Abstract Castleman disease (CD) describes a group of heterogeneous hematologic disorders with characteristic histopathological features. CD can present with unicentric or multicentric (MCD) regions of lymph node enlargement. Some cases of MCD are caused by human herpesvirus-8 (HHV-8), whereas others are HHV-8–negative/idiopathic (iMCD). Treatment of iMCD is challenging, and outcomes can be poor because no uniform treatment guidelines exist, few systematic studies have been conducted, and no agreed upon response criteria have been described. The purpose of this paper is to establish consensus, evidence-based treatment guidelines based on the severity of iMCD to improve outcomes. An international Working Group of 42 experts from 10 countries was convened by the Castleman Disease Collaborative Network to establish consensus guidelines for the management of iMCD based on published literature, review of treatment effectiveness for 344 cases, and expert opinion. The anti–interleukin-6 monoclonal antibody siltuximab (or tocilizumab, if siltuximab is not available) with or without corticosteroids is the preferred first-line therapy for iMCD. In the most severe cases, adjuvant combination chemotherapy is recommended. Additional agents are recommended, tailored by disease severity, as second- and third-line therapies for treatment failures. Response criteria were formulated to facilitate the evaluation of treatment failure or success. These guidelines should help treating physicians to stratify patients based on disease severity in order to select the best available therapeutic option. An international registry for patients with CD (ACCELERATE, #NCT02817997) was established in October 2016 to collect patient outcomes to increase the evidence base for selection of therapies in the future.

OBJECTIVEAdjunctive-to-insulin therapy with sodium-glucose cotransporter 2 (SGLT2) inhibition may improve glycemic control in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODSWe evaluated the glycemic efficacy and safety of empagliflozin 25 mg daily in 40 patients treated for 8 weeks in a single-arm open-label proof-of-concept trial (NCT01392560). RESULTSMean A1C decreased from 8.0 6 0.9% (64 6 10 mmol/mol) to 7.6 6 0.9% (60 6 10 mmol/mol) (P < 0.0001), fasting glucose from 9.0 6 4.3 to 7.0 6 3.2 mmol/L (P = 0.008), symptomatic hypoglycemia (<3.0 mmol/L) from 0.12 to 0.04 events per patient per day (P = 0.0004), and daily insulin dose from 54.7 6 20.4 to 45.8 6 18.8 units/day (P < 0.0001). Mean urinary excretion of glucose increased from 19 6 19 to 134 6 61 g/day (P < 0.0001). Weight decreased from 72.6 6 12.7 to 70.0 6 12.3 kg (P < 0.0001), and waist circumference decreased from 82.9 6 8.7 to 79.1 6 8.0 cm (P < 0.0001). CONCLUSIONSThis proof-of-concept study strongly supports a randomized clinical trial of adjunctive-to-insulin empagliflozin in patients with T1D.

Purpose -Researchers debate whether tacit knowledge sharing through information technology (IT) is actually possible. However, with the advent of social web tools, it has been argued that most shortcomings of tacit knowledge sharing are likely to disappear. The purpose of this paper is two-fold: first, to demonstrate the existing debates in the literature regarding tacit knowledge sharing using IT; and second, to identify key research gaps that lay the foundations for future research into tacit knowledge sharing using the social web.Design/methodology/approach -This paper reviews current literature on IT-mediated tacit knowledge sharing and opens a discussion on tacit knowledge sharing through the use of the social web.Findings -First, the existing schools of thought in regards to IT ability for tacit knowledge sharing are introduced. Next, difficulties of sharing tacit knowledge through the use of IT are discussed. Then, potentials and pitfalls of social web tools are presented. Finally, the paper concludes that whilst there are significant theoretical arguments supporting the notion that the social web facilitates tacit knowledge sharing there is a lack of empirical evidence to support these arguments and further work is required.Research limitations/implications -The limitations of the review include: covering only papers that were published in English, issues of access to full texts of some resources, and the possibility of missing some resources due to search strings used or limited coverage of databases searched.Originality/value -The paper contributes to the fast growing literature on the intersection of KM and IT particularly by focusing on tacit knowledge sharing in social media space. The paper highlights the need for further studies in this area by discussing the current situation in the literature and disclosing the emerging questions and gaps for future studies.

Healthcare professionals' use of social media platforms, such as blogs, wikis, and social networking web sites has grown considerably in recent years. However, few studies have explored the perspectives and experiences of physicians in adopting social media in healthcare. This article aims to identify the potential benefits and challenges of adopting social media by physicians and demonstrates this by presenting findings from a survey conducted with physicians. A qualitative survey design was employed to achieve the research goal. Semi-structured interviews were conducted with 24 physicians from around the world who were active users of social media. The data were analyzed using the thematic analysis approach. The study revealed six main reasons and six major challenges for physicians adopting social media. The main reasons to join social media were as follows: staying connected with colleagues, reaching out and networking with the wider community, sharing knowledge, engaging in continued medical education, benchmarking, and branding. The main challenges of adopting social media by physicians were also as follows: maintaining confidentiality, lack of active participation, finding time, lack of trust, workplace acceptance and support, and information anarchy. By revealing the main benefits as well as the challenges of adopting social media by physicians, the study provides an opportunity for healthcare 3 professionals to better understand the scope and impact of social media in healthcare, and assists them to adopt and harness social media effectively, and maximize the benefits for the specific needs of the clinical community.

Phenomenography is a qualitative research approach that seeks to explore variation in how people experience various aspects of their world. Phenomenography has been used in numerous information research studies that have explored various phenomena of interest in the library and information sphere. This paper provides an overview of the phenomenographic method and discusses key assumptions that underlie this approach to research. Aspects including data collection, data analysis and the outcomes of phenomenographic research are also detailed. The paper concludes with an illustration of how phenomenography was used in research to investigate students’ experiences of web-based information searching. The results of this research demonstrate how the phenomenographic approach yields insights into variation, making it possible to develop greater understanding of the phenomenon as it was experienced, and to draw upon these experiences to improve and enhance current practice.

Purpose This paper aims to explore the potential contributions of social media in supporting tacit knowledge sharing, according to the physicians’ perspectives and experiences. Design/methodology/approach Adopting a qualitative survey design, 24 physicians were interviewed. Purposive and snowball sampling were used to select the participants. Thematic analysis approach was used for data analysis. Findings The study revealed five major themes and over 20 sub-themes as potential contributions of social media to tacit knowledge flow among physicians. The themes included socialising, practising, networking, storytelling and encountering. In addition, with the help of the literature and the supporting data, the study proposed a conceptual model that explains the potential contribution of social media to tacit knowledge sharing. Research limitations/implications The study had both theoretical (the difficulty of distinguishing tacit and explicit knowledge in practice) and practical limitations (small sample size). The study findings have implications for the healthcare industry whose clinical teams are not always physically co-located but must exchange their critical experiential and tacit knowledge. Originality/value The study has opened up a new discussion of this area by demonstrating and conceptualising how social media tools may facilitate tacit knowledge sharing.

BACKGROUND. Idiopathic multicentric Castleman disease (iMCD) is a hematologic illness involving cytokine-induced lymphoproliferation, systemic inflammation, cytopenias, and life-threatening multi-organ dysfunction. The molecular underpinnings of interleukin-6 (IL-6) blockade-refractory patients remain unknown; no targeted therapies exist. In this study, we searched for therapeutic targets in IL-6 blockade-refractory iMCD patients with the thrombocytopenia, anasarca, fever/ elevated C-reactive protein, reticulin myelofibrosis, renal dysfunction, organomegaly (TAFRO) clinical subtype. METHODS. We analyzed tissues and blood samples from 3 IL-6 blockade-refractory iMCD-TAFRO patients. Cytokine panels, quantitative serum proteomics, flow cytometry of PBMCs, and pathway analyses were employed to identify novel therapeutic targets. To confirm elevated mTOR signaling, a candidate therapeutic target from the above assays, immunohistochemistry was performed for phosphorylated S6, a read-out of mTOR activation, in 3 iMCD lymph node tissue samples and controls. Proteomic, immunophenotypic, and clinical response assessments were performed to quantify the effects of administration of the mTOR inhibitor sirolimus. RESULTS. Studies of 3 IL-6 blockade-refractory iMCD cases revealed increased CD8 + T cell activation, VEGF-A, and PI3K/ Akt/mTOR pathway activity. Administration of sirolimus substantially attenuated CD8 + T cell activation and decreased VEGF-A levels. Sirolimus induced clinical benefit responses in all 3 patients with durable and ongoing remissions of 66, 19, and 19 months. CONCLUSION. This precision medicine approach identifies PI3K/Akt/mTOR signaling as the first pharmacologically targetable pathogenic process in IL-6 blockade-refractory iMCD. Prospective evaluation of sirolimus in treatment-refractory iMCD is planned (NCT03933904).

The purpose of this paper is to investigate how social media may support information encountering (i.e., where individuals encounter useful and interesting information while seeking or browsing for some other information) and how this may lead to facilitation of tacit knowledge creation and sharing. The study employed a qualitative survey design that interviewed twenty-four physicians who were active users of social media to better understand the phenomenon of information encountering on social media. The data was analysed using the thematic analysis approach. The study found six main ways through which social media supports information encountering. Furthermore, drawing upon knowledge creation theories, the study concluded that information encountering on social media facilitates tacit knowledge creation and sharing among individuals. The study provides new directions for further empirical investigations to examine whether information encountering on social media actually leads to tacit knowledge creation and sharing. The findings of the study may also provide opportunities for users to adopt social media effectively or gain greater value from social media use.