Supporting General Practitioners to Deprescribe Benzodiazepines and Z‐Drugs in Primary Care: Findings From a Modified Delphi Study

ABSTRACT Long‐term use of benzodiazepines and Z‐drugs (collectively known as benzodiazepine receptor agonists; BZRAs) is associated with a range of adverse effects including dependence and withdrawal on stopping or reducing the dose. Deprescribing is recommended to improve patient outcomes and reduce medication‐related harm, but its implementation in primary care is hindered by various barriers. This study aimed to identify the strategies that Australian general practitioners (GPs) agree were most useful in supporting them to deprescribe BZRAs. A modified Delphi was conducted online over three rounds with 38 Australian GPs. Participants were registered GPs with ≥ 10 years' experience in either addiction, mental health, sleep, pain management, or aged care. Participants rated and provided feedback on 61 implementation strategies over three rounds until they achieved either consensus or stability. Included strategies were mapped to the theoretical domains framework to understand their links to behaviour change mechanisms. Twenty‐five strategies reached a consensus for inclusion indicating their importance to supporting GPs to deprescribe BZRAs. The most important strategies included extended consultation times, provision of clear deprescribing protocols and establishing practice‐level agreement on deprescribing policies. Findings provide a prioritised set of implementation strategies to address the barriers to BZRA deprescribing and offer a strong foundation for future research and policy to improve deprescribing in primary care.

Medically Assisted Dying Practices: What Role for Clinical Ethicists?

ABSTRACT Medically assisted dying (AD) practices have been legalized in several jurisdictions throughout the world over the last two decades. Because of this increased trend, more individuals now have access to a self‐chosen death. Despite its legalization and the diversity of frameworks governing AD, it remains fraught with ethical challenges. However, there is a dearth of literature regarding the specific roles clinical ethicists (CEs) may have in AD provision. We sought to address this literature gap by: (1) Gathering healthcare professionals' (HPs) and CEs perspectives on how CEs may contribute; (2) Identifying how CEs may have been involved thus far; (3) Identifying promising practices and pitfalls related to their involvement. An exploratory qualitative study using focus groups, purposive and snowball sampling. Four online focus groups were held. Groups comprised of (1) HPs and (2) CEs from Quebec and Switzerland. Data was analyzed using thematic analysis. Altogether 21 persons participated, among them 10 ethicists and 11 HPs. Four major themes were identified: (1) Specific Roles for CEs ; (2) CEs competencies deemed useful in AD provision ; (3) Operationalization of CEs’ involvement 5) Obstacles/Pitfalls associated to CEs’ involvement in AD . Several roles for CEs have been identified that have been associated with specific ethical challenges that arise in AD. Findings indicate that CEs' integration in AD should be context dependent and should consider several misconceptions associated with the field of clinical ethics in general.

Clinical Ethicists and Medical Assistance in Dying (MAiD): Possible Roles and Challenges

ABSTRACT Assisted dying (AD) presents a range of challenges for clinical ethicists (CEs) and healthcare institutions seeking to involve them in its provision. Questions regarding the legitimacy, scope, and nature of CE involvement remain underexplored in the literature. This article addresses this gap by first outlining the professional standards that guide CE practice and presenting arguments for the value of ethics expertise in AD contexts. We then examine the Canadian MAiD landscape and draw on the experiences of CEs—particularly within a healthcare institution in Quebec—to propose a typology of roles that CEs have occupied at various moments and levels throughout the emergence and institutionalization of AD. These roles span micro to macro levels of involvement and reflect both practical contributions and normative considerations. In the final section, we return to the foundational normative questions raised at the outset—not to offer definitive answers, but to contribute meaningfully to ongoing reflection about CE involvement in AD. By analyzing professional standards alongside the diverse roles CEs have played, we assess the benefits and challenges of their participation in this ethically complex domain and offer guidance for institutions seeking to engage ethics expertise in AD policy and practice.

Longitudinal trajectories of parent–teacher communication during elementary school: Investigating child academic skills, school enjoyment and self‐perceived ability

Abstract Background Parent–teacher communication is key to children's school functioning. It can help teachers adjust their educational practices and interactions with students and increase parent involvement at school. Aims This study establishes longitudinal trajectories of parent–teacher communication, as reported by parents and examines the correlates and prospective association with students' academic abilities, school enjoyment and self‐perceived ability. Sample A population‐based cohort of school‐aged children ( N  = 1486, 51.4% boys). Methods The quality of parent–teacher communication was reported by mothers when the children were aged 6, 7, 8 and 10 years. At age 10, children's mathematics and vocabulary skills were measured using standardized measures. At age 12, children provided self‐reports on school enjoyment and self‐perceived ability. Results Latent class growth analysis identified three trajectories: high (60.9%, n  = 906), moderately high (34.4%, n  = 512) and low‐quality parent–teacher communication (4.7%, n  = 68). Child externalizing and internalizing behaviours, as well as suboptimal parenting practices, were associated with the low‐quality trajectory. Children of mothers in the low‐quality parent–teacher communication trajectory reported lower self‐perceived ability at age 12, compared to children in the high‐quality communication trajectory. However, there were no significant differences between the groups in school enjoyment, vocabulary skills or mathematics skills. Conclusions Findings reveal that preventive efforts could be implemented by teachers to actively engage with parents of these children. This could involve providing guidance to parents on effective communication strategies, while teachers should also be mindful of their own communication skills.

Mapping VEXAS ‐associated and rare UBA1 variants in the United Kingdom : Insights from patient cohorts and the general population

Summary Somatic mutations in UBA1 are linked to VEXAS syndrome, a late‐onset inflammatory disorder with rheumatological and haematological features, primarily affecting elderly men. This study examines the epidemiology of VEXAS in the United Kingdom using genomic databases and patient cohorts to estimate prevalence, identify novel UBA1 variants and predict their pathogenicity. Analysing data from the UK Biobank, 100 000 Genomes Project and clinical diagnostic laboratories, we found that VEXAS prevalence in UK males over 50 is lower than in US‐based cohorts. Notably, canonical (Met41) UBA1 mutations appear in ~1% of individuals with autoinflammatory disorders who have not been referred to haematology. However, among those investigated for myeloid malignancies, VEXAS is relatively common, with an estimated incidence of 1.51 per 100 000, or 171 new cases each year. We identified 47 UBA1 non‐Met41 variants of uncertain significance, with several showing clonal dominance and clustering in functional domains, suggesting potential pathogenicity. Clinical presentation associated with non‐Met41 variants often diverged from classical VEXAS features, underscoring the need for further studies. Our findings highlight the importance of broader screening for both canonical and non‐canonical UBA1 mutations to improve understanding of VEXAS syndrome and its underlying mechanisms.

COVID ‐19‐related mortality in a real‐world cohort of 18 883 patients with premalignant and malignant haematological neoplasms: An analysis from the UK 's Haematological Malignancy Research Network

Summary When the World Health Organization (WHO) declared the global COVID‐19 pandemic, it was recognised that patients with haematological cancers would be more susceptible to severe disease. Set within a UK population of ~4 million ( https://hmrn.org/ ), all patients diagnosed with haematological neoplasms 2005–2019 who were alive on 1 January 2020 were followed up until March 2023. For comparative purposes, a similar age‐ and sex‐matched general population cohort was also constructed. COVID‐19 deaths were classified using ICD‐10 codes and a multiple cause of death analysis was undertaken using a competing risk approach. Deaths of 486/18 883 haematology patients were attributed to COVID‐19, yielding a cumulative incidence of 2.59% (95% confidence interval [CI]: 2.37–2.82) that was significantly higher than that of the general population (1.65; 95% CI: 1.58–1.72). In both cohorts, risks were higher in men, older people and those with co‐morbidities. Within the patient cohort, excess mortality was largely concentrated in those suffering from more indolent conditions. Patients with the premalignancy MBL suffered from the highest excess mortality in the early phase of the pandemic when, unlike patients with malignancies, they were not advised to shield. Effects of shielding were evident and a clear vaccination benefit was demonstrated, with the exception of CLL and MCL; findings that warrant consideration in relation to other viruses.

Assessment of measurable residual disease in ovarian tissue collected for fertility preservation in patients in remission from acute myeloid leukaemia: A pilot study

Summary Allogeneic haematopoietic stem cell transplantation (ASCT) is a curative treatment for acute myeloid leukaemia (AML) but carries a high risk of gonadotoxicity. Ovarian tissue cryopreservation (OTC) offers a fertility preservation option, yet its safety in AML remains uncertain due to the risk of leukaemic cell reintroduction. The FERTILAM pilot study evaluated measurable residual disease (MRD) in ovarian tissue collected at complete remission (CR) from nine AML patients undergoing OTC before ASCT. MRD was assessed using patient‐specific clonal markers via droplet digital polymerase chain reaction on DNA and RNA from bone marrow (BM), ovarian cortex and medulla. At CR, MRD‐DNA was detected in ovarian cortex of four of nine patients, all with concurrent MRD positivity in BM. Three patients were negative in both BM and ovarian tissue. Paired cortex/medulla analyses showed concordant MRD‐DNA results in five of six patients. BM MRD‐RNA and MRD‐DNA were fully concordant, whereas two discrepancies were observed between MRD‐DNA and MRD‐RNA in ovarian tissue. These findings suggest potential leukaemic cell persistence in ovarian tissue despite CR and highlight the need for sensitive molecular assays to assess safety prior to ovarian tissue transplantation.

Comparison of short‐term complications after open, laparoscopic and robot‐assisted radical prostatectomy

Objective The objective of this study is to address the lack of real‐life study comparing the impact of the three surgical approaches for radical prostatectomy (RP), i.e., open (ORP), laparoscopic (LRP) and robot‐assisted (RARP), on the occurrence of postoperative events by measuring the association between surgical approach and risk of death, transfer to an intensive care unit (ICU), or complications during hospitalisation for RP. Patients and methods This study used the French National Health Data System (Système National des Données de Santé [SNDS]) to study the 38 481 patients who underwent a RP in French hospitals in 2020–2021. The primary endpoint was the occurrence of any event (death, ICU admission, or complications) during hospitalisation for RP. Secondary endpoints were the occurrence of death, ICU admission, complications, and each of the complication subtypes. Outcomes were analysed by uni‐ and multivariable logistic regression. Results A RARP was associated with the lowest risk of an event during hospitalisation, followed by LRP compared with ORP (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.48–0.55; and aOR 0.63, 95% CI 0.58–0.68, respectively). RARP was associated with a reduction in the risk of most complications compared with ORP. Minimally‐invasive procedures were associated with an increased risk of hernia. To the best of our knowledge, this is the first French nationwide study of its sort and limitations are related to the observational nature of our study, the use of a medico‐administrative database, and the length of follow‐up. To confirm the main results 30‐day sensitivity analyses were performed. Conclusions There were significantly fewer short‐term postoperative events for RARP. Additional studies with a longer follow‐up period are required to investigate the medium‐ and long‐term risks.

Urologic chronic pelvic pain syndrome 3‐year symptom trajectories: the Multidisciplinary Approach to the Study of Chronic Pelvic Pain ( MAPP) Symptom Patterns Study

Objectives To characterise 3‐year pelvic pain and urinary symptom trajectories and to identify baseline factors associated with urologic chronic pelvic pain syndrome (UCPPS) improvement. Patients and Methods The Trans‐Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Symptom Patterns Study was a multicentre, prospective cohort study of UCPPS, including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. Patients completed four weekly run‐in assessments, baseline visit, and quarterly visits up to 3 years, providing clinical and patient‐reported data. A functional clustering approach, applied separately to Pelvic Pain Severity (PPS) and Urinary Symptom Severity (USS) longitudinal change scores, was used to generate symptom trajectory clusters dichotomised as Group 0 ‘improvers’ vs Groups 1–3 ‘non‐improvers’. Logistic regression models explored baseline factors associated with improvement and included run‐in period average and baseline scores to adjust for regression to the mean effects. Results A total of 545 patients (66% female) were followed for a median (interquartile range) of 34 (23–35) months. Four trajectory clusters were identified for each of PPS and USS, consistent with moderate improvement (Group 0), slight improvement (Group 1), no change (Group 2), and slight worsening (Group 3). In all, 18% and 19% of patients were in the moderately improved PPS and USS groups, respectively, representing 30% of patients overall. Female sex, better sleep, and less opioid use were associated with PPS improvement (Group 0); younger age and baseline cystoscopic treatment were associated with USS improvement (Group 0). Conclusion In all, 30% of patients with UCPPS demonstrated improvement in pain and/or urinary symptoms over 3 years. Baseline factors associated with improvement may represent markers of a milder or localised phenotype and/or treatment effects.

A 5‐month‐old infant with a pineal tumor