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Prospektive randomisierte kontrollierte klinische Studie zur Wirksamkeit eines Eigentrainings mit der Digitalen Gesundheitsanwendung „Mawendo“ bei der Behandlung von Krankheiten der Patella (ICD-10-GM M22): Evaluation der DiGA MAWENDOMayer, T., Koska, D., Harsch, A.-K., Maiwald, Christian 06 August 2024 (has links)
In der vorliegenden randomisierten kontrollierten Studie wurde die Wirksamkeit der digitalen Gesundheitsanwendung (DiGA) Mawendo bei der Behandlung von Krankheiten der Patella untersucht und mit der Standardtherapie Physiotherapie der gesetzlichen Krankenversicherung (GKV-Physiotherapie) verglichen. In die Studie eingeschlossen wurden 259 Patienten mit einer ärztlich diagnostizierten Erkrankung der Patella gemäß ICD-10 Klassifikation M22. Nach randomisierter Zuteilung auf die Behandlungsarme absolvierten die Patienten über den 12-wöchigen Behandlungszeitraum entweder ein Eigentraining mit der DiGA Mawendo (Interventionsgruppe IG, 136 Patienten) oder wurden in einer physiotherapeutischen Einrichtung behandelt (Kontrollgruppe KG, 123 Patienten). Für den Nachweis des medizinischen Nutzens (mN) wurden zwei primäre Endpunkte untersucht:
- Endpunkt 1: Verbesserung des Funktionszustandes (mNFunktion)
- Endpunkt 2: Verbesserung der Morbidität durch Schmerzreduktion (mNSchmerz)
Beide Endpunkte wurden mittels eines elektronischen Fragebogens erhoben. Der Endpunkt mNFunktion wurde mithilfe der deutschen Version des Patient Reported Outcome (PRO) KOOS (Knee Injury and Osteoarthritis Outcome Score) erfasst. Die Skala „Activities of Daily Living“ (KOOSADL) quantifizierte hier den mNFunktion (Wertebereich 0-100 Punkte (P), 100 P = bestmöglicher Funktionszustand). Der Endpunkt mNSchmerz wurde durch einen gesondert abgefragten Schmerzscore auf Basis einer Visuellen Analogskala (VAS, Wertebereich 0-100 Punkte, 100 P = stärkste vorstellbare Schmerzen) erhoben. Die Erhebungszeitpunkte wurden wie folgt definiert:
Pre (t0): Vor Beginn der ersten Trainingseinheit mit der DiGA Mawendo bzw. vor dem
ersten Behandlungstermin einer GKV-Physiotherapie.
Post (t12): Nach der Behandlungsdauer von 12 Wochen.
Als Nachweis des mN wurde die Überlegenheit (statistisch signifikant und klinisch relevant) der DiGA gegenüber der GKV-Physiotherapie in einem der beiden Endpunkte definiert. Mit der vorliegenden Studie konnte in beiden Endpunkten eine statistisch signifikante und klinisch relevante Überlegenheit der DiGA Mawendo gegenüber der Standardtherapie gezeigt werden. Im Endpunkt mNFunktion erzielte die IG eine mittlere Verbesserung von 15,7 P (95 % KI [13,7 P; 17,6 P]) gegenüber
einer Verbesserung von 3,4 P (95 % KI [1,3 P; 5,5 P]) in der KG (Unterschied zwischen IG und KG statistisch signifikant mit p < 0,00001). Im zweiten Endpunkt mNSchmerz reduzierte sich der VAS-Schmerzscore in der IG im Mittel um -22,5 P (95 % KI [-25,2 P; -19,9 P]) gegenüber -6,3 Punkten (95 % KI [-8,7 P; -4,0 P]) in
der KG (Unterschied zwischen IG und KG statistisch signifikant mit p < 0,00001). Darüber hinaus wurden in beiden Endpunkten die vorher festgelegten minimalen klinisch relevanten Differenzen (KOOSADL = 10 P, VAS = 10 P) deutlich übertroffen und sogar Verbesserungen im Bereich von „substantial clinical benefits“ erreicht. Medizinischer Nutzen und positiver Versorgunseffekt (pVe) der DiGA Mawendo sind somit evident.
Neben dem mN zeigte sich bei Anwendung der DiGA Mawendo in dieser Studie ein weiterer positiver Aspekt. Die klinisch relevante Reduktion des Schmerzes in der IG äußerte sich in einem erheblich verringerten Anteil von Patienten, die zum Zeitpunkt der Post-Befragung Schmerzmittel einnahmen (IG: 28,0 % Pre -> 3,0 % Post vs. KG: 31,4 % Pre -> 29,8 % Post). Dadurch kann mit weniger Nebenwirkungen gerechnet und das Risiko für potenzielle Folgeschäden und -kosten verringert werden.
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The perception and treatment of mental illness by selected Pentecostal pastors in Polokwane : towards an interventionMauda, Lesley Takalani January 2022 (has links)
Thesis (Ph.D. (Psychology)) -- University of Limpopo, 2022. / Mental illness is a high burden of disease especially in Low- and Medium-Income Countries (LMICs) like South Africa. In many LMICs, there is a paucity of Mental Health Professionals (MHCPs). As a result, people with mental illness call their faith healers or religious/spiritual leaders (pastors in this study) when experiencing mental health problems. Pastors are more accessible, share the same religious/spiritual beliefs about mental illness with their congregants and often provide religious/spiritual solutions to those who consult with them. Thus, they are often preferred over MHCPs. However, pastors are rarely involved as partners in community based mental health programs.
While mental illness is mainly clinically diagnosed and recognised by MHCPs using the DSM-5 and ICD-10 codes, less is known in South Africa with regards to the views of pastors with regards to their notions of what mental illness is. Thus, it may be complex for Pentecostal pastors to clearly distinguish between spirit possession and mental illness as much as it is complex for MHCPs who struggle with accommodating their patients’ religious/spiritual beliefs. Religious/spiritual beliefs are significant in many Africans seeking mental health recovery. However, less has been explored in South Africa in the area of religion/spirituality and its relevance in the practice of clinical psychology. Western based psychotherapeutic methods of intervention which exclude the religious/spiritual domain of African clients continue to dominate the practise of psychology in Africa.
Given the above, this study aimed to explore and understand selected Pentecostal pastors’ perception and treatment of mental illness. The research objectives were, namely: (1) to establish the notions held by Pentecostal pastors’ regarding what mental illness is (2) to establish Pentecostal pastors’ perception of what causes mental illness; (3) to determine Pentecostal pastors’ perceptions of how and by whom mental illness can be recognised, diagnosed, treated and managed; (4) To determine Pentecostal pastors’ views regarding their own roles in the management of mental illness; and (5) To canvass and describe Pentecostal pastors’ perceptions about collaboration for purposes of an intervention programme aimed at providing a holistic care and treatment of religious/spiritual patients.
The study was qualitative, and the exploratory research approach was adopted. The research was informed by the Bio-Psycho-Social-Spiritual (BPSS) model. Purposive sampling was used to select nineteen (19) participants. In-depth semi-structured interviews were conducted. Data were analysed using Thematic Analysis (TA). The following six major themes emerged from the analysed data: (i) Notions of mental illness; (ii) Causes of mental illness;(iii) Recognition and diagnosis of mental illness (iv) Notions on the treatment and management of mental illness; (v) Perceived roles in the treatment and management of mental illness; (vi) Views regarding collaboration with MHCPs.
The participants held a multifactorial view of mental illness. They were limited in their understanding of mental illness and perceived it mainly to be madness (psychosis). The participants’ perception of mental illness was influenced by their theological (Pentecostal) as well as their cultural backgrounds (Black Africans). The participants indicated that they lacked training in mental health issues. As such, they were not opposed to collaborating with MHCPs. They mentioned that their roles included counselling, prayer, support, and referral. This study also discovered that Pentecostal pastors upheld three treatment approaches of mental illness namely: The Full-Collaborative Approach; The Partial-Collaborative Approach and the Non-Collaborative Approach. Findings of the study were discussed, and recommendations were made including the proposed intervention programme between pastors and MHCPs with the aim of facilitating a referral process and collaboration between the two professions. / National Institute for the Humanities and
Social Sciences (NIHSS), and South African Humanities
Deans Association (SAHUDA)
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Finns det evidens för att höghastighetsmanipulation av nacken kan orsaka stroke? / Is there evidence that high velocity manipulation of the cervical spine can cause stroke?Eriksson, Andreas January 2020 (has links)
Höghastighetsmanipulation av nacken är en manuell behandlingsteknik mot smärta i framförallt nacken och skuldrorna. Tekniken har enligt flera källor visats hänga samman med risken för att drabbas av skador på de kärl som försörjer hjärnan med blod, med bland annat stroke som följd. Andra källor har å andra sidan visat att de är en teknik som är säker att utföra. Den här litteraturstudien har sammanställt och utvärderat forskning som på olika sätt söker utreda om det påstådda sambandet är kausalt eller inte. Metoden som valdes var att genom en av SBU färdigställd mall värdera forskningsartiklar och sedan sortera dem efter relevans, för att på så sätt avgöra huruvida sambandet kan ses som kausalt eller inte. Studieresultatet visade att frågan är för komplex för att kunna besvaras i en enskild studie, och att mer forskning behövs inom flera delområden innan frågan kan besvaras fullt ut. Orsaken till detta är att det finns flera orsaksmekanismer, och flera riskgrupper, för denna typ av skada, där flera ännu är okända. Detta gör att en fullständig kartläggning av samband i frågan ännu inte är möjlig. Däremot är det sannolikt att tekniken kan verka som en utlösande faktor, en trigger, hos vissa personer i riskgrupperna. Därför kan det sägas finnas en risk med tekniken rent praktiskt, oavsett om ett kausalt samband mellan tekniken och stroke i sig existerar eller inte. / High Velocity Manipulation of the cervical spine is a manual treatment technique against pain in foremost the neck, shoulders. The technique has according to multiple sources been connected to the risk of injury to the blood vessels that supply the brain with blood, with among others stroke as a consequence. Other sources have on the other hand shown it the technique to be safe to perform. This literature study has compiled and evaluated research that in various ways tries to find out if said connection is causal The method used was to evaluate articles through a pre-made form from SBU, and then to sort them according to relevance to see if the connection is causal or not. The result showed that the question is too complex to be answered in a single study, and that more research is needed to answer the question in full. This is due to the fact that there are multiple mechanisms behinds this form om injury, that the risk seems to exists in certain groups, and that some of these are not yet identifiable. On the other hand there is a high probability that the technique might act as an activating factor in these groups. Because of this there can be said that a risk exists with the technique in practice, no matter if there is a casual connection between the technique and stroke in itself or not.
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Trendy ve spotřebě antidepresiv v ČR v období 2003-2008 / Trends of the Consumption of Antidepressants in the Czech Republic in the period 2003-2008Kantorová, Alice January 2010 (has links)
Depressive disorder, etiology, objective criteria for identifying depression, depression and suicide, depression in ICD-10, treatment, chemicals in the brain and transmission of information, action mechanism of antidepressants, cutting depression, comorbidity, biological and psychotherapeutic treatment options, pharmacotherapy, ATC classification drugs, antidepressants,classification according to the distribution of the ATC, guidelines for the treatment of depression. Identifying the trend and volume of consumption of antidepressants - the code N06A in the Czech Republic in the period 2003-2008 using data from the Všeobecná zdravotní pojišťovna ČR and a comparison based on specific criteria: regional (consumption by region), gender (consumption by gender), age (consumption by age groups), season and month (consumption in different seasons and months) and ATC groups (consumption by chemical / therapeutic / pharmacological subgroups N06A * - 4th level ATC class and consumption by subgroups of chemical substances N06A ***, ie . active substances - 5th level ATC classification). A rough estimate of possible share of depressive and neurotic disorders found in consumption, based on additional data from the database of the Všeobecná zdravotní pojišťovna ČR.
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Transmedicalism : A critical discourse analysis on transnormativity in online discussion websites and publishing platforms / Transmedicalism : En kritisk diskursanalys om transnormativitet i nätanslutna diskussion webbplatser och publicerings plattformarCannerstad, Kim January 2021 (has links)
No description available.
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