Rationale and Aim: Infants with Congenital Heart Disease (CHD) are at risk for neurodevelopmental delays, emotional, social and behavioral difficulties. Hospitalization early in life and associated stressors may contribute to these challenges. Family-centered Care (FCC) is a health care approach that is respectful of and responsive to the needs and values of a family and has shown to be effective in improving health outcomes of premature infants, as well as the mental well-being of their parents. However, there is limited empirical data available on FCC practices in pediatric cardiology and associations with parent and infant outcomes. Methods and Analysis: In this cross-sectional study, we will explore FCC practices at two pediatric cardiac intensive care units in Germany, assess parent satisfaction with FCC, and investigate associations with parental mental well-being and parenting stress, as well as infant physical and mental well-being. We will collect data of 280 infants with CHD and their families. Data will be analyzed using multivariate statistics and multilevel modeling. Implications and Dissemination: The study protocol was approved by the medical ethics committees of both partner sites and registered with the German registry for clinical trials (NR DRKS00023964). This study serves as a first step to investigate FCC practices in a pediatric cardiology setting, providing insight into the relationship between FCC and parent and infant outcomes in a population of infants with CHD. Results will be disseminated in peer-reviewed journals.
Objective To assess the prevalence of congenital heart disease (CHD) in Germany in relation to phenotypes, severity and gender. Design Cross-sectional registry study. Setting We analyzed data from patients with CHD born between 1996 and 2015. Patients A total of 26 630 patients, registered with the NRCHD, were born between 1996 and 2015. 10 927 patients were excluded from the current analysis due to prior registration with the NRCHD under the German PAN Prevalence Study, which showed a potential bias in the inclusion of this patient population (proportion of mild cardiac lesions was comparatively high due to improved diagnostic capability for earlier identifying minor lesions). At least 15 703 patients with demographic data and detailed medical information were included in the current study. Interventions None. Outcome Measures Prevalence of CHD in Germany differentiated into gender, severity, and phenotype. Results In total, 15 703 patients with CHD (47.1% female) were included in this study. The five most common phenotypes were found to be ventricular septal defect (19.2%), atrial septal defect (13.0%), Tetralogy of Fallot (9.3%), univentricular heart (9.4%), and coractation of the aortae (7.0%). The prevalence of CHD in regard to severity changed over the duration of the observation period. From 1996 to 2007, the number of simple CHD rose steadily (P < .001), whereas the number of severe CHD has grown significantly since 2008/2009 (P < .001). In regard to gender, the prevalence of simple CHD was higher in females, whereas complex lesions were more common in males (P < .001). Conclusions Our study shows a growing number of registered severe CHD in the recent decade in Germany. This development is noteworthy as it implicates a growing demand for first intensive hospital care, expert pediatric cardiologic aftercare, and consequently higher economic impact for this patient population.
Emotional disorders are characterized by cognitive biases towards negative stimuli, and a lack of biases towards positive ones. Therefore, we developed a cognitive bias modification training, modifying approach-avoidance tendencies to diverse emotional pictures. In Study 1, a negative training (pull negative, push positive pictures) was compared to a positive training (vice versa) in 141 students. The pre-existing positivity bias remained after positive training, but reversed into a negativity bias after negative training. This effect transferred to an attentional bias. The training affected neither mood nor emotional vulnerability to stress. In Study 2, we investigated the effects of the positive training in 102 dysphoric and non-dysphoric students, all in a sad mood state. Compared to placebo training, the positive training strengthened a positivity bias, and it reduced emotional vulnerability in dysphoric students. This suggests potential therapeutic value of the training, but further studies are needed.
Background: Die familienorientierte Versorgung (engl. Family-Centered Care, FCC) ist ein ganzheitlicher Versorgungsansatz in der stationären Betreuung von Kindern. In der Neonatologie gibt es bereits eine Vielzahl von Studien, die zeigen, dass dieser Versorgungsansatz mit einer besseren körperlichen Erholung des Kindes einhergeht und Stress, Ängstlichkeit und Depressivität der Eltern reduziert. In der Kinderkardiologie gibt es zu diesem Thema bisher kaum wissenschaftliche Erkenntnisse.
Background: Negative appraisals of the trauma and its sequelae play a crucial role in the development and maintenance of Posttraumatic Stress Disorder (PTSD). Experimental studies have shown promise in reducing negative appraisal through Cognitive Bias Modification (CBM) training. Objective: To determine whether an online CBM training designed to modify dysfunctional appraisals is successful in reducing appraisal bias in PTSD patients. Method: In this double-blinded 2-arm randomised clinical trial, 107 patients with PTSD were randomly allocated to active (n = 49) or control online CBM training (n = 57). Training comprised the completion of four sessions of online CBM training within one week. Change in bias, as measured by a scenario task and questionnaire (i.e. PostTraumatic Cognition Inventory), was the primary outcome. Secondary outcome included change in PTSD symptoms. Assessments took place prior to training, during training sessions, post-training and at 1- and 6-month follow-up. Results: Intent-to-treat analysis indicated that there was no interaction effect of condition by time. Regardless of training condition, participants showed a small to moderate decline in appraisal bias and PTSD symptoms from pre- to post-training. In both conditions, bias change during training sessions was related to decline in PTSD symptomatology following training. No moderators of outcome were found. Conclusions: There was no evidence that active training was more effective than control training in reducing dysfunctional appraisals. In both conditions, participants showed a decline in dysfunctional appraisals and PTSD symptoms following training. Importantly, bias reduction during training was related to PTSD symptom decline following training. Explanations and future research directions are discussed. CBM training aimed at reducing negative appraisals yielded promising findings in clinical analogue samples• In this RCT, active CBM training did not lead to a greater decline in dysfunctional appraisals than control training.• This study highlights the impact of appraisal on PTSD symptoms: irrespective of training condition, bias reduction during training was related to lower PTSD symptoms following training. • Follow-up studies are needed to further explore the possible clinical efficacy of CBM interventions in PTSD.
During treatment in the ICU, patients, relatives, as well as staff members are exposed to a variety of potentially traumatic experiences. The study explores current concepts to prevent negative effects on mental health resulting from intensive care treatment.
Background: Negative appraisals of the trauma and its sequelae play a crucial role in the development and maintenance of Posttraumatic Stress Disorder (PTSD). Experimental studies have shown promise in reducing negative appraisal through Cognitive Bias Modification (CBM) training. Objective: To determine whether an online CBM training designed to modify dysfunctional appraisals is successful in reducing appraisal bias in PTSD patients. Method: In this double-blinded 2-arm randomised clinical trial, 107 patients with PTSD were randomly allocated to active (n = 49) or control online CBM training (n = 57). Training comprised the completion of four sessions of online CBM training within one week. Change in bias, as measured by a scenario task and questionnaire (i.e. PostTraumatic Cognition Inventory), was the primary outcome. Secondary outcome included change in PTSD symptoms. Assessments took place prior to training, during training sessions, post-training and at 1- and 6-month follow-up. Results: Intent-to-treat analysis indicated that there was no interaction effect of condition by time. Regardless of training condition, participants showed a small to moderate decline in appraisal bias and PTSD symptoms from pre- to post-training. In both conditions, bias change during training sessions was related to decline in PTSD symptomatology following training. No moderators of outcome were found. Conclusions: There was no evidence that active training was more effective than control training in reducing dysfunctional appraisals. In both conditions, participants showed a decline in dysfunctional appraisals and PTSD symptoms following training. Importantly, bias reduction during training was related to PTSD symptom decline following training. Explanations and future research directions are discussed. CBM training aimed at reducing negative appraisals yielded promising findings in clinical analogue samples• In this RCT, active CBM training did not lead to a greater decline in dysfunctional appraisals than control training.• This study highlights the impact of appraisal on PTSD symptoms: irrespective of training condition, bias reduction during training was related to lower PTSD symptoms following training. • Follow-up studies are needed to further explore the possible clinical efficacy of CBM interventions in PTSD.
