[German S1 Guideline Long-/Post-COVID]. / S1-Leitlinie Long-/Post-COVID.

The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.

[Psychotherapy and psychological procedures for fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. / Psychotherapie und psychologische Verfahren beim Fibromyalgiesyndrom : Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten.

BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A systematic search of the literature for systematic reviews of randomized, controlled studies on psychological and psychotherapeutic procedures from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: Cognitive behavioral therapies received a strong recommendation but biofeedback, guided imagery and hypnosis received a weak recommendation.

[Multimodal therapy of fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. / Multimodale Therapie des Fibromyalgiesyndroms : Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten.

BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n = 8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews on randomized controlled trials of multimodal therapy from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: The use of multimodal therapy (combination of aerobic exercise with at least one psychological therapy) with a duration of at least 24 h is strongly recommended for patients with severe forms of fibromyalgia.

[General treatment principles, coordination of care and patient education in fibromyalgia syndrome : Updated guidelines 2017 and overview of systematic review articles]. / Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom : Aktualisierte Leitlinie 2017 und Übersicht von systematischen Übersichtsarbeiten.

BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews on randomized, controlled trials on patient education and shared decision-making from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences, clinical and practical applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: The diagnosis of fibromyalgia syndrome should be explicitly communicated to the affected individual. Shared decision-making with the patient on the therapeutic options based on individual preferences of the patient, comorbidities and the success of previous treatment is recommended. A step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.

[Neglect-like symptoms after operations on the upper extremities]. / Neglect-like-Symptome bei Operationen an der oberen Extremität.

BACKGROUND: Neglect-like symptoms (NLS) describe the experience of perceiving a limb as foreign and could be detected in chronic pain disorders as well as after knee joint replacement. The aim of the present study was to find out whether patients with and without NLS after surgery of the upper extremities differ with respect to pain intensity and psychosocial variables and if NLS are associated with chronic postoperative pain (CPSP). METHODS: In this study 241 patients were interviewed using a validated questionnaire preoperatively as well as 1 day, 4 weeks, 3 months and 6 months postoperatively. Patients with and without NLS were compared using the χ2-test or Mann-Whitney U­test. The level of significance was adjusted for multiple testing. RESULTS: The NLS could be found to a slight extent throughout the entire study period. Patients with NLS showed significantly higher maximum pain scores at every measurement time point: average difference (∆ = 3, adjusted p < 0.005), a higher impairment due to pain (∆ = 15, adjusted p < 0.005), more anxiety (∆ = 3, adjusted p < 0.005), depression (∆ = 3, average adjusted p < 0.003) and kinesiophobia (∆ = 4, preoperative not significant, average postoperative adjusted p = 0.004). Preoperatively, more stressful life events (p = 0.002) and higher stress values (p < 0.001) were reported. In patients with CPSP, NLS occurred significantly more often (74%) than in patients without clinically relevant pain (17.5%. p < 0.001). CONCLUSION: The occurrence of NLS is associated with higher pain scores, more impairment due to pain and a higher psychosocial burden and they are more frequent in patients with CPSP. Further investigations are needed to show if NLS are an independent risk factor for the chronification of pain and if NLS play an independent role in the pathogenesis of pain.

[A Screening-Tool for Three Dimensions of Work-Related Behavior and Experience Patterns in the Psychosomatic Rehabilitation - A Proposal for a Short-Form of the Occupational Stress and Coping Inventory (AVEM-3D)]. / Ein Verfahren zum Screening dreier Dimensionen arbeitsbezogener Verhaltens- und Erlebensmuster in der psychosomatischen Rehabilitation ­ Vorschlag für eine Kurzform AVEM-3D.

Objectives: The assessment of work pressures is of particular importance in psychosomatic rehabilitation. An established questionnaire is the Occupational Stress and Coping Inventory (German abbr. AVEM), but it is quite long and with regard to scoring time-consuming in routine clinical care. It should therefore be tested, whether a shortened version of the AVEM can be developed, which is able to assess the formerly described three second-order factors of the AVEM, namely Working Commitment, Resilience, and Emotions, sufficiently reliable and valid, and which also may be used for screening of patients with prominent work-related behavior and experience patterns. Methods: Data were collected at admission from consecutive samples of three hospitals of psychosomatic rehabilitation (N = 10,635 patients). The sample was randomly divided in two subsamples (design and validation sample). Using exploratory principal component analyses in the design sample, items with the highest factor loadings for the three new scales were selected and evaluated psychometrically using the validation sample. Possible Cut-off values ought to be derived from distribution patterns of scores in the scales. Relationships with sociodemographic, occupational and diagnosis-related characteristics, as well as with patterns of work-related experiences and behaviors are examined. Results: The three performed principal component analyses explained in the design sample on the respective first factor between 31 % and 34 % of the variance. The selected 20 items were assigned to the 3-factor structure in the validation sample as expected. The three new scales are sufficiently reliable with values of Cronbach's α between 0,84 and 0,88. The naming of the three new scales is based on the names of the secondary factors. Cut-off values for the identification of distinctive patient-reported data are proposed. Conclusion: Main advantages of the proposed shortened version AVEM-3D are that with a considerable smaller number of items the three main dimensions of relevant work-related behavior and experience patterns can be reliably measured. The proposed measure is simple and economic to use and interpret. Based on the present sample we provide means and standard deviations as reference at admission of psychosomatic rehabilitation. As a limitation it should be mentioned that further evaluation of reliability, validity and sensitivity to change restricted to the items of the shortened version is necessary. The practicability and validity of the proposed cut-off values cannot yet be conclusively assessed. Finally, the validity of the AVEM-3D in groups of indications other than psychosomatic patients and in healthy persons remains to be examined.

[The improvement of the transfer into daily life of progressive relaxation after an inpatient psychosomatic rehabilitation]. / Verbesserung des Transfers von Progressiver Relaxation in den Alltag der Patienten nach stationärer psychosomatischer Rehabilitation.

AIM OF THE STUDY: The aim of the current study was the identification of predictors for a successful transfer of progressive relaxation (PR) into clinical and daily life. Furthermore the development of tension-related symptoms dependening of the frequency of continuous practise was detected. METHODS: 411 patients of a psychosomatic rehabilitation clinic attended a 6-h-course of progressive relaxation and were interviewed at 3 different times by a modified version of the "diagnostisches und evaluatives Instrumentarium für Entspannungstraining und Entspannungstherapie (ET-EVA)": at the beginning of therapy (T1), at discharge (T2) and 3 months after discharge by postal service (T3). After 3 months 274 patients (78.3%) sent the completed questionnaires back. The frequency of exercising by at least once a week was defined as successful. To detect the extent of symptom improvement, difference values between the different measuring times and effect sizes were calculated. To identify predictors of the frequency of daily practise, bivariate correlations and linear regression were used. RESULTS: 69.4% of the patients continued the exercises successfully beyond the course. The improved experience of relaxation directly after the program (r=-0.184; p<0.01) had a positive influence on the frequency of practising during hospital stay. 3 months after discharge 50.4% of the participants were practising at least once a week. The frequency of practise during hospital stay (r=0.558; p<0.01) and the experience of relaxation at T3 (r=-0.356; p<0.01) could be identified as predictors of a successful transfer into daily life of progressive relaxation. In the context of the linear regression the effect of the frequency of practise during hospital stay (Beta=0.506; p<0.01) and the experience of relaxation after 3 months (Beta=-0.275; p<0.01) remained significant predictors and explaines 40.9% of the variance. The items of all 6 symptom scales decreased significantly from T1 to T2 (p<0.01) and the feeling of discomfort after 3 months was significantly below the base level of T1 (p<0.01). The patients who practised at least once a week - compared to the not-practising patients - declared significantly less tension-related symptoms at T3 (p<0.01) and could achieve a significantly stronger change of wellbeing and relaxation experience at T2 and T3 (p<0.01). CONCLUSION: 50.4% of the patient implemented the relaxation training in their daily routine. The experienced alteration in terms of self-efficacy plays a meaningful role concerning the frequency of practise in hospital stay and daily routine. In future courses attention should be paid to the initial experience of relaxation. The frequency of practise once a week turned out to be the most effective.

[Female patients with fibromyalgia syndrome in somatic and psychosomatic rehabilitation center - an exploratory study on access routes and differences in patient characteristics]. / Fibromyalgiesyndrom-Patientinnen in psychosomatischen und somatischen Rehabilitationseinrichtungen - eine explorative Studie zu Zugangswegen und Unterschieden in Patientenmerkmalen.

STUDY OBJECTIVE: Fibromyalgia syndrome (FMS) is characterized by e. g. chronic, multilocular pain, and mental health problems. In Germany, patients with FMS are treated in somatic and psychosomatic rehabilitation centers - specialized for rheumatic diseases (somatic) or psychosomatic diseases. The aim of this study is to identify the status quo of FMS patients' access routes to the rehabilitation system, and to identify their predictors for being assigned to one or the other indication group. METHOD: Our cohort consists of 197 FMS patients from 3 psychosomatic (M=49.9 years) and 223 FMS patients (M=50.2 years) from 3 somatic rehabilitation centers. At the beginning of rehabilitation, patients filled out a questionnaire packet to identify their access routes to the rehabilitation centers and to record patients' disease-related, psychosocial and socio-demographic characteristics. To analyze the results we used descriptive calculations, calculated bivariate correlations, and conducted binary logistic regression analysis for the prediction of group membership. RESULTS: The access routes of FMS patients to a somatic or a psychosomatic rehabilitation center were often similar. Some items revealed significant group differences, i. e., a higher primary -rejection rate, longer waiting period between application for rehabilitation and its approval, and between the application itself and initiation of psychosomatic rehabilitation in comparison to somatic FMS patients. Prior experience of out-patient psychotherapy, and expectations ("psychological support") for the rehabilitation were predictive patient characteristics for the assignment into a psychosomatic rehabilitation center. Marriage, motivation, and expectations ("physical improvement" and "interaction with other patients") for the rehabilitation were predictive patient characteristics for the assignment in a somatic rehabilitation center. The predictors clarified 32% of the variance of group membership. CONCLUSION: Our results provide initial evidence of how FMS patients access the German rehabilitation system and which of their characteristics are responsible for being assigned to a particular rehabilitation setting.

[Mental disorders in patients with fibromyalgia syndrome: screening in centres of different medical specialties]. / Psychische Störungen beim Fibromyalgiesyndrom: Screening in Einrichtungen verschiedener Fachrichtungen.

BACKGROUND: Systematic reviews have reported a wide range of prevalence rates for depressive, anxiety and posttraumatic stress disorders (PTSD) in patients with fibromyalgia syndrome (FMS) which have been partially explained by setting differences. No data are currently available on the prevalence of potential mental disorders depending on the medical specialty in Germany. MATERIAL AND METHODS: All consecutive FMS patients of 8 study centres (3 rheumatology/orthopaedic surgery, 3 psychosomatic/pain medicine, 2 physical/integrative medicine) were assessed from February 1 to July 31, 2012 with standardised questionnaires. Patients with FMS diagnosed by a study physician were included. Non-German speaking and mentally retarded patients were excluded. The German version of the Patient Health Questionnaire 4 was used to screen for potential depressive and anxiety disorders. Severe life events were assessed by the trauma list of the Munich Composite International Diagnostic Interview and symptom criteria of PTSD of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) using the Posttraumatic Diagnostic Scale. RESULTS: Of 538 patients, 396 patients (93.9 % women, mean age 52.3 years, mean duration since chronic widespread pain 12.8 years, mean duration since FMS diagnosis 4.5 years) were analysed. In all, 65.7 % of patients met the criteria of a potential depressive disorder, 67.9 % of a potential anxiety disorder and 45.5 % of a potential PTSD. Potential depressive disorders were more frequent in the psychosomatic/pain medicine setting than in the rheumatology setting. CONCLUSION: Potential mental disorders were frequent in FMS patients regardless of the medical specialty. All FMS patients of all types of clinical settings should be screened for mental disorders.

Establishing a brain-death donor model in pigs.

INTRODUCTION: An animal model that imitates human conditions might be useful not only to monitor pathomechanisms of brain death and biochemical cascades but also to investigate novel strategies to ameliorate organ quality and functionality after multiorgan donation. METHODS: Brain death was induced in 15 pigs by inserting a catheter into the intracranial space after trephination of the skull and augmenting intracranial pressure until brain stem herniation. Intracranial pressure was monitored continuously; after 60 minutes, brain death diagnostics were performed by a neurologist including electroencephalogram (EEG) and clinical examinations. Clinical examinations included testing of brain stem reflexes as well as apnoe testing; then intensive donor care was performed according to standard guidelines until 24 hours after confirmation of brain death. Intensive donor care was performed according to standard guidelines for 24 hours after brain death. RESULTS: Sixty minutes after brain-death induction, neurological examination and EEG examination confirmed brain death. Intracranial pressure increased continuously, remaining stable after the occurrence of brain death. All 15 animals showed typical signs of brain death such as diabetes insipidus, hypertensive and hypotensive periods, as well as tachycardia. All symptoms were treated with standard medications. After 24 hours of brain death we performed successful multiorgan retrieval. DISCUSSION: Brain death can be induced in a pig model by inserting a catheter after trephination of the skull. According to standard guidelines the brain-death diagnosis was established by a flat-line EEG, which occurred in all animals at 60 minutes after induction.

[Fibromyalgia syndrome. General principles and coordination of clinical care and patient education]. / Das Fibromyalgiesyndrom. Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung.

BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: A diagnosis of FMS should be explicitly communicated with the afflicted individual. A step-wise treatment, depending on the severity of FMS and the responses to therapeutic measures, is recommended. Therapy should only be continued if the positive effects outweigh the side effects. The English full-text version of this article is available at SpringerLink (under "Supplemental").

[Multicomponent therapy of fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. / Multimodale Therapie des Fibromyalgiesyndroms. Systematische Übersicht, Metaanalyse und Leitlinie.

BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: The use of a multicomponent therapy (the combination of aerobic exercise with at least one psychological therapy) for a minimum of 24 h is strongly recommended for patients with severe FMS. The English full-text version of this article is available at SpringerLink (under "Supplemental").

[Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. / Psychotherapie von Patienten mit Fibromyalgiesyndrom. Systematische Übersicht, Metaanalyse und Leitlinie.

BACKGROUND: The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011. MATERIALS AND METHODS: The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The recommendations were based on level of evidence, efficacy (meta-analysis of the outcomes pain, sleep, fatigue and health-related quality of life), acceptability (total dropout rate), risks (adverse events) and applicability of treatment modalities in the German health care system. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies. RESULTS AND CONCLUSION: Cognitive behavioral therapy combined with aerobic exercise (multicomponent therapy) is strongly recommended. Relaxation as single therapy should not be applied. The English full-text version of this article is available at SpringerLink (under "Supplemental").

[Psychosomatic aspects in orthopedics]. / Psychosomatische Aspekte in der Orthopädie.

Psychosomatic disease patterns are a common differential diagnosis for orthopedic symptoms. Furthermore, mental factors, such as the method of disease processing or mental comorbidities, such as depression or somatization disorders have a great influence on the chronification of orthopedic complaints and the outcome following orthopedic interventions. The aim of this article is to present the psychosomatic pathomechanisms and disease patterns relevant for orthopedics and to derive recommendations for physician-patient communication, diagnostics, therapy and assessment.

[Assessment of the capability of performance of patients with psychic and psychosomatic diseases--a diagnostic model]. / Begutachtung der Leistungsfähigkeit bei Personen mit psychischen und psychosomatischen Störungen--ein diagnostisches Modell.

The limited availability of appropriate methods and criteria makes the assessment of capability by psychic and psychosomatic disorders difficult. This article displays and discusses the standards relating to content and method in capability assessments. The underlying diagnostic model of assessment capability has been conceptualised and tested empirically by a multicentric and interdisciplinary work-group. Different diagnostic levels of the manual are outlined as well as the procedures of operationalisation of the diagnostic categories. Furthermore, first results of empirical analysis are described and important conditions of the application of the diagnostic model are discussed.

[Treatment of pulmonary arterial hypertension (PAH): recommendations of the Cologne Consensus Conference 2010]. / Therapie der pulmonal arteriellen Hypertonie (PAH): Empfehlungen der Kölner Konsensus-Konferenz 2010.

The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension have been adopted for Germany. The guidelines contain detailed recommendations for the treatment of pulmonary arterial hypertension (PAH). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2010, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the treatment of PAH. This commentary summarizes the results and recommendations of the working group on treatment of PAH.

[Quality of life in dysphonia]. / Lebensqualität bei Dysphonien.

Quality of life is multidimensional and comprises physical, emotional, and social aspects. It has always been the implicit focus of medical work. However, since the 1980s it has been possible to measure it explicitly. Quality of life is impaired in dysphonic patients; this finding is supported by specific studies on self-reported physical, emotional, and social well-being. For practical application of these data, it is recommended to measure all three domains. From a therapeutic point of view, verbal intervention following the PLISSIT model (permission, limited information, special suggestions, intensive therapy) has been proven to enhance patient satisfaction. Therefore, this clinical procedure is recommended for routine application in dysphonic patients.

[Diagnosis and therapy of fibromyalgia syndrome]. / Diagnostik und Therapie des Fibromyalgiesyndroms.

The meaningfulness of the term fibromyalgia syndrome (FMS), possible diagnostic criteria, and the therapeutic procedure, were for a long time points of contention between different professional associations. In an interdisciplinary S3 guideline on the definition, pathophysiology, diagnosis and therapy of FMS, it has now been possible to work out a consensus that is accepted by all involved professional associations and patient representatives on the basis of the available evidence. The most important results for clinical practice are presented and discussed here using case examples. The number of FMS patients in Germany is estimated to lie at 1.6 million (2% of the population), and 80-90% of those affected are women. FMS is classified under the functional somatic syndromes of the diseases of the musculoskeletal system and of the connective tissue (ICD 10 M 79.7). Comorbidities with other functional somatic syndromes and mental disorders are frequent. The clinical diagnosis of an FMS can ensue both by examining the tender points and also based on symptoms. Basic therapy includes elucidation and psychoeducation, aerobic endurance training adapted to the individual performance capability, operant behavioural therapy, and as a drug-based therapy option, amitriptyline 25-50mg/d (all level of evidence 1a). A graded therapeutic procedure which includes the patients in the decision-making is recommended.

[Satisfaction of dysphonic patients with psychosomatic assessment and intervention]. / Zufriedenheit dysphoner Patienten mit einer psychosomatischen Diagnostik und Intervention.

BACKGROUND: Comorbid physical and psychological complaints are more common in patients with dysphonia than in the general population. In a prospective randomized study the effects of structured psychosomatic diagnostics and verbal intervention on the satisfaction of patients with dysphonia were investigated. MATERIALS AND METHODS: A total of 54 dysphonic patients (33 women, 21 men, age 51.1+/-16.4 years) with dysphonia (organic n=36, functional n=18) were examined and their subjective experiences were collected by the following psychometric questionnaires: voice-related quality of life (VRQOL), hospital anxiety and depression scale (HADS-D) and the "Giessener Beschwerdebogen" (Giessen questionnaire on physical complaints GBB). Patients were randomized into 2 groups: group 1 (n=27) filled in the questionnaires and the answers were reviewed within the medical consultation. This was followed by an interview on patient satisfaction. In the control group 2 (n=27) a medical examination and consultation were carried out and then questioned on patient satisfaction. The psychometric questionnaires were completed by the patients shortly before leaving the department. RESULTS: The study group 1 was significantly more satisfied than group 2 on different statistic levels according to the items compared. CONCLUSIONS: Patients suffering from dysphonia are positively influenced with respect to patient satisfaction by a structured psychosomatic diagnostic and intervention.