Practical Conclusions Research Articles

Choosing the optimal therapy for metastatic renal cell carcinoma: Insights from a real-world comparative study.

The evolution of combination therapies integrating immune checkpoint inhibitors has revolutionized the first-line treatment of metastatic renal cell carcinoma (mRCC). Although these therapies are clinically approved, direct comparisons between dual immune checkpoint inhibitors (IOIO) and immune checkpoint inhibitors combined with tyrosine kinase inhibitors (IOTKI) in clinical trials are lacking. This gap creates uncertainties in selecting the most appropriate treatment based on patient-specific factors. This study employed the inverse probability of treatment weighting (IPTW) method to analyze progression-free survival (PFS) and overall survival (OS) for patients with mRCC receiving IOIO or IOTKI treatment regimens. A total of 171 patients were analyzed after applying inclusion criteria and propensity scoring. The study found no significant differences in PFS and OS between the two treatment modalities in the IPTW cohort. However, subgroup analyses revealed that IOTKI therapy was associated with better PFS and OS for patients without bone metastases and better OS for patients with a body mass index (BMI) over 25. IOIO therapy showed better OS for patients with a BMI below 18.5. Both IOIO and IOTKI therapies were effective. Therapy selection could be better tailored to patient characteristics by including factors such as the presence of bone metastases and BMI. This study enhances understanding of how patient-specific factors interact with different treatment modalities, potentially guiding more personalized treatment decisions in clinical practice for mRCC.

Pediatric Obesity Pharmacotherapy: State of the Science, Research Gaps, and Opportunities.

Pediatric obesity is a major public health problem, affecting nearly 20% of children and adolescents living in the United States. In 2023, the American Academy of Pediatrics released its first clinical practice guideline for the evaluation and management of child and adolescent obesity and recommended integrating health behavior and lifestyle interventions with pharmacological treatment when medically indicated. However, there is a limited evidence base to guide antiobesity medication treatment decisions in clinical practice and limited data on long-term safety during this critical period of growth and development in youth. Thus, in November of 2023, the National Institute of Diabetes and Digestive and Kidney Diseases sponsored a workshop to identify knowledge gaps and opportunities for research on the use of pharmacotherapy for obesity in children and adolescents. Leading scientific and clinical experts in obesity pathophysiology and treatment, pharmacotherapy, clinical trial design, and health equity and disparities, among others, identified gaps in clinical trial design, guidance for clinical use of medications in children and adolescents, additional treatment outcomes beyond body fat or weight, and improvement in care delivery. Adolescent patients and caregivers with lived experience of obesity and weight management were also invited to participate in a panel discussion, providing personal perspectives on living with obesity, clinical care considerations, and research needs. This article summarizes the workshop proceedings on the state of the science and identifies gaps and opportunities for future research to inform optimal and equitable medical management of children and adolescents with obesity.

Automated Classification of Coronary Plaque on Intravascular Ultrasound by Deep Classifier Cascades.

Intravascular ultrasound (IVUS) is the gold standard modality for in vivo visualization of coronary arteries and atherosclerotic plaques. Classification of coronary plaques helps to characterize heterogeneous components and evaluate the risk of plaque rupture. Manual classification is time-consuming and labor-intensive. Several machine learning-based classification approaches have been proposed and evaluated in recent years. In the current study, we develop a novel pipeline composed of serial classifiers for distinguishing IVUS images into five categories: normal, calcified plaque, attenuated plaque, fibrous plaque, and echolucent plaque. The cascades comprise densely connected classification models and machine learning classifiers at different stages. Over 100,000 IVUS frames of five different lesion types were collected and labeled from 471 patients for model training and evaluation. The overall accuracy of the proposed classifier is 0.877, indicating that the proposed framework has the capacity to identify the nature and category of coronary plaques in IVUS images. Further, it may provide real-time assistance on plaque identification and facilitate clinical decision-making in routine practice.

An exploratory study on a comprehensive set of criteria for facade assessment

Purpose The presentation of all required criteria that a facade should fulfill needs to be revised, particularly considering novel perspectives on facade. This study aims to fill this need because leaving it unsolved leads the specialists to evaluate and design facades based on insufficient data resulting in imprecise decisions in both areas. Design/methodology/approach An exploratory study was conducted based on library resources to identify and extract the criteria, which were coded openly and axially, and categorized via a new standpoint. Shannon method was also used to analyze categories’ frequencies. Findings In total, 42 criteria were found and organized in five categories: “Environmental Aspects,” “Social Impacts,” “Economic Aspects,” “Efficiency and Effectiveness” and “Technical Issues.” This study adds 20 criteria, including “Natural Resource Depletion” and “Clients’ Preferences,” to facade assessment criteria compared to previous studies. Compared to similar research, “Technical Aspects” is augmented to this field's categorizations, whereas “Social Impacts” and “Environmental Aspects” are provided in a more extensive way. Research limitations/implications The research proceeded until theoretical saturation; therefore, there is no claim to be the most comprehensive. The findings are instrumental to professionals for making practical decisions. The concentration and frequency of the literature will offer an insight to academics about the pioneering fields of facade development. Originality/value This study presents a comprehensive and up-to-date set of facade assessment criteria based on new approaches that see facade as a multifunctional component that must address various requirements beyond aesthetics.

Infection and infestation-related adverse events of biologics in psoriasis: insights from the Food and Drug Administration Adverse Event Reporting System (FAERS)

ABSTRACT Objective The study aims to thoroughly assess the adverse events related to infections and infestations associated with biological agents used for psoriasis using the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) database. Methods We analyzed FAERS data from the first quarter of 2004 to the fourth quarter of 2023. The study included TNF-α inhibitors (etanercept, infliximab, adalimumab), IL-12/23 inhibitors (ustekinumab), IL-23p19 inhibitors (guselkumab), and IL-17 inhibitors (secukinumab, ixekizumab). We used disproportionality analysis and Bayesian methods to quantify the related adverse event (AE) signals. Results Most AEs related to infections and infestations are already listed on the drug packaging labels. Notably, TNF-α inhibitors are associated with a significantly higher incidence of tuberculosis-related diseases compared to other biological agents. In contrast, IL-17 inhibitors show a greater variety and number of fungal infection-related AEs than their counterparts. Furthermore, our study has identified new potential AEs that require the attention of clinicians. Conclusion In clinical practice, it is advisable to monitor the risks of infections and infestations in patients receiving biological agents for psoriasis to enable early detection and intervention. Our findings highlight the need for further epidemiological investigations to establish causality and guide clinical practice in managing these risks effectively.

From Thesis to Scientific Articles: Publication of Neonatal Research in Ecuador

Objective: To determine the proportion of scientific articles published by health professionals in Neonatology services in Ecuador in the last 20 years. Theoretical framework: Perinatal research is a priority in public health. Writing a thesis allows students to acquire research skills. Publishing these findings in indexed journals ensures their validity and relevance, becoming references for future studies, systematic reviews, hospital protocols and clinical guidelines. Method: Bibliometric study that examined the temporal evolution, research design, language, affiliations, keywords, journals and academic degrees of thesis writers. The search was carried out in databases and repositories from the last 20 years, using Zotero, Mendeley, Rayyan and R for the analysis. Results and Discussion: It was identified that 13% of the theses were published in indexed journals in Ecuador. (79%) corresponded to postgraduate studies in pediatrics and neonatology. Almost half (48.97%) were published in local journals and the majority (63.69%) in Spanish. The low rate of scientific publication is a common problem in Spanish-speaking countries. Ecuador contributes only 0.11% of world publications. Research implications: Strengthen research training for students and encourage other professionals involved in newborn care to publish their theses. Originality/Value: The publication of theses as scientific articles contributes to the advancement of knowledge. This process broadens the scope of research, enhancing its impact and application in clinical practice and evidence-based decision-making.

Business analytics in managerial decision-making: top management perceptions

Purpose Firms seek to improve their decision-making and enable more “fact-based” decisions by using business analytics. While the benefits of using business analytics to monitor, develop and improve daily operations have been reported by many scholars, using it in more complex top management decisions has received less attention. Building on the resource-based view of the firm, this study aims to investigate top management perceptions of using business analytics for making decisions on firm resources. Design/methodology/approach This study uses semi-structured interviews to collect perceptions of 12 top managers in large firms on when and why they use business analytics in their decision-making. Findings Top managers use business analytics output as their main source of information for monitoring ongoing business performance against set targets and taking corrective actions. Concerning future-oriented planning and strategic decision-making involving more complex changes on the firms’ resource base, top managers proactively complement knowledge derived via business analytics with other sources of knowledge, such as stakeholder and expert opinions. Moreover, top managers use of business analytics depends on their own expectations of its value potential and on the expectations of their organization. Originality/value This study adds to the extant literature on the business value of business analytics by outlining the purposes and reasons for top management business analytics use. By demonstrating when and why top managers apply business analytics when making decisions on the firm’s current and future resource base, this study contributes to the discussion on the resource-based view and decision-making practices of the firm.

Specifics of the Constitutional Right to Establish and Operate the Trade Unions

Introduction. In the framework of the legal regulation of the trade union activities in Russia, a number of regulations cause certain contradictions with regard to establishment of the social and labour relations. Difficulties in interaction of the trade unions with the employers and the state, supplemented by the competition with the private labour, arise the problem of preserving the institution under study as the one aimed at the formation of a system of social partnership, development of the labour environment, national economy and social equality. Therefore, the research strives to investigate the constitutional requirements for establishment and operation of the trade unions to enable harmonization of the social and labour relations. By finding the legislative gaps in the process of implementing the rights of citizens to establish and operate the trade unions, it is possible to modernize the regulatory legal institutions in this field. The aim of the research is to study the specifics of the constitutional right to establish and operate the trade unions.Materials and Methods. The methodological framework was organised based on the selection, analysis and systematisation of the relevant regulatory and legal data and research works in the subject area. The use of a set of general scientific (dialectical, logical, systemic) and specific scientific methods of cognition (comparative legal, dogmatic legal, sociolegal) made it possible to study the principles of state regulation of the trade union activities, identify the gaps in their work and shortcomings due to be eliminated, as well as to summarise the factors of applicability of the constitutional operational procedure to the activities of the trade union organisations in Russia.Results. The constitutional right to establish and operate the trade unions has been analysed. It has been acknowledged that determination of the legal advantages of the trade union members does not correlate with the process of declining the popularity of this institution in the Russian Federation. It has been revealed that this trend is caused by the several problems, i.e.: the multiplicity of the legislative requirements creates a number of contradictions in the relations between the trade unions and employers preventing the full freedom of organisations’ activities; the process of establishing the trade unions is complicated by the need to incorporate the legal entity, the legislative predetermination and formality do not give freedom to the organisations in compiling the charter and making changes to it without permission of the state; the principles of the internal relations regulation must comply with the standard provisions of the Labour Code of the Russian Federation, which also limits the trade union activity; the court defence of the rights of the trade union members needs to be revised and modernized to eliminate the ambiguous provisions and reduce the bureaucratic processes. The use of the variable collective agreements and principles of social partnership aimed at harmonisation of the social and labour relations have been proposed as the solutions to the identified problems.Discussion and Conclusion. The study has identified the key issues and underdeveloped aspects of the constitutional regulation of the trade union activities in the Russian Federation, which could be solved through the optimisation of the excessive legislative requirements, issuing the updated provisions on court defence of the trade union members, establishing the full independence and autonomy of such organisations in the matters of internal regulation, as well as through the development of the system of social partnership. The theoretical and practical conclusions drawn in the paper could be used for further research in the field of improving the legal literacy of the trade union members.

Health utilities of patients with epilepsy in a Canadian population.

Health state utilities are required to obtain quality adjusted life years, a common metric that informs clinical decision-making at individual, group, and health policy levels. Health state utilities are different from health-related quality of life, and their distribution across patients with epilepsy, as well as the factors that impact them, have not been studied in depth. We aimed to describe the distribution of health state utilities in people with epilepsy and the impact of different combinations of clinical and demographic factors on health state evaluation. We performed a retrospective analysis of patients' data prospectively collected in the Calgary Comprehensive Epilepsy Program registry. Patient-reported health state utilities were measured using the 5-level EuroQol 5-Dimension scale (EQ-5D-5L) completed at their initial assessment. EQ-5D-5L index scores were derived via the time trade-off approach based on Canadian norms, and their distribution across different health states and patient characteristics was obtained. The Tobit regression model was used to evaluate the determinants of EQ-5D-5L index scores. Of 1446 patients included in this analysis, 724 (50.5%) were female. The median (interquartile range) Canada-normed EQ-5D-5L index score was .87 (.71-.91). Patients with significantly lower health utilities were more likely to be female (p = .008), to be older (p = .034), to be unmarried (p = .013), to have failed to achieve 1-year seizure freedom (p < .001), to have no postsecondary education (p = .028), to be depressed (p < .001), to have antiseizure medication side effects (p = .001), to be unemployed (p < .001), and to be unable to drive (p < .001). A look-up table of health utilities based on combinations of clinical-demographic characteristics was produced. Health utility estimates for combinations of different health states in people with epilepsy attending specialty clinics are now available. These can help guide clinical decision-making in routine clinical practice, economic evaluations of treatment interventions, and health care policies.

Taking an argumentation approach to statistical investigations: developing student data-ing practices

AbstractResearch literature has provided considerable insight as to how young students might come to deeper understandings of statistical concepts, processes and representations through investigations. However, ‘data-ing’—the critical thinking aspects of decision-making while engaging in statistical investigations—has shown to be more difficult to grasp. Data-ing aspects of statistical investigations identified in literature as particularly challenging include: generating researchable questions, knowing when or how to apply statistical knowledge, seeing a need for evidence to support conclusions, and knowing how to use data as evidence. Argumentation practices necessitate a focus on the use of evidence to logically support a claim, thereby offering potential to focus students on the sufficiency and quality of evidence and the conclusions that can be drawn. As such, argumentation offers potential to support students to engage in data decision-making practices. In the research described here, an argumentation focus was used to guide a statistical investigation with a class of 9–10-year-old students in a suburban Australian school. Analysis of classroom interactions and children's work samples suggested that taking an argument-based focus supported students’ developing capacity to overcome the aforementioned challenges and to engage in critical, decision-making practices with authentic, messy data within the context of the investigation.

Anesthesia Providers' Knowledge of Medication Interference with Hormonal Contraception: A Multisite Survey.

Sugammadex, aprepitant, and fosaprepitant are increasingly used perioperatively. These medications may interfere with the effectiveness of hormonal contraception. This study assessed anesthesia providers' use of sugammadex and aprepitant, their knowledge of interactions with hormonal birth control, and patient counseling practices to identify possible knowledge gaps or opportunities for practice improvement. In January 2023, an electronic survey was distributed to all anesthesia providers at Mayo Clinic sites (Mayo Clinic Rochester, Mayo Clinic Arizona, Mayo Clinic Florida, and Mayo Clinic Health System hospitals). The survey included 32 questions assessing providers' use of sugammadex and aprepitant, their knowledge of the medications' interactions with hormonal contraceptives (HC), their perceptions regarding education of these interactions during training, and their perioperative patient counseling practices. The collected data were analyzed using descriptive statistics. A total of 337 of 1092 (31%) providers completed the survey. While almost all respondents (324; 96%) knew that sugammadex may interfere with oral contraceptive effectiveness, only 158 (47%) knew about aprepitant's potential contraceptive interference. Only 176 providers (52%) knew the recommended duration for alternative contraceptive methods after use after sugammadex, and 119 providers (35%) knew the recommended duration after aprepitant exposure. Most respondents considered the interference of these perioperative drugs with HCs to be clinically relevant (sugammadex, 217, 64%; aprepitant, 191, 58%). Despite the common belief that the decision between these medications and alternatives should be shared between provider and patient, most providers reported rarely engaging in such shared decision-making (SDM) in practice. Most providers recognized the need for preoperative discussions on sugammadex (280, 83%) and aprepitant (257, 76%), yet 184 providers (73%) never or rarely discussed contraception use before surgery for aprepitant, and 135 (36%) never or rarely did so for sugammadex. Lastly, many providers believed that the interference between sugammadex, aprepitant, and HC was poorly taught during training. The results of this study highlight the need for increased education and awareness among anesthesia providers regarding drug interactions with HCs during the perioperative period. To facilitate SDM, it is imperative that providers discuss alternative medications and the potential need for additional contraception methods after drug administration and communicate the risks with patients preoperatively to enable informed and SDM. The patient's preferences should be accounted for, especially if they are unwilling or unable to use an alternative contraceptive for 7 to 30 days, thereby avoiding the complexities and burdens of altering birth control methods.

Оценка обеспеченности человеческим капиталом аграрного сектора экономики

Abstract. The formation and use of human capital in the agricultural economy must meet modern economic requirements and the level of development of agricultural production. The assessment of the efficiency of the use of human resources and the quality of products plays a key role in adapting to changing market conditions. Therefore, it is important to constantly strengthen human resources to ensure a prompt response to market challenges. At the same time, agricultural production is currently undergoing changes in all key areas. This article analyzes the availability and efficiency of the use of agricultural enterprises' labor resources, based on statistical data for the Russian Federation. In this regard, the purpose of this scientific study is to analyze the availability of human capital in agriculture. The objectives of the study include carrying out a qualitative and quantitative assessment of labor resources. Methods. The methodological basis is based on the general scientific principles of a systematic approach. The analysis uses logical, factorial, comparative and strategic methods, as well as methods of qualitative research of the main trends in the presence and use of human capital in agriculture. Results. The analysis of the formation and use of human capital in agriculture in its quantitative and qualitative assessment in the Russian Federation is carried out: the dynamics of rural population density and the number of workers, the growth rate of wages of agricultural workers, the grouping of those employed in agriculture by level of education, gender and age is given. Scientific novelty. As a result of the research, new theoretical and practical conclusions were obtained, including: 1) identification and classification of socio-economic conditions that promote or, conversely, hinder the effective use and preservation of human capital in the agricultural sector; 2) comprehensive schemes for the formation of human capital in the agricultural sector are proposed, taking into account internal and external factors; 3) the need for the formation of a comfortable socio-economic environment in rural areas is justified; 4) confirmed the need to provide special support measures to attract highly qualified specialists to rural areas.

Modern trials are most useful when they are pragmatic and explanatory - there is no continuum

Over half a century ago, the terms “pragmatic” and “explanatory” were introduced to biomedicine by Schwartz and Lellouch, presenting two distinct conceptual approaches to trial design. Today, we frequently say that there are pragmatic trials and there are explanatory trials. Pragmatic trials inform decision-making in practice, explanatory trials aim to understand the mechanism of an intervention. They are often perceived as diametral extremes of a continuum.In this commentary, we argue that with the digitalization of health care and clinical research ways for modern trial designs were were paved and new avenues opened, and that there is no such continuum. Since the groundbreaking work of Schwartz and Lellouch, new approaches and methods have become available that allow researchers to address pragmatic and explanatory questions in parallel in the same trial. Emerging availability of routinely collected “real-world” data, development of decentralized trial techniques, and creation of digital biomarkers allow to observe health outcomes with minimal or no interference in real-world care. This overcomes previous limitations to study mechanisms of interventions in routine care and makes the idea of a continuum obsolete. We argue that pragmatism and explanatorism need to be understood as two distinct but compatible conceptual dimensions to open new perspectives for using novel technologies to design the most informative clinical trials and making better clinical and regulatory decisions.We base our argument on an analysis of the concept of a continuum and highlight its limitations. We review key trial design features and introduce a new concept that sees explanatory design features as fundamental, invasive or non-invasive, sufficient or insufficient. We describe their impact on pragmatism and explanatorism and show how multidimensional pragmatic-explanatory trials that are most useful are possible today.

A fusion model for multiple partial-order quotient spaces based on three-way decision

With a quotient space, a complex problem can be transformed into an appropriate granularity for processing. However, within a quotient space, there are no partial order relations between information granules. In practical decision-making, it may be necessary to deal with quotient spaces that have partial order relations between information granules. In this paper, first, the concept of a partial-order quotient space is proposed and some of its properties are studied. Second, a fusion model for multiple partial-order quotient spaces based on three-way decision is proposed, and some related theorems are proved. Finally, a case study of teacher evaluation, an experiment on real data, and several simulation experiments are presented to demonstrate the practicality of the proposed model in this paper.

Exploring the feasibility of integrating ultra‐high field magnetic resonance imaging neuroimaging with multimodal artificial intelligence for clinical diagnostics

AbstractBackgroundThe integration of 7 Tesla (7T) magnetic resonance imaging (MRI) with advanced multimodal artificial intelligence (AI) models represents a promising frontier in neuroimaging. The superior spatial resolution of 7TMRI provides detailed visualizations of brain structure, which are crucial forunderstanding complex central nervous system diseases and tumors. Concurrently, the application of multimodal AI to medical images enables interactive imaging‐based diagnostic conversation.MethodsIn this paper, we systematically investigate the capacity and feasibility of applying the existing advanced multimodal AI model ChatGPT‐4V to 7T MRI under the context of brain tumors. First, we test whether ChatGPT‐4V has knowledge about 7T MRI, and whether it can differentiate 7T MRI from 3T MRI. In addition, we explore whether ChatGPT‐4V can recognize different 7T MRI modalities and whether it can correctly offer diagnosis of tumors based on single or multiple modality 7T MRI.ResultsChatGPT‐4V exhibited accuracy of 84.4% in 3T‐vs‐7T differentiation and accuracy of 78.9% in 7T modality recognition. Meanwhile, in a human evaluation with three clinical experts, ChatGPT obtained average scores of 9.27/20 in single modality‐based diagnosis and 21.25/25 in multiple modality‐based diagnosis. Our study indicates that single‐modality diagnosis and the interpretability of diagnostic decisions in clinical practice should be enhanced when ChatGPT‐4V is applied to 7T data.ConclusionsIn general, our analysis suggests that such integration has promise as a tool to improve the workflow of diagnostics in neurology, with a potentially transformative impact in the fields of medical image analysis and patient management.

Deep Learning to Predict the Future Growth of Geographic Atrophy from Fundus Autofluorescence

PurposeThe region of growth (ROG) of geographic atrophy (GA) throughout the macular area has an impact on visual outcomes. Here, we developed multiple deep learning (DL) models to predict the 1-year ROG of GA lesions using fundus autofluorescence (FAF) images. DesignIn this retrospective analysis, 3 types of models were developed using FAF images collected 6 months after baseline to predict the GA lesion area (segmented lesion mask) at 1.5 years, FAF images collected at baseline and 6 months to predict the GA lesion at 1.5 years, and FAF images collected 6 months after baseline to predict the GA lesion at 1 and 1.5 years. The 1-year ROG from the 6-month visit was derived by taking the difference between the GA lesion area (segmented lesion mask) at the 1.5-year and 6-month visits. ParticipantsPatients enrolled in the following lampalizumab clinical trials and prospective observational studies: NCT02247479, NCT02247531, NCT02479386, and NCT02399072. MethodsDatasets of study eyes from 597 patients were split into model training (310), validation (78), and test sets (209), stratified by baseline or initial lesion area, lesion growth rate, foveal involvement, and focality. DL experiments were performed using the 2-dimensional U-Net, whole-lesion and multiclass models were developed. Main Outcome MeasuresThe performance of the models was evaluated by calculating the Dice score, coefficient of determination (R2), and the squared Pearson correlation coefficient (r2) between the true and derived GA lesion 1-year ROG. ResultsThe model using baseline and 6-month FAF images to predict GA lesion enlargement at 1.5 years had the best performance for the derived 1-year ROG. Mean Dice scores were 0.73, 0.68, and 0.70, respectively, in the training, validation, and test sets. The R2 (0.77, 0.53, and 0.79) and r2 (0.83, 0.61, and 0.79) showed similar trends across the 3 sets. ConclusionsThese findings show the potential of using baseline and/or 6-month visit FAF images to predict 1-year GA ROG using a DL approach. This work could potentially help support decision making in clinical trials and more informed treatment decisions in clinical practice.

Seizures and Epilepsy: An Overview for UK Medical Students.

Epilepsy is a common neurological disorderimpacting millions globally, marked by recurrent, unprovoked seizures. This review article, tailored for UK medical students, provides a broad clinical overview of epilepsy, focusing on its pathophysiology, classification, and management strategies. The article clarifies the distinction between epilepsy and seizures and delves into key areas, including risk factors, clinical features, and differential diagnosis. The discussion extends to diagnostic methods, underscoring the importance of conducting a thorough evaluation in diagnosing and managing epilepsy effectively. Data were drawn from the UK National Institute for Health and Care Excellence (NICE) guidelines, World Health Organization (WHO) reports, and key peer-reviewed studies. Particular attention was given to UK-specific data on epilepsy incidence, treatment gaps, and clinical outcomes. A review of relevant literature was conducted, covering epidemiology, pathophysiology, diagnostic protocols, and management strategies based on UK practices. Finally, the article addresses the acute management of seizures and the pharmacological and non-pharmacological management of epilepsy based on the NICE guidelines. The goal is to offer medical students a concise yet comprehensive understanding of epilepsy, preparing them for practical, evidence-based decision-making in clinical practice.

Survey on first-line therapeutic management of relapsing–remitting multiple sclerosis in clinical practice in Spain

IntroductionCurrent therapies for relapsing–remitting multiple sclerosis (RRMS) help reduce morbidity and delay disease progression. However, the available information on factors influencing decision-making regarding first-line treatment remain poorly understood. MethodsBased on a review of the literature and the experience of a scientific committee made up by 2 neurologists, an ad hoc survey was developed and distributed to Spanish neurologists. It included 22 questions related to the first-line therapeutic management of RRMS. ResultsSixty neurologists (mean age: 45.6 years, 60% women, mean of 16.0 years of experience, mean of 93.8 patients with RRMS attended/month) participated in the study. Neurologists considered that the 3 most important treatment characteristics (1–8 points, with higher scores denoting greater relevance) in treatment decision-making were efficacy in disease control (7.8±0.5), safety/tolerability (6.7±0.9), and improvements in patient quality of life (5.0±1.5); regarding patient characteristics, the 3 most important (1–7 points) were disease activity (6.9±0.5), intention to become pregnant (5.0±1.0), and level of disability (4.3±1.8). Dimethyl fumarate (32.6%) was the most frequently prescribed treatment, followed by teriflunomide (24.8%) and glatiramer acetate (17.6%). According to over 87% of the specialists, the latter drug was considered the most appropriate treatment for patients with liver disorders, who intended to become pregnant, and who presented low disease activity. ConclusionsOur study provides evidence on the first-line therapeutic management of non-aggressive forms of RRMS and the factors influencing decision-making in routine clinical practice.

Treatment methods for oesophageal strictures in paediatric patients with epidermolysis bullosa: a systematic review

BackgroundEpidermolysis bullosa (EB) is a collection of rare, inherited disorders that require treatment in specialised centres by multidisciplinary teams knowledgeable about the unique features and challenges of EB manifestations and...

The Effect of Cultural Norms on Group Decision-Making in Japanese Corporations

This paper explores the impact of cultural norms, particularly collectivism and social harmony, on group decision-making practices in Japanese corporations. Focusing on consensus-building mechanisms such as nemawashi and ringi-sho, the study examines how these practices foster inclusivity, mitigate conflict, and promote long-term organizational stability. It also highlights the challenges posed by slow decision-making processes and the risk of groupthink, which can stifle innovation and agility in a fast-paced global market. While consensus-building leads to more widely supported and risk-averse decisions, the paper suggests that balancing these traditional practices with more agile decision-making models is essential for Japanese corporations to remain competitive. The findings provide valuable insights into how Japanese firms might integrate global business practices while preserving their cultural identity.