Evidence-based Recommendations Research Articles

Safeguarding public facilities: a study on enhancing safety in mosque amenities through slip-resistance and surface innovations

PurposeThis study critically examines the safety aspects of ablution spaces in United Arab Emirates (UAE) mosques, emphasising the evaluation of smooth ceramic tile floorings prone to water accumulation. As an integral practice in Islamic worship, ablution spaces cater to a diverse demographic, making their safety a paramount concern. This study aims to meticulously assess slip-resistance properties and surface characteristics to provide practical recommendations for enhanced safety measures.Design/methodology/approachThe investigation involves in situ measurements of traction properties and an extensive analysis of surface features in thirty mosques across the UAE. This comprehensive approach allows for identifying the unique challenges posed by ceramic tile floorings in ablution spaces. The study uses a portable tribometer for dynamic friction coefficient measurements, ensuring accurate slip-resistance evaluations. Surface texture analysis uses a portable profilometer to quantify roughness parameters.FindingsThe study’s findings significantly advance the comprehension of safety considerations in ablution spaces. Through empirical evidence and evidence-based insights, the research identifies immediate safety concerns and provides practical recommendations to create secure and inclusive environments within mosques. The emphasis lies on safeguarding the well-being of worshippers and contributing to the broader goal of safety in religious spaces.Originality/valueThe original contribution of this study lies in its dual focus on immediate safety concerns and the deeper understanding of unique safety challenges within ablution spaces. By offering evidence-based insights and practical recommendations, the research strives to make meaningful contributions to creating secure and inclusive environments within mosques.

Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis

BackgroundThis systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers.MethodsA comprehensive search in March 2023 across Web of Science, PubMed, Scopus, ScienceDirect, SID, IranMedex, and IranDoc, enhanced by hand-searching references and Google Scholar, identified cross-sectional studies on cognitive screening in Iranian seniors. We assessed diagnostic accuracy, cognitive domains, and test strengths and weaknesses. A bivariate random-effects meta-analysis provided summary estimates and 95% confidence intervals, illustrated in forest plots.ResultsOur review, derived from an initial screening of 38 articles, focused on 17 studies involving 14 cognitive screening tools and participant counts from 60 to 350, mostly from specialized clinics. The MMSE was the only tool examined in at least three studies, prompting a meta-analysis revealing its sensitivity at 0.89 and specificity at 0.77 for dementia detection, albeit amidst significant heterogeneity (I^2 > 80%). ACE-III demonstrated the highest diagnostic accuracy for MCI and dementia, while MoCA’s performance was deemed adequate for MCI and excellent for dementia. High bias risk in studies limits interpretation.ConclusionThis review identifies key cognitive tools for dementia and MCI in Iranian older adults, tailored to educational levels for use in primary and specialized care. It emphasizes the need for further validation to enhance diagnostic precision across diverse settings, within a concise framework prioritizing brevity and accuracy for clinical applicability.

World Health Organization (WHO) guideline on the complementary feeding of infants and young children aged 6-23 months 2023: A multisociety response.

The recent World Health Organization(WHO) guideline aims to provide evidence-based recommendations on complementary feeding (CF) of healthy term infants and young children 6-23 months living in low-, middle-, and high-income countries, including both breastfed and non-breastfed children. Like WHO, our organizations aim to promote optimal infant and young child nutrition and health, with a focus on promoting breastfeeding as well as appropriate and timely CF. In this paper, we share our concerns about aspects of the guideline, some of which may have the potential to cause unintended harm in infants and young children and suggest alternative or modified proposals.

SAGES guideline for the diagnosis and treatment of appendicitis.

Appendicitis is an extremely common disease with a variety of medical and surgical treatment approaches. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians and patients in decisions regarding the diagnosis and treatment of appendicitis. A systematic review was conducted from 2010 to 2022 to answer 8 key questions relating to the diagnosis of appendicitis, operative or nonoperative management, and specific technical and post-operative issues for appendectomy. The results of this systematic review were then presented to a panel of adult and pediatric surgeons. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Conditional recommendations were made in favor of uncomplicated and complicated appendicitis being managed operatively, either delayed (>12h) or immediate operation (<12h), either suction and lavage or suction alone, no routine drain placement, treatment with short-term antibiotics postoperatively for complicated appendicitis, and complicated appendicitis previously treated nonoperatively undergoing interval appendectomy. A conditional recommendation signals that the benefits of adhering to a recommendation probably outweigh the harms although it does also indicate uncertainty. These recommendations should provide guidance with regard to current controversies in appendicitis. The panel also highlighted future research opportunities where the evidence base can be strengthened.

The Impacts of the Low-FODMAP Diet on the Management of Irritable Bowel Syndrome Symptoms: Possibilities, Feasibility, and Alternatives

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) condition characterized by a myriad of GI symptoms (e.g., diarrhea, nutrient malabsorption) that vary in severity. Due to its complex and individual nature, there is no known cure for IBS, but many diets have been assessed for their viability in managing symptoms. The low-FODMAP diet has recently been investigated for its potential benefits for IBS patients. FODMAPs, or Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols are short- and medium-chain carbohydrates that are poorly absorbed in the small intestine and are prone to absorb water and ferment in the colon. Consumption of these FODMAPs correlates with increasing severity of IBS symptoms. The purpose of this randomized controlled trial systematic review was to compile various evidence-based dietary recommendations for the low-FODMAP diet for adult patients suffering from IBS from randomized controlled and clinical trials. The possibilities, feasibilities, and potential alternatives are proposed to determine if there is sufficient evidence to recommend the low-FODMAP diet for this patient population. Over 1,000 studies were screened and 6 were reviewed to determine the benefits of this diet. It was found that the low-FODMAP diet has demonstrated efficacy in delivering IBS symptom relief by changing patients’ metabolomes, microbiomes, and physiology. Specifically, this diet showed a greater overall decrease in abdominal pain, bloating, stool consistency, frequency, and urgency. Greater diversity of actinobacteria was found in the stool samples of these patients. Nociceptive neurons were also shown to be less sensitive and GI gas production was also markedly decreased. Despite these benefits, the low-FODMAP diet is more recommended for acute flare-ups due to its difficult adherence and attrition. Instead, we conclude that the balanced Mediterranean diet contains aspects of the traditional Mediterranean and low-FODMAP diet that can relieve IBS symptoms for daily life, while the low-FODMAP diet can be an effective treatment to ameliorate conditions when severe symptoms are experienced.

Challenges and Opportunities of Livelihood Diversification in Ethiopia: A Review Article

Diversifying sources of income has been recognized as a crucial approach to alleviate poverty, mitigate food insecurity, and enhance the overall well-being of rural residents in Ethiopia. This review outlines the key challenges and opportunities associated with livelihood diversification in the country. The study identifies several primary constraints that hinder livelihood diversification, including inadequate infrastructure development, scarcity of arable land, limited access to credit services, gender disparities, and poor rural-urban linkages. However, it also highlights potential avenues for sustainable livelihoods through diversification, such as the promotion of sustainable land management practices, adoption of climate-resilient agricultural strategies, and the provision of training and capacity building programs. To facilitate successful livelihood diversification, the review emphasizes the urgency of investing in infrastructure development and ensuring access to credit services. Moreover, it underscores the importance of promoting gender equality to mitigate the challenges faced by women in diversifying their livelihoods. Encouraging sustainable land management practices, implementing climate-resilient agricultural strategies, and providing comprehensive training and capacity building programs are identified as critical measures to support diversification efforts in Ethiopia effectively. The review offers evidence-based policy recommendations to inform government agencies, non-governmental organizations (NGOs), and other stakeholders on effective strategies that can enhance livelihood diversification in the country, while also ensuring inclusivity and sustainability. The significance of livelihood diversification within Ethiopia&amp;apos;s development agenda cannot be overstated, and it is imperative for stakeholders to act in addressing the identified challenges and capitalizing on the opportunities presented by diversification. By doing so, they can contribute to poverty reduction and sustainable development in the country. However, it is essential to note that further research is necessary to explore the efficacy of livelihood diversification strategies in different contexts and identify additional opportunities and challenges that may arise.

Improving access to suicide prevention services through the National Suicide Prevention Framework implementation: The community level evidence-based recommendations

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The South African Prostate Cancer Screening Guidelines

Prostate cancer (PCa) is the most widespread solid organ malignancy in males and ranks as the fifth leading cause of death globally. Identifying and treating men with clinically significant disease while avoiding the over-diagnosis and over-treatment of indolent disease remains a significant challenge. Several professional associations have developed guidelines on screening and early diagnosis of asymptomatic men with prostate-specific antigen testing. With recent updates from several large randomised prospective trials, the South African Urological Association and the Prostate Cancer Foundation of South Africa have developed these evidence-based recommendations to guide clinicians on PCa screening and early diagnosis for South African men.

Cost-effectiveness of outpatient adherence to recommendations for monitoring of patients hospitalized for heart failure.

A set of indicators to assess the quality of care for patients hospitalized for heart failure was developed by an expert working group of the Italian Health Ministry. Because a better performance profile measured using these indicators does not necessarily translate to better outcomes, a study to validate these indicators through their relationship with measurable clinical outcomes and healthcare costs supported by the Italian National Health System was carried out. Residents of four Italian regions (Lombardy, Marche, Lazio, and Sicily) who were newly hospitalized for heart failure (irrespective of stage and New York Heart Association class) during 2014-2015 entered in the cohort and followed up until 2019. Adherence to evidence-based recommendations [i.e. renin-angiotensin-aldosterone system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and echocardiograms (ECCs)] experienced during the first year after index discharge was assessed. Composite clinical outcomes (cardiovascular hospital admissions and all-cause mortality) and healthcare costs (hospitalizations, drugs, and outpatient services) were assessed during the follow-up. The restricted mean survival time at 5years (denoted as the number of months free from clinical outcomes), the hazard of clinical outcomes (according to the Cox model), and average annual healthcare cost (expressed in euros per person-year) were compared between adherent and non-adherent patients. A non-parametric bootstrap method based on 1000 resamples was used to account for uncertainty in cost-effectiveness estimates. A total of 41406 patients were included in this study (46.3% males, mean age 76.9±9.4years). Adherence to RAS inhibitors, beta-blockers, MRAs, and ECCs were 64%, 57%, 62%, and 20% among the cohort members, respectively. Compared with non-adherent patients, those who adhered to ECCs, RAS inhibitors, beta-blockers, and MRAs experienced (i) a delay in the composite outcome of 1.6, 1.9, 1.6, and 0.6months and reduced risks of 9% (95% confidence interval, 2-14%), 11% (7-14%), 8% (5-11%), and 4% (-1-8%), respectively; and (ii) lower (€262, €92, and €571 per year for RAS inhibitors, beta-blockers, and MRAs, respectively) and higher costs (€511 per year for ECC). Adherence to RAS inhibitors, beta-blockers, and MRAs showed a delay in the composite outcome and a saving of costs in 98%, 84%, and 93% of the 1000 bootstrap replications, respectively. Strict monitoring of patients with heart failure through regular clinical examinations and drug therapies should be considered the cornerstone of national guidelines and audits.

Guía para el manejo de los trastornos del desarrollo sexual en la infancia, Medellín 2020-2021

Objective: to present a local guide for the management of disorders of sexual development (DSD) in childhood. Disorders of sexual development are situations in which a newborn has congenital incoherence between chromosomal, gonadal and / or genital development. Materials and methods: the Guide for action on anomalies of sexual differentiation (ADS) / different sexual development (DSD) of the Spanish Pediatric Association published in 2018 was adapted, according to the guidelines of the Guide for Adoption-Adaptation of Guides of the Ministry of Health and Social Protection and the Institute of Technological Evaluation in Health in Colombia 2017. The GRADE system was used for the global qualification of the evidence and this guide was evaluated with the AGREE II-Global Rating Scale (AGREE II-GRS) tool. Through the Delphi method, a consensus was made with national experts who contributed their opinions about the diagnosis, management and follow-up of these disorders, which were included. Results: a guide was developed with 15 evidence-based recommendations for the diagnosis, treatment and follow-up of TDS in childhood. Conclusions: the management of TDS in childhood requires the participation of an interdisciplinary group that, in accordance with the recommendations in the light of current knowledge, guarantees to advance and improve technologies for both its diagnosis, as well as for its various therapies and the follow-up that implies the complexity of these disorders.

Quality and Safety in Nursing: Recommendations From a Systematic Review.

As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.

Prescribing Patterns of Nonrecommended Medications for Children With Acute COVID-19.

Repurposed medications for acute coronavirus disease 2019 (COVID-19) continued to be prescribed after results from rigorous studies and national guidelines discouraged use. We aimed to describe prescribing rates of nonrecommended medications for acute COVID-19 in children, associations with demographic factors, and provider type and specialty. In this retrospective cohort of children <18 years in a large United States all-payer claims database, we identified prescriptions within 2 weeks of an acute COVID-19 diagnosis. We calculated prescription rate, performed multivariable logistic regression to identify risk factors, and described prescriber type and specialty during nonrecommended periods defined by national guidelines. We identified 3 082 626 COVID-19 diagnoses in 2 949 118 children between March 7, 2020 and December 31, 2022. Hydroxychloroquine (HCQ) and ivermectin were prescribed in 0.03% and 0.14% of COVID-19 cases, respectively, during nonrecommended periods (after September 12, 2020 for HCQ and February 5, 2021 for ivermectin) with considerable variation by state. Prescription rates were 4 times the national average in Arkansas (HCQ) and Oklahoma (ivermectin). Older age, nonpublic insurance, and emergency department or urgent care visit were associated with increased risk of either prescription. Additionally, residence in nonurban and low-income areas was associated with ivermectin prescription. General practitioners had the highest rates of prescribing. Although nonrecommended medication prescription rates were low, the overall COVID-19 burden translated into high numbers of ineffective and potentially harmful prescriptions. Understanding overuse patterns can help mitigate downstream consequences of misinformation. Reaching providers and parents with clear evidence-based recommendations is crucial to children's health.

[Chinese expert consensus on treatment of osteoporotic fractures with teriparatide (2024 edition)].

Osteoporotic fracture is the most serious complication of osteoporosis, which is a special type of pathologic fracture of the skeleton that occurs because of osteoporosis. It is characterized by delayed fracture healing, high risk of re-fracture, high rate of disability and death, difficulty in treatment and long treatment time, and re-fracture has a"cascade effect". Guidelines in different countries recommend that patients with osteoporotic fractures and those at very high risk of fracture should consider anabolic agents as first treatment choice. Teriparatide is the only anabolic agent approved by National Medical Products Administration (NMPA), and it has the clinical efficacy of improving fracture healing, reducing the risk of re-fracture, and improving bone microstructure in the treatment of osteoporotic fracture. Due to deficiencies in the current standardization of clinical use of teriparatide, Committee of Accelerated Rehabilitation After Osteoporotic Fractures of China Association of Rehabilitation Technology Transformation and Promotion, Bone and Joint Group of Chinese Society of Osteoporosis and Bone Mineral Research and Osteoporosis Working Committee of Chinese Association of Orthopedic Surgeons developed this consensus. The development of this consensus follows the modified Delphi method and forms 8 evidence-based medical recommendations, aiming to propose methods and precautions for standardizing the application of teriparatide, and to emphasize the importance of teriparatide application for the treatment of patients with osteoporotic fracture.

Digital Finance-Fintech and it’s Impact on Financial Inclusion in India

Financial inclusion stands as a critical driver of economic empowerment and social development, ensuring that individuals across diverse socio-economic strata have access to and can effectively utilize formal financial services. In the context of India, where millions have historically been excluded from traditional banking systems, the emergence of digital finance presents a promising avenue for bridging this gap and fostering greater financial inclusion. This research paper delves into the transformative role of digital finance in driving financial inclusion in India, with a particular focus on understanding its impact on key aspects of financial access and empowerment. Central to our exploration is the definition of financial inclusion as the ability to access and effectively utilize a spectrum of formal financial services. In this context, we examine how digital tools such as credit/debit cards, internet banking, mobile banking, and the Unified Payments Interface (UPI) can empower individuals, particularly those who have been previously excluded from traditional banking systems. By investigating the impact of these digital instruments across ten key aspects of financial inclusion, including convenience, success rate of transactions, affordability, security, user-friendliness, timeliness, customer care support, internet connectivity, and overall usability, we aim to discern their strengths and weaknesses in promoting financial inclusion. Through a systematic analysis of each dimension, we seek to uncover the transformative potential of digital finance in bridging the financial gap in India. Our research will contribute valuable insights into the effectiveness of digital finance initiatives in fostering financial inclusion, providing evidence-based recommendations for policymakers, financial institutions, and fintech companies seeking to create a more inclusive financial landscape for all segments of Indian society. This research is not merely theoretical but grounded in empirical evidence and real-world observations. By synthesizing findings from existing literature and complementing it with primary data analysis, we aim to provide a comprehensive understanding of the dynamics shaping digital finance and financial inclusion in India. Our findings will be particularly relevant for policymakers, financial regulators, and industry stakeholders, informing strategic decision-making and shaping the future direction of digital finance initiatives in India.

A systematic review and meta-analysis of randomized controlled trials on the effectiveness of high-intensity laser therapy in the management of neck pain.

The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).

Conspiracy Theories, Vaccine Hesitancy and Determinants of Vaccination Acceptance in Nigeria: A Conceptual Review

Purpose: This conceptual review aims to dissect the intricate web of conspiracy theories, vaccine hesitancy and determinants of vaccination acceptance within Nigeria's socio-cultural context, shedding light on their genesis, propagation and impact on public health outcomes. Methodology: Employing a multidisciplinary approach, this study synthesizes existing literature and theoretical frameworks from various disciplines, including sociology, anthropology, public health, and communication studies. Methodological rigor is ensured through comprehensive literature review and critical appraisal of relevant studies, enabling a holistic exploration of the subject matter. Findings: Through a systematic analysis, the review identifies and examines socio-cultural, economic and political influences that shape vaccination behavior in Nigeria. It illuminates the multifaceted determinants contributing to vaccine hesitancy, ranging from religious beliefs to historical legacies to socio-economic factors and healthcare accessibility challenges. The review also highlights the genesis and propagation of conspiracy narratives, their impact on public trust in vaccination and consequent implications for immunization uptake. Unique Contribution to Theory, Policy and Practice: This review makes several contributions to theory, policy, and practice in the field of vaccination and public health. Firstly, it advances theoretical understanding by synthesizing existing knowledge and proposing conceptual frameworks that elucidate the socio-cultural, economic, and political determinants of vaccination behavior in Nigeria. Secondly, it informs policy development by identifying key areas for intervention, such as addressing vaccine hesitancy, countering misinformation, and strengthening healthcare infrastructure to enhance vaccine delivery. Finally, it offers practical insights for public health practitioners and policymakers, providing evidence-based recommendations for designing effective vaccination campaigns, communication strategies, and community engagement initiatives tailored to the Nigerian context.

SAGES guidelines for the use of laparoscopy during pregnancy.

When pregnant patients present with nonobstetric pathology, the physicians caring for them may be uncertain about the optimal management strategy. The aim of this guideline is to develop evidence-based recommendations for pregnant patients presenting with common surgical pathologies including appendicitis, biliary disease, and inflammatory bowel disease (IBD). The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee convened a working group to address these issues. The group generated five key questions and completed a systematic review and meta-analysis of the literature. An expert panel then met to form evidence-based recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Expert opinion was utilized when the available evidence was deemed insufficient. The expert panel agreed on ten recommendations addressing the management of appendicitis, biliary disease, and IBD during pregnancy. Conditional recommendations were made in favor of appendectomy over nonoperative treatment of appendicitis, laparoscopic appendectomy over open appendectomy, and laparoscopic cholecystectomy over nonoperative treatment of biliary disease and acute cholecystitis specifically. Based on expert opinion, the panel also suggested either operative or nonoperative treatment of biliary diseases other than acute cholecystitis in the third trimester, endoscopic retrograde cholangiopancreatography rather than common bile duct exploration for symptomatic choledocholithiasis, applying the same criteria for emergent surgical intervention in pregnant and non-pregnant IBD patients, utilizing an open rather than minimally invasive approach for pregnant patients requiring emergent surgical treatment of IBD, and managing pregnant patients with active IBD flares in a multidisciplinary fashion at centers with IBD expertise.

Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision.

Hereditary adenomatous polyposis syndromes, including familial adenomatous polyposis and other rare adenomatous polyposis syndromes, increase the lifetime risk of colorectal and other cancers. A team of 38 experts convened to update the 2008 European recommendations for the clinical management of patients with adenomatous polyposis syndromes. Additionally, other rare monogenic adenomatous polyposis syndromes were reviewed and added. Eighty-nine clinically relevant questions were answered after a systematic review of the existing literature with grading of the evidence according to Grading of Recommendations, Assessment, Development, and Evaluation methodology. Two levels of consensus were identified: consensus threshold (≥67% of voting guideline committee members voting either 'Strongly agree' or 'Agree' during the Delphi rounds) and high threshold (consensus ≥ 80%). One hundred and forty statements reached a high level of consensus concerning the management of hereditary adenomatous polyposis syndromes. These updated guidelines provide current, comprehensive, and evidence-based practical recommendations for the management of surveillance and treatment of familial adenomatous polyposis patients, encompassing additionally MUTYH-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach and other recently identified polyposis syndromes based on pathogenic variants in other genes than APC or MUTYH. Due to the rarity of these diseases, patients should be managed at specialized centres.

Management of chronic kidney disease for Māori in Aotearoa New Zealand: a summary of clinical practice guidelines

aims: The kaupapa of the Caring for Australians and New Zealanders with Kidney Impairment (CARI) Clinical practice guidelines for management of chronic kidney disease for Māori in Aotearoa New Zealand is to provide whānau-centred and evidence-based recommendations to healthcare systems, healthcare providers and healthcare workers. The guidelines include screening, identification, management and system-level responses to chronic kidney disease (CKD) to deliver best practice care to Māori affected by CKD across community, primary and secondary services. methods: The guidelines are funded by the Ministry of Health – Manatū Hauora and are written by a panel of Māori and non-Māori clinicians and literacy experts across Aotearoa New Zealand from Kaupapa Māori organisations, general practice and nephrology units using standardised methods. The guidelines’ methodology included consultation with whānau Māori with lived experience of CKD and primary and secondary care practitioners. Additional guideline development would be required to inform management of CKD for non-Māori in Aotearoa New Zealand. results: The guidelines provide recommendations about equity, governance and accountability, cultural safety, case management, information systems, social determinants of equity and wellbeing and screening. conclusions: Recommendations to health services for Māori with CKD are based on giving effect to Te Tiriti o Waitangi and best practice care to prevent CKD, delaying its progression, treating kidney failure through timely transplantation, delivering in community and providing high-quality symptom management.

Integrating decision analysis into South Africa's spending review methodology

ABSTRACT In 2016, the Government Technical Advisory Centre (GTAC) delivered training on the spending review methodology. During the training, it became evident that officials were not accustomed to analysing expenditure and performance data in the manner required for a spending review. They found it difficult to translate their analysis into findings and recommendations. In 2021, GTAC introduced the concept of decision analysis into its training curriculum. The primary reason for introducing decision analysis in the methodology was to empower officials with the tools needed to synthesise expenditure and performance data, identify diverse options and formulate evidence-based recommendations. In turn, it was hoped that these recommendations would then prompt decisions and actions by the political executive or senior managers. This research note explains how decision analysis can be used to outline the range of choices available to officials based on the analysis and findings from their spending reviews. In particular, it details the South African experience in using decision trees as part of the spending review methodology to enable government officials to think through their findings, message them appropriately and craft actionable recommendations.