Guided self-help CBT for distressing voices (the GiVE intervention): predictors of engagement and outcome in routine clinical practice.

Predicting outcomes of mood, anxiety and somatoform disorders: The Leiden routine outcome monitoring study

Characterization of Poor Visual Outcomes of Diabetic Macular Edema: The Fight Retinal Blindness! Project

e12522 Background: Adjuvant abemaciclib (aA) combined with endocrine therapy (ET) is one of standard treatment for HR+/HER2- early breast cancer (BC). While efficacy has been established in MonarchE clinical trial, comprehensive real-world evidence of abemaciclib effectiveness, especially in high-risk populations with early BC, remains limited. This multicenter observational study evaluated aA outcomes in routine clinical practice. Methods: This retrospective analysis included 160 HR+/HER2- breast cancer patients receiving A with ET across multiple centers in Moscow. Primary endpoint was invasive disease-free survival (iDFS). Secondary endpoints included safety, treatment duration, and reasons for discontinuation. Survival estimates were calculated using Kaplan-Meier methodology. Data cutoff was December 2024, with median follow-up of 21.0 months (range 5.5-46.1). Results: Median age was 50 years (range 27-74); 46.3% patients were premenopausal. Disease stage distribution included Stage II (40%), and Stage III (60%). Among Stage III patients (n=96), 45% had T4 disease and 39.4% had N3 nodal involvement. Most patients (81.2%) presented with high-risk features: Ki-67>20%, grade 3 (37.4%), lymph node involvement (83.1%). Prior treatment included neoadjuvant chemotherapy in 62.5% and adjuvant in 37.5% of patients, with 88.1% receiving anthracycline-taxane combinations. At baseline, 89.4% received aromatase inhibitors, 10% switched from tamoxifen to aromatase inhibitors, and 0.6% continued tamoxifen as ET partner. Seven progression events (4.4%) were documented during follow-up. The iDFS rates were 99.4%, 96.2%, and 95.6% at 12, 24, and 36 months, respectively. Median time to progression in patients with disease recurrence was 17.7 months (range 6.1-29.8). At data cutoff, 101 patients (63.1%) continued treatment, 29 (18.1%) completed planned therapy duration. Main reasons for discontinuation included toxicity (n=13, 8.1%), disease progression (n=7, 4.4%), treatment refusal (n=7, 4.4%) and other reasons (n=3, 1.9%). Most common adverse events were neutropenia (13.8%, including Gr. 3 in 5%) and diarrhea (10.6%, predominantly Gr. 1-2). Dose reductions were required in 22% of patients. Conclusions: In this real-world cohort of HR+/HER2- with locally advanced BC disease and high-risk features, abemaciclib demonstrated favorable efficacy with 12, 24 and 36 months iDFS rates comparable to MonarchE despite more unfavorable patient characteristics. Safety profile was manageable through dose modifications, with most patients maintaining long-term treatment. These results support adjuvant abemaciclib's effectiveness in routine clinical practice, particularly in high-risk patient populations.

Purpose The purpose of this study was to evaluate 2-year visual outcomes in patients with diabetic macular edema (DME) treated with anti-VEGF agents in a routine clinical setting. Methods The medical records of patients treated with ranibizumab or aflibercept due to DME at the Eye Hospital, University Medical Centre Ljubljana, Slovenia, between January 2016 and March 2019 were retrospectively reviewed. After applying inclusion and exclusion criteria, 123 patients (123 eyes) were included in the study. Results Baseline visual acuity (VA) was 60.9 ± 15.2 letters (median 63; range 7–85). Baseline central retinal subfield thickness (CRT) was 440.7 ± 132.5 μm (median 430; range 114–1000). No significant change in VA over 2 years was found (mean change +2.1 ± 16.8 letters (median 2; range −53–52)). However, there was a significant change in VA in the subgroup with baseline VA <70 letters (mean change +5.7 ± 17.9 letters (median 5; range −52–52)). VA gains of ≥15 letters were achieved in 25 eyes (20.3%). Changes in CRT were significant over 2 years. Patients received 4.5 ± 2.1 (median 5, range 1–9) and 2.6 ± 2.3 (median 2, range 0–8) injections in the first and second years, respectively. Conclusions The two-year visual outcomes in this retrospective analysis appear to be comparable to previously reported outcomes in routine clinical practice. Our analysis provides some information about the effectiveness of anti-VEGF treatment in routine clinical practice in Slovenia. More intensive treatment should be implemented in the management of patients in order to achieve better visual outcomes.

Cognitive behaviour therapy is recommended internationally as a treatment for psychosis (targeting symptoms such as auditory hallucinations, or "voices"). Yet mental health services are commonly unable to offer such resource-intensive psychological interventions. Brief, symptom-specific and less resource-intensive therapies are being developed as one initiative to increase access. However, as access increases, so might the risk of offering therapy to clients who are not optimally disposed to engage with and benefit from therapy. Thus, it is important to identify who is most/least likely to engage with and benefit from therapy, and when. In the current study, 225 clients were assessed for suitability for a brief, 4-session, manualized, cognitive behaviour therapy-based intervention for voices (named coping strategy enhancement therapy) and 144 commenced therapy, at a transdiagnostic voices clinic based in Sussex, UK. This article reports on the value of depression, anxiety, stress, insight into the origin of voices, length of voice hearing, and demographics in the prediction of engagement and outcomes. The study found that higher levels of baseline depression, anxiety, and stress were significantly associated with poorer outcomes, especially if clients also had high levels of voice-related distress. The engagement analyses showed that levels of voice-related distress at baseline predicted dropout. These findings highlight the importance of assessing negative affect and voice-related distress prior to commencing therapy for distressing voices, to help determine if the client is suitable or ready for brief-coping strategy enhancement.

Introduction: Patients older than 80 years of age are under-represented in randomized trials of endovascular thrombectomy (EVT). In the large Florida Stroke Registry, we aimed to evaluate the impact of age on EVT outcomes in routine clinical practice. Methods: Prospectively collected data from Get with the Guidelines- Stroke hospitals participating in the Florida Stroke Registry from January 2010 to April 2020 were reviewed. The impact of age on discharge outcomes was studied using multivariate analysis with generalized estimating equations adjusting for sex, race, NIHSS, time from onset to treatment, intravenous thrombolysis, and hospital-based characteristics (size, EVT volume, and stroke center certification), and region. Results: Among 8,344 EVT patients (mean age 71±15, 49% male), 32.9% were ≥ 80 years of age. Patients ≥ 80 years were more likely hypertensive (76% vs 63%), with atrial fibrillation (56% vs 26%), presented earlier to the hospital (onset to arrival 108 vs 126 min), with more severe strokes (NIHSS 17 (IQR=11) vs 15 (IQR=11)) and less likely to ambulate independently at baseline. Short term discharge outcomes and treatment complications, stratified by age ≥ 80 or &lt; 80 are shown in the Table. In multivariable analysis, elderly patients were less likely to achieve independent ambulation (OR: 0.37, CI 0.32, 0.43) and be discharged home/rehabilitation (OR 0.36, CI 0.33, 0.40). In the continuously adjusted model, for every year increase in age, the odds of independent ambulation decreased by 3% per year (p&lt;0.001) for patients 60-80 years of age and decreased by 7% for those over the age of 80. Discussion: In routine practice, one third of endovascularly treated LVO patients are over 80. Our data shows that EVT is safe in this population; however, age remains an independent predictor of poor discharge outcomes, especially in those over the age of 80.

This study was conducted to longitudinally assess the impact of an automatically generated survivorship care plan (SCP) on patient-reported outcomes in routine clinical practice. Primary outcomes were patient satisfaction with information and care. Secondary outcomes included illness perceptions and health care use. Twelve hospitals were randomly assigned to SCP care or usual care in a pragmatic, cluster randomized trial. Newly diagnosed patients with endometrial cancer completed questionnaires after diagnosis (n = 221; 75% response), 6 months (n = 158), and 12 months (n = 147). An SCP application was built in the Web-based ROGY (Registration System Oncological Gynecology). By clicking the SCP button, a patient-tailored SCP was generated. In the SCP care arm, 74% of patients received an SCP. They reported receiving more information about their treatment (mean [M] = 57, standard deviation [SD] = 20 v M = 47, SD = 24; P = .03), other services (M = 35, SD = 22 v M = 25, SD = 22; P = .03), and different places of care (M = 27, SD = 25 v M = 23, SD = 26; P = .04) than the usual care arm (scales, 0 to 100). However, there were no differences regarding satisfaction with information or care. Patients in the SCP care arm experienced more symptoms (M = 3.3, SD = 2.0 v M = 2.6, SD = 1.6; P = .03), were more concerned about their illness (M = 4.4, SD = 2.3 v M = 3.9, SD = 2.1; P = .03), were more affected emotionally (M = 4.0, SD = 2.2 v M = 3.7, SD = 2.2; P = .046), and reported more cancer-related contact with their primary care physician (M = 1.8, SD = 2.0 v M = 1.1, SD = 0.9; P = .003) than those in the usual care arm (scale, 1 to 10). These effects did not differ over time. The present trial showed no evidence of a benefit of SCPs on satisfaction with information and care. Furthermore, SCPs increased patients' concerns, emotional impact, experienced symptoms, and the amount of cancer-related contact with the primary care physician. Whether this may ultimately lead to more empowered patients should be investigated further.

Background: Measuring and comparing grip and pinch strengths with their normative data is a valid method to detect intensity of the numerous damages of hand. The aim of the study was to establish the normative data of grip strength and three types of pinch strengths (Key, Tip and Palmar) in healthy Saudi’s children. Method: In this cross-sectional study, of grip strength and three types of pinch strengths (Tip, Key and Palmar) were recorded for 82 healthy children (41 boys and 41 girls) heathy children aged 7-18 years. The Camry Electronic Hand Dynamometer and Hydraulic Pinch Gauge were used to measure grip strength and pinch strength, respectively. Result: Normative data of grip and pinch strengths were provided. Grip and pinch strengths of both genders were close to each other’s and increasing consistently with increasing age. The maximum grip strength and pinch strength was obtained in the group of 14-18 years among both genders. In addition: Study results showed that there was a significant association between weight and all the hand grip strength and pinch strength (p &lt; 0.05) in boys whereas BMI considered as an effective parameter on grip strength and tip pinch strength in girls. Conclusions: Findings from the present study provide reference values for hand grip strength and pinch strength for healthy children from 6- which will be useful to guide rehabilitation outcomes in routine clinical practice.18 years of age which will be useful to guide rehabilitation outcomes in routine clinical practice.

BackgroundTo investigate the comparative effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1-RA) on cardiovascular outcomes in routine clinical practice, which have never been directly compared in head-to-head outcome trials. MethodsWe compared outcomes of adults who newly started SGLT2i or GLP1-RA therapy in Stockholm, Sweden, during 2013–2019. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular (CV) death, myocardial infarction and stroke. Secondary outcomes included the individual MACE components and hospitalization for heart failure. Cox regression with propensity score overlap weighting was used to estimate hazard ratios (HRs) with 95% confidence intervals and adjust for 57 covariates. ResultsWe included 12,375 individuals, of which 5489 initiated SGLT2i and 6886 GLP1-RA therapy, followed for median 1.6 years. Mean age was 61 years and 37.6% were women. Compared with GLP1-RA, SGLT2i new users had similar risk of MACE risk (adjusted HR 1.04; 95% CI 0.83–1.31). The adjusted HRs (95% CI) for SGLT2i vs. GLP1-RA were 0.80 (0.59–1.09) for heart failure hospitalization, 0.95 (0.58–1.55) for cardiovascular death, 0.91 (0.67–1.24) for myocardial infarction and 1.71 (1.14–2.59) for ischemic stroke (5-year absolute risk difference for stroke 1.9% [95% CI 0.8–3.0]). ConclusionsIn a largely primary-prevention population of people undergoing routine care, no differences were observed in MACE risk among initiators of SGLT2i and GLP1-RA. However, compared with GLP1RA, the use of SGLT2i was associated with an increased risk of ischemic stroke that was small in absolute magnitude.

Bystander-initiated cardiopulmonary resuscitation can curb the deterioration of regional cerebral oxygen saturation on hospital arrival in patients with cardiac arrest

Prediction of the Therapeutic Outcome

Evidence from randomized clinical trials shows that mechanical thrombectomy (MT) enhances functional outcomes in patients with large core ischemic stroke. To evaluate trends in the use of revascularization therapies, particularly MT, and their impact on functional outcomes in patients with large core ischemic stroke in routine clinical settings. Observational data from the Stroke Code Registry of Catalonia (CICAT, 2016-2024) were analyzed. Patients with anterior circulation ischemic stroke and Alberta Stroke Program Early CT Score (ASPECTS) <6, whether treated with reperfusion therapies or not, were included. Statistical analyses included trend analysis and multivariable logistic regression to identify predictors of favorable outcomes (modified Rankin Scale score 0-3 at 90 days) and mortality. Among 599 patients, MT use increased significantly from 22% pre-2022 to 36% post-2022. This increase was associated with improved functional outcomes, with favorable outcomes rising from 29% to 43% post-2022. MT was a significant independent predictor of favorable outcomes (OR 3.4, 95% CI 2.1 to 5.5) and reduced mortality (OR 0.46, 95% CI 0.32 to 0.68). Intravenous thrombolysis also improved outcomes (OR 2.1, 95% CI 1.3 to 3.5). The benefit of MT was consistent across ASPECTS subgroups (0-2 and 3-5). Mediation analysis indicated that 88% of improvement could be attributed to increased MT use. Increased MT use significantly improved outcomes for patients with large core ischemic stroke, particularly after 2022. Benefits were observed across subgroups, including those with very low ASPECTS. These findings support broadening MT access and suggest the need to update treatment guidelines to consider patients with large ischemic cores, aiming to optimize outcomes in routine clinical practice.

The Promise of the Quantitative Electroencephalogram as a Predictor of Antidepressant Treatment Outcomes in Major Depressive Disorder

Cerebral oximetry – The holy grail of non-invasive cerebral perfusion monitoring in cardiac arrest or just a false dawn?

Results from a Prospective Real World Study Show Strong Efficacy of Idelalisib in CLL, Including High-Risk CLL, and Provide Evidence That Pjp Prophylaxis Positively Impacts on Overall Survival