Building Research Infrastructure to Develop Greater Learning Efficiencies (BRIDGE).

In this manuscript, we outline our developed version of a Learning Health System (LHS) in oncology implemented at the Department of Veterans Affairs (VA). Transferring healthcare into an LHS framework has been one of the spearpoints of VA's Central Office and given the general lack of evidence generated through randomized control clinical trials to guide medical decisions in oncology, this domain is one of the most suitable for this change. We describe our technical solution, which includes a large real-world data repository, a data science and algorithm development framework, and the mechanism by which results are brought back to the clinic and to the patient.

Matching Patients to Accelerate Clinical Trials (MPACT): Enabling Technology for Oncology Clinical Trial Workflow.

Clinical trial enrollment is impeded by the significant time burden placed on research coordinators screening eligible patients. With 50,000 new cancer cases every year, the Veterans Health Administration (VHA) has made increased access for Veterans to high-quality clinical trials a priority. To aid in this effort, we worked with research coordinators to build the MPACT (Matching Patients to Accelerate Clinical Trials) platform with a goal of improving efficiency in the screening process.

Patient- reported reasons for non-participation in a COVID-19 therapeutics clinical trial: Findings from a multi-center investigation.

Background: Early in the pandemic, there were no evidence-based treatments for SARS-CoV-2, creating an urgent need to identify effective therapeutics. However, public participation in medical research is low; trial enrollment in the US is typically 10-20%. Thus, the aim of this study was to identify common themes underpinning patient reasons to decline participation and evaluate the impact of specific contextual factors.

Subcutaneous sarilumab for the treatment of hospitalized patients with moderate to severe COVID19 disease: A pragmatic, embedded randomized clinical trial.

Importance And Objective: The aim of this pragmatic, embedded, adaptive trial was to measure the effectiveness of the subcutaneous anti-IL-6R antibody sarilumab, when added to an evolving standard of care (SOC), for clinical management of inpatients with moderate to severe COVID-19 disease.

Design: Two-arm, randomized, open-label controlled trial comparing SOC alone to SOC plus sarilumab. The trial used a randomized play-the-winner design and was fully embedded within the electronic health record (EHR) system.

Serum albumin and risks of hospitalization and death: Findings from the Atherosclerosis Risk in Communities study.

Objectives: To determine whether lower serum albumin in community-dwelling, older adults is associated with increased risk of hospitalization and death independent of pre-existing disease.

Design: Prospective cohort study of participants in the fifth visit of the Atherosclerosis Risk in Communities (ARIC) study. Baseline data were collected from 2011 to 2013.

The National Cancer Institute and Department of Veterans Affairs Interagency Group to Accelerate Trials Enrollment (NAVIGATE): A federal collaboration to improve cancer care.

Cancer clinical trials represent an important option for patients with a diagnosis of cancer and the clinician-investigators involved in their care who seek options for their disease. For all who are impacted by cancer, these studies offer opportunities for greater learning. Conducting these important studies involves several challenges, including recruiting eligible participants.

The VA Point-of-Care Precision Oncology Program: Balancing Access with Rapid Learning in Molecular Cancer Medicine.

The Department of Veterans Affairs (VA) recognized the need to balance patient-centered care with responsible creation of generalizable knowledge on the effectiveness of molecular medicine tools. Embracing the principles of the rapid learning health-care system, a new clinical program called the Precision Oncology Program (POP) was created in New England. The POP integrates generalized knowledge about molecular medicine in cancer with a database of observations from previously treated veterans.

Implementation of a Precision Oncology Program as an Exemplar of a Learning Health Care System in the VA.

The program determines and disseminates precision oncology best practices; enhances patient and provider engagement; and fosters collaboration among the VA, National Cancer Institute, academia, other health care systems, and industry to provide cancer patients with access to clinical trial participation.

Million Veteran Program: A mega-biobank to study genetic influences on health and disease.

Objective: To describe the design and ongoing conduct of the Million Veteran Program (MVP), as an observational cohort study and mega-biobank in the Department of Veterans Affairs (VA) health care system.

Study Design And Setting: Data are being collected from participants using questionnaires, the VA electronic health record, and a blood sample for genomic and other testing. Several ongoing projects are linked to MVP, both as peer-reviewed research studies and as activities to help develop an infrastructure for future, broad-based research uses.

UK postgraduate medicine examinations: opportunities for international candidates.

The medical profession is global, and ambitious trainee physicians around the world are eager to attain internationally recognised postgraduate medical qualifications. The MRCP(UK) and specialty certificate examinations of the Federation of Royal Colleges of Physicians of the United Kingdom provide such qualifications, and between 2002 and 2013, the number of international candidates attempting these examinations grew substantially. Delivering these proven and reliable UK-based examinations in other countries has many local benefits: it enhances careers, strengthens medical training and improves standards of patient care.

A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: a randomized, controlled trial.

Background: Improving a patient's ability to self-monitor and manage changes in chronic obstructive pulmonary disease (COPD) symptoms may improve outcomes.

Objective: To determine the efficacy of a comprehensive care management program (CCMP) in reducing the risk for COPD hospitalization.

Design: A randomized, controlled trial comparing CCMP with guideline-based usual care.

MTAS--where are we now?

As the UK's medical training fiasco continues, Colleen Shannon takes a detailed snapshot of where trainees currently stand

Friends and relations.

Good political relationships can bring tangible rewards, as well as helping to protect your reputation. There will be shared goals and joint working will deliver more health improvements to more groups of people. Build communication with the media and politicians--and meet key people regularly to maintain it.

Breaking the time barrier.

The DoH must deliver annual savings of pound 6.5bn by 2008. Productive time will help achieve these savings through increased efficiency.

Primary care. Feel the power.

Twenty-one sites in England have piloted local area agreements, which are contract-like arrangements. LAAs are intended to simplify funding by reducing the number of funding streams directed at specific areas. Supporters say LAAs cut through red tape and allow access to resources usually outside NHS control.

Future of pharmacies. Over the counter revolution.

The new pharmacy contract is expected to revolutionalise the profession, but the timetable for implementation is tight. The contract will provide direct incentives for improving the quality of patient care, rewarding quality over quantity. Primary care trusts are currently working out how to budget for implementation.

Community services. Buried treasure.

Central Cornwall PCT suffers from a historical under-investment in community services. Fines related to delayed discharge will bring in pounds sterling 2m, which will help build up community capacity. A reorganisation of community hospitals is being planned.

Sterilisation services. Knife point.

Sterile services departments are in such a poor state that new centres are needed. A super-centre, shared between local trusts, is to be tried in Bradford and Leeds. Stocks and movement of instruments will need close monitoring under a centralised system.