Research indicates that patients with a lifetime history of suicide attempts are particularly burdened. However, investigations of their characteristics and comparisons with other patients are scarce. This study aimed to fill this research gap, using routine clinical data and guided by theoretical models. Data of N = 706 patients (54.4% women) was collected at the psychosomatic inpatient/day-clinic unit of a German university clinic. It comprised sociodemographic data and information about previous experiences (e.g., childhood abuse and neglect), symptom measures (e.g., the PHQ-9) and individual differences (e.g., the level of personality functioning assessed with the OPD-SQS). Groups were compared using independent t-tests or χ2-tests. Of the total sample, 118 patients (16.7%) reported suicide attempts. Those with a history of suicide attempts were more likely to have a migration background and a lower level of education, smoke (heavily) and use illegal substances. They reported lower levels of personality functioning, more current symptoms and traumatic previous experiences of abuse and neglect. Screening for previous suicidal behavior as well as associated factors can yield valuable information for clinical practice. Many group differences map onto previously observed specific risk factors for suicidal behavior, supporting the conceptual models and underscoring their relevance among clinical populations as well.

Interdisciplinary multimodal pain therapy (IMPT) is an established procedure in the treatment of chronic pain. In daily practice, many institutions regard so-called booster units as an integral part of IMPT. However, no consensual recommendations and evidence for booster concepts are available to date. This article uses the results of a discussion between clinical experts in the field of IMPT at the German Pain Congress in 2022 in order to show the status quo in care. It has been shown that currently applied booster offers vary greatly in terms of time intervals, intensities, therapy content and patient selection and that there is a need for structural and process parameters for the implementation of cross-sectoral booster treatments. In conclusion, the authors outline how the development of these parameters will be planned as an expert consensus with the participation of interested institutions and the inclusion of the patient perspective and offer opportunities for participation in this process.
UNASSIGNED: Die interdisziplinäre multimodale Schmerztherapie (IMST) gehört zu den etablierten Verfahren in der Behandlung chronischer Schmerzen. Im praktischen Alltag werden sogenannte Boostereinheiten von vielen behandelnden Einrichtungen als integraler Bestandteil der stationären bzw. teilstationären IMST angesehen. Allerdings liegen bisher keine konsentierten Empfehlungen und Evidenznachweise für Boosterkonzepte vor. Der vorliegende Beitrag zeigt anhand der Ergebnisse einer Diskussionsveranstaltung („Thementisch“) im Rahmen des Deutschen Schmerzkongresses 2022 den Status quo in der Versorgung auf. Es ließ sich nachweisen, dass aktuell angewendete Boosterangebote in Bezug auf Zeitintervalle, Intensitäten, Therapieinhalte und Patientenauswahl stark variieren und ein Bedarf an Struktur- und Prozessparametern zur Umsetzung von sektorenübergreifenden Boosterbehandlungen besteht. Als Fazit stellen wir dar, wie die Ausarbeitung dieser Parameter als Expertenkonsens unter Beteiligung interessierter Einrichtungen und Einbeziehung der Patientenperspektive geplant ist, und bieten Möglichkeiten zur Beteiligung an diesem Prozess an.

BACKGROUND: Schema therapy is effective for most outpatients with personality disorders (PDs). However, a subgroup does not sufficiently benefit from outpatient programmes. Despite its common clinical use, a thorough evaluation of day treatment group schema therapy (GST) is lacking.
OBJECTIVE: This study aimed to investigate the effectiveness of day treatment GST for patients with PDs.
METHODS: Negative core beliefs were the primary outcome in a multiple baseline single-case design, measured weekly before and during 30 weeks of day treatment GST. Secondary outcomes included severity of primary PD, early maladaptive schemas (EMS), schema modes and general psychopathology measured before and after day treatment GST. Intervention effects were evaluated through visual inspection and randomization test analysis, with a reliable change index calculated for the secondary outcome measures.
RESULTS: A total of 79% of treatment completers showed a significant positive effect of day treatment GST with large effect sizes (Cohen\'s d: 0.96-10.04). Secondary outcomes supported these findings: 56% had a significant decrease in the severity of primary PD and 53% in general psychopathology. In addition, 63% of EMS and 72% of schema modes (87.5% for functional schema modes) showed significant positive reliable changes.
CONCLUSIONS: This is the first empirical study that demonstrated the effectiveness of day treatment GST in patients with severe PDs. Day treatment GST can serve as a stepped care treatment option for nonresponsive patients in outpatient programmes. Further randomized controlled (cost-)effectiveness research is necessary to substantiate these findings and investigate the specific patient populations for which day treatment is essential.

UNASSIGNED: The present study examined the follow-up of a multimodal day clinic group-based therapy program for patients with trauma-related disorders and investigated potential differences for patients with classic PTSD versus cPTSD.
UNASSIGNED: Sixty-six patients were contacted 6 and 12 months after discharge of our 8-week program and completed various questionnaires (Essen Trauma Inventory (ETI), Beck Depression Inventory-Revised (BDI-II), Screening scale of complex PTSD (SkPTBS), Patient Health Questionnaire (PHQ)-Somatization, as well as single items to therapy utilization and life events in the interim period). Due to organizational reasons a control group could not be included. Statistical analyses included repeated-measures ANOVA with cPTSD as between-subject factor.
UNASSIGNED: The reduction of depressive symptoms at discharge was persistent at 6 and 12 months follow-up. Somatization symptoms were increased at discharge, but were leveled out at 6 months follow-up. The same effect was found for cPTSD symptoms in those patients with non-complex trauma-related disorders: Their increase of cPTSD symptoms was flattened at 6 months follow-up. Patients with a very high risk for cPTSD showed a strong linear reduction of cPTSD symptoms from admission to discharge and 6 months follow-up. cPTSD patients had a higher symptom load compared to patients without cPTSD on all time points and scales.
UNASSIGNED: Multimodal, day clinic trauma-focused treatment is associated with positive changes even after 6 and 12 months. Positive therapy outcomes (reduced depression, reduced cPTSD symptoms for patients with a very high risk for cPTSD) could be maintained. However, PTSD symptomatology was not significantly reduced. Increases in somatoform symptoms were leveled out and can therefore be regarded as side effects of treatment, which may be connected with actualization of trauma in the intensive psychotherapeutic treatment. Further analyses should be applied in larger samples and a control group.

Background: In the German healthcare system benefits include inpatient and day clinic psychotherapy of trauma-related disorders, which are often provided in gender specific groups. Despite this widespread practice, the actual impact and potential outcome have been studied relatively scarcely and are still open to debate. The present study therefore examines whether the therapeutic relationships in the group vary depending on the group composition and whether this has an effect on therapy outcome. Methods: 66 patients (N = 55 women) were treated in our multimodal, day clinic groupbased treatment program and filled out symptom questionnaires (ETI, BDI-II, PHQ-15, Questionnaire on social support) at admission and discharge and the Group Questionnaire (GQ; including subscales positive bonding, positive working and negative relationships) at the end of each of the eight weeks of treatment. Patients took part in five women-only and six mixed-gender groups and underwent therapy in a closed group format, so that they began and ended therapy within the same group. All patients were diagnosed with trauma-related disorders, which included PTSD, cPTSD, depression, somatoform disorders and further mental diseases. Outcome data were examined using functional regression analysis and linear mixed models. Results: In women-only groups, positive bonding and positive working relationship were significantly higher than in mixed-gender groups. Negative relationship ratings were significantly lower in women-only groups, especially in the middle phase of treatment. However, no effect of an exclusively female group composition on treatment outcome was found, except for the higher increase of perceived social support for patients treated in women-only groups. Conclusions: Group relationships were considered more pleasant in women-only groups than in mixed-gender groups, but this had no effect on the symptom-based therapy outcome. To enhance feelings of safety and comfort, traumatized women should have the possibility to choose whether to be treated in a women-only or a mixed-gender group.
Zusammenfassung Hintergrund: Das deutsche Gesundheitssystem beinhaltet stationäre und teilstationäre Psychotherapie für Patient:innen mit Traumafolgestörungen; diese wird häufig in geschlechtsspezifischen Gruppen angeboten. Trotz dieser weit verbreiteten Praxis wurden der Einfluss sowie die Ergebnisse wenig untersucht. Die vorliegende Studie überprüft daher, ob die therapeutischen Beziehungen innerhalb der Gruppe je nach geschlechtsspezifischer Gruppenzusammensetzung variieren und ob dies einen Effekt auf den Therapieerfolg hat. Methode: 66 Patient:innen (davon 55 Frauen) wurden in unserem multimodalen, gruppenbasierten tagesklinischen Therapieprogramm behandelt. Sie füllten bei Aufnahme und bei Entlassung symptombezogene Fragebögen (ETI, BDI-II, PHQ-15, Fragebogen zur sozialen Unterstützung) sowie am Ende jeder der acht Therapiewochen den Gruppenfragebogen (GQ) aus. Letzterer beinhaltet die Subskalen Verbundenheit, Arbeitsbeziehung und Negative Beziehung. Die Patient:innen wurden fünf reinen Frauengruppen und sechs gemischten Gruppen zugeteilt und blieben für die gesamte Dauer der Behandlung als Gruppe zusammen. Alle Patient:innen erhielten die Diagnose einer Traumafolgestörung (PTBS, komplexe PTBS, Depression, somatoforme und andere psychische Erkrankungen). Die Datenanalyse erfolgte mittels funktionaler Regression sowie gemischten Modellen. Ergebnisse: Verbundenheit und Arbeitsbeziehung waren in reinen Frauengruppen signifikant höher ausgeprägt als in gemischten Gruppen. Die Skala negative Beziehung wurde in Frauengruppen signifikant niedriger eingeschätzt, besonders in der mittleren Phase der Behandlung. Wir konnten keinen signifikanten Effekt der Gruppenzusammensetzung auf die symptombezogenen Therapieergebnisse feststellen. Lediglich hinsichtlich der wahrgenommenen sozialen Unterstützung stellten wir einen stärkeren Anstieg bei Patientinnen in reinen Frauengruppen fest. Diskussion: Die therapeutischen Gruppenbeziehungen wurden in reinen Frauengruppen angenehmer eingeschätzt als in gemischten Gruppen. Dies hatte jedoch keinen Effekt auf den symptombezogenen Therapieerfolg. Um das Gefühl von Sicherheit und Wohlbefinden zu stärken, sollten Patientinnen mit Traumafolgestörungen die Möglichkeit haben, zu wählen, ob sie in einer Frauengruppe oder in einer gemischten Gruppe behandelt werden.

Medical progress is increasingly enabling more and more stationary treatment to be provided in the outpatient sector. This development should be welcomed, as healthcare costs have been rising for years. The design of efficient processes and a needs-based infrastructure enable further savings. According to international recommendations (EHS/IEHS), outpatient treatment of unilateral inguinal hernias is recommended.
Data from patients in GZO Hospital Wetzikon/Zurich between 2019 and 2021 for unilateral inguinal hernia repair was included in this study (n = 234). Any over- or under-coverage correlated with one of the three treatment groups: stationary, partially stationary and patients treated in outpatients clinic. Complications and 30-day readmissions were also monitored.
Final revenue for all patients is -95.36 CHF. For stationary treatments, the mean shifts down to -575.01 CHF, for partially stationary treatments the mean shifts up to -24.73 CHF, and for patients in outpatient clinic final revenue is 793.12 CHF. This result is also consistent with the operation times, which are lowest in the outpatient clinic with a mean of 36 min, significantly longer in the partially stationary setting with 58 min, and longest in the stationary setting with 76 min. The same applies to the anesthesia times and the relevant care times by the nurses as the most important cost factors in addition to the supply and allocation costs.
We show that cost-effective elective unilateral inguinal hernia care in the outpatient clinic with profit (mean 793.12 CHF) is possible. Stationary unilateral hernia care (mean -575.01 CHF) is loss-making. Crucial factors for cost efficiency are optimized processes in the operating room (anesthesia, surgical technique and quality, operating time), as well as optimized care processes with minimal preoperative services and care times for the patient. However, at the same time, these optimizations pose a challenge to surgical and anesthesiology training and structures with high levels of preoperative and Postoperative services and pay-as-you-go costs. The complication rate is 0.91% lower than in a comparable study. The readmission within 30 days post-operation results with a positive deviation of -3.53% (stationary) and with a negative deviation of +2.29% (outpatient clinic) compared to a comparative study.

Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growing number of people with PD and the lack of general practitioners and neurologists, particularly in rural areas in Germany, specialized PD staff (PDS), such as PD nurse specialists and Parkinson Assistants (PASS), will play an increasingly important role in the care of people with PD over the coming years. PDS have several tasks, such as having a role as an educator or adviser for other health professionals or an advocate for people with PD to represent and justify their needs. PD nurse specialists have been established for a long time in the Netherlands, England, the USA, and Scandinavia. In contrast, in Germany, distinct PDS models and projects have been established. However, these projects and models show substantial heterogeneity in terms of access requirements, education, theoretical and practical skills, principal workplace (inpatient vs. outpatient), and reimbursement. This review provides an overview of the existing forms and regional models for PDS in Germany. PDS reimbursement concepts must be established that will foster an implementation throughout Germany. Additionally, development of professional roles in nursing and more specialized care in Germany is needed.

Although our understanding of Parkinson´s disease (PD) has improved and effective treatments are available, caring for people with PD remains a challenge. The large heterogeneity in terms of motor symptoms, nonmotor symptoms, and disease progression makes tailored individual therapy and individual timing of treatment necessary. On the other hand, only limited resources are available for a growing number of patients, and the high quality of treatment cannot be guaranteed across the board. At this point, networks can help to make better use of resources and improve care. The working group PD Networks and Integrated Care, part of the German Parkinson Society, is entrusted to convene clinicians, therapists, nurses, researchers, and patients to promote the development of PD networks. This article summarizes the work carried out by the working group PD Networks and Integrated Care in the development of standards of network care for patients with PD in Germany.

In the day clinic of the Department of Psychiatry and Psychotherapy of the LMU Munich, a multimodal therapy concept is offered. The goals of treatment are, in addition to the reduction of symptoms, an expansion of everyday life skills and the professional and social reintegration of patients.
The effectiveness of the therapeutic work was evaluated over a period of just under 3 years. Both the therapist and the patients themselves assessed the success of the treatment.
Subjective measures: The affective (BDI: 17.45 at the beginning vs. 9.38 at the end) and the anxiety symptoms (STAI: 49.51 at the beginning vs. 42.11 at the end) decreased. The quality of life (WHOQOL-Bref: 40.96 at the beginning vs. 62.50 at the end) increased. Performance (COPM: 3.81 at start vs. 6.91 at end) and satisfaction with it (COPM: 3.48 at start vs. 7.08 at end) improved. Physician\'s judgment: The global assessment of functioning (GAF: start of therapy 54.91 vs. end of therapy 68.14) and the clinical global impression (CGI: start of therapy 4.48 vs. treatment end 3.03) showed an improvement. All results were significant.
The day clinic\'s treatment concept seems to work comprehensively, both in patients with depressive disorder and in patients with schizophrenic disease.

At the Department of Psychiatry and Psychotherapy of the University of Munich a \"day clinic for substance use disorders\" was opened in 2014. A multimodal treatment concept for patients with addictions was developed. Employees of the clinic performed a first scientific study to assess the effects of treatment approaches on the course of the disease.
Data were collected over two years to evaluate the treatment concept. I. a., the severity of depressive symptoms, anxiety symptoms, craving and several aspects of the subjective quality of life were documented. In addition, participants were examined about their contentment with the day-clinic treatment.
Symptoms of depression, anxiety and craving were significantly reduced during the day-clinic treatment. The subjective quality of life increased almost in all areas.
In order to stabilize patients with addictions, a multimodal treatment concept can be applied effectively.