Friedrich Edelhäuser

Objectives: This hybrid study assessed the implementation and clinical effectiveness of a structured mental health care workflow for epilepsy. Methods: Eligible inpatients were screened systematically. Patients with scores above cutoff scores underwent structured diagnostic interviews followed by a multi‐component psychotherapeutic intervention (one or two sessions) aiming to develop a personalized treatment plan. Follow‐up at 1, 3, 6, and 12 months assessed treatment plan adherence and reliable change indices (RCIs) of outcomes (self‐reported depressive and anxiety symptoms, health‐related quality of life, work and social adjustment). Implementation was assessed through initial step penetration, fidelity of workflow execution, and diagnostic/therapeutic yields (appropriateness). Results: Of 345 inpatients with epilepsy, 210 were eligible and 202 entered screening. Neurocognitive and linguistic deficits were the most important reasons that only 59% of all inpatients completed the screening procedure. The workflow was implemented with high fidelity (96% across all steps) and proved clinically appropriate for the population, with one in five screened patients with epilepsy receiving a psychiatric diagnosis and a personalized treatment plan based on the brief, tailored psychotherapeutic intervention ( n = 41). Fifteen of these patients (37%) had not been diagnosed previously. After 12 months, 17 patients (41%) were lost to follow‐up; this group showed significantly higher baseline depression scores. Of the 24 patients with complete follow‐up data, 17 (71%) had initiated the recommended treatment. Eleven of those who had started treatment (65%) showed reliable improvements in at least one outcome, whereas no improvements were observed in non‐adherent patients. Significance: The integrated workflow was implemented with high fidelity and was associated with promising outcomes. However, the findings highlight the need for structural reforms to improve access and effectiveness for patients with cognitive impairment, language barriers, and severe depressive symptoms.

This article explores the topic of meditation hindrances and breakthroughs. In the traditional literature, meditation hindrances are seen as phenomena counteracting meditative activity. However, hindrances are also seen as grounds for meditative growth and breakthroughs. In current meditation research, there is an effort to understand negative effects, sometimes referred to as challenging, adverse, or harmful effects. Little is known about how people experience and deal with meditation hindrances, and especially how they experience the dissolution of hindrances (breakthroughs). The method applied to shed light on this is an innovative and multilevel phenomenological method, which includes biographical exploration, daily notetaking and reflection, and micro-phenomenology. The participants consisted of a group of five people, and the setting was a 6-day meditation retreat. We offer a new perspective on this research not only by developing the concept of meditation hindrances but also by suggesting and showing how negative effects may be part of a process leading up to a breakthrough, where the negative aspect dissolves, potentially giving rise to positive outcomes.

Intracranial pressure (ICP) burden or pressure time dose (PTD) is a valuable clinical indicator for pending intracranial hypertension, mostly based on threshold exceedance. Pulse frequency and waveform morphology (WFM) of the ICP signal contribute to PTD. The temporal resolution of the ICP signal has a great influence on PTD calculation but has not been systematically studied yet. Hence, the temporal resolution of the ICP signal on PTD calculation is investigated. We retrospectively analysed continuous 48 h ICP recordings with high temporal resolution obtained from 94 patients at the intensive care unit who underwent neurosurgery due to an intracranial haemorrhage and received an intracranial pressure probe (43 females, median age: 72 years, range: 23 to 88 years). The cumulative area under the curve above the threshold of 20 mmHg was compared for different temporal resolutions of the ICP signal (beat-to-beat, 1 s, 300 s, 1800 s, 3600 s). Events with prolonged ICP elevation were compared to those with few isolated threshold exceedances. PTD increased for lower temporal resolutions independent of WFM and frequency of threshold exceedance. PTD_beat-to-beat best reflected the impact of frequency of threshold exceedance and WFM. Events that could be distinguished in PTD_beat-to-beat became magnified more than 7-fold in PTD_1s and more than 104 times in PTD_1h, indicating an overestimation of PTD. PTD calculation should be standardised, and beat-by-beat PTD could serve as an easy-to-grasp indicator for the impact of frequency and WFM of ICP elevations on ICP burden.

Introduction: The University of Witten/Herdecke (UW/H) was founded in 1982 as the first privately run German university. In addition to economics, dentistry, a center for life sciences and the institute for general studies, the main focus from the inception of the University was the development of a model course in medical studies. Methodology: A description of the history of the development of medical studies in relation to the reasons for its founding, its founding ideals and their implementation; phases of development, transformations and influencing factors are presented in detail. External assessments are also used for this purpose. Result: The "Herdecke Model" was first implemented with the initial group of medical students in 1983. In the past 36 years the curriculum for medical education in Witten/Herdecke has evolved to meet internal and external requirements. The goals of the founders for a reform of medical studies and the founding ideals of the UW/H have continued to lead the University through a continuous reform process of medical training. From the first model of a reform degree course at UW/H 1983 to the current Model Study Course/Modellstudiengang (MSG 2018^plus), these reforms have manifested themselves in four major phases spanning a 15 year period. Landmarks of the reforms include the first systematic introduction of problem-oriented learning in Germany, and clinical and practical training with real patients in both clinical and general medical elective blocks that far surpass the Medical Licensure Act's requirements. Additionally noteworthy are the introduction of PY training wards and the active participation and co-design role students may hold. Discussion: Due to the small size of UW/H, reforms can be tested quickly and implemented with ease and flexibility. This facilitates a "laboratory setting" for the testing of future-oriented innovations. The small size has allowed various concepts to be able to be used as models, thus serving as stimuli for larger change in medical studies in Germany.

Objective : Symbolic transformations of the cardiac interbeat interval series yield a coarse-grained description of the dynamical information of the underlying system and complement standard measures of heart rate variability. The most commonly utilized coarse graining procedures are strongly influenced by the presence of a few extreme values wasting precious symbols to code very unlikely values. Approach : Here, we used a transformation procedure that ensured the appearance of each symbol with equal probability using a short alphabet, A ₄ = {0, 1, 2, 3}, and a long alphabet, A ₆ = {0, 1, 2, 3, 4, 5}. The procedure was applied to the cardiac interbeat interval series of 17 healthy subjects, obtained during graded head-up tilt tests at tilt table inclinations of 0°, 15°, 30°, 45°, 60°, 75°, 90°. The dynamics of the symbolic series was assessed by the rate of symbolic pattern categories. Symbolic patterns of length three were grouped according to the variations of the symbols in each pattern: no variation (0V%), one variation (1V%), two like variations (2LV%) and two unlike variations (2UV%) of the symbols. Main results : As for the alphabet A ₄ , the linear regression analysis on tilt angle showed that 0V% increased with increasing tilt angle whereas 1V%, 2LV% and 2UV% decreased. As for the alphabet A ₆ , the categories 0V%, and 1V% increased with increasing tilt angle whereas 2LV% and 2UV% decreased. Significance : The symbolic transformation ensuring a uniform distribution of the symbols is capable of reflecting changes in the cardiac autonomic nervous system during graded head-up tilt. This approach is more robust against outliers and data with skewed distributions compared to previously used symbolizations.

Good communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students’ experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students’ ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency. Thematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity. Reflection on real difficult clinical communication situations appears to increase medical students’ ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer. Reflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students’ overall communicative competency.

Mind-body therapies are beneficial for several diseases (e.g. chronic pain, arterial hypertension, mood disorders). Eurythmy therapy (EYT) is a mind-body therapy from Anthroposophic Medicine. In each EYT exercise a short sequence of body movements and simultaneous guided imagery is repeated several times. In this study, the simultaneous effects of two different EYT exercises on cardiac autonomic regulation as assessed by spectral analysis of heart rate variability (HRV) were investigated. Twenty healthy subjects (age: 29.1 ± 9.3 years, 13 female) performed two different EYT exercises (EYT-A and EYT-B) for 8 min. Each EYT exercise was compared against two matched control exercises: control exercise 1 (CE1-A and CE1-B) consisted of a repetition of the body movements of the EYT exercise but without guided imagery, control exercise 2 consisted of walking on the spot (CE2-A and CE2-B). Spectral power of HRV during each exercise was quantified on the basis of Holter ECG recordings. During EYT-A the frequency of the peak oscillation in the very low frequency (VLF) band matched the repetition rate of the sequence of body movements (0.02 Hz). Low frequency (LF) oscillations were augmented when compared to the control exercises (EYT-A: 7.31 ± 0.84, CE1-A: 6.98 ± 0.90, CE2-A: 6.52 ± 0.87 ln ms2, p < 0.05). They showed a peak frequency at 0.08 Hz indicating that the body postures had an impact in HRV. Performing EYT-B increased VLF oscillations when compared to the control exercises (EYT-B: 9.32 ± 0.82, CE1-B: 6.31 ± 0.75, CE2-B: 6.04 ± 0.80 ln ms2, p < 0.05). The frequency of the peak oscillation again matched the repetition rate of the sequence of body movements (0.028 Hz). The repetition of the sequence of body movements of both EYT exercises clearly affected cardiac autonomic regulation in a rhythmic manner according to the stimulus of the specific body movements of each EYT exercise. These results offer a physiological basis to develop a rationale for specific clinical indications of these EYT exercises such as stress reduction or prevention of hypertension. Clinical trials registration number: DRKS00006760 (registered on 10/10/2014, i.e. retrospective registration); view details at http://www.drks.de/DRKS00006760

The analysis of symbolic dynamics applied to physiological time series retrieves dynamical properties of the underlying regulation which are robust against the symbolic transformation. In this study, three different transformations to produce a symbolic series were applied to fetal RR interval series to test whether they reflect individual changes of fetal heart rate variability in the course of pregnancy. Each transformation was applied to 215 heartbeat datasets obtained from 11 fetuses during the second and the third trimester of pregnancy (at least 10 datasets per fetus, median 17). In the symbolic series, the occurrence of symbolic sequences of length 3 was categorized according to the amount of variations in the sequence: no variation of the symbols, one variation, two variations. Linear regression with respect to gestational age showed that the individual course during pregnancy performed best using a binary transformation reflecting whether the RR interval differences are below or above a threshold. The median goodness of fit of the individual regression lines was 0.73 and also the variability among the individual slopes was low. Other transformations to symbolic dynamics performed worse but were still able to reflect the individual progress of fetal cardiovascular regulation.

Background. Light exposure to the eye can influence different physiological functions, for example, the suprachiasmatic nucleus (SCN). By affecting the autonomic nervous system, the SCN may influence the heart rate variability (HRV). Standardized colored light exposure alters HRV but the results are inconsistent. In this study we investigated the effects of nonstandardized red light (approx. 640 nm) and blue (approx. 480 nm) light (approx. 50 lx) on cardiorespiratory coordination and HRV.Methods. 17 healthy subjects (7 males, age: 26.5 ± 6.2 years) were exposed to the following sequence (10 minutes each): daylight-red light-daylight-blue light-daylight. Red and blue lights were created by daylight passing through colored glass panes. Spectral measures of HRV (LF: low frequency, HF: high frequency oscillations, and sympathovagal balance LF/HF) and measures of cardiorespiratory coordination (HRR: heart respiration ratio, PCR: phase coordination ratio) were analyzed.Results. The LF component increased and the HF component decreased after red light. Consequently, LF/HF increased after red light. Furthermore, during red light HRR and PCR confined to 4 : 1, that is, 4 heartbeats during one respiratory cycle.Conclusion. Nonstandardized red and blue lights are able to alter the autonomic control reflected by HRV as well as cardiorespiratory coordination.