Cooperation of German ophthalmologists in routine care of patients with neovascular age-related macular degeneration: results of the non-interventional BRIDGE study.

PURPOSE: In the non-interventional ophthalmological study 'BRIDGE' the routine care of patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab was observed in Germany. A patient regularly sees the general ophthalmologist (GO) for monitoring and, if needed, the injecting ophthalmologist (IO) for intravitreal injections (IVI). Thus, patients are routinely treated by two ophthalmologists in parallel and patient care depends on their collaboration. This cooperation was evaluated based on network questionnaires. METHODS: 'BRIDGE' was a multicenter, national, open-label, prospective, observational study, conducted between July 2010 and December 2012. The network questionnaire for GOs consisted of 51 questions, while the similar questionnaire for IOs consisted of 43 questions, addressing the type and details of the individual collaboration. The statistical analysis was purely descriptive. RESULTS: The network questionnaire for GOs was completed by 152 GOs, regularly cooperating with 2.5 ± 1.1 IOs, while the questionnaire for IOs was completed by 43 IOs, regularly cooperating with 23.2 ± 23.6 GOs. Generally, both GOs and IOs stated that they regularly exchange information regarding the patients' situation. Diagnostic standards were only established for 15 % of the GOs' collaborations and for 35 % of the IOs' collaborations. After initial treatment, both GOs and IOs agreed on the medical significance of regular monitoring visits performed by the GOs. Agreements on re-treatment criteria were only established in the case of 16 % of the GOs and 28 % of the IOs. Overall, both GOs and IOs were satisfied with the current situation, with regard to the medical treatment situation for patients and to the cooperation within the networks. CONCLUSIONS: The network questionnaires revealed well-established cooperation between IOs and GOs in Germany with an accepted division of responsibilities for the routine care of patients with nAMD. However, the cooperation between two ophthalmologists treating one patient harbors risks. Agreements on diagnostic and re-treatment criteria would help to improve network performance and outcomes.

[The influence of anxiety, depression and post traumatic stress disorder on quality of life after thoracic organ transplantation]. / Psychosoziale Belastung und Lebensqualität bei Patienten nach Herz- oder Lungentransplantation.

OBJECTIVES: This study examines stress factors, resources of coping, psychopathological symptoms and their influence on health-related quality of life (QoL) in patients after heart or lung transplantation. METHODS: 82 Patients were examined with the questionnaires SF-36 (QoL), HADS-D (anxiety and depression), IES-R and PTSS-10 (post traumatic stress disorder, PTSD) 32.3 (4-86) months after transplantation. Stress factors, resources and diagnostic criteria for PTSD were investigated by structured interview. RESULTS: In the entire sample, anxiety, depression and QoL were in the range of normal population. A subgroup of 13 patients with a PTSD diagnose had significantly reduced QoL. Anxiety and intrusion explained the 42 % variance of psychosocial score of QOL. CONCLUSIONS: There was a lower influence of depression on the medical score of QoL. Psychological symptoms such as anxiety, depression and PTSD significantly influence QoL after heart or lung transplantation. Patients with a PTSD diagnose had poor QoL. Screening for PTSD should be part of routine evaluation after organ transplantation.