Quality of Life Improvement Following Blepharoplasty: A Prospective Study.

BACKGROUND: Our previous retrospective study indicates that esthetic surgery in general results in a significant improvement in Quality of life (QoL). This is the first indication-specific prospective evaluation of QoL after blepharoplasty using standardized and validated questionnaires. OBJECTIVES: To report changes in QoL after blepharoplasty prospectively with a 6-month follow-up. METHODS: The same surgical team performed an esthetic blepharoplasty on 50 patients. Participants answered 1 set of questionnaires preoperatively and 6 months postoperatively. The instrument consisted of a self-developed indication-specific part specially designed for blepharoplasty and 4 validated and standardized testing instruments (FLZ, FPI-R, RSES, and PHQ-4) with norm data for German-speaking countries available. RESULTS: This study reveals a high rate of satisfaction after blepharoplasty. 96% felt better about themselves and 94% would undergo the procedure again. Statistically significant increased values were found postoperatively in the items "income" ( P =0.016), "family life" ( P =0.028), "partner relationship" ( P =0.039), "ability to relax" ( P <0.001), "energy" ( P <0.001), "hobbies" ( P <0.001), and with their outer appearance in general ( P =0.018). Blepharoplasty showed a statistically significant improvement in emotional stability ( P =0.017) and a reduction in depressive symptoms ( P <0.001). Our patients had statistically significantly higher self-esteem before ( P <0.001) and after ( P <0.001) the intervention. CONCLUSION: Our prospective study shows that blepharoplasty increases most aspects of QoL significantly, has a positive effect on emotional and physical well-being, and reduces the incidence of depressive symptoms and anxiety.

[Differences in Area Specific Life Satisfaction Between East and West Germans in the Years 1991, 2006 and 2020]. / Unterschiede in der Zufriedenheit verschiedener Lebensbereiche zwischen Ost- und Westdeutschen in den Jahren 1991, 2006 und 2020.

RESEARCH: Question How did the general and area specific life satisfaction evolve between East and West Germany between 1991 and 2020? METHODS: Based on three representative surveys in the years 1991, 2006 and 2020 life satisfaction between East and West Germany was examined using mean comparison with tests of significance. The influence of relevant sociodemographic variables was calculated using Univariate Variance Analyses. RESULTS: 1991 large differences in the general life satisfaction as well as with satisfaction in the areas of living, spare time, health, finances and occupational did occur, with people in East Germany reporting to be less satisfied. These differences align during the observation time. DISCUSSION: The discrepancy in the general and area specific life satisfaction between East and West Germans did align during the last 30 years. A reason might be the improved economical living conditions in East Germany.

Quality of Life after Rhinoplasty: A Prospective Study.

As our previous studies have shown, cosmetic surgery has a positive correlation with postoperative well-being. The aim of this study was to prospectively examine the postoperative changes in quality of life (QoL) after a rhinoplasty. Thirty-four patients who underwent septorhinoplasty performed by a single surgeon from July 2015 to October 2018 reported in indication-specific self-developed and different validated questionnaires (FLZM or Fragen zur Lebenszufriedenheit Module, Freiburg Personality Inventor, Rosenberg self-esteem scale, Functional Rhinoplasty Outcome Inventory 17 [FROI-17], and Glasgow Benefit Inventory [GBI]) on the status of their QoL preoperatively (T0) and 6 months' follow-up (T1). Our goal was to assess the difference in psyche and self-esteem and to get objective insights into the effect of the operation. Significant improvements in QoL in terms of general module, health, and appearance were noted. The general part of the FLZM showed increasing T1 values in the sum scores (p = 0.005). With regard to the item "health," T1 was better than the norm data (p = 0.003). The statistically significant improvement for the item nose appearance (p < 0.0001) after operation and T1 versus reference data (p < 0.010) should be highlighted. The subjective patient ratings showed statistically significant T1 improvements for all items of the FROI-17: overall nose (p < 0.0001), nasal function (p = 0.001), general/further symptoms (p = 0.006), and confidence increased by aesthetic changes (p < 0.0001). Furthermore, the GBI score shows an improved QoL after rhinoplasty (p < 0.0001). Based on the assessment of a variety of disease- and nondisease-specific validated questionnaires, numerous improvements in the QoL of the patients were observed. Therefore, we support septorhinoplasty as a meaningful procedure regarding QoL improvement. The level of evidence is Level II prospective cohort study.

Quality of Life and Satisfaction in Transgender Men After Phalloplasty in a Retrospective Study.

BACKGROUND: Partly as a result of the increasing attention directed toward transgender individuals and despite much research work on the topic of quality of life (QOL) of transgender, there is still a lack of studies using standardized questionnaires in their evaluation. AIMS: We designed a survey to evaluate the influence of surgery after phalloplasty (osteofasciocutaneous fibula free flap or osteofasciocutaneous radial free forearm flap) on QOL, emotional stability, self-esteem, and psyche of postoperated transgender men. METHODS: The present study included 32 transgender men who had undergone gender-affirming surgery (GAS) exclusively in our department between 2000 and 2012. Apart from our self-developed, indication-specific questionnaire with questions on socioeconomic and demographic data as well as postoperative satisfaction, the testing instrument included 4 frequently used, standardized testing instruments, which we compared with normative data. These included (a) a self-assessment test Fragebogen zur Lebenszufriedenheit with questions on QOL consisting of 3 modules (general satisfaction, satisfaction with health, and satisfaction with body image/outer appearance), (b) the Freiburg Personality Inventory, (c) the Rosenberg Self-Esteem Questionnaire, and (d) the Patient Health Questionnaire 4. FINDINGS: Our self-developed, indication-specific questionnaire showed that 88% of our patients were very satisfied with the aesthetic result, 75% have had sex after surgery, and 72% were very satisfied with sexual function after GAS. Eighty-one percent had a strong improvement of QOL, and 91% would undergo the same treatment again. Eighty-four percent would recommend GAS to others. All patients lived as men fulltime. DISCUSSION: Our study reveals that GAS plays an important part in the interdisciplinary treatment of transgender individuals as it improves the QOL in transgender men in most aspects of everyday life and has a positive influence on the patients' psyche and self-esteem in a retrospective study.

Psychological Pathologies and Sexual Orientation in Transgender Women Undergoing Gender Confirming Treatment.

BACKGROUND: There are few studies evaluating depression, self-esteem, and mental health after gender confirming treatment of transgender women. Most of these studies include different surgical techniques and nonvalidated questionnaires. With our survey, we are aiming to assess psychopathologies and mental health as well as sexuality among a group of patients treated by the same surgeon performing our self-developed combined surgical technique. This vaginoplasty approach is characterized by constructing the vaginal cavity with parts of the penile and scrotal skin as well as the longitudinally incised urethra. MATERIALS AND METHODS: Forty-seven transgender women who underwent gender confirming treatment between 2007 and 2013 were included in a retrospective study. The assessment of our study group was performed by means of self-developed indication-specific questionnaires and 3 standardized questionnaires that can be compared with norm data. RESULTS: Preoperative psychotherapy was mostly considered as helpful by the patients, yet postoperatively, only a third of our study participants were still under therapeutic treatment. Furthermore, we could show a change in sexual preference toward a more bisexual orientation. Gender confirming treatment satisfied the expectations for most of the patients and, in their opinion, should have been performed earlier. Results of the standardized Patient Health Questionnaire 4, a short depression screening questionnaire, did not significantly differ from healthy norm data. The Freiburg Personality Inventory, Revised, revealed normal emotionality and sane self-assessment within our study group. High self-esteem and significantly higher scores than norm data were found for the Rosenberg Self-esteem Scale. CONCLUSIONS: Gender confirming treatment with the combined technique is an important part of a multi-structured treatment of transgenders and does have effects on psychological well-being. It seems to decrease psychopathologies and implicates several ameliorations for transgender women. Findings need to be verified in prospective studies including preoperative evaluations.

Quality of life following aesthetic liposuction: A prospective outcome study.

BACKGROUND: The authors' previous research suggested the hypothesis that aesthetic surgery in general has a positive impact on quality of life (QoL). This prospective study aimed to investigate the indication-specific effect on QoL in patients undergoing aesthetic liposuction. To our knowledge, no other prospective study has been conducted using standardised and validated questionnaires with a comparable return rate and sample size. METHODS: Sixty-four patients underwent aesthetic liposuction. Forty-two patients met the inclusion criteria, and 38 of them answered one set of questionnaires preoperatively and the follow-up set at six months post-operatively. The testing instrument included a self-developed, indication-specific questionnaire and four standardised and validated questionnaires with German norm data available: Questions on Life Satisfaction, Modules (FLZM, German version), the Freiburg Personality Inventory-Revised (FPI-R), the Rosenberg Self-Esteem Scale (RSES) and the Patient Health Questionnaire (PHQ-4). RESULTS: Our self-developed indication-specific questionnaire showed high satisfaction with the postoperative results. The FLZM demonstrated significant improvements for all modules, concerning life in general (p = 0.02), health (p = 0.04) and body image (p = 0.02). Moreover, the FPI-R revealed a significant improvement in emotional stability (p < 0.01). Moreover, the PHQ-4 showed a significant reduction in overall psychological distress (p = 0.03) and anxiety (p = 0.01). CONCLUSION: Liposuction had significant impact on QoL. The surgery led to a higher satisfaction not only with the result of intervention and the outer appearance specifically but also with life and the state of health generally. It improved emotional stability and reduced anxiety. Therefore, the authors' hypothesis in a previous research was confirmed for this specific indication prospectively.

The Effect of Blepharoplasty on Our Patient's Quality of Life, Emotional Stability, and Self-Esteem.

BACKGROUND: Several studies have been conducted evaluating psychological effects following aesthetic surgery, however few of them following blepharoplasty! PURPOSE: To determine whether blepharoplasty affects quality of life and satisfaction as well as, emotional stability and self-esteem in patients who underwent only blepharoplasty. DESIGN: A retrospective study including transdermal blepharoplasty operations between the years 1995 and 2008. METHODS: A self-developed and indication-specific questionnaire especially for blepharoplasty, as well as the standardized testing instruments FLZM, FPI-R, and RSES, concerning quality of life, body image, personality, and self-esteem was utilized. PARTICIPANTS: A total of 123 patients were included in the study. Forty-six patients participated in the study. MAIN OUTCOMES AND MEASURES: Results were compared with the existing representative norm data from the German speaking countries. RESULTS: In the indication-specific questionnaire, 44 patients reported a positive influence on their personal wellbeing, and 33 were more satisfied with their appearance (follow-up 3-95 months; average 48.5 months); 20 felt more self-confident, and 25 felt more attractive.Statistically significant increased values in quality of life (FLZM) were found in the aspects work (P = 0.02), mobility (P < 0.001) and independence from assistance or help (P < 0.001).Higher scores concerning personality and self-esteem compared with the respective random sample were found in the questionnaires FPI-R (P = 0.02) and RSES (P < 0.001). CONCLUSION AND RELEVANCE: Among plastic surgical interventions, blepharoplasty is a minimal invasive operation, which is very well tolerated by patients. Patients take advantage in personal wellbeing, self-esteem, and different aspects of their daily life.

Aesthetic abdominoplasty has a positive impact on quality of life prospectively.

BACKGROUND: In our previous retrospective study, we detected an increased quality of life after aesthetic abdominoplasty. In this survey, we analyzed quality of life, self-esteem, emotional stability, and mental health before and after aesthetic abdominoplasty prospectively. METHODS: Twenty-two female patients were surveyed before and six months after their surgeries. The testing instrument consisted of a self-developed indication-specific questionnaire and four standardized tests (Questions on Life Satisfaction plus a specified part body image, Rosenberg Self-Esteem Scale, Freiburg Personality Inventory, and Patient Health Questionnaire-4). RESULTS: Significantly increased values were found concerning feeling comfortable in swimwear in front of the mirror or the sexual partner and at social or professional activities (each p=0.000). Women had less problems doing sports (p=0.029) and felt more feminine (p=0.012). Sum scores of general life satisfaction (p=0.016) and scores of the items leisure activity (p=0.003), relaxing abilities (p=0.002), and sexuality (p=0.046) showed significant improvements. The body image improved in general (p=0.010) and in particular in the items abdomen, hips, and waist (each p=0.000). Emotional stability increased significantly (p=0.029). We detected a mild mental depression in 27% and a moderate depression in 32% of our patients before surgery. Depressive disorders were significantly reduced (p=0.004) down to mild depression in 18% and moderate depression in 9% of the patients. CONCLUSION: Positive results for quality of life shown in the retrospective study were confirmed. Abdominoplasty improves general life satisfaction and satisfaction with health and outer appearance and increases emotional stability. Depressive patients showed a significant improvement after aesthetic abdominoplasty.

Male-to-Female Sex Reassignment Surgery using the Combined Vaginoplasty Technique: Satisfaction of Transgender Patients with Aesthetic, Functional, and Sexual Outcomes.

BACKGROUND: Currently available patient-reported outcome measures are limited in the field of sex reassignment surgery (SRS). Standardized questionnaires deliver high evidence data on satisfaction of male-to-female (MTF) transgender patients but do not allow any modification in their clinical application. We therefore designed a prospective study using self-developed indication-specific questionnaires to evaluate the aesthetic, functional, and sexual outcomes of MTF patients undergoing SRS. METHODS: Forty-nine adult MTF transgender patients who underwent two-stage SRS were eligible for study inclusion between September 2012 and January 2014. Forty patients (= N) ultimately filled out both parts of the questionnaire sets: 1 day before the first stage (T0) and 6 months after the second stage of SRS (T1). These questionnaires focused on demographic characteristics, the satisfaction with aesthetic and functional results, and sexuality. RESULTS: Patients rated their surgical satisfaction of most items with mean scores above 7 on a 0-10-point scale. Many items evaluating everyday life activities improved significantly after SRS compared to T0 (p < 0.01). All but one patient (97.5%) reported no regrets about having undergone surgery, and the majority recommended it to other patients with gender dysphoria. Femininity and sexual activity increased significantly postoperatively (p < 0.01). Satisfaction with intercourse and orgasm was high: 6.70 and 8.21, respectively, on a 0-10 scale. CONCLUSION: Satisfaction with the cosmetic outcome, as well as the functional and sexual outcomes, reveal positive effects of SRS using the combined technique on transgender patient lives. Nevertheless, standardized and validated SRS-specific questionnaires are lacking. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Male-to-Female Sex Reassignment Surgery Using the Combined Technique Leads to Increased Quality of Life in a Prospective Study.

BACKGROUND: The authors' previous research showed that various plastic surgical procedures can increase a patient's quality of life in its different aspects. In a prospective setting, they evaluated whether sex reassignment surgery has similar effects for male-to-female transgender patients compared to baseline data before sex reassignment surgery. METHODS: All 39 patients who underwent their first-stage male-to-female sex reassignment surgery between October of 2012 and January of 2014 received one set of questionnaires preoperatively (time 0) and approximately 6 months after their final operation (time 1). Each set contained self-developed, indication-specific questions combined with the standardized validated Questions on Life Satisfaction, Modules (German version) questionnaire, the Freiburg Personality Inventory, the Rosenberg Self-Esteem Scale, and the Patient Health Questionnaire, which were compared to available norm data. RESULTS: The mean patient age was 38.6 years. The majority of the patients were highly educated, childless, and single. Significant improvements were found in the Questions on Life Satisfaction, Modules (German version), especially for the items "partnership," "ability to relax," "energy," "freedom from anxiety," "hair," "breast," and "penis/vagina" (p < 0.01). Furthermore, the patients appeared more emotionally stable (p = 0.03), showed higher self-esteem (p = 0.01), and showed much lower depression/anxiety (p < 0.01). CONCLUSIONS: The positive study findings were confirmed with the results from prior retrospective studies. However, medical literature focuses largely on surgical and functional satisfaction and not overall quality of life. In addition, standardized questionnaires are used rarely and solely retrospectively, with the risk of recall bias. The increased quality of life of transgender women postoperatively endorses sex reassignment surgery as a valuable option for these patients. CLINICAL QUESTON/LEVEL OF EVIDENCE: Therapeutic, IV.

Combined vaginoplasty technique for male-to-female sex reassignment surgery: Operative approach and outcomes.

BACKGROUND: Several therapy options exist for male-to-female (MTF) transgenders desiring sex reassignment. Surgery includes numerous different procedures. Of those, vaginoplasty is predominant and aims at providing attractive esthetics and fully functional genitals. This study aimed to present the surgical results of our modified combined vaginoplasty technique in a consecutive patient cohort. METHODS: We included 40 MTF transgender patients who underwent a two-stage sex reassignment surgery (SRS) in an observational prospective study between September 2012 and January 2014. Demographic characteristics, medical and surgical history, operative details, and outcomes after surgery were documented. Postoperatively, 23 patients received a pelvic examination following the standardized protocol. RESULTS: Measured vaginal depth was 11.77-14.99 cm depending on the size of the dilator used (25-40 mm). Vaginal, clitoral, and labial sensitivities were intact and favorable in all examined patients. Nineteen women (47.5%) opted for breast augmentations to achieve a feminine cosmesis, making it the most common nongenital operation. Complications were mostly minor and temporary. Severe adverse events, such as wound infections (n = 3), colon injuries (3), short (1) or narrow (1) vaginas, or partial clitoral necroses (1), were rare and immediately addressed by the surgical team. No vaginal construction was lost, and no secondary reconstructive approaches were required. CONCLUSION: Satisfactory physical results and favorable low rates of complications endorse our combined technique for MTF SRS. These findings, however, need to be confirmed by other research groups as well. Therefore, in our opinion, MTF SRS remains an evolving area of development, whose research is aiming to establish a state-of-the-art surgical technique.

Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery.

BACKGROUND: Surveys on quality of life (QOL) of male-to-female (MTF) transsexuals have found low QOL scores before and increased satisfaction scores after sex-reassignment surgery (SRS). To our knowledge, many of them lack standardized questionnaires and comparisons with normative data to evaluate different vaginoplasty techniques. AIM: To analyze patient satisfaction and QOL after SRS. METHODS: Forty-seven patients participated in this study. All patients had surgery with our self-developed combined technique on average 19 months before the survey. They completed a self-developed indication-specific questionnaire concerning demographic and socioeconomic issues and postoperative satisfaction. Furthermore, a standardized self-assessment questionnaire on satisfaction and QOL (Fragen zur LebenszufriedenheitModule [FLZM]; Questions on Life SatisfactionModules) was used. The FLZM consists of three modules (general life satisfaction, satisfaction with health, and satisfaction with body image) with scores of weighted satisfaction for each item. Results of the general and health modules were compared with normative data. OUTCOMES: Demographics, QOL, general life satisfaction, satisfaction with health, and satisfaction with body image. RESULTS: The self-developed indication-specific questionnaire showed that 91% experienced an improvement of QOL. All patients stated they would undergo SRS again and did not regret it at all. Patients stated their femininity significantly increased. For the FLZM, the sum score for general life satisfaction (P < .001) was significantly lower than the normative data, whereas the sum score of the satisfaction with health module (P = .038) did not reach statistical significance. The two modules also showed positive trends for different items. Values of the body image module showed a significant increase in satisfaction with breasts (P < .001) and genitals (P = .002). CLINICAL IMPLICATIONS: The findings of this survey emphasize the importance of SRS in the interdisciplinary gender-reassignment process. The detailed description of our combined technique could help to improve the surgical outcome and patient satisfaction of this complex and non-standardized surgery. STRENGTHS AND LIMITATIONS: This is the first description of a new surgical technique (combined technique) for MTF SRS. QOL was assessed by a large number of patients by standardized questionnaires and could be compared with normative data. Because this is a retrospective study, we can draw only careful conclusions for pre- and postoperative changes. CONCLUSION: Our self-developed combined surgical technique seemed to have a positive influence on QOL after SRS. Satisfaction with breasts, genitals, and femininity increased significantly and show the importance of surgical treatment as a key therapeutic option for MTF transsexuals. Papadopulos NA, Lellé J-D, Zavlin D, et al. Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery. J Sex Med 2017;14:721-730.

The Psychologic and Psychosocial Impact of Otoplasty on Children and Adults.

BACKGROUND: In previous studies, our research group already evaluated the impact of aesthetic surgery on "quality of life" (QoL). This study evaluates QoL factors and perceptions of well-being after otoplasty as a single indication. METHODS: Eighty-one patients who underwent otoplasty were divided into three age groups: Youth 1 (Y1) = 8-12 years (n = 17), Youth 1 (Y2) = 13-17 years (n = 13), and Adult ≥18 years (n = 51). For competitive analysis, 2 groups of tests were used: a standardized self-assessment test on life satisfaction (FLZ(M)), the Glasgow Benefit Inventory (GBI), the standardized Rosenberg Self-Esteem Scale (RSES), the standardized Freiburg Personality Inventory (FPI-R), the Patient Health Questionnaire 4 (PHQ-4), and a self-developed and indication-specific questionnaire for "Adult" group. The tools for the groups Y1 and Y2 were: PHQ-4, KINDL(R), the Glasgow Child Benefit Inventory (GCBI), and a self-developed and indication-specific questionnaire either. RESULTS: Our data bared numerous significant improvements on patients' QoL. In the items "friends" (P = 0.036) and "freedom of anxiety" (P = 0.034) of the FLZ(M), important improvements were found. In section "satisfaction with appearance" (body image), the items "hair" (P = 0.003) and "ear" (P = 0.034) were to point out. The RSES (P = 0.001) and the FPI-R (P = 0.035) data indicated a well-balanced emotional stability. The results of the GBI/GCBI (P = 0.000/P = 0.000) showed a higher QoL of postsurgery patients. The data of the KINDL questionnaire provided increasing values in the modules "friends" (P = 0.033) and "total score" (P = 0.040) for boys of the ages 8 to 12. For all age groups, there was a less affinity to depression (PHQ-4) and a high satisfaction with the aesthetical result (indication-specific questionnaire). CONCLUSIONS: This study showed higher QoL in all age groups by using standardized tools in comparison with the norm data. The knowledge of postoperative psychologic benefits, such as "satisfaction with appearance" (body image) and "different areas of life," self-confidence, and self-esteem as well as lower level of depression support meaningfulness of otoplasty. LEVEL OF EVIDENCE: Therapeutic, III: Retrospective cohort or comparative study.

The Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF)--an expert rating scale for distress screening: development and psychometric properties.

BACKGROUND: The aim of this study is to validate the Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF), a six item interview-based expert rating scale for distress screening in cancer patients. METHODS: Using a heterogeneous multicenter study sample (n = 1551), we examined validity, reliability, and dimensionality of the PO-Bado SF. The Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, the Questionnaire on Stress in Cancer, and the Patient Health Questionnaire were used to investigate convergent validity. Confirmatory factor analysis was applied to address unidimensionality. An optimal cutoff point was determined by ROC analysis and the maximum of Youden's index. An additional study with n = 41 audio recorded PO-Bado SF interviews was carried out to assess inter-rater reliability. RESULTS: Mean age of the study sample was 64.0 (SD = 12.0), 42% were women. About 24% of the patients suffered from metastases. The one-factor solution was confirmed; internal consistency of the PO-Bado SF was high (α = 0.84). The PO-Bado SF total score correlated significantly with all psychosocial measures, the highest correlation was with the HADS total score (r = 0.64). Patients with severe disease conditions (metastases, psychological/psychiatric treatment in the past, low performance status) received higher distress ratings (p < 0.001). Using HADS total score (>13) as external criterion, an optimal PO-Bado SF cutoff score of >9 emerged (sensitivity 0.75; specificity 0.82). Inter-rater reliability was satisfactory for each of the six items (intra class correlation of 0.75 to 0.85). CONCLUSIONS: The PO-Bado SF is a short, reliable and valid expert rating scale to identify distressed cancer patients.

The effect of including a 'psychooncological statement' in the discharge summary on patient-physician communication: a randomized controlled trial.

OBJECTIVE: The objective of this study is to determine whether the inclusion of a 'psychooncological statement' (PO-statement) in the discharge summary enhances patient-physician communication about psychosocial issues across the inpatient and outpatient sector. METHODS: A total of 1416 cancer patients were randomly assigned to the intervention (with PO-statement in the discharge summary) or control group (discharge summary without PO-statement). Shortly before discharge from the hospital (T1), patients from the intervention group were screened for psychosocial distress. Based on the electronic clinical documentation system, screening results were subsequently integrated into the discharge summary, which automatically generated a PO-statement. To determine the effect of the PO-statement, patients as well as their primary care physicians (n = 596) were asked during follow-up care (T2) whether psychosocial distress was discussed during the last consultation. RESULTS: Including a PO-statement in the discharge summary did not result in more frequent discussions about psychosocial issues compared with the control group from the patients' and physicians' perspectives. Instead, discussions about psychosocial well-being were significantly associated with women of the patient (p = <0.001) and the physician (p = 0.011), medical discipline (gynecologists; p = 0.002), cancer diagnosis (gynecological cancer; p = 0.002), metastases (p = <0.001), professional training of patients (none, p = 0.026), and psychosocial qualification of physicians (p = 0.018). CONCLUSION: Written information on psychosocial distress in the discharge summary alone does not affect communication.

Psychoanalytic versus psychodynamic therapy for depression: a three-year follow-up study.

The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and three-year follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.

Comparison of cognitive-behaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients - a three-year follow-up study.

OBJECTIVE: The study investigates the effectiveness of long-term psychotherapies. Cognitive-behaviour therapy was compared with psychoanalytic and psychodynamic therapy in the treatment of patients with a primary diagnosis of unipolar depression. METHOD: In a prospective, quasi-experimental design 100 patients were compared at pre- and post-treatment and three-year follow-up. Outcome measures were the Beck Depression Inventory and Global Severity Index for measuring symptoms, the Inventory of Interpersonal Problems and the Social Support Questionnaire for measurement of social-interpersonal functioning, and the INTREX Introject Questionnaire for measuring personality structure. Comparative effectiveness of the experimental groups was analyzed using mixed models. RESULTS: We found significant outcome differences between psychoanalytic therapy and cognitive-behaviour therapy in depressive and global psychiatric symptoms, partly social-interpersonal and personality structure at three-year follow-up. Psychodynamic therapy was superior to cognitive-behaviour therapy in the reduction of interpersonal problems. CONCLUSION: Psychoanalytic therapy shows significantly longer-lasting effects compared to cognitive-behaviour therapy three years after termination of treatment, which is discussed as a dose-effect.

Health-related quality of life supersedes other psychosocial predictors of long-term survival in cancer patients undergoing radiotherapy.

BACKGROUND: To investigate the prognostic value of several psychosocial factors for long-term survival in cancer patients. MATERIAL AND METHODS: Baseline data were gathered in routine radiotherapy practice during 44 months. The analysis is based on 938 patients for whom follow-up data were available. Baseline psychosocial distress, depression, health-related quality of life (HRQOL), and life satisfaction were assessed using Questionnaire on Stress in Cancer Patients (QSC-R23), Self-Rating Depression Scale (SDS), Functional Assessment of Therapy - General (FACT-G) questionnaire, and Questions on Life Satisfaction (FLZ(M)). Patients were followed up for 7 to 10 years. Kaplan-Meier plots and Cox proportional hazards models were used to investigate associations between sociodemographic, clinical, psychosocial factors and overall survival (OS). RESULTS: Patients' median survival time was 35 months (95% CI 28.9-41.1). Significant multivariate predictors of OS were age, health insurance type, Karnofsky performance status, cancer site, and cancer stage. Controlling for these variables, HRQOL was the only psychosocial predictor of survival (hazard ratio 0.988, 95% CI 0.979-0.997, p =0.009). The physical well-being and the functional well-being subscales of the FACT-G emerged as the relevant HRQOL facets predictive of survival. CONCLUSION: HRQOL has incremental predictive value for long-term survival in cancer patients.

Does abdominoplasty have a positive influence on quality of life, self-esteem, and emotional stability?

BACKGROUND: In a previous prospective study, the authors evaluated the quality of life in patients undergoing aesthetic surgery. In this survey, the authors split up the operative indication and analyzed quality of life, self-esteem, and emotional stability after abdominoplasty alone. METHODS: Sixty-three patients participated in the study. The testing instrument consisted of a self-developed questionnaire to collect demographic and socioeconomic data and a postoperative complication questionnaire developed especially for abdominoplasties. In addition, a standardized self-assessment test on satisfaction and quality of life (Questions on Life Satisfaction), the Rosenberg Self -Esteem Questionnaire, and the Freiburg Personality Inventory were used. RESULTS: Significantly increasing values in some items of the standardized self-assessment test on satisfaction and quality of life were found: sum scores of the General Life Satisfaction showed a significant improvement (p = 0.004) and the scores of the items housing/living conditions (p = 0.000) and family life/children (p = 0.000). Within the Satisfaction with Health module, a significant improvement in the items mobility (p = 0.02) and independence from assistance (p = 0.01) was found. Values in the module Satisfaction with Appearance (Body Image) increased regarding satisfaction with the abdomen (p = 0.001). Over 84 percent were very satisfied with the aesthetic result, 93.4 percent would undergo the same treatment again, and 88.9 percent would further recommend the operation. Data revealed that participants' self-esteem was very high and their emotional stability was very well balanced. CONCLUSIONS: This study demonstrates that abdominoplasty increases most aspects of quality of life, particularly family life, living conditions, mobility, and independency from assistance. Also, patient self-esteem and emotional stability ratings are very high postoperatively.