The short form of the QES with 23 items is a valid instrument for the examination of social and psychic burdens of psoriasis and atopic dermatitis patients. The recording of the stigmatization feeling and of the quality of life determines different, supplementary aspects of the illness-related stress of patients with chronic skin diseases.
Objective: The aim of our study is to compare attitudes to psychotherapeutic treatment among patients with chronic skin diseases, outpatients from a clinic for psychosomatic medicine, psychology students, and medicine students. For this purpose, a questionnaire assessing the attitudes among patients and healthy individuals towards psychotherapeutic treatment and psychotherapists was developed. Subjects and Methods: 541 inpatients with chronic skin diseases, 218 outpatients from a clinic for psychosomatic medicine, 106 psychology, and 341 medicine students completed the Questionnaire on Attitudes towards Psychotherapeutic Treatment (QAPT). Results: Item analysis confirmed 20 out of the original 24 items. Four dimensions of the QAPT were determined: competence of the psychotherapist, judgment by others, general attitude, and acceptance. Conclusion: Data analyses showed that outpatients from a clinic for psychosomatic medicine and psychology students have a more positive attitude towards psychotherapy and psychotherapists than inpatients with chronic skin diseases and medicine students that hold more skeptical views on psychotherapy. This suggests that special efforts to inform and motivate patients with chronic skin diseases are required if psychotherapy is advisable.
Medical rehabilitation represents the interdisciplinary management of a person's functional health. This term implies concepts of functioning, disability and health and represents the core notion of the international classification of functioning, disability and health (ICF). Four components -- anatomic structure, body functions, activities and participation, environmental factors and personal factors -- make the ICF applicable from a biological, individual and social perspective. At present the ICF is used as a system of classification, a research tool and as a theoretical basis in rehabilitation medicine. Its clinical application will depend on the improvement of its practicability and compatibility with currently used tools in dermatologic rehabilitation. ICF offers the opportunity to define, weight and classify diseases of the skin and their psychosocial consequences.
Objective: The aim of this longitudinal study is to compare different dimensions of coping in psoriasis patients dependent on the development of the severity of this chronic skin disease. For this purpose we examined the patients’ coping and their skin state in a 1-year follow-up. Methods: We assessed the severity of psoriasis with the Psoriasis Area and Severity Index (PASI) and the Self-Administered PASI (SPASI), and coping with the ‘Trier Coping with Illness Scales’ in 262 inpatients. The severity of psoriasis estimated with the (S)PASI was defined as ‘mild’ ([S]PASI 0.0 - 5.0), ‘moderate’ ([S]PASI > 5.0 - 12.0), or ‘severe’ ([S]PASI > 12.0). We divided the sample into five patient groups based on the somatic course of the (S)PASI in the 1-year follow-up: ‘improved’, ‘equally mild’, ‘equally moderate’, ‘equally severe’, and ‘worse’. Results: Psoriasis patients of the ‘improved’ and ‘equally mild’ groups showed a significant increase on the scale ‘Search for Social Integration’ (p = 0.041 and p = 0.005) and a significant decrease in the dimensions ‘Threat Minimization’ (p = 0.040 and p = 0.022) and ‘Search for Information and Exchange of Experiences’ (p = 0.003 each) in the follow-up. However, significantly higher values in the dimensions ‘Rumination’ (p = 0.029) and ‘Search for Support in Religion’ (p = 0.001) in the follow- up were revealed for the patients of the ‘worse’ group. Conclusion: The analysis firstly shows a clear empirically-based challenge in which areas patients with ‘equally severe’ or ‘worse’ psoriasis should be supported, i.e. the fields ‘Search for Social Integration’, ‘Threat Minimization’, and ‘Search for Information and Exchange of Experiences’. In addition, results suggest that special psychological or psychotherapeutic efforts are necessary to help this group to develop an alternative behavior to the depression-associated ‘rumination’.
Off -Label-Use von Arzneimitteln in der gesetzlichen Krankenversicherung Off -Label Prescription of Drugs in the Statutory Health Insurancesetz) und nur f ü r diesen. Die Anwendung von in Deutschland nicht zugelassenen Arzneimitteln wird mit " Off-Label-Use " nicht erfasst. Das bedeutet, dass ein Medikament verordnungsf ä hig sein muss, um Off-Label eingesetzt werden zu k ö nnen [1] . Verordnungsf ä hig ist ein Arzneimittel, wenn es in einem Land der europ ä ischen Union oder einem anderen Land zugelassen ist. F ü r die Leistungspflicht der gesetzlichen Krankenversicherung bei einer Arzneimittelverordnung m ü ssen weitere Normen (SGB V, Arzneimittelrichtlinie, Rechtsprechung des Bundessozialgerichts (BSG) und des Bundesverfassungsgerichts (BVerfG) beachtet werden. In der Rechtsprechung des BSG wird der Begriff Off-Label-Use mit " zulassungs ü berschreitender
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