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This article provides guidelines for assessing and managing bleeding risk before invasive procedures. It recommends individualized assessment and decision-making based on the specific procedure and patient characteristics. The article discusses the management of anticoagulant and antiplatelet therapy, the limitations of routine coagulation testing, and the potential use of global haemostatic and platelet function testing to predict bleeding risk. It also addresses the use of plasma products and platelet transfusions in the ICU, emphasizing the lack of evidence supporting their prophylactic use. The article highlights the importance of operator and procedural factors in reducing the risk of complications during procedures. [Extracted from the article]

In the mid‐southern United States, rice (Oryza sativa L.) is flooded primarily to suppress weed germination and growth. Two experiments were conducted to determine whether herbicide performance in conventional or Clearfield rice weed control programs was affected by intermittent flooding. The effects of flooding and herbicide program on barnyardgrass [Echinochloa crus‐galli (L.) P. Beauv] control, rice grain yield, and water applied were investigated at the Delta Research and Extension Center in Stoneville, MS, on Sharkey clay (very fine, smectitic, thermic Chromic Epiaquert). For herbicides commonly applied in conventional (clomazone, quinclorac, pendimethalin, thiobencarb, fenoxaprop‐ethyl, cyhalofop‐butyl, and bisypriboac sodium) or Clearfield rice weed control programs (imazethapyr plus bispyribac‐sodium followed by imazethapyr, imazamox or bispyribac‐sodium), intermittent flooding had no adverse effect on barnyardgrass control relative to a continuous flood. Moreover, initiating irrigation when the perched water table drops to 8 inches below the soil surface had no effect on rice grain yield and reduced water applied by 51%. Mid‐southern US rice producers can capture the water‐saving benefits of intermittent flooding while having no adverse effects on herbicide activity or crop productivity in conventional and Clearfield systems. Core Ideas: Barnyardgrass control did not differ between intermittently and continuously flooded systems.Initiating irrigation when perched water table drops 8 inches below soil surface had no effect on rice grain yield.Intermittent flooding reduced water applied 51% compared to continuous flooding. [ABSTRACT FROM AUTHOR]

This paper describes a novel approach to explore how regulators, working with patients and practitioners, may contribute to supporting person‐centred care and processes of shared decision making in implementing professional standards and reducing harms. Osteopathic patients report high levels of patient care. However, areas of consultations less likely to be rated as high included "fully understanding your concerns," "helping you to take control," and "making a plan of action with you," suggestive of a paternalistic approach to care and a barrier to the effective implementation of standards. This programme explored how to support patients and practitioners to make more explicit what is important to support consultations with better communication in accordance with standards. A series of workshops took place involving approximately 80 participants, which explored and identified practitioner and patient values; these were themed to develop a common framework and tested using case studies. Aspects of what enables or presents a barrier to a positive consultation were further explored with real patient narratives, and a range of resources were subsequently developed, which may support patients and practitioners to make explicit what is important to them in a consultation. A series of approaches and tools were then developed for piloting including patient curriculum vitae; patient goal planner; patient animation to support preparation for an appointment; infographic: a patient poster or leaflet; practitioner reflective tool; and an audio recording to increase awareness and understanding of values‐based practice. In conclusion, a range of approaches may help to support patients and practitioners to make explicit what is important to them in a consultation. The next phase of our programme will use a range of methods including cluster sampling, pre‐testing and post‐testing with the Consultation and Relational Empathy (CARE) measure tool, and interviews and focus groups with users and practitioners to demonstrate impact. [ABSTRACT FROM AUTHOR]

This article details how a council service established an integrated management system ( IMS) within a wider corporate framework. In this context, an IMS was used as a tool to improve (i) Performance, (ii) Quality, (iii) Environment, and (iv) Health and Safety Management. A key factor was that the IMS had to be appropriate for accreditation and integratible with an emerging corporate management framework. In this case study, the authors provided a literature review before considering the issues facing the management team in implementing the IMS. Next, the discussion reflected on how the IMS has delivered improvements before concluding with recommendations on how to implement an IMS within similar services. These points of learning may be relevant beyond local government. This article therefore provides a summary of action research and the steps taken to deliver an IMS within a broader context. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study measured: 1) levels of awareness and understanding among practicing obstetricians regarding umbilical cord blood (UCB) donation and the use of UCB in transplant therapy, 2) motivations for obstetricians to support donation and collection for donation to a public cord blood bank (CBB), and 3) current practices for discussing this option with their patients. STUDY DESIGN AND METHODS: Obstetricians practicing in major metropolitan areas in the United States were randomly surveyed in 2009. Of 2041 surveys mailed, 295 were returned, 139 from obstetricians with privileges at hospitals affiliated with a public CBB (affiliated) and 156 from obstetricians without such privileges (nonaffiliated). Cross-tabulation analyses were conducted to compare responses between these two groups. RESULTS: Both affiliated and nonaffiliated obstetricians report being somewhat or very familiar with the use of cord blood in transplant therapy (88% vs. 82%, respectively; p = NS), but some misperceptions concerning clinical application exist. Eighty percent of affiliated obstetricians feel confident discussing cord blood options with their patients; however, 49% indicated that they have insufficient knowledge of cord blood donation to effectively answer patients' questions about donation. CONCLUSION: Obstetricians are generally familiar with the utility of donated cord blood in transplantation, but could benefit from additional information regarding how cord blood is used in transplantation. Further, obstetricians play an important role in encouraging women to donate their baby's cord blood to a public CBB, are willing to do so, and indicate a desire for more information so they can effectively educate their patients. [ABSTRACT FROM AUTHOR]

The article describes the case of a late steroid-refractory immunotherapy-induced colitis relapse in a 65-year-old man without the precipitant of further immunotherapy. Highlights include severe colitis of the entire colon with oedema according to colonoscopy, the challenge of gaining hospital formulary or Pharmaceutical Benefits Scheme (PBS) approval, and PBS approval of combination immunotherapy for melanoma and renal cell carcinoma.

Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints., (© 2019 The Authors. Liver International published by John Wiley & Sons Ltd.)