Adrian Gillissen

Background: Connective tissue disease-associated interstitial lung disease (CTD-ILD) is a clinically relevant subtype of fibrotic ILD. We compared baseline characteristics, treatment patterns, transplant-free survival (TFS) and progression-free survival (PFS) between CTD-ILD and non-CTD ILD. Methods: In the prospective German INSIGHTS-ILD registry, patients with known CTD status at baseline were classified as CTD-ILD or non-CTD ILD. TFS and PFS were analysed using Kaplan–Meier and log-rank tests. PFS was defined by a prespecified composite end-point including lung function decline, oxygen escalation, 6-min walk distance decline, respiratory hospitalisation, death or clinical worsening prompting any medical therapy escalation or switch. Cox models included the unadjusted Model A; Model B adjusted for age, sex, smoking, comorbidity count and baseline antifibrotic therapy; Model C additionally adjusted for baseline forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide; and Model D additionally adjusted for time since diagnosis. Results: 332 patients (35.7%) had CTD-ILD and 598 (64.3%) had non-CTD ILD. Patients with CTD-ILD were younger, more often female and more frequently received immunomodulatory therapy, whereas antifibrotic use was similar between groups. TFS was similar at 1 year (90.8% versus 90.9%; p=0.57) and at 2 years (83.7% versus 81.9%). In contrast, PFS was higher in CTD-ILD at 1 year (71.8% versus 62.7%; p=0.0032) and 2 years (52.6% versus 41.7%), with less FVC decline over follow-up. CTD-ILD was associated with a lower risk of progression in the unadjusted model (HR 0.73, 95% CI 0.59–0.90; p=0.003) and across all adjusted models. Conclusion: In routine care, CTD-ILD showed similar TFS but better PFS and less FVC decline than non-CTD ILD.

Objectives: Quality and safety in healthcare are of the utmost importance, but little is known about whether undergraduate students are aware of patient safety concepts. The objectives of our study were to assess the perception of medical students of challenges in patient safety, and collect their perceptions of error management and prevention. Methods: This study used an exploratory mixed method strategy. The first study phase collected data from semi-structured interviews of 28 students. Based on this, an online survey was constructed and sent to about 80,000 medical students in Germany. 1053 replies were received and analyzed for responses based on gender, curriculum type (problem based [PBC] vs. science based curriculum [SBC]) and years of training. Results: Most students understand the importance of patient safety, error avoidance, and the challenges of patient safety interventions. Four themes were identified: (a) the culture of patient safety (what is a good doctor? Doctors’ responsibility), (b) the working environment (the inevitability of mistakes, high work load, hierarchy, competition, teamwork), (c) the challenges of risk reduction (error avoidance, management, skills), and (d) materialistic issue (income vs. humanistic values). Female students were more risk aware than male students. Sixteen percent of students expect negative effects (e.g. punishment) when medical errors were disclosed in a team. Regardless, >70% regard teamwork as an effective error avoidance measure. Error disclosure willingness was high (89.7%). Conclusions: Although not formally part of the curriculum, students had a positive perspective concerning patient safety. The opportunities and challenges for incorporating patient safety content into the training curriculum were identified and presented.

Background and Objectives: The aim of this study was to investigate in the millennium medical student generation the influence of the curriculum (problem-based curriculum [PBC] vs science-based curriculum [SBC]), gender and semester level on medical students’ motives to study medicine, their attitudes toward their career and in this regard their view about their study condition in university. Methods: Semi-structured qualitative interviews with 28 medical students were performed and analyzed using Mayring’s content analysis. Based on these results, a quantitative questionnaire for a nationwide survey was developed using a mixed-method-approach and send to most medical faculties in Germany. Data from n=1053 students entered statistical analysis. Results: Humanistic ideals prevailed in the choice to enter medical school and to become a physician. PBC students were found to be significantly (p< 0.001) more idealistic and patient oriented, and they regard their curriculum more competitive than SBC-students (p< 0.001). A balanced work and family life is essential for all students but particularly important for the PBC – group, male and undergraduate students. The majority of students wanted to work with patients and omitted patient-distant line of work. Undergraduate SBC-students saw their studies as old-fashioned citing lack of patient contact (p< 0.001 compared to PBC), which eased in the graduate study part. Conclusion: This study found major differences in student’s perceptions depending on curriculum type. PBC-students were more idealistic, and humanistic ideals prevailed in comparison to SBC. For both, close patient contact is essential in their training. Particularly for female students, lifestyle factors and a balanced work-life-integration outweigh career ambitiousness. This study offers an important insight to policy makers and educators to understand the motivation and perceptions of the millennial student generation regarding their studies and future career plans, which should be considered in educational policies.

Digital technologies in health care, including artificial intelligence (AI) and robotics, constantly increase. The aim of this study was to explore attitudes of 2020 medical students’ generation towards various aspects of eHealth technologies with the focus on AI using an exploratory sequential mixed-method analysis. Data from semi-structured interviews with 28 students from five medical faculties were used to construct an online survey send to about 80,000 medical students in Germany. Most students expressed positive attitudes towards digital applications in medicine. Students with a problem-based curriculum (PBC) in contrast to those with a science-based curriculum (SBC) and male undergraduate students think that AI solutions result in better diagnosis than those from physicians (p < 0.001). Male undergraduate students had the most positive view of AI (p < 0.002). Around 38% of the students felt ill-prepared and could not answer AI-related questions because digitization in medicine and AI are not a formal part of the medical curriculum. AI rating regarding the usefulness in diagnostics differed significantly between groups. Higher emphasis in medical curriculum of digital solutions in patient care is postulated.

The REACT study, which evaluated the efficacy of roflumilast given together with LABA and LAMA and had as its primary endpoint reduction of moderate and severe exacerbations of chronic obstructive pulmonary disease (COPD) per patient and year,...

Inhaled corticosteroids (ICS) are less clinically effective in chronic obstructive pulmonary disease (COPD) than in asthma. In asthma, they inhibit the underlying bronchial inflammation, thus optimizing both lung function and the prognosis. In COPD,...

Background: Calretinin is one of the well-established immunohistochemical markers in the diagnostics of malignant mesothelioma (MM). Its utility as a diagnostic tool in human blood, however, is scarcely investigated. The aim of this study was to develop an enzyme-linked immunosorbent assay (ELISA) for human calretinin in blood and to assess its usefulness as a potential minimally invasive diagnostic marker for MM. Methods: Initially, attempts were made to establish an assay using commercially available antibodies and to optimize it by including a biotin-streptavidin complex into the assay protocol. Subsequently, a novel ELISA based on polyclonal antibodies raised in rabbit immunized with human recombinant calretinin was developed. The assay performance in human serum and plasma (EDTA/heparin) and the influence of calcium concentrations on antibody recognition were studied. Stability of spiked-in calretinin in EDTA plasma under different storage conditions was also examined. In preliminary studies serum and plasma samples from 97 healthy volunteers, 35 asbestos-exposed workers, and 42 MM patients were analyzed. Results: The mean detection range of the new ELISA was 0.12 to 8.97 ng/ml calretinin. The assay demonstrated markedly lower background and significantly higher sensitivity compared to the initially contrived assay that used commercial antibodies. Recovery rate experiments confirmed dependence of calretinin antibody recognition on calcium concentration. Calcium adjustment is necessary for calretinin measurement in EDTA plasma. Spiked-in calretinin revealed high stability in EDTA plasma when stored at room temperature, 4°C, or after repeated freeze/thaw cycles. Median calretinin values in healthy volunteers, asbestos workers, and MM patients were 0.20, 0.33, and 0.84 ng/ml, respectively (p < 0.0001 for healthy vs. MM, p = 0.0036 for healthy vs. asbestos-exposed, p < 0.0001 for asbestos-exposed vs. MM). Median values in patients with epithelioid and biphasic MM were similar. No influence of age, gender, smoking status, or type of medium (plasma/serum) on calretinin values was found. Conclusions: The novel assay is highly sensitive and applicable to human serum and plasma. Calretinin appears to be a promising marker for the blood-based detection of MM and might complement other markers. However, further studies are required to prove its usefulness in the diagnosis of MM patients.