Role of Genetic Analysis in New Treatments of Acute Myeloid Leukemia

Genetics has an important role in the risk stratification and management of the patients with acute myeloid leukemia (AML). Molecular testing can’t take the place of cytogenetic testing results, but has complementary role to help refine prognosis of the disease, especially within specific AML subgroups. Molecular genetic analysis of CEBPA, NPM1, and FLT3 is already the standard of care in AML patients, and mutations in several additional genes are assuming increasing importance. The French-American-British (FAB) classification and the World Health Organization (WHO) classification are the most classifications for AML. The aim of this chapter is a review on the role of genetic analysis in new treatments of AML

Health care managers’ perspectives on the sources of evidence in evidence-based hospital management: A qualitative study in Iran

Background: Evidence-based management (EBMgt) has been developed as a management framework for improving the quality of management decisions. To use that, we need to identify the source of evidence in decision-making.  Therefore, the purpose of this study was to identify the sources of evidence in managing hospitals. Methods: Qualitative methods were used to explore the sources of evidence and to identify hospital managers’ attitudes towards evidence-based management. A series of semi-structured interviews (n=48), with a purposive sample of 48 participants, were conducted in 2016. Also, four focus group discussions (FGDs) were conducted with health managers and specialists in the field of management. A questionnaire was used for collection of demographic characteristics and managers’ perspectives. Results: Six main themes emerged from the interviews including: scientific and research evidence, facts and information of hospital, political-social  development plans, managers’ professional expertise and ethical-moral  evidence. Also, the results showed that the majority of participants believed to use the evidence-based hospital management (95.83%). Conclusions: Our study suggested that a full evidence-based hospital manager someone who is using all the sources of evidence for making hospital decisions. Using hexagon of evidence sources, managers can identify the best available evidence for hospital decisions and to make the best decision in the process of evidence-based decision making.  Keywords: Evidence-based management, management decisions, hospital  managers, health secto

The Realm of Oncological Lung Surgery: From Past to Present and Future Perspectives

In this chapter, a historical overview as well as an overview of state of the art of the surgical techniques for the treatment of lung cancer is outlined. The chapter focuses on the introduction of open surgery, video-assisted thoracic surgery (VATS), uniportal VATS (UVATS), and robotic-assisted thoracic surgery (RATS) techniques for lung resections. A short introduction on upcoming techniques and modalities is given. The currently available tools as three-dimensional (3D) computed tomography (CT), virtual reality, and endo-bronchial surgery will be discussed. Based on the current development, this chapter attempts to delineate the horizon of oncological lung surgery. The information is generated not only from the available literature, but also from the experiences of surgeons and other physicians as well as co-workers involved in lung cancer treatment around the world. This chapter can be seen as a general introduction to several aspects of oncological lung surgery

An Evidence-Based Framework for Evidence-Based Management in Healthcare Organizations: A Delphi Study

BACKGROUND: Evidence-based management (EBMgt) is a growing literature concept in management sciences which claims that management decision-making must be based on the best available evidence. The aim of this paper is to present and provide an evidence-based framework for EBMgt to improve decision-making in healthcare organizations.METHODS: A two-round Delphi survey was used to collect the factors affecting EBMgt. Purposive and snowball sampling methods were used in both rounds. In round 1, we conducted a systematic review and a series of semi-structured interviews (n=45). In round 2, a specific questionnaire with four main parts was designed. The experts (n=21) were asked to rate on a 9-point Likert scale the importance of each factor. The data was collected through Google Forms (n=11) and paper forms (n=10).RESULTS: Participants were mostly men (73%). Overall, 126 factors were selected in round 1. Factors were classified into 4 categories: facilitators, barriers, the sources of evidence and EBMgt process that consisted of 48, 46, 22 and 10 factors, respectively. In round 2, based on median scores, many factors (n=114) were found to be very important. Only, 12 factors have a median score of less than 3 and were excluded from the study. Finally, 114 factors were confirmed.CONCLUSIONS: Confirmed factors played significant roles in affecting the practice of EBMgt among healthcare managers. We tried to facilitate interaction between these factors in the framework. Depending on the type of problem, using six steps of EBMgt process, managers will select the best evidence among six sources of evidence.KEYWORDS: Evidence-based management, evidence-based framework, healthcare organization

Preparing for the future of cardiothoracic surgery with virtual reality simulation and surgical planning:a narrative review

Background and Objective: Virtual reality (VR) technology in cardiothoracic surgery has been an area of interest for almost three decades, but computational limitations had restricted its implementation. Recent advances in computing power have facilitated the creation of high-fidelity VR simulations and anatomy visualisation tools. We undertook a non-systematic narrative review of literature on VR simulations and preoperative planning tools in cardiothoracic surgery and present the state-of-the-art, and a future outlook. Methods: A comprehensive search through MEDLINE database was performed in November 2022 for all publications that describe the use of VR in cardiothoracic surgery regarding training purposes, education, simulation, and procedural planning. We excluded papers that were not in English or Dutch, and that used two-dimensional (2D) screens, augmented, and simulated reality. Key Content and Findings: Results were categorised as simulators and preoperative planning tools. Current surgical simulators include the lobectomy module in the LapSim for video assisted thorascopic surgery which has been extensively validated, and the more recent robotic assisted lobectomy simulators from Robotix Mentor and Da Vinci SimNow, which are increasingly becoming integrated into the robotic surgery curriculum. Other perioperative simulators include the CardioPulmonary VR Resuscitation simulator for advanced life support after cardiac surgery, and the VR Extracorporeal Circulation (ECC) simulator for perfusionists to simulate the use of a heart-lung machine (HLM). For surgical planning, there are many small-scale tools available, and many case/pilot studies have been published utilising the visualisation possibilities provided by VR, including congenital cardiac, congenital thoracic, adult cardiac, and adult thoracic diseases. Conclusions: There are many promising tools becoming available to leverage the immersive power of VR in cardiothoracic surgery. The path to validate these simulators is well described, but large-scale trials producing high-level evidence for their efficacy are absent as of yet. Our view is that these tools will become increasingly integral parts of daily practice in this field in the coming decade.</p

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : an analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2.5 originating from ambient and household air pollution.Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2.5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2.5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2.5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals.Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2.5 exposure, with an estimated 3.78 (95% uncertainty interval 2.68-4.83) deaths per 100 000 population and 167 (117-223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13.4% (9.49-17.5) of deaths and 13.6% (9.73-17.9) of DALYs due to type 2 diabetes were contributed by ambient PM2.5, and 6.50% (4.22-9.53) of deaths and 5.92% (3.81-8.64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2.5.Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2.5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : An analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations