Global colorectal cancer research, 2007-2021: Outputs and funding

The purpose of this study was to provide an evidence base for colorectal cancer research activity that might influence policy, mainly at the national level. Improvements in healthcare delivery have lengthened life expectancy, but within a situation of increased cancer incidence. The disease burden of CRC has risen significantly, particularly in Africa, Asia and Latin America. Research is key to its control and reduction, but few studies have delineated the volume and funding of global research on CRC. We identified research papers in the Web of Science (WoS) from 2007 to 2021, and determined the contributions of the leading countries, the research domains studied, and their sources of funding. We identified 62 716 papers, representing 5.7% of all cancer papers. This percentage was somewhat disproportionate to the disease burden (7.7% in 2015), especially in Eastern Europe. International collaboration increased over the time period in almost all countries except in China. Genetics, surgery and prognosis were the leading research domains. However, research on palliative care and quality-of-life in CRC was lacking. In Western Europe, the main funding source was the charity sector, particularly in the UK, but in most other countries government played the leading role, especially in China and the USA. There was little support from industry. Several Asian countries provided minimal contestable funding, which may have reduced the impact of their CRC research. Certain countries must perform more CRC research overall, especially in domains such as screening, palliative care and quality-of-life. The private-non-profit sector should be an alternative source of support.     

Top advances of the year: Hepatobiliary cancers

This commentary reviews top advances in hepatobiliary cancer research in 2021–2022, focusing on leveraging immunotherapeutics in combination with other therapies earlier in the disease course and targeted to patient's individualized biomarkers that may predict response or resistance to checkpoint inhibitors.     

Sample size re-estimation for clinical trials with longitudinal negative binomial counts including time trends

In some diseases, such as multiple sclerosis, lesion counts obtained from magnetic resonance imaging (MRI) are used as markers of disease progression. This leads to longitudinal, and typically overdispersed, count data outcomes in clinical trials. Models for such data invariably include a number of nuisance parameters, which can be difficult to specify at the planning stage, leading to considerable uncertainty in sample size specification. Consequently, blinded sample size re-estimation procedures are used, allowing for an adjustment of the sample size within an ongoing trial by estimating relevant nuisance parameters at an interim point, without compromising trial integrity. To date, the methods available for re-estimation have required an assumption that the mean count is time-constant within patients. We propose a new modeling approach that maintains the advantages of established procedures but allows for general underlying and treatment-specific time trends in the mean response. A simulation study is conducted to assess the effectiveness of blinded sample size re-estimation methods over fixed designs. Sample sizes attained through blinded sample size re-estimation procedures are shown to maintain the desired study power without inflating the Type I error rate and the procedure is demonstrated on MRI data from a recent study in multiple sclerosis.     

Discourses of professionalism: Metaphors,theory and practice

Professionalism is a contested concept and different discourses have differed by scope and epistemology. The theory of communicative action integrates epistemology (knowledge interests) with that of scope (lifeworld).

Aim: To pragmatically inform learning of professionalism.

Methods: apply the theory of communicative action to professionalism discourses.

Results: Previous professionalism discourses translated into four frames: technical; communicative; improvement, and critical. These can be viewed as four metaphors the scale; conversation; consensus conference, and protest. The theory of communicative action demonstrated that a critical frame was often lacking from discussions of professionalism and emphasized critiquing the assumptions made, the way power was utilized, and the ends to which actions were directed. Using these frameworks connected discourses on professionalism to other key medical discourses particularly quality improvement, patient centeredness, social justice, and the professional well-being.

Conclusion: The theory of communicative action adds value by introducing criteria for the evaluation of individual truth claims that expands the discussion beyond accuracy to include sincerity, ethics and coherence; and it emphasizes promoting free speech and the inclusion of diverse views and stakeholders. The theory of communicative action provides a coherent and useful framework for viewing professionalism that integrates with broader discussions about philosophy, truth claims, and post-modern society.     

Anesthetist‐delivered intraoperative transesophageal echocardiography in pediatric cardiac surgery

This article reviews the evidence for anesthetist‐delivered perioperative transesophageal echocardiography for children undergoing cardiac surgery. It addresses the additional issues of training, developing practice, accreditation, and the requirement for collaboration with pediatric cardiologists, surgeons and other members of the perioperative team. Finally an overview of the potential structure of an anesthetist‐delivered perioperative transesophageal echocardiography service is presented.