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With the increasing emphasis on diversity, equity, and inclusion (DEI) in organizations and institutions, academic societies in gastroenterology and hepatology are beginning to take actionable steps toward achieving DEI. The successful implementation of DEI initiatives leads to excellence in the field, improved patient outcomes, particularly in areas where health disparities are prevalent, and advances in the gastrointestinal discipline. Such implementation also results in a workforce that better reflects the growing diversity of the population. This review defines DEI and introduces the DEI policies and strategies adopted by the academic societies of gastroenterology in other countries. This paper proposes strategies to integrate DEI better into the Korean Society of Gastroenterology, emphasizing the importance of embedding DEI into the culture and strategic framework. The key strategies include establishing a DEI committee, setting clear targets, and conducting formal assessments to measure DEI progress. This study focused on enhancing workforce diversity, particularly among women and young doctors, and advocates for the need to support their academic development through male allyship and the promotion of equitable and inclusive academic cultures.

Purpose: Guidelines for management and treatment of appendicitis recommends the removal of a normal-looking appendix, but the recommendations are deemed as weak because they are based on low quality evidence. We aimed to provide an overview of the recommendations from the European societies or associations of surgeons regarding the treatment of acute appendicitis and especially recommendations for the macroscopically normal-looking appendix., Methods: European surgical societies were contacted and sent an electronic questionnaire. Questions concerned if the association had a national guideline or recommended an existing one, and if they recommended a specific approach for the management of the normal-looking appendix, including who decided to remove the appendix., Results: We contacted surgical societies from 28 European countries, and 17 surgical societies (61%) responded. Two societies had a national guideline for the treatment of appendicitis and one of these addressed how to treat the normal-looking appendix. Most societies (59%) answered that the operating surgeon decided whether to remove the normal-looking appendix. Eleven societies recommended using an existing guideline (65%), four societies (24%) did not recommend a guideline, and two societies did not know., Conclusion: Only two surgical societies had a published national recommendation or guideline on the treatment of suspected appendicitis, only one had a guideline for the management of the normal-looking appendix, and most societies answered that the operating surgeon decided., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

The Burn Therapist Certification (BT-C) was introduced in 2018 to acknowledge occupational therapists (OT) and physical therapists (PT) with specialized knowledge, skill, and experience in the promotion of quality burn rehabilitation. Currently, BT-Cs make up 11.7% of therapists working in burn rehabilitation (n = 39/333). The purpose of this review is to report on the contributions of BT-Cs to organizational leadership of the American Burn Association (ABA) and in the generation of new knowledge through peer-reviewed publications. Despite the small percentage of burn therapists who are certified, they have a disproportionately large involvement in leadership within the ABA and burn research in the Journal of Burn Care and Rehabilitation (JBCR). From 2018 to 2023, BT-Cs have contributed to nearly one-half (n = 26/56) of therapy authored publications in the JBCR and almost one-third (n = 65/202) of accepted abstracts at the ABA annual meeting. Certified burn therapists demonstrate substantial involvement throughout the ABA, including maintaining an 85% membership rate and, on average, serve in 53% (n = 31/59) of the therapy allotted committee positions. Therapist pursuit of certification can have a profound impact on the burn community through publication, leadership, and development of care standards. Although therapists have indicated a desire to pursue certification, barriers related to a lack of association and center support have been identified. The burn community has endorsed certification as a mark of excellence for nurses and physicians. Maximizing the value of a transdisciplinary approach to burn care is also dependent on the excellence of therapies. If the burn community desires improved engagement and contribution from therapies, it should support therapist certification., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Lung cancer, a malignant tumor remaining high incidence and mortality rates in China and globally, places huge burdens to families and the public healthcare system. In order to improve the diagnosis and treatment of lung cancer, enhance patients' knowledge of the disease, promote evidence-based guidelines to patients, and facilitate shared decision-making, the Chinese Medical Association convened multidisciplinary experts, patients, and public representatives to develop the Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer for patients. The guideline selected most concerned issues, drew on information from domestic and international guidelines, latest research findings, and clinical experience of lung cancer, and combined them with current clinical practices in China and patients' needs. This guideline aims to provide comprehensive, scientific, and practical information on lung cancer diagnosis and treatment for patients and their families, help them further understanding the basic knowledge, diagnosis and treatment process, treatment methods, and prognosis management of lung cancer, enhance the self-management ability of patients, and raise the public awareness and participation in lung cancer prevention and treatment.

The latest pulmonary function guideline from the Brazilian Thoracic Association was published in 2002, since which there have been updates to international guidelines (mainly those from the European Respiratory Society and the American Thoracic Society), as well as new national and international publications on various aspects of the performance, interpretation, and clinical implications of spirometry. Despite those updates, a careful analysis of what applies to the reality in Brazil is essential, because there have been studies that evaluated individuals who are representative of our population and who could show responses different from those of individuals in other regions of the world. This document is the result of the work of a group of specialists in pulmonary function who evaluated relevant scientific articles that could be applicable to the population of Brazil. After the discussions, new spirometry guidelines were drawn up, covering various aspects such as its technical parameters and performance; its indications and contraindications; its interpretation; concepts of normality and their related variability; reference values; classification of functional severity; and response to an inhaled bronchodilator. Finally, the guidelines emphasize the need to always interpret spirometry results in the context of the clinical condition of the patient and of the pretest probability.

This article shows the most recent data on the evolution of the number of resident physicians and vacancies from R1 to R5, as well as the number of programs and institutions accredited by the National Commission for Medical Residency (CNRM). It also discusses the types and modalities of evaluation of medical residency, with a focus on the assessment of competencies throughout in-service training, which were incorporated into the most recent CNRM resolution, at the end of 2023, which amended and updated the 2006 directives. Finally, it shows the experience of six Medical Societies that conduct periodic evaluation of resident physicians, presented at a Brazilian Medical Association event.

Revision of anterior cruciate ligament (ACL) reconstruction is more challenging than primary ACL reconstruction and often yields less favorable outcomes. The European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) has established a consensus regarding preoperative diagnosis, assessment, and selection criteria for ACL revision surgery. This consensus addresses 18 key issues that are most pertinent to clinical practice, providing guiding recommendations aimed at improving the prognosis of ACL revisions.

Although Emergency Medicine is now globally an established specialty, the Nordic countries have been relatively slow to implement it into their health care systems. To facilitate the development of EM in the Nordic area, a working group was formed with representation from all national EM societies; DASEM (Danish Society for Emergency Medicine), FiSEM (Finnish Society of Emergency Medicine), ISEM (Icelandic Society for Emergency Medicine), NCEM (Norwegian College of Emergency Medicine), and SWESEM (Swedish Society for Emergency Medicine). This group was tasked with creating a Nordic EM manifesto-to create a definition and developmental goals for Nordic Emergency Medicine. The commentary provides an overview of the current status and challenges facing EM in the Nordic countries., Competing Interests: Declarations. Competing interest: The authors declare no competing interests., (© 2025. The Author(s).)

In response to increased focus on the issue of Assisted Dying (AD) in the UK due to the presentation of The Terminally Ill Adults (End of Life) Bill 2024-25 [1] and bills before parliaments in the Isle of Man, Guernsey and Scotland, the British Geriatric Society (BGS) recently developed a position statement opposing legalisation of AD in the UK [2]. We set out our key reasoning behind this position, namely the current adverse health and social care context and significant concern about whether effective safeguards can be created to protect older people with complex needs from undue harms. The BGS asks for improved, personalised, multidisciplinary care for older people at the end of their lives, including high-quality palliative and end-of-life care. It urges caution about legalisation and offers its expertise in any potential future shaping and implementation of AD legislation. This should include a conscience clause for professionals objecting to direct involvement. The main outcomes from a survey of member's opinions are also outlined [2]. The majority were against legalisation of AD; however, a significant minority were in favour, with some undecided. This diversity of opinion highlights a need for the Society to maintain balance and nuance on this difficult and emotive issue, warranting future BGS reviews if the relevant legislation changes., (© The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The Highlights Lecture, presented at the closing session of each SNMMI Annual Meeting, was originated and presented for more than 30 y by Henry N. Wagner, Jr., MD. Beginning in 2010, the duties of summarizing selected significant presentations at the meeting were divided annually among 4 distinguished nuclear and molecular medicine subject matter experts. The 2024 Highlights Lectures were delivered on June 11 at the SNMMI Annual Meeting in Toronto, Canada. Presented here is the lecture by Twyla Bartel, DO, MBA, from Global Advanced Imaging, PLLC (Little Rock, AR), who reviewed general clinical specialties topics from the meeting. Note that in the following presentation summary, numerals in brackets represent abstract numbers as published in The Journal of Nuclear Medicine (2024;65[suppl 2])., (© 2025 by the Society of Nuclear Medicine and Molecular Imaging.)

Purpose: There is evidence of the role of dark adaptation (DA) as a functional biomarker in age-related macular degeneration (AMD) where foveal cones are impacted during the initial stages of AMD. In this study we determine the repeatability of smartphone application (MOBILE DA) to evaluate the cone-mediated dark adaptation (DA) in healthy young adults., Methods: Testing was done by placing a smartphone in front of the subject in a dark room. The App presented a 1.5° flashing stimulus at 3° eccentricity using an adaptive staircase. A 14800 lux white bulb was used for bleaching before testing. In two different sessions 1 week apart, the cone-mediated dark adaptation was measured in 40 healthy subjects aged 21.4 ± 3.4 with good visual acuity (VA). Cone-mediated DA recovery threshold was measured for 5 min. Threshold recovery functions were fitted to an exponential decay model to determine the time constant (τ, minutes) of cone sensitivity recovery and final cone luminance threshold (LT f ). Repeatability was estimated by the Bland-Altman method, whereby the mean difference (MD) and the 95% limits agreement were determinate as the coefficient of repeatability (COR)., Results: Mean time constant ( t ) values was 1.28 ± 0.43 minutes in session 1 and 1.28 ± 5.4 for the session 2 and for the final luminance threshold the mean values were -2.12 ± 0.23 log cd/m2 for the session 1 and -2.13 ± 0.28 for the session 2. Mean differences in time constant measurements and LT f between session 1 and 2 were not significant. COR value for t was 1minute and COR value for LTf was 0.33 log cd/m 2 ., Conclusions: The MOBILE-DA offered repeatable measurements. The APP was able to detect rapid changes in light sensitivity that occur during cone-mediated dark adaptation indicating the clinical potential of using mobile device based DA measurements., (© 2025 The Authors Acta Ophthalmologica © 2025 Acta Ophthalmologica Scandinavica Foundation.)

Cardiology providers and healthcare clinicians tackling heart failure (HF) face an escalating challenge: rising prevalence rates and widening disparities among populations. In this context, leveraging up-to-date and specialized data becomes paramount. Although the American Heart Association's (AHA) Heart and Stroke Statistics provides a sweeping overview of cardiovascular health with a few pages dedicated to HF and cardiomyopathy, the Heart Failure Society of America's (HFSA) HF Stats annual publication offers an up-to-date and in-depth look at multiple themes related to HF epidemiology, global trends, outcomes and much more. This article highlights the unique benefits of HF Stats, why providers and clinicians should want to utilize the report and its dedicated website, HFStats.org, and how the report contents can enhance clinical practice, research, and patient care., (Copyright © 2024. Published by Elsevier Inc.)

Radiofrequency ablation (RFA) is a minimally invasive treatment modality used as an alternative to surgery in patients with benign thyroid nodules, recurrent thyroid cancers (RTCs), and primary thyroid microcarcinomas. The Korean Society of Thyroid Radiology (KSThR) initially developed recommendations for the optimal use of RFA for thyroid tumors in 2009 and revised them in 2012 and 2017. As new meaningful evidence has accumulated since 2017 and in response to a growing global interest in the use of RFA for treating malignant thyroid lesions, the task force committee members of the KSThR decided to update the guidelines on the use of RFA for the management of RTCs based on a comprehensive analysis of current literature and expert consensus., Competing Interests: Jung Hwan Baek: Consultant of radiofrequency company, STARmed since 2017., (Copyright © 2025 The Korean Society of Radiology.)

Professional medical societies are organizations consisting of health care professionals who share research, clinical, or social interests within a particular specialty or subspeciality of medicine. Professional societies offer members benefits including education, networking, research support, and opportunities for leadership and professional growth. These benefits can all contribute to improving a physician's proficiency in patient care, leadership, and academic pursuits. There is a paucity of information in the literature regarding strategies for successful professional society involvement and advancement. This study will provide a framework for successful professional society involvement for the early-career (<5 years in practice) orthopedic sports medicine surgeon., Competing Interests: Disclosure E.V. is on the editorial board of Arthroscopy; is a committee member of the Arthroscopy Association of North America, and performs unrelated consulting on shoulder arthroplasty for Exactech, outside the submitted work. T.S. is on the editorial board of Arthroscopy; is a committee member of the American Orthopaedic Society for Sports Medicine and American Academy of Orthopaedic Surgeons; performs unrelated consulting on shoulder arthroplasty for DJO Surgical; and is on the Social Media Board of the Arthroscopy Association of North America, outside the submitted work. C.D. has nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A significant number of prostate cancer patients are long-term survivors after primary definitive therapy, and the occurrence of late side effects, such as second primary cancers, has gained interest. The aim of this editorial is to discuss the most current evidence on second primary cancers based on six retrospective studies published in 2021-2024 using large data repositories not accounting for all possible confounding factors, such as smoking or pre-existing comorbidities. Overall, prostate cancer patients treated with curative radiotherapy have an increased risk (0.7-1%) of the development of second primary cancers compared to patients treated with surgery up to 25 years after treatment. However, current evidence suggests that the implementation of intensity modulated radiation therapy is not increasing the risk of second primary cancers compared to conformal 3D-planned radiotherapy. Furthermore, increasing evidence indicates that highly conformal radiotherapy techniques may not increase the probability of second primary cancers compared to radical prostatectomy. Consequently, future studies should consider the radiotherapy technique and other confounding factors to provide a more accurate estimation of the occurrence of second primary cancers., Competing Interests: Conflict of interest: C. Zamboglou, D. M. Aebersold, C. Albrecht, D. Boehmer, U. Ganswindt, N.-S. Schmidt-Hegemann, S. Hoecht, T. Hölscher, S. A. Koerber, A.-C. Mueller, P. Niehoff, J.C. Peeken, M. Pinkawa, B. Polat, S.K.B. Spohn, F. Wolf, D. Zips and T. Wiegel declare that they have no competing interests., (© 2024. The Author(s).)

There is growing evidence about how physical activity can improve cancer care. Unfortunately, exercise is still not widely prescribed to oncology patients, despite the benefit it brings. For this to occur, it is necessary for a multidisciplinary approach involving different types of healthcare professionals, given that each treatment be tailored for each single case. Besides incorporating appropriate infrastructures and referral pathways, we need to integrate exercise into healthcare practice, which ameliorates patients' quality of life and treatment side effects. From the Spanish Society of Medical Oncology (SEOM), and through the Exercise and Cancer Working Group, we indicate considerations, analyze patient care scenarios, and propose a referral pathway algorithm for exercise prescription, taking in account the patient's needs. In later sections of this paper, we describe how this algorithm could be implemented, and how the exercise programs should be built, including the physical activity contents, the settings, and the delivery mode. We conclude that professionals, infrastructures, and organizations should be available at every assistance level to create programs providing adequate exercise training for cancer patients., Competing Interests: Declarations. Conflict of interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s).)

Introduction: Hybrid [ 18 F]FDG PET imaging is currently the method of choice for a wide variety of infectious and inflammatory disorders and was recently adopted in several clinical guidelines. A large amount of evidence-based articles, guidelines and appropriate use criteria have been published since the first version of this guideline in 2013., Purpose: To provide updated evidence-based information to assist physicians in recommending, performing and interpreting hybrid [ 18 F]FDG PET examinations for infectious and inflammatory disorders in the adult population., Methods: A systematic literature search of evidence-based articles using whole-body [ 18 F]FDG hybrid imaging on the indications covered within this guideline was performed. All systematic reviews and meta-analyses published within the last 10 years until January 2023 were identified in PubMed/Medline or Cochrane. For each indication covered in this manuscript, diagnostic performance was provided based on meta-analyses or systematic reviews. If not available, results from prospective or retrospective studies were considered based on predefined selection criteria. RESULTS AND CONCLUSIONS: Hybrid [ 18 F]FDG PET is extremely useful in the work-up and management of adults with infectious and inflammatory diseases, as supported by extensive and rapidly growing evidence-based literature and adoption in clinical guidelines. Practical recommendations are provided describing evidence-based indications as well as interpretation criteria and pitfalls. Monitoring treatment response is the most challenging but insufficiently studied potential application in infection and inflammation imaging., Competing Interests: Declarations. Ethics approval: This guideline did not involve human participants or animals, and hence was exempt from institutional review board approval. Consent to participate: Not applicable. Consent to publish: Not applicable. Conflicts of interest: Authors Mike Machaba Sathekge, Ora Israel, and Arturo Chiti are editors of this journal. GA: Novartis – Advanced Accelerator Applications- speaker honoraria GT: nothing to disclose MP-G: supported by a Fonds de recherche du Québec – Santé (FRQ-S) clinical research scholar award JB: nothing to disclose AC: Novartis – Advanced Accelerator Applications, advisory boards and speaker honoraria; Sirtex, speaker honorarium; General Electric Healthcare, speaker honorarium; Telix, advisory board; Bracco, speaker honorarium; European Journal of Nuclear Medicine and Molecular Imaging, Editor in Chief EHD: nothing to disclose AWJMG: nothing to disclose CJP: nothing to disclose MS: nothing to disclose AS: nothing to disclose FJ: nothing to disclose OI: GE Healthcare- consultant OG: nothing to disclose, (© 2024. The Author(s).)

The 15th Annual Report from The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support includes 29,634 continuous-flow left ventricular assist devices from the 10-year period between 2014 and 2024. The outcomes reported here demonstrate continued improved survival in the current era of fully magnetically levitated devices, with a significantly higher 1-year (85.7% vs 78.4%) and 5-year (59.7% vs 43.7%) survival than those receiving non-magnetically levitated devices. Magnetically levitated device recipients are experiencing a lower incidence of adverse events, including freedom from gastrointestinal bleeding (72.6%), device malfunction (82.9%), and stroke (86.7%) at 5 years. Additionally, a focus on a subgroup of patients younger than 50 years of age has demonstrated both superior outcomes in survival (91.6% survival at 1 year and 72.6% survival at 5 years) and decreased incidence of adverse events compared with older recipients. This younger cohort also demonstrated more tolerance to the characteristics of sex, race, ethnicity, and psychosocial indicators that are associated with worse outcomes after heart transplantation. Based upon these data, a potential net prolongation of life may be realized by considering prolonged left ventricular assist device support prior to heart transplantation in this population. These analyses provide preliminary data that could positively influence adoption of left ventricular assist device technology in groups previously not seen as candidates for this therapy, while providing a more responsible donor allocation strategy for advanced heart failure patients., Competing Interests: Disclosures Dan M. Meyer is on the clinical advisory board of PercAssist Corp. Aditi Nayak is on the clinical advisory board of PumpinHeart Limited, Ireland. Katherine L. Wood reports a relationship with Abbott that includes consulting or advisory. Sarah Schettle reports a relationship with the Medtronic Advisory Panel, and consulting with Abbott. James K. Kirklin discloses receiving partial salary support from the Society of Thoracic Surgeons (STS) as Director of the Data Center for STS Intermacs and being part owner and President of Kirklin Solutions, Inc., a University of Alabama at Birmingham (UAB) healthcare technology start-up company. Francis D. Pagani is a noncompensated ad-hoc scientific advisor for Abbott, Berlin Heals, FineHeart, and Medtronic, a non-compensated medical monitor for Abiomed, Scientific advisor for BrioHealth with travel compensation; and a member of the Data and Safety Monitoring Board (DSMB) for Carmat; and receives partial salary support from Blue Cross / Blue Shield of Michigan as Associate Director of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Manreet K. Kanwar is on the Advisory Board for Abiomed, Abbott and CorWave, on CEC for BiVACOR, and a speaker for Abiomed. The other authors have no conflicts of interest to disclose., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: To provide a set of living treatment recommendations that will give contemporary guidance on the management of patients with axial spondyloarthritis (axSpA) in Canada., Methods: The Spondyloarthritis Research Consortium of Canada (SPARCC), in conjunction with the Canadian Rheumatology Association, organized a treatment recommendations panel composed of rheumatologists, researchers, allied health professionals, and a patient advocate. A Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach was used, in which existing guidelines were adopted or adapted to a Canadian context. Recommendations were also placed in a health equity framework., Results: Fifty-six recommendations were made for patients with active axSpA, stable axSpA, active or stable axSpA, for comorbidities, and for assessment, screening, and imaging. Recommendations were also made for principles of management, disease monitoring, and ethical considerations., Conclusion: These living treatment recommendations will provide up-to-date guidance for the management of axSpA for Canadian practice. As part of the living model, they will be updated regularly as changes occur in the treatment landscape., (Copyright © 2024 by the Journal of Rheumatology.)

The National Cancer Database (NCDB) collects data from approximately 1,500 Commission on Cancer (CoC) facilities and represent 73.7% of newly diagnosed cancers nationwide. The American College of Surgeons Cancer Program developed it first annual report from the NCDB 2021 participant user file reporting new observations and recent trends of cancer diagnoses, patient demographics, and treatments as well as an in-depth report on treatment and outcomes in breast, pancreas, and colon cancers. Of the 1,328,131 cancers diagnosed in 2021 at 1,281 reporting CoC hospitals, one-fifth continue to be female breast cancer. In 2021, the NCDB's 5 most common adult cancers were breast, prostate, lung, colon, and melanoma and varied by patient sex. Use of neoadjuvant systemic therapy increased in recent years in pancreas, breast, and urinary bladder cancer, although a slight decrease in pancreas and breast cancer was observed in 2021. Breast cancer has high survival rates, especially in lower-stage disease and estrogen receptor-positive/human epidermal growth factor receptor 2-negative disease. There is increase in neoadjuvant systemic therapy use, especially in human epidermal growth factor receptor 2-positive disease and estrogen receptor-negative disease. Colon cancer presents most commonly as stage III or II with a primary in the cecum or ascending colon in 38.9%. The majority are microsatellite instability stable, Kirsten rat sarcoma viral oncogene homologue normal, and CEA positive. Survival is most dependent on stage but also associated with microsatellite instability stability, abnormal Kirsten rat sarcoma viral oncogene homologue, and positive CEA. Pancreatic cancer presents with stage IV disease in nearly half, although an increase in stage I disease is seen. The most common location is pancreatic head. Survival is relatively low and most dependent on stage., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Review the subsequent impact of recommendations made by the 2004 American Surgical Association Blue Ribbon Committee (BRC I) Report on Surgical Education., Background: Current leaders of the American College of Surgeons and the American Surgical Association convened an expert panel to review the impact of the BRC I report and make recommendations for future improvements in surgical education., Methods: BRC I members reviewed the 2004 recommendations in light of the current status of surgical education., Results: Some of the recommendations of BRC I have gained traction and have been implemented. There is a well-organized national curriculum and numerous educational offerings. There has been greater emphasis on preparing faculty to teach, and there are ample opportunities for professional advancement as an educator. The number of residents has grown, although not at a pace to meet the country's needs either by total number or geographic distribution. The number of women in the profession has increased. There is greater awareness and attention to resident (and faculty) well-being. The anticipated radical change in the educational scheme has not been adopted. Training in surgical research still depends on the resources and interests of individual programs. Financing student and graduate medical education remains a challenge., Conclusions: The medical landscape has changed considerably since BRC I published its findings in 2005. A contemporary assessment of surgical education and training is needed to meet the future needs of the profession and our patients., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction and Objectives: The development of specific heart failure (HF) units has improved the management of patients with this disease due to improved organization and resource management. The Spanish Society of Cardiology (SEC) has defined 3 types of HF units (community, specialized, and advanced) based on their complexity and service portfolio. Our aim was to compare the characteristics, treatment, and outcomes of patients with HF according to the type of unit., Methods: We analyzed data from the SEC-Excelente-IC quality accreditation program registry, with 1716 patients consecutively included in two 1-month cutoffs (March and October) from 2019 to 2021 by 45 SEC-accredited HF units. We compared the characteristics, treatment and 1-year outcomes between the 3 types of units., Results: Of the 1716 patients, 13.2% were treated in community units, 65.9% in specialized units, and 20.9% in advanced units. The rates of mortality (27.5 vs 15.5/100 patients-year; P<.001), admissions for HF (39.7 vs 29.2/100 patients-year; P=.019), total decompensations (56.1 vs 40.5/100 patients-year; P=.003), and combined death/admission for HF (45.2 vs 31.4/100 patients-year; P=.005) were higher in community units than in specialized/advanced units. Follow-up in a community unit was an independent predictor of higher mortality and admissions at 1 year., Conclusions: Compared with follow-up by more specialized units, follow-up in a community unit was associated with a higher decompensation rate and increased 1-year mortality., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Physician involvement in political advocacy has become increasingly important in recent years. This study aims to explore the types of involvement and barriers to involvement in political advocacy among American Shoulder and Elbow Surgeons (ASES) members, identify issues considered most important by ASES members, and assess demographic factors that might correlate with involvement in political advocacy efforts among ASES members., Methods: This survey was conducted by the ASES Political Advocacy Committee over a 2-week period in June 2021. The survey collected demographic information including sex, ethnicity, years in practice, practice type, political affiliation, and level of current involvement in political advocacy. Additional questions consisted of thoughts regarding current health care policy issues and the role of the American Academy of Orthopaedic Surgeons/ASES regarding such policy issues., Results: We received 297 responses for a total response rate of 27%. Of those who responded, 24.6% identified as Democrat, 33% identified as Republican, and 42.4% identified as Independent. There was no difference in political affiliation between membership groups. Physician Reimbursement (82%), Medical Liability Reform (50%), and Physician Ownership (50%) were the most important issues identified among respondents. Physician Ownership, Physician Reimbursement and Graduate Medical Education and Student Loan Reform were most important to those in early practice, while Quality and Research was most important to those with greater than 25 years of practice experience., Conclusion: There is strong agreement among surgeons regarding the most important political advocacy issues. The efforts of the American Academy of Orthopaedic Surgeons and ASES should focus on these areas. Additionally, the vast majority of respondents felt that advocacy efforts had a positive impact on patients and surgeons., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The World Psychiatric Association (WPA) Working Group on Digital Psychiatry aims to digitally supplement, support and improve mental health and care literacy, acceptance and accessibility across WPA member countries and National Psychiatric Associations (NPAs). To help with this goal, the present study was set to explore first the global status of digital mental health and care across NPAs METHODS: An international expert survey on the digitalization level across all 145 WPA NPAs was electronically distributed through Qualtrics. Descriptive statistics were carried out on the global dataset., Results: Across all 145 responses, 57 were included for analysis (39.3 % response rate). Most NPAs reported lacking an official section on digital mental health (73.7 %), missing national (59.6 %) or regional policies (82.5 %), clinical guidelines (>60 % depending on the digital tool/program), and education/training in both medicine (77.2 %) either and psychiatry training programs (71.9 %). Telemedicine seemed to be the most regulated digital tool in more than half of all included NPAs. Telemedicine (45.6 %) and telemental healthcare (38.6 %) were generally reimbursed. The reported highest priority areas for future actions across WPA Regions were education and training, and the development of guidelines., Conclusion: This study represents a benchmark in the work of the WG on Digital Psychiatry. It presents clear priority areas that will guide the delivery of targeted actions aimed to promote digital mental health and care, and ultimately, equitable mental health outcomes around the world. Overall, the highest priorities to be globally implemented are represented by education/training and evidence-based clinical practice guidelines., Competing Interests: Declaration of Competing Interest All the authors report no relevant conflicts of interest for this article., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The American Medical Informatics Association (AMIA) Task Force on Diversity, Equity, and Inclusion (DEI) was established to address systemic racism and health disparities in biomedical and health informatics, aligning with AMIA's mission to transform healthcare. AMIA's DEI initiatives were spurred by member voices responding to police brutality and COVID-19's impact on Black/African American communities., Materials and Methods: The Task Force, consisting of 20 members across 3 groups aligned with AMIA's 2020-2025 Strategic Plan, met biweekly to develop DEI recommendations with the help of 16 additional volunteers. These recommendations were reviewed, prioritized, and presented to the AMIA Board of Directors for approval., Results: In 9 months, the Task Force (1) created a logic model to support workforce diversity and raise AMIA's DEI awareness, (2) conducted an environmental scan of other associations' DEI activities, (3) developed a DEI framework for AMIA meetings, (4) gathered member feedback, (5) cultivated DEI educational resources, (6) created a Board nominations and diversity session, (7) reviewed the Board's Strategic Planning for DEI alignment, (8) led a program to increase diversity at the 2020 AMIA Virtual Annual Symposium, and (9) standardized socially-assigned race and ethnicity data collection., Discussion: The Task Force proposed actionable recommendations that focused on AMIA's role in addressing systemic racism and health equity, helping the organization understand its member diversity., Conclusion: This work supported marginalized groups, broadened the research agenda, and positioned AMIA as a DEI leader while reinforcing the need for ongoing transformation within informatics., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

This summary of the proceedings of the 2023 ACR Intersociety Meeting discusses the seven most important challenges facing radiology today: declining reimbursement, corporatization and consolidation, inadequate labor force, imaging appropriateness, burnout, turf wars with nonphysicians, and workflow efficiency. Participants in the Intersociety Summer Conference-2023 focused their effort on identifying potential solutions given how critical these topics are to the sustainability of the profession., (Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

To establish a consensus on the definition and management of idiopathic gastroparesis, international experts (selected by neurogastroenterology and motility societies and initiated by the Rome Foundation) devised 144 statements using the Delphi method, with at least 80% agreement required. This consensus defined idiopathic gastroparesis as the presence of symptoms associated with delayed gastric emptying in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms. Frequently co-existing symptoms are early satiation and postprandial fullness. Diagnosis requires the presence of these symptoms alongside delayed gastric emptying, measured by a 4 h scintigraphy or gastric emptying breath test of a mixed composition meal in the absence of mechanical obstruction. Therapeutic options with proven efficacy were sparse. Dietary adjustments, nutritional support (per guidelines from the European Society for Clinical Nutrition and Metabolism for substantial weight loss or intractable vomiting), and opioid cessation were recommended by a consensus opinion. Antiemetic and prokinetic agents were also considered potentially beneficial. This consensus offers a global perspective on idiopathic gastroparesis., Competing Interests: Declaration of interests JT has given scientific advice to Aclipse, Adare, AlfaSigma, Bayer, Clasado, Danone, Falk, FitForMe, Ironwood, Kyowa Kirin, Menarini, Promed, Ricordati, Takeda, Truvion, Tsumura, and Zeria Pharmaceuticals; has received financial research support from Biohit, Kiowa Kirin, ProMed, Sofar, and Takeda; and has served on the speaker bureau for Abbott, Bio-Codex, Mayoly, Menarini, ProMed, Schwabe, Takeda, and Truvion Pharmaceuticals. BEL is on scientific advisory boards for Ironwood, Salix, Takeda, and Sanofi. VS is a consultant or speaker for AlfaSigma, Bayer, Coloplast, and Metagenics. HM has received speaking fees from Takeda, Viatris, EA Pharma, and Astra. GG has served as a consultant or speaker for Laborie, Medtronic, Kyowa Kirin, Lilly, and Enterra Medical. GO’G is a director and shareholder of Insides Company and Alimetry and holds patents and other intellectual property in the fields of gastrointestinal electrophysiology and neuromodulation (US11712566B2; US20230083795A1). BM has participated in the advisory board and received grant support from Atmo, and grant support from Takeda, Medtronic, and the Gastroparesis Consortium (NIDDK NIH UO1 grant). LN is a consultant for Enterra Medical, Ardelyx, Phathom, Evoke, and Takeda. All other authors have no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Food security exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs for an active and healthy life. While there is a lengthy body of literature examining food insecurity among children, food insecurity among adolescents and young adults (AYAs) has been relatively understudied. The literature demonstrates that AYAs experiencing food insecurity have poorer physical, mental, and psychosocial health outcomes than their peers, which may persist into adulthood. As AYAs reach reproductive maturity, those experiencing food insecurity are more likely to have children who are also poorly nourished, perpetuating intergenerational poor nutrition and its associated health and socioeconomic costs. In this position paper, Society for Adolescent Health and Medicine (SAHM) recommends actions that healthcare professionals can take to achieve a goal of universal food security among AYAs. As SAHM strives to promote the optimal health of AYAs around the world, the positions in this paper affirm SAHM's commitment to promoting food security for all AYAs., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index-Daily Diary (ANMS GCSI-DD) is a patient-reported outcome (PRO) instrument for gastroparesis. This study evaluated the psychometric properties of the ANMS GCSI-DD and determined a meaningful change threshold using the data from a phase 2b trial in adults with moderate-to-severe idiopathic or diabetic gastroparesis (DG)., Methods: The psychometric properties of ANMS GCSI-DD were analyzed using other clinician- and patient-reported outcomes from 242 patients during the 12-week trial. Trial exit interviews were conducted in a cohort of 32 patients to capture their perspectives on meaningful change from the trial., Results: ANMS GCSI-DD demonstrated good performance: unidimensionality scores exhibited good fit; internal consistency reliability was >0.70; test-retest reliability was above 0.90, and convergent validity showed strong correlations (0.70-0.90) with overall severity rating and moderate correlations (0.30-0.70) with other outcomes. ANMS GCSI-DD scores discriminated among groups with varying severity of gastroparesis symptoms in known-groups validity (p < 0.001) and were responsive to symptom improvement. Triangulation of the quantitative anchor-based estimates of 0.9-1.4 category points as a meaningful change in the ANMS GCSI-DD composite score, and the qualitative exit interview findings of 0.5-1.5 as meaningful change, supports a one-point change on a five-point scale (0-4) as the meaningful change threshold., Conclusion: The ANMS GCSI-DD is a reliable and valid PRO instrument to employ in clinical development for patients with moderate-to-severe idiopathic or DG, and a one-point score change in the ANMS GCSI-DD composite score is recommended as a meaningful change threshold of symptom change., (© 2024 John Wiley & Sons Ltd.)

Background: The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was expanded in 2017 to include more granular detail on thoracic aortic surgeries. We describe the first validated risk model in thoracic aortic surgery from the STS ACSD., Methods: The study population consisted of patients undergoing nonemergent isolated ascending aortic aneurysm repair by open or clamped distal anastomoses, including those requiring aortic root or valve replacement. Model outcomes included operative mortality, 30-day major morbidity (cardiac reoperation, deep sternal wound infection, stroke, prolonged ventilation, renal failure), and a composite of both. To select the predictors, univariate associations and clinical face validity of models were examined. Models were evaluated by their ability to distinguish between patients with and without specific outcomes (discrimination) and their predictive accuracy (calibration)., Results: Between 2017 and 2021, 24,051 eligible patients underwent ascending aortic aneurysm surgery at 905 hospitals. Procedures included 8913 aortic root replacements, 2135 valve-sparing root replacements, 7545 ascending aortic replacements with aortic valve replacement, and 5458 ascending aortic replacements. Circulatory arrest was performed in 7316 (30.4%) cases. Operative mortality was 1.9%, and 12.2% of patients experienced major morbidity including 2.4% incidence of stroke. The adjusted C statistics for the model were 0.74, 0.67, and 0.67 for mortality, morbidity, and the composite, respectively. Previous stroke and circulatory arrest were associated with new stroke. Genetic aortopathy was associated with less mortality., Conclusions: A new STS ACSD risk model to predict mortality and morbidity after ascending aneurysm surgery has been developed, and predictors of better and worse outcomes have been identified., Competing Interests: Disclosures Nimesh Desai reports a relationship with W. L. Gore & Associates Inc that includes: consulting or advisory; with Terumo Medical Corp that includes: consulting or advisory; with Artivion, Inc that includes: consulting or advisory; with Edwards Lifesciences Corporation that includes: consulting or advisory; and with Baxter International Inc that includes: consulting or advisory. Hiroo Takayama reports a relationship with Edwards Lifesciences which includes consulting and advisory and W.L. Gore which includes consulting and advisory. Eric Roselli reports a relationship with Artivion, Inc that includes: consulting or advisory and a licensing agreement; with Cook Medical Inc that includes: consulting or advisory; with Edwards Lifesciences Corporation that includes: consulting or advisory; with W. L. Gore & Associates Inc that includes: consulting or advisory; with Medtronic that includes: consulting or advisory; with JenaValve Technology Inc that includes: speaking and lecture fees; with LifeNet Inc that includes: speaking and lecture fees; and with Terumo Aortic that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

The American Society of Clinical Oncology (ASCO) updated the guidelines for the treatment of advanced gastroesophageal (GE) cancer in 2023, signifying a major shift towards targeted therapeutics and precision medicine. This article serves as an imaging-based review of recent developments in the care of patients with GE cancer. We cover the epidemiology, the developing treatment paradigms, and the imaging assessment of GE malignancy. In addition, this review aims to familiarize radiologists with the unique adverse effects pertaining to therapeutics, surgeries, radiation therapies, and associated imaging corollaries. A case-based approach will be used to both explore the efficacy of modern treatments and demonstrate their adverse effects, such as chemotherapy-associated pneumonitis, radiation esophagitis, and anastomotic failure. With this comprehensive exploration of gastroesophageal cancer, radiologists will be equipped with the essential tools to inform the treatment decisions made by medical oncologists, radiation oncologists, and surgical oncologists in the new era of precision medicine., Competing Interests: Declarations. Conflict of interest: The authors declare no conflict of interest., (© 2024. The Author(s).)

Recommendations for the Medical Treatment of ADHD in Comorbid, Substance-Related Disorders: Statement of the Joint Addiction Commission of the German Child and Adolescent Psychiatric Society and Associations Abstract: Objective: Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often occur together in adolescents. The available guidelines give the group of children and adolescents with ADHD and comorbid SUD little consideration. Method: The Joint Addiction Commission of the German Child and Adolescent Psychiatric Society and Associations has drawn up a statement with treatment recommendations intended to provide orientation as a best-practice approach. Results: Early treatment with stimulants in adolescents with ADHD and SUD may.

Study Design: Retrospective registry analysis., Objective: To examine predictions of individual Scoliosis Research Society-22r (SRS-22r) questions one year after surgery for adolescent idiopathic scoliosis (AIS)., Summary of Background Data: A precision-medicine approach to AIS surgery will inform patients of the likelihood of achieving particular results from surgery, specifically individual responses to the SRS-22r questionnaire., Methods: A multicenter AIS registry was queried for surgical AIS patients treated between 2002 and 2020. Preoperative data collected included standard demographic data, deformity descriptive data, and SRS-22r scores. Postoperative one-year SRS-22r scores were modeled using ordinal logistic regression. The highest probability was the most likely response. Model performance was examined by c-statistics, where c >0.8 was considered excellent. Ceiling effects were measured by the proportion of patients reporting "5" to each question., Results: A total of 3251 patients contributed data to the study; mean age 14.4 (±2.2) years, female 2631 (81%), major thoracic coronal curve 53°, mean lumbar 41°. C-statistic values ranged from 0.6 (poor) to 0.8 (excellent), evidence of varied predictive capabilities. Q17 ("days off work/school," c = 0.84, ceiling achieved 75%) and Q15 ("financial difficulties," c = 0.86, ceiling achieved 82%) had the greatest predictive capabilities while Q11 ("pain medication," c=0.73, ceiling achieved 67%), Q10 ("appearance," c=0.72, ceiling achieved 35%), and Q19 ("attractive," c=0.69, ceiling achieved 37%) performed poorly., Conclusions: Prediction of individual SRS-22r item responses, perhaps most germane to AIS treatment, was poor. The prediction of less relevant outcomes, where ceiling effects are present, was greater as the models chose "5" for all responses. These ceiling effects may limit discrimination and hamper efforts at personalized outcome predictions., Level of Evidence: Level 3., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: An update of the 2007 and 2014 surveys of the American Brachytherapy Society (ABS) will elucidate current practice patterns of cervical cancer brachytherapy., Methods: A 40-question survey was sent to all ABS members in June-July 2023 and February 2024; 167 responses were received, with 140 used for analysis. Results were compared to the 2014 survey using chi-squared testing. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI) for outcomes of interest., Results: Compared to 2014, MRI use for treatment planning of the first brachytherapy fraction increased from 34% to 63% (p < 0.001), prescription to the high-risk clinical target volume (HR-CTV) increased from 52% to 94% (p < 0.001), while Point A prescription decreased from 42% to 16% (p < 0.001). Additionally, procedural guidance with ultrasound significantly increased (79% vs. 32%, p < 0.001) along with the use of interstitial needles (always or nearly always, >80%) (29% vs. 4%, p < 0.001). MRI availability around the time of procedure was the largest challenge to incorporating MRI into brachytherapy treatment planning. Compared to those with MRI access reserved specifically for Radiation Oncology, respondents with shared-access or out-of-department MRI were less likely to obtain treatment planning MRIs for each brachytherapy fraction (22% vs. 75%; aOR 0.10 [95% CI, 0.03-0.30], p < 0.001)., Conclusion: For cervix cancer brachytherapy there has been significant increase in the use of MRI-based volumetric brachytherapy treatment planning, ultrasound guidance during procedures and the addition of interstitial needles. These advancements in practice patterns are congruent with published consensus guidelines and ongoing training initiatives. However, MRI access and lack of easy availability continue to be significant challenges for optimizing cervix brachytherapy., (Copyright © 2024 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

The knowledge of pericardial diseases has now improved, including prospective and retrospective cohort studies focusing on the pathogenesis, diagnosis, treatment, and outcomes. The complex interplay between genetic predisposition (especially for autoinflammatory conditions), inflammation, and autoimmunity is now known to trigger recurrences of pericarditis. Moreover, diagnostic capabilities have improved with the implementation of multimodality imaging, particularly cardiac magnetic resonance (CMR), to detect and monitor pericardial inflammation, to allow diagnosis in more complicated cases, and tailor the duration of therapy based on objective parameters. A new class of drugs, the anti-IL-1 agents, have been introduced for patients with an inflammatory phenotype of presentation, and not responding to conventional anti-inflammatory therapies, including NSAID, colchicine, and corticosteroids. At present, the clinical management of pericardial diseases is definitely on the road of evidence-based medicine with new ongoing European guidelines focusing on the spectrum of inflammatory myocardial and pericardial syndromes., (Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Purpose: To evaluate the representation of women as speakers at U.S. radiology annual scientific meetings (ASM)., Methods: This retrospective study analyzed speaker demographic data from the Society of Interventional Radiology (SIR) and American Roentgen Ray Society (ARRS) ASM between 2019 and 2022. Speaker gender was identified through publicly available profiles, and the percentage of female speakers was calculated for each year. Statistical significance of trends was determined using chi-squared tests, and linear regression analysis was employed to assess trends and to predict future representation., Results: At the SIR ASM, female representation increased from 20.0 % (67 of 334 speakers) in 2019 to 26.5 % (90 of 340 speakers) in 2022. Chi-squared tests showed a statistically significant increase when adjusted for the percentage of female membership. At the ARRS ASM, female representation fluctuated, dropping from 36.6 % (104 of 284 speakers) in 2019 to 17.7 % (43 of 243 speakers) in 2020, then rising to 48.5 % (190 of 392 speakers) in 2022. A chi-squared test revealed significant variation in female representation across the years (p < 0.0001)., Conclusion: While both ASM showed an overall positive trend in female speaker representation, SIR demonstrated consistent increases, whereas ARRS exhibited significant fluctuations. Continued efforts in advocacy and targeted interventions are needed to sustain progress and address the gender gap in radiology., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: The revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms once histology is confirmed: (1) standardized whole-body staging, (2) special algorithms for non-malignant entities, and (3) multiplicity, genetic tumor syndromes, and pitfalls., Materials and Methods: A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by the level of agreement (0 to 10) during two iterative rounds, that could result in 'group consensus', 'group agreement', or 'lack of agreement'., Results: The three sections contain 24 statements with comments. Group consensus was reached in 95.8% and group agreement in 4.2%. For whole-body staging, pulmonary MDCT should be performed in all high-grade sarcomas. Whole-body MRI is preferred for staging bone metastasis, with [ 18 F]FDG-PET/CT as an alternative modality in PET-avid tumors. Patients with alveolar soft part sarcoma, clear cell sarcoma, and angiosarcoma should be screened for brain metastases. Special algorithms are recommended for entities such as rhabdomyosarcoma, extraskeletal Ewing sarcoma, myxoid liposarcoma, and neurofibromatosis type 1 associated malignant peripheral nerve sheath tumors. Satisfaction of search should be avoided in potential multiplicity., Conclusion: Standardized whole-body staging includes pulmonary MDCT in all high-grade sarcomas; entity-dependent modifications and specific algorithms are recommended for sarcomas and non-malignant soft tissue tumors., Clinical Relevance Statement: These updated ESSR soft tissue tumor imaging guidelines aim to provide support in decision-making, helping to avoid common pitfalls, by providing general and entity-specific algorithms, techniques, and reporting recommendations for whole-body staging in sarcoma and non-malignant soft tissue tumors., Key Points: An early, accurate, diagnosis is crucial for the prognosis of patients with soft tissue tumors. These updated guidelines provide best practice expert consensus for standardized imaging algorithms, techniques, and reporting. Standardization can improve the comparability examinations and provide databases for large data analysis., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Univ.-Prof. Priv.-Doz. Dr. I.M.N.H. Conflict of interest: A.B. is a member of the European Radiology Editorial Board. He has not taken part in the review or selection process of this article. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was not required for this study because patients were not involved. Ethical approval: Institutional Review Board approval was not required because patients were not involved. Study subjects or cohorts overlap: Study subjects or cohorts have not been previously reported. Methodology: Expert consensus is performed by a Delphi process Perspective: not applicable Study design: not applicable Location: multicentre study, (© 2024. The Author(s).)

The Society for Adolescent Health and Medicine and the International Association for Adolescent Health recognize that climate change impacts multiple dimensions of health and well-being for adolescents and young adults. According to the World Health Organization, climate change is one of the top 10 health threats facing humanity. No aspect of adolescent health is spared from the consequences of climate change: food and housing insecurity, heat-related morbidity and mortality, water-borne diseases, infectious diseases, including sexually transmitted infections and HIV, mental health disorders, gender-based violence, conflict, internal displacement, and migration are all impacted. Vulnerable populations, such as adolescents and young adults, and those living in lower- to middle-income countries and environmental justice communities, are the ones whose health will be most affected. The Society for Adolescent Health and Medicine and the International Association for Adolescent Health call for urgent action in alignment with the United Nations Sustainable Development Goals and the Convention on the Rights of the Child to avert the irreversible consequences of climate change. Health professionals and health-care organizations can and should help lead global climate action along with youth, supporting mitigation and adaptation strategies that protect young people. Adolescent health professionals and organizations must advocate for climate justice and equitable resources, urge health systems to mitigate their adverse impacts on the environment, advocate for health organizations to focus on green investments, be leaders in climate education of the next generation of adolescent health professionals, and focus research on equitable strategies to reduce climate harms., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Despite maximally motivated and professionally outstanding young talent, the particularly stressful surgical disciplines have recruitment concerns. In recent years various sections and subsidiary societies of the German Society for Orthopedics and Trauma Surgery (DGOU) have developed and distributed personnel and institution-related certificates. Organ-specific and procedure-specific certificates are very popular to confer increased visibility to individuals and institutions. Many specialists for orthopedics and trauma surgery specialized early in fields, such as foot, knee, shoulder, elbow or arthroscopic surgery. General traumatology, treatment of polytrauma and complex traumatology of the chest and abdomen are becoming more and more unattractive. Knife attacks and also the "truck attack" at the Breitscheidplatz in Berlin illustrate the smoldering terror situation in Germany. The Federal Criminal Police Office also recently announced that the incidence of domestic violence increased by 6.5% in 2023 alone. This cannot be mastered with specialization alone. The visibility and the attractiveness of specialized trauma surgery must be increased and structures for appropriate specialization must be achieved. The possible introduction of a qualification "specialized trauma surgery" is discussed. In current considerations of the German Society of Trauma Surgery (DGU), the Academy for Trauma Surgery (AUC) and the Working Group for Osteosynthesis Issues (AO) Trauma Germany, a stepwise acquisition of defined knowledge from the principles on basic contents up to specialization and expert knowledge, could lead to the acquisition of the qualification in "specialized trauma surgery"., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: J.C. Katthagen, M.F. Lodde, C.A. Müller, M.J. Raschke und T. Fuchs geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

A recent American College of Obstetricians and Gynecologists Clinical Practice Update continues to recommend targeted (as opposed to universal) screening for pregestational diabetes, no longer recommends screening for early gestational diabetes mellitus (GDM), and provides updated guidelines for immediate postpartum testing for diabetes in patients with GDM. Here, we present data that the targeted screening paradigm, which has repeatedly been shown to fail in practice because of its complexity, no longer makes sense in the context of the high and rising prevalence of diabetes and diabetic risk factors, and we argue that the time has come for universal early pregnancy screening for pregestational diabetes. Furthermore, the recommendation against early screening for GDM is based on 2021 U.S. Preventive Services Task Force guidance, which in turn is based almost entirely on a single underpowered study that excluded individuals at highest risk and does not account for more recent research showing benefits of early diagnosis and treatment. Universal early pregnancy screening for pregestational diabetes may also help to identify patients at risk who will benefit from early GDM diagnosis and treatment and may provide rationale for prioritizing postpartum diabetes testing., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

The Society of Radiologists in Ultrasound convened a multisociety panel to develop a first-trimester US lexicon based on scientific evidence, societal guidelines, and expert consensus that would be appropriate for imagers, clinicians, and patients. Through a modified Delphi process with consensus of at least 80%, agreement was reached for preferred terms, synonyms, and terms to avoid. An intrauterine pregnancy (IUP) is defined as a pregnancy implanted in a normal location within the uterus. In contrast, an ectopic pregnancy (EP) is any pregnancy implanted in an abnormal location, whether extrauterine or intrauterine, thus categorizing cesarean scar implantations as EPs. The term pregnancy of unknown location is used in the setting of a pregnant patient without evidence of a definite or probable IUP or EP at transvaginal US. Since cardiac development is a gradual process and cardiac chambers are not fully formed in the first trimester, the term cardiac activity is recommended in lieu of 'heart motion' or 'heartbeat.' The terms 'living' and 'viable' should also be avoided in the first trimester. 'Pregnancy failure' is replaced by early pregnancy loss (EPL). When paired with various modifiers, EPL is used to describe a pregnancy in the first trimester that may or will not progress, is in the process of expulsion, or has either incompletely or completely passed., Competing Interests: Disclosures of conflicts of interest S.K.R. Book royalties from Elsevier. M.M.H. Payment for lectures, travel, or visiting professorship from Massachusetts General Hospital/Brigham Women’s Hospital, University of Toronto, McMaster University, World Class CME, and Hoag Medical Group; section editor for RadioGraphics. P.M.D. No relevant relationships. M.C.F. Payment for panel discussion from GE HealthCare. A. Kennedy Royalties and writer’s fees from Elsevier; honoraria from World Class CME and University of California Davis; support for travel from the RSNA; secretary of the Society of Radiologists in Ultrasound. R.A. No relevant relationships. K.B. Patents planned, issued, or pending with Kristyn Brandi MD MPH LLC. L.D. No relevant relationships. S.K.H. Grants from the National Center for Advancing Translational Sciences at the National Institutes of Health; payment for presentations from Organon; payment for expert testimony from Huff Powell Bailey; support for attending meeting from the American College of Obstetricians and Gynecologists (ACOG); section secretary of the Pennsylvania ACOG. A. Kamaya Book royalties from Elsevier. A. Koyama No relevant relationships. P.C.L. Honoraria for editor role from RoshReview (now Blueprint); support to attend meeting from Individuals with Intellectual or Development Disability Engaged, Aligned and Leading project workgroup funded by the Patient-Centered Outcomes Research Institute; secretary-treasurer of the New York Chapter of the American College of Emergency Physicians and past chair of the American College of Emergency Physicians Emergency Ultrasound Section. K.E.M. No relevant relationships. T.M. Book royalties from Elsevier. S.G.O. No relevant relationships. K.O. No relevant relationships. R.S. Honoraria and support for travel to meetings from World Class CME. S.S. Grants from the National Institutes of Health, AbbVie, and Organon. L.M.S. No relevant relationships., (Copyright © 2024 Elsevier Inc., RSNA. Published by Elsevier Inc. All rights reserved.)

Hypertension is responsible for more than two million deaths due to cardiovascular disease annually in Latin America (LATAM), of which one million occurs before 70 years of age. Hypertension is the main risk factor for cardiovascular morbidity and mortality, affecting between 20 and 40% of LATAM adults. Since the publication of the 2017 LASH hypertension guidelines, reports from different LATAM countries have confirmed the burden of hypertension on cardiovascular disease events and mortality in the region. Many studies in the region have reported and emphasized the dramatically insufficient blood pressure control. The extremely low rates of awareness, treatment, and control of hypertension, particularly in patients with metabolic disorders, is a recognized severe problem in LATAM. Earlier implementation of antihypertensive interventions and management of all cardiovascular risk factors is the recognized best strategy to improve the natural history of cardiovascular disease in LATAM. The 2024 LASH guidelines have been developed by a large group of experts from internal medicine, cardiology, nephrology, endocrinology, general medicine, geriatrics, pharmacology, and epidemiology of different countries of LATAM and Europe. A careful search for novel studies on hypertension and related diseases in LATAM, together with the new evidence that emerged since the 2017 LASH guidelines, support all statements and recommendations. This update aims to provide clear, concise, accessible, and useful recommendations for health professionals to improve awareness, treatment, and control of hypertension and associated cardiovascular risk factors in the region., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: The British Thyroid Association (BTA) Guidelines for the Management of Thyroid Cancer advocate for fine-needle aspiration cytology for all thyroid nodules graded indeterminate (U3) at ultrasound assessment. This approach raises concerns regarding potential over-diagnosis of low-risk lesions. Conversely, equivalent Thyroid Imaging Reporting and Data Systems (TIRADS) guidelines permit surveillance or discharge of indeterminate thyroid nodules of certain sizes. This service analysis analyses how guideline choice impacts the fine-needle aspiration cytology rate and subsequent surgical management of indeterminate thyroid nodules., Materials and Methods: All patients with an indeterminate (U3) thyroid nodule identified on ultrasound over a 12-month period were included. Indeterminate thyroid nodules were retrospectively rescored using three equivalent TIRADS classifications by three independent reviewers, blinded to the histopathology. Hypothetical differences in fine-needle aspiration cytology rates and surgical activity were then compared., Results: Ninety-six nodules were identified. Retrospective application of TIRADS guidelines resulted in a hypothetical 44.8-55.2% reduction in fine-needle aspiration cytology performed for indeterminate thyroid nodules compared to BTA. A statistically significant increase in rates of surgical activity for indeterminate thyroid nodules was observed between BTA guidance and all retrospectively applied TIRADS guidelines (p < 0.001). Of four confirmed thyroid cancers, three would have been unanimously removed., Conclusion: Under BTA guidance, increased fine-needle aspiration cytology rates for indeterminate thyroid nodules resulted in significantly increased surgical activity in our cohort compared to retrospectively applied TIRADS guidelines., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2024 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Orthopedic advocacy is an indispensable tool for surgeons to help shape health care policies and address the mounting challenges they face in providing quality care to patients and maintaining a sustainable practice. Health care advocacy embodies a commitment to fair health care access and provider autonomy, employs diverse strategies to amplify patient and doctor voices, and advances public health imperatives. Orthopedic advocacy confronts a myriad of legislative challenges specific to the orthopedic specialty, from reimbursement complexities to regulatory burdens. This necessitates strategic alliances and grassroots engagement to effectuate meaningful change. By fostering public awareness and legislative engagement, individual surgeons can drive transformative reforms, ensuring orthopedic practice aligns with patient needs and advances health care impartiality. The American Academy of Orthopaedic Surgeons advocacy program along with its subspecialty affiliates, such as the American Shoulder and Elbow Surgeons political advocacy committee, have a structured approach to advocacy comprising government relations, grassroots mobilization, and educational initiatives. This review explores the basis of health care advocacy including the structure of the American Academy of Orthopaedic Surgeons advocacy program. In addition to highlighting key legislative issues facing front-line orthopedic surgeons, this manuscript provides some provisional insights on how individual surgeons can engage in orthopedic advocacy to drive positive change., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Japanese patients with polycystic ovary syndrome (PCOS) exhibit distinct body type characteristics, such that the rate of overweight/obese women is remarkably low. In addition, hyperandrogenism is relatively rare among Japanese PCOS patients. Therefore, these factors are considered in PCOS diagnostic criteria used in Japan. Diagnostic criteria for PCOS were recently revised by the Japan Society of Obstetrics and Gynecology based on a nationwide survey of PCOS and released on December 5, 2023 (JSOG2024). JSOG2024 criteria diagnosed PCOS according to the following three items: (1) irregular menstrual cycle/chronic anovulation, (2) polycystic ovarian morphology or elevated serum anti-Müllerian hormone (AMH) level, and (3) hyperandrogenism or high luteinizing hormone. The presence of all three items is required to diagnose PCOS, after excluding other diseases with symptoms similar to PCOS. We also established AMH cut-off values by age and a system for evaluating ovarian findings useful for both the JSOG2024 and Rotterdam criteria. We anticipate that the JSOG2024 criteria with cut-off values will enhance the treatment of Japanese patients with PCOS and those of other ethnicities with low obesity and hirsutism., (© 2024 Japan Society of Obstetrics and Gynecology.)

Background: The scientific debate concerning clinical, translational and surgical aspects of iNPH could still be limited in respect to the incidence of this condition. The aim of this paper is to systematically assess the extent of the debate on INPH in the context of the congresses of the relevant medical and scientific societies in our Country., Methods: We thoroughly examined the websites and scientific programs of 12 leading scientific societies linked to medical specialities involved in diagnosis and management of INPH, among which the neurological, neurosurgical, neurophysiological, rehabilitation medicine and urologic societies. The amount of time (in hours) was examined in a time span of events which took place between 2019 and 2023., Results: Notably, across 4 years (2019-2023), a total of 7 out of 12 (58.3%) of the aforementioned leading scientific societies dedicated a total of zero minutes to the topic "iNPH", two further societies hosted talks for a total of less than one hours concerning such condition. The amount of time dedicated to giant intracranial aneurysms and vestibular schwannomas was in respect to the incidence of the conditions, significantly longer than the time spent debating on iNPH., Conclusions: The results demonstrates that in our country, despite the high and increasing incidence of INPH, the awareness raised on the topic could still be limited, especially compared to other, significantly rarer intracranial conditions such as giant intracranial aneurysms and vestibular schwannomas., (Copyright © 2024 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: This report evaluates rheumatologists' stated adherence to and agreement with the 2020 American College of Rheumatology (ACR) Guideline for the Management of Gout., Methods: A 57-item questionnaire was administered to a sample of US rheumatologists. Stated adherence scores were based on several guideline recommendations reported to be followed by rheumatologists in practice, whereas stated agreement scores were based on whether respondents always followed the recommendations., Results: All 201 rheumatologists approached completed the questionnaire. The mean overall stated adherence score was 11.5 (maximum 15), whereas the mean overall stated agreement score was 7.7 (maximum 14). Less experienced rheumatologists (≤ 8 yrs; n = 49) were likely to claim adherence to more individual ACR recommendations than those with more experience (> 8 yrs; n = 152; mean stated adherence score: 12.3 vs 11.3; P ≤ 0.05). Rheumatologists who claimed to see ≤ 75 patients with gout in 6 months (n = 66) had a mean stated adherence score of 12.1 vs 11.2 for those who claimed to have seen > 75 patients ( P ≤ 0.05). Approximately 78% of rheumatologists claimed to follow the guideline for initiating urate-lowering therapy (ULT), and 89% were likely to prescribe allopurinol as a first-line ULT. Claimed adherence to recommendations for dosing was lower (febuxostat: 43%; allopurinol: 39%). Rheumatologists from academic settings were more likely to prescribe an interleukin-1 inhibitor for gout flares., Conclusion: The self-reported practice of the surveyed US rheumatologists was generally concordant with the 2020 ACR Guideline for the Management of Gout. However, there were gaps in guideline knowledge and stated adherence among rheumatologists, mainly concerning the dosing of treatment regimens., (Copyright © 2024 by the Journal of Rheumatology.)

Aim: To provide information including the trend of gynecological malignancies in Japan, we hereby present the Annual Patient Report for 2021 and the Annual Treatment Report for 2016, on the outcomes of patients who started treatment in 2016., Methods: The Japan Society of Obstetrics and Gynecology maintains an annual tumor registry, where information on gynecological malignancies from various participating institutions is gathered. The data of patients whose treatment with gynecologic malignancies was initiated in 2021 were analyzed retrospectively. Survival of the patients who started treatment with cervical, endometrial, and ovarian cancer in 2016 was analyzed by using the Kaplan-Meier, log-rank, and Wilcoxson tests., Results: Treatment was initiated in 2021 for 8006 patients with cervical cancer, 13 912 with endometrial cancer, 8337 with ovarian, tubal, and peritoneal cancer, 2375 with ovarian borderline tumors, and with the others (226 vulvar cancer, 161 vaginal cancer, 437 uterine sarcoma, 47 uterine adenosarcoma, 160 trophoblastic diseases). This clinicopathological information was summarized as the Patient Annual Report. The 5-year survival rates of the patients with cervical cancer were 92.3%, 77.0%, 56.1%, and 30.3% for stages I, II, III, and IV, respectively. The 5-year survival rates for the patients with endometrial cancer were 94.1%, 88.8%, 71.2%, and 24.5% for stages I, II, III, and IV, respectively. The 5-year survival rates for the patients with ovarian cancer (surface epithelial-stromal tumors) were 91.3%, 78.8%, 54.3%, and 36.8% for stages I, II, III, and IV, respectively., Conclusion: The annual tumor report is an important survey that provides knowledge on gynecological malignancy trends in Japan., (© 2024 Japan Society of Obstetrics and Gynecology.)

This article reviews the contemporary and inclusive definition of cancer survivorship, including patients with and without disease who have completed or continue to undergo treatment. The Spanish Society of Medical Oncology (SEOM) describes in this article the needs of these patients and outlines a care model based on an estimation of cancer incidence and identification of patient needs, to enable the provision of practical actions to achieve effective care. The objectives of this review are to identify the main effects of cancer on survivors and to establish appropriate ways of measuring these effects, as well as discussing the management of physical, psychological and social, occupational, financial, and other health-related needs. We suggest a multidisciplinary care model and training programs for the different professionals involved in care, and highlight challenges and the future role of the SEOM and health-care policy in ensuring optimum care of cancer survivors., Competing Interests: Declarations. Conflict of interests: Alejandro Gallego declares receipt of honoraria or consultation fees from GSK, MSD, AstraZeneca, and Clovis; participation in speakers bureau for Roche, AstraZeneca, MSD, Clovis, and GSK; and travel/accommodation/expenses from Roche, MSD, GSK, AstraZeneca, and PharmaMar. Carmen Beato declares that they have no conflicts of interest. Elena Brozos declares consultancy or advisory honoraria from Bayer, Pfizer, and Servier; travel and accommodation expenses from Amgen, Lilly and Company, Daiichi Sankyo, LEO Pharma, Merck, Pfizer, Roche, Rovi, Sanofi, and Servier; and payment or honoraria for educational activities from Amgen, Bayer, Kyowa Kirin, LEO Pharma, Merck, Pierre Fabre, Rovi, Roche, and Sanofi. Susana De La Cruz declares consulting fees and honoraria from AstraZeneca, Daiichi Sankyo, Pfizer, Lilly, Novartis, Seagen, Gilead, and Adamed; travel grants from Pfizer, Novartis, AstraZeneca, and Gilead; and advisory roles for Pfizer, AstraZeneca, Daiichi Sankyo, and Seagen. Ruth Vera García declares honoraria from or acted in an advisory role for Roche, Sanofi, MSD, Merck, Eisai, Novartis, Pierre Fabre, Lilly, BAXTER, and ABBOTT; funding for educational or research programs from Roche, Lilly and MSD, as well as payment of travel/accommodation expenses from Roche, Merck, Sanofi, Pierre Fabre, and MSD. Ethical approval: The manuscript does not contain clinical studies or patient data. Consent to participate: Not applicable. Consent to publish: Not applicable., (© 2024. The Author(s).)

Background and Aims: Training in interventional endoscopy is offered by nonaccredited advanced endoscopy fellowship programs (AEFPs). The number of these programs has increased dramatically with a concurrent increase in the breadth and complexity of interventional endoscopy procedures. Accreditation is governed by competency-based education, yet what constitutes a "high-quality" nonaccredited AEFP has not been defined. Using an evidence-based consensus process, we aimed to establish standards for AEFPs., Methods: The RAND UCLA appropriateness method, a well-described modified Delphi process to develop quality indicators, was used. A task force established by the American Society for Gastrointestinal Endoscopy drafted potential quality indicators (structure, process, and outcome) in 6 categories: activity preceding training; structure of AEFPs; training in ERCP, EUS, and EMR; and luminal stent placement. Three rounds of iterative feedback from 20 experts were conducted. Round 0 involved discussion of project details. In round 1, experts independently ranked proposed quality indicators on a 9-point interval scale ranging from highly inappropriate (1) to highly appropriate (9). Next, proposed quality indicators were discussed and reworded in a group meeting followed by round 2, in which experts independently reranked proposed quality indicators and provided benchmarks (when applicable). The median score for each quality indicator was calculated. Mean absolute deviation from the median was calculated, and appropriateness of potential quality indicators was assessed using the BIOMED concerted action on appropriateness definition, P value method, and interpercentile range adjusted for symmetry definition. A quality indicator was deemed appropriate if the median score was ≥7 and met criteria for appropriateness using all 3 defined statistical methods., Results: Of 89 proposed quality indicators, 37 statements met criteria as appropriate for a quality indicator (activity preceding training, 2; structure of AEFPs, 10; training in ERCP, 7; training in EUS, 8; training in EMR, 7; luminal stent placement, 3). Minimum thresholds were defined for 19 relevant quality indicators for number of trainers, procedures during fellowship, and procedures before assessment of competence. Among the final appropriate quality indicators were that all trainees should undergo qualitative and quantitative competence assessments using validated tools at least quarterly with documented feedback throughout the training period and that trainees should track outcomes and relevant quality metrics for specific procedures., Conclusions: This consensus process using validated methodology established standards for an AEFP in an effort to ensure adequate training in the most commonly taught interventional endoscopic procedures (ERCP, EUS, EMR, and luminal stent placement) during fellowship. An important component of an AEFP is the use of competency-based assessments that are compliant with the Accreditation Council for Graduate Medical Education's Next Accreditation System, with the goal of ensuring that trainees achieve specific milestones in their progression to achieving cognitive and technical competency., Competing Interests: Disclosure The following authors disclosed financial relationships: G. A. Cote: Consultant for Interpace Diagnostics and Olympus Corporation; research support from Abbvie Pharmaceuticals. R. N. Keswani: Consultant for Medtronic and Boston Scientific. R. H. Yadlapati: Consultant for Medtronic, Phathom Pharmaceuticals, and StatLinkMD; research support from Ironwood Pharmaceuticals; advisory board with stock options in RJS Mediagnostix. T. M. Berzin: Consultant for Medtronic, Boston Scientific, Wision AI, Magentiq Eye, and RSIP Vision. P. Chahal: Consultant for Boston Scientific and Medtronic. J. Cohen: Consultant for Olympus America and Micro-Tech; stock owner in GI Windows, Virtual Health Partners, and Rom-Tech; owner of MD Medical Navigators. W. J. Coyle: Speaker for Abbvie, Pharm and Regeneron, and Pharm D. Early: Scientific advisory board for Guardant Health. N. M. Guda: Consultant for Boston Scientific and Hemostasis Inc LLC; speaker for Lupin Pharmaceuticals, India. S. Inamdar: Consultant for Pentax Medical. E. J. Shin: Consultant for Boston Scientific. U. D. Siddiqui: Consultant and speaker for Olympus, Boston Scientific, ConMed, Medtronic, and Cook Medical; research support from Olympus and Boston Scientific. All other authors disclosed no financial relationships., (Copyright © 2025 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)