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Osteoarthritis (OA) is the most common joint disease due to the increasing life expectancy of the world's population. Every 2nd patient over the age of 50 suffers from knee or hip OA, and this is directly related to the increased burden on healthcare. Accumulated data on the comorbid profile of patients with OA dictate the need to identify disease phenotypes in order to provide personalized care. Individual clinical manifestations of OA also require a differential approach: the pain treatment requires consideration of the patient's psycho-emotional profile and the possibility of involving nociceptive pathways in the process. However, due to the ambiguity of existing clinical guidelines, most experts note a number of difficulties in prescribing treatment for patients with OA.The resolution presents an agreed opinion of experts on the algorithms for managing patients with OA, starting from the primary level, with the gradual involvement of related specialists. Some issues of a personalized approach are considered depending on the presence of comorbid pathology and the severity of individual symptoms of the disease. The prospects of the combined use of pharmacological and non-drug methods of treatment are noted; emphasis was placed on the importance of rehabilitation measures at the first level of medical care, provided to patients with OA, long before the development of structural changes.The proposed algorithms for managing patients can be considered as the basis for future recommendations for managing patients with this pathology.

The treatment landscape for IgA nephropathy (IgAN) is rapidly evolving with the introduction of novel therapies targeting diverse disease pathways. Some have already been approved in different countries, while others are under investigation in randomized controlled trials (RCTs) with encouraging results. However, almost all performed RCTs have included only patients with refractory non-nephrotic proteinuria and preserved renal function. Other clinical presentations (rapidly progressive forms, malignant hypertension, thrombotic microangiopathy, nephrotic syndrome) have received less attention and are systematically excluded from RCTs. On the other hand, certain aspects, such as the impact of hematuria or the management in special populations (e.g. pregnant patients or transplant recipients), remain underexplored. This review proposes therapeutic algorithms to guide treatment decisions in different clinical scenarios, while highlighting gaps in current research., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

The past 25 years have proved that palliative care is effective in improving care of seriously ill patients. Research attention must pivot to focus on policy changes and systems and models of care that ensure easy access to quality palliative care to all patients who need it. Education, alone, has not worked. Leaving it to individual organizations to decide has not worked. The question of whether incentives should be used has arisen. Should we design treatment algorithms, such as for cardiopulmonary resuscitation, where palliative care is part of standard care and requires an "opt out"? Should payers pay more to health care organizations who demonstrate they provide universal access to palliative care and how can we control for unintended consequences? Should provision of specialist palliative care be required for a health care organization to be accredited? How can we advance the state of the science and best support the workforce? [ABSTRACT FROM AUTHOR]

Purpose: Anti-vascular endothelial growth factor (Anti-VEGF) therapy is currently seen as the standard for treatment of neovascular AMD (nAMD). However, while treatments are highly effective, decisions for initial treatment and retreatment are often challenging for non-retina specialists. The purpose of this study is to develop convolutional neural networks (CNN) that can differentiate treatment indicated presentations of nAMD for referral to treatment centre based solely on SD-OCT. This provides the basis for developing an applicable medical decision support system subsequently. Methods: SD-OCT volumes of a consecutive real-life cohort of 1503 nAMD patients were analysed and two experiments were carried out. To differentiate between no treatment class vs. initial treatment nAMD class and stabilised nAMD vs. active nAMD, two novel CNNs, based on SD-OCT volume scans, were developed and tested for robustness and performance. In a step towards explainable artificial intelligence (AI), saliency maps of the SD-OCT volume scans of 24 initial indication decisions with a predicted probability of > 97.5% were analysed (score 0–2 in respect to staining intensity). An AI benchmark against retina specialists was performed. Results: At the first experiment, the area under curve (AUC) of the receiver-operating characteristic (ROC) for the differentiation of patients for the initial analysis was 0.927 (standard deviation (SD): 0.018), for the second experiment (retreatment analysis) 0.865 (SD: 0.027). The results were robust to downsampling (¼ of the original resolution) and cross-validation (tenfold). In addition, there was a high correlation between the AI analysis and expert opinion in a sample of 102 cases for differentiation of patients needing treatment (κ = 0.824). On saliency maps, the relevant structures for individual initial indication decisions were the retina/vitreous interface, subretinal space, intraretinal cysts, subretinal pigment epithelium space, and the choroid. Conclusion: The developed AI algorithms can define and differentiate presentations of AMD, which should be referred for treatment or retreatment with anti-VEGF therapy. This may support non-retina specialists to interpret SD-OCT on expert opinion level. The individual decision of the algorithm can be supervised by saliency maps. [ABSTRACT FROM AUTHOR]

Background: There is an increasing diversification in the treatment landscape for inflammatory bowel diseases (IBD) leading to therapeutic challenges that can only incompletely be covered by prospective randomized double-blind trials. Real-world observations are therefore an important tool to provide insights into therapeutic strategies., Objectives: To describe the real-world treatment algorithms in an IBD referral centre., Design: Single-centre retrospective cohort study., Methods: We retrospectively analysed prospectively collected data on treatment sequences and outcomes from 502 patients with Crohn's disease (CD) and ulcerative colitis (UC) treated with infliximab, adalimumab, vedolizumab or ustekinumab at a large German tertiary referral centre., Results: Treatment decisions correlated to baseline patient characteristics. Over time, infliximab continued to be the preferred first-line option in CD and UC, although ustekinumab and vedolizumab, respectively, became increasingly important choices. Remission rates decreased with the advancement of therapy lines., Conclusion: We provide insights into the evolution of tertiary centre real-world treatment sequences that might - together with other observations - help to guide the selection of therapies in IBD. Our data also strongly underscore the unmet need for biomarkers supporting treatment decisions., Trial Registration: None., Competing Interests: M.F.N. has served as an advisor for Pentax, Giuliani, MSD, Abbvie, Janssen, Takeda and Boehringer. S.Z. received honoraria from Takeda, Roche, Galapagos, Ferring, Falk, Kiowa Kyrin, Lilly and Janssen. FV served as a speaker or consultant for AbbVie, Janssen-Cilag, Lilly, Galapagos and Pentax. M.F.N. and S.Z. received research support from Takeda, Shire (a part of Takeda) and Roche. The other authors declare no conflicts of interest., (© The Author(s), 2024.)

• Delphi method used captured a multidisciplinary perspective for managing LA-HNSCC. • Systemic treatment of LA-HNSCC depend on patient tolerability of high-dose cisplatin. • Strong consensus on cisplatin regimens shows evidence-based practice in the region. • Practice variability due to access, practical factors and areas of limited evidence. To develop consensus on patient characteristics and disease-related factors considered in deciding treatment approaches for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) based on real-world treatment patterns in 4 territories in Asia-Pacific. A three-round modified Delphi involving a multidisciplinary panel of HN surgeons, medical oncologists, and radiation oncologists was used. Of 41 panelists recruited, responses of 26 from Australia, Japan, Singapore, and Taiwan were analyzed. All panelists had ≥five years' experience managing LA-HNSCC patients and treated ≥15 patients with LA-HNSCC annually. All statements on definitions of LA-HNSCC, treatment intolerance and cisplatin dosing reached consensus. 4 of 7 statements on unresectability, 2 of 4 on adjuvant chemoradiotherapy, 7 of 13 on induction chemotherapy, 1 of 8 on absolute contraindications and 7 of 11 on relative contraindications to high-dose cisplatin did not reach consensus. In all territories except Taiwan, high-dose cisplatin was preferred in definitive and adjuvant settings for patients with no contraindications to cisplatin; weekly cisplatin (40 mg/m2) preferred for patients with relative contraindications to high-dose cisplatin. For Taiwan, the main treatment option was weekly cisplatin. For patients with absolute contraindications to cisplatin, carboplatin ± 5-fluorouracil or radiotherapy alone were preferred alternatives in both definitive and adjuvant settings. This multidisciplinary consensus provides insights into management of LA-HNSCC in Asia-Pacific based on patient- and disease-related factors that guide selection of treatment modality and systemic treatment. Despite strong consensus on use of cisplatin-based regimens, areas of non-consensus showed that variability in practice exists where there is limited evidence. [ABSTRACT FROM AUTHOR]

Purpose: Traditionally, an acute wrist radiograph series comprises posteroanterior, oblique, and lateral projections. There is controversy within the field of orthopedics, however, over the value of the oblique view in determining a plan of care for a given fracture. An external survey of practicing hand surgeons was conducted to evaluate whether the addition of the oblique view to a 2-view (posteroanterior and lateral) series resulted in a difference in the initial intervention plan for closed distal radius fractures (DRFs)., Methods: Participants, licensed and practicing hand surgeons in the United States, reviewed 30 sets of wrist radiograph studies twice (once as a complete 3-view series and again with the oblique omitted) in a randomized order. Cases were randomly selected to include 10 pediatric, 10 geriatric, and 10 intermediate/adult DRFs. After reviewing the films and demographic information, the participants selected their preferred initial intervention from the following list: (1) treatment using a cast or orthosis without reduction, (2) closed reduction under or without fluoroscopy with treatment using a cast or orthosis, (3) closed reduction and percutaneous fixation with treatment using a cast or orthosis, and (4) open reduction internal fixation and subsequent treatment in a cast or orthosis., Results: A calculated Cohen kappa for the entire sample revealed a statistically significant and strong association between 2- and 3-view survey answers (κ = 0.81, P < .001 ). Each pairing was examined separately, and 90% of the questions had a statistically significant ( P < .05) Cohen kappa pairing; however, many were in the 0.5-0.75 range., Conclusions: The data support the hypothesis that the addition of an oblique view radiograph to a posteroanterior and lateral series does not change surgical decision-making in the initial evaluation of acute closed DRF in many situations. However, although most cases had a statistically significant ( P < .05) agreement between the surveys, the oblique view did result in some meaningful intervention changes. Therefore, the elimination of the oblique view cannot be supported by our findings., Clinical Relevance: This is a decision analysis survey study designed to investigate how the oblique-view radiograph influences DRF surgical decision-making.

Significance: Chronic venous disease (CVD) is prevalent in the aging population and leads to venous leg ulcers (VLUs). These wounds can last and recur for years, significantly impacting quality of life. A large body of literature exists on CVD and VLU diagnosis and treatment. Multiple algorithms, guidelines, and consensus documents have been published on this topic, highlighting the importance of this issue in clinical practice. However, these documents are not fully aligned with each other. Recent Advances: The latest update of the internationally used classification system for CVD was recently published. Our review aims to summarize the existing information to provide an educational tool for clinicians new to this topic, and to highlight the commonalities between the published recommendations. Critical issues: VLUs need to be treated with consideration for the extent of venous disease present in the patient. This requires a good understanding of the various components involved and the possible additional concomitant conditions by the first-line clinician who encounters the patient. A multidisciplinary team is necessary for a successful overall treatment plan, and this plan should be tailored to each patient's specific needs and lifestyle. Future Directions: Compression is still the mainstay of treatment for CVD and VLUs. Compression is needed long term, but it does not suffice by itself to prevent recurrences without interventional correction. Venous intervention should be offered early to prevent or slow disease progression and reduce recurrence.