Expert Recommendations Research Articles

Expert Panel Consensus Recommendations for Allergic Rhinitis in Patients with Asthma in India.

Allergic rhinitis and asthma are commonly coexisting conditions, significantly impacting patient health and quality of life. Despite their interrelation, diagnosing allergic rhinitis in patients with asthma remains challenging, leading to underdiagnosis and suboptimal management. The expert consensus engaged a modified Delphi method involving 29 experts including pulmonologists, ear, nose, and throat surgeons, and allergologists. Through group discussions, consensus statements were developed regarding the epidemiology, diagnosis, and management of allergic rhinitis and asthma. Final consensus statements were formulated based on the experts' collective clinical judgment and experience. This expert consensus provides updated recommendations tailored to the Indian context, addressing the gaps in existing research and clinical practice. By promoting a systematic and evidence-based approach to diagnosis and management, this consensus aims to support clinicians in effectively identifying and treating allergic rhinitis in patients with asthma, thereby improving overall disease management and patient well-being.

National recommendations of the Croatian Chamber of Medical Biochemists and Working group for Laboratory hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine: Management of samples with suspected EDTA-induced pseudothrombocytopenia.

Pseudothrombocytopenia (PTCP) is defined by the occurence of spouriously low platelet count as a consequence of in vitro platelet aggregation. It is a rare and benign artifact, not associated with any specific disorder or therapy, that becomes clinically relevant when it is not timely and reliably recognized. Thus, it may result in inappropriate clinical decisions (i.e. unnecessary further testing, misdiagnoses and potential patients' mismanagement) unavoidably compromising patient safety. The most common form of PTCP is caused by ethylenediaminetetraacetic acid (EDTA). Several approaches for the management of samples with EDTA-induced PTCP have been described in the literature. However, expert recommendations are scarce. The scope of these recommendations is to assist in achieving national harmonisation in laboratory management (i.e. detecting and reporting platelet counts) of samples with EDTA-induced PTCP. These minimal recommendations were prepared by the members of the joint working group of the Croatian Chamber of Medical Biochemists and Working group for Laboratory Hematology of the Croatian Society of Medical Biochemistry and Laboratory Medicine, and might be customized according to specific conditions (i.e. personnel and equipment) of each individual laboratory. These recommendations are primarily intended to all laboratory professionals involved in the management of samples with EDTA-induced PTCP, but also to other healthcare professionals involved in collecting samples and interpreting complete blood count results.

Strategies for implementation of a transmural fall-prevention care pathway for older adults with fall-related injuries at the emergency department

BackgroundAlthough indicated, referrals for multifactorial fall risk assessments in older adults with fall related injuries presenting at the emergency department (ED) are not standard. The implementation of a transmural fall-prevention care pathway (TFCP) could bridge this gap by guiding patients to multifactorial fall risk assessments and personalised multidomain interventions in primary care. This study aims to develop and evaluate implementation strategies for a TFCP.MethodsIn this mixed-methods implementation study, strategies were developed using the Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Matching Tool. These were evaluated with patients, involved healthcare professionals, and other stakeholders using the Reach, Adoption, Implementation, and Maintenance of the RE-AIM framework in two cycles. Patients of the TFCP consisted of frail community dwelling individuals aged 65 and over presenting at the ED with fall related injuries.ResultsDuring the first implementation phase, strategies were focussed on assessing readiness, adaptability, local champions, incentives and education for all involved healthcare professions in the TFCP. Only 34.4% of eligible patients were informed of the TFCP at the ED, 30.6% agreed to a fall risk assessment and 8.3% patients received the fall risk assessment. In the second phase, this improved to 67.1%, 64.6%, and 35.4%, respectively. Strategies in this phase focussed on adaptability, obtaining sustainable financial resources, local champions, assessing readiness, and education. The implementation was facilitated by strategies related to awareness, champion recruitment, educational meetings, adaptability of TFCP elements and evaluations of facilitators and barriers.ConclusionThe study outlined strategies for implementing TFCPs in EDs. Strategies included increasing awareness, utilising local champions, educational initiatives, adaptability of the TFCP, and continuous monitoring of facilitators and barriers. These insights can serve as a blueprint for enhancing fall prevention efforts for older adults in emergency department settings.

Organisational cyber resilience: a heuristic for bridging foundations and applications

PurposeThe drive for digitalisation has increased the scope of cyber threats which can exploit the growing footprint of information and communication technology infrastructure supporting modern societies. Despite substantial interest and efforts in researching and building organisational cyber resilience, the resulting body of work is heterogeneous and has yet to reach maturity. This paper aims to address the gap in the conceptualisation of cyber resilience in academic and practice-oriented grey literature.Design/methodology/approachIn this conceptual paper, we firstly seek to explore the available foundations of resilience as a construct and consider how these can be applied to organisational cybersecurity. To that aim, this study employs a targeted literature review approach, incorporating systematic elements to ensure rigour. Literature was identified through comprehensive searches in key academic databases, reference chaining and expert recommendations. Articles were selected based on relevance and contribution to the field, resulting in a thematic analysis to identify gaps and propose a heuristic model for cyber resilience. With this approach, we aim to position the emerging view of cyber resilience relative to risk analysis, while highlighting its domain of “conceptual comparative advantage” – the types of applications it is best suited to address. Finally, a high-level heuristic model for cyber resilience is proposed, which functions across the relevant policy, strategy and operational dimensions while also considering its relationship with cyber risk management.FindingsA conceptual model for organisational cyber resilience is proposed which helps position and frame research contributions in this domain relative to risk analysis, highlighting its domain of comparative advantage. The model integrates policy, strategy and operational dimensions, in a manner conducive to bridging foundations and applications of the concept of cyber risk management. The proposed model provides a critical point of reference to evaluate individual models, frameworks and tools.Originality/valueThis paper is a pioneering effort to overcome the current gaps between conceptual and practical views of cyber resilience. It proposes a new, risk-aligned view of the concept of cyber resilience and provides a structural foundation for further research and practice in the field.

Learner training for phonetic transcription of typical and/or disordered speech: A scoping review.

Phonetic transcription is a core skill of speech and language therapists/pathologists (SLT/Ps) for clinical assessment of speech sounds and/or errors, and linguists for investigation of phonetic phenomena in various languages; hence, it is included in the curriculum of the corresponding degree programme. Many experts and course instructors have discussed their opinions on different aspects of phonetic transcription teaching and/or reported their own training programmes. However, no review has systematically summarized the types of expert recommendations and training methodology reported in the literature. Such information is important for mapping the knowledge gaps, refining current teaching and planning further research. To systematically summarize (1) the materials and procedures for delivering and evaluating phonetic transcription training programmes, and (2) the opinions from experts in phonetic transcription teaching regarding but not limited to the content, rationale(s), format and structure, and timing of teaching phonetic transcription of typical speech and/or disordered speech reported in the literature. A scoping review was carried out by following the Joanna Briggs Institute methodology. PubMed, EBSCOhost and Web of Science were searched and citation searching of included papers was completed. The included papers were divided into training programme reports, of which data (e.g., type and number of speech stimuli used, type and number of learners, outcome measures) were charted, and expert opinion papers, analysed using content analysis. A total of 565 studies were retrieved. After excluding duplicates and irrelevant papers and merging two sources that reported the same training, a total of 23 sources on training programmes and six opinion papers were analysed. Most training were for English and for SLT/P students, with some for the linguistics students. There are variations in the training content (with phonetic transcription practice as the main procedure), delivery mode (some presented via websites or computer software), stimuli (audio recordings of typical adults and children with speech disorders were most used), feedback (mostly immediate feedback using answer keys) and outcome measures (mainly transcription accuracy of learners and user opinions). Content analysis of opinion papers determined five main categories: rationale for training; aspects of the delivery of training; transcription; problem areas noted; and strategies/resources. Implications and considerations for teaching are discussed, along with recommendations for research in the design of evidence-based training. The findings can contribute to the development of general guidelines about phonetic transcription training in educational programmes and the establishment of pre-registration competencies. What is already known on this subject Phonetic transcription is a core skill of SLT/Ps and linguists for clinical speech assessment and research, and it is an important component in the curriculum of the relevant degree programmes. Many experts and course instructors have discussed their opinions regarding phonetic transcription teaching and/or reported their own training programmes in various sources such as books and book chapters, research papers and conference proceedings. What this paper adds to the existing knowledge The paper reports a scoping review that systematically summarized the materials and procedures for delivering and evaluating phonetic transcription programmes and experts' opinions and recommendations for phonetic transcription teaching, reported in the literature. The data from these two types of sources allowed an integrated discussion of the various aspects of phonetic transcription training, such as content, format and structure, materials and timing of teaching and the evaluation of training efficacy. What are the potential or actual clinical implications of this work? The data synthesized and discussed provide a foundation for a review of current practice in phonetic transcription teaching in SLT education. The findings can contribute to the development of general guidelines about phonetic transcription training in educational programmes and the establishment of pre-registration competencies.

The perpetual evidence-practice gap: addressing ongoing barriers to chronic pain management in primary care in three steps.

Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap. A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both deductive and inductive approaches were used during analysis. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to inform our analysis and findings. We identified determinants of evidence-based chronic pain management across the CFIR domains of Intervention Characteristics, Characteristics of Individuals, and the Outer Setting and reported implementation strategies. Based on identified themes, we developed a three-step process to support the ongoing and pragmatic implementation of evidence-based chronic pain management in primary care settings. Previous efforts exist to integrate implementation science into chronic pain management; yet a gap persists. Implementation approaches should prioritize the needs of people living with chronic pain and their families. Further, future approaches or strategies used should build on the current three-step model to include the fourth step of tailoring existing implementation strategies to the specific needs of chronic pain in the clinical context.

How to give an effective conference presentation.

At some point in their careers, nurses may choose or be invited to give a conference presentation, online or in person. For some, this can be an exciting opportunity to share best practice, impart knowledge and receive feedback, for example, on a local service initiative they have been involved in. For others, it can be a stressful experience, especially if they are not confident in presenting. However, giving conference presentations is an important skill in nursing leadership, particularly when sharing a new method of care or innovative service. Although there is no specific evidence base underlying conference presentation, expert recommendations indicate that a well-delivered presentation relies on thorough preparation, an avoidance of excessive on-screen text and the use of images and key messages to ensure the audience gains maximum benefit. • When preparing a presentation, you should consider aspects such as what the conference organisers require, the time allocated for the presentation and how to prepare the appropriate number of clear and well-presented slides. • Consider the key points that you wish to communicate to the audience and use a balanced mix of text and images. • Maintain a focus on the presentation's application to nursing practice, so that audience members can take away key learning points and apply these to their own practice. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your presentation skills. • How you could use this information to educate nursing students or other colleagues about effective conference presentation.

Nursing procedures for assisting victims of violence in emergency units

The objective of this study was to carry out the cross-cultural adaptation of the Questionnaire on Preservation of Traces in Victim Assistance by Nurses to the Brazilian reality. The method used was composed by the steps: (1) semantic equivalence; (2) idiomatic equivalence; (3) empirical equivalence; (4) conceptual equivalence; and (5) pre-test. Based on the experts' analysis and recommendations, adjustments were made regarding semantic and empirical equivalence; during the assessment of idiomatic and conceptual equivalence, no changes were made. The pre-test was performed with 24 nurses and the value of Cronbach's alpha coefficient was α = 0.973. The instrument's feasibility assessment showed that most participants found it easy to understand the questionnaire's instructions and questions and mark the answers, which demonstrates its validity with the sample in the pre-test. The performance of the forensic nurse is essential in emergency services. The adapted instrument is valid for use in the Brazilian context.

Convenings as a tool for enhancing implementation strategies: lessons from the Black Women First initiative

BackgroundThe Expert Recommendations for Implementing Change (ERIC) project identified 73 strategies for supporting the implementation of a novel intervention and evidence-informed practices. In this paper, we explore convenings, which engage stakeholders in proactive dialogues, as a mechanism to deliver multiple strategies that support sites adapting and implementing evidence-informed bundled interventions for Black women with HIV.MethodsWe use an instrumental case study design to explore strategies embedded in biannual convenings hosted by the Black Women First Initiative (BWF) Evaluation and Technical Assistance Provider (ETAP). Data sources including planning documents, direct observation of the convenings and analysis of convening attendee feedback surveys were analyzed.ResultsUsing instrumental case study design, we found that convenings were a helpful tool that allowed for cross-site communication and collaboration. Communal re-examination of implementation strategies, coupled with training and network-weaving, created a rich learning environment to identify potential intervention adaptations and changes, unify on data collection, and prepare to test these adaptations at each respective site.ConclusionsWe discuss lessons learned when using convenings to help health care and community-based settings collectively explore and address adaptation and implementation barriers as they implement evidence-informed interventions to improve health outcomes for populations affected by chronic conditions, such as HIV.

Classifying compounds as prebiotics - scientific perspectives and recommendations.

Microbiomes provide key contributions to health and potentially important therapeutic targets. Conceived nearly 30 years ago, the prebiotic concept posits that targeted modulation of host microbial communities through the provision of selectively utilized growth substrates provides an effective approach to improving health. Although the basic tenets of this concept remain the same, it is timely to address certain challenges pertaining to prebiotics, including establishing that prebiotic-induced microbiota modulation causes the health outcome, determining which members within a complex microbial community directly utilize specific substrates in vivo and when those microbial effects sufficiently satisfy selectivity requirements, and clarification of the scientific principles on which the term 'prebiotic' is predicated to inspire proper use. In this Expert Recommendation, we provide a framework for the classification of compounds as prebiotics. We discuss ecological principles by which substrates modulate microbiomes and methodologies useful for characterizing such changes. We then propose statistical approaches that can be used to establish causal links between selective effects on the microbiome and health effects on the host, which can help address existing challenges. We use this information to provide the minimum criteria needed to classify compounds as prebiotics. Furthermore, communications to consumers and regulatory approaches to prebiotics worldwide are discussed.

Challenges in the diagnosis and management of dry tamponade.

Dry tamponade is a rare complication of percutaneous coronary intervention. It encompasses a heterogenous pathophysiology and is used to describe hemodynamic compromise secondary to a coronary artery perforation, without free-flowing fluid in the pericardium. Tamponade physiology can result from compressive epicardial, intramyocardial, subepicardial hematomas, or dissecting intramyocardial hematomas. The diagnosis of dry tamponade requires hemodynamic derangement in the context of a compressive hematoma as demonstrated by imaging. Although echocardiography can often help identify dry tamponade, additional studies including right heart catheterization, computed tomography, or cardiac magnetic resonance imaging can inform the exact mechanism and help guide management. This article describes a case of dry tamponade, reviews the existing literature on the topic, and offers expert recommendations on diagnosis and management.

Defining precancer: a grand challenge for the cancer community.

The term 'precancer' typically refers to an early stage of neoplastic development that is distinguishable from normal tissue owing to molecular and phenotypic alterations, resulting in abnormal cells that are at least partially self-sustaining and function outside of normal cellular cues that constrain cell proliferation and survival. Although such cells are often histologically distinct from both the corresponding normal and invasive cancer cells of the same tissue origin, defining precancer remains a challenge for boththe research and clinical communities. Once sufficient molecular and phenotypic changes have occurred in the precancer, the tissue is identified as a 'cancer' by a histopathologist. While even diagnosing cancer can at times be challenging, the determination of invasive cancer is generally less ambiguous and suggests a high likelihood of and potential for metastatic disease. The 'hallmarks of cancer' set out the fundamental organizing principles of malignant transformation but exactly how many of these hallmarks and in what configuration they define precancer has not been clearly and consistently determined. In this Expert Recommendation, we provide a starting point for a conceptual framework for defining precancer, which is based on molecular, pathological, clinical and epidemiological criteria, with the goal of advancing our understanding of the initial changes that occur and opportunities to intervene at the earliest possible time point.

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

IntroductionDog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given? MethodsA structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed. ResultsA total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days. ConclusionHigh-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed. Level of EvidenceLevel II – systematic review.

Expert-Guided Large Language Models for Clinical Decision Support in Precision Oncology.

Rapidly expanding medical literature challenges oncologists seeking targeted cancer therapies. General-purpose large language models (LLMs) lack domain-specific knowledge, limiting their clinical utility. This study introduces the LLM system Medical Evidence Retrieval and Data Integration for Tailored Healthcare (MEREDITH), designed to support treatment recommendations in precision oncology. Built on Google's Gemini Pro LLM, MEREDITH uses retrieval-augmented generation and chain of thought. We evaluated MEREDITH on 10 publicly available fictional oncology cases with iterative feedback from a molecular tumor board (MTB) at a major German cancer center. Initially limited to PubMed-indexed literature (draft system), MEREDITH was enhanced to incorporate clinical studies on drug response within the specific tumor type, trial databases, drug approval status, and oncologic guidelines. The MTB provided a benchmark with manually curated treatment recommendations and assessed the clinical relevance of LLM-generated options (qualitative assessment). We measured semantic cosine similarity between LLM suggestions and clinician responses (quantitative assessment). MEREDITH identified a broader range of treatment options (median 4) compared with MTB experts (median 2). These options included therapies on the basis of preclinical data and combination treatments, expanding the treatment possibilities for consideration by the MTB. This broader approach was achieved by incorporating a curated medical data set that contextualized molecular targetability. Mirroring the approach MTB experts use to evaluate MTB cases improved the LLM's ability to generate relevant suggestions. This is supported by high concordance between LLM suggestions and expert recommendations (94.7% for the enhanced system) and a significant increase in semantic similarity from the draft to the enhanced system (from 0.71 to 0.76, P = .01). Expert feedback and domain-specific data augment LLM performance. Future research should investigate responsible LLM integration into real-world clinical workflows.

Cognitive Impairment as A Vulnerability for Exploitation: A Scoping Review.

Exploitation is a form of abuse that occurs when one person unfairly manipulates another for profit or personal gain. Various individual and social characteristics have the potential to increase an individual's risk of being exploited. Cognitive impairment is one potential vulnerability factor that has received minimal research attention. This scoping review aimed to investigate cognitive impairment as a factor that may increase an individual's vulnerability to exploitation. Study inclusion criteria were: (a) empirical studies; (b) studies presenting extractable data related to cognitive impairment and exploitation; (c) studies exploring cognitive impairment as a vulnerability factor for exploitation; (d) studies published after 1998; and (e) studies available in English. A six-step search strategy was employed: (a) electronic searches of bibliographic databases; (b) screening reference lists of included studies; (c) forward citation tracking in Google Scholar; (d) expert recommendations; (e) website searches of relevant Non-Governmental Organizations (NGOs); and (f) a call for evidence. Twenty studies met the inclusion criteria. Three types of exploitation were reported: sexual (n = 10), financial (n = 8), and criminal (n = 2). Intellectual disability (n = 8) and mental health (n = 8) were the most frequently described forms of cognitive impairment. The results indicate that cognitive impairment is a factor that increases vulnerability to exploitation. However, the limited number and disparate nature of the studies means that it is impossible to disentangle all the complexities in the relationship between cognitive impairment and exploitation. Further research is needed to understand if cognitive impairment increases vulnerability to all types of exploitation or if it results in varying levels of susceptibility to different types of exploitation.

ID: 341437 Remote Management of SCS Devices for Chronic Pain: Update on Expert Recommendations and Available Evidence

ID: 341437 Remote Management of SCS Devices for Chronic Pain: Update on Expert Recommendations and Available Evidence

Identification and Analysis of Key Factors Affecting Digital Transformation of Small and Medium-Sized Manufacturing Enterprises

The digital transformation of small and medium-sized manufacturing enterprises is influenced by various factors, and the relationship between them is not yet clear. Studying the factors that affect the digital transformation of small and medium-sized enterprises can promote the digital transformation process of small and medium-sized manufacturing enterprises. On the basis of summarizing literature and expert recommendations, this study identified the influencing factors in the digital transformation process of small and medium-sized manufacturing enterprises, and analyzed the key influencing factors using a combined method of DEMATEL-ISM-MICMAC (Decision-Making Test and Evaluation Laboratory-Interpretive Structural Model-Matrices Impacts Croises-Multiplication Appliance Classement). Research has found that digital policies, market demand, business model innovation, third-party data-driven services, and the digital foundation of enterprises are key factors in the process of digital transformation. In addition, the causal factors in the DEMATEL method, the essential factors in the ISM method analysis, and the independent factors in the MICMAC technique analysis can mutually support and complement each other. This study enriches the methodology for studying the factors of digital transformation and provides reference for the digital transformation of small and medium-sized manufacturing enterprises and government policy formulation.

Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation

BackgroundElectronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers.MethodsImplementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy’s feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review.ResultsOf the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups.ConclusionWe present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.

International expert guidance for defining and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound: a consensus statement

Diagnostic imaging using CT enterography, magnetic resonance enterography, and intestinal ultrasound are important tools in evaluating stricturing Crohn's disease. Definitions of strictures have been developed for CT enterography and magnetic resonance enterography. However, expert recommendations for definitions and treatment response of strictures on intestinal ultrasound are not available. The aim of this study was to standardise definitions, diagnosis, and treatment response criteria in small bowel stricturing Crohn's disease on intestinal ultrasound. Using modified RAND-University of California Los Angeles Appropriateness Method, a diverse expert panel of 13 gastroenterologists, seven radiologists, and two patient representatives was assembled. A total of 466 statements on definitions and response to therapy of stricturing Crohn's disease on intestinal ultrasound were generated from a systematic review and from expert opinion, with subsequent rating for appropriateness. Two rounds of voting with an interposed survey result discussion were performed. Statements were classified as inappropriate, uncertain, or appropriate based on the median panel rating and degree of disagreement. Appropriateness was rated using a nine-point Likert scale (1 being inappropriate, 9 being highly appropriate). A naive or anastomotic small bowel Crohn's disease stricture on intestinal ultrasound is defined by the combination of bowel wall thickening, luminal narrowing, and pre-stenotic dilation. Bowel wall thickness is defined as being more than 3 mm. Luminal narrowing is defined as either a luminal diameter reduction of more than 50% in the narrowest area and relative to a normal adjacent bowel loop, or a luminal diameter of less than 1 cm. Pre-stenotic dilation is defined as more than 2·5 cm or an increase in bowel diameter relative to a normal adjacent bowel loop. Definitions for grading hyperaemia, inflammatory fat, wall stratification, intestinal ultrasound machine technical parameters, and image acquisition were also devised. Treatment response of strictures was defined as reduction in stricture length, bowel wall thickening, luminal narrowing, pre-stenotic dilation, and motility abnormalities. To our knowledge, this is the first intestinal ultrasound appropriateness rating exercise conducted for defining, diagnosing, and measuring response to therapy in small bowel stricturing Crohn's disease and informs future clinical use and intestinal ultrasound index development for clinical trials. Leona M and Harry B Helmsley Charitable Trust.

Evaluating Large Language Models for Material Selection

Abstract Material selection is a crucial step in conceptual design due to its significant impact on the functionality, aesthetics, manufacturability, and sustainability impact of the final product. This study investigates the use of Large Language Models (LLMs) for material selection in the product design process and compares the performance of LLMs against expert choices for various design scenarios. By collecting a dataset of expert material preferences, the study provides a basis for evaluating how well LLMs can align with expert recommendations through prompt engineering and hyperparameter tuning. The divergence between LLM and expert recommendations is measured across different model configurations, prompt strategies, and temperature settings. This approach allows for a detailed analysis of factors influencing the LLMs' effectiveness in recommending materials. The results from this study highlight two failure modes, and identify parallel prompting as a useful prompt-engineering method when using LLMs for material selection. The findings further suggest that, while LLMs can provide valuable assistance, their recommendations often vary significantly from those of human experts. This discrepancy underscores the need for further research into how LLMs can be better tailored to replicate expert decision-making in material selection. This work contributes to the growing body of knowledge on how LLMs can be integrated into the design process, offering insights into their current limitations and potential for future improvements.