Personalized prognosis stratification of newly diagnosed glioblastoma applying a statistical decision tree model.

PURPOSE: Glioblastoma (GBM) is the most frequent glioma in adults with a high treatment resistance resulting into limited survival. The individual prognosis varies depending on individual prognostic factors, that must be considered while counseling patients with newly diagnosed GBM. The aim of this study was to elaborate a risk stratification algorithm based on reliable prognostic factors to facilitate a personalized prognosis estimation early on after diagnosis. METHODS: A consecutive patient cohort with confirmed GBM treated between 2010 and 2021 was retrospectively analyzed. Clinical, radiological, and molecular parameters were assessed and included in the analysis. Overall survival (OS) was the primary outcome parameter. After identifying the strongest prognostic factors, a risk stratification algorithm was elaborated with estimated odds of survival. RESULTS: A total of 462 GBM patients were analyzed. The strongest prognostic factors were Charlson Comorbidity Index (CCI), extent of tumor resection, and adjuvant treatment. Patients with CCI ≤ 1 receiving tumor resection had the highest survival odds (88% for 10 months). On the contrary, patients with CCI > 3 receiving no adjuvant treatment had the lowest survival odds (0% for 10 months). The 10-months survival rate in patients with CCI > 3 receiving adjuvant treatment was 56% for patients younger than 70 years and 22% for patients older than 70 years. CONCLUSION: A risk stratification algorithm based on significant prognostic factors allowed a personalized early prognosis estimation at the time of GBM diagnosis, that can contribute to a more personalized patient counseling.

[Fears in Dealing with Suicidal Patients: A Comparative Examination of Licensed Psychotherapists and Psychotherapeutic Trainees]. / Ängste im Umgang mit suizidalen Patient/innen: Eine vergleichende Untersuchung von approbierten Psychotherapeut/innen und Psychotherapeut/innen in Ausbildung.

OBJECTIVE: A patient's suicide is the most frequently mentioned occupational fear of psychotherapists. In the present study, fears in dealing with suicidal patients shall be specified - regarding licensed psychotherapists (LP) as well as psychotherapeutic trainees (PT). The results were compared to an analogous examination from 1996. METHODS: N=271 psychologists, thereof n=90 licensed psychotherapists and n=181 psychotherapeutic trainees, participated in an online survey. Fears in dealing with suicidal patients and occupational experiences with suicidal patients were investigated using a German Questionnaire of Capturing Therapists' Fears with Suicidal Patients by Dorrmann (2016). Furthermore, suicide-linked knowledge was examined with a short self-designed test. The following hypotheses were investigated: (1) LP have less fears in dealing with suicidal patients than PT, (2) PT and LP differ from each other regarding their suicide-linked knowledge and occupational experience, (3) the results of the current survey show less fears in dealing with suicidal patients than the results of a preceding survey by Dorrmann (1996). Eventually, the following exploratory issue was considered: Does the status (LP vs. PT) have impact on the fears while being mediated by the occupational experience as well as the suicide-linked knowledge? RESULTS: The following fears are most commonly mentioned by therapists: fear of feelings of guilt/self-blame after a suicide/attempted suicide, fear of misjudgment and the associated consequences, fear of legal consequences after a suicide/attempted suicide and fear of accusations by others (relatives of the patient/colleagues) after a suicide/attempted suicide. Psychotherapeutic trainees report higher fears dealing with suicidal patients than approbated psychotherapists. Professional experience mediates the correlation between professional status and fears. In comparison, therapists today report less fears than 20 years ago. CONCLUSION: Therapists are mainly afraid of the consequences of a suicide/attempted suicide. However, in total, fears are represented in a more moderate form and seem to be less distinctive than 20 years ago. It can be assumed that an increasing professionalization of the therapeutic interaction with suicidal patients has led to a reduction of therapists' fears.

Understanding suicidal ideation-a network analysis of the Interpersonal Needs Questionnaire.

INTRODUCTION: Identifying various interacting risk factors for suicidality is important to develop preventive measures. The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) postulates suicidal ideation resulting from the occurrence of Perceived Burdensomeness (PB) and Thwarted Belongingness (TB). Suicidal behavior ultimately occurs if people have a Capability for Suicide. In past studies, the validity of TB was often not empirically confirmed, questioning which of the aspects of TB are central and related to suicidal ideation and whether applied measurement methods adequately capture the construct. METHOD: Using a sample of 3,404 individuals from different clinical and nonclinical settings, 30% (1,023) of whom reported suicidal ideation, two network analyses were conducted on the Interpersonal Needs Questionnaire (INQ) and a variable mapping suicidal ideation. RESULTS: Analyses revealed that some items of the INQ were not related to suicidal ideation and the most central items did not have the strongest associations to suicidal ideation. CONCLUSION: Based on these results, a shortened version of the INQ with the four items that showed the strongest associations with suicidal ideation in the network analyses was suggested.