Einstellungen (synonym Grundüberzeugungen, Schemata) von Patienten zu verändern, ist ein wichtiger Bestandteil jeder psychologischen Therapie. Grundüberzeugungen können – wie bei den meisten Menschen – positiv („Ich bin liebenswert“, „Ich bin wertvoll“ usw.), bei psychischen Störungen meist negativ (Depressionen, Ängste, Zwänge usw.), doch auch dysfunktional positiv (Hypomanie, Narzissmus usw.) sein. Die Veränderung von dominierenden, überaktiven, beeinträchtigenden Grundüberzeugungen gilt als wesentliche therapeutische Aufgabe. Dafür gibt es zwei grundsätzliche Möglichkeiten, verändernd zu wirken: verbale Kommunikation und Anleitung zur aktiven Teilnahme.
AIMS:Integrating a diabetes management system (DMS) and personal coaching in patient care may reduce the burden of type 2 diabetes (T2DM) on patients and help address the multifaceted challenges associated with diabetes management. This study aims to assess the impact of the DMS with online coaching in patients with T2DM on changes in HbA1c levels, quality of life, and usability over 26 weeks. MATERIALS AND METHODS:In a multicentre, randomised, controlled trial, adults with T2DM were randomised 1:1 to either 52 weeks of DMS with remote coaching or to usual care by their diabetologist. The DMS enabled a digital diary of blood pressure, blood glucose, and other health parameters, while coaching sessions included structured assessments of individual patient needs. The primary endpoint was changes in the HbA1c level from baseline to 26 weeks. Secondary endpoints included health-related quality of life (SF-12), diabetes-related problems (PAID), and DMS usability (System Usability Scale) at 26-week follow-up. RESULTS:One hundred and fourteen participants (49 females, 58 ± 11 years old [mean ± standard deviation], HbA1c: 8.3% ± 0.7%, body mass index [BMI]: 35.3 ± 7.9 kg/m2, diabetes duration: 13.6 ± 7.7 years) were randomised and completed baseline. Ninety participants (39 female, age: 58 ± 11 years old, HbA1c: 8.3% ± 0.7%, BMI: 35.2 ± 7.6 kg/m2, diabetes duration: 14 ± 8 years) completed 26-week follow-up. The HbA1c levels improved significantly in the intervention group in comparison to the control group (-0.9% ± 1.0% vs. -0.5% ± 1.0%, p = 0.044). No significant differences were observed in SF-12 and PAID scores at 26-week follow-up. Thirty-two of forty-three participants who used DMS completed the SUS questionnaire with an average score of 55.4 ± 27.9. CONCLUSIONS:DMS with coaching improved glycaemic control compared to usual care in patients with T2DM at 26-week follow-up.
3543 Background: BRAF V600E mutation in metastatic colorectal cancer (mCRC) is associated with poor prognosis. Registrational approval of anti-EGFR antibodies does not exclude their use in BRAF V600E mutated (mut) mCRC, while current guidelines explicitly advise against the use of anti-EGFR-directed therapy and recommend the use of chemotherapy plus anti-VEGF antibodies. The present analysis of single-patient data evaluates the therapeutic benefit from anti-EGFR- vs. anti-VEGF-directed therapy in BRAF V600E mut mCRC. Methods: We conducted a pooled analysis of eight first-line AIO-studies (FIRE-1, FIRE-3, FIRE-4, FIRE-4.5, CIOX, XELAVIRI, PANAMA, VOLFI) including 251 evaluable pts with BRAF V600E mut and RAS wild-type mCRC. Right-sided primary tumors (RSPT) included tumors from the caecum to the colon transversum, while left-sided tumors (LSPT) included the splenic flexure to the rectum. Results: Of 251 BRAF V600E mut pts, exact primary tumor location was available in 230 pts. In this cohort, 117 were male (50.9%) and 113 female (49.1%). LSPT was observed in 106 (46.1%) pts compared to 124 (53.9%) with RSPT. In the entire cohort, median OS (mOS) of LSPT vs. RSPT did not differ significantly (15.2 months vs. 13.4 months; HR 0.96; 95% CI, 0.70–1.29; P=0.77). Pts with LSPT showed a numerical survival benefit with anti-EGFR therapy compared to anti-VEGF therapy (17.8 months vs. 11.8 months; HR 0.71; 95% CI, 0.45–1.14; P=0.16). This effect was observed independent of sex. In contrast, pts with RSPT showed a trend towards inferior outcome with anti-EGFR vs. anti-VEGF therapy (11.6 months vs. 17.1 months; HR 1.31; 95% CI, 0.84–2.05; P=0.23). This effect was primarily driven by females, who experienced a significant survival disadvantage with anti-EGFR therapy (10.2 months vs. 17.1 months; HR 1.85; 95% CI, 1.05–3.25; P=0.031). For males, however, both anti-VEGF and anti-EGFR antibodies were associated with comparable outcome. Conclusions: The present analysis performed in the first-line treatment of BRAF V600E mut mCRC suggests a survival benefit from anti-EGFR antibodies in pts with LSPT, independent of gender. Male pts with RSPT appear to derive comparable benefit from anti-EGFR and anti-VEGF antibodies, while female pts exhibit a survival disadvantage from anti-EGFR antibodies. Clinical trial information: NCT00433927 (FIRE-3), NCT02934529 (FIRE-4), NCT04034459 (FIRE-4.5), NCT01249638 (ML22011), NCT00254137 (CIOX), NCT01991873 (PANAMA), NCT01328171 (VOLFI). [clinicaltrials.gov].
Zusammenfassung: Die jüngsten Revisionen der Krankheitsklassifikationssysteme DSM-5 und ICD-11 stärken die Rolle der Neuropsychologie bei der Diagnose neurokognitiver Störungen. Zugleich ist eine gewisse Stagnation der neuropsychologischen Methodenentwicklung auf dem Gebiet der Demenzdiagnostik zu verzeichnen. Vor diesem Hintergrund wurde im Rahmen des computergestützten Wiener Testsystems (WTS) das portable Test-Set Cognitive Functions Dementia (CFD) entwickelt und anhand der hier berichteten multizentrischen Beobachtungsstudie im klinischen Einsatz evaluiert. Bei guter Akzeptanz zeigten sich keine besonderen Anwendungsprobleme. Die 14 Hauptvariablen und 6 Indizes des CFD unterscheiden Demenz-Erkrankte ( n = 131) deutlich von Gesunden ( n = 407) sowie Personen mit Depression (n = 145), leichter kognitiver Störung (n = 57) und Morbus Parkinson ( n = 52). Im Vergleich zum Mini-Mental Status Test (MMST) ist das CFD sensitiver für diskrete Beeinträchtigungen neurokognitiver Funktionen. Die Ergebnisse belegen die Eignung des Test-Sets für die Demenz-Früherkennung und Differenzialdiagnostik Demenz vs. Depression.
