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Background: Chronic pain services in the United Kingdom are required to provide services which meet the diverse needs of patients, but little is known about the access and use of these services by Minority Ethnic groups. This protocol describes a scoping review that aims to assess whether adults who access secondary and tertiary chronic pain services are representative of the UK population. Methods: A scoping review will be conducted, comprising comprehensive searches of the literature using EMBASE, MEDLINE and CINAHL databases, and grey literature for records that address the study aims. Studies that meet the eligibility criteria will report on: (i) access to chronic pain services in secondary and/or tertiary care in the United Kingdom, (ii) by adults and, (iii) state the ethnicity of the involved participants within the demographics. Both qualitative and quantitative methodologies will be included to draw broad conclusions of what the cumulative evidence says on this topic. Publication dates are limited to between 2004 and 2021 as demographic data from studies published during this period best represent the UK population recorded in the 2011 UK census. The screening and selection process will be conducted by four reviewers and data will be extracted by one reviewer. A descriptive synthesis of the extracted data will be performed. Discussion: This scoping review will be among the first to explore whether the current adult population of those with chronic pain who are accessing chronic pain services in secondary and/or tertiary care across the United Kingdom are representative of the UK Minority Ethnic population. [ABSTRACT FROM AUTHOR]

In order to improve the outcome observed with azacitidine (AZA) in higher‐risk Myelodysplastic syndrome (MDS), its combination with other drugs in MDS must be evaluated. So far, no combination has not been shown to be more effective than AZA alone. AZA‐PLUS was a phase II trial that, in a "pick a winner" approach, randomly assigned patients with higher‐risk MDS, CMML and low blast count AML to: AZA; AZA plus lenalidomide; AZA plus Valproic Acid or AZA plus Idarubicin. 322 patients were included. After six cycles, 69 (21.4%) CR + PR were observed with no benefit from any combination. Median EFS and OS were 17.2 and 19.7 months in the whole cohort, respectively, with no difference across randomised arms. Infection and rates of hospitalisation during the first six cycles were higher in the AZA‐LEN And AZA‐IDA arm, related to increased myelosuppression. Factors associated with better response were IPSS, favourable or intermediate karyotype, haemoglobin, lower circulating blast count, fibrinogen level and lower LDH, while poorer survival was seen in therapy‐related MDS and, in the case of TP53, PTPN11 or CSF3R mutation. The combinations used did not improve the outcome obtained with AZA alone. However, our "pick a winner" randomised strategy may remain useful with potentially more active drugs to be tested in combination with AZA. [ABSTRACT FROM AUTHOR]

Context Person‐centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person‐centredness are successful. Methods: A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person‐centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person‐centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person‐centredness. Results: Sixty‐one papers representing fifty‐three interventions were included in the final synthesis. Nine context–intervention–mechanism–outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person‐centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person‐centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person‐centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person‐centredness. Conclusion: Our findings offer explanations as to why communication skills‐based interventions may be insufficient to develop learners' person‐centredness. Integrating experiential person‐centred learning with theory on why person‐centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person‐centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person‐centredness. By reviewing training strategies, the authors offer practical explanations for what does and doesn't work to support person‐centredness, arguing it is critical for us to explain why person‐centredness matters. [ABSTRACT FROM AUTHOR]

Background: MDS‐RS patients are characterized by chronic anemia and a low risk of Acute Myeloid Leukemia (AML) progression and they generally become Red Blood Cell (RBC) transfusion dependent (TD). Study design and methods: We performed a retrospective "real‐life" observational study of 6 months in 100 MDS‐RS TD patients, recruited in 12 French centers, to describe transfusion characteristics, and evaluate the frequency and causes of hospitalizations, health costs, and morbidity, associated with transfusion dependency, in a French population of RBC transfusion‐dependent MDS‐RS patients. Results: 79% of the patients had high transfusion burden (HTB) and 21% low transfusion burden (LTB). HTB patients had a longer disease duration (6 vs. 3.7 years, p = 0.0078), more frequent iron chelation (82% vs. 50%, p = 0.0052) and higher serum ferritin (p = 0.03). During the 6‐month study period, 22% of the patients required inpatient hospitalization, 36% of them for symptomatic anemia requiring emergency RBC transfusion. The 6‐month median transfusion costs, including the cost of the day care facility, transportation to and from the hospital, iron chelation, and lab tests, was 16,188€/patient. Discussion: MDS‐RS represents the archetypal type of chronically transfused lower‐risk MDS. Most of those patients have a high transfusion burden and thus frequently need visits to the hospital's day care facility, and frequent hospitalizations, with an overall high median treatment cost. Those costs should be compared with costs of new treatments potentially able to avoid RBC transfusion dependence and to reduce the complications of chronic anemia in MDS‐RS patients. [ABSTRACT FROM AUTHOR]

Bansal explores how systems‐based enquiry might productively shift focus from individual success or failure, to broader support of wellbeing and burnout prevention. [ABSTRACT FROM AUTHOR]

The involvement of non‐researcher contributors (eg, stakeholders, patients and the public, decision and policy makers, experts, lay contributors) has taken a variety of forms within evidence syntheses. Realist reviews are a form of evidence synthesis that involves non‐researcher contributors yet this practice has received little attention. In particular, the role of patient and public involvement (PPI) has not been clearly documented. This review of reviews describes the ways in which contributor involvement, including PPI, is documented within healthcare realist reviews published over the last five years. A total of 448 papers published between 2014 and 2019 were screened, yielding 71 full‐text papers included in this review. Statements about contributor involvement were synthesized across each review using framework analysis. Three themes are described in this article including nomenclature, nature of involvement, and reporting impact. Papers indicate that contributor involvement in realist reviews refers to stakeholders, experts, or advisory groups (ie, professionals, clinicians, or academics). Patients and the public are occasionally subsumed into these groups and in doing so, the nature and impact of their involvement become challenging to identify and at times, is lost completely. Our review findings indicate a need for the realist review community to develop guidance to support researchers in their future collaboration with contributors, including patients and the public. [ABSTRACT FROM AUTHOR]

Firstly, we measured S100A8 from 78 bone marrow (BM) plasmas, including 50 acute myeloid leukemia (AML) patients, myeloproliferative neoplasms (MPN), myelodysplastic syndrome (MDS), and healthy donors (HD). (D) Correlation of BM [S100A8] with the percentage of leukemic cells in BM, determined through cytology analysis in AML patients. However, no linear correlation was observed between BM [S100A8] and myeloid precursors or granulocytes in BM, ( I P i =.21, I P i =.29, respectively; Figure S1). Interestingly, the percentage of blasts in BM was negatively correlated with BM [S100A8] ( I P i < .05, R = -0.31, Figure D), suggesting that blasts were not the main source of S100A8. [Extracted from the article]

Attributing value to teaching work has been problematic, but here Park et al. offer holistic reframing as a potential solution. [ABSTRACT FROM AUTHOR]

Context: Globally, primary health care is facing workforce shortages. Longer and higher‐quality placements in primary care increase the likelihood of medical students choosing this specialty. However, the recruitment and retention of community primary care teachers are challenging. Relevant research was predominantly carried out in the 1990s. We seek to understand contemporary facilitators and barriers to general practitioner (GP) engagement with undergraduate education. Communities of practice (CoP) theory offers a novel conceptualisation, which may be pertinent in other community‐based teaching settings. Methods: Semi‐structured interviews were undertaken with 24 GP teachers at four UK medical schools. We purposively sampled GPs new to teaching, established GP teachers and GPs who had recently stopped teaching. We undertook NVivo‐assisted deductive and inductive thematic analysis of transcripts. We used CoP theory to interpret data. Results: Communities of practice theory illustrated that teachers negotiate membership of three CoPs: (i) clinical practice; (ii) the medical school, and (iii) teaching. The delivery of clinical care and teaching may be integrated or exist in tension. This can depend upon the positioning of the teaching and teacher as central or peripheral to the clinical CoP. Remuneration, workload, space and the expansion of GP trainee numbers impact on this. Teachers did not identify strongly as members of the medical school or a teaching community. Perceptions of membership were affected by medical school communication and support. The findings demonstrate gaps in medical school recruitment. Conclusions: This research demonstrates the marginalisation of primary care‐based teaching and proposes a novel explanation rooted in CoP theory. Concepts including identity and membership may be pertinent to other community‐based teaching settings. We recommend that medical schools review and broaden recruitment methods. Teacher retention may be improved by optimising the interface between medical schools and teachers, fostering a teaching community, increasing professional rewards for teaching involvement and altering medical school expectations of learning in primary care. The authors demonstrate, through use of Communities of Practice theory, ways to improve retention and recruitment of community‐based clinical teachers. [ABSTRACT FROM AUTHOR]

Summary: Many patients with lower‐risk myelodysplastic syndrome (MDS) experience anaemia, which has negative consequences. Erythropoiesis‐stimulating agents (ESAs) and their biosimilars are used to treat anaemia in MDS and, currently, epoetin alfa and darbepoetin alfa are commonly used and recommended by clinical guidelines. To better understand the evidence available on the use of ESAs for anaemia in lower‐risk MDS, we conducted a systematic literature review to identify randomized and nonrandomized prospective studies reporting on clinical efficacy/effectiveness, patient‐reported quality of life (QoL), and safety. We extended our review to include retrospective studies for darbepoetin alfa specifically and to ascertain the feasibility of completing an indirect network meta‐analysis comparing epoetin and darbepoetin alfa. Overall, 53 articles reporting on 35 studies were included. The studies indicated a clinical benefit of ESAs, with benefits observed across key clinical outcomes. ESAs showed consistent improvement in erythroid response rates (ESA‐naïve, 45–73%; previous ESA exposure, 25–75%) and duration of response. Comparative studies demonstrated similar progression to acute myeloid leukaemia and several showed improved overall survival and QoL. Limited safety concerns were identified. This analysis confirmed ESA therapy should be the foremost first‐line treatment of anaemia in most patients with lower‐risk MDS who lack the 5q deletion. [ABSTRACT FROM AUTHOR]

Summary: Isolated trisomy 8 (+8) is a frequent cytogenetic abnormality in the myelodysplastic syndromes (MDS), but its characteristics are poorly reported. We performed a retrospective study of 138 MDS patients with isolated +8, classified or reclassified as MDS (excluding MDS/myeloproliferative neoplasm). Myeloproliferative (MP) features were defined by the repeated presence of one of the following: white blood cell count >10 × 109/l, myelemia (presence of circulating immature granulocytes with a predominance of more mature forms) >2%, palpable splenomegaly. Fifty‐four patients (39·1%) had MP features: 28 at diagnosis, 26 were acquired during evolution. MP forms had more EZH2 (33·3% vs. 12·0% in non‐MP, P = 0·047), ASXL1 (66·7% vs. 42·3%, P = 0·048) and STAG2 mutations (77·8% vs. 21·7%, P = 0·006). Median event‐free survival (EFS) and overall survival (OS) were 25 and 27 months for patients with MP features at diagnosis, versus 28 (P = 0·15) and 39 months (P = 0·085) for those without MP features, respectively. Among the 57 patients who received hypomethylating agent (HMA), OS was lower in MP cases (13 months vs. 23 months in non‐MP cases, P = 0.02). In conclusion, MP features are frequent in MDS with isolated +8. MP forms had more EZH2, ASXL1 and STAG2 mutations, responded poorly to HMA, and tended to have poorer survival than non‐MP forms. [ABSTRACT FROM AUTHOR]

Summary: Treatment with azacitidine (AZA) has been suggested to be of benefit for higher‐risk myelodysplastic syndrome (HR‐MDS) patients with chromosome 7 abnormalities (Abn 7). This retrospective study of 235 HR‐MDS patients with Abn 7 treated with AZA (n = 115) versus best supportive care (BSC; n = 120), assessed AZA treatment as a time‐varying variable in multivariable analysis. A Cox Regression model with time‐interaction terms of overall survival (OS) at different time points confirmed that, while chromosome 7 cytogenetic categories (complex karyotype [CK] versus non‐CK) and International Prognostic Scoring System risk (high versus intermediate‐2) retained poor prognosis over time, AZA treatment had a favourable impact on OS during the first 3 years of treatment compared to BSC (Hazard ratio [HR] 0·5 P < 0·001 at 1 year, 0·7 P = 0·019 at 2 years; 0·73 P = 0·029 at 3 years). This benefit was present in all chromosome 7 categories, but tended to be greater in patients with CK (risk reduction of 82%, 68% and 53% at 1, 3 and 6 months in CK patients; 79% at 1 month in non‐CK patients, P < 0·05 for all). AZA also significantly improved progression‐free survival (P < 0·01). This study confirms a time‐dependent benefit of AZA on outcome in patients with HR‐MDS and cytogenetic abnormalities involving chromosome 7, especially for those with CK. [ABSTRACT FROM AUTHOR]

The article focuses on diagnosing myelodysplastic syndrome according to the World Health Organization (WHO), which included a refractory cytopenia with unilineage dysplasia (RCUD) category in 2008. Topics discussed include findings of the rare occurrence of WHO 2008 refractory neutropenia (RN) and refractory thrombocytopenia (RT) diagnoses, diagnosis of single cytopenia after 2008, and AML progression in IN and IT.

We conducted a systematic review and meta-analysis to estimate the efficacy of darbepoetin alpha ( DA) for treatment of myelodysplastic syndrome ( MDS)-related anaemia. Eligible studies were prospective, interventional, and reported World Health Organization, French-American-British, or International Prognostic Scoring System ( IPSS) criteria. Outcomes included erythroid response rate (primary); haemoglobin response; change in haemoglobin, transfusion status, and quality-of-life (QoL); and safety. Ten studies ( N = 647) were analysed. Erythroid response rate range was 38-72%; median response duration range was 12-51+ months. Patients with erythropoietin ( EPO) <100 iu/l had 35% [95% confidence interval ( CI): 22-48%; P < 0·001) better response than patients with EPO >100 iu/l. Erythropoesis-stimulating agent ( ESA)-naïve patients had 17% (95% CI: 3-32%; P = 0·022) greater response rate than those previously treated with ESA. Nonetheless, previously treated patients had response rates of 25-75%. Higher baseline haemoglobin levels, higher dose, transfusion-independence and low-risk IPSS status were reported by several studies to be associated with better response. QoL, transfusion rates and haemoglobin levels improved with treatment. Hypertension, thromboembolism and progression to acute myeloid leukaemia were reported in 2%, 1% and 1% of patients, respectively. This meta-analysis suggests that DA treatment can be useful for improving erythroid response in MDS patients with anaemia, even among patients previously treated with ESA. [ABSTRACT FROM AUTHOR]

The authors express their opinions regarding the article "The 'missing person' in roles-based competency models: a historical, cross-national, contrastive case study" by C. Whitehead, V. Selleger, J. van de Kreeke, and B. Hodges. They discuss the debate concerning competency-based frameworks in clinical education, the critical discourse analysis methods of theorist Michel Foucault, and the focus on doctors or patients as the subject in care.

Objectives and methods Chronic myelomonocytic leukemia ( CMML) is a severe disease for which allogeneic stem cell transplantation (allo- SCT) remains the only potentially curative treatment. We describe a retrospective study determining prognostic factors for outcome after allo- SCT in consecutive 73 patients with CMML reported to the SFGM- TC registry between 1992 and 2009. Results At diagnosis, median age was 53 yrs, and 36% patients had palpable splenomegaly (SPM). 48, 13, and 9 patients had good, intermediate, and poor risk karyotype, respectively, according to IPSS, 61% patients had CMML-1, and 39% had CMML-2. 41/31/1 cases had an HLA-identical sibling, an unrelated and haploidentical donor, respectively. 43 patients received reduced-intensity conditioning. With a median follow-up of 23 month, acute grade 2-4 and chronic GVHD developed in 21 and 25 patients, respectively. The 3-year OS, NRM (non-relapse mortality), EFS, and CIR (cumulative incidence of relapse) were 32%, 36%, 29% and 35%, respectively. OS was not influenced by the CR status, marrow blasts% at allo-SCT, prior treatments, and cGVHD. Using multivariate analysis, year of transplant < 2004 ( YOT) ( P = 0.005) was associated with higher NRM, YOT < 2004 ( P = 0.04) and SPM at allo- SCT ( P = 0.02) with lower EFS, and YOT < 2004 ( P = 0.03) and SPM at allo- SCT ( P = 0.04) with poorer OS. Conclusions Allogeneic stem cell transplantation is a valid treatment option for patients with CMML, and its outcome has improved with YOT > 2004. Splenomegaly seems to be a negative factor of OS and EFS in this series. [ABSTRACT FROM AUTHOR]

Marrow cells from patients with higher-risk myelodysplastic syndrome ( MDS) exhibit constitutive nuclear factor ( NF)-κB activation. The proteasome inhibitor, bortezomib, has limited efficacy as a single agent in acute myeloid leukaemia. Its activity on leukaemic cell lines is potentiated by chemotherapy. We treated 43 higher-risk MDS patients with bortezomib (1·5 mg/m2, days 1, 4, 8 and 11) and low dose cytarabine arabinoside ( LDAC; 10 mg/m2, then 20 mg/m2 from days 1-14), every 28 d for four cycles. Median follow-up was 29·7 months. Responses were seen in 12 of the 43 patients (28%), including complete response ( CR, n = 1), marrow- CR ( n = 3), partial response ( PR, n = 5) and haematological improvement ( HI, n = 3). Responses were seen in 12 (36%) of the 33 previously untreated patients (11% CR, 13% PR, 2·5% HI), compared to none in the 12 previously treated patients ( P < 0·01). Responders had better overall survival (median 18·2 vs. 10 months). One CR and 3 marrow- CRs were seen in patients with complex karyotypes. Main toxicity was haematological, responsible for infection in six patients and bleeding in 3. Three patients with Grade 1-2 pre-treatment haematotoxicity developed Grade 3-4 toxicity. Neuropathy was seen in 12% of patients. The addition of bortezomib to LDAC in higher-risk MDS may improve results obtained with LDAC alone, especially in patients with unfavourable karyotypes. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 372-380 Context Text is familiar to us all. This paper offers an introduction to, and an exploration of, the range of methodological possibilities open to the education researcher who has chosen to use text as a research data source. It encourages a purposeful deliberation of the different textual sources available as data, the range of methodological approaches possible and the types of interpretation that can be adopted when embarking on an empirical study using textual data. Methods Approaches to interpreting text are varied and utilise a range of analytical and interpretative strategies. To illustrate the theoretical points raised within this paper, two contrasting methods were applied to the same text. Tag cloud analysis and performative narrative analysis (PNA) were employed to analyse Chapter 4 of the UK government's 2010 White Paper Equity and excellence: Liberating the NHS. Results The adoption of these contrasting methodologies, which are not currently used extensively in medical education research, revealed that some common issues were identified by both tag clouds and PNA, but, in addition, each approach was able to unveil something unique about the text. Conclusions These two methods highlight the range of affordances, or possibilities, that textual analysis will have on the results. We suggest that medical education researchers should be encouraged to move away from the current dominant and privileged methodologies that seek to provide answers and explore other methods and approaches to textual data that encourage us to question and reflect more deeply. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to autologous stem cell transplantation in patients who object to a blood transfusion.

The article discusses a study of the prognostic impact of eukaryotic Initiating Factor 4E protein expression in patients with acute myeloid leukaemia (AML). It examines the expressions of the eIF4E protein in AML samples by immunohistochemistry and Western blot. Results shows that there is no correlation between prognosis and eIF4E expression in AML patients treated by conventional chemotherapy.

The article presents a study on the use of the thrombopoietin receptor agonist romiplostim in managing Immune Thrombocytopenic Purpura (ITP). It notes that the findings of the study reveal that romiplostim induction will contribute to a rapid normalization of the platelet count while a relapse will occur if this will be discontinued. This drug is also used to diagnose a non-Hodgkin lymphoma through a tissue sample biopsy.

The article presents a case study of three patients in which haematological and autoimmune manifestations had dramatic response to 5-azacytidine. It mentions the case of a 69-year-old man who has a four-year history of swelling of joints and senerogative polyarthritis. Furthermore, the case of a 64-year-old patient who has a five-year history of polyarthralgia which was associated with hypodermatitis of lower limbs without biological markers is discussed.