PROforma is an executable process modeling language that has been used successfully to build and deploy a range of decision support systems, guidelines, and other clinical applications. It is one of a number of recent proposals for representing clinical protocols and guidelines in a machine-executable format (see ). In this report, the authors outline the task model for the language and provide an operational semantics for process enactment together with a semantics for expressions, which may be used to query the state of a task during enactment. The operational semantics includes a number of public operations that may be performed on an application by an external agent, including operations that change the values of data items, recommend or make decisions, manage tasks that have been performed, and perform any task state changes that are implied by the current state of the application. Disclosure: PROforma has been used as the basis of a commercial decision support and guideline technology Arezzo (Infermed, London, UK; details in text).

We compared intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) in the treatment of 50 patients with Guillain-Barré syndrome (GBS). Standard outcome measures did not differ for the two groups. Sixty-one percent of the PLEX-treated group and 69% of the IVIG-treated group improved by one disability grade at 1 month. The complication rate was higher in the PLEX-treated group. We conclude that the efficacy of IVIG in the treatment of GBS is comparable with that of PLEX and that it can be used safely, although we had a small number of patients. We did not observe a higher relapse rate with IVIG. The usefulness of combination therapy is unknown at this time.

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These suppression-release effects of high-dose denosumab on bone remodeling raise questions about safety of fixed dosing and treatment duration. In young people, weight-adjusted dosing and safety monitoring during and after antiresorptive therapy is required.