[Validation of the German-language version of the Injustice Experience Questionnaire (IEQ) in five outpatient clinics]. / Validierung der deutschen Übersetzung des Injustice Experience Questionnaire (IEQ) in 5 ambulanten Schmerzbehandlungseinrichtungen.

INTRODUCTION: Occupational and social rehabilitation can be influenced by perceived injustice that results from pain. Currently, the Injustice Experience Questionnaire (IEQ), the tool most commonly used to assess perceived injustice, is not available in German. The aim of this study was the validation of the German-language version of the IEQ. MATERIALS AND METHODS: The validation of the IEQ was carried out via a web-based survey. For this purpose, participants completed the IEQ and construct-related scales analogous to the original study Tampa Scale of Kinesiophobia (TSK), Depression scale of the Depression Anxiety and Stress Scales (D-DASS), Pain Disability Index (PDI), and McGill Pain Questionnaire (MPQ). In addition, the participants completed questions on their socioeconomic status and on the cause of their pain, taken from the German Pain Questionnaire. RESULTS: Of 223 respondents, 134 (60.1%) returned a completed questionnaire and were included in the study. In all, 26.1% of participants reported suffering from pain resulting from accidents. None of the reviewed one- to three-factor solutions for the IEQ's structure achieved a good model fit. The best results were found for a two-factor solution, whereby the exploratory factor analysis revealed almost all items loaded highly on both factors and the confirmatory factor analysis showed high correlations between the factors. These findings are consistent with previous studies. The IEQ correlated highly and significantly with the other psychological instruments. There were no floor or ceiling effects. Cronbach's α for the German IEQ version was 0.93 and thus attests a high level of internal consistency. CONCLUSION: The analyses attest the excellent psychometric properties of the German translation of the IEQ and so the German-language version of the IEQ can be used as a validated questionnaire to screen for perceived injustice.

[German transcultural translation of the Injustice Experience Questionnaire]. / Deutsche transkulturelle Übersetzung des Injustice Experience Questionnaire.

BACKGROUND: Occupational and social rehabilitation is influenced by perceived injustice as a result of injury. To assess perceived injustice, the Injustice Experience Questionnaire (IEQ) has been developed and is available in English. The aim of this study was to translate and culturally adapt the English version of the IEQ into German. MATERIALS AND METHODS: The IEQ was translated into German according to the criteria for the transcultural adaptation of self-assessment tools. The translation was examined in a sample of 19 pain patients as to whether the translated items were comprehensible, unacceptable or offensive, and what their meaning and the reason for the chosen response were. Data were assessed using nonparametric statistical methods. RESULTS: The German translation of the IEQ showed a high degree of comprehensibility. The items' meanings and participants' selected answer options were rated as highly plausible by two raters and the wording of the items was assessed as being neither unacceptable nor offensive by participants. Because of the slightly increased values with regard to Item 3, whose meaning was unrecognized by the raters, the term "Unachtsamkeit" was replaced by "Unaufmerksamkeit." CONCLUSION: The study attests to the cultural and linguistic intelligibility and precision of the German translation of the IEQ. In a follow-up study, the translation should be validated in a larger sample of pain patients.

[The effects of setting a standard in the acute pain therapy on a ward : Parameters for patient and provider satisfaction and cost structure (STANDAKU)]. / Auswirkung einer stationsweiten Standardisierung der Akutschmerztherapie : Parameter zur Patienten- und Providerzufriedenheit und Kostenstruktur (STANDAKU).

BACKGROUND: There is neither a "gold standard" nor commonly approved therapy goals in postoperative pain therapy. In a multi-center study, more than 80% of all patients treated stated that they suffered from postoperative pain. Moreover, patients evaluated the pain therapy as significantly worse than other medical or nursing practices. Therefore, there is a need for optimization in therapy for acute pain. OBJECTIVES: The goal of our project was to figure out if the introduction of a "pain treatment standard" would increase the satisfaction of patients, physicians, and nurses, and reduce the costs of pain-related medicine. MATERIALS AND METHODS: Overall, 2769 patients and 285 providers (202 nurses and 83 physicians) were polled. The medication costs in ten areas of the ward were evaluated and compared. The providers were offered a training course on the "pain standard" and it was officially introduced onto the wards. After some time, the satisfaction of patients and providers and the use of medicine were recorded again. RESULTS AND DISCUSSION: The maximum pain values declared by the patients significantly decreased after the introduction of the "pain standard." The satisfaction with pain therapy significantly increased for the patients and for the providers. The reported minimum pain values of the patients did not change significantly. The costs of pain medicine slightly increased. In general, there was a positive effect of introducing a "pain standard" for patients and providers.

[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.

[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.

[Slot machine gambling behaviour in East Germany 1990-2000]. / Spielverhalten an Geldspielautomaten in den neuen Bundesländern 1990-2000.

TARGET: To test the hypothesis that parameters of slot machine gambling behaviour and related treatment cases have been increasing heavily in the new Länder of Germany (after reunification). METHOD: Data from the National Population Survey 2000 and from the EBIS Treatment Monitoring System (1998-2000) were compared with figures from previous analyses for 1990-1997. RESULTS: The percentage of people with gambling experience increased, but the proportion of currently active gamblers decreased. The proportion of frequent gamblers (as an indicator of high-risk behaviour) did not change. The annual average number of new outpatient treatment cases per treatment facility increased, from a low baseline of 1.5 cases, by about 20 %. All figures are still below those for former Western Germany. CONCLUSION: At least until 2000 A.D., the expected extreme increase in gambling behaviour and related treatment demand did not occur.

[Emergency treatment in chest trauma (author's transl)]. / Notfallmassnahmen beim Thoraxtrauma.

The measures taken by the emergency physician can in many cases decisively affect the subsequent course of a chest trauma. In cases where the injured person has to be extricated from collapsed structures the medical officer has to decide on the mode and sequence of the rescue operation, prevent further damage and initiate shock therapy, intubation and artificial ventilation while the rescue operation is in progress. Emergency treatment also includes infusion therapy, if necessary via a central venous catheter; intubation, suction drainage and artificial ventilation; evacuation of fluid from the pleural cavity, mediastinum and pericardium combined with electrodiagnosis (ECG) and electrotherapy (defibrillation) if necessary. By closely observing the reaction and condition of the patient during transport to hospital he can provide important information regarding further treatment, especially in polytraumatized persons. Close collaboration between the trained rescue teams of the Fire Service, the emergency medical officer and the hospital staff has succeeded in reducing the mortality rate of combined chest injuries to 13%. 87% of cases who had received emergency treatment were subsequently admitted to hospital.

[Non-resecting surgery for gastroduodenal ulcer. III. Clinical results (author's transl)]. / Die nicht-resezierende Chirurgie des Gastro-Duodenal-Ulkus. III. Klinische Resultate

During the last 12 years, 1489 vagotomies were performed at the Chirurgische Poliklinik of Munich University; 1339 of them were selective proximal vagotomies (SPV). The main indication was duodenal ulcer (n = 915) and gastric ulcer (n = 188), including emergency operations for extensive bleeding. Further indications were: sliding hiatal hernia, erosive gastritis and achalasia of the cardia. The SPA was combined in all cases with a pyloroplasty based on form and function. The results are shown in detail related to mortality (elective 0.5%), recurrency (1.6%) and functional results (good 88.2%, fair 7.2%, poor 4.6%). The combined operation of SPV with pyloroplasty is, in our opinion, an operative procedure which allows non resectioning surgical treatment of GDU without selection, i.e. based on form and function.

[Puncture techniques in emergency medicine (author's transl)]. / Punktions - Techniken in der Notfallmedizin

In order to be able to carry out effective emergency medicine outside the hospital, knowledge of some of the important puncture techniques is essential. Sometimes injection and infusion is required under difficult conditions, and sometimes decompression punctures are the vitally decisive interventions. Among these are central venous access via the subclavian vein, intracardial injection, decompression puncture in cardiac tamponade, relief of tension pneumothorax, cannulation of the trachea and relief of mediastinal emphysema. These interventions are outlined according to indication, technique and complications.

[Ten years of emergency medical service in Munich. Experiences and results]. / 10 Jahre Notarztdienst in München. Erfahrungen und Ergebnisse

The emergency ambulances of the emergency medical service in Munich have been called out on 89,748 occasions. From the point of view of the specialties involved, internist emergencies were the most frequent with more than half the calls. One fifth of the emergencies were street accidents, occupational and domestic accidents. Genuine saving of life was possible in 1.3% of the cases. Vital functions were disturbed in 10% of all emergencies. With increasing popularity, the emergency ambulance is called to every urgent medical case, because it appears for every patient with unsurpassed reliability and speed. Herein lies the dangers of misuse and decreasing efficiency of an organization originally conceived only for victims of street accidents.