Members Of Working Group Research Articles

Organizational Management Models in Public Educational Institutions: Strategies to Improve Performance in Low- and Middle-Income Countries

The objective of this research study is to analyze organizational management models for comprehensive basic education in low- and middle-income countries and Latin America. A systematic review was carried out, information had to be selected and extracted from 4 databases of scientific journals. The different experiences of organizational management models, which help to increase the levels of efficiency, effectiveness and interrelation in public entities, giving priority to the structure in various structural issues of international and national interest, emphasizing education. The research design is quantitative descriptive of systematic reviews of organizational management models in public educational institutions. Given its articulation design and from its interdisciplinary perspective, an organizational model has been included to improve the performance of each of these members of an institution's working group.

Building Engagement-Capable Environments for Health System Transformation: Development and Early Implementation of a Capability Framework for Patient, Family and Caregiver Engagement in Ontario Health Teams.

Despite widespread calls to involve patients, families and caregivers (PFCs) as partners at all levels of health system planning and design, there is unevenness in how engagement efforts are supported across these settings. The concept of 'engagement-capable environments' offers a way forward to uncover the key requirements for sustainable, high-quality engagement, but more work is needed to identify the specific competencies required to create these environments. We addressed this gap by developing a capability framework for Ontario Health Teams (OHTs), a newly established structure for planning, designing, organizing and delivering care in Ontario, Canada. The framework was co-developed by a Working Group of OHT staff and leaders, PFC partners, researchers and government personnel. Project activities occurred over four phases: (1) planning, (2) evidence review and surveying of intended users to identify key competencies, (3) framework design and (4) implementation. An evidence review identified more than 90 potential competencies for this work. These results were contextualized and expanded through a survey of OHT stakeholders to brainstorm potential competencies, supports and enablers for engagement. Surveys were completed by 69 individuals; 689 knowledge and skill competency statements, 462 attitude and behaviour competency statements and 250 supports and enablers were brainstormed. The statements were analysed and organized into initial competency categories, which were reviewed, discussed and iteratively refined by Working Group members and through broader consultations with the OHT community. The final framework includes six competency domains and four support and enabler domains, each with sub-domain elements, mapped across a three-stage maturity model. The framework has been disseminated across OHTs, and its adoption and implementation are now requirements within OHT agreements. The framework combines a strong conceptual foundation with actionable elements informed by the literature and consultations with the intended users of the framework. Although developed for OHTs, the framework should be broadly applicable to other health system organizations seeking similar health system transformation goals. Patient, family and caregiver partners were involved at all stages and in all aspects of the work. As end users of the framework, their perspectives, knowledge and opinions were critical.

AI-readiness for Biomedical Data: Bridge2AI Recommendations.

Biomedical research and clinical practice are in the midst of a transition toward significantly increased use of artificial intelligence (AI) and machine learning (ML) methods. These advances promise to enable qualitatively deeper insight into complex challenges formerly beyond the reach of analytic methods and human intuition while placing increased demands on ethical and explainable artificial intelligence (XAI), given the opaque nature of many deep learning methods. The U.S. National Institutes of Health (NIH) has initiated a significant research and development program, Bridge2AI, aimed at producing new "flagship" datasets designed to support AI/ML analysis of complex biomedical challenges, elucidate best practices, develop tools and standards in AI/ML data science, and disseminate these datasets, tools, and methods broadly to the biomedical community. An essential set of concepts to be developed and disseminated in this program along with the data and tools produced are criteria for AI-readiness of data, including critical considerations for XAI and ethical, legal, and social implications (ELSI) of AI technologies. NIH Bridge to Artificial Intelligence (Bridge2AI) Standards Working Group members prepared this article to present methods for assessing the AI-readiness of biomedical data and the data standards perspectives and criteria we have developed throughout this program. While the field is rapidly evolving, these criteria are foundational for scientific rigor and the ethical design and application of biomedical AI methods.

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

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

Applying the Multimodal Improvement Strategy framework to understand current gaps in the use of antibiograms in hospitals caring for children with cancer in the Eastern Mediterranean and African regions

Abstract Background Empiric use of antibiotics in sick children guided by local antimicrobial susceptibilities (AMS) increases initial therapy effectiveness. Antibiograms (ABG) are cumulative AMS based on results of isolates susceptible to antimicrobial agents routinely tested in an institution over a specific time period. Although ABG use can enhance healthcare quality, for optimum quality healthcare the World Health Organization (WHO) recommends the use of frameworks such as the multimodal improvement strategy (MMIS). We used the MMIS framework to analyze the literature and understand gaps in using ABG in low- and middle-income countries (LMIC). The 5 WHO MMIS components are: system change, training and education, monitoring and feedback, reminders and communication, and a culture of safety, summarized as “build it, teach it, check it, sell it, and live it”. By combining elements of a scoping methodology with the MMIS framework, we reviewed the literature surrounding ABG and report the results here. Methods We assembled a 24-member working group (WG) interested in improving infection care and prevention (ICP) in their institutions in the Eastern Mediterranean and African regions. The WG members (physicians, pharmacists, and microbiologists) met virtually twice monthly from March to October 2023. We searched PubMed using essential keywords such as antibiogram, antibiotic, antimicrobial, antibacterial, isolate, and sensitivity test, and supporting keywords such as misuse, resistance, adherence, guideline, susceptibility, development, improvement, stewardship, low-income, middle-income and LMIC. Any identified additional papers were screened for relevance. We grouped the literature according to the five components of the MMIS framework focusing on information on the ABG tool, training in ABG, the outcomes of its use, promotion of its use, and elevation of its importance institutionally. The WG members reviewed literature assigned to each of the five MMIS components, and presented oral reports of main points, gaps, and how to fill the gaps according to a rubric encompassing relevance assessment, methodological evaluation, content evaluation and recommendations. Results We identified 66 publications with authors originating from Africa (n=23, 34.8%), the Americas (n=29, 43.9%), Asia (n=13, 19.7%), Europe (n=12, 18.2%) and Oceania (n=2, 3%). The publications fell into MMIS-Build (n=16, 24.2%), MMIS-Teach (n=16, 24.2%), MMIS-Check (n=14, 21.2%), MMIS-Sell (n=10, 15.2%), and MMIS-Live (n=10, 15.2%). WG members reviewed their assigned papers, discussed them in virtual meetings, and identified 20 papers as strongly relevant. According to the WG members, the literature reviews and discussion improved their ABG knowledge and perception of the utility of evaluation and education applied to ABG. The multidisciplinary WG composition and the MMIS allowed ABG perspectives of new solutions and ideas. Although using a complex framework as MMIS applied to a scarce literature of ABG was challenging, it promoted a deeper understanding of topics and enhanced group cohesion and communication. Conclusion We found a gap in the literature of ABG, especially in LMIC, and it was not often recommended. A lower number of publications within MMIS-Live and MMIS-Sell indicated suboptimal emphasis in sustaining this practice in healthcare. Using the MMIS framework focused discussions of WG members, improved ABG knowledge and clarified the utility of educational interventions.

The development of a tool for the assessment of oral health program in a pediatric cancer unit

Abstract Background Oral diseases and associated illnesses interfere with cancer treatment, increase morbidity, prolong hospital stay, and increase costs. Oral care of children with cancer is essential to prevent oral diseases and decrease its symptoms. Standardized oral health and hygiene (OHH) practices must be a priority and incorporated as a routine cancer care quality. To improve OHH, baseline information of practices, processes and institutional support are necessary. Here, we report the steps we followed to develop a tool for evaluating OHH practices, support, and resources available in a pediatric cancer unit. Methods We conformed a working group (WG) integrated by healthcare professionals in pediatric, infectious diseases, oncology, and dentistry acquainted with the care of children with cancer. The steps proposed by the WG included: (1) literature review of published surveys in OHH; (2) interviews with practicing healthcare providers regarding OHH in pediatrics; (3) identification, adoption and adaptation of the Hand Hygiene Self-assessment framework (HHSAF), a survey model based on the multimodal improvement strategy (MMIS); (4) building of OHH tool; (5) validation test of OHH tool; and (6) pilot testing in recruited pediatric hematology and oncology centers. Google form version 0.8. Microsoft office excel 2021 (18.0) was used to build the OHH survey and obtain the WG member responses. The final draft of the survey was approved by WG members. We will evaluate survey validity in the pilot test among members of the PRINCIPAL network, a community of pediatric infectious disease experts and preventionists of Latin America. Results We found few reports on OHH practices in children cancer surveys. The WG met virtually and monthly from March to December 2023 to build the OHH survey. Our final survey version was organized following the model of the HHSAF and integrated into five main sections. These sections had items (Q) that requested answers regarding OHH practices and resources and institutional support (6Q); training and education of patients, families, and healthcare providers (6Q); evaluation and feedback of OHH processes in pediatric oncology unit and OHH practices of patients (6Q); reminders of OHH practices in the workplace (3Q); and hospital leadership support (2Q). The survey was made up of multiple choice and Likert scale questions. Each of the answers had a weight, and if all the items were present, the total was 400 points. Based on the total points obtained, we categorized the quality of the OHH practices of the pediatric oncology unit in inadequate (0-100); basic (101-200), intermediate (201-300), advanced (>300). The survey tool must be answered by an assigned team of the pediatric oncology unit oral health including a family member representative, and it could take less than 15 minutes to complete. Conclusion We developed a 21-item OHH practices survey following the WHO recommendations to use a MMIS model. We found that our newly developed tool was comprehensive and potentially helpful to assess OHH practices and identify success factors in best practices in OHH in pediatric oncology units. Our next step is pilot testing to evaluate our survey tool validity and reliability.

Developing a research agenda on NATure-based and Animal-assisted Intervention Strategies (NATAIS) in people with neurodegenerative diseases with a specific focus on social isolation and loneliness: a group concept mapping procedure

BackgroundSocial isolation and feelings of loneliness are very prevalent in people with neurodegenerative diseases and are associated with a lower quality of life and other negative outcomes. These problems were increased during the COVID-19 pandemic resulting in initiatives to address social isolation. Given the potential benefits of nature-based and animal-assisted intervention strategies (NATAIS), it is crucial to further investigate if and how these strategies might minimize negative effects of social isolation and feelings of loneliness in this population. Therefore, the aim of this project was to develop a research agenda for NATAIS in people with neurodegenerative diseases, especially during challenging times, such as pandemics.MethodsThis article outlines the process and results of a group concept mapping procedure aimed at developing a research agenda based on a logic model. In total, 19 work group members participated through a combination of in-person and online group meetings. Additionally, face-to-face group sessions were held at two international scientific conferences, during which feedback was solicited from 12 experts in the field of NATAIS and psychogeriatrics.ResultsThe group concept mapping procedure resulted in 14 clusters describing various future research topics, which were further refined and detailed during group discussions. The remaining eleven clusters, encompassing important research themes within the field of NATAIS, were organized into a logic model and summarized into the research agenda. The overarching cluster ‘ethical issues, possible risk factors, and their solutions’ was considered the most relevant during times of increased social isolation, such as during a pandemic, along with the necessity for more accessible NATAIS.ConclusionsThis project resulted in a research agenda, directing future research and fostering collaboration between practitioners and researchers in the field of NATAIS. Such an enhanced partnership between science and practice has the potential to significantly contribute to the well-being of people with neurodegenerative diseases, in their daily lives and also during pandemics.

Implementation of a common data model in Health Data Research Network Canada: Lessons learned

BackgroundThe Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) is a standardized structure for observational data that enables collaborative health research. Health Data Research Network (HDRN Canada) is conducting a pilot study to implement this standard at partner data linkage centers. ObjectiveOur objective is to describe the process used to implement the OMOP CDM, methodological and technical challenges, and the approach to evaluate CDM implementation at multiple sites. ApproachCDM working group members include technical staff from data linkage centers in four provinces and a national data coordinating center, HDRN Canada operational and executive leads, and OMOP CDM consultants. The evaluation aims to collect quantitative and qualitative information on Extract, Transform, and Load (ETL) processes, performance of the CDM in a multi-site observational case study, and data quality. ResultsInitial steps have included collaborative learning about the CDM structure, importing open-source tools and licensed coding standards (i.e., Systematized Nomenclature of Medicine-Clinical Terms [SNOMED-CT], RxNorm) at data linkage centres, and exploring the technical requirements for developing ETL processes and hosting OMOP data. Creation of select OMOP tables has been accompanied by discussions about models for mapping clinical and prescription drug coding standards. A scoping review of evaluation strategies is underway. Conclusions and ImplicationsThe benefits of standardizing health data for multi-site research and supporting the production of findable, accessible, interoperable and reusable (FAIR) national data underscores the importance of HDRN Canada embarking on this OMOP CDM implementation project. The lessons learned will benefit other multi-site data standardization initiatives.

Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study.

There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. RR2-10.2196/40446.

GRADE guidance 39: using GRADE-ADOLOPMENT to adopt, adapt or create contextualized recommendations from source guidelines and evidence syntheses

Background and ObjectiveThe Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT methodology has been widely used to adopt, adapt, or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. The objective of this guidance is to refine the operationalization for applying GRADE-ADOLOPMENT. MethodsThrough iterative discussions, online meetings, and email communications, the GRADE-ADOLOPMENT project group drafted the updated guidance. We then conducted a review of handbooks of guideline-producing organizations, and a scoping review of published and planned adolopment guideline projects. The lead authors refined the existing approach based on the scoping review findings and feedback from members of the GRADE working group. We presented the revised approach to the group in November 2022 (approximately 115 people), in May 2023 (approximately 100 people), and twice in September 2023 (approximately 60 and 90 people) for approval. ResultsThis GRADE guidance shows how to effectively and efficiently contextualize recommendations using the GRADE-ADOLOPMENT approach by doing the following: (1) showcasing alternative pathways for starting an adolopment effort; (2) elaborating on the different essential steps of this approach, such as building on existing evidence-to-decision (EtDs), when available or developing new EtDs, if necessary; and (3) providing examples from adolopment case studies to facilitate the application of the approach. We demonstrate how to use contextual evidence to make judgments about EtD criteria, and highlight the importance of making the resulting EtDs available to facilitate adolopment efforts by others. ConclusionThis updated GRADE guidance further operationalizes the application of GRADE-ADOLOPMENT based on over 6 years of experience. It serves to support uptake and application by end users interested in contextualizing recommendations to a local setting or specific reality in a short period of time or with limited resources.

Developing Catchment Area Data Dashboards for Cancer Centers: A Stakeholder- engaged Approach.

Data dashboards that can communicate complex and diverse catchment area data effectively can transform cancer prevention and care delivery and strengthen community engagement efforts. Engaging stakeholders in data dashboard development, by seeking their inputs and collecting feedback, has the potential to maximize user-centeredness. To describe a systematic, stakeholder-driven, and theory-based approach for developing catchment area data visualization tools for cancer centers. Cancer-relevant catchment area data were identified from national- and state-level data sources (including cancer registries, national surveys, and administrative claims databases). A prototype tool for data visualization was designed, developed, and tested based on the OPT-In [ O rganize, P lan, T est, In tegrate] framework. A working group of multi-disciplinary experts collected stakeholder feedback through formative assessment to understand data and design preferences. Thematic areas, data elements, and the composition and placement of data visuals in the prototype were identified and refined by working group members. Visualizations were rendered in Tableau © and embedded in a public-facing website. A mixed-method approach was used to assess the understandability and actionability of the tool and to collect open-ended feedback that informed action items for improvisation. We developed a visualization dashboard that illustrates cancer incidence and mortality, risk factor prevalence, healthcare access, and social determinants of health for the Hollings Cancer Center catchment area. Color-coded maps, time-series plots, and graphs illustrate these catchment area data. A total of 21 participants representing key stakeholders [general audience (n=4), community advisory board members and other representatives (n=7), and researchers (n=10)] were identified. The understandability and actionability scores exceeded the minimum (80%) threshold. Stakeholders' feedback confirmed that the tool is effective in communicating cancer data and is useful for education and advocacy. Themes that emerged from qualitative data suggest that additional changes to the tool such as a warm color palette, data source transparency, and the addition of analytical features (data overlaying and area-resolution selection) would further enhance the tool. Integration of communication efforts and messages within a broader context is in progress. A catchment area data resource developed through a systematic, stakeholder- driven, and theory-based approach can meet (and surpass) benchmarks for understandability and actionability, and lead to an overall positive response from stakeholders. Creating channels for advocacy and forming community partnerships will be the next step necessary to promote policies and programs for improving cancer outcomes in the catchment areas.

Genetic testing for childhood cancer predisposition syndromes: Controversies and recommendations from the SIOPE Host Genome Working Group meeting 2022

BackgroundCancer Predisposition Syndromes (CPSs) have been identified in 7–15 % of children with cancer. The possibilities for germline genetic testing have increased in recent years, presenting new opportunities but also challenges. There is currently no consensus on germline genetic testing in children with cancer in diagnostic settings. MethodsThe International Society of Pediatric Oncology Europe (SIOPE) Host Genome Working Group used a consensus development conference method to reach agreement on four key topics: Who do we test? Which genes do we test? What do we disclose? How do we evaluate the benefits of testing? ResultsThe Working Group members agreed that: (1) All children with cancer should undergo clinical screening for their risk of harboring a CPS. (2) Targeted genetic testing based on clinical indication is recommended. Comprehensive CPS gene panels with more than 100–150 genes for all children with cancer should preferably be evaluated within research settings. (3) Smaller actionable gene panels can be considered including genes supporting diagnosis or influencing treatment decisions. (4) Clear pre-test information and consenting processes that highlight potential outcomes and implications of germline genetic testing are imperative. (5) Consequences of genetic testing, treatment adaption, and tumor surveillance in children with CPSs, including economic impact and psychosocial factors, should be further explored. ConclusionsThese consensus-based recommendations provide guidance on germline genetic testing in children with cancer. Regular review of these recommendations is essential. Collaboration and the use of data sharing platforms can further improve screening procedures and its impact on care.

Marine connectivity conservation: Guidance for MPA and MPA network design and management

The importance of considering ecological connectivity in the design of marine protected areas (MPAs) and ecologically coherent networks of protected areas across coasts and oceans has risen in prominence with the 2022 Kunming-Montreal Global Biodiversity Framework. This short communication highlights key messages emerging from a specialist conference session on marine connectivity by members of the IUCN-WCPA Marine Connectivity Working Group at the Fifth International Marine Protected Areas Congress (IMPAC5) in Vancouver in 2023. We consider the importance of spatial and temporal scale, knowledge and data gaps and some of the technological and scientific advances that are generating insights into species movements that can inform the ecologically meaningful design of protected areas for effective conservation of ecosystem integrity, biodiversity and the flow of ecosystem services.

Strategies for Accelerated Drug Development: An Industry Perspective Based on an IQ Consortium Survey of CMC Considerations

Over the past decade, there has been an increase in accelerated drug development with successful regulatory approval that has provided rapid access of novel medicines to patients world-wide. This has created the opportunity for the pharmaceutical industry to continuously improve the process of quickly bringing new medicines to patients with unmet medical needs. This can be accomplished through sharing the learnings and advancements in drug development, enhancing regulatory interactions, and collaborating with academics on developing the underlying science to reduce drug development timelines. In this paper, the IQ Consortium – Accelerated Drug Development working group members intend to share recommendations for optimizing strategies that build efficiencies in accelerated pathways for regulatory approval. Information was obtained by surveying member pharmaceutical companies with respect to recent expedited submissions within the past 5 years to gain insights as to which development strategies were successful. The learnings from this analysis are provided, which includes shared learnings in formulation development, stability, analytical methods, manufacturing, and importation testing as well as regulatory considerations. Each of these sections provide a summary illustrating the key data collected as well as a discussion that is aimed to guide pharmaceutical companies on strategies to consider streamlining development activities and expedite the drug to market.

Navigating the future of Alzheimer’s care in Ireland - a service model for disease-modifying therapies in small and medium-sized healthcare systems

BackgroundA new class of antibody-based drug therapy with the potential for disease modification is now available for Alzheimer’s disease (AD). However, the complexity of drug eligibility, administration, cost, and safety of such disease modifying therapies (DMTs) necessitates adopting new treatment and care pathways. A working group was convened in Ireland to consider the implications of, and health system readiness for, DMTs for AD, and to describe a service model for the detection, diagnosis, and management of early AD in the Irish context, providing a template for similar small-medium sized healthcare systems.MethodsA series of facilitated workshops with a multidisciplinary working group, including Patient and Public Involvement (PPI) members, were undertaken. This informed a series of recommendations for the implementation of new DMTs using an evidence-based conceptual framework for health system readiness based on [1] material resources and structures and [2] human and institutional relationships, values, and norms.ResultsWe describe a hub-and-spoke model, which utilises the existing dementia care ecosystem as outlined in Ireland’s Model of Care for Dementia, with Regional Specialist Memory Services (RSMS) acting as central hubs and Memory Assessment and Support Services (MASS) functioning as spokes for less central areas. We provide criteria for DMT referral, eligibility, administration, and ongoing monitoring.ConclusionsHealthcare systems worldwide are acknowledging the need for advanced clinical pathways for AD, driven by better diagnostics and the emergence of DMTs. Despite facing significant challenges in integrating DMTs into existing care models, the potential for overcoming challenges exists through increased funding, resources, and the development of a structured national treatment network, as proposed in Ireland’s Model of Care for Dementia. This approach offers a replicable blueprint for other healthcare systems with similar scale and complexity.

#2990 Prevalence and risk factors of altered control of BP during the night in a large hemodialysis population investigated by 48 hours ABPM

Abstract Background and Aims Altered BP control during the night (non-dipping, reverse dipping and nocturnal hypertension) is recognized as a powerful risk factor for death and CV events in the hemodialysis (HD) population. However, these alterations have been described in relatively small studies and the epidemiology and risk factors for subtypes non-dipping and nocturnal hypertension are still poorly characterized in the current literature. We investigated the problem in a large Registry (The EURECAm Registry) that is the sole that adopted state of the art 48 h ABPM recording in the HD population. Method We included in this analysis 534 HD patients, enrolled in 7 centers, led by members of the EURECA-m working group, in 3 European countries. 48 h ABPM was measured by using well validated instruments (AAMI/ESH/ISO). As recommended by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes during the night. Hypertension was defined as 48 h blood pressure (BP) >130/80, nocturnal hypertension as a nighttime BP >120/70 mmHg, non-dipping as a night/day systolic BP fall <10% and reverse dipping as a night/day ratio >1. Results Among 534 HD patients, 317 were hypertensive and. 217 normotensive. As many as 274 patients were non-dippers (51%), 32% were reverse dippers, and 381 (71%) had nocturnal hypertension. Of note, forty-one per cent of non-dippers, 37% of reverse dippers and 19% of patients with nocturnal hypertension were normotensives. As expected, the majority of reverse dippers (87%) had frank nocturnal hypertension. In a combined analysis of non-dippers and reverse dippers, as compared to dippers, these patients more frequently exhibited atrial fibrillation and had lower Heart Rate both pre-dialysis (72± 11 vs 77±13 bpm, P = 0.004) and post-dialysis (74± 13 vs 78±14 bpm, P = 0.03) and lower serum albumin (3.9±0.4 vs 4.0±0.3 g/dL, P = 0.02) but did not differ for age and gender. Conclusion In a large cohort of HD patients investigated by the state-of-the-art technique, 48 h ABPM alterations in the nocturnal BP profile were almost universal, and nocturnal hypertension was the more prevalent alteration, followed by non-dipping and reverse dipping. These alterations were independent of age and gender. Long-term, granular follow-up analyses are warranted to identify the prognostic value of these alterations.

American Dental Education Association Compendium Entrustable Professional Activities Workgroup report.

Entrustable professional activities (EPAs) are discrete clinical tasks that can be evaluated to help define readiness for independent practice in the health professions and are intended to increase trust in the dental graduate. EPAs provide a framework that bridges competencies to clinical practice. This report describes the work of the American Dental Education Association (ADEA) Compendium EPA Workgroup to develop a list of EPAs for dental education and supportive resources, including specifications and a glossary. Preliminary work including literature and resource review, mapping of existing competencies, and review of other health professions' EPAs informed the development of our EPAs list. Workgroup members achieved consensus using a modified Delphi process. A Qualtrics survey using a validated rubric for the assessment of EPAs as described in peer-reviewed literature was used. Dental educators, including academic deans, were surveyed for feedback on the content and format of the EPAs. Based on findings in the literature analysis of existing EPAs and competencies in health professions, a list of EPAs was developed along with a description of specifications. The EPA workgroup (nine members from multiple institutions) used the Delphi process in receiving feedback from various experts. A list of 11 core EPAs was vetted by dental educators including academic deans (n=∼23), and the process of development was reviewed by EPAs experts outside dental education. A glossary was developed to align language. These EPAs define the scope of dental practice. This report represents Phase 1 of the EPA framework development and vetting process. Future directions will include a broader vetting of the EPA list, faculty development, and national standardized technology that support this work to optimize implementation.

Applying simulation learning theory to identify instructional strategies for Generation Z emergency medicine residency education

AbstractIntroductionGeneration Z learners are entering emergency medicine (EM) residency training, bringing unique learning preferences that influence their engagement with residency education. To optimally teach and motivate this incoming generation of learners, EM educators must understand and adapt to the changing instructional landscape.MethodologyThe Simulation Leaders Advancing the Next Generation in Emergency Medicine (SLANG‐EM) Workgroup was created to identify effective educational strategies for Generation Z learners entering EM. Members were faculty in the Society for Academic Emergency Medicine (SAEM) Simulation Academy, well versed in learning theory supporting simulation‐based education (SBE) and actively involved in EM residency education.Unique treatment/analysisThrough primary and secondary literature searches, the SLANG‐EM Workgroup identified four distinctive learning preferences of Generation Z learners: (1) individualized and self‐paced learning, (2) engaging and visual learning environments, (3) immediate and actionable feedback, and (4) combined personal and academic support. Workgroup members evaluated these learning preferences using a novel conceptual framework informed by the theoretical principles underpinning SBE, recommending instructional strategies for Generation Z EM residency learners across multiple educational environments.Implications for educatorsInstructional strategies were described for the didactic, simulation, and clinical learning environments. In the didactic environment, identified instructional strategies included meaningful asynchronous education, interactive small‐group learning, and improved multimedia design. In the simulation environment, educational innovations particularly suitable for Generation Z learners included learner‐centered debriefing, rapid‐cycle deliberate practice, and virtual simulation. In the clinical environment, described instructional strategies involved setting learner‐centered goals and delivering facilitative feedback in the context of an educational alliance. Overall, these instructional strategies were clustered around themes of student‐centered education and the educator as facilitator, which align well with Generation Z learning preferences. These findings were synthesized and presented as an advanced workshop, “Delivering Effective Education to the Next Generation,” at the 2023 SAEM Annual Meeting.

Defining evidence requirements for a Development Framework for Pharmacists (DFP) in community pharmacy practice

Background: The Development Framework for Pharmacists (DFP) was implemented in a pharmacy chain to guide pharmacist development. Both pharmacists and their supervisors faced challenges in defining evidence and performance levels for Domain 1 (Expert professional practice) standards. This study explored these challenges in a community pharmacy setting. Methods: Three online focus group discussions (FGDs) involving a DFP workgroup member and representatives from community pharmacies and polyclinics were conducted. The FGDs were facilitated by guiding questions and evidences gathered from pharmacists who had attempted the DFP. The FGDs were recorded, transcribed, and coded thematically. Results: Participants viewed the DFP as relevant to community practice but suggested aligning DFP evidence examples with community pharmacists’ responsibilities. Key themes from the FGDs included: (1) The need for clear definitions for descriptors, especially when identical evidence was used for different standards; (2) Professional education can be Domain 1 evidence when skills learned are demonstrated in the workplace; (3) Potential inclusion of education and training activities in Domain 1. (4) The need for a criteria model to assess pharmacists’ performance level in various roles and situations; (5) Clarification regarding the term "group of patients" (6) Considering back-end work as Domain 1 evidence. Conclusion: Addressing the above themes could enhance DFP integration for community pharmacists.

Effectiveness of G-CSF in chemotherapy for digestive system tumors: a systematic review of the Clinical Practice Guidelines for the Use of G-CSF 2022 delineated by the Japan Society of Clinical Oncology.

Granulocyte colony-stimulating factor (G-CSF) reportedly reduces the risk of neutropenia and subsequent infections caused by cancer chemotherapy. Although several guidelines recommend using G-CSF in primary prophylaxis according to the incidence rate of chemotherapy-induced febrile neutropenia (FN), the effectiveness of G-CSF in digestive system tumor chemotherapy remains unclear. To address these clinical questions, we conducted a systematic review as part of revising the Clinical Practice Guidelines for the Use of G-CSF 2022 published by the Japan Society of Clinical Oncology. This systematic review addressed two main clinical questions (CQ): CQ1: "Is primary prophylaxis with G-CSF effective in chemotherapy?", and CQ2: "Is increasing the intensity of chemotherapy with G-CSF effective?" We reviewed different types of digestive system tumors, including esophageal, gastric, pancreatic, biliary tract, colorectal, and neuroendocrine carcinomas. PubMed, Cochrane Library, and Ichushi-Web databases were searched for information sources. Independent systematic reviewers conducted two rounds of screening and selected relevant records for each CQ. Finally, the working group members synthesized the strength of evidence and recommendations. After two rounds of screening, 5/0/3/0/2/0 records were extracted for CQ1 of esophageal/gastric/pancreatic/biliary tract/colorectal/ and neuroendocrine carcinoma, respectively. Additionally, a total of 2/6/1 records were extracted for CQ2 of esophageal/pancreatic/colorectal cancer, respectively. The strength of evidence and recommendations were evaluated for CQ1 of colorectal cancer; however, we could not synthesize recommendations for other CQs owing to the lack of records. The use of G-CSF for primary prophylaxis in chemotherapy for colorectal cancer is inappropriate.