Discontinuation of BRAF/MEK-Directed Targeted Therapy after Complete Remission of Metastatic Melanoma—A Retrospective Multicenter ADOReg Study

The advent of BRAF/MEK inhibitors (BRAFi/MEKi) has significantly improved progressionfree (PFS) and overall survival (OS) for patients with advanced BRAF-V600-mutant melanoma. Long-term survivors have been identified particularly among patients with a complete response (CR) to BRAF/MEK-directed targeted therapy (TT). However, it remains unclear which patients who achieved a CR maintain a durable response and whether treatment cessation might be a safe option in these patients. Therefore, this study investigated the impact of treatment cessation on the clinical course of patients with a CR upon BRAF/MEK-directed-TT. We retrospectively selected patients with BRAF-V600-mutant advanced non-resectable melanoma who had been treated with BRAFi ± MEKi therapy and achieved a CR upon treatment out of the multicentric skin cancer registry ADOReg. Data on baseline patient characteristics, duration of TT, treatment cessation, tumor progression (TP) and response to second-line treatments were collected and analyzed. Of 461 patients who received BRAF/MEK-directed TT 37 achieved a CR. TP after initial CR was observed in 22 patients (60%) mainly affecting patients who discontinued TT (n = 22/26), whereas all patients with ongoing TT (n = 11) maintained their CR. Accordingly, patients who discontinued TT had a higher risk of TP compared to patients with ongoing treatment (p < 0.001). However, our data also show that patients who received TT for more than 16 months and who discontinued TT for other reasons than TP or toxicity did not have a shorter PFS compared to patients with ongoing treatment. Response rates to second-line treatment being initiated in 21 patients, varied between 27% for immune-checkpoint inhibitors (ICI) and 60% for BRAFi/MEKi rechallenge. In summary, we identified a considerable number of patients who achieved a CR upon BRAF/MEK-directed TT in this contemporary realworld cohort of patients with BRAF-V600-mutant melanoma. Sustained PFS was not restricted to ongoing TT but was also found in patients who discontinued TT

Phlebologie an deutschen Hautkliniken: eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Phlebologie

Reich-Schupke S, Alm J, Altmeyer P, et al. Phlebologie an deutschen Hautkliniken: Eine Bestandsaufnahme im Auftrag der Deutschen Gesellschaft für Phlebologie. Hautarzt. 2013;64(9):685-694.Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). To investigate the reasons for this development, we-on behalf of the DGP-sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.Hintergrund Venenleiden sind eine Volkskrankheit und haben eine enorme sozioökonomische Bedeutung. Dennoch scheint der Anteil der phlebologisch tätigen Dermatologen entsprechend den Zahlen der Deutschen Gesellschaft für Phlebologie (DGP) abzunehmen. Methoden Um die Ursachen dieser Entwicklung zu untersuchen, führten wir im Herbst 2012 im Auftrag der DGP eine Befragungsstudie zur Phlebologie an 120 deutschen Hautkliniken durch. Ergebnisse In 76 antwortenden Klinien gab es im Mittel 1,5 Phlebologen und 0,9 Ärzte mit Voraussetzungen zur Weiterbildungsermächtigung Phlebologie. In 71,1 % der Kliniken gab es einen Phlebologen, in 73,7 % eine phlebologische Sprechstunde. Zur Diagnostik wurden besonders die Doppler- (89,5 %) und Duplexsonographie (86,8 %) eingesetzt. In der Therapie führte die Kompressionstherapie (94,7 %), gefolgt von Sklerosierungstherapien (flüssig 78,9 %, Schaum 63,2 %, Katheter 18,4 %), den endoluminalen thermischen Verfahren (Radiowelle 28,9 %, Laser 17,1 %) und den operativen Eingriffen (vor allem Cross- und Saphenektomie 67,1 %, Seitenastexhairese 75 %). Die durchschnittlichen Behandlungszahlen waren sehr heterogen. Schlussfolgerung Die Phlebologie spielt in der Dermatologie weiterhin eine wichtige Rolle. Mehrheitlich sind in den Kliniken die Möglichkeiten zur Weiterbildung Phlebologie gegeben. Es wird ein breites Spektrum an phlebologischen Techniken zur Diagnostik und Therapie angeboten

Entwicklung eines neuen Screeninginstruments zum Screening auf Dysphagie bei geriatrischen Patienten: das Dysphagie Screening-Tool Geriatrie

Background!#!Oropharyngeal dysphagia is widespread in geriatric patients and is nearly always multicausal. It is often insufficiently recognized and leads to severe complications. The available and established screening tools all focus primarily on patients with neurological diseases, usually following a stroke.!##!Material and methods!#!The working group on dysphagia of the German Society of Geriatrics (DGG), which is comprised of physicians, speech and language therapists and dysphagia therapists, performed a literature review on dysphagia screening tools. Based on the results of the literature search and own experience, a new screening instrument suitable for geriatric patients was developed and agreed by the consensus group.!##!Results!#!The new screening instrument for the detection of oropharyngeal dysphagia in geriatric patients consists of three parts: 1) consciousness and posture control while sitting, 2) ability to swallow saliva and to cough as well as tongue motility and 3) the water swallowing test. The screening can be applied by trained medical personnel and can easily be integrated into everyday practice.!##!Conclusion!#!The new screening tool is especially aimed at geriatric patients. It has advantages compared to previously recommended screening tests. Initial experiences with the instrument show good practicability and acceptance in geriatric teams. Further studies have to test the validity of the instrument

Clinical Legal Education in Europe and Implementation of Sustainable Development Goals

Clinical legal education is a form of experiential learning where law students have the opportunity to integrate legal theory and practice by provide a range of legal services to the community whilst developing their own skills, knowledge and sense of professional responsibility. Clinical legal education grew to prominence during the 1960s civil rights movement in the United States, but it has been slower to develop throughout much of Europe. However, recent years have seen the expansion of clinical legal education programmes throughout Europe as well as the development of a European Network for Clinical Legal Education (ENCLE). This contribution will draw upon various forms of clinical legal education and critically analyse how these methodologies contribute to achieving the Sustainable Development Goals within the European region. The authors will consider the impact of clinical legal education on both the students and the wider community. For example, many clinical legal education programmes adopt a ‘live-client’ model in which students advise and represent individual clients. Whilst such models contribute to alleviating poverty, challenging discriminatory practise, and reducing inequalities, it seems evident that its impact is not limited to the individual client. Clinical legal education attempts to bridge the gap between classroom education and the reality of professional practice, emphasizing the sensitization of students as future professionals to the problems of social justice and to foster a sense of social responsibility. In addition, students engaging in clinical legal education are encouraged throughout their experience to envisage how legal institutions and practices can be reformed and reorganized to best serve the society, contributing as such to the production of knowledge based on experience rather on theory. Furthermore, clinical legal education programmes, through alternative models such as public legal education programmes, are providing information on legal rights and responsibilities thus empowering the wider community. Alternatively, policy clinics engage students in research with the aim of influencing law reform and/or policy change. Finally, this contribution will consider whether more can be done to realise the full potential of clinical legal education in achieving the sustainable development goals. In particular, the authors will consider whether clinical legal education remains at the fringe of many European law school programmes rather than as a core component. Further, the authors will posit that the establishment of partnerships, including partnerships with other disciples, and networks will lead to achieving greater societal impact

Using real-life cases as a basis for learning: experiences from Amsterdam and Zagreb

The aim of this chapter is to discuss the use of the case-study method and real-life cases in transferring knowledge about migration and asylum law to university students. The chapter focuses on two educational examples, the UNESCO Chair on Free Movement of Persons, Migration and Inter-Cultural Dialogue of the University of Zagreb and the Migration Law Clinic of the Vrije Universiteit Amsterdam (VU University). Both examples are not only similar in that they use real-life cases as their basis but also in that they encourage students to become active participants in their own learning. Another common characteristic is that they focus on European migration law and the roles and impact of decisions of the Court of Justice of the European Union (CJEU) and the European Court of Human Rights (ECtHR). In this context, education moves beyond the substantive rules and addresses the dynamics of law and the legal process. The examples demonstrate that education based on case-studies and real-life cases have much to offer to students, teaching staff and, where applicable, those actively involved in cases before the courts and tribunals, as it makes in-class discussions lively and meaningful to students