Latest Guidance Research Articles

ICC 국제표준은행관행(ISBP 821) 개정사항에 관한 고찰

Purpose: This paper introduces the ICC opinions related to the revision of ISBP 821 and the content of the ISBP revision to trade and finance practitioners who handle letters of credit. Hence, they can apply the latest ISBP when examining documents related to letters of credit and reviewing the presented documents. Research design, data, and methodology: This paper analyzed the ICC opinions and related cases and revised paragraphs of ISBP 821. Results: ISBP 821 is the latest guidance for reviewing documents under the letters of credit, reflecting the practices agreed upon by the ICC National Committee, and is a must-know for letter of credit beneficiaries to prepare and present documents to the nominated bank or issuing bank. Therefore, financial institutions, including banks, and traders that handle letters of credit, must be aware of the revised ISBP 821. Conclusions: ISBP 821 is a rule that must be observed when presenting and reviewing a letter of credit in accordance with UCP 600. If the parties to the letter of credit do not abide by ISBP 821, they will be judged accordingly by the ICC Banking Committee, and there is a high likelihood of losing in court.

MSR34 Diversity in Clinical Trials: Life Science Initiatives and Challenges in Light of the FDA’s Latest Guidance

MSR34 Diversity in Clinical Trials: Life Science Initiatives and Challenges in Light of the FDA’s Latest Guidance

Detecting and managing the patient with chronic kidney disease in primary care: A review of the latest guidelines.

Chronic kidney disease (CKD) is a major global health problem, affecting about 9.5% of the population and 850 million people worldwide. In primary care, most CKD is caused by diabetes and/or hypertension, but a substantial proportion of cases may have alternative causes. During the early stages, CKD is asymptomatic, and many people are unaware that they are living with the disease. Despite the lack of symptoms, CKD is associated with elevated risks of cardiovascular disease, progressive kidney disease, kidney failure and premature mortality. Risk reduction strategies are effective and cost-effective but require early diagnosis through testing of the estimated glomerular filtration rate and albuminuria in high-risk populations. Once diagnosed, the treatment of CKD centres around lifestyle interventions, blood pressure and glycaemic control, and preventative treatments for cardiovascular disease and kidney disease progression. Most patients with CKD should be managed with statins, renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter-2 inhibitors. Additional treatment options to reduce cardiorenal risk are available in patients with diabetes, including glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists. The Kidney Failure Risk Equation is a new tool that can support the identification of patients at high risk of progressive kidney disease and kidney failure and can be used to guide referrals to nephrology. This review summarizes the latest guidance relevant to managing adults with, or at risk of, CKD and provides practical advice for managing patients with CKD in primary care.

Fitness to practise: the latest guidance.

Fitness to practise: the latest guidance.

Aspirin for Primary Prevention of Cardiovascular Disease: What We Now Know

Cardiovascular disease (CVD), including coronary artery disease and stroke, is the leading cause of death worldwide. Advances in primary and secondary prevention of CVD have improved patient prognoses and outcomes, however, it is imperative that the clinician and patient engage in early risk factor screening and preventive management of modifiable risk factors for CVD. In addition to blood lipid and blood pressure lowering medications, aspirin has been a long-standing therapy targeted to the prevention of CVD based on its antiplatelet and anti-inflammatory activity. However, recent articles and reports on updates to clinical guidelines for the primary prevention of CVD have resulted in confusion about aspirin recommendations. This review aims to assess the latest guidance on aspirin in CVD prevention and how to identify appropriately at-risk patients who may benefit from low-dose aspirin therapy as part of their CVD preventive healthcare choices. Additionally, this review will provide practical application guidance about clinician-patient conversations to clearly explain the benefits and risks of aspirin use and ensure a patient-centric decision to initiate aspirin therapy.

Recognizing patients as candidates for temporary mechanical circulatory support along the spectrum of cardiogenic shock

Abstract A growing body of evidence indicates that the benefits of temporary mechanical circulatory support (tMCS) in patients with cardiogenic shock (CS) is dependent on its aetiology and timing of implantation. As such, appropriate diagnosis, screening, selection, and treatment is crucial to achieving good outcomes with tMCS. Here, the latest guidance on CS phenotypes and diagnostics for correctly identifying tMCS candidates is discussed. This includes comprehensive overviews of patient screening with attention given to differences in CS presentation between the sexes, and contraindications for mechanical circulatory support.

Management of cardiac implantable electronic devices around the time of dermatological procedures requiring electrosurgery: an important guidance update.

In collaboration with the British Heart Rhythm Society (BHRS), the British Society for Dermatological Surgery (BSDS) has recently updated its guidance on the management of cardiac implantable electronic devices (CIEDs) around the time of dermatological procedures requiring electrosurgery. A section and comprehensive flowchart specific to dermatological surgery now exist in the national BHRS guidance. This letter brings the latest guidance to readers’ attention and outlines important changes that should streamline care for this cohort of patients.

Targeting malnutrition in patients with COPD in the community.

The number of individuals living with chronic obstructive pulmonary disease (COPD) is increasing, but nutritional care can be inconsistent, especially in those with stable COPD. Historically, poor appetite and weight loss have been considered the norm during the progression of COPD into the later stage. However, it is imperative that nutritional assessment, support and management is undertaken from diagnosis, because malnutrition can lead to exacerbations of COPD and increased hospitalisation. Poor nutrition in individuals with COPD has been shown to predict an increase in mortality and with the care of patients taking place principally in the community, the nutritional aspects of care should be assessed, monitored and managed, in accordance with the latest guidance. The lack of a nutritional Quality Outcome Framework indicator for COPD can leave nutrition overlooked, but evidence shows that screening, assessment and planning can have an overall positive impact.

What's next for immunisations in primary care?

Dr Catherine Heffernan looks at the latest guidance for nurses on vaccinations

Treatment approaches for severe Stenotrophomonas maltophilia infections.

Stenotrophomonas maltophilia is an emerged opportunistic pathogen. Intrinsic multidrug resistance makes treating infections caused by S. maltophilia a great clinical challenge. Herein, we provide an update on the most recent literature on treatment options for severe S. maltophilia infections. Trimethoprim-sulfamethoxazole (SXT) is recognized as the first-line therapy for S. maltophilia infections. However, its clinical use is based on good in vitro activity and favorable clinical outcomes, rather than on solid minimum inhibitory concentration (MIC) correlations with pharmacokinetic/pharmacodynamics (PK/PD) and/or clinical outcomes. The same is true for other treatment options like levofloxacin (LVX) and minocycline (MIN). Recent PK/PD studies question the current clinical breakpoints for SXT, LVX, and MIN. Based on this, the latest guidance issued by the Infectious Diseases Society of America (IDSA) recommends using these agents only as part of a combination therapy. Alternatively, novel therapeutic options such as cefiderocol (FDC) and ceftazidime-avibactam plus aztreonam (CZA-ATM) are suggested, based on limited but promising clinical data. PK/PD data and controlled clinical studies are needed to optimize current treatment options. Presently, combination therapy of SXT, LVX, MIN, or FDC, or monotherapy with CZA-ATM are recommended therapeutic options for severe-to-moderate S. maltophilia infections.

Could this be sepsis?

Sepsis is a common and dangerous condition. Early recognition and consequent initiation of appropriate management has significant impact on the morbidity and mortality of this condition. This article aims to help GPs to suspect sepsis and put into action an initial management plan in primary care. This article references all the latest guidance, helping GPs to manage sepsis effectively and safely.

Cardiac Emergency Response Plan: Is Your School Prepared?

School nurses play a major role in school readiness and emergency management, collaborating in safety assessment of schools and leading efforts to ensure the overall wellness of each child. Sudden cardiac arrest is a growing concern among students, and schools are a place of gathering, not only of our students and educators but also for the community, as family and friends support children in performances, sporting events, and religious or cultural activities. Implementing a school Cardiac Emergency Response Plan (CERP) provides a lifesaving resource for the entire community. This article will review the incidence of sudden cardiac arrest, discuss the latest guidance regarding preventive cardiac screening questions for all children, and share how one school district implemented a CERP using readily available resources.

Clinical Considerations for the Integration of Adjuvant Olaparib into Practice for Early Breast Cancer: A Canadian Perspective.

With the recent Health Canada approval of olaparib for high-risk, HER2-negative early breast cancer, physicians are now facing the practical challenges of integrating olaparib into current management of triple-negative breast cancer (TNBC) and HR-positive, HER2-negative (HR+/HER2-) early breast cancer. This review provides perspectives on some of the challenges related to identification of olaparib candidates, with a focus on the latest guidance for germline BRCA testing and considerations regarding high-risk disease definitions. Updated treatment pathways are explored for both disease states, including other adjuvant treatment options such as pembrolizumab, capecitabine, and abemaciclib. Gaps in the current literature regarding the sequential or combined use of these adjuvant therapies are noted and future, potentially informative, studies are briefly examined.

Principled estimation and evaluation of treatment effect heterogeneity: A case study application to dabigatran for patients with atrial fibrillation

Objective:To apply the latest guidance for estimating and evaluating heterogeneous treatment effects (HTEs) in an end-to-end case study of the Long-term Anticoagulation Therapy (RE-LY) trial, and summarize the main takeaways from applying state-of-the-art metalearners and novel evaluation metrics in-depth to inform their applications to personalized care in biomedical research. Methods:Based on the characteristics of the RE-LY data, we selected four metalearners (S-learner with Lasso, X-learner with Lasso, R-learner with random survival forest and Lasso, and causal survival forest) to estimate the HTEs of dabigatran. For the outcomes of (1) stroke or systemic embolism and (2) major bleeding, we compared dabigatran 150 mg, dabigatran 110 mg, and warfarin. We assessed the overestimation of treatment heterogeneity by the metalearners via a global null analysis and their discrimination and calibration ability using two novel metrics: rank-weighted average treatment effects (RATE) and estimated calibration error for treatment heterogeneity. Finally, we visualized the relationships between estimated treatment effects and baseline covariates using partial dependence plots. Results:The RATE metric suggested that either the applied metalearners had poor performance of estimating HTEs or there was no treatment heterogeneity for either the stroke/SE or major bleeding outcome of any treatment comparison. Partial dependence plots revealed that several covariates had consistent relationships with the treatment effects estimated by multiple metalearners. The applied metalearners showed differential performance across outcomes and treatment comparisons, and the X- and R-learners yielded smaller calibration errors than the others. Conclusions:HTE estimation is difficult, and a principled estimation and evaluation process is necessary to provide reliable evidence and prevent false discoveries. We have demonstrated how to choose appropriate metalearners based on specific data properties, applied them using the off-the-shelf implementation tool survlearners, and evaluated their performance using recently defined formal metrics. We suggest that clinical implications should be drawn based on the common trends across the applied metalearners.

COPD: what GPNs need to know from the latest GOLD update

Every year, the Global Initiative for Obstructive Lung Disease publishes its update on COPD. Beverley Bostock provides an overview of what the latest publication means for general practice nurses The latest guidance from the Global Initiative for Obstructive Lung Disease (GOLD) on chronic obstructive pulmonary disease (COPD) will have an impact on the management of patients in general practice. The definition of COPD has been updated as well as the recommended approach to diagnosis. Updated treatment recommendations act as an important reminder for primary care clinicians to implement interventions that are relevant in the community setting and to refer on for more specialised interventions in secondary care as appropriate. The replacement of the ABCD assessment tool with the ABE approach underlines the significant impact that exacerbations can have in the management of COPD, independent of the symptom burden. Updated sections on exacerbations remind clinicians of the importance of considering comorbid or new diagnoses as the cause of any symptoms.

Changes in Clinical Training for Nursing Students during the COVID-19 Pandemic: A Scoping Review.

(1) Background: The COVID-19 pandemic has cost social, economic, cultural, and educational life, distressing nursing training and practice. This study aimed to map the literature on changes in clinical training for nursing students during the COVID-19 pandemic. (2) Methods: A scoping review was conducted according to JBI methodology's latest guidance. A set of relevant electronic databases and grey literature was searched to report results published in English, Spanish, and Portuguese. (3) Results: A total of 12 studies were included in the study, addressing changes in clinical training in undergraduate nursing students due to COVID-19 pandemic activity, published between 2020 and 2022. (4) Conclusions: Nursing schools made an effort to replace traditional clinical training with several activities, primarily based on simulation or virtual activities. However, contact with others is essential, and simulation programs or scenarios cannot provide it.

Metallic Plasmonic Nanostructure Arrays for Enhanced Solar Photocatalysis

AbstractPlasmon‐enhanced photocatalysis has emerged as a promising technology for solar‐to‐chemical energy conversion. Compared to isolated or disordered metal nanostructures, by controlling the morphology, composition, size, spacing, and dispersion of individual nanocomponents, plasmonic nanostructure arrays with coupling architectures yield strong broadband light‐harvesting capability, efficient charge transfer, enhanced local electromagnetic fields, and large contact interfaces. Although metallic nanostructure arrays are extensively studied for various applications, such as refractive index sensing, surface‐enhanced spectroscopy, plasmon‐enhanced luminescence, plasmon nanolasing, and perfect light absorption, the connection between surface plasmon resonance and enhanced photocatalysis remains relatively unexplored. In this study, an overview of plasmonic nanostructure arrays over a broad range, from 0D to 3D, for efficient photocatalysis is presented. By reviewing the fundamental mechanisms, recent applications, and latest developments of plasmonic nanostructure arrays in solar‐driven chemical conversion, this study reports on the latest guidance toward the integration of plasmonic nanostructures for functional devices in the fields of plasmonic, photonics, photodetection, and solar‐energy harvesting.

Tai Chi increases functional connectivity and decreases chronic fatigue syndrome: A pilot intervention study with machine learning and fMRI analysis.

The latest guidance on chronic fatigue syndrome (CFS) recommends exercise therapy. Tai Chi, an exercise method in traditional Chinese medicine, is reportedly helpful for CFS. However, the mechanism remains unclear. The present longitudinal study aimed to detect the influence of Tai Chi on functional brain connectivity in CFS. The study recruited 20 CFS patients and 20 healthy controls to receive eight sessions of Tai Chi exercise over a period of one month. Before the Tai Chi exercise, an abnormal functional brain connectivity for recognizing CFS was generated by a linear support vector model. The prediction ability of the structure was validated with a random forest classification under a permutation test. Then, the functional connections (FCs) of the structure were analyzed in the large-scale brain network after Tai Chi exercise while taking the changes in the Fatigue Scale-14, Pittsburgh Sleep Quality Index (PSQI), and the 36-item short-form health survey (SF-36) as clinical effectiveness evaluation. The registration number is ChiCTR2000032577 in the Chinese Clinical Trial Registry. 1) The score of the Fatigue Scale-14 decreased significantly in the CFS patients, and the scores of the PSQI and SF-36 changed significantly both in CFS patients and healthy controls. 2) Sixty FCs were considered significant to discriminate CFS (P = 0.000, best accuracy 90%), with 80.5% ± 9% average accuracy. 3) The FCs that were majorly related to the left frontoparietal network (FPN) and default mode network (DMN) significantly increased (P = 0.0032 and P = 0.001) in CFS patients after Tai Chi exercise. 4) The change of FCs in the left FPN and DMN were positively correlated (r = 0.40, P = 0.012). These results demonstrated that the 60 FCs we found using machine learning could be neural biomarkers to discriminate between CFS patients and healthy controls. Tai Chi exercise may improve CFS patients' fatigue syndrome, sleep quality, and body health statement by strengthening the functional connectivity of the left FPN and DMN under these FCs. The findings promote our understanding of Tai Chi exercise's value in treating CFS.

A surgical procedure to deliver a triphasic calcium-based implant material to address local bone loss and strengthen an osteoporotic proximal femur: a case report

Bone loss associated with the systemic skeletal disease osteoporosis results in weakened or fragile bone, the most serious consequence of which is fracture. A 67-year-old post-menopausal Caucasian woman presented with a diagnosis of osteoporosis by FRAX and DXA and a history of a fragility hip fracture. The patient was classified according to the latest guidance document for treating patients with post-menopausal osteoporosis from the International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis. The patient was at very high risk for major osteoporotic fracture, including hip fracture. This case report describes the use of a minimally invasive surgical procedure to address bone loss in the proximal femur associated with osteoporosis. Local osteo-enhancement procedure (LOEP), a minimally invasive surgical procedure, was performed using a triphasic calcium-based implant material, AGN1. LOEP was carried out under general anesthesia and fluoroscopic navigation. The area of bone loss in the proximal femur, the enhancement site, was identified, debrided, and irrigated to prepare it for low-pressure filling with AGN1 implant material. The patient recovered from the procedure without incident and was discharged without activity limitations after an overnight stay. X-ray imaging and DXA scans were used to evaluate implant material resorption and replacement with bone over a 3.25-year follow up. A significant and sustained increase in femoral neck and total hip BMD was observed (pre vs 3.25 years post-procedure: 0.546 vs 1.031 gm/cm2 and 0.628 vs 0.96 gm/cm2, respectively), which corresponded to a change in the patient’s T-score from the osteoporosis range to normal. Based on the use of T-scores to measure the risk of fragility fractures, and acknowledging the well-published limitations of doing so, the hip fracture risk of this patient was reduced from very high to low. This case report documents the use of this minimally invasive, targeted procedure to address hip fragility fracture (the most serious issue in the systemic disease osteoporosis), with AGN1 implant material used to replace bone lost in the proximal femur.

Predicting antipsychotic-induced weight gain in first episode psychosis-a protocol for a field-wide systematic review of prognostic factor studies

<p><strong>Background:</strong> One significant complexity associated with management of antipsychotic-induced weight gain (AIWG) is extensive interindividual variability amongst patients in initial susceptibility to AIWG, time to plateau of weight gain, and resultant final amount of weight gained. Prior to antipsychotic commencement, risk-stratified information highlighting those at increased risk of experiencing significant AIWG would allow tailored weight monitoring and subsequent management protocols to be developed.</p><p><strong>Methods: </strong>This protocol is for a planned systematic review to identify the current utility of baseline clinical, sociodemographic, and biological prognostic factors in predicting the likelihood of significant AIWG occurring prior to antipsychotic commencement. The cohort assessed will be antipsychotic-naïve adults with a first episode of psychosis. Searches for both randomised and prospective non-randomised studies will be undertaken by searching four electronic databases and two trial registers, followed by reference searching, forward citation searching and liaison with content experts. A meta-analysis of study results will be undertaken where study quality and homogeneity allow. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework modified for prognostic research will be used to assess evidence certainty. This protocol was prepared in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols guideline and latest guidance from the Prognosis Methods Group of the Cochrane Collaboration.</p><p><strong>Results: </strong>This review will establish the current quantity, quality and clinical utility of evidence addressing the prognostic association of clinical, biological, and sociodemographic factors in prospectively identifying those more likely to experience significant AIWG.</p><p><strong>Registration details:</strong> PROSPERO registration number CRD42021258148.</p>