International Expert Recommendations Research Articles

International expert recommendations on image acquisition for in vivo reflectance confocal microscopy of cutaneous tumors

No international recommendations exist for a minimum imaging requirement per lesion using reflectance confocal microscopy (RCM). This may be beneficial given the increasing use of remote RCM interpretation internationally. ObjectiveTo develop international expert recommendations for image acquisition using the tissue-coupled RCM for diagnosis of cutaneous tumor. MethodsUsing a modified Delphi approach, a core group developed the scope and drafted initial recommendations before circulation to a larger group, the Cutaneous Imaging Expert Resource Group (CIERG) of the American Academy of Dermatology. Each review round consisted of a period of open comment, followed by revisions. ResultsThe recommendations were developed following five alternating rounds of review among the core group and CIERG. These were divided into subsections of imaging personnel, recommended lesion criteria, clinical and lesion information to be provided, lesion preparation, image acquisition, mosaic cube settings, and additional captures based on lesion characteristics and suspected diagnosis. LimitationsThe current recommendations are limited to tissue-coupled RCM for diagnosis of cutaneous tumors. It is one component of the larger picture of quality assurance and will require ongoing review. ConclusionsThese recommendations serve as a resource to facilitate quality assurance, economical use of time, accurate diagnosis and international collaboration.

Procedural and organizational aspects of electronic evidence collection during international cooperation

The article is devoted to issues of international cooperation during criminal proceedings and features of electronic evidence collection, which are managed by a foreign service provider. The Criminal Procedure Code of Ukraine does not contain a definition of electronic evidence, but criminal justice is increasingly faced with the need to collect, evaluate and use such evidence for sentencing. The lack of normative certainty does not contribute to the unity of judicial practice, the issue of evaluating electronic evidence obtained within the framework of international legal assistance is especially acute. In such situations, it is necessary to assess the legality of the law enforcement agency's activities, compliance with conventional guarantees of human rights compliance, fulfillment of obligations to use electronic evidence exclusively in the proceedings in which it was obtained, to check the fact of repeated appeals to the central body of international cooperation in another state with a request for permission to use such evidence in other proceedings, when such a need arose, etc.
 Courts consider prosecutor's requests for temporary access to electronic data or to conduct a search, sometimes making mistakes in specifying the jurisdiction where the evidence originated or where the consequences of the criminal activity occurred. Procedural requirements, which are provided for by international acts, determine the need to apply to the state in whose territory the entity that owns, accumulates and manages data is located. The content of the request submitted to the court must be substantively consistent with the type of electronic evidence and the method of obtaining it in another jurisdiction, which is not always taken into account (request for preservation of evidence/preservation of evidence).
 The collection of electronic evidence takes place through a complex procedure of interaction between law enforcement agencies, service providers, liaison officers, and attaché officers working in the embassies of different states. Therefore, in addition to procedural aspects, it is advisable to take into account the legislation of other states for the effective use of organizational rules (the most effective channels for obtaining evidence).
 The study of gaps in the current legislation and the recommendations of international experts contributes to the formation of a holistic theoretical vision of the normative consolidation of international mutual legal assistance for obtaining electronic evidence and the introduction of proposals for the consolidation of such a mechanism in the special law of Ukraine.

When is it safe for the liver donor to be discharged home and prevent unnecessary re‐hospitalizations? – A systematic review of the literature and expert panel recommendations

Few data are available on discharge criteria after living liver donation (LLD). To identify the features for fit for discharge checklist after LLD to prevent unnecessary re-hospitalizations and to provide international expert recommendations. Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. The critical outcomes included were complications rates and liver function (defined by elevated bilirubin and INR) (CRD42021260725). Total 57/1710 studies were included in qualitative analysis and 28/57 on the final analysis. No randomized controlled trials were identified. The complications rate was reported in 20/28 studies and ranged from 7.8% to 71.2%. Post hepatectomy liver function was reported in 13 studies. The Quality of Evidence (QoE) was Low and Very-Low for complications rate and liver function test, respectively. Monitoring and prevention of donor complicationsshould be crucial in decision making of discharge.Pain and dietcontrol, removal of all drains and catheters, deep venous thrombosis prophylaxis, and useroutine imaging (CT scan or liver ultrasound) before discharge should be included as fit for discharge checklist (QoE; Low | GRADE of recommendation; Strong). Transient Impaired liver function (defined by elevated bilirubin and INR), a prognostic marker of outcome after liver resection,usually occurs after donor right hepatectomy and should be monitored.Improving trends forbilirubin and INR value should be observed by day5post hepatectomyand be included in thefit for discharge checklist. (QoE; Very-Low | GRADE; Strong).

REASONING OF THE IMPROVED MODEL OF SURGICAL CARE FOR PATIENTS WITH THYROID PATHOLOGY

The aim of the study was to substantiate the improved functional and organizational model of surgical care for patients with thyroid pathology based on a multidisciplinary approach. Materials and methods. A systematic analysis of the incidence of thyroid pathology in the population, recommendations of international experts, data from international and domestic scientific sources on the topic, results of own research on the basis of the Municipal non-profit enterprise "Kyiv City Clinical Endocrinology Center" in 2019-2021 was carried out; conceptual modeling; graphic.Results. The high incidence of oncological diseases in the population, in particular, of the thyroid gland, and the risks of postoperative complications during surgical treatment led to the introduction of a multidisciplinary approach, which involves the integration of knowledge and skills of specialists of various disciplines through close cooperation and communication. In Ukraine, a multidisciplinary approach has not been implemented. An improved functional-organizational model of surgical care for patients with thyroid gland pathology was substantiated, the innovative elements of which were: patient-orientation; a multidisciplinary team of specialists as a freelance functional and structural unit of a health care institution; strengthening of interaction between secondary and primary health care institutions, outpatient and inpatient stages; improvement of regulatory and legal regulation of the interdisciplinary approach at the sectoral, regional and local levels, involvement of specialized associations of doctors and public organizations of patients in its introduction.Conclusions. The introduction of a multidisciplinary approach as an innovative organizational technology of clinical activity at the system level is substantiated.

COVID 19 and vaccine safety

Introduction. COVID-19 disease, caused by SARS-CoV-2 virus, has been recognised as pandemic by WHO since March 11, 2020. It has been estimated that the disease is responsible for the death of 3.11 million people worldwide. Although several therapeutic agents have been evaluated for the treatment of COVID-19 disease, vaccines are considered to be the safest form of protecting patients against COVID-19. The safety of each vaccine is vital to control the pandemic. Due to the fact that vaccines have been launched quite recently and their production technologies are different, the safety of each preparation should be looked into separately. Nucleic acids do not trigger such a strong immune response on their own as viral vectors and that is why mRNA vaccines seem to be the safest types of vaccines. In December 2020, after a year since detecting the first case of by SARS-CoV-2 infection in humans, the first anti-COVID-19 vaccine became available.Objective. The purpose of this review was to present the literature data and the latest recommendations on risks related with COVID-19 vaccines.Method. The latest literature was reviewed based on PubMed and Google Scholar databases, using the following keywords: COVID-19; vaccines; safetyConclusions. Anti-COVID-19 vaccines seem not to cause many adverse events and side effects such as fever, chills, muscle pain, headache and fatigue. These are not serious and subside after taking over-the-counter pain relievers. Currently, there are no information on safety and efficacy of vaccines in pregnant and breast-feeding women, international expert recommendations leave the decision about vaccination with a woman, who should previously consult the benefits and risks involved with her doctor.

Fabry disease and COVID-19: International expert recommendations for management based on real-world experience

The rapid spread of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has raised questions about Fabry disease (FD) as an independent risk factor for severe COVID-19 symptoms. Available real-world data on 22 patients from an international group of healthcare providers reveals that most patients with FD experience mild-to-moderate COVID-19 symptoms with an additional complication of Fabry pain crises and transient worsening of kidney function in some cases; however, two patients over the age of 55 years with renal or cardiac disease experienced critical COVID-19 complications. These outcomes support the theory that pre-existent tissue injury and inflammation may predispose patients with more advanced FD to a more severe course of COVID-19, while less advanced FD patients do not appear to be more susceptible than the general population. Given these observed risk factors, it is best to reinforce all recommended safety precautions for individuals with advanced FD. Diagnosis of FD should not preclude providing full therapeutic and organ support as needed for patients with FD and severe or critical COVID-19, although a FD-specific safety profile review should always be conducted prior to initiating COVID-19-specific therapies. Continued specific FD therapy with enzyme replacement therapy, chaperone therapy, dialysis, renin-angiotensin blockers or participation to clinical trials during the pandemic is recommended as FD progression will only increase susceptibility to infection. In order to compile outcome data and inform best practices, an international registry for patients affected by Fabry and infected by COVID-19 should be established.

INTERNAL AUDIT AS AN EFFICIENT CORPORATE CONTROL TOOL UNDER THE CONDITIONS OF THE COVID-19 PANDEMIC

Under the conditions of the Covid-19 pandemic the classic functionality of internal audit is subject to review. It is necessary to change the usual activity trajectory, meet the dialogue with the company’s business administration on the issues of business running. The advisory function which allows to conduct an independent assessment as well as to insure the implementation of anti-crisis measures planned by the company’s business administration steps forward. The article analyses the interest of scholars in the research topic using Google Trends research tools and Google Ngram Viewer. The concept of internal audit in the system of corporate control is considered. The objectives of internal audit and their relationship for corporate control have been identified. The principles of optimal organization of the internal audit service of the enterprise are described. The necessity of an internal audit service existence as an effective tool of corporate control has been proved. The role of internal audit during the COVID-19 pandemic has been identified and the measures taken by internal auditors to respond to the challenges posed to the business by COVID-19 have been explored. Audit processes during the COVID-19 pandemic are described. The need to make changes to the plan in case of non-compliance of the plan with the most significant risks is stated. The trends of expected risks caused by the COVID-19 pandemic have been identified. The steps for risk identification and assessment are presented, in particular: risk identification; risks assessment and its analysis and risk response. The directions of internal audit activity during the COVID-19 pandemic are indicated. The recommendations of international experts on internal audit are analysed, the priority of internal audit areas is presented. The priority of the consulting function of internal audit is emphasised. The participation of the internal audit service in anti-crisis measures to overcome the consequences of the COVID-19 pandemic is proposed.

Fabry disease and COVID-19: international expert recommendations for management based on real-world experience.

The rapid spread of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has raised questions about Fabry disease (FD) as an independent risk factor for severe COVID-19 symptoms. Available real-world data on 22 patients from an international group of healthcare providers reveals that most patients with FD experience mild-to-moderate COVID-19 symptoms with an additional complication of Fabry pain crises and transient worsening of kidney function in some cases; however, two patients over the age of 55 years with renal or cardiac disease experienced critical COVID-19 complications. These outcomes support the theory that pre-existent tissue injury and inflammation may predispose patients with more advanced FD to a more severe course of COVID-19, while less advanced FD patients do not appear to be more susceptible than the general population. Given these observed risk factors, it is best to reinforce all recommended safety precautions for individuals with advanced FD. Diagnosis of FD should not preclude providing full therapeutic and organ support as needed for patients with FD and severe or critical COVID-19, although a FD-specific safety profile review should always be conducted prior to initiating COVID-19-specific therapies. Continued specific FD therapy with enzyme replacement therapy, chaperone therapy, dialysis, renin–angiotensin blockers or participation to clinical trials during the pandemic is recommended as FD progression will only increase susceptibility to infection. In order to compile outcome data and inform best practices, an international registry for patients affected by Fabry and infected by COVID-19 should be established.

Consensus on Infertility Management and Fertility Preservation Related to Polycystic Ovary Syndrome

There is currently no universally accepted unified diagnostic standard for infertility treatment and maternity protection related to polycystic ovary syndrome (PCOS) worldwide, and the treatment options vary greatly. To improve the understanding of PCOS-related infertility among Chinese obstetricians and gynecologists at all levels for better patient diagnosis and management, we have referred to the international expert recommendations and literature and taken into account the Chinese clinical practice to develop the “Consensus on infertility management and fertility preservation related to PCOS.”

Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

SummaryTracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.

International expert recommendations of clinical features to prompt referral for diagnostic assessment of cerebral palsy.

To establish international expert recommendations on clinical features to prompt referral for diagnostic assessment of cerebral palsy (CP). An online Delphi survey was conducted with international experts in early identification and intervention for children with CP, to validate the results obtained in two previous consensus groups with Canadian content experts and knowledge users. We sent two rounds of questionnaires by e-mail. Participants rated their agreement using a 4-point Likert scale, along with optional open-ended questions for additional feedback. Additionally, a panel of experts and knowledge-users reviewed the results of each round and determined the content of subsequent surveys. Overall, there was high-level of agreement on: (1) six clinical features that should prompt referral for diagnosis; (2) two 'warning sign' features that warrant monitoring rather than immediate referral for diagnosis; and (3) five referral recommendations to other healthcare professionals to occur simultaneously with referral for diagnosis. There was high agreement among international experts, suggesting that the features and referral recommendations proposed for primary care physicians for early detection of CP were broadly generalizable. These results will inform the content of educational tools to improve the early detection of CP in the primary care context. International experts provide strong agreement on clinical features to detect cerebral palsy. Consensus on clinical 'warning signs' to monitor over time. Referral recommendations from primary care to specialized health services are identified.

How are Argentina and Chile facing shared biodiversity loss?

Biodiversity loss remains one of the most pressing issues for global governance. This situation can be seen in Argentina and Chile through the effects of biodiversity loss caused by the introduction and expansion of beavers in Southern Patagonia. This case is interesting because, despite the Beagle conflict (i.e., the border dispute) between these countries some decades ago, nowadays Argentina and Chile are facing shared environmental problems and both are actively seeking solutions. The main question in this paper is, how did Argentina and Chile search for a solution to shared environmental problems caused by the expansion of beavers in Southern Patagonia? This paper tackles this question and presents the results of the conducted qualitative research. The results indicate that, in order to understand what Argentina and Chile are doing to achieve a solution to their shared environmental problems, research cannot be exclusively focus on domestic affairs. Instead, this issue requires taking into account how international dimensions influenced domestic policies. As this paper argues, in Argentina and Chile, international cooperation is a method of influencing biodiversity governance through funds granted by international organizations and international expert recommendations.

Diastolic dysfunction of the left ventricle

Chronic heart failure (CHF) is one of the most common, severe and prognostically unfavorable complications of cardiovascular diseases. The author of the article considers in detail the developmental factors of the diastolic function of the left ventricle, its diagnostic criteria, the importance of echocardiographic research to assess the severity of diastolic dysfunction in patients with a reduced and preserved left ventricular ejection fraction. Based on the general recommendations of international experts there are provided recommendations for managing patients with heart failure and preserved / moderately reduced left ventricular ejection fraction.

Bevacizumab — cardiovascular side effects in daily practice

The formation of new blood vessels is essential for tumour growth and metastasis. Bevacizumab, monoclonal antibody binding VEGF, is applicable in the therapy of several metastatic cancer diseases. This direct interference in the mechanisms of angiogenesis results in certain cardiovascular complications such as arterial hypertension, venous and arterial thromboembolic events, and heart failure. Knowledge of risk factors, early diagnosis, and treatment seem to be crucial for the prognosis of patients. This article presents the problem of cardiovascular side effects related to bevacizumab with some selected recommendations of international experts and the Position Paper of the European Society of Cardiology.

Analysis of the Juvenile Idiopathic Arthritis Immunization Schedule

Background:The connection between vaccination and autoimmune diseases (and rheumatic pathology in particular) is still a subject of discussions. When discussing the possibility of vaccinating rheumatic patients we should take into account the ultra high dangers that infectious diseases pose for such patients, including those that can be prevented by vaccination. We should also take into account the experience of using various vaccine types in rheumatic patients, which illustrates of their high safety profile.Objective:Our aim was to study the immunization schedule in children with juvenile idiopathic arthritis.Methods:The evaluation of vaccine history and other anamnestic data in juvenile idiopathic arthritis patients was based on individual medical records (individual child’s card/preventive vaccination certificate), as well as questionnaires filled by mothers.Results:It has been determined that a significant proportion of children with vaccination schedule deviations are juvenile idiopathic arthritis patients. Almost one in four children with a confirmed rheumatic diagnosis has not been immunized against the major vaccine-preventable diseases. In one non-vaccinated group, there was a case of juvenile arthritis onset after recovering from measles. A small number of patient mothers connects the manifestation of rheumatic diseases with vaccination.Conclusion:Violations of vaccination status in JIA patients require corrections according to the results of clinical studies and the recommendations of international experts.

Nonrespiratory pediatric logistic organ dysfunction-2 score is a good predictor of mortality in children with acute respiratory failure.

Multiple organ dysfunction, not respiratory failure, is the major cause of death in children with acute lung injury or acute respiratory distress syndrome. This study was undertaken to estimate the predictive value of death of the nonrespiratory Pediatric Logistic Organ Dysfunction-2 in children with acute respiratory failure. Analysis of the database of the recently published Pediatric Logistic Organ Dysfunction-2. Nine multidisciplinary, tertiary-care PICU of university-affiliated hospitals in France and Belgium. All consecutive children (excluding neonates) admitted to these PICUs (June 2006 to October 2007) and having acute respiratory failure. None. We prospectively collected data on variables considered for the Pediatric Logistic Organ Dysfunction-2 score during PICU stay up to eight time points: days 1, 2, 5, 8, 12, 16, and 18, plus PICU discharge. For each variable considered in the Pediatric Logistic Organ Dysfunction-2 score, the most abnormal value observed during time points was collected. Outcome was vital status at PICU discharge. We used areas under receiver operating characteristic curve to estimate the discrimination and Hosmer-Lemeshow goodness-of-fit tests to estimate calibration of the Pediatric Logistic Organ Dysfunction-2 and the nonrespiratory Pediatric Logistic Organ Dysfunction-2 scores, with correction for the optimism bias using a bootstrap resampling method. We included 1,572 consecutive patients (median age, 20.6 months; interquartile range, 5.5-80.2; mortality rate, 9.5%). Discrimination of the Pediatric Logistic Organ Dysfunction-2 and the nonrespiratory Pediatric Logistic Organ Dysfunction-2 were excellent (areas under receiver operating characteristic curve = 0.93 and 0.92, respectively) and calibration (chi-square test for goodness-of-fit = 5.8, p = 0.45 and 7.6, p = 0.27, respectively) was good. The four nonrespiratory organ dysfunctions were closely related to the risk of mortality (p< 0.001). Our study demonstrates that the nonrespiratory Pediatric Logistic Organ Dysfunction-2 score of the entire PICU stay is highly predictive of death in children with acute respiratory failure of whom 94.3% were invasively ventilated. The nonrespiratory Pediatric Logistic Organ Dysfunction-2 score could represent the nonrespiratory organ failure definition tool whose development was recommended in the international expert recommendations on pediatric acute respiratory distress syndrome.

Neurocognitive disorders in DSM 5 project — Personal comments

The actual criteria for diagnosis of dementia have many shortages, due to the fact that both DSM 4 and ICD 10 criteria are essentially based on the typical evolution of Alzheimer's disease, which is the most frequent, but not the only one cause of dementia in the general population. In the new project of DSM-5, proposed for public debate by the American Psychiatric Association (APA), new criteria for neurocognitive disorders are defined which seem more suitable to cover in a much more appropriate way all the entities potentially leading to dementia. In our view, these new criteria are also in line with the updated knowledge about these diseases as they are reflected in the recent publications and recommendations of international experts and medical associations.

Standardized Multidisciplinary Evaluation Yields Significant Previously Undiagnosed Morbidity in Adult Women with Turner Syndrome

Besides short stature and gonadal dysgenesis, Turner syndrome (TS) is associated with various abnormalities. Adults with TS have a reduced life expectancy, mainly related to structural abnormalities of the heart and aorta, and an increased risk of atherosclerosis. Our objective was to investigate the yield of an initial standardized multidisciplinary screening in adult TS patients. This was an observational study at a multidisciplinary care unit for adult women with TS. Participants were adult women with TS (n = 150). Mean age was 31.0 ± 10.4 yr, with 47% karyotype 45,X. All women were consulted by an endocrinologist, a gynecologist, a cardiologist, an otorhinolaryngologist, and when indicated, a psychologist. The screening included magnetic resonance imaging of the heart and aorta, echocardiography, electrocardiogram, dual-energy x-ray absorptiometry, renal ultrasound, audiogram, and laboratory investigations according to international expert recommendations. New diagnoses and prevalence of TS-associated morbidity were evaluated. Thirty percent of patients currently lacked medical follow-up, and 15% lacked estrogen replacement therapy in the recent last years. The following disorders were newly diagnosed: bicuspid aortic valve (n = 13), coarctation of the aorta (n = 9), elongation of the transverse aortic arch (n = 27), dilation of the aorta (n = 34), osteoporosis (n = 8), osteopenia (n = 56), renal abnormalities (n = 7), subclinical hypothyroidism (n = 33), celiac disease (n = 3), glucose intolerance (n = 12), dyslipidemia (n = 52), hypertension (n = 39), and hearing loss warranting a hearing aid (n = 8). Psychological consultation was needed in 23 cases. Standardized multidisciplinary evaluation of adult women with TS as advocated by expert opinion is effective and identifies significant morbidity. Girls with TS benefit from a careful transition to ongoing adult medical care.

Allergen-specific immunotherapy for respiratory allergies: From meta-analysis to registration and beyond

Allergen-specific immunotherapy (SIT) is an etiology-based treatment for respiratory and Hymenoptera-allergic diseases. Although introduced a century ago, SIT was not widely accepted for many years until its efficacy in the treatment of both allergic rhinoconjunctivitis and allergic asthma was demonstrated in appropriate double-blind, placebo-controlled trials and its mechanism of action was better understood. The indications for allergen-specific immunotherapy have been specified in consensus reports. Allergen-specific immunotherapy is primarily targeted to benefit patients with Hymenoptera allergy or severe upper and mild to moderate lower allergic respiratory diseases that are poorly controlled by pharmacologic treatments or who are unable or unwilling to use the latter. Several recent developments have helped to reinforce the position of SIT in the overall therapeutic management of respiratory allergies: (1) improvement in the quality of allergen extracts as a result of standardization, (2) better understanding of SIT's mechanism of action, (3) the introduction of sublingual tablets and their rigorous registration as pharmaceutical therapies by regulatory agencies, and (4) rationalization of prescribing patterns. There is a requirement for additional well designed, well executed, randomized trials in adults and children with allergic rhinitis and asthma, with a special focus on optimal patient selection, dosage, and treatment duration. In this review, the authors put into perspective current international expert recommendations on the use of SIT (in relation to levels of clinical evidence) and analyze what is needed for the future.

Research Diagnostic Criteria for Temporomandibular Disorders: current status &amp; future relevance1

The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), published in 1992, was based on international expert recommendations and available empirical data. The major rationale was to offer a putative diagnostic and classification system whose reliability, validity and clinical usefulness for TMD diagnosis and classification could be scientifically evaluated and then revised using an evidence-based model for successive iterations. The present journal issue attests to the accomplishment of that major objective: the RDC/TMD has been translated into 18 languages and used very extensively in international research. One important component of that research has been to yield reliable and valid data resulting in an evidence-based revision of the RDC/TMD now available for continuing research and clinical application. The present article offers recommendations and speculations regarding how the RDC/TMD may continue to serve the function of guiding future research and, most importantly, serve as an evidence-based diagnostic and classification system to aid in the rational choice of clinical care for TMD sufferers around the world.