Impressions of action and critical action learning:exploring the leadership development of senior doctors in an English healthcare organization

This paper aims to explore the influence of one cycle of a learning set experience in a postgraduate medical leadership development programme. It does so from two perspectives: first, from the self-reports of nine senior doctors working in leadership roles in England in the National Health Service; and second from a researcher perspective as we present our research process, findings and perceptions on the use of action learning (AL) and critical action learning (CAL) for leadership development in the complex and unpredictable context of that service. The paper affirms other study findings that CAL in the development of participants’ collective reflexivity has the potential to deal with emotions and power relations in organizational life. An original contribution lies in advancing the idea that CAL can help build resilience in doctor leaders and groups in uncertain conditions such that they are able to challenge current care delivery and effect change in organizational performance

Precision medicine in pediatric oncology: Lessons learned and next steps

The maturation of genomic technologies has enabled new discoveries in disease pathogenesis as well as new approaches to patient care. In pediatric oncology, patients may now receive individualized genomic analysis to identify molecular aberrations of relevance for diagnosis and/or treatment. In this context, several recent clinical studies have begun to explore the feasibility and utility of genomics‐driven precision medicine. Here, we review the major developments in this field, discuss current limitations, and explore aspects of the clinical implementation of precision medicine, which lack consensus. Lastly, we discuss ongoing scientific efforts in this arena, which may yield future clinical applications.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135962/1/pbc26288.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135962/2/pbc26288_am.pd

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Market Intelligence Guide / Acquisition Research Sponsored Report Series

Acquisition Research Sponsored Report Series for the Graduate School of Business & Public Policy.Sound market research is the foundation of effective acquisition decisions and processes. However, this axiom appears to be undervalued in the government procurement domain. While agencies are responsible for conducting market research appropriate to the procurement situation, very little guidance is available to assist acquisition personnel to meet the intent of the FAR. The FAR offers little direction; Parts 10 and 12 dedicate a mere 1,477 words to the topic of market research. Existing market research guides are outdated do not emphasize efficient outcomes, and do not address market research needed to support strategic sourcing. The government?s current approach to market research is ad hoc, inconsistent, and redundant since information is rarely shared between buying activities. Additionally, no existing research or policy addresses how to properly organize or resource the collection and use of market research. Furthermore, specific skills for determining needed information, finding it, analyzing it, and disseminating it are not systematically taught or developed in the government?s acquisition workforce. Many commercial best practices (e.g., industry analysis and a purchasing portfolio matrix) that are transferrable to the not-for-profit sector are absent. Each of these tools is essential to designing the optimal contract that reaps the most value from the exchange. Therefore, this market intelligence guide is developed to address the aforementioned deficiencies in an effort to provide acquisition personnel practical guidance on conducting meaningful market research. It is targeted toward strategic sourcing and complex, high-value federal procurements