This study investigates the motivations of industry stakeholders who voluntarily serve on discipline-based advisory boards in Australian business schools. These boards play a critical role in aligning academic curricula with industry needs, and their use is strongly encouraged by accrediting bodies such as AACSB and EQUIS. Despite this, little is known about why professionals contribute their time and expertise without compensation. Using a qualitative methodology, the research draws on 25 semi-structured interviews with board members across three universities. Drawing on Clary and Snyder's functional theory of volunteer motivation, as a lens for analysis, the findings reveal that values, esteem, learning, and career-related motivations are the primary drivers of engagement, while social and protective functions are less influential. Participants expressed a desire to give back, influence curriculum, and support student outcomes as motivational drivers. Esteem-related motivations, such as recognition and professional credibility, were also prevalent. Learning and career benefits—particularly knowledge exchange and networking—sustained ongoing engagement. Relational dynamics and inclusive board culture also contributed to retention. These insights challenge traditional views of volunteerism and highlight the strategic nature of stakeholder engagement in higher education advisory contexts. The study offers practical recommendations for recruiting and retaining advisory board members, including aligning engagement strategies with career stage motivations and providing feedback on the impact of their contributions. • Industry stakeholders volunteer to give back, influence curriculum, and support students. • Engagement sustained by networking, knowledge exchange, and career development benefits. • Career stage shapes motivations: early career seek learning, seniors seek impact. • Inclusive, welcoming board culture fosters long-term stakeholder engagement. • Advisory boards as strategic volunteerism: influence, impact, and curriculum alignment.

Stroke is the second leading cause of death and the third leading cause of disability worldwide, with global economic costs exceeding US $890 billion annually and a projected 50% rise in deaths between 2020 and 2050. So far, stroke has been addressed within the World Health Organization (WHO) Global Noncommunicable Disease (NCD) Action Plan 2023-2030 and the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031, but until now, no World Health Assembly resolution has been specifically dedicated to stroke. To present the first WHO Resolution specifically dedicated to stroke (EB158/CONF./9), describe its content and significance, and analyze its implications for global public health. This article presents and analyzes resolution EB158/CONF./9-"Reducing the burden of stroke: strengthening prevention, acute care, rehabilitation and health-system readiness", as advanced by the WHO Executive Board at its 158th session on 3 February 2026 and adopted by the Member States in the Seventy-ninth World Health Assembly.Key content of the resolution:In February 2026, the 158th session of the WHO Executive Board advanced the first WHO resolution dedicated to stroke, proposed by Egypt and co-sponsored by Chile, Georgia, Palestine, Paraguay, and Tunisia, and adopted by Member States at the Seventy-ninth World Health Assembly. The resolution frames stroke as a continuum of care and sets out 16 operative actions for Member States (OP1), organized under three categories: (1) primary interventions across the prevention spectrum; (2) acute care and rehabilitation; and (3) surveillance and data; all underpinned by a health-system strengthening approach. A further eight requests to the Director-General (OP2) provide WHO's mandate to act, covering normative guidance, technical support, monitoring, research, medicine access, regional cooperation, and progress reporting.Public health implication:The resolution establishes a comprehensive stroke action plan across the full continuum of care. Its legacy will depend not on its adoption in Geneva but on whether political commitment is matched by sustained implementation, investment, robust monitoring, and accountability grounded in stroke-specific indicators.

Women on corporate boards in developed markets

Since its founding in 1930, the American Academy of Pediatrics (AAP) has recognized that comprehensive child health requires not only primary care but also specialized procedural expertise. Beginning with the establishment of the Section on Surgery in 1948, pediatric surgical and procedural disciplines progressively organized within the academy to ensure that children's unique operative, anesthetic, radiologic, and dental needs were represented in policy, education, and advocacy. Over subsequent decades, sections devoted to anesthesiology and pain medicine, urology, orthopedics, otolaryngology-head and neck surgery, radiology, ophthalmology, plastic surgery, neurological surgery, and oral health were formed, each emerging from sustained advocacy by leaders who understood that children require standards distinct from adult-based models of care. Although subspecialty certification through American Board of Medical Specialties member boards strengthened professional identity in several disciplines, section status within the AAP provided a critical platform for multidisciplinary collaboration, guideline development, and national advocacy. The creation of the Surgical Advisory Panel in 1998 unified these sections and strengthened representation on the AAP Board of Directors. In 2023, organizational restructuring led to the formation of the Pediatric Surgical Specialties Alliance, which aligned 10 sections within a coordinated framework. Together, these specialists now represent more than 2000 members and shape national standards in trauma systems, perioperative safety, imaging, sedation, congenital anomaly management, injury prevention, and oral health, affirming that optimal pediatric care depends on integrated partnerships between general pediatricians and procedural experts.

Bladder cancer is associated with substantial morbidity and long-term surveillance burden, particularly for patients with non-muscle-invasive disease, with significant impact on quality of life. In 2019, Bessa et al. [1] published the first stakeholder-driven (patients and healthcare professionals) consensus outlining the top 10 research priorities in bladder cancer. These 10 research priorities could be categorised into three research themes: predictive and prognostic biomarkers, optimisation of diagnostic pathways, and surveillance following radical therapy [1]. Their work represented a landmark shift towards the systematic integration of patient, clinical, and scientific perspectives in shaping the research agenda. Recognising rapid advancements in genomic biomarker discovery [2], molecular profiling [3], and novel therapeutics [4] in the years since, notwithstanding the effects of the global pandemic, we conducted an updated consensus exercise to reassess contemporary research needs. Using an interactive survey methodology adapted from the original study, we engaged 27 individuals including healthcare professionals, researchers across a spectrum of disciplines, charities, and patient advocates in live polling and facilitated discussion, evidence review, and iterative ranking of pertinent research questions. Rankings from the updated exercise were compared with those from 2019 to assess changes in emphasis over time. This updated prioritisation highlights an ongoing shift towards a biomarker-led, precision-medicine research agenda in bladder cancer. While not intended to define clinical standards, the findings provide direction for future translational studies, biomarker validation efforts, and trial design, with relevance to the risk-adapted management of both non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). The most highly ranked research question focused on whether validated urinary biomarkers could substitute or reduce the frequency of cystoscopy follow-up in patients with high-risk NMIBC. The burden of frequent cystoscopy (citing discomfort, anxiety, procedural risks) and the cumulative resource impact on healthcare systems remains an issue. Compared with the Bessa et al. [1] findings, the strength of preference for non-invasive approaches has intensified, reflecting increasing patient awareness of emerging biomarker technologies. Eight of the top 10 priorities (compared to six in 2019) directly involved biomarker development, validation, or implementation. These include biomarkers for NMIBC surveillance and metastatic disease, diagnostic markers to improve early detection, molecular profiling and genomic stratification of NMIBC and MIBC, predictive biomarkers for neoadjuvant chemotherapy and immunotherapy, and biomarkers supporting early cystectomy decision-making. This biomarker-driven vision demonstrates an enhanced translational focus within the bladder cancer community and aligns strongly with contemporary precision-medicine frameworks [5, 6]. Patient advocacy input continues to indicate emphasis on quality-of-life considerations including reduced invasiveness, acceptability of tests, and minimisation of procedure-related burden. These values influence the importance of non-invasive diagnostics, early detection, and timely, personalised treatment strategies. Similar to the 2019 review, patient perspectives helped ensure that priorities reflected real-world needs rather than solely technological potential. Several newly elevated priorities reflect the rapid evolution of therapy and molecular oncology for risk stratification (Table 1). Priorities focused on therapy include predictive biomarkers for neoadjuvant therapy (recognising the heterogeneous response to chemotherapy and immunotherapy) and integration of molecular profiling (particularly to guide treatment selection in high-risk NMIBC and MIBC). Considerations around risk include genomic risk stratification and enabling identification of patients at high risk of progression. These themes collectively indicate increasing integration of genomic and molecular tools into clinical decision-making, signalling a maturation of precision urology. The priority areas identified have both immediate and long-term implications for clinical practice. Immediate benefits from translational innovations that are available now include reduced cystoscopy burden, improved patient experience and acceptability, and potential cost reductions for healthcare systems [2]. Long-term benefits include personalised treatment pathways informed by molecular features and/or liquid biopsies [2, 3, 7], improved survival through refined therapy selection, and enhanced quality of life via minimisation of invasive procedures. The consensus also underscores the need for multicentre biomarker validation studies, real-world implementation research, and integration of genomic, transcriptomic and liquid biopsy data into risk-stratified clinical pathways. Stakeholders highlighted the importance of robust evidence generation, pragmatic study design, and widespread adoption of quality-of-life metrics in future trials. Overall, this updated exercise confirms the enduring relevance of the original priorities while demonstrating an evolution towards a biomarker-led and molecularly-profiled personalised approach to bladder cancer research. The prioritised themes provide a clear roadmap for clinicians, researchers, funders, and policymakers to reduce the burden of bladder cancer. Continued stakeholder engagement, dedicated funding for biomarker validation, and coordinated multicentre collaboration will be essential for translating these priorities into improved patient outcomes. Richard T. Bryan is an unpaid charity trustee for Action Bladder Cancer UK (UK), an advisory board member for Nonacus Limited (UK), and receives consultancy fees from Cystotech ApS (Denmark) and Nonacus Limited (UK). The remaining authors have no disclosures.

Are there distinct symptom clusters in women with endometriosis and adenomyosis, and how do these clusters predict quality of life? Latent class analyses of 22438 women with endometriosis identified four symptom phenotypes, including high pain-gastrointestinal and psychological-neurological clusters; adenomyosis cases were concentrated in high‑pain classes without a minimal‑symptom group, and high‑burden phenotypes had poorer quality of life. Endometriosis and adenomyosis are heterogeneous conditions with diagnostic delays of 4-11 years. The classification based on surgical findings and imaging fails to capture the complex, systemic symptom combinations that affect patients' quality of life (QoL). Large-scale cross-sectional cohort study using data from the United States-based All of Us Research Program (Controlled Tier v8; May 2018-October 2023). The dataset included 22438 women with electronic health records (EHR) and/or self-reported endometriosis. Four Latent Class Analyses (LCA) were performed on different patient groups: (i) the full endometriosis cohort (n = 22 438); (ii) an age-corrected subset restricted to premenopausal women (aged 18-45; n = 5542) to minimize menopausal confounding; and two subgroups derived from the age-corrected cohort to test whether concomitant adenomyosis defines distinct symptomatic phenotypes: (iii) clinically confirmed endometriosis without adenomyosis (n = 1797) and (iv) adenomyosis with endometriosis (n = 643). LCA was performed using 19 self-reported and EHR-derived symptoms and comorbidities (e.g. chronic pelvic pain, migraine, depression, gastrointestinal symptoms) to identify patient subgroups. Multinomial logistic regression assessed sociodemographic (age, BMI, deprivation index) and clinical predictors (hormonal contraceptive use, surgical history) of class membership. The association between latent classes and QoL outcomes was evaluated using data from the 'Overall Health' and 'Health Care Access and Utilization' surveys. Data are available via the All of Us Researcher Workbench (https://workbench.allofus.org). Latent class analysis of clinically confirmed endometriosis identified four distinct symptom phenotypes, most notably a severe 'High Pain & Gastrointestinal with Mood Symptoms' (High) cluster and a unique 'Predominantly Psychological/Neurological' cluster that challenges traditional gynecological-focused diagnostic frameworks. Patients with adenomyosis exhibited a distinct profile with two high-pain symptom classes and the absence of a fully asymptomatic group, indicating a higher overall disease burden. Membership in the High class was significantly associated with lower general health scores, reduced social satisfaction, and increased barriers to healthcare access. The All of Us is a United States-based research program, and the findings should be replicated in other independent cohorts to confirm generalizability across other geographical regions. The cross-sectional design limits causal inference regarding QoL outcomes. Also, the analyses rely on a mix of diagnostic approaches, including surgical and non-surgical clinical and self-reported diagnoses, which is both a strength and a limitation. The 'Minimal Symptom Burden' class may reflect under-documentation of symptoms in clinical records rather than a true lack of symptoms, and the High class may reflect to patients who have higher multimorbidity, hence have more hospital visits. These results support a shift toward personalized, interdisciplinary management of endometriosis that addresses mental health and gastrointestinal symptoms alongside pelvic pain. The identification of a 'Predominantly Psychological/Neurological' cluster suggests that young women presenting with non-classical symptoms (anxiety, migraine, depression) could be screened for endometriosis to reduce diagnostic delays and improve life-course potential. D.K. was supported by a 'Ramón y Cajal' fellowship from the Spanish Ministry of Science and Innovation (RYC2024-050099-I). O.G. was supported by a postdoctoral award from the Amy P Goldman Foundation. I.F. is the co-founder and co-owner of Sur180 Therapeutics, which is developing a novel treatment for endometriosis, and the Chief Scientific Officer of Nura Health, which is developing a non-invasive diagnostic solution for the disease. I.F. has received ARPA-H grant no. ARPA-H-ICHUB-24-101-1035 as Principal Investigator, consulting fees from Nura Health and Sur180 Therapeutics, and stock and share options in both companies. I.F. is also the inventor on patents for 'Compositions and methods for treating endometriosis' (US10695341 and US10729693) and serves as an unpaid Board Member of the World Endometriosis Society and the Fundación Puertorriqueña de Pacientes con Endometriosis (ENDOPR). H.S.T. received speaker fees from Gedeon Richter, a grant from AbbVie through Yale University, consulting fees from Regeneron, and is a co-inventor on Yale's endometriosis biomarkers and treatments (including US11993816B2, US10982282B2, and US12286629B2). He also serves on the boards of the Environmental Health Trust and Environment and Human Health. N/A.

This study examines the communication crisis in the conflict between the Nahdlatul Ulama Executive Board (PBNU) and the National Awakening Party (PKB) using Fairclough’s Critical Discourse Analysis (CDA) approach. The research object consists of the message constructions of each party as represented in mainstream media publications and official releases, including the Vice President’s statement (01 August 2024, wapresri.go.id), Kompas articles (07 and 25 August 2024), and detikBali (11 August 2024). These secondary data sources were analyzed to understand how PBNU and PKB shape, assert, and maintain their respective discourses during the escalation of the conflict. The analysis reveals that PBNU frames its messages through a moral–cultural lens, emphasizing the organization’s role in safeguarding religious values and positioning the conflict as an internal matter requiring rectification. Conversely, PKB employs a political legitimacy frame, asserting the party’s independence, rejecting external intervention, and emphasizing a professional political agenda. The divergence in message constructions generates communication asynchrony, potentially reinforcing organizational polarization and public perception disparities. The study underscores that critical discourse analysis of media publications offers profound insights into inter-institutional communication crises and highlights the importance of strategic message management in mitigating conflict.

Women Emergency Physicians and Gender Disparities from Entry to Advancement.

Purpose This study explores how Swedish biotechnology incubators coordinate and control critical resources through strategic networking. It examines the mechanisms that enable incubators to manage resource flows and identifies the key partners involved in these exchanges within Sweden's innovation ecosystem. Design/methodology/approach We analyze strategic practices by a qualitative multiple-case approach, drawing on semi-structured interviews with CEOs and board members from seven major biotechnology incubators in Sweden. Data were analyzed through a qualitative content analysis, combining deductive coding based on the resource-based view framework with inductive identification of emerging network actors and interaction patterns. Findings The analysis reveals four core categories of resources including human, financial, operational and technological resources acquired through diverse network alliances. Universities, science parks, investors, government agencies and service providers emerge as key partners in resource acquisition. Incubators employ trust-based relationships, organized interaction mechanisms, specialization strategies and geographical proximity to sustain and expand these networks. The findings also show variation in incubator business models and highlight how proximity to universities and science parks enhances credibility, resource access and collaborative opportunities. Originality/value This paper provides an in-depth understanding of how resource coordination unfolds within biotechnology incubation networks. By integrating theoretical and empirical perspectives, it contributes to the literature on strategic incubator management, with implications for innovation policy and incubator best practice.

"Bringing one's own unique perspective into research" - Participants' experiences and perceptions regarding the implementation of a citizen advisory board in general practice research

ISMTE Board of Directors’ Update – Q2 2026

STAR Protocols question-and-answer series: CRISPR.

ABSTRACT The rise of US asset management and the expansion of assetisation into essential sectors such as healthcare or housing have intensified political scrutiny and public backlash. Amid counter-mobilisations and calls for social values in capitalism, this study examines asset managers’ networks that serve as an infrastructure of interest defence. Empirically, we map executive and board members’ affiliations with policy organisations and philanthropic institutions, highlighting divisions within the industry. Our findings reveal that alternative asset managers rely less on traditional policy groups and think tanks than conventional asset managers, instead cultivating ties with more conservative organisations. Additionally, we explore the role of gender in leveraging interest defence networks. Our findings suggest that conventional asset managers may rely on women’s engagement with philanthropic causes to enhance their public legitimacy. By integrating perspectives on instrumental and symbolic power, this study contributes to debates on struggles within asset management, interest defence and the role of gender in political economy.

This study examines organizational racial power dynamics through a case study of the interactions between a Diversity, Equity, and Inclusion (DEI) Committee and the Board of Directors at an organization specializing in health care practitioner training. We explore how power-defined as control over resources by certain individuals while others lack such control-can be utilized constructively or destructively. Understanding the hoarding of power to maintain hierarchies, rather than fostering equitable systems, is crucial for driving proactive organizational change. Employing a case study methodology, we analyze the division of power within an organization and elucidate behaviors that led to the concentration of power, highlighting its detrimental use. We also examine how organizational leadership systematically undermined the DEI Committee's efforts to establish an accountable, transparently governed organization committed to justice, equity, diversity, and inclusion. Our analysis reveals that when existing power structures are threatened, they adapt to defend their dominance, often at the expense of the organization's mission. A failure to integrate DEI principles resulted in the loss of relationships with field experts and inflicted harm on its members, ultimately leading to the organization's collapse. Harm included symptoms of racial stress and trauma in racialized board members. In addition to exposing governance failures, this study illuminates the psychological and racial trauma experienced by affected members, linking structural exclusion to cumulative harm. This analysis is contextualized within current events, where similar patterns of dismantling equity-focused initiatives are observed at national levels. This paper offers a unique and timely perspective on advancing organizational equity, particularly relevant for diversity consultants tasked with analyzing and resolving problematic organizational dynamics. We provide guidelines for distinguishing between appropriate Board governance and detrimental power hoarding, contributing to the broader discourse on fostering equitable organizational practice.

Does a natural cycle result in higher clinical pregnancy rates (CPR) with foetal heartbeat compared to an artificial cycle for frozen-thawed embryo transfer (FET) preparation in ovulatory women? The CPR with foetal heartbeat did not differ between natural and artificial cycles in ovulatory women undergoing FET. Several protocols for endometrial preparation have been developed for the increasing number of FET cycles in reproductive medicine. In natural cycle FET (NC-FET), spontaneous ovulation is used to time the embryo thawing and transfer, while in artificial cycle FET (AC-FET), endometrial preparation involves sequential oestrogen and progesterone administration. Current evidence on pregnancy rates does not favour one regimen over the other in women with regular ovulatory cycles. We conducted a multicentre, open-label, randomised trial comparing NC-FET with AC-FET across five Belgian fertility centres. Between October 2018 and October 2024, 561 women were randomised (1:1) using a computer-generated allocation after written informed consent. The primary outcome was CPR with foetal heartbeat per cycle analysed on an intention-to-treat basis. Secondary outcomes included endometrial thickness, number of clinic visits for FET cycle monitoring and the rates of (biochemical) pregnancy, ongoing pregnancy, live birth, miscarriage, ectopic pregnancy, multiple pregnancy and cycle cancellation. Obstetric outcomes were recorded for all ongoing pregnancies. Women aged 18-45 with regular ovulatory cycles and normal uterine cavities undergoing FET after vitrification and warming of one or two day-3 embryos or blastocysts were included. In NC-FET, spontaneous ovulation was detected by serial ultrasounds and serum LH and oestradiol measurements. In AC-FET, oestradiol valerate (6 mg/day) was administered from cycle day 2 (increased to 8 mg/day after 1 week if endometrial thickness was <7 mm) and micronized progesterone (600 mg/day) was initiated once endometrial thickness reached ≥7 mm. Clinical pregnancy rates with foetal heartbeat were similar between NC-FET and AC-FET in both intention-to-treat (33.1% [94/284] vs 28.9% [80/277]; RR 1.15, 95% CI 0.89, 1.47) and as-treated analyses (34.3% [97/283] vs 31.8% [77/242]; RR 1.08, 95% CI 0.85, 1.38). Cycle cancellations were less frequent in NC-FET (3.9% vs 9.4%; RR 0.41, 95% CI 0.21, 0.82), but NC-FET required more monitoring visits (mean 3.0 vs 2.4; P = 0.0002). Caesarean section was more common after AC-FET (42.7% vs 20.2%; P = 0.003). Other reproductive, obstetric, and perinatal outcomes did not differ significantly between groups. The sample size was powered to detect a difference in CPR with foetal heartbeat, not for comparing live birth rates or obstetric outcomes. The study was performed in ovulatory women undergoing FET, and therefore, results may not be applicable to other populations. This RCT demonstrates no significant difference in CPR with foetal heartbeat in NC-FET and AC-FET in ovulatory women. Given recent data suggesting higher obstetric risks with AC-FET, NC-FET may be preferred in women with normal ovulatory cycles. The study was an investigator-initiated study supported by internal KU Leuven funding (Project number C14/18/106 and C14/24/152) and funding from the Research Foundation Flanders (G.084515N and G.0B1819N to J.V.). K.P. has received grants from Ferring. C.B. has received speaker fees from Gedeon Richter, paid to her institution; travel support from Gedeon Richter, Ferring Pharmaceuticals, and Intuitive; and holds a leadership role as Senior Deputy of the ESHRE SIG Endometriosis and Endometrial Disorders. C.T. has received grants from Merck SA, paid to her institution; consulting fees and speaker fees from Gedeon Richter; travel support from Ferring and Gedeon Richter; and holds leadership roles as Deputy Editor of JNIG and as a board member. A.V. has received speaker fees from Gedeon Richter, paid to his institution, and holds a leadership role as Senior Deputy of the ESHRE SIG Endometriosis and Endometrial Disorders. The other authors declare that there is no conflict of interest to disclose with respect to the content of this article. This trial has been registered at ClinicalTrials.gov (NCT03642665). 17 July 2018. 27 October 2018.

STAR Protocols question-and-answer series: RNA-seq.

Genomic data sharing enhances efficiency in medical practice by facilitating faster data access and collaboration across settings. However, the same arrangements that enable efficiency could also raise legal inequalities, especially concerning data ownership and access. Yet these inequities are intensified in cross-border collaborations where power dynamics disadvantage low and middle income (LMIC) researchers. A qualitative phenomenological study was conducted in Uganda. Key informant interviews (KIIs) were conducted with 49 stakeholders working at different points across the genomic research landscape and four focus group discussions (FGDs) were conducted with people currently or previously enrolled in genomic studies, or their caretakers. The stakeholders who took part in the KIIs included genomic researchers (16), research ethics committee (REC) members (14), practicing lawyers (3), community advisory board (CAB) members (8) and national research regulators (8). A theory of decolonization was used to clarify rooted power imbalances and unfairness. Through thematic analysis six concerns were identified: (1) inadequate regulatory frameworks, (2) limited access to the shared data, (3) unclear data ownership (4) absence of benefit sharing frameworks, (5) contested intellectual property rights and (6) rethinking power asymmetries and struggles. The wide spread perception by research participants that the Global North collaborators owned the data, eroded community trust. There was limited clarity on data ownership, with Ugandan researchers expressing differing views, on ownership, custodianship, and shared ownership leading to calls for co-ownership. In the absence of benefit-sharing frameworks to regulate the distribution of commercial value, data commercialization disadvantaged Ugandan researchers and participants, reinforcing colonial-like inequalities. Current governance systems mirror colonial patterns in the control and sharing of genomic data in Uganda. These patterns are reinforced not only by cross-border power asymmetries but also by internal power dynamics within the country, including institutional hierarchies and regulatory gaps that limit local decision-making authority. Addressing this requires rethinking governance structures and promoting local or co-ownership models that reflect African interests and support decolonized approaches to data governance. Not applicable. This study did not involve a clinical trial.

This paper synthesises a series of four studies in the exploration of the concept of Return on Investment (ROI) in relation to healthcare Quality Improvement (QI) programmes (QI-ROI). We followed a multi-stage mixed-methods integration approach where four studies were first conducted and reported separately. The four study designs were linked to enable us to build a cohesive understanding of QI-ROI. Collective findings were then analysed and interpreted to identify the main QI-ROI concept domains. Two studies were based on an extensive global interdisciplinary systematic literature review N = 68; one a qualitative study N = 16, and last, a Delphi study N = 23. For the latter two studies, participants were from the UK National Health Service and included 24 board members, 15 service and clinical directors, and QI leaders. Several benefits were seen to represent ROI from QI programmes. These encompassed internal (e.g., development) and external (e.g., service user socio-economic benefits), intervention outcomes (e.g., clinical benefits) and implementation outcomes (e.g., spread). Further, the benefits included lessons from 'failed' QI programmes. Together, these benefits encompass monetary and non-monetary value of QI along a programme's journey. We view these benefits as four main domains: development, improvement, savings, and sustainability or DISS. QI has several organisational and health system benefits contained within the DISS construct. These benefits support various organisational goals such as quality improvement, organisational development, performance and resilience. We posit that the collective findings are applicable to many organisations that provide interdisciplinary healthcare services globally.

Polypharmacy and potentially inappropriate medications are highly prevalent in primary care and are associated with adverse drug events, reduced adherence, and diminished quality of life. Deprescribing is a key strategy to address these challenges, but its implementation is complex, particularly when long-term preventive medications are involved and decisions are preference-sensitive. Digital tools may support shared decision making in deprescribing, yet many existing tools lack clear implementation orientation. This study describes the iterative refinement of arribaMediQuit, a digital deprescribing tool for primary care, with the aim of improving usability, ethical robustness, and implementation potential. The refinement followed an iterative, participatory development process informed by the Medical Research Council framework for complex interventions and the International Patient Decision Aid Standards. Multiple stakeholder groups were involved, including general practitioners, researchers in health services and pharmacology, members of a patient advisory board, experts in medical ethics, and the original developers of the tool. Regular expert meetings were used to review content, terminology, visual design, decision logic, and deprescribing strategies. Feedback was continuously integrated into successive versions of the tool. The study focused on qualitative refinement rather than outcome evaluation. Key refinements included the development of a dynamic medication database and a structured categorization of medications into three categories (symptomatic, intermediate, and preventive medications) with tailored decision processes. A new linear decision model was introduced for preventive medications to better reflect value-sensitive trade-offs under uncertainty. Terminology and visual elements were revised to align with everyday clinical language and to enhance patient comprehensibility. Ethical considerations, including the communication of benefits, harms, and withdrawal symptoms, were explicitly addressed. Stakeholders also identified potential future uses of the tool, such as educational applications and integration with other deprescribing or medication review tools. The iterative, theory-informed refinement of arribaMediQuit illustrates how shared decision making principles can be operationalized in a deprescribing tool designed for routine primary care. By integrating technical guidance with value-sensitive deliberation and implementation considerations, the tool shows promise for supporting ethically grounded and feasible deprescribing. Future studies will evaluate feasibility, acceptability, and use in routine practice.

The Alabama Genomic Health Initiative (AGHI), funded by the state of Alabama, aims to provide genomic testing, interpretation, and counseling free of charge to Alabama residents. A 14-member Community Advisory Board (CAB) was convened in 2021 to provide community insight on integrating genomic medicine into clinical care and assessing future perspectives. The CAB was comprised of members from diverse ethnic backgrounds and represented a wide range of age groups, with balanced gender representation from two Alabama counties. The CAB met quarterly, and the team explored the perceptions of members related to genomic medicine through qualitative inquiry with exploratory quantitative findings. Self-administered pre- and post-surveys, completed prior to the first CAB meeting (pre) and after meeting five (post), were utilized to evaluate positive and negative views towards the future of genomic medicine. Five meetings were conducted in a focus group format, and transcripts were coded and analyzed to identify emerging themes. Ten of fourteen (71%) CAB members completed both surveys. Results indicate there was a slight shift in responses related to the future of genomic medicine from pre to post-test, but no significant changes were noted. Eleven of fourteen (80%) CAB members attended four out of five meetings. The prominent themes included barriers to genomic testing, strategies for recruitment, and recommendations for sharing test results. Members believed that participation in the CAB facilitated acquiring new knowledge and insight on genomic medicine.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12687-026-00885-9.