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Background: Aesthetics medicine, a controversial branch of clinical medicine known for its high degree of commercialization, faces numerous conflicts, particularly in some developing countries. The global aesthetics medicine industry requires enhancements of its legal and supervision framework and risk management systems. Aims: This paper aimed to provide a comprehensive visual analysis of academic achievements related to regulatory and legal issues in the field of aesthetic medicine and to identify its development trends and research hotspots. Methods: The Web of Science Core Collection was employed to retrieve relevant studies, resulting in a total of 602 research articles after selection. Utilizing bibliometric methods and CiteSpace, this study analyzed the primary countries, institutions, authors, journals, hotspots, frontiers, and trends in this domain. Results: The findings indicated rapid increases in the number of published papers. The United States emerged as the leading contributor with 131 research papers and the highest intermediate centrality. Eleven keyword clusters were identified, with "adolescence" and "office‐based surgery" being the most recent topics. We also analyzed the trends and frontiers of legal research in medical aesthetics. Conclusion: The importance of informed consent has been increasingly emphasized, and research in the field of medical aesthetics has been gradually expanding beyond individual cosmetic procedures. The management system has become more comprehensive, moreover, guidelines and medical laws have been continually published, with research shifting toward a holistic perspective that encompasses patients, medical aesthetic providers, and regulatory authorities in the study of medical aesthetics regulation and legislation. This paper also proposes some innovative directions for future research and applications. [ABSTRACT FROM AUTHOR]

Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma‐focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health‐related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health‐related adjustment and coping within the context of trauma‐focused treatment. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease contribute significantly to societal and individual impact globally. High‐quality management of these long‐term health conditions is important to prevent deterioration of health, although potentially more complex for patients with intellectual disabilities in residential care. Disease management in this context particularly benefits from complete and accurate recording of disease management. Without complete records, long‐term health conditions are more difficult to track due to the level of uncertainty regarding which clinical examinations have and have not been performed. This study therefore aims to examine the recording routines of quality indicators for disease monitoring for chronically ill patients with intellectual disabilities in Dutch residential care. Methods: This retrospective study utilised medical record data from a large Dutch long‐term care provider. We assessed the occurrence of cardiovascular disease (ICPC‐2 codes K74, K75, K76, K89 and K90), type 2 diabetes mellitus (T90, T90.02) and/or COPD (R91, R95). For adults with intellectual disabilities and long‐term condition, we analysed data entries in an 18‐month period (between July 2020 and December 2021). Observed consultation rates were calculated and presented in median with interquartile range and contrasted against the baseline number of consultations in primary care. Information on recorded quality indicators was presented in frequencies and percentages. Findings: Of the three long‐term conditions investigated, the most common was type 2 diabetes mellitus (8.6%; n = 287), followed by cardiovascular disease (5.8%; n = 195) and COPD (3.0%; n = 101). Of those who received management for their long‐term condition from their contracted GP, patients with type 2 diabetes mellitus, cardiovascular disease, or COPD had fewer consultations in 2021 than the Dutch baseline. Discussion of lifestyle was often not recorded. Disease monitoring quality indicators were recorded more often but at a lower frequency than expected. Conclusions: Because of the infrequent recording of quality indicators, recording of management of long‐term conditions for patients with intellectual disabilities in long‐term care appears suboptimal. Although this may not directly harm individual patients, it may jeopardise the quality of management of long‐term conditions, as suboptimal recording limits opportunities for evaluation and improvement. Within a broader trend towards data‐driven work methods in healthcare, recording of quality indicators requires attention from practice, research and policy. We should watch over long‐term diseases to help people stay healthy. We run tests, like checking blood pressure. The results are written in their medical records. These tests are like quality checks.We wanted to see if and how these quality checks were used, mostly for people with a learning disability living in care homes who also have heart disease, diabetes, or lung problems.We looked at their medical papers to see if these checks were there. We also looked at how often they saw the doctor.We found that chronically ill people with a learning disability went to the doctor quite often. But not as often as we expected. Also, the checks were not always written down. The talks about their lifestyle with the doctors were not noted very often.This can impact how well doctors care for the health issues of people with learning disability. [ABSTRACT FROM AUTHOR]

Over 10 million ED visits occur each year across Australia and Aotearoa New Zealand. Outside basic administrative data focused on time‐based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection represents a missed opportunity to improve the care we deliver each day. The present paper outlines a proposal for a National Acute Care Secure Health Data Environment, including design, possible applications, and the steps taken to date by the Australasian College for Emergency Medicine ED Epidemiology Network in collaboration with the College of Emergency Nursing Australasia. Optimal use of the existing information collected routinely during clinical care of emergency patients has the potential to enable data‐driven quality improvement and research, leading to better care and better outcomes for millions of patients and families each year. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The objective of this study was to apply a paper-based clinical reminder to improve the adherence to lipid guidelines. Methods Patients with coronary heart disease (CHD) without lipid-lowering therapy (LLT) were recruited, and medical records were reviewed. Eligible subjects were randomized; a clinical reminder stating current standards and local insurance policy was stamped on the paper chart in the study group but not in the control. The primary outcome was new LLT subscription in the 6-month follow-up period, and the secondary end point was the composite result of LLT or lipid profile check-up. Results Ninety-two patients were assigned to the study group and 102 to the control group. The primary outcome showed no difference at the end of 6 months (OR: 1.70, P = 0.248, 95% CI: 0.69–4.19). The secondary end point was significantly higher in the reminder group (OR: 2.81, P = 0.001, 95% CI: 1.57–5.04). Conclusion A paper chart based clinical reminder providing update clinical recommendations could modify the doctor's behaviour and improve the attention to lipid levels. However, its effect cannot be transformed into an increase in LLT or a decrease in low-density lipoprotein level owing to local policy constraint. [ABSTRACT FROM AUTHOR]

Skin prick testing (SPT) in combination with the clinical history of the patient is one important step in the diagnosis of IgE-mediated occupational allergies. However, skin test performance is related to the quality of allergen extracts. The present consensus document was prepared by an EAACI Task Force consisting of an expert panel of allergologists and occupational physicians from Germany, Italy, Spain, France, Austria, and Poland. All members of the panel were also involved in the data collection within the European multicentre study STADOCA ( Standard diagnosis for occupational allergy). The aim of this Task Force was the assessment of the quality of commercially available SPT solutions for selected occupational allergens under standardized procedure conditions in different European centres and institutes of Occupational Medicine. The data evaluation shows a wide variability among SPT solutions and also indicates that the sensitivity of several SPT solutions is low. Therefore, improvement and standardization of SPT solutions for occupational allergens is highly recommended. Clinical practitioners should also not presume that their SPT solutions are fully reliable. The main objective of the document is to issue consensus suggestions for the use of SPT with occupational allergens based on the European multicentre study STADOCA, on existing scientific evidence and the expertise of a panel of allergologists. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dementia is increasing, bringing a range of challenges, such as eating, drinking and swallowing (EDS) difficulties, that are associated with aspiration, which can be fatal. Early identification of EDS difficulty in early‐stage dementia could prevent complications, but reliable indicators are needed to help develop pathways to support the diagnosis. Previous reviews of this area require updating. Aims: To identify reliable and clinically measurable indicators of EDS difficulty used in early‐stage dementia. Methods & Procedures: A systematic search was conducted using common databases (MEDLINE, EMBASE and PsychInfo). Articles reporting indicators of EDS difficulty in early‐stage dementia or mild cognitive impairment were included. The reliability of included studies was critically appraised using the risk of bias tools. Study outcomes were narratively reviewed by considering the reliability, clinical measurability and applicability of EDS indicators to early‐stage dementia. Outcomes & Results: Initial searches returned 2443 articles. After removing duplicates, limiting to English language and human studies, 1589 articles remained. After reviewing titles, 60 abstracts were reviewed, yielding 18 full‐text articles. A total of 12 articles were excluded that did not report at least one indicator of EDS difficulty in early‐stage dementia, or where the reported association was not strong. Six included studies that reported eight indicators of EDS difficulty in early‐stage dementia (four studies including people with Alzheimer's disease). On the balance of measurability, reliability and applicability, the most promising indicators of EDS difficulty were: delayed oral transit, rinsing ability, sarcopenia and polypharmacy. Additional, less reliable and applicable indicators included: always opened lips and non‐amnestic mild cognitive impairment, especially in men. The delayed pharyngeal response is subjectively measured when instrumental assessment is not available and the 'candy sucking test' cannot be recommended because there is an inherent choking risk. Conclusions & Implications: EDS difficulty in early‐stage dementia can be highlighted by indicators that could be combined to create enhanced pathways to support the early identification of EDS difficulties for people living with early‐stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. Exploring the experiences of people living with dementia and their families' perspectives on potential indicators of EDS difficulty may add to the existing evidence base. WHAT THIS PAPER ADDS: What is already known on the subject: Early identification of EDS difficulty in early‐stage dementia may prevent complications, but more reliable and clinically measurable indicators of EDS difficulty are needed to help develop pathways to support diagnosis. What this paper adds to existing knowledge: A comprehensive range of studies related to EDS identification in early‐stage dementia have been selected and reviewed. Across six included studies, the most promising indicators of EDS difficulty in early‐stage dementia included delayed oral transit, poor rinsing ability, presence of sarcopenia and polypharmacy. What are the potential or actual clinical implications of this work?: This study could help to develop pathways to support the early identification of EDS difficulties for people living with early‐stage dementia with a view to preventing complications and facilitating informed discussions regarding wishes in the event of further deterioration. [ABSTRACT FROM AUTHOR]

Complex trauma generally refers to a child's exposure to multiple traumatic events often within the context of an interpersonal relationship. Childhood traumatic events are commonplace and can have significant implications for physical and mental health. However, traumatic events are often not assessed by clinicians involved in their care. This paper outlines an approach to assessing complex trauma in young children in clinical settings. This approach involves an initial interview, an assessment of traumatic events and trauma symptoms in the child, an assessment of the parent–child interaction, an understanding of the child's functioning in multiple settings, and an assessment of parental trauma where relevant. Complex trauma takes time to assess and is dependent on the parent's ability to recognise and acknowledge the effect trauma has had. The paper concludes with some of the challenges when assessing complex trauma in young children in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Education is, after gaming, the second largest sector embracing augmented reality (AR) at an accelerated pace, yet studies on AR's potential as an efficient learning environment had mixed results. Objectives: This study's primary objective is to test students' interaction with graphical 3D elements in AR and its impact on information retention. The second objective is to compare information retention from AR engagement with information retention from exposure to identical 3D content delivered via instructional video. Finally, the third objective explores students' perceptions of AR as a learning environment. Methods: Sixty‐five college students participated in a two‐arm experiment followed by semi‐structured interviews. Results and Conclusion: AR can efficiently deliver a meaningful learning experience and promotes information retention. Nevertheless, AR's interactive features and novelty may distract learners while they engage with the virtual environment. Objective data obtained through eye tracking and video monitoring showed similar levels of engagement with a 3D model for both environments. While both AR and video groups showed significant knowledge gain from pre to post‐intervention, the video format was overall significantly more effective than AR in increasing topic‐related information retention. However, participants preferred the AR learning environment significantly more than the video. Takeaways: Although effective, AR is still a distracting instructional environment. Designing learning experiences tailored explicitly for AR environments requires additional research to ensure its successful deployment as a learning tool. Lay Description: What is already known about this topic: Education is the second‐fastest growing sector to adopt and experiment with augmented reality (AR).Hardware and software tools to create AR environments have reached the consumer level.The advantage of immersing learners in dedicated virtual environments seems obvious.Research has had mixed results in validating AR as a proper learning environment. What this paper adds: AR is a viable environment which supports information retention.For many students, the medium's novelty promotes engagement with the content.Students prefer AR to video lectures, but it may distract them from learning.Regarding information retention, video lectures do better than AR. The implications of study findings for practitioners: Learning experiences in AR should be reserved for some specific topics and designed purposedly.Progressive exposure of learners to AR environments may produce habituation and decrease distraction. [ABSTRACT FROM AUTHOR]

Purpose: Differences in Indigenous worldviews, practices and values highlight the need for Indigenous‐specific health quality indicators, such as patient‐reported outcome measures (PROMs) and patient‐reported experience measures (PREMs). The purpose of this paper is to present our methodology, as part of a larger study that sought to develop a framework for creating Indigenous‐specific PROMs and PREMs. Methods: The research design was informed by Indigenous research methodology and a community‐based participatory approach. It had three core components: (1) a literature exploration of existing Indigenous‐specific PROMs and PREMs; (2) interviews with researchers with expertise in PROMs and PREMs developed for Indigenous populations and community leaders interested in using these Indigenous‐informed evaluation tools; and (3) conversations with Indigenous community members about their experiences with health surveys. Interviews were audio‐recorded and transcribed verbatim; transcripts were analyzed qualitatively using an inductive and deductive approach. Themes and sub‐themes were identified to build a framework that honours Indigenous knowledges and ways of knowing. Results were validated with select research participants and the Project Advisory Committee. Results: Findings demonstrate how relationship building is the necessary starting point for engagement when developing survey instruments with Indigenous peoples. Engagement requires respectful collaboration through all stages of the project from determining what questions are asked to how the information will be collected, interpreted, and managed. A relational stance requires responsibility to Indigenous communities and peoples that goes beyond research carried out using a western scientific lens. It means ensuring that the project is beneficial to the community and framing questions based on Indigenous knowledge, worldviews, and community involvement. Conclusions: This study employed a collaborative, participatory qualitative approach to develop a framework for creating PROMs and PREMs with Indigenous peoples. The methods described offer concrete examples of strategies that can be employed to support relationship‐building and collaboration when developing Indigenous‐specific survey instruments. [ABSTRACT FROM AUTHOR]

Background: Edentulous sites with limited horizontal tooth‐implant distance pose a challenge to clinicians. This case report describes root amputation of an adjacent compromised molar to maintain an optimal tooth‐implant distance Methods and Results: A 41‐year‐old female was referred for extraction and implant placement to replace her left, maxillary second premolar (#13), which had been diagnosed with a vertical root fracture. Extraction and ridge preservation of #13 was completed without complication. The 4‐month postsurgical clinical examination revealed a narrow mesial‐distal distance (5.69 mm) of the edentulous space (#13), which was influenced by the degree of divergence of the mesial buccal root of tooth #14. Cone‐beam computed tomography (CBCT) analysis verified a periapical lesion on the mesial‐buccal root of tooth #14. The amputation of the endodontically compromised mesial‐buccal root of #14 was treatment planned to provide space and facilitate placement of a standard diameter implant without compromising the implant or adjacent teeth. Crestal bone levels were verified and maintained at the 1 year postoperative follow‐up. Conclusion: The findings of the case report demonstrate how root amputation of a compromised molar is an alternative solution for managing spatial limitations in contemporary implant dentistry. More studies are required to assess the reliability and long‐term success of this approach. Key points: Why is this case new information?There is insufficient evidence on the long‐term efficacy of narrow‐diameter implants. Clinical treatment guidelines are not sufficiently available.This paper presents an alternative approach to managing a specific scenario where mesial‐distance distance is limited using root amputation of an adjacent compromised tooth. What are the keys to successful management of this case?Comprehensive diagnosis and stringent case selectionMultidisciplinary treatment planningEvidence‐based decision making What are the primary limitations to success in this case?Very specific clinical application; adjacent compromised toothLong‐term follow up is required [ABSTRACT FROM AUTHOR]

With decades of pre‐clinical studies culminating in the recent clinical application of xenotransplantation, it would appear timely to provide recommendations for operationalizing oversight of xenotransplantation clinical trials. Ethical issues with clinical xenotransplantation have been described for decades, largely centering on animal welfare, the risks posed to the recipient, and public health risks posed by potential spread of xenozoonosis. Much less attention has been given to considerations relating to potentially elevated risks faced by those who may care for or otherwise have close contact with xenograft recipients. This paper examines the ethical and logistical issues raised by the potential exposure to xenozoonotic disease faced by close contacts of xenotransplant recipients—defined herein as including but not limited to caregivers, household contacts, and sexual partners—which warrants special attention given their increased risk of exposure to infection compared to the general public. We discuss implications of assent or consent by these close contacts to potentially undergo, along with the recipient, procedures for infection screening and possible quarantine. We then propose several options and recommendations for operationalizing oversight of xenotransplantation clinical trials that could account for and address close contacts' education on and agency regarding the risk of xenozoonosis. [ABSTRACT FROM AUTHOR]

As carbon monoxide has a broad spectrum of biological activities, its production by plasma is a significant advantage in medicine. This paper presents a comparative study of the CO production of two plasma jets: a MHz‐jet and a kHz‐jet. Both were fed with a helium gas with CO2 ${\text{CO}}_{2}$ admixture (0%–1%). CO was produced by CO2 ${\text{CO}}_{2}$ dissociation and its maximal concentration was hundreds of parts per million, which is safe for clinical applications. For the same specific energy input, the CO production was more efficient for the kHz‐jet than the MHz‐jet. Both had antibacterial properties on Escherichia coli, and the addition of CO2 ${\text{CO}}_{2}$ improved them for the MHz‐jet, while it reduced them for the kHz‐jet. [ABSTRACT FROM AUTHOR]

The article presents different studies related to a variety of internal medicines and respective illness that can be treated. These include the early warning score (EWS), which is considered a useful tool in detecting patients who deteriorate their clinical condition. Meanwhile, physicians should also address issues manifesting a poor vascular health. It also notes that benchmarking method have confounded the estimates of the treatment outcomes.

Despite aggressive and innovative therapy, patients with multiple myeloma (MM) invariably relapse and die of their disease. New options for non- cytotoxic salvage therapy and additional therapeutic strategies are needed. Arsenic trioxide, an antitumour agent with a multifaceted mechanism of action, induces apoptosis in vitro in MM cell lines and freshly isolated cells from MM patients and, in preliminary studies, displayed clinical activity in patients with late-stage MM. A phase 2, multicentre, open-label study of arsenic trioxide was conducted in 24 MM patients; eight had relapsed and 16 were refractory to prior therapy. Patients received arsenic trioxide 025 mg/kg/d for 5 d/week during the first 2 weeks of each 4-week cycle. Sixteen patients had grade 3 or 4 neutropenia and one required antibiotics. Reductions (25% or more) in serum M-protein levels occurred in eight of 24 (33%) patients. An additional six (25%) patients had stable disease. The median time to response was 675 d, with a median duration of response of 130 d. Arsenic trioxide therapy lowered serum creatinine levels in two patients with high baseline values. These data indicate that arsenic trioxide is active and reasonably well tolerated as a single-agent salvage therapy, even in patients with late-stage, relapsed and refractory MM. [ABSTRACT FROM AUTHOR]

Background: The Association for the Advancement of Blood and Biotherapies Clinical Transfusion Medicine Committee (CTMC) composes a summary of new and important advances in transfusion medicine (TM) on an annual basis. Since 2018, this has been assembled into a manuscript and published in Transfusion. Study design and methods: CTMC members selected original manuscripts relevant to TM that were published electronically and/or in print during calendar year 2022. Papers were selected based on perceived importance and/or originality. References for selected papers were made available to CTMC members to provide feedback. Members were also encouraged to identify papers that may have been omitted initially. They then worked in groups of two to three to write a summary for each new publication within their broader topic. Each topic summary was then reviewed and edited by two separate committee members. The final manuscript was assembled by the first and senior authors. While this review is extensive, it is not a systematic review and some publications considered important by readers may have been excluded. Results: For calendar year 2022, summaries of key publications were assembled for the following broader topics within TM: blood component therapy; infectious diseases, blood donor testing, and collections; patient blood management; immunohematology and genomics; hemostasis; hemoglobinopathies; apheresis and cell therapy; pediatrics; and health care disparities, diversity, equity, and inclusion. Discussion: This Committee Report reviews and summarizes important publications and advances in TM published during calendar year 2022, and maybe a useful educational tool. [ABSTRACT FROM AUTHOR]

Aim: Reports of patients with hepatitis B have highlighted associations between polymorphisms in the human leukocyte antigen (HLA)‐DPB1, CXCL13, and CXCR5 genes and disease pathology. Owing to its potential to contribute to the development of new diagnostic and therapeutic methods, we aimed to establish a reliable host genome analysis technique that can be used in countries with inadequate infrastructure. Method: We compared multiple commercially available kits for dried blood spot (DBS)‐based sample collection to develop a basic DBS‐based host genome analysis technique. We then collected blood samples from Cambodian patients with hepatitis B and performed single‐nucleotide polymorphism genotyping and HLA allele typing by the DBS system. Result: We were able to perform single‐nucleotide polymorphism genotyping and HLA allele typing with host DNA samples obtained using a combination of a HemaSpot™ filter paper‐based device and a SMITEST® EX‐R&D DNA extraction kit. The accuracy of genotyping using samples obtained by this method was not inferior to one using samples obtained by venipuncture. In the Cambodian population, significant associations of HLA‐DPB1*04:01 with protection against chronic hepatitis B virus (HBV) infection, and HLA‐DPB1*05:01 and HLA‐DPB1*13:01 with susceptibility to chronic HBV infection were identified. Conclusion: Based on the DBS system, we clarified the associations of HLA‐DPB1 alleles with chronic HBV infection in the Cambodian population for the first time. Because the DBS is a low‐cost, durable, transportable, and easy‐to‐handle modality, genetic analysis based on the DBS system is a feasible strategy for obtaining a deeper understanding of HBV epidemiology, especially in middle‐ or low‐income countries. [ABSTRACT FROM AUTHOR]

Periodontal treatment is quickly moving towards a philosophy consisting of a less invasive approach. In this context, minimally invasive nonsurgical therapy (MINST) is a promising option. This paper reviews the concepts behind minimal invasiveness in nonsurgical periodontology and reports the state‐of the art evidence for this topic. Instruments used and protocols suggested for these applications are introduced and discussed. The original papers reviewed show probing pocket depth (PPD) reductions and clinical attachment level (CAL) gains ranging from 2 to 4 mm between baseline and 6 months to 5 years posttreatment for intrabony defects and from 1.5 to 3 mm between baseline and 2‐6 months of follow‐up for full‐mouth results. These clinical outcomes are accompanied by statistically significant reductions in radiographic bone defect depth and increases in intrabony defect angles posttreatment. Wound healing mechanisms following MINST are presented, and clinical applications and directions for future research are suggested. [ABSTRACT FROM AUTHOR]

Aim: To assess the clinical utility of exome sequencing for patients with developmental and epileptic encephalopathies (DEEs). Method: Over 2 years, patients with DEEs were recruited for singleton exome sequencing. Parental segregation was performed where indicated. Results: Of the 103 patients recruited (54 males, 49 females; aged 2 weeks–17 years), the genetic aetiology was identified in 36 out of 103 (35%) with management implications in 13 out of 36. Exome sequencing revealed pathogenic or likely pathogenic variants in 30 out of 103 (29%) patients, variants of unknown significance in 39 out of 103 (38%), and 34 out of 103 (33%) were negative on exome analysis. After the description of new genetic diseases, a molecular diagnosis was subsequently made for six patients or through newly available high‐density chromosomal microarray testing. Interpretation: We demonstrate the utility of exome sequencing in routine clinical care of children with DEEs. We highlight that molecular diagnosis often leads to changes in management and informs accurate prognostic and reproductive counselling. Our findings reinforce the need for ongoing analysis of genomic data to identify the aetiology in patients in whom the cause is unknown. The implementation of genomic testing in the care of children with DEEs should become routine in clinical practice. What this paper adds: The cause was identified in 35% of patients with developmental and epileptic encephalopathies.KCNQ2, CDKL5, SCN1A, and STXBP1 were the most frequently identified genes.Reanalysis of genomic data found the cause in an additional six patients.Genetic aetiology was identified in 41% of children with seizure onset under 2 years, compared to 18% with older onset.Finding the molecular cause led to management changes in 36% of patients with DEEs. What this paper adds: The cause was identified in 35% of patients with developmental and epileptic encephalopathies.KCNQ2, CDKL5, SCN1A, and STXBP1 were the most frequently identified genes.Reanalysis of genomic data found the cause in an additional six patients.Genetic aetiology was identified in 41% of children with seizure onset under 2 years, compared to 18% with older onset.Finding the molecular cause led to management changes in 36% of patients with DEEs. [ABSTRACT FROM AUTHOR]

There is a lack of a safe and effective technology to monitor intracranial pressure accurately and non‐destructively. In this paper, the relationship between reduced scattering coefficient and intracranial pressure in clinical patients under different brain edema states was studied. First, the brain edema MC simulation model was constructed based on different types of brain edema. The results laid a foundation for clinical ICP detection. Second, the changes of ICP and reduced scattering coefficient caused by brain edema were studied in clinical application. It was found that when the patient developed brain edema, the reduced scattering coefficient and ICP showed corresponding changes. Finally, the mathematical model of invasive ICP and reduced scattering coefficient was established. It was found that the sensitivity of 834 nm light to brain tissue changes was higher than that of 692 nm light, which could be used to reflect the changes of brain tissue physiological state. [ABSTRACT FROM AUTHOR]

Background: Small interference RNA (siRNA) has emerged as the most desired method for researchers and clinicians who wish to silence a specific gene of interest and has been extensively developed as a therapeutic agent. This review points to collecting all clinical trials on siRNA and understanding its benefits, pharmacokinetics and safety by reading articles published in the last 5 years. Materials and Methods: Searching in the PubMed database using 'siRNA' and 'in vivo' with limits to articles published in the previous 5 years, article type 'clinical trials' and language 'English' to acquire papers on in vivo studies on siRNA approaches. Features of siRNA clinical trials registered at https://clinicaltrials.gov/ were analysed. Results: So far, 55 clinical studies have been published on siRNA. Many published clinical trials on siRNA showed tolerability, safety and effectiveness in treating cancers like breast, lung, colon, and other organs and other diseases like viral infections and hereditary diseases. Many different routes of administration can silence many genes at the same time. Limitations and uncertainties associated with siRNA treatment include the effectiveness of cellular uptake, precise targeting of the intended tissue or cell and prompt elimination from the body. Conclusions: The siRNA or RNAi method will be one of the most critical and influential techniques to fight against many different diseases. Although the RNAi approach has certain advantages, it also has limitations concerning clinical applications. Overcoming these limitations remains a daunting challenge. [ABSTRACT FROM AUTHOR]

Introduction: The threshold concept framework (TCF) was first described nearly 20 years ago, but its application in the field of medical education has recently seen a significant growth of interest with a diverse range of literature published on the subject. The transformative nature of threshold concepts (TCs) offers potential for the design of learning experiences and curricula across the medical education continuum. A scoping review was conducted to map the extent of the current literature regarding TCs in medical education—to describe the types of available evidence and its focus—and identify research gaps. Methods: The review followed the JBI Manual for Evidence Synthesis approach for scoping reviews. Four databases and two additional websites were searched for articles exploring TCs in medical education. Data were analysed using quantitative and qualitative thematic approaches. A framework of conceptual change was used to synthesise the TCs identified. Results: Thirty‐six papers, spanning undergraduate, postgraduate and continuing medical education, were included in the final analysis. The most frequent application of the TCF was in the identification of TCs, which related to basic scientific knowledge, ways of thinking and ways of practising in medicine. Uncertainty, patient care, clinical reasoning and professional identify formation were themes that emerged at multiple stages of training. Several papers evaluated the use of the TCF in teaching. Conclusion: The understanding and embodiment of TCs increases in complexity across the medical education continuum, with TCs recurring with changes in clinical environment and responsibilities. This lends support to a holistic approach to curriculum design spanning all stages of training. Further research is needed to develop a consistent approach for describing and applying the TCF in medical education and to address how the TCF can be used in teaching and how threshold crossing can be measured. Understanding and embodiment of threshold concepts across the medical education continuum is argued through this review to support a holistic approach to curriculum design. [ABSTRACT FROM AUTHOR]

This paper explores cardiac electrophysiological simulations of the monodomain equations and introduces a novel subcycling time integration algorithm to exploit the structure of the ionic model. The aim of this work is to improve upon the efficiency of parallel cardiac monodomain simulations by using our subcycling algorithm in the computation of the ionic model to handle the local sharp changes of the solution. This will reduce the turnaround time for the simulation of basic cardiac electrical function on both idealized and patient‐specific geometry. Numerical experiments show that the proposed approach is accurate and also has close to linear parallel scalability on a computer with more than 1000 processor cores. Ultimately, the reduction in simulation time can be beneficial in clinical applications, where multiple simulations are often required to tune a model to match clinical measurements. [ABSTRACT FROM AUTHOR]

Gossypin is a flavonoid compound prepared from chinese medicine Hibiscus, which not only has significant pharmacological activities in antioxidant, anti‐inflammatory, neuroprotective, anti‐cancer, anti‐tumor, and anti‐diabetic aspects, but also has the advantages of small side effects and easy preparation because it is extracted from traditional chinese medicine, so it has received widespread attention from scholars and researchers. This paper reviews the pharmacological effects and mechanisms of gossypin in recent years, and hopes to provide a theoretical basis for its clinical application. [ABSTRACT FROM AUTHOR]

Patient enrollment, data sharing, and data privacy are enormous medical challenges for clinical trial studies. In recent years, blockchain technology has drawn the attention of various researchers and institutes. As a new and innovative distributed ledger technology, blockchain can be critical to addressing these challenges, thus making clinical research transparent and building public trust fairly and openly. However, the existing literature lacks a comprehensive survey on the adoption of blockchain in clinical trials. To fill the research void, this paper presents a punctilious taxonomy of blockchain technology in clinical trials according to the literature. This taxonomy comprises decentralized scenarios, decentralized practices, blockchain types, deployment methods, and consensus algorithms. The results show that blockchain technology can cover all aspects of the clinical trial study in a decentralized, secure, transparent manner. Besides, some open research challenges of blockchain are categorized into three groups: technical challenges, security challenges, and organizational challenges. Moreover, some recent blockchain projects, micro applications in clinical trials, and several research areas or technologies for future research and development are discussed. [ABSTRACT FROM AUTHOR]

Background: Heart transplant (HTx) recipients are at an increased risk of developing infections or malignancies due to immunosuppressive medication. Thus, regular aftercare in those patients is of utmost importance. The extent of collateral damage due to the COVID‐19 pandemic (delayed or canceled clinical visits and diagnostics) on high‐risk patients is yet unknown. We believe that, especially for HTx‐patients, data acquisition on potential pandemic‐related nonattendance is crucial to improve clinical care in the future. Therefore, we aim to decipher possible COVID‐19‐related alterations in attendance to clinical care after HTx using a survey‐based approach. Methods: HTx recipients, 2 years beyond transplantation were selected (n = 75). We filed a paper‐based questionnaire or an online survey containing nine items about COVID‐19‐related exceptional circumstances. Fifty‐two patients (69%) returned fully answered questionnaires. Results: A perceived impact on daily life was evident with 79% of all patients, reporting a moderate‐to‐severe negative influence of the COVID‐19 pandemic on daily routine. We detected increased nonattendance of clinical care during the COVID‐19 pandemic compared to prepandemic time (38 vs. 6%, p <.0001). The various diagnostic modalities of aftercare were heterogeneously affected, ranging from 2% nonattendance for influence vaccination and 18% for colonoscopy. Off note, nonattendance to clinical care within the pandemic was independent of perceived impact of the pandemia on daily life (p >.68). Conclusions: For the first time, we objectively demonstrate a significant decrease in attendance to clinical care in HTx recipients during the COVID‐19 pandemic. Efforts are needed to increase attendance in this highly vulnerable patient cohort. [ABSTRACT FROM AUTHOR]

Summary: Mesenchymal stromal cells (MSCs) are non‐haematopoietic cells found in fetal and adult organs, that play important roles in tissue repair, inflammation and immune modulation. MSCs residing in the bone marrow interact closely with haematopoietic cells and comprise an important component of the microenvironment supporting haematopoiesis, in both health and disease states. Since their identification in 1970, basic scientific and preclinical research efforts have shed light on the role of MSCs in the regulation of haematopoiesis and evoked interest in their clinical application in haematopoietic stem cell transplantation (HSCT) and malignant haematology. Over the last two decades, these research efforts have led to numerous clinical trials, which have established the safety of MSC therapy; however, the optimal mode of administration and the benefit remain inconclusive. In this paper, we will review the clinical experience with use of MSCs in HSCT for enhancement of engraftment, prevention and treatment of graft‐versus‐host disease and haemorrhagic cystitis. Then, we will discuss the contradictory evidence regarding tumour‐promoting versus tumour‐suppressing effects of MSCs in haematological malignancies, which may have relevance for future clinical applications. [ABSTRACT FROM AUTHOR]

The odds ratio (OR) has been misunderstood in evidence based medicine and clinical epidemiology. Currently, "noncollapsibility" is considered a problem with interpretation of the OR and it is thought that the OR is rarely the parameter of interest for causal inference or interpretation of effect modification. The current focus on the relative risk (RR) and risk difference (RD) suffers from an important limitation: they are not solely measures of effect and vary numerically with baseline risk. In this paper, generalized linear models are examined in terms of the three binary effect measures commonly used in epidemiology to demonstrate that ORs may be the only way to interpret effect modification and have properties that should make them the parameter of interest for causal inference. We look forward to discussion, debate, and counter‐views on this issue from the epidemiology community. [ABSTRACT FROM AUTHOR]

Doulas are non‐medical support persons, paid for privatively by clients, who offer emotional support during pregnancy and childbirth. While doulas work alongside clinical care providers, such as physicians, midwives, and nurses, they are unregulated and typically have no formal standing in hospitals. As with other types of care work, doula practice is shaped by gendered assumptions about women's "natural" and boundless capacity to provide care. In this paper, I draw on interviews with 26 doulas practicing in Toronto, Canada, to explore the nature of doulas' caring dilemma―the tension between an altruistic motivation to provide care and a desire for greater professional autonomy and control over working conditions among care workers. I show that doulas' self‐imposed obligation to provide a specific model of care, along with their desire to fill gaps in maternity care, results in a caring dilemma that places their own needs in opposition to those of their clients. In response to their significant caring demands, some doulas attempt to alter their work to improve their working conditions. [ABSTRACT FROM AUTHOR]

Higher dose rates, a trend for radiotherapy machines, can be beneficial in shortening treatment times for radiosurgery and mitigating the effects of motion. Recently, even higher doses (e.g., 100 times greater) have become targeted because of their potential to generate the FLASH effect (FE). We refer to these physical dose rates as ultra‐high (UHDR). The complete relationship between UHDR and the FE is unknown. But UHDR systems are needed to explore the relationship further and to deliver clinical UHDR treatments, where indicated. Despite the challenging set of unknowns, the authors seek to make reasonable assumptions to probe how existing and developing technology can address the UHDR conditions needed to provide beam generation capable of producing the FE in preclinical and clinical applications. As a preface, this paper discusses the known and unknown relationships between UHDR and the FE. Based on these, different accelerator and ionizing radiation types are then discussed regarding the relevant UHDR needs. The details of UHDR beam production are discussed for existing and potential future systems such as linacs, cyclotrons, synchrotrons, synchrocyclotrons, and laser accelerators. In addition, various UHDR delivery mechanisms are discussed, along with required developments in beam diagnostics and dose control systems. [ABSTRACT FROM AUTHOR]

Presents a clinical case which identified azo dyes as skin allergens in carbonless copy paper manufacturing. Presenting signs and symptoms; Results of diagnostic examinations; Therapeutic options.

Quantitative systems pharmacology (QSP) is a relatively new discipline within modelling and simulation that has gained wide attention over the past few years. The application of QSP models spans drug‐target identification and validation, through all drug development phases as well as clinical applications. Due to their detailed mechanistic nature, QSP models are capable of extrapolating knowledge to predict outcomes in scenarios that have not been tested experimentally, making them an important resource in experimental and clinical pharmacology. However, these models are complicated to work with due to their size and inherent complexity. This makes many applications of QSP models for simulation, parameter estimation and trial design computationally intractable. A number of techniques have been developed to simplify QSP models into smaller models that are more amenable to further analyses while retaining their accurate predictive capabilities. Different simplification techniques have different strengths and weaknesses and hence different utilities. Understanding the utilities of different methods is essential for selection of the best method for a particular situation. In this paper, we have created an overall framework for model simplification techniques that allows a natural categorisation of methods based on their utility. We provide a brief description of the concept underpinning the different methods and example applications. A summary of the utilities of methods is intended to provide a guide to modellers in their model endeavours to simplify these complicated models. [ABSTRACT FROM AUTHOR]

Background: Creating concept maps can help students overcome challenges of accurate knowledge monitoring and thus foster learning. However, students' knowledge often contains gaps and misconceptions, even after concept map creation. Theoretically, students could benefit from additional support, but it is unclear whether this might also be the case for (more practical‐oriented) secondary vocational students. Objectives: This study investigated whether the effectiveness of concept maps for learning could be improved by providing students with expert examples and reflection prompts in addition to their self‐generated concept maps. Methods: First‐year secondary vocational students (N = 91, Mage = 17.3 years) participated in this study, which utilized a pretest‐intervention‐posttest design. Regarding the intervention, students worked in two successive online learning environments, in which they had to present their knowledge in concept maps. After creation, students' concept maps were, depending on condition, supplemented with (1) an expert example with comparative feedback (a combined concept map) and related reflection prompts, (2) the combined concept map only, or (3) no combined concept map and no prompts. Results and Conclusions: Analyses based on students' domain knowledge demonstrate that students significantly increased their knowledge in all conditions. Data indicate that there was no significant difference in knowledge gain between conditions. Further analysis showed that students in the experimental conditions demonstrated higher learning gains if they consulted the combined concept map more often than their peers. Implications: Access to an example in addition to students' self‐generated concept maps seems promising in fostering their knowledge acquisition. However, secondary vocational students might need additional ways of support to guarantee higher learning gains. Avenues to increase the effectiveness of support are discussed. Lay Description: What is currently known about the subject matter: Creating a concept map can be an effective means to promote student learning by facilitating their knowledge monitoring.Students' knowledge often contains gaps and misconceptions, even after concept map creation.There is evidence that feedback is needed to realize an effect on students' learning. What is the paper adding to this: Innovative implementation of concept map feedback in a self‐directed online learning environment.Exploration of the added value of support to process concept map feedback.Focus on a generally overlooked and unique target group: secondary vocational students. What are the implications of study findings for practitioners: The adopted unique implementation of concept map feedback seems promising for increasing students' learning.When designing support for secondary vocational students it is necessary to take the unique characteristics of these learners into account. [ABSTRACT FROM AUTHOR]

Gastroenterology has been an early leader in bridging the gap between artificial intelligence (AI) model development and clinical trial validation, and in recent years we have seen the publication of several randomized clinical trials examining the role of AI in gastroenterology. As AI applications for clinical medicine advance rapidly, there is a clear need for guidance surrounding AI‐specific study design, evaluation, comparison, analysis and reporting of results. Several initiatives are in the publication or pre‐publication phase including AI‐specific amendments to minimum reporting guidelines for clinical trials, society task force initiatives aimed at priority use cases and research priorities, and minimum reporting guidelines that guide the reporting of clinical prediction models. In this paper, we examine applications of AI in clinical trials and discuss elements of newly published AI‐specific extensions to the Consolidated Standards of Reporting Trials and Standard Protocol Items: Recommendations for Interventional Trials statements that guide clinical trial reporting and development. We then review AI applications at the pre‐trial level in both endoscopy and other subfields of gastroenterology and explore areas where further guidance is needed to supplement the current guidance available at the pre‐trial level. [ABSTRACT FROM AUTHOR]

Catalpol and its derivatives were found in a variety of Chinese medicinal plants and possess various biological activities, such as anti‐inflammatory, anti‐oxidant, neuroprotective, cardiovascular protective, anti‐tumor and hypoglycemic and so on. The extensive pharmacological activities of catalpol have been attracted much attention to researchers, but the clinical applications are limited by poor lipid solubility, low bioavailability and short half‐life, so pharmacologists have made various structural modifications to catalpol, such as increasing lipid solubility to enhance its biological activities in the hope that it can be widely used in clinical applications. In this paper, using "Catalpol" and "Catalpol derivatives" as the keywords, more than 200 articles from 1965 to 2021 were obtained from databases, such as CNKI, PubMed, Scifinder and so on. Finally, 93 articles were selected to systematically analyze the structure and efficacy of catalpol and its derivatives according to pharmacological activity, which will provide ideas for the development of new catalpol drugs in the future. [ABSTRACT FROM AUTHOR]

Purpose: Deformable image registration (DIR) of lung four‐dimensional computed tomography (4DCT) plays a vital role in a wide range of clinical applications. Most of the existing deep learning–based lung 4DCT DIR methods focus on pairwise registration which aims to register two images with large deformation. However, the temporal continuities of deformation fields between phases are ignored. This paper proposes a fast and accurate deep learning–based lung 4DCT DIR approach that leverages the temporal component of 4DCT images. Methods: We present Lung‐CRNet, an end‐to‐end convolutional recurrent registration neural network for lung 4DCT images and reformulate 4DCT DIR as a spatiotemporal sequence predicting problem in which the input is a sequence of three‐dimensional computed tomography images from the inspiratory phase to the expiratory phase in a respiratory cycle. The first phase in the sequence is selected as the only reference image and the rest as moving images. Multiple convolutional gated recurrent units (ConvGRUs) are stacked to capture the temporal clues between images. The proposed network is trained in an unsupervised way using a spatial transformer layer. During inference, Lung‐CRNet is able to yield the respective displacement field for each reference‐moving image pair in the input sequence. Results: We have trained the proposed network using a publicly available lung 4DCT dataset and evaluated performance on the widely used the DIR‐Lab dataset. The mean and standard deviation of target registration error are 1.56 ± 1.05 mm on the DIR‐Lab dataset. The computation time for each forward prediction is less than 1 s on average. Conclusions: The proposed Lung‐CRNet is comparable to the existing state‐of‐the‐art deep learning‐based 4DCT DIR methods in both accuracy and speed. Additionally, the architecture of Lung‐CRNet can be generalized to suit other groupwise registration tasks which align multiple images simultaneously. [ABSTRACT FROM AUTHOR]

Purpose: Feature maps created from deep convolutional neural networks (DCNNs) have been widely used for visual explanation of DCNN‐based classification tasks. However, many clinical applications such as benign‐malignant classification of lung nodules normally require quantitative and objective interpretability, rather than just visualization. In this paper, we propose a novel interpretable multi‐task attention learning network named IMAL‐Net for early invasive adenocarcinoma screening in chest computed tomography images, which takes advantage of segmentation prior to assist interpretable classification. Methods: Two sub‐ResNets are firstly integrated together via a prior‐attention mechanism for simultaneous nodule segmentation and invasiveness classification. Then, numerous radiomic features from the segmentation results are concatenated with high‐level semantic features from the classification subnetwork by FC layers to achieve superior performance. Meanwhile, an end‐to‐end feature selection mechanism (named FSM) is designed to quantify crucial radiomic features greatly affecting the prediction of each sample, and thus it can provide clinically applicable interpretability to the prediction result. Results: Nodule samples from a total of 1626 patients were collected from two grade‐A hospitals for large‐scale verification. Five‐fold cross validation demonstrated that the proposed IMAL‐Net can achieve an AUC score of 93.8% ± 1.1% and a recall score of 93.8% ± 2.8% for identification of invasive lung adenocarcinoma. Conclusions: It can be concluded that fusing semantic features and radiomic features can achieve obvious improvements in the invasiveness classification task. Moreover, by learning more fine‐grained semantic features and highlighting the most important radiomics features, the proposed attention and FSM mechanisms not only can further improve the performance but also can be used for both visual explanations and objective analysis of the classification results. [ABSTRACT FROM AUTHOR]

Background: Robust quality indicators (QIs) are essential for monitoring and improving the quality of care and learning from good practice. We aimed to identify and assess QIs for the care of older people and people with dementia who are nearing the end of life and recommend QIs for use with routinely collected electronic data across care settings. Methods: A systematic review was conducted, including five databases and reference chaining. Studies describing the development of QIs for care of older people and those with dementia nearing the end of life were included. QIs were categorized as relating to processes or outcomes, and mapped against six care domains. The psychometric properties (acceptability, evidence base, definition, feasibility, reliability, and validity) of each QI were assessed; QIs were categorized as robust, moderate, or poor. Results: From 12,980 titles and abstracts screened, 37 papers and 976 QIs were included. Process and outcome QIs accounted for 780 (79.7%) and 196 (20.3%) of all QIs, respectively. Many of the QIs concerned physical aspects of care (n = 492, 50.4%), and very few concerned spiritual and cultural aspects of care (n = 19, 1.9%). Three hundred and fifteen (32.3%) QIs were robust and of those 220 were measurable using routinely collected electronic data. The final shortlist of 71 QIs came from seven studies. Conclusions: Of the numerous QIs developed for care of older adults and those with dementia nearing the end of life, most had poor or moderate psychometric properties or were not designed for use with routinely collected electronic datasets. Infrastructure for data availability, combined with use of robust QIs, is important for enhancing understanding of care provided to this population, identifying unmet needs, and improving service provision. [ABSTRACT FROM AUTHOR]

Purpose: Prescriptive and predictive analytics and artificial intelligence (AI) provide tools to analyze data with objectivity. In this paper, we provide an overview of how these techniques can improve nursing care, and we detail a quantitative model to afford managerial insights about care management in a Hospital in Colombia. Our main purpose is to provide tools to improve key performance indicators for the care management of inpatients which includes the nurse workload. Methods: The optimal nurse‐to‐patient assignment problem is addressed using analytics, lean health care, and AI. Also, we propose a new mathematical model to optimize the nurse‐to‐patient assignment decisions considering several variables about the patient state such as the Barthel index, their risks, the complexity of the care, and the mental state. Findings: Our results show that there are several processes inherent to compassionate nursing care that can be improved using technology. By using data analytics, we can also provide insights about the high variability of the care requirements and, by using models, find nurse‐to‐patient assignments that are nearly perfectly balanced. Conclusions: We illustrated this improvement with a pilot test that makes the equitable distribution of nursing workload the functionality of this strategy. The findings can be useful in highly complex hospitals in Latin America. Clinical Relevance: The proposed model presents an opportunity to make near perfectly balanced nurse‐to‐patient assignments according to the number of patients and their health conditions using technology. [ABSTRACT FROM AUTHOR]

Background: The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM), which has been made available as a manuscript published in Transfusion since 2018. Methods: CTMC committee members reviewed original manuscripts including TM‐related topics published electronically (ahead) or in print from December 2019 to December 2020. The selection of topics and manuscripts was discussed at committee meetings and chosen based on relevance and originality. Next, committee members worked in pairs to create a synopsis of each topic, which was then reviewed by two additional committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is extensive, it is not exhaustive, and some papers may have been excluded or missed. Results: The following topics are included: COVID‐19 effects on the blood supply and regulatory landscape, COVID convalescent plasma, adult transfusion practices, whole blood, molecular immunohematology, pediatric TM, cellular therapy, and apheresis medicine. Conclusions: This synopsis provides easy access to relevant topics and may be useful as an educational tool. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: This paper examines a remarkable dispute between Dutch insurers, hospitals, doctors, and patients about a set of quality indicators. In 2013, private insurers planned to drastically reform Dutch emergency care using quality indicators they had formulated drawing from clinical guidelines, RCTs, and systematic reviews. Insurers' plans caused much debate in the field of emergency care. As quality indicators have come to play a more central role in health care governance, the questions what constitutes good evidence for them, how they ought to be used, and who controls them have become politically and morally charged. This paper is a case study of how a Dutch public knowledge institution, the National Health Care Institute, intervened in this dispute and how they addressed these questions. Method: We conducted ethnographic research into the knowledge work of the National Health Care Institute. Research entailed document analysis, participant observation, in‐depth conversations, and formal interviews with 5 key‐informants. Results: The National Health Care Institute problematized not only the evidence supporting insurers' indicators, but also—and especially—the scope, purpose, and use of the indicators. Our analysis shows the institute's struggle to reconcile the technical rationality of quality indicators with their social and political implications in practice. The institute deconstructed quality indicators as national standards and, instead, promoted the use of indicators in dialogue with stakeholders and their local and contextual knowledge. Conclusions: Even if quality indicators are based on scientific evidence, they are not axiomatically good or useful. Both proponents and critics of Evidence‐based Medicine always feared uncritical use of evidence by third parties. For non‐medical parties who have no access to primary care processes, the type of standardized knowledge professed by Evidence‐based Medicine provides the easiest way to gain insights into "what works" in clinical practice. This case study reminds us that using standardized knowledge for the management of health care quality requires the involvement of stakeholders for the development and implementation of indicators, and for the interpretation of their results. [ABSTRACT FROM AUTHOR]

Long‐term safety of adalimumab in psoriasis clinical studies has been established. The objective of this research was to review real‐world evidence of adalimumab safety from registries of adult patients with psoriasis treated in clinical practice. Databases (BIOSIS Previews, Current Contents Search, Derwent Drug File, EMBASE, EMBASE Alert, EMCare, MEDLINE, SciSearch) were searched for psoriasis registries with adalimumab safety data. Eligible papers were English language manuscripts (conference abstracts excluded) from psoriasis registries presenting safety data for adult patients with psoriasis receiving adalimumab. The incidence and rate (events/100 patient‐years [PY]) of adverse events (AEs), serious AEs (SAEs) and AEs of special interest are reported. Abstracts of 425 publications were screened, and 401 publications excluded (208 conference abstracts; 193 papers). Remaining manuscripts were fully screened; 14 were excluded (no adalimumab data, n = 10; no safety data, n = 2; no on‐treatment data, n = 1; not English, n = 1), and 10 selected. Overall rates of AEs (4273 [22.2/100PY]) and SAEs (827 [4.3/100PY]) were reported in the ESPRIT registry (N = 6059). Rates of infections (7.7–14.7/100PY) and serious infections (<0.6–2.0/100PY) were reported in four studies. Cardiovascular‐related events were reported in three studies: ≤0.1/100PY per major cardiac event in ESPRIT, <0.5/100PY major cardiac events in PsoBest and serious cardiovascular events in two patients (<1%) in DERMBIO. Malignancies were reported in three studies (any malignancy, 0.9/100PY; malignancies excluding non‐melanoma skin cancer [NMSC], <0.6/100PY; NMSC, 0.6–<0.5/100PY). These findings suggest that real‐world safety of adalimumab is consistent across different psoriasis registries, which supports the existing long‐term safety profile of adalimumab from clinical studies. [ABSTRACT FROM AUTHOR]

Background: Health care teams are increasingly forced to navigate complex challenges to achieve their collective aim of delivering high‐quality, safe patient care. The teamwork literature has struggled to develop strategies that promote effective adaptive behaviours among health care teams. In part, this challenge stems from the fact that truly collective adaptive behaviour requires members of the teams to abandon the human urge to act self‐sufficiently. Nature contains striking examples of collective behaviour as seen in social insects, fish and bird colonies. This collective behaviour is known as Swarm Intelligence (SI). SI remains poorly described in the health care team literature and its potential benefits hidden. Objective: In this cross‐cutting edge paper, I explore the principles of SI as they pertain to systemic or collective adaptation in human teams. In particular, I consider the principles of trace‐based communication and collective self‐healing and what they might offer to team adaptation researchers in medical education. Results: From a SI perspective, a solution to a problem emerges as a result of the collective action of the members of the swarm, not the individual action. This collective action is achieved via four principles: direct and indirect communication, awareness, self‐determination and collective self‐healing. Among those principles, trace‐based communication and collective self‐healing have been purposefully used by other industries to foster team adaptation. Trace‐based communication relies on leaving 'traces' in the environment to drive the behaviour of others. Collective self‐healing is the ability of the swarm to cope with failure and adapt to changes by permitting swarm members to be interchangeable. Conclusions: While allowing teams to rely on indirect communication and to be interchangeable might create discomfort to our ways of thinking, teams outside health care are demonstrating their value to advance human teamwork. SI offers a helpful analogy and a constructive language for thinking about team adaptation. Drawing analogy to swarm intelligence, Cristancho introduces the principles of collective self‐healing and trace‐based communication to offer a constructive language for thinking about team adaptation in healthcare. [ABSTRACT FROM AUTHOR]

Aim: The use of probiotics has been covered by many guidelines, position papers and evidence-based recommendations, but few have referred to specific patient groups or clinical indications. This review summarises recommendations and scientifically credited guidelines on the use of probiotics for children with selected clinical conditions and provides practice points.Methods: An expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric health care and review and summarise the guidelines, recommendations, position papers and high-quality evidence.Results: The panel found that specific probiotic strains were effective in preventing antibiotic-associated and nosocomial diarrhoea, treating acute gastroenteritis and treating infantile colic in breastfed infants. However, special caution is indicated for premature infants, immunocompromised and critically ill patients and those with central venous catheters, cardiac valvular disease and short-gut syndrome. This review discusses the safety of using probiotics in selected groups of paediatric patients and the quality of the available products providing practice points based on proved findings.Conclusion: Efficacy of probiotics is strain specific. Their benefits are currently scientifically proven for their use in selected clinical conditions in children and not recommended for certain patient groups. [ABSTRACT FROM AUTHOR]

Context: Medical education and workplace learning is bound to develop through tensions between providing high quality patient care and providing training of the future specialist healthcare workforce. This paper on the Change Laboratory and the theoretical framework supporting it, shows examples on how to explore inherent and contradictory tensions in medical education and healthcare and use them as a driving force for change. We argue that the traditional tools and theories for change and fixing tensions are inadequate and therefore suggest an alternative strategy found in Cultural‐Historical Activity Theory (CHAT) and the Change Laboratory method. Methods: The Change Laboratory intervention method builds on the theoretical framework of CHAT and specifically the theory of expansive learning. The Change Laboratory intervention method uses well‐defined steps for participants in collaboration with researchers/facilitators to co‐construct and develop new ways of going about their work practice. Results: Drawing on our own research on implementing the Change Laboratory intervention method we present two case examples of interventions in respectively a Finnish surgical unit and a Danish paediatric outpatient clinic. Conclusions: The Change Laboratory intervention offers ways to systematically leverage tensions in medical education and thus could be effective in developing and designing organisational and professional change. It is not a quick fix solution as participators must be motivated and engaged in uncovering inherent contradictions in their activity systems (workplace) and get familiar with the concepts and theory underlying the intervention and its procedures. Profound knowledge and transformative agency emerges when participants and facilitators/researchers are given the time and opportunity to analyse both historical practice, current data on practice, and organisational issues collaboratively in order to envision and redesign their practice and learning environment. The Change Laboratory intervention offers ways to leverage tensions in medical education to help design change in participants practice and learning environment. [ABSTRACT FROM AUTHOR]

The authors highlight barriers to a lack of engagement with relational approaches to medical education by synthesising findings from four State of the Science papers focused on Social aspects of health professional education. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) for access assessment and guided cannulation has become more common in hemodialysis units. The aims of this scoping review were to determine: circumstances in which renal nurses and technicians use POCUS; the barriers and facilitators; and evidence of the effects of POCUS in guiding assessment and cannulation. A search was conducted of CINAHL, Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ProQuest, Trove and Google Scholar as grey literature sources. Of 1904 publications, 21 studies met inclusion criteria (11 full text and 10 abstracts). These included primary research publications (n = 5), clinical observational cohort studies (n = 5), case studies (n = 3), published guidelines (n = 2), and published position papers (n = 6). POCUS was used for: assessing arteriovenous fistula (AVF) maturation; identifying landmarks and abnormalities; assessing alternate cannulation sites; performing new AVF cannulation; performing difficult cannulation; increasing cannulation accuracy; performing cannulation through stents; and patient self-cannulation training. There were scant data on the barriers to, and facilitators of the use of POCUS, and a distinct lack of empirical evidence to support its use. These knowledge gaps highlight the need for further clinical studies, particularly randomized clinical trials, to test the effectiveness of POCUS in hemodialysis for assessment and guided cannulation. [ABSTRACT FROM AUTHOR]

Background: The AABB Clinical Transfusion Medicine Committee (CTMC) compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine (TM) for the board of director's review. This synopsis is now made available as a manuscript published in TRANSFUSION.Study Design and Methods: CTMC committee members review original manuscripts including TM-related topics published in different journals between late 2018 and 2019. The selection of topics and manuscripts are discussed at committee meetings and are chosen based on relevance and originality. After the topics and manuscripts are selected, committee members work in pairs to create a synopsis of the topics, which is then reviewed by two committee members. The first and senior authors of this manuscript assembled the final manuscript. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed.Results: The following topics are included: infectious risks to the blood supply, iron donor studies, pre-transfusion testing interference and genotyping, cold agglutinin disease (CAD), HLA alloimmunization in platelet transfusions, patient blood management, updates to TACO and TRALI definitions, pediatric TM, and advances in apheresis medicine.Conclusion: This synopsis provides easy access to relevant topics and may be useful as an educational tool. [ABSTRACT FROM AUTHOR]

Compulsory community treatment for people with severe mental illness remains controversial due to conflicting research evidence. Recently, there have been challenges to the conventional view that trial‐based evidence should take precedence. This paper adds to these challenges in three ways. First, it emphasizes the need for critiques of trials to engage with conceptual and not just technical issues. Second, it develops a critique of trials centred on both how we can have knowledge and what it is we can have knowledge of. Third, it uses this critique to develop a research strategy that capitalizes on the information in large‐scale datasets. [ABSTRACT FROM AUTHOR]