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The safety and use of perioperative dexamethasone in the perioperative management of primary sporadic supratentorial meningiomas
No full textObjective: Despite the lack of prospective evidence for the perioperative use of dexamethasone in meningioma surgery, its use is well established in the daily routine of several centers. The present study evaluates the effect of dexamethasone on postoperative complications, peritumoral T2/FLAIR hyperintensity, and progression-free survival in patients with supratentorial meningiomas undergoing resection.
Methods: A total of 148 patients who underwent resection of a primary sporadic supratentorial meningioma at the authors’ institution between 2018 and 2020 were included in this retrospective cohort. Safety criteria were side effects of dexamethasone (e.g. hyperglycemia), surgical morbidities, length of stay, and mortality. The individual Karnofsky Performance Scales (KPS) were evaluated regarding the individual development and the delta of KPS at 3- and 12-months compared to baseline KPS was calculated. Longitudinal assessment of the peritumoral T2-/FLAIR hyperintensity changes was performed.
Results: The use of both pre- and postoperative dexamethasone did not influence the incidence rates of wound infections, infarctions, postoperative seizures, pulmonary embolism, postoperative hemorrhage, mortality, length of stay, new-onset hyperglycemia and new neurological deficits. Perioperative Dexamethasone use was associated with an improved Karnofsky performance development at 3- (delta of KPS 3.3 vs. -1.9, p=0.001) and 12-months (delta of KPS 3.8 vs. -1.1, p=0.008) compared to the preoperative Karnofsky performance status. Multivariable analysis revealed that perioperative dexamethasone use enhances the KPS improvement (OR: 3.65, 95% CI: 1.01-13.18, p=0.048). Persistent peritumoral T2/FLAIR hyperintensity changes were observed in 35 cases of 70 patients with available follow-up images and a baseline edema (50.0%). Perioperative dexamethasone use enhanced the reduction of the preoperative peritumoral T2-/FLAIR hyperintensity changes (mean reduction of maximum diameter: 1.8 cm vs. 1.1 cm, p=0.023). Perioperative dexamethasone use was independently associated with a lower risk for persistent peritumoral T2-/FLAIR hyperintensity changes (OR: 3.77, 95% CI: 1.05-13.54, p=0.042) The perioperative use of dexamethasone did not influence the progression-free survival time in Simpson grade I or II resected WHO grade 1 meningiomas (log-rank test: p=0.27).
Conclusion: Perioperative dexamethasone use seems to be safe in surgery for primary supratentorial meningiomas. Dexamethasone use might enhance the functionality by reducing postoperative peritumoral T2-/FLAIR hyperintensities. These findings highlight the need for prospective data
Characterization and Management of Stable Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation
No full textBackground/Objectives: To date, data regarding the characteristics and management of obstructive, stable coronary artery disease (CAD) encountered in patients undergoing transcatheter aortic valve implantation (TAVI) are sparse. The aim of the study was to analyze granular details, treatment, and outcomes of patients undergoing TAVI with obstructive, stable CAD from real-world practice. Methods: REVASC-TAVI (Management of myocardial REVASCularization in patients undergoing Transcatheter Aortic Valve Implantation with coronary artery disease) is an investigator-initiated, multicenter registry, which collected data from patients undergoing TAVI with obstructive stable CAD found during the pre-TAVI work-up. Results: A total of 2025 patients from 30 centers worldwide with complete follow-up were included in the registry. Most patients had single-vessel CAD (56.1%). An involvement of proximal coronary tracts was detected in 62.5% of cases, with 12.0% of patients having CAD in left main (LM). Most patients received percutaneous coronary intervention (PCI) (n = 1617, 79.9%), especially those with proximal CAD (90.4%). At 2 years, the rates of all-cause death [Kaplan–Meier (KM) estimates 20.1% vs. 18.8%, plog-rank = 0.86] and of the composite of all-cause death, stroke, myocardial infarction, and rehospitalization for heart failure (KM estimates 29.7% vs. 27.5%, plog-rank = 0.82) did not differ between patients undergoing PCI and those who were not. Conclusions: Patients undergoing TAVI with obstructive CAD more commonly had a single-vessel disease and an involvement of proximal coronary tracts. They were commonly treated with PCI, with similar outcomes compared to those treated conservatively
Canine peripheral non-conventional TCRαβ+ CD4-CD8α- double-negative T cells show T helper 2-like and regulatory properties
No full textThe dog is an important companion animal and also serves as model species for human diseases. Given the central role of T cells in immune responses, a basic understanding of canine conventional T cell receptor (TCR)αβ+ T cells, comprising CD4+ single-positive (sp) T helper (Th) and CD8α+ sp cytotoxic T cell subsets, is available. However, characterization of canine non-conventional TCRαβ+ CD4+CD8α+ double-positive (dp) and TCRαβ+ CD4−CD8α− double-negative (dn) T cells is limited. In this study, we performed a comprehensive analysis of canine dp and dn T cells in comparison with their conventional counterparts. TCRαβ+ T cells from peripheral blood of healthy dogs were sorted according to their CD4/CD8α phenotype into four populations (i.e. CD4+ sp, CD8α+ sp, dp, and dn) and selected surface markers, transcription factors and effector molecules were analyzed ex vivo and after in vitro stimulation by RT-qPCR. Novel characteristics of canine dp T cells were identified, expanding the previously characterized Th1-like phenotype to Th17-like and Th2-like properties. Overall, mRNA expression of various Th cell-associated cytokines (i.e. IFNG, IL17A, IL4, IL13) in dp T cells upon stimulation highlights their versatile immunological potential. Furthermore, we demonstrated that the CD4-CD8α- dn phenotype is stable during in vitro stimulation. Strikingly, dn T cells were found to express highest mRNA levels of type 2 effector cytokines (IL4, IL5, and IL13) upon stimulation. Their strong ability to produce IL-4 was confirmed at the protein level. Upon stimulation, the percentage of IL-4-producing cells was even higher in the non-conventional dn than in the conventional CD4+ sp population. Constitutive transcription of IL1RL1 (encoding IL-33Rα) further supports Th2-like properties within the dn T cell population. These data point to a role of dn T cells in type 2 immunity. In addition, the high potential of dn T cells to transcribe the gene encoding the co-inhibitory receptor CTLA-4 and to produce the inhibitory cytokine IL-10 indicates putative immunosuppressive capacity of this population. In summary, this study reveals important novel aspects of canine non-conventional T cells providing the basis for further studies on their effector and/or regulatory functions to elucidate their role in health and disease
Association of immune evasion in myeloid sarcomas with disease manifestation and patients’ survival
No full textIntroduction: Myeloid sarcomas (MS) comprise rare extramedullary manifestations of myeloid neoplasms with poor patients’ outcome. While the clinical relevance of the tumor microenvironment (TME) is well established in many malignancies, there exists limited information in MS.
Methods: The expression of the human leukocyte antigen class I (HLA-I) antigens, HLA-I antigen processing and presenting machinery (APM) components and the composition of the TME of 45 MS and paired bone marrow (BM) samples from two independent cohorts were assessed by immunohistochemistry, multispectral imaging, and RNA sequencing (RNAseq).
Results: A significant downregulation of the HLA-I heavy chain (HC; 67.5%) and ß2-microglobulin (ß2M; 64.8%), but an upregulation of HLA-G was found in MS compared to BM samples, which was confirmed in a publicly available dataset. Moreover, MS tumors showed a predominantly immune cell excluded TME with decreased numbers of tissue infiltrating lymphocytes (TILs) (9.5%) compared to paired BM (22.9%). RNAseq analysis of a subset of 10 MS patients with preserved and reduced HLA-I HC expression revealed 150 differentially expressed genes and a significantly reduced expression of inflammatory response genes was found in samples with preserved HLA-I expression. Furthermore, low HLA-I expression and low TIL numbers in the TME of MS cases were linked to an inferior patients’ outcome.
Discussion: This study demonstrated a high prevalence of immune escape strategies in the pathogenesis and extramedullary spread of MS, which was also found in patients without evidence of any BM pathology, which yields the rational for the development of novel individually tailored therapies for MS patients
Increasing Exploitation Durability of Two-Layer Cast Mill Rolls and Assessment of the Applicability of the XGBoost Machine Learning Method to Manage Their Quality
No full textThe increase in exploitation durability of two-layer cast rolls with the working layer made
of high chromium cast iron allows one to significantly improve the quality of rolled metal as well as
to increase the economic efficiency of the manufacturing process. However, it is severely hindered
due to the massiveness of castings, the impossibility of both evaluating mechanical properties along
the depth of the working layer, and providing the structural uniformity of the working surface
and the decrease in stresses. In our research, aiming to enhance the exploitation durability of sheet
rolls, it is recommended to achieve structural uniformity by CuMg alloying, which increases the
concentration of copper up to 2.78 wt.% in certain zones and, owing to the accelerated austenite
decomposition at a high temperature during the cool-down of the castings, led to the reduction in
excessive strength and the level of heat stresses in the castings. We propose the regimes of cyclic heat
treatments which, due to the decomposition of retained austenite and the fragmentation of structure,
control the level of hardness to reduce and uniformize the level of stresses along the length of a barrel.
A further improvement in the predictions of exploitation durability using XGboost method, which
was performed based on the chemical composition of the working layer of high-chromium cast iron
and heat treatment parameters, requires taking into account the factors characterizing exploitation
conditions of specific rolling mills and the transformations of structural-phase state of the surface
obtained by a non-destructive control method. As the controlled parameter, the hardness measured
on the roll’s surface is recommended, while the gradient change in mechanical properties along the
working layer depth can be feasibly analyzed by a magnetic method of coercive force measuring
Detection of Sulfonamide Antibiotics Using an Elastic Hydrogel Microparticles-Based Optical Biosensor
No full textSulfonamide antibiotics were the first synthetic antibiotics on the market and still have a broad field of application. Their extensive usage, wrong disposal, and limited degradation technologies in wastewater treatment plants lead to high concentrations in the environment, resulting in a negative impact on ecosystems and an acceleration of antibiotic resistance. Although lab-based analytical methods allow for sulfonamide detection, comprehensive monitoring is hampered by the nonavailability of on-site, inexpensive sensing technologies. In this work, we exploit functionalized elastic hydrogel microparticles and their ability to easily deform upon specific binding with enzyme-coated surfaces to establish the groundwork of a biosensing assay for the fast and straightforward detection of sulfonamide antibiotics. The detection assay is based on sulfamethoxazole-functionalized hydrogel microparticles as sensor probes and the biomimetic interaction of sulfonamide analytes with their natural target enzyme, dihydropteroate synthase (DHPS). DHPS from S. pneumoniae was recombinantly produced by E. coli and covalently coupled on a glass biochip using a reactive maleic anhydride copolymer coating. Monodisperse poly(ethylene glycol) hydrogel microparticles of 50 μm in diameter were synthesized within a microfluidic setup, followed by the oriented coupling of a sulfamethoxazole derivative to the microparticle surface. In proof-of-concept experiments, sulfamethoxazole, as the most used sulfonamide antibiotic in medical applications, was demonstrated to be specifically detectable above a concentration of 10 μM. With its straightforward detection principle, this assay has the potential to be used for point-of-use monitoring of sulfonamide antibiotic contaminants in the environment
One Justice for All? Social Dilemmas, Environmental Risks and Different Notions of Distributive Justice
No full textA just or fair distribution of environmental bads and goods is important for solving
environmental social dilemmas and is a core idea of environmental justice politics and research.
Environmental justice is mostly associated with egalitarianism as the sole justice principle for all
people. In contrast, we argue that it is important to uncover and consider heterogeneity in justice
concerns to achieve socially accepted solutions to environmental social dilemmas. With noise
pollution as an example, we explore citizens’ preferences for justice principles regarding the allocation
of politically initiated environmental benefits. In our survey in four European cities, respondents
were asked to choose between different outcomes of a program to reduce road traffic noise in line
with the following four notions of distributive justice: equal shares, equal outcomes, the greatest
benefit for the least advantaged (Rawls), and the greatest benefit for the greatest number (Bentham).
We found that most respondents chose Rawls’ principle, a preference that was stable over time but
weaker when explicitly introducing the veil of ignorance. The preference for Rawls notwithstanding,
we observed substantial heterogeneity in justice preferences. Multinomial logit analyses of survey
and geo-referenced data on noise exposure showed that respondents with a higher socio-economic
status and lower exposure to traffic noise were more likely to choose Rawls’ principle. Taken together,
our study confirms the prominence of Rawls’ principle, demonstrates empirically the heterogeneity
of justice preferences, and calls for more direct measurements of such preferences in research on
environmental social dilemmas, environmental justice, and beyond
Review article: Drought as a continuum – memory effects in interlinked hydrological, ecological, and social systems
No full textDroughts are often long-lasting phenomena, without a distinct start or end and with impacts cascading across sectors and systems, creating long-term legacies. Nevertheless, our current perceptions and management of droughts and their impacts are often event-based, which can limit the effective assessment of drought risks and reduction of drought impacts. Here, we advocate for changing this perspective and viewing drought as a hydrological–ecological–social continuum. We take a systems theory perspective and focus on how “memory” causes feedback and interactions between parts of the interconnected systems at different timescales. We first discuss the characteristics of the drought continuum with a focus on the hydrological, ecological, and social systems separately, and then we study the system of systems. Our analysis is based on a review of the literature and a study of five cases: Chile, the Colorado River basin in the USA, northeast Brazil, Kenya, and the Rhine River basin in northwest Europe. We find that the memories of past dry and wet periods, carried by both bio-physical (e.g. groundwater, vegetation) and social systems (e.g. people, governance), influence how future drought risk manifests. We identify four archetypes of drought dynamics: impact and recovery, slow resilience building, gradual collapse, and high resilience–big shock. The interactions between the hydrological, ecological, and social systems result in systems shifting between these types, which plays out differently in the five case studies. We call for more research on drought preconditions and recovery in different systems, on dynamics cascading between systems and triggering system changes, and on dynamic vulnerability and maladaptation. Additionally, we advocate for more continuous monitoring of drought hazards and impacts, modelling tools that better incorporate memories and adaptation responses, and management strategies that increase societal and institutional memory. This will help us to better deal with the complex hydrological–ecological–social drought continuum and identify effective pathways to adaptation and mitigation
Kunsttherapie in der Pädiatrischen Onkologie im Fokus: Bestandsaufnahme struktureller Rahmenbedingungen, Ableitung von Qualitätskriterien und Zuordnung von kunsttherapeutischen Interventionen zu den Zielbereichen der S3-Leitlinie „Psychosoziale Versorgung in der Pädiatrischen Onkologie und Hämatologie“
No full textZusammenfassung
Hintergrund: Kunsttherapie ermöglicht als Fachrichtung der Künstlerischen Therapien einen nonverbalen Ausdruck sowie Zugang zu nicht bewussten Inhalten durch Verwendung künstlerischer Materialien und Techniken. Kunsttherapie gehört in vielen pädiatrisch-onkologische Kliniken bereits zum psychosozialen Versorgungsangebot für an Krebs erkrankte Kinder und Jugendliche und kann helfen, emotionale Belastungen zu minimieren, die aus der Diagnose und Behandlung resultieren. Die vorliegende explorative Studie hat zum Ziel, eine Grundlage für die Versorgungsstrukturen der Kunsttherapie in der Pädiatrischen Onkologie in Deutschland zu liefern.
Fragestellung: Dafür wurden erstmals kunsttherapeutisch tätige Fachkräfte in der Pädiatrischen Onkologie und Hämatologie im bundesdeutschen Raum zu den strukturellen Rahmenbedingungen ihrer Tätigkeit sowie Verbesserungsmöglichkeiten befragt. Zudem gaben die Fachkräfte an, ob die von ihnen durchgeführten kunsttherapeutischen Interventionen den Zielbereichen der S3 Leitlinie „Psychosoziale Versorgung in der Pädiatrischen Onkologie und Hämatologie“ zuordenbar sind.
Methode: Dazu wurden n=27 derzeit im Arbeitsfeld der Pädiatrischen Onkologie tätigen Kunsttherapeut*innen als Expert*innen ihres Fachgebietes mittels eines Fragebogens mit offenen und geschlossenen Antwortformaten befragt. Die Auswertung erfolgte deskriptiv.
Ergebnisse: Überwiegend sind die Kunsttherapeut*innen universitär ausgebildet und verfügen über zusätzliche therapeutische Qualifikationen. Die Mehrheit von ihnen arbeitet in der Akutversorgung sowie im Rehabilitationsbereich und ist die Hälfte ihrer Arbeitszeit im direkten Patient*innenkontakt in Einzel-, Gruppen- oder Familiensettings. Im stationären Kontext sind die Kunsttherapeut*innen in das multidisziplinäre Team fest integriert und ihre Arbeit wird durch Dokumentation sichtbar.
Sie arbeiten überwiegend in Teilzeit bei heterogener Bezahlung aus spendenbasierten Drittmitteln, haben häufig mehrere Arbeitgeber, verfügen nicht über funktionale Arbeitsräume und es gibt einen Mangel an evidenzbasierten Manualen und Forschung. Aufgrund dieser Arbeitsbedingungen halten die Fachkräfte eine berufsrechtliche Aufwertung der Kunsttherapeutischen Disziplin für notwendig.
Kunsttherapeutinnen arbeiten überwiegend an den Zielkategorien in Modul 3 der S3 Leitlinie „Psychosoziale Versorgung in der Pädiatrischen Onkologie und Hämatologie“. Es wird vor allem am Erhalt der Lebensqualität sowie präventiv gearbeitet, z. B. durch die Förderung von Autonomie- und Selbstwertstärkung, Stärkung der individuellen Ressourcen, Förderung verbaler und nonverbaler Ausdrucksmöglichkeiten sowie emotionaler Entlastung.
Fazit: Die Kunsttherapie ist fester Bestandteil in der deutschen pädiatrisch-onkologischen Versorgungslandschaft. Die Disziplin benötigt eine stärkere berufsrechtliche Anerkennung, um qualitätssichernde Standards etablieren zu können.:INHALTSVERZEICHNIS
1 EINLEITUNG 1
2 HINTERGRUND: PÄDIATRISCHE ONKOLOGIE UND HÄMATOLOGIE 6
2.1 HÄMATO-ONKOLGISCHE ERKRANKUNGEN IM KINDER- UND JUGENDALTER 6
2.2 PSYCHOSOZIALE VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE 8
2.2.1 Ursprünge und Entwicklung der Psychosozialen Versorgung in der Pädiatrischen Onkologie 9
2.2.2 Das Konzept Psychosozialer Versorgung 10
2.3 DIE S3-LEITLINIE FÜR PSYCHOSOZIALE VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE 12
3 HINTERGRUND KUNSTTHERAPIE 14
3.1 GRUNDHALTUNG UND VERFAHREN 14
3.2 WIRKSAMKEIT UND EVIDENZ 18
3.3 INDIKATIONEN UND ANWENDUNGSGEBIETE 20
3.4 AUSBILDUNG UND BERUFLICHE BESONDERHEITEN 21
3.5 KUNSTTHERAPIE IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE 23
3.5.1 Familienorientierte Kunsttherapie im pädiatrisch-onkologischen Akutsetting 27
3.5.2 Interventionsbeispiel „Hand in Hand“ 28
3.6 IMPLEMENTIERUNG DER KUNSTTHERAPIE IN DIE S3-LEITLINIE „PSYCHOSOZIALE VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE“ 31
3.7 AKTUELLE QUALIFIZIERUNGSPROZESSE INNERHALB DES FACHGEBIETES 33
3.7.1 „Zertifikat Pädiatrische Psychoonkolog*in“ in der PSAPOH 33
3.7.2 „Zertifikat Künstlerische Therapien“ – Spezifikation in der PSAPOH 34
3.7.3 OnkoZert 35
4 KUNSTTHERAPIE IM FOKUS: BUNDESWEITE BESTANDSANALYSE KUNSTTHERAPEUTISCHER INTERVENTIONEN UND DEREN ZUORDNUNG ZU DEN ZIELBEREICHEN DER S3-LEITLINIE 37
4.1 FRAGESTELLUNGEN 38
4.2 METHODE 38
4.2.1 Studiendesign 39
4.2.2 Messinstrument 39
4.2.3 Ein- und Ausschlusskriterien 40
4.2.4 Rekrutierung und Stichprobe 41
4.2.5 Ethikvotum 42
4.2.6 Aufklärung und Einholung der Informierten Einwilligung 42
4.3 STATISTISCHE ANALYSE 43
5 ERGEBNISSE 44
5.1 ERGEBNISSE 1. TEIL: IST-ZUSTAND KUNSTTHERAPEUTISCHER VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE IN DER BUNDESREPUBLIK DEUTSCHLAND 44
5.1.1 Qualifikation 44
5.1.2 Qualitätssicherung 48
5.1.3 Tätigkeitsbereiche 50
5.1.4 Interdisziplinarität und Integration der Kunsttherapie 51
5.1.5 Arbeitsstruktureller Rahmen, Finanzierung und Kosten 56
5.1.6 Setting und Teilnehmende der Kunsttherapie 59
5.1.7 Zeit 61
5.1.8 Raum 63
5.1.9 Vernetzung und Forschung 64
5.2 ERGEBNISSE 2. TEIL: SOLL-ZUSTAND AUS SICHT DER BEFRAGTEN EXPERT*INNEN 69
5.2.1 Arbeitsrahmen 69
5.2.2 Persönliche Arbeitsrahmenbedingungen 70
5.2.3 Kunsttherapie mit den Teilnehmenden 71
5.2.4 Evaluation, Forschung und Außenwahrnehmung 72
5.2.5 Bezug zu den Zielbereichen der psychosozialen Basisversorgung gemäß der zugrunde liegenden S3-Leitlinienversion 72
5.2.6 Anmerkungen der VPN 73
5.3 ERGEBNISSE 2. TEIL: ZUORDNUNG DER KUNSTTHERAPEUTISCHEN ARBEIT IM PÄDIATRISCH-ONKOLOGISCHEN SETTING ZU DEN ZIELBEREICHEN DER PSAPOH-S3-LEITLINIE 75
5.3.1 Zielbereiche der S3-Leitlinie 77
5.3.2 Modul 3 der S3-Leitlinie als hauptsächlicher Zielbereich kunsttherapeutischer Interventionen 85
6 DISKUSSION: STANDARDISIERTE VIELFALT VS. VIELFÄLTIGER STANDARD 88
6.1 DISKUSSION DES ERHOBENEN IST- UND SOLL-ZUSTANDES DER KUNSTTHERAPIE IN DER PÄDIATRISCHEN ONKOLOGIE 89
6.1.1 Integration und Implementierung der Kunsttherapie in das pädiatrisch-onkologische Arbeitsfeld 89
6.1.2 Qualifikations- und Ausbildungshintergrund der Kunsttherapeut*innen in der Pädiatrischen Onkologie 94
6.1.3 Sicherung der kunsttherapeutischen Praxisqualität im Feld der Pädiatrischen Onkologie 99
6.1.4 Forschung und Evaluation 108
6.2 DISKUSSION ZUR ZUORDNUNG KUNSTTHERAPEUTISCHER INTERVENTIONEN ZU DEN ZIELBEREICHEN DER S3-LEITLINE 115
6.2.1 Kunsttherapeutische Umsetzung der Zielbereiche in der S3-Leitlinie 118
6.3 METHODENKRITIK UND LIMITATIONEN 126
6.3.1 Kritische Betrachtung der Fragestellungen 126
6.3.2 Kritische Betrachtung des Studiendesigns 127
6.3.3 Kritische Betrachtung der Untersuchungsmethode 129
7 SCHLUSSFOLGERUNGEN 130
8 KURZEMPFEHLUNGEN AUF EINEN BLICK 136
9 LITERATUR 139
10 ABBILDUNGS- UND TABELLENVERZEICHNIS 151
11 ANHANG 154
11.1 INFORMATIONSSCHREIBEN ZUM EXPERT*INNENFRAGEBOGEN 154
11.2 DATENSCHUTZERKLÄRUNG ZUM EXPERT*INNENFRAGEBOGEN 156
11.3 EXPERT*INNENFRAGEBOGEN 158
11.4 ERGEBNISSE 188
11.5 RATERLISTE 259
11.6 ÜBERBLICK ÜBER DEN EINSATZ SPEZIELLER ÜBUNGEN IM MODUL 3 DER PSYCHOSOZIALEN VERSORGUNG 278
11.7 ZUSAMMENHANG VON VERNETZUNG UND KENNTNIS SOWIE ANWENDUNG DER S3-LEITLINIE 281
12 ERKLÄRUNG GEMÄß ANLAGE 4 DER PROMOTIONSORDNUNG 282
12.1 TABELLARISCHER LEBENSLAUF 283Summary
Background: Art therapy, as a specialty of artistic therapies, enables non-verbal expression and access to unconscious content through the use of artistic materials and techniques. Art therapy is already part of the psychosocial care offered to children and adolescents with cancer in many paediatric oncology clinics and can help to minimize emotional stress resulting from diagnosis and treatment. The aim of this exploratory study is to establish a basis for the care structures of art therapy in pediatric oncology in Germany.
Research question: For the first time, professionals working in art therapy in pediatric oncology and hematology in Germany were surveyed with regard to the structural framework conditions of their work and opportunities for improvement. In addition, the professionals indicated whether their art therapy interventions can be assigned to the target areas of the S3 guideline for psychosocial care in pediatric oncology and hematology.
Methods: For this purpose, n=27 art therapists currently working in the field of pediatric oncology were interviewed as experts using a questionnaire with open and closed response formats. The analysis was descriptive.
Results: The majority of the art therapists are university-educated and have additional therapeutic qualifications. They work predominantly in acute care and rehabilitation settings and spend half of their working time in direct contact with patients in individual, group or family settings. In an inpatient context, they are firmly integrated into the multidisciplinary team and their work is visible through documentation.
They predominantly work part-time with heterogeneous pay from donation-based third-party funds, often have several employers, do not have functional workspaces and there is a lack of evidence-based manuals and research. Due to these working conditions, the art therapists consider it necessary to upgrade the professional status of the art therapy discipline.
Art therapists mainly work on the target categories in module 3 of the S3 guideline for psychosocial care in pediatric oncology and hematology. The main focus is on maintaining quality of life and prevention, e. g. by promoting autonomy and self-esteem, strengthening individual resources, promoting verbal and non-verbal expression and emotional relief.
Conclusion: Art therapy in pediatric oncology in Germany is an integral part of the pediatric oncology care landscape. The discipline requires greater professional recognition in order to establish quality assurance standards.:INHALTSVERZEICHNIS
1 EINLEITUNG 1
2 HINTERGRUND: PÄDIATRISCHE ONKOLOGIE UND HÄMATOLOGIE 6
2.1 HÄMATO-ONKOLGISCHE ERKRANKUNGEN IM KINDER- UND JUGENDALTER 6
2.2 PSYCHOSOZIALE VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE 8
2.2.1 Ursprünge und Entwicklung der Psychosozialen Versorgung in der Pädiatrischen Onkologie 9
2.2.2 Das Konzept Psychosozialer Versorgung 10
2.3 DIE S3-LEITLINIE FÜR PSYCHOSOZIALE VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE 12
3 HINTERGRUND KUNSTTHERAPIE 14
3.1 GRUNDHALTUNG UND VERFAHREN 14
3.2 WIRKSAMKEIT UND EVIDENZ 18
3.3 INDIKATIONEN UND ANWENDUNGSGEBIETE 20
3.4 AUSBILDUNG UND BERUFLICHE BESONDERHEITEN 21
3.5 KUNSTTHERAPIE IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE 23
3.5.1 Familienorientierte Kunsttherapie im pädiatrisch-onkologischen Akutsetting 27
3.5.2 Interventionsbeispiel „Hand in Hand“ 28
3.6 IMPLEMENTIERUNG DER KUNSTTHERAPIE IN DIE S3-LEITLINIE „PSYCHOSOZIALE VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE UND HÄMATOLOGIE“ 31
3.7 AKTUELLE QUALIFIZIERUNGSPROZESSE INNERHALB DES FACHGEBIETES 33
3.7.1 „Zertifikat Pädiatrische Psychoonkolog*in“ in der PSAPOH 33
3.7.2 „Zertifikat Künstlerische Therapien“ – Spezifikation in der PSAPOH 34
3.7.3 OnkoZert 35
4 KUNSTTHERAPIE IM FOKUS: BUNDESWEITE BESTANDSANALYSE KUNSTTHERAPEUTISCHER INTERVENTIONEN UND DEREN ZUORDNUNG ZU DEN ZIELBEREICHEN DER S3-LEITLINIE 37
4.1 FRAGESTELLUNGEN 38
4.2 METHODE 38
4.2.1 Studiendesign 39
4.2.2 Messinstrument 39
4.2.3 Ein- und Ausschlusskriterien 40
4.2.4 Rekrutierung und Stichprobe 41
4.2.5 Ethikvotum 42
4.2.6 Aufklärung und Einholung der Informierten Einwilligung 42
4.3 STATISTISCHE ANALYSE 43
5 ERGEBNISSE 44
5.1 ERGEBNISSE 1. TEIL: IST-ZUSTAND KUNSTTHERAPEUTISCHER VERSORGUNG IN DER PÄDIATRISCHEN ONKOLOGIE IN DER BUNDESREPUBLIK DEUTSCHLAND 44
5.1.1 Qualifikation 44
5.1.2 Qualitätssicherung 48
5.1.3 Tätigkeitsbereiche 50
5.1.4 Interdisziplinarität und Integration der Kunsttherapie 51
5.1.5 Arbeitsstruktureller Rahmen, Finanzierung und Kosten 56
5.1.6 Setting und Teilnehmende der Kunsttherapie 59
5.1.7 Zeit 61
5.1.8 Raum 63
5.1.9 Vernetzung und Forschung 64
5.2 ERGEBNISSE 2. TEIL: SOLL-ZUSTAND AUS SICHT DER BEFRAGTEN EXPERT*INNEN 69
5.2.1 Arbeitsrahmen 69
5.2.2 Persönliche Arbeitsrahmenbedingungen 70
5.2.3 Kunsttherapie mit den Teilnehmenden 71
5.2.4 Evaluation, Forschung und Außenwahrnehmung 72
5.2.5 Bezug zu den Zielbereichen der psychosozialen Basisversorgung gemäß der zugrunde liegenden S3-Leitlinienversion 72
5.2.6 Anmerkungen der VPN 73
5.3 ERGEBNISSE 2. TEIL: ZUORDNUNG DER KUNSTTHERAPEUTISCHEN ARBEIT IM PÄDIATRISCH-ONKOLOGISCHEN SETTING ZU DEN ZIELBEREICHEN DER PSAPOH-S3-LEITLINIE 75
5.3.1 Zielbereiche der S3-Leitlinie 77
5.3.2 Modul 3 der S3-Leitlinie als hauptsächlicher Zielbereich kunsttherapeutischer Interventionen 85
6 DISKUSSION: STANDARDISIERTE VIELFALT VS. VIELFÄLTIGER STANDARD 88
6.1 DISKUSSION DES ERHOBENEN IST- UND SOLL-ZUSTANDES DER KUNSTTHERAPIE IN DER PÄDIATRISCHEN ONKOLOGIE 89
6.1.1 Integration und Implementierung der Kunsttherapie in das pädiatrisch-onkologische Arbeitsfeld 89
6.1.2 Qualifikations- und Ausbildungshintergrund der Kunsttherapeut*innen in der Pädiatrischen Onkologie 94
6.1.3 Sicherung der kunsttherapeutischen Praxisqualität im Feld der Pädiatrischen Onkologie 99
6.1.4 Forschung und Evaluation 108
6.2 DISKUSSION ZUR ZUORDNUNG KUNSTTHERAPEUTISCHER INTERVENTIONEN ZU DEN ZIELBEREICHEN DER S3-LEITLINE 115
6.2.1 Kunsttherapeutische Umsetzung der Zielbereiche in der S3-Leitlinie 118
6.3 METHODENKRITIK UND LIMITATIONEN 126
6.3.1 Kritische Betrachtung der Fragestellungen 126
6.3.2 Kritische Betrachtung des Studiendesigns 127
6.3.3 Kritische Betrachtung der Untersuchungsmethode 129
7 SCHLUSSFOLGERUNGEN 130
8 KURZEMPFEHLUNGEN AUF EINEN BLICK 136
9 LITERATUR 139
10 ABBILDUNGS- UND TABELLENVERZEICHNIS 151
11 ANHANG 154
11.1 INFORMATIONSSCHREIBEN ZUM EXPERT*INNENFRAGEBOGEN 154
11.2 DATENSCHUTZERKLÄRUNG ZUM EXPERT*INNENFRAGEBOGEN 156
11.3 EXPERT*INNENFRAGEBOGEN 158
11.4 ERGEBNISSE 188
11.5 RATERLISTE 259
11.6 ÜBERBLICK ÜBER DEN EINSATZ SPEZIELLER ÜBUNGEN IM MODUL 3 DER PSYCHOSOZIALEN VERSORGUNG 278
11.7 ZUSAMMENHANG VON VERNETZUNG UND KENNTNIS SOWIE ANWENDUNG DER S3-LEITLINIE 281
12 ERKLÄRUNG GEMÄß ANLAGE 4 DER PROMOTIONSORDNUNG 282
12.1 TABELLARISCHER LEBENSLAUF 28
