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Animals : An Open Access Journal From... Jan 2024Housing cetaceans in netted sea pens is not new and is common for many accredited managed-care facilities. Hence, the distinction between sanctuary and sea pen is more... (Review)
Review
Housing cetaceans in netted sea pens is not new and is common for many accredited managed-care facilities. Hence, the distinction between sanctuary and sea pen is more about the philosophies of those who run these sanctuary facilities, the effects of these philosophies on the animals' welfare, and how proponents of these sanctuaries fund the care of these animals. Here, I consider what plans exist for cetacean sanctuaries and discuss the caveats and challenges associated with this form of activist-managed captivity. One goal for stakeholders should be to disregard the emotional connotations of the word "sanctuary" and explore these proposals objectively with the best interest of the animals in mind. Another focus should be related to gauging the public's understanding of proposed welfare benefits to determine if long-term supporters of donation-based sanctuary models will likely see their expectations met as NGOs and their government partners consider moving forward with cetacean sanctuary experiments.
PubMed: 38275795
DOI: 10.3390/ani14020335 -
European Journal of Cancer (Oxford,... Nov 2023Recently, the new 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer (EC) critically integrating new pathological...
Verification of the prognostic precision of the new 2023 FIGO staging system in endometrial cancer patients - An international pooled analysis of three ESGO accredited centres.
BACKGROUND
Recently, the new 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer (EC) critically integrating new pathological and molecular features was published. The present study evaluated the clinical impact of the new 2023 FIGO staging system by comparing it to the previous 2009 system.
METHODS
This is an international, pooled retrospective study of 519 EC patients who underwent primary treatment (and molecular characterisation) at three European Society of Gynaecological Oncology (ESGO) accredited centres in Austria/Italy. Patients were categorised according to the 2009 and the 2023 FIGO staging systems. Stage shifts were analysed and (sub)stage specific 5-year progression-free (PFS) and overall survival (OS) rates were calculated and compared. Different statistical tests were applied to evaluate the prognostic precision of the two FIGO staging systems and to compare them to each other.
RESULTS
(Sub)stage shifts occurred in 143/519 (27.6%) patients: 123 upshifts (23.7%) and 20 (3.9%) downshifts. 2023 FIGO staging system identified a stage I cohort with a notably higher 5-year PFS rate compared to 2009 (93.0% versus 87.4%, respectively). For stage II disease, the 5-year PFS rate was similar in the 2023 and the 2009 FIGO staging systems (70.2% versus 71.2%, respectively). The two new molecularly defined 2023 FIGO substages IAm and IICm displayed distinct, particularly favourable and adverse oncologic outcomes within early stage disease, respectively. A remarkably lower 5-year PFS rate for stage III patients was revealed in the 2023 FIGO staging system compared to 2009 (44.4% versus 54.1%, respectively). All applied statistical tests confirmed a more accurate prediction of PFS and OS by the 2023 FIGO staging system compared to 2009.
CONCLUSION
The new 2023 FIGO stating system led to a substantial stage shift in about one quarter of patients leading to a higher prognostic precision. In early stage disease, the new substages added further prognostic granularity and identified treatment relevant subgroups.
PubMed: 37748967
DOI: 10.1016/j.ejca.2023.113317 -
BMC Medical Education Mar 2024We have recently published the experience of the accreditation body of undergraduate medical education in Iran on developing and validating standards based on the WFME...
We have recently published the experience of the accreditation body of undergraduate medical education in Iran on developing and validating standards based on the WFME framework (Gandomkar et al., BMC Med Educ 23:379, 2023). Agabagheri et al. extended our work and proposed a blueprint for post-accreditation monitoring based on their experience in developing an official guide in their Matters Arising (Aghabagheri et al., BMC Med Educ). The authors have used post-accreditation monitoring as a process of monitoring and controlling accreditation activities, procedures often referred to as meta-evaluation or meta-accreditation (depending on the objectives of evaluation) in the literature. On the contrary, post-accreditation monitoring alludes to the process of continuous quality improvement of educational programs after accreditation. We would like to make clarifications between post-accreditation monitoring, meta-evaluation and meta-accreditation which have been used interchangeably in their paper. Considering the emerging interests in scholarship and non-scholarship activities and reports in undergraduate medical education accreditation, this clarification provides a better understanding of the roles of these crucial concepts in the accreditation process.
Topics: Humans; Curriculum; Education, Medical, Undergraduate; Education, Medical; Accreditation; Schools, Medical
PubMed: 38454500
DOI: 10.1186/s12909-024-05214-7 -
Frontiers in Public Health 2023The AfIHQSA Model is the model for building quality resilient health systems. It is proposed as a compliment to and in many instances as an alternative to the many other...
The AfIHQSA Model is the model for building quality resilient health systems. It is proposed as a compliment to and in many instances as an alternative to the many other existing in ensuring a systematic and a sustained approach to improving outcomes in African health systems. It seeks to bring the necessary transformation to healthcare quality and patient safety and facilitate the attainment of desired outcomes. The model is unique in its iterative nature and how it places premium on sustaining the gains of improvement. The authors are concerned about the lack of sustainability of the many quality improvement efforts on the continent and how they all fade out into obscurity upon the exit of the proponents. Six iterative steps are proposed in the use of the model and these are: leadership commitment and buy-in; situational analysis of quality management capacity; systems strengthening for quality management; quality improvement interventions for care outcomes; standardization/accreditation/certification; and iterative monitoring, evaluation of performance of interventions and learning. Most of the quality interventions and efforts on the continent have failed because the steps in this model have not been sufficiently followed and addressed. The required strengthening of the various components of the health system necessary to sufficiently bear the weight of any quality intervention and guarantee sustainability of the gains is often ignored. As authors, we have therefore formally adopted the use of this model and plan to further continue evaluating and monitoring its utility and its generalizability in different institutions and countries.
Topics: Humans; Accreditation; Quality of Health Care; Certification; Health Facilities; Quality Improvement
PubMed: 38106891
DOI: 10.3389/fpubh.2023.1269330 -
Forensic Science International. Synergy 2023Forensic science in the United States is one of the few high-consequence industries that primarily relies on voluntary compliance to ensure quality. Previous efforts to...
Forensic science in the United States is one of the few high-consequence industries that primarily relies on voluntary compliance to ensure quality. Previous efforts to improve forensic science have been largely unsuccessful because appropriate support was not in place to assist providers with complying, there was no incentive for providers to comply, or both conditions occurred simultaneously. This perspective outlines how creating the necessary infrastructure and incentives can lead to positive change in this unregulated environment and how it can be used as a model to improve all aspects of forensic practice. Examples are provided that illustrate how this model has been successful when both infrastructure and incentives were present simultaneously and how the model failed when only one component was introduced. A detailed plan is also included outlining how this model can be used to achieve universal accreditation of forensic providers in the United States.
PubMed: 37692098
DOI: 10.1016/j.fsisyn.2023.100435 -
Frontiers in Cardiovascular Medicine 2023Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality and morbidity in individuals with type 2 diabetes mellitus (T2DM). Accordingly, several... (Review)
Review
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality and morbidity in individuals with type 2 diabetes mellitus (T2DM). Accordingly, several scientific societies have released clinical practice guidelines to assist health professionals in ASCVD risk management in patients with T2DM. However, some recommendations differ from each other, contributing to uncertainty about the optimal clinical management of patients with T2DM and established ASCVD or at high risk for ASCVD. Thus, the purpose of this paper is to discuss recent evidence-based guidelines on ASCVD risk stratification and prevention in patients with T2DM, in terms of disparities and similarities. To close the gap between different guidelines, a multidisciplinary approach involving general practitioners, endocrinologists, and cardiologists may enhance the coordination of diagnosis, therapy, and long-term follow-up of ASCVD in patients with T2DM.
PubMed: 37829695
DOI: 10.3389/fcvm.2023.1227769 -
Cureus Sep 2023Rheumatology fellowship programs represent a pivotal juncture for aspiring specialists, embarking on a transformative journey of expertise and care. The League of Arab...
Rheumatology fellowship programs represent a pivotal juncture for aspiring specialists, embarking on a transformative journey of expertise and care. The League of Arab States, comprising 22 nations and a collective population of 464.68 million as of 2022, established the Arab Board of Health Specialization in February 1978. This visionary initiative aimed to curb the emigration of Arab physicians and address the scarcity of specialized medical practitioners in the Arab world. Since the establishment of the Internal Medicine specialty in 1979, the curriculum and examinations have undergone sustained refinement and enhancement. In a significant stride, the Arab Board established the Scientific Committee of the Rheumatology Fellowship Program on November 28, 2022. Its main goal is to ensure that graduating fellows will be of high caliber and can contribute to the care of patients with rheumatic disease in the Arab world. This editorial illustrates the historical trajectory of the Arab Board's evolution and chronicles the dynamic expedition of shaping the rheumatology fellowship program.
PubMed: 37736239
DOI: 10.7759/cureus.45624 -
Ultrasound International Open 2024To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond. National representatives...
To provide an overview on education, training, practice requirements, and fields of application of neurosonology in Europe and beyond. National representatives and experts in neurosonology were surveyed regarding neurosonology requirements and practice in their countries. Descriptive statistics were used to report the data. Between February 1 and March 31, 2023, 42/46 (91.3%) national representatives responded to our questionnaire and the completion rate was 100%. Most countries (71.4%) offer a neurosonology training program during neurology residency, but it is part of the undergraduate medical program only in 30.9%. National certification is available in 47.6% of the countries surveyed and most countries (76.2%) require certification to practice. In 50% of the countries, candidates are assessed by a board examination, while in 26.2% they just need to document their practice. There is no formal accreditation of neurosonology centers in 78.6% of the countries surveyed. Only a few require certified personnel and appropriate equipment. Adequate teaching and research activities are only rarely necessary elements for laboratory accreditation. Our results indicate that there is a substantial need for transnational harmonization of neurosonological standards to guarantee uniformity and quality of performance. This survey will also provide guidance to promote an international accrediting council and create a quality-controlled laboratory network for implementing neurosonology in clinical trials.
PubMed: 38463153
DOI: 10.1055/a-2243-9625 -
Oncogene Nov 2023Digital pathology (DP), or the digitization of pathology images, has transformed oncology research and cancer diagnostics. The application of artificial intelligence... (Review)
Review
Digital pathology (DP), or the digitization of pathology images, has transformed oncology research and cancer diagnostics. The application of artificial intelligence (AI) and other forms of machine learning (ML) to these images allows for better interpretation of morphology, improved quantitation of biomarkers, introduction of novel concepts to discovery and diagnostics (such as spatial distribution of cellular elements), and the promise of a new paradigm of cancer biomarkers. The application of AI to tissue analysis can take several conceptual approaches, within the domains of language modelling and image analysis, such as Deep Learning Convolutional Neural Networks, Multiple Instance Learning approaches, or the modelling of risk scores and their application to ML. The use of different approaches solves different problems within pathology workflows, including assistive applications for the detection and grading of tumours, quantification of biomarkers, and the delivery of established and new image-based biomarkers for treatment prediction and prognostic purposes. All these AI formats, applied to digital tissue images, are also beginning to transform our approach to clinical trials. In parallel, the novelty of DP/AI devices and the related computational science pipeline introduces new requirements for manufacturers to build into their design, development, regulatory and post-market processes, which may need to be taken into account when using AI applied to tissues in cancer discovery. Finally, DP/AI represents challenge to the way we accredit new diagnostic tools with clinical applicability, the understanding of which will allow cancer patients to have access to a new generation of complex biomarkers.
Topics: Humans; Artificial Intelligence; Machine Learning; Biomarkers, Tumor; Medical Oncology; Neoplasms
PubMed: 37875656
DOI: 10.1038/s41388-023-02857-6 -
Journal of Taibah University Medical... Feb 2024Delivering high-quality care is a cornerstone of achieving satisfying health outcomes, and evidence-based medicine is the basis for doing so. For that, some governments...
Delivering high-quality care is a cornerstone of achieving satisfying health outcomes, and evidence-based medicine is the basis for doing so. For that, some governments mandate accreditation programs for the healthcare sector. One of these programs is CBAHI in KSA (SA), and many studies have shown positive healthcare outcomes associated with CBAHI accreditation in SA. While these achievements indicate progress, challenges remain. Variability in the quality of healthcare services across different regions of SA is a concern. Furthermore, the fact that healthcare is a complex industry that is rapidly evolving poses many challenges. CBAHI tries to overcome these challenges by continuously developing standards, obtaining international accreditation, and training surveyors to assess healthcare facilities across SA. The success of these efforts will help enhance the SA healthcare system's credibility and attract international patients who are seeking high-quality care.
PubMed: 37964863
DOI: 10.1016/j.jtumed.2023.10.002