Search Results (72)

Introduction: Recent guidelines developed by the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) focused on the dietetic management of obesity in adults. The present study aimed to explore the perspectives of healthcare professionals regarding these guidelines. Methods: In total, 85 registered dietitians/nutritionists from Greece, the Netherlands, the Republic of Ireland, and the United Kingdom completed an online survey, and 10 were interviewed, in February–March 2023. Demographic data were also collected. Results: Awareness of the EASO-EFAD guidelines among registered dietitians/nutritionists was moderate (57.6%), but only 20% had read them in full. Dietitians with higher education and relevant experience were more likely to have read the guidelines. Less than half reported that key evidence-based recommendations, such as individualized medical nutrition therapy and intensive behavioral interventions, are already included in national guidance. Recommendations like portfolio or DASH diets, partial meal replacements, and calorie restriction were less commonly part of national guidance/usual practice. A small percentage of participants described their adoption of several nutritional approaches novel to them. These included the portfolio dietary pattern, partial meal replacements, and intermittent fasting or continuous calorie restriction. For some Irish dietitians, prioritizing weight as the main outcome conflicted with their emphasis on overall health and individualized nutrition therapy. Other barriers of recommendation implementation included exclusive availability in English, rapid changes in obesity management, staffing shortages, limited multidisciplinary collaboration, and inconsistent knowledge among healthcare providers. Conclusions: The present study identified gaps in the adoption of the EASO-EFAD guidelines into dietetic/clinical practice. EFAD will develop strategies to disseminate these guidelines at different levels of stakeholders (national/local authorities, dietitians/nutritionists, and patients). Full article

Over the past two decades, patient safety and clinical risk management have become strategic priorities for healthcare systems worldwide. In this context, the London Protocol has emerged as one of the most influential methodologies for investigating adverse events through a systemic, non-punitive lens. The 2024 edition, curated by Vincent, Adams, Bellandi, and colleagues, represents a significant evolution of the original 2004 framework. It integrates recent advancements in safety science, human factors, and digital health, while placing a stronger emphasis on resilience, proactive learning, and stakeholder engagement. This article critically examines the structure, key principles, and innovations of the London Protocol 2024, highlighting its departure from incident-centered analysis toward a broader understanding of both failures and successes. The protocol encourages fewer but more in-depth investigations, producing actionable and sustainable recommendations rather than generic reports. It also underscores the importance of involving patients and families as active partners in safety processes, recognizing their unique perspectives on communication, care pathways, and system failures. Beyond its strengths—holistic analysis, multidisciplinary collaboration, and cultural openness—the systemic approach presents challenges, including methodological complexity, resource requirements, and cultural resistance in blame-oriented environments. This paper discusses these limitations and explores how leadership, staff engagement, and digital technologies (including artificial intelligence) can help overcome them. Ultimately, the London Protocol 2024 emerges not only as a methodological tool but as a catalyst for cultural transformation, fostering healthcare systems that are safer, more resilient, and committed to continuous learning. Full article

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide. Full article

Green Infrastructure (GI) has increasingly been recognised as a crucial strategy for enhancing urban resilience, particularly in urban transportation systems facing the challenges of climate change. Although several conceptual frameworks for GI planning have been proposed, empirical studies examining their application in urban transport planning contexts remain limited. This study aims to validate a recently developed GI conceptual framework by evaluating its applicability in urban transportation systems. A structured questionnaire was administered to 94 participants in Aotearoa New Zealand comprising urban planners, engineers, architects, policymakers, and academics involved in transportation and sustainability planning with special focus on GI. The framework was assessed across key dimensions including the perceived benefits of GI in transportation, stakeholder and collaborative practices barriers to implementation, and indicators of perceived effectiveness. The results confirm that the stakeholders’ perceptions of GI are significantly aligned with the dimensions of the conceptual framework, reinforcing its validity in assessing GI effectiveness. Key findings highlight a disconnect between stakeholders’ general familiarity with GI and their understanding of its multifunctional benefits beyond stormwater management. Also, the prevalence of multidisciplinary collaboration suggests that additional interdisciplinary and transdisciplinary approaches are required for more holistic GI planning. This study recommends that the conceptual framework be considered for city adaptation to GI integration, and to do so effectively, these knowledge and cooperation gaps must be addressed Full article

The AECO (Architecture, Engineering, Construction, and Operation) sector is highly complex, involving multidisciplinary collaboration, extensive data management, and significant financial investments. Decisions in early phases significantly impact operational and maintenance costs, as well as the environmental and economic sustainability of a project over its lifecycle. Cost efficiency and sustainability are critical and interconnected goals across the sector, spanning all phases of a building’s lifecycle. Ontologies, as formal and structured representations of knowledge within a particular domain, have the potential to enhance cost efficiency by improving decision-making, reducing redundancies, and optimizing resource allocation. Despite their relevance, cost ontologies are still lacking in the AECO sector. This paper addresses this gap by presenting both a methodological and conceptual contribution: it outlines a structured and iterative methodology for developing a cost ontology, and it defines the core concepts required to semantically represent construction cost information. The methodology emphasizes stakeholder engagement and refinement cycles, while the ontological structure ensures machine-readability and interoperability. The approach involves a preliminary analysis of the necessary cost parameters for defining the ontology and a subsequent validation of a practical case study. The results show the development of a heterogeneous and standardized data structure designed to define a cost ontology, aimed at improving the updatability, transparency, and sustainability-oriented interpretation of construction cost data by both humans and machines. Full article

The Netherlands has established climate-adaptive strategies shaped by its long history of water-related climate events, such as the floods in 1421 and 1953. UNESCO World Heritage (WH) properties in The Netherlands reflect centuries of human intervention and natural processes to adapt and mitigate climate challenges, including spatial design and hydraulic engineering. The Dutch Climate Research Initiative also highlights cultural heritage as an integral component in preparing for the 2026 National Climate Adaptation Strategy. This article aims to unveil climate-adaptive World Heritage management strategies (CAWHMSs), using WH properties in The Netherlands as a case study. It collects textual data from Statements of Outstanding Universal Value, State of Conservation Reports by the State Parties and management plans. Through qualitative coding and keywords aggregation of the documents, the visualised results of a Sankey diagram and two semantic networks confirmed two CAWHMSs: conservation and developing WH properties as collaborative knowledge hubs. Conservation supports regulating urban climate and sustainable water management. As collaborative knowledge hubs, multidisciplinary sectors explore opportunities to align WH properties with broader sustainable development initiatives. They also deepen younger generations’ awareness of cultural and natural significance relevant to mitigating climate threats. The results emphasise WH as a contributor to climate adaptation. Cross-sectoral stakeholders can advance holistic climate adaptation efforts using CAWHMSs. Full article

Value management (VM) is a management approach aimed at inspiring individuals, nurturing their talents, and fostering synergy and innovation, all with the objective of enhancing an organization’s overall performance. This methodology seeks to reduce costs while actively engaging a diverse array of stakeholders throughout the project lifecycle. Despite its significance in construction projects, there exists a notable gap in the literature regarding the implementation of value management in public works. This study aims to identify the barriers that hinder the effective implementation of value management, as well as the critical success factors and potential risks associated with its adoption in public projects. Additionally, it assesses Turkey’s readiness for implementation within the construction sector by examining awareness levels, legislative issues, and other pertinent topics. To conduct the study, a quantitative survey was administered to 337 participants from various roles within the Turkish construction sector. The findings revealed that the inherent complexity of construction projects, time constraints, and difficulties in alternative selection are the primary barriers to implementing the value management approach in public works. Regarding the critical success factors for effective VM implementation, the involvement of end users, a collaborative workshop environment, and the multidisciplinary composition of the VM team were identified as the most significant contributors to success. Additionally, the study highlighted potential risks associated with the adoption of VM in public works, including low operating efficiency, a low participation rate in tenders, and cost overruns. The discussion also addressed legislative and process-oriented strategies for the potential adoption of value management. Full article

The increasing complexity of data management in the Architecture, Engineering, and Construction (AEC) industry, driven by the adoption of distributed digital twins (dDTws) and cloud-based solutions, presents challenges in interoperability, data sovereignty, and scalability. Existing Building Information Modeling (BIM) and Common Data Environment (CDE) frameworks often fall short in addressing these issues due to their reliance on centralized and proprietary systems. This paper introduces a novel framework that transforms the Information Container for Linked Document Delivery (ICDD) into a dynamic, graph-based architecture. Unlike conventional file-based ICDD implementations, this approach enables fine-grained, semantically rich linking and querying across distributed models while maintaining data sovereignty and version control. The framework is designed to enhance real-time collaboration, ensure secure and sovereign data management, and improve interoperability across diverse project stakeholders. The framework leverages graph databases, semantic web technologies, and ISO standards such as ISO 21597 to facilitate seamless data exchange, automated linking, and advanced version control. Key functionalities include federated data storage, compliance with local and international regulations, and support for multidisciplinary workflows in large-scale AEC projects. To demonstrate the feasibility of the proposed framework, a simplified use case scenario is implemented and analyzed. By addressing critical challenges and enabling seamless integration of emerging technologies such as digital twins, this study advances the state of the art in data management for the AEC industry, providing a robust foundation for future innovations. Full article

Background and Objectives: Maxillofacial trauma represents a significant global health challenge with substantial physical, psychological, and socioeconomic consequences. Materials and Methods: This narrative review analyzed 112 articles published between 2000 and 2024 examining epidemiology, prevention, economics, and outcomes of maxillofacial trauma in critical care settings. Results: Road traffic accidents remain the primary cause globally, followed by interpersonal violence and occupational injuries. Effective prevention strategies include seat belt laws, helmet legislation, and violence prevention programs. Economic burden encompasses direct healthcare costs (averaging USD 55,385 per hospitalization), productivity losses (11.8 workdays lost per incident), and rehabilitation expenses (USD 3800–18,000 per patient). Surgical management has evolved toward early intervention, minimally invasive approaches, and advanced techniques using computer-aided design and 3D printing. Complications affect 3–33% of patients, with significant functional disabilities and psychological sequelae (post-traumatic stress disorder in 27%, depression/anxiety in 20–40%). Conclusion: Maxillofacial trauma management requires multidisciplinary approaches addressing both immediate treatment and long-term rehabilitation. Despite technological advances, disparities in specialized care access persist globally. Future efforts should implement evidence-based prevention strategies, reduce care disparities, and develop comprehensive approaches addressing physical, psychological, and socioeconomic dimensions through collaboration among healthcare professionals, policymakers, and community stakeholders. Full article

Continuity of care is fundamental to the efficacy of primary healthcare, fostering trust, enhancing patient satisfaction, and improving health outcomes. However, the implementation of Ministerial Decree 77/2022, which advocates for team-based care in multidisciplinary Community Health Centers, presents challenges to these established principles. This article proposes strategies to maintain continuity and trust whilst supporting the reform objectives, specifically tailored to the unique linguistic and cultural context of the Autonomous Province of Bolzano—South Tyrol. A synthesis of regional healthcare reports, academic literature, and practical insights from implementing Ministerial Decree 77/2022 was performed to develop strategies addressing challenges such as ensuring continuity, minimizing administrative burdens, and promoting patient and general practitioner engagement. Strategies include establishing Community Health Centers as integration hubs, assigning primary providers within teams, formalizing personalized care contracts, leveraging digital tools for collaboration, and expanding the roles of nurses and care coordinators. Additional measures focus on building infrastructure for telemedicine and home-based care, engaging patients through transparent communication and feedback loops, and preserving GP autonomy through flexible participation models and incentives. Strategies adapted to accommodate South Tyrol’s demographic, cultural, and systemic characteristics can maintain continuity and trust during the transition to team-based care. By addressing key risks and fostering collaboration among stakeholders, these reforms can enhance healthcare delivery without compromising the principles of personalized, patient-centered care. Full article

Background/Objectives: Artificial intelligence (AI) is transforming healthcare, enabling advances in diagnostics, treatment optimization, and patient care. Yet, its integration raises ethical, regulatory, and societal challenges. Key concerns include data privacy risks, algorithmic bias, and regulatory gaps that struggle to keep pace with AI advancements. This study aims to synthesize a multidisciplinary framework for trustworthy AI in healthcare, focusing on transparency, accountability, fairness, sustainability, and global collaboration. It moves beyond high-level ethical discussions to provide actionable strategies for implementing trustworthy AI in clinical contexts. Methods: A structured literature review was conducted using PubMed, Scopus, and Web of Science. Studies were selected based on relevance to AI ethics, governance, and policy in healthcare, prioritizing peer-reviewed articles, policy analyses, case studies, and ethical guidelines from authoritative sources published within the last decade. The conceptual approach integrates perspectives from clinicians, ethicists, policymakers, and technologists, offering a holistic “ecosystem” view of AI. No clinical trials or patient-level interventions were conducted. Results: The analysis identifies key gaps in current AI governance and introduces the Regulatory Genome—an adaptive AI oversight framework aligned with global policy trends and Sustainable Development Goals. It introduces quantifiable trustworthiness metrics, a comparative analysis of AI categories for clinical applications, and bias mitigation strategies. Additionally, it presents interdisciplinary policy recommendations for aligning AI deployment with ethical, regulatory, and environmental sustainability goals. This study emphasizes measurable standards, multi-stakeholder engagement strategies, and global partnerships to ensure that future AI innovations meet ethical and practical healthcare needs. Conclusions: Trustworthy AI in healthcare requires more than technical advancements—it demands robust ethical safeguards, proactive regulation, and continuous collaboration. By adopting the recommended roadmap, stakeholders can foster responsible innovation, improve patient outcomes, and maintain public trust in AI-driven healthcare. Full article

Plastic waste poses a critical challenge in the healthcare sector due to its predominant reliance on a linear “make-use-dispose” model, where plastics are typically incinerated or landfilled. This study examines Swedish healthcare waste management practices, encompassing Swedish and EU regulatory frameworks, hospital protocols, disinfection methods, and recycling processes. A key barrier to recycling healthcare plastic waste (HCPW) is the uncertainty surrounding effective decontamination. To overcome this, the paper proposes a circular solution involving on-site microwave-assisted disinfection and shredding, followed by chemical recycling through pyrolysis. This approach considers operational, legal, and technological landscapes and underscores the need for a multidisciplinary solution to enable the transition. This paper also presents a stakeholder collaboration and value capture matrix, identifying the shared value in collaboration among key stakeholders, including hospitals and healthcare service providers, on-site disinfection machine manufacturers, waste management firms, and chemical recycling companies, to advance recycling and foster a circular economy for HCPW. Full article

Adolescents and young adults (AYAs), often defined as those aged 15–39 years, face unique challenges in oncology that are often unmet by conventional care models. This systematic review examines evidence on establishing dedicated AYA oncology units, focusing on logistical, infrastructural, and personnel-related recommendations. A PRISMA-guided search of PubMed (2000–2024) identified seven studies that emphasized early stakeholder involvement and collaboration between pediatric and adult oncology teams to ensure comprehensive care. Multidisciplinary teams (MDTs) of oncologists, nurses, and psychosocial support staff were highlighted as essential to address AYA patients’ diverse needs. Care models varied, with some advocating consultation-based services and others supporting dedicated units. Priorities included increasing clinical trial enrollment, fertility counseling, and creating environments attuned to AYA patients’ social and psychological needs. Key barriers included limited funding, institutional resistance, and inadequate pediatric/adult team collaboration. Despite progress, the lack of standardized guidelines and long-term data on AYA unit efficacy remains a challenge. Further research is required to develop outcome metrics, refine care models, and enhance survival and quality of life for AYA cancer patients. Full article

Tabletop exercises offer a structured opportunity to assess strengths and potential gaps in preparedness and response plans in a safe learning environment. The New York City Health + Hospitals System-Wide Special Pathogens Program conducted an innovative and multidisciplinary tabletop exercise involving escalating scenarios of highly pathogenic avian influenza (HPAI) H5N1 in 2023. The goals were to assess patient screening processes for infectious diseases within healthcare facilities, infection prevention and control strategies, risk communication, and notification and involvement of public health stakeholders. Participants reflected on previous outbreak responses, discussed the importance of risk communication, and shared insights on tools and resources that would better support healthcare professionals in identifying and managing patients with HPAI/H5N1 infection. Key takeaways included establishing clear protocols for HPAI/H5N1 management, providing timely education to healthcare professionals, and assessing useful communication modalities. Methods: The exercise included escalating scenarios involving a single case of HPAI/H5N1 advancing to community transmission. Key participants spanned clinical departments, infection prevention and control, emergency management, and local public health stakeholders. Structured discussions targeted triggers for escalation, infection prevention strategies, and communication pathways. Results: Findings highlighted the need for tailored screening criteria, robust infection prevention protocols, clear communication strategies, and collaboration with public health authorities. Specific improvements included refining triage and isolation protocols, enhancing staff education, and leveraging syndromic surveillance systems. Conclusion: This exercise underscored the importance of proactive planning, multidisciplinary collaboration, and integration of biosafety measures to strengthen healthcare system resilience against HPAI/H5N1. Full article

Poor information management is predominant in construction projects and tends to have a negative effect on project outcomes. The use of technology, in particular building information modelling (BIM), has been promoted to address information management issues. However, the adoption of BIM is fraught with challenges, such as a lack of standardisation and difficulties in effectively adopting standards such as ISO 19650. This research aims to deepen knowledge and improve the management of BIM standards, particularly in using ISO 19650 to collaboratively deliver construction projects by applying process modelling techniques. By employing a mixed-methods approach that combines document analysis and qualitative interviews, this study critically examines the principles and requirements of ISO 19650 and their practical implications. It focuses on how process modelling can clarify complex concepts and improve information management. The findings indicate that process modelling significantly aids in comprehending ISO 19650, making its intricate concepts more accessible to multidisciplinary teams, enhancing stakeholder communication, improving project execution efficiency, and reducing errors and rework. Furthermore, this research emphasises the need to distinguish ISO 19650-derived elements from those adapted from other sources to ensure transparency and integrity in project management practices. The main implications of this study are two-fold. From a research perspective, it contributes to the academic discourse by addressing a critical gap in the literature, which has largely focused on BIM technology implementation rather than the processes and workflows necessary for effective standard adoption. From a practical perspective, this study promotes transparency and integrity in project management practices, enabling organisations to adopt and adhere to standardised practices more effectively in collaborative environments. Full article