Lama H. Nazer

Introduction: Recent guidelines recommend race-free CKD-EPI estimated glomerular filtration rate (eGFR) over the Cockcroft–Gault creatinine clearance (eCrC-CG) for dosing medications. However, many institutions continue using eCrCl-CG due to uncertainty regarding the clinical impact of this transition. This study evaluated differences in carboplatin doses using both equations in a real-world dataset. Methods: This was a retrospective cohort study that included adult patients with cancer who received carboplatin between January and July 2025. Patients were identified using institutional medical records. For each patient, we determined the actual carboplatin dose prescribed, which used the eCrCl_CG for renal function, and we recalculated the dose using the CKD-EPI eGFR. The Calvert formula was used to determine the carboplatin doses. Only first-cycle patient data were analyzed. The primary outcome was the proportion of patients with clinically significant differences between the two dosing methods, defined as ≥10%. Multivariable logistic regression was used to identify predictors of a clinically significant discrepancy, with results reported as odds ratios. Results: Over the study period, 366 patients were included. The median age was 58 years (IQR 47–65), 271 (74%) were females, and the most common type of cancer was breast (n = 142, 39%). Estimated renal function was median of 82 mL/min (IQR 68–97) using the eCrCl-CG equation and 98 mL/min (IQR 83–106) with the CKD-EPI eGFR equation. A difference of ≥10% in carboplatin doses was reported in 142 patients (39%), with the CKD-EPI resulting in higher doses in most cases (99%). Factors associated with clinically significant differences between the two formulas were age (OR 1.14, 95% CI 1.10–1.18, p < 0.001), serum creatinine (OR 0.094, 95% CI 0.018–0.453, p = 0.004) and body weight (OR 0.96, 95% CI 0.95–0.98, p < 0.001). Conclusions: Carboplatin dosing varies according to the renal function estimation method. In 4 out of 10 patients, eCrCl-CG resulted in more than 10% lower doses than those calculated using CKD-EPI eGFR. Age, serum creatinine, and weight predict significant dose differences.

Digital health has the potential to mitigate health inequity for priority populations who are underserved or marginalized by the health system. However, there is a lack of practical guidance on how to include priority communities in the coproduction of digital health technologies, particularly across the entire lifecycle of innovation, including research, development, and evaluation. The aim of this scoping review was to systematically identify and assess published methods used during digital health innovation to promote equitable inclusion of priority communities at every stage of the Centre for eHealth Research roadmap for digital health technologies. This review was based on the Arksey and O'Malley framework for scoping reviews. A 6-stage framework was used to execute the review. To increase the trustworthiness of the findings, an expert advisory group was consulted, and their feedback incorporated into the final manuscript. The Participant, Concept, and Context framework was used to structure the inclusion criteria. The review identified a total of 106 articles, 58 methods, 4 approaches, and 17 research adjustments used to coproduce digital health technologies with priority communities. Common methods across multiple stages included interviews, focus groups, surveys, and workshops; however, the most accessible way to make equity a practical reality during health technology innovation is to appoint a priority population community advisor, or advisory group, from project inception to project closure. Visual and creative methods like photovoice, home tours, and body-mapping were also used, often by priority population researchers themselves. Research adjustments that promote patient safety and comfort, enhanced literacy, peer-support, and recognize sociocultural and demographic considerations have been used to increase the inclusion of priority populations during digital health innovation. Embedding equity is possible using the practical methods and research adjustments identified to promote inclusive coproduction. Professionals working across health care, health informatics, research, digital health, and technology development can use these findings to center digital health equity during technology innovation. This research also recognizes that coproduction must draw on epistemological frameworks, or ways of thinking, which support Indigenous and other priority population knowledge systems. A solely Western lens risks reinforcing structural barriers and overlooking essential knowledge, as demonstrated by this review when the search strategy missed key scholarly works by priority population authors themselves.

Background and Objective: Intravenous magnesium is commonly used in critically ill patients; however, data on the serum level response following its administration are limited. This study aimed to evaluate serum magnesium changes after administration of intravenous magnesium sulfate (IV‐MgSO ₄ ) and identify predictors of a greater response among critically ill patients. Methodology: This retrospective multicenter study included adult critically ill patients from the Medical Information Mart for Intensive Care IV and eICU databases. Patients were included if they received IV‐MgSO ₄ and had serum magnesium measured within 36 h before and after administration. Patients receiving renal replacement therapy, total parenteral nutrition, magnesium‐containing intravenous fluids, or oral magnesium supplementation were excluded. Linear regression analyses were performed to identify predictors of greater magnesium response. Results: The study included 25,637 patients who received 54,556 doses of IV‐MgSO ₄ . The mean age was 62.8 ± 16.5 Standard deviation years, and 13,180 (51.4%) were females. The most common intensive care unit admission diagnoses were cardiovascular ( n = 7399; 28.9%) and respiratory ( n = 4245; 16.6%). Baseline magnesium levels were normal in 39,149 (71.8%) episodes, mild‐to‐moderate hypomagnesemia in 13,588 (24.9%), and severe hypomagnesemia in 1819 (3.3%). Median serum magnesium increased by 0.15 mg/dL (interquartile range (IQR) 0.05–0.25) per 1 g of IV‐MgSO ₄ administered, and the greatest increase was observed in patients with severe hypomagnesemia (median [IQR]: 0.25 mg/dL [0.10–0.50]), followed by mild‐to‐moderate hypomagnesemia (median [IQR]: 0.22 mg/dL [0.10–0.40]). Predictors of greater response to IV‐MgSO ₄ were lower initial magnesium ( β = 0.2035; 95% confidence interval (CI): 0.193 to 0.214; p < 0.001) and reduced renal function ( β = 0.2557; 95% CI: 0.212 to 0.300; p < 0.001). Conclusion: Among a large cohort of critically ill patients, 1 g of IV‐MgSO ₄ was associated with a median serum magnesium increase of 0.15 mg/dL. Lower initial magnesium and reduced renal function were predictors of greater serum magnesium increase with intravenous replacement.

Background: Open health data repositories receive billions in public funding, yet no systematic framework exists to evaluate their downstream scholarly impact, the composition of the research communities they cultivate, or the breadth of disciplines they reach. We introduce a two-degree citation methodology to quantify knowledge diffusion from open data, normalized by funding, and apply it to four major health data repositories. Methods: Using the OpenAlex bibliometric database (January–February 2026), we identified all first-degree citing publications ( n = 30,049) and their second-degree citing publications ( n = 485,396), defined as papers citing those first-degree publications, for MIMIC (versions I– IV; retrospective EHR data; $14.4M), UK Biobank (prospective cohort with genomics; $525.5M), OpenSAFELY (federated EHR platform; $53.7M), and All of Us (prospective national cohort with biobanking and community engagement; $2,160M). We extracted author demographics (gender via Genderize.io, institutional country income via World Bank 2024 classifications) and research topics. Chi-square tests with odds ratios assessed demographic differences across repositories. Results: Funding-normalized first-degree papers per $1M ranged from 689 (MIMIC) to 1 (All of Us), though these figures reflect total program investment, which included community engagement and biobanking for prospective cohorts in addition to data-curation costs. The citation amplification ratio was consistent across these four repositories (9.3–11.5×). Author demographics differed significantly ( p < 0.001): LMIC authorship ranged from 41.8% (MIMIC) to 4.3% (All of Us), while female authorship showed the opposite pattern, lowest for MIMIC (31.8%) and highest for All of Us (43.2%). Female authors were consistently underrepresented in senior (last-author) compared with first-author positions across all repositories. Differences in scope, design, and what funding covers limit direct comparisons. Conclusions: Open health data generates a consistent ∼10× indirect citation amplification beyond its direct users, a ratio that held across repositories spanning over two orders of magnitude in funding. The large differences in funding-normalized output partly reflect structural differences between retrospective databases and prospective cohorts. Low-cost access combined with intentional community building attracted globally diverse research communities with LMIC investigators in intellectual leadership positions, while a persistent gender gap in senior authorship across all repositories reflects disciplinary and structural inequities that data access policies alone cannot address. Future evaluations of open data investments should examine who is producing research, from where, in what positions, and whether their participation translates into locally relevant knowledge production. Take-home message: Open health data shows a consistent ∼10× citation amplification ratio beyond direct users. Low-barrier access and active community-building are associated with globally diverse research communities, including LMIC researchers in leadership positions, yet representational equity in authorship does not guarantee locally relevant knowledge production. A persistent gender gap in senior authorship across all repositories reflects disciplinary and structural inequities that data access policies alone cannot address.

OBJECTIVE: A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on clinical criteria that would be used to define refractory septic shock. DESIGN: Review of literature, expert panel position statements, and Delphi rounds with an international expert group. SETTING: Consensus was defined as having at least 75% of panellists in agreement or disagreement on the three highest or lowest levels of a 7-point Likert scale or based on responses to single- or multiple-choice questions, respectively. SUBJECTS: A panel of multinational, multiprofessional and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine (57 invitations and 56 participants). MEASUREMENTS AND MAIN RESULTS: A five-round Delphi process was conducted for consensus and stability. The steering committee proposed 34 statements, and five of them were rejected by panel experts after round 2. Among 29 statements selected from eight domains, consensus was reached for 13. The panel agreed on the need for a comprehensive consensus set of clinical criteria for refractory septic shock. Markers of organ dysfunction (75%, 2 rounds), tissue perfusion (91.1%, 2 rounds) including lactate (94.6%, 2 rounds) and capillary refill time (76.8%, 2 rounds), assessment of fluid-responsiveness after initial resuscitation (92.9%, 5 rounds), and use of vasoactive drugs at norepinephrine equivalents greater than 0.5 µg/kg/min (75.0%, 3 rounds), were selected as clinical criteria of refractory septic shock. The use of critical care ultrasound (CCUS) (92.9%, 3 rounds) was the single diagnostic modality that reached a consensus-based agreement. CONCLUSIONS: A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.

A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on clinical criteria that would be used to define refractory septic shock. Review of literature, expert panel position statements, and Delphi rounds with an international expert group. Consensus was defined as having at least 75% of panellists in agreement or disagreement on the three highest or lowest levels of a 7-point Likert scale or based on responses to single- or multiple-choice questions, respectively. A panel of multinational, multiprofessional, and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine (57 invitations and 56 participants). A five-round Delphi process was conducted for consensus and stability. The steering committee proposed 34 statements, and five of them were rejected by panel experts after round 2. Among 29 statements selected from eight domains, consensus was reached for 13. The panel agreed on the need for a comprehensive consensus set of clinical criteria for refractory septic shock. Markers of organ dysfunction (75%, 2 rounds), tissue perfusion (91.1%, 2 rounds) including lactate (94.6%, 2 rounds) and capillary refill time (76.8%, 2 rounds), assessment of fluid responsiveness after initial resuscitation (92.9%, 5 rounds), and use of vasoactive drugs at norepinephrine equivalents greater than 0.5 µg/kg/min (75.0%, 3 rounds) were selected as clinical criteria of refractory septic shock. The use of critical care ultrasound (CCUS) (92.9%, 3 rounds) was the single diagnostic modality that reached a consensus-based agreement. A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 µg per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.

Patients with breast cancer experience various types of adverse events (AEs) during their treatment journey. We aimed to evaluate the incidence, characteristics, and impact of serious AEs in breast cancer patients receiving antineoplastic treatment in the ambulatory setting. A 4‐month prospective observational study that included patients with breast cancer treated in the chemotherapy infusion clinics. Patients were assessed for serious AEs, defined as any AE that resulted in a visit to the emergency department (ED) with or without hospital admission, or required any clinical intervention, which were considered as the addition of supportive medications or modifications to the treatment protocol. Characteristics of the patients and antineoplastic regimens as well as the type of AEs were recorded. During the study period, 1168 patients received 2547 cycles. The mean age was 50 ± 11.6 (SD) years and patients had received a median (IQR) of 3 (1–5) treatment cycles prior to enrollment. Among the study cohort, 465 patients(40%) developed at least one serious AE. A total of 660 (26%) cycles were associated with 757 AEs, which required ED visits, addition of supportive medications, and modifications to the treatment protocol in 58%, 29%, and 17% of the cycles, respectively. Most common AEs were musculoskeletal (n = 132, 17%) and gastrointestinal (n = 125, 16.5%). Taxane‐based regimens were associated with the most AEs (n = 286, 38%). In a cohort of patients with breast cancer treated in the ambulatory setting, 4 out of 10 patients developed at least one serious AE during the study period. Future research should identify measures to reduce the incidence and severity of such complications.

OBJECTIVES: To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis. DESIGN: Randomized, controlled, single-blinded trial. SETTING: A comprehensive multidisciplinary cancer hospital in Jordan. PATIENTS: Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours. INTERVENTIONS: Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels. MEASUREMENTS AND MAIN RESULTS: Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6–10) and 7 (5–9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8–16) and 3.4 (0.5–26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4–11) and 8 (5–13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17–24) and 20 (16–23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively. CONCLUSIONS: In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.