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Asian Society of Mastology (ASOMA) is an international body of experts from disciplines of surgery, radiology, pathology, medical and radiation oncology, plastic surgery, and breast support group dedicated to improving the care of patients with breast diseases. The clinical breast assessment (CBA) of patients with a focused history and clinical breast examination (CBE) is an essential and initial component of triple assessment in the evaluation of patients presenting with breast diseases. CBE is also an affordable method of screening for breast cancer. It adds to breast imaging by providing additional information about the breast lesion and providing a sense of reassurance to the patients. CBA needs to be implemented in a systematic and uniform fashion throughout the world by all the clinicians involved in breast care. The optimal method for CBE has not yet been fully established. This article highlights the importance of CBE and discusses the studies comparing various methods of CBE on breast models and human subjects to provide the evidence to support the most valid and reliable method of CBE.

Abstract Glucocorticoids are widely prescribed as anti-inflammatory and immunosuppressive agents. This results in at least 1% of the population using chronic glucocorticoid therapy, being at risk for glucocorticoid-induced adrenal insufficiency. This risk is dependent on the dose, duration and potency of the glucocorticoid, route of administration, and individual susceptibility. Once glucocorticoid-induced adrenal insufficiency develops or is suspected, it necessitates careful education and management of affected patients. Tapering glucocorticoids can be challenging when symptoms of glucocorticoid withdrawal develop, which overlap with those of adrenal insufficiency. In general, tapering of glucocorticoids can be more rapidly within a supraphysiological range, followed by a slower taper when on physiological glucocorticoid dosing. The degree and persistence of HPA axis suppression after cessation of glucocorticoid therapy are dependent on overall exposure and recovery of adrenal function varies greatly amongst individuals. This first European Society of Endocrinology/Endocrine Society joint clinical practice guideline provides guidance on this clinically relevant condition to aid clinicians involved in the care of patients on chronic glucocorticoid therapy.

Many definitions of the term clinical pharmacy exist, but a number of ambiguities remain. In order to clarify the European Society of Clinical Pharmacy (ESCP) position on what defines clinical pharmacy, a consultation exercise was conducted among ESCP members with the findings used as the basis for an updated definition. The updated definition clarifies that clinical pharmacy (1) represents both a professional practice and field of research, (2) aims to optimise the utilisation of medicines in order to achieve person-centered and public health goals, (3) as a practice encompasses cognitive, managerial and interpersonal activities targeting all stages of the medicines use process, and as a field of research generates knowledge that informs clinical decision-making, health care organisation or policy, (4) as a practice is restricted to pharmacists, (5) can be practiced regardless of setting, and (6) encompasses pharmaceutical care but is not restricted to it.

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.