ivosidenib

Essentials of Pediatric Emergency Medicine Fellowship: Clinical Updates From the Past Decade.

Kane Ian D ID, Fang Andrea A, Meltzer James A JA, Werner Heidi H et al.

Ten years ago, a comprehensive series of articles was published in Pediatric Emergency Care detailing the state of pediatric emergency medicine (PEM) fellowship education. We intend to provide an update to the clinical elements of fellowship training, with a companion article to follow that will address the nonclinical domains. This article will summarize the core components of fellowship as mandated by the Accreditation Council for Graduate Medical Education (ACGME) and review significant changes and challenges to fellowship education that have occurred over the past decade. In light of upcoming modifications to fellowship education, including an increased focus on competency-based medical education and the addition of a 2-year, clinically oriented fellowship option, it is vital for stakeholders to be familiar with the core elements of PEM fellowship training as the curriculum is adapted to meet the needs of trainees and their patients.

Preparedness for early detection of oral cancer and oral potentially malignant disorders among Saudi dental students: a multicenter cross-sectional survey.

Tarakji Bassel B, Alsalhani Anas A, Mehsen Alali Faisal F, Alqhtani Nasser Raqe NR et al.

Oral cancer remains a major global health challenge, with delayed diagnosis contributing to poor prognosis and reduced survival. Dental students play an important role in early detection; however, deficiencies in preparedness and diagnostic confidence have been reported. This study assessed oral cancer knowledge, oral potentially malignant disorder (OPMD) awareness, and diagnostic confidence among Saudi dental students. A quantitative cross-sectional online survey was conducted among 354 dental students and interns from governmental and private dental schools in Saudi Arabia. The questionnaire assessed oral cancer knowledge, OPMD knowledge, and self-reported diagnostic confidence related to screening and biopsy procedures. Participants were classified as meeting or not meeting a study-defined minimum operational threshold of ≥60% of the maximum possible score in each domain; this cutoff was not interpreted as a definition of "good" performance or clinical competence. Associations between participant characteristics and study outcomes were examined using chi-square tests and multivariable binary logistic regression analyses. Overall, 81.9% of participants met the oral cancer knowledge threshold, 55.4% met the OPMD knowledge threshold, and 24.0% met the diagnostic confidence threshold. Most participants correctly identified major oral cancer risk factors, including tobacco smoking (97.2%), alcohol consumption (92.7%), and human papillomavirus infection (86.7%). However, clinically oriented response patterns highlighted areas for educational attention. 20.1% selected the prespecified specialist-referral response for management of a persistent suspicious lesion, while 35.6% recognized factors associated with increased malignant transformation risk in leukoplakia. Intern status remained independently associated with meeting the oral cancer knowledge and diagnostic confidence thresholds in multivariable analyses. The diagnostic-confidence outcome reflected self-perceived preparedness rather than observed screening, referral, or procedural competence. A high proportion of Saudi dental students met the study-defined oral cancer knowledge threshold; however, self-reported diagnostic confidence and preparedness for early detection remained considerably lower. Strengthening competency-based oral cancer education and clinical training may improve early detection preparedness and referral practices among future dental practitioners. Because the domains assessed different constructs and had different effective cutoffs, their threshold proportions should not be compared directly; the diagnostic-confidence findings represent perceived preparedness only.

EXPRESS: Diagnostic and prognostic value of on-site CT-derived fractional flow reserve in intracranial atherosclerotic stenosis.

Wang Xinran X, Zeng Xuan X, Guo Jian J, Shi Zhao Z et al.

The role of CT-derived fractional flow reserve (CT-FFR) in cerebrovascular disease remains undefined. This study validated the diagnostic and prognostic value of an on-site CT-FFR in symptomatic intracranial atherosclerotic stenosis (sICAS) patients. This retrospective study enrolled sICAS patients with 30 - 99% stenosis confirmed by CTA, divided into two substudies. The diagnostic performance study included 259 patients undergoing CTA and CT perfusion (CTP) or four-dimensional CTA (CTP as reference standard). In prognosis study, 452 patients with at least 1-year follow-up were included. Computational fluid dynamics (CFD) model was used to measure CT-FFR. Diagnostic performance was assessed by receiver-operating characteristic (ROC) curves, and predictive value by Cox regression analysis. The diagnostic performance of CT-FFR was significantly higher than diameter stenosis (DS) on both per-patient (P = 0.009) and per-lesion (P = 0.004) basis. And the cut-off value of CT-FFR diagnosing cerebral hypoperfusion was 0.80. 15.0% (68 / 452) patients experienced recurrent ischemic events during the median 24 (17-33) months follow-up. CT-FFR provided incremental prognostic value beyond traditional cardiovascular risks plus DS (AUC = 0.797 vs 0.716, P < 0.001). This on-site CT-FFR can serve as a valuable tool for diagnosis and risk stratification in sICAS patients.

Suspected Rosuvastatin-Associated Bullous Pemphigoid: A Diagnostic and Therapeutic Challenge.

Gandhi Shirley S, Clark Barrie B, Ashraf Iman I, Qadir Nadim N et al.