Berlin Institute of Health at Charité - Universitätsmedizin Berlin

Clinical learning environments (CLEs) are critical components of nursing education, as they influence skill acquisition, professional identity development, and learning outcomes. The aim was to systematically map the evidence regarding (1) factors of CLE that affect learning outcomes in higher nursing education, (2) the barriers and facilitators to implementing favourable CLEs, and (3) the outcomes, outcome measurement instruments, and possible effects of the CLE. A scoping review was conducted, including evidence published between 2001 and 2024, using seven databases via EBSCOhost (CINAHL, ERIC, MEDLINE, APA PsycArticles, APA PsycInfo, and Teacher Reference Centre). The reference lists of all included articles were searched manually. Data were independently extracted using a predefined table and synthesized by thematic analysis. One hundred studies were included: 80 descriptive studies, 11 intervention studies and nine reviews. Four overarching factors were identified, influencing the CLE of nursing students: (1) physical learning environment, (2) guidance and education, (3) cooperation between university and hospital, and (4) interprofessional relationships. We identified outcomes in 16 different areas, most often measured by unstandardized instruments. Barriers and facilitators were categorized into four categories: 1) university-clinical cooperation, (2) placement design, (3) roles and responsibilities, and (4) educational mentorship concepts. The findings indicate that many studies were conducted addressing various aspects of the CLE in nursing education. However, the majority of studies were descriptive, and there is an urgent need to investigate the effects of interventions to enhance the CLE to improve nursing students' learning outcomes. Most studies look at student perception; few focus on assessing clinical skills. Further research is needed to examine the interplay of clinical skills, CLEs and student perception. • The nursing clinical learning environment (CLE) is influenced by factors such as the environment, guidance, cooperation, and relationships. • Curriculum misalignment, poor placement preparation, and unclear expectations impair the CLE. • Evidence about the effects of CLE factors on learning outcomes is limited. • Most outcomes are measured using unstandardized instruments. • Comparability of study results is difficult due to outcome heterogeneity.

Cerebral small vessel disease (CSVD) is a common incidental MRI finding in patients with transient ischemic attack (TIA) and stroke and has been linked to cognitive decline. This study investigated the prevalence of CSVD imaging biomarkers in TIA patients and their association with cognitive performance over 3 years. We included 246 TIA patients from the INSPiRE-TMS study (ClinicalTrials.gov: NCT01586702). CSVD was assessed on baseline 3 T MRI using a composite score (0-4) including white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (PVS). Cognitive performance was evaluated using the Montreal Cognitive Assessment (MoCA) at baseline and annually for 3 years. At least one CSVD imaging biomarker was present in 58.5% of patients. Lacunes (36.6%) were the most common, followed by PVS (28.1%), WMH (19.5%), and CMBs (17.9%). Higher CSVD-score was independently associated with greater cognitive decline over 3 years (β = -0.52, 95% CI -0.95- -0.08, p = 0.020), along with older age (β = -0.08, 95% CI -0.13 to -0.03, p = 0.001). CMB burden was the strongest predictive component of the CSVD-score (β = 0.42, 95% CI -0.63 to -0.22, p < 0.001). CSVD-score was particularly associated with decline in the memory domain (adjusted β of -0.18, 95% CI -0.32 to -0.04, p = 0.015). CSVD imaging markers are present in over half of TIA patients and are independently associated with cognitive decline up to 3 years, with the strongest effect on memory. Whether the presence of CMBs is the strongest predictive imaging biomarker of cognitive decline in TIA patients requires confirmation in further studies.

Handheld ultrasound (HHUS) devices are increasingly used in clinical practice due to their portability and cost-effectiveness. However, HHUS image quality remains variable, and a standardized expert-based evaluation protocol is lacking. This study compares the image quality of B-mode recordings of five HHUS models with a high-end reference system (HEUS) using a blinded assessment to identify differences, covariates, offering a standardized evaluation framework.In this blinded, multi-center study, video sequences of the liver, pancreas, and sigmoid colon were recorded in ten volunteers using 5 HHUS devices - Vscan Air, Butterfly iQ+, Philips Lumify, Clarius C3, and Clarius C3 HD3 - and one HEUS (GE Logiq E10). Twenty-two physicians with many years of abdominal ultrasound experience rated blinded clips for 5 image quality parameters.The HEUS consistently received the highest ratings. Image quality differed significantly between HHUS devices. Clarius systems showed the smallest deviation from the reference, followed by Vscan Air and Philips Lumify. All image parameters significantly correlated with the overall impression, without a single dominant factor. The patients' BMI had no relevant influence. Examiner experience was less impactful than device familiarity and personal preference.The image quality of HEUS remained superior to all tested HHUS devices. Further subdivision of image quality aspects did not provide additional information. Furthermore, we could not identify significant covariates in our setup. These findings could justify simplified setups with reduced questionnaires and requirements for examiners.

Standard of care for non-metastatic colon cancer is surgery followed by stage-guided adjuvant therapy and/or structured follow-up. Upfront surgery in resectable colon cancer is irrespective of local T/N stage, whereas adjuvant systemic therapy is recommended according to pathological staging. The role of neoadjuvant chemotherapy remains unclear. Whereas perioperative systemic therapy in colon cancer seems to be safe and may lead to pathologic downstaging, evidence on improved survival and quality of life remains scarce. The PROTECTOR / FIRE‑10 trial aims to generate evidence that perioperative systemic therapy improves survival without compromising quality of life in locally advanced, mismatch-repair proficient colon cancer patients. Open-label, randomized, controlled, multicenter, phase III study with two parallel arms. Patients with locally advanced colon or upper rectal cancer staged cT3-4 and/or cN+ are randomized in a 2:1 fashion (favoring preoperative therapy) to investigate the efficacy, patient reported quality of life, and safety of preoperative therapy followed by surgery (Arm A) versus direct surgery followed by non-study specific stage-guided adjuvant therapy (Arm B). Stratification during randomization will be performed according to the following parameters: Fit for mFOLFOXIRI vs. mFOLFOX/CAPOX vs. 80%-mFOLFOX/CAPOX, ECOG 0 vs. ECOG 1-2, and left-sided primary vs. right-sided primary tumor. Only patients with confirmed mismatch-repair proficient and/or microsatellite stable tumor can be included. Preoperative treatment in Arm A is performed for a maximum of 6 biweekly cycles of FOLFOX/FOLFOXIRI or for a maximum of 4 triweekly cycles CAPOX (i.e., appr. 12 weeks). Patients in both arms should undergo quality-controlled surgery of the primary tumor, performed as complete mesocolic excision. Patients will be followed up with regard to relapse, survival and if applicable subsequent anti-cancer treatments until death or for at least 5 years after randomization, whichever date is earlier. The PROTECTOR / FIRE‑10 trial compares preoperative systemic therapy to upfront surgery (with stage-guided adjuvant therapy) in patients with locally advanced colon cancer. This study is registered with clinicaltrials.gov (NCT06899477) and EudraCT (2023-508076-11-00).

In the project funded by the Innovation Committee at the G-BA, the S3 guideline for the diagnosis and treatment of AA was developed between 2023 and 2025. The interdisciplinary expert panel consisted of representatives from the German Dermatological Society, in particular from the Pediatric Dermatology Working Group, the Professional Association of German Dermatologists, the German Society for Psychosomatic Medicine and Psychotherapy, the German Society for Pediatrics and Adolescent Medicine, the Austrian Society for Dermatology and Venereology, a hairdresser as an external consultant and two patient representatives. In the first of two parts, we present the key statements on epidemiology and the recommendations for diagnosis. Data from Germany show a population-based prevalence of AA of 0.22% (95%CI 0.21-0.22) for 2016 and 0.21% (95%CI 0.20-0.22) for 2020. This means that 170,000 people in Germany were diagnosed with alopecia areata (AA) in 2020. International data show a pooled prevalence of 2.1%, but with large regional differences. Data on the incidence of AA from Germany show that 72 patients per 100,000 were newly diagnosed with AA in 2020 (RR 0.072%; 95%CI 0.07-0.08). Extrapolated to the German population, this means that around 70,000 people were newly diagnosed with AA in 2020.

Matrix effects (ME) during LC-ESI-MS analysis are a commonly acknowledged issue for a variety of matrices and analytes. Although sample preparation techniques are steadily evolving to reduce ME, the complexity and variability of the urine matrix remain a challenge, especially for multi-analyte methods. To investigate the extent of ME implications on method performance and quantification, we used stable isotope-labelled standards (SIL-IS) of 11 mycotoxins to evaluate the magnitude and variability of ME in urine samples from two cohorts: Bangladeshi adult women (n = 50) and Swedish children of both sexes (n = 340). Significant ME differences were observed between the two cohorts for eight of the 11 mycotoxins. Additionally, intra-cohort ME variability turned out to be very high with interquartile ranges (IQR) above 15% for 14 out of 22 analyte-cohort combinations. Maximum IQR values were observed for sterigmatocystin in the Bangladeshi cohort (318%), strongly impacting quantitative results obtained with matrix(-matched) calibration. Further experiments on a small German cohort of four subjects, each providing four to five urine samples, revealed high variability of ME within each individual. Factors influencing ME were investigated, showing little to no impact of sex and a moderate impact of age for some analytes in the Swedish cohort. Nonetheless, especially the more polar analytes, showing stronger signal suppression, demonstrated clear correlation of ME with density and creatinine concentration of the urine samples. As a result, urine samples with very high or low density or creatinine values require careful handling in regard to sensitivity or quantification errors when matrix(-matched) calibration without SIL-IS is applied.

The medieval market Berlin, nucleus and starting point of what eventually became Germany's capital, was mirrored by another medieval settlement named Cölln (Lat. colonia) on the opposite side of the Spree River. In Cölln, St. Peter's cemetery was in use from about 1150-1717. In this study we investigated individuals from the earliest graves of this cemetery regarding their geographic origin using genetic analyses on bones and teeth as well isotopic analyses on dental enamel. Genetic analysis of 96 individuals was done for 16 autosomal STRs as well as the amelogenin marker for sex determination. We identified 54 unrelated males, who were typed for 27 Y-chromosomal STRs and assigned to 12 different Y-haplogroups. The Y-haplogroup distribution of St. Peter's showed a high similarity to the population of present-day Germany with high amounts of both R1a (31.5 %) and R1b (44.4 %) as well as I1 (11.1 %) and I2a (7.4 %). Geographic ancestry prediction, using AMOVA analysis, revealed a high genetic similarity between the populations of St. Peter's and the present-day German population. Significant differences could be detected for neighboring western and eastern European populations. MtDNA typing for all 96 individuals using coding region SNPs demonstrated a characteristic European distribution with haplogroups H (46.9 %), U (17.7 %), T (12.5 %), J (7.3 %) and K (8.3 %). Further typing for 48 individuals was done by sequencing the full mtDNA control region, revealing only trace amounts of Slavic-associated haplogroups. The strontium and oxygen isotope analysis of 66 of the earliest graves showed that most individuals came from the Berlin-Brandenburg area and the adjacent regions, with signs of migration limited to a few individuals.