Die Bioenergetische Analyse als mögliches Verbindungsglied zwischen westlicher Psychotherapie und Chinesischer Medizin

Traditional Chinese Medicine in its modern form observes psychic processes of the ill individual only partly and in a culture-specific way. [1, 2 and 3] To understand better the psychosomatic correlations at formation, experience and processing of pain and functional disorders it can therefore make sense to also take into consideration western psychosomatic models, whose basic concepts are compatible with Traditional Chinese Medicine. Bioenergetic Analysis can fulfill these expectations with its understanding of the functional identity of psychic and somatic processes. It contributes to an ‚energetic’ understanding of psychomatically induced pain and functional disorders, and it delivers basic methods for the development of new treatments of these disorders with the help of acupuncture, acupressure, Chinese pharmatherapy and Qigong.     

Evidenz-basierte Medizin: eine Einführung für klinisch Tätige

In Germany, the term "evidence-based medicine" still leads to confusion. To our continental understanding "evidence" refers to the self-evident, what is obvious and unequivocally clear without any methodological mediation. In English speaking countries, "evidence" is defined as available and disputable facts indicating whether or not a proposition is valid. In clinical medicine both types of evidence are indispensable. However at present "external (i.e. anglosaxon) evidence" from sound-evaluative clinical research is actually needed to define and justify clinical indication rules. The rationale of the concept is obviously consequentialistic, it primarily considers the clinical and community effectiveness of any medical intervention. The paper finally discusses some of the ethical problems involved in evidence-based medicine.     

Estimation of left ventricular myocardial function by the ejection fraction in isolated, chronic, pure aortic regurgitation

In patients with aortic regurgitation (AR), the left ventricular (LV) ejection fraction (EF) may not adequately reflect depressions of myocardial contractility due to decreased aortic impedance. The sensitivity of end-systolic pressure-volume relations and stress-volume relations in detecting myocardial depression in patients with AR was studied. In 12 patients with normal valvular function but with varying LV function (due to coronary heart disease in 9 patients and dilated cardiomyopathy in 3 patients) (group 1), and in 8 patients with AR (group 2), LV angiography was performed before and after sublingual application of isosorbide dinitrate. Heart rate was kept constant by right atrial pacing. In group 1, the slope k of the end-systolic pressure-volume relation was to EF at rest: k = 0.091.e0.051 EF; r = 0.88. In AR, this relation was shifted significantly to the right: k = 0.019.e0.066 EF; r = 0.92. This shift persisted when the end-systolic stress-volume relation instead of the end-systolic pressure-volume relation was calculated. Thus, in patients with AR the end-systolic pressure-volume relation is flatter than that in patients with intact valvular function at a given EF. The same is true for the end-systolic stress-volume relation. The data indicate that EF overestimates myocardial contractility in AR compared with end-systolic pressure-volume or stress-volume relations. This overestimation is probably a result of decreased aortic impedance in AR.     

Reduction of creatine kinase and creatine kinase-MB indexes of infarct size by intravenous verapamil

In a prospective, controlled study, 29 patients were randomly allocated to receive intravenous verapamil, 5 to 10 mg/hour, for 2 days starting at a mean of 8 hours after the onset of myocardial infarction. Twenty-five patients received no specific treatment and served as control subjects. Left ventricular (LV) filling pressure in all patients was initially less than 15 mm Hg. Age, infarct localization and hemodynamic values on admission (Swan-Ganz catheter) were comparable in both groups. Maximal creatine kinase (CK) and creatine kinase-MB (CK-MB) values were markedly lower in the verapamil group than in the control group (CK 547 vs 703 U/liter, p less than 0.05; CK-MB 51 vs 68 U/liter, p less than 0.025), as was infarct weight (48 vs 65 g-Eq, p less than 0.03; CK-MB 31 vs 49 g-Eq, p less than 0.005). Arterial blood pressure was 10% lower in the verapamil group than in the control group. Systemic vascular resistance and LV filling pressure remained unchanged. Verapamil reduced myocardial infarction size by about 30% in patients without LV failure and the arterial pressure was reduced.     

Therapeutische Effekte eines externen chinesischen Arzneimittelteilbades bei 64 fastenden und nicht-fastenden Patienten mit rheumatoider Arthritis

Background

We conducted a controlled, non-randomized observational study on 64 participants suffering from rheumatoide arthritis of hands and/or feet.

Methods

32 inpatient participants were fasting 7–14 days according to Buchinger's method. In addition they bathed their hands and/or feet for 20 minutes in a Chinese medical bath on a daily basis (group A). The other 32 patients only bathed their hands and/or feet in the Chinese medical bath (group B). Both patient collectives completed a questionaire concerning pain recognition, morning stiffness, mobility, additional medication and therapies, co-medication, co-therapies and side effects.

Results

Both therapeutical groups showed a significant reduction of pain, morning stiffness and an improvement of mobility. There were no significant differences concerning their efficacy of treatment. In group A, additional medication could be reduced in 50 % of these participants, as opposed to 23 % of the patients in group B. This result showed no statistical significance due to the small group size. 10 % of the patients in group A noticed side effects of the therapy as opposed to 26 % of the patients in group B.

Conclusions

The study shows that the treatment with the external Chinese medical bath may provide a treatment option for patients with rheumatoide arthritis of the hands and/or feet who are not suited for fasting therapy.     

Das alternde Immunsystem und chronische Erkrankungen: Akupunktur, extrazelluläre Matrix und die Pflanzenformel Padma 28 im Rahmen eines strukturierten Präventions- und Therapiekonzepts

The natural process of aging leads to changes in the immune system, the so-called immunosenescence. One characteristic among others is a shift of the immune response towards cellular defense. Endogenous and exogenous triggers and lifestyle factors with pro-inflammatory effects increase oxidative stress, and through long-time accumulation lead to a chronic, low-level inflammatory status called inflammaging.Inflammaging is the basis for a range of chronic inflammatory diseases of the later part of life and thus constitutes the common denominator of diseases such as atherosclerosis, diabetes mellitus type 2, chronic periodontitis and different cancers. Inflammaging is aggravated or accelerated by an impairment of the functionality and the ability for regulation of the extracellular matrix (ECM). This may be caused e.g. by oxidative and pro-inflammatory processes, by a disturbed acid-base homeostasis or by an increased formation of advanced glycation endproducts (AGEs).Therefore, a structured three-armed prevention and therapy concept is proposed for the spectrum of chronic inflammatory diseases, in which different methods from the field of complementary medicine with a regulative, modulating mode of action can be used. Different acupuncture and acupressure methods as well as herbal multicompound formulations from Asian medicine systems can regenerate and protect the ECM and trigger the body's own anti-inflammatory mechanisms. With the example of Padma 28, a pharmaceutical composition based on Tibetan Medicine, the anti-inflammatory, cytoprotective and anti-oxidative potential of herbal remedies is illustrated.In the context of a matrix-based, structured treatment concept such remedies can make an important contribution to the prevention and therapy of chronic, inflammatory, age-related diseases.     

Information on mammography screening--from deception to insight

Information about mammography-screening as a basis for informed-decision making has to be evidence-based and presented in an unbiased format. This includes communication of results about effectiveness/lack of effectiveness of screening programmes (breast cancer mortality, total mortality), the quality of mammography as a screening test (sensitivity, specificity, positive and negative predictive values), and possible harm (consequences of false positive and false negative results, overdiagnosis of breast cancer, overtreatment). Outcome data have to be communicated as natural frequencies rather than relative differences. In order to avoid framing of data equal emphasis has to be put on the proportion of persons who are likely to benefit and those who are unlikely to benefit or likely to be harmed.     

132. Interdisziplinäre Zusammenarbeit —aus der Sicht des Soziologen

Zusammenfassung Die Bedingungen, die eine Verwirklichung des Wunsches nach interdisziplinärer Zusammenarbeit erschweren, werden ebenso untersucht, wie die Grenzen einer solchen Kooperation im Falle der Soziologie und der Medizin. Die Sozialforschung verfügt über Ergebnisse, welche die ärztliche Berufsausübung verbessern könnten, die aber auch als Eingriff in die Kompetenz des Arztes bewertet werden. Grundsätzlichere Probleme ergeben sich dann, wenn die Deutungsschemata verschiedener Fächer in Konkurrenz miteinander geraten —wie im Falle der Erklärung von Krankheit. Während dies für Wissenschaften befruchtend wirkt, ist die Hoffnung auf eine Überwindung der Aspekthaftigkeit fachlicherErklärungen eine Schimäre.     

Evidenzbasierte Medizin für den Bürger

Zusammenfassung Die Methode der evidenzbasierten Medizin beinhaltet die Forderung nach einer hohen Aktualität und Qualität medizinischer Informationen. Im Idealfall basiert diese auf Daten aus randomisierten klinischen Studien. Diese „beste verfügbare externe Evidenz“ ist die Grundlage für ein effektives Arzt-Patienten-Gespräch so wie für laiengerechte Angebote von Gesundheitsinformationen. Der Artikel beschreibt die internationalen und deutschsprachigen Bemühungen zur Bereitstellung von evidenz-basierten Patienteninformationen und die Einflüsse, die diese Bemühungen auf die Modelle der Arzt-Patienten-Kommunikation haben.     

Evidenz-basierte Intensivmedizin

Zusammenfassung Der Terminus Evidenz-basierte Medizin beschreibt den Prozess der klinischen Entscheidungsfindung im Sinne einer optimalen und patientenzentrierten Therapieentscheidung. Die Evidenz-basierte Medizin beruht auf der Anwendung rational begründbarer Therapieprinzipien im Gegensatz zur intuitiven Therapie. Nicht alle publizierten Artikel sind gleichermaßen als Grundlage einer Evidenz-basierten Medizin geeignet. Nicht wenige Arbeiten enthalten Daten von unzureichender methodischer Qualität, um die eigene Therapieentscheidung zu beeinflussen. Deshalb ist eine kritische und strukturierte Auseinandersetzung mit der Literatur unabdingbar. Der Prozess der Evidenz-basierten Medizin und deren Umsetzung in die tägliche intensivmedizinische Praxis werden im folgenden Artikel detailliert dargestellt. Neben der kritischen Datenanalyse verlangt die Evidenz-basierte Medizin auch eine abschließende Beurteilung der Ergebnisqualität. Diese kann anhand von Surrogatparametern (Organversagen, Ressourcennutzung oder Lebensqualität) sowie der Gesamtsterblichkeit der Patienten evaluiert werden. Erst die Integration des eigenen Wissens und die ausreichende Kenntnis und Bewertung der aktuellen Literatur lassen die Umsetzung der gewonnenen Erkenntnisse in eine erfolgreiche Therapie münden.