French annual national observational study of 2015 outpatient and inpatient healthcare utilization by approximately half a million patients with previous heart failure diagnosis.

BACKGROUND: Heart failure management guidelines have been published, but the degree of adherence to these guidelines remains unknown. AIMS: To study in 2015 healthcare utilization and causes of death for people previously identified with heart failure. METHODS: The national health data system was used to identify adult general scheme (86% of the French population) hospitalized for heart failure between 2011 and 2014 or with only a long-term chronic disease allowance for heart failure. The frequency and median (interquartile range) of at least one healthcare use among those still alive in 2015 was calculated. RESULTS: A total of 499,296 adults (1.4% of the population) were included, and 429,853 were alive in 2015; median age 79 (68-86) years. At least one utilization was observed for a general practitioner in 95% of patients (median 8 [interquartile range 5-13] consultations), a cardiologist in 42% (2 [1-3]), a nurse in 78% (16 [4-100]), a loop diuretic in 64% (11 [8-12] dispensations), an aldosterone antagonist in 21% (8 [5-11]), a thiazide in 15% (7 [4-11]), a renin-angiotensin system inhibitor in 68% (11 [8-13]), a beta-blocker in 65% (11 [7-13]), a beta-blocker plus a renin-angiotensin system inhibitor in 57%, and a beta-blocker plus a renin-angiotensin system inhibitor plus an aldosterone antagonist in 37%. Hospitalization for heart failure was present for 8% (1 [1,2]). Higher levels of healthcare utilization were observed in the presence of hospitalization for heart failure before 2015. Among the 13.9% of people who died in 2015, heart failure accounted for 8% of causes, cardiovascular disease accounted for 39%. CONCLUSIONS: General practitioners and nurses are the main actors in the regular follow-up of patients with heart failure, whereas cardiologist consultations and dispensing of first-line treatments are insufficient with respect to guidelines.

Digital Health Tools and Patients With Drug Use Disorders: Qualitative Patient Experience Study of the Electronic Case-Finding and Help Assessment Tool (eCHAT).

BACKGROUND: One of the promises of digital health is to better engage patients and improve care for vulnerable populations. Patients with drug use disorders are a vulnerable population who often do not receive the care they need, both for their drug use disorders as well as their other health care needs. Appropriate primary care for patients with drug use disorders needs to be patient-centered, holistic, highly accessible, and engaging. The electronic Case-finding and Help Assessment Tool (eCHAT) was designed as a patient-centered tool for the identification and measurement of problematic health behaviors and mood states. OBJECTIVE: The aim of this study was to explore the patient experience of eCHAT at an Australian family medicine clinic for patients with drug use disorders. METHODS: A total of 12 semistructured interviews were conducted with patients, two interviews were conducted with doctors, and one focus group was conducted with patient advocates who were former patients of the clinic where the study took place. The transcripts were analyzed using inductive thematic analysis. RESULTS: The key themes identified from the interviews and the focus group were as follows: (1) eCHAT helped reduce stigma related to drug use in the doctor-patient consultation, (2) restricted answer options impacted the ability of patients to tell their stories, (3) patient-related response factors, (4) increased efficiency in the consultation process, and (5) divergence in level of concern around security and privacy. CONCLUSIONS: eCHAT has the potential to help vulnerable patients in primary care to engage more with their doctors and reduce experiences of stigma. eCHAT may be a useful digital health intervention in a family medicine clinic for patients with drug use disorders. It has the potential to improve patient engagement and access to health care, which are crucial areas of need in this vulnerable population. However, it is important to clearly communicate the privacy risk of digital health tools and to implement eCHAT such that it will add value to, rather than displace, in-person consultations with the family doctor.

Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure.

AIM: The aim of this study was to evaluate the suitability and comprehensibility of the integrated palliative care outcome scale for the evaluation of palliative care needs in patients with heart failure. METHODS AND RESULTS: This cross-sectional study investigated 100 heart failure patients (40 women, 60 men; median age 79 years) within the first few days of their hospitalisation by applying the integrated palliative care outcome scale (3-day recall period) and two additional self-developed questions about the suitability and comprehensibility of the integrated palliative care outcome scale. Clinically relevant somatic and psycho-emotional symptoms were reported very frequently (approximately 75% each), followed by communicational needs or practical issues. Ninety-five per cent of patients thought the integrated palliative care outcome scale very easy to understand, and 91% judged the integrated palliative care outcome scale suitable to assess palliative care needs. CONCLUSION: The integrated palliative care outcome scale was well accepted by hospitalised patients with heart failure and identified a high burden of both physical and psycho-emotional symptoms. Screening for palliative care has to consider patients and their relatives alike, and should be part of a comprehensive care concept jointly integrated into clinical routine by primary and specialised palliative care teams.

Cross-validation of the Care Dependency Scale in intensive care unit (ICU-CDS).

OBJECTIVES: The Care Dependency Scale is a theory-based, comprehensive tool widely used in low-intensity care settings to evaluate patients' dependency. This study aimed to test the psychometric properties of the Care Dependency Scale in intensive care units. RESEARCH METHODOLOGY/DESIGN: A multicentre cross-sectional validation study was conducted. Exploratory factor analysis and confirmatory factor analysis were performed using a Maximum Likelihood robust estimator with Geomin oblique rotation. SETTING: Adult patients admitted to intensive care units of four Italian hospitals. RESULTS: The sample included 453 patients (mean age = 68 years, 62% male). The exploratory factor analysis, conducted on a subsample of 227 patients, revealed a two-factor structure (Physical care dependency and Psychosocial care dependency) with good fit indexes. The confirmatory factor analysis was conducted on another subsample of 226 patients and a second-order factor was specified. The model tested yielded adequate fit indexes. Concurrent and known-groups validity, and reliability, were also adequate. CONCLUSION: The Care Dependency Scale is a multidimensional, valid and reliable tool able to assess the care dependency of critically ill patients. It can help to distinguish between physical and psychosocial needs and to create a base for patient-customised and holistic care.

"Things Are Different Now But": Older LGBT Adults' Experiences and Unmet Needs in Health Care.

Background: Approximately 2.7 million U.S. older adults self-identify as lesbian, gay, bisexual, and transgender (LGBT). Many felt unsafe revealing their sexual orientation until relatively recently, and may still not be "out" to medical providers. The aim of this study was to increase understanding of the experiences and needs of older LGBT adults when accessing care. Method: Individual semistructured interviews were conducted with 10 individuals aged 65 years or older from a local LGBT community. Interviews were audio taped and transcribed verbatim. Transcripts were analyzed via thematic analysis. Results: Major themes were "Outness," "Things are Different Now," and "Additional Resources." These describe participant comfort with being "out"; how treatment they received changed over time, and needed services or other options from the community. Conclusion: While many older LGBT adults are accustomed to navigating social mores to avoid negative experiences, nurses as well as other health care providers must be prepared to create trusting relationships with these individuals to provide truly comprehensive care.

Development of a tool to identify and assess psychosocial and spiritual needs in end-of-life patients: The ENP-E scale.

OBJECTIVE: The goal of this study is to describe the development of a new tool, the Psychosocial and Spiritual Needs Evaluation scale Instrumento de Evaluación de Necesidades Psicosociales y Espirituales del Enfermo al Final de Vida (ENP-E), designed to assess the psychosocial needs of end-of-life (EOL) patients. And, secondarily, to describe the face validity and psychometric properties of this instrument in the Spanish-speaking context. METHOD: The scale was developed through a seven-stage process: (1) literature review; (2) expert panel establishment; (3) discussion and agreement on the most relevant dimensions of psychosocial care; (4) description of key indicators and consensus-based questions to evaluate such dimensions; (5) assessment of the scale by external palliative care (PC) professionals; (6) evaluation by patients; and (7) analysis of scale's psychometrics properties. To assess content validity, 30 PC professionals and 20 patients evaluated the questionnaire. To determine psychometric properties, 150 participants completed these scales: the ENP-E; the Hospital Anxiety and Depression Scale; item 15 from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative; and the Distress Thermometer. RESULT: All respondents evaluated the tool as "excellent." In terms of construct validity, the internal consistency (Cronbach's alpha = 0.74) and temporal stability (test-retest r = 0.74, p < 0.1) were both adequate. On the factorial analysis, four factors (emotional-wellbeing, social support, spiritual, and information) explained 58.4% of the variance. This scale has a sensitivity of 76.3%, specificity of 78.9%, and the cutoff is 28. SIGNIFICANCE OF RESULTS: To provide quality PC to EOL patients, it is essential to determine the psychosocial factors that influence well-being. This requires the use of reliable and specific instruments. The ENP-E is a novel tool that provides a systematic, holistic assessment of the psychosocial needs of EOL patients. Its routine use would allow clinicians to monitor such needs over time. This would, in turn, permit comprehensive, highly individualized interventions to improve effective PC approach.

Palliative care: the need of the modern era.

There is a great need for palliative care in the modern era of medicine. Despite medical advances, patients with life-limiting illnesses still suffer significantly. Palliative care emerged a half century ago as an ethos based on compassion and care for patients and their families to relieve their suffering. It entails a paradigm shift from the biomedical model to the biopsychospiritual model. Palliative care is recognised by the World Health Organization as an essential part of the continuum of universal health coverage. In 2014, the World Health Assembly approved a resolution on "Strengthening of palliative care as a component of comprehensive care throughout the life course". Despite Hong Kong's relatively good local palliative care service coverage for patients who died of cancer and end-stage renal failure, service gaps for palliative care do exist among our ageing population with non-malignant life-limiting illnesses. We strongly urge the Hong Kong Government to develop our local palliative care policy in response to the World Health Assembly's resolution. Growing international and local evidence demonstrates the impacts of palliative care on patient outcomes, caregivers, and health care. Such outcomes can be service-based, disease-based, or symptom/suffering-based. The goal of palliative care is to relieve health-related suffering. Evidence-based management of pain, breathlessness, and psychospiritual suffering are discussed. Care in the end-of-life phase should be an integral part of palliative care, promoting patient choice, advance care planning, and good death.

Hyperbaric medicine today: an historically noble discipline challenged by loss of critical access and overutilization - invited commentary.

As the title implies, much appears amiss with hyperbaric medicine. Long recognized for its life-saving, CNS-sparing,infection-fighting and tissue-salving attributes, its current application has been rightly called into question by a broad cross-section of health care delivery system stakeholders [1, 2, 3, 4, 5]. This paper will examine what lies behind the stunning loss of availability for a majority of the Federal Drug Administration-approved uses, arguably those for which patients have the most to gain. It will address overutilization in the context of an erosion of practice standards and widespread manipulation of the reimbursement process. It will make suggestions aimed at restoring its broader availability across the full extent of FDA-approved uses. Finally, it offers guidance to ensure that HBO2 therapy is employed only when medically necessary by adoption of the drug administration "rights" principle, namely the right indication for the right patient at the right time and only for the right amount of time.

Evaluation of a clinical needs assessment and exploration of the associated supports for students with a disability in clinical practice: part 2.

Engagement and successful completion of nursing and midwifery programmes may be predicated on the identification and implementation of reasonable accommodations to facilitate clinical learning for students with a disability. This qualitative study aims to evaluate a clinical needs assessment for students with a disability and explore their experiences of support in clinical practice. A purposive sample of year one undergraduate students was used. Four students consented to participate and undertook an individual interview. Their disabilities were categorised as specific learning disability (dyslexia) (n = 3) and mental health (n = 1). Data analysis revealed two main themes 'students' experiences of disclosure' and 'receiving support'. Findings revealed that all students disclosed on placement, however, the extent of disclosure was influenced by personal and environmental factors. Students used the clinical needs assessment to highlight accommodations to clinical staff on placement. Issues of concern that arose, included communication between all key stakeholders, negative staff attitudes and the need to improve the provision of accommodations. This preliminary evaluation indicates that the Clinical Needs Assessment bridges the gap in provision of student support between higher education and healthcare institutions. Findings suggest that competence based needs assessments can identify individualised reasonable accommodations for students undertaking clinical placements.

American indians and spiritual needs during hospitalization: developing a model of spiritual care.

PURPOSE: Although spirituality is typically intertwined with health in Native cultures, little research has examined the relationship between American Indians' spiritual needs and overall satisfaction with service provision during hospitalization. This study examined this relationship, in tandem with the effects of 8 potential mediators, to develop a model of spiritual care for older hospitalized American Indians. DESIGN AND METHODS: Structural equation modeling was used with a sample of American Indians (N = 860), aged 50 and older, who were consecutively discharged from hospitals across the United States over a 12-month period. RESULTS: As posited, addressing spiritual needs was positively associated with overall satisfaction with service provision. The relationship between spiritual needs and satisfaction was fully mediated by 4 variables: nursing staff, the discharge process, physicians, and visitors. IMPLICATIONS: As the first study to develop and test a model of spiritual care for older hospitalized American Indians, this study provides practitioners with the information to provide more effective, culturally relevant services to older American Indians.

Evaluación de las necesidades de actualización de conocimientos en materia de fitoterapia de los farmacéuticos de la ciudad de Madrid / Evaluation of the needs of updating knowledge in the field of phytotherapy for the pharmacists from madrid city

El consumo de productos de plantas medicinales, para la prevención y/o tratamiento de diversos problemas de salud, ha experimentado un notable incremento en el estado español, especialmente en las farmacias. Esto es debido entre otros factores a la constatación científica de su eficacia y seguridad y a la labor profesional realizada por parte de los farmacéuticos en la recomendación de estos preparados. En este trabajo se realiza una evaluación de las necesidades de formación de los farmacéuticos en la ciudad de Madrid como base fundamental para realizar una buena dispensación de plantas medicinales, en res- puesta a la demanda de los pacientes. Respecto a estudios anteriores, los resultados obtenidos indican un incremento en la demanda de preparados de plantas medicinales por parte de los pacientes, principalmente mujeres. Asimismo se aprecia una mayor tendencia a elegir la oficina de farmacia como lugar de adquisición, al reconocer la mejor cualificación del farmacéutico en esta materia. No se observa una modificación sustancial en cuanto a la demanda por grupos terapéuticos, si bien la crisis económica parece influir en un incremento de la dispensación de plantas para el tratamiento de la ansiedad. Los farmacéuticos encuestados muestran su interés por ampliar y actualizar los conocimientos en fitoterapia mediante acciones formativas directas y próximas (AU)

The consumption of herbal products for the prevention and / or treatment of various health problems, has seen a remarkable increase in the Spanish state, especially in pharmacies, this is due among other factors to the scientific findings of its effectiveness and safety and the great effort made by pharmacists in the recommendation of these preparations. This paper assesses the training needs of pharmacists in the city of Madrid as the foundation for a good dispensing of medicinal plants, in response to patient demand. The results we get indicate an increase in the demand of natural preparations on the part of patients, ainly women. Also there is a greater tendency to choose the pharmacy as a place to buy it, recognizing that the pharmacist is more qualified in this area. We do not find a substantial change in the demand for treatment groups, but the economic crisis seems to influence in the consume of phytotherapy plant ìs for the treatment of anxiety. The pharmacists of the study show their interest in increase and update their knowledge in herbal drug with compatible courses with their professional life’s (AU)

A psychometric analysis of the spiritual needs inventory in informal caregivers of patients with cancer in hospice home care.

PURPOSE/OBJECTIVES: To test the validity and reliability of the Spiritual Needs Inventory (SNI) in measuring the spiritual needs of informal caregivers of patients with cancer in hospice home care. DESIGN: A subanalysis of a longitudinal, randomized hospice clinical trial. SETTING: Two hospices in the southwestern United States. SAMPLE: 410 informal caregivers of patients with cancer in hospice home care. METHODS: To test the hypotheses, Pearson and Spearman correlations, principal factor analysis with oblique rotation, and coefficient alpha were conducted. MAIN RESEARCH VARIABLES: Spiritual needs, depression, social support. FINDINGS: The SNI showed a small but significant positive correlation with the social support (p = 0.003). A three-factor solution of the SNI accounted for about 55% of the variability. The first factor captured a traditional religious measure, with the original patient-reported subscales of inspiration, spiritual activities, and religion collapsing into this one factor. The second and third factors were similar to the original patient study. Cronbach alpha for the total scale was 0.88. The factor alphas ranged from 0.68-0.89. CONCLUSIONS: The current study provides early evidence for the validity and reliability of the SNI in informal caregivers of patients with cancer in hospice home care. Additional testing in other populations is recommended. IMPLICATIONS FOR NURSING: Use of the SNI with hospice caregivers could aid nurses in the identification of spiritual needs, enabling the development of plans of individualized, high-quality care.

Validation of the Spiritual Distress Assessment Tool in older hospitalized patients.

BACKGROUND: The Spiritual Distress Assessment Tool (SDAT) is a 5-item instrument developed to assess unmet spiritual needs in hospitalized elderly patients and to determine the presence of spiritual distress. The objective of this study was to investigate the SDAT psychometric properties. METHODS: This cross-sectional study was performed in a Geriatric Rehabilitation Unit. Patients (N = 203), aged 65 years and over with Mini Mental State Exam score ≥ 20, were consecutively enrolled over a 6-month period. Data on health, functional, cognitive, affective and spiritual status were collected upon admission. Interviews using the SDAT (score from 0 to 15, higher scores indicating higher distress) were conducted by a trained chaplain. Factor analysis, measures of internal consistency (inter-item and item-to-total correlations, Cronbach α), and reliability (intra-rater and inter-rater) were performed. Criterion-related validity was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp) and the question "Are you at peace?" as criterion-standard. Concurrent and predictive validity were assessed using the Geriatric Depression Scale (GDS), occurrence of a family meeting, hospital length of stay (LOS) and destination at discharge. RESULTS: SDAT scores ranged from 1 to 11 (mean 5.6 ± 2.4). Overall, 65.0% (132/203) of the patients reported some spiritual distress on SDAT total score and 22.2% (45/203) reported at least one severe unmet spiritual need. A two-factor solution explained 60% of the variance. Inter-item correlations ranged from 0.11 to 0.41 (eight out of ten with P < 0.05). Item-to-total correlations ranged from 0.57 to 0.66 (all P < 0.001). Cronbach α was acceptable (0.60). Intra-rater and inter-rater reliabilities were high (Intraclass Correlation Coefficients ranging from 0.87 to 0.96). SDAT correlated significantly with the FACIT-Sp, "Are you at peace?", GDS (Rho -0.45, -0.33, and 0.43, respectively, all P < .001), and LOS (Rho 0.15, P = .03). Compared with patients showing no severely unmet spiritual need, patients with at least one severe unmet spiritual need had higher odds of occurrence of a family meeting (adjOR 4.7, 95%CI 1.4-16.3, P = .02) and were more often discharged to a nursing home (13.3% vs 3.8%; P = .027). CONCLUSIONS: SDAT has acceptable psychometrics properties and appears to be a valid and reliable instrument to assess spiritual distress in elderly hospitalized patients.

Predictors of dependency on nursing care after stroke: results from the Dortmund and Münster stroke registry.

BACKGROUND: The long-term effects of stroke have been inadequately studied. We identified social and clinical factors that were associated with application for insurance payments for long-term care within 3.6 years after stroke. METHODS: In a quality-assurance project called "Stroke Northwest Germany," information was obtained from 2286 stroke patients on their socio-demographic background, type of stroke, comorbidities, and degree of physical impairment during their hospital stay, as measured on the Rankin Scale, the Barthel Index, and the Neurological Symptom Scale. We used logistic regression models to identify possible associations between these factors and application for insurance payments for long-term care within 3.6 years after stroke. We developed an appropriate prognostic model by means of backward selection. RESULTS: 734 (32.1%) of the patients participated in follow-up and reported whether they had applied for insurance payments for long-term care. 22.5% had submitted an application. The rate of application was positively correlated with age, female sex, the number of comorbidities and complications during hospitalization, and the degree of physical impairment. CONCLUSION: Stroke has major long-term effects. The probability that a stroke patient will apply for insurance payments for long-term care is a function of the patient's age, sex, previous stroke history, and physical impairment as measured on the Rankin Scale and the Barthel Index.

Reliable integrative assessment of health care needs in elderly persons: the INTERMED for the Elderly (IM-E).

OBJECTIVE: With the increasing prevalence of multiple conditions in older age, the high prevalence of mental disorders, and the many social challenges facing elderly people, a high-risk patient group in need of interdisciplinary (biological, psychological, and social) care is emerging. The INTERMED interview is an integrative assessment method that identifies patients with complex health care needs. The aim of this study was to develop and evaluate the INTERMED for the Elderly (IM-E), specifically for use in populations of elderly persons. METHODS: In focus groups conducted with the authors of the original INTERMED, the variables and anchor points that had to be adjusted to the needs and situation of the elderly and to the demands of a population-based study were discussed and altered. The final version of the IM-E was conducted with 42 elderly persons. Participants were doubly scored by two trained raters; the interrater reliability [intraclass correlation coefficient (ICC) (2,1)] was calculated. RESULTS: The IM-E was well accepted by the elderly persons interviewed. ICCs for the various domains of the IM-E ranged between .87 and .95, while the ICC for the sum score was .95. Regarding the cutoff point of 20/21 for patients with complex health care needs, a κ of .75 was achieved. CONCLUSIONS: The IM-E is a reliable integrative assessment instrument. It is well suited for epidemiological settings to adequately describe the percentage of elderly patients with complex health care needs. In clinical settings, it can be used to identify elderly patients in need of interdisciplinary care.

Necesidades docentes en Evaluación y Prevención del Riesgo Tóxico: de la Toxicología Experimental a la Reguladora / Educational needs in Toxic Prevention and Risk Assessment: From experimental to Regulatory Toxicology

Se revisan las necesidades formativas para una serie de raas aplicadas de la toxicología derivadas de las áreas fundamentales mecanística y de evaluación toxicológica, que comprenden fundamentalmente la toxicología de sistemas, la evaluación del riesgo y la toxicología reguladora. Son materias necesarias para el desempeño profesional en los organismos nacionales, autonómicos y locales responsables de la regulación e inspección de la comercialización y uso de compuestos industriales, medicamentos, productos cosméticos, alimentarios o fitosanitarios, o de contaminantes ambientales o laborales, así como en industrias y consultorías. Se han identificado más de 25 actividades científicas de gran relevancia realizadas en España desde 1995, con una media de 1,6 actividades por año. Los principales grados de las ciencias de la salud incluyen una asignatura troncal de Toxicología, que puede aparecer como optativa en otros, generalmente de 6 créditos ECTS, con un programa muy uniforme, que incluye entre sus descriptores la estimación del riesgo, la evaluación toxicológica, el empleo de métodos alternativos y las bases de la toxicología reguladora. En relación con los estudios de postgrado, se identifican másteres con una gran variedad de contenidos y enfoques, que en algunos casos cubren un abanico muy amplio de disciplinas, incluyendo las toxicológicas, así como otros que cubren las áreas específicas de la toxicología. De la revisión transversal de los programas docentes de pregrado, postgrado y doctorado en España, se deduce la paulatina adaptación al EEES y la adecuada inclusión en los mismos de materias sobre evaluación experimental de la toxicidad, prevención del riesgo tóxico y toxicología reguladora (AU)

The training needs for a range of applied toxicology branches arising from the fundamental areas of mechanistic and toxicological evaluation, which mainly comprise of systems toxicology , risk assessment and regulatory toxicology , are reviewed. Thet are necessary for professional performance in national, regional and local authorities responsible for regulation and inspection of the marketing and use of industrial chemicals, pharmaceuticals, cosmetics, food or plant protection products or environmental or occupational pollutants, as well as industries and consultancies. There are more than 25 highly relevant scientific activities carried out in Spain since 1995, with an average of 1.6 activities per year . The main bachelor's degrees of the health sciences include a very uniform obligatory subject of T oxicology , which may appear as an option in others, usually with 6 ECTS credits, which includes among its descriptors risk e stimation assessment toxicology, the use of alternative methods and the basis for regulatory toxicology. In relation to postgraduate studies, masters were identified with a variety of topics and approaches, which in some cases cover a very wide range of disciplines, including toxicology and other covering in depth the specific toxicologic areas. From the transversal review of the teaching programs at under graduate, graduate and doctoral degrees in Spain, it was deduced a gradual adaptation to the EHEA and the appropriate inclusion of subjetcs on experimental evaluation of toxicity , toxic hazard prevention and regulatory toxicology (AU)

[Are there differences in the assessment of medical and non-medical interventions?]. / Unterschiede in der Bewertung von medikamentösen und nichtmedikamentösen Massnahmen?

Usually medical and/or non-medical interventions are applied to treat both acute and chronic disease. The non-medical measures include a broad range of heterogeneous principles, among them surgical, physical, technical and psychological ones. Not uncommonly, these measures derive from particular theoretical concepts. They frequently involve complex interventions, that is, programmes with varying combinations of different interacting measures. It has been postulated by advocates of the so called complementary medicine that 'different treatment concepts and hence different assessment methods' not only do, but must exist. This claim will be examined in a four-step procedure, and it will be demonstrated that this claim cannot be maintained: 1) in the face of the German Social Code, Book V Para. 35b Sect. 1, 2) with respect to the required and available knowledge base, 3) against the background of professionally approved international standards of EbM and 4) the requirements of scientific acceptance of psychotherapeutic methods and procedures.