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* Context.--Neoplastic cellularity assessment has become an essential component of molecular oncology testing; however, there are currently no best practice recommendations or guidelines for this potentially variable step in the testing process. Objective.--To describe the domestic and international practices of neoplastic cellularity assessment and to determine how variations in laboratory practices affect neoplastic cellularity assessment accuracy. Design.--Data were derived from 57 US and international laboratories that participated in the 2019 College of American Pathologists Neoplastic Cellularity Proficiency Testing Survey (NEO-B 2019). NEO-B 2019 included 29 laboratory practice questions and 5 images exhibiting challenging histologic features. Participants assessed the neoplastic cellularity of hematoxylin-eosin-stained digital images, and results were compared to a criterion standard derived from a manual cell count. Results.--The survey responses showed variations in the laboratory practices for the assessment of neoplastic cellularity, including the definition of neoplastic cellularity, assessment methodology, counting practices, and quality assurance practices. In some instances, variation in laboratory practice affected neoplastic cellularity assessment performance. Conclusions.--The results highlight the need for a consensus definition and improved standardization of the assessment of neoplastic cellularity. We put forth an initial set of best practice recommendations to begin the process of standardizing neoplastic cellularity assessment. (Arch Pathol Lab Med. 2022;146:1062-1071; doi: 10.5858/arpa.2021-0166-CP), In the era of precision medicine, molecular oncology testing has become critical to identifying clinically relevant mutations in a variety of cancer genes that are used in diagnosis, prognosis, and/or [...]

Introduction: HIV pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission. United States Public Health Service (USPHS) clinical practice guidelines define biobehavioral indications for initiation. To assess guideline implementation, it is critical to quantify PrEP nonusers who are indicated and PrEP users who are not indicated. We sought to estimate current PrEP use among US men who have sex with men (MSM), characterize whether their PrEP use aligned with their current indications for PrEP, and assess whether the association between PrEP indications and PrEP use differed by demography or geography. Methods: Using data from a US web-based sexual network study of MSM between 2017 and 2019, we measured PrEP usage and assessed whether respondents met indications for PrEP. Log-binomial regression was used to estimate the relationship between PrEP indications and PrEP use, with adjustment for geography, age and race/ethnicity. Results: Of 3508 sexually active, HIV-negative MSM, 34% met indications for PrEP. The proportion with current PrEP use was 32% among MSM meeting indications and 11% among those without indications. Nearly 40% of those currently using PrEP did not meet indications for PrEP, and 68% of MSM with indications for PrEP were not currently using PrEP. After adjusting for geography and demographics, MSM with PrEP indications were about three times as likely to be currently using PrEP. This association varied slightly, but not significantly, by geographic region, age and race/ethnicity. Conclusions: Indications for PrEP strongly predicted current PrEP use among US MSM. However, we identified substantial misalignment between indications and use in both directions (indicated MSM who were not benefitting from PrEP, and MSM taking PrEP while not presently being indicated). PrEP underuse by those at greatest risk for HIV acquisition may limit the projected impact of PrEP implementation, despite reported increases in PrEP provision. This calls for further implementation efforts to improve PrEP delivery to those most in need during periods of elevated sexual risk and to close the gap between indications and uptake. Keywords: HIV; pre-exposure prophylaxis; prevention; men who have sex with men, 1 | INTRODUCTION Despite biomedical advances in human immunodeficiency virus (HIV) prevention with antiretroviral pre-exposure prophylaxis (PrEP), the burden of HIV among men who have sex with men (MSM) remains [...]

The impact of the severe acute respiratory syndrome coronavirus 2 pandemic is placing tremendous pressure on government and the biomedical research enterprise to quickly develop safe, effective therapies and move [...]

Summary Nurses often have an important role in devising or updating local policies and protocols, but are rarely prepared for a process that requires careful consideration of existing resources and [...]

When damage from a hurricane led to the closure of Vermont's only state-run psychiatric facility, the situation ultimately presented an unforeseen opportunity. In time, the facility transformed from 'the scapegoat [...]

The authors present the findings of a special task group (STG) organized to explore effective training strategies for the practice guidelines focused on diverse populations. They provide a brief literature review and summarize survey data from academic training directors regarding current use of practice guidelines. The authors then describe the Integrative Training Model (ITM), developed by the STG, as a framework for students and professionals to incorporate the complex array of information contained in each set of guidelines. Unique challenges associated with incorporating the ITM are described, as well as pedagogical considerations for both students and current professionals. The authors believe the ITM may help students and professionals increase their diversity competence by developing a more holistic understanding of the various dimensions and social group experiences that affect their clients and themselves. Keywords: multiculturalism; training; diversity

This report describes the development and measurement characteristics of a new measure of smoking knowledge, attitudes, and practices (S-KAP) among treatment providers. Data are based on survey responses from 336 paid staff working in one of three drug abuse treatment or HI V care settings. Exploratory factor analysis, used to examine the factor structure, pointed towards five underlying factors: a single 'knowledge' factor, three 'attitude' factors ('treatment barriers,' 'counselor self-efficacy, 'and 'counselor attitudes') and a single 'practices' factor. The Knowledge scale had a standardized Cronbach's alpha coefficient of. 85. The coefficients for Barriers, Self-Efficacy, and Attitude s were .81, .72, and .74, respectively, The Practice scale had a standardized Cronbach's alpha coefficient of. 91. These results indicate that the proposed scales have reasonably good psychometric characteristics and will allow researchers to quantify staff knowledge, attitudes, and practices regarding smoking cessation treatments and issues.

Byline: R. Phillip Dellinger (1,15), Jean M. Carlet (2), Henry Masur (3), Herwig Gerlach (4), Thierry Calandra (5), Jonathan Cohen (6), Juan Gea-Banacloche (8), Didier Keh (7), John C. Marshall (9), Margaret M. Parker (10), Graham Ramsay (11), Janice L. Zimmerman (12), Jean-Louis Vincent (13), M. M. Levy (14) Keywords: Sepsis; Severe sepsis; Septic shock; Sepsis syndrome; Infection; Guidelines; Evidence-based medicine; Surviving Sepsis Campaign Abstract: Objective To develop management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. Design The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along 5 levels to create recommendation grades from A--E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management. Participants Participants included 44 critical care and infectious disease experts representing 11 international organizations. Results A total of 46 recommendations plus pediatric management considerations. Conclusions Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually, and even more rapidly when some important new knowledge becomes available. Author Affiliation: (1) Section of Critical Care Medicine, Cooper University Hospital, One Cooper Plaza, 393 Dorrance, Camden, NJ 08103, USA (2) Service de la Reanimation Polyvalente, Fondation Hopital Saint-Joseph, Paris, France (3) Critical Care Medicine, National Institutes of Health, Bethesda, MD, USA (4) Dept. for Anesthesiology & Critical Care Medicine, Vivantes-Klinikum Neukoelln, Berlin, Germany (5) Laboratoire de Maladies Infectieuses Dept. de Medecine Interne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (6) Brighton and Sussex Medical School, Falmer, United Kingdom (7) Clinic of Anesthesiology and Surgical Intensive Care Medicine, Charite, Campus Virchow-Clinic, Berlin, Germany (8) Infectious Disease Section, Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA (9) Toronto General Hospital, Toronto, Ontario, Canada (10) Pediatrics, SUNY at Stony Brook, Stony Brook, NY, USA (11) University Hospital, Mastricht, Netherlands (12) Department of Medicine, Baylor College of Medicine, Houston, TX, USA (13) Department of Intensive Care, Erasme University Hospital, Brussels, Belgium (14) Brown University School of Medicine, Providence, RI, USA (15) Cooper Health Systems, One Cooper Plaza, 393 Dorrance, Camden, NJ 08103, USA Article History: Registration Date: 02/02/2004 Received Date: 06/01/2004 Accepted Date: 29/01/2004 Online Date: 03/03/2004 Article note: This article is published jointly with Critical Care Medicine Electronic Supplementary Material Supplementary material is available in the online version of this articel at http://dx.doi.org/10.1007/s00134-004-2210-z Chairs: R. Phillip Dellinger, MD* Henry Masur, MD Jean M. Carlet, MD Herwig Gerlach, MD, PhD**. Committee members: Richard J. Beale, MD** Marc Bonten, MD Christian Brun-Buisson, MD Thierry Calandra, MD Joseph A. Carcillo, MD Jonathan Cohen, MD** Catherine Cordonnier, MD E. Patchen Dellinger, MD Jean-Francois Dhainaut, MD, PhD Roger G. Finch, MD Simon Finfer, MD Francois A. Fourrier, MD Juan Gea-Banacloche MD Maurene A. Harvey, RN, MPH** Jan A. Hazelzet, MD Steven M. Hollenberg, MD James H. Jorgensen, PhD Didier Keh, MD Mitchell M. Levy*, MD Ronald V. Maier, MD Dennis G. Maki, MD John J. Marini, MD John C. Marshall, MD Steven M. Opal, MD Tiffany M. Osborn, MD Margaret M. Parker, MD** Joseph E. Parrillo, MD Graham Ramsay, MD* Andrew Rhodes, MD Jonathan E. Sevransky, MD Charles L. Sprung, MD, JD** Antoni Torres, MD Jeffery S. Vender, MD Jean-Louis Vincent, MD, PhD** Janice L. Zimmerman, MD. Associate members: E. David Bennett, MD Pierre-Yves Bochud, MD Alain Cariou, MD Glenn S. Murphy, MD Martin Nitsun, MD Joseph W. Szokol, MD Stephen Trzeciak, MD Christophe Vinsonneau, MD. *Executive Committee, Surviving Sepsis Campaign. **Steering Committee, Surviving Sepsis Campaign. Sponsoring organizations: American Association of Critical-Care Nurses American College of Chest Physicians American College of Emergency Physicians American Thoracic Society Australian and New Zealand Intensive Care Society European Society of Clinical Microbiology and Infectious Diseases European Society of Intensive Care Medicine European Respiratory Society International Sepsis Forum Society of Critical Care Medicine Surgical Infection Society. The Surviving Sepsis Campaign is administered jointly by the European Society of Intensive Care Medicine, International Sepsis Forum, and the Society of Critical Care Medicine, and is supported in part by unrestricted educational grants from Baxter Bioscience, Edwards Lifesciences, and Eli Lilly and Company (majority sponsor). The authors and the publisher have exercised great care to ensure that drug dosages, formulas, and other information presented in this book are accurate and in accord with the professional standards in effect at the time of publication. Readers are, however, advised to always check the manufacturer's product information sheet that is packaged with the respective products to be fully informed of changes in recommended dosages, contraindications, and the like before prescribing or administering any drug.

'One thing is sure. We have to do something. We have to do the best we know how at the moment ... ' Franklin D. Roosevelt 'To get anywhere, or [...]

If you find that you don't get enough done by day's end, take heart. You can accomplish tasks more quickly and efficiently by identifying and avoiding common time-wasters, experts say. [...]

If you doubt that clinical practice guidelines can play a decisive role in malpractice litigation, consider this case: A baby was born prematurely, congenitally blind in her right eye. She [...]

As governments are developing schemes for universal health coverage (UHC) and progressing towards the sustainable development goals (SDGs), they need relevant and context-sensitive evidence to support different policies and interventions. [...]

Author(s): Andrew Rhodes [sup.1] , Rui P. Moreno [sup.2] , Jean-Daniel Chiche [sup.3] [sup.4] [sup.5] [sup.6] [sup.7] Author Affiliations: (1) grid.451349.e, Department of Intensive Care Medicine, St George's Healthcare NHS [...]

The American Psychiatric Association's (2000) 'Practice Guideline for the Treatment of Patients With Eating Disorders' (PGED) provides useful, practical advice on the clinical and medical management of eating disorders, and an informative summary of the evidence on their epidemiology, nature, and treatment. The main limitation is the methodological adequacy and application of the coding system used to establish level of clinical confidence in treatment recommendations. The PGED represents a mix of science and expert clinical judgment that results in an overinclusiveness and several questionable conclusions. The PGED provides a balanced analysis of pharmacological treatment of anorexia and bulimia nervosa but not binge-eating disorder. Although it notes that cognitive behavior therapy enjoys the most scientific support of any treatment for bulimia nervosa, the PGED misses an opportunity to promote dissemination of this approach. The guideline misleadingly characterizes core cognitive-behavioral treatment strategies as 'nutritional rehabilitation.'

Comprehensive information on combined antiretroviral therapy (cART) regimens in rural Sub‐Saharan Africa over time is scarce, particularly on the use of stavudine (d4T) and second‐line regimens. Since 2010, World Health Organization (WHO) guidelines discourage using stavudine in first‐line regimens due to frequent and severe side‐effects. This study examined the practical adaption of this phasing‐out and described trends in use of various cART combinations in a rural Tanzanian setting. We analyzed longitudinal, prospectively collected data of HIV‐1‐infected adults initiating cART within the Kilombero Ulanga Antiretroviral Cohort (KIULARCO) in Ifakara, Tanzania from 2007–2011. This analysis included data of 3068 patients over a 5‐year period. Of these subjects, 1997 (66.9%) were female, median age was 37 (interquartile range [IQR] 31–44) years and median CD4 cell count at enrollment was 178 cells/µl (IQR 88‐291). The percentage of prescriptions containing stavudine in initial regimens (Table 1) fell from a peak of 75% in 2008 to 12.2% in 2011 (p for trend Initial cART with stavudine declined to low levels according to recommendations but the overall use of stavudine remains substantial. The usage of second‐line treatment is unusually low in view of expected therapeutic failure rates, indicating potential difficulties in management of suspected treatment failure cases. Monitoring of prescription trends is a simple and feasible approach to identify deficits in the implementation of treatment guidelines for optimal outcomes., Abbreviations DOI: [...]