Evidence-based Practice Recommendations Research Articles

Protocol for a Systematic and Scoping Review of Emergent Motion Capture Technology for Upper Extremity Assessment in Stroke.

A significant proportion of stroke survivors, ranging from 50% to 88%, experience upper limb motor impairments. Traditional upper limb assessments in clinical settings rely on subjective observations, leading to inconsistencies. Motion capture (MoCap) systems offer objective, precise assessments of kinematics. This review aims to systematically evaluate emergent MoCap technologies for upper limb assessment in stroke patients. This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Cochrane Handbook for Systematic Reviews of Interventions version 6.4. The review is registered with the Open Science Framework (OSF). Searches will be conducted in PubMed, MEDLINE, CINAHL, CENTRAL, and IEEE Xplore. We will include peer-reviewed studies from 2014 to 2024, in English, focusing on adults (≥18 years) post-stroke using MoCap technologies for upper limb assessment. Two or more reviewers will independently screen, select, and extract data. A narrative synthesis will describe the evidence's quality and content. This review will enhance our understanding of MoCap technologies for upper limb assessment post-stroke, identifying strengths, limitations, and providing evidence-based recommendations for clinical practice and future research. It aims to bridge the gap by capturing and analysing the latest advancements and their clinical applications.

European Stroke Organisation (ESO) standard operating procedure for white papers (expert consensus based clinical guidance).

Promoting the highest quality, evidence-based research across Europe is a priority of the European Stroke Organisation (ESO). The ESO Guideline Board communicate and promote evidence-based recommendations for clinical practice through their Guidelines. However, there are many aspects of stroke care where robust scientific evidence may be unavailable or difficult to obtain. Thus, there is a need for practical, consensus guidance, produced following robust, consistent, and transparent methods, that is suitable for high-priority clinical scenarios where evidence is currently lacking. The ESO Guideline Board developed methods for producing practical clinical guidance based on expert consensus in response to this need. These ESO' White Papers' are intended to complement standard ESO Guidelines. Here, we outline the ESO White Papers' standard operating procedure (SOP). We will describe the motivation for creating White Papers, the preferred composition of writing groups and expert consensus panellists, the methods for achieving consensus, and how results will be communicated. To ensure that all voting members have an equal voice, our methods are based upon the Delphi process of repeated rounds of anonymous voting, feedback and review. We hope that the White Papers will add further value to the clinical practice guidance that is offered by ESO. We look forward to receiving suggestions for White Paper topics from the stroke community.

AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals.

Hepatitis B reactivation (HBVr) can occur due to a variety of immune-modulating exposures, including multiple drug classes and disease states. Antiviral prophylaxis can be effective in mitigating the risk of HBVr. In select cases, clinical monitoring without antiviral prophylaxis is sufficient for managing the risk of HBVr. This clinical practice guideline update aims to inform frontline health care practitioners by providing evidence-based practice recommendation for the management of HBVr in at-risk individuals. The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel conducted a systematic evidence review to identify new studies since publication of the first version of this clinical practice guideline in 2014. The Evidence to Decision framework was used to develop recommendations regarding the role of antiviral prophylaxis and monitoring without antiviral prophylaxis for management of HBVr. Clinical recommendations were based on the balance between desirable and undesirable effects, patient values, costs, and health equity considerations. The panel agreed on 4 recommendations. Based on evidence and baseline risk assessment, the panel made a strong recommendation in favor of antiviral prophylaxis for individuals at high risk of HBVr. For individuals at moderate risk of HBVr, a conditional recommendation was made in favor of antiviral prophylaxis. For individuals at low risk of HBVr, a conditional recommendation was made in favor of monitoring alone without antiviral prophylaxis. Monitoring should be performed at 1- to 3-month intervals, and must include assessment of hepatitis B viral load in addition to assessment of alanine aminotransferase. For individuals deemed to be at-risk of HBVr, the panel agreed on a strong recommendation in favor of testing for HBV; given universal Centers for Disease Control and Prevention screening guidance for hepatitis B for all adults 18 years and older by testing for HBV surface antigen, hepatitis B surface antibody, and total hepatitis B core antibody, stratifying screening practices by magnitude of HBVr risk is no longer needed. This document provides updated guidance for the management of HBVr in at-risk individuals. Limitations and gaps in the evidence are highlighted. This guideline is expected to require updating in 5 years from publication.

P-386. Assessing Implementation of Evidence-Based Practice Recommendations for Prevention of Surgical Site Infections Through a Statewide Survey of Nebraska Hospitals

Abstract Background Almost half of surgical site infections (SSIs) are preventable by application of evidence-based strategies. An online survey of Nebraska hospitals was conducted by the Nebraska Healthcare-Associated Infections/Antimicrobial Resistance Advisory Council’s SSI Subcommittee between March and May 2023 to assess implementation of evidence-based practice recommendations (EBPR) from national guidelines. Methods Infection preventionists completed the survey in collaboration with their perioperative teams. In addition to facility demographics, data was collected on general SSI prevention practices along with those specific to colon procedures, hysterectomies, and cesarean sections. Implementation frequencies were calculated for each EBPR after excluding missing responses.Figure 2:Routine Audits Conducted by Facilities Results Response rates for acute care and critical access hospitals were 72% (21/29) and 47% (30/64), respectively. Most EBPR (19/30) assessed were reported to be implemented by majority ( >50%) of the hospitals. The least implemented EBPR was vaginal cleansing prior to all cesarean sections (16%, 5/31) (Figure 1). Audits to monitor operating room traffic and skin antisepsis were conducted by approximately a third of hospitals (31%, 15/49 and 33%, 16/48, respectively) (Figure 2). Among hospitals that performed hysterectomies (n=23), less than half reported performing vaginal cleansing prior to all hysterectomies (43%), presence of policies/protocols for pre- and intraoperative antibiotic use for hysterectomies (39%) and monitoring of antimicrobial prophylaxis practices for hysterectomies (43%). Least implemented colon procedure specific EBPR in hospitals performing these procedures (n=26) included having standardized policies/procedures for mechanical bowel preparation (35%), presence of policies/protocols for pre- and intraoperative antibiotic use for colon procedures (50%,) and monitoring of antimicrobial prophylaxis practices for colon procedures (54%). Conclusion Several EBPR for SSI prevention are not routinely implemented highlighting the need for educational efforts to raise awareness among hospitals. Future studies should focus on identifying practice barriers and mitigation strategies to increase implementation. Disclosures Trevor C. Van Schooneveld, MD, FSHEA, FIDSA, AN2 Therapeutics: Grant/Research Support|BioMerieux: Grant/Research Support|BioMerieux: Honoraria|Thermo-Fisher: Honoraria Renuga Vivekanandan, MD, MDconsult: Ownership Interest Muhammad Salman Ashraf, MBBS, Merck & Co. Inc: Grant/Research Support

Sports and Sustainable Development: A Systematic Review of Their Contribution to the SDGs and Public Health

This systematic review aims to explore the role of sports in achieving the United Nations’ Sustainable Development Goals (SDGs), with a special focus on SDG 3, which pertains to health and well-being. It seeks to analyze how sports can prevent non-communicable diseases, promote mental and physical health, and offer constructive alternatives for addiction prevention and treatment. A systematic literature review was conducted following the PRISMA-NMA 2020 guidelines. The research question was formulated using the PICO framework. Databases such as PubMed, Scopus, and Science Direct were searched using appropriate keywords and Boolean operators. Eligibility criteria were applied to select relevant studies, which were then assessed for quality using CASPe and GRADE systems. The review identified that sports significantly contribute to the achievement of multiple SDGs, notably SDG 3, by enhancing physical and mental health, reducing non-communicable diseases, and promoting well-being. From the analysis of the reviewed articles, which include these aspects, it is concluded that sport significantly impacts sustainable development and can be a powerful tool to address public health and social problems. Sports also play a vital role in economic growth, social inclusion, and gender equality. However, challenges such as inequitable access to sports facilities, gender disparities, and environmental impacts of sports activities were highlighted. This review provides a comprehensive analysis of the multifaceted impact of sports on sustainable development, emphasizing its potential to address health and social challenges. It offers evidence-based insights and practical recommendations for integrating sports into sustainable development strategies, highlighting the need for inclusive and environmentally responsible sports policies and practices.

Case Study on Cultural Industry Empowerment in Urban Renewal: A Focus on Guangzhou, China

In recent years, the strategic development and utilization of historical and cultural resources in historic urban areas to foster advanced cultural industries has become a pivotal approach for promoting urban renewal. However, there are significant differences between the urban development models of Western countries and the unique context of China, rendering it challenging to directly apply Western theories to explain China’s urban development. As one of the leading cities in both cultural industry growth and urban renewal in China, Guangzhou offers a valuable case for examining how cultural industries can effectively empower urban renewal. This paper aims to explore and analyze the mechanisms through which cultural industry development influences urban renewal in China, using Guangzhou as a case to illustrate the dynamic interactions between cultural industries and urban transformation. Furthermore, it proposes a contextualized model and strategy for the role of cultural industries in driving urban renewal, thereby providing evidence-based insights and practical recommendations for enhancing the contribution of cultural industries to urban development. This study suggests that Guangzhou should further advance this goal by strengthening policy support, promoting the digital cultural industry, strengthening infrastructure for cultural industry spaces, and developing distinctive cultural industry projects, thus facilitating sustainable and high-quality urban development.

Arthroscopic and Open Surgery Show Comparable Efficacy in the Treatment of Lateral Epicondylitis: A Systematic Review.

The purpose of this systematic review is to compare the outcomes of open surgery versus arthroscopic surgery in the treatment of lateral epicondylitis, focusing on pain relief, functional recovery, complication rates, and patient satisfaction, in order to provide evidence-based recommendations for clinical practice and identify areas for future research. The systematic review process was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search was conducted across PubMed, Embase, Cochrane Library, Google Scholar, and Web of Science. Studies comparing open and arthroscopic surgery for lateral epicondylitis were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized studies. Outcomes assessed included recurrence pain, persistent pain, infection rates, reoperation rates, nerve-related complications, hematoma, patient satisfaction, visual analog scale, disabilities of the arm, shoulder, and hand score, operation time, and return to work time. Both randomized controlled trials (RCTs) and non-RCTs were included. 14 studies, comprising 6 RCTs and 8 cohort studies with a total of 20153 participants, were included. Both surgical techniques yielded comparable outcomes in terms of recurrence pain (arthroscopic: 0% to 13.3%; open: 2.9% to 13.2%), persistent pain (arthroscopic: 0% to 13.3%; open: 0% to 11.9%), patient dissatisfaction (arthroscopic: 4.9% to 13.3%; open: 3.8% to 16.7%), infection rates (arthroscopic: 0% to 13.3%; open: 0% to 6.7%), reoperation rates (arthroscopic: 2.4% to 7.1%; open: 2.9% to 5.3%), nerve-related complications (arthroscopic: 0% to 6.7%; open: 0% to 7.7%), and hematoma (arthroscopic: 0% to 5%; open: 0% to 6.7%). The surgical time for arthroscopy (34 to 36 min) was generally longer than that for the open group (22.5 to 34.7 min). No significant differences in functional outcomes were observed in the majority of studies. Both arthroscopic and open surgeries provide similar clinical outcomes for lateral epicondylitis, with no significant differences in functional results. Despite longer operative times, arthroscopic surgery is expected to become the preferred approach due to its minimally invasive nature.

Saudi National Clinical Practice Guidelines for Management of Adult Systemic Lupus Erythematosus.

To provide evidence-based clinical practice recommendations for managing Systemic Lupus Erythematosus (SLE) in Saudi Arabia. This EULAR-adapted national guideline in which a multidisciplinary task force utilized the modified Delphi method to develop 31 clinical key questions. A systematic literature review was conducted to update the evidence since the EULAR publication. After reaching a consensus agreement, two rounds of voting and group discussion were conducted to generate consolidated recommendations/statements. A significant number of patients in Saudi Arabia experience delays in accessing rheumatologists, highlighting the significance of timely referral to SLE specialists or rheumatologists to ensure accurate diagnosis and prompt treatment. The primary goal of Glucocorticoid (GC) therapy in SLE patients is to establish disease control with a minimum dose and duration. Steroid-sparing agent utilization facilitates steroid-sparing goals. Hydroxychloroquine is recommended for all SLE patients, though physicians must carefully monitor toxicity and prioritize regular medication adherence assessment. SLE management during pregnancy starts from preconception time by assessing disease activity, major organ involvement, hypercoagulability status, and concomitant diseases that may negatively impact maternal and fetal outcomes. Multidisciplinary care with close monitoring may optimize both maternal and fetal outcomes. For patients with antiphospholipid antibodies, low-dose aspirin prophylaxis is recommended. Also, Long-term anticoagulant medications are fundamental to prevent secondary antiphospholipid syndrome due to high thrombosis recurrence. This Saudi National Clinical Practice guidelines for SLE management provide evidence-based recommendations and guidance for healthcare providers in Saudi Arabia who are managing patients with SLE. These guidelines will help to standardize healthcare service, improve provider education, and perhaps lead to better treatment outcomes for SLE patients.

Development of evidence-based standards for inpatient physiotherapy services: a systematic review and content analysis of clinical practice guidelines

ObjectivePerformance standards are critical to service design and quality improvement. There are no published standards defining the care inpatients should receive from physiotherapists in Aotearoa New Zealand. This study aims...

Factors Influencing Information Quality of Information Systems: A Systematic Literature Review

In today's digital era, information quality in information systems is essential for organizational effectiveness and decision-making. This systematic literature review aims to assess and synthesize factors influencing information quality across various systems, focusing on key dimensions such as reliability, accessibility, usability, accuracy, completeness, and timeliness. The existing literature is fragmented, lacking an integrated theory that comprehensively addresses the significance of information quality. Thus, a systematic review was conducted following the PRISMA framework to address this gap and provide evidence-based recommendations for research and practice. Studies were identified, screened, and selected from Scopus and Web of Science. After an initial search using specific keywords, a total of 1,548 articles were found that contained specified terms or strings in various combinations. Of these, 31 studies were chosen for full review based on predefined inclusion and exclusion criteria. The analysis was organized into three primary themes: i) Core Information Quality Factors, ii) Synergizing Information Quality with System and Service Quality, and iii) Impact of Information Quality on User Satisfaction and Organizational Outcomes. The results emphasize the significant role of high information quality in enhancing user satisfaction and operational efficiency. Different industries prioritize various quality dimensions according to their specific needs. Therefore, this review elucidates the imperative function of good quality information in reinforcing information systems' proper functioning, calling for empirical studies to develop holistic frameworks that incorporate multiple dimensions and impact analysis across different domains.

Screening and surveillance practices for Multiple Endocrine Neoplasia type 1-related Neuroendocrine Tumours in European Neuroendocrine Tumor Society Centers of Excellence (ENETS CoE)-An ENETS MEN1 task force questionnaire study.

Multiple Endocrine Neoplasia type 1 (MEN1) Clinical Practice Guidelines (2012) are predominantly based on expert opinion due to limited available evidence at the time, leaving room for interpretation and variation in practices. Evidence on the natural course of MEN1-related neuroendocrine tumours (NET) and the value of screening programs has increased and new imaging techniques have emerged. The aim of this study is to provide insight in the current practices of screening and surveillance for MEN1-related NETs in ENETS Centers of Excellence (CoEs). A clinical practice questionnaire was distributed among all 65 ENETS CoEs. Response rate was 91% (59/65). In 14% of CoEs <10 patients, in 50% 10-49, in 31% 50-100 and in 3 centres (5%) >100 patients with MEN1 are seen. Practices with regard to screening and surveillance of NETs were markedly heterogeneous. Differences between countries were noted in the use of gut hormones for biochemical screening and the choice for imaging modality for screening/surveillance of pancreatic NETs (PanNETs). Magnetic resonance imaging (MRI) is the preferred modality for screening and surveillance of PanNETs, whereas this is computed tomography (CT) for thoracic NETs. Practices regarding screening for thoracic NETs were more homogeneous among larger volume CoEs, with longer screening intervals. The majority of CoEs tailored the surveillance of small pancreatic and lung NETs to observed growth rate. 68% of CoEs advise patients with clinical MEN1 with negative genetic testing to undergo periodic screening like mutation-positive patients. In conclusion, there is still marked heterogeneity in practice, although there are also common trends. Differences were sometimes associated with volume or country, but often no association was found. This underscores the need for clear and evidence-based practice recommendations.

The Impact of Surgical Timing on Outcomes in Patients Undergoing Arteriovenous FistulaCreation for Hemodialysis. A Meta-analysis

Background: Arteriovenous fistula (AVF) creation is the preferred method for vascular access in hemodialysis patients, offering better long-term patency, fewer complications, and lower infection rates compared to other options. However, the timing of AVF creation plays a critical role in determining outcomes. This meta-analysis examines the impact of surgical timing on AVF success, focusing on primary failure rates, maturation time, patency, and postoperative complications. Objectives: We sought to evaluate whether the timing of AVF creation impacts outcomes in hemodialysis patients and to provide evidence-based recommendations for clinical practice. Methods: Following PRISMA guidelines, a comprehensive meta-analysis was conducted from major databases (PubMed, Embase, Cochrane) until 2024 that included data. We selected studies based on defined criteria, and assessed for quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Primary failure rates, maturation time, primary and secondary patency and postoperative complications were analyzed as outcomes. Heterogeneity was addressed with random effects models, and subgroup analyses were carried out on the basis of patient characteristics. Results: Early AVF creation (creating an AVF ≥ 6 months prior to dialysis initiation) was shown to reduced primary failure rate by 50%, shortened maturation time by 2 to 3 weeks and increase primary patency rates by up to 35%. Early AVF creation, on the other hand, was also accompanied by fewer postoperative complications, including infection and thrombosis, versus delayed AVF creation. Consistent benefits were seen for different patient profiles in subgroup analyses. Conclusion: Early AVF creation is associated with superior outcomes, including lower failure rates, quicker maturation, and fewer complications. These findings support early AVF as the preferred practice in hemodialysis care, enhancing long-term patient outcomes and quality of care.

Scoping review of review methodologies used for guiding evidence-based practice in critical care: a protocol

IntroductionA literature review provides a synthesis on a selection of papers about a specific topic. This is used by health practitioners in critical care as in other specialities when making...

What does international evidence tell us about the health of people with childhood social care (CSC) experiences?

Abstract International research into the health of people with childhood social care (CSC) experiences has found evidence of worse mental health and emotional-behavioural wellbeing, higher rates of substance use, neurodevelopmental conditions, and avoidable mortality. Lower vaccination rates and worse dental health among those in care has also been reported in few countries. However, research results have been more mixed with regard to some physical health conditions, with higher prevalence of asthma and respiratory ill health among foster children reported in the US but no obvious differences found in the UK. Are there countries where these inequalities are less pronounced, and can we draw such conclusions based on available evidence? When making international comparisons or aiming to give policy advice, we also need to consider the quality of our evidence. Has this been based on small sample sizes or without comparison to other children and adjusting for relevant (socioeconomic) confounders? Most of our current knowledge is also cross-sectional and we do not know if some health conditions precede entry to care and may even be risk-factors for entering social care. Recent longitudinal and cross-sectoral data linkage programmes in many nations (Australia, UK, Canada) have a potential to change this and provide a foundation for evidence-based recommendations for policy and practice.

Highlights From the 2023 Revision of Pediatric Tactical Emergency Casualty Care Guidelines.

In 2023 the Committee for Tactical Emergency Casualty Care (C-TECC) issued updated Pediatric Tactical Emergency Casualty Care (TECC) Guidelines (Guidelines) that focus on the delivery of stabilizing care of children who are the victims of high-threat incidents such as an active shooter event. The Guidelines provide evidence-based and best practice recommendations to those individuals and departments that specifically provide operational medical support to law enforcement agencies caring for children in this uniquely dangerous environment where traditional resources may not be available. This article highlights key takeaway points from the Guidelines, including several updates since the first version was released in 2013.The evidence base for the care of children in this environment is lacking, and medical care delivered in the high-threat environment is inconsistent and often not optimized for the care of infants and children. The Guidelines are supported from the existing literature base where possible, and where it is not, by consensus as to the current best practices as determined by iterative deliberations among the diverse and experienced group of stakeholders who are members of C-TECC. The Guidelines provide patient assessment and management information specific to the care of children in the following 3 dynamic phases of the high-threat environment: Direct Threat, Indirect Threat, and Evacuation. The phases represent a continuum of risk to the patient and the responder ranging from extreme (such as ongoing gunfire) to minimal (during movement toward definitive medical care).The high-threat environment is dynamic and there is competing safety, tactical/operational, and patient care priorities for responders when infants and children are injured. The Guidelines provide recommendations on the type of medical and psychological care that should be considered under each phase of threat and establishes the context for how and why to deliver (or potentially defer) certain interventions under some circumstances in order the maximize the opportunity for a good outcome for an injured pediatric patient. The Guidelines also emphasize the importance of synergizing hospital-based pediatric trauma care with those law enforcement and fire/emergency medical services that may provide field care to children under high-threat circumstances.

The Integration of AI-Driven Decision Support Systems in Healthcare: Enhancements, Challenges, and Future Directions

Artificial Intelligence (AI) is transforming the healthcare landscape by enhancing diagnostic accuracy, operational efficiency, and patient management through AI-driven Decision Support Systems (AI-DSS). These systems leverage vast datasets, including electronic health records and various biomolecular markers, to provide evidence-based recommendations for clinical practice. Despite their potential, challenges such as data quality, algorithmic bias, and ethical concerns persist. This paper explores the capabilities of AI-DSS in healthcare, the methodologies underpinning their operation, and the ethical considerations that accompany their implementation. Additionally, the paper discusses future trends in AI integration within healthcare, emphasizing the importance of ongoing collaboration between healthcare professionals and AI researchers to address existing limitations and opti-mize patient outcomes. Keywords: Artificial Intelligence, Decision Support Systems, Healthcare, Diagnostic Accuracy, Predictive Analytics, Ethical Considerations, Data Privacy, Machine Learning, Personalized Medicine

SEOM-GEICO Clinical Guidelines on cervical cancer (2023)

Cervical cancer (CC) is the fourth most common cancer and the fourth leading cause of mortality in women worldwide. It is strongly associated with high-risk human papillomavirus infection. High-income countries that have implemented human papillomavirus (HPV) vaccination and screening programs have seen dramatic reductions in CC incidence, while developing countries where these programs are not available continue to experience high rates of CC deaths. In early-stage CC, the primary treatment is surgery or radiotherapy, whereas concurrent chemo-radiotherapy (CRT) remains the conventional approach in locally advanced stages until the upcoming approval of immunotherapy. The incorporation of immunotherapy in combination with chemotherapy (with or without bevacizumab) in first line and as monotherapy in second line after platinum-based chemotherapy, has significantly increased overall survival (OS) in recurrent or metastatic CC. The purpose of this guideline is to summarize the most relevant evidence in the diagnosis, treatment, and follow-up of CC and to provide evidence-based recommendations for clinical practice.

Development of sport policy and practice recommendations for pregnant, postpartum and parenting Canadian high-performance athletes

Our objective is to describe the development of evidence-based policy and practice recommendations for pregnant, postpartum and parenting Canadian high-performance athletes. A community-based participatory research approach was employed as the...

Effectiveness of Flipped Classrooms for K–12 Students: Evidence From a Three-Level Meta-Analysis

Flipped classrooms (FCs) in K–12 schools are growing in popularity. However, previous studies have reported inconsistent findings on the effects of FCs, and the conditions under which FCs are effective remain unclear. This three-level meta-analysis synthesized the effects of FCs versus traditional classrooms (TCs) on various learning domains among K–12 students based on 129 studies with 399 effect sizes (N = 12,727). The results revealed that FCs have a significant positive effect on K–12 students’ overall performance (without outliers: g = 0.53 [0.44,0.62], 95% prediction interval [–0.60, 1.66]) and on both the cognitive domain and the affective domain. Moderator analyses showed that region, measured outcome, outcome dilution, instructor equivalence, and publication type were significant predictors. In addition, the educational context and research methodology characteristics accounted for a significant proportion of the variability in overall effects. These findings provide valuable evidence-based recommendations for future research and practice.

The Polish Society of Gynecological Oncology Guidelines for the Diagnosis and Treatment of Cervical Cancer (v2024.0).

Background: Recent publications underscore the need for updated recommendations addressing less radical surgery for <2 cm tumors, induction chemotherapy, or immunotherapy for locally advanced stages of cervical cancer, as well as for the systemic therapy for recurrent or metastatic cervical cancer. Aim: To summarize the current evidence for the diagnosis, treatment, and follow-up of cervical cancer and provide evidence-based clinical practice recommendations. Methods: Developed according to AGREE II standards, the guidelines classify scientific evidence based on the Agency for Health Technology Assessment and Tariff System criteria. Recommendations are graded by evidence strength and consensus level from the development group. Key Results: (1) Early-Stage Cancer: Stromal invasion and lymphovascular space involvement (LVSI) from pretreatment biopsy identify candidates for surgery, particularly for simple hysterectomy. (2) Surgical Approach: Minimally invasive surgery is not recommended, except for T1A, LVSI-negative tumors, due to a reduction in life expectancy. (3) Locally Advanced Cancer: concurrent chemoradiation (CCRT) followed by brachytherapy (BRT) is the cornerstone treatment. Low-risk patients (fewer than two metastatic nodes or FIGO IB2-II) may consider induction chemotherapy (ICT) followed by CCRT and BRT after 7 days. High-risk patients (two or more metastatic nodes or FIGO IIIA, IIIB, and IVA) benefit from pembrolizumab with CCRT and maintenance therapy. (4) Metastatic, Persistent, and Recurrent Cancer: A PD-L1 status from pretreatment biopsy identifies candidates for Pembrolizumab with available systemic treatment, while triplet therapy (Atezolizumab/Bevacizumab/chemotherapy) becomes a PD-L1-independent option. Conclusions: These evidence-based guidelines aim to improve clinical outcomes through precise treatment strategies based on individual risk factors, predictors, and disease stages.