The University Hospital of Düsseldorf (German: Universitätsklinikum Düsseldorf) is located in the south of Düsseldorf, the state capital of the German state of North Rhine-Westphalia and center of the populous Rhine-Ruhr metropolitan region. It treats approximately 45,000 inpatients and 300,000 outpatients every year in 32 clinics and 34 institutes. The hospital has more than 1,200 inpatient beds. It has roughly 5,500 employees, including 1,300 nurses and 800 physicians. Many facilities are self-operated (crafts, training centers). The board consists of the medical director, the commercial director, the director of nursing and the dean of the medical faculty..
Patients with glioblastoma represent a highly vulnerable cohort as they often experience rapid health deterioration with severe symptom burden including neurological, (neuro)psychological, and psychiatric symptoms. The aim of this sub-analysis of the “Early Palliative Care for Patients with Glioblastoma” (EPCOG) trial was to investigate the specific challenges of conducting a multicenter, randomized, controlled, clinical trial in glioblastoma patients testing a specialized palliative care (PC) intervention. We analyzed screening protocols and protocol deviations with respect to number and reasons for non-participation, skipped/delayed visits and attrition using descriptive statistics and content analysis of free-text comments. In total, 41.5
Abstract Background Diagnostic pathways based on PSA, digital rectal examination (DRE), and systematic biopsy (SB) may miss clinically significant prostate cancer (csPCa) and lead to overdiagnosis of indolent disease. Multiparametric MRI (mpMRI) and MRI-targeted biopsy (TB) improve detection of csPCa; however, the additional diagnostic value of routine SB in biopsy-naïve men with suspicious MRI findings remains controversial. Methods PRIMA is a randomized, prospective, multicenter non-inferiority diagnostic accuracy trial in eight German hospitals. Biopsy-naïve men aged 50–75 years with PSA ≥ 3 ng/ml and/or suspicious DRE undergo mpMRI (PI-RADS v2.1, PI-QUAL v2). Men with PI-RADS 4–5 or PI-RADS 3 with PSA density > 0.15 are randomized 1:1 to TB only (Arm A) or TB + SB (Arm B). Persistent PI-RADS 4–5 lesions with negative biopsy undergo MRI in-bore biopsy. Outcomes Co-primary endpoints are csPCa (ISUP ≥ 2) detection and detection of clinically insignificant cancer (ISUP 1). Secondary endpoints include patient-reported outcomes (EORTC-QLQ-C30, EPIC-26, VAS), biopsy-related complications, biopsy approach, MRI in-bore yield, AI/radiomics validation and follow-up cancer incidence. Sample size One thousand nine hundred eight men were allocated to achieve 1590 analyzable patients (> 80% power; non-inferiority margin δ = 13%). Discussion PRIMA will provide high-level evidence whether systematic biopsy can be safely omitted in MRI-positive biopsy-naïve men, potentially reducing diagnostic morbidity and overtreatment. Trial registration ClinicalTrials.gov NCT04993508. Registered on 2 December 2022.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential treatment for selected patients with refractory out-of-hospital cardiac arrest (OHCA). Randomized controlled trials (RCTs) emphasize the importance of appropriate patient selection. Expert consensus statements recommend six criteria for ECPR suitability: age ≤ 75 years, witnessed OHCA, bystander cardiopulmonary resuscitation (CPR), no-flow time ≤ 5 min (min), low-flow time ≤ 60 min, and an initial shockable rhythm. Although widely accepted, these items are not supported by robust data and adherence varies greatly. We present an analysis from the German Cardiac Arrest Registry (G-CAR) describing the current state of ECPR across participating centers. Of 1,644 patients in G-CAR, 576 patients (34.6
