Deutsches Arzteblatt international最新文献

Background: The gold standard for evaluating interventions in medicine and health care is the randomized controlled trial (RCT). In practice, however, RCTs may be difficult to conduct because of high costs, ethical aspects, or practical considerations. This is particularly true of studies on the population level, e.g., for the evaluation of health policy measures.

Methods: We present a type of study design called the interrupted time series (ITS) and its critical interpretation, with several illustrative examples. This discussion is based on selected meth - odological publications.

Results: ITS are suitable for the assessment of interventions with a clear point of intervention (interruption). They are analyzed with the statistical methods of time-series analysis. One strength of ITS is that they can be used to estimate an immediate effect as well as a gradually developing effect. Under certain assumptions, the findings of an ITS analysis can be interpreted causally. The main assumption underlying an ITS is that the trend after the intervention would have been exactly the same as the trend before the intervention if the intervention had not taken place and all other conditions had remained unchanged. A further assumption is that there should be no differences in the pre- versus postintervention phases in the subjects or other entities being tested (e.g., hospitals) that might affect the measured endpoints (e.g., differences in mean age affecting measured mortality). Moreover, the intervention periods must be properly distinct from one another in order to prevent biased effect estimates. The robustness of the assumptions should also be checked with sensitivity analyses.

Conclusion: As long as all sources of bias have been avoided and the findings are both plausible and robust, the effects revealed by ITS can be interpreted as causal. ITS may serve as an alternative method for evaluating intervention effects when an RCT cannot be performed.

Background: Systemic therapy (ST) was approved as a further psychotherapy approach in line with the German Psychotherapy Directive's requirements in 2020 for adults and in 2024 for children and adolescents, and is thus covered by statutory health insurance.

Methods: Selective literature review on the theoretical foundations and clinical practice of ST, including recent meta-analyses of its efficacy.

Results: The theoretical foundations of ST include systems and communication theory, moderate constructivism, the multigenera - tional perspective, and, in some manuals, the attachment perspective. Structural-strategic family therapy and the solution-focused therapy approach are key elements of its clinical practice. ST is mostly provided in individual or multi-person settings. Important interventions include solution-focused and circular questions, positive reframing, genograms, sculptures, tasks, and prescriptions. Several disorder-specific ST manuals have been developed. The efficacy of ST has been evaluated in 7 recent meta-analyses: ST has been found effective against various disorders, both in adults (affective disorders, anxiety/obsessive-compulsive disorders, substance use disorders, eating disorders, schizophrenia/psychotic disorders) and in children and adolescents (anxiety/obsessive-compulsive disorders, hyperkinetic disorders, substance use disorders, eating disorders, and mixed disorders). For example, in the treatment of depression in adults, ST was shown to be superior to no add-on treatment (Hedges g: 1.09, 95% confidence interval [0.78; 1.40]).

Conclusion: ST broadens the scope of treatment options for mental disorders, with a specific focus on their social context.

Background: Dengue fever is a common infectious disease in the tropical and subtropical zones, with more than 100 million symptomatic cases per year. Mosquitoes of the genus Aedes (Aedes aegypti, Aedes albopticus) are vectors of the disease, and their spread has led to rising case numbers around the world. Physicians in Europe, too, are increasingly being confronted by this challenge.

Methods: This review is based on the findings of a selective search in international publication databases, as well as on the WHO guideline of 2009 and the current recommendations of the Robert Koch Institute.

Results: Dengue fever takes a mild course in more than 90% of cases. Severe dengue fever, up to and including shock and/or mucosal hemorrhages, is rare and carries a mortality of 1-5%. The disease characteristically takes a triphasic course (febrile phase, critical phase, recovery phase). It is diagnosed by the direct demonstration of the pathogen (e.g., with the reverse transcriptase polymerase chain reaction [RT-PCR] up to day 5 of the illness) or by serology. Patients are classified into one of three risk groups depending on their findings and comorbidities and are then treated either as outpatients or in the hospital. The treatment is symptomatic, as no treatment directed against the cause of the disease is available. The key measures are adequate volume replacement and, in patients with hemorrhage, the transfusion of blood products. Preventive steps include vaccination after a documented initial infection and the meticulous avoidance of mosquito bites.

Conclusion: Climate change and global mobility have led to a worldwide increase in dengue fever. The disease only rarely takes a severe course. In such cases, rapid symptomatic treatment as needed is the key to the avoidance of severe complications.