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Abstract Moving towards a cleaner, greener, and more sustainable future, expanding electric vehicles (EVs) adoption is inevitable. However, uncontrolled charging of EVs, especially with their increased penetration among the utility grid, imposes several negative technical impacts, including grid instability and deteriorated power quality in addition to overloading conditions. Hence, smart and coordinated charging is crucial in EV electrification, where Vehicle-to-Grid (V2G) technology is gaining much interest. Owing to its inherited capability of bi-directional power flow, V2G is capable of enhancing grid stability and resilience, load balancing, and congestion alleviation, as well as supporting renewable energy sources (RESs) integration. However, as with most emerging technologies, there are still technical research gaps that need to be addressed. In addition to these technical impacts, other multidisciplinary factors must be investigated to promote EVs adoption and V2G implementation. This paper provides a detailed demonstration of the technical problems associated with EVs penetration in distribution networks along with quantifiable insights into these limitations and the corresponding mitigation schemes. In addition, it discusses V2G benefits for power systems and consumers, as well as explores their technical barriers and research directions to adequately regulate their services and encourage EV’s owners to its embracement. Moreover, other factors, including regulatory, social, economic and environmental ones that affect EV market penetration are being studied and related challenges are analyzed to draw recommendations that aid market growth.

Plain English Summary Eating disorders (EDs) are common and can be deadly, yet treatment approaches are not currently meeting the needs of individuals in Canada requiring care. As noted in the existing literature, ED treatment is largely inaccessible in Canada and can be ineffective in facilitating long-term recovery. Recent research has suggested that improvement to publicly funded, hospital-based ED treatment for adults is necessary and that those in Canada with lived experience should be involved in the process of doing so. This paper is based on a study that set out to explore ED treatment and gather potential recommendations from eleven individuals in Canada with lived experience. Several recommendations were identified to improve ED treatment in Canada, while simultaneously addressing harmful stigma about people with lived experience with EDs. These recommendations included providing interim support, ensuring individualized care, offering dignified treatment, increasing resources, and directly targeting stigma. From this study, it is suggested that current ED treatment methods must change to improve health outcomes and reduce stigma, and exploring the perspectives of those with lived experience is a promising method for doing so.

The aim of this guideline is to assist physicians in the management of patients with cardiovascular pathology and obstructive sleep-disordered breathing. The article consists data on diagnostic tactics for patients with possible sleep-breathing disorders, describes the basic principles of obstructive sleep apnea treatment, and substantiates the clinical significance of obstructive sleep apnea therapy initiating in the management of patients with cardiovascular diseases.

Abstract Background Enhancing long-term support for post-stroke cognitive impairment is a top research priority. Addressing current gaps in UK post-stroke cognitive care provision requires a pragmatic and scalable intervention that can be integrated within the existing stroke care pathway. This study aimed to develop consensus on an initial set of core features for a UK-based monitoring and psychoeducational intervention for cognitive changes after stroke. Methods An expert panel of UK healthcare professionals and researchers participated in an online modified Delphi survey. Candidate intervention features were identified from clinical guidelines, existing literature, research team/collaborator expertise, and PPI group lived experience. Survey participants indicated whether they agreed/disagreed/had no opinion about including each candidate feature in the intervention and free-text responses were invited. We analysed responses for consensus (≥ 75% agreement) using descriptive statistics, with items not reaching consensus carried into subsequent rounds. Template analysis was used to identify similarities/differences in viewpoints for items that did not reach consensus. Results Three survey rounds were completed by 36, 29 and 26 participants, respectively. Participants agreed reviews should include a stroke-specific cognitive screen (97% agree) and assessment of other psychological changes (low mood, anxiety, fatigue: 94%, 90%, 89% agree, respectively). They agreed stroke survivors should be offered at least one review, regardless of their cognitive profile in hospital. They agreed on the importance of various cognition-focused psychoeducation topics, and formal (100% agree) and informal (79% agree) training for those conducting reviews. Consensus was not reached on the review mode (in person/remote options: 67% agree), offering reviews one-year post-discharge to patients without acute cognitive impairments (68% disagree), or including a dementia screen (63% disagree) and/or neuropsychological assessment battery (58% disagree). However, there were similarities in participant viewpoints. For example, participants emphasised the importance of onwards referral where clinically indicated. Conclusions The UK-based post-stroke monitoring and psychoeducation intervention was originally conceptualised as a cognitive care pathway, but expert participants agreed on the importance of simultaneously addressing related psychological changes (e.g. low mood, anxiety). There was clear consensus on a minimum set of intervention features. Recommendations outlined here may usefully inform local service improvements.

Background Successful liberation from mechanical ventilation is one of the most crucial processes in critical care, because it is the first step through which a respiratory failure patient begins to transition out of the intensive care unit, and return to normal life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider scientific and systematic approaches, as well as the individual experiences of healthcare professionals. Recently, numerous studies have investigated methods and tools to identify when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians for liberation from the ventilator. Methods Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. These evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved the recommendations. Results Recommendations for nine questions on ventilator liberation about Population, Intervention, Comparator, and Outcome (PICO) are presented in this document. This guideline presents seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation. Conclusion We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.

Introduction. Glucocorticoid-induced osteoporosis (GIOP) is a bone metabolic disease that develops as a result of glucocorticoid (GC) use, is one of the most frequent causes of secondary osteoporosis, leads to an increase in the risk of low-energy fractures, disability and mortality of GC users. Despite the few stu­dies conducted in Ukraine on the epidemiology and treatment of GIOP, there have been no national recommendations for its ma­nagement until now, which has become the background for their creation. The purpose was to develop national guidelines for the diagnosis, prevention, and treatment of GIOP based on the analytical analysis of modern literary sources to improve the awareness of the medical community of Ukraine, improve management, and reduce the socio-economic burden of the disease. Materials and ­methods. A group of 18 experts, leading Ukrainian scientists in various fields, was created to develop the guideline. An analysis of current literary sources on epidemiology, risk factors, diagnosis, prevention and treatment of GIOP, and monitoring of the effectiveness and safety of its treatment was carried out. Evidence was synthesized ­using the GRADE system, and a critical assessment of the quality of the recommendations was carried out using the AGREE II tool. ­Results. The guideline consists of 12 provisions on screening, diagnosis, prevention, and treatment of GIOP. The authors emphasized the need to increase the awareness of the medical community of Ukraine regarding the problem, as well as patients regarding the possible side effects of GC. They presented the features of the clinical assessment of the osteoporotic fracture risk in GC users, as well as modern and available in Ukraine methods of diagnosis and treatment of GIOP. Conclusion. The first Ukrainian guideline for screening, diagnosis, prevention, and treatment of GIOP is an important national tool for its management, which is recommended by the Board of the Ukrainian Association of Osteoporosis for use in practical health care by doctors of various specialties.

Relevance. The regulation of orphan drugs plays a key role in the development of medicines for rare diseases that affect only a small percentage of the population. This specialized regulatory framework is designed to encourage pharmaceutical companies to allocate resources to the development of drugs for diseases that might otherwise be overlooked due to limited commercial appeal. Experts from Cogentia Healthcare Consulting Ltd. analyzed trends in the assessment of orphan drugs in the UK.Objective. The aim of this work was to analyze and present the main trends in the optimization of decision-making regarding orphan drugs based on the data of an analysis conducted by the experts of Cogentia Healthcare Consulting Ltd.Results. Regulatory bodies have shown some flexibility in the assessment of orphan drugs and have used approaches designed to address uncertainties in the evidence, accepting, in some cases, low-quality evidence, expert opinion and evidence from real-world clinical practice and applying more flexible pharmacoeconomic approaches. However, despite the existing assumptions, the evaluation process for orphan drugs often takes longer than that for non-orphan drugs.Conclusions. Although different approaches to market regulation for orphan drugs have helped stimulate their development worldwide and address unmet medical needs, delays in decision-making for orphan drugs have seriously affected their availability to patients in need.

Actinic keratosis is a common skin condition that has the potential to develop into malignant neoplastic lesions. Factors that are known to increase the likelihood of developing actinic keratosis include older age, male gender, UV exposure, and immunosuppressive treatment. Understanding the pathogenesis and significance of actinic keratosis as an initial form of the neoplastic process associated with a sequence of lesions arising on photodamaged skin has led to the concept of field cancerization. The choice of the optimal therapeutic pathway depends on the number of actinic keratosis lesions and the degree of photodamage in the skin, as well as the advancement of skin lesions. The clinical presentation of skin lesions also allows monitoring of the patient’s condition over time and assessing response to treatment, and facilitates rational decisions regarding potential therapy adjustments. This article outlines the guidelines for the diagnosis and treatment of actinic keratosis in Poland and presents an evidence-based management regimen that incorporates the practical clinical experience of dermatology experts. The recommendations cover a range of topics including topical treatment options, cryosurgery, photodynamic therapy with a photosensitizing agent, and combination treatments.

Abstract Background Persons with disabilities (PwDs) experience various adverse sexual and reproductive health (SRH) outcomes. However, there is a paucity of evidence on the strategies to improve their SRH outcomes. This study, therefore, used a pluralistic approach to explore PwDs and healthcare providers’ (HPs) perspectives on how to improve the SRH of PwDs in Ghana. Methods In-depth interviews were conducted with 62 purposively selected stakeholders (37 PwDs and 25 HPs) in the Kumasi Metropolis and Offinso North District. The data was subjected to reflexive thematic analysis. Results Six major themes were generated from the data: Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity – ‘nothing about us, without us’, Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Educating for disability-inclusive healthcare environment. These recommendations were synthesised to develop the THRIVE model–a comprehensive data driven framework from stakeholders that emphasises the importance of factors such as Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity – ‘nothing about us, without us’, Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Enforcement of physical accessibility to improve their SRH outcomes. Conclusion Using the evidence based THRIVE model could facilitate the development and strengthening of existing interventions and policies including the disability Act 715 to improve the SRH access and outcomes of PwDs in Ghana and other low-and middle-income countries.

Abstract Background Low English language literacy is a common barrier to participation in clinical trials. Patient information leaflets (PILs) used in clinical trials are often lengthy, complex and have poor readability; this is a persistent and prevalent problem common to trials across the world. Simplifying the information provided in PILs can lead to improved understanding, comprehension and knowledge. The aim of this project was to develop recommendations for developing accessible PILs for clinical trials through a literature review of published and grey literature and co-working with marginalised communities, patients, and health and social care charities. Methods A literature review of MEDLINE, Embase and online resources was conducted, and recommendations for developing accessible PILs were extracted from eligible published and grey literature. Grey literature which contained insights into more inclusive forms of communication was also identified and summarised. Meetings were held with two racially marginalised community groups, two groups involving autistic adults and/or adults with learning difficulties and a patient advisory group. Examples of accessible PILs were shared and discussions held about the content and format of the PILs and suggestions for changes/improvements. National Voices, a coalition of health and social care charities in England, held a national online workshop with charities and lived experience partners. Recommendations identified from the multiple sources were coded, collated and refined to develop an overarching framework of recommendations. Results The framework consists of 74 recommendations for developing accessible PILs for clinical trials. Recommendations cover the five topics of formatting, information presentation, writing style, content and accessibility. Conclusions This project has developed a comprehensive framework of recommendations to guide researchers in the development of accessible PILs for clinical trials. Findings from previous research and from co-working with marginalised communities, patients and health and social care charities were collated to ensure that a diverse range of voices and experiences informed the framework. These recommendations aim to support researchers to develop better study information to reduce English language literacy as a barrier to participation in clinical trials.

Resumen: Antecedentes y objetivo: La enfermedad renal crónica (ERC) se asocia a una elevada morbilidad, carga y consumo de recursos, y constituye un importante desafío para los sistemas sanitarios. El objetivo de este trabajo fue analizar los modelos asistenciales de atención a estos pacientes y consensuar los factores clave que deben implementarse para un modelo óptimo de atención en la ERC, a través de una visión multidisciplinar e integradora. Materiales y métodos: Se conformó un panel multidisciplinar de profesionales con experiencia en el ámbito de la ERC, integrado por un comité asesor (CA) de 15 expertos y un panel adicional de 44 también especialistas. Se identificaron los retos y las áreas de mejora a lo largo de todo el proceso asistencial, a través de la revisión de la evidencia científica y entrevistas individuales al CA. Se consensuaron los factores clave para un modelo óptimo de atención en la ERC que fueron valorados utilizando la metodología de consenso RAND Corporation y Universidad de California en Los Ángeles (RAND/UCLA) (Delphi adaptado), valorando su adecuación y necesidad. Resultados: Se identificaron 38 factores clave para un modelo óptimo de atención al paciente con ERC, estructurados en cuatro retos: 1) desarrollo de modelos de gestión de la ERC y aumento de la visibilidad de la enfermedad, 2) prevención, optimización del cribado, diagnóstico precoz y registro de la ERC en todos los niveles asistenciales, 3) seguimiento integral, multidisciplinar y coordinado, asegurando la optimización terapéutica y la continuidad asistencial, y 4) refuerzo de la formación en ERC a los profesionales sanitarios y pacientes. Un total de 35 factores clave fueron valorados por el panel como adecuados y claramente necesarios, y de estos, 14 fueron considerados altamente prioritarios. Conclusiones: Existe un consenso sobre la necesidad de priorizar la atención de la ERC tanto a nivel institucional como social, avanzando hacia modelos óptimos de atención en ERC basados en la prevención y detección precoz de la enfermedad, así como en el seguimiento integral y coordinado de los pacientes y la formación y concienciación a todos los niveles. Los factores clave identificados constituyen una hoja de ruta implantable en las distintas comunidades autónomas (CCAA) que puede contribuir a una mejora significativa en la atención a estos pacientes. Abstract: Background and Purpose: Chronic kidney disease (CKD) is associated with high morbidity, burden, and resource utilization, and represents a major challenge for healthcare systems. The purpose of this study was to analyse the care patterns for these patients and to reach a consensus on the key factors that should be implemented for an optimal care model in CKD, through a multidisciplinary and integrative vision. Materials and Methods: A multidisciplinary panel of professionals with experience in the field of CKD was formed, composed of an advisory committee of 15 experts and an additional panel of 44 experts. Challenges and areas for improvement across the continuum of care were identified through review of scientific evidence and individual interviews with the advisory committee. Key factors for an optimal model of care in CKD were agreed and assessed using the Rand/UCLA consensus methodology (adapted Delphi), evaluating their appropriateness and necessity. Results: 38 key factors were identified for an optimal CKD patient care model, organised into four challenges: 1) Development of CKD management models and increased visibility of the disease, 2) Prevention, optimisation of screening, early diagnosis and registration of CKD at all levels of care, 3) Comprehensive, multidisciplinary and coordinated monitoring, ensuring therapeutic optimisation and continuity of care, and 4) Reinforcement of CKD training for health care professionals and patients. 35 key factors were assessed by the panel as adequate and clearly necessary, and of these, 14 were considered highly imperative. Conclusions: There is consensus on the need to prioritise CKD care at both institutional and societal levels, moving towards optimal models of CKD care based on prevention and early detection of the disease, as well as comprehensive and coordinated patient monitoring and training and awareness-raising at all levels. The key factors identified constitute a roadmap that can be implemented in the different Autonomous Communities and contribute to a significant improvement in the patient's care.

Abstract Pangenomics is a relatively new scientific field which investigates the union of all the genomes of a clade. The word pan means everything in ancient Greek; the term pangenomics originally regarded genomes of bacteria and was later intended to refer to human genomes as well. Modern bioinformatics offers several tools to analyze pangenomics data, paving the way to an emerging field that we can call computational pangenomics. Current computational power available for the bioinformatics community has made computational pangenomic analyses easy to perform, but this higher accessibility to pangenomics analysis also increases the chances to make mistakes and to produce misleading or inflated results, especially by beginners. To handle this problem, we present here a few quick tips for efficient and correct computational pangenomic analyses with a focus on bacterial pangenomics, by describing common mistakes to avoid and experienced best practices to follow in this field. We believe our recommendations can help the readers perform more robust and sound pangenomic analyses and to generate more reliable results.

Abstract Background Ensuring diversity in clinical trials can be a challenge, which may be exacerbated when recruiting vulnerable populations, such as participants with mental health illness. As recruitment continues to be the major cause of trial delays, researchers are turning to online recruitment strategies, e.g. social media, to reach a wider population and reduce recruitment time and costs. There is mixed evidence for the use of online recruitment strategies; therefore, the REcruitment in Mental health trials: broadening the ‘net’, opportunities for INclusivity through online methoDs (RE-MIND) study aimed to identify evidence and provide guidance for use of online strategies in recruitment to mental health trials, with a focus on whether online strategies can enhance inclusivity. This commentary, as part of the RE-MIND study, focusses on providing recommendations for recruitment strategy selection in future research with the aim to improve trial efficiency. A mixed-methods approach was employed involving three work packages: (I) an evidence review of a cohort of 97 recently published randomised controlled trials/feasibility or pilot studies in mental health to assess the impact of online versus offline recruitment; (II) a qualitative study investigating the experiences of n = 23 key stakeholders on use of an online recruitment approach in mental health clinical trials; (III) combining the results of WP1 and WP2 to produce recommendations on the use of an online recruitment strategy in mental health clinical trials. The findings from WP1 and 2 have been published elsewhere; this commentary represents the results of the third work package. Conclusion For external validity, clinical trial participants should reflect the populations that will ultimately receive the interventions being tested, if proven effective. To guide researchers on their options for inclusive recruitment strategies, we have developed a list of considerations and practical recommendations on how to maximise the use of online recruitment methods.

Esports and high-performance human-computer interaction are at the forefront of implementing new hardware and software technologies Despite that, there is a paucity of research on how championship-level esports professionals approach aspects of their preparation.

Abstract Background There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda. Methods We conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework. Results Our findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices. Conclusion The multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities.

Abstract Background Tuberous sclerosis complex (TSC) is a rare approximate 1:6000 birth incidence, a genetic disease with a wide variability of physical and neuropsychiatric symptoms. Patients require lifelong care from multiple healthcare specialities, for which International and United Kingdom (UK) TSC consensus recommendations exist. Personalised care delivered by a centralised coordinated team of TSC experts is recommended. There is no such service for the estimated 600 TSC patients in the Republic of Ireland (ROI) and there is a paucity of information regarding the healthcare of this group. Purpose Evaluate the baseline care of patients with TSC attending epilepsy services in the Republic of Ireland (ROI) against UK TSC consensus recommendations. Methods Patients with a diagnosis of TSC attending 12 adult and paediatric epilepsy centres in the ROI were identified. Clinical audits measured the baseline care of a subset of these patients against UK, TSC clinical recommendations. Data was anonymised and analysed at Trinity College Dublin. Results One hundred thirty-five TSC patients attending twelve epilepsy centres were identified. Adults (n = 67) paediatric (n = 68). The care of 83 patients was audited (n = 63 ≥ 18 years) and (n = 20

Context: Osteoarthritis (OA) is a prevalent degenerative condition seen daily in primary health-care (PHC) centers. Although diagnosis and management place a considerable burden on physicians, national guidelines have demonstrated the importance of proper diagnosis and management. Aims: In this study, we intend to evaluate the knowledge and attitudes of primary care physicians in Saudi Arabia about the management of OA. Settings and Design: a cross-sectional study evaluating the knowledge and attitude of PHC physicians in managing OA and barriers to implementing guidelines. Methods: Simple random sampling of 401 primary care physicians was given questionnaires to obtain the data. Statistical Analysis Used: Descriptive statistics were used to present the data. Results: In terms of management, most respondents rated American College of Rheumatology recommendations for hip and knee OA and National Institute for Health and Clinical Excellence (38.2%) and (26.4%), respectively, as their biggest influences, followed by their own practice guidelines (17%) and professional experience (7.7%). Pain was the most assessed complaint (84.3%), followed by function/walking test/mobility/stiffness (69.6%). Other factors included impact on life quality (54.1%), effect on independent living (36.7%), depression (20%), and sleep quality (36.2%), effect on relationships and family (17.7%), and effect on sexual relationships (8.7%). Conclusions: We found that the appropriate execution of national OA guidelines is crucial for attaining a positive patient outcome. We underlined the challenges posed by primary care physicians in their approach to managing OA patients, the inadequacy of available information, and the necessity for approved courses on OA national guidelines recommendations.

Non-invasive ultrasound neuromodulation has experienced exponential growth in the neuroscientific literature, recently also including clinical studies and applications. However, clinical recommendations for the secure and effective application of ultrasound neuromodulation in pathological brains are currently lacking. Here, clinical experts with neuroscientific expertise in clinical brain stimulation and ultrasound neuromodulation present initial clinical recommendations for ultrasound neuromodulation with relevance for all ultrasound neuromodulation techniques. The recommendations start with methodological safety issues focusing on technical issues to avoid harm to the brain. This is followed by clinical safety issues focusing on important factors concerning pathological situations.

Background: The period following pregnancy is a critical time window when future habits with respect to physical activity (PA) and sedentary behavior (SB) are established; therefore, it warrants guidance. The purpose of this scoping review was to summarize public health-oriented country-specific postpartum PA and SB guidelines worldwide. Methods: To identify guidelines published since 2010, we performed a (a) systematic search of 4 databases (CINAHL, Global Health, PubMed, and SPORTDiscus), (b) structured repeatable web-based search separately for 194 countries, and (c) separate web-based search. Only the most recent guideline was included for each country. Results: We identified 22 countries with public health-oriented postpartum guidelines for PA and 11 countries with SB guidelines. The continents with guidelines included Europe (n = 12), Asia (n = 5), Oceania (n = 2), Africa (n = 1), North America (n = 1), and South America (n = 1). The most common benefits recorded for PA included weight control/management (n = 10), reducing the risk of postpartum depression or depressive symptoms (n = 9), and improving mood/well-being (n = 8). Postpartum guidelines specified exercises to engage in, including pelvic floor exercises (n = 17); muscle strengthening, weight training, or resistance exercises (n = 13); aerobics/general aerobic activity (n = 13); walking (n = 11); cycling (n = 9); and swimming (n = 9). Eleven guidelines remarked on the interaction between PA and breastfeeding; several guidelines stated that PA did not impact breast milk quantity (n = 7), breast milk quality (n = 6), or infant growth (n = 3). For SB, suggestions included limiting long-term sitting and interrupting sitting with PA. Conclusion: Country-specific postpartum guidelines for PA and SB can help promote healthy behaviors using a culturally appropriate context while providing specific guidance to public health practitioners.

The recent COVID-19 pandemic highlighted the importance of socio-economic rights and sustainable development not only in Africa but globally. This article discusses the relationship between socio-economic rights and sustainable development. This is followed by a discussion on the impact of pandemics and epidemics on socio-economic rights and the significant effect they can have on the realisation and enjoyment of such rights. Focusing on Africa, the discussion turns to the impact of pandemics and epidemics on sustainable development before looking at the lessons learned from such pandemics and epidemics. Because the recommendations flow from the lessons, these are discussed together. The main recommendation is that a human rights-based approach should be adopted not only in sustainable development but also in any post-pandemic recovery efforts and programmes. Other recommendations include building resilient health systems, addressing the root causes of poverty and inequality, prioritising investment in digital technologies and improving social protection systems, among others.

Abstract Background Oral diseases are a major global public health problem, impacting the quality of life of those affected. While consensus exists on the importance of high-quality, evidence-informed guidelines to inform practice and public health decisions in medicine, appropriate methodologies and standards are not commonly adhered to among producers of oral health guidelines. This study aimed to systematically identify organizations that develop evidence-informed guidelines in oral health globally and survey the methodological process followed to formulate recommendations. Methods We searched numerous electronic databases, guideline repositories, and websites of guideline developers, scientific societies, and international organizations (January 2012–October 2023) to identify organizations that develop guidelines addressing any oral health topic and that explicitly declare the inclusion of research evidence in their development. Pairs of reviewers independently evaluated potentially eligible organizations according to predefined selection criteria and extracted data about the organization’s characteristics, key features of their guidelines, and the process followed when formulating formal recommendations. Descriptive statistics were used to analyze and summarize data. Results We included 46 organizations that developed evidence-informed guidelines in oral health. The organizations were mainly professional associations and scientific societies (67%), followed by governmental organizations (28%). In total, organizations produced 55 different guideline document types, most of them containing recommendations for clinical practice (77%). Panels were primarily composed of healthcare professionals (87%), followed by research methodologists (40%), policymakers (24%), and patient partners (18%). Most (60%) of the guidelines reported their funding source, but only one out of three (33%) included a conflict of interest (COI) policy management. The methodology used in the 55 guideline document types varied across the organizations, but only 19 (35%) contained formal recommendations. Half (51%) of the guideline documents referred to a methodology handbook, 46% suggested a structured approach or system for rating the certainty of the evidence and the strength of recommendations, and 37% mentioned using a framework to move from evidence to decisions, with the GRADE-EtD being the most widely used (27%). Conclusion Our findings underscore the need for alignment and standardization of both terminology and methodologies used in oral health guidelines with current international standards to formulate trustworthy recommendations.

The article studies psychological aspects of the perception by the State University of Management students of a complex control three-stage system, providing a full and comprehensive assessment of knowledge and skills acquired by students in foreign language learning. The authors briefly describe the control system itself, consider the principles of compiling an online survey and analyze the resulting students’ responses, revealing the peculiarities of their foreign language control activities perception. The conducted survey made it possible to identify the problems and difficulties faced by students during the exam session, analyze the factors affecting the psychological comfort state when doing assignments, and develop recommendations aimed at the control system further improvement. The purpose of the study is to maximize the control quality at all stages of foreign language learning. The student survey data show that the respondents objectively and positively perceive both the control format and its structural and content features. In addition, students adequately assess the tasks complexity level offered to them and the results of their own learning activities.

Post-COVID-19 condition is defined as the presence of symptoms that cannot be explained by other diagnoses, lasting for at least 2 months, occurring three months after a possible or confirmed SARS-CoV-2 infection. It is the result of a complex interplay of biological, psychological, and sociocultural factors, characterized by a high number of affected individuals, complex pathogenesis, diverse symptoms, and a significant need for long-term care. The diagnosis is considered exclusionary and can be classified into six subtypes, including non-severe COVID-19 multiorgan sequelae, pulmonary fibrosis sequelae, myalgic encephalomyelitis or chronic fatigue syndrome, postural orthostatic tachycardia syndrome, post-intensive care syndrome, and medical or clinical sequelae. Based on comprehensive evaluation, treatment and care can be provided through a multidisciplinary approach involving medication, diet, exercise, psychological interventions, patient education, and other methods.

Staying and climbing in high mountains (>2,500 m) involves changes in diet due to poor access to fresh food, lack of appetite, food poisoning, environmental conditions and physiological changes. The purpose of this review is to summarize the current knowledge on the principles of nutrition, hydration and supplementation in high-altitude conditions and to propose practical recommendations/solutions based on scientific literature data. Databases such as Pubmed, Scopus, ScienceDirect and Google Scholar were searched to find studies published from 2000 to 2023 considering articles that were randomized, double-blind, placebo-controlled trials, narrative review articles, systematic reviews and meta-analyses. The manuscript provides recommendations for energy supply, dietary macronutrients and micronutrients, hydration, as well as supplementation recommendations and practical tips for mountaineers. In view of the difficulties of being in high mountains and practicing alpine climbing, as described in the review, it is important to increase athletes’ awareness of nutrition and supplementation in order to improve well-being, physical performance and increase the chance of achieving a mountain goal, and to provide the appropriate dietary care necessary to educate mountaineers and personalize recommendations to the needs of the individual.

Combining Non-Invasive Brain Stimulation (NIBS) techniques with the recording of brain electrophysiological activity is an increasingly widespread approach in neuroscience. Particularly successful has been the simultaneous combination of Transcranial Magnetic Stimulation (TMS) and Electroencephalography (EEG). Unfortunately, the strong magnetic pulse required to effectively interact with brain activity inevitably induces artifacts in the concurrent EEG acquisition. Therefore, a careful but aggressive pre-processing is required to efficiently remove artifacts. Unfortunately, as already reported in the literature, different preprocessing approaches can introduce variability in the results. Here we aim at characterizing the three main TMS-EEG preprocessing pipelines currently available, namely ARTIST (Wu et al., 2018), TESA (Rogasch et al., 2017) and SOUND/SSP-SIR (Mutanen et al., 2018, 2016), providing an insight to researchers who need to choose between different approaches. Differently from previous works, we tested the pipelines using a synthetic TMS-EEG signal with a known ground-truth (the artifacts-free to-be-reconstructed signal). In this way, it was possible to assess the reliability of each pipeline precisely and quantitatively, providing a more robust reference for future research. In summary, we found that all pipelines performed well, but with differences in terms of the spatio-temporal precision of the ground-truth reconstruction. Crucially, the three pipelines impacted differently on the inter-trial variability, with ARTIST introducing inter-trial variability not already intrinsic to the ground-truth signal.

Orientation: The South African short-term motor insurance industry is highly competitive, offering clients many choices. Therefore, the long-term retention of clients is crucial for an insurance company’s sustainability. Research purpose: The study aims to report on the context-specific communication challenges during the claims stage and to propose recommendations to mitigate them from an interpersonal communication perspective. Motivation for the study: Studies on client retention have been conducted from a marketing or corporate communication perspective, but it is not known how interpersonal communication during the claims phase could impact long-term relationships. Research design, approach and method: We followed a qualitative approach, with a single case study design. Semi-structured interviews were conducted with senior management and claims administrators in the motor insurance department of a large South African insurer. The data were inductively analysed through qualitative content analysis from which the challenges were identified. Main findings: A lack of mutual understanding, ineffective conflict management, a lack of trust and one-way communication were identified as the main challenges experienced by claims administrators in their communication with clients during the claims stage. Practical/managerial implications: Practical principles such as sympathy and empathy, listening, feedback, respect, providing and clarifying information and providing access to resources, together with ethical and transparent communication, two-way symmetrical communication and dialogue should be included in claims administrators’ training to enable them to understand and adapt to the client’s needs. Contribution/value-add: A framework for training claims administrators operating in this context is presented, offering a theoretical and practical contribution.

Current recommendations for RA treatment determine the need to reduce the dose and duration of glucocorticoid(GC) use. This is due to the wide spectrum and high frequency (up to 100%) of serious adverse events (AE) during GC treatment. However, in real practice GCs in RA are used very often (in Russia, Western Europe and the USA they are used in about 50% of patients), and often in long-term courses. This is explained by the fact that the combination of disease-modifying antirheumatic drugs (DMARDs), including biologics (bDMARDs) and Janus kinase inhibitors (JAK), with GCs allows to achieve faster improvement of patients’ condition and therefore is very “convenient” for many patients and physicians.However, it is very difficult to ensure dose reduction and (especially!) complete discontinuation of GC administration afterwards. Clinical and observational studies show that 30–40% of patients manage to discontinue the use of GCs during treatment with bDMARDs and JAK. In addition, discontinuation of GCs may significantly increase the risk of RA flare, even with complex pathogenetic therapy.Nevertheless, prolonged use of GCs, including low doses (less than 7.5 mg/day of prednisolone) should be considered as an indicator of the severity of the disease course and inadequacy of the current therapy. Therefore, we should strive for personalization of RA therapy, selection of DMARDs based on the assessment of the disease phenotype and predictors of response to treatment with different drugs, achieving the main goal of therapy – remission/low disease activity and achievement of acceptable quality of life, without the use of GCs.

Introduction and Objectives: Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery. Methods: The WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance. Results:: The WG outlined standardization in four major areas: (1) study design, (2) pretreatment demographics and characterization of the study population, (3) intraoperative events, and (4) post-treatment evaluation, and complications. Forty-two items were evaluated and graded as: STANDARD — must be included; ADDITIONAL — may be included for a specific study and is inclusive of the Standard items; OPTIMAL — may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY — not relevant. Conclusion:: A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long-term outcomes for female patients undergoing surgery to correct SUI.

Abstract Background Young people with depression are met with stigma related to their mental health, which exacerbates loneliness, social isolation, and depression symptoms. While disclosing depression could improve one's mental health, stigma can also make social interactions more challenging and reduce the likelihood of receiving treatment. This research explored young people's experiences with stigma and recommendations for addressing it. Methods Semi‐structured interviews conducted with N = 35 young people aged 18–25 years (Mage = 20.09) were analyzed with thematic analysis. Participants met the criteria for clinical depression using the Mood and Feelings Questionnaire (score >27) or had recently obtained a medical diagnosis (N = 18) of depression by a medical professional. Results Participants faced stigma when deciding to disclose their depression, which fed into a vicious cycle influencing feelings of loneliness, social isolation, and withdrawal. Their recommendations for others to avoid this cycle can be summarized under three main themes: (1) Social affirmation: identify allies and build meaningful connections; (2) Self‐affirmation: build a constructive relationship with the self; and (3) Societal affirmation: structural changes are needed. Conclusions The current research indicates that social, self‐, and societal affirmation are considered important for reducing the detrimental impacts of stigma. Policies and programs are needed that provide mental health support to young people, and public awareness campaigns that guide young people to appropriate resources (i.e., support and intervention) via governmental public health bodies.

Primary cutaneous lymphomas are a heterogeneous group of rare lymphoproliferative diseases that are initially limited to the skin but potentially also involve the lymph nodes, blood, and occasionally visceral organs. They develop from mature T cells, B cells, and NK cells. The classification includes a wide range of pathologies, each characterized by distinct clinical symptoms and variations in disease course. Cutaneous lymphomas are typically chronic in nature, and a complete cure is rarely achievable. Since primary cutaneous lymphomas are uncommon and present in many variants, they pose diagnostic and therapeutic challenges that require multidisciplinary collaboration between dermatologists, pathologists, hematologists, and oncologists. We present revised guidelines for the diagnosis and treatment of primary cutaneous lymphomas, with the goal of simplifying the diagnostic and therapeutic procedure in routine clinical practice. The guidelines cover the clinical, histopathological, and dermoscopic characteristics of skin lesions, along with recommendations for the diagnostic and therapeutic management of primary cutaneous lymphomas. When selecting the most suitable therapeutic approach for individual patients diagnosed with primary cutaneous lymphoma, the main factor to consider should be the clinical stage of the disease. However, other factors, such as the patient’s age, overall health, and medical history, should also be taken into account. The choice of therapy should be guided by finding optimal efficacy and safety. The guidelines also include globally recognized therapeutic approaches that are currently not accessible in Poland. The recommendations rely on the existing Polish and global guidelines, and the knowledge and experience of experts.

The relevance of this study is argued by the need to implement international practices of combating corruption and to improve the efficiency of legal mechanisms and instruments for combating corruption in all spheres of the state’s life. The purpose of this study was to conduct a comprehensive investigation of the effectiveness of international legal instruments for combating corruption in Ukraine. To fulfil this purpose, it was necessary to perform the following tasks: to identify international legal instruments for fighting corruption; to investigate ways to assess the level of corruption perception in the world; to determine the progress in the fight against corruption in Ukraine; to identify problems that prevent the increase of the corruption perception index in Ukraine; to develop tools for improving the level of combating corruption in Ukraine. The principles of dialectics served as the basis of the methodological framework of the study, which included such general scientific and special legal cognition methods as comparative legal, formal legal, analysis, and synthesis. Based on the analysis of secondary sources, the study established the significance of analysing and classifying the definition of international legal instruments for combating corruption and ways of assessing the level of perception of corruption in the world. The analysis of statistical data and sociological surveys helped to establish the progress of the fight against corruption in Ukraine, which is reflected in the concrete data of monitoring the level of perception of corruption in Ukraine. The emphasis was placed on a systematic approach to identifying the problems that hinder the improvement of the corruption perception index in Ukraine. Using the comparative legal method, the study compared the provisions of Ukrainian and international legislation directly related to the issues of combating corruption and its manifestations. The conclusions of the study were formulated, with propositions of concrete tools for improving the level of combating corruption in Ukraine by improving the activities of state structures. The study reviewed and analysed relevant scientific articles of Ukrainian and foreign researchers. The practical significance of this study lies in the possibility of using its findings in the activities of Ukrainian state bodies, considering the international experts’ assessment of the effectiveness of the anti-corruption instruments already applied

The essence of clinical practice guidelines lies in their recommendations. It is common to find strong recommendations supported by low-quality evidence in current published guidelines. There is a typical misunderstanding among medical professionals that without high-quality evidence, it is impossible to develop high-quality guidelines or only expert consensus can be developed. Based on the GRADE approach, this paper explains the concept and clinical significance of low-quality evidence, and introduces the methods for formulating recommendations based on low-quality evidence in guidelines, with the aim to provide reference for guideline developers and users in China.

Abstract Background Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1INH) is a genetic rare disease characterized by recurrent, transient and unpredictable episodes of cold, non-pruriginous oedema without associated urticaria. The characteristics of the disease have a considerable impact on the quality of life of patients. The aim of this study was to increase understanding of the patient journey of HAE in Spain. Methods A multidisciplinary committee of 16 HAE experts (allergy, immunology, emergency department, hospital pharmacy and nursing) and 3 representatives of the Spanish Hereditary Angioedema Patient Association (AEDAF) who were patients or caregivers participated in the study. A review of the publications on HAE treatment was performed. Semi-structured interviews were performed to HAE experts, patients, or caregivers. Three meetings with the experts, patients and caregivers were held to share, discuss, and validate data obtained from literature and interviews and to build the model. Results Throughout the project, the patient journey has been drawn up, dividing it into the stages of pre-diagnosis, diagnosis and treatment/follow-up. Some areas for improvement have been identified. Firstly, there is a need to enhance awareness and training on HAE among healthcare professionals, with a particular emphasis on primary care and emergency department personnel. Secondly, efforts should be made to minimize patient referral times to allergy/immunology specialists, ensuring timely access to appropriate care. Thirdly, it is crucial to encourage the study of the relatives of diagnosed patients to early identify potential cases. Fourthly, equitable access to self-administered treatments should be ensured, facilitated by systems that enable medication delivery at home and proper education and training for patients. Equitable access to long-term prophylactic treatment should also be prioritized for all patients in need. To standardize HAE management, the development of consensus guidelines that reduce variability in clinical practice is essential. Lastly, promoting research studies to enhance knowledge of the disease and align its treatment with new developments in the healthcare field should be encouraged. Conclusions The knowledge of the patient journey in HAE allowed us to identify improvement areas with the final aim to optimize the disease management.

A significant decline in both incidence and prevalence of cervical cancers after widespread-introducing cervical screening strategy by Papanicolau test (Pap test) has been found in the world, but cervical cancer is still one of the most common female cancers, reporting the fourth prevalence and also one of the leading causes to result in main women-associated morbidity and mortality, particularly for those women living in low- and middle-income countries. Cervical cancer is one of the most important health concerns directly destroying the global health-care system, partly because of not only increasing the disability either secondary to diseases themselves of victims or mediated by treatment-related adverse events to the survivors but also acting as a leading cause of death of diseased patients worldwide, alarming the urgent need to do something to minimize the catastrophic diseases-related heavy socioeconomic burden. It is fortunate that cervical cancer is a preventable disease, based on its strong association with human papillomavirus (HPV) infection (more than 95%), particularly for those high-risk HPV (HR-HPV) and its high possibility by detecting HPV infection before the development of cervical cancer as well as an effective prevention by HPV vaccination. That is why WHO (World Health Organization) considers cervical cancer as a public problem and attempts to accelerate the elimination of cervical cancer program by three-pillar approach (90:70:90% targets), including (1) 90% of girls are fully vaccinated with HPV vaccine by 15 years of age; (2) 70% of women are screened with a high-performance test by 35 and 45 years of age and precancerous lesions are treated early; and (3) 90% of women identified with cervical diseases receive appropriate and adequate treatment. Herein, this review focuses on the HPV vaccination as Part I, including global recommendations and Taiwan government's policy for HPV vaccination.

The European Society for Medical Oncology (ESMO) has produced the very first expert-based guidance for reporting real-world evidence (RWE) studies specifically for oncology. The publication addresses nuances of modern RWE research in oncology and provides a comprehensive list of detailed key recommendations — that have also been transcribed into an interactive informative scoring checklist tool — for full article development in different RWE research scenarios.

Relevance. Off-label use of medications is a common practice in clinical settings. To address the growing interest in this issue, the International Society for Pharmacoepidemiology (ISPE) has developed new general guidelines for off-label prescribing in clinical practice that emphasize the importance of evidence-based medicine and promote transparent communication between healthcare professionals and patients.Objective. The aim of this work was to analyze and present key trends for optimizing off-label prescribing decisions based on the ISPE recommendations (2023).Results. The report highlights five main recommendations: seeking strong scientific evidence, including the use of real-world data; using expert knowledge to evaluate and summarize evidence; developing recommendations with rigorous consistency; aligning the use of off-label medications with research; and strengthening collaboration among regulators, researchers, clinicians, and the pharmaceutical industry.Conclusions. A comprehensive approach is required to address the problem of off-label use of medicines. Implementation of these initiatives will reduce the risks associated with off-label use, generate sustainable scientific evidence, and improve the quality of patient care.

Agricultural expansion and intensification worldwide has caused a reduction in ecological infrastructures for insects, herbaceous plants, and vertebrate insectivores, among other organisms. Agriculture is recognized as one of the key influences in biodiversity decline, and initiatives such as the European Green Deal highlight the need to reduce ecosystem degradation. Among fruit crops, grapes are considered one of the most intensive agricultural systems with the greatest economic relevance. This study presents a compilation of management practices to enhance biodiversity performance, which applies generally to the agricultural sector and, in particular, to viticulture, concerning the diversity of plants, semi-natural habitats, soil management, and the chemical control strategies and pesticides used in agricultural cultivation. Through a critical review, this study identifies a set of recommendations for biodiversity performance and their corresponding effects, contributing to the dissemination of management options to boost biodiversity performance. The results highlight opportunities for future investigations in determining the needed conditions to ensure both biodiversity enhancement and productive gains, and understanding the long-term effects of innovative biodiversity-friendly approaches.

Abstract Introduction Low-sodium oxybate (LXB) is approved for treatment of narcolepsy in patients aged 7 years and older and treatment of idiopathic hypersomnia in adults. LXB contains the same active moiety with 92% less sodium than sodium oxybate (SXB). As the indication for oxybate treatment in patients with idiopathic hypersomnia is new and allows for individualized dosing optimization, guidance for beginning LXB treatment is needed. In particular, clinicians may benefit from guidance regarding treatment initiation, dosing/regimen options, potential challenges, and treatment expectations. Additionally, pharmacokinetic profiles differ slightly between both treatments, and further guidance on transitioning from SXB to LXB in patients with narcolepsy may aid clinicians. Methods An expert panel of five sleep specialists was convened to obtain consensus on recommendations for these topics using a modified Delphi process. Results Across two virtual meetings, the panel agreed on 31 recommendations with a high degree of consensus that fell into four overarching topics: (1) introducing LXB to patients; (2) initiating LXB for adult narcolepsy and idiopathic hypersomnia; (3) addressing challenges in using LXB; and (4) transitioning from SXB to LXB. The panel recommended that clinicians provide a clear overview of how LXB works for treating symptoms in narcolepsy or idiopathic hypersomnia, as appropriate for their patients, explain safety aspects, and set expectations prior to initiating LXB treatment. Strategies for initial dosing and regimen are provided. Strategies for adjusting the dose, regimen, timing, and consideration of individual factors were developed for specific instances in which patients may have trouble staying asleep or waking up, as well as guidance for addressing potential adverse events, such as nausea, dizziness, anxiety, and depression. Discussion points based on existing literature and clinical experience were included as relevant for each statement. Conclusion Clinicians may use this resource to guide LXB dosing optimization with patients.

Background. Assessment of the qualitative state of agricultural lands is a crucial component in the field of agricultural management and environmental control, representing a persistent scientific challenge. The use of unmanned aerial vehicles (UAVs) equipped with a set of sensors for such assessment allows for prompt acquisition of accurate and reliable information for objective monitoring, enabling a significant improvement in the quality of conclusions and the development of recommendations for enhancing land resource management and sustainable agricultural land development. Purpose. To develop a methodology for the utilization of UAVs in assessing the qualitative state of agricultural lands in the Sakhalin region, aiming to apply this approach for optimizing agrotechnical practices. Materials and Methods. In specific agricultural zones of the Sakhalin region, a remote assessment of the quality state was conducted. Using a set of sensors placed on UAVs, air quality, temperature, humidity, and dust level were determined. Results. It has been shown that the use of UAVs in agriculture in the Sakhalin region offers broad opportunities for monitoring agricultural indicators, enabling the creation of a compact and flexible data collection system through the connection and integration of various sensors, thus facilitating the development of a scalable system. A model for the application of UAVs in the ecological monitoring of agricultural lands in the Sakhalin region has been developed, featuring an original interface for real-time sensor data processing and storage in a specialized database. To implement the model, a methodology for utilizing UAVs to assess the quality state of agricultural lands in the Sakhalin region was developed and tested. Conclusions. The obtained results confirmed the effectiveness of this approach for collecting primary ecological data. The selection of suitable UAVs and sensors, accurate data collection and analysis, as well as the development of scientifically justified recommendations, provided the foundation for constructing a model for the application of UAVs in the ecological monitoring of agricultural lands in the Sakhalin region. The developed model can be considered a prototype of a comprehensive monitoring system, which can be scalable by modifying the set of utilized sensors.

Objectives Education in biomedical and health informatics is essential for managing complex healthcare systems, bridging the gap between healthcare and information technology, and adapting to the digital requirements of the healthcare industry. This review presents the current status of biomedical and health informatics education domestically and internationally and proposes recommendations for future development. Methods We analyzed evidence from reports and papers to explore global trends and international and domestic examples of education. The challenges and future strategies in Korea were also discussed based on the experts’ opinions. Results This review presents international recommendations for establishing education in biomedical and health informatics, as well as global examples at the undergraduate and graduate levels in medical and nursing education. It provides a thorough examination of the best practices, strategies, and competencies in informatics education. The review also assesses the current state of medical informatics and nursing informatics education in Korea. We highlight the challenges faced by academic institutions and conclude with a call to action for educators to enhance the preparation of professionals to effectively utilize technology in any healthcare setting. Conclusions To adapt to the digitalization of healthcare, systematic and continuous workforce development is essential. Future education should prioritize curriculum innovations and the establishment of integrated education programs, focusing not only on students but also on educators and all healthcare personnel in the field. Addressing these challenges requires collaboration among educational institutions, academic societies, government agencies, and international bodies dedicated to systematic and continuous workforce development.

Abstract Purpose Whole grains have recently been promoted as beneficial to diabetes prevention. However, the evidence for the glycemic benefits of whole grains seems to conflict between the cohort studies and randomized control trials (RCTs). To fill the research gap, we conducted a meta-analysis to determine the effects of whole grains on diabetes prevention and to inform recommendations. Methods We searched PubMed, Clarivate Web of Science, and Cochrane Library until March 2024. We used the risk ratio (RR) of type 2 diabetes to represent the clinical outcomes for cohort studies, while the biomarkers, including fasting blood glucose and insulin, HbA1C, and HOMA-IR, were utilized to show outcomes for RCTs. Dose-response relationships between whole grain intakes and outcomes were tested with random effects meta-regression models and restricted cubic splines models. This study is registered with PROSPERO, CRD42021281639. Results Ten prospective cohort studies and 37 RCTs were included. Cohort studies suggested a 50 g/day whole grain intake reduced the risk of type 2 diabetes (RR = 0.761, 95% CI: 0.700 to 0.828, I 2 = 72.39%, P

Abstract Telestroke networks aim to improve acute stroke care within their catchment area. Through a teleconsultation service, the network centers provide support to network hospitals that lack continuous neurological expertise for acute stroke management decisions. Although the importance of telemedical treatment in stroke care is steadily increasing, so far no standards exist for the organization of the teleconsultation service in networks. To ensure a high-level of quality for all processes and measures concerning telemedical stroke treatment, the commission for telemedical stroke care of the German Stroke Society (Deutsche Schlaganfall-Gesellschaft, DSG) created the following recommendations on how to organize a teleconsultation service within a telestroke network. The recommendations are the result of an adjustment process between the authors and include guidance on requirements, qualifications, processes and quality management within the teleconsultation service.

Janice Du Mont,1,2 Frances Montemurro,1 Rhonelle Bruder,1,2 C Emma Kelly,1 Frances Recknor,1 Robin Mason1,2 1Women’s College Research Institute, Women’s College Hospital, Toronto, ON, M5S 1B2, Canada; 2Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, CanadaCorrespondence: Janice Du Mont, Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, Email janice.dumont@wchospital.caAbstract: Health care providers are highly likely to encounter persons who have been domestically sex trafficked and, therefore, possess valuable insights that could be useful in understanding and improving existing services and supports. In-depth interviews were conducted with 31 health care providers residing and working in Canada’s largest province, Ontario. Results were analyzed using Braun and Clarke’s analytical framework. Across providers, a key theme was identified: “Facilitators to improve care”, which was comprised of two sub-themes, “Address needs in service provision” and “Center unique needs of survivors”. From these results, eight wide-ranging recommendations to improve services and supports were developed (eg, Jointly mobilize an intersectoral, collaborative, and coordinated approach to sex trafficking service provision; Employ a survivor-driven approach to designing and delivering sex trafficking services). These recommendations hold the potential to enhance services in Canada and beyond by reducing barriers to access and care, facilitating disclosure, aiding in recovery, and empowering those who have been domestically sex trafficked.Keywords: domestic, human trafficking, health care, recommendations, sex trafficking, social services

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolves, infection management in vulnerable populations requires formalized guidance. Although low-virulence variants of SARS-CoV-2 remain predominant, they pose an increased risk of severe illness in adults with rheumatic and musculoskeletal diseases (RMDs). Several disease-specific (chronic long-grade inflammation, concomitant immunosuppression) and individual (advanced age, multimorbidity, pregnancy, vaccination status) factors contribute to excess risk in RMD populations. Various post-COVID-19 manifestations are also increasingly reported and appear more commonly than in the general population. At a pathogenetic level, complex interplay involving innate and acquired immune dysregulation, viral persistence, and genetic predisposition shapes a unique susceptibility profile. Moreover, incident cases of SARS-CoV-2 infection as a trigger factor for the development of autoimmune conditions have been reported. Vaccination remains a key preventive strategy, and encouraging active education and awareness will be crucial for rheumatologists in the upcoming years. In patients with RMDs, COVID-19 vaccines’ benefits outweigh the risks. Derivation of specialized diagnostic and therapeutic protocols within a comprehensive COVID-19 care plan represents an ideal scenario for healthcare system organization. Vigilance for symptoms of infection and rapid diagnosis are key for introducing antiviral treatment in patients with RMDs in a timely manner. This review provides updated guidance on optimal immunization, diagnosis, and antiviral treatment strategies.

Abstract Background Research to improve healthcare experiences for women with vaginismus tends to be produced from the perspective of healthcare professionals or health-based researchers. There is lacking research on women’s experiences and recommendations to improve help-seeking for vaginismus from their perspective. To address this research gap, this qualitative study aimed to identify the issues that women face when help-seeking for vaginismus and their recommendations to address it. This sought to support the wellbeing of patients to advocate for their healthcare needs which is often overlooked. Methods Using a feminist theoretical approach, semi-structured interviews were conducted with 21 participants who sought help for their vaginismus. Thematic analysis was employed to analyse participants’ recommendations. Results Four main themes emerged: Increase awareness of vaginismus, Dismantle myths about sex, Destigmatise vaginismus, and Empower people with vaginismus during medical consultations. Subthemes were identified as actionable strategies that participants recommended to improve help-seeking and healthcare for vaginismus. Conclusions The findings from this study can inform healthcare practice and policy to foster better synchronicity between health professionals and their patients’ perceptions and expectations of treating vaginismus. This can promote more acceptance of patients’ advocacy of their needs and goals to improve the therapeutic alliance and treatment outcomes for vaginismus in healthcare practice. The strategies recommended to increase awareness of vaginismus and challenge its stigma should be considered in policy to incite a culture of change in healthcare practice and broader society.

Abstract Background Pakistan has made numerous attempts to establish and implement a national mandatory CME program which currently do not exist. The purpose of this study is to explore the views of major CME providers in order to identify possible strengths and weaknesses in the current program, and offer evidence-based recommendations to help further enhance the national CME program in Pakistan. Methods An exploratory study design using a case study approach through in depth interviews was conducted to examine CME providers’ experiences and perceptions. The study was conducted in Pakistan between August and November 2019 with CME providers from Sindh, Punjab, the North-West Frontier Province, and the Federal Capital Territory. Thirty-six providers recognised by the Pakistan Medical and Dental Council who were involved in providing CME activities at the national level and whose contact information was publicly available on their websites, were selected for the study. Of the 36 providers invited, 22 participated in this study. Results The results generated several organising themes grouped into three major themes: (1) CME current practices, (2) CME past experiences, and (3) Future developments. Conclusion Participants recommended needs-based educational activities for physicians, a well-structured central regulatory CME body collaborating with existing providers, involving experienced providers for rural CME, accrediting diverse local providers, limiting commercial entities’ role, and implementing CME with proper preparation and a phased approach.

Abstract Background Early detection of long-term, often asymptomatic, middle ear infection in young Aboriginal and Torres Strait Islander children is more likely to be achieved when ear health and hearing checks are routinely undertaken in primary healthcare. Evidence consistently demonstrates the adverse impacts of this condition on the development and wellbeing of children and their families. We aimed to develop feasible, evidence- and consensus-based primary healthcare recommendations addressing the components and timing of ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years, not already known to have, nor being actively managed for, ear and hearing problems. Methods A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation. Results Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed. Conclusions The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.

Resumen: El último documento de consenso del Grupo de Estudio de Enfermedades Desmielinizantes de la Sociedad Española de Neurología sobre el tratamiento de la esclerosis múltiple (EM) data del año 2016. Aunque muchas consideraciones continúan todavía vigentes, desde entonces se han producido cambios significativos en el manejo y tratamiento de esta enfermedad, motivados no solo por la aprobación de nuevos fármacos con diferentes mecanismos de acción, sino también por la evolución de conceptos otrora consolidados. Esto ha permitido abordar situaciones especiales como el embarazo y la vacunación desde otra perspectiva, e incluir nuevas variables en la toma de decisiones en práctica clínica, como plantear tratamiento modificador de la enfermedad (TME) de alta eficacia en fases tempranas, considerar la perspectiva del paciente y utilizar nuevas tecnologías como monitorización remota.Estos cambios han motivado la presente actualización del consenso mediante metodología Delphi, con el objetivo de reflejar el nuevo paradigma de manejo del paciente con EM basándose en la evidencia científica y la experiencia clínica de los participantes.Entre las principales conclusiones destacan como recomendaciones: iniciar TME inmunomodulador en el síndrome radiológico aislado con actividad radiológica persistente, evaluar la perspectiva del paciente y abandonar la terminología «líneas de tratamiento» en la clasificación de los TME (consenso mayor del 90%). Tras el diagnóstico de EM la elección del primer TME debería considerar la presencia/ausencia de factores de mal pronóstico (epidemiológicos, clínicos, radiológicos y biomarcadores) para la aparición de nuevos brotes o progresión de discapacidad, pudiendo plantear desde el inicio TME de alta eficacia. Abstract: The last consensus statement of the Spanish Society of Neurology's Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient's perspective, and the use of such novel technologies as remote monitoring.In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants.The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term “lines of therapy” no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.

Puerto Rico (PR) is a United States (US) territory with a history of colonial violence, poverty, and government corruption. Due to these sociopolitical factors and natural disasters (e.g., hurricanes and earthquakes), there has been a sharp increase in PR residents migrating to the mainland US. Local media and professional health organizations focus on the impact of medical migration on the PR health system (e.g., health personnel shortages and long waiting periods for critical care). According to the PR College of Physicians and Surgeons, 365–500 physicians have left annually since 2014, which represents a crisis of access to health services. However, few studies have focused on ways to mitigate medical migration from PR to the US mainland. This article describes the recommendations provided by migrating and non-migrating Puerto Rican Physicians (PRPs) to mitigate medical migration from PR to the US mainland. We focus on qualitative data from a mixed-methods NIH-funded study (1R01MD014188) to explore factors that motivate or mitigate migration among migrating (n = 26) and non-migrating (n = 24) PRPs. Interviews were analyzed following thematic analysis guidelines. Results show the following themes: 1) strategies to retain early-career medical residents living in PR; 2) recommendations for local government on future health policy; and 3) work environment initiatives for health institutions to mitigate physician migration. Findings suggest multilevel efforts are required to mitigate medical migration in PR.

Participation of children and young people with disabilities is often restricted and needs to be higher on the agenda of relevant municipal service providers. With a sociology of childhood perspective and based on thematic analysis of two focus group discussions and one individual interview with children and young people with various (dis)abilities, we present and discuss their recommendations for achieving increased participation in activities and services within their local communities in two Norwegian municipalities. The findings are presented as six themes concerning service development participation, local activities, staff interaction, language and respect, community meeting places for youth with functional variations and inclusive built environments. Our findings should be of immediate concern for service providers, healthcare staff, policymakers and others who are responsible for services and policies aiming at increasing children’s participation in their daily life environments.