Understanding patterns of accumulation: Improving forecast-based decisions via nudging.

In this study we investigated challenges associated with comprehension of graphical patterns of accumulation (Experiment 1) and how to improve accumulation-based reasoning via nudging (Experiment 2). On each trial participants were presented with two separate graphs, each depicting a linear, saturating, or exponential data trajectory. They were then asked to make a binary decision based on their forecasts of how these trends would evolve. Correct responses were associated with a focus on the rate of increase in graphs; incorrect responses were driven by prior knowledge and beliefs regarding the context and/or selective attention towards the early phases of the line trajectories. To encourage participants to think more critically and accurately about the presented data, in Experiment 2, participants completed a nudge phase: they either made a forecast about a near horizon or read particular values on the studied trajectories prior to making their decisions. Forecasting about how the studied trajectories would progress led to improvements in determining expected accumulation growth. Merely reading values on the existing trajectory did not lead to improvements in decision accuracy. We demonstrate that actively asking participants to make specific forecasts prior to making decisions based on the accumulation trajectories improves decision accuracy.

Medical device-related pressure injuries in paediatric patients: An incidence study in a children's hospital.

AIM: To determine the incidence of pressure injuries from medical devices in children. BACKGROUND: Medical devices can cause pressure injuries on skin and soft tissues. DESIGN: A prospective, descriptive study adhering to STROBE guidelines. METHODS: This study was conducted in the third-level Paediatric Intensive Care Unit of Ege University Hospital in Izmir, Türkiye between April 2019 and October 2019 in Türkiye. Patients aged between 1 month and 18 years with medical devices were observed for pressure injuries using Braden scales and a specific monitoring form. RESULTS: In this study, we followed 522 medical devices applied to 96 patients. The three most commonly used medical devices were the ECG probe (21%), the blood pressure cuff (16%) and the saturation probe. Out of the 522 medical devices followed, 36 caused pressure injuries (6.8%). CONCLUSION: The incidence of medical device-related pressure injuries was found to be high. Effective training and implementation strategies need to be devised for paediatric nurses to prevent pressure injuries associated with medical devices. RELEVANCE TO CLINICAL PRACTICE: The results of this study reveal that pressure injuries related to medical devices are an important health problem in paediatric hospitals. Therefore, awareness-raising and educational activities among health professionals and nurses should be accelerated. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution in the study.

The effect of COVID-19 fear level on nursing students' attitudes towards E-learning.

The COVID-19 pandemic has affected the educational, social, and psychological lives of children and young people. Many countries have transitioned to online education because of the pandemic. This study aimed to examine the levels of fear of nursing students about COVID-19 and their attitudes towards e-learning. This study was designed as a cross-sectional and descriptive study. The data were collected using the COVID-19 Phobia Scale and the Attitude Scale Towards E-learning. This research was conducted with nursing students (n = 301) who received online education due to the COVID-19 pandemic. The students' mean COVID-19 Phobia Scale score was 49.26 ± 15.88; the mean Attitude Scale Towards E-learning score was 59.46 ± 17.00, and a significantly positive relationship was found between the participants' scores on both scales (r = 0.122; p < 0.034). The COVID-19 pandemic has caused students to experience psychological and social problems. It is essential to have sufficient infrastructure to effectively maintain online education.

Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy.

BACKGROUND: There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). METHODS: A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. RESULTS: The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. CONCLUSION: Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.

The prognostic importance of glucose-to-lymphocyte ratio and uric acid in metastatic breast cancer patients treated with Cdk 4/6 inhibitors.

Aim: To demonstrate the prognostic importance of glucose-to-lymphocyte ratio (GLR) and uric acid (UA) in patients with metastatic breast cancer (MBC) receiving Cdk 4/6 inhibitors. Materials & methods: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, GLR, UA and CA15-3 were analyzed to assess their prognostic value using Kaplan-Meier curves and Cox regression analysis in 101 patients with MBC, retrospectively. Results: Importantly, both progression-free survival and overall survival were shorter in the group with high neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), GLR and UA. In the multivariate analysis, GLR and UA levels were independent prognostic factors for both progression-free survival and overall survival. Conclusion: In patients with MBC, GLR and UA are independent factors that predict survival times.

Some studies on solid organ malignancies have shown the predictive importance of the glucose-to-white blood cell count ratio obtained by dividing blood sugar by the lymphocyte count and uric acid (UA) resulting from protein metabolism. This study aimed to investigate the predictive significance of the glucose-to-white blood cell count ratio and UA in blood before the use of Cdk inhibitors in patients with hormone receptor-positive and HER2-negative metastatic breast cancer. The results show that higher glucose-to-white blood cell count ratio and UA are associated with survival parameters and serve as independent predictive factors for shorter progression-free survival, disease-free survival and overall survival. Thus, glucose-to-white blood cell count ratio and UA can be used to better predict the survival and prognosis of patients using Cdk inhibitors.

The Effects of Designing an Educational Animation Movie in Virtual Reality on Preoperative Fear and Postoperative Pain in Pediatric Patients: A Randomized Controlled Trial.

PURPOSE: The purpose of the study was to investigate the effects of watching an educational animated movie on fear and pain in children aged 6 to 12 years old. DESIGN: A randomized controlled trial. METHODS: In this study, the CONSORT checklist was used as a guide. The sample of participants (n = 132) was allocated to the Educational Animation Group (n = 44), Documentary Group (n = 44), and Control Group (n = 44) using block randomization. During the data collection, an information form, the Children's Fear Scale and Wong-Baker Faces Pain Rating Scale were used. FINDINGS: Preoperative fear and postoperative pain scores were significantly lower in the Educational Animation group than in the other groups. CONCLUSIONS: The educational animated movie was found to be an effective method in reducing preoperative fear and postoperative pain. Educational animated movies, which were effective in reducing the fear and pain of the child in the preparatory operations, increased the educational effectiveness and cooperation of the child.

Prognostic significance of hemoglobin-to-red cell distribution width ratio in patients with metastatic renal cancer.

The aim of the current research was to investigate the prognostic significance of pretreatment hemoglobin-to-red cell distribution width ratio (HRR) in patients with renal cell carcinoma (RCC). The neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, lymphocyte-to-monocyte ratio (LMR) and HRR were analyzed retrospectively to assess their prognostic value using Kaplan-Meier curves and Cox regression analysis in 198 patients with RCC. High HRR (0.72) and high LMR (2.43) were found to be associated with longer progression-free survival and overall survival. A multivariate analysis identified International Metastatic Renal Cell Carcinoma Database Consortium prognostic score, tumor stage, node stage, LMR and HRR as independent prognostic factors for progression-free survival, as well as International Metastatic Renal Cell Carcinoma Database Consortium score, neutrophil-to-lymphocyte ratio and HRR for overall survival. HRR is a an independent prognostic parameter predicting the progression and survival of patients with RCC.

Lay abstract Hemoglobin-to-red cell distribution width ratio (HRR) may be associated with lifespan in patients with cancer, as shown in previous studies of solid organ malignancy. The present study investigates the prognostic significance of pretreatment HRR in patients with renal cell carcinoma. A higher HRR was associated with longer survival in the present study, indicating the value of HRR as a predictor of survival and prognosis in renal cancer.

Sigmoid Sinus Thrombosis Followed by Splenic Infarction Due to Imatinib Therapy in a Patient with Gastrointestinal Stromal Tumor; Hematological Side Effects of Imatinib.

Imatinib has an important place as an adjuvant therapy as well as in the treatment of metastatic disease caused by gastrointestinal stromal tumor (GIST), which is one of the common mesenchymal tumors of the gastrointestinal tract. Imatinib is a tyrosine kinase inhibitor and is generally well tolerated. However, it can cause some serious adverse effects. The most common of these are edema on the face and legs, headache, fatigue, nausea, vomiting, and rash on the skin. The most serious side effects, albeit less common, are gastrointestinal or intraabdominal bleeding. However, thrombotic events such as sigmoid sinus thrombosis and splenic infarction are extremely rare. The current report presents a patient with GIST who is treated with imatinib 400 mg/day. The patient presented with edema on the face and headache in the second month of imatinib therapy, after which she was diagnosed with sigmoid sinus thrombosis. The patient who presented with abdominal pain approximately three months later developed splenic infarction. She was administered acetylsalicylic acid, supplemental oxygen (O2) in the first episode of thrombosis, and imatinib therapy was discontinued. The patient's complaints and thrombus regressed, after which imatinib therapy was resumed. She was administered intravenous hydration, supplemental oxygen, analgesics, and imatinib therapy was discontinued after the patient sustained splenic infarction. After resolution of sigmoid sinus thrombosis and the regression of splenic infarction area, the patient was switched to sunitinib therapy. She is attending routine control visits. Sigmoid sinus thrombosis and splenic infarction should be kept in mind as a rare cause of headache and abdominal pain in patients treated with imatinib, and detailed neurological and gastrointestinal evaluation should be performed.

The Diagnostic Value of Superb Microvascular Imaging in Prediction of Uterine Artery Embolization Treatment Response in Uterine Leiomyomas.

OBJECTIVES: We aimed to determine if superb microvascular imaging (SMI) can predict response to uterine artery embolization (UAE) as compared with power Doppler ultrasound. METHODS: The blood flow and the volume of the dominant leiomyoma was evaluated by power Doppler ultrasonography (PDUS) and SMI 1 day before and 3 months after the UAE procedure. SMI and PDUS blood flow were classified to 4 grades of vascularity. The change in fibroid volume in Grades 0-2 (hypovascular group) was compared to the hypervascular Grade 3 group. RESULTS: Twenty-eight women (mean age, 40.9 years; range, 33-53 years) were examined with PDUS and SMI before and 3 months after UAE. The volume reduction was statistically significantly higher hypervascular group (P < .05). When we accept 30% or more volume reduction as a good response to UAE, the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of SMI were 100, 64, 73.6, 100, and 82.1%, respectively. There was excellent agreement between the two blinded observers in SMI measurements. CONCLUSIONS: SMI, with its high reproducibility, provides further microvessel information than PDUS in uterine fibroids. It may be a useful tool in prediction of response to UAE treatment and improve counseling and patient selection for UAE versus medical or surgical treatment options.

The Significance of Controlling Nutritional Status (CONUT) Score as a Novel Prognostic Parameter in Small Cell Lung Cancer.

PURPOSE: The immuno-nutritional status is closely related to the prognosis in many cancers. Controlling nutritional status (CONUT) score is a new parameter that reflects the immuno-nutritional status and is prognostic in some cancers. However, the prognostic significance of the CONUT score in small cell lung cancer (SCLC) is unknown. We aimed to demonstrate the prognostic significance of the CONUT score in patients with SCLC. METHODS: Two hundred sixteen patients who were followed up with SCLC were included in the study retrospectively. According to the receiver operating characteristic (ROC) curve analysis, the optimal cutoff values were determined for the CONUT score, and the patients were divided into low (< 2) and high (≥ 2) CONUT groups. Neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and prognostic nutritional index (PNI) were grouped based on a cutoff point 2.84, 626, and 46.1, respectively. Cox regression analyses were used to assess their prognostic values for progression-free survival (PFS) and overall survival (OS). RESULTS: The high CONUT group had significantly worse PFS and OS than the low CONUT group (p < 0.001, p < 0.001). In univariate analysis, stage, prophylactic cranial irradiation, extrapulmonary lesion, PNI, body mass index, CONUT score were found to be significant for both PFS and OS. In multivariate analysis, only CONUT score and stage were found as independent prognostic factors for both PFS (p: 0.018, p: 0.046) and OS (p: 0.038, p: 0.006). CONCLUSION: The CONUT score at the time of diagnosis is an independent prognostic parameter that predicts recurrence and survival times in SCLC.

Comparison of the Effectiveness of Two Different Methods of Decreasing Pain During Phlebotomy in Children: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to examine the effect of the applications of external cold and vibration and blowing soap bubbles during phlebotomy in children aged between 3 and 6 years. DESIGN: This study is a randomized controlled trial. METHODS: The sample was obtained using block randomization. Children were divided into three groups: "external cold and vibration group," "blowing soap bubbles group," and "control group." Children, their parents, the nurse, and the researcher rated the children's pain during phlebotomy. FINDINGS: A statistically significant difference between groups was found on pain scores. Pain scores were lower in the groups of external cold and vibration, and blowing soap bubbles than the control group. CONCLUSIONS: The methods of external cold and vibration and blowing soap bubbles had a pain relieving effect in children aged between 3 and 6 years during phlebotomy.

Comparative analysis of the patients with community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP) requiring hospitalization.

INTRODUCTION: The recently introduced concept of health care-associated pneumonia (HCAP), referring to patients with frequent healthcare contacts and at higher risk of contracting resistant pathogens is controversial. MATERIALS AND METHODS: A prospective study comparing patients with HCAP and community-acquired pneumonia (CAP) in the our center. The primary outcome was 30 day mortality. RESULT: A total of the 169 patients HCAP 36 (21.3%); CAP 133 (78.7%) were evaluated. HCAP patients were older than patients with CAP [median age was 72.5 (43-96), 60.0 (18-91) years p<0.05]. The most common Klebsiella pneumoniae (16.6%) and Pseudomonas aeruginosa (8.3%) were gram-negative bacteria in the SBIP group; In the TGP group, gram-positive bacteria were more frequently isolated. Polymicrobial agents (22.2% vs. 3.7% p<0.05) and MDR pathogens (57.1% vs. 24% p<0.05) were more common in patients with HCAP. Mortality rate (22.2% vs. 6% p<0.05) was also higher in HCAP more than CAP. CONCLUSIONS: HCAP was common among patients with pneumonia requiring hospitalization and mortality rate was high. The patients with HCAP were different from CAP in terms of demographic and clinical features, etiology, outcome.

Investigation of the relationship between asthma and subclinical atherosclerosis by carotid/femoral intima media and epicardial fat thickness measurement.

OBJECTIVE: Since asthma and atherosclerosis may share similar pathophysiological mechanism, this study is planned to investigate whether epicardial fat thickness (EFT), carotid and femoral intima media thicknesses, which are markers of subclinical atherosclerosis, are increased in patients with asthma. METHODS: The study was designed as a cross-sectional study. A total of 154 participants (83 patients with asthma and 71 healthy volunteers) were enrolled into the study. Epicardial fat, carotid, and femoral intima media thicknesses were measured and recorded in both groups. The statistical difference between the two groups was examined. RESULTS: Both carotid and femoral intima media thicknesses were significantly higher in patients with asthma compared to control group (5.52 ± 0.4 mm vs. 5.36 ± 0.4 mm; p = 0.038 and 5.64 ± 0.4 mm vs. 5.46 ± 0.5 mm; p = 0.036, respectively). However, there was not a significant difference in EFT between the groups [5.9 mm (5.3-6.6; IQR = 1.3) vs. 5.6 mm (4.7-6.5; IQR = 1.8); p = 0.1]. On comparison of control group and asthma subgroups (mild, moderate, and severe), there was a statistically significant difference among these four groups in terms of carotid and femoral intima media thicknesses (p = 0.002 and p < 0.001, respectively). Subgroup analyses showed that this difference was mainly due to patients with severe asthma. CONCLUSIONS: Carotid and femoral intima media thicknesses in asthmatic patients were found to be increased compared to the normal population. As a result, the risk of subclinical atherosclerosis in asthmatic patients may be high.

Knowledge, Behaviors, and Attitudes About Human Papilloma Virus Among Nursing Students in Izmir, Turkey.

Human papillomavirus (HPV) is transmitted through sexual contact and can cause cervical cancer. The aim of this study was to determine knowledge, behaviors, and attitudes about human papillomavirus (HPV) in nursing students in a baccalaureate program. This study was conducted with a sample of 624 students. Data were collected via questionnaires administered during the first class time. Students' knowledge about HPV was high; 90.5% knew HPV can cause cervical cancer; 94.6% recognized it as a sexually transmitted disease. Although; 87.7% stated a vaccine is available to protect women from HPV, nearly all participants (98.1%) had not received HPV vaccination. Findings show students' level of knowledge about HPV's risk factors and modes of transmission were high. However, this knowledge did not translate into engagement in health related behaviors such as being vaccinated against HPV.

Effects of Virtual Reality and External Cold and Vibration on Pain in 7- to 12-Year-Old Children During Phlebotomy: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the effects of the virtual reality (VR) and external cold and vibration methods on pain scores in children aged 7 to 12 years during phlebotomy. DESIGN: A randomized controlled study. METHODS: The sample of children (n = 121) was allocated to the groups (group 1, VR; group 2, external cold and vibration; group 3, control) by blocked randomization. Pain scores were assessed after the phlebotomy using self-report, parent's reports, report from the nurse who attempted the phlebotomy, and researchers' report with the Wong-Baker FACES scale. FINDINGS: Pain scores were determined to be lower in groups 1 and 2. Although there was no difference between the groups 1 and 2, a statistically significant difference was found between groups 1 or 2 and group 3 based on all pain scores. CONCLUSIONS: Results suggest that VR and external cold and vibration are effective in reducing the pain in 7- to 12-year-old children during phlebotomy. VR can be used safely for the pain management of children who are growing up in the age of technology.

Can tree species diversity be assessed with Landsat data in a temperate forest?

The diversity of forest trees as an indicator of ecosystem health can be assessed using the spectral characteristics of plant communities through remote sensing data. The objectives of this study were to investigate alpha and beta tree diversity using Landsat data for six dates in the Gönen dam watershed of Turkey. We used richness and the Shannon and Simpson diversity indices to calculate tree alpha diversity. We also represented the relationship between beta diversity and remotely sensed data using species composition similarity and spectral distance similarity of sampling plots via quantile regression. A total of 99 sampling units, each 20 m × 20 m, were selected using geographically stratified random sampling method. Within each plot, the tree species were identified, and all of the trees with a diameter at breast height (dbh) larger than 7 cm were measured. Presence/absence and abundance data (tree species number and tree species basal area) of tree species were used to determine the relationship between richness and the Shannon and Simpson diversity indices, which were computed with ground field data, and spectral variables derived (2 × 2 pixels and 3 × 3 pixels) from Landsat 8 OLI data. The Shannon-Weiner index had the highest correlation. For all six dates, NDVI (normalized difference vegetation index) was the spectral variable most strongly correlated with the Shannon index and the tree diversity variables. The Ratio of green to red (VI) was the spectral variable least correlated with the tree diversity variables and the Shannon basal area. In both beta diversity curves, the slope of the OLS regression was low, while in the upper quantile, it was approximately twice the lower quantiles. The Jaccard index is closed to one with little difference in both two beta diversity approaches. This result is due to increasing the similarity between the sampling plots when they are located close to each other. The intercept differences between two investigated beta diversity were strongly related to the development stage of a number of sampling plots in the tree species basal area method. To obtain beta diversity, the tree basal area method indicates better result than the tree species number method at representing similarity of regions which are located close together. In conclusion, NDVI is helpful for estimating the alpha diversity of trees over large areas when the vegetation is at the maximum growing season. Beta diversity could be obtained with the spectral heterogeneity of Landsat data. Future tree diversity studies using remote sensing data should select data sets when vegetation is at the maximum growing season. Also, forest tree diversity investigations can be identified by using higher-resolution remote sensing data such as ESA Sentinel 2 data which is freely available since June 2015.

Determination of methods used by the neonatal care unit nurses for management of procedural pain in Turkey.

OBJECTIVE: To determine the pharmacological and non-pharmacological methods used by neonatal intensive care unit nurses to reduce procedural pain. METHODS: The cross-sectional study was conducted from September 2011 to June 2012 and comprised nurses employed in the paediatric departments, consisting of neonatal intensive care units and newborn units, of 15 hospitals in various cities of Turkey: 8 in Istanbul, 3 in Izmir and two each in Antalya and Edirne. Data was collected using a questionnaire and analysed using SPSS 15. RESULTS: The mean age of the 486 nurses was 28.19±5.14 years; 316(65%) had bachelor's degrees; 278(57.2%) had nursing experience greater than 6 years; and 322(72.5%) had newborn nursing experience greater than 6 years. Overall, 364(74.9%) nurses used non-pharmacological methods, and 145(29.8%) used pharmacological methods for pain relief. The most commonly used non-pharmacological methods were skin touch 364(75%) and giving a pacifier 269(55.3%). The most commonly used pharmacological methods were paracetamol and ibuprofen by 145(29.8%) nurses. A statistically significant difference was found between the level of education and use of pharmacological and non-pharmacological methods for pain relief (p< 0.05). CONCLUSIONS: Among the nurses in both groups, very little pain management was used for invasive procedures. Educational programmes for pain management in newborns should be arranged to develop an institutional culture. Guidelines for these patients' pain management should also be established.

Effectiveness of infant massage on babies growth, mother-baby attachment and mothers' self-confidence: A randomized controlled trial.

Infant massage is a unique massage that can be application to babies in the postpartum period for centuries. While baby massage provides contact between the baby and the mother, it supports the growth processes of the baby. This study aimed to investigate the effects of online infant massage training on infant growth, mother-infant attachment, and mothers' self-confidence. This randomized controlled clinical trial included 60 healthy-term infants and mother. The Demographic Data Collection Form, Maternal Attachment Scale, and Pharis Self-Confidence Scale were completed by all the mothers participating in the study. At the end of the 4th week, infant massage training was given to the mothers of the babies in the massage group by the primary investigator. Body weight, height, and head circumference measurements were made at the end of the 4th, 8th, 12th, 16th, and 20th week of both group babies. At the end of the 20th week, the self-confidence of the mothers in both groups was assessed using the Maternal Attachment Scale and Pharis Self-Confidence Scale. Infants in the massage group had significantly higher mean body weight at the end of the 8th week (p = 0.006) and mean height at the end of 20th week (p = 0.05) than the infants in the control group. The Maternal Attachment Scale values were higher for the mothers in the massage group (p = 0.030). Infant massage is an effective method that strengthens maternal attachment and increases body weight and height in infants. The study is registered under the ClinicalTrials.gov identifier NCT05302427.

Biological therapy management from the initial selection of biologics to switching between biologics in severe asthma.

The aim of this review is to elaborate the management of biologic therapy from initial selection to switching biologics in severe asthma. A nonsystematic review was performed for biological therapy management in severe asthma. Depending on clinical characteristics and biomarkers, selecting the preferred biologic based on super-responder criteria from previous studies may result in adequate clinical efficacy in most patients. On the other hand, no matter how carefully the choice is made, in some patients, it may be necessary to discontinue the drug due to suboptimal clinical response or even no response. This may result in the need to switch to a different biological therapy. How long the biological treatment of patients whose asthma is controlled with biologics will be continued and according to which criteria they will be terminated remains unclear. It has been shown that in patients with a long history of good response to biologics, asthma control may be impaired when biologics are discontinued, while it may persist in others. Therefore, discontinuation of biologics may be a viable strategy in a particular patient group. Clinicians should make the best use of all predictive factors to identify patients who will most benefit from each biologic. Patients who do not meet a predefined response criterion after sufficient time for response evaluation and who are eligible for one or more alternative biological agents should be offered the opportunity to switch to another biologic. There is no consensus on when the biologics used in severe asthma that produce favorable results should be discontinued. In our opinion, treatment should continue for at least five years, as premature termination may potentially deteriorate asthma control.