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The report of an imaging procedure is a critical component of an examination, being the final and often the only communication from the interpreting physician to the referring or treating physician. Very limited evidence and few recommendations or guidelines on reporting imaging studies are available; therefore, an European position statement on how to report nuclear cardiology might be useful. The current paper combines the limited existing evidence with expert consensus, previously published recommendations as well as current clinical practices. For all the applications discussed in this paper (myocardial perfusion, viability, innervation, and function as acquired by single photon emission computed tomography and positron emission tomography or hybrid imaging), headings cover laboratory and patient demographics, clinical indication, tracer administration and image acquisition, findings, and conclusion of the report. The statement also discusses recommended terminology in nuclear cardiology, image display, and preliminary reports. It is hoped that this statement may lead to more attention to create well-written and standardized nuclear cardiology reports and eventually lead to improved clinical outcome. [ABSTRACT FROM AUTHOR]

Academic Medical Centres (AMCs) are important organisations for shaping healthcare. The purpose of this scoping review is to understand the scope and type of evidence related to the organisation of European AMCs. We selected the study population intending to obtain a demographic cross-section of European countries: Czech Republic, Germany, Latvia, the Netherlands, Poland, Spain, Sweden and the UK. We focused our search strategy on the relationship between medical schools and AMCs, the organisation of governing bodies, and legal ownership. We searched the bibliographic databases of PubMed and Web of Science (most recent search date 17-06-2022). To enrich the search result, we used Google search engines to conduct targeted searches for relevant websites. Our search strategy yielded 4,672 records for consideration. After screening and reviewing full-text papers, 108 sources were included. Our scoping review provided insight into the scope and type of evidence related to the organisation of European AMCs. Limited literature is available on the organisation of these AMCs. Information from national-level websites complemented the literature and provided a more complete picture of the organisation of European AMCs. We found some meta-level similarities regarding the relationship between universities and AMCs, the role of the dean and the public ownership of the medical school and the AMC. In addition, we found several reasons why a particular organisational and ownership structure was chosen. There is no uniform model for AMC organisations (apart from some meta-level similarities). Based on this study, we cannot explain the diversity in these models. Therefore, further research is needed to explain these variations. For example, by generating a set of hypotheses through in-depth case studies that also focus on the context of AMCs. These hypotheses can then be tested in a larger number of countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cardinaal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Hospital governance is broadening its orientation from cost and production controls towards 'improving performance on clinical outcomes'. Given this new focus one might assume that doctors are drawn into hospital management across OECD countries. Hospital performance in terms of patient health, quality of care and efficiency outcomes is supposed to benefit from their involvement. However, international comparative evidence supporting this idea is limited. Just a few studies indicate that there may be a positive relationship between medical doctors being part of hospital boards, and overall hospital performance. More importantly, the assumed relationship between these so-called doctor managers and hospital performance has remained a 'black-box' thus far. However, there is an increasing literature on the implementation of quality management systems in hospitals and their relation with improved performance. It seems therefore fair to assume that the relation between the involvement of doctors in hospital management and improved hospital performance is partly mediated via quality management systems. The threefold aim of this paper is to 1) perform a quick scan of the current situation with regard to doctor managers in hospital management in 19 OECD countries, 2) explore the phenomenon of doctor managers in depth in 7 OECD countries, and 3) investigate whether doctor involvement in hospital management is associated with more advanced implementation of quality management systems.Methods: This study draws both on a quick scan amongst country coordinators in OECD's Health Care Quality Indicator program, and on the DUQuE project which focused on the implementation of quality management systems in European hospitals.Results: This paper reports two main findings. First, medical doctors fulfil a broad scope of managerial roles at departmental and hospital level but only partly accompanied by formal decision making responsibilities. Second, doctor managers having more formal decision making responsibilities in strategic hospital management areas is positively associated with the level of implementation of quality management systems.Conclusions: Our findings suggest that doctors are increasingly involved in hospital management in OECD countries, and that this may lead to better implemented quality management systems, when doctors take up managerial roles and are involved in strategic management decision making. [ABSTRACT FROM AUTHOR]

Simple Summary: This opinion paper describes the regulatory hurdles for a clinical oncologist and physician scientist to activate an Investigator-Initiated Trial (IIT) before and after 2004 with German regulation as an example. Changes in legal framework with impacts on time and costs to activate a clinical trial are described. Evidence needed to reach the objective of higher patient safety and trial quality by European Union (EU) Clinical Trial Directive (CTD) 2001/20 is discussed. Shortly after the beginning of the year 2000, multiple legal changes with impacts on the regulatory framework of clinical trials became effective almost simultaneously. They included the European Union (EU) Clinical Trial Directive (CTD) 2001/20 followed by major changes in national drug laws, the change in the legal status of German University Hospitals (1998), and a new disease-related groups (DRG)-based reimbursement system for hospitals in Germany (2000). Together, these changes created enormous bureaucratic and financial inhibition of activation and conduct of academic investigator-initiated clinical trials (IIT). Examples for activating clinical trials in oncology before and after 2004 are outlined and discussed, focussing on extended time frames, the establishment of centralized responsibility structures and the exploding financial consequences. In addition, the evolution of trial numbers and the distribution of trial initiators between "commercial" and "academic" over time are discussed together with the occurrence of clinical registries. At the same time, progress in molecular biology led to a plethora of new targets for effective pharmacological therapy of life-threatening diseases such as cancer, and the overall number of clinical trials has not decreased. Yet, judging the regulatory and administrative hurdles between scientific study design and first-patient on trial before and after 2004 and weighing these against the lack of evidence that this regulation has achieved its goal to enhance patient safety and trial quality, the necessity to completely overhaul this CTD becomes obvious. A main goal of such an initiative should be to minimize bureaucracy. For the specific situation in Germany, relocation of responsibility and freedom to operate in University Hospitals and Medical Faculties back to the physician–scientists and reduction in interference by legal divisions should be a goal as well as increasing the public financial support for IITs. [ABSTRACT FROM AUTHOR]

The article presents the authors' reply to a letter from D. Meyre regarding their systematic review and meta-analysis on the associations of variants of proprotein convertase subtilisine/kexin type I gene (PCSKI) with obesity. The reply addresses Meyre's criticisms of what he perceives as errors in the paper including an assertion that meta-analysis included 2 overlapping cohorts and suggestion that the analysis was underpowered to find significant association of rs632 with body mass index.

Background and Objectives: Cardiac rehabilitation (CR) plays an essential role in peripheral artery disease (PAD), leading to improved functional status, increased quality of life, and reduced arterial stiffness. We aimed to assess factors associated with clinical improvement 6 months after enrolment in a rehabilitation program at an academic medical center in north-eastern Europe. Materials and Methods: We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. At the 6-months follow-up, 75 patients (77.3%) showed improved clinical status. We analyzed demographics and clinical and paraclinical parameters in order to explore factors associated with a favorable outcome. Results: Hypertension (p = 0.002), diabetes mellitus (p = 0.002), dyslipidemia (p = 0.045), and obesity (p = 0.564) were associated with no clinical improvement. Smoking cessation (p < 0.001), changing sedentary lifestyle (p = 0.032), and improvement of lipid and carbohydrate profile as well as functional status parameters and ambulatory arterial stiffness index (p = 0.008) were factors associated with clinical improvement at the 6-months follow-up. Conclusions: PAD patients require an integrative, multidisciplinary management to maintain functional status and increase quality of life. Improving carbohydrate and lipid profile, adopting a healthy lifestyle, quitting smoking and increasing exercise capacity are predictors for clinical improvement 6 months after enrolment in a CR program. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the practice of extracorporeal shockwave lithotripsy (ESWL) treatment from different aspects (indications, technical, and equipment-related characteristics) through a questionnaire response by the experienced endourologist in the European centers. Materials and Methods: A survey of 72 questions on four main topics was prepared by our team to evaluate the demographics of technical equipment, treatment applications, and pretreatment preparations. The survey was mailed to 200 endourologists, of whom 97 academic endourologists enrolled, 75% of them were from university or training hospitals and 69% have experience of >10 years in urology. Results: Of the urologist, 74% had direct access to ESWL-device, and the endourologist was mainly responsible for the ESWL unit with the 61% rate and was secondly the technician, which was trained on ESWL (25%). The factors that affect the decision for ESWL include the stone's size, location, density, composition, and kidney anatomy. Stone density was the most preferred for the ESWL decision and the cut-off value was <1000 hounsfield unit for the 71% of endourologists. Increased oral hydration and medical expulsive treatments were commonly used and recommended after the ESWL session. Routine antibiotic prophylaxis was not used by most of the endourologists (45%), and ureteroscopy (39%) was the most responded approach after steinstrasse formation. Conclusion: Survey answers revealed that most of the experienced European endourologists decide to treatment alternatives following the suggested guidelines and ESWL is still a valuable option for urinary stone treatment. [ABSTRACT FROM AUTHOR]

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Celiac disease is an autoimmune disorder that affects genetically predisposed individuals upon the ingestion of gluten. It is now considered one of the most common genetic disorders in Europe and Asian Pacific region with a prevalence of up to 2.67% of the population. The true prevalence of celiac disease may still be underestimated. Studies remain limited by sample size and selection bias. Celiac disease predisposes to the development of gastrointestinal malignancies, especially lymphomas and small bowel adenocarcinoma. The risk of developing a celiac disease associated malignancies remains uncertain, despite numerous studies. In Middle Eastern countries, the literature regarding celiac disease has expanded significantly in recent years. These studies reported have largely concentrated on the epidemiology of Celiac disease and there is an absolute and relative paucity of published research regarding celiac disease associated malignancy. The aim of this article is to review the current literature and evaluate the risk of gastrointestinal malignancies among patients with celiac disease and then review studies from the Asian Pacific region of the world. [ABSTRACT FROM AUTHOR]

The article presents a study that examines the effectiveness of mortality evaluation on patients with prostate cancer. It describes the method of the study that uses estimation procedure in the expected number of deaths related to prostate cancer diagnoses. It outlines the findings of the study which indicates that attendees have lower all-cause mortality rate and higher probability of prostate cancer compared to non-attendees.

OBJECTIVE Training in cardiothoracic surgery across Europe remains diverse and variable despite the ever closer integration of European countries at all levels and in all areas of life. Coupled with the increasing ease of movement across Europe, the need for uniform training programmes has arisen to allow for equivalent accreditation and certification. METHODS We review the current training paradigms within the specialty across the world and in Europe and also explore the concept of competence. RESULTS There are diverse training systems across the world and in Europe in particular. Competence-based training is the new model of training; however, competence remains difficult to define and measure. We propose a European Training Programme in Cardiothoracic Surgery that aims to standardize training across the European countries. CONCLUSIONS The difficulties in unifying training across Europe are numerous, but it is time to implement a European Training System in Cardiothoracic Surgery that will deliver a competence-based curriculum. [ABSTRACT FROM AUTHOR]

Background: Academic Medical Centers (AMCs) are organizations that link three functions: providing highly specialized medical services, teaching activities and conducting research. The aim of the study was to provide an international comparison of the governance and organization models of AMCs. The analysis covered 10 European countries (Cyprus, Czechia, Denmark, Germany, Italy, Latvia, Netherlands, Norway, Poland, Spain) and Israel. Methods: The study has an explorative and descriptive character. The methods involved: (1) the creation of a conceptual framework; (2) the development of a dedicated questionnaire; (3) data collection and analysis. The data was collected based on purposive sampling. There were 26 respondents from 11 countries. Results: There is no standardized definition of AMCs across countries. Different types of hospital providers do link patientcare, teaching and research. Depending on the country and particular institution, the balance between these three functions, as well as the scope might vary a lot. The majority of the participating countries face either public or not-for-profit ownership for AMCs and medical faculties. However, the relationship between hospital and faculty varies substantially. Main internal governance challenges focus on lack of responsiveness to change and financial conflicts between the three core tasks. External challenges relate to financial sustainability and workforce shortages. Most respondents believe that in the nearby future the governance of AMCs will evolve to a more functionally integrated model of the three functions. Conclusions: The study fills the gap in the literature on organization and governance of European AMCs. Although, there are substantial differences in the models of governance across countries, many challenges are highly similar. This raises important questions for future research (e.g. focusing solely on one function) as well as policy (the potential for cross-national learning). Key messages:· There is no standardized definition of AMCs across countries and different types of organizations are used to link the three functions of providing patientcare, teaching activities and research. · Despite the organizational and legal differences, AMCs in different countries face similar challenges (nimbleness and financial conflicts between the three functions; health workforce shortages). [ABSTRACT FROM AUTHOR]

Consumers and patients are unsure of whom to trust for nutritional advice. Although medical doctors are seen as experts in nutrition and their advice is regularly followed, data are lacking on the amount of nutrition education in European medical school curricula. In line with US research, we distributed a survey on required and/or optional nutrition contact hours to medical education directors of all accredited medical schools (N=217) in Western European Union countries (N=14). In total, respondents from 32 medical schools (14.7%) from 10 countries indicated that nutrition education, in some form, was required in 68.8% of schools where, on average, 23.68 h of required nutrition education was provided. The results from this small-scale survey are comparable to a 2010 US study; conversely, European educators were satisfied with the amount of nutrition education. We substantiate the increasing concern over the inadequate amounts of nutrition education provided to medical students in Europe. [ABSTRACT FROM AUTHOR]