OBJECTIVE: Survival benefit from anticancer treatments, even if modest, improves a patient\'s chances of accessing future innovations, thereby creating real option value (ROV). There is no empirical evidence on the impact of potential future innovations on oncologists\' treatment recommendations.
METHODS: We conducted a national online survey of practicing medical and hematological oncologists. We presented a hypothetical metastatic cancer patient with median survival of 6 months under four decision-making scenarios with varying expected efficacy and time to arrival of future innovations. We assessed the likelihood of discussing future innovations with their patients and the likelihood that future innovations would influence their current treatment recommendation, as well as factors associated with these 2 outcomes using multivariate logistic regressions.
RESULTS: 201 oncologists completed the survey. When future innovations were expected to improve survival by 6 months and be available in 6 months, 76% of oncologists were likely or very likely to discuss the innovations with their patients, and 68% reported they would influence their current treatment recommendations. A one-month increase in the expected survival improvement of future innovation was associated with a 1.17 (95% CI: 1.1-1.25) greater odds of reporting likely or very likely to discuss future innovations with their patients, while a one-month increase in the expected time to arrival was associated with a 0.91 (95% CI: 0.88-0.94) lower odds.
CONCLUSIONS: As potential future innovations appear to influence oncologists\' treatments recommendations, evidence to inform clinical guidelines and value assessments should consider data on ROV impacts to support informed treatment decision-making.

Video recordings of oncology interviews reveal how doctors rely on worry to establish medical expertise, facilitate treatment decision-making, and construct worry parameters to help patients understand whether there is a reasonable need for worry or not. Doctors express worry as frequently as cancer patients during oncology interviews, but they face a dilemma: how to provide care for cancer patients without directly stating they are worried about them? Plausible explanations are offered for why doctors do not state personal worries. Conversation analytic methods were employed to identify how doctors rely on worry to achieve distinct social actions. Four worry formulations are examined: (1) variations of \"we worry\" (and at times, non-specific and second person \"you\"), (2) hypothetical worry scenarios, (3) dismissing worry and offering assurance, and (4) doctors claiming they are not worried, bothered, or alarmed. Doctors align with and speak for the professionals and institutions they represent, expressing collective worries and claiming the legitimate right to worry (or not). Doctors also avoid abandoning patients to their own decision-making, yet do not formulate worry to coerce deference or dictate patients\' choices. In all cases patients agreed and displayed minimal resistance to doctors\' worry formulations. These findings contribute to ongoing work across institutional settings where participants have been shown to construct objective, legitimate claims meriting worries about diverse problems. Work is underway to examine when and how patients explicitly raise and doctors respond to cancer worries. Clinical implications are raised for how doctors can use worry to legitimize best treatment options, help patients minimize their worries, rely on hypothetical scenarios allowing patients to compare how other patients managed their cancer, and not dismiss the importance of minimizing the need to worry as a resource for offering reassurance.

International guidelines on the treatment of myasthenia gravis (MG) have been published but are not tailored to the Belgian situation. This publication presents recommendations from a group of Belgian MG experts for the practical management of MG in Belgium. It includes recommendations for treatment of adult patients with generalized myasthenia gravis (gMG) or ocular myasthenia gravis (oMG). Depending on the MG-related antibody a treatment sequence is suggested with therapies that can be added on if the treatment goal is not achieved. Selection of treatments was based on the level of evidence of efficacy, registration and reimbursement status in Belgium, common daily practice and the personal views and experiences of the authors. The paper reflects the situation in February 2024. In addition to the treatment considerations, other relevant aspects in the management of MG are addressed, including comorbidities, drugs aggravating disease symptoms, pregnancy, and vaccination. As many new treatments might potentially come to market, a realistic future perspective on the impact of these treatments on clinical practice is given. In conclusion, these recommendations intend to be a guide for neurologists treating patients with MG in Belgium.

There is extensive literature emerging in the field of dentistry with the aim to optimize clinical practice. Evidence-based guidelines (EBGs) are designed to collate diagnostic criteria and clinical treatment for a range of conditions based on high-quality evidence. Recently, advancements in Artificial Intelligence (AI) have instigated further queries into its applicability and integration into dentistry. Hence, the aim of this study was to develop a model that can be used to assess the accuracy of treatment recommendations for dental conditions generated by individual clinicians and the outcomes of AI outputs. For this pilot study, a Delphi panel of six experts led by CoTreat AI provided the definition and developed evidence-based recommendations for subgingival and supragingival calculus. For the rapid review-a pragmatic approach that aims to rapidly assess the evidence base using a systematic methodology-the Ovid Medline database was searched for subgingival and supragingival calculus. Studies were selected and reported based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and this study complied with the minimum requirements for completing a restricted systematic review. Treatment recommendations were also searched for these same conditions in ChatGPT (version 3.5 and 4) and Bard (now Gemini). Adherence to the recommendations of the standard was assessed using qualitative content analysis and agreement scores for interrater reliability. Treatment recommendations by AI programs generally aligned with the current literature, with an agreement of up to 75%, although data sources were not provided by these tools, except for Bard. The clinician\'s rapid review results suggested several procedures that may increase the likelihood of overtreatment, as did GPT4. In terms of overall accuracy, GPT4 outperformed all other tools, including rapid review (Cohen\'s kappa 0.42 vs. 0.28). In summary, this study provides preliminary observations for the suitability of different evidence-generating methods to inform clinical dental practice.

BACKGROUND: Regarding treatment of women of childbearing potential with epilepsy, several aspects of family planning and desire to have children have to be taken into account.
OBJECTIVE: Overview of current data on mutual implications of epileptic seizures, antiseizure medication (ASM), pregnancy and child development.
METHODS: Review of the current literature, discussion and presentation of resulting treatment recommendations.
RESULTS: Many ASMs bear the potential for clinically relevant interactions with both contraceptives and altered concentrations of sexual hormones and modified pharmacokinetics during pregnancy. All ASMs show an increased risk for congenital malformations; however, due to seizure-related risks for the mother and child effective ASM treatment during pregnancy is crucial.
CONCLUSIONS: When considering the special aspects of consultation and treatment of women of childbearing potential with epilepsy most pregnancies are uncomplicated.
UNASSIGNED: HINTERGRUND: Bei Frauen mit Epilepsie im reproduktiven Alter müssen die Themen Verhütung und Kinderwunsch in der Beratung und Therapie berücksichtigt werden.
UNASSIGNED: Überblick zum aktuellen Kenntnisstand über wechselseitige Auswirkungen von epileptischen Anfällen, anfallssuppressiver Medikation (ASM), Schwangerschaft und kindlicher Entwicklung.
METHODS: Review der aktuellen Literatur, Diskussion der Datenlage und Ableitung von Therapieempfehlungen.
UNASSIGNED: Viele ASM haben das Potenzial für klinisch relevante Interaktionen sowohl mit Kontrazeptiva als auch aufgrund veränderter Sexualhormonkonzentrationen und Pharmakokinetik in der Schwangerschaft. Alle ASM gehen mit einem erhöhten Fehlbildungsrisiko für das Kind einher. Aufgrund anfallsassoziierter Risiken für Mutter und Kind ist eine effektive ASM in der Schwangerschaft jedoch ebenfalls unerlässlich.
UNASSIGNED: Unter Berücksichtigung der speziellen Aspekte von Beratung und Therapie von Frauen im reproduktiven Alter verläuft ein Großteil der Schwangerschaften bei Frauen mit Epilepsie komplikationslos.

Recommendations for the treatment of chronic obstructive pulmonary disease (COPD) have shifted towards a more restrictive use of inhaled corticosteroids (ICS). We aimed to identify the nationwide development over time in the use of ICS treatment in COPD. We conducted a register-based repeated cross-sectional study using Danish nationwide registers. On a yearly basis from 1998 to 2018, we included all patients in Denmark ≥ 40 years of age with an ICD-10 diagnosis of COPD (J44). Accumulated ICS use was calculated for each year based on redeemed prescriptions. Patients were divided into the following groups: No ICS, low-dose ICS, medium-dose ICS, or high-dose ICS. From 1998 to 2018, the yearly proportion of patients without ICS treatment increased (from 50.6% to 57.6%), the proportion of patients on low-dose ICS treatment increased (from 11.3% to 14.9%), and the proportion of patients on high-dose ICS treatment decreased (from 17.0% to 9.4%). We demonstrated a national reduction in the use of ICS treatment in COPD from 1998 to 2018, with an increase in the proportion of patients without ICS and on low-dose ICS treatment and a decrease in the proportion of patients on high-dose ICS treatment.

METHODS: This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue.
OBJECTIVE: Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoracolumbar burst fractures (TL) fractures.
METHODS: We will describe the methodology used in the AO Spine TL A3/4 Study prospective observational study and how the radiographs collected for this study were utilized to study the relationships between various variables that factor into surgeon decision making.
RESULTS: With 22 expert spine trauma surgeons analyzing the acute CT scans of 183 patients with TL fractures we were able to perform pairwise analyses, look at reliability and correlations between responses and develop frequency tables, and regression models to assess the relationships and interactions between variables. We also used machine learning to develop decision trees.
CONCLUSIONS: This paper outlines the overall methodological elements that are common to the subsequent papers in this focus issue.

METHODS: Predictive algorithm via decision tree.
OBJECTIVE: Artificial intelligence (AI) remain an emerging field and have not previously been used to guide therapeutic decision making in thoracolumbar burst fractures. Building such models may reduce the variability in treatment recommendations. The goal of this study was to build a mathematical prediction rule based upon radiographic variables to guide treatment decisions.
METHODS: Twenty-two surgeons from the AO Knowledge Forum Trauma reviewed 183 cases from the Spine TL A3/A4 prospective study (classification, degree of certainty of posterior ligamentous complex (PLC) injury, use of M1 modifier, degree of comminution, treatment recommendation). Reviewers\' regions were classified as Europe, North/South America and Asia. Classification and regression trees were used to create models that would predict the treatment recommendation based upon radiographic variables. We applied the decision tree model which accounts for the possibility of non-normal distributions of data. Cross-validation technique as used to validate the multivariable analyses.
RESULTS: The accuracy of the model was excellent at 82.4%. Variables included in the algorithm were certainty of PLC injury (%), degree of comminution (%), the use of M1 modifier and geographical regions. The algorithm showed that if a patient has a certainty of PLC injury over 57.5%, then there is a 97.0% chance of receiving surgery. If certainty of PLC injury was low and comminution was above 37.5%, a patient had 74.2% chance of receiving surgery in Europe and Asia vs 22.7% chance in North/South America. Throughout the algorithm, the use of the M1 modifier increased the probability of receiving surgery by 21.4% on average.
CONCLUSIONS: This study presents a predictive analytic algorithm to guide decision-making in the treatment of thoracolumbar burst fractures without neurological deficits. PLC injury assessment over 57.5% was highly predictive of receiving surgery (97.0%). A high degree of comminution resulted in a higher chance of receiving surgery in Europe or Asia vs North/South America. Future studies could include clinical and other variables to enhance predictive ability or use machine learning for outcomes prediction in thoracolumbar burst fractures.

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Hereditary transthyretin (ATTRv; v for variant) amyloidosis is a rare, multisystem, progressive, and fatal disease in which polyneuropathy is a cardinal manifestation. Due to a lack of United States (US)-specific guidance on ATTRv amyloidosis with polyneuropathy, a panel of US-based expert clinicians convened to address identification, monitoring, and treatment of this disease. ATTRv amyloidosis with polyneuropathy should be suspected in unexplained progressive neuropathy, especially if associated with systemic symptoms or family history. The diagnosis is confirmed through genetic testing, biopsy, or cardiac technetium-based scintigraphy. Treatment should be initiated as soon as possible after diagnosis, with gene-silencing therapeutics recommended as a first-line option. Consensus is lacking on what represents \"disease progression\" during treatment; however, the aggressive natural history of this disease should be considered when evaluating the effectiveness of any therapy.