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Abstract Background Anamorelin was approved in Japan in 2021 to treat cancer cachexia associated with non‐small cell lung, gastric, pancreatic, or colorectal cancers. Post‐marketing surveillance is being conducted to evaluate the real‐world safety and effectiveness of anamorelin. Methods This prospective, observational surveillance registered all patients who started treatment with anamorelin after April 21, 2021. Hyperglycemia, hepatic impairment, conduction disorders, and their associated adverse events related to treatment were defined as main safety specifications. Body weight (BW) and appetite were assessed as effectiveness specifications. Results This analysis was based on data as of January 21, 2023. The safety and effectiveness analysis sets included 6016 and 4511 patients, respectively. Treatment‐related adverse events in ≥1% of patients were hyperglycemia (3.9%) and nausea (2.6%). The incidences of hyperglycemia, hepatic impairment, conduction disorders, and their associated adverse events related to treatment were 4.8%, 1.2%, and 1.1%, respectively. The mean changes (standard error [SE]) in BW from baseline to weeks 3, 12, 24, and 52 were 0.64 (0.05) kg, 1.19 (0.12) kg, 1.40 (0.21) kg, and 1.42 (0.39) kg, respectively. The mean changes (SE) in Functional Assessment of Anorexia/Cachexia Treatment 5‐item Anorexia Symptom Scale total scores from baseline to weeks 3, 12, 24, and 52 were 3.2 (0.09), 4.8 (0.18), 5.2 (0.30), and 5.3 (0.47), respectively, exceeding the clinically meaningful improvement score (2.0 points). Conclusion The overall safety of anamorelin raised no new safety concerns, although continued caution may be required for hyperglycemia and nausea. Improvements in BW and appetite were also observed in real‐world clinical settings.

Abstract Advances in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) over the past decade changed the disease landscape, yet global insight on clinical practices remains limited. The CTEPH global cross‐sectional scientific survey (CLARITY) aimed to gather information on the current diagnosis, treatment, and management of CTEPH and to identify unmet medical needs. This paper focuses on the treatment and management of CTEPH patients. The survey was circulated to hospital‐based medical specialists through Scientific Societies and other medical organizations from September 2021 to May 2022. The majority of the 212 respondents involved in the treatment of CTEPH were from centers performing up to 50 pulmonary endarterectomy (PEA) and/or balloon pulmonary angioplasty (BPA) procedures per year. Variation was observed in the reported proportion of patients deemed eligible for PEA/BPA, as well as those that underwent the procedures, including multimodal treatment and subsequent follow‐up practices. Prescription of pulmonary arterial hypertension‐specific therapy was reported for a variable proportion of patients in the preoperative setting and in most nonoperable patients. Reported use of vitamin K antagonists and direct oral anticoagulants was similar (86% vs. 82%) but driven by different factors. This study presents heterogeneity in treatment approaches for CTEPH, which may be attributed to center‐specific experience and region‐specific barriers to care, highlighting the need for new clinical and cohort studies, comprehensive clinical guidelines, and continued education.

Abstract Aims To describe nursing students' experiences of a TeamSTEPPS® longitudinal team training program and the application of teamwork skills in clinical practice. Design A descriptive qualitative design. Methods Overall, 22 nursing students participated in six online focus group interviews after attending a TeamSTEPPS® team training program from their first semester. The data were audio‐recorded, transcribed and analysed using inductive content analysis and reported following the COREQ guidelines. The focus group interviews took place in the students' fifth's semester. Results The main category “Learning teamwork is not an event; it's a journey” emerged from 3 generic categories and 12 subcategories. The participants reported that grasping the relevance of team training and the use of teamwork skills takes time. Utilizing these skills improved their awareness of being a team member and facilitated learning. Conclusion Team training raised the participants' awareness of teamwork as an essential component of being a professional nurse. Additionally, understanding the complexity of teamwork takes time.

Abstract Objective Greater self‐monitoring of caloric intake and weight has been associated with success at both initial weight loss and long‐term maintenance. Given the existence of wide variability in weight loss outcomes and the key role of self‐monitoring within behavioral weight management interventions, this study examined individual variability in associations between self‐monitoring and weight change and whether demographic factors could predict who may best benefit from self‐monitoring. Methods Participants were 72 adults with overweight or obesity (mean ± SD, age = 50.6 ± 10.3; body mass index = 31.2 ± 4.5 kg/m2; 71%Female; 83%White) enrolled in a 12‐week weight loss program followed by a 40‐week observational maintenance period. Participants were encouraged to self‐monitor caloric intake and weight daily and to report these data via a study website each week. Multilevel mixed models were used to estimate week‐to‐week associations between self‐monitoring and weight change, by individual and linear regressions and ANOVAs were used to explore demographic differences in these associations. Results Most participants (68%) demonstrated statistically significant negative associations between self‐monitoring of either caloric intake or weight and weight change. Of these, 76% benefited from self‐monitoring both caloric intake and weight, 18% from self‐monitoring caloric intake only, and 6% from self‐weighing only. The magnitude of associations between self‐monitoring and weight change did not significantly differ by age, gender, race/ethnicity, education, or income, all ps > 0.05. Conclusions Differences in the effectiveness of self‐monitoring for weight loss were not observed by demographic characteristics. Future research should examine if other factors may predict the effectiveness of self‐monitoring.

Abstract Early recognition and diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is crucial for improving prognosis and reducing the disease burden. Established clinical practice guidelines describe interventions for the diagnosis and evaluation of CTEPH, yet limited insight remains into clinical practice variation and barriers to care. The CTEPH global cross‐sectional scientific survey (CLARITY) was developed to gather insights into the current diagnosis, treatment, and management of CTEPH and to identify unmet medical needs. This paper focuses on the recognition and diagnosis of CTEPH and the referral and evaluation of these patients. The survey was offered to hospital‐based medical specialists through Scientific Societies and other medical organizations, from September 2021 to May 2022. Response data from 353 physicians showed that self‐reported awareness of CTEPH increased over the past 10 years among 96% of respondents. Clinical practices in acute pulmonary embolism (PE) follow‐up and CTEPH diagnosis differed among respondents. While 50% of respondents working in a nonexpert center reported to refer patients to an expert pulmonary hypertension/CTEPH center when CTEPH is suspected, 51% of these physicians did not report referral of patients with a confirmed diagnosis for further evaluation. Up to 50% of respondents involved in the evaluation of referred patients have concluded a different operability status than that indicated by the referring center. This study indicates that early diagnosis and timely treatment of CTEPH is challenged by suboptimal acute PE follow‐up and patient referral practices. Nonadherence to guideline recommendations may be impacted by various barriers to care, which were shown to vary by geographical region.

Abstract Aim To explore nurses' experiences and perspectives about evidence‐based practice (EBP) implementation in the healthcare context. Design A qualitative descriptive study design using focus group discussions (FGDs). Method Sixty‐four nurses who purposefully selected and worked at various healthcare organizations in Bisha Governorate, Saudi Arabia, were included. Eight FGDs were used to obtain data using open‐ended questions. The collected data underwent inductive qualitative content analysis. Results Two main categories were extracted: experiences and perspectives towards EBP. The experiences category emerged into four sub‐categories: familiarity with concepts and benefits, steps, dissemination sources of EBP and sources of EBP knowledge, while perspectives towards the EBP category included four sub‐categories: application of EBP in clinical practice, barriers, facilitators and EBP application methods. The participants experienced being in a non‐supportive and non‐encouraging atmosphere which results from a lack of organizational commitment to EBP implementation and illuminates the complexities involved in the integration process. Conclusion The nurses' experience with EBP indicated that there was limited support for the implementation of this approach. Furthermore, they experienced varying barriers to EBP implementation. They viewed EBP as a complex technique as they lacked knowledge and skills related to the formulation of research questions, and retrieving, applying and disseminating of EBP in clinical practice decision‐making. That is due to barriers pertinent to the individual, organizational and patient factors. The key to successfully implementing an EBP in nursing practice is to promote professional development, comprehensive and continuous training, a culture of change, organizational support and motivation. Clinical Relevance Through the construction and provision of ongoing educational interventions and mentoring programmes about EBP, healthcare organizations and nursing leadership may develop a comprehensive strategy to encourage staff nurses' participation in the EBP process. This is to enhance nurses' experiences and perspectives towards the EBP approach and overcome the barriers to effective implementation. No Patient or Public Contribution to this Study Patients or the general public were not involved in the design, analysis or interpretation of the data in this study.

Abstract Pulmonary hypertension (PH) is the most severe complication in preterm infants with bronchopulmonary dysplasia (BPD) and associated with significant mortality. Diagnostic and treatment strategies, however, still lack standardization. By the use of a survey study (PH in BPD), we assessed clinical practice (diagnosis, treatment, follow‐up) in preterm infants with early postnatal persistent pulmonary hypertension of the newborn (PPHN) as well as at risk for or with established BPD‐associated PH between 06/2018 and 10/2020 in two‐thirds of all German perinatal centers with >70 very low birthweight infants/year including their cardiology departments and outpatient units. Data were analyzed descriptively by measures of locations and distributional shares. In routine postnatal care, clinical presentation and echocardiography were reported as the main diagnostic modalities to screen for PPHN in preterm infants, whereas biomarkers brain natriuretic peptide/N‐terminal pro b‐type natriuretic peptide were infrequently used. For PPHN treatment, inhaled nitric oxide was used in varying frequency. The majority of participants agreed to prescribe diuretics and steroids (systemic/inhaled) for infants at risk for or with established BPD‐associated PH and strongly agreed on recommending respiratory syncytial virus immunization and the use of home monitoring upon discharge. Reported oxygen saturation targets, however, varied in these patients in in‐ and outpatient care. The survey reveals shared practices in diagnostic and therapeutic strategies for preterms with PPHN and BPD‐associated PH in Germany. Future studies are needed to agree on detailed echo parameters and biomarkers to diagnose and monitor disease next to a much‐needed agreement on the use of pulmonary vasodilators, steroids, and diuretics as well as target oxygen saturation levels.

Abstract INTRODUCTION Disease‐modifying therapies (DMTs) for Alzheimer's disease (AD) will increase diagnostic demand. A non‐invasive blood‐based biomarker (BBBM) test for detection of amyloid‐β pathology may reduce diagnostic barriers and facilitate DMT initiation. OBJECTIVE To explore heterogeneity in AD care pathways and potential role of BBBM tests. METHODS Survey of 213 healthcare professionals/payers in US/China/UK/Germany/Spain/France and two advisory boards (US/Europe). RESULTS Current diagnostic pathways are heterogeneous, meaning many AD patients are missed while low‐risk patients undergo unnecessary procedures. Confirmatory amyloid testing (cerebrospinal fluid biomarkers/positron emission tomography) is utilized in few patients, resulting in diagnostic/treatment delays. A high negative‐predictive‐value test could streamline the diagnostic pathway by reducing unnecessary procedures in low‐risk patients; supporting confirmatory testing where needed. Imminent approval of DMTs will increase need for fast and reliable AD diagnostic tests. DISCUSSION An easy‐to‐use, accurate, non‐invasive BBBM test for amyloid pathology could guide diagnostic procedures or referral, streamlining early diagnosis and DMT initiation. Highlights This study explored AD care pathways and how BBBM may meet diagnostic demands Current diagnostic pathways are heterogeneous, with country and setting variations Many AD patients are missed, while low‐risk patients undergo unnecessary procedures An easy‐to‐use, accurate, non‐invasive BBBM test for amyloid pathology is needed This test could streamline early diagnosis of amyloid pathology and DMT initiation

Abstract Aim Unsafe medication behaviour was the direct cause of medication error, while the current status of unsafe medication behaviour among Chinese clinical nurses remains uncertain. To investigate unsafe medication behaviour among Chinese nurses and to analyse its associated factors. Design A cross‐sectional online study was conducted in 31 provinces and municipalities of mainland China. Methods The electronic self‐administered questionnaire was used to collect data from July–August 2020, including demographic information (age, gender, initial degree, ultimate education degree, hospital levels, unit nature, professional position, duty, departments, working years and working regions) and an adapted nurse unsafe medication behaviour scale measuring self‐reported nurse unsafe medication behaviour (SR‐NUMB). A generalized linear mixed model was applied to determine the influencing factors. Results A total of 10,153 Chinese nurses responded online, and 7,873 responses that met the time control requirements were included finally. It turned out that 80.49% of Chinese nurses had SR‐NUMB. Specifically, 72.81% of them had unsafe medication behaviours in the process of medication administration, followed by medication monitoring (53.09%), medication preservation and dispensing (47.42%), and medical order processing (44.53%). A generalized linear mixed model demonstrated that male nurses and nurses who work in secondary hospitals or general hospitals, those who have higher professional positions or duties, those who have been working for 5–10 years, and those who are working in emergency and intensive critical units may have higher level of SR‐NUMB compared to other nurses. Conclusion Suboptimal SR‐NUMB among Chinese nurses was identified in our findings. Associated factors, such as gender, hospital levels, unit nature, professional position, duty, working years and departments, should be targeted in future prevention and intervention efforts for safe medication management among Chinese nurses.

Abstract Aim To describe and compare the clinical learning environment in community‐based home care and primary health care in postgraduate district nursing students' education. Design Cross‐sectional study design. Methods A convenience sample of postgraduate district nursing students was derived from five Swedish universities in 2016 and 2017. Results The postgraduate district nursing students were generally satisfied with the clinical learning environment in their clinical placement. In clinical placement, several factors affected the students' opportunities to learn, such as sufficiently meaningful learning situations with multidimensional content. A working environment that imposed psychosocial strain and high levels of stress among the staff negatively affected the students' learning. To further improve their learning from clinical practices, the students need preceptors who have the skills and competence required to support more advanced reflections and critical thinking on caring situations.

Abstract Background and Aim Sofosbuvir–velpatasvir was recommended for subsidy to treat chronic hepatitis C in Singapore in 2018. We measured the impact of the subsidy decision on clinical practice and patient outcomes. Specifically, we looked at pre‐ and post‐subsidy changes in the utilization and prescribing pattern of chronic hepatitis C treatment and the real‐world clinical effectiveness. Method Utilization trends and prescribing patterns were assessed using aggregated drug utilization data from public hospitals' dispensing systems and clinical data from the national electronic health record database, respectively. An audit was conducted to evaluate sustained virological response rate 12 weeks post treatment (SVR12). Results Use of sofosbuvir–velpatasvir increased sharply since its subsidy listing and dropped subsequently, whereas the utilization of comparator drugs remained low. Prescribing rate of sofosbuvir–velpatasvir increased from 13.7% in the pre‐subsidy period to 90.2% in the post‐subsidy period; 39.1% of patients previously on pegylated interferon and ribavirin switched to sofosbuvir–velpatasvir following its subsidy listing. In the audit, 365 out of 375 patients (97.3% [95% confidence interval: 95.1–98.6%]) achieved SVR12. Conclusion The subsidy decision led to increased accessibility to patients and intended changes in clinical practice. Sofosbuvir–velpatasvir was also clinically effective in the real world. These findings augur well for the continued eradication of chronic hepatitis C infection in Singapore.

Abstract Aim This study explored the experiences of undergraduate nursing students who worked clinically during the COVID‐19 pandemic in Irish healthcare settings. Design A qualitative descriptive approach was employed. Methods Online focus group interviews were used to collect data from general nursing students (N = 47) between February and April 2021. Data were analysed using thematic analysis. Results Descriptive thematic analysis of the data revealed five themes; changes in care delivery, changes in communication and relationships with the patient, an emotionally charged work atmosphere, coping strategies during the pandemic and student learning specific to COVID‐19. Challenges such as an increased workload, fear of contracting the virus and taking on novel and additional roles were revealed. Students remained undeterred, and despite the many challenges faced, they largely viewed their experiences as a source of personal and professional growth, and benefitted from the learning opportunities afforded to them.

Abstract Objective To examine the efficacy and safety of fenfluramine in patients with Dravet syndrome (DS) in three age groups:

Abstract In 2021, the Universal Health Coverage Payment Scheme of Thailand approved home blood pressure monitoring (HBPM) devices for reimbursement. National utilization of HBPM devices will begin in 2022. This article provides the recommendations for HBPM from the Thai Hypertension Society. In this report, the authors review the benefits of HBPM and recommend confirming the diagnosis of hypertension by HBPM. Devices for HBPM should be the automated and validated upper arm cuff devices. HBPM should be ideally done for seven consecutive days before each clinic visit and take at least two readings (1 min apart) in the morning and before going to bed. The average blood pressure (BP) of 125–134/75–84 mmHg is classified as high normal BP and hypertension is BP of 135/85 mmHg or more. Target BP levels depend on the age of the patients; that is,

Abstract Background The multidisciplinary team (MDT) of precision medicine refers to an expert group composed of experts from multiple disciplines, which uses the concept of precision medicine to regularly discuss related diseases, in order to solve difficult clinical problems and put forward feasible personalized treatment schemes for patients. Methods and results The composition and function of precision medicine MDT is defined based on our clinical practice. MDT consists of core fixed members, extended members, auxiliary personnel and secretary. The overall workflow of MDT includes patient selection, organization, discussion and follow‐up. Under this workflow, our MDT team handled many cases, and some of them have been reported. Conclusion We focused on the strategy analysis on multidisciplinary team of precision medicine including composition, function, management, and criteria, hoping to provide a novel and standardized treatment mode for patients.

Abstract Background ARFID (avoidant restrictive food intake disorder) is a relatively new diagnostic term covering a number of well‐recognised, clinically significant disturbances in eating behaviour unrelated to body weight/shape concerns. Its phenotypic heterogeneity combined with much about the condition remaining unknown, can contribute to uncertainties about best practice. While other reviews of the evidence base for ARFID exist, few specifically target health care professionals and implications for clinical practice. Methods A narrative review was conducted to synthesise the findings of ARFID papers in scientific journals focussing on four key areas relevant to clinical practice: prevalence, assessment and characterisation of clinical presentations, treatment, and service delivery. Freely available online databases were searched for case studies and series, research reports, review articles, and meta‐analyses. Findings were reviewed and practice implications considered, resulting in proposed clinical recommendations and future research directions. Results We discuss what is currently known about the four key areas included in this review. Based on available evidence as well as gaps identified in the literature, recommendations for clinical practice are derived and practice‐related research priorities are proposed for each of the four of the areas explored. Conclusion Prevalence studies highlight the need for referral and care pathways to be embedded across a range of health care services. While research into ARFID is increasing, further studies across all areas of ARFID are required and there remains a pressing need for guidance on systematic assessment, evidence‐based management, and optimal service delivery models. Informed clinical practice is currently predominantly reliant on expert consensus and small‐scale studies, with ongoing routine clinical data capture, robust treatment trials and evaluation of clinical pathways all required. Despite this, a number a positive practice points emerge.

Abstract Background We conducted a multicenter, retrospective study on the efficacy and safety of naldemedine in thoracic cancer patients using opioids in clinical practice. Methods We retrospectively evaluated thoracic cancer patients treated with naldemedine at 10 institutions in Japan. Clinical data of patients administered naldemedine between June 2017 and August 2019 were extracted from electronic medical records. Inclusion criteria were as follows: (i) patients hospitalized for at least seven days before and after naldemedine administration, and (ii) those whose frequency of defecation was entered in the medical records. Results Forty patients were analyzed, and defecation frequency was observed for at least seven days before and after naldemedine administration. The response rate was 65.0% (95% CI: 50.2%–79.7%). The number of defecations increased significantly after naldemedine administration in the overall population, as well as among only those who defecated

Abstract Skin ageing is a complex process. Both intrinsic and extrinsic factors have a role in determining the speed, progression and phenotypic outcomes of the process. Typical clinical signs of ageing, such as wrinkles, thinning and sagging of the skin, are usually first noticed in the mid‐20s to early 30s. However, real‐world studies report that younger Asian women between the ages of 18 and 24 years are perceiving emerging signs of ageing, including dull skin, uneven skin tone, dryness, transient wrinkles, and a lack of skin firmness. These observations have led to a hypothesis that a phase of preageing may exist, where clinical signs of ageing are not yet present, but an individual starts to notice subtle changes in their skin's appearance. This paper discusses the concept of preageing in Asian populations and provides recommendations for recognising and managing the preageing process in clinical practice.

Abstract Background Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing. Aim The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites. Design Discourse paper. Methods This discourse paper is based on our own experiences and is supported by literature and theory. Results Well‐functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.

Abstract Aims To describe the mentoring competence of clinical practice nurse mentors and identify different mentor profiles. Design Cross‐sectional research design, secondary analysis. Methods An international, cross‐sectional study design was performed in five European countries. A total of 1 604 mentors from 33 healthcare organizations participated in the study between 2016–2019. The Mentors' Competence Instrument (MCI), which includes seven sub‐dimensions and 44 items, was used to collect data. K‐means cluster and binary regression analyses were performed to detect mentor profiles and determine how various factors affect competence, respectively. Results The K‐means cluster analysis identified three distinct profiles: A (n = 926); B (n = 566); and C (n = 85). The profiles showed significantly different values (p

Abstract Background Approximately 8%–12% of couples worldwide face infertility, with infertility of individuals assigned male at birth (AMAB) contributing to at least 50% of cases. Conventional semen analysis commonly used to detect sperm abnormalities is insufficient, as 30% of AMAB patients experiencing infertility show normal results in this test. From a genetic perspective, the assessment of sperm DNA fragmentation (SDF) is important as a parameter of sperm quality. Methods In this narrative study, we review and discuss pathophysiological causes, DNA repair mechanisms, and management of high SDF. We then summarize literature exploring the association between SDF and reproductive outcomes. Main Findings Recent systematic reviews and meta‐analyses have revealed a significant association between high SDF in AMAB individuals and adverse reproductive outcomes including embryo development, natural conception, intrauterine insemination, and in vitro fertilization. However, the association with live birth rates and pregnancy rates following intracytoplasmic injection remains inconclusive. The disparities among quantitative assays, inconsistent reference range values, absent high‐quality prospective clinical trials, and clinical heterogeneity in AMAB patients with elevated SDF represent the main limitations affecting SDF testing. Conclusion The evaluation and management of SDF plays an important role in a subset of AMAB infertility, but widespread integration into clinical guidelines will require future high‐quality clinical trials and assay standardization.

Background Diagnosis of pulmonary hypertension (PH) is often delayed or missed, leading to disease progression and missed treatment opportunities. In this study, we measured variation in care provided by board‐certified cardiologists and pulmonologists in simulated patients with potentially undiagnosed PH. Methods and Results In a cross‐sectional study (https://www.clinicaltrials.gov, NCT04693793), 219 US practicing cardiologists and pulmonologists cared for simulated patients presenting with symptoms of chronic dyspnea and associated signs of potential PH. We scored the clinical quality‐of‐care decisions made in a clinical encounter against predetermined evidence‐based criteria. Overall, quality‐of‐care scores ranged from 18% to 74%, averaging 43.2%±11.5%. PH, when present, was correctly suspected 49.1% of the time. Conversely, physicians incorrectly identified PH in 53.7% of non‐PH cases. Physicians ordered 2‐dimensional echocardiography in just 64.3% of cases overall. Physicians who ordered 2‐dimensional echocardiography in the PH cases were significantly more likely to get the presumptive diagnosis (61.9% versus 30.7%; P

Aim: Dietitians are a well-placed profession to be providing pre-emptive oral health promotion. Despite recommendations that oral health promotion should be routinely part of dietetic practice, there is limited data informing the current practices of clinical dietitians in this area across Australia. Hence, the aim of this study was to investigate the knowledge and practices of Australian dietitians and oral health promotion., Methods: A cross-sectional survey was undertaken involving registered clinical dietitians in Australia using purposive and snowballing sampling (social media/dietetic organisations/public databases). Data were analysed using descriptive and inferential statistics., Results: A total of 149 dietitians participated in the national survey. Overall, dietitians were knowledgeable about oral health risk factors and preventative measures across general health domains. Majority of dietitians agreed that oral health can affect nutrition interventions (95.5%) and dietitians should be discussing oral health (88.0%). However, nearly half were not confident in providing counselling or education and felt that undergraduate training for oral health promotion was inadequate (78.2%). A small proportion (6.0%) of dietitians were already providing oral health promotion regularly. Key barriers included a lack of clear guidelines for practice, limited training opportunities and indistinct referral pathways., Conclusion: Dietitians have acknowledged that oral health promotion should be incorporated into their practice. However, they are challenged by a lack of resources and training to support this in clinical practice. SO WHAT?: Capacity building dietitians to promote oral health allows opportunity for improvement in the oral health, nutritional status and quality of life of priority population groups., (© 2024 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Abstract Aim This study aims to explore the challenges and benefits of using the nursing process in a Ghanaian Hospital. Design The study employed a qualitative descriptive design to explore the challenges and the benefits of the utilization of the nursing process. Methods Twelve (12) Registered Nurses were recruited for the study using purposive sampling. Recorded in‐depth interviews were conducted and data were analysed using thematic analysis. Results The study found a low nurse‐to‐patient ratio, inadequate knowledge, apathy, inadequate logistics, poor supervision as challenges. However, quality and cost‐effective care improved nurse–patient relationships, and job satisfaction was found to be the benefits of nursing process use. Interventions to improve its utilization should be targeted towards improving the nurse‐to‐patient ratio, provision of adequate resources and inclusion of the nursing care plan in patient folders.

Abstract Purpose The optimal practice regarding cervical lymph node biopsy (CLNB) remains to be defined to provide the best clinical management in nasopharyngeal carcinoma (NPC). This study aimed to investigate the effect of CLNB on the survival of NPC patients. Methods Patients diagnosed with NPC from 2004 to 2015 were identified using the Surveillance, Epidemiology, and End Results database. Multivariate logistic regression, Kaplan–Meier method, Cox proportional hazards regression analysis, and propensity score matching (PSM) were used to determine the factors associated with CLNB and prognostic effect of CLNB of NPC. Results We included 1903 patients in this study. There were 321 (16.9%) and 1582 (83.1%) patients with and without CLNB, respectively. The percentage of CLNB was 19.4% in 2004 and was decreased to 8.6% in 2015 (p = 0.044). Patients diagnosed in later years (p = 0.008), older age (p

Abstract This study aimed to investigate the hypertension management abilities of rural physicians in a high‐altitude Tibetan area. A cross‐sectional survey was conducted in the Ganzi Tibetan Autonomous Prefecture, China, in October 2020. Information about healthcare resources in local medical institutions, along with the knowledge, attitudes, practices, and training status of primary care physicians, was collected. Limited resources were observed in terms of equipment, drugs, and personnel in the 18 township hospitals included. A total of 132 physicians participated in this survey. The scores for hypertension‐related knowledge, attitudes toward hypertension management, routine practice ability, priority given to hypertension, and confidence in performing certain tasks were 32.60%, 67.40%, 18.90%, 65.15%, and 35.60%, respectively. The most concerning issues lay in the ignorance of the healthy lifestyle, undervaluation of cardiovascular risks, and lack of confidence in optimally performing management activities. Only 9.85% of the physicians received more than 24 days of training per year; 28.79% preferred a longer training time. While training was generally provided in conference sessions (63.64% of current training programs), physicians preferred remote education (55.30%), and on‐site guidance (46.21%) from professionals. The current training was centered around clinical skills (61.36%) and was identified as a major training requirement by the physicians surveyed (80.30%). This survey suggests that the medical resources may not be effective, with deficiencies present in the knowledge and practices of primary care physicians in the Sichuan Tibetan area. Hypertension education and skill‐development courses based on the specific issues identified should be provided to these physicians in the future.

Abstract Background and Aims Clinical skills practice is an essential component in standardized residency training. However, traditionally skill training methods are dogmatic and not all residents are exposed to such prescribed situations during their residency. The aims of this study were to evaluate the effectiveness and influence factors of a four‐step approach combining situational simulation teaching methods in clinical practice for residents. Methods Enrolled all second‐year residents from the internal medicine base between May 2017 and May 2018 (n = 94), randomly divided into two groups. Forty‐eight residents were selected as experimental group, while the others 46 as the control group. Adopted traditional clinical practice method in the teaching and assessment of the control group, while used four‐step approach combining situational simulation teaching method in experimental group. We compared the theoretical and skill assessment scores in preclass and postclass. Conducted a satisfaction survey after class and analyzed the influencing factors of the teaching effect evaluation. Results There were no significant differences in the theoretical and skill assessment scores between experimental group and control group at the beginning. After the class, both the average skill assessment and Direct Observation of Procedural Skills scores of the experimental group were higher than those of the control. Satisfaction survey findings identified that the experimental group expressed higher satisfaction. Logistic regression showed that educational background, “situational simulation mode helps to improve clinical skills training,” “helps to maintain attention during learning,” and “helps improve the ability to exercise analysis and solve problems” were the influencing factors of learners' satisfaction. Conclusion The application of four‐step approach combining situational simulation teaching methods in the clinical practice of residents can significantly improve skills, thinking ability, decision‐making ability, and teaching satisfaction. Therefore, four‐step approach combining situational simulation teaching methods is worth promoting in teaching clinical skills for internal medicine residency training.

Background Lymphoma is the most common malignancy in blood system. There are still unmet treatment needs in Hodgkin's and non‐Hodgkin's lymphoma. Materials & Methods We searched reviews and clinical trials on genetic medicine of lymphoma in Pubmed, the prevelance of lymphoma in Pubmed as well as SEER. Results Genetic analysis helps the practice in lymphoma. For some molecules have become diagnostic markers in some subtypes of lymphoma. Some genetic disorder could forecast the prognosis. Besides, new target drug could be chosen as individual treatment according to the genetic changes in lymphoma cells. Conclusion Precision medicine has shown promising future in the field of lymphoma.

Abstract Hypertension is an important public health issue due to its association with a number of serious diseases, including cardiovascular disease and stroke. The importance of evaluating hypertension taking into account different blood pressure (BP) profiles and BP variability (BPV) is increasingly being recognized, and is particularly relevant in Asian populations given the specific features of hypertension in the region (including greater salt sensitivity and a high rate of nocturnal hypertension). Ambulatory BP monitoring (ABPM) is the gold standard for diagnosing hypertension and assessing 24‐hour BP and provides data on several important parameters that cannot be obtained using any other form of BP measurement. In addition, ABPM parameters provide better information on cardio‐ and cerebrovascular risk than office BP. ABPM should be used in all patients with elevated BP, particularly those with unstable office or home BP, or who are suspected to have white‐coat or masked hypertension. ABPM is also an important part of hypertension diagnosis and monitoring in high‐risk patients. ABPM needs to be performed using a validated device and good practice techniques, and has a role both in hypertension diagnosis and in monitoring the response to antihypertensive therapy to ensure strict BP control throughout the 24‐hour period. Use of ABPM in clinical practice may be limited by cost and accessibility, and practical education of physicians and patients is essential. The ABPM evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for ABPM in Asia.

Abstract Aim The aim was to determine how nurse practitioner (NP) roles are translated into clinical practice across Victoria, Australia. This paper reports details about NP work patterns and scopes of practice across multiple clinical settings and geographic locations. Design A quantitative survey design was used. A data abstraction tool, based on previous work, was adapted for this study. Methods All NPs in one state of Australia were eligible to participate in the study and invited to complete an online survey about their NP practice. A previously developed data collection tool, capturing practice patterns of NPs, was adapted for online use in REDCAP. The data were exported, and descriptive statistics were analysed using SPSS. Results Participants were mostly female, with males accounting for 25%. Findings indicate several NPs working in outpatient settings, community settings and forensic care. Patterns of practice—prescribing and ordering diagnostics—are associated with clinical context and model of care of the NP work.

Abstract Aim Previous research has mainly focused on the advantages of PCC and less on its disadvantages. Hence, there is a need to further explore the recent research regarding PCC from both sides. Therefore, the aim of this paper is to elucidate the advantages and disadvantages of PCC. Design Discussion paper. Methods We searched relevant literature published January 2000–March 2018 in PubMed, Medline, CHINAL, Scopus and Web of Science. Results The results showed that PCC can contribute to improved health and well‐being, improved mutual interaction in relationships, improved cost‐effectiveness and improved work environment, while the disadvantages can involve increased personal and financial costs, exclusion of certain groups, increased personal and financial costs, exclusion of staff's personhood and unfairness due to empathy. An analysis of the existing literature on PCC showed paradoxes, which call for further investigation.

Abstract Aims To examine the experience of new nurses working in the neurology ward and the differences between their training and hospital practice. Design Qualitative. Methods The interviews were conducted from 15 July–28 August 2017, in a quiet and comfortable meeting room at the hospital. Data were collected through interviews with 12 newly graduated nurses working at a neurology ward. Results The results yielded four themes: “ineffective learning of nervous system theory in college,” “difference between learning theory and practical application,” “difficulty in nursing intervention for various clinical symptoms” and “need for teaching method based on actual cases.” Conclusion The findings can be used for the development of effective nursing education programmes to reduce the gap between theory and practice.

Abstract Competency in the application of point‐of‐care ultrasound (POCUS) has come to be an expected fundamental skill set for advanced practice providers (APPs) in the emergency department. Both American College of Emergency Physicians and the Society of Emergency Medicine Physician Assistants approve of and endorse POCUS use by APPs. However, clinical exposure to and practice of ultrasound in this setting is often variable and without structure. POCUS training must be evolved into a system where developed skills are compatible with clinical need and expectations of APPs. At our institution, we developed a formal, structured POCUS training program for emergency medicine (EM) APPs (including physician assistants and nurse practitioners) and evaluated its efficacy quantitatively by means of a proficiency index. This report examines the EM POCUS training most common to physician assistants and nurse practitioners before practicing at our institution and explores the components of our POCUS training program that have affected program development.

Abstract Background There is a lack of high quality evidence to guide the optimal management of diabetes‐related foot infection, particularly in cases of severe diabetes‐related foot infection and diabetes‐related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes‐related foot infection. Methods Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi‐choice and open‐ended questions on clinical management of diabetes‐related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non‐parametric statistical tests. Open‐text responses were examined using inductive content analysis. Results 29 vascular and 20 orthopaedic surgeons completed the survey. One‐third (28.6%) used best‐practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non‐surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe‐to‐bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes‐related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways. Conclusions Most vascular and orthopaedic surgeons do not use best‐practice guidelines to assist in decisions about management of diabetes‐related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes‐related foot infection.

Abstract Background Children with neurodevelopmental disorders share common phenotypes, support needs and comorbidities. Such overlap suggests the value of transdiagnostic assessment pathways that contribute to knowledge about research and clinical needs of these children and their families. Despite this, large transdiagnostic data collection networks for neurodevelopmental disorders are not well developed. This paper describes the development of a nationally supported transdiagnostic clinical and research assessment protocol across Australia. The vision is to establish a harmonised network for data collection and collaboration that promotes transdiagnostic clinical practice and research. Methods Clinicians, researchers and community groups across Australia were consulted using surveys and national summits to identify assessment instruments and unmet needs. A national research committee was formed and, using a consensus approach, selected assessment instruments according to pre‐determined criteria to form a harmonised transdiagnostic assessment protocol. Results Identified assessment instruments were clustered into domains of transdiagnostic assessment needs, which included child functioning/quality of life, child mental health, caregiver mental health, and family background information. From this, the research committee identified a core set of nine measures and an extended set of 14 measures that capture these domains with potential for further modifications as recommended by clinicians, researchers and community members. Conclusion The protocol proposed here was established through a strong partnership between clinicians, researchers and the community. It will enable (i) consensus driven transdiagnostic clinical assessments for children with neurodevelopmental disorders, and (ii) research studies that will inform large transdiagnostic datasets across neurodevelopmental disorders and that can be used to inform research and policy beyond narrow diagnostic groups. The long‐term vision is to use this framework to facilitate collaboration across clinics to enable large‐scale data collection and research. Ultimately, the transdiagnostic assessment data can be used to inform practice and improve the lives of children with neurodevelopmental disorders and their families.

Background: Dysphagia affects over half of adults after stroke. Dysphagia rehabilitation aims to improve swallowing and reduce negative outcomes for these adults. However, significant variability exists in dysphagia rehabilitation. Research is needed to explore the underlying clinician-specific and workplace factors that contribute to variability in dysphagia rehabilitation after stroke., Aim: To explore factors influencing speech pathology practice in dysphagia rehabilitation after stroke., Methods & Procedures: We used a phenomenological approach with an interpretivist perspective. Twenty speech pathologists working in dysphagia rehabilitation participated from different workplace settings around Australia. Five semi-structured focus groups were conducted online. Data were inductively analysed using thematic analysis with a coding reliability method., Outcomes & Results: Four themes were discussed within focus groups: (1) relationship between experienced and less experienced clinicians: 'Following what other people have done', (2) need for collaborative learning: 'A safe space to share and train', (3) variation between settings impacts on continuity of care: 'There's a difference between community and acute', and (4) working effectively with multidisciplinary teams (MDT): 'An MDT which can listen to the voice of speech pathology'., Conclusions & Implications: Relationships between senior and junior speech pathologists, within speech pathology and MDT, and across inpatient and community settings influenced speech pathology practice. Flattened hierarchies in speech pathology, collaborative learning in workplaces, mutual respect within teams and connection across inpatient and community settings could improve the quality and consistency of dysphagia rehabilitation after stroke., What This Paper Adds: What is already known on this subject Dysphagia rehabilitation can improve swallowing after a stroke. However, dysphagia rehabilitation is characterised by variability in clinical practice. Clinician-specific and workplace factors influence clinical practice and may contribute to variability in dysphagia rehabilitation. What this study adds Professional relationships influence speech pathologists' clinical practice, including relationships between senior and junior clinicians, between inpatient and community settings and with peers and multidisciplinary teams. Workplace norms and hierarchies, poor continuity of care between settings and competing priorities from other disciplines can hinder dysphagia rehabilitation. However, collaborative learning, positive workplace cultures and respectful transdisciplinary care can improve the quality and consistency of clinical practice. What are the clinical implications of this work? Flattening hierarchies in the workplace can foster a safe learning space. Further, questioning workplace norms and seeking out peer learning within and across settings can build clinical skills and confidence. Developing positive workplace cultures that support continuous development may be key for empowering speech pathologists to provide high-quality and consistent dysphagia rehabilitation., (© 2024 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Advances in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) over the past decade changed the disease landscape, yet global insight on clinical practices remains limited. The CTEPH global cross-sectional scientific survey (CLARITY) aimed to gather information on the current diagnosis, treatment, and management of CTEPH and to identify unmet medical needs. This paper focuses on the treatment and management of CTEPH patients. The survey was circulated to hospital-based medical specialists through Scientific Societies and other medical organizations from September 2021 to May 2022. The majority of the 212 respondents involved in the treatment of CTEPH were from centers performing up to 50 pulmonary endarterectomy (PEA) and/or balloon pulmonary angioplasty (BPA) procedures per year. Variation was observed in the reported proportion of patients deemed eligible for PEA/BPA, as well as those that underwent the procedures, including multimodal treatment and subsequent follow-up practices. Prescription of pulmonary arterial hypertension-specific therapy was reported for a variable proportion of patients in the preoperative setting and in most nonoperable patients. Reported use of vitamin K antagonists and direct oral anticoagulants was similar (86% vs. 82%) but driven by different factors. This study presents heterogeneity in treatment approaches for CTEPH, which may be attributed to center-specific experience and region-specific barriers to care, highlighting the need for new clinical and cohort studies, comprehensive clinical guidelines, and continued education., Competing Interests: Nika Skoro‐Sajer reports fees for lectures and/or consultations from Actelion, AOP Orphan Pharmaceuticals, Bayer, Cordis, GlaxoSmithKline, Janssen, Pfizer, Medtronic, and United Therapeutics. Karen Sheares reports educational support and honoraria for consultations from Actelion, Janssen. Gustavo Heresi reports fees for non‐branded, non‐promotional lectures from Bayer and fees for consultations from Bayer and Janssen. Grzegorz Kopeć reports fees for lectures and/or consultations from Acceleron, Actelion, AOP Health, Bayer, Ferrer, Janssen, and MSD. Mario Terra‐Filho reports consultation fees from Bayer and Janssen. Amélie Beaudet and Virginie Gressin are employees of Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson. Kohtaro Abe reports having received a research grant from Actelion Pharmaceuticals Japan. The remaining authors declare no conflict of interest., (© 2024 The Author(s). Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)

Objective: There is international interest in the integration of patient-reported outcome measures (PROMs) into routine HIV care, but little work has synthesized the content of published initiatives. We conducted a rapid scoping review primarily to identify their selected patient-reported outcomes and respective instruments., Methods: Four databases were searched on 4 May 2022 (Medline, Embase, CINAHL and PsychINFO) for relevant English language documents published from 2005 onwards. Dual review of at least 20% of records, full texts and data extraction was performed. Outcomes and instruments were classified with an adapted 14-domain taxonomy. Instruments with evidence of validation were described., Results: Of 13 062 records generated for review, we retained a final sample of 94 documents, referring to 60 distinct initiatives led mostly in the USA (n = 29; 48% of initiatives), Europe (n = 16; 27%) and Africa (n = 9; 15%). The measured patient-reported outcome domains were: mental health (n = 42; 70%), substance use (n = 23; 38%), self-management (n = 16; 27%), symptoms (n = 12; 20%), sexual/reproductive health (n = 12; 20%), physical health (n = 9; 15%), treatment (n= 8; 13%), cognition (n = 7; 12%), quality of life (n = 7; 12%), violence/abuse (n = 6; 10%), stigma (n = 6; 10%), socioeconomic issues (n = 5; 8%), social support (n = 3; 5%) and body/facial appearance (n = 1; 2%). Initiatives measured 2.6 outcome domains, on average (range = 1-11). In total, 62 distinct validated PROMs were identified, with 53 initiatives (88%) employing at least one (M = 2.2). Overwhelmingly, the most used instrument was any version of the Patient Health Questionnaire to measure symptoms of depression, employed by over a third (26; 43%) of initiatives., Conclusion: Published PROM initiatives in HIV care have spanned 19 countries and disproportionately target mental health and substance use., (© 2024 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)

Background: Spoken discourse impairments post-traumatic brain injury (TBI) are well-documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech-language pathologist (SLP) is recommended for adults with discourse impairments post-TBI, with an emphasis on context-sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice., Aims: To explore the under-researched area of clinical practice for spoken discourse interventions with adults post-TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base., Methods & Procedures: Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi-structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach., Outcomes & Results: Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight-building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client-specific factors and rationales prioritized tailored, context-sensitive and goal-directed treatment., Conclusions & Implications: This study provided insight into a previously under-researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post-TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post-TBI, from initial assessment to outcome measurement, may help inform clinical decision-making and the transfer of research to practice., What This Paper Adds: What is already known on the subject Spoken discourse impairments occur in dialogic and monologic productions post-TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision-making for discourse interventions post-TBI are limited. What this paper adds to existing knowledge This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post-TBI. It details the factors that influence clinical decision-making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work? This study identifies the broad and complex considerations required to deliver context-sensitive discourse intervention post-TBI. It indicates the need for an in-depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience., (© 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Spoken discourse is commonly affected after traumatic brain injury (TBI). Although guidelines recommend prioritizing discourse-level skills in cognitive communication management, previous literature has highlighted challenges in managing discourse clinically. Little is known about how speech-language pathologists (SLPs) assess and treat discourse after TBI., Aims: To investigate current SLP practice to determine the alignment of clinical practice with research evidence and recommendations., Methods & Procedures: This online survey consisted of 30 questions on SLPs' practice with discourse assessment, analysis and treatment processes, including the materials and methods used and rationales for decision-making. Participants were recruited through national and international SLP professional bodies, TBI-specific or SLP special-interest groups and social media. Survey responses were analysed using descriptive statistics, with free text included to support individual responses., Outcomes & Results: There were 70 participants, from Australia, the United States, UK and New Zealand. Nearly half the participants had over 11 years of experience working with adults with TBI and a quarter had over 20 years of experience. Participants reported that they regularly evaluated the discourse ability of people with TBI, most commonly during spontaneous conversation or with a personal narrative task. Discourse intervention approaches mostly targeted client self-monitoring ability, social skills or conversational interactions. Practice varied dependent on setting, with more SLPs in community or outpatient services undertaking discourse assessment and treatment than in hospital settings., Conclusions & Implications: Overall, survey respondents' management of spoken discourse aligned with recommendations in the research literature, incorporating an individualized, goal-based approach. Factors affecting the use of discourse in practice included client-specific factors and needs, availability of time for transcription and analysis, and SLPs' knowledge level and confidence with discourse. Increased knowledge of discourse methods and treatment approaches could help inform decision-making for SLPs working in TBI., What This Paper Adds: What is already known on this subject Spoken discourse is one of the most affected areas of communication for people with TBI. Although recent research has provided guidance on assessment and treatment options for TBI discourse, it is unknown how SLPs manage spoken discourse clinically. What this paper adds to existing knowledge This research adds to the limited research on how SLPs across clinical settings and regions manage discourse assessment and treatment. Respondents' practice was generally aligned with recommendations, featuring individualized, goal-based practice. Potential barriers to discourse implementation included client factors and SLP knowledge, training, and service delivery factors. What are the potential or actual clinical implications of this work? This survey provides evidence that clinical translation is starting to occur in this field, but there remains a need for increased knowledge of assessment and treatment methods, training, and TBI-specific resources to better support SLP practice, particularly relating to transcription. Core reporting outcomes in research on TBI discourse management would assist with translation of the findings to practice., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Early recognition and diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is crucial for improving prognosis and reducing the disease burden. Established clinical practice guidelines describe interventions for the diagnosis and evaluation of CTEPH, yet limited insight remains into clinical practice variation and barriers to care. The CTEPH global cross-sectional scientific survey (CLARITY) was developed to gather insights into the current diagnosis, treatment, and management of CTEPH and to identify unmet medical needs. This paper focuses on the recognition and diagnosis of CTEPH and the referral and evaluation of these patients. The survey was offered to hospital-based medical specialists through Scientific Societies and other medical organizations, from September 2021 to May 2022. Response data from 353 physicians showed that self-reported awareness of CTEPH increased over the past 10 years among 96% of respondents. Clinical practices in acute pulmonary embolism (PE) follow-up and CTEPH diagnosis differed among respondents. While 50% of respondents working in a nonexpert center reported to refer patients to an expert pulmonary hypertension/CTEPH center when CTEPH is suspected, 51% of these physicians did not report referral of patients with a confirmed diagnosis for further evaluation. Up to 50% of respondents involved in the evaluation of referred patients have concluded a different operability status than that indicated by the referring center. This study indicates that early diagnosis and timely treatment of CTEPH is challenged by suboptimal acute PE follow-up and patient referral practices. Nonadherence to guideline recommendations may be impacted by various barriers to care, which were shown to vary by geographical region., Competing Interests: Grzegorz Kopeć reports fees for lectures and/or consultations from Acceleron, Actelion, AOP Health, Bayer, Ferrer, Janssen, and MSD; Kohtaro Abe reports having received a research grant from Actelion Pharmaceuticals Japan; Amélie Beaudet and Virginie Gressin are employees of Actelion Pharmaceuticals Ltd., a Janssen Pharmaceutical Company of Johnson & Johnson; Karen Sheares reports educational support and honoraria for consultations from Actelion, Janssen; Nika Skoro‐Sajer reports fees for lectures and/or consultations from Actelion, AOP Orphan Pharmaceuticals, Bayer, Cordis, GlaxoSmithKline, Pfizer, Medtronic, and United Therapeutics; Mario Terra‐Filho reports consultation fees from Bayer and Janssen; Gustavo Heresi reports fees for non‐branded, non‐promotional lectures from Bayer and fees for consultations from Bayer and Janssen., (© 2024 Actelion Pharmaceuticals Ltd. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)

Pulmonary hypertension (PH) is the most severe complication in preterm infants with bronchopulmonary dysplasia (BPD) and associated with significant mortality. Diagnostic and treatment strategies, however, still lack standardization. By the use of a survey study (PH in BPD), we assessed clinical practice (diagnosis, treatment, follow-up) in preterm infants with early postnatal persistent pulmonary hypertension of the newborn (PPHN) as well as at risk for or with established BPD-associated PH between 06/2018 and 10/2020 in two-thirds of all German perinatal centers with >70 very low birthweight infants/year including their cardiology departments and outpatient units. Data were analyzed descriptively by measures of locations and distributional shares. In routine postnatal care, clinical presentation and echocardiography were reported as the main diagnostic modalities to screen for PPHN in preterm infants, whereas biomarkers brain natriuretic peptide/N-terminal pro b-type natriuretic peptide were infrequently used. For PPHN treatment, inhaled nitric oxide was used in varying frequency. The majority of participants agreed to prescribe diuretics and steroids (systemic/inhaled) for infants at risk for or with established BPD-associated PH and strongly agreed on recommending respiratory syncytial virus immunization and the use of home monitoring upon discharge. Reported oxygen saturation targets, however, varied in these patients in in- and outpatient care. The survey reveals shared practices in diagnostic and therapeutic strategies for preterms with PPHN and BPD-associated PH in Germany. Future studies are needed to agree on detailed echo parameters and biomarkers to diagnose and monitor disease next to a much-needed agreement on the use of pulmonary vasodilators, steroids, and diuretics as well as target oxygen saturation levels., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)