Accessible online at: www.karger.com/ver Belegen und gibt Anregungen für die klinisch-psychologische Forschung und Praxis, wobei auch Kosten-Nutzen-Relationen berücksichtigt werden. Anschließend stellt Weck Instrumente zur Erfassung psychotherapeutischer Kompetenzen vor, wobei vor allem die deutsche Version der ursprünglich von Young und Beck entwickelten Cognitive Therapy Scale (CTS) im Fokus steht [Weck et al., 2010]. Die Beurteilung psychotherapeutischer Kompetenzen anhand dieses Instruments erfolgt durch unabhängige und trainierte Rater im Rahmen von Audio-/Videoaufzeichnungen oder Live-Beobachtungen. Dieses Instrument ist sowohl für den Forschungsals auch Praxiskontext gut geeignet und erfasst allgemeine therapeutische Kompetenzen (z.B. interpersonelle Effektivität, Ressourcenaktivierung, etc.) und sitzungsstrukturierende Kompetenzen (z.B. Tagesordnung, Zeitaspekte, etc.). Weck gibt zusätzlich einen Studienüberblick über den Zusammenhang von psychotherapeutischen Kompetenzen und Therapieerfolg. Abschließend thematisiert Weck die Förderung psychotherapeutischer Kompetenzen, wobei er zunächst der Frage nachgeht, ob diese erlernbar sind. Er stellt unterschiedliche Trainingsmaßnahmen vor (z.B. Helping Skills Training), geht auf deren Evidenzbasierung ein und erläutert anschließend verschiedene Methoden zur Förderung psychotherapeutischer Kompetenzen (z.B. Training, Feedback, (Live-)Supervision). Der Autor schließt mit einer Zusammenfassung und diskutiert vor allem die Perspektive der klinisch-psychologischen Forschung. Wie der Klappentext verspricht, ist das Buch gut lesbar sowie kurz und knapp geschrieben. Im Hinblick auf die erwähnten Zielgruppen (Ausbildungstherapeuten mit großem Interesse am Thema sowie erfahrene Psychotherapeuten, die den Anspruch verfolgen, die eigene Tätigkeit zu reflektieren) ist die Publikation nicht spezifisch genug formuliert und gibt leider zu wenige praktische Empfehlungen. Als Zielgruppe hätten sicherlich auch Supervisoren aufgeführt werden können sowie Fachpersonal, das an der Verbesserung von Ausund Weiterbildung von Psychotherapeuten beteiligt ist. In jedem Fall lassen sich hilfreiche Erkenntnisse aus den Darstellungen ableiten. Der Leser, der sich theoretisch fundiert dem Thema psychotherapeutische Kompetenzen widmen möchte, findet in diesem Buch einen wertvollen Überblick zu relevanten Theorien, Modellen und Instrumenten sowie Anregungen für deren Implikation in der Praxis.

Effects of a Protein Optimized Diet Combined with Moderate Resistance Training on the Postoperative Course in Older Patients with Hip Fracture

About 35% of the Austrian population have a BMI above 25 kg/m(2); underweight (BMI below 20.5 kg/m(2)) does not seem to represent any significant problem. Malnutrition is frequently observed in individuals in homes for the aged and nursing homes and also in hospitalized patients, but precise data on residents in such homes are lacking. In hospitals, over 30% of patients must be designated as undernourished: this percentage is higher among oncological patients (up to 82%). Timely and valid data on malnutrition (which includes not only undernutrition but also overnutrition) must be gathered in order to carry out adequate nutritional therapy. Instruments for establishing diagnosis of malnutrition (SGA, INS, NRS 2002) will be discussed that enable differential assessment of malnutrition (over and undernourishment). In our investigation BMI is not a valide parameter to recognize malnutrition. The test of Kondrup et al. (NRS 2002) seems to be a relative sensitive test (about 95%) for recognition malnutrition.

It has been shown that the quotient of serum urea and serum creatinine to determine the severity of a disease in intensive care unit (ICU) patients at the beginning of treatment correlates with urea production rate (degree of protein catabolism) and creatinine index (muscle mass parameter). This study aimed to show whether the urea/creatinine quotient is suitable for determining the degree of ongoing protein catabolism in ICU patients in routine clinical practice. Method: 64 patients at ICU with traumatology, cardiosurgeiy and general surgery patients who underwent more than 3 days of intensive care were enrolled in the study. The studied parameters were urea production rate, creatinine index and ureafcreatinine quotient, These parameters were determined every 2nd day for a maximum of 31 days. Results: 5 patients died during their ICU stay, and 15 (23.5%) were already undernourished on admission to the ICU. Urea production rate and urea/creatinine quotient rose from ICU day 3 to day 11 (mean 28 to 51 gid and 40 to 65 mg). Nutritionally deficient patients showed clearly elevated urea/creatinine quotients, often over 100. In normally nourished patients a significant correlation between urea production rate and ureafcreatinine quotient (r, 0.307 and 0,542; p < 0.05) was seen until ICU day 9, but not in nutritionally deficient patients, At the commencement of ICU treatment the creatinine index was in the lower normal range, but continually dropped to a mean of 52 % by the end of the study period. A significant negative correlation was observed between creatinine index and urea/creatinine quotient until day 11 (r, - 0.407 and - 0.284; p < 0.05). Discussion: Normally nourished ICU patients showed a more pronounced increase in urea production rate (protein catabolism). Protein catabolism affected muscle mass (creatinine index), with mean daily muscle mass loss being 1 %. The decrease was smaller in nutritionally deficient patients due to their diminished muscle mass. Nutritionally deficient ICU patients and patients require ICU treatment for a longer period probably lose less protein and muscle mass than do normally nourished patients. For longer observation periods the ureafcreatinine quotient does not appear to be a suitable parameter for monitoring catabolism (urea production rate), although in renal insufficiency patients it does indeed correlate with protein catabolism.

Effects of a Protein Optimized Diet Combined with Moderate Resistance Training on the Postoperative Course in Older Patients with Hip Fracture

Evaluation of Nutritional Status In the average population it is common to be overweight (above 30%), while in hospital patients it is more common to show a lack of nutrition (above 40%). Either form of malnutrition leads to an increase in morbidity as well as mortality. Analyzing the nutritional status adequately allows to implement an appropriate therapy regarding nutrition (nutritional team). The nutritional status can be measured by particular parameters or by use of nutritional scores. The aim will be to gather the data easily and inexpensively and to reveal the statements and conclusions in a sensitive and specific manner. Anthropometric, labor chemical and immunological parameters are mostly of no value as they may be affected by the underlying illness; e.g. the body mass index (BMI) is not a very sensitive measure. The significance of stress related parameters is increasing. So far, there is no 'golden standard' regarding the score systems, but they are to be executed without too much effort. While the 'Subject Global Assessment' (SGA) ('score of condition') mainly includes inquired data, the 'Nutritional Risk Screening' (NRS) also includes stress related metabolism and weight loss, and the amended 'Innsbruck Nutrition Score' (INS) further considers several metabolic laboratory parameters. Key factor is an estimation of the risks involved for the patients in order to allow for an appropriate nutritional therapy.

Effects of a Protein Optimized Diet Combined with Moderate Resistance Training on the Postoperative Course in Older Patients with Hip Fracture

All in all, the courses were considered important and recommendable, particularly with regard to communication, organization, time management and cost awareness. Streamlining (i. e. more content in less time), stronger practical orientation and a switch from mainly local to more international speakers would be important steps toward improving course quality. Thanks to its demonstrated quality, it can be said that the university course for health and hospital management held by the University of Innsbruck and evaluated in this study is certainly a worthwhile course offered in a still emerging market, namely one that will come under increasing pressure from the candidates for executive positions in the health professions to provide what is best for their careers and the health services industry in general.

Aim of the Study: Participation in courses for health and hospital management is increasingly becoming a conditio sine quanon for candidates for executive positions in the health professions. The aim of this study was thus to evaluate the two-semester university course for health and hospital management offered by the University of Innsbruck since 1994. Methods: A structured telephone survey was conducted to poll the participants (n = 184) of previous courses concerning time invested, cost-benefit ratio, quality of the course as well as implementation of course content. Results: The university courses (n = 7) for health and hospital management of the University of Innsbruck evaluated in this study were rated in the upper half of the of the five-part scale (scores 2 to 3) for overall quality, cost-benefit ratio and implementation of course content. Only approx. 25 % of the course participants reported that the course had a positive influence on their career. The relatively high course fee was borne in part by the local hospital operator, a fact that had a certain influence on the selection of course participants. Participation in the course was largely made possible by exemptions from job duties (approx. 75 %) and to a lesser extent by vacation time (approx. 20 %) or time off for overtime (approx. 5 %). Of total absences from the course (3,18 +/- 3,41 d) 75 % was for job-related reasons, 6 % for illness and 19 % for other reasons. Overall, participants were absent more often, the larger the number of personnel in their department or clinic. Conclusion: All in all, the courses were considered important and recommendable, particularly with regard to communication, organization, time management and cost awareness. Streamlining (i.e. more content in less time), stronger practical orientation and a switch from mainly local, to more international speakers would be important steps toward improving course quality. Thanks to its demonstrated quality, it can be said that the university course for health and hospital management held by the University of Innsbruck and evaluated in this study is certainly a worthwhile course offered in a still, emerging market, namely one that will come under increasing pressure from the candidates for executive positions in the health professions to provide what is best for their careers and, the health services industry in general.

Effects of a Protein Optimized Diet Combined with Moderate Resistance Training on the Postoperative Course in Older Patients with Hip Fracture

Bei 26 Patienten mit schwerer Pankreatitis, die während eines Zeitraumes von 2 Jahren (Januar 1991 bis Dezember 1992) an der Intensivstation der Universitätsklinik für Anästhesie in Behandlung waren, wurde der Krankheitsverlauf insbesondere im Hinblick auf das Vorliegen und die prognostische Bedeutung einer Hypertriglyzeridämie ausgewertet. Bei 13 Patienten (11 Manner, 2 Frauen, mittleres Alter 42 ± 9 Jahre) fand sich bei der Aufnahmeuntersuchung eine Hypertriglyzeridämie mit Werten zwischen 330 und 4000 mg/dl, die Lipidelektrophorese zeigte in alien Fallen eine Hyperlipidämie Typ IV. Bei 4 dieser Patienten bestand ein insulinpflichtiger Diabetes mellitus, bei 5 wurde anamnestisch ein der Pankreatitis unmittelbar vorausgehender vermehrter Alkoholkonsum festgestellt. Neben den chirurgischen Interventionen einschlieβlich Drainage und Lavage sowie allgemeinintensiv-medizinischen Maβnahmen erfolgte bei 8 Patienten mit Hypertriglyzeridämie eine Plasmapherese. Fünf der 13 Patienten mit Hypertriglyzeridämie-assoziierter Pankreatitis verstarben an einem Multiorganversagen. Die Mortalitätsrate lag damit bei 38%, in der Vergleichsgruppe mit lithogener Genese bzw. Pankreatitis bei chronischem Alkoholkonsum betrug sie 46%. Die schlechte Krankheitsprognose zeigt die vorsorgemedizinische Bedeutung einer Therapie der Hypertriglyzeridämie auf, da sie die Entwicklung einer Pankreatitis mit alien daraus resultierenden Komplikationen verhindern kann. Die Routinediagnostik bei akuter Pankreatitis sollte eine Bestimmung der Plasmatriglyzeride beinhalten.