Aktuelle Publikationen

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Hier finden Sie einige kürzlich erschiene Fachzeitschriftenartikel.

S Knecht, V. Koushk, T. Schmidt-Wilcke, B. Studer (in press). „Krankenhausmedizinische Interventionen in der neurologischen Anschlussrehabilitation“ [Acute care interventions in inpatient neurorehabilitation]. Der Nervenarzt

Zusammenfassung:

Behandlungen in einem Krankenhaus unterscheiden sich von Behandlungen in einer Rehabilitationsklinik rechtlich dadurch, dass den Patienten im Krankenhaus jederzeitige Hilfe durch Ärzte und anderes qualifiziertes Personal zur Verfügung stehen muss – in der Rehabilitationsklinik hingegen nicht. Seit der Abfassung der zugehörigen Sozialgesetze vor über 30 Jahren werden mehr akutmedizinische Interventionen durchgeführt und die Zahl der Älteren in der Bevölkerung hat zugenommen. Infolgedessen sind Patienten heute älter und multimorbider und dadurch komplikationsgefährdeter. Dies gilt insbesondere für die postakute neurologische Versorgung. Deswegen sind die ursprünglichen Rahmenkonzepte für neurologische Rehabilitationsbehandlung fragwürdig geworden. Wir untersuchten daher prospektiv, wie häufig Patienten in der neurologischen Anschlussrehabilitation akute Komplikationen entwickelten und sofortiger Hilfe durch qualifiziertes Personal bedurften. Wir fanden unter 759 innerhalb einer sechsmonatigen Beobachtungsperiode behandelten Patienten 602 kranken-hausmedizinische Komplikation (Stürze, akute Harnwegsinfekte, Fieber anderer Art, Clostridium-difficile-Diarrhöen, Pneumonien, respiratorische Insuffizienz, Septitiden, epileptische Anfälle und Herzrhythmusstörungen). Insgesamt musste so in der untersuchten Einrichtung im Mittel mehr als dreimal pro Tag akutmedizinisch interveniert werden. Wir schlussfolgern, dass neurologische Anschlussrehabilitation dem bisherigen sozialgesetzlichen Rahmen entwachsen ist und Krankenhausbehandlung umfasst.

Abstract:

German law mandates that hospitals have physicians and other qualified personnel on duty at all times. This is not required for inpatient rehabilitation centers. This law was devised more than 30 years ago, while in the meantime life expectancy and morbidity have increased such that patients entering rehabilitation centers today are at greater risk for medical complications. Therefore, we prospectively tested how often patients in a large inpatient neurorehabilitation suffer complications that require immediate attention by physicians, thus qualifying as hospital care. In 759 patients observed over a period of 6 months we found 602 complications requiring immediate interventions by physicians (falls, urinary tract infections, fever otherwise, clostridium difficile associated diarrhea, pneumonias, respira-tory insufficiencies, sepsis, seizures, arrhythmias). On average there were at least 3 acute care interventions per day at the center. We conclude that neurological inpatient rehabilitation has outgrown its legal foundations and includes hospital care.

 

B Studer, SN Geniole, M Becker, C. Eisenegger, S Knecht (2020). „Inducing illusory control ensures persistence when rewards fade and when others outperform us”. Psychonomic Bulletin & Review

Full article: https://link.springer.com/article/10.3758/s13423-020-01745-4

Abstract:

Persisting even when the rewards of continued effort are fading is essential for achieving long-term goals, skills, and good health, alike. Yet, we often quit when things get hard. Here, we tested whether augmenting the feeling of control through external measures increases persistence under such discouraging circumstances. In two laboratory experiments, we first induced illusory control by manipulating the base-rate of positive outcomes and then tested the effect of this elevation of participants’ perceived control upon their persistence under diminishing returns and in a competition against a stronger opponent. Induced illusory control significantly enhanced people’s persistence in both of these motivationally challenging situations. Our findings demonstrate that motivation is dependent upon perceived, rather than objective, control, and reveal that this can be leveraged to counteract quitting behavior when things get hard, for instance in rehabilitation, physical activity interventions, or other training settings.

 

A Timm, S Knecht, M Florian, H Pickenbrock, B Studer, T Schmidt-Wilcke (2020). “Frequency and nature of pain in patients undergoing neurorehabilitation”. Clinical Rehabilitation, 0269215520956784

Full article: https://journals.sagepub.com/doi/full/10.1177/0269215520956784

Abstract:

Objective: This prospective study investigated the extent to which patients undergoing neurorehabilitation reported pain, how this pain developed during inpatient stay and whether patients were treated accordingly (using pain medication).

Methods: The extent of pain, performance in daily activities, with a focus on possible impairment from pain, and pain medication were assessed at the beginning and the end of neurorehabilitation treatment. Overall 584 patients, with various neurological diagnoses, such as stroke, intracerebral hemorrhage, polyneuropathy, etc. were classified into four groups based on whether they reported having “no pain,” “mild pain,” “moderate pain,” or “severe pain.” All patients received conventional neurorehabilitation therapy in the Mauritius Hospital, Germany.

Results: A total of 149 patients had clinically relevant pain at the beginning of their inpatient stay, at a group level this did not change significantly during the treatment period. At the end of inpatient stay, a slight increase was noted in patients reporting pain. Overall 164 patients suffered from moderate or severe pain, operationalized of pain scores >3 on the visual analog scale. A total of 145 patients who had pain at the end of inpatient stay, did not receive pain medication. There was a weak negative association between pain at baseline and activities of daily living at the end of the treatment period, such that, patients with higher pain levels tended to showed lower Barthel Index scores at the end.

Conclusion: In our study, about one-third of patients suffered from clinically relevant pain during neurorehabilitation treatment and most of them did not receive any pain medication.

 

S Knecht, B Studer (2019). “Integrierte Neurorehabilitation verbessert Versorgungseffizienz [Integrated neurorehabilitation improves efficacy of treatment]“. Der Nervenarzt, 89(4):371-378

Vollständiger Artikel: https://link.springer.com/article/10.1007/s00115-018-0641-y 

Zusammenfassung:

Neurorehabilitation umfasst medizinische und funktionelle Therapie. Wenn Patienten in der Nach-Krankenhaus-Phase erneut akutmedizinisch behandelt werden müssen, dies aber die Möglichkeiten der Rehabilitationsklinik übersteigt, müssen sie in geeignete Akutkrankenhäuser verlegt werden. Dies erzeugt systemische Zusatzkosten, ist medizinisch risikobehaftet und verzögert die weitere Rehabilitation. Wir überprüften, wie die Integration medizinischer Nachbardisziplinen und einer Krankenhausabteilung in Neurorehabilitationskliniken die Rate von Verlegungen in Akutkrankenhäuser beeinflusst. Die besondere Situation in Nordrhein-Westfalen, welches als letztes Bundesland Neurorehabilitationsbetten in den Krankenhausplan aufgenommen hat, ermöglichte eine Longitudinaluntersuchung über 10 Jahre. Wir analysierten die Verlegungsraten an einer der ersten Kliniken des Landes, die neben Rehabilitationsbehandlung (nach §40 SGB V) mittlerweile auch Krankenhausbehandlung (nach § 39 SGB V) erbringen und zur Vorbereitung integrierte Versorgungsstrukturen aufgebaut haben. Im untersuchten Zentrum (Mauritius Therapieklinik Meerbusch) stieg das mittlere Patientenalter zwischen 2007 und 2017 von 69 auf 72 Jahre und der Anteil der Schwerkranken bei Aufnahme stieg um 70 %. Ab 2012 wurde schrittweise die Facharztkompetenz um neurologische Nachbardisziplinen erweitert, das diagnostische und interventionelle Spektrum ergänzt und Frühwarn- und 24/7-Notfallteams etabliert sowie die Möglichkeit zur akutmedizinische Weiterversorgung in neu eingerichteten Intensiv- und Beatmungsbetten geschaffen. Im Ergebnis halbierten sich in allen Neurorehabilitationsphasen die Verlegungen in Krankenhäuser. Angesichts so eingesparter Kosten für Krankenhausbehandlungen, vermindertem Risiko durch Verlegung und unterbrechungsfreier Rehabilitation schlussfolgern wir, dass die über Fächer und Sektoren integrierte Neurorehabilitation gegenüber isolierten Strukturen die Patientenversorgung verbessert.

Abstract:

Neurorehabilitation comprises medical and functional treatment. If patients in the post-hospital phase need acute medical interventions but these cannot be provided by the rehabilitation center, patients must be referred to suitable acute care hospitals; however, such referrals incur additional costs, are fraught with medical risks and delay further rehabilitation. We evaluated how integrating non-neurological medical specialties and a hospital unit into a neurorehabilitation center affects the rate of acute hospital referrals. The special situation in North-Rhine Westfalia, which was the last state in Germany to grant restricted hospital certification to neurorehabilitation centers, enabled a longitudinal assessment over 10 years. We analyzed the referral rate at one of the first hospitals in the state, which in addition to rehabilitation treatment (according to § 40 of the Social Security Code V, SGB V) now also provide hospital treatment (according to § 39 SGB V) and have reorganized in preparation for integrated treatment structures. In the center investigated (St. Mauritius Therapy Hospital Meerbusch) the average patient age increased between 2007 and 2017 from 69 years to 72 years and the proportion of severely ill patients on admission by 70%. Starting in 2012 integrated structures were established in a stepwise fashion with the inclusion of specialists in intensive care, cardiology and neurosurgery, extension of the diagnostic and interventional spectrum and establishment of a 24/7 emergency team with back-up from a new intensive care and mechanical ventilation unit. As a result referrals to hospitals dropped by more than 50% in all categories of disease severity despite the increase in age and morbidity. In view of the savings in costs of hospital treatment, reduced risks due to transfer and less interruption of rehabilitation, it is concluded that the efficacy of patient treatment is improved by discipline and sector integrated neurorehabilitation compared to isolated structures.