Expert Opinion Research Articles

Key Opinion Leaders' Interviews to Inform the Future of Benefit-Risk Planning in the Medical Total Product Life Cycle of Global Pharmaceutical and Medical Device Organizations.

Key opinion leader (KOL) interviews were conducted by the Benefit-Risk Assessment Planning(BRAP) Taskforce to seek expert opinion mainly from industry and regulatory bodies, about the current status and future direction of benefit-risk assessment (BRA) planning in the lifecycle of medical product development. The findings from these interviews are intended to help communication concerning planning for BRA between industry and regulators and shape future guidance. Key opinion leader interviews consisted of 5 questions related to BRA planning, which were administered to volunteers (mainly clinicians and statisticians) within a pool of experienced pharmaceutical and medical device professionals representing academia, industry, regulatory agenciesand a patient group. The interviewees' responses to the 5 questions were summarized. To analyze the qualitative data, a Coding System was developed to label themes arising from the interviews. The key findings from the interviews were summarized into a Master Template. A quantitative analysis based on descriptive statistics was also conducted. Of the 27 interviewees, there were 11 professionals from regulatory agencies, 11 from industry, 4 from academia and 1 from a patient advocacy group. Key findings based on the comments provided by 48% of the interviewees indicated the need of incorporating BRA into other (e.g., existing) processes with the importance of alignment between processes being stressed in the comments provided by 59% of the interviewees. Commencing BRA early in the product lifecycle was emphasized in comments provided by 44% of the interviewees. Among other needs identified were an appropriate contextualization of benefits and risks (based on comments provided by 41% of interviewees) through adoption of an integrated approach with structured support by regulatory agencies and a need for understanding the audience with better communication of benefit-risk (BR) among all stakeholders (based on comments provided by 44% of the interviewees). Almost all comments provided by interviewees (96%) highlighted the importance of utilizing patient experience/preference to guide new product development and BRA. Comments provided by 74% of the interviewees expressed the need to understand patient tolerance for risk and trade-offs, with a majority (78%) of interviewees highlighting how to gather information, and 59% stressing the need for the selection and development of appropriate methodologies as important considerations for enhancing the quality and relevance of the data collected from patients. Interviewees indicated that BRA should commence early in the medical product development and inform decision-making throughout the product lifecycle. Better planning and integration of BRA into existing processes within industry would be valuable. The importance of incorporating the patient voice into BRA and medical product development was emphasized. Other key findings from the KOL interviews included a need for improved communication of BR information, and establishment of methodologies for performing BRA and soliciting patient input.

Primary central nervous system lymphomas: EHA-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.

This EHA-ESMO Clinical Practice Guideline provides key recommendations for managing primary DLBCL of the CNS.The guideline covers clinical, imaging and pathological diagnosis, staging and risk assessment, treatment and follow-up.Algorithms for first-line and salvage treatments are provided.The author group encompasses a multidisciplinary group of experts from different institutions and countries in Europe.Recommendations are based on available scientific data and the authors' collective expert opinion.

Clinical and economic benefit of genomic testing strategies to guide the treatment of patients with HR+/HER2- breast cancer in the US.

10584 Background: Multiple testing technologies are available to inform treatment decisions for hormone receptor positive (HR+) and human epidermal growth factor receptor 2 negative (HER2-) early-stage breast cancer, including tumor profiling and germline genetic testing (GGT). The 21-gene assay provides an estimate of distant recurrence risk and potential clinical benefit of chemotherapy. GGT identifies pathogenic variants which inform lifetime cancer risk as well may inform therapy options. This study explored the potential synergy of utilizing both tests by assessing the cost-effectiveness of this strategy compared to no testing from a societal perspective. Methods: A health economic model was developed using best practices to assess a patient cohort with HR+/HER2-, node-negative (N0) or node-positive (N1) breast cancer that was guided to surgical and adjuvant treatment by GGT ( ATM, BRCA1/2, CDH1, CHEK2, PALB2, PTEN,and TP53) and the 21-gene assay. Treatment effectiveness was informed by clinical trials (TAILORx and RxPONDER); costs for treatment, monitoring, and health utilities were sourced from literature. Clinical expert opinion and guidelines informed current US clinical practice. The base case analysis evaluated lifetime total costs, life-years, and quality-adjusted life years (QALYs) versus no testing. Scenario and sensitivity analyses were performed to evaluate model robustness. Results: The testing strategy was dominant (lower cost and higher QALYs gained) compared to no testing leading to a QALY improvement of 0.286 and cost savings of $16,463 in the N0 population (Table) and a 0.099 QALY improvement and $299 cost savings in the N1 population. Scenario analyses indicated that while the 21-gene assay was the primary driver of results, there were synergistic effects when tests were combined. Sensitivity analysis supported cost-effectiveness at most willingness-to-pay thresholds and identified the probability of chemotherapy and rate of distant recurrence as the most impactful model inputs. Conclusions: Using a testing strategy including both the 21-gene assay and GGT enables optimization of treatment decisions in early HR+/HER2- breast cancer, improving patient outcomes at reduced costs. [Table: see text]

Development and Standardization of an Osteoradionecrosis Classification System in Head and Neck Cancer: Implementation of a Risk-Based Model.

Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN. Consecutive patients with head and neck cancer (HNC) treated with curative-intent intensity-modulated radiation therapy (IMRT) (≥45 Gy) from 2011 to 2017 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared with 15 existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection). ORN was identified in 219 of 2,732 (8%) consecutive patients with HNC. Factors associated with high risk of ORN were oral cavity or oropharyngeal primaries, received IMRT dose ≥60 Gy, current/ex-smokers, and/or stage III to IV periodontal condition. The ORN rate for high-risk versus low-risk patients was 12.7% versus 3.1% (P < .001) with an AUC of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, ClinRad, was proposed on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems. We identified risk factors for ORN and proposed a novel ORN classification system on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN and may facilitate clinical care and clinical trials.

Prioritizing solutions of green Reverse logistics barriers with Fuzzy DEMATEL – FUCOM – SWARA methods

Green Logistics (GL) and Reverse Logistics (RL) concepts are important for the sustainable development of logistics activities. Although the concept of RL seems to be a part of GL, it is not correct to consider all activities carried out within RL within the scope of GL and it is important to integrate these two concepts. To support the Sustainable Development Goals (SDGs), these two concepts are discussed in an integrated manner in this study. The main objectives of this study are to find barriers in the RL and GL concepts, to cluster barriers, and to present solution strategies. In this study, 21 barriers to GL and 28 barriers to RL are determined by a detailed literature review under the categories of Management & Organizational, Economic & Financial, Social, Technology & Infrastructure, Environment, and Legal. GL and RL barriers are clustered and 17 solution strategies are presented within the scope of Green Reverse Logistics (GRL) with the support of a literature review and expert opinion. Developed solution strategies are examined by the Fuzzy DEMATEL, FUCOM, and SWARA methods. The solution strategies are assessed, and their impact levels are ranked through the applied methods. As a result of the study, it is seen that the strategies that affect all strategies the most are “Provision of financial, administrative, and infrastructure support” and “Increase of public awareness on environmental”. In the results of the research, it is determined that the four most effective solution strategies are “Increase of public awareness on environmental”, “Collaboration between functions & stakeholders”, “Provision of financial, administrative, and infrastructure support”, and “Benchmarking the practices”. Such a detailed study has not been found, and it is thought that the study will lead to the development of a sustainable understanding in terms of both addressing GRL problems together and developing solution strategies. Implementing the strategies in the order determined as a result of the study will support the effective removal of barriers to GRL.

Current Status and Management of Chronic Myeloid Leukemia in the Gulf Region: Survey Results and Expert Opinion.

Studies on chronic myeloid leukemia (CML) in the Gulf region are scarce, consisting of a survey and expert meeting that included 15 experts in 2023 which discussed CML diagnosis, testing, treatment objectives, toxicities, and discontinuation in the Gulf region. Most patients were reported to be in first-line therapy, and the most common treatments were imatinib/imatinib generic in first-line and dasatinib in second- and third-lines. Mutation analysis was not reported to be routinely performed at the time of diagnosis but rather in case of progression to accelerated/blast phase or any sign of loss of response. While all participants were aware that BCR-ABL should be monitored every three months during the first year of treatment, 10% reported monitoring BCR-ABL every six months in practice due to test cost and lab capability. The most important first-line therapy objective was "achievement of major molecular response" (MMR) in younger patients and "overall survival" in older ones. The most important treatment objectives were "MMR" and "early molecular response followed by prolongation of overall survival" in the short term and "treatment-free remission" in the long term. The current practices in CML in the Gulf region appear to be similar to global figures.

Navigating the Agricultural Landscape

Abstract: In today’s world agricultural landscape, technological progress has become essential for improving productivity, sustainability, and profitability. This paper investigates Farm Tech Central, an innovative platform that sits at the intersection of agricultural technology and information sharing. Through a thorough examination, this paper clarifies the crucial role played by Farm Tech Central in enabling access to state-of-the-art agricultural technologies, research findings, and best practices. Acting as a central hub for farmers, agronomists, researchers, and industry stakeholders, Farm Tech Central provides users with valuable resources and tools to enhance farm operations, manage risks, and take advantage of emerging opportunities. Utilizing case studies, data analysis, and expert opinions, this paper delves into how Farm Tech Central is transforming agriculture by promoting modernization, encouraging sustainable practices, and fostering innovation. As the agricultural sector continues its journey towards digitalization and technological integration, Farm Tech Central emerges as a leading platform for collaboration, knowledge sharing, and technological progress, poised to usher in a new era of agricultural excellence

Transmission Pipeline Planning from Kregan Water Treatment Plant to Watu Gadjah Tank by PERUMDA PDAM Sleman Using EPANET 2.2

Clean water is vital as it directly impacts health and influences various aspects of life, including social, economic, and cultural activities. To address the clean water supply requirements in the area, PERUMDA PDAM Sleman, Yogyakarta, is currently planning for a transmission network linking the Kregan WTP to the Watu Gadjah Tank. The pipeline planning is carried out to ensure efficient and optimal network performance. The pipeline planning use both primary and secondary data. The primary data was obtained from surveys, while the secondary data was obtained though previous research and planning, regulation, and from the other sources. The pipeline network analysis carried out using EPANET 2.2. software. EPTANET was selected because of its cost-effectiveness and robust capabilities in modeling drinking water networks, with the advantage of being re-programmable. The results of the analysis are then adjusted to the planning standards that applicable in Indonesia. Risk analysis was carried out based on experience and expert opinion. The results of the planning showed that the maximum pressure on the transmission network was 84.21m on Pendowo Road. The velocity between 1.03 m/s and 1.63 m/ss with the highest headloss was 10.33 m/km. Based on the results of the planning, the entire parameter meets the standard of the applicable planning criteria. The results of the analysis indicate that the technical specifications of the pipe used must be able to withstand a pressure of 92,63m. There was a potential risk that network performance may be disrupted both in terms of network performance, implementation of development, and operational stages. The re-examination and the development of operational standard procedures is needed to ensure that planning has been in line with the expectations, can be implemented, and can be operated efficiently.

Objectives of Administration and State Support of the Agro-Industrial Complex in the Far Eastern Federal District in the Context of Ensuring Food Security in Russia

The article depicts an urgent problem of ensuring food security of Russia – development of agro-industrial complex in Far Eastern Federal District. An analysis of current condition of agro-industrial complex and measures of its support is conducted. The position on insufficiency of general and special measures to support the agro-industrial complex in the Far Eastern Federal District is expressed. Specific solutions to identified problems are proposed. The article features the positions of correspondent ministries of the Russian Federation, deputies of the State Duma, the opinions of scientists and experts, unique materials for further research and scientific and practical analysis of problems in administering the Far Eastern Federal District regions. The publication was prepared based on the materials of the round table “On adopted measures of special legal regulation of the agro-industrial complex development in the Far Eastern Federal District”, held by the Committee for the Development of the Far East and the Arctic on February 22, 2024.

Deep Learning-Based Automatic Classification of Ischemic Stroke Subtype Using Diffusion-Weighted Images.

Accurate classification of ischemic stroke subtype is important for effective secondary prevention of stroke. We used diffusion-weighted image (DWI) and atrial fibrillation (AF) data to train a deep learning algorithm to classify stroke subtype. Model development was done in 2,988 patients with ischemic stroke from three centers by using U-net for infarct segmentation and EfficientNetV2 for subtype classification. Experienced neurologists (n=5) determined subtypes for external test datasets, while establishing a consensus for clinical trial datasets. Automatically segmented infarcts were fed into the model (DWI-only algorithm). Subsequently, another model was trained, with AF included as a categorical variable (DWI+AF algorithm). These models were tested: (1) internally against the opinion of the labeling experts, (2) against fresh external DWI data, and (3) against clinical trial dataset. In the training-and-validation datasets, the mean (±standard deviation) age was 68.0±12.5 (61.1% male). In internal testing, compared with the experts, the DWI-only and the DWI+AF algorithms respectively achieved moderate (65.3%) and near-strong (79.1%) agreement. In external testing, both algorithms again showed good agreements (59.3%-60.7% and 73.7%-74.0%, respectively). In the clinical trial dataset, compared with the expert consensus, percentage agreements and Cohen's kappa were respectively 58.1% and 0.34 for the DWI-only vs. 72.9% and 0.57 for the DWI+AF algorithms. The corresponding values between experts were comparable (76.0% and 0.61) to the DWI+AF algorithm. Our model trained on a large dataset of DWI (both with or without AF information) was able to classify ischemic stroke subtypes comparable to a consensus of stroke experts.

Hard-to-reach schools? Discrimination experienced by parents with a migrant background. A participatory research approach

ABSTRACT This study investigated the discrimination experienced by parents with a migrant background in German schools. For this, we shifted the perspective from speaking about to speaking with parents using the critical incident technique as a participatory research approach. The sample included 40 parents from 20 countries of origin, with different languages of origin who had lived in Germany for between two and ten years. The most frequently reported experiences were of low expectations of competence, stereotypical attributions and the deliberate withholding of information. Parents described the pathologising of behaviours due to their family backgrounds that was equated with problem behaviour and the need for treatment. Additionally, school staff alleged that parents were unable or unwilling to support their children in academic matters, giving their ‘migrant status’ as justification. Schools did not offer opportunities for clarification or made it a requirement to seek expert opinion on a child’s mental health before providing opportunities for clarification. Further discriminatory effects, such as the outcomes of self-fulfilling prophecies; feelings of humiliation, helplessness and exclusion; and the fear of being disadvantaged, became evident, which exhausted families mentally and physically. The discussed implications aim at establishing concepts that raise awareness of discrimination and the consequences.

Nanomaterials in Drug Delivery: Strengths and Opportunities in Medicine.

There is a myriad of diseases that plague the world ranging from infectious, cancer and other chronic diseases with varying interventions. However, the dynamism of causative agents of infectious diseases and incessant mutations accompanying other forms of chronic diseases like cancer, have worsened the treatment outcomes. These factors often lead to treatment failure via different drug resistance mechanisms. More so, the cost of developing newer drugs is huge. This underscores the need for a paradigm shift in the drug delivery approach in order to achieve desired treatment outcomes. There is intensified research in nanomedicine, which has shown promises in improving the therapeutic outcome of drugs at preclinical stages with increased efficacy and reduced toxicity. Regardless of the huge benefits of nanotechnology in drug delivery, challenges such as regulatory approval, scalability, cost implication and potential toxicity must be addressed via streamlining of regulatory hurdles and increased research funding. In conclusion, the idea of nanotechnology in drug delivery holds immense promise for optimizing therapeutic outcomes. This work presents opportunities to revolutionize treatment strategies, providing expert opinions on translating the huge amount of research in nanomedicine into clinical benefits for patients with resistant infections and cancer.

The multifaceted perspectives of future business continuity- aftermath of COVID 19

"The Multifaceted Perspectives of Future Business Continuity- aftermath of COVID-19" explores the diverse and complex dimensions of business continuity in the post-pandemic era. This study examines the various challenges and opportunities faced by organizations as they navigate the aftermath of COVID-19 and adapt to the new normal. It examines the multifaceted perspectives that encompass economic, technological, social, environmental, and organizational aspects, shedding light on the potential strategies and innovative solutions that can enhance resilience and ensure sustainable business continuity. The findings highlight the critical importance of agility, digital transformation, stakeholder collaboration, risk management, and adaptive leadership in shaping the future of business continuity. The study uses mixed methodology to capture the expert opinion and the stakeholder’s views on this topic.

Expert opinion regarding early screening, patient awareness, and telemedicine practices in Indian settings

Objective: To collect clinicians’ perspectives regarding the significance of early screening, patient awareness, and telemedicine practice in routine Indian settings for diabetes management. Methodology: The study employed a 25-item questionnaire to gather insights from specialists across different Indian settings regarding their perspectives on early screening, patient awareness, and telemedicine practices among diabetologists. Results: According to the cross-sectional survey, 59% of respondents believed that regular awareness programs were helpful in the early screening of diabetes among high-risk individuals. Meanwhile, 64% of clinicians reported that clinical-level screening was a more effective tool for early screening. Around 74% of clinicians reported that microvascular complications namely diabetic retinopathy, diabetic neuropathy, and diabetic kidney diseases should be targeted during early screening of diabetes. The American Diabetes Association (ADA) risk score was the most commonly used risk score for early diabetes screening, according to 54% of clinicians. Moreover, 67% of clinicians reported that 11 to 25% of diabetic individuals had complications of lipitension, and 64% reported that 11 to 20% of T2DM individuals had depression. Regarding telemedicine, 65% of clinicians preferred to use it occasionally. However, at an individual level, factors like cost, literacy, less familiarity with using the tool, and emotional reasons hindered the effective adoption of telemedicine, as reported by 56% of clinicians. Conclusion: The survey highlighted the effectiveness of awareness programs and clinical-level screening for early diabetes management, emphasizing the importance of targeting microvascular complications. Increased prevalence of complications like lipitension and depression was noted in diabetic individuals. Telemedicine, though recognized as valuable, faces challenges due to individual-level factors.

The Saudi Gastroenterology Association consensus on the clinical care pathway for the diagnosis and treatment of GERD.

Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in outpatient general medicine and gastroenterology clinics. GERD may present with classic esophageal symptoms, extraesophageal symptoms, or mixed symptoms. The diagnosis and treatment of GERD are challenging due to the variety of symptoms and multifactorial pathophysiology. Since there is no consensus on the diagnosis and treatment of GERD in Saudi Arabia, the Saudi Gastroenterology Association established an expert group to formulate a consensus on the clinical care pathway for the diagnosis and treatment of GERD to update health-care providers in Saudi Arabia. The expert group reviewed the literature including recently published international guidelines, clinical trials, and expert opinion and conducted virtual and in-person meetings. A total of 22 statements on the definition, diagnosis, and treatment of GERD were formulated, and three algorithms for the clinical care of GERD were developed with a detailed description for each step. The expert group endorsed the new definition of GERD, the practical principles of interpretation of the diagnostic GERD evaluation, and the practical guidance for GERD treatment including medical, surgical, and endoscopic therapy. The expert group recommends further studies to investigate local data on the diagnosis and treatment of GERD.

Expert Opinion on Screening and Risk Stratification of Heart Diseases in Indian Women

Expert Opinion on Screening and Risk Stratification of Heart Diseases in Indian Women

Uncovering gaps in management of vasomotor symptoms: findings from a national need assessment.

This national needs assessment study explores the knowledge, attitude, beliefs, and practices (KABP) gaps related to vasomotor symptoms (VMS) associated with menopause among primary care and OB/GYN clinicians. VMS significantly impacts healthcare costs, workplace productivity, and patient psychosocial health, but a notable disconnect exists between healthcare providers and patients, with provider reticence and knowledge gaps playing a contributing role. This study aims to identify and propose optimal educational strategies to address these barriers, with attention to health disparities affecting women of color. Methods employed include a multimodal approach of literature review, expert opinion, qualitative interviews, surveys, focus groups, and case studies, ensuring diverse clinician input. Data collection involved in-depth clinician interviews, a nationally disseminated clinician survey, and focus groups. Results indicate a critical deficiency in healthcare providers' understanding and management of VMS, especially among OB/GYN residents, with 75 % showing limited knowledge. The study also highlights the disproportionate impact of knowledge gaps on women of color, emphasizing the need for a culturally informed approach in medical training and practice. There's a notable discrepancy between clinicians' current and desired abilities in managing VMS, indicating a need for ongoing professional development. Significant variability in approaches to diagnosing and treating VMS, as well as substantial knowledge gaps about treatment options, underscore the need for evidence-based protocols. Although VMS are a normal aspect of aging, they can significantly disrupt quality of life for many women, necessitating intervention. Beyond the immediate discomfort, VMS can impact quality of life and trigger insomnia and mood disturbances. This study exposes both new and previously recognized gaps in healthcare providers' knowledge and management skills concerning VMS treatment options, particularly regarding hormonal and nonhormonal therapies. Furthermore, our findings highlight the need for a deeper understanding of how VMS uniquely impacts women of diverse backgrounds. Research, including the Study of Women's Health Across the Nation (SWAN), suggests that the experience and severity of VMS may be influenced by socioeconomic status, race/ethnicity, body mass index (BMI), and smoking status. However, the complex interplay of these factors and their relative contributions remain unclear. Further investigation is crucial to facilitate equitable access to effective treatment for all women. To bridge these gaps, improved education starting as early as residency is essential. This education should address common misconceptions about VMS and its management. Healthcare providers must enhance their competence in discussing the broad spectrum of VMS impacts and employ effective communication strategies to ensure that patients are well-informed about their symptoms and available treatment options.

CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient.

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.

Exploring global barriers to optimal ovarian cancer care: thematic analysis

ObjectiveTo explore the barriers to ovarian cancer care, as reported in the open ended responses of a global expert opinion survey, highlighting areas for improvement in global ovarian cancer care....

Agile methodologies: Adapting product management to rapidly changing market conditions

This review paper explores the effectiveness of agile methodologies in adapting product management practices to the dynamics of rapidly changing market conditions. The paper synthesizes existing literature on the application of agile principles across different sectors, focusing on how these methodologies facilitate responsiveness and adaptability in product management. The core analysis centers on the comparison of traditional and agile product management approaches, drawing on case studies and expert opinions to highlight the benefits and challenges associated with agile adoption. Key findings demonstrate that agile methodologies, such as Scrum and Kanban, enable organizations to enhance product innovation and customer satisfaction by fostering a culture of continuous improvement and rapid response to market feedback. Despite these advantages, the review also identifies potential drawbacks, including the complexity of transitioning to agile frameworks and the scalability of agile practices in large organizations. The paper argues that agile methodologies are crucial for companies aiming to remain competitive in fluctuating markets, provided there is a strategic commitment to agile transformation and an investment in overcoming the initial hurdles of adoption. Recommendations for effective implementation of agile practices in product management are provided to guide organizations in their agile journey.