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Diagnosing Alzheimers disease (AD) poses significant challenges to health care, often resulting in delayed or inadequate patient care. The clinical integration of blood-based biomarkers (BBMs) for AD holds promise in enabling early detection of pathology and timely intervention. However, several critical considerations, such as the lack of consistent guidelines for assessing cognition, limited understanding of BBM test characteristics, insufficient evidence on BBM performance across diverse populations, and the ethical management of test results, must be addressed for widespread clinical implementation of BBMs in the United States. The Global CEO Initiative on Alzheimers Disease BBM Workgroup convened to address these challenges and provide recommendations that underscore the importance of evidence-based guidelines, improved training for health-care professionals, patient empowerment through informed decision making, and the necessity of community-based studies to understand BBM performance in real-world populations. Multi-stakeholder engagement is essential to implement these recommendations and ensure credible guidance and education are accessible to all stakeholders.

Blood-based biomarkers (BBM) for Alzheimers disease (AD) are being increasingly used in clinical practice to support an AD diagnosis. In contrast to traditional diagnostic modalities, such as amyloid positron emission tomography and cerebrospinal fluid biomarkers, BBMs offer a more accessible and lower cost alternative for AD biomarker testing. Their unique scalability addresses the anticipated surge in demand for biomarker testing with the emergence of disease-modifying treatments (DMTs) that require confirmation of amyloid pathology. To facilitate the uptake of BBMs in clinical practice, The Global CEO Initiative on Alzheimers Disease convened a BBM Workgroup to provide recommendations for two clinical implementational pathways for BBMs: one for current use for triaging and another for future use to confirm amyloid pathology. These pathways provide a standardized diagnostic approach with guidance on interpreting BBM test results. Integrating BBMs into clinical practice will simplify the diagnostic process and facilitate timely access to DMTs for eligible patients.

BACKGROUND/OBJECTIVES: The phase 3 REGAIN study and its open-label extension demonstrated the efficacy of the complement C5 inhibitor eculizumab in patients with treatment-refractory, acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG). The aim of the ELEVATE study was to assess the effectiveness of eculizumab in clinical practice in adults with MG in the United States. METHODS: A retrospective chart review was conducted in adults with MG who initiated eculizumab treatment between October 23, 2017 and December 31, 2019. Outcomes assessed before and during eculizumab treatment using a pre- versus post-treatment study design included Myasthenia Gravis-Activities of Daily Living (MG-ADL) total scores; minimal symptom expression (MSE); physician impression of clinical change; minimal manifestation status (MMS); and concomitant medication use. RESULTS: In total, 119 patients were included in the study. A significant reduction was observed in mean MG-ADL total score, from 8.0 before eculizumab initiation to 5.4 at 3 months and to 4.7 at 24 months after eculizumab initiation (both p

AbstractBackground:Aims:Methods:Results:Conclusions:The Clinical Outcomes in Routine Evaluation (CORE) system was launched in 1998 intended to support the development of practice-based evidence and to reduce the research/practice gap. Since then, CORE instruments have been widely used.To map the utilization of the CORE system as reflected in peer-reviewed literature.We followed the guidelines for conducting a scoping review.We identified 721 papers from 1998 to 2021 citing the CORE system, with 636 of them referencing its use in clinical settings. There has been a marked increase in use of the system over that period. All CORE instruments were used at least once, spanning 39 countries and 24 languages. Papers had a broad spectrum of objectives and populations across diagnoses and settings, aligning with the authors’ planned versatility for the CORE system.In the light of the findings, we present a guide to enhance the reporting of work utilizing the CORE system. This could be applied to all practice-based evidence data collection, CORE or otherwise. [ABSTRACT FROM AUTHOR]

Feedback literacy includes students' abilities to understand, use and benefit from feedback processes; it is important for the development of self-directed learning, SDL. Considering all of the places where students can potentially learn, especially the clinic, we would argue that feedback has been too narrowly defined. This study aims to explore the different shapes feedback can take for students in their clinical practice. Nursing students at different educational levels were interviewed about their learning after completing a five-week clinical placement within elderly care. Their narratives were explored using a qualitative content analysis of both the manifest and latent content. Interestingly, feedback was shown to be generated by the students themselves: Noticing what others do and what happens on site; Active participation providing first-hand experiences; Getting and taking responsibility; and Understanding what you know and what you need to learn. Although not termed feedback by the students, comparison with their own thoughts, feelings, and behaviours as they observed, participated, and reflected emerged as important to their learning. For this internal feedback to become useful in the development of feedback literacy and SDL, students' reflections are paramount. [ABSTRACT FROM AUTHOR]

Introduction Management of testicular torsion varies between specialties resulting in lack of standardization. The aim of this survey was to assess pre-, peri-, and postoperative differences. Methods An online questionnaire was distributed in 2023 to general and pediatric surgeons, pediatric urologists, and urologists by the Trainees of European Pediatric Surgery. Main Results Among 88 respondents (92% tertiary referral hospital), 38% always or usually perform sonography in case of suspected torsion respectively. In addition, 15% always attempt manual detorsion and 44% depending on the clinical presentation. Most surgeons (93%) favor a scrotal approach. Interestingly, pediatric surgeons choose a transscrotal while other specialties opt for a midline incision (p = 0.002). The majority (57%) employ a three-point fixation, while 42% opt for a two-point fixation. In case of necrotic testis, 61% puncture the testis with 52% opting for surgical removal, while 33% perform orchiectomy and 6% leave it in situ. Regarding necrotic or borderline-appearing testis, 54% take a biopsy. Furthermore, 82% perform prophylactic orchidopexy of the contralateral side during the same session. Postoperative antibiotics are always administered by 12%, while 52% do so sometimes. Most perform sonographic (58%) or clinical (57%) follow-up 3 months postoperatively. Notably, pediatric surgeons and urologists perform follow-up more frequently themselves, while general surgeons/urologists recommend follow-up by pediatricians (p = 0.002). In addition, 76% of responders affirm adhering to European Association of Urology guidelines. Unawareness of guidelines and institutional practices are reasons most commonly cited for nonadherence. Conclusion Our study reveals significant disparities in the pre-, peri-, and postoperative management of testicular torsion underscoring the need for establishing standardized practices. [ABSTRACT FROM AUTHOR]

Objective: Mobile health (mHealth), defined as the use of mobile phones or applications in healthcare, has been developed to enhance asthma care; yet implementation is inconsistent, and few studies have focused on provider perspectives on use in daily practice. The purpose of this study was to explore primary care pediatric provider perspectives regarding mHealth use in clinical practice for children with asthma. Methods: A qualitative, descriptive approach was utilized to perform semi-structured interviews on asthma mHealth use with providers caring for children with asthma. Interview transcripts were coded by two independent investigators and any differences were reconciled. Interviews continued until thematic saturation was achieved. Results and Conclusions: Seventeen pediatric providers were recruited and interviewed. Three themes identified included implementation benefits, implementation barriers, and reporting desires, with 11 subthemes. Many subthemes were consistent across providers (e.g. self-management benefits and electronic medical record integration), while others such as provider clinical burden and approach to integrating mHealth data reports into daily workflow demonstrated variability. Provider perspectives highlight the potential of mHealth applications in asthma self-management while offering challenges related to clinical burden and suggestions for reporting and workflow integration. These results provide valuable perspectives on mHealth use and reporting to ensure provider efficiency and technology-enhanced asthma care. This study investigates pediatric provider perspectives on asthma mobile health use and reporting in daily practice, a topic that has not sufficiently been explored within the literature. Results can guide best practices, encourage more consistent use, and maximize the benefits of asthma mHealth tools by providers. [ABSTRACT FROM AUTHOR]

The topic of humor (and laughter) in healthcare contexts has attracted considerable scholarly interest, especially in professional-patient communication. Yet much remains to be investigated about its forms and functions in backstage inter-professional interaction from a discourse analytical/pragmatic perspective. In this light, this paper explores the role of humor in interpersonal conflict management in hospital handover meetings with the aim of providing insights into both the various functions this inconspicuous discursive strategy may perform on a macro-level, as well as the way this is achieved at the micro-level. Interpersonal conflict is said to be an inherent aspect of such high-stakes medical settings, and conflict management is of vital importance for negotiating patients' cases and treatment paths. Drawing on authentic handover meetings recorded at a hospital in New Zealand, we provide useful insights into the ways in which conflicts are managed and medical knowledge is transferred in these backstage encounters. The paper shows how different kinds of potentially face-threatening humor is used to manage and avoid conflict by those in superior as well as those in more junior positions. Finally, we argue that these ways of 'doing' humor in conflict management are a reflection (and reinforcement) of the team's close-knit social relations and directly address the high-stakes nature of these medical encounters. [ABSTRACT FROM AUTHOR]

Background: The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines (CPGs) for various pathologies. An extension to the Consolidated Standards for Reporting (CONSORT) checklist provides authors with a framework for reporting harms in randomized controlled trials (RCTs). Objectives: The purpose of this study was to measure harms reporting among RCTs cited as supporting evidence for the AAOS CPG on the treatment of clavicle fractures. This study also sought to determine whether these reporting rates changed over time. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used the AAOS CPG for clavicle fractures and conducted a linear regression analysis to model the relationship between the year of publication and the total CONSORT checklist percentage adherence over time. Results: There were 28 RCTs cited as supporting evidence for the clavicle fractures CPG included in the final sample. The average number of the 18 CONSORT Extension for Harms items appropriately reported across all included RCTs was 9.32 (51.8%). Nine checklist items had more than 50% compliance (50%), 3 items had between 20% and 50% compliance (16.7%), and 6 items had less than 20% compliance (33.3%). The linear regression model demonstrated no significant improvement in CONSORT Harms reporting over time. Conclusions: Adverse events are inadequately reported in RCTs cited as supporting evidence for the AAOS Treatment of Clavicle Fractures CPGs. We recommend the utilization of standardized adverse event reporting tools specific to orthopedic trauma literature to facilitate ease in adverse event reporting among RCTs. [ABSTRACT FROM AUTHOR]

Medical misinformation (false health or medical‐related information) has seen a rapid increase in volume recently, with the global surge in social media usage and further exacerbation by the COVID‐19 pandemic. This may put more lives at stake, as misinformation is an often‐cited reason that people make dangerous health choices, engage in harmful practices and reject beneficial health treatments. In this article, we explore the drivers and consequences, as well as suggest several strategies at the personal, educational and systemic level, for physicians to guide and communicate with patients who subscribe to medical misinformation. [ABSTRACT FROM AUTHOR]

Aims: This study aims to improve the interpretability and clinical utility of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) by identifying distinct financial toxicity classes in adults with diabetes. Methods: Data included a sample of 600 adults with Type 1 or Type 2 diabetes and high A1c. Latent Class Analysis was used to identify subgroups of patients based on COST-FACIT score patterns. Results: We identified 3 financial toxicity classes (high, medium and low) with strong indicators of membership classification. Multiple indicators of financial stress, maladaptive cost-coping behaviors, more comorbidities, more prescribed medications, more diabetes distress, more depressive symptoms, closer to the federal poverty level, female, having lower educational attainment and being single were all significant predictors of high financial toxicity class membership. A score of 26 on the COST-FACIT was the strongest threshold for sorting high vs. medium/low financial toxicity, with a positive predictive value (PPV) of 76% and negative predictive value (NPV) of 93%. Conclusion: The COST-FACIT can be used to reliably identify people with diabetes that have high financial toxicity. Integrating this new cut-score into clinical practice may help clinical teams identify people in need of additional support due to financial toxicity. [ABSTRACT FROM AUTHOR]

Background: Interest in wearable device use in Parkinson's disease (PD) has grown rapidly with many compelling studies supporting diagnostic and therapeutic uses. Concurrently, consumer devices have proliferated and their role in health and wellness has expanded. However, incorporation of consumer and medical wearable devices into medical care has in our experience been limited. Objective: We sought to assess the current state of consumer and medical wearable device use among those with PD and to understand the factors impacting their rate of use. Methods: An anonymous online survey of individuals with PD in the US was conducted from July 9th, 2023, to Jan 8th, 2024, with 298 completed responses collected. Results: Greater than 90% of respondents were interested in new technologies with 67% having had experiences with consumer wearable devices. Only 24% were using consumer devices for disease management and many functions were not fully utilized. Medical wearable device use was very limited with only 8% having used a device. Users of both consumer and medical wearables generally reported low barriers to use despite continued strong perceptions on the importance of cost, impact on care, comfort, and other factors. Conclusion: This study demonstrates that for the clinical management of PD there is limited use of wearable devices even among individuals who are motivated and experienced with consumer wearable device use. Additionally, it is suggested that substantial barriers to medical wearable use are likely originating from the provider and/or systemic level. [ABSTRACT FROM AUTHOR]

Pemphigus is an autoimmune blistering disorder characterized by the presence of intraepidermal blisters and erosions, primarily affecting the mucosa and/or skin. There are no established Indian guidelines for the management of pemphigus, and Western guidelines cannot be directly applied due to differences in clinicodemographic profiles, comorbidities, and resource limitations. These guidelines aim to provide Indian dermatologists with evidence-based and consensus-driven recommendations for the management of pemphigus vulgaris (PV) and pemphigus foliaceous (PF), taking into account the unique challenges posed by the Indian healthcare setting. The guidelines focus on the comprehensive management of PV and PF, addressing diagnosis, treatment, monitoring, and follow-up. It is intended for dermatologists working in both outpatient and inpatient settings across India. The first draft of the guidelines was prepared by the writing group and then reviewed by 19 national experts in pemphigus management, including inputs from allied specialties. Areas with limited evidence or anticipated variation in recommendations were subjected to rounds of voting, with responses categorized as "strongly agree," "agree," "neutral," "disagree," or "strongly disagree." Suggestions were incorporated, and statements were revised until a mean agreement score of 4 or higher was reached across 16 key areas after four voting rounds. These guidelines offer a structured approach to managing pemphigus in India, addressing the need for region-specific recommendations that account for unique challenges such as resource constraints and specific comorbidities in Indian patients. They serve as a valuable resource for dermatologists treating pemphigus in a range of clinical settings. [ABSTRACT FROM AUTHOR]