BMC nephrologyShimaa A Shabaka, Ghada El-Kannishy, Eman Nagy, Mohammed Kamal Nassar
BACKGROUND: Acute kidney injury (AKI) is a global health problem associated with substantial morbidity, mortality, and healthcare costs. Despite advances in prevention and management, in-hospital mortality remains high, particularly among critically ill patients. OBJECTIVES: To determine incidence, risk factors of AKI among patients admitted to Mansoura Nephrology and Dialysis Unit (MNDU), a tertiary nephrology referral center in Dakahlia governorate, Egypt, over one year, and to identify predictors of renal recovery at discharge and in-hospital mortality. METHODS: This prospective observational study was conducted from June 2022 to May 2023 and included adult patients admitted with various kidney disorders. Patients were classified into AKI and non-AKI groups according to KDIGO 2012 criteria. Clinical, laboratory, and outcome data were analyzed, and multivariable regression analyses were used to identify independent predictors of in-hospital mortality and renal recovery after AKI. RESULTS: A total of 839 patients were enrolled, including 330 (39.3%) with AKI and 509 (60.7%) without AKI. The most common pathophysiological causes of AKI were pre-renal (54.2%) followed by intrinsic renal (38.5%) one. In-hospital mortality was significantly higher in AKI than non-AKI group (17.3% vs. 3.8%), with septic shock being the leading cause of death (84.2%). Among patients with AKI, 45.2% achieved complete renal recovery, 21.8% had partial recovery, and 33.0% had no recovery at discharge. On multivariable logistic regression analyses, KDIGO Stage 3 AKI (adjusted OR 0.277, P = 0.046), kidney replacement therapy (adjusted OR 0.409, P = 0.004), and requirement of vasopressor therapy (adjusted OR 0.041, P < 0.001) were independently associated with lower odds of renal recovery, whereas necessity of vasopressor therapy emerged as the only independent predictor of in-hospital mortality (adjusted OR 420.511, 95% CI 97.451-1814.543; P < 0.001). CONCLUSIONS: AKI was common among hospitalized patients and was associated with substantially increased in-hospital mortality. Vasopressor requirement was the strongest independent predictor of mortality, emphasizing the prognostic impact of hemodynamic instability and critical illness severity. Severe AKI (KDIGO Stage 3), kidney replacement therapy, and vasopressor necessity were independently associated with reduced renal recovery at discharge. These readily available clinical indicators may support early risk stratification and guide closer monitoring of high-risk patients.
BMJ openIvan Zahradka, Vojtech Petr, Filip Tichanek, Adriana Chroma, Tomas Neskudla, Michal Kahle, Robert Bem, Pavel Trunecka, Vera Adamkova, Petra Hruba, Ivo Hlavac, …
OBJECTIVES: To determine the prevalence of chronic kidney disease (CKD) in internal medicine outpatients in a Central European tertiary care setting, identify associated risk factors and assess use and potential impact of renoprotective therapies. We hypothesised that CKD is common, underdiagnosed and undertreated. DESIGN: Cross-sectional observational study. SETTING: Tertiary care outpatient clinics in Central Europe. PARTICIPANTS: 1933 adult outpatients at risk for CKD were screened; an expanded cohort of 2903 patients with available laboratory data was included for secondary analyses. Inclusion required assessment of estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) within the study period. Kidney transplant recipients were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was CKD prevalence defined by eGFR and uACR per kidney disease improving global outcomes criteria. Secondary outcomes included detection of previously unrecognised CKD, associations with clinical risk factors and prescription rates of renoprotective therapies. CKD prevalence was also assessed using age-calibrated eGFR thresholds. An exploratory outcome was model-projected gain in dialysis-free time with treatment initiation. RESULTS: CKD prevalence was 32.5% (95% credible interval (CrI) 30.5 to 34.6) and remained high after age-calibrated eGFR adjustment. One new case was revealed for every 5.2 patients screened. CKD odds increased with age (per 25 years: OR 3.81, 95% CrI 3.09 to 4.67), non-renal transplantation (OR 4.38, 95% CrI 3.30 to 5.84), hypertension (OR 2.61, 95% CrI 1.96 to 3.54), heart failure or atrial fibrillation (OR 1.59, 95% CrI 1.29 to 1.96), type 1 (OR 1.97, 95% CrI 1.47 to 2.63) and type 2 diabetes (OR 1.46, 95% CrI 1.21 to 1.77), and atherosclerotic disease (OR 1.49, 95% CrI 1.20 to 1.82). Renoprotective therapy use was suboptimal (sodium-glucose co-transporter-2 inhibitors 42%, glucagon-like peptide-1 receptor agonists 41.7%, nonsteroidal mineralocorticoid receptor antagonists 6.7% of eligible patients). The model-projected gain in dialysis-free time by initiation of renoprotective treatment was estimated to be 11.13 months per CKDe patient on average. CONCLUSIONS: CKD is highly prevalent in tertiary care outpatients and efficiently detected through targeted screening. Suboptimal use of renoprotective therapies highlights a major treatment gap. Further research should address implementation strategies. TRIAL REGISTRATION NUMBER: NCT07153432.
Journal of medical systemsTim Wilhelmi, Vanessa Bartsch, Marius Platt, Asarnusch Rashid, Johannes Hornig, Martin Krusche, Axel J Hueber, Daniel Fink, Alexander Pfeil, Gabriel Dischereit…
Patients with rheumatic diseases have persistent information needs that are not fully addressed in routine care. We developed and evaluated guideline-grounded, large language model (LLM) chatbots to support patient self-management and education in rheumatology.Ten disease-specific chatbots based on German guidelines were co-developed and deployed through 13 rheumatology centres and six patient organisations. Chatbot users rated responses and completed a questionnaire. User questions, feedback, and response characteristics were analysed using category-based coding and a six-dimensional LLM-as-a-judge assessment, with LLM-based ratings compared with rheumatologist ratings in random subsets.Between September 2025 and January 2026, 6291 questions were recorded. Thirteen question categories were identified, most commonly disease-specific questions (50.2%), medication and monitoring (37.3%) and diagnostics (28.2%). The chatbots were unable to answer in 263 interactions (4.2%). Of 2671 responses rated by users, 2481 (92.9%) received a positive rating. Insufficient detail was the most common reason for negative ratings (125/190, 65.8%). Among 602 questionnaire respondents, 84.6% reported that the chatbot was easy to use, 84.1% that answers were easy to understand, and 80.2% that it was a useful addition to patient education. In the LLM-based evaluation, 95.3% of answers were rated as completely safe and 79.1% as completely correct. Guideline adherence was assessed separately, with 45.0% rated as fully adherent; agreement with physician assessment was weak.Guideline-grounded chatbots received predominantly positive user feedback in real-world use, while LLM-based evaluation suggested that most responses were safe and correct. User questions and feedback may help guide iterative improvements to source content and patient education materials. Further studies are needed to evaluate educational effectiveness and independently validate response quality and clinical safety.
BACKGROUND: Left ventricular ejection fraction (EF) and global longitudinal strain (GLS) are widely used for cardiac surveillance in patients receiving potentially cardiotoxic cancer therapy. While GLS is more sensitive for detecting early myocardial dysfunction, the relationship between EF and GLS in routine clinical practice remains incompletely characterized, and discordance between these parameters may complicate clinical interpretation. METHODS: This retrospective observational study included 117 oncology patients undergoing serial echocardiographic assessment at baseline, early follow-up (6-12 weeks), and short-term follow-up (3-6 months). EF was measured by biplane Simpson's method, and GLS by speckle-tracking echocardiography as absolute values. EF deterioration was defined as a ≥ 10% absolute reduction or EF < 53%, while GLS deterioration was defined as a ≥ 15% relative reduction in absolute GLS magnitude. Concordance between EF and GLS deterioration was assessed, using Cohen's kappa and McNemar's test. RESULTS: Mean EF and GLS values remained stable (EF p = 0.124; GLS p = 0.803). EF deterioration occurred in 32 patients (27.4%), and GLS deterioration in 25 patients (21.4%). Discordance was common, with isolated GLS deterioration in 17 patients (14.5%), and EF deterioration without GLS decline in 24 patients (20.5%), representing discordance in 41% of patients. Agreement was poor (κ = 0.05), and McNemar's test was not significant (p = 0.27). ΔGLS showed a weak association with ΔEF (r = 0.19, p = 0.036). CONCLUSIONS: Although systolic function remained stable overall, clinically relevant deterioration occurred in a subset. Frequent EF-GLS discordance highlights their complementary but non-interchangeable roles in cardio-oncology surveillance.
Laboratory medicineYusuf Yesil, Alpay Medetalibeyoglu, Evin Ademoglu
INTRODUCTION: Routine laboratory panels are nearly universal, but the panels' joint information is underused. We evaluated contemporaneous classification of International Statistical Classification of Diseases, Tenth Revision (ICD-10) code groups from same-encounter laboratory results. METHODS: We developed 17 eXtreme Gradient Boosting (XGBoost) classifiers in 242 648 adult internal medicine encounters using age, sex, and results from 34 assays, with ICD-10 codes used only as outcomes. Stratified 10-fold cross-validation assessed discrimination, calibration, and decision curve performance. Leakage-free recalibration and fold-specific thresholds targeted 95% specificity. Using an 80-patient temporal holdout cohort, we compared the model with 3 large language models accessed through an application programming interface and findings from 1 specialist physician. RESULTS: The mean cross-validated area under the curve (AUC) was 0.893. With identical preprocessing, the mean AUC was 0.892 for XGBoost and 0.809 for logistic regression. Recalibration changed the mean intercept and slope to -0.002 and 0.999, respectively, and the Brier score from 0.099 to 0.044. The holdout micro-averaged AUC was 0.880 vs 0.729 to 0.739 for language models; paired differences were 0.141 to 0.151 (all P < .005). Matched-specificity sensitivity differences favored the model but were imprecise. DISCUSSION: Routine panels contain substantial information about contemporaneous ICD-10 coding, supporting prospective multicenter evaluation rather than a diagnostic claim.
Southern medical journalPaul Park, Paul Koscumb, Nadia Ahmed, Jeremy Carter, Elizabeth Davis, T Preston Hill
OBJECTIVES: Diagnostic point-of-care ultrasound (POCUS) increasingly is recognized as a valuable bedside assessment tool; however, the most commonly cited barrier to starting a POCUS curriculum in Internal Medicine residency has been the lack of in-house experts. We propose collaborating with the emergency department because all of their faculty are POCUS trained during residency. METHODS: At the University of Texas Medical Branch, we partnered with the emergency department to create a hands-on core rotation starting in 2023 for all postgraduate year-1 residents to improve their skills, knowledge, and confidence with diagnostic POCUS. The residents watched didactic videos in addition to working with faculty and ultrasound technicians one to one for 2 weeks on live patients. RESULTS: The efficacy of the curriculum was evaluated using a pre- and postcourse knowledge quiz, a confidence survey, and a skills assessment. Out of 40 residents, 24 completed the written knowledge quiz and confidence survey, and 14 completed the skills assessment. Overall, the data showed significant improvement in all three evaluation methods. CONCLUSIONS: The success of starting a new POCUS curriculum depends heavily on the ability of the program to recruit expert educators, and that degree may vary by institution. We believe this study shows one way that success may be achieved.
Southern medical journalShervin Eskandari, Avneesh Prabakar, Tej Murudkar, Dev Shah, Sharad Virmani, William J Healy
OBJECTIVE: Healthcare disparities between rural and urban regions highlight barriers to care, yet access to nephrology services in nonmetropolitan areas remains poorly characterized. This study evaluates the distribution of nephrologists and dialysis centers across Georgia and examines how these patterns relate to county-level chronic kidney disease (CKD) prevalence. METHODS: The Georgia All-Payer Claims Database estimated CKD prevalence, the Centers for Medicare & Medicaid Services Dialysis Facility Care Compare database identified dialysis centers, and the Georgia Composite Medical Board Physician Workforce Database located nephrologists. Using 2023 Rural-Urban Continuum Codes, counties were classified as metropolitan (codes 1-3) or nonmetropolitan (codes 4-9). Physician and facility density were calculated per population and land area, and travel burden was estimated using distances from county centroids to the nearest nephrology resource. RESULTS: A total of 347 nephrologists and 360 dialysis centers were identified across Georgia. Nonmetropolitan counties had higher CKD prevalence than did metropolitan counties (7.02% vs. 6.26%, P=0.002) and lower nephrologist density per 100,000 residents (0.7 vs. 1.8, P<0.001) and per 100 mi2 (0.06 vs. 1.29, P<0.001). In addition, nonmetropolitan counties had fewer dialysis centers per 100 mi2 (0.22 vs. 1.25, P<0.001). Nonmetropolitan counties experienced longer travel distances to the nearest nephrologist (15.85 vs. 8.19 miles, P<0.001) and dialysis center (9.30 vs. 6.46 mi, P=0.011). CONCLUSIONS: There are significant disparities in CKD burden and access to nephrology care in Georgia. Rural counties experience higher disease prevalence but a reduced availability of specialist services.
BACKGROUND: Outpatient procedures are an important part of primary care practice; however, few trainees or attendings feel they have adequate skills to perform them. This curricular intervention aimed to improve internal medicine (IM) Post-Graduate Year 1 (PGY1) outpatient procedure training through a 2-h skills session and procedure rotation. APPROACH: Thirty-seven PGY1 residents attended a 2-h skills session covering the utility and evidence behind common outpatient procedures with an opportunity to practice procedures on models. Residents already assigned to one continuity clinic rotated through a specific procedure clinic while the other continuity clinics received the standard curriculum. The skills session and procedure clinic were started in 2023 and evaluated during 2024-2025 academic year. EVALUATION: Residents were surveyed prior to the skills session and at the end of their PGY1 year. The primary outcomes measured were self-reported procedure volume and confidence. The two-tailed Mann-Whitney U test was used to compare differences between groups. Residents completing the procedure clinic rotation demonstrated higher confidence scores for performing procedures (median 4 [IQR 0] vs. 2 [IQR 2.5] on 5-point Likert scale, p = 0.009) and discussing procedures with patients (median 4 [IQR 1] vs. 3 [IQR 2], p = 0.027). Residents completing the rotation also reported performing significantly more procedures during their PGY1 year (median 5 [IQR 2] vs. 1 [IQR 2], p = 0.001). IMPLICATIONS: A hands-on skills session followed by procedure clinic rotation was associated with higher PGY1 confidence in discussing and performing outpatient procedures. The curriculum was integrated into existing residency program infrastructure and continuity clinic rotation.
Journal of thoracic oncology : official publication of the International Association for the Study of Lung CancerWilliam D Travis, Marina K Baine, Mary Beth Beasley, Elizabeth Brambilla, Lukas Bubendorf, Allen Burke, Andrew Churg, Wendy Cooper, Sanja Dacic, Francoise Gale…
In its 20-year history, the Journal of Thoracic Oncology (JTO) has published many major articles that have had a profound impact on the pathology of thoracic malignancies. One reason JTO has had such a great influence on thoracic oncology is the visionary leadership of the International Association for the Study of Lung Cancer (IASLC), which emphasizes an international, multidisciplinary approach across all its endeavors. JTO is one of the most important initiatives of the IASLC, and its global scope, encompassing all specialties, has enabled many pathologists to play a important role in the journal. This is reflected in the participation of multiple pathologists on the editorial board and in the prioritization of publishing impactful articles led by pathologists. This has been a good investment for JTO and IASLC, because eight of the top 20 most cited articles in the journal in the past 20 years were led by pathologists. This article reviews the many advances published in JTO, most of which concern lung cancer, mesothelioma, thymic tumors, and cardiac tumors. During this period, many breakthroughs occurred in surgical pathology, small biopsy and cytology, management of lung cancer after neoadjuvant therapy, molecular genetics, and biomarker testing. Many of these advances have had a direct impact on patient care, providing new ways to stratify patients for therapeutic management decisions.
Journal of genetic counselingKira Dzedzy, Luise Johannes, Hannah L Helber, Stefanie N Dugan, Dominika Bajguz, Radhika N Sawh
Hematology is an emerging subspecialty in genetic counseling. In order to standardize current practice and provide a solid foundation for advancement and growth, it is crucial to characterize the role of genetic counselors (GCs) working in this space. To date, no such characterization has been established. The purpose of this study was to characterize the roles of genetic counselors working in the field of hematology, explore GCs' preparedness for work in hematology, and assess whether non-hematology GCs perceived a value in having designated hematology GCs at their institutions. A survey distributed through the National Society of Genetic Counselors (NSGC) listserv yielded responses from 92 individuals meeting the inclusion criteria, with 84 participants providing complete responses that were analyzed in this study. Numerous aspects of the roles of the hematology genetic counselor role were characterized, including job settings (clinical: multidisciplinary team, independent visits, hematologist-paired; non-clinical), patient population served (diagnoses and quantity/length/recurrence of visits), and elements of genetic counseling competencies and skills utilized in various settings. Hematology-specific knowledge acquisition was reported to occur largely outside of typical didactic and experiential components of GC training programs, commonly via independent learning and also through on-the-job training sometimes supported by GC or hematology colleagues. Seventy percent of non-hematology GCs indicated that it would be beneficial to have a designated hematology GC at their institutions, citing feeling less equipped to see all hematological indications. The findings from this study begin to define the current roles of hematology GCs, emphasize the need for dedicated resources and expertise to address patient needs in this subspecialty. Ultimately, this can inform opportunities for expansion of the field further into the hematology domain.
Hematology/oncology clinics of North AmericaYu Fujiwara, Shumei Kato, Razelle Kurzrock
With multiple molecular targeted therapies available for patients with cancer that correspond to a specific genetic alteration, the selection of the best treatment is essential to ensure therapeutic efficacy. Molecular tumor boards (MTBs) play a key role in this process to deliver personalized medicine to patients with cancer in a multidisciplinary manner. Historically, personalized medicine has been offered to patients with advanced cancer, but the incorporation of molecular targeted therapies and immunotherapy into the perioperative setting requires clinicians to understand the role of the MTB. Evidence is accumulating to support feasibility and survival benefit in patients treated with matched therapy.
BACKGROUND: Genomic cardiology is an emerging field integrating genetic, molecular, imaging, and digital health data to improve cardiovascular disease (CVD) prevention, diagnosis, and treatment. The genetic architecture of CVD encompasses rare, high-impact variants as well as polygenic susceptibility, both of which influence disease risk, severity, and clinical outcomes. HYPOTHESIS: Integration of genomic information, including rare variants and polygenic risk scores (PRS), with clinical, imaging, biomarker, and artificial intelligence (AI)-based approaches may enhance personalized cardiovascular risk stratification and therapeutic decision-making. METHODS: This review summarizes current applications and emerging developments in genomic cardiology, including whole-genome and whole-exome sequencing, multigene panels, structural variant detection, PRS, multi-omics integration, and AI-assisted risk prediction. Current challenges and emerging therapeutic approaches, including RNA-based therapies and gene editing, are also discussed. RESULTS: Clinical genomic tools are increasingly being incorporated into the evaluation of inherited cardiac conditions. PRS can identify individuals with elevated lifelong CVD risk, although their current clinical utility is primarily as risk-enhancing markers rather than standalone diagnostic tests. Integration of genomic, clinical, imaging, and biomarker data using AI may further improve risk prediction and personalized treatment selection. However, ancestry bias, uncertainty in variant interpretation, limited accessibility, workflow integration barriers, and ethical and privacy concerns remain important challenges. CONCLUSIONS: Genomic cardiology has substantial potential to advance precision cardiovascular medicine. Continued development of diverse genomic databases, standardized clinical implementation frameworks, and emerging genomic therapies will be important for translating genomic advances into equitable and clinically meaningful cardiovascular care.
NMR in biomedicineNaama Lev-Cohain, Jacob Sosna, Rachel Katz-Brull
Hyperpolarized MRI is a medical imaging technology that has been used so far only in focused clinical studies. This technology enables metabolic imaging without ionizing radiation and is combined with standard-of-care MRI protocols. Unlike metabolic imaging performed with radiolabeled materials (e.g., PET and SPECT), hyperpolarized MRI enables differentiation between the injected metabolic substrate and its product(s). In this way, the number of imaging contrasts that may be attained is relatively large. The purpose of this review is two-fold: to provide coherent terminology for the various contrasts obtained in HP-MRI to facilitate further development in medicine and to highlight its potential contribution to liver nodule characterization. We reviewed 33 hyperpolarized MRI papers published from 2013 to 2024 that describe clinical studies in human subjects and patients, and characterized the metabolic contrast provided by this technology across various organs and in cancer tumors. We have further reviewed 20 preclinical studies of hyperpolarized MRI in the liver to evaluate the potential of this technology for early detection and characterization of hepatocellular carcinoma. Most clinical studies have used a single hyperpolarized substrate, namely, pyruvate, labeled with carbon-13 at position 1 ([1-13C]pyruvate). Even with this single substrate, the number of possible imaging contrasts is high, making the interpretation of these images challenging. We aimed to explain these imaging contrasts and provide a consistent nomenclature for them that will serve the medical community. Preclinical MRI studies using hyperpolarized substrates suggest the potential to characterize liver nodules in patients. In summary, hyperpolarized MRI is a promising clinical imaging modality in oncology; however, the small number of patients investigated so far precludes addressing possible biological confounding factors. Further studies are required for improving tumor characterization using this technology, and studies in liver imaging aimed at early detection of HCC are warranted.
Liver international : official journal of the International Association for the Study of the LiverHaoshuang Fu, Yanan Du, Gangde Zhao, Yuelin Xiao, Shuying Song, Xinya Zang, Tianhui Zhou, Yan Zhuang, Ruidong Mo, Rongtao Lai, Qing Xie
BACKGROUND & AIMS: Drug-induced liver injury (DILI) would progress to chronicity or death. Large language models (LLMs) may enhance clinical decision-making, yet their utility relative to physicians in DILI remains unclear. Therefore, we evaluated their performance in predicting DILI outcomes. METHODS: We enrolled 943 DILI patients from three centers as internal and external cohorts. Based on 12-month follow-up, outcomes were classified as recovery, 6/12-month chronicity, and death. LLMs (Gemini-2.5 Pro, GPT-5.1, DeepSeek-3.2), hepatologists (Junior, middle, senior), and models (Hy's Law, nHy's Law, MELD Score) estimated probabilities of outcomes. LLM-Rules (VOTE, OR, AND) were applied to enhance stability. Model performance was assessed. RESULTS: For 6-month chronicity, the senior achieved highest AUROC (0.61) with an accuracy of 70%. Gemini-2.5 Pro and GPT-5.1 yielded AUROCs of 0.60 and 0.59, respectively, outperforming junior and middle hepatologists. Gemini-2.5 Pro demonstrated strongest agreement with senior (κ = 0.43). LLMs all exhibited lower accuracy and specificity than hepatologists. A similar result was observed in 12-month chronicity. For overall mortality, the senior achieved highest AUROC (0.87) with an accuracy of 83%. Gemini-2.5 Pro and GPT-5.1 achieved AUROCs of 0.86, outperforming junior hepatologist, Hy's Law, and nHy's Law. GPT-5.1 achieved strongest agreement with senior (κ = 0.25). LLM-Rules demonstrated stability for predicting outcomes across cohorts. OR and AND rules improved sensitivity and specificity, respectively. CONCLUSIONS: GPT-5.1 and Gemini-2.5 Pro showed AUROCs approaching senior hepatologists for DILI outcomes with limited accuracy and specificity. LLM-Rules demonstrated stable performance across cohorts with improved sensitivity or specificity, supporting the potential of multi-LLM approaches as clinician-supervised complementary tools.
Health expectations : an international journal of public participation in health care and health policyDarren Haywood, Sue Woodall, Annika Hegde, Jai Carmichael, Evan Dauer, Alexia Samiotis, Nicolas H Hart
Lived experience is increasingly recognised as an essential source of expertise in healthcare research, service design, policy and quality improvement. In psycho-oncology, consumer involvement is now widely encouraged in research and service development; however comparatively little attention has been paid to the role of lived experience in educating and training the psycho-oncology workforce. We argue that involving people with lived experience should become a minimum requirement in developing, delivering, and evaluating psycho-oncology education and training. Given that psycho-oncology is fundamentally concerned with understanding and responding to the lived experience of cancer consumer involvement in education and training must be expected. To support meaningful implementation, we provide Principles for Lived Experience-Informed Psycho-Oncology Education and Training: representation, partnership, support, and accountability. Embedding lived experience expertise throughout psycho-oncology workforce development will strengthen the relevance, authenticity, and person-centredness of future education and training initiatives and may improve consumer outcomes.
Cleveland Clinic journal of medicinePavel Kibrik, Enrico Prajiante Bertolino, Sasan Partovi, G Jay Bishop, Aravinda Nanjundappa, Lee Kirksey
The 2024 American Heart Association and American College of Cardiology multisociety peripheral artery disease (PAD) guideline updates the 2016 guideline by clarifying clinical terminology, using trial evidence to guide pharmacotherapy, and addressing equity and access to care. This article summarizes the main clinical recommendations and how to implement them.
Hematology/oncology clinics of North AmericaAli Benjamin Abbasi, Vincent Wu, Julie E Lang, Laura J Esserman
Outcomes for patients with breast cancer have improved over time due to increased screening and the availability of more effective therapies. It is important to recognize that breast cancer is a heterogeneous disease that requires treatment based on molecular characteristics. Early endpoints such as pathologic complete response correlate with event-free survival, allowing the opportunity to consider de-escalation of certain cancer treatments to avoid overtreatment. This article discusses clinical trials of tailoring treatment (eg, I-SPY2) and screening (eg, WISDOM) to individual patients based on their unique risk features.
Hematology/oncology clinics of North AmericaWilliam G Lee, Eugene S Kim
Pediatric precision oncology has provided a greater understanding of the wide range of molecular alterations in difficult-to-treat or rare tumors with the aims of increasing survival as well as decreasing toxicity and morbidity from current cytotoxic therapies. In this article, the authors discuss the current state of pediatric precision oncology which has increased access to novel targeted therapies while also providing a framework for clinical implementation in this unique population. The authors evaluate the targetable mutations currently under investigation-with a focus on pediatric solid tumors-and discuss the key surgical implications associated with novel targeted therapies.
International journal of gynecological cancer : official journal of the International Gynecological Cancer SocietyRadwa Hablase, Alexander Shushkevich, Ana Tatiana Palacios Torres, Anisa Mburu, Houssein El Hajj, Nicolò Bizzarri, Stamatios Petousis, Joanna Kacperczyk-Bartni…
OBJECTIVE: Gynecologic oncology surgery is delivered by clinicians with diverse specialty backgrounds and varied training pathways. The Q-GOAL (Quality in Gynecologic Oncology Advancement for Learning) study aimed to explore the heterogeneity of these training experiences, identify common training structures and surgical exposure profiles, evaluate self-reported surgical confidence, and compare these findings across income levels. METHODS: An open, cross-sectional, web-based survey was conducted between July and September 2025 using convenience and snowball sampling. The survey was distributed globally to trainees and consultants in obstetrics and gynecology, general surgery, gynecologic oncology, and surgical oncology. Descriptive statistics and exploratory unsupervised multi-variate analyses were performed. RESULTS: A total of 1,035 clinicians participated (92% completion rate), of whom 64% were from low- and middle-income countries. Most respondents had an obstetrics and gynecology background, with general surgeons contributing a greater proportion in low- and middle-income countries than in high-income countries (23% vs 5.5%). Training pathways included dedicated sub-specialty programs, rotation-based training, and a small proportion reporting no formal training. Rotation-based training was associated with a less structured training environment in the latent class analysis. Multiple correspondence analysis identified distinct low-, intermediate-, and high-volume training profiles. Increased surgical exposure was associated with higher self-reported confidence, and income status remained an independent predictor of surgical confidence. CONCLUSIONS: The study demonstrated the diversity of the workforce delivering gynecologic oncology surgery globally. These findings highlight the need for internationally harmonized training standards and a minimum level of surgical exposure, while recognizing the differences among health care systems worldwide.
The Lancet. RheumatologySven Plein, Taryn Youngstein, Brittany Weber, Maya H Buch
The European Society of Cardiology (ESC) released new guidelines in 2025 for the management of myocarditis and pericarditis, which include systemic autoimmune rheumatic diseases as one of the potential aetiologies. Myopericardial involvement in systemic autoimmune rheumatic diseases is common and associated with poor outcomes; however, the unique pathophysiology of myopericardial involvement in systemic autoimmune rheumatic diseases poses specific challenges and limits the applicability of the generic diagnostic pathways proposed in the 2025 ESC guidelines to the systemic autoimmune rheumatic disease population. Myopericardial disease in patients with systemic autoimmune rheumatic disease is usually subclinical, often with atypical clinical presentation, and the accuracy of conventional biomarkers including advanced imaging, to detect myopericaridal disease is reduced in this population compared with the general population due to chronic inflamation. Management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases primarily targets the underlying rheumatic disease; however, disease-specific guidance and multidisciplinary care pathways for the management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases are urgently required and should be developed jointly by experts in both rheumatology and cardiology.
International journal of gynecological cancer : official journal of the International Gynecological Cancer SocietyAudrey Tieko Tsunoda, Angelica Nogueira-Rodrigues, Glauco Baiocchi Neto, Bruno Roberto Braga Azevedo, Renato Moretti-Marques, Rosilene Jara Reis, Vanessa Alvar…
Access to gynecologic oncology care varies substantially across health care systems and is influenced by organizational, geographic, workforce, and referral network factors that extend beyond the availability of specialized services. Using Brazil as an illustrative case of a large middle-income country with a mixed public-private health system, we performed a narrative policy and health-systems analysis, integrating evidence from global cancer surgery, gynecologic oncology, health-system organization, and international models of cancer care delivery. The objective was to examine access to gynecologic oncology from a health-systems perspective and to develop a conceptual framework describing the organizational dimensions of access that may be applicable across diverse health care settings. The literature was examined to identify recurrent concepts related to the organization of gynecologic oncology care. These concepts were grouped into broader themes and progressively consolidated into the nine domains of the Brazilian-informed Gynecologic Oncology Access and Sustainability Framework: burden, geography, organization, workforce, quality, financing, education, digital integration, and sustainability. Building on the Global Cancer Surgery framework, we also propose an expanded model that considers safe, equitable, timely, and networked care as complementary dimensions of access. To support the interpretation of the proposed framework, we developed the Gynecologic Oncology Network Maturity Framework, a conceptual framework for network organizational development, together with a scalable four-tier model linking local services, regional cancer units, specialized referral hubs, and centers of excellence. The Brazilian-informed Gynecologic Oncology Access and Sustainability Framework is intended as a conceptual model to support the description, discussion, and planning of gynecologic oncology networks. The Gynecologic Oncology Network Maturity Framework is proposed as a conceptual framework for describing network organizational development and requires prospective validation before benchmarking applications. Together, these frameworks should be interpreted as a foundation for future empirical evaluation, refinement, and implementation across different health-system contexts.
Journal of applied clinical medical physicsPatrick N McDermott, Robert C Halford, Brayden Halvorson, Ian Lake, Jian Liang, Akin Ogretici, Avery Peterson, Evelyn Sebastian, Xiangkun Xu
BACKGROUND AND PURPOSE: Radiation shielding surveys require location and evaluation of radiation hotspots in shielding barriers. This process is normally done by using a conventional survey meter and slowly moving the survey meter manually across the face of the barrier. It would be advantageous to have a radiation image of the barrier showing hot spots. This would hasten the process, potentially reveal hidden hot spots and provide clear and unprecedented documentation for a variety of radiation sources, including HDR afterloaders, linacs, Gamma Knife and CT simulators. The purpose of this study is to evaluate a new survey instrument that can superimpose radiation "heat" maps on optical images, allowing the user to "see" the radiation distribution. METHODS: A new survey instrument, the RAVIN (manufactured by M3D, Inc. Ann Arbor MI) has been evaluated for potential use in shielding surveys of linac vaults, HDR suites, Gamma Knife, CT simulators, and the search for lost radioactive seeds. This instrument also provides a NIST traceable calibrated measurement of the exposure rate or the air-kerma rate. In addition, the instrument can show the spectrum of the measured radiation and can identify a wide range of commonly used isotopes. Comparisons have been made with conventional survey meters. RESULTS: Heat maps have been acquired for the open door of a linac vault, linac head activation, an HDR afterloader, a Gamma Knife, the entrance to a CT simulator and an I-125 seed. The camera provides some interesting information about the spectrum of radiation encountered in different shielding circumstances in radiation oncology. An example is the spectrum of radiation emerging from a thick linac 18 MV concrete primary barrier. The instrument shows a pronounced peak between 100 and 150 keV, with a long high energy, but low amplitude tail. Comparison with ionization chamber survey meters shows that this instrument can accurately measure air kerma rates from continuous high energy sources of radiation but cannot be used to measure air kerma rates from pulsed linac beams due to its relatively long dead time of 30 µs. CONCLUSION: The RAVIN camera is an innovative instrument that allows visualization of radiation under some circumstances while simultaneously accumulating an energy spectrum. The ability to "see" radiation is remarkable. This instrument is, however, probably not useful for routine radiation surveys of barriers in radiation oncology. This is due to the inability to reliably image heat maps for low levels of radiation (as are generally encountered outside shielding barriers) and to accurately localize the source.
RMD openMichele di Lernia, Konstantin Louis Thuere, Sebastian E Sattui, Kornelis S M van der Geest, Frank Buttgereit, Christian Dejaco
OBJECTIVES: To study the implementation of the 2015 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) management recommendations for polymyalgia rheumatica (PMR) among rheumatologists and general practitioners (GPs). METHODS: An online survey (Survey Monkey) comprising 28 questions was distributed among members of the EULAR Study Group on PMR and giant cell arteritis (n=375). Each member was asked to invite at least one GP (snowball principle) with experience in PMR to participate. Statistical analysis included descriptive statistics; differences were tested using Fisher's exact test. RESULTS: There were 308 respondents from 37 countries including data from 211 rheumatologists and 73 GPs. Adherence to the 2015 EULAR/ACR recommendations was higher among rheumatologists (83%) than GPs (35%). Rheumatologists (96%) prescribed glucocorticoids more frequently at dosages within the recommended range than GPs (84%). Concerning tapering, a similar proportion of rheumatologists (83%) and GPs (72%) reached the suggested 10 mg prednisone equivalent after 4-8 weeks. Almost all rheumatologists used methotrexate as a glucocorticoid-sparing agent (95%) as compared with only 26% of GPs. Similarly, 70% of rheumatologists, but only 2% of GPs, had experience with interleukin-6 receptor inhibitors for PMR. For follow-up, more rheumatologists preferred scheduled (as opposed to on demand) visits than GPs (99% vs 82%), while more GPs than rheumatologists (47% vs 31%) planned a short follow-up interval (4-8 weeks) in the first year of disease. CONCLUSION: Implementation of the EULAR/ACR recommendation for the management of PMR remains incomplete, particularly among GPs. Future updates should incorporate projects to foster diffusion and implementation of the recommendations among all professionals managing this disease.
Current opinion in nephrology and hypertensionIfeoma Isabella Ulasi, Ugochi Chika Onu, Chinwuba Kenneth Ijoma
PURPOSE OF REVIEW: Chronic kidney disease (CKD) is a worsening global health problem that disproportionately affects rural populations, especially in low-income and middle-income countries (LMICs). Managing patients with CKD presents significant challenges, including limited access to healthcare. Key contributing factors include geographical barriers, a shortage of nephrology specialists, and insufficient healthcare infrastructure. As CKD is projected to become the fifth leading cause of death by 2040, it is crucial to develop innovative alternatives to the traditional care model to help bridge the gap in care in line with SDG 3. RECENT FINDINGS: Lessons learned from the COVID-19 pandemic include the successful use of telemedicine-telenephrology for healthcare delivery. However, uptake among underserved populations remains challenging. However, a review of evidence suggests that such challenges are surmountable, as telenephrology has been practised in some resource-constrained remote areas. The results across these populations included shorter waiting times, lower costs, reduced health-related travel, higher overall satisfaction, and lower mortality rates. SUMMARY: These findings portray telenephrology as a technological solution for kidney health inequities. However, government support, digital infrastructure development, bridging of the digital divide, and community engagement are essential.
Rhode Island medical journal (2013)Victoria Koenigsberger, Meghan Geary, Ali Yalcindag, Madeleine Ward
BACKGROUND: Young adults with rheumatic conditions encounter challenges when transitioning to an adult rheumatologist. At the Hasbro Pediatric Rheumatology Clinic, patients aged 18 and older were historically provided a list of adult rheumatologists; however, no formal transition process existed. We assessed the feasibility and acceptability of a pilot model to systematically transition pediatric patients to an adult rheumatologist using aspects of the Six Core Elements of Health Care Transition (HCT) from Got Transition®. METHODS: A multidisciplinary team facilitated the program. Eligibility included: 18 years of age with stable, confirmed (or suspected) rheumatic disease. Program structure was implemented across three pediatric and one adult visit. Patient-reported transition readiness was assessed at initial and final pediatric visits using the Transition Readiness Assessment (TRA) from Got Transition®. RESULTS: Sixty-four patients aged 18 and older had appointments with the Hasbro Pediatric Rheumatology Clinic from May 1, 2024 to Jan. 31, 2025. Thirteen were eligible; eight entered the pilot (61.5%). The mean age at recruitment was 19.5 years (range: 18-23). The study achieved a 62.5% retention rate, with 80% completion of video visits with adult rheumatologists and zero no-shows. TRA scores were high at baseline, although of note patients initially scored their readiness lower in areas related to transition confidence and navigating health care. The greatest mean score increase was seen for navigating health care (+2.7). CONCLUSION: This rheumatology transition pilot demonstrated preliminary feasibility. Systemic changes to reimbursement and clinician education are needed to support HCT sustainability.
JMIR human factorsMaria Matsangidou, Mikolaj R Kowal, Jakob Yianni, Maria Krini, Samir Pathak, Katie Gordon, Malcolm A Luker, Deborah D Stocken, David Jayne, Constantinos S Patt…
BACKGROUND: Hepato-pancreato-biliary (HPB) oncology involves complex surgical planning and multidisciplinary decision-making that present significant cognitive, spatial, and communicative challenges. While augmented reality (AR) technologies are emerging as valuable tools in surgical planning, most existing systems are developed in a technologically deterministic manner, often without consideration of patients' lived experiences or the collaborative needs of multidisciplinary clinical teams. This limits their integration into complex workflows and their potential for meaningful clinical impact. OBJECTIVE: This study aimed to co-design and evaluate a human-centered AR system that supports spatial understanding, emotional sensitivity, and collaborative decision-making in HPB surgical oncology. METHODS: This mixed methods human-centered design study was conducted between February 2024 and September 2025 and comprised 2 phases. In Phase 1, convenience sampling was used to recruit 14 oncology health care professionals (surgeons, oncologists, and psycho-oncology specialists) and 10 patients with cancer from multidisciplinary oncology care settings to participate in co-design workshops and semistructured interviews exploring the cognitive, communicative, emotional, and workflow requirements for an AR system supporting HPB surgical oncology. Qualitative data were analyzed using reflexive thematic analysis and informed iterative prototype development. In Phase 2, the resulting AR prototype was evaluated through usability testing with 10 hepatobiliary clinicians using simulated multidisciplinary tumor board planning scenarios. Usability was assessed using the System Usability Scale (SUS), supplemented by observational data and qualitative feedback. RESULTS: The co-design process identified intersecting spatial, cognitive, emotional, and communicative challenges in HPB surgical oncology. These findings informed the iterative development of an AR prototype that functioned as a shared cognitive and communicative workspace. The system enabled collaborative manipulation of 3D anatomical models, emotionally calibrated visualizations, and seamless integration with existing planning workflows. The prototype achieved a mean SUS score of 67.25 (SD 7.95), indicating acceptable usability. In simulated multidisciplinary tumor board scenarios, clinicians reported improved spatial understanding, reduced cognitive load, and enhanced interdisciplinary communication. Patients with cancer participating in the co-design phase valued the ability to engage with their own anatomy in an emotionally manageable way and reported that interactive visualization improved their understanding and sense of agency. Overall, the findings suggest that AR systems designed with human-centered methods can function not only as visualization tools but also as boundary objects that support communication and distributed cognition in complex cancer care settings. CONCLUSIONS: A human-centered co-design process can guide the development of AR systems that extend beyond technical novelty to become emotionally attuned, cognitively supportive, and workflow-compatible tools in surgical oncology. By foregrounding the needs of both patients and professionals, AR can function as a boundary object that facilitates collaborative decision-making, empathetic communication, and multidisciplinary coordination in complex oncology care. This study provides actionable design recommendations for developing AR technologies that are meaningfully integrated into complex clinical contexts.
Clinical journal of oncology nursingRichard Nishan Boyajian, Molly Hagen, Sugato Bagchi, Shilpa Mahatma, Ashleigh Kowtoniuk, Quoc-Dien Trinh, Tarun Kumar, Paul L Nguyen
BACKGROUND: The U.S. oncology workforce is not increasing at the same pace as the cancer survivor population. Cancer care requires extended coordination across multiple disciplines. Oncology teams need technological solutions to support patient surveillance and meet growing care demands. OBJECTIVES: The purpose of this study was to develop and test an artificial intelligence (AI) approach to identify and track care states in patients with prostate cancer. METHODS: The study examined data from a retrospective cohort of 180 patients to develop ground truth care state assignments with parameters set by clinicians, then developed an AI model that set its own parameters for care state assignment and tested it on this cohort dataset. The study assessed the agreement between assignments made by the AI model and clinician specialists. FINDINGS: The AI model produced care state assignments for all 180 patients in less than one second, and agreement with the clinician-assigned care state was 95%.
Journal of the American College of CardiologyAnnemarie Thompson, Kirsten E Fleischmann, Nathaniel R Smilowitz, Lisa de Las Fuentes, Debabrata Mukherjee, Niti R Aggarwal, Faraz S Ahmad, Robert B Allen, S E…
AIM: The "2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS: A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
International journal of medical informaticsMonika Shekhawat, Ashok Kumar Nagar, Arpita A Gupta, Alma Rachel Koshy, V Sai Sankalp Naidu, Pura Krishnamurthy Kiran, Neeraja Sathyakkagari
INTRODUCTION: Cancer is a major public health challenge in India, with an estimated 1.4 million new cases each year. Despite this burden, the ratio of oncologists to new cancer patients is critically low, about one specialist per 1600 new diagnoses per year. The AI-driven CDSS could help offset the oncologist shortage in LMICs. OneRx.AI is an RAG platform grounded in international and national oncology guidelines. We evaluated its Expert-rated accuracy, clinical safety, Guideline concordance and decision impact, confidence, efficiency, and inter-rater reliability (IRR) in Indian practice. METHODOLOGY: A prospective, multicentre, expert-validation study conducted at three tertiary oncology centres in India. Three Oncologist-clinicians independently evaluated de-identified queries across five cancer types. Individuals and common-prompt evaluation phases were analysed separately. Co-primary endpoints were assessed using one-sample z-tests with 95% Wilson confidence intervals, and inter-rater reliability was measured using the pre-specified Gwet's AC1 statistic. RESULTS: Of 124 submitted clinical queries, 110 (88.7%) met the eligibility criteria. Expert-rated fully correct clinical accuracy was 82.7%, expert-rated clinical safety was 100%, and fully concordant guideline recommendations were 94.5%. Composite rates for Expert-rated clinical accuracy and guideline concordance were 100%. Expert-rated Clinical accuracy showed Gwet's AC1 = 0.707. Expert-rated Safety and guideline concordance received uniform ratings across evaluators. Citation accuracy was 86.4%, decision-influence rate 92.7%, physician-confidence increased by a mean of 1.69 (p < 0.0001), and median time to clinical recommendation decreased from 389.2 s to 47.2 s, representing an 87.9% reduction (p < 0.0001). CONCLUSION: OneRx.AI demonstrated high expert-rated clinical performance in this exploratory, ceiling-affected evaluation, supporting progression to a larger Stage II study.
CirculationWriting Committee Members, Annemarie Thompson, Kirsten E Fleischmann, Nathaniel R Smilowitz, Lisa de Las Fuentes, Debabrata Mukherjee, Niti R Aggarwal, Faraz S…
AIM: The "2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS: A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
MedEdPORTAL : the journal of teaching and learning resourcesAnna Maria Gramelspacher, Bernice Man, Brandon Bedell, Michael Blackie
INTRODUCTION: Engaging in reflective practice is a critical component of training resident physicians toward competency in clinic practice, yet opportunities to engage in it are rare. To be effective practicing clinicians, residents must be able to reflect on and learn from their clinical work. METHODS: One 60-minute 55-word story reflective writing workshop was delivered to 3 groups of second- and third-year internal medicine residents as part of a mandatory curriculum. RESULTS: Each session was led by 2 facilitators with varying levels of training in health humanities. Sixty-one residents completed the workshop, and 54 of them completed a postworkshop survey (89% response rate). All respondents enjoyed the session, and 87% found that the session improved their connection to colleagues. Eighty-two percent of respondents agreed or strongly agreed that the workshop improved their well-being. Ninety-four percent found the session valuable. Ninety-eight percent agreed or strongly agreed that the workshop offers a safe space to process emotionally distressing and/or difficult experiences related to patient care. Seventy-five percent agreed or strongly agreed that the session improved their understanding of their role within a health care team. DISCUSSION: This workshop is an accessible way to incorporate reflective practice into a busy resident curriculum. The facilitated close reading and writing of 55-word stories offered a safe and effective way for residents to process emotionally distressing experiences, form greater connections with colleagues, deepen their understanding of their role as health care providers, and improve well-being.
Irish medical journalR Fagan, J Deegan, W Paine, S Hickey, C Sheil, M Kelly, K Malomo, J Browne, O Ntlholang
AIMS: To evaluate adherence to Health Service Executive (HSE) criteria, identify predictors of testing deviations, and assess the clinical management of vitamin D results in a general internal medicine (GIM) inpatient cohort. METHODS: A retrospective review of 408 GIM inpatients categorised into four groups based on HSE-defined testing appropriateness: (1) testing indicated and ordered, (2) indicated but not ordered, (3) not indicated but ordered, and (4) not indicated and not ordered. Testing appropriateness was assessed against HSE Lab criteria, and predictors of testing practices and vitamin D levels were analysed using logistic regression models in R statistical software (v4.1.2), adjusted for age, gender, ethnicity, and hospital length of stay. RESULTS: Of 408 patients, 143 (35%) deviated from guidelines: 91 (22.3%) lacked indicated testing, while 50 (12.3%) underwent unindicated tests. Older age (OR 1.08 per year, 95% CI 1.04-1.13; p<0.001) and prolonged hospitalisation (OR 1.01 per day, 95% CI 1.00-1.01; p=0.03) predicted testing regardless of indication. Of 77 tested patients, 48 (62.3%) had sufficient levels (≥50 nmol/L), 13 (16.9%) insufficient (30-49 nmol/L), and 16 (20.8%) deficient (<30 nmol/L). DISCUSSION: Deviations from HSE Lab criteria were frequently observed, with older patients overtested and high-risk populations undertested.
JMIR research protocolsNazanin Falconer, Shelley Wilkinson, Centaine Snoswell, Chariclia Paradissis, Kelvin Robertson, Ian Coombes, William Y S Wang, Keshia De Guzman, Holly Foot, Li…
BACKGROUND: Transition of care (TOC) is a high-risk period for medication errors as patients move between multiple health care professionals, settings, and changing medication regimens. Ineffective communication systems further increase the likelihood of medication harm and hospital readmission. A TOC service with tailored, patient-specific support may help reduce these risks. Cardiovascular medicines significantly contribute to medication harm, and patients recovering from acute myocardial infarction (AMI) or cardiothoracic surgery (CS) are vulnerable due to complex regimens and frequent medication changes. Pharmacists, as medication experts embedded within cardiology teams, are well positioned to support these high-risk patients, facilitate safer transitions from hospital to home, and provide coordinated postdischarge follow-up. OBJECTIVE: This study aims to evaluate the impact of a pharmacist-led interdisciplinary TOC service on reducing medication harm for cardiology patients post-AMI or CS. METHODS: The study will be conducted in two phases: phase 1-intervention development will combine scoping review findings with stakeholder input to design an evidence-based, cocreated, culturally relevant intervention, underpinned by implementation science. A risk prediction model will be developed and validated to identify AMI/CS patients at high risk of medication-related unplanned readmission within 30 days. Phase 2: the RECARD (Reduce Hospital Readmissions for High-Risk Cardiology Patients) trial will use a pre-post design across 3 Australian tertiary hospitals (2 metropolitan and 1 regional) to compare a retrospective usual care patient cohort (referred to as "pre") with a different prospective patient cohort (referred to as "post") that includes both usual care and intervention AMI/CS patients receiving the TOC service. Only high-risk poststudy patients will receive the intervention TOC service, consisting of an individualized bundle of TOC activities to optimize medication management, while the remaining poststudy patients will receive usual care. A unique feature of the service is its capacity for hospital clinicians to conduct postdischarge home visits for patients needing additional support. The primary outcome for this study is medication-related 30-day hospital readmission. The analysis will consist of multivariable logistic regression. An economic analysis will be conducted to evaluate the costs associated with the intervention and medication-related readmissions. A comprehensive process evaluation will be conducted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to enable learnings from the trial to inform sustainable improvements in this field. A patient survey will be administered at the end of the trial to assess patient experience and elicit patient preferences using a discrete choice experiment. RESULTS: The predata are currently being collected for patients discharged from the 3 hospital sites during the 12-month prestudy period. The postdata intervention began on December 10, 2025. As of May 27, 2026, a total of 343 patients have been recruited at the 3 study sites. CONCLUSIONS: The findings of this study will inform future implementation of a sustainable cardiac TOC model within the Australian health care setting.
The Lancet. OncologyRaffaella Casolino, Joaquin Mateo, Elisabeth G E de Vries, Amber Johns, Melanie Courtot, Rita T Lawlor, Sandra Perdomo, Stacy W Gray, Raquel Perez-Lopez, Clare…
Cancer genomics and precision oncology are increasingly central to cancer care, but many health systems struggle to implement them equitably, effectively, and sustainably. This Commission defines the current global precision oncology landscape and analyses the scientific, structural, and health-system challenges shaping its delivery and impact. Findings indicate that access to cancer genomics and precision oncology remains profoundly unequal across and within countries, leaving millions of patients without guideline-indicated interventions each year. These disparities extend to research, with genomic studies and clinical trials concentrated in high-income settings and among populations of predominantly European ancestry. At the same time, fragmented and poorly integrated data ecosystems restrict evidence generation, knowledge sharing, and clinical impact. Beyond questions of access and implementation, the clinical benefit of precision oncology is highly heterogeneous. The greatest and most consistent gains are confined to a few well validated biomarker-treatment pairings, typically supported by companion diagnostics; broader approaches such as comprehensive genomic profiling and tumour-agnostic strategies, might expand options for selected patients, but only a few patients receiving matched therapy derive meaningful benefit. The Commission also identifies a paradox of success: rapid expansion of precision oncology has increased cognitive, organisational, data, workforce, and financial burdens, while evidence of broad population-level benefit has lagged behind. In response, the Commission offers a comprehensive and context-responsive approach for integrating cancer genomics and precision oncology into health systems effectively, equitably, and sustainably. The Commission developed a value-based resource-stratified implementation framework, a system-readiness assessment tool, a precision oncology workforce competency-based framework, a precision oncology monitoring and evaluation framework, and principles for responsible data sharing and health-system learning. Cancer genomics and precision oncology can improve outcomes and strengthen health systems if scaled equitably, sustainably, and according to evidence, public value, national context, and patient needs. This Commission offers a basis for global consensus on a more equitable, evidence-informed, and sustainable path forward.
Palliative & supportive careRaffaele Giusti, Fotios Loupakis, Mirella Moro, Monica Mariniello, Elena Liotta, Marco Filetti, Maria Anna Siciliano, Giampiero Porzio
OBJECTIVES: Bereavement care is integral to oncology but seldom formalized in residency curricula. We assessed bereavement education, self-perceived preparedness, and emotional burden among oncology residents, and explored associations between formal training and preparedness.>. METHODS: We conducted an anonymous web-based cross-sectional survey of 165 oncology residents from 25 countries. Items assessed demographics, training characteristics, formal bereavement education, caregiver interactions, preparedness, challenges, and emotional consequences. Associations between formal training and 4-level preparedness used χ2; a binary contrast (≥"Somewhat prepared" vs <"Somewhat prepared") estimated odds ratios (ORs). Pearson's assessed correlation between caregiver-interaction frequency and preparedness.r. RESULTS: Respondents were 55.2% female; 47.9% worked in academic centers; 44.2% had ≥5 years of training. Formal bereavement education was uncommon (17.0%). Preparedness was "Somewhat/Very" in 53.3% and "Not very/Not at all" in 46.7%. Training was associated with higher preparedness (χ2=13.03, df=3, =0.0046); being at least "Somewhat prepared" was more likely with training (OR 3.94, 95% CI 1.51-10.33). Interaction frequency correlated weakly with preparedness (=0.15). Common challenges were emotional fatigue (64.8%), fear of overstepping professional boundaries (56.4%), lack of training (53.3%), and time constraints (50.3%). Emotional consequences were frequent: 54.5% occasionally and 27.3% deeply affected; 36.6% had considered leaving residency. Nearly all endorsed bereavement education as integral to oncology training (99.4%). SIGNIFICANCE OF RESULTS: Training gaps co-exist with substantial emotional burden. Structured bereavement curricula, mentorship, and reflective practice may strengthen preparedness and resilience and improve caregiver support. Prospective studies should evaluate implementation strategies and effects on clinician well-being and care delivery.>.
Zhonghua yi xue za zhiOncology Society of Chinese Medical Association
To further standardize the prevention and management of lung cancer in China, improve the level of diagnosis and treatment, enhance patient prognosis, and provide evidence-based professional recommendations for clinical practitioners at all levels, the Oncology Society of Chinese Medical Association organized experts from respiratory medicine, medical oncology, thoracic surgery, radiation oncology, radiology, and pathology to develop the "Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2026 edition)" through a consensus conference. Compared with the 2025 edition, the 2026 edition incorporates updates and refinements in several aspects. In the lung cancer screening section, quality control requirements for low-dose computed tomography screening have been further detailed, and the introduction and scope of application of opportunistic screening and artificial intelligence technologies in lung cancer screening have been added. In the pathology section, on the basis of the latest clinical research findings and newly approved indications by the National Medical Products Administration (NMPA), the recommendations for molecular pathological testing have been supplemented, with several new gene testing-related recommendations added. In the treatment section, perioperative neoadjuvant and adjuvant treatment regimens for non-small cell lung cancer have been updated according to newly approved drugs and indications; additional options for consolidation immunotherapy after concurrent or sequential chemoradiotherapy for unresectable stage Ⅲ non-small cell lung cancer have been incorporated; and first-line and subsequent-line treatment strategies for patients with advanced epidermal growth factor receptor (EGFR)-mutations have been further refined. In addition, treatment recommendations for patients with non-small cell lung cancer harboring molecular subtypes such as anaplastic lymphoma kinase (ALK) fusion, KRAS G12C mutation, human epidermal growth factor receptor 2 (HER-2) mutations, and MET amplification have also been updated based on the approval of novel agents. This guideline adheres to NMPA-approved indications as the core principle, is grounded in drugs practically available in China and integrates recommendations from international guidelines as well as the current status of clinical practice in China. It synthesizes the latest evidence-based medical advances in recent years covering lung cancer screening, diagnosis, pathology, genetic testing, immunologic and molecular biomarker testing, treatment modalities, and follow-up, with the aim of providing reasonable and practical recommendations for clinicians at all levels, as well as professionals in radiology, laboratory medicine, and related disciplines.
BMC cancerWiebke Geertz, Laura Inhestern, Isabelle Scholl, Corinna Bergelt
BACKGROUND: When a parent is diagnosed with cancer, it can place a significant burden on the entire family. The aim of this study is therefore to analyse the psychological distress experienced over time among cancer patients or their partners who are raising minor children and who utilize a family-oriented counselling service (COSIP), and to compare these data with those of a group receiving routine psycho-oncological care (PO). METHODS: We conducted a secondary, longitudinal observational study based on routine care data from users of an outpatient psycho-oncological clinic. The database comprised assessments at baseline and at 6- and 12-month follow-ups, including measures of distress, anxiety and depression for COSIP and PO users. For COSIP users additional data on health-related quality of life (HRQoL), parental concerns, and family functioning was included. We conducted descriptive analyses and examined baseline group differences using t-tests and Pearson's chi-square tests. Longitudinal trajectories were analysed using linear mixed-effects models. RESULTS: Data from n = 34 parents who had registered themselves and their families for a COSIP counselling session between 2020 and 2022 were included in the analyses. Among the COSIP users, the time since the initial diagnosis was shorter on average (p = .017) and the parents were separated less frequently (p = .015) than in the group of PO users (n = 34). At baseline, PO and COSIP users exhibited elevated levels of psychological burden, with over 80% of parents reporting clinically significant distress, 54% presenting with moderate to severe anxiety symptoms, and 50% showing elevated levels of depressive symptoms. In the adjusted model, a significant main effect of time, for distress F(2, 107.24) = 14.72, p < .001, depression F(2, 69.61) = 12.27, p < .001 and anxiety F(2, 84.11) = 17.02, p < .001, but no group difference were found. We identified a significant effect of time for parental concerns F(2, 17.24) = 7.41, p = .006, parental HRQoL F(2, 31.52) = 4.34, p = .022 and children's HRQoL F(2, 28.11) = 5.21, p = .012 among COSIP users. CONCLUSION: Parents who are confronted with a cancer diagnosis show high levels of psychological distress. Over time, a significant decrease in psychological distress among both groups and family-related outcomes in COSIP users was identified. Interestingly, no significant differences were observed between the groups, suggesting that the type of psycho-oncological support (individual or family-centred) may not differentially affect parental burden.
From simulations to virtual reality to AI, technology is increasingly used to bridge gaps in medical education. In this News and Perspectives article, JMIR Correspondent Simon Spichak interviews gastroenterologist and renowned gastroenterology educator Samir Grover, MD, about his perspectives on tech in medical education.
Medical education systems vary widely across countries, yet the structure of medical and postgraduate training in China remains relatively unfamiliar to international readers. China has developed a relatively comprehensive pathway spanning undergraduate education, postgraduate programs, standardized residency training, and standardized specialty training, thereby shaping an evolving framework that aims to integrate clinical practice with scientific research. Within this framework, postgraduate nephrology education highlights both clinical training and research development. In recent years, Critical Care Nephrology has demonstrated notable strengths in the management of critical illness, blood purification, and multidisciplinary collaboration. This review provides an overview of the development, current status, and future trends in medical and postgraduate nephrology education in China, with a particular focus on the emerging role of Critical Care Nephrology.
TrialsKajsa Norberg Wieslander, Sara Frygner-Holm, Stefan Nilsson, Malin Lövgren, Anna Höglund, Tove Godskesen
BACKGROUND: Research is essential for improving outcomes in paediatric oncology, yet decisions about research participation often occur during emotionally vulnerable periods for families. Although children's assent is ethically required, it is not always meaningfully implemented in practice. Understanding how children, siblings and parents experience the child's involvement in the assent process, including their attitudes towards research, is crucial for promoting ethically sound research and supporting genuine child participation. The aim of this study was to describe how children with cancer, siblings and parents experience the child's assent process during research recruitment in paediatric oncology, with particular attention to its motivational and relational dimensions. METHODS: A descriptive qualitative study design. Interviews were undertaken with children with cancer (n = 11), siblings (n = 17) and parents (n = 9) regarding their experiences of recruitment to various types of research in Sweden. Data was analysed using reflexive thematic analysis. RESULTS: Two main themes were identified: a moral and emotional commitment to research, and relational assent-trust, loyalty and parental mediation. Children, siblings and parents described research participation as meaningful and morally significant in a vulnerable situation. Children's involvement in assent ranged from active participation to limited influence, with some decisions made primarily by parents. Decisions about research participation were shaped by relational dynamics, in which trust, loyalty, and emotional vulnerability and parental mediation played central roles. CONCLUSIONS: Families are strongly motivated to contribute to research in paediatric oncology. However, sustaining trust and safeguarding research integrity require consistent and meaningful implementation of children's assent. Child-centred, flexible, and context-sensitive assent processes are key, alongside ethical awareness of how relational dynamics shape children's autonomy. Recognising parents as key partners is essential for upholding both ethical standards and children's rights in paediatric research.