Therapeutic Guidelines

Transurethral bulking agent (TBA) injections and single incision slings (SIS) are low risk, minimally invasive options increasingly being used in the treatment of primary stress urinary incontinence (SUI); however, comparative trials are lacking. We describe the study design and rationale for the Transurethral Bulking Agent Injection versus Single-Incision Sling for Stress Urinary Incontinence (BASIS) trial. The study methods, inclusion criteria, assessments, safety and efficacy outcomes, and follow-up are reported. We also present methods for selection of surgical devices and public private partnerships for product donation. The engagement of anesthesia co-investigators to develop an office-based protocol is also described. The BASIS trial is a multicentered, double-blind, randomized controlled, superiority study of up to 2 injections of TBA (Bulkamid) versus SIS (Solyx) at 12 months, with follow-up through 36 months. Women with primary, stress-predominant urinary incontinence without indication for general or regional anesthesia are eligible. A patient-centered primary outcome of Patient Global Impression of Improvement was used to calculate the sample size of 358. Secondary efficacy and safety outcomes of objective and subjective success, retreatment, and adverse events (including de novo pelvic floor muscle tenderness and dyspareunia), and cost-effectiveness analyses are planned. The feasibility of an office-based anesthesia protocol with sedation and local anesthesia will also be evaluated. Results from the BASIS study will provide level 1 evidence on the comparative-effectiveness of 2 minimally invasive office-based treatments. Important safety data and 3-year outcomes will help clinicians and patients make informed decisions about primary SUI procedure options.

The American College of Occupational and Environmental Medicine's (ACOEM) foundation guideline on General Approach to Initial Assessment and Documentation is intended to address the initial approach to assessment of some of the most common occupational medicine clinical problems. This approach includes a medical and occupational history, identification of body part(s) involved, effect of present illness or injury on patient's functionality, screening for disability risk factors that may affect the outcome, a detailed work history including type and duration of exposure. It is also important to maintain good recordkeeping and privacy of records when assessing patients for a work-related injury or illness. The reader is referred to ACOEM's other disorder-specific guidelines for more-specific guidance.

SUMMARYAminoglycosides (gentamicin, tobramycin and amikacin) are highly effective parenteral drugs commonly used as initial empirical therapy of serious Gram-negative infections. They have rapid bactericidal activity and relatively low rates of resistance in Australia compared with other antibiotics used to manage Gram-negative infections.Therapeutic Guidelines: Antibiotic was updated in March 2025 and provides new guidance on the role of aminoglycosides, optimised dosing, and drug selection. The guidelines now recommend that dosing in adults is based on lean body weight, and provide calculators to assist with dose calculations.Therapeutic drug monitoring is required when aminoglycoside therapy is expected to continue beyond 48 hours; monitoring the area under the aminoglycoside concentration–time curve is recommended in adults.

This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Work Disability Prevention and Management Guideline reviews the available evidence and provides recommendations to clinicians regarding interventions to help patients remain at or return to work. Systematic literature reviews were conducted. Studies were graded and evidence tables were created, with involvement of a multidisciplinary expert panel that evaluated the evidence and finalized recommendations for all clinical questions. Extensive peer review was performed. Consensus recommendations were formulated when evidence was lacking. Evidence-based recommendations have been developed to guide work disability prevention and management. Clinicians should utilize quality evidence in determining treatment methods to prevent and alleviate work disability for workers. This guideline offers an evidence-based framework for preventing and mitigating work disability for individual adults in the active workforce. It is designed for use by healthcare clinicians who desire to minimize the negative impact of health conditions on working people's lives and livelihoods.

On the cover: The African Potato Association (APA), established in 1985, actively promotes research and development in the potato and sweetpotato sectors across Africa, particularly to address food security challenges under changing climatic conditions. Despite a decrease in governmental agricultural expenditure from 2001 to 2020, the APA remains dedicated to enhancing research dissemination and fostering collaborations among researchers within and beyond Africa. This commitment is showcased in a special section published in the May-June Crop Science issue featuring 30 papers from the 12th Triennial APA Conference, aiming to connect researchers, practitioners, and both public and private sectors to utilize research for effective product and program development. Read the introduction to the special section by lead guest editor Dr. Jan Low et al. (https://doi.org/10.1002/csc2.21268). Photo credit: Hugh Rutherford (top); International Potato Center (bottom).

This study aims to clarify the relationship between peripheral neuropathy in hand-arm vibration syndrome and cumulative exposure index. 68 participants without symptoms were surveyed. The participants were divided into three groups based on past and current vibration exposure (VE). Comparison among groups according to past VE showed that the median and ulnar sensory nerve conduction velocities and median sensory nerve action potential (SNAP) amplitude were significantly lower in past high and low exposure groups than in the past nonexposure group. Comparison among groups according to current VE showed that the median and ulnar SNAP amplitudes were significantly lower in the current high exposure group than in the current low or nonexposure group. Vibration tool handlers have potential peripheral nerve lesions at a certain stage without subjective symptoms of the finger.

On the cover: A scientist from the R&D team of Eurofins Hydrologie Est, Maxéville, France, is working on a liquid chromatography-tandem mass spectrometry instrument. The chemistry laboratory is able to monitor the presence of organic and inorganic contaminants in industrial, drinking, and environmental water matrices, such as PFAS in rainwaters. See M. Berthou et al., “Is it raining PFAS in France? An analysis of 52 PFAS at nanogram per liter levels in French rainwaters during autumn season,” https://doi.org/10.1002/jeq2.20525. Photo by Violaine Gérard.

Duodenal leak is a feared complication of repair, and innovative complex repairs with adjunctive measures (CRAM) were developed to decrease both leak occurrence and severity when leaks occur. Data on the association of CRAM and duodenal leak are sparse, and its impact on duodenal leak outcomes is nonexistent. We hypothesized that primary repair alone (PRA) would be associated with decreased duodenal leak rates; however, CRAM would be associated with improved recovery and outcomes when leaks do occur. A retrospective, multicenter analysis from 35 Level 1 trauma centers included patients older than 14 years with operative, traumatic duodenal injuries (January 2010 to December 2020). The study sample compared duodenal operative repair strategy: PRA versus CRAM (any repair plus pyloric exclusion, gastrojejunostomy, triple tube drainage, duodenectomy). The sample (N = 861) was primarily young (33 years) men (84%) with penetrating injuries (77%); 523 underwent PRA and 338 underwent CRAM. Complex repairs with adjunctive measures were more critically injured than PRA and had higher leak rates (CRAM 21% vs. PRA 8%, p < 0.001). Adverse outcomes were more common after CRAM with more interventional radiology drains, prolonged nothing by mouth and length of stay, greater mortality, and more readmissions than PRA (all p < 0.05). Importantly, CRAM had no positive impact on leak recovery; there was no difference in number of operations, drain duration, nothing by mouth duration, need for interventional radiology drainage, hospital length of stay, or mortality between PRA leak versus CRAM leak patients (all p > 0.05). Furthermore, CRAM leaks had longer antibiotic duration, more gastrointestinal complications, and longer duration until leak resolution (all p < 0.05). Primary repair alone was associated with 60% lower odds of leak, whereas injury grades II to IV, damage control, and body mass index had higher odds of leak (all p < 0.05). There were no leaks among patients with grades IV and V injuries repaired by PRA. Complex repairs with adjunctive measures did not prevent duodenal leaks and, moreover, did not reduce adverse sequelae when leaks did occur. Our results suggest that CRAM is not a protective operative duodenal repair strategy, and PRA should be pursued for all injury grades when feasible. Therapeutic/Care Management; Level IV.