Intersectoral cooperation between university hospitals and physicians in private practice in Germany- where the potential for optimization lies.

BACKGROUND: Intersectoral cooperation between physicians in private practice and hospitals is highly relevant for ensuring the quality of medical care. However, the experiences and potential for optimization at this interface from the perspective of physicians in private practice have not yet been systematically investigated. The aim of this questionnaire survey was to record participants' experiences with regard to cooperation with university hospitals and to identify the potential for optimizing intersectoral cooperation. METHODS: We performed a prospective cross-sectional study using an online survey among practising physicians of all disciplines offering ambulatory care in Germany. The link to a 41-item questionnaire was sent via mail using a commercial mail distributor in which 1095 practising physicians participated. Baseline statistics were performed with SurveyMonkey and Excel. RESULTS: A total of 70.6%/722 of the responding physicians in private practice rated cooperation with university hospitals as satisfactory. Satisfaction with the quality of treatment was confirmed by 87.2%/956 of the physicians. The subjectively perceived complication rate in patient care was assessed as rare (80.9%/886). However, the median waiting time for patients in the inpatient discharge letter was 4 weeks. The accessibility of medical contact persons was rated as rather difficult by 52.6%/577 of the physicians. A total of 48.6%/629 of the participants considered better communication as an equal partner to be an important potential for optimization. Likewise, 65.2%/714 participants wished for closer cooperation in pre- and/or post inpatient care. CONCLUSION: The following optimization potentials were identified: timely discharge letters, clear online presentations of clinical contacts, improved accessibility by telephone, introduction or further development of a referral portal, regular intersectoral training and/or "get-togethers", regular surveys of general practitioners and implementation of resulting measures, further development of cross-sectoral communication channels and strengthening of hospital IT.

How to read a next-generation sequencing report-what oncologists need to know.

Next-generation sequencing (NGS) of tumor cell-derived DNA/RNA to screen for targetable genomic alterations is now widely available and has become part of routine practice in oncology. NGS testing strategies depend on cancer type, disease stage and the impact of results on treatment selection. The European Society for Medical Oncology (ESMO) has recently published recommendations for the use of NGS in patients with advanced cancer. We complement the ESMO recommendations with a practical review of how oncologists should read and interpret NGS reports. A concise and straightforward NGS report contains details of the tumor sample, the technology used and highlights not only the most important and potentially actionable results, but also other pathogenic alterations detected. Variants of unknown significance should also be listed. Interpretation of NGS reports should be a joint effort between molecular pathologists, tumor biologists and clinicians. Rather than relying and acting on the information provided by the NGS report, oncologists need to obtain a basic level of understanding to read and interpret NGS results. Comprehensive annotated databases are available for clinicians to review the information detailed in the NGS report. Molecular tumor boards do not only stimulate debate and exchange, but may also help to interpret challenging reports and to ensure continuing medical education.

Patterns of progression on osimertinib in EGFR T790M positive NSCLC: A Swiss cohort study.

INTRODUCTION: Osimertinib is an EGFR tyrosine kinase inhibitor (TKI) with antitumor activity in non-small cell lung cancer (NSCLC) with EGFR T790 M mutations. The incidence of oligo-progression (PD) on osimertinib is unknown. METHODS: We retrospectively analyzed 50 pre-treated EGFR T790M-positive NSCLC patients treated with osimertinib at seven Swiss centers. Oligo-PD was defined as PD in ≤ 5 lesions. Mutational profiling of pre- and post-osimertinib tumor samples was performed. RESULTS: Median age was 62 years (37-89), 64% were females, 86% had a PS ≤ 1, 54%/13% were never/current smokers. Median follow-up was 15.3 (IQR: 8.6-21.6) months. Overall response rate was 80%, median progression-free survival 12.1 months (95% CI 8.3-18.3), median overall survival 28 months (95% CI 20.2-not reached [NR]) and median treatment duration 18.8 months (95%CI 16-8-NR). PD occurred in 36 patients (72%). 73% had oligo-PD. Median osimertinib treatment duration in patients with oligo-PD was 19.6 vs. 7 months if systemic PD (p = 0.007). The number of progressive lesions in patients with oligo-PD was 1 (27%), 2 (35%) and 3-5 (39%). Sites of PD included lungs (56%), bones (44%), and brain (17%). Sixteen patients with oligo-PD continued treatment with osimertinib for a median of 6.7 months beyond PD. Thirteen received local ablative treatment (LAT). In pre- and post-PD tumor tissue multiple molecular alterations were detected. CONCLUSION: In patients with acquired resistance to osimertinib, we observed a high rate (73%) of oligo-PD. Outcomes of patients receiving LAT were favorable, supporting the concept of osimertinib treatment beyond progression in combination with LAT of progressing lesions.

[Health-related quality of life in asthma patients from general practice]. / Gesundheitsbezogene Lebensqualität bei Asthmapatienten in der Hausarztpraxis.

OBJECTIVE: This study investigates health-related quality of life in asthma patients from general practices in comparison with a general population sample. It further examines the association between health-related quality of life, socio-demographic characteristics and smoking behaviour. PATIENTS AND METHODS: 838 asthma patients with a mean age of 47.8 +/- 16.3 years AND 66 % female participants from 83 general practices in the region of Göttingen and Freiburg/Germany completed the St. George's Respiratory Questionnaire (SGRQ), an instrument to assess health-related quality of life, and they completed questions on socio-demographic variables and smoking behaviour. SGRQ values were compared with estimates for the general population generated in Spain. The association between SGRQ and socio-demographic characteristics and smoking behaviour was analysed by multivariate linear regression models. RESULTS: The SGRQ total values for asthma patients were three times higher than in the general population sample corresponding to a higher level of restrictions in quality of life. Both in the general population sample and in asthma patients non-smokers had a better health-related quality of life than smokers, especially with respect to respiratory symptoms. In the multivariate analysis, socio-demographic characteristics and smoking behaviour were differently related to health-related quality of life. In smokers, the level of impairment by asthma symptoms was the higher the more they had smoked. Impairment in daily activities increased with increasing age and decreasing professional status. Increasing psycho-social restrictions were associated with higher age and lower educational level. CONCLUSION: Assessing health-related quality of life in its different dimensions enables the general practitioner to conclude on the individual impairment caused by the disease. This facilitates targeted therapeutic interventions. Results from this study underline once more that quality of life should be integrated as an additional clinical parameter in population-based analyses of health care use.

Transient visual field defects induced by transcranial magnetic stimulation over human occipital pole.

Transient visual field defects (VFDs) and phosphenes were induced in normal volunteers by means of transcranial magnetic stimulation (TMS) using a circular magnetic coil of 12.5 cm diameter placed with its lower rim 2-4 cm above the inion in the midline. Subjects had to detect small, bright dots presented randomly for 14 ms in one of 60 locations on a computer screen resulting in a plot of the central 9 degrees of the visual field. In 8 of 17 subjects, transient VFDs were inducible at peak magnetic field strenghts of 1.1-1.4 T. In the central 1-3 degrees, detection of targets was impaired in both the upper and lower visual field, whereas at 4-9 degrees large parts of only the lower visual field were affected with a sharp cut-off along the horizontal meridian. Targets at 1 degree in the lower field were affected with lower TMS intensities than corresponding locations in the upper or peripheral locations in the lower field. Detection of central targets was affected at more caudal stimulation sites than detection of peripheral targets. Phosphenes were elicitable in 14 of 17 subjects at clearly lower field strengths of 0.6-1.0 T. Many subjects perceived chromatophosphenes. From a discussion of the literature on patients with VFDs and the known topography of the human visual system, it is concluded that the transient VFDs at 1-3 degrees are probably due to stimulation of both striate cortex (V1) and extrastriate areas (V2/V3), while VFDs in the lower visual field at eccentricities 4-9 degrees are due to stimulation of V2/V3 but not V1.