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Malnutrition in cancer patients is the result of a variety of factors. Decreased intake, absorption disorders, metabolic disorders and increased REE are the main causes of malnutrition. The incidence of malnutrition in cancer patients is higher than that in patients with benign diseases, and the consequences are more serious. Malnourished cancer patients have more comorbidities and complications, higher medical costs, shorter survival times, and decreased tolerance and sensitivity to tumor-control therapy. Therefore, cancer patients are in greater need of nutrition therapy, which should become a necessary basic treatment and a first-line treatment for cancer. NST should be the core member of the multidisciplinary integrated treatment [multidisciplinary treatment (MDT) to holistic integrative management (HIM)] of cancer. [ABSTRACT FROM AUTHOR]

Infertility management and measures to reduce its prevalence are of considerable importance. In recent years, knowledge translation has been emphasized and prioritized in various fields, especially medical sciences, as a means to improve the health of communities. The purpose of this study is to describe the application of knowledge translation in the field of infertility. The necessary measures for effective infertility management are situated within four main areas: building a culture of awareness around infertility, preventing infertility, diagnosing infertility, and treating infertility. Implementing knowledge translation within each of these areas represents an essential and effective step toward reducing infertility prevalence. One of the most influential knowledge translation tools for building awareness and shaping culture is the media, which can play a critical role in educating the public. Infertility is caused by a variety of factors, including some that are specific to men (e.g., developmental diseases in male children), others specific to women (e.g., ovulatory disorders), and factors affecting both sexes (e.g., sexually transmitted diseases). Therefore, providing comprehensive education and increasing community awareness in these areas are crucial steps for infertility prevention. Despite advancements in infertility treatments, many individuals remain unaware of available options. Enhancing public knowledge of treatment methods, including fertility preservation strategies such as ovarian and egg freezing, is essential. Furthermore, raising awareness about issues such as insurance coverage for infertility treatments is equally important, as economic constraints are often significant barriers to seeking care. Additionally, certain aspects of infertility treatment, such as third-party reproduction, warrant focused attention from policymakers and officials. Through the development of strategic policy briefs by experts, policymakers can establish effective frameworks to address these challenges. In conclusion, utilizing knowledge translation tools such as raising awareness through the media, developing strategic policy briefs, and creating evidence-based guidelines by researchers and specialists in infertility management is a critical step toward reducing infertility prevalence and improving overall community health. [ABSTRACT FROM AUTHOR]

Abstract Malnutrition in cancer patients is the result of a variety of factors. Decreased intake, absorption disorders, metabolic disorders and increased REE are the main causes of malnutrition. The incidence of malnutrition in cancer patients is higher than that in patients with benign diseases, and the consequences are more serious. Malnourished cancer patients have more comorbidities and complications, higher medical costs, shorter survival times, and decreased tolerance and sensitivity to tumor-control therapy. Therefore, cancer patients are in greater need of nutrition therapy, which should become a necessary basic treatment and a first-line treatment for cancer. NST should be the core member of the multidisciplinary integrated treatment [multidisciplinary treatment (MDT) to holistic integrative management (HIM)] of cancer.

Abstract Background The postpartum period is a vital time for women, infants, spouses, parents, caregivers and families. Considering the importance of postpartum care and the necessity of using comprehensive and up-to-date clinical guidelines in Iran, this study was designed to implement a indigenized clinical guideline in Iran on maternal outcomes, including maternal functioning, postpartum depression and postpartum specific anxiety (primary outcomes) as well as infant care, maternal health problems, experiencing violence, feeding method and contraception use (secondary outcomes). Methods This randomized controlled trial was conducted with 272 postpartum women in Taleghani and Alzahra hospitals in Tabriz in 2023. Participants were randomly allocated to intervention and control groups. The intervention group received care and training based on clinical guideline while the control group received routine care and training. Both groups were followed up by telephone at the second and sixth week after delivery. Questionnaires assessing maternal health problems and postpartum depression were completed in the second and sixth weeks and while assessments of maternal functioning, postpartum depression, postpartum specific anxiety, infant care behavior, and experiences of violence were conducted in the sixth week after delivery. ANCOVA, independent-t tests, and Mann-Whitney U tests were used for data analysis. Results There was no significant difference between the two groups regarding of socio-demographic characteristics (P

Context The Xihuang pill (XHP) is a traditional Chinese medicine formulation that has been historically used in the prevention and treatment of proliferative breast diseases. However, there is a lack of guidelines that offer recommendations for its clinical use.Objective The task force from the Chinese Guangdong Pharmaceutical Association aims to develop evidence-based guidelines for XHP to prevent and treat proliferative breast diseases.Methods We searched six Chinese and English electronic databases, including the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Wanfang Medical Database, PubMed, and Embase, up to November 1, 2022. Publications (case reports, clinical observation, clinical trials, reviews) on using XHP to treat proliferative breast diseases were manually searched. The search terms were Xihuang pill, hyperplasia of the mammary gland, breast lump, and mastalgia. The writing team developed recommendations based on the best available evidence.Results Treatment should be customized based on syndrome identification. We recommend using XHP for the prevention and treatment of breast hyperplasia disease when a patient presents the following syndromes: concurrent blood stasis syndrome, concurrent phlegm-stasis syndrome, and concurrent liver fire syndrome. Safety indicators, including blood analysis and liver and kidney function monitoring, should be performed regularly during treatment.Conclusions Current clinical evidence suggests that XHP can be used as a standalone treatment or in conjunction with other medications to prevent and manage breast hyperplasia diseases. More randomized controlled studies are warranted to establish high-quality evidence of its use.

Abstract Background Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines. Methods Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs. Results We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines. Conclusions Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well.

Abstract Prostate cancer (PC) is an epithelial malignancy occurring in the prostate. PC ranks second in incidence among all male malignancies globally by the latest statistics from the World Health Organization. Notably, China has seen a more rapid increase in PC incidence compared to developed European and American nations. By 2022, the newly reported cases and deaths due to PC in China increased to 134,200 and 47,500, respectively. Thus, early diagnosis and standardized treatment for prostate cancer in China remain far-reaching objectives. Burgeoning research on advanced PC and castration-resistant prostate cancer in recent years have paved the way for a new era of integrated treatment methods including novel endocrine drugs, chemotherapy, targeted therapy, and immunotherapy. Future therapies involve precision treatment guided by genetic testing and individualized integrated treatment as part of a multidisciplinary integrated diagnosis and treatment model for PC. The Genitourinary Oncology Committee of the China Anti-Cancer Association (CACA-GU) has invited multidisciplinary experts across fields including surgery, oncology, pathology, radiology, herbal medicine, physiatry, and psychology to collaboratively write, discuss, and revise guidelines on managing PC. The CACA Guidelines for Holistic Integrative Management of Prostate Cancer includes epidemiology, screening and diagnosis, treatment for localized PC, diagnosis and treatment of PC recurrence after radical prostatectomy, management of metastatic PC, traditional Chinese medicine diagnosis and treatment of PC, and rehabilitation from PC. This guideline aims to standardize the clinical diagnosis and treatment management of PC in China. It is more aligned with China’s clinical practice, highlights Chinese characteristics, and bears significant clinical importance.

Background: The postpartum period is a vital time for women, infants, spouses, parents, caregivers and families. Considering the importance of postpartum care and the necessity of using comprehensive and up-to-date clinical guidelines in Iran, this study was designed to implement a indigenized clinical guideline in Iran on maternal outcomes, including maternal functioning, postpartum depression and postpartum specific anxiety (primary outcomes) as well as infant care, maternal health problems, experiencing violence, feeding method and contraception use (secondary outcomes). Methods: This randomized controlled trial was conducted with 272 postpartum women in Taleghani and Alzahra hospitals in Tabriz in 2023. Participants were randomly allocated to intervention and control groups. The intervention group received care and training based on clinical guideline while the control group received routine care and training. Both groups were followed up by telephone at the second and sixth week after delivery. Questionnaires assessing maternal health problems and postpartum depression were completed in the second and sixth weeks and while assessments of maternal functioning, postpartum depression, postpartum specific anxiety, infant care behavior, and experiences of violence were conducted in the sixth week after delivery. ANCOVA, independent-t tests, and Mann-Whitney U tests were used for data analysis. Results: There was no significant difference between the two groups regarding of socio-demographic characteristics (P < 0.05). Additionally, there were no significant differences in the mean score of maternal functioning, anxiety, depression, infant care behavior or experiences of violence after the intervention between the intervention and control groups based on ANCOVA or Mann-Whitney U tests (P < 0.05). However, the rate of infant formula use was significantly lower in the intervention group (12.9%) compared to the control group (23.4%) (P = 0.027). In terms of contraceptive methods used, 24.3% of the intervention group and 22.2% of the control group reported using reliable contraceptive methods)P = 0.035(. Furthermore, 98.5% of participants in the intervention group expressed satisfaction with the education and recommendations provided, compared to 88.2% in the control group (P = 0.002). Conclusion: Providing clinical guideline-based care was associated with increased breastfeeding rates, greater use of reliable contraception methods, and higher levels of maternal satisfaction. However, it did not have a significant impact on other maternal outcomes. Trial registration: Iranian Registry of Clinical Trials (IRCT) IRCT20120718010324N76 Date of registration 27/1/2023. URL: https://trialsearch.who.int/Trial2.aspx? TrialID: IRCT20120718010324N76 Date of first registration: 27/3/2023. [ABSTRACT FROM AUTHOR]

Purpose: A comprehensive understanding of neural distribution within the vastus medialis is crucial for the effective administration of botulinum neurotoxin injections to manage spasticity. The aim of this study was to develop an anatomically informed approach to guide the administration of botulinum neurotoxin injections into the vastus medialis muscle. Methods: Using a modified Sihler's method, we examined the vastus medialis muscles (20 specimens) to delineate the distribution of nerves relative to a transverse line extending from the anterior superior iliac spine to the base of patella. The vastus medialis muscle was divided into 10 areas from top to bottom. Then, using two fresh cadavers, ultrasonography-guided injections were performed based on the distribution of nerves within the vastus medialis. Each specimen was subsequently dissected to verify if the dye was accurately directed to the most densely innervated regions of the vastus medialis and to assess the precision of the injections. Results: The intramuscular nerve distribution within the vastus medialis muscle showed distinct patterns, particularly in areas between 6 and 9. Four injections were successfully administered on each side, targeting the regions between 6 and 9 of the vastus medialis. Upon dissection of the cadavers, the dye was found to be distributed along the muscle fiber. Conclusion: We recommend targeting botulinum neurotoxin injections toward regions displaying a prominent nerve distribution, specifically focusing on areas between 6 and 9. By adhering to these guidelines, clinicians can minimize doses and mitigate potential adverse effects, such as gait disturbances, antibody development, and bruising, resulting from multiple injections. Furthermore, these findings can be incorporated into electromyography practices. [ABSTRACT FROM AUTHOR]

Context: The Xihuang pill (XHP) is a traditional Chinese medicine formulation that has been historically used in the prevention and treatment of proliferative breast diseases. However, there is a lack of guidelines that offer recommendations for its clinical use. Objective: The task force from the Chinese Guangdong Pharmaceutical Association aims to develop evidence-based guidelines for XHP to prevent and treat proliferative breast diseases. Methods: We searched six Chinese and English electronic databases, including the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, the Wanfang Medical Database, PubMed, and Embase, up to November 1, 2022. Publications (case reports, clinical observation, clinical trials, reviews) on using XHP to treat proliferative breast diseases were manually searched. The search terms were Xihuang pill, hyperplasia of the mammary gland, breast lump, and mastalgia. The writing team developed recommendations based on the best available evidence. Results: Treatment should be customized based on syndrome identification. We recommend using XHP for the prevention and treatment of breast hyperplasia disease when a patient presents the following syndromes: concurrent blood stasis syndrome, concurrent phlegm-stasis syndrome, and concurrent liver fire syndrome. Safety indicators, including blood analysis and liver and kidney function monitoring, should be performed regularly during treatment. Conclusions: Current clinical evidence suggests that XHP can be used as a standalone treatment or in conjunction with other medications to prevent and manage breast hyperplasia diseases. More randomized controlled studies are warranted to establish high-quality evidence of its use. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines. Methods: Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs. Results: We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines. Conclusions: Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well. [ABSTRACT FROM AUTHOR]

Prostate cancer (PC) is an epithelial malignancy occurring in the prostate. PC ranks second in incidence among all male malignancies globally by the latest statistics from the World Health Organization. Notably, China has seen a more rapid increase in PC incidence compared to developed European and American nations. By 2022, the newly reported cases and deaths due to PC in China increased to 134,200 and 47,500, respectively. Thus, early diagnosis and standardized treatment for prostate cancer in China remain far-reaching objectives. Burgeoning research on advanced PC and castration-resistant prostate cancer in recent years have paved the way for a new era of integrated treatment methods including novel endocrine drugs, chemotherapy, targeted therapy, and immunotherapy. Future therapies involve precision treatment guided by genetic testing and individualized integrated treatment as part of a multidisciplinary integrated diagnosis and treatment model for PC. The Genitourinary Oncology Committee of the China Anti-Cancer Association (CACA-GU) has invited multidisciplinary experts across fields including surgery, oncology, pathology, radiology, herbal medicine, physiatry, and psychology to collaboratively write, discuss, and revise guidelines on managing PC. The CACA Guidelines for Holistic Integrative Management of Prostate Cancer includes epidemiology, screening and diagnosis, treatment for localized PC, diagnosis and treatment of PC recurrence after radical prostatectomy, management of metastatic PC, traditional Chinese medicine diagnosis and treatment of PC, and rehabilitation from PC. This guideline aims to standardize the clinical diagnosis and treatment management of PC in China. It is more aligned with China's clinical practice, highlights Chinese characteristics, and bears significant clinical importance. [ABSTRACT FROM AUTHOR]

IntroductionThis study systematically reviews and synthesizes recommendations from national and international clinical practice guidelines (CPGs) regarding the primary prevention of atherosclerotic cardiovascular disease (ASCVD) in adults in primary care settings.MethodsCPGs were retrieved from MEDLINE, Trip, guideline repositories, and websites of guidelines-producing societies. Two reviewers independently screened the guidelines for eligibility, assessed their quality, and extracted study characteristics and relevant recommendations for further consistency analysis. Recommendations, with their strength and evidence level, were thematically coded and clustered around clinical questions using ATLAS.ti.ResultsWe included 26 CPGs from which we extracted 581 recommendations on risk assessment, non-pharmacological, and pharmacological interventions. Twenty-one guidelines (81%) were rated as having “very good” methodological quality. We categorized the recommendations into 124 clusters. Forty-four clusters (35%) included consistent recommendations, but only four of them (3%) included highly consistent recommendations. These clusters emphasized avoiding routine prescriptions of nicotinic acid, aspirin, and fibrates for primary ASCVD prevention alone, and recommending 20 mg/day of atorvastatin for high-risk ASCVD patients. The recommendations also highlighted the importance of adhering to a Mediterranean-type diet, patient-centered counseling, and standardized risk assessment for patients over the age of 40.DiscussionThis review underscores the heterogeneity in primary ASCVD prevention recommendations and the importance of personalized strategies for at-risk individuals.Systematic review registrationPROSPERO, CRD42023394605, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023394605.

Spinal cord injury (SCI) is a destructive neuropathological condition characterized by the temporary or permanent impairment of spinal cord function, resulting in motor, sensory, and autonomic dysfunctions. Based on the principles of evidence-based medicine, the development of clinical practice guidelines of integrated Chinese and western medicine rehabilitation for SCI can provide clinicians with a comprehensive and standardized framework for SCI treatment and rehabilitation. This scientific, standardized and unified practice guideline covers the technical scope, normative references documents, terms and definitions, SCI classifications and clinical diagnosis, rehabilitation assessment, rehabilitation diagnosis and treatment program and treatment of common complications, etc. Rehabilitation assessment of SCI mainly includes sensory examination, motor examination, motor or sensory function rating, quality of life assessment, functional assessment and psychological function assessment (stress assessment, cognitive function assessment, and emotional state assessment). Rehabilitation diagnosis and treatment program of SCI mainly includes early treatment principles, drug therapy, physical therapy (muscle strength training, balance and gait training, aerobic exercise, electrical stimulation and other therapies), occupational therapy (joint range of motion training, activities of daily living training, resting motor skill training, upper limb function training and wheelchair skills training), assistive devices, traditional Chinese medicine therapy, including single drug therapy (ligustrazine, salvia miltiorrhiza injection, roasted nux vomica, etc.) and compound therapy (salvia miltiorrhiza ligustrazine injection, Buyang Huanwu decoction, Huoxue Tongdu decoction, erxian decoction, Yiqi Huoxue decoction and self-formulated decoction, etc.), acupuncture therapy and other therapies (new drug therapy, cell therapy, neuromodulation technology and brain-spine interface technology). Common complications of SCI include autonomic hyperreflexia, deep vein thrombosis, heterotopic ossification, orthostatic hypotension, pressure ulcers and urinary tract infection. This guideline can provide guidance for all kinds of rehabilitation institutions at all levels as well as the department of orthopedics and traumatology of traditional Chinese medicine, department of orthopedics of integrated traditional Chinese and western medicine, acupuncture and moxibustion department, Tuina department and rehabilitation medicine department in the hospitals of traditional Chinese medicine or general hospitals in China to perform SCI clinical diagnosis, rehabilitation assessment, rehabilitation treatment and treatment of common complications, with good clinical applicability, safety and effectiveness.

Abstract Background Kawasaki disease (KD) is a pyretic ailment predominantly observed in children aged below 5 years. There is currently a dearth of precise markers for timely identification of incomplete Kawasaki disease (IKD). It is imperative to develop updated, comprehensive, and evidence-based guidelines to effectively direct clinical practice. Methods The guideline development group comprised individuals with diverse expertise in both content and methodology and carried out an extensive exploration of the following digital repositories: CNKI, VIP, Wanfang Data, UpToDate, BMJ, Clinical Evidence, National Guideline Clearinghouse, Joanna Briggs Institute Library, Cochrane Library, and PubMed. The entire period from the establishment of these databases until January 1, 2024 was covered. To evaluate IKD, systematic reviews and randomised controlled trials were assessed using the risk of prejudice instrument specified in the Cochrane Handbook, along with the evidence robustness framework established by the GRADE group. The recommendations were formulated based on the findings, considering the evidence strength. After several iterations of expert consensus, the relevant professional committees in China endorsed the ultimate guideline. Results These guidelines address clinical questions regarding the classification and definition of KD, diagnosis of IKD, treatment during the acute phase of IKD, and follow-up of IKD. Conclusions To provide healthcare professionals with guidance and decision-making bases for the diagnosis and treatment of IKD in China, 13 recommendations were formulated based on expert consensus and evidence of best practices.

This study describes the multifaceted experiences of children with cancer and their parents throughout the cancer trajectory. Being a mixed method study it explores both the quantitative and qualitative aspects from children and parents point of view in a selected oncology hospital. For this research, the researcher did purposive sampling of 50 children with cancer and 50 parents of children with cancer from January 2024-June 2024. Children with first time diagnosis of Cancer (0-3 months of diagnosis) and (4-7 months of diagnosis) in two cohorts aged 12-18 years, admitted in the ward or coming to day care were selected as sample. Similarly parents of children with first time diagnosis having children in the same age group were selected. Two standardized tool were selected-Memorial Symptom Assessment Scale (MSAS) to assess the experience of children with cancer and WHO QOL BREF (AUSTRALIAN VERSION) to assess the experience of parents of a children with cancer.-In the first cohort-For the qualitative part detailed interview was taken from children and parents. The results of the study are as follows-Using MSAS "How often did you have"--In the first cohort-Feeling sad had the highest mean of 1.9. In the second cohort nausea had the highest mean of 2.2. "How severe was it usually"-in the first cohort-Feeling sad had the highest mean of 1. In the second cohort lack of energy had the highest mean of 1.5. "How severe did it DISTRES or BOTHER you?" In the first cohort feeling sad had the highest mean of 1.6, in the second cohort lack of appetite had the highest mean of 1.7. In section II of MSAS scale "How severe was it usually". In the first cohort -Hair loss had the highest mean of 1.6, in the second cohort also -hair loss had the highest mean of 1.6. For "How severe did it DISTRESS or BOTHER you?"- In the first cohort-hair loss had the highest mean of 1.4, in the second cohort also hair loss had the highest mean of 1.4. For WHO QOL (BREF) Australian Version researcher found that in the first cohort (0-3) months of diagnosis, among the four domains-Domain 4-Environment had the highest mean of 13.9. In the second cohort (4-7) months of diagnosis-Domain 3-Social relationship had the highest mean of 14.4. In the Qualitative part of the study two themes emerged after interviewing children and their parents. Progress in the initial stage of the disease, development in the treatment process. In the last part a Clinical Guideline for Psychological support in Pediatric Oncology was prepared. The results of this study suggest that it is very much important for the nursing staff working in Pediatric wards to know the experiences of children with cancer and their parents during the cancer trajectory to help them cross the difficult journey. [ABSTRACT FROM AUTHOR]

Background: Kawasaki disease (KD) is a pyretic ailment predominantly observed in children aged below 5 years. There is currently a dearth of precise markers for timely identification of incomplete Kawasaki disease (IKD). It is imperative to develop updated, comprehensive, and evidence-based guidelines to effectively direct clinical practice. Methods: The guideline development group comprised individuals with diverse expertise in both content and methodology and carried out an extensive exploration of the following digital repositories: CNKI, VIP, Wanfang Data, UpToDate, BMJ, Clinical Evidence, National Guideline Clearinghouse, Joanna Briggs Institute Library, Cochrane Library, and PubMed. The entire period from the establishment of these databases until January 1, 2024 was covered. To evaluate IKD, systematic reviews and randomised controlled trials were assessed using the risk of prejudice instrument specified in the Cochrane Handbook, along with the evidence robustness framework established by the GRADE group. The recommendations were formulated based on the findings, considering the evidence strength. After several iterations of expert consensus, the relevant professional committees in China endorsed the ultimate guideline. Results: These guidelines address clinical questions regarding the classification and definition of KD, diagnosis of IKD, treatment during the acute phase of IKD, and follow-up of IKD. Conclusions: To provide healthcare professionals with guidance and decision-making bases for the diagnosis and treatment of IKD in China, 13 recommendations were formulated based on expert consensus and evidence of best practices. [ABSTRACT FROM AUTHOR]

Marfan syndrome (MFS) is a rare congenital disorder of the connective tissue, leading to thoracic aortic aneurysms (TAA) and dissection, among other complications. Currently, the most efficient strategy to prevent life-threatening dissection is preventive surgery. Periodic imaging applying complex techniques is required to monitor TAA progression and to guide the timing of surgical intervention. Thus, there is an acute demand for non-invasive biomarkers for diagnosis and prognosis, as well as for innovative therapeutic targets of MFS. Unraveling the intricate pathomolecular mechanisms underlying the syndrome is vital to address these needs. High-throughput platforms are particularly well-suited for this purpose, as they enable the integration of different datasets, such as transcriptomic and epigenetic profiles. In this narrative review, we summarize relevant studies investigating changes in both the coding and non-coding transcriptome and epigenome in MFS-induced TAA. The collective findings highlight the implicated pathways, such as TGF-β signaling, extracellular matrix structure, inflammation, and mitochondrial dysfunction. Potential candidates as biomarkers, such as miR-200c, as well as therapeutic targets emerged, like Tfam, associated with mitochondrial respiration, or miR-632, stimulating endothelial-to-mesenchymal transition. While these discoveries are promising, rigorous and extensive validation in large patient cohorts is indispensable to confirm their clinical relevance and therapeutic potential. [ABSTRACT FROM AUTHOR]

There are many systems of rating quality of evidence and grading strength of recommendations, this may cause confusion for clinicians when reading guideline evidence and recommendations. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system is the most widely used rating system in the world. This article is to briefly introduce the evidence rating and 4 main factors of formulating recommendations in GRADE. We will use several published guidelines led by Chinese hospital pharmacy as examples to illustrate GRADE system, to help clinicians understand GRADE system and apply guideline evidence and recommendations into clinical practice with critical thinking. [ABSTRACT FROM AUTHOR]

Abstract Introduction Clinical guidelines are crucial for assisting health professionals to make correct clinical decisions. However, manual clinical guidelines are not accessible, and this increases the workload. So, a mobile-based clinical guideline application is needed to provide real-time information access. Hence, this study aimed to assess health professionals’ intention to accept mobile-based clinical guideline applications and verify the unified theory of acceptance and technology utilization model. Methods Institutional-based cross-sectional study design was used among 803 study participants. The sample size was determined based on structural equation model parameter estimation criteria with stratified random sampling. Amos version 23 software was used for analysis. Internal consistency of latent variable items, and convergent and divergent validity, were evaluated using composite reliability, AVE, and a cross-loading matrix. Model fitness of the data was assessed based on a set of criteria, and it was achieved. P-value

Current implant therapy is a frequently employed treatment for individuals who have lost teeth, as it offers functional and biological advantages over old prostheses. Concurrently, active exploration of intervention strategies aims to prevent the progression of peri-implant diseases and manage the existing peri-implant tissue damage. Indian Society of Periodontology has recognized the need for systematic documents to update the everyday clinical practice of general dental practitioners and has provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral health-care delivery across the country. The current clinical practice recommendations focused on peri-implant care to bridge the gap between academic theory and clinical practice by compiling evidence-based suggestions for preventing and treating peri-implant diseases. Twenty-eight subject experts across the country prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three sections covering peri-implant health and maintenance, peri-implant mucositis, and peri-implantitis. It will be a quick and concise reference for oral implant practitioners in patient management. The guidelines provide distinct definitions, signs, and symptoms, treatment required; recall visit specifications for plausible clinical case situations, and home-care recommendations regarding maintaining peri-implant health. The document advocates combined efforts of oral implant practitioners and the population at large with evidence-based, integrated, and comprehensive peri-implant care. By providing accessible, applicable guidance, these guidelines would empower dental professionals to uphold the well-being of implant patients and ensure the long-term success of implant therapy.

Abstract Background The postpartum is a vital period for women, newborns, spouses, parents, caregivers, and families. Regarding the importance of postpartum care and the lack of comprehensive and up-to-date clinical guidelines in the country of Iran, the postpartum clinical guidelines have been adapted. Methods Cultural adaptation was conducted in three stages. In the first stage, the adaptation team was formed and the process was approved. During the second stage, a systematic literature review was conducted using international databases to identify English-language clinical guidelines published within the last 10 years. Out of 17 guidelines and documents initially selected, 5 guidelines meeting the inclusion and exclusion criteria and published within the last 5 years were chosen following a thorough review by the search team. In the secondary selection, the guidelines were investigated by two subject-matter experts based on AGREE II Checklist, and regarding the high evaluation score obtained by the WHO Recommendations on Postnatal Care of the Mother and Newborn (2022), and the National Institute for Health and Care Excellence (NICE,2021) guideline for postnatal care were selected for cultural adaptation. In the third stage, the opinions of experts from all over the country were collected and scored using the Delphi method, and a final guideline was formulated. Results The adapted postpartum clinical guideline has offered 56 recommendations. The recommendations are categorized into four major themes including mother care, newborn care, health system and health promotion interventions and post caesarean care. Conclusion Applying evidence-based recommendations for the care of mothers and babies in the postpartum period will enhance the health system, promote the provision of care after vaginal and caesarean births, and ensure a positive postnatal experience for mothers, fathers, babies, and families.

Knowledge translation is the sharing of knowledge obtained from research with knowledge users, including community members, organizations, and policymakers, to use it to improve systems and improve the provision of services and products. The implementation of the knowledge translation process in the health field is facing challenges in our country, which is partly because of insufficient knowledge about the concept of knowledge translation and how to implement the knowledge translation process. In the present study, the definition of knowledge translation, and how the process and tools of knowledge translation were discussed, and then, while reviewing the status of knowledge translation in Iranian universities of medical sciences, solutions for the implementation of knowledge translation were presented. Some of the mentioned knowledge translation tools in this study are podcasts, three-minute thesis presentations, webinars, infographics, research news from research results, press releases, journal clubs, policy briefs, and clinical guidelines. The situation of knowledge translation has been reported as inappropriate and incomplete in medical sciences universities of Iran. In these studies, the evaluation was done using the evaluation tool of knowledge translation, which included the four areas of audience needs assessment, knowledge production, knowledge transfer, and evidence application. According to the current situation of knowledge translation, the implementation solutions of knowledge translation in each field have been presented separately. Appropriate networking between knowledge producers and knowledge users, as well as holding regular meetings with representatives of executive organizations and industry owners to determine research priorities, are among the solutions presented in the audience needs assessment section. Creating the infrastructure to carry out research projects based on the needs of the audience, allocating the necessary resources for the implementation of research projects, active participation of representatives of executive organizations in the process of conducting research, creating an internal network between academic researchers to advance research priorities as much as possible, and also pay attention to the quality of knowledge production to gain the trust of the audience are the solutions provided in the knowledge production sector. Acquainting researchers with the field of knowledge transfer and its importance, allocating resources to implement the knowledge transfer process, using appropriate and up-to-date tools for knowledge transfer by researchers, and creating rules to support researchers who, before publishing their research findings in reputable journals, publish them through other means of knowledge transfer, institutionalizing the mechanisms of benefiting from the research achievements in the general education program, and also considering the incentive plans for the transfer of the produced knowledge are among the solutions presented in the knowledge transfer section. Producing valid and reliable evidence, placing produced evidence at the disposal of policymakers, building trust in the audience by researchers, policymakers, and relevant officials to use produced evidence, informing the audience about the need to use production evidence, creating appropriate communication between knowledge producers and knowledge users through the use of knowledge brokers, the existence of resources and financial support for the use of evidence by policymakers as well as target audiences are some of the solutions provided in the use of evidence section

Background: Hypertension is a risk factor for heart and blood vessel diseases, so it is crucial to teach patients how to control their hypertension and follow up on the training implementation. Accordingly, the present study aims to examine the effect of training according to the American Heart Association (AHA) and the American College of Cardiology (ACC) clinical practice guideline, with and without follow-up through telenursing on stage 1 hypertension among older adult patients with stable angina pectoris. Methods: This is quasi-experimental research conducted in 2021 with a pre-test and post-test design and a control group. The study subjects were 59 patients with stage I hypertension suffering from stable angina pectoris who were referred to Ahmadieh Heart Clinic affiliated with Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh City, Iran. The participants were recruited by targeted sampling and were assigned into intervention (n=30) and control (n=29) groups using the balanced block randomization. Both groups underwent lifestyle modification training based on ACC/AHA clinical practice guideline. In the experimental group, follow-up was done through telenursing once a week for three months, and the control group followed the clinic’s standard services. The data were gathered using a demographic set of questions and an aneroid sphygmomanometer. The obtained data were analyzed using the t-test, chi-square test, Mann-Whitney test, Wilcoxon test, and Fisher exact test in SPSS software, version 20. The significance level was set at P

Introduction: Clinical guidelines are crucial for assisting health professionals to make correct clinical decisions. However, manual clinical guidelines are not accessible, and this increases the workload. So, a mobile-based clinical guideline application is needed to provide real-time information access. Hence, this study aimed to assess health professionals' intention to accept mobile-based clinical guideline applications and verify the unified theory of acceptance and technology utilization model. Methods: Institutional-based cross-sectional study design was used among 803 study participants. The sample size was determined based on structural equation model parameter estimation criteria with stratified random sampling. Amos version 23 software was used for analysis. Internal consistency of latent variable items, and convergent and divergent validity, were evaluated using composite reliability, AVE, and a cross-loading matrix. Model fitness of the data was assessed based on a set of criteria, and it was achieved. P-value < 0.05 was considered for assessing the formulated hypothesis. Results: Effort expectancy and social influence had a significant effect on health professionals' attitudes, with path coefficients of (β = 0.61, P-value < 0.01), and (β = 0.510, P-value < 0.01) respectively. Performance expectancy, facilitating condition, and attitude had significant effects on health professionals' acceptance of mobile-based clinical guideline applications with path coefficients of (β = 0.37, P-value < 0.001), (β = 0.44, P-value < 0.001) and (β = 0.57, P-value < 0.05) respectively. Effort expectancy and social influence were mediated by attitude and had a significant partial relationship with health professionals' acceptance of mobile-based clinical guideline application with standardized estimation coefficients of (β = 0.22, P-value = 0.027), and (β = 0.19, P-value = 0.031) respectively. All the latent variables accounted for 57% of health professionals' attitudes, and latent variables with attitudes accounted for 63% of individuals' acceptance of mobile-based clinical guideline applications. Conclusions: The unified theory of acceptance and use of the technology model was a good model for assessing individuals' acceptance of mobile-based clinical guidelines applications. So, enhancing health professionals' attitudes, and computer literacy through training are needed. Mobile application development based on user requirements is critical for technology adoption, and people's support is also important for health professionals to accept and use the application. [ABSTRACT FROM AUTHOR]

Background: Charcot neuro‐osteoarthropathy (CNO) is a rare but devastating complication of diabetes associated with high rates of morbidity; yet, many nonfoot specialists are unaware of it, resulting in missed and delayed diagnosis. Clinical practice guidelines (CPGs) have proven useful in improving quality of care and standardizing practice in diabetes and diabetic foot care. However, little is known about the consistency in recommendations for identification and management of active CNO. Aim: The aim of this study is to review European national diabetes CPGs for the diagnosis and management of active CNO and to assess their methodological rigor and transparency. Methods: A systematic search was performed to identify diabetes national CPGs across Europe. Guidelines in any language were reviewed to explore whether they provided a definition for active CNO and recommendations for diagnosis, monitoring, and management. Methodological rigor and transparency were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE‐II) tool, which comprises 23 key items organized within six domains with an overall guideline assessment score of ≥ 60% considered to be of adequate quality to recommend use. Each guideline was assessed by two reviewers, and inter‐rater agreement (Kendall's W) was calculated for AGREE‐II scores. Results: Seventeen CPGs met the inclusion criteria. Breadth of CNO content varied across guidelines (median (IQR) word count: 327; Q1 = 151; Q3 = 790), and 53% provided a definition for active CNO. Recommendations for diagnosis and monitoring were provided by 82% and 53%, respectively, with offloading being the most common management recommendation (88%). Four guidelines (24%) reached threshold for recommendation for use in clinical practice (≥ 60%) with the scope and purpose domain scoring highest (mean (SD): 67%, ± 23%). The remaining domains had average scores ranging between 19% and 53%. Inter‐rater agreement was strong (W = 0.882; p < 0.001). Conclusions: European national CPGs for diabetes provide limited recommendations on active CNO. All guidelines showcased deficits in their methodology, suggesting that more rigorous methods should be employed for diabetes CPG development across Europe. [ABSTRACT FROM AUTHOR]

Background: To appraise the quality of clinical practice guidelines for glaucoma suspects, and to assess their consistency for how a 'glaucoma suspect' is defined and their recommendations for treatment initiation for such individuals. Methods: This study included all documents that self‐identified as a 'guideline' and provided recommendation(s) for the clinical care of glaucoma suspects. The quality of eligible guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: From 1196 records retrieved from comprehensive searches and two records manually included, 20 clinical practice guidelines were deemed eligible. Based on an appraisal using the AGREE II instrument, 16 (80%) guidelines had ≤2 domains with scores >66%. Overall, the lowest scoring domains were for applicability, editorial independence and stakeholder involvement. There was relatively poor agreement across the guidelines for what defines a 'glaucoma suspect' or 'primary open angle glaucoma [POAG] suspect', as well as the recommendations and criteria for treatment initiation in these populations. There was better agreement for the definition and recommendations for treatment initiation for 'primary angle closure suspects'. Conclusions: There is substantial room to improve the methodological quality of most current international clinical guidelines for glaucoma suspects. Clinicians should consider this finding when using such guidelines to inform their care of glaucoma suspects. Substantial variation in the definition of a POAG suspect and recommendations for treatment initiation underscores important gaps in the current evidence for the accurate prediction of glaucoma development and treatment effectiveness in these individuals. [ABSTRACT FROM AUTHOR]

Knowledge translation is the sharing of knowledge obtained from research with knowledge users, including community members, organizations, and policymakers, to use it to improve systems and improve the provision of services and products. The implementation of the knowledge translation process in the health field is facing challenges in our country, which is partly because of insufficient knowledge about the concept of knowledge translation and how to implement the knowledge translation process. In the present study, the definition of knowledge translation, and how the process and tools of knowledge translation were discussed, and then, while reviewing the status of knowledge translation in Iranian universities of medical sciences, solutions for the implementation of knowledge translation were presented. Some of the mentioned knowledge translation tools in this study are podcasts, threeminute thesis presentations, webinars, infographics, research news from research results, press releases, journal clubs, policy briefs, and clinical guidelines. The situation of knowledge translation has been reported as inappropriate and incomplete in medical sciences universities of Iran. In these studies, the evaluation was done using the evaluation tool of knowledge translation, which included the four areas of audience needs assessment, knowledge production, knowledge transfer, and evidence application. According to the current situation of knowledge translation, the implementation solutions of knowledge translation in each field have been presented separately. Appropriate networking between knowledge producers and knowledge users, as well as holding regular meetings with representatives of executive organizations and industry owners to determine research priorities, are among the solutions presented in the audience needs assessment section. Creating the infrastructure to carry out research projects based on the needs of the audience, allocating the necessary resources for the implementation of research projects, active participation of representatives of executive organizations in the process of conducting research, creating an internal network between academic researchers to advance research priorities as much as possible, and also pay attention to the quality of knowledge production to gain the trust of the audience are the solutions provided in the knowledge production sector. Acquainting researchers with the field of knowledge transfer and its importance, allocating resources to implement the knowledge transfer process, using appropriate and up-to-date tools for knowledge transfer by researchers, and creating rules to support researchers who, before publishing their research findings in reputable journals, publish them through other means of knowledge transfer, institutionalizing the mechanisms of benefiting from the research achievements in the general education program, and also considering the incentive plans for the transfer of the produced knowledge are among the solutions presented in the knowledge transfer section. Producing valid and reliable evidence, placing produced evidence at the disposal of policymakers, building trust in the audience by researchers, policymakers, and relevant officials to use produced evidence, informing the audience about the need to use production evidence, creating appropriate communication between knowledge producers and knowledge users through the use of knowledge brokers, the existence of resources and financial support for the use of evidence by policymakers as well as target audiences are some of the solutions provided in the use of evidence section. [ABSTRACT FROM AUTHOR]

Will digitalised clinical guidelines be compatible with individualised and personalised patient care if the disease definitions and classifications used within them contain embedded preferences? Taking bone health as a case study, we found the dominant definition of osteoporosis installs the consensus preference judgement of a 1992 International Expert Committee in the form of a threshold cut-off on the bone mineral density continuum. We found that subsequent UK clinical guidelines follow suit on this diagnostic threshold, but also endorse preference-sensitive thresholds for interventions to prevent fractures, including ones underpinned by cost-effectiveness analysis. The resulting pre-emption of patient’s preferences needs to be removed if ‘computable’ guidelines are to be reconcilable with personalised care. The challenges to be met in digitalisation therefore include major conceptual ones as well as the technical ones that are currently the almost exclusive focus. [ABSTRACT FROM AUTHOR]

Background: The postpartum is a vital period for women, newborns, spouses, parents, caregivers, and families. Regarding the importance of postpartum care and the lack of comprehensive and up-to-date clinical guidelines in the country of Iran, the postpartum clinical guidelines have been adapted. Methods: Cultural adaptation was conducted in three stages. In the first stage, the adaptation team was formed and the process was approved. During the second stage, a systematic literature review was conducted using international databases to identify English-language clinical guidelines published within the last 10 years. Out of 17 guidelines and documents initially selected, 5 guidelines meeting the inclusion and exclusion criteria and published within the last 5 years were chosen following a thorough review by the search team. In the secondary selection, the guidelines were investigated by two subject-matter experts based on AGREE II Checklist, and regarding the high evaluation score obtained by the WHO Recommendations on Postnatal Care of the Mother and Newborn (2022), and the National Institute for Health and Care Excellence (NICE,2021) guideline for postnatal care were selected for cultural adaptation. In the third stage, the opinions of experts from all over the country were collected and scored using the Delphi method, and a final guideline was formulated. Results: The adapted postpartum clinical guideline has offered 56 recommendations. The recommendations are categorized into four major themes including mother care, newborn care, health system and health promotion interventions and post caesarean care. Conclusion: Applying evidence-based recommendations for the care of mothers and babies in the postpartum period will enhance the health system, promote the provision of care after vaginal and caesarean births, and ensure a positive postnatal experience for mothers, fathers, babies, and families. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a risk factor for heart and blood vessel diseases, so it is crucial to teach patients how to control their hypertension and follow up on the training implementation. Accordingly, the present study aims to examine the effect of training according to the American Heart Association (AHA) and the American College of Cardiology (ACC) clinical practice guideline, with and without follow-up through telenursing on stage 1 hypertension among older adult patients with stable angina pectoris. Methods: This is quasi-experimental research conducted in 2021 with a pre-test and post-test design and a control group. The study subjects were 59 patients with stage I hypertension suffering from stable angina pectoris who were referred to Ahmadieh Heart Clinic affiliated with Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh City, Iran. The participants were recruited by targeted sampling and were assigned into intervention (n=30) and control (n=29) groups using the balanced block randomization. Both groups underwent lifestyle modification training based on ACC/ AHA clinical practice guideline. In the experimental group, follow-up was done through telenursing once a week for three months, and the control group followed the clinic's standard services. The data were gathered using a demographic set of questions and an aneroid sphygmomanometer. The obtained data were analyzed using the t-test, chi-square test, Mann-Whitney test, Wilcoxon test, and Fisher exact test in SPSS software, version 20. The significance level was set at P<0.05. Results: Compared to before the intervention, systolic blood pressure (P=0.009) and diastolic blood pressure (P=0.019) of the experimental group decreased significantly after the intervention. However, no significant difference was seen in the average pulse pressure (P=0.125) of the intervention group after the intervention. After the intervention, the systolic (P=0.001) and diastolic (P=0.002) blood pressure, as well as pulse pressure (P=0.006) of the intervention group, decreased significantly compared to the control group. Conclusion: Telenursing is suggested as an efficient method of controlling and managing hypertension in older adults with stable angina pectoris. [ABSTRACT FROM AUTHOR]

Stroke is a disease in which cerebral blood vessels are damaged by a variety of causes, producing focal or overall brain tissue damage. With the acceleration of population aging and urbanization, stroke has become the leading cause of death and disability among adult residents in China. Many studies and guidelines suggest that early rehabilitation should be carried out as soon as possible for critically ill stroke patients when their vital signs are stable. Early systematic rehabilitation intervention is of great significance in improving the overall functional status, reducing the duration of mechanical ventilation, reducing the number of days of intensive care hospitalization, and reducing medical costs. The development of stroke critical care rehabilitation guidelines based on the principles of evidence-based medicine can provide clinicians with comprehensive and standardized practice guidelines. This guideline standardizes the implementation process of stroke critical care rehabilitation from the aspects of scope, definition, terminology, principles, general rules of implementation, rehabilitation content, conditions of rehabilitation implementation, and quality control of rehabilitation, forming a scientific, standardized, and unified operational guideline. The main contents include: ①principle: severe stroke rehabilitation should follow the principles of early rehabilitation, individualization, safety and control, and comprehensive intervention; ②general rules of rehabilitation implementation; ③rehabilitation implementation process: including the establishment of personal files, signing of the Informed Consent Form, assessment of rehabilitation intervention, rehabilitation assessment, formulation of rehabilitation goals and plans, implementation of rehabilitation training, assessment of rehabilitation efficacy, referral, and follow-up; ④rehabilitation content: timing of intervention, rehabilitation assessment (history), rehabilitation quality control, and rehabilitation quality control. Timing of rehabilitation intervention, rehabilitation assessment (history assessment, physical examination, laboratory examination, imaging examination, assessment of conscious state, cognitive function assessment, motor function assessment, swallowing function assessment, ADL function assessment, mental state assessment, respiratory function assessment, diarrhea function assessment, pain assessment, agitation and sedation assessment, cooperation assessment, delirium assessment, nutritional assessment, screening for deep vein thrombosis), rehabilitation goals and plan development; content of rehabilitation intervention The content of rehabilitation intervention (motor function rehabilitation, circulatory function rehabilitation, respiratory function rehabilitation, swallowing function rehabilitation, consciousness disorder rehabilitation, bladder function rehabilitation, rectal function rehabilitation, musculoskeletal joint rehabilitation, skin management, pain and agitation management, deep vein thrombosis management, shoulder subluxation management, nutritional support management), the frequency of rehabilitation interventions, rehabilitation education, the requirements of rehabilitation implementation, the evaluation of the efficacy of rehabilitation, and the indicators of suspension of rehabilitation interventions. intervention pause indicators, rehabilitation efficacy evaluation, referral, follow-up; ⑤rehabilitation implementation conditions: basic conditions, environmental and facility conditions, personnel conditions; ⑥rehabilitation quality control: rehabilitation quality control system, rehabilitation quality assessment system, service feedback mechanism, emergency plan. This guideline will effectively promote the promotion and popularization of stroke intensive rehabilitation at all levels of medical institutions in China and provide guidance for all levels of medical institutions to carry out stroke intensive rehabilitation with good clinical applicability and effectiveness.

BACKGROUND: Lumbar magnetic resonance imaging (LMRI) is often performed early in the course of care, which can be discordant with guidelines for non-serious low back pain. Our primary hypothesis was that adults receiving chiropractic spinal manipulative therapy (CSMT) for incident radicular low back pain (rLBP) would have reduced odds of early LMRI over 6-weeks follow-up compared to those receiving other care (a range of medical care, excluding CSMT). As a secondary hypothesis, CSMT recipients were also expected to have reduced odds of LMRI over 6-months and 1-years follow-up. METHODS: A national 84-million-patient health records database including large academic healthcare organizations (TriNetX) was queried for adults age 20-70 with rLBP newly-diagnosed between January 31, 2012 and January 31, 2022. Receipt or non-receipt of CSMT determined cohort allocation. Patients with prior lumbar imaging and serious pathology within 90 days of diagnosis were excluded. Propensity score matching controlled for variables associated with LMRI utilization (e.g., demographics). Odds ratios (ORs) of LMRI over 6-weeks, 6-months, and 1-years follow-up after rLBP diagnosis were calculated. RESULTS: After matching, there were 12,353 patients per cohort (mean age 50 years, 56% female), with a small but statistically significant reduction in odds of early LMRI in the CSMT compared to other care cohort over 6-weeks follow-up (9%, 10%, OR [95% CI] 0.88 [0.81-0.96] P = 0.0046). There was a small but statistically significant increase in odds of LMRI among patients in the CSMT relative to the other care cohort over 6-months (12%, 11%, OR [95% CI] 1.10 [1.02-1.19], P

Timothy Deer,1 Ankur A Patel,2 Dawood Sayed,3 Ashley Bailey-Classen,4 Ashley Comer,1 Benjamin Gill,5 Kiran Patel,6 Alaa Abd-Elsayed,7 Natalie Strand,8 Jonathan M Hagedorn,9 Zohra Hussaini,3 Nasir Khatri,10 Ryan Budwany,1 Melissa Murphy,11 Dan Nguyen,12 Vwaire Orhurhu,13 Morteza Rabii,14 Douglas Beall,15 Stephen Hochschuler,16 Michael E Schatman,17,18 Timothy Lubenow,19 Richard Guyer,16,20 Ahmed M Raslan21 1The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 2Weill Cornell Tri-Institutional Pain Medicine Program, Department of Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA; 3Department of Anesthesiology and Pain Medicine, the University of Kansas Medical Center, Kansas City, KS, USA; 4Trinity Pain Medicine Associates, Fort Worth, TX, USA; 5Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO, USA; 6Lenox Hill Hospital, Northwell Health, New York, NY, USA; 7Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; 8Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA; 9Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 10Novant Health Spine Specialists, Charlotte, NC, USA; 11North Texas Orthopedics and Spine Center, Grapevine, TX, USA; 12Neuroradiology and Pain Solutions of Oklahoma, Oklahoma City, OK, USA; 13Department of Anesthesia, University of Pittsburgh Medical Center, Susquehanna, PA, USA; 14Crimson Pain Management, Overland Park, Kansas, KS, USA; 15Comprehensive Specialty Care, Edmond, OK, USA; 16Texas Back Institute, Plano, TX, USA; 17Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 18Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA; 19Department of Anesthesiology, Rush University Medical Center, Chicago, IL, USA; 20Department of Orthopedic Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA; 21Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, USACorrespondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email dsayed@kumc.eduIntroduction: The evolution of treatment options for painful spinal disorders in diverse settings has produced a variety of approaches to patient care among clinicians from multiple professional backgrounds. The American Society of Pain and Neuroscience (ASPN) Best Practice group identified a need for a multidisciplinary guideline regarding appropriate and effective informed consent processes for spine procedures.Objective: The ASPN Informed Consent Guideline was developed to provide clinicians with a comprehensive evaluation of patient consent practices during the treatment of spine pathology.Methods: After a needs assessment, ASPN determined that best practice regarding proper informed consent for spinal procedures was needed and a process of selecting faculty was developed based on expertise, diversity, and knowledge of the subject matter. A comprehensive literature search was conducted and when appropriate, evidence grading was performed. Recommendations were based on evidence when available, and when limited, based on consensus opinion.Results: Following a comprehensive review and analysis of the available evidence, the ASPN Informed Consent Guideline group rated the literature to assist with specification of best practice regarding patient consent during the management of spine disorders.Conclusion: Careful attention to informed consent is critical in achieving an optimal outcome and properly educating patients. This process involves a discussion of risks, advantages, and alternatives to treatment. As the field of interventional pain and spine continues to grow, it is imperative that clinicians effectively educate patients and obtain comprehensive informed consent for invasive procedures. This consent should be tailored to the patient’s specific needs to ensure an essential recognition of patient autonomy and reasonable expectations of treatment.Keywords: informed consent, best practice, clinical guideline, pain medicine, spine intervention, spine surgery

IntroductionThe CAREPATH Project aims to develop a patient-centered integrated care platform tailored to older adults with multimorbidity, including mild cognitive impairment (MCI) or mild dementia. Our goal is to empower multidisciplinary care teams to craft personalized holistic care plans while adhering to evidence-based guidelines. This necessitates the creation of clear specifications for clinical decision support (CDS) services, consolidating guidance from multiple evidence-based clinical guidelines. Thus, a co-creation approach involving both clinical and technical experts is essential.MethodsThis paper outlines a robust methodology for generating implementable specifications for CDS services to automate clinical guidelines. We have established a co-creation framework to facilitate collaborative exploration of clinical guidelines between clinical experts and software engineers. We have proposed an open, repeatable, and traceable method for translating evidence-based guideline narratives into implementable specifications of CDS services. Our approach, based on international standards such as CDS-Hooks and HL7 FHIR, enhances interoperability and potential adoption of CDS services across diverse healthcare systems.ResultsThis methodology has been followed to create implementable specifications for 65 CDS services, automating CAREPATH consensus guideline consolidating guidance from 25 selected evidence-based guidelines. A total of 296 CDS rules have been formally defined, with input parameters defined as clinical concepts bound to FHIR resources and international code systems. Outputs include 346 well-defined CDS Cards, offering clear guidance for care plan activities and goal suggestions. These specifications have led to the implementation of 65 CDS services integrated into the CAREPATH Adaptive Integrated Care Platform.DiscussionOur methodology offers a systematic, replicable process for generating CDS specifications, ensuring consistency and reliability across implementation. By fostering collaboration between clinical expertise and technical proficiency, we enhance the quality and relevance of generated specifications. Clear traceability enables stakeholders to track the development process and ensure adherence to guideline recommendations.

Great strides have been made in the past decade to lower barriers to clinical pharmacogenomics implementation. Nevertheless, PGx consultation prior to prescribing therapeutics is not yet mainstream. This review addresses the current climate surrounding PGx implementation, focusing primarily on strategies for implementation at academic institutions, particularly at The University of Chicago, and provides an up-to-date guide of resources supporting the development of PGx programs. Remaining challenges and recent strategies for overcoming these challenges to implementation are discussed. [ABSTRACT FROM AUTHOR]

Introduction. The potential benefits from digitalisation processes will only be fully realised if the conceptual challenges they uncover are accepted and addressed, alongside the technical ones such as interoperability. Will 'computable' clinical guidelines be compatible with personalised care if the definition of the relevant disease embeds preferences that pre-empt those of the individual patient? Method. As a case study we investigated the definition of diabetes in glycaemic management guidelines. Result. The dominant component of its definition - HbA1c -6.5% - embeds the consensus preference judgement of a 2009 International Expert Committee. Discussion. This preference-sensitive threshold for the diagnosis of diabetes has subsequently been endorsed in many guidelines relating to glycaemic management, though there are signs of awareness and concern with its implications. Conclusion. Those seeking to digitalise guidelines by making them 'computable' need to acknowledge and address their inbuilt preference-sensitivity - if they wish to further care that respects patient's preferences. [ABSTRACT FROM AUTHOR]

Background: People with Parkinson's disease has significant and increasing physical, psychosocial and spiritual needs, as well as problems with coordination and continuity of care. Despite the benefits that palliative care could offer, there is no consensus on how it should be delivered. Aim: The aim of this study is to provide a pragmatic overview of the evidence to make clinical recommendations to improve palliative care for people with Parkinson's disease and their caregivers. Design: A systematic review method was adopted to determine the strength of evidence, supported by feedback from an expert panel, to generate the 'do', 'do not do' and 'do not know' recommendations for palliative care. Data sources: Searches were conducted via OVID to access CINAHL, MEDLINE, EMBASE and the Cochrane Library from 01/01/2006 to 31/05/2021. An additional search was conducted in December 2022. The search was limited to articles that included empirical studies of approaches to enabling palliative care. Results: A total of 62 studies met inclusion criteria. There is evidence that education about palliative care and movement disorders is essential. palliative care should be multi-disciplinary, individualised and coordinated. Proactive involvement and support of caregivers throughout the illness is recommended. Limited data provide referral indicators for palliative care integration. Discussions about advance care planning should be held early. Conclusions: Consideration of palliative care integration based on symptom burden and personal preferences, coordination and continuity of care are needed to maintain the quality of life of people with Parkinson's disease and their caregivers. [ABSTRACT FROM AUTHOR]

Current implant therapy is a frequently employed treatment for individuals who have lost teeth, as it offers functional and biological advantages over old prostheses. Concurrently, active exploration of intervention strategies aims to prevent the progression of peri‑implant diseases and manage the existing peri‑implant tissue damage. Indian Society of Periodontology has recognized the need for systematic documents to update the everyday clinical practice of general dental practitioners and has provided evidence‑based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health‑related awareness and standards of oral health‑care delivery across the country. The current clinical practice recommendations focused on peri‑implant care to bridge the gap between academic theory and clinical practice by compiling evidence‑based suggestions for preventing and treating peri‑implant diseases. Twenty‑eight subject experts across the country prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three sections covering peri‑implant health and maintenance, peri‑implant mucositis, and peri‑implantitis. It will be a quick and concise reference for oral implant practitioners in patient management. The guidelines provide distinct definitions, signs, and symptoms, treatment required; recall visit specifications for plausible clinical case situations, and home‑care recommendations regarding maintaining peri‑implant health. The document advocates combined efforts of oral implant practitioners and the population at large with evidence‑based, integrated, and comprehensive peri‑implant care. By providing accessible, applicable guidance, these guidelines would empower dental professionals to uphold the well‑being of implant patients and ensure the long‑term success of implant therapy. [ABSTRACT FROM AUTHOR]

Retracted clinical trials may be influential in citing systematic reviews and clinical guidelines. We assessed the influence of 27 retracted trials on systematic reviews and clinical guidelines (citing publications), then alerted authors to these retractions. Citing publications were randomized to up to three e-mails to contact author with/without up to two coauthors, with/without the editor. After one year we assessed corrective action. We included 88 citing publications; 51% (45/88) had findings likely to change if retracted trials were removed, 87% (39/45) likely substantially. 51% (44/86) of contacted citing publications replied. Including three authors rather than the contact author alone was more likely to elicit a reply (P = 0.03). Including the editor did not increase replies (P = 0.66). Whether findings were judged likely to change, and size of the likely change, had no effect on response rate or action taken. One year after e-mails were sent only nine publications had published notifications. E-Mail alerts to authors and editors are inadequate to correct the impact of retracted publications in citing systematic reviews and guidelines. Changes to bibliographic and referencing systems, and submission processes are needed. Citing publications with retracted citations should be marked until authors resolve concerns. [ABSTRACT FROM AUTHOR]