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* Context.--Mesothelioma is an uncommon tumor that can be difficult to diagnose. Objective.--To provide updated, practical guidelines for the pathologic diagnosis of mesothelioma. Data Sources.--Pathologists involved in the International Mesothelioma Interest Group and others with expertise in mesothelioma contributed to this update. Reference material includes peer-reviewed publications and textbooks. Conclusions.--There was consensus opinion regarding guidelines for (1) histomorphologic diagnosis of mesothelial tumors, including distinction of epithelioid, biphasic, and sarcomatoid mesothelioma; recognition of morphologic variants and patterns; and recognition of common morphologic pitfalls; (2) molecular pathogenesis of mesothelioma; (3) application of immunohistochemical markers to establish mesothelial lineage and distinguish mesothelioma from common morphologic differentials; (4) application of ancillary studies to distinguish benign from malignant mesothelial proliferations, including BAP1 and MTAP immunostains; novel immunomarkers such as Merlin and p53; fluorescence in situ hybridization (FISH) for homozygous deletion of CDKN2A; and novel molecular assays; (5) practical recommendations for routine reporting of mesothelioma, including grading epithelioid mesothelioma and other prognostic parameters; (6) diagnosis of mesothelioma in situ; (7) cytologic diagnosis of mesothelioma, including use of immunostains and molecular assays; and (8) features of nonmalignant peritoneal mesothelial lesions. (Arch Pathol Lab Med. 2024;148:1251-1271; doi: 10.5858/arpa.2023-0304-RA), Pathologic diagnosis of mesothelioma continues to evolve. These updated guidelines (1) reflect the authors' expert opinion, informed by a thorough review of relevant literature. The contents were discussed at the [...]

The World Health Organization (WHO) plays an Important role In developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE- Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations. [phrase omitted] L'Organisation mondiale de la Sante (OMS) joue un role crucial dans l'elaboration de lignes directrices ethiques et fondees sur des donnees factuelles qui viennent soutenir le personnel de sante, les gestionnaires de programmes et les responsables politiques, en particulier dans les pays qui ne disposent pas de capacites suffisantes pour developper les leurs. Bien que la mise au point de ces lignes directrices suive des methodes rigoureuses, il est souvent indispensable de contextualiser les recommandations pour les rendre applicables, faisables et acceptables a l'echelle nationale. Ladaptation et l'adoption de lignes directrices mondiales doivent s'effectuer en toute transparence, de maniere systematique et participative, en vue de preserver leur credibilite tout en assurant le niveau d'implication necessaire a leur deploiement. Ce document s'appuie sur un exemple provenant d'Estonie pour illustrer le processus, les exigences et les resultats lies a la mise en pratique de lignes directrices emises par l'OMS grace a une contextualisation efficace. Le travail realise en Estonie a montre que cette contextualisation pouvait reduire le temps consacre au developpement de la ligne directrice et faire baisser les couts. Afin d'aider les pays a adapter les lignes directrices, notamment celles elaborees par l'OMS, a chaque contexte local tout en conservant leur fiabilite et leur pertinence, le Bureau regional de l'OMS pour l'Europe a redige un manuel qui s'inspire de l'approche GRADEAdolopment pour guider ce processus. En outre, une evaluation rapide de 21 des 53 Etats Membres de la Region europeenne de l'OMS a revele que nombre d'entre eux avaient besoin d'assistance et de conseils pour developper leurs capacites de contextualisation des lignes directrices. Nous suggerons, pour combler les lacunes, une strategie constituee de quatre axes pour la poursuite des travaux: la standardisation des methodes, l'institutionnalisation des initiatives et programmes relatifs aux lignes directrices, la promotion d'un apprentissage commun et continu, ainsi que la mise a disposition d'un soutien et l'identification des ressources. Renforcer les capacites des pays a contextualiser les lignes directrices mondiales est essentiel et revetira une importance particuliere face a de futures menaces sanitaires telles que les pandemies, le changement climatique et les situations de conflit. [phrase omitted] La Organizacion Mundial de la Salud (OMS) desempena una funcion importante en la elaboracion de directrices basadas en evidencias y solidas desde el punto de vista etico para ayudar al personal sanitario, los gestores de programas y los responsables de formular politicas, sobre todo en paises que tienen una capacidad limitada para crear sus propias directrices. Aunque la elaboracion de estas directrices sigue metodos rigurosos, suele ser necesario contextualizar las recomendaciones para asegurar su aplicabilidad, viabilidad y aceptabilidad a nivel nacional. La adaptacion y la adopcion de directrices mundiales deben realizarse de forma transparente, sistematica y participativa para mantener la credibilidad y asegurar al mismo tiempo la apropiacion necesaria para su implementacion. En este documento, se presenta un ejemplo de Estonia que muestra el proceso, los requisitos y los resultados de la aplicacion de las directrices de la OMS mediante una contextualizacion efectiva. El trabajo realizado en Estonia demostro que la contextualizacion puede acortar el tiempo de elaboracion de las directrices y reducir los costes. Para ayudar a los paises a adaptar las directrices, incluidas las elaboradas por la OMS, a los contextos locales, manteniendo al mismo tiempo su fiabilidad y pertinencia, la Oficina Regional para Europa de la OMS ha elaborado un manual basado en el enfoque GRADE-Adolopment para orientar este proceso. Ademas, una evaluacion rapida de 21 de los 53 Estados Miembros de la Region de Europa de la OMS revelo que muchos paises necesitan orientacion y apoyo para crear capacidad a fin de contextualizar las directrices. Para abordar las carencias de capacidad, se sugiere una via de avance que abarca cuatro areas de trabajo ulterior: estandarizar metodos, institucionalizar programas e iniciativas de directrices, promover el aprendizaje continuo y compartido, y proporcionar apoyo e identificar recursos. El refuerzo de las capacidades de los paises para contextualizar las directrices mundiales es crucial y sera de especial relevancia durante futuras amenazas para la salud, como las pandemias, el cambio climatico y las situaciones de conflicto., Introduction The World Health Organization (WHO) has the mandate to develop guidelines and provide recommendations under its normative and global standard-setting function. (1) These guidelines assist health workers, programme managers [...]

Author(s): Santosh Sharma [1]; Tuhin Mistry (corresponding author) [2]; Kartik Sonawane [2] Dear Editor, The superficial parasternal intercostal plane block (SPIPB), formerly the pecto-intercostal fascial plane block, is a valuable [...]

Dr Raed Habach does not miss the drama. An emergency clinician and trauma team lead at the Emergency Medicine Institute in Chisinau, Moldova, he vividly remembers the kinds of situation [...]

Author(s): Peter Hutten-Czapski (corresponding author) [1] Guidelines are often promulgated by specialists and special interests without regard to the fact that the adoption of any guideline is balanced by the [...]

Background In biomedical research, it is often desirable to seek consensus among individuals who have differing perspectives and experience. This is important when evidence is emerging, inconsistent, limited, or absent. Even when research evidence is abundant, clinical recommendations, policy decisions, and priority-setting may still require agreement from multiple, sometimes ideologically opposed parties. Despite their prominence and influence on key decisions, consensus methods are often poorly reported. Our aim was to develop the first reporting guideline dedicated to and applicable to all consensus methods used in biomedical research regardless of the objective of the consensus process, called ACCORD (ACcurate COnsensus Reporting Document). Methods and findings We followed methodology recommended by the EQUATOR Network for the development of reporting guidelines: a systematic review was followed by a Delphi process and meetings to finalize the ACCORD checklist. The preliminary checklist was drawn from the systematic review of existing literature on the quality of reporting of consensus methods and suggestions from the Steering Committee. A Delphi panel (n = 72) was recruited with representation from 6 continents and a broad range of experience, including clinical, research, policy, and patient perspectives. The 3 rounds of the Delphi process were completed by 58, 54, and 51 panelists. The preliminary checklist of 56 items was refined to a final checklist of 35 items relating to the article title (n = 1), introduction (n = 3), methods (n = 21), results (n = 5), discussion (n = 2), and other information (n = 3). Conclusions The ACCORD checklist is the first reporting guideline applicable to all consensus-based studies. It will support authors in writing accurate, detailed manuscripts, thereby improving the completeness and transparency of reporting and providing readers with clarity regarding the methods used to reach agreement. Furthermore, the checklist will make the rigor of the consensus methods used to guide the recommendations clear for readers. Reporting consensus studies with greater clarity and transparency may enhance trust in the recommendations made by consensus panels., Author(s): William T. Gattrell 1,*, Patricia Logullo 2, Esther J. van Zuuren 3, Amy Price 4, Ellen L. Hughes 5, Paul Blazey 6, Christopher C. Winchester 7,8, David Tovey 9, [...]

A medical malpractice lawsuit may be brought against health care providers, if there was a possibility of a negligence, or failure to meet the standard of care. Recently, clinical practice guidelines have increasingly been used as evidence of the standard of care. Nevertheless, it is not clear whether these guidelines can be used as evidence of the standard of care. We carried out a snapshot study to know whether or not there were dissociations between the current standard of anesthesia care and recommendations made by clinical practice guidelines. We asked all the 80 heads of Anesthesiology departments of Japanese public and private Universities, to answer questions related to difficult airway management after induction of anesthesia, postoperative monitoring of breathing, and of the presence or the absence of neuropathy of the lower legs after regional anesthesia. The response rate was 71% (57/80). The majority of anesthesiologists had little experience with front-of-neck access in patient, and responders might frequently make repeated attempts at tracheal intubation. Postoperative monitoring was frequently not routinely performed. In conclusion, this study has shown that there may be various degrees of dissociations between the current standard of anesthesia care and the recommendations made by clinical practice guidelines that had been used as evidence of the standard of care in medical malpractice lawsuit cases in Japan., Author(s): Takero Arai [sup.1], Takashi Asai [sup.1], Yasuhisa Okuda [sup.1] Author Affiliations: (1) grid.416093.9, Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, , 2-1-50 Minamikoshigaya, 343-8555, Koshigaya, Saitama, Japan [...]

Background HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, 'Which demand creation strategies are effective for enhancing uptake of HTS?' focused on populations globally. Methods and findings The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane's risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk [RR]: 2.01, 95% confidence interval [CI]: [1.30, 3.09], p < 0.05; risk difference [RD]: 0.29, 95% CI [0.16, 0.43], p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI [1.02, 3.86], p < 0.05; RD: 0.12, 95% CI [0.03, 0.21], p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI [1.15, 2.15], p < 0.05; RD: 0.18, 95% CI [0.06, 0.31], p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI [1.07, 2.20], p < 0.05; RD: 0.17, 95% CI [0.00, 0.34], p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI [1.09, 2.16], p < 0.05; RD: 0.11, 95% CI [0.03, 0.19], p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI [1.21, 1.91], p < 0.05; RD: 0.15, 95% CI [0.07, 0.22], p < 0.05, N = 11 RCTs) all significantly and importantly ([greater than or equal to]50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly ( Conclusions Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas., Author(s): Anjuli D. Wagner 1,*, Irene N. Njuguna 1,2, Jillian Neary 3, Kendall A. Lawley 3, Diana K. N. Louden 4, Ruchi Tiwari 1, Wenwen Jiang 3, Ngozi Kalu 5, [...]