Several commercial and academic autologous chimeric antigen receptor T-cell (CAR-T) products targeting CD19 have been approved in Europe for relapsed/refractory B-cell acute lymphoblastic leukemia, ...high-grade B-cell lymphoma and mantle cell lymphoma. Products for other diseases such as multiple myeloma and follicular lymphoma are likely to be approved by the European Medicines Agency in the near future.
The European Society for Blood and Marrow Transplantation (EBMT)-Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association collaborated to draft best practice recommendations based on the current literature to support health care professionals in delivering consistent, high-quality care in this rapidly moving field.
Thirty-six CAR-T experts (medical, nursing, pharmacy/laboratory) assembled to draft recommendations to cover all aspects of CAR-T patient care and supply chain management, from patient selection to long-term follow-up, post-authorisation safety surveillance and regulatory issues.
We provide practical, clinically relevant recommendations on the use of these high-cost, logistically complex therapies for haematologists/oncologists, nurses and other stakeholders including pharmacists and health sector administrators involved in the delivery of CAR-T in the clinic.
In a recent article, 'Why lockdown of the elderly is not ageist and why levelling down equality is wrong', Savulescu and Cameron argue that a selective lockdown of older people is not ageist because ...it would treat people unequally based on morally relevant differences. This response argues that a selective lockdown of older people living in long-term care homes would be unjust because it would allow the expansive liberties of the general public to undermine the basic liberties of older people, and because it would discriminate on the basis of extrinsic disadvantages.
•While research on the impact Prison Rape Elimination Act (PREA) has produced a number of key outcomes related to content, there is a lack of knowledge regarding the process of conducting evaluations ...of PREA. This is surprisingly considering that researchers must address the perceptions and needs of various key groups: inmate, staff and administrators. Moreover, future research activities are likely to take place in high security state prisons, which are unique milieus. It is important that researchers share the lessons they learned while conducting the evaluations.•The current study utilizes a “lessons learned” approach to discuss the impact of the PREA Demonstration Project on a state prison system that includes 19 correctional institutions. Results indicate the benefits of merging the philosophical orientation of key stakeholders, establishing benchmarks, and the need for partnerships with prosecutors. A comparison of the perceptions of correctional administrators, inmates, and front-line correctional officers regarding PREA is included. Also featured are the “lessons learned” from the implementation of PREA into four prison sites, along with the concept of building trust and the impact of lockdowns due to staff shortages.
The Prison Rape Elimination Act (PREA) was designed to address sexual violence in prison. While previous has focused on sexual violence occurring in correctional facilities, there has been a dearth of studies that document the expertise, experience, or reflections of program following the cimplementation of PREA- within a correctional system. The current study utilizes a “lessons learned” approach to discuss the impact of the PREA Demonstration Project on a state prison system that includes 19 correctional institutions. Results indicate the benefits of merging the philosophical orientation of key stakeholders, establishing benchmarks, and the need for partnerships with prosecutors. A comparison of the perceptions of correctional administrators, inmates, and front-line correctional officers regarding PREA is included. Also featured are the “lessons learned” from the implementation of PREA into four prison sites, along with the concept of building trust and the impact of lockdowns due to staff shortages.
➤ Clinicians should be careful to assess for associated injuries including anterolateral complex and medial meniscal ramp lesions or lateral meniscal posterior root tears.➤ Consideration of lateral ...extra-articular augmentation should be given for patients with >12° of posterior tibial slope.➤ Patients with preoperative knee hyperextension (>5°) or other nonmodifiable risk factors, including high-risk osseous geometry, may benefit from a concomitant anterolateral augmentation procedure to improve rotational stability.➤ Meniscal lesions should be addressed at the time of anterior cruciate ligament reconstruction with meniscal root or ramp repair.
The integration of artificial intelligence technologies, such as large language models (LLMs), in health care holds potential for improved efficiency and decision support. However, ethical concerns ...must be addressed before widespread adoption. This article focuses on the ethical principles surrounding the use of Generative Pretrained Transformer-4 and its conversational model, ChatGPT, in healthcare settings. One concern is potential inaccuracies in generated content. LLMs can produce believable yet incorrect information, risking errors in medical records. Opacity of training data exacerbates this, hindering accuracy assessment. To mitigate, LLMs should train on precise, validated medical data sets. Model bias is another critical concern because LLMs may perpetuate biases from their training, leading to medically inaccurate and discriminatory responses. Sampling, programming, and compliance biases contribute necessitating careful consideration to avoid perpetuating harmful stereotypes. Privacy is paramount in health care, using public LLMs raises risks. Strict data-sharing agreements and Health Insurance Portability and Accountability Act (HIPAA)-compliant training protocols are necessary to protect patient privacy. Although artificial intelligence technologies offer promising opportunities in health care, careful consideration of ethical principles is crucial. Addressing concerns of inaccuracy, bias, and privacy will ensure responsible and patient-centered implementation, benefiting both healthcare professionals and patients.
For the Prison Rape Elimination Act (PREA) to prevent sexual victimization in the correctional system, incarcerated persons and corrections staff must hold favorable views of this law, and behave in ...manners conducive toward its mission. In regards to behavior, both populations must report allegations of sexual misconduct, and be cautious in their interactions with one another. Currently, no study has researched whether these perceptual and behavioral expectations are being followed, or the factors influencing them. Mixed-methodological questionnaire data gathered from incarcerated persons (n = 490) and corrections staff (n = 222) who were in three state prisons located in the southeastern United States revealed how our custodial sample, compared to staff, were less likely to view PREA favorably, or to adopt behaviors supportive of this policy. Statistically significant correlates of self-reported behaviors included age, sex, and race. Discussion of results centers around ways of creating institutional cultures embracing of PREA.
Clinical documentation is a critical aspect of health care that enables healthcare providers to communicate effectively with each other and maintain accurate patient care records. Artificial ...intelligence tools, such as chatbots and virtual assistants, have the potential to assist healthcare providers in clinical documentation. ChatGPT is an artificial intelligence conversational model that generates human-like responses to text-based prompts. In this study, we sought to investigate ChatGPT's ability to assist with writing a history of present illness based on standardized patient histories.
A blinded, randomized controlled study was conducted to compare the use of typing, dictation, and ChatGPT as tools to document history of present illness (HPI) of standardized patient histories. Eleven study participants, consisting of medical students, orthopaedic surgery residents, and attending surgeons, completed three HPIs using a different documentation technique for each one. Participants were randomized into cohorts based on the type of documentation technique. Participants were asked to interview standardized patients and document the patient's history of present illness using their assigned method.
ChatGPT was found to be intermediate for speed; dictation was fastest, but produced markedly longer and higher quality patient histories based on Physician Documentation Quality Instrument score compared with dictation and typing. However, ChatGPT included erroneous information in 36% of the documents. Poor agreement existed on the quality of patient histories between reviewers.
Our study suggests that ChatGPT has the potential to improve clinical documentation by producing more comprehensive and organized HPIs. ChatGPT can generate longer and more detailed documentation compared with typing or dictation documentation methods. However, additional studies are needed to investigate and address concerns regarding privacy, bias, and accuracy of information.
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