Clinical Dissemination and Implementation of EBTs From the Ground Up:How to Develop a Multi-Site CBT“Clinical Dissemination Practice”The Case Example of the Child&Family Institute

The recent proliferation of empirically-supported treatments(ESTs)into the private sector has led to more U.S.children and families receiving high quality treatments and improved treatment outcomes.However,there remains a significant dearth of evidence-based clinics,service providers,and training programs nationally,particularly in more remote communities.The Child&Family Institute(CFI)was founded in 2011 as the world’s first Clinical Dissemination Practice and training institute,comprising five core unifying stages and initiatives:(1)Dissemination Through Training,(2)Dissemination Through Community Partnership,(3)Dissemination Through Integrated Behavioral Health,(4)Dissemination Through Technology,and(5)Dissemination Through Multi-State,Multi-Site Program Development and Implementation,all with a common goal of raising awareness and leveraging local and national resources to disseminate and implement accessible,affordable,evidence-based care to children,families,and communities across the United States,and beyond.Perhaps most central and unique to CFI’s five initiatives,and its overall core values and mission,is the accessibility and affordability of services for each and every child.Preliminary feedback from patients,students,collaborators,local politicians and stakeholders,partner organizations,and the broader communities in the regions served has been enthusiastic,and several grant submissions and research partnerships are underway,to test the effectiveness of CFI programming and evidence-based treatments in“real-world”clinics nationwide.

Requirements for implementation of artificial intelligence in the practice of gastrointestinal pathology

Tremendous advances in artificial intelligence(AI)in medical image analysis have been achieved in recent years.The integration of AI is expected to cause a revolution in various areas of medicine,including gastrointestinal(GI)pathology.Currently,deep learning algorithms have shown promising benefits in areas of diagnostic histopathology,such as tumor identification,classification,prognosis prediction,and biomarker/genetic alteration prediction.While AI cannot substitute pathologists,carefully constructed AI applications may increase workforce productivity and diagnostic accuracy in pathology practice.Regardless of these promising advances,unlike the areas of radiology or cardiology imaging,no histopathology-based AI application has been approved by a regulatory authority or for public reimbursement.Thus,implying that there are still some obstacles to be overcome before AI applications can be safely and effectively implemented in real-life pathology practice.The challenges have been identified at different stages of the development process,such as needs identification,data curation,model development,validation,regulation,modification of daily workflow,and cost-effectiveness balance.The aim of this review is to present challenges in the process of AI development,validation,and regulation that should be overcome for its implementation in real-life GI pathology practice.

Pharmacogenetics implementation in the clinics:information and guidelines for germline variants

The aim of this work was to supply an overview of the germline Pharmacogenetics that can be already implemented in the oncology clinical practice.An explanation of the three pillars considered necessary for determining which genetic polymorphisms should be used has been provided.These are PharmGKB single nucleotide polymorphism(SNP)-Drug Clinical Annotations with levels of evidence 1 or 2;the genetic information provided in the drug labels by the drug regulatory main agencies(Food and Drug Administration and European Medicines Agency,mainly);and the guidelines elaborated by international expert consortia(mainly Clinical Pharmacogenetics Implementation Consortium and Dutch Pharmacogenetics Working Group).A summary of the relevant SNPs and the recommendations on how to apply their results has also been compiled.

Designing and implementing multicenter clinical randomized controlled trials on moxibustion with large samples

Implementing clinical trials with large multicenter samples is an important way to scientifically evaluate and demonstrate the curative effect of moxibustion.At present,clinical trials on moxibustion with large multicenter samples are prospering in China.It is necessary for research units to have good research professionals and technical platforms as well as a highly standardized and scientifically feasible methodology of research.Taking tasks in the ongoing national 973 project and in the sci-tech support program of the "11th 5-year plan",for example,this research captures the characteristics of moxibustion,carries out deep analysis and introduces specific methods and the important significance of clinical research tasks on moxibustion in designing multicenter plans,implementing experiments,supervising quality and strengthening compliance.

Pharmacogenetics of thiopurines

Polychemotherapeutic protocols for the treatment of pediatric acute lymphoblastic leukemia(ALL)always include thiopurines.Specific approaches vary in terms of drugs,dosages and combinations.Such therapeutic schemes,including risk-adapted intensity,have been extremely successful for children with ALL who have reached an outstanding 5-year survival of greater than 90%in developed countries.Innovative drugs such as the proteasome inhibitor bortezomib and the bi-specific T cell engager blinatumomab are available to further improve therapeutic outcomes.Nevertheless,daily oral thiopurines remain the backbone maintenance or continuation therapy.Pharmacogenetics allows the personalization of thiopurine therapy in pediatric ALL and clinical guidelines to tailor therapy on the basis of genetic variants in TPMT and NUDT15 genes are already available.Other genes of interest,such as ITPA and PACSIN2,have been implicated in interindividual variability in thiopurines efficacy and adverse effects and need additional research to be implemented in clinical protocols.In this review we will discuss current literature and clinical guidelines available to implement pharmacogenetics for tailoring therapy with thiopurines in pediatric ALL.