Acorn

Reviewing a book about Solutions Focus (SF) is different from other types of reviews. In this case the reviewer — in this specific case, I —must make a choice: should I review the book in a traditional way with a balance of praise and critique? Or should I adopt a more solutions-focused orientation and focus heavily on what works in the book? When it came to writing this review, the decision was easy. In all honesty, it was largely made for me, because there was just so much to like, so much that works well, so many instances in which the authors provide practical and useful information.

ObjectivesWe describe two recent cases managed through the West Midlands Perinatal Palliative Care Service (WMPPCS), and in doing so to share the learnings our teams had from these rare cases.MethodsThis is a case series review of suspected anencephalies diagnosed antenatally, who were referred to the WMPPCS from January to September 2023.ResultsAntenatal ultrasound diagnosed anencephaly in each case, one was referred antenatally to the WMPPCS. In each case the baby was born in a District General Hospital, and after around 72 hours of survival the WMPPCS was contacted for input and support to consider discharge as the babies were feeding and stable without respiratory intervention. Discharge planning included symptom management plan, community nursing connection, anticipatory prescribing, advance care plan and planning follow up.In the first case discharge home was coordinated by palliative care services with collaboration between hospital, hospice and community teams. This baby had a large mass extending from the incomplete posterior cranium (occipital encephalocoele), which over days at home became difficult to manage. Difficulties included discomfort, keeping the wound clean, odour, distress of family and distress of community teams providing clinical support. Neurosurgery team was able to support admission at the children’s hospital. Further imaging confirmed presence of cerebrum, excluding ancephaly. Following careful multidisciplinary discussion with family, encephalocoele and skin defect closure was performed, with no complication. This baby continues to be well at home now at six months of age, grateful for this intervention.The second case had been seen antenatally by the WMPPCS service, but an expectation of early death led to a delay notifying the team after the birth of this baby. At initial review with palliative care, based on the previous case, dressing recommendations were provided and discussion with neurosurgery occurred to consider options in care. Family were grateful to feel teams were actively managing the baby, particularly as they were concerned about comfort related to the open wound, and after multidisciplinary counselling around this went to discuss as a family. Unfortunately this baby died at 6 days of age before further progress could be made.ConclusionAlthough both of these babies were diagnosed as anencephaly during pregnancy, both were subsequently born with open encephalocoeles. The distinction is important because encephalocoeles are associated with higher survival rate. Appropriate management of the open tissue reduces risk of fulminant meningitis, facilitates positioning and nursing, thereby maximising comfort and minimising distress to families and treating services. Retrospectively, fetal MRI would have helped diagnosis, prognosis and family counselling. These cases were a valuable reminder to approach babies with poor prognoses with an open mind as to the diagnosis and their needs. The first case provided valuable learning that led to earlier collaborative planning for the second baby, and earlier institution of best practice dressing management.

"CritCat.Org." Technical Services Quarterly, 40(4), pp. 316–317 Disclosure statementNo potential conflict of interest was reported by the author(s).

Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician’s toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients.

画像認識に有効とされる機械学習手法であるConvolution Neural Network(以下,CNNとする.)を用いて,屋外に設置されたアスファルトプラント内ストックヤードを撮影した画像をもとに,骨材体積の算出を試みた.CNNの予測値に大きく寄与したピクセルを可視化する技術であるGrad-CAMにより得られた結果より,太陽光による照度の変動が数量算出精度に大きく影響する知見を得た.解決策として,画像の輝度値解析などにより画像全体のコントラスト処理を行った画像をCNNの学習用画像に取り入れた.結果として,これらの処理を行うことにより,屋外の環境光の変化に対し頑健な特徴抽出器が得られることを確認した.

BackgroundRenal cell carcinoma (RCC) is a disease of genomic alterations, of which the complete panorama helps in facilitating molecular-guided therapy. Germline mutation profiles and associated somatic and clinical characteristics remains unexplored in Chinese RCC patients.MethodsWe retrospectively profiled the germline and somatic mutations of 322 unselected RCC patients using a panel consisting of 808 cancer-related genes. We categorized patients into three groups based on germline mutation status and compared the somatic mutation spectrum among different groups.ResultsApproximately one out of ten (9.9%) RCC patients were identified to carry pathogenic/likely pathogenic (P/LP) germline variants (PGVs), of which 3.7% were variants in syndromic RCC-associated genes and 6.2% were other cancer-predisposition genes. The most common PGV was found in VHL (2.2%), followed by FH, TSC2, ATM, BRCA1, NBN, and BLM (0.6% each). Young patients (≤46 years) were more likely to harbor PGVs. Variants in syndromic RCC-associated genes were predominant identified in young patients, while variants in other cancer-predisposition genes were found in patients >46 years more frequently. Furthermore, 39.3% (11/28) of patients carrying PGVs were detected to have somatic “second hit” events. Germline and somatic sequencing, including microsatellite instability (MSI) status analysis, provided potentially actionable therapeutic targets in 17.1% of patients in the whole cohort.ConclusionsOur results revealed that approximately 10% of RCC patients carried clinically significant germline mutations. Current guidelines recommendation for genetic testing seemed not sensitive enough to identify patients with hereditary RCC susceptibility. It is rational to promote genetic testing in RCC population.

BACKGROUNDDrug development in recurrent glioblastoma multiforme (rGBM) is challenging. For randomized controlled trials (RCTs) short survival horizons and limited life-prolonging treatment options may delay accrual and introduce bias through differential dropout of control patients. Comparing results of a single-arm Phase 2b trial of intratumoral delivery of MDNA55 (an interleukin-4 receptor targeted fusion protein) to an external control arm, we sought early efficacy insights and consideration by the FDA of incorporating an ECA in a Phase 3 registrational trial.METHODSUsing propensity score weighting, we compared rGBM patients from the Phase 2b trial (NCT02858895) (2017-2019) to patients from rGBM registries who had received standard of care therapies (2011-2019) and met eligibility requirements. Propensity scores were estimated using a logistic regression model with 11 covariates. We compared the propensity score weighted groups according to demographic and disease attributes before and after weighting and compared overall survival between the two groups.RESULTSThrough propensity score weighting, 43 (98%, 43/44) MDNA55 patients and 40.80 weighted ECA patients (from 62 unweighted registry patients) were identified for comparison. MDNA55 and ECA patients were balanced on all baseline characteristics (i.e., standardized mean difference ≤ 0.15). Compared to ECA patients, MDNA55 patients had a 37% lower hazard of death (hazard ratio 0.63, 95% confidence interval: 0.39,1.02).CONCLUSIONIn advance of a Phase 3 trial, comparison of Phase 2b trial results to an ECA suggests that MDNA55 may be efficacious in rGBM. In view of the known challenges associated with drug development for rGBM, these results provided a proof-of-concept for the design of a novel hybrid Phase 3 trial. This planned Phase 3 trial incorporates propensity score weighting to create a composite hybrid randomized and external control arm, an approach preferred by the FDA over full replacement of a randomized control with an external control.