Introduction

Interprofessional collaboration is essential in modern clinical practice. Since the introduction of interprofessional training wards (IPSTAs) in 1996, these units have aimed to strengthen teamwork and communication across professional boundaries. This study, conducted at Regensburg University Hospital, evaluates and compares patient outcomes, cost-effectiveness, cross-sector care quality, interprofessional collaboration, and satisfaction among patients, families, and caregivers between the A-STAR interprofessional training ward and conventional wards.

Aims & Methods

The study was conducted at the A-STAR interprofessional training ward and at conventional gastroenterology-focused wards of Regensburg University Hospital between October 2019 and October 2025. Anonymized, standardized questionnaires were utilized to assess clinical outcomes, cost efficiency, and satisfaction, employing instruments such as the Collaboration and Satisfaction About Care Decisions (CSACD) and the Family Satisfaction in the Intensive Care Unit (FS-ICU) tools. Feedback on cross-sectoral care transitions was obtained from both general practitioners and patients. Furthermore, between October and December 2024, nursing trainees, medical students, nursing staff, and physicians from both the A-STAR ward and the conventional wards were systematically observed during weekday shifts, with the duration and content of their activities systematically documented.

Results

The analysis included 1,514 A-STAR patients and 5,847 from standard wards. Clinical outcomes, such as discharges against medical advice, readmissions due to complications, and mortality, showed no significant differences between groups. However, A-STAR demonstrated higher cost-efficiency, with lower material costs and increased DRG revenue per case. Satisfaction among patients, families, and caregivers was significantly higher on the interprofessional ward. After discharge, only 3.03% of A-STAR patients developed new complaints compared to 22.45% of patients from the normal ward (χ²=6.431; p=0.011). No A-STAR patients (n=32) required post-discharge medication adjustments by their outpatient physicians, whereas 12.63% of patients from the normal ward did (χ²=4.464; p=0.035). Interprofessional interactions tended to last longer on the A-STAR ward (median: 47 minutes; IQR: 60) compared to conventional wards (median: 36 minutes; IQR: 29; p = 0.083, U = 38.500, Z = -1.731). Contacts with physiotherapists were significantly longer on A-STAR (median: 19 minutes; IQR: 60) than on conventional wards (median: 0 minutes; IQR: 1; p < 0.001, U = 13.000, Z = -3.426).

Conclusion

The implementation of the interprofessional A-STAR ward at Regensburg University Hospital maintained clinical safety while improving cost-efficiency and significantly enhancing patient, family, and caregiver satisfaction. Patients treated on A-STAR experienced fewer post-discharge complications and medication adjustments. Longer and more intensive interprofessional interactions, especially with physiotherapists, may have contributed to these positive outcomes. A-STAR demonstrates that structured interprofessional care can add measurable value to clinical practice without compromising patient outcomes.

Disclosure

All authors are employed at the department where the A-STAR interprofessional training ward is implemented.

Introduction

Radioactive phosphorus (³²P) is an innovative therapy for locally advanced pancreatic cancer that is implanted through endoscopic ultrasound (EUS). Pancreatic cancer is the fourth cause of death and is responsible for 7% of all deaths caused by cancer. Nowadays the improvement of chemotherapy and the usage of combination therapies led to a better prognosis and studies showed an improvement of the survival parameters (OS, Free Progression Survival). One of the most innovative therapies is the implantation of radioactive phosphorus-32 which is a type of brachytherapy. It is indicated for the treatment of patients with Locally Advanced Pancreatic Cancer (LAPC) in combination with gemcitabine-based chemotherapy.

Aims & Methods

The primary goal of this study is to determine the safety of the intra-tumoral implantation of radioactive phosphorus (³²P) through EUS and the complications of the procedure of implantation. The secondary goals are to determine the Local Disease Control Rate (LDCR) at 16 weeks and the effectiveness of the implantation of radioactive phosphorus by measuring Overall Survival (OS), Progression Free Survival (PFS) and Local Progression Free Survival (LPFS). We currently have made the implantation in eight patients with similar clinical and demographic features who suffer from locally advanced pancreatic cancer. They receive gemcitabine-based chemotherapy in combination with an intra-tumoral therapy with radioactive phosphorus (³²P) through a 22-gauge FNA needle guided by EUS. The adverse events of the implantation are evaluated by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. The LDCR is evaluated at 16 weeks and the alteration of Tumor Volume every two months for the first year after implantation and every three months the second year after implantation according to RECIST 1.1.

Results

The eight procedures (median age of patients: 68,5 years) were unremarkable and no complication during the procedure was noted. The patients did not have any major adverse events during the day of the procedure. Five out of eight patients (62,5%) revealed mild abdominal pain on the second day which recovered with typical pain killers. The LDCR, for all patients, at 16 weeks, was 100%. Two of the patients had a major reduction in the tumor so it was resectable. The operations were without any complications and the pathology test showed R0 resection. Two patients died after 12 months of follow up (one patient showed progression disease after 10 months from implantation and one patient had stable disease until death) and one patient revealed progression of disease after 12 months and is still alive after 15 months of follow up. Three patients have stable disease after 6 months of follow up, even though a slight reduction of the tumor has been noted. The six patients (including the two that died and not including the two that underwent surgery) have been followed up for 6 to 15 months, depending on time of implantation. The median Progression Free Survival for these six patients is 7 months (max 12 months – min 6 months) and the median Local Progression Free Survival is 6 months (max 12 months – min 6 months).

Conclusion

We must include more patients to conduct more useful results, but the initial results look promising.

References

1.Wungki P, Akhil C, Eileen M. Pancreatic Cancer: A Review. JAMA. 2021 September 07;326(9):851-862.
2.OncoSil System: Instruction for Use
3.Audrey V, Joseph H, Rich S, et al. Pancreatic cancer. Lancet. 2011 August 13; 378(9791): 607-620. doi: 10.1016/S0140-6736(10)62307-0.

Disclosure

​None to report

Introduction

The rs7057398 mutation in the CLDN2-MORC4 locus on the X chromosome has been linked to chronic pancreatitis according to several recent publications and a meta-analysis. However, the mutation itself is located very far from both genes (CLDN2 and MORC4), and according to our current knowledge, the protein products of CLDNS and MORC4 genes are not functionally related to the development of chronic pancreatitis.

Aims & Methods

Our aim was to investigate the frequency of the rs7057398 mutation in Hungarian patients with alcoholic and non-alcoholic pancreatitis and controls. Our study included 139 non-alcoholic (NACP) and 161 alcoholic chronic pancreatitis (ACP) patients and 509 controls recruited by the Hungarian Pancreatic Study Group (HPSG). The rs7057398 mutation (CLDN2 c.-26930T>C) status in DNA samples was examined by conventional PCR amplification and Sanger sequencing.

Results

The “C” allele of the rs7057398 mutation showed significant accumulation in patients with chronic pancreatitis (p<0.0001, OR 1.96, 95% CI 1.6-2.4), especially in the alcoholic group (p<0.0001, OR 2.56, 95% CI 1.98-3.3). When women are grouped separately, it is seen that the significant accumulation of the “C” allele is only significant in alcoholic chronic pancreatitis (p<0.005, OR: 2.5, CI: 1.3-4.8), which is also confirmed by the genotype distribution in the same group containing only women (dominant model: p 0.017, OR 3.55, 95% CI 1.3-10, recessive model: p 0.049, OR 3.01, 95% CI: 1.01-9.01).

Conclusion

The rs7057398 mutation located in the CLDN2-MORC4 locus on the X chromosome predisposes to the development of chronic pancreatitis in the Hungarian population, which association is particularly true in chronic pancreatitis of alcoholic etiology.

Introduction

Early diagnosis of pancreatic cancer is crucial for improving patient outcomes. High-grade pancreatic intraepithelial neoplasia (HG-PanIN), considered a carcinoma in situ of the pancreas, can lead to long-term survival when surgically resected—even in the absence of detectable lesions on conventional imaging such as CT or MRI. In this study, we analyzed resected cases of HG-PanIN collected through the Japanese Early-stage Diagnosis Project of Pancreatic Cancer (JEDPAC), focusing on correlations between histopathological findings and preoperative imaging to identify potential diagnostic indicators.

Aims & Methods

Fifty cases (32 males, 18 females; age range 52–89 years, mean age 69.8 years) of surgically resected HG-PanIN, confirmed via central pathological review by two expert pathologists, were selected from JEDPAC-affiliated centers between 2011 and 2018. Preoperative imaging findings—including CT, MRI (MRCP), EUS, and ERCP—were retrospectively compared with pathological data.

Results

Lesions were located in the pancreatic head in 11 cases and in the body/tail in 39 cases. Sixteen cases involved only the main pancreatic duct (MPD, Group A), 27 involved both MPD and branch ducts (Group B), and 7 were confined to branch ducts (Group C). In Groups A and B, 40 cases showed longitudinal intraductal spread of ≥10 mm, and 14 exhibited skip lesions with discontinuous HG-PanIN components. MPD stenosis was frequently observed in cases with ≥10 mm ductal spread, particularly in Groups A and B, and was often accompanied by focal parenchymal atrophy corresponding to the lesion. In skip lesions, however, HG-PanIN foci did not consistently correspond to areas of ductal stenosis, making precise preoperative localization by imaging difficult. In Group C, round or oval-shaped cystic lesions near branch ducts were frequently identified, and associated parenchymal atrophy was minimal.

Conclusion

HG-PanIN often involves both main and branch pancreatic ducts, with MPD stenosis and localized parenchymal atrophy serving as important imaging clues for diagnosis. However, skip lesions challenge accurate localization with current imaging modalities. In cases confined to branch ducts, subtle atrophy and the presence of small, round cystic lesions may aid early detection.

Introduction

Pancreatic fluid collections (PFCs) are significant local complications that can arise from acute pancreatitis, and its management often involves drainage, although the benefits of metal stents over plastic stents remain uncertain. This meta-analysis compared the efficacy and safety of metal stents versus plastic stents for endoscopic ultrasound (EUS)-guided drainage of PFCs.

Aims & Methods

We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing metal with plastic stents for drainage of PFCs. The odds ratio (OR) was used for binary outcomes and the mean difference (MD) for continuous outcomes with their respective 95% confidence interval (CI).

Results

This study included eight RCTs and over 500 patients. Procedure duration was shorter in the metal stent arm compared with the plastic stent arm (MD -10.63; 95%CI -16.12 to -5.15, p<0.001). However, there was no statistically significant difference between metal and plastic stents in clinical success (p=0.78), technical success (p=0.65), overall mortality (p=0.48), recurrence (p=0.23), number of interventions (p=0.85), need of necrosectomy (p=0.35), need of surgery (p=0.35), length of hospitalization (p=0.86), exocrine insufficiency (p=0.54), endocrine insufficiency (p=0.77), and AEs (p=0.36).

Conclusion

Metal stents for EUS-guided drainage of PFCs are associated with a shorter procedure duration. Besides that, it did not improve other clinically relevant outcomes in comparison with plastic stents.

Introduction

Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have demonstrated metabolic and cardiovascular benefits in patients with type 2 diabetes (T2D). However, their potential effect on pancreatic cancer (PC) risk remains unclear.

Aims & Methods

We aimed to examine the association between SGLT-2i use and PC risk in T2D patients prescribed metformin. We conducted a retrospective cohort study using a territory-wide electronic healthcare database, retrieving adult patients (≥18 years) with T2D who initiated metformin between 2015 and 2022. The index date was the first metformin prescription during the study period. Patients were observed until PC, pancreatectomy, death, or study end date (December 31, 2022). Exclusion criteria included prior history of PC, IgG4 disease, pancreatectomy, or fewer than two HbA1c measurements during follow-up. The outcome and exposure of interest was PC and SGLT-2i use (including dapagliflozin, empagliflozin, canagliflozin and ertugliflozin), respectively. SGLT-2i exposure was defined as continuous use during 90-day entry period following the index date. Cox proportional hazards model with propensity score (PS) matching (1:2) on 28 covariates – age, sex, smoking, alcohol use, body mass index (BMI), diabetes duration and complications, glycemic control (in terms of time-weighted mean HbA1c), history of pancreatitis and cholangitis, comorbidities, and concomitant medication use (aspirin, statins, and other antidiabetic medications) – were used to estimate hazard ratios (HRs). Sensitivity analysis by treating medication use as time-varying variable was conducted to address immortal time bias.

Results

Among 144,468 matched patients (mean age:59.3±11.2 years; male:58.3%; 48,156 SGLT-2i users and 96,312 SGLT-2i non-users), 441 (0.31%) developed PC during a mean follow-up of 6.6±2.0years. The mean duration of SGLT-2i use was 2.1±1.6 years. SGLT-2i use was associated with lowered PC risk (aHR:0.43; 95% CI:0.34-0.55), irrespective of empagliflozin (aHR0.43; 95%CI: 0.33-0.57) or dapagliflozin use (aHR:0.33; 95% CI:0.22-0.49). When drug use was modelled as time-varying variables, the protective effect remained significant (aHR:0.35; 95% CI:0.15-0.78). Furthermore, a dose- and duration-dependent relationship was observed. The aHR was 0.88 (95% CI:0.84-0.92) per 100-cumulative defined daily dose (cDDD) increase in use, and 0.66 (95% CI:0.59-0.75) per 1-year increase in use. Subgroup analysis showed beneficial effects persistent regardless of age (cutoff of 65 years), sex, BMI (cutoff of 25 kg/m²), diabetes complications, usage of other medications (aspirin, statins, and insulin).

Conclusion

SGLT-2i use was associated with a lower risk of PC in a dose- and duration-dependent manner, which was independent of glycemic control, among T2D patients treated with metformin. These findings provide insights into informing the choice of second-line anti-diabetic drug in lowering PC risk in T2D metformin users.

Introduction

We aimed to assess the role of islet autoimmunity and family history of diabetes in the presence of CFRD in children with CF.

Aims & Methods

Data from 78 children were analysed from the CF-related Pancreatic Disorders Registry. Pancreatic islet autoantibodies (AABs) (glutamic acid decarboxylase (GAD), insulin (IAA), islet antigen-2 (IA-2) and zinc transporter 8 (ZnT8) were measured and family history of diabetes was collected in a cross-sectional manner. Family history of T1DM and T2DM was assessed using the criterion by Blackman et al., 2009 and Ferrat et al., 2020. Fischer, Kruskal-Wallis and Mann-Witney U test were used.

Results

Males comprised 55% of the study population, with a median age of 8.7 years (IQR: 5.4–14.0 years). 51 children were on CFTR modulator therapy. Children with CFRD were significantly older with a median age of 15.9 years (IQR: 7.5–18.7) for any AAB-positive CFRD compared to 8.0 years (IQR: 6.2–12.4) for non-CFRD, and 12.1 years (IQR: 9.9–13.5) for AAB-negative CFRD compared to 7.9 years (IQR: 4.0–13.6) for non-CFRD. Any AAB and single AAB positivity was significantly associated with CFRD (Table 1). Only two children reported T1DM in any relative. Family history of diabetes showed no association with CFRD. Any AAB positivity frequency was comparable among children with positive and negative family history (Blackman criteria p=0.136; Ferrat criteria p=0.133).

Conclusion

Islet AAB positivity is associated with CFRD in children with CF. CFRD, regardless of autoantibody status, is more common in older individuals, which aligns with known disease progression in cystic fibrosis. The usefulness of family history of diabetes as a prognostic factor in the development of CFRD is limited.