management

Q&A Collections: Classroom-Management Advice

All Classroom Q&A posts sharing classroom-management advice (from the past nine years!) are described and linked to in this compilation post.




management

Are Aspiring Teachers Learning Classroom Management? It Varies

The strategy of reinforcing good behavior with praise is the least likely to be taught in teacher-prep programs, an analysis finds.




management

News24 Business | BOOK REVIEW | Why many time management tricks don't work (and one that does)

Most time management strategies are dropped as quickly as they are picked up for one key reason: insight is so much more important than theory, says Ian Mann. And this author's insight is invaluable.




management

Are Aspiring Teachers Learning Classroom Management? It Varies

The strategy of reinforcing good behavior with praise is the least likely to be taught in teacher-prep programs, an analysis finds.




management

Talk to explore flood management, infrastructure funding in New Zealand

Patrick Walsh, an economist at the U.S. Environmental Protection Agency, will give the talk, “Distributional Impacts of Flood Adaptation and Infrastructure Funding in New Zealand,” at noon on Wednesday, Dec. 4, in 157 Hosler Building on Penn State's University Park campus. 




management

Reputation Management: What It Is And Mastering The How

This article delves into this evolution, highlighting the importance of digital tools, like AI, for keeping track of what's said about you online




management

Why Your Business Needs A Crisis Management Plan

The article will provide strategies for effectively leveraging these tools to your advantage




management

AG Jennings’ Consumer Protection Unit files Action Against Unlicensed Debt-Management Services Company

Attorney General Kathy Jennings’ Consumer Protection Unit announced Monday that it filed an administrative lawsuit against Centerdon Group, Inc. n/k/a Hilvanim Group, Inc., a California corporation, for violating the Delaware Uniform Debt-Management Services Act, the Delaware Consumer Fraud Act and the Delaware Deceptive Trade Practices Act. “Delawareans who are struggling with debt deserve our help, […]



  • Department of Justice
  • Department of Justice Press Releases
  • News
  • Attorney General Kathy Jennings
  • Consumer Protection Unit

management

DNREC to Host Nov. 14 Webinar about Storm Water Management and Living Shorelines

DNREC, in conjunction with the Delaware Living Shorelines Committee, will host a free webinar Thursday, Nov. 14 about nature-based stormwater management and living shoreline projects.




management

SAS Customer Intelligence 360: Introduction to marketing data management

No matter what your brand's level of marketing maturity is, SAS can help you move from data to insight to action with rich functionality for adaptive planning, journey activation and an embedded real-time decision engine – all fueled by powerful analytics and artificial intelligence (AI) capabilities. Let's begin with a [...]

SAS Customer Intelligence 360: Introduction to marketing data management was published on Customer Intelligence Blog.




management

SAS Customer Intelligence 360: Identity management, profiling and unified data model for hybrid marketing

Customer data platforms (CDPs), data management platforms (DMPs), people-based marketing, identity graphs, and more overlapping topics represent an important ingredient of any martech brainstorming session in 2020. As your brand spreads out across touchpoints — from web to mobile applications, as well as call centers, email and direct mail — [...]

SAS Customer Intelligence 360: Identity management, profiling and unified data model for hybrid marketing was published on Customer Intelligence Blog.




management

Unlocking the Concepts of IEEE 1801 Standard for Efficient Power Management

Power efficiency is a critical factor in the fast-evolving world of semiconductor design.

The IEEE 1801 standard, also known as UPF (Unified Power Format), was developed by the IEEE to address the intricate challenges associated with power management in contemporary semiconductor designs. This standard offers a uniform framework for defining power domains, power states, and power intent, ensuring consistency across diverse tools and phases of the design process. By utilizing UPF, you can precisely model and regulate power consumption, a critical aspect for battery-operated devices, high-performance computing, and energy-efficient designs.

The key concepts of IEEE 1801 are:

  1. Power domains
  2. Power states
  3. Power gating and isolation
  4. Power switches
  5. Level shifters, isolation, and retention cells
  6. Macro model

Based on these building blocks, you write the power intent of the design.

The power intent for the design includes identifying/implementing low-power strategies that provide a clear description of the power architecture of a design.

The power definitions can effectively manage power consumption and ensure the chip meets its power and performance requirements.

You can start by creating the Power Supply Network, which defines how power is supplied to the design's various power domains and logic cells.

What's the next step to build the file? How do you understand the various concepts related to IEEE 1801? How do you complete the rest of the power intent file?

Relax!

Gear up to attend the training class created just for you to dive deep into the entire format and explore this exciting power specification method/format with hands-on labs in one day!

Training

Fundamentals of IEEE 1801 Low-Power Specification Format Training

This course is a complete tutorial for understanding the fundamentals of IEEE 1801 low-power specification format concepts. You learn about IEEE 1801 power supply networks, ground ports and nets, creating and connecting supply ports/nets, power domain, power switch, power states, defining isolation and level shifter strategies, hierarchical IEEE 1801, and various versions of the IEEE 1801. You also explore how power intent information can be used for a design across various flow stages, such as functional verification, synthesis, logic equivalency checking, place-and-route, test, timing signoff, power integrity, and so forth, using Cadence® tools.

Labs

We ensure that your learning journey is smooth with hands-on labs covering various design scenarios.

Lab Videos

Now, the exciting part is that to help you further, we have created engaging videos of the training labs. You can refer to the lab module's instructions in demo format at https://support.cadence.com.

Lab DemoChecking Power Supply Network in IEEE 1801 format and Running IEEE 1801 Quality Checks using Conformal Low Power

Lab Demo: Checking Power Intent for The Macro Connections in IEEE 1801 Format And Running IEEE 1801 Quality Checks using Conformal Low Power 

Online Class

Here is the course link.

Get ready for the most thrilling experience with Accelerated Learning!

The more you know, the faster you go!

Grab the cycle  or hike it, based on your existing knowledge.

Take the quiz and increase your learning pace!!

What's Next?

Grab your Badge after finishing the training and flaunt the expertise you have built up. 😊

Ready to take a tour of this power specification world? Let's help you enroll in this course.

We organize this training for you as a "Blended" or "Live" training. Please reach out to Cadence Training for further information. If you want to ensure you are always the first to know about anything new in training, you can use the SUBSCRIBE button on the landing page to sign up for our regular training newsletters.

Related Short Training Bytes/Videos

Enhance the learning experience with short videos:

Genus Synthesis Solution: Video Library

 Joules RTL Power Solution: Video Library

Related Training

 Low-Power Synthesis Flow with Genus Synthesis Solution

Genus Low-Power Synthesis Flow with IEEE 1801

Related Blogs

It's the Digital Era; Why Not Showcase Your Brand Through a Digital Badge! - Digital Design - Cadence Blogs - Cadence Community

Relax in Summer with Cooler IC chips and Ice-Cream! Do you want to Explore the Recipe? - Digital Design - Cadence Blogs - Cadence Community

Power Is HOT and Touches Everything and Everybody! But the Challenge Is To Deal With Low Power During Design Synthesis; How? - Digital Design - Cadence Blogs - Cadence Community

Binge on Chip Design Concepts this Weekend! - Digital Design - Cadence Blogs - Cadence Community




management

The Warming Arctic Requires Precautionary Management

The Warming Arctic Requires Precautionary Management The Warming Arctic Requires Precautionary Management

stanfords

Web Article

Recent online articles and analysis that have been published on the East-West Center website.

Explore

Web Article

Recent online articles and analysis that have been published on the East-West Center website.

Explore




management

Abiodun promises prudent resource management

Ogun State Governor, Dapo Abiodun, on Tuesday, said his administration is committed to pursuing fiscal responsibility, through public financial management reforms. This, he said, is to build strong institutions that will promote accountability and transparency. Abiodun made the commitment in Abeokuta during the Treasury Board Meeting on Year 2025-2027 Medium Term Expenditure Framework and the


Read More




management

FCMB attains ISO Certification for Quality Management

Leading financial services provider, First City Monument Bank (FCMB), has been awarded the prestigious International Organisation for Standardisation (ISO) 9001:2015 certificate for Quality Management System. The Bank was presented with the certificate by the Standards Organisation of Nigeria (SON), following a comprehensive audit and evaluation exercise conducted by the Organisation. The exercise covered departments and […]

FCMB attains ISO Certification for Quality Management




management

Financial mismanagement: Gauteng Health Department’s R743 million debt to suppliers




management

Japan's 7-Eleven reportedly considering management buyout of up to $58B

TOKYO, Japan — Japan’s Seven & i Holdings 3382.T is considering launching a management buyout that would see the retailer go private in a deal that could be worth up to $58 billion, Bloomberg News reported on Wednesday. The Nikkei newspaper also reported that the owner of the 7-Eleven convenience store chain was looking at […]...

Keep on reading: Japan's 7-Eleven reportedly considering management buyout of up to $58B




management

2024 Asian Regional Forum on Investment Management of Foreign Exchange Reserves - Roberta Casali

Opening remarks by Roberta Casali, ADB Vice-President for Finance and Risk Management, at the 2024 Asian Regional Forum on Investment Management of Foreign Exchange Reserves, 25 September 2024, Japan




management

Asian Impact Webinar 80: Statistical Data and Metadata eXchange for Enhanced Data Management

Decision makers need to analyze, exchange, and disseminate statistical information effectively in today’s data-driven world. See how Statistical Data and Metadata eXchange (SDMX) standards are helping create robust data links across the globe.




management

Associate IT Officer (Technology Operations Governance and Service Management)

ADB has a vacancy for the position of Associate IT Officer (Technology Operations Governance and Service Management) in the Information Technology Department . The deadline for submitting applications is on 19-NOV-2024.




management

Asian Development Blog: Four Ways to Strengthen Public Financial Management Systems and Drive Reform

Public financial management systems in Asia and the Pacific face significant challenges, with many indicators falling short of international standards. Fixing these issues requires a strategic, transparent, and carefully timed approach to reform.




management

Asian Development Blog: Five Ways to Strengthen Public Financial Management Systems and Drive Reform

Public financial management systems in Asia and the Pacific face significant challenges, with many indicators falling short of international standards. Fixing these issues requires a strategic, transparent, and carefully timed approach to reform.




management

Development Asia: Designing a Comprehensive Public Financial Management Reform Plan for the Philippines




management

to write a project management report

to write a project management report




management

Climate-Resilient Fiscal Management: Experience from Southeast Asia

This report considers how finance and planning ministries can respond strategically to climate risk, highlighting best practices from Southeast Asia and identifying crosscutting priorities.




management

2940-PRC: Hubei Huangshi Urban Pollution Control and Environmental Management Project[LR-C01-1 Ci lake dredging part 1 Bid No.: 0703-1520CIC1J602]




management

2970/L8262-CAM: GMS Flood and Drought Risk Management and Mitigation Project[CAM2-ICB-W02- Upgrading of Damnak Chheukrom Irrigation System Main Canal]




management

Loan No. 2492/2493-UZB (SF): Water Resources Management Sector Project [WRMSP/ICB/03]




management

Public Financial Management Project 3rd Additional Financing




management

Capacity Development for Climate Mitigative Water Management Technology

The technical assistance (TA), which will be approved with the proposed Integrated Water Resources Management Project, will help the Ministry of Water Resources and Meteorology: (i) implement one of the activities of output 2 (para 6), (ii) inform rice farmers about and train them to implement innovative climate mitigative water management technology, and (iii) disseminate this innovative AWD technology to the entire country. The TA project's demonstration activities are expected to reduce emissions by 11,750 tons of carbon dioxide equivalent.




management

Digital Agriculture Management for Improved Food Security Project




management

Preparing the Babeldaob Island Urban Resilience Project (formerly Strengthening Urban Planning and Management)

For approval in 2023.




management

Pain Management

Title: Pain Management
Category: Diseases and Conditions
Created: 12/7/2006 12:00:00 AM
Last Editorial Review: 7/28/2022 12:00:00 AM




management

Cholesterol Management

Title: Cholesterol Management
Category: Diseases and Conditions
Created: 12/31/1997 12:00:00 AM
Last Editorial Review: 7/6/2022 12:00:00 AM




management

Evidence-based management of symptoms in serious respiratory illness: what is in our toolbox?

Extract

Living with a respiratory illness requires patients to manage a wide range of symptoms, many of which will worsen as a disease progresses. Breathlessness is a hallmark feature of respiratory conditions, occurring in almost all individuals with COPD and interstitial lung disease (ILD) [1, 2]. Cough is present in 78% of people with ILD and is frequently distressing, with physical, social and emotional impacts [1, 3].




management

Cannabis and Pain Management

Family physicians are fielding questions about cannabis --particularly for the use of cannabis for treatment of pain. Like about every substance ingested to treat medical conditions, cannabis has risks and benefits. But regarding evidence-based practice and practice-based recommendations for patients about cannabis use, the cart is in front of the horse. Cannabis use is still illegal at a federal level and a Schedule 1 drug, but most states have challenged federal law by decriminalizing or legalizing cannabis for a variety of uses. Research is difficult due to this federal status as a Schedule 1 drug since federal funding is not readily available to support research. As a result, physicians have little to no guidance about the clinical usefulness of the product. This article explores what we know and what we are learning about cannabis, and the authors provide clinical guidance for patient care based on this evidence.




management

Be SMART About Asthma Management: Single Maintenance and Reliever Therapy

Single maintenance and reliever therapy (SMART) is an asthma treatment approach that utilizes combined inhaled corticosteroids and long-acting β-agonists for maintenance and quick relief therapy. Despite the evidence for its benefits in asthma treatment and its adoption into American and international asthma guidelines and recommendations, SMART remains a practice of some debate. This article reviews the available evidence for SMART and offers guidance for its integration into comprehensive asthma management. Overall, short-acting β-agonist-only asthma therapy regimens should be avoided, regardless of condition severity (SOR A Recommendation). Family medicine clinicians should start SMART for patients requiring either GINA Step 3 or 4 therapy, especially if they have signs of poor adherence (SOR B Recommendation). Finally, use budesonide-formoterol over other inhaled corticosteroid/long-acting β-agonist combinations when implementing SMART (SOR B Recommendation).




management

Assessing Patient Readiness for Hospital Discharge, Discharge Communication, and Transitional Care Management

Background:

Discharge communication between hospitalists and primary care clinicians is essential to improve care coordination, minimize adverse events, and decrease unplanned health services use. Health-related social needs are key drivers of health, and hospitalists and primary care clinicians value communicating social needs at discharge.

Objective:

To 1) characterize the current state of discharge communications between an academic medical center hospital and primary care clinicians at associated clinics; 2) seek feedback about the potential usefulness of discharge readiness information to primary care clinicians.

Design:

Exploratory, convergent mixed methods.

Participants:

Primary care clinicians from Family Medicine and General Internal Medicine of an academic medical center in the US Intermountain West.

Approach:

Literature-informed REDCap survey. Semistructured interview guide developed with key informants, grounded in current literature. Survey data were descriptively summarized; interview data were deductively and inductively coded, organized by topics.

Results:

Two key topics emerged: 1) discharge communication, with interrelated topics of transitional care management and follow-up appointment challenges, and recommendations for improving discharge communication; and 2) usefulness of the discharge readiness information, included interrelated topics related to lack of shared understanding about roles and responsibilities across settings and ethical concerns related to identifying problems that may not have solutions.

Conclusions:

While reiterating perennial discharge communication and transitional care management challenges, this study reveals new evidence about how these issues are interrelated with assessing and responding to patients’ lack of readiness for discharge and unmet social needs during care transitions. Primary care clinicians had mixed views on the usefulness of discharge readiness information. We offer recommendations for improving discharge communication and transitional care management (TCM) processes, which may be applicable in other care settings.




management

A Review of Artificial Intelligence and Machine Learning in Product Life Cycle Management

The pursuit of harnessing data for knowledge creation has been an enduring quest, with the advent of machine learning (ML) and artificial intelligence (AI) marking significant milestones in this journey. ML, a subset of AI, emerged as the practice of employing mathematical models to enable computers to learn and improve autonomously based on their experiences. In the pharmaceutical and biopharmaceutical sectors, a significant portion of manufacturing data remains untapped or insufficient for practical use. Recognizing the potential advantages of leveraging the available data for process design and optimization, manufacturers face the daunting challenge of data utilization. Diverse proprietary data formats and parallel data generation systems compound the complexity. The transition to Pharma 4.0 necessitates a paradigm shift in data capture, storage, and accessibility for manufacturing and process operations. This paper highlights the pivotal role of AI in converting process data into actionable knowledge to support critical functions throughout the whole product life cycle. Furthermore, it underscores the importance of maintaining compliance with data integrity guidelines, as mandated by regulatory bodies globally. Embracing AI-driven transformations is a crucial step toward shaping the future of the pharmaceutical industry, ensuring its competitiveness and resilience in an evolving landscape.




management

A worldwide perspective of long COVID management: how can we END-COVID?

Extract

As of 15 May 2024, >775 million confirmed cases of COVID-19 and >7 million deaths have been reported to the World Health Organization [1]. Although most patients with COVID-19 survive, survivors are at risk of long COVID, the sequelae of the viral infection affecting multiple organ systems [2]. Long COVID poses a substantial burden to individuals and society, even with a conservative estimate of 10% prevalence among COVID-19 survivors [3–5]. However, as the symptoms of long COVID vary substantially, ranging from respiratory symptoms, such as dyspnoea and cough, to fatigue and cognitive impairment [6], developing a standard set of investigations and management protocols for patients with long COVID is challenging.




management

A worldwide look into long COVID-19 management: an END-COVID survey

Background

Long COVID is a heterogeneous clinical syndrome characterised by a variety of reported symptoms and signs. Its clinical management is expected to differ significantly worldwide.

Methods

A survey-based study investigating long COVID-related standard operating procedures (SOPs) has been conducted by the European Respiratory Society (ERS) END-COVID clinical research collaboration with the support of other international societies (ALAT, APSR, CHEST, ESCMID and PATS). A global analysis of the results is provided here, alongside sub-population analysis based on continents, national income levels, type of involved healthcare professional and inclusion or exclusion of paediatric patients.

Findings

1015 healthcare professionals from 110 different countries worldwide participated in this study, the majority of them being respiratory physicians (60.6%). A dedicated long COVID programme was present in 55.4% of the investigated institutions, with hospital admission during the acute infection being the main inclusion criteria to access them. Consistent differences in long COVID-related procedures were identified among centres, mainly regarding the multidisciplinary approach, the availability of telemedicine and psychological support, the type of requested exams and the total amount of visits in the centre.

Interpretation

Long COVID management shows important differences related to geographical areas and national income levels. SOPs were significantly different when centres were managed by a pulmonologist or when paediatric patients were included.




management

Multidisciplinary management of adult patients with chylothorax: a consensus statement

The management of chylothorax remains challenging given the limited evidence and significant heterogeneity in practice. In addition, there are no practical guidelines on the optimal approach to manage this complex condition. We convened an international group of 27 experts from 20 institutions across five countries and four specialties (pulmonary, interventional radiology, thoracic surgery and nutrition) with experience and expertise in managing adult patients with chylothorax. We performed a literature and internet search for reports addressing seven clinically relevant PICO (Patient, Intervention, Comparison and Outcome) questions pertaining to the management of adult patients with chylothorax. This consensus statement, consisting of best practice statements based on expert consensus addressing these seven PICO questions, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with provider experience. Panel members participated in the development of the final best practice statements using the modified Delphi technique. Our consensus statement aims to offer guidance in clinical decision making when managing patients with chylothorax while also identifying gaps in knowledge and informing future research.




management

Reassessing Halm's clinical stability criteria in community-acquired pneumonia management

Background

Halm's clinical stability criteria have long guided antibiotic treatment and hospital discharge decisions for patients hospitalised with community-acquired pneumonia (CAP). Originally introduced in 1998, these criteria were established based on a relatively small and select patient population. Consequently, our study aims to reassess their applicability in the management of CAP in a contemporary real-world setting.

Methods

This cohort study included 2918 immunocompetent patients hospitalised with CAP from three hospitals in Denmark between 2017 and 2020. The primary outcome was time to achieve clinical stability as defined by Halm's criteria. Additionally, we examined recurrence of clinical instability and severe complications. Cumulative incidence function or Kaplan–Meier survival curves were used to analyse these outcomes, considering competing risks.

Results

The study population primarily comprised elderly individuals (median age 75 years) with significant comorbidities. The median time to clinical stability according to Halm's criteria was 4 days, with one-fifth experiencing recurrence of instability after early clinical response (stability within 3 days). Severe complications within 30 days mainly comprised mortality, with rates of 5.1% (64/1257) overall in those with early clinical response, 1.7% (18/1045) in the subgroup without do-not-resuscitate orders and 17.3% (276/1595) among the rest.

Conclusion

Halm's clinical stability criteria effectively classify CAP patients with different disease courses, yet achieving stability required more time in this ageing population with substantial comorbidities and more severe disease. Early clinical response indicates reduced risk of complications, especially in those without do-not-resuscitate orders.




management

Impact of 18F-FES PET/CT on Clinical Decisions in the Management of Recurrent or Metastatic Breast Cancer

The clinical impact of 16α-18F-fluoro-17β-estradiol (18F-FES) PET/CT on patient management has not been well investigated. The aim of this study was to assess the clinical impact of 18F-FES PET/CT on the management of patients with recurrent or metastatic breast cancer. Methods: Study subjects were identified retrospectively from a database of a prospective trial for postmarketing surveillance of 18F-FES between 2021 and 2023. Patients who were suspected or known to have recurrent or metastatic estrogen receptor–positive breast cancer based on a routine standard workup were included. Planned management before and actual management after 18F-FES PET/CT were assessed by 2 experienced medical oncologists via medical chart review. A 5-point questionnaire was provided to evaluate the value of 18F-FES PET/CT for management planning. The rate of intention-to-treat and interdisciplinary changes, and the impact of 18F-FES PET/CT according to PET/CT result or clinical indication, were examined. Results: Of the 344 included patients, 120 (35%) experienced a change in management after 18F-FES PET/CT. In 139 (40%) patients,18F-FES PET/CT supported the existing management decision without a change in management. Intention-to-treat and interdisciplinary changes accounted for 64% (77/120) and 68% (82/120) of all changes, respectively. A higher rate of change was observed when lesions were 18F-FES–negative (44% [36/81]) than 18F-FES–positive (30% [51/172]) or mixed 18F-FES–positive/negative (36% [33/91]). Regarding clinical indications, the highest rate of change was shown when evaluating the origins of metastasis of double primary cancers (64% [9/14]). Conclusion: 18F-FES PET/CT modified the management of recurrent or metastatic breast cancer, serving as an impactful imaging modality in clinical practice.




management

Is the Clinical Application of CXCR4 Imaging in the Diagnosis and Management of Primary Aldosteronism Really Happening?




management

Weight management with orlistat in type 2 diabetes: an electronic health records study

BackgroundOrlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM).AimTo explore associations between patient characteristics and orlistat prescribing, and to determine associations of orlistat with weight loss in T2DM and prediabetes.Design and settingCohort study using anonymised health records from a UK database of general practice.MethodThe UK Clinical Practice Research Datalink (CPRD) Aurum database was searched to compile a cohort of patients aged ≥18 years, first diagnosed with T2DM or prediabetes in 2016 or 2017. Once the data had been collated, multivariable logistic regression models were used to determine associations with starting orlistat and stopping it early (<12 weeks of prescriptions) and orlistat’s associations with weight loss in those who had not been prescribed second-line antidiabetic medications.ResultsOut of 100 552 patients with incident T2DM or prediabetes, 655 (0.8%) patients with T2DM and 128 (0.7%) patients with prediabetes were prescribed orlistat. Younger people, females, those in areas of deprivation, current smokers, those coprescribed metformin, and those recorded as having hypertension were statistically significantly more likely to be prescribed orlistat; higher baseline glycated haemoglobin levels were associated with early stopping. In comparison with patients not on orlistat, those who continued using it for ≥12 weeks were more likely to lose ≥5% weight (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI] = 1.07 to 2.67) but those who stopped orlistat early were less likely to lose ≥5% weight (AOR 0.56, 95% CI = 0.29 to 1.09).ConclusionOrlistat was significantly associated with weight loss in patients with T2DM and prediabetes when taken for at least 12 weeks; however, it was infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications for patients with T2DM and prediabetes, but barriers to continued use means it may not be effective for everyone in managing weight loss.




management

A Cluster-Randomized Study of Technology-Assisted Health Coaching for Weight Management in Primary Care [Original Research]

PURPOSE

We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care.

METHODS

This cluster-randomized controlled trial enrolled 19 primary care teams with 63 clinicians; 9 teams were randomized to GEM and 10 to enhanced usual care (EUC). The GEM intervention included 1 in-person and up to 12 telephone-delivered coaching sessions. Coaches supported goal setting and engagement with weight management programs, facilitated by a software tool. Patients in the EUC arm received educational handouts. We enrolled patients who spoke English or Spanish, were aged 18 to 69 years, and either were overweight (body mass index 25-29 kg/m2) with a weight-related comorbidity or had obesity (body mass index ≥30 kg/m2). The primary outcome (weight change at 12 months) and exploratory outcomes (eg, program attendance, diet, physical activity) were analyzed according to intention to treat.

RESULTS

We enrolled 489 patients (220 in the GEM arm, 269 in the EUC arm). Their mean (SD) age was 49.8 (12.1) years; 44% were male, 41% Hispanic, and 44% non-Hispanic Black. At 12 months, the mean adjusted weight change (standard error) was –1.4 (0.8) kg in the GEM arm vs –0.8 (1.6) kg in the EUC arm, a nonsignificant difference (P = .48). There were no statistically significant differences in secondary outcomes. Exploratory analyses showed that the GEM arm had a greater change than the EUC arm in mean number of weekly minutes of moderate to vigorous physical activity other than walking, a finding that may warrant further exploration.

CONCLUSIONS

The GEM intervention did not achieve clinically important weight loss in primary care. Although this was a negative study possibly affected by health system resource limitations and disruptions, its findings can guide the development of similar interventions. Future studies could explore the efficacy of higher-intensity interventions and interventions that include medication and bariatric surgery options, in addition to lifestyle modification.




management

[PERSPECTIVES] New Paradigms in the Clinical Management of Li-Fraumeni Syndrome

Approximately 8.5%–16.2% of childhood cancers are associated with a pathogenic/likely pathogenic germline variant—a prevalence that is likely to rise with improvements in phenotype recognition, sequencing, and variant validation. One highly informative, classical hereditary cancer predisposition syndrome is Li–Fraumeni syndrome (LFS), associated with germline variants in the TP53 tumor suppressor gene, and a >90% cumulative lifetime cancer risk. In seeking to improve outcomes for young LFS patients, we must improve the specificity and sensitivity of existing cancer surveillance programs and explore how to complement early detection strategies with pharmacology-based risk-reduction interventions. Here, we describe novel precision screening technologies and clinical strategies for cancer risk reduction. In particular, we summarize the biomarkers for early diagnosis and risk stratification of LFS patients from birth, noninvasive and machine learning–based cancer screening, and drugs that have shown the potential to be repurposed for cancer prevention.




management

Management of opioid use disorder: 2024 update to the national clinical practice guideline [Guideline]

Background

In an evolving landscape of practices and policies, reviewing and incorporating the latest scientific evidence is necessary to ensure optimal clinical management for people with opioid use disorder. We provide a synopsis of the 2024 update of the 2018 National Guideline for the Clinical Management of Opioid Use Disorder, from the Canadian Research Initiative in Substance Matters.

Methods

For this update, we followed the United States Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines and used the Appraisal of Guidelines Research and Evaluation—Recommendation Excellence tool to ensure guideline quality. We carried out a comprehensive systematic literature review, capturing the relevant literature from Jan. 1, 2017, to Sept. 14, 2023. We drafted and graded recommendations according to the Grading of Recommendations, Assessments, Development and Evaluation approach. A multidisciplinary external national committee, which included people with living or lived experience of opioid use disorder, provided input that was incorporated into the guideline.

Recommendations

From the initial 11 recommendations in the 2018 guideline, 3 remained unchanged, and 8 were updated. Specifically, 4 recommendations were consolidated into a single revised recommendation; 1 recommendation was split into 2; another recommendation was moved to become a special consideration; and 2 recommendations were revised. Key changes have arisen from substantial evidence supporting that methadone and buprenorphine are similarly effective, particularly in reducing opioid use and adverse events, and both are now considered preferred first-line treatment options. Slow-release oral morphine is recommended as a second-line option. Psychosocial interventions can be offered as adjunctive treatment but should not be mandatory. The guideline reaffirms the importance of avoiding withdrawal management as a standalone intervention and of incorporating evidence-based harm reduction services along the continuum of care.

Interpretation

This guideline update presents new recommendations based on the latest literature for standardized management of opioid use disorder. The aim is to establish a robust foundation upon which provincial and territorial bodies can develop guidance for optimal care.




management

Management of central sleep apnoea: a review of non-hypercapnic causes

Central sleep apnoea (CSA) is characterised by recurrent episodes of airway cessation or reduction in the absence of respiratory effort. Although CSA is less common than obstructive sleep apnoea, it shares similar symptoms. CSA can be secondary to various medical conditions, high altitude and medication exposure. CSA can also emerge during obstructive sleep apnoea therapy. There are a range of treatment options and selecting the right therapy requires an understanding of the pathophysiology of CSA. This review explores the aetiology, pathophysiology and clinical management of non-hypercapnic CSA.