Ensuring Quality in Interventional Cytopathology

Adhering to an antithrombotic medication regimen is essential to reducing recurrent stroke in adult stroke survivors. The purpose of this study was to evaluate the feasibility and acceptability of the SystemCHANGE (SC) and attention control (AC) intervention in older adult, nonadherent ischemic stroke patients. A pilot randomized controlled trial was conducted to determine the feasibility and acceptability of an SC versus AC intervention in older adult, nonadherent stroke survivors in the management of antithrombotic medication. Participants were masked to group assignment. Stroke survivors 50 years or older, taking at least 1 once-a-day antithrombotic medication, were recruited from a Midwest Comprehensive Stroke Center-affiliated neurology office. They were screened electronically using the Medication Event Monitoring System for 2 months to determine baseline medication adherence. Nonadherent stroke survivors (medication adherence < 0.97) were randomized to SC or AC intervention and monitored for 3 months. SC focused on redesigning the interpersonal environmental system and daily routines. The AC group was provided education materials on stroke that consisted of stroke risk factor reduction, stroke facts, rehabilitation, and nutrition with the primary investigator. Participation and intervention experience interviews were evaluated for themes. Thirty participants were recruited: median age was 64 years, 46.7% of them were male, and they took an average of 7.77 (SD, 3.191; range, 3-15) prescribed medications. The number of over-the-counter medications taken (excluding aspirin) on a regular basis averaged 1.9 (SD, 0.8; range, 1-4). Two participants were nonadherent and were randomized to the 2 arms. Both participants had positive feedback and were not inconvenienced by their participation in the study. Neither participant voiced concerns about the intervention, survey demands, time requirement, or completing the surveys on the primary investigator's laptop. The SC and AC intervention protocols were feasible and acceptable to the participants in this study. Additional pilot testing is needed to further evaluate the intervention and its effect on medication adherence in this population.

The management of antithrombotic medications in patients requiring invasive procedures is a common problem in hospital medicine, for which there is limited evidence to guide clinical decision making. Existing guidelines do not address many hospital-based procedures and have not kept pace with the introduction of newer antiplatelet and anticoagulant medications. This article provides a conceptual framework for the periprocedural management of antithrombotic therapy, with a focus on the procedures that hospitalists are most likely to perform and the pharmacology of the common and newer antithrombotic medications.

Acute lower gastrointestinal bleeding (LGIB) is a common reason for hospitalization in the United States and is associated with significant utilization of hospital resources, as well as considerable morbidity and mortality. These revised guidelines implement the Grading of Recommendations, Assessment, Development, and Evaluation methodology to propose recommendations for the use of risk stratification tools, thresholds for red blood cell transfusion, reversal agents for patients on anticoagulants, diagnostic testing including colonoscopy and computed tomography angiography (CTA), endoscopic therapeutic options, and management of antithrombotic medications after hospital discharge. Important changes since the previous iteration of this guideline include recommendations for the use of risk stratification tools to identify patients with LGIB at low risk of a hospital-based intervention, the role for reversal agents in patients with life-threatening LGIB on vitamin K antagonists and direct oral anticoagulants, the increasing role for CTA in patients with severe LGIB, and the management of patients who have a positive CTA. We recommend that most patients requiring inpatient colonoscopy undergo a nonurgent colonoscopy because performing an urgent colonoscopy within 24 hours of presentation has not been shown to improve important clinical outcomes such as rebleeding. Finally, we provide updated recommendations regarding resumption of antiplatelet and anticoagulant medications after cessation of LGIB.

The Promise of Nursing Home Medical Direction: A Work in Progress

Background: The interaction between the heart and kidneys involves complex mechanisms, leading to a clinical condition known as cardiorenal syndrome (CRS), where dysfunction in one organ leads to impairment of the other. This syndrome can be acute or chronic, affecting both organs simultaneously. Summary: In 2008, the Acute Dialysis Quality Group classified CRS into two main categories: cardiorenal CRS and renocardiac CRS, based on the primary organ affected. Cardiorenal CRS includes two subtypes where heart failure causes kidney injury (types 1 and 2), while renocardiac CRS (types 3 and 4) refers to kidney injury leading to cardiac dysfunction, either from acute kidney injury or chronic kidney disease. Type 5 CRS is termed as secondary CRS which involves both organ dysfunction due to an acute systemic disease, such as sepsis, infections, or chronic conditions like diabetes mellitus. This review examines the cardiovascular involvement in various nephrological diseases commonly seen in clinical practice, with a focus on types 3–5 CRS in children from a nephrology perspective. Key Messages: CRS is common in pediatric patients with cardiac, renal, or systemic conditions and poses a significant risk of mortality. The lack of longitudinal studies or specific biomarkers for the diagnosis, treatment, and follow-up of CRS in children is evident. Aspects such as the development of new biomarkers, ongoing research into neurohormonal mechanisms, meta-analyses, and introduction of algorithms for the follow-up period may reshape patient management. Specific diagnostic tools or therapeutic interventions for CRS management in children should be implemented. Collaborative efforts among pediatricians, cardiologists, and nephrologists are essential for developing effective treatments. Large-scale studies are needed to better understand CRS and develop targeted therapies to improve outcomes for pediatric patients, reducing morbidity and mortality.

There has been some research at the intersection of beliefs and translation (as a form of applied language knowledge) in recent times. Investigations have focused on translators’, students’ and teachers’ beliefs about different aspects of translation, including translation as a product, a process or a subject of teaching and learning. The topics of interest have ranged from translators’ beliefs about the professional world of translators (Katan 2009), the impact of translators’ beliefs on translation quality (Araghizade 2016, Yousefi 2017), teachers’ and students’ beliefs on the nature of knowledge and learning (Li 2017), teachers’ practices and beliefs about inclusion in the English language classroom (Al Siyabi et al. 2024), teachers’ and students’ beliefs about translator competence and training practices (Wu et al. 2019), to teachers’ beliefs on the role of machine translation in translator education (Hellmich and Vinall 2021, Rico and Pastor 2022). This paper aims to add to this body of knowledge by exploring teachers’ and students' beliefs about translator competence and training practices in the Macedonian context.The purpose of this paper is to identify and compare the beliefs held by translation students and their teachers with reference to translator competencies as well as to explore the way in which these are addressed in existing training practices. The study presented in this paper is conducted among students and teachers at the Department of Translation and Interpreting at the “Blaze Koneski” Faculty of Philology in Skopje, Republic of North Macedonia, using a mixed method approach following Wu et al. (2019). The paper addresses three research questions: what teachers and students believe are the components of translation competence, how much they think these are addressed in current training practices and the similarities and differences between the beliefs of both groups. The results of the study have pedagogical implications. They help teachers become aware of their own beliefs about the importance of the different subcomponents of translation competence and whether these are reflected in their teaching practice. The results also help increase teachers’ awareness of the translation students’ beliefs about translation competence as well as their perception of the teaching methods. Finally, the results show if there are any mismatches between the beliefs of the two groups that need to be addressed in future practice and research.

Evidence-based practice (EBP) has become a cornerstone of modern health care, aiming to ensure that patient care is guided by the best available research evidence, clinical expertise, and patient preferences. The integration of research findings into clinical practice enhances care quality, reduces variability in treatment, and promotes better health outcomes. Both nursing and medical research contribute uniquely to this evidence base: Nursing research often emphasizes patient-centered care, psychosocial aspects, and holistic interventions, whereas medical research typically focuses on pathophysiology, diagnostics, and treatment efficacy. Despite the significant contributions of each discipline individually, gaps remain in translating research into clinical practice due to differences in methodology, focus, and communication between professionals. Integrating nursing and medical research offers an opportunity to bridge these gaps by combining perspectives, improving interdisciplinary collaboration, and ensuring that interventions address both clinical effectiveness and patient experience. The purpose of this editorial is to highlight the importance of collaborative research efforts between nursing and medical disciplines, discuss the benefits and challenges of integration, and explore strategies to foster interdisciplinary research. By emphasizing the synergy between nursing and medical research, this article aims to provide insights into how collaborative efforts can lead to improved patient safety, quality of care, and overall healthcare outcomes.

Purpose This study aimed to outline the changing forms of speech-language pathology practices, for both clinical services, as well as the profession's education and practicum training in the time of COVID-19 at the European University Cyprus (EUC). This study also aimed to document the steps taken to continue service delivery safely and effectively for both the EUC's Speech, Language and Hearing Clinic's clients and the speech-language therapy students completing their practicum. Method The steps for the access to and continuity of speech-language therapy services and education/training are outlined chronologically, throughout the different phases of the COVID-19 pandemic status in the country. The rise of telepractice, telesupervision, and distance learning, adapted as solutions to the obstacles caused by the pandemic, are explained in detail, while the benefits and limitations are discussed at each step. The professional development that had to take place before this rise is also described. Conclusions The utilization of online/telecommunication technology for education, practical training, and speech-language pathologist service delivery during the time of COVID-19 in Cyprus is here to stay and will probably affect the future of the profession's clinical practice, and consequently, training programs in Cyprus in the years to come. It is uncertain if the effects of such adaptations can generalize in other populations or countries, especially where regulations and policies are already in place, or where the technological foundation is not similar. Through the benefits and limitations presented, conclusions are drawn for the future applications of telepractice, telesupervision, and distance learning post–COVID-19. Suggestions are made for the possible areas of future research, concerning clinical practice and clinical practicum training, as well as for the need to define regulations and establish these types of services in the country. Supplemental Material https://doi.org/10.23641/asha.15057396

PurposeThe purpose of this paper is to explore the scope for action of local human resource managers, who are employed in foreign subsidiaries of multinational companies (MNCs), for implementing training activities. These managers are situated in relationships to headquarters and the local environment. Related to this is the question whether MNCs contribute to the local skill base by implementing training activities or whether they exploit the existing skill formation system.Design/methodology/approachThis study focusses on German subsidiaries of MNCs with headquarters in the USA and the UK, France, China and Japan. The study is based on 107 expert interviews with subsidiary managers and representatives of local stakeholder organisations, such as educational organisations, chambers, economic promotion agencies and governmental bodies in Germany.FindingsThe study reveals that headquarters introduce general schemes for training. In addition to these MNC-internal trainings, local managers use their information advantage over headquarters to implement dual training activities.Research limitations/implicationsThe training activities of subsidiaries are dependent on the institutional settings of the host country.Practical implicationsAlbeit dual training activities are laborious and tie the local managers down for the medium and long term, the future need of the subsidiary for adequately skilled workforce prompts local managers’ engagement in implementing dual training activities.Social implicationsSubsidiaries contribute to the local skill base and do not act in a free-rider position, at least in the German variety of capitalism.Originality/valueThe study deepens insights on distanced relations within and how subsidiaries generate scope for action by using this kind of relationships.

The UK's contribution to cancer control in low-income and middle-income countries.

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

Shaw, MP, Andersen, V, Sæterbakken, AH, Paulsen, G, Samnøy, LE, and Solstad, TEJ. Contemporary training practices of Norwegian powerlifters. J Strength Cond Res 36(9): 2544-2551, 2022-The aim of this study was to explore the contemporary training practices of Norwegian powerlifters. One hundred twenty-four Norwegian powerlifters completed an electronic questionnaire that surveyed their current training practices with a focus on 2 areas: (a) training content and (b) training design and monitoring. One hundred seventeen respondents met the inclusion criteria, and the sample included World, European, and Norwegian champions. Where data were dichotomized, chi-square tests were used. The most frequently reported (58.1%) category of training was 5-6 times per week, with no statistically significant associations between levels of competitors (international vs. noninternational) (X 2 (1) = 0.414, p = 0.52). The most frequently reported load used in training was 71-80% 1 repetition maximum. The majority of Norwegian (76.9%) powerlifters train with variable resistance, with those competing internationally more likely to use elastic bands (X 2 (1) = 4.473, p = 0.034). 32.5% of respondents reported that they included strength training exercises in their training. Norwegian powerlifters' training differs from practices previously identified in the literature, with a higher prevalence of elastic resistance, particularly for those competing internationally, and a decreased use of strength training exercises at all levels. Norwegian powerlifters train frequently (5 or more times per week) and with submaximal loads.

This paper describes the design of a training system in which three-dimensional (3-D) graphics are employed to help satellite operations trainees learn about satellite systems. The design takes into account training practices and support requirements of the satellite systems instructors who will be using it and ways in which trainees should be able to interact with and use the 3-D graphics. The training system must significantly improve the rate of satellite system knowledge acquisition beyond the rate obtained using current training practices. To this end, training principles that facilitate the acquisition of complex, functional, and integrated knowledge guided the design of a training system infrastructure that puts 3-D graphics to optimal use.

Background: Endometriosis is a chronic disease characterized by endometrial-like tissue outside the uterus. Superficial endometriosis (SE) is the most prevalent form, yet it remains underdiagnosed due to subtle clinical and imaging presentations. Traditionally, diagnosis relies on laparoscopy, which is relatively invasive and often contributes to diagnostic delay. With advancements in imaging techniques, especially transvaginal ultrasound (TVS), a reassessment of the diagnostic approach for SE is needed. This review updates the understanding of SE diagnostics and integrates both historical perspectives and contemporary clinical insights. Objectives: The review aimed to explore advancements in the diagnosis of SE, focusing on the growing role of TVS as a non-invasive diagnostic tool. Additionally, it seeks to highlight emerging diagnostic challenges and present new approaches to managing SE to offer updated recommendations for clinicians. Methods: A comprehensive literature search was conducted using PubMed, MEDLINE, and Google Scholar. The following keywords were used: “superficial endometriosis,” “diagnostic pathways,” “endometriosis diagnosis,” “superficial lesions,” “transvaginal ultrasound,” “laparoscopy,” “non-invasive imaging,” and “diagnostic accuracy.” Only English-language articles were included, focusing on original research, metanalyses, and clinical guidelines, offering historical and current perspectives. In addition to the literature review, contemporary insights were gathered from our clinical practice at a tertiary endometriosis clinic to offer real-world context to the literature findings. Outcome: The review highlights TVS as a promising non-invasive method for diagnosing SE. While SE has historically been diagnosed through laparoscopy, TVS is gaining recognition as a valuable tool for detecting SE lesions, particularly through the identification of key sonographic features such as hyperechoic foci and cystic spaces. These advancements help overcome the challenges posed by the variability of SE presentation on imaging. Emerging techniques, such as sonoPODography, further enhance SE diagnosis and offer the potential for broader clinical application. Despite challenges such as the need for operator expertise and variability in lesion presentation, the literature and clinical insights support the growing utility of TVS in diagnosing SE. Conclusions and Outlook: TVS has significant potential as a non-invasive diagnostic tool for SE. While limitations such as variability in sensitivity and the need for operator expertise remain, TVS can significantly reduce reliance on invasive methods like laparoscopy. Additionally, the review provides insights into managing cases, where TVS results are negative for SE. In such cases, clinicians must adopt a patient-centered approach that emphasizes symptom management, patient autonomy, and education about possible risks and treatment options. Rather than defaulting to a “watchful waiting” or a “one size fits all” strategy, it is essential to engage patients in shared decision-making, allowing them to make informed choices about further diagnostic or therapeutic interventions. This review underscores the importance of integrating TVS into routine diagnostic pathways for SE, improving early detection and enhancing patient care. Future research should focus on refining TVS techniques, establishing standardized diagnostic criteria, and exploring alternative diagnostic strategies for patients with negative imaging results. This approach has the potential to shift the paradigm of SE management, reducing diagnostic delays and empowering patients with a more proactive, informed approach to their care.

708 Book Reviews TECHNOLOGY AND CULTURE not providing a historiographic survey of this new economic theory as it applies to business history. Perhaps the essay most useful to historians of technology is the one by JoAnne Yates, which describes information supply and demand factors inside the business firm in the period 1850—1920 through a case study of Scovill Manufacturing Company. However, this example has already been given thorough analysis in her book, Control through Communication (Baltimore: Johns Hopkins University Press, 1989). The papers, which resulted from a conference organized by the (U.S.) National Bureau of Economic Research, were not refereed. As the telling comments in the published commentaries, especially those of Hounshell and Charles Sabel, make clear, the essays would have profited from rewriting. All in all, these studies give at best an emblem­ atic vision of what economic theory might contribute to business history, and they leave me wondering whether economists have the will to pursue this goal. William Aspray Dr. Aspray writes on the history of information and is the editor of Technological Competitiveness: Contemporary and Historical Perspectives on the Electrical, Electronics, and Computer Industries (IEEE Press). In the Servitude of Power: Energy and Civilisation through the Ages. By Jean-Claude Debeir, Jean-Paul Deléage, and Daniel Hémery. Lon­ don: Zed Books, 1991; distributed by Humanities Press Interna­ tional, Atlantic Highlands, N.J. Pp. xv + 286; tables, notes, glossary, appendix, index. $55.00/£32.95 (cloth); $19.95/£12.95 (paper). First published in 1986 in France and recently revised and translated into English, this collaborative effort between two French historians and a French physicist seeks to provide an alternative perspective on the energy crisis by moving “beyond the limits of existing approaches to the energy crisis ... to place it in an historical perspective” (p. xv). The authors argue that the existing approaches based on empirical studies do not provide a solid foundation for the analysis of society’s relation to energy. Convinced that one-dimensional modes of analysis will not provide solutions for the future, they address economic, social, and ecological interdependence as a means ofdetermining and assessing the role of energy on the future of humanity. A variety of past energy structures of the ancient Western world and medieval Europe, imperial China, industrial Europe, and North America are discussed, as are the more contemporary issues of the oil crisis, the breakup of energy structures of the Third World, and nuclear power. The book is divided into eleven well-written chapters. The first two document the ecological and social regulations of energy, discuss energy systems and rent, and provide an overview of energy from TECHNOLOGY AND CULTURE Book Reviews 709 prehistory to antiquity. Chapter 3 discusses the Chinese energy model as an exemplary one that has lasted through the centuries. Focusing on the energy structure of food production, high-calorie yield con­ verters, cultivation of the soil, fuel sources, and social control of energy are covered. Chapters 4 and 5, in contrast to the stable Chinese energy model, address the impact of mechanization on European industrialization, focusing on agriculture, mill development, and capi­ talism. Chapters 6 and 7 concentrate on coal, artificial light, oil, and electricity as components of production over demand characteristics of the capitalist energy system and the oil crisis. Nuclear power is discussed in chapters 8—10, using the French model of electronuclear develop­ ment. Chapter 10 centers on the problems of the nuclear energy industry. The final chapter looks at the worldwide energy crisis. The book is well-researched and written in a clear and concise manner. Numerous tables, graphs, and maps support the material in each chapter and add a refreshing note to the text. References are found in the chapter notes located at the end of the book and testify to the tremendous amount of research undertaken. The glossary is enhanced with graphics and charts. Included in the appendix are graphic repre­ sentations of firewood availability in selected countries, extent of risk of desertification, and oil and uranium production and consumption. Historians and students of technology will find the social and ecological emphasis on energy most refreshing. The authors have provided detailed accounts of technical developments and...