Ms. Barth. 97 - Theologische Sammelhandschrift

Vorbesitzer: Konrad von Gelnhausen; Jungo Frosch; Bartholomaeusstift Frankfurt am Main

Die materielle Begründung des Deutschen Bundesstaates durch die organische Gestaltung der Staatengebiete : ein unpartheiisches, patriotisches Votum, der hohen konstituirenden Nationalversammlung in Frankfurt zur geneigten Prüfung ehrerbietigst vorgelegt

Boberach: Der Deutsche Bund soll durch Mediatisierung der Kleinstaaten, vor allem Bildung der Königreiche Schwaben und Hessen als militärisch starke Westmark aus den sieben Einzelstaaten Südwestdeutschlands, neu gegliedert und Preußen an Nord- und Ostsee durch Einverleibung der Hansestädte als Seemacht gestärkt werden. Frankfurt soll Sitz der Reichsgewalt werden

ASSIP Attempted Suicide Short Intervention Program. A Manual for Clinicans

Attempted Suicide is the main risk factor for suicide. The Attempted Suicide Short Intervention Program (ASSIP) described in this manual is an innovative brief therapy that has proven to be highly effective in reducing the risk of further attempts. ASSIP is the result of the authors' extensive practical experience in the treatment of suicidal individuals. The emphasis is on the therapeutic alliance with the suicidal patient, based on an initial video-recorded narrative interview and the development of personalized safety strategies. The three to four therapy sessions are followed by continuing contact with patients by means of regular letters.

Workshop: ASSIP - Attempted Suicide Short Intervention Program. Theory, Practice, and 24 Months Follow-up RCT.

Background: ASSIP is a manualized brief therapy based on a model of suicide as goal-directed action, aimed at establishing a therapeutic alliance in a patient-oriented, collaborative approach. The main goals of the three-session program ASSIP are for patients to understand, from an observer’s position, patterns leading to a suicidal crisis, recognize triggers and warning signs, and to establish individual safety strategies for future suicidal crises. An ongoing therapeutic support is provided with regular letters over 24 months. Method: The study was conducted in a naturalistic setting. 120 Patients were randomly assigned to an intervention group (60 participants) treated with ASSIP combined with follow-up contact through letters, and a control group (60 participants) receiving a single session of clinical assessment. Both groups had treatment as usual. Patients completed a set of psychosocial and clinical questionnaires every six months over a period of 24 months. Results: In the ASSIP group 5 patients made a total of 5 reattempts, compared to 15 patients with 41 reattempts in the control group. The survival analysis yielded a significant difference with a Wald Chi2 of .000003. The ASSIP group had significantly lower suicidal ideation and fewer days of inpatient treatment compared to the control group. Higher scores in the Penn Helping Alliance Questionnaire were associated with lower suicidal ideation during follow-up. Conclusions: ASSIP is a highly effective brief therapy for patients with recent suicide attempts. Forming a strong therapeutic alliance is considered to be a major factor for outcome. ASSIP can be used with minimal training by experienced therapists. An English version of the manual will be published in May 2015.

Kurztherapie für Patienten nach Suizidversuch. ASSIP – Attempted Suicide Short Intervention ProgramTherapiemanual

Theoretischer Hintergrund: Ein erfolgter Suizidversuch ist der grösste Risikofaktor für einen späteren Suizid. Der aktuelle Stand der Forschung zeigt, dass es bislang kaum Therapieansätze gibt, die dieses Risiko langfristig zu reduzieren vermögen. Methoden: ASSIP ist eine spezifische Kurztherapie für Patienten nach einem Suizidversuch und beruht auf einem handlungstheoretischen Konzept von Suizid. Es vereint Elemente der Bindungstheorie mit kognitiv-verhaltenstherapeutischen Strategien. Ergebnisse: Im Rahmen einer randomisierten Effektivitätsstudie (N=120) konnte gezeigt werden, dass die Interventionsgruppe im Vergleich zu ihrer Kontrollgruppe über zwei Jahre hinweg signifikant weniger wiederholte Suizidersuch aufwies. Weitere wichtige Ergebnisse werden präsentiert. Diskussion: Durch den Aufbau einer losen aber anhaltenden Therapiebeziehung, wie auch von Strategien im Umgang mit suizidalen Krisen, finden weniger Suizidhandlungen statt und ein besserer Umgang mit suizidalen Krisen wird möglich.

Are suicide attempters wired differently?

Objective: Limited research exists on internal risk processes in suicide attempters and factors that distinguish them from non-suicidal, depressive individuals. In this qualitative study, we investigated Plans, motives, and underlying self-regulatory processes of the two groups and conducted a comparative analysis. Methods: We analyzed narrative interviews of 17 suicide attempters and intake interviews of 17 non-suicidal, depressive patients using Plan Analysis. Then, we developed a prototypical Plan structure for both groups. Results: Suicidal behavior serves various Plans only found in suicide attempters. Plans of this group are especially related to social perfectionism and withdrawal in order to protect their self-esteem. Depressive patients employ several interpersonal control and coping strategies, which might help prevent suicidal behavior. Conclusion: The prototypical Plan structure of suicide attempters may be a valuable tool for clinicians to detect critical Plans and motives in their interaction with patients, which are related to suicide risk.

Kerkerblüthen aus Bruchsal

Boberach: Ein gefangener Teilnehmer des Ersten Badischen Aufstands betrauert, z.T. in alemannischer Mundart, den gescheiterten Versuch, eine deutsche Republik zu errichten. Die Einwohner der ehemaligen Grafschaft Hauenstein huldigen dem Reichsverweser

Interventional Laser-assisted Extraction of an Infected Trapped Ventriculoatrial Shunt Based on Techniques for Pacemaker Lead Explantation.

We present a case of successful interventional laser-assisted extraction of an endovascularly trapped long-term implanted ventriculoatrial shunt in a patient with shunt-associated septicemia. This approach is based on modified techniques for explantation of pacemaker leads and might be considered an additional option for extraction of otherwise nonremovable trapped endovascular catheters in experienced centers.

Pain hypersensitivity and spinal nociceptive hypersensitivity in chronic pain: prevalence and associated factors.

Hypersensitivity of pain pathways is considered a relevant determinant of symptoms in chronic pain patients, but data on its prevalence are very limited. To our knowledge, no data on the prevalence of spinal nociceptive hypersensitivity are available. We studied the prevalence of pain hypersensitivity and spinal nociceptive hypersensitivity in 961 consecutive patients with various chronic pain conditions. Pain threshold and nociceptive withdrawal reflex threshold to electrical stimulation were used to assess pain hypersensitivity and spinal nociceptive hypersensitivity, respectively. Using 10th percentile cutoff of previously determined reference values, the prevalence of pain hypersensitivity and spinal nociceptive hypersensitivity (95% confidence interval) was 71.2 (68.3-74.0) and 80.0 (77.0-82.6), respectively. As a secondary aim, we analyzed demographic, psychosocial, and clinical characteristics as factors potentially associated with pain hypersensitivity and spinal nociceptive hypersensitivity using logistic regression models. Both hypersensitivity parameters were unaffected by most factors analyzed. Depression, catastrophizing, pain-related sleep interference, and average pain intensity were significantly associated with hypersensitivity. However, none of them was significant for both unadjusted and adjusted analyses. Furthermore, the odds ratios were very low, indicating modest quantitative impact. To our knowledge, this is the largest prevalence study on central hypersensitivity and the first one on the prevalence of spinal nociceptive hypersensitivity in chronic pain patients. The results revealed an impressively high prevalence, supporting a high clinical relevance of this phenomenon. Electrical pain thresholds and nociceptive withdrawal reflex explore aspects of pain processing that are mostly independent of sociodemographic, psychological, and clinical pain-related characteristics.

A randomised controlled trial: can acupuncture reduce drug requirement during analgosedation with propofol and alfentanil for colonoscopy? A study protocol.

BACKGROUND The number of colonoscopies tremendously increased in recent years and will further rise in the near future. Because of patients' growing expectation on comfort during medical procedures, it is not surprising that the demand for sedation also expands. Propofol in combination with alfentanil is known to provide excellent analgosedation, however, its use is associated with respiratory and cardiovascular depression. Acupuncture could be a technique to reduce drug requirement while providing the same level of sedation and analgesia. METHODS/DESIGN The study will be performed as a single centre, randomised, placebo controlled trial. 153 patients scheduled for propofol/alfentanil sedation during colonoscopy will be randomly assigned to receive electroacupuncture (P6, ST36, LI4), sham acupuncture, or placebo acupuncture. Following endoscopy patients and gastroenterologists have to fill in questionnaires about their sedation experiences. Additionally, patients have to accomplish the Trieger test before and after the procedure. Patient monitoring includes time adapted HR, SpO2, ECG, NIBP, exCO2, OAA/S, and the Aldrete score. The primary outcome parameter is the dosage of propofol necessary for an adequate level of sedation to tolerate the procedure (OAA/S < 4). Effectiveness of sedation, classified by satisfaction levels measured by questionnaires is the secondary outcome parameter. DISCUSSION Moderate to deep sedation using propofol is increasingly applied during colonoscopies with a high satisfaction level among patients despite well-known hemodynamic and respiratory side effects of this hypnotic agent. Acupuncture is known to attenuate gastrointestinal discomfort and pain. We hypothesize that the combination of conventional sedation techniques with acupuncture may result in equally satisfied patients with a lower risk of respiratory and hemodynamic events during colonoscopies. TRIAL REGISTRATION This trial is registered in the Nederland's Trial Register NTR 4325 . The first patient was randomized on 13 February 2014.

Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence.

OBJECTIVE Endoscopic lung volume reduction (ELVR) with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax. METHODS Seventy-two (72) emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32) patients received standard post-implantation medical management (Standard Medical Care (SMC)), and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC)). RESULTS The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02). Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02). Major clinical outcomes showed no significant differences between the two cohorts. CONCLUSIONS In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.