Helios Kliniken

Background:Cerebrovascular events are a potentially serious complication of giant cell arteritis (GCA) with intracranial involvement. However, diagnosing GCA in this context remains challenging, as classical clinical features may be absent.Objectives:To identify characteristic cerebellar infarct patterns associated with intracranial GCA and to differentiate them from other common causes of posterior circulation stroke.Design:Multicenter retrospective study.Methods:A total of 125 patients with cerebellar infarctions of various etiologies were included. Among these, 19 patients had confirmed intracranial GCA. Infarct patterns were compared to those seen in strokes of cardioembolic origin (n = 42), arterio-arterial embolism from proximal vertebral artery atherosclerosis (n = 13), local atherosclerotic stenosis of the V4 segment (n = 21), and vertebral artery dissection (n = 30). Infarct topography was assessed using acute-phase diffusion-weighted magnetic resonance imaging. Sensitivity and specificity were calculated for individual imaging features.Results:Distinct imaging signatures were observed in patients with GCA. A “corona-like” infarct pattern, defined by sparing of the medial branch of the proximal posterior inferior cerebellar artery (PICA), demonstrated a sensitivity of 79% and a specificity of 64%. A patchy infarct pattern, characterized by scattered non-confluent lesions, was present in 53% of GCA cases and showed high specificity (93%). When both features were present, specificity increased to 98% and sensitivity was reduced to 47%.Conclusion:Our findings reveal a distinct cerebellar infarct pattern associated with intracranial GCA, characterized by a corona-like configuration and patchy lesions predominantly involving the lateral PICA territory. Recognition of this imaging phenotype may enhance diagnostic accuracy in challenging cases and facilitate the timely initiation of immunosuppressive therapy.

BackgroundThe implementation of unit-dose dispensing systems (UDDS) in hospital pharmacies represents a major milestone in the digital transformation of medication therapy management, operational efficiency, and improving patient safety. However, the absence of standardized metrics for workforce planning and cost assessment has limited widespread adoption. This gap makes it increasingly challenging for healthcare stakeholders to optimize the allocation of limited medical and financial resources.MethodsUsing data from a 1,800-bed tertiary care hospital with 1,680 UDDS beds (2021–2024), this study establishes benchmarks for staffing requirements and associated costs. The following key performance metrics were analyzed: task-specific work times, unit-dose machine utilization, and productivity indicators such as blistered tablet output and blister bag production per full-time equivalent (FTE).ResultsThe findings indicate a staffing benchmark of 0.45 FTE per 100 UDDS-covered hospital beds to support both implementation and routine operations. Workforce efficiency improved significantly, with the number of FTEs per 1 million blistered tablets decreasing from 3.2 in 2021 to 1.7 in 2024. Concurrently, the cost per blister bag improved from €0.55 in 2021 to €0.22 in 2024, well within the optimal unit target price range of €0.20-€0.25; blistered tablet production tripled, rising from 1.5x106 to 4.7x106 between 2021 and 2024 respectively. A gold standard of 1 FTE per 10,000 cases was established to optimize staffing and operational workflows. The sharp decline in FTE per 1 million requirements from 5.45 to 2.29 underscores the pivotal role of experienced clinical pharmacists in ensuring safe, accurate, and resource-optimized prescription validation.ConclusionThe proposed benchmarks provide practical guidance for improving UDDS productivity, optimizing resource allocation, and strengthening workforce management. Our findings provide a framework that supports continuous UDDS improvement in hospital pharmacy operations and evidence-based decision-making for key stakeholders. By establishing clear UDDS benchmarks, this study supports cost-efficient UDDS operations while providing surrogate indicators of patient safety and clinical quality.

This study aimed to explore the current status, hotspots, and trends in research on polyunsaturated fatty acids (PUFAs) and cardiovascular inflammation. Literature related to cardiovascular inflammation and PUFAs from the Web of Science Core Collection between January 1, 2009, and July 1, 2024, was retrieved using specific search terms, and the data were visualized and analyzed using CiteSpace (version 6.3.R3) and VOSviewer (version 1.6.20). PUFAs and cardiovascular inflammation publications have been found to grow over the past 15 years. The United States leads in this field, with Nutrients being the leading journal. Harvard University and the University of California system are the most influential institutions. Most publications are in immunology and medical journals, while citations are primarily in biology and nutrition journals. International collaboration is strong, with Mozaffarian and Calder making significant contributions. Bhatt et al. and Bosch et al. have the most citations and the highest centrality, respectively. Research trends focus on the relationship between PUFAs and inflammatory markers, the anti-inflammatory mechanisms of PUFAs, and their association with diseases. Omega-3 and omega-6 PUFAs show divergent impacts on inflammation and cardiovascular diseases (CVD) risk, with gut microbiota mediating bidirectional regulation. Emerging research directions in PUFAs' anti-inflammatory mechanisms encompass gut microbiota, oxidative stress, and pro-resolving mechanisms, with gut microbiota as the current focus. This bibliometric analysis has highlighted sustained growth and global collaboration in PUFAs-cardiovascular inflammation research. Key emerging mechanisms have been found to focus on the gut-microbiota-PUFAs axis, oxidative stress, and pro-resolving pathways, pointing towards future translational opportunities.

BackgroundStatutory health insurance claims data are used for risk adjusted quality assessment of inpatient treatments. This study evaluated the impact of clinical data on quality assessment of the treatment of acute myocardial infarction (AMI), and whether the content of clinical factors can be approximated by claims data.Material and methodsIn this observational study, claims data of statutory health insurance in Germany were linked retrospectively with clinical data from 14 hospitals. The hybrid study population encompassed 3148 cases with inpatient treatment of AMI who underwent coronary angiography. Quality indicators for five outcomes were developed by means of stepwise logistic regression. Using claims data from a nationwide study population of 165 130 AMI cases and a subsample of the same size as the hybrid group, the performances of the risk adjustment models were compared by receiver operating characteristic-area under the curve (ROC-AUC) and standardised mortality/morbidity ratios (SMR).ResultsAs clinical risk factors, a haemoglobin value of ≤10 g/dL and an estimated glomerular filtration rate of ≤60 mL/min/1.73qm were included, but did not result in a gain of ROC-AUC (w/o clinical variables: 0.74–0.86; with: 0.74–0.87). By approximating the content of these clinical factors by means of claims data, an increase in model performance of up to 4.7% was achieved (with surrogates: 0.77–0.89), but did not influence the final quality assessment by SMR.ConclusionsWhile replication of our findings is necessary, our models for risk adjustment and surrogates for two clinical factors show that comparative quality reporting using claims data is feasible, although with acknowledged limitations. This would minimise the data set for quality assessment of AMI treatment in accordance with the principle of data minimisation and avoid the need for additional manual documentation.

Real-world evidence (RWE) plays an increasingly important role in healthcare decision-making, yet most industry-sponsored RWE studies are not intended for regulatory or reimbursement submission. While many such studies are conducted rigorously, this non-submission evidence base often operates without consistent protocol pre-specification, analytical transparency, or structured oversight, creating variability in quality and credibility. This Policy Brief examines this governance blind spot and argues that the challenge is structural rather than individual or intentional. Drawing on regulatory pilots and harmonisation initiatives, it shows that tools to strengthen non-submission RWE already exist but are unevenly applied. A framework is proposed based on three pillars: protocol registration, analytical transparency, and proportionate internal governance, including accountability for patient-contributed data. Extending these safeguards beyond submission-grade studies would raise baseline RWE quality and strengthen trust in RWE.

Introduction Visceral (VAT), subcutaneous (SFT), and total body fat (FM) contribute to hepatic steatosis, yet their relative and sex-specific effects across total, regional, and site-specific levels remain unclear. We investigated associations between fat depots, standardized skinfold sites, and liver fat (LF) while adjusting for key metabolic covariates.Methods In this secondary data analysis of a cross-sectional study, 48 adults (50% women; 49.6 ± 20.9 y; BMI 25.7 ± 3.7 kg/m²) underwent quantitative MRI to assess VAT and LF and ultrasound-based body mapping to quantify total and regional SFT as well as standardized skinfold sites. Bioelectrical impedance analysis determined FM. Regression analyses were conducted with LF as the dependent variable, identifying and controlling for significant covariates (diabetes mellitus [DM], arterial hypertension [aHT], hypercholesterolemia [HC], physical activity, age) (partial r). The Lindeman–Merenda–Gold (LMG) method decomposed total R² into fat-specific contributions. Total fat depots were adjusted for body surface area (BSA).Results All regression models examining associations with LF showed total r values ranging from 0.63 to 0.79. In men, DM was the only significant covariate (p = 0.002). Values are given as: partial r, LMG share (% of R2). LF correlated with VAT/BSA (0.40, 51%), total SFT/BSA (0.38, 42%), and FM/BSA (0.36, 51%). Regionally, upper-body SFT (0.40, 45%) and SFT_arms (0.37, 47%) contributed most, whereas lower-body SFT (0.35, 13%) showed minimal impact. The triceps skinfold was the most influential site among skinfolds (0.45, 50%). In women, HC was the only significant covariate (p = 0.02). LF correlated with VAT/BSA (0.40, 49%), total SFT/BSA (0.51, 27%), and FM/BSA (0.47, 36%). Regional models yielded upper-body SFT (0.43, 36%), SFT_arms (0.38, 23%), and lower-body SFT (0.41, 9%). Among single sites, the umbilical skinfold was most relevant (0.43, 36%), followed by the biceps (0.42, 33%).ConclusionVAT remains pivotal for LF in both sexes, yet SFT exhibits clear sex- and region-specific relevance. Only subcutaneous fat of the upper-body and arms contributed meaningfully to liver fat. Simple skinfold assessments—particularly triceps in men—may serve as practical indicator for early risk stratification. Larger, prospective cohorts are needed to confirm these findings.Trial registrationNot applicable this study did not involve any health care intervention.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12944-025-02809-x.

Penile cancer is arare yet highly aggressive urological malignancy, the management of which has undergone afundamental paradigm shift in recent years. Organ-preserving strategies have gained increasing importance and, particularly in early-stage disease, provide an oncologically safe alternative to radical surgery. This article examines the stage-specific management of the primary tumor, integrating current guideline recommendations, surgical techniques, and functional as well as psychosocial considerations. Special attention is given to the role of intraoperative frozen section analysis, the determination of adequate surgical margins, and the prognostic significance of local recurrence for overall survival. The findings underscore the necessity of individualized, risk-adapted treatment planning within specialized centers.