding the quality of care can be used for a targeted development of the program.


Asunto(s)
Enfermedad Coronaria/terapia , Manejo de la Enfermedad , Adulto , Anciano , Fármacos Cardiovasculares/economía , Fármacos Cardiovasculares/uso terapéutico , Enfermedad Coronaria/economía , Enfermedad Coronaria/mortalidad , Análisis Costo-Beneficio , Costos y Análisis de Costo , Prestación Integrada de Atención de Salud/economía , Evaluación de la Discapacidad , Femenino , Alemania , Adhesión a Directriz/economía , Humanos , Tiempo de Internación/economía , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Proyectos Piloto , Puntaje de Propensión , Resultado del Tratamiento
3.
Artículo en Alemán | MEDLINE | ID: mdl-25652116

RESUMEN

BACKGROUND: The integrated care system Gesundes Kinzigtal (ICSGK), one of the most comprehensive population-based ICS in Germany, started its work nearly 9 years ago. The ICSGK is pursuing the Triple Aim: improving the health of the population, improving the individual's experience of care, and at the same time reducing the per capita costs of care. OBJECTIVES: To evaluate the impact of the ICSGK on the Triple Aim. MATERIALS AND METHODS: The ICSGK is being evaluated externally and internally via a mix of diverse quantitative and qualitative methods. This paper presents selected results for each Triple Aim dimension. RESULTS AND CONCLUSIONS: Regarding population health, most of the quality indicators examined by the external scientific evaluation show positive development. For example, the prevalence of patients with fractures among all insurants with osteoporosis is presented. In 2011, this prevalence was approximately 26 % in the "Kinzigtal" population (aged ≥ 20 years old) in comparison to 33 % in the control group. As far as patient experience is concerned, to the question "Would you recommend becoming a member of Gesundes Kinzigtal to your friends or relatives?" 92.1 % of those questioned answered "Yes, for sure" or "Yes, probably." Twenty-four percent of those questioned further stated that they would now live "more healthy" than before enrolment in the ICSGK. In the subgroup of questioned insurants who had objective agreements with their doctors 45.4 % answered in this way. On the subject of cost-effectiveness, for both participating socil health insurance schemes, cost savings relative to the costs normally expected for the ICSGK population concerned are observed every year. In the seventh intervention year (2012) the total is 4.56 million Euros for the AOK Baden-Württemberg (BW), which is a contribution margin of 146 Euros per insurant for the 31.156 insurants concerned (LKK BW = 322 Euros per insurant relative to cost savings). The results presented in this paper indicate positive effects in all three Triple Aim dimensions. Further longitudinal studies are recommended to validate those first results together with a detailed analysis to obtain in-depth insights into the specific influence of subcomponents of the total intervention.


Asunto(s)
Análisis Costo-Beneficio/economía , Prestación Integrada de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Sistemas Prepagos de Salud/organización & administración , Modelos Económicos , Satisfacción del Paciente/economía , Alemania , Accesibilidad a los Servicios de Salud/economía , Investigación sobre Servicios de Salud/tendencias , Humanos , Modelos Organizacionales , Satisfacción del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Revisión de Utilización de Recursos
4.
J Clin Exp Neuropsychol ; 37(1): 16-26, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25658671

RESUMEN

OBJECTIVE: Deficits in sustaining attention are common in various organic brain diseases. A recent study proposed self-alert training (SAT) as a technique to improve sustained attention. In the SAT, individuals learn to gain volitional control over their own state of arousal by means of electrodermal biofeedback. METHOD: In this study, we investigated the behavioral, electrodermal, and electroencephalogram correlates of the SAT with a blinded, randomized, and active-controlled pre-post study design. Sustained attention capacity was assessed with the Sustained Attention to Response Task (SART). RESULTS: The SAT resulted in strong phasic increases in skin conductance response (SCR), but endogenous control of SCR without feedback was problematic. Electroencephalogram analysis revealed stronger alpha reduction during SART for the SAT than for the control group. Behaviorally, the SAT group performed more accurately and more slowly after intervention than the control group. CONCLUSION: The study provides further evidence that SAT helps to maintain SART accuracy over prolonged periods of time. Whether this accuracy is more related to sustained attention or response inhibition is discussed.


Asunto(s)
Ritmo alfa/fisiología , Nivel de Alerta/fisiología , Atención/fisiología , Biorretroalimentación Psicológica , Inhibición Psicológica , Autocontrol , Adulto , Análisis de Varianza , Electroencefalografía , Femenino , Respuesta Galvánica de la Piel , Humanos , Masculino , Pruebas Neuropsicológicas , Tiempo de Reacción , Método Simple Ciego , Adulto Joven
5.
Z Evid Fortbild Qual Gesundhwes ; 105(8): 585-9, 2011.
Artículo en Alemán | MEDLINE | ID: mdl-22142881

RESUMEN

The regional integrated care model "Gesundes Kinzigtal" pursues the idea of integrated health care with special focus on increasing the health gain of the served population. Physicians (general practitioners) and psychotherapists, physiotherapists, hospitals, nursing services, non-profit associations, fitness centers, and health insurance companies work closely together with a regional management company and its programs on prevention and care coordination and enhancement. The 10 year-project is run by a company that was founded by the physician network "MQNK" and "OptiMedis AG", a corporation with public health background specialising in integrated health care. The aim of this project is to enhance prevention and quality of health care for a whole region in a sustainable way, and to decrease costs of care. The article describes the special funding model of the project, the engagement of patients, and the different health and prevention programmes. The programmes and projects are developed, implemented, and evaluated by multidisciplinary teams.


Asunto(s)
Planificación en Salud Comunitaria/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Implementación de Plan de Salud/organización & administración , Programas Nacionales de Salud/organización & administración , Planificación en Salud Comunitaria/economía , Planificación en Salud Comunitaria/tendencias , Conducta Cooperativa , Control de Costos/economía , Control de Costos/organización & administración , Control de Costos/tendencias , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/tendencias , Predicción , Alemania , Implementación de Plan de Salud/economía , Implementación de Plan de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Comunicación Interdisciplinaria , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/tendencias , Grupo de Atención al Paciente/economía , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/tendencias , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/tendencias , Corporaciones Profesionales/economía , Corporaciones Profesionales/organización & administración , Corporaciones Profesionales/tendencias , Mejoramiento de la Calidad/economía , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/tendencias , Regionalización/economía , Regionalización/organización & administración , Regionalización/tendencias
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