Psychosomatic Primary Care in Gynecology-Assessment and Acceptance by Residents for Obstetrics and Gynecology in Germany.

Background: The course "Psychosomatic Primary Care" has been part of the training curriculum of obstetrics and gynecology in Germany since 2003. The aim of the course is to train up physicians, whose prior training primarily focussed on somatic care, to enable them to offer care also taking into account biopsychosocial aspects. Taking the guidelines for psychotherapy as a template, the aim of psychosomatic primary care is to recognize the etiological links between psychological and somatic factors which contribute to diseases. The necessity for a compulsory course as part of training in gynecology was recently critically discussed. Major points discussed included the question whether the current forms of teaching, consisting of courses, are outdated and whether the required skills should be part of regular daily training. Method: A 3-part online questionnaire consisting of 30 items was developed and sent to 2431 residents in the period from September to December 2012 through the online mailing list of the DGGG. Results: The 540 residents who responded to the questionnaire were predominantly female (83.3 %) with an average age of 30 years; 50.3 % were in their 1st to their 4th year of training. Over the longer term, the majority of respondents (56.1 %) hoped to continue working in a hospital and regularly (84.6 %) attended teaching courses voluntarily. 70.9 % of them had already attended the course "Psychosomatic Primary Care". Of the group who had completed the course, 29.4 % were satisfied with the offer. The main criticism directed against the course was its scope which 24.1 % considered completely inadequate. 24.5 % considered the course to be an important part of training, while 16.5 % would have preferred that the course be abolished. 18 % of respondents reported that psychosomatic medicine did not feature regularly in their daily clinical routine. Perspective: Because of the huge gap between what is currently offered and the experiences reported by the respondents, the Young Forum of the DGGG and the DGPFG have expanded the program of courses offered by the DGPFG, which will offer practice-oriented courses to future gynecologists across Germany in cooperation with the DAGG. The first courses are held in Heidelberg and Erlangen in 2014.

[Consenting and declining patients for an intervention group after breast cancer surgery differ in terms of quality of life, coping and immunological functional assays]. / Teilnehmerinnen und Ablehnerinnen einer Interventionsgruppe nach Mammakarzinom unterscheiden sich in Lebensqualität, Krankheitsbewältigung und immunologischen Funktionsuntersuchungen.

OBJECTIVE: Psychosocial intervention during the course of cancer is still being controversially disputed in psychosomatic studies. Immunological and endocrinological parameters can serve as links in observing the influence of the interactive processes involved. MATERIAL AND METHODS: The approach to determine whether psychotherapeutic intervention can lead to an improved quality of life on the one hand, and to a change in immune defenses in breast cancer patients as well, employed using the EORTC QLQ-C30 and optimistic self-efficacy (OKE) as well as evaluating lymphocyte subpopulations, lymphocyte proliferation and NK cell activity. Fifty-three breast cancer patients were offered the chance to participate in a psychosocial intervention group. Twenty-three accepted the offer. Randomized sampling of the group participants was determined twice by using the 30 EORTC QLQ-C30 parameters. In addition, immune function was measured before beginning (T1) and after completing the group intervention sessions (T2). This data was compared with that of the declining group. RESULTS: The analysis of the individual EORTC parameters in the pre- and post-comparison showed a decrease in "emotional strain" and an increase in "all-around quality of life" at the T2 test period. NK cell activity was increased at T2 as well in the participating group and was higher than that of the declining group both at T1 and T2 testing times. CONCLUSION: Participation in the psychosocial intervention group resulted in a marked decrease in the emotional strain and an increase in the quality of life. The increased NK-cell activity with lowered T-cell activation in comparison to the decliners hints at a coherence between coping behaviour and changes of the immunological cell function. The results of this study will be investigated further in a greater sample.

[Coping with illness/quality of life and immunologic parameters of patients with breast carcinoma and benign tumors]. / Krankheitsbewältigung/Lebensqualität und immunologische Parameter bei Patientinnen mit Mammakarzinom und benignen Tumoren.

OBJECTIVE: Maladaptive coping of the cancer illness leads to considerable psychosocial burden which can-as a chronic stress factor-impair various immune functions, e.g. cellular immunity. PATIENTS AND METHODS: In a collective of 118 patients suffering from mammary carcinoma and 48 patients suffering from benign mammary tumors Coping was measured with the EORTC-MAC-scale and Quality of life with three questionnaires. Out of the immunologic variables the lymphocyte subpopulations were determined with flow cytometry. Immunglobulines, neopterin, C-reactive protein, and herpes serology were determined using standard methods. RESULTS: At follow up a slight increase of the mean vales of sum-scores is observed for the adverse coping mechanisms, like helplessness/despair and fear. On the other hand, the values for the coping styles fatalism and denial decrease. Significant correlations are seen between anxious attitude and number of natural killer cells (CD16 and CD56). It must be pointed out that area of social contact show an inverse correlation in patients with mammary cancers: a strong improvement correlates with diminished natural killer cells as well as reduced activated killer cells. CONCLUSIONS: The aim of this study is to determine whether a high risk group can be defined using these parameters and if these parameter can be influenced by psychotherapeutic interventions such as establishing "Coping-support-groups".

[The induction of abortion and the priming of the cervix with prostaglandin F2 alpha and prostaglandin E2 by intra-amniotic, extra-amniotic and intra-cervical application (author's transl)]. / Abortinduktion und "Priming" mit Prostaglandin-F2alpha und Prostaglandin-E2--Vergleich der intraamnialen, der extraamnialen und intrazervikalen Applikation.

PIP: More than 130 terminations of pregnancy in the 2nd and 3rd trimesters are reported. In 100 cases, the results of priming prior to therapeutic abortion in the 1st trimester of pregnancy are available. Compared are application for induction of abortion by the extraamniotic, the intraamniotic, and the intracervical route. The results with PGF2alpha and PGE2 gel intracervically are reported. The shortest interval between induction of abortion and abortion was 15 hours with regular application of PGE2 gel into the cervical canal. The failure rate was reduced to 5% with regular applications. The failure rate with irregular application was 22%. With the intraamniotic administration of PGF2alpha, the most severe side effects such as shock symptoms or bronchospasm were noticed. Gastrointestinal side effects such as diarrhea were only noticed with the administration of PGF2alpha. Following a single intracervical application, the so-called priming dose, 67-69% of the cases reached a sufficient dilatation of the cervix up to Hagar number 8. In 16-19% of the cases with the application of PGE2, a spontaneous abortion was achieved with a single dose. Side effects such as marked uterine cramps, nausea, and vomiting were noticed in less than 30% of the cases receiving a priming dose. Our results suggest that a regular and short term application of PG is necessary for the induction of abortion. Relatively short intervals between induction of abortion and abortion and a low failure rate of induction of abortion can thus be achieved. The intracervical application of PGE2 gel or PGF2alpha gel results in sufficient and gentle dilatation of the cervix for a suction curettage in the 1st trimester of pregnancy in about 70% of the cases. The priming dose is recommended for primigravidas or cases with rigid cervix. (author's)^ieng