Whitehaven

Researchers are evaluating whether regular MRI scans can better detect cancer progression in patients on active surveillance for low to medium risk prostate cancer compared to the current standard care recommended by NICE. This study focuses on patients who have chosen active surveillance, as immediate treatment may not improve survival but can cause significant side effects. The trial aims to improve detection of progression over 5 years with fewer biopsies, PSA tests, and clinic visits, potentially reducing anxiety and healthcare costs. Participants will be randomly assigned to either regular MRI scans or the current standard of care. Those in the MRI group will have PSA tests every 6 months and MRI scans annually if they have visible lesions or medium risk cancer. Other patients will have PSA every 6 months and MRI scans in years 1, 3, and 5. Targeted biopsies will be done if MRI shows signs of progression. The standard care group will follow NICE guidelines with regular PSA tests, rectal exams, and biopsies as indicated. During the study, patients will undergo diagnostic MRI scans and biopsies as needed, with monitoring including PSA testing and clinical examinations. The main outcomes measured are biopsy results and cancer staging over 5 years. The study is not blinded and stratifies patients by MRI lesion visibility, cancer grade, and time since diagnosis to ensure balanced groups. The total duration of follow-up is 5 years to assess progression detection and resource use.

Researchers are evaluating a range of treatments to improve outcomes for adults admitted to intensive care units (ICUs) with severe community-acquired pneumonia (CAP), including cases caused by influenza and COVID-19. This Phase 3 adaptive platform trial, REMAP-CAP, is designed to test multiple treatment strategies simultaneously and adapt over time, allowing new treatments to be added as questions are answered. The trial also serves as a platform to quickly evaluate treatments during respiratory pandemics, such as COVID-19, through a sub-study called REMAP-COVID in the United States. Participants receive various interventions including antibiotics like ceftriaxone, moxifloxacin, or piperacillin-tazobactam, as well as macrolide therapies given for different durations. Other treatments assessed include corticosteroids such as hydrocortisone and dexamethasone, antiviral agents like oseltamivir and remdesivir, immune modulators including tocilizumab and baricitinib, and supportive care strategies such as mechanical ventilation methods. Dosing and duration vary for each treatment, with some interventions now closed. Treatments are administered according to local guidelines and clinical decisions, with some requiring intravenous or enteral routes. Participants are closely monitored with assessments focusing on survival and organ support status in the ICU up to 90 days after enrollment. The main outcomes measured include all-cause mortality by day 90 and the number of days alive without needing organ support in the ICU by day 21. The study collects data continuously to adapt treatment assignments for new participants, aiming to identify the most effective therapies. Follow-up and safety monitoring continue throughout hospitalization and up to 90 days after admission.