[Brain check-up: a structured approach diagnosing mild cognitive impairment in the primary care setting]. / Gehirn-Check-up: strukturiertes Vorgehen zur Diagnostik von kognitiven Störungen im hausärztlichen Setting.

BACKGROUND: The reason-related identification of mild cognitive impairment (MCI) in primary care is helpful to treat reversible causes or decelerate progression to dementia by optimal management of existing risk factors. In this process general practitioners are in a key position. The present feasibility study investigated the practicability of a diagnostic algorithm (brain check-up), comprising neuropsychological examinations, differential diagnoses and follow-up measures. METHOD: By means of a standardized questionnaire, the utilization and practicability of the brain check-up was surveyed in n = 37 medical practices of general practitioners and internists in Germany. RESULTS: The brain check-up was performed by n = 37 physicians in 389 patients (66%). The main barriers to implementation included patients' fear of facing the results, the professionals' lack of time, and costs. Overall, 73% of the participants agreed that the brain check-up was practical in everyday treatment. Long waiting times for an appointment with a neurological/psychiatric specialist were perceived as a barrier for optimal care. CONCLUSION: The structured algorithm is convenient in physician's everyday practice and can contribute to identify patients with MCI more easily. Therefore, it appears to be a helpful tool in primary care. To achieve sustainability in everyday use, identified barriers need to be addressed during the implementation phase.

Investigating information needs and preferences regarding digital mental health services among medical and psychology students in Germany: A qualitative study.

Background: Since 2020, physicians and psychotherapists in Germany can prescribe digital mental health services (dMHSs). However, even future healthcare professionals (HCPs), such as medical and psychology students, remain reluctant to use dMHSs, although they are a risk group for mental health issues themselves. Reasons include scepticism and lacking awareness of dMHSs, which can be addressed by acceptance-facilitating interventions (AFIs) such as information strategies. To date, though, little is known about their information needs. Methods: Semi-structured interviews with n = 21 students were conducted between August and September 2021. Students of legal age studying psychology or medicine at a German university could participate. Interview recordings were transcribed verbatim and content-analyzed according to Mayring, using deductive and inductive coding. Results: Most students reported having little experience with dMHSs. Digital health has barely been raised in their study, even though it was perceived as crucial for personal needs as well as in preparation for their work as HCPs. Students favoured receiving information on and recommendations for dMHSs from their university via, e.g. social media or seminars. Among others, information about data safety, scientific evidence base and application scope were preferred. Additionally, information on costs as well as user reviews seemed to be essential components of information strategies because students were concerned that high costs or low usability would hinder uptake. Conclusions: The results give first insights on how future HCPs would like to be informed on dMHSs. Future research should focus on systematic variations of AFIs' components mimicking real-world decision scenarios to increase the adoption of dMHSs.

[Clinical and pathological prognostic factors for the long-term survival of patients with pT1 renal cell carcinoma]. / Klinische und pathologische Prognosefaktoren für das Langzeitüberleben von Patienten mit pT1 Nierenzellkarzinom.

Introduction The incidence of renal cell carcinoma (RCC) has been increasing over the past few decades. Simultaneously, due to improved imaging, small renal masses at stage pT1 have been diagnosed more frequently. However, it is known that even small RCCs may recur and metastasize at a late point of time. This study aimed to identify easy-to-assess clinical and histopathological prognostic markers for long-term survival. Patients/Methods We performed a retrospective analysis of patients who underwent surgical treatment of a pT1 RCC in a single centre between 1993 and 2007. The prognostic impact of clinical and histopathological parameters was investigated regarding recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Univariate Kaplan-Meier analysis and multivariate Cox regression analysis were performed using SPSS 23. Results Overall, 571 patients were included with a median follow-up of 111 months. Univariate analysis revealed that higher grading (p = 0.031) and stage pT1b (p < 0.001) were statistically significantly associated with worse RFS. Likewise, stage pT1b (p = 0.001) and grading G2/3 (p = 0.019) were significantly associated with shorter CSS. Multivariate analysis revealed that stage pT1b was the only predictor for reduced RFS (p = 0.001) and CSS (p = 0.009). Total nephrectomy (p = 0.024), and diabetes (p < 0.001) were significantly associated with reduced OS. Multivariate analysis revealed that multifocal tumours (p = 0.041) and diabetes (p < 0.001) were the best predictive factors for OS.  Conclusion The identified prognostic parameters may help to provide a risk-adapted after follow-up for patients with small renal tumours.