We propose a novel three-stage FIND-RESOLVE-LABEL workflow for crowdsourced annotation to reduce ambiguity in task instructions and, thus, improve annotation quality. Stage 1 (FIND) asks the crowd to find examples whose correct label seems ambiguous given task instructions. Workers are also asked to provide a short tag that describes the ambiguous concept embodied by the specific instance found. We compare collaborative vs. non-collaborative designs for this stage. In Stage 2 (RESOLVE), the requester selects one or more of these ambiguous examples to label (resolving ambiguity). The new label(s) are automatically injected back into task instructions in order to improve clarity. Finally, in Stage 3 (LABEL), workers perform the actual annotation using the revised guidelines with clarifying examples. We compare three designs using these examples: examples only, tags only, or both. We report image labeling experiments over six task designs using Amazon\'s Mechanical Turk. Results show improved annotation accuracy and further insights regarding effective design for crowdsourced annotation tasks.

Specimen management is a complex process that involves multiple steps and numerous health care personnel. Preventable specimen-related errors are common and can occur during any phase of the specimen management process. Perioperative nurses manage specimens during the preanalytical phase before specimens are delivered to the laboratory for analysis. Errors in the preanalytical phase may include mislabeling, miscommunication, loss of a specimen, improper fixation of the specimen, and transport failures. The AORN \"Guideline for specimen management\" provides guidance for managing specimens collected during surgical and other invasive procedures, including recommendations for handling specific types of specimens. This article discusses the guideline recommendations for intraoperative team communication, transfer from the sterile field, containment, transport, and quality. A scenario describes a facility team\'s use of a root cause analysis and a failure modes and effects analysis tool to assess the risk and effects of specimen errors and create a process improvement plan.

Varied perspectives on the later stage of anorexia nervosa (AN) have left the field of eating disorders without a consistent label or definition for this subpopulation. As a result, diverse criteria when recruiting participants have led to incomparable results across research studies and a lack of guidance when assessing and treating patients in the clinical context. The aim of the current study was to develop consensus-based guidelines on the labeling and defining of the later stage of AN.
Utilizing the Delphi methodology, a professional panel of experts (N = 21) participated in three rounds of questionnaires. Five open-ended questions (Round 1) were analyzed using content analysis to form statements relating to a classification system for labeling and defining the later stage of AN. A total of 80 statements were rated in terms of panelists\' level of agreement (Rounds 2 and 3).
Consensus was achieved for 28.8% of statements and a further 16.3% of statements reached near consensus in the second and third round of questionnaires. Two labels were identified with five defining features achieving consensus.
Findings from the study suggest an alternative approach to labeling be adopted with consensus-based guidelines established for defining the later stage of AN. Implications that may occur from a unified classification system are explored with longitudinal research required to assess the impact on patients experiencing the later stage of AN.

Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS-STS-AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and haemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis-patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.

BACKGROUND: Non-Food and Drug Administration (FDA) or off-label medication prescribing occurs commonly in the intensive care unit (ICU). Off-label medication use creates a concern for untoward adverse effects; however, this worry may be alleviated by supportive literature.
OBJECTIVE: To evaluate the evidence behind off-label medication use by determining the presence of guideline support and compare graded recommendations to an online tertiary resource, DRUGDEX.
METHODS: Off-label medication use was identified prospectively over 3 months in medical ICUs in 3 academic medical centers. Literature searches were conducted in PubMed and the national guideline clearinghouse website to determine the presence of guideline support. DRUGDEX was also searched for strength-of-evidence ratings to serve as a comparator.
RESULTS: A total of 287 off-label medication indication searches resulted in 44% (126/287) without identified evidence; 253 guidelines were identified for 56% (161/287) of indications. Of the published guidelines, 89% (226/253) supported the off-label indication. In the DRUGDEX comparison, 67% (97/144) of guideline gradings disagree with DRUGDEX, whereas 33% (47/144) of the gradings matched the online database.
CONCLUSIONS: Because more than half of off-label medication use has the benefit of supportive guidelines recommendations and a majority of gradings are inconsistent with DRUGDEX, clinicians should consider utilizing guidelines to inform off-label medication use in the ICU. Still, there is a considerable amount of off-label medication use in the ICU that lacks supporting evidence, and use remains concerning because it may lead to inappropriate treatment and adverse events.