Angela Buchholz

Introduction: Psychosocial distress is common in patients before and after solid organ transplantation. Regular screening facilitates the early identification of distressed patients and the provision of appropriate professional care. However, feasible screening tools that address the specific problems of transplant patients are missing. Thus, the aim of this mixed methods study was to develop transplant-specific problem lists for patients before (transplant candidates) and after (transplant recipients) solid organ transplantation which can be used as a quick and easily applicable screening tool for psychosocial distress.Method: An electronic database search resulted in a preliminary item list including 36 problems common in transplant candidates and 44 problems in transplant recipients. A total of N = 117 patients and N = 48 health care providers participated in a paper-pencil survey to assess the relevance and comprehensibility of the problem lists. Qualitative interviews about the clarity and completeness of problem lists were performed with N = 58 patients and N = 3 transplant nurses. Data analysis included the calculation of descriptive statistics and content analysis of interviews and survey open response fields. To test the concurrent validity of the problem list for patients, patients completed the problem list in combination with the National Comprehensive Cancer Network (NCNN) distress thermometer and a short form of the Patient Health Questionnaire (PHQ-4) as part of routine care.Results: The finalized list for transplant candidates includes 21 items and the list for transplant recipients 22 items, each covering four categories: problems in everyday life, social problems, worries and anxieties, physical and psychological problems. In the course of the study, sufficient data was gathered only from transplant recipients (N = 100). The number of problems endorsed by transplant recipients correlated significantly with measures of depression and distress (distress: r = 0.41, p < 0.001; PHQ-4: r = 0.63, p < 0.001; PHQ-2: r = 0.53, p < 0.001; GAD-2: r = 0.60, p < 0.001). The developed problem lists cover relevant psychosocial problems and can help to identify distress in patients before and after transplantation.Discussion: The problem list for transplant recipients showed sufficient concurrent validity, psychometric properties of the problem list for transplant candidates should be investigated in further studies.

Bei Menschen mit Substanzkonsumstörungen treten besonders häufig affektive Störungen, schizophrene Psychosen, Angsterkrankungen und posttraumatische Belastungsstörungen auf. Die richtige Diagnosestellung und eine störungsspezifische Psychotherapie sind für den weiteren Erkrankungsverlauf entscheidend. Obwohl eine integrierte Behandlung der komorbiden Störungen in aktuellen Leitlinien empfohlen wird, wird sie durch viele Barrieren erschwert. Substance use disorders (SUD) frequently co-occur with other mental disorders, particularly affective disorders, anxiety disorders, schizophrenia, and post-traumatic stress disorder (PTSD). This can exacerbate the course of both conditions, in many cases leading to longer suffering, higher relapse rates, and poorer prognoses. This article describes challenges for health care and evidence-based psychotherapeutic approaches for treating SUD and psychiatric comorbidities. Key approaches such as Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) have proven particularly effective. Current guidelines recommend integrated treatment of both disorders to enable a coherent and flexible therapeutic process. However, structural barriers, especially in outpatient settings, continue to limit access to integrated care. The article concludes by discussing specialized treatment approaches for various comorbidities and emphasizes the need for further research and specialized care offerings. Article published online: 06 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Introduction: Psychosocial distress and mental health problems are common in patients before and after solid organ transplantation and can negatively affect morbidity, mortality, and adherence. Even though regular screening is recommended to identify patients with high levels of distress, the implementation in routine care has been insufficient so far.Methods: Two newly developed problem lists for patients before and after transplantations were pilot implemented for 8 weeks at the Medical Center Hamburg Eppendorf (UKE) to identify factors facilitating and impeding their implementation.Results: Health care professionals evaluated its appropriateness, feasibility, and the cooperation with the psychologists before (HCPs: n = 23) and after (HCPs: n = 19) the implementation. Four psychologists assessed the appropriateness and feasibility by answering to open-ended and close-ended questions. Additionally, patients before (n = 8) and after (n = 100) transplantation filled out the screening and rated its acceptance. Only the data of the patients after transplantation were analyzed due to the small sample size of patients before transplantation. HCPs and psychologists rated the screenings as very appropriate [HCPs: M = 3.84 (SD = 0.77) to M = 4.32 (SD = 0.58)]. It was also highly accepted among patients [M = 4.23 (SD = 0.85) to M = 4.68 (SD = 0.65)]. Contentment with the psychological support and understanding of the mental health problems among HCPs increased significantly from before to after the implementation (U = 107.50, p < 0.05, r = 0.33; U = 107.00, p < 0.05, r = 0.34). The feasibility of the problem list post-Tx in routine care, however, was seen as challenging [HCPs: M = 3.11 (SD = 1.05) to M = 3.47 (SD = 1.07)].Discussion: The distress screening was accepted and improved the cooperation between different professions. Barriers to implementation can be lack of staff and resources. Future studies should assess the adoption and sustainability of the screening in routine care.

Zusammenfassung: Ziel der Studie Maßnahmen zur Entstigmatisierung von Substanzkonsumstörungen (SKS) sollten möglichst frühzeitig in Ausbildung und Studium adressiert werden. Bisherige Studien zeigten einen positiven Einfluss von Berufserfahrungen auf die spätere Arbeitsbereitschaft im Zusammenhang mit SKS. Diese Studie untersucht, inwieweit stigmatisierende Einstellungen gegenüber Menschen mit SKS die Berufsinteressen von Studierenden der Psychologie beeinflussen und welche weiteren Faktoren mit einer Bereitschaft für eine spätere Tätigkeit im Suchtbereich assoziiert sind. Des Weiteren stellt sich die Frage, ob und in welchem Maße der eigene Alkoholkonsum stigmatisierende Einstellungen gegenüber Menschen mit einer Alkoholkonsumstörung (AKS) beeinflusst. Methodik Es wurde eine Online-Befragung mit 157 Psychologiestudierenden in Deutschland durchgeführt. Die Stichprobe umfasst Bachelor- und Masterstudierende jeglicher Studiengänge, die der Psychologie zugeordnet werden können und wurde im Schneeballverfahren in sozialen Medien erhoben. Die Rekrutierung dauerte 3 Wochen. In einem von den Autorinnen zusammengestellten Fragebogen wurden bisherige Berufserfahrung und –Interessen erhoben. Als potenzielle Einflussfaktoren wurden praktische und private Erfahrungen mit SKS. Der Alkoholkonsum wurde mit dem AUDIT-C und das Ausmaß stigmatisierender Einstellungen mit dem OMS-HC erhoben. Ergebnisse Eigener Alkoholkonsum (AUDIT-C; p=,021) hatte einen positiven, während das Ausmaß stigmatisierender Einstellungen (OMS-HC; p<,001) einen negativer Einfluss auf die Bereitschaft zeigte, später im Suchtbereich zu arbeiten. Der AUDIT-C zeigte sich zudem als signifikanter Prädiktor für die Stigma-Ausprägung (p<,001). Die Studiendauer, Vorliegen und Dauer praktischer Erfahrung, Erfahrung mit SKS im engeren Umfeld zeigten keinen signifikanten Einfluss auf die Bereitschaft. Die Psychologie-Studierenden der vorliegenden Untersuchung wiesen im Mittel eine höhere Stigma-Ausprägung auf als eine Vergleichsstichprobe von Psycholog*innen und Medizinstudierenden in der Literatur zur OMS-HC. Schlussfolgerung Sowohl der eigene Alkoholkonsum als auch das Ausmaß stigmatisierender Einstellungen konnten als signifikante Prädiktoren für eine Tätigkeit in der Versorgung von SKS identifiziert werden. Zudem wurde festgestellt, dass der Alkoholkonsum der Studierenden ein signifikanter Prädiktor für die stigmatisierende Einstellungen ist. Maßnahmen zur Entstigmatisierung sollten frühzeitig adressiert werden, da die Stichprobe bereits zum Zeitpunkt der Erhebung ein erhöhtes Maß an stigmatisierenden Einstellungen aufweisen.

Bei Menschen mit Substanzkonsumstörungen treten besonders häufig affektive Störungen, schizophrene Psychosen, Angsterkrankungen und posttraumatische Belastungsstörungen auf. Die richtige Diagnosestellung und eine störungsspezifische Psychotherapie sind für den weiteren Erkrankungsverlauf entscheidend. Obwohl eine integrierte Behandlung der komorbiden Störungen in aktuellen Leitlinien empfohlen wird, wird sie durch viele Barrieren erschwert. Article published online: 03 May 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background: In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. Methods: The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory—European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. Results: Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen’s kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. Conclusions: While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. Trial Registration: German Clinical Trials Register DRKS00005035. Registered 03/06/2013.

Background: Young adults who underwent liver transplantation in childhood (YALTs) are highly vulnerable to non‐adherent behavior and psychosocial problems. During the COVID‐19 pandemic, special efforts may be necessary to maintain contact with these patients and offer support. This can be achieved through the use of telemedicine. The study's objective was to assess adherence and the psychosocial situation of YALTs during the COVID‐19 pandemic in Germany and to evaluate the utilization of video consultations.Methods: In May 2020, a questionnaire was sent to YALTs treated at the Hamburg University Transplant Center, accompanied by the offer of video appointments with the attending physician. The questionnaire included the Generalized Anxiety Disorder Scale 7, the Patient Health Questionnaire 2, and questions compiled by the authors.Results: Of 98 YALTs, 12% used the video consultation, while 65% had an in‐person appointment. The 56 patients who completed the questionnaire did not report reduced medication adherence during the pandemic, but 40% missed follow‐up visits with their primary care physician or check‐up laboratory tests. About 70% of YALTs were afraid to visit their physician and the transplant center, and 34% were afraid of a SARS‐CoV‐2 infection. Mental health and well‐being were unimpaired.Conclusions: During the COVID‐19 pandemic, YALTs in our study did not show an increased need for psychosocial support, but a majority were afraid to attend medical appointments, and 40% reported lower appointment adherence. Acceptance of video consultations was lower than expected. The reasons for this need to be further investigated in order to optimize care.

Ziel der Studie Für die erfolgreiche Implementierung von Leitlinien sind kontextspezifische Umsetzungsstrategien, welche die spezifische Versorgungssituation sowie mögliche Umsetzungsbarrieren berücksichtigen, vielversprechend. Ziel dieser Untersuchung war es, mögliche Barrieren und präferierte Umsetzungsstrategien für die Implementierung der S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“ aus der Perspektive von Behandlern und Betroffenen zu erfassen. Methodik Als Teil des vom Bundesministerium für Gesundheit geförderten Projekts Implementierung und Evaluation der S3-Leitlinie zu Screening, Diagnose und Behandlung alkoholbezogener Störungen (IMPELA) wurden Barrieren und mögliche Strategien für die Umsetzung der Leitlinienempfehlungen mithilfe eines selbst entwickelten Fragebogens querschnittlich erhoben. Sowohl Gesundheitsfachpersonal aus Primärversorgung und Suchthilfe (Behandler) als auch Betroffene von alkoholbezogenen Störungen und deren Angehörige in der Modellregion Bundesland Bremen wurden mithilfe unterschiedlicher Rekrutierungsstrategien (postalisch, persönlich, über ausgelegte Flyer) zur Teilnahme eingeladen. Der Fragebogen konnte in Papierversion oder online bearbeitet werden. Zusätzlich wurde der Fragebogen online über relevante Fachgesellschaften und Patientenorganisationen mithilfe von E-Mailverteilern bundesweit verbreitet. Ergebnisse Datensätze von 263 Behandlern wurden in die Auswertung eingeschlossen, davon 163 (62%) Behandler aus Bremen und 100 (38%) aus anderen Bundesländern. Die Behandler waren im Mittel zwischen 51,7 (Bremen) und 50,9 (Bundesweit) Jahre alt und hatten 22,8 (Bremen) bzw. 23,7 (Bundesweit) Jahre Berufserfahrung. Die Mehrheit der Befragten waren Ärzte (62,6% Bremen; 50% Bundesweit). Als Hauptbarrieren empfanden die Behandler das mangelnde Wissen über die Existenz der Leitlinie (65,6% Bremen; 44% Bundesweit) und die geringen zeitlichen Ressourcen im Behandlungsalltag (68,7% Bremen; 50% Bundesweit). Als mögliche Umsetzungsstrategien wurden u. a. die stärkere Information der Fachöffentlichkeit (33,7% Bremen; 39% Bundesweit) sowie Fact-Sheets (34,9% Bremen; 38% Bundesweit) genannt. Zusätzlich konnten Daten von 94 Betroffenen/Angehörigen ausgewertet werden (57,7% männlich; Alter M=44,7 Jahre). Von diesen gaben 51 Personen (54,3%) an, bereits selbst eine Suchtbehandlung in Anspruch genommen zu haben. Als Schwierigkeiten für die Versorgung benannten die Betroffenen/Angehörigen am häufigsten, dass Betroffene aus Angst vor Konsequenzen keine Hilfe suchen (n=51; 54%) oder ihre Probleme nicht wahrhaben wollen (n=49, 52,1%), sowie zu lange Wartezeiten auf Behandlungsplätze (n=45; 47,8%). Verbesserungspotential sahen die Betroffenen v. a. in den Bereichen Screening („Ansprechen des Alkoholkonsums“; n=44; 46,8%) und einem nahtlosen Übergang zwischen verschiedenen Behandlungssettings (n=42; 44,6%). Schlussfolgerungen Zusätzlich zu den bisherigen Bemühungen zur Disseminierung der S3-Leitlinie Screening, Diagnose und Behandlung alkoholbezogener Störungen legen die Ergebnisse dieser Studie die Notwendigkeit einer kontextspezifischen Förderung der Leitlinienumsetzung nahe. Purpose Aim of the study was to investigate barriers and facilitators for the implementation of the S3-guideline on screening, diagnostics and treatment of alcohol-related disorders to inform the development of context specific implementation strategies. Methods As part of the project “Implementation and Evaluation of the S3-Guideline on screening, diagnostics and treatment of alcohol-related disorders” (IMPELA), funded by the German Ministry of Health, we conducted a cross-sectional survey among health care professionals as well as persons suffering from alcohol use disorders and their relatives in the federal state Bremen. The questionnaire was developed by the study group and consisted of relevant barriers and facilitators for the implementation of the S3-guideline. For dissemination in Bremen, various strategies were applied (postal, face-to-face, leaflets). In addition, the questionnaire was distributed online via mailing lists of all German associations who were involved in the guideline development. Results Data from 263 health care professionals were included in the analyses. Of those, 163 (62%) lived in the city of Bremen and 100 (38%) in other federal states. Mean age was 51.7 (Bremen) and 50.9 (other federal states), and they had about 22.8 (Bremen) or 23.7 years (other federal states) of work experience. The majority of the health professionals (62.2% Bremen; 50% other federal states) were physicians. A lack of knowledge regarding the guideline (65,6% Bremen; 44% other federal states) and a lack of time (68,7% Bremen; 50% other federal states) were seen as major barriers by the health professionals. More information for professionals (33,7% Bremen; 39% other federal states) and fact-sheets (34,9% Bremen; 38% other federal states) were regarded as important strategies facilitating guideline implementation. In addition, 94 persons suffering from alcohol use disorders/relatives were reached (57.7% male; age M=44.7 years). Of those, 51 utilized substance abuse treatment before (54.3%). Barriers to optimal patient care were seen in the fact that persons with alcohol use disorders do not seek treatment because they fear consequences (n=51; 54%) or because they deny having alcohol problems (N=49, 52.1%), as well as too long waiting time before treatment. Relevant facilitators were seen in screening beyond the health care system (n=44; 46.8%) and a better coordination between different treatment sectors. Conclusions Given the results of this study, specific facilitation strategies are needed in addition to the previous dissemination efforts...

We aimed to develop a modular Core Set based on the International Classification of Functioning, Disability and Health (ICF) for describing functioning in patients with substance use disorders (SUD...