Society Guidelines Research Articles

Cervical screening during pregnancy - a review of recommendations.

Cervical cytology is a vital screening tool used to detect precancerous and cancerous cells in the cervix. The procedure is crucial in preventing cervical cancer by enabling the early detection and treatment of abnormal cells. In the context of pregnancy, cytology remains an essential component of prenatal care. Numerous studies confirmed that cytology was safe for both the mother and the fetus when performed correctly. The interpretation of cytological results during pregnancy requires careful consideration due to physiological changes in the cervix, which may mimic or obscure pathological findings. The review describes physiological changes in cervical cytology during pregnancy, interpretation challenges and the guidelines of international societies in this topic.

Serum Biomarkers of Pulmonary Damage and Risk for Progression of Rheumatoid Arthritis–Associated Interstitial Lung Disease

ObjectiveTo investigate baseline and change of pulmonary damage biomarkers (serum Krebs von den Lungen 6 [KL-6], human surfactant protein D [hSP-D], and matrix metalloproteinase 7 [MMP-7]) with rheumatoid arthritis–associated interstitial lung disease (RA-ILD) progression.MethodsIn the Korean Rheumatoid Arthritis Interstitial Lung Disease (KORAIL) cohort, a prospective cohort, we enrolled patients with RA and ILD confirmed by chest computed tomography imaging and followed annually. ILD progression was defined as worsening in physiological and radiological domains of the 2022 American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society guideline for progressive pulmonary fibrosis (PPF). Associations between biomarkers and RA-ILD progression were analyzed using multivariable Cox regression, adjusting for potential confounders.ResultsWe analyzed 136 patients with RA-ILD (mean age 66.5 yrs, 30% male, 60.3% with usual interstitial pneumonia pattern). During a median 3.0 years of follow-up, 47 patients (34.6%) experienced progression. Higher baseline KL-6 and hSP-D levels were associated with higher risk of ILD progression (multivariable hazard ratios [HRs] 1.37 [95% CI 1.03-1.82] and 1.51 [95% CI 1.09-2.08], respectively), whereas only the highest quartile of MMP-7 showed an increased risk (multivariable HR 2.60 [95% CI 1.07-6.33]). Increasing levels of serum KL-6 at 1 year showed the strongest association with progression (ΔKL-6: multivariable HR 2.00 [95% CI 1.29-3.11]), additionally adjusting for baseline biomarker levels.ConclusionIn this first prospective study to apply PPF criteria to RA-ILD, 34.6% progressed over 3 years. Higher baseline KL-6 and hSP-D were associated with progression. In follow-up, greater change in KL-6 was associated with progression. Serial measurement of pulmonary damage biomarkers may predict RA-ILD progression and may be helpful in monitoring patients and treatment decisions.

Lynch Syndrome: Similarities and Differences of Recommendations in Published Guidelines.

In this review, we aimed to compare the recommendations for Lynch syndrome (LS). We compared the LS's guidelines of different medical societies, including recommendations for cancer surveillance, aspirin treatment, and universal screening. Most guidelines for LS patients recommend intervals of 1-2 years for performing colonoscopy, though there is disagreement regarding the age to begin CRC screening (dependent on status as a MLH1/MSH2 or MSH6/PMS2 carrier). There are inconsistencies between LS guidelines for gastric cancer surveillance. Most guidelines do not recommend routine surveillance of the pancreas and small bowel. Most but not all of the guidelines support endometrial and ovarian surveillance with transvaginal ultrasound and endometrial biopsy. Only two societies recommend urological surveillance, while others recommend surveillance among high-risk carriers with family history only. There is significant disagreement between the guidelines about the recommendation for limited or extended bowel resection among patients with CRC. Aspirin use is recommended by most societies, though some with reservations, and most of them recommend universal screening. There are significant disparities and disagreements in the guidelines and recommendations for patients with LS, causing confusion and difficulties for clinicians. Harmonization and cooperation are needed between the societies creating LS guidelines.

Dietary-Lifestyle Patterns and Colorectal Cancer Risk: Global Cancer Update Programme (CUP Global) Systematic Literature Review.

While healthy dietary and lifestyle factors have been individually linked to lower colorectal cancer (CRC) risks, recommendations for whole diet-lifestyle patterns remained unestablished due to limited studies and inconsistent pattern definitions. This updated review synthesized literature on dietary-lifestyle patterns and CRC risk/mortality. PubMed and Embase were searched through 31 March 2023 for randomized controlled trials and prospective cohort studies examining adulthood dietary patterns combined with modifiable lifestyle factors such as adiposity, smoking, alcohol consumption, physical activity, and/or others. Patterns were categorized by derivation methods: a priori, a posteriori, and a hybrid combining both; and were then descriptively reviewed for the primary outcomes: CRC risk or mortality. The Global Cancer Update Programme Expert Committee and Expert Panel independently graded the evidence on the likelihood of causality using pre-defined grading criteria. Thirty-three observational studies were reviewed. 'Strong-probable' evidence was concluded for higher levels of alignment with the a priori-derived World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations score and lower CRC risk; and 'limited-suggestive' evidence for the American Cancer Society guidelines and Healthy Lifestyle Index with lower CRC risk (mainly due to concerns about risk of bias for confounding). A posteriori-derived patterns lack firm evidence (only one study). 'Strong-probable' evidence was concluded for higher levels of alignment with the Empirical Lifestyle Index for Hyperinsulinemia hybrid pattern and higher CRC risk. By cancer subsite, only the WCRF/AICR recommendations score showed 'strong-probable' evidence with lower colon cancer risk. All exposure-mortality pairs were graded 'limited-no conclusion'. The evidence for other pattern-outcome associations was graded as 'limited-no conclusion'. Adopting a healthy pattern of diet, maintaining a healthy weight, staying physically active, and embracing health-conscious habits, such as avoiding tobacco and moderating alcohol, are collectively associated with a lower CRC risk. Healthy lifestyle habits are key to primary CRC prevention.

Deprescribing in Older Adults With Type 2 Diabetes: Associations With Patients' Perspectives: The Diabetes and Aging Study.

Little is known about how patients' preferences, expectations, and beliefs (jointly referred to as perspectives) influence deprescribing. We evaluated the association of patients' self-reported perspectives with subsequent deprescribing of diabetes medications in older adults with type 2 diabetes. Longitudinal cohort study of 1629 pharmacologically treated adults ages 65-100 years with type 2 diabetes who received care at Kaiser Permanente of Northern California (KPNC) and participated in the Diabetes Preferences and Self-Care survey (2019). The survey asked questions about perspectives regarding the use of diabetes medications. Deprescribing was identified during the 24 months following the survey and defined as any of the following: discontinuation of one or more therapeutic classes, reduction in frequency of daily dosing, reduction in total daily pill count, or reduction in total daily dose for oral hypoglycemic agents. Rates of deprescribing and measures of relative risk were calculated for patients' perspectives and select clinical factors. Models predicting deprescribing were adjusted for age, sex, race/ethnicity, health literacy, baseline number of diabetes medications, duration of diabetes, overtreatment per Endocrine Society guidelines, and KPNC eligibility for targeted deprescribing and weighted to account for the age-stratified complex sampling design and survey response. Six hundred seventy-three (38%) patients experienced deprescribing over a mean follow-up of 23 months. Deprescribing was significantly associated with the following patient perspectives: not expecting to need diabetes medication for life (RR = 1.48, 95% CI: 1.07-2.03) and not recognizing that taking fewer medications could lead to higher blood sugar levels (RR = 1.31, 95% CI: 1.09-1.58). Patients' perspectives may enable or hinder deprescribing, emphasizing the importance of soliciting these perspectives during shared decision-making. Effective deprescribing will benefit from understanding patients' perspectives and fostering patient-provider communication about medication changes throughout the disease course.

Association of serum vitamin D level and live birth rate in women undergoing frozen embryo transfer-a retrospective cohort study.

To assess the association of serum vitamin D level and the live birth rate in women undergoing frozen embryo transfer (FET). This is a retrospective cohort study involving 1489 infertile women who had frozen embryo transfer at two tertiary reproductive medicine centres from 2019 to 2021. Only the first frozen embryo transfer was included for women who had repeated transfers during the period. Archived serum samples taken at LH surge or before the start of progestogens for FET were analysed for 25(OH)D levels using mass spectrometry. The main outcome measure was the live birth rate. Vitamin D deficiency was defined as serum 25(OH)D < 50nmol/l (< 20ng/ml) based on the Endocrine Society Clinical Practice guidelines. The median age was 36 (25th-75th percentile 34-38) years. 37.7% (561/1489) women had cleavage stage embryo transfer and 62.3% (928/1489) women had blastocyst transfer. When analysing the results based on the threshold in the Endocrine Society guideline of 50 nmol/l (20 ng/ml) for vitamin D deficiency, there were no statistically significant differences in the live birth rate in the vitamin D deficient and non-deficient groups [151/489 (30.9%) vs 341/998 (34.2%), OR 0.861, 95% CI 0.683-1.086 P = 0.205]. There were no statistically significant differences in the pregnancy rates, ongoing pregnancy rates, and miscarriage rates between the two groups. Serum vitamin D is not associated with birth rate in women undergoing FET.

Retrospective Analysis Comparing Lung-RADS v2022 and British Thoracic Society Guidelines for Differentiating Lung Metastases from Primary Lung Cancer

Retrospective Analysis Comparing Lung-RADS v2022 and British Thoracic Society Guidelines for Differentiating Lung Metastases from Primary Lung Cancer

Adherence to guidelines for incidental pulmonary nodules: insights from a Nordic survey.

There is limited data on the real-world management of incidental pulmonary nodules (IPN). In this article, we review current practices and adherence to international guidelines in the Nordic countries. This non-interventional, observational survey study based on an online survey consisting of 13 questions. In total, 32 hospitals responded to the survey, with 11 from Denmark, 10 from Sweden, 7 from Norway, and 4 from Finland, resulting in an overall response rate of 86% (32/37). These institutions reported following a median of 20 new lung nodules monthly (5-400 IPN cases per month). In Denmark and Sweden, 100% of respondents indicated the presence of national guidelines. In Norway, this rate was 86%, and in Finland 80%. Among the primary guidelines followed, 70% of respondents reported using national guidelines, 20% used international guidelines, and only 10% reported relying on local/institutional guidelines as their first choice. Most sites used a combination of international and national guidelines (75%, 24/32). Available international guidelines were equally represented, with 35% using the Fleischner Criteria, 30% using British Thoracic Society guidelines, and 35% using others (e.g. European Society for Medical Oncology, National Comprehensive Cancer Network). There was variation in which department held primary responsibility for IPN follow-up. The article also demonstrated differences in suggested follow-up cases from the survey. The study reveals strong adherence to guidelines among Nordic hospitals, with a notable preference for hybrid approaches that combine different guidelines. We need continued efforts to harmonize and update guidelines.

Development and External Validation of a Machine Learning Model to Predict Restriction from Spirometry.

Though European Respiratory Society and American Thoracic Society (ERS/ATS) guidelines for pulmonary function test (PFT) interpretation recommend the use of the forced vital capacity (FVC) lower limit of normal (LLN) to exclude restriction, recent data suggest that the negative predictive value (NPV) of the FVC LLN is lower than has been accepted, particularly among non-Hispanic Black patients. Using a machine learning (ML) model-rather than the FVC LLN-to exclude restriction may improve the accuracy and equity of PFT interpretation. We sought to develop and externally validate a ML model to predict restriction from spirometry and to assess the potential impact of this model on PFT interpretation. We included PFTs with both static and dynamic lung volume measurements for patients between 18 and 80 years of age tested at pulmonary diagnostic labs within two health systems. We used PFTs from one health system to train logistic regression, random forest, and boosted tree models to predict restriction using demographic, anthropometric, and spirometric data. We used PFTs from the second health system to externally validate these models. The primary measure of model performance was the NPV. Model equity was assessed by comparing the NPV among non-Hispanic Black and non-Hispanic White patients. A total of 42 462 PFTs were used for model development and 24 524 for external validation. The prevalence of restriction was 29.8% in the development dataset and 39.6% in the validation dataset. Performance was similar across the three ML models with the best performance seen with the random forest model. The overall NPV of the random forest model (88.3%, 95% confidence interval [CI] 87.8% to 88.9%) was significantly greater than that of the FVC LLN (72.7%, 95% CI 72.1% to 73.3%). The NPV of the random forest model was greater than that of the FVC LLN among both non-Hispanic Black (74.6% [95% CI 72.5% to 76.6%] versus 49.5% [95% CI 47.8% to 51.2%]) and non-Hispanic White (90.9% [95% CI 90.3% to 91.5%] versus 79.6% [95% CI 78.9% to 80.3%]) patients. Using a ML model to exclude restriction from spirometry improves both the accuracy and equity of PFT interpretation.

Type 2 Diabetes Disease and Management Patterns Across a Large, Diverse Healthcare System: Issues and Opportunities for Guideline-Directed Therapies.

The prevalence, chronicity and clinical impact of type 2 diabetes (T2D) defines this disease state as a critical determinant in morbidity and mortality, as encountered by individuals, health care systems, and public health in general. The need to understand and optimize T2D identification and management is now further heightened by the advent of medications with established cardiovascular (CV) and kidney benefits in such patients, namely sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA). Prescription rates for these agents have remained low despite guidelines incorporating and emphasizing their use. Better understanding T2D disease and management patterns, including percentage of patients meeting guideline indications, is necessary to address undertreatment, improve patient management, and enable better strategies. We evaluated such issues, including eligibility for and utilization of SGLT2i and GLP-1 RA, in a large health system caring for over 1.5 million patients annually. The electronic health record (EHR) at a large health network in the Northeastern United States was queried to identify patients 18 yrs of age or older with T2D and at least 1 hemoglobin A1c (HbA1c) between 1/1/2020 and 1/1/2023, examining those with T2D and 1) atherosclerotic CV disease (ASCVD), 2) an estimated 10-year ASCVD risk score ≥10% without known ASCVD, 3) heart failure (HF), and/or 4) chronic kidney disease (CKD) based on EHR listed comorbidities. Demographics, medications, comorbidities, and indications for SGLT2i and/or GLP-1 RA therapy were assessed by one or more of the 4 indications above as outlined in society guidelines. Of the 147,338 patients who met inclusion criteria, 47% were female, 28% were non-white, and 14% with a non-English language preference. Of those, 121,508 (83%) had an indication for either SGLT2i or GLP-1 RA based on guideline recommendations: 17% were prescribed an SGLT2i, 22% were prescribed GLP-1 RA, and 6% of patients were prescribed both medications, with only 32% of those eligible prescribed therapy. Of patients eligible for either an SGLT2i or GLP-1 RA therapy not currently receiving either therapy, 49% had 10-year ASCVD risk ≥10% without known ASCVD, 42% had ASCVD, 52% had CKD, and 14% had HF. More than four out of five patients with T2D had a CV or kidney indication for either SGLT2i or GLP-1 RA. However, uptake of SGLT2i/GLP-1 RA in these high-risk populations remains low (just 32%) across this health network. Future studies are needed to identify better strategies to overcome provider, patient, and system-level barriers to the uptake and dissemination of guideline-concordant T2D therapies.

The American Clinical Neurophysiology Society Guideline on Indications for Continuous Electroencephalography Monitoring in Neonates.

Continuous EEG (cEEG) monitoring is increasingly used in the management of neonates with seizures. There remains debate on what clinically relevant information can be gained from cEEG in neonates with suspected seizures, at high risk for seizures, or with definite seizures, as well as the use of cEEG for prognosis in a variety of conditions. In this guideline, we address these questions using American Clinical Neurophysiology Society structured methodology for clinical guideline development. A working group was formed from American Clinical Neurophysiology Society membership with expertise in neonatal cEEG and a set of priority questions developed. We performed literature searches in PubMed and EMBASE to identify relevant studies. Evidence tables were compiled from extracted data and quality assessments performed. A modification of the GRADE process was used to evaluate the body of evidence and draft recommendations. Our working group identified six priority questions to evaluate the accuracy of cEEG for neonatal seizure diagnosis and the formulation of prognosis. An initial literature search yielded 18,167 results, which were distilled to a set of 217 articles. Overall, the quality of evidence for most priority questions was rated as very low and we provided conditional recommendations based on published literature and expert consensus. For each priority question, we also considered the benefits and harms of cEEG, with relative harms considered to be far less than the potential benefits across recommendations. We present evidence-based clinical guidelines regarding indications for cEEG monitoring in neonates. Considering resource utilization and feasibility, when cEEG monitoring results have a likelihood of altering clinical decision making, the authors felt the resource investment was justifiable.

Serum GFAP and UCH-L1 for the identification of clinically important traumatic brain injury in children in France: a diagnostic accuracy substudy

Many children with mild traumatic brain injury (mTBI), defined by a Glasgow Coma Scale (GCS) score between 13 and 15, undergo hospitalisation or cranial CT (CCT) scans despite the absence of clinically important traumatic brain injury (ciTBI; ie, hospitalisation >2 days associated with intracranial lesions on CCT, neurosurgical intervention, intensive care admission, or death). Clinical algorithms have reduced CCT scans and hospitalisations by 10%. We aimed to established age-appropriate reference values for GFAP and UCH-L1 and evaluate their diagnostic test performance in identifying ciTBI in children. This study was a diagnostic test accuracy substudy within the PROS100B stepped wedge cluster randomised trial that included children aged 16 years or younger, clinically managed within 3 h of mTBI, with a GCS score of 15 requiring hospitalisation or CCT scan according to French Pediatric Society guidelines (equivalent to the intermediate risk group of the PECARN algorithm). Enrolment for PROS100B occurred from Nov 1, 2016, to Oct 31, 2021, at 11 hospital emergency departments in France. Stored blood samples collected from March 1, 2015, to Oct 31, 2015, from children aged 16 years or younger who were outpatients for allergic conditions unrelated to mTBI and free of neurological disease were used as a control group to calculate reference values of GFAP and UCH-L1 across four age groups (<6 months, 6 months to <2 years, 2 years to <4 years, and 4 years to <16 years). The diagnostic test performance of GFAP and UCH-L1, both above the reference range to identify ciTBI, was evaluated in the children with mTBI. GFAP and UCH-L1 were measured with the Alinity analyser (Abbott, Chicago, IL, USA). Reference values were calculated from GFAP and UCH-L1 measured in samples from 718 control children (378 [53%] boys and 340 [47%] girls). 531 children (334 [63%] boys and 197 [37%] girls) aged 0-16 years with mTBI were included. By applying our reference values for GFAP and UCH-L1 across four age groups the biomarker combination (both biomarkers above reference ranges) had a sensitivity of 100% (95% CI 69-100), a negative predictive value of 100% (99-100), a specificity of 67% (63-71), a positive likelihood ratio of 3·01 (2·67-3·40), a negative likelihood ratio of 0, and an area under the curve of 0·83 (0·81-0·85) in identifying ciTBI. Serum GFAP and UCH-L1 identify ciTBI in children with 100% sensitivity and 67% specificity, which could potentially reduce unnecessary CCT scans and hospitalisations in children with mTBI if implemented. French Ministry of Health.

Evidence-Based Approaches to Food Allergy Diagnosis

The prevalence of food allergy has increased in the past decades. However, most studies are based on self-reported clinical history of food allergy rather than food challenge-confirmed ones; these may overestimate the prevalence of food allergy. Food allergy has been identified as one of the most common causes of anaphylaxis, especially among children. Like other studies, the study by Rosero et al., published in this issue, identified that food is the most common trigger for anaphylaxis among pediatric patients admitted to a tertiary hospital.1 The incidence of food-induced anaphylaxis in children worldwide is varied, with a range of 1 to 77 per 100,000 person‐years.2 Moreover, almost half of all patients with food allergies experienced anaphylaxis in any previous reaction (46%, 2556/5587), based on the Food Allergy Research &amp; Education (FARE) Patient Registry.3 The most common food triggers causing anaphylaxis in adults are crustaceans and eggs, cow’s milk, nuts, wheat, and shellfish among children.4,5 A detailed allergy-focused clinical history is the first step in the diagnostic work-up among patients suspected to have food allergies. The allergy-focused history will serve as a guide to the allergy tests that will be done. Skin prick tests (SPT) to allergen extracts and fresh food, serum-specific IgE (sIgE) to allergen extracts and individual allergen components, and basophil activation test (BAT) are recommended tests to support the diagnosis of IgE-mediated allergy.6 These tests have high to moderate sensitivity (negative result rules out FA) and specificity (positive result rules in FA) to a variety of food.7 BAT is suggested to support the diagnosis of food allergy among those with an equivocal diagnosis of IgE-mediated allergy to peanut and sesame. The gold standard for diagnosing food allergy is the oral food challenge (OFC). However, the OFC is resource-intensive and may pose severe allergic reactions. In the EAACI guidelines on diagnosing IgE-mediated FA, OFC is the recommended reference diagnostic procedure to confirm or exclude FA.6 Based on the same guidelines, the double-blind placebo-controlled food challenge is suggested if an open OFC outcome is indeterminate and in research studies. There are tests available in laboratories that lack evidence of diagnostic validity and do not show a correlation with food allergy. Patients will seek physicians' opinions regarding these tests or will come to the clinic with the results of these tests marketed as food allergy or food intolerance tests. Society guidelines and practice parameters do not recommend unvalidated tests to diagnose food allergy.6,8-10 These tests, such as IgG or IgG4 antibody level, hair analysis, electrodermal testing, antigen leukocyte antibody test, mediator release test, and kinesiology.11 The Philippine Society of Allergy, Asthma, and Immunology does not recommend food-specific IgG testing to identify or predict adverse reactions to food.9 The production of food-specific IgG or IgG4 is a normal immunologic response linked to the development of tolerance, not food allergy or intolerance. Identifying the food trigger through an allergy-focused clinical history and validated diagnostic tests is essential to prevent future adverse reactions, eliminate unnecessary food elimination, prevent nutritional deficiencies, and improve quality of life.

Comparison of Lung-RADS Version 2022 and British Thoracic Society Guidelines in Classifying Solid Pulmonary Nodules Detected at Lung Cancer Screening CT

Background and Objectives: Lung cancer screening is critical for early detection and management, particularly through the use of computed tomography (CT). This study aims to compare the Lung Imaging Reporting and Data System (Lung-RADS) Version 2022 with the British Thoracic Society (BTS) guidelines in classifying solid pulmonary nodules detected at lung cancer screening CT examinations. Materials and Methods: This retrospective study included 224 patients who underwent lung cancer screening CT between 2016 and 2022 and had a reported solid pulmonary nodule. A fellowship-trained thoracic radiologist reviewed the CT images, characterizing nodules by size, location, margins, attenuation, calcification, growth at follow-up, and final pathologic diagnosis if malignant. The sensitivity and specificity of Lung-RADS Version 2022 in detecting malignant nodules were compared with those of the BTS guidelines using the McNemar test. Results: Of the 224 patients, 198 (88%) had nodules deemed benign, while 26 (12%) had malignant nodules. The Lung-RADS Version 2022 resulted in higher specificity than the BTS guidelines (85% vs. 65%, p &lt; 0.001), without sacrificing sensitivity (92% for both). Nodules larger than 8 mm, spiculated margins, upper lobe location, and interval growth were associated with higher malignancy risk (p &lt; 0.01). Conclusions: Compared with the BTS guidelines, Lung-RADS Version 2022 reduces the number of false-positive screening CT examinations while maintaining high sensitivity for detecting malignant solid pulmonary nodules.

A simulated 'can't intubate, can't oxygenate' manikin crossover study investigating a modified front-of-neck access airway device.

A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel-bougie-endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel-bougie-ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation. We then performed a simulation crossover study using 20 volunteer anaesthetic doctors to compare this modification with the traditional technique. After a standardised pre-recorded video demonstration, participants performed simulated tube insertion using both the standard 'scalpel-bougie-ETT' technique and the SAFE airway device in randomised order. Participants were filmed for accurate timestamping. The primary outcome was time to successful tube insertion while secondary outcomes included number of attempts and ease of insertion. Overall time to cuff inflation was shorter, statistically and practically, with the SAFE airway device compared with the ETT (median 30 vs. 52 seconds, P < 0.001). Twenty-five percent of participants required multiple attempts using the ETT method versus 5% using the SAFE airway device, which was also rated as being easier to use. This study demonstrates that the SAFE airway device was fast, effective, easy to use and acceptable to airway practitioners in a simulated manikin environment. These findings indicate that further studies of the SAFE airway device are warranted.

Artificial Intelligence and Machine Learning Predicting Transarterial Chemoembolization Outcomes: A Systematic Review.

Major society guidelines recommend transarterial chemoembolization (TACE) as the standard of care for intermediate-stage hepatocellular carcinoma (HCC) patients. However, predicting treatment response remains challenging. As artificial intelligence (AI) may predict therapeutic responses, this systematic review aims to assess the performance and effectiveness of radiomics and AI-based models in predicting TACE outcomes in patients with HCC. A systemic search was conducted on Medline and Embase databases from inception to 7th April 2024. Included studies generated a predictive model for TACE response and evaluated its performance by area under the curve (AUC), specificity, or sensitivity analysis. Systematic reviews, meta-analyses, case series and reports, pediatric, and animal studies were excluded. Secondary search of references of included articles ensured comprehensiveness. 64 articles, with 13,412 TACE-treated patients, were included. AI in pre-treatment CT scans provided value in predicting the efficacy of TACE in HCC treatment. A positive association was observed for AI in pre-treatment MRI scans. Models incorporating radiomics had numerically better performance than those incorporating manual measured radiological variables. 39 studies demonstrated that combined predictive models had numerically better performance than models based solely on imaging or non-imaging features. A combined predictive model incorporating clinical features, laboratory investigations, and radiological characteristics may effectively predict response to TACE treatment for HCC.

Interobserver Variability in Manual Versus Semi-Automatic CT Assessments of Small Lung Nodule Diameter and Volume.

This study aimed to assess the interobserver variability of semi-automatic diameter and volumetric measurements versus manual diameter measurements for small lung nodules identified on computed tomography scans. The radiological patient database was searched for CT thorax examinations with at least one noncalcified solid nodule (∼3-10 mm). Three radiologists with four to six years of experience evaluated each nodule in accordance with the Fleischner Society guidelines using standard diameter measurements, semi-automatic lesion diameter measurements, and volumetric assessments. Spearman's correlation coefficient measured intermeasurement agreement. We used descriptive Bland-Altman plots to visualize agreement in the measured data. Potential discrepancies were analyzed. We studied a total of twenty-six nodules. Spearman's test showed that there was a much stronger relationship (p < 0.05) between reviewers for the semi-automatic diameter and volume measurements (avg. r = 0.97 ± 0.017 and 0.99 ± 0.005, respectively) than for the manual method (avg. r = 0.91 ± 0.017). In the Bland-Altman test, the semi-automatic diameter measure outperformed the manual method for all comparisons, while the volumetric method had better results in two out of three comparisons. The incidence of reviewers modifying the software's automatic outline varied between 62% and 92%. Semi-automatic techniques significantly reduced interobserver variability for small solid nodules, which has important implications for diagnostic assessments and screening. Both the semi-automatic diameter and semi-automatic volume measurements showed improvements over the manual measurement approach. Training could further diminish observer variability, given the considerable diversity in the number of adjustments among reviewers.

Update on diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - recommendations of Section of Multiple Sclerosis and Neuroimmunology of Polish Neurological Society.

An expert panel of the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society has developed principles for the management of neuromyelitis optica spectrum disorders (NMOSD). These principles are based on expert opinion and data from the literature published up to May 2023. Recommendations were developed based on the results of the most recent clinical trials, guidelines of foreign and international scientific societies, and the authors' clinical experience. The principles for diagnosing NMOSD are discussed, with particular emphasis on serological and neuroimaging diagnosis. Recommendations for the treatment of relapses and chronic immunosuppressive treatment, including the most recent methods of immunotherapy, are also presented. Additionally, the principles of monitoring treatment efficacy and safety are included. Therapy regimens are completed with recommendations for symptomatic treatment. The paper also includes an algorithm for vaccination in patients with NMOSD. Therapeutic management in pregnant women with NMOSD is discussed.

HATE CRIMES AS A CULTURAL PHENOMENON: THE EXPERIENCE OF LATVIAN SOCIETY

Changes in the international situation during the last decades have become the reason for new conflicts and aggravations at the national level. The 2015 European migrant crisis (Refugee crisis), 2022 Russian invasion of Ukraine have become a catalyst for increase in hate crimes. In order to recognize the criminal offense as a hate crime in the sense of the Latvian regulatory framework, it is necessary to establish two criteria: (a) the composition of the criminal offence is included in the Criminal Law; (b) a motive of hatred against a particular protected group of society can be stated in the criminal offence. It is the motive – hate or prejudice – that distinguishes hate crimes from other types of crimes.Prejudice is a negative assessment of a social group and its members. These are objectively unfounded assumptions and erroneous generalizations that, in the opinion of the offender, separate the representatives of this group from the rest of society. Persistent prejudices are called stereotypes. Unlike prejudice, stereotypes are not necessarily negative in nature. However, stereotypes are not based on objective truth either. It follows from court practice that hate crimes were directed against several groups of Latvian society: against ethnic groups (Latvians, Russians, Ukrainians, Jews, Gypsies or Roma, etc.), against representatives of various religious denominations, against asylum seekers, against people from other countries, against sexual minorities as well as against other groups. Stereotypes are often based on personal or negative cultural experiences of previous generations.In this context, it can be mentioned that it is specifically culture that is the basic factor according to which it is possible to understand, identify and reduce hate speech. Professor Aleksandrs Krugļevskis believed that with a change in cultural understanding, expanding public participation in cultural processes, the level of legal awareness will rise and tendencies, intentions to commit a criminal offense will disappear. Criminal law as a cultural factor creates a system that corresponds to the level of education and culture of the people. The above also corresponds to the vision of Latvia’s cohesive society policy “Guidelines for Cohesive and Active Civil Society 2021–2027”: mutual trust, participation, and cooperation between different social groups have improved among Latvian residents, and the level of tolerance has increased, stereotypes and prejudices against different social group representatives have decreased.Statistical data show that since the start of the war in Ukraine, the number of registered hate crimes in Latvia has increased. These show the relevance of the chosen topic. The authors of the article offer their vision of the problem of hate crimes, studying hate crimes as a cultural phenomenon, paying special attention to the experience of Latvian society in this area.

AN AUDIT OF OXYGEN PRESCRIBING PRACTICES IN RESPIRATORY WARDS OF A TERTIARY CARE HOSPITAL IN NOTTINGHAMSHIRE, UK

Background: This audit primarily assesses compliance with the British Thoracic Society guidelines (BTS) for oxygen prescriptions in the Respiratory Department at King’s Mill Hospital. The results of this audit aim to guide the strategies to improve the oxygen prescription practices in the Trust. Methods: We collected the data on oxygen prescriptions, from the electronic prescribing system, of all the patients admitted in the three respiratory wards of King’s Mill Hospital over the period of one week. This data was then recorded and analysed using Audit management and Tracking© (AMAT). Results: The overall compliance score to BTS guidelines for oxygen prescription was 12.2%. Out of the 152 patients, only 8 (5%) had oxygen therapy prescribed and a target oxygen saturation range was identified. No patient had an identifiable oxygen delivery method on their prescription. Conclusion: The current practices of oxygen prescription at the respiratory department of King’s Mill Hospital are suboptimal. These findings highlight the risk of serious potential consequences and the opportunity to implement safe prescribing measures for oxygen, like other prescribed medications.