OBJECTIVE: Approximately 16,000 new cases of lung cancer are diagnosed each year in Australia and Aotearoa New Zealand, and it is the leading cause of cancer death in the region. Unwarranted variation in lung cancer care and outcomes has been described for many years, although clinical quality indicators to facilitate benchmarking across Australasia have not been established. The purpose of this study was to establish clinical quality indicators applicable to lung and other thoracic cancers across Australia and Aotearoa New Zealand.
METHODS: Following a literature review, a modified three round eDelphi consensus process was completed between October 2022 and June 2023. Participants included clinicians from all relevant disciplines, patient advocates, researchers and other stakeholders, with representatives from all Australian states and territories and Aotearoa New Zealand. Consensus was set at a threshold of 70%, with the first two rounds conducted as online surveys, and the final round held as a hybrid in person and virtual consensus meeting.
RESULTS: The literature review identified 422 international thoracic oncology indicators, and a total of 71 indicators were evaluated over the course of the Delphi consensus. Ultimately, 27 clinical quality indicators reached consensus, covering the continuum of thoracic oncologic care from diagnosis to first line treatment. Indicators benchmarking supportive care were poorly represented. Attendant numeric quality standards were developed to facilitate benchmarking.
CONCLUSIONS: Twenty-seven clinical quality indicators relevant to thoracic oncology care in Australasia were developed. Real world implementation will now be explored utilizing a prospective dataset collected across Australia.

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Best, is to be \'of the highest quality, or being the most suitable, pleasing, or effective type of thing or person\'. Within medical education, \'best-ness\' is evident within best practice guides and recommendations, and within research, where best evidence influences design and conduct. Yet, much of the evidence of best-ness fails to consider best for who and where, what, and when. Thinking needs reframing, given that \"best-ness\" and medical education are such good bedfellows, but it is critical that we recognise the impact and influence of context - that practice can be good, but cannot be universally and unflinchingly best.

OBJECTIVE: This study assessed the quality of campus alcohol policies against best practice to assist campus decision-makers in strengthening their campus alcohol policies and reducing student alcohol use and harm.
METHODS: Drawing on empirical literature and expert opinion, we developed an evidence-based scoring rubric to assess the quality of campus alcohol policies across 10 alcohol policy domains. Campus alcohol policy data were collected from 12 Atlantic Canadian universities. All extracted data were verified by the institutions and then scored.
RESULTS: On average, post-secondary institutions are implementing only a third of the evidence-based alcohol policies captured by the 10 domains assessed. The average campus policy score was 33% (range 15‒49%). Of the 10 domains examined, only enforcement achieved an average score above 50%, followed closely by leadership and surveillance at 48%. The two heaviest-weighted domains-availability and access, and advertising and sponsorship-had average scores of 27% and 24%, respectively. However, if post-secondary campuses adopted the highest scoring policies from across all 12 campuses, they could achieve a score of 74%, indicating improvement is possible.
CONCLUSIONS: Atlantic Canadian universities are collectively achieving less than half their potential to reduce student alcohol-related harm. However, this study identifies opportunities where policies can be enhanced or modified. The fact that most policies are present at one or more campuses highlights that policy recommendations are an achievable goal for campuses. Campuses are encouraged to look to each other as models for improving their own policies.
RéSUMé: OBJECTIF: L’étude a évalué la qualité des politiques relatives à l’alcool sur les campus par rapport aux pratiques exemplaires afin d’aider les décideurs des campus à renforcer leurs politiques relatives à l’alcool et à réduire la consommation d’alcool et les méfaits connexes dans la population étudiante. MéTHODE: En faisant appel à la littérature empirique et aux opinions d’experts, nous avons élaboré une grille de notation factuelle pour évaluer la qualité des politiques relatives à l’alcool sur les campus dans 10 domaines associés aux politiques sur l’alcool. Les données des politiques relatives à l’alcool sur les campus sont extraites des politiques de 12 universités du Canada atlantique. Toutes les données extraites ont été confirmées par les établissements, après quoi nous leur avons attribué une note. RéSULTATS: En moyenne, les établissements postsecondaires ne mettent en œuvre que le tiers des politiques factuelles relatives à l’alcool faisant partie des 10 domaines évalués. La note moyenne des politiques des campus a été de 33 % (intervalle de 15 à 49 %). Des 10 domaines pris en compte, seule la mise en application a obtenu une note moyenne de plus de 50 %, suivie de près par le leadership et la surveillance, à 48 %. Les notes moyennes dans les deux domaines les plus lourdement pondérés (disponibilité et accès, et publicité et commandites) ont été de 27 % et de 24 %, respectivement. Toutefois, si les campus postsecondaires adoptaient les politiques les mieux notées des 12 campus, ils obtiendraient une note de 74 %; une amélioration est donc possible. CONCLUSION: Les universités du Canada atlantique réalisent collectivement moins de la moitié de leur potentiel de réduction des méfaits liés à l’alcool dans la population étudiante. Notre étude indique cependant des possibilités d’améliorer ou de modifier les politiques. Le fait que la plupart des politiques recommandées sont présentes sur un ou plusieurs campus montre qu’elles constituent un objectif réalisable. Nous encourageons chaque campus à améliorer ses propres politiques en s’inspirant de celles des autres.

Advances in biomarker-based diagnostic modalities, recent approval of anti-amyloid monoclonal antibodies for early Alzheimer\'s disease (AD; mild cognitive impairment or mild dementia due to AD) and late-stage clinical development of other disease-modifying therapies for AD necessitate a significant paradigm shift in the early detection, diagnosis and management of AD. Anti-amyloid monoclonal antibodies target the underlying pathophysiological mechanisms of AD and have demonstrated a significant reduction in the rate of clinical decline in cognitive and functional outcome measures in patients with early AD. With growing recognition of the benefit of early interventions in AD, an increasing number of people may seek diagnosis for their subjective cognitive problems in an already busy medical system. Various factors such as limited examination time, lack of expertise for cognitive assessment and limited access to specialized tests can impact diagnostic accuracy and timely detection of AD. To overcome these challenges, a new model of care will be required. In this paper, we provide practical guidance for institutional readiness for anti-amyloid therapies for early AD in Asia, in terms of best practices for identifying eligible patients and diagnosing them appropriately, safe administration of anti-amyloid monoclonal antibodies and monitoring of treatment, managing potential adverse events such as infusion reactions and amyloid-related imaging abnormalities, and cross-disciplinary collaboration. Education and training will be the cornerstone for the establishment of new pathways of care for the identification of patients with early AD and delivery of anti-amyloid therapies in a safe and efficient manner to eligible patients.

The publication of Clinical and Laboratory Standards Institute\'s guideline H62 has provided the flow cytometry community with much-needed guidance on development and validation of flow cytometric assays (CLSI, 2021). It has also paved the way for additional exploration of certain topics requiring additional guidance. Flow cytometric analysis of rare matrices, or unique and/or less frequently encountered specimen types, is one such topic and is the focus of this manuscript. This document is the result of a collaboration subject matter experts from a diverse range of backgrounds and seeks to provide best practice consensus guidance regarding these types of specimens. Herein, we define rare matrix samples in the setting of flow cytometric analysis, address validation implications and challenges with these samples, and describe important considerations of using these samples in both clinical and research settings.

BACKGROUND: Current literature lacks consensus on initial assessments and routine follow-up care of patients with alpha-mannosidosis (AM). A Delphi panel was conducted to generate and validate recommendations on best practices for initial assessment, routine follow-up care, and integrated care coordination of patients with AM.
METHODS: A modified Delphi method involving 3 rounds of online surveys was used. An independent administrator and 2 nonvoting physician co-chairs managed survey development, anonymous data collection, and analysis. A multidisciplinary panel comprising 20 physicians from 12 countries responded to 57 open-ended questions in the first survey. Round 2 consisted of 11 ranking questions and 44 voting statements. In round 3, panelists voted to validate 60 consensus statements. The panel response rate was ≥95% in all 3 rounds. Panelists used 5-point Likert scales to indicate importance (score of ≥3) or agreement (score of ≥4). Consensus was defined a priori as ≥75% agreement with ≥75% of panelists voting.
RESULTS: Consensus was reached on 60 statements, encompassing 3 key areas: initial assessments, routine follow-up care, and treatment-related follow-up. The panel agreed on the type and frequency of assessments related to genetic testing, baseline evaluations, quality of life, biochemical measures, affected body systems, treatment received, and integrated care coordination in patients with AM. Forty-nine statements reached 90% to 100% consensus, 8 statements reached 80% to 85% consensus, and 1 statement reached 75% consensus. Two statements each reached consensus on 15 baseline assessments to be conducted at the initial follow-up visit after diagnosis in pediatric and adult patients.
CONCLUSIONS: This is the first Delphi study providing internationally applicable, best-practice recommendations for monitoring patients with AM that may improve their care and well-being.

It is estimated that one in seven individuals, more than 15% of the population in the UK, are neurodivergent. In recent years, there has been a notable increase in university students disclosing disabilities, specific learning difficulties, or mental health conditions. Despite this, students with disabilities and learning differences often experience lower levels of well-being compared to their peers, and their completion rates are significantly lower. Two years ago, I was tasked with creating a training program for academic staff to enhance their support for neurodivergent students. In this commentary, I share reflections on what I have learned while developing this training, and I outline effective strategies and approaches that can be implemented in the design and delivery of educational content. I advocate a collaborative approach to training development with neurodivergent students and with colleagues with various roles. The commentary draws upon the Universal Design for Learning framework to advocate for an educational environment that is welcoming and accommodating to all learners. It champions strength-based practices, steering clear of the traditional deficit-focused narratives. My goal with this reflection is to prompt educators to reflect on their teaching methodologies, engage in conversations with their students, and to consider substantial pedagogical changes that prioritize inclusivity over reasonable adjustments.

Industry representatives on the ICH S1B(R1) Expert Working Group (EWG) worked closely with colleagues from the Drug Regulatory Authorities to develop an addendum to the ICH S1B guideline on carcinogenicity studies that allows for a weight-of-evidence (WoE) carcinogenicity assessment in some cases, rather than conducting a 2-year rat carcinogenicity study. A subgroup of the EWG composed of regulators have published in this issue a detailed analysis of the Prospective Evaluation Study (PES) conducted under the auspices of the ICH S1B(R1) EWG. Based on the experience gained through the Prospective Evaluation Study (PES) process, industry members of the EWG have prepared the following commentary to aid sponsors in assessing the standard WoE factors, considering how novel investigative approaches may be used to support a WoE assessment, and preparing appropriate documentation of the WoE assessment for presentation to regulatory authorities. The commentary also reviews some of the implementation challenges sponsors must consider in developing a carcinogenicity assessment strategy. Finally, case examples drawn from previously marketed products are provided as a supplement to this commentary to provide additional examples of how WoE criteria may be applied. The information and opinions expressed in this commentary are aimed at increasing the quality of WoE assessments to ensure the successful implementation of this approach.

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