Position Paper Research Articles

BIOLOGICAL THERAPY IN CHRONIC RHINOSINUSITIS WITH NASAL POLYPS: A LITERATURE REVIEW OF TREATMENT METHODS INCLUDING DUPILUMAB AND MEPOLIZUMAB

Introduction and purpose: Nasal polyps occur in chronic mucosal inflammation of the nasal cavity. Overgrown mucosa forms pale colored, smooth, lobular, poorly vascularized structures which expand into nasal cavity causing obstruction, nasal congestion and hyposmia. Corticosteroids used topically or systemically significantly improve patients’ quality of life by reducing the size of the polyps, however long-term steroid use is associated with systemic side effects. Sinus surgeries alleviate breathing problems, however sinonasal symptoms can reoccur even 3 years after the surgery. Recently introduced biological treatment such as mepolizumab or dupilumab, showed itself effective and safe. Studies show that patients treated with dupilumab or mepolizumab have lower risk of sinonasal symptoms reoccurrence. The aim of this review is to investigate the treatment methods in chronic rhinosinusitis with nasal polyps and the potential of the new biological therapy. Materials and methods: A literature review was conducted using databases including PubMed, Scopus and Google Scholar. Additionally, European position paper on rhinosinusitis and nasal polyps (2020) was used. Search terms included “chronic rhinosinusitis with nasal polyps”, “nasal polyposis”, “endoscopic sinus surgery”, “mepolizumab”, “dupilumab”. Summary and Conclusions: Steroid therapy and endoscopic sinus surgery as a well-known form of therapies alleviate symptoms of chronic rhinosinusitis with nasal polyps although often do not offer sustain outcomes. New studies concerning biological therapy including dupilumab and mepolizumab suggest a potential breakthrough for patients. Reoccurrence rate was significantly lower, and symptom control enhanced due to biological therapeutics. Dupilumab and mepolizumab should be considered in CRSwNP treatment.

GETECCU POSITION PAPER ON FRAGILITY, ADVANCED AGE AND INFLAMMATORY BOWEL DISEASE.

GETECCU POSITION PAPER ON FRAGILITY, ADVANCED AGE AND INFLAMMATORY BOWEL DISEASE.

Oncology Pharmacy Practice: Key insights, challenges, and perspectives - A position paper from the French Society for Oncology Pharmacy (SFPO).

Oncology Pharmacy Practice: Key insights, challenges, and perspectives - A position paper from the French Society for Oncology Pharmacy (SFPO).

Guidelines for the correct use of the nomenclature of biochemical indices of bone status: a position statement of the Joint IOF Working Group and IFCC Committee on Bone Metabolism

The presented guidelines are an update of the position paper, endorsed by the International Osteoporosis Foundation (IOF), on nomenclature of bone markers published over 2 decades ago. Novel insight into bone biology and pathophysiology of bone disorders has highlighted the increasing relevance of new and known mediators implicated in various aspects of bone metabolism. This updated guideline proposes the nomenclature Bone Status Indices (BSI) as the comprehensive classification rather than bone turnover markers, bone markers, metabolic markers of bone turnover or metabolic markers of bone turnover, that are currently in use for the implicated molecules. On behalf of the IFCC Committee on Bone Metabolism and the Joint IOF Working Group and IFCC Committee on Bone Metabolism, the authors propose standardized nomenclature, abbreviations and measurement units for the bone status indices.

Queering Asia, querying method

This position paper responds to the topic of “Queer Asia as Method” by addressing each keyword individually and incrementally as phrases. It begins with the term “Asia” and argues that oppression still suffered by gendered and queer subjects in many parts of Asia should caution us against celebratory discourses in the name of Asia. It moves on to consider the notion of “Asia as method” and suggests that a hostility to theory in the name of method betrays a spectrum of affective-cognitive reflexes that smack of (at best) unconscious bias to (at worst) toxic masculinity. Lastly, it proposes that “queering Asia as method” demands that we reflect upon what we do and why we do it, rather than who we are and how we do things. In the final analysis, there are cultural and political battles yet to be fought – and won – in queering Asia and querying method.

Management of pediatric inflammatory bowel diseases in limited-resource settings: A position paper from the Paediatric IBD Porto Group of ESPGHAN.

Pediatric inflammatory bowel diseases (PIBDs), despite being more prevalent in westernized nations, show an increasing incidence worldwide. Accurate evaluation, diagnosis, therapy, and monitoring are mandatory for the adequate management of patients, as is a sensible use of expensive resources, which may be limited in some parts of the world. This limitation often poses challenges to diagnose and treat patients. As the long-term prognosis very much depends on early diagnosis and remission of active disease, it is important to consider reasonable alternatives that may help clinicians to act accordingly within resource constraints, without downgrading previously published guidelines. A group of experts from the "Paediatric IBD Porto Group" of European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) as well as pediatric and adult IBD experts, trained in IBD centers and having working experience in limited-resource settings (LR settings), joined efforts to suggest alternative options in settings where resources are limited, while prioritizing an acceptable cost-effectiveness ratio. Almost all recently published ESPGHAN guidelines and position papers on PIBD were evaluated, and the writing group framed proposals for adaptation in situations with limited access to more expensive resources or tools. Ninety consensus-based recommendations, derived from the available evidence, were formulated. Diagnostic protocol, biochemical evaluation, imaging and endoscopy, monitoring and options for nutritional, medical and surgical treatment were addressed. Cooperation between professionals and institutions was suggested to improve quality of care and optimize use of available expertise. Patient education, counseling, mental health and transition of care were also addressed. Diagnosis and management of PIBD are complex and costly in medical resources, but some alternative protocols could provide acceptable results and help with accurate diagnosis and management. These recommendations and practice points may offer useful guidance in settings where resources may be limited while still providing good medical practice.

Body Modifications in Adolescents: Risks, Responsibilities, and the Role of Paediatricians.

This European Academy of Paediatrics (EAP) position paper provides a comprehensive overview of body modifications (BMs) among adolescents, addressing prevalence, health implications and regulatory gaps. Based on these findings, it offers evidence-based recommendations for healthcare providers and policymakers to improve adolescent healthcare through informed counselling, preventive strategies and strengthening regulations. This position paper was developed by the EAP, the official paediatric section of the European Union of Medical Specialists (UEMS), through targeted literature review and consensus discussions by the Strategic Advisory Group for Adolescent Health, with final approval by the EAP Executive Committee. A literature review revealed high body modification prevalence among European adolescents, significant health risks and correlations with risk-taking behaviours. Key gaps included inconsistent regulatory frameworks and a lack of healthcare provider guidance. The EAP developed recommendations for integrating body modification discussions into routine care, strengthening regulations and improving healthcare provider education. Paediatricians should integrate discussions on body modifications into routine consultations, ensuring adolescents make informed decisions while promoting body positivity. Strengthening regulations, standardising safety measures and improving healthcare provider education are essential steps towards safeguarding adolescent health.

The Use of Omics Sciences in Allergic Diseases From Bench to Bedside: An EAACI Position Paper.

Omics have revolutionized our understanding of allergic diseases, with increasingly more studies adopting techniques like genomics, proteomics, and metabolomics over the years. Integrating high-dimensional omics data with clinical features can enable more precise disease classification and biomarker identification, leading to improved disease management and the development of novel therapies. However, translating these discoveries into clinical practice remains a challenge. In this European Academy of Allergy and Clinical Immunology (EAACI) Position Paper, the Task Force (TF) "The Use of Omics Sciences in Asthma and Allergy Clinical Practice" performed a broad review of recent papers where omics technologies were used in the context of clinical studies and provided a summary of relevant findings in the field of asthma, atopic dermatitis, allergic rhinitis, food allergy and drug hypersensitivity reactions. Particular attention was dedicated to studies investigating overlapping diseases/co-morbidities, revealing unique and shared signatures that could guide future therapeutic and research efforts. Furthermore, current hurdles in translating findings from bench to bedside were explained, and possible solutions were offered. With this position paper, the TF aims to assist researchers and clinicians by providing an overview of the investigations performed to date, highlighting gaps in research, limitations, and avenues for further exploration in clinical practice.

The Delegation of Thought: Education and Judgement in the Age of Artificial Intelligence

This position paper analyses the silent transformation of the concept of education in the age of artificial intelligence. Based on the thesis that thought processes are increasingly being delegated and judgement replaced by algorithmic assistance, the text analyses the cultural, epistemic and institutional consequences of this development. Education is no longer understood as a form of intellectual self-activity, but as a functional operating competence reduced to accessibility, usability and immediate availability. The article pursues an essayistic-diagnostic approach and locates the crisis of education in schools and universities as an example. There, the areas of tension between autonomy and automation, between the desire to ask questions and the economy of answers, are paradigmatically revealed. The delegation of thinking to AI is not understood as a technological danger, but as cultural incapacitation legitimised by convenience and pressure to be efficient. The argumentation pleads for a reconstruction of education as the ability to form interdisciplinary judgements, to orient oneself intellectually and to criticise the technological world view. Artificial intelligence must not become an epistemic authority, but must itself be made the subject of education-based reflection. The paper concludes with a plea for an education that is not limited to access, but rather proves itself in thinking, especially where technology invites thinking, but does not replace it.

Postoperative Anti-IgE Therapy for Chronic Rhinosinusitis With Nasal Polyps and Asthma: Efficacy and Prognostic Factors.

Omalizumab has demonstrated efficacy in treating chronic rhinosinusitis (CRS) with nasal polyps and comorbid asthma (NPwAS) in preoperative settings. However, real-world evidence regarding its postoperative application remains limited. This study aimed to assess the effectiveness and safety of omalizumab in managing NPwAS following endoscopic sinus surgery (ESS), and to identify predictors for treatment response. This prospective observational study enrolled 60 NPwAS patients who underwent ESS between January 2020 and March 2023. Participants were divided into two groups: Control group (receiving standard care: nasal saline lavage and budesonide nasal spray) and Omalizumab group (receiving omalizumab in addition to standard care). Disease assessments, including total nasal symptom score (TNSS), visual analog scale (VAS) score, asthma control test (ACT), and sino-nasal outcome test-22 (SNOT-22), were conducted at baseline and 6 months post-treatment. Blood and nasal polyp tissue samples were collected to explore potential predictors. CRS disease control was categorized as controlled, partly controlled, or uncontrolled based on the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). Thirty patients in the Omalizumab group and 28 in the Control group completed the treatment and follow-up. At 6 months, CRS control was significantly better in the Omalizumab group compared to the Control group, with response rates of 40% and 14.3%, respectively (p = 0.009). The Omalizumab group also demonstrated greater mean improvements from baseline in TNSS, loss of smell score, and SNOT-22 score compared to the Control group. The treatment exhibited a favorable safety profile. Omalizumab significantly improved clinical outcomes in NPwAS patients 6 months post-surgery, underscoring its potential as an effective adjunctive therapy in the postoperative management of NPwAS.

Vitamin E nomenclature: Summary and response to articles published in the FRBM Vitamin E Discussion Forum.

Vitamin E nomenclature: Summary and response to articles published in the FRBM Vitamin E Discussion Forum.

Music and Parental Wellbeing: A Position Paper

This article sets out a collective vision for a new Music and Parental Wellbeing Alliance. It starts from the premise that challenges to parental wellbeing represent a persistent, global concern. When unchecked, these challenges can lead to negative consequences for the whole family. Music is common in the lives of many parents around the world; yet despite emerging evidence, it is not yet considered as an option in most parental care pathways. To address this requires a collaborative approach, leading to the founding of the Music and Parental Wellbeing Research Network in 2023. As a network comprising of parents, musicians, music therapists, healthcare practitioners, researchers, arts leaders, and policy experts, we set ourselves the task of proposing and setting out a direction for the field of music and parental wellbeing. We embarked on agreeing the key steps needed to advance the field, and the driving principles underpinning such endeavor, arriving at a vision for our ongoing work: To enable, sustain, and expand an international and interdisciplinary community that works towards ensuring that all parents have the opportunity – and are empowered and equipped – to engage with music that can support their wellbeing. In this short article, we articulate a mission for a new Music and Parental Wellbeing Alliance that is focused on achieving our vision through SHAPING evidence and practice, SUPPORTING professionals working in the field, and SHARING the potential of music in supporting parental wellbeing. We invite readers to join us in progressing this mission.

Clinical diagnosis and management of drug reaction with eosinophilia and systemic symptoms (DRESS) in children: An EAACI position paper.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but severe cutaneous adverse drug reaction encountered in both adults and children with a significant mortality rate. A number of guidelines or consensus reports have been published for optimal diagnosis and treatment of DRESS in adults, but none specifically forchildren. It is increasingly evident that there are significant differences in drug pharmacokinetics, metabolism, co-occurring infections, comorbidities, clinical manifestations, and severity of drug allergies between children and adults, as well as across different pediatric age groups. This position paper aimed to evaluate and compare all the available data related to clinical features, diagnosis, and treatment of DRESS in adults and children in an attempt to identify the differences and gaps, and produce recommendations on diagnosis and treatment of this fatal disorder in children. A search of MEDLINE (via PubMed) and Web of Science from 2000 to 2024, including studies that assessed children with DRESS syndrome, was performed. In the absence of pediatric-specific data, studies involving adults or mixed populations (both adults and children) were also analyzed. Among a total of retrieved 5264 records, following duplicate removal and full-text assessment, a total of 493 manuscripts related to DRESS were included in the report and recommendation generation. The recommendations for the clinical diagnosis and treatment of DRESS in children were formulated in accordance with the directionality and strength guidelines suggested by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group and related research. Among retrieved records, there was only one randomized controlled trial, one meta-analysis, one systematic review, six retrospective comparative studies on treatment, and one systematic review on the accuracy of skin tests in DRESS. All of these studies were conducted in adults, rarely involving children, and none were exclusively performed in pediatric populations. Comparison of systematic case reviews revealed that some aspects of clinical features, prognosis, and mortality in children differed from those in adults. The diagnosis of DRESS is based on several clinical and laboratory criteria, which have been developed for adult patients but have not been validated for children. Causality assessment tools, invivo skin tests, and invitro tests have been used widely in adults to identify the culprit drugs in DRESS, while these tools are more rarely employed or reported in children. Adult guidelines or consensus reports recommend a severity-based, stepwise treatment approach for DRESS, whereas no such severity classification or treatment algorithms exist exclusively for children, leading to inconsistent management with numerous instances of overtreatment and undertreatment. There is very limited evidence-based data on the diagnosis and management of DRESS both in adults and in children. Until more evidence becomes available, we propose a diagnostic algorithm, a DRESS severity classification, and a severity-based tailored treatment approach, all adapted to pediatric needs together with issued recommendations to enable physicians to provide better care and reduce morbidity and mortality in pediatric patients.

Position Paper: Extending Credibility Assessment of In Silico Medicine Predictors to Machine Learning Predictors.

There are several situations where it would be convenient if a quantity of interest essential to support a medical or regulatory decision could be predicted as a function of other measurable quantities rather than measured experimentally. To do so, we need to ensure that in all practical cases, the predicted value does not differ from what we would measure experimentally by more than an acceptable threshold, defined by the context in which that quantity of interest is used in the decision-making process. This is called Credibility Assessment. Initial work, which guided the elaboration of the first technical standard on the topic (ASME VV-40:2018), focused on predictive models built from available mechanistic knowledge of the phenomenon of interest. For this class of predictive models, sometimes called biophysical models, a credibility assessment practice based on the so-called verification, Validation, Uncertainty, Quantification and Applicability (VVUQA) analysis is accepted. Through theoretical considerations, this position paper aims to summarise a complex debate on whether such an approach can be extended to predictive models built without any mechanistic knowledge (machine learning (ML) predictors). We conclude that the VVUQA can be extended to ML-based predictors; however, since there is no certainty that the features used to predict the quantity of interest are necessary and sufficient, according to the VVUQA framework, such credibility assessment is limited to the test sets used for the validation studies. This calls for a Total Product Life Cycle approach, where periodic retesting of ML-based predictors is part of post-marketing surveillance to ensure that no "unknown bias" may play a role.

ANMCO Position paper in collaboration with ITACARE-P: Management of hospital discharge

Hospital discharge is a crucial moment in the continuity of care, acting as a bridge between the acute phase and the treatment pathway that follows. Far from being a simple administrative act, it is a complex process requiring careful planning, effective communication, and the active involvement of all the stakeholders of the healthcare system, including the patient. Poor discharge management can have a negative impact on clinical outcomes, resulting in a higher risk of hospital readmission and inefficient use of healthcare resources. Taking into account the increasingly old, fragile population showing a high prevalence of comorbidities and complex care needs, it is essential to consider discharge as a comprehensive and integrated approach to the care continuum. This document arises from the necessity to share an updated and practical model for the management of hospital discharge, based on the latest scientific evidence and multidisciplinary experience, its aim being to promote continuity of care and personalized treatment as well as to improve health outcomes. The authors intend to provide clinical cardiologists with a unified tool for the management of patient discharge, offering concrete proposals to improve communication between physicians and patients, optimize therapies, and positively impact health outcomes.

Effectiveness of dupilumab in chronic rhinosinusitis with nasal polyps: A retrospective study of clinical and imaging outcomes.

To evaluate dupilumab's outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) cases. A retrospective analysis was carried out at Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia on 145 adult CRSwNP patients treated with dupilumab between January 2020 and December 2023 following the European position paper on rhinosinusitis and nasal polyps 2020 guidelines. Primary outcomes included changes in Lund-Mackay computed tomography (CT) scores, immunoglobulin E levels, and visual analog scale (VAS) smell score over +12 months. Significant improvements were noted post-treatment. Lund-Mackay CT scores decreased from 12.5 to 5.5 (p<0.001), and VAS smell scores dropped from 10.0 to 0.0 (p<0.001). Immunoglobulin E levels reduced from 250.5 to 63.5 (p<0.001). After treatment, 93.3% of patients avoided sinus surgery, 78.6% reported improved asthma status, and 60% used dupilumab as monotherapy. This study supports dupilumab's effectiveness in treating severe CRSwNP, showing significant improvements in CT imaging and overall medical condition over 12 months. Dupilumab reduced systemic corticosteroid use and rescue surgeries. While promising, further trials are needed to validate its use as monotherapy. Identifying those who gain most from biologic therapy is crucial.

Modernizing Risk Adjustment in Health Care: A Position Paper of the American College of Physicians.

Risk adjustment is a critical component of health care reimbursement aimed at ensuring fair compensation on the basis of the characteristics of patients receiving care. Optimizing risk adjustment is not just a matter of improving efficiency or predictive accuracy; it is a crucial step toward achieving health equity by ensuring that resources are directed toward patients who need them most and reducing incentives to exclude or neglect high-risk patients. The authors reviewed available publications from PubMed and Google Scholar published between 2000 and 2025, as well as relevant news articles, policy documents, websites, and other sources related to risk adjustment and application areas. This process yielded 8 recommendations related to standardizing risk adjustment methods, promoting data interoperability, implementing strategies to enable more accurate and continuous reflections of patients' health status, integrating valid and reliable metrics into regular evaluation and feedback mechanisms, limiting "gaming" opportunities and incentives, creating valid ways to measure costs of caring for patients who are experiencing health care disparities and inequities and/or are disproportionately affected by social drivers of health, evaluating and leveraging advanced analytics and machine learning when able to improve risk adjustment models, and promoting research and implementation methods that combine elements of both prospective and concurrent risk adjustment. Implementation of these risk adjustment recommendations has broad implications for various entities in the health care ecosystem.

A Review of Two Ethnic Groups, African Americans and Asian Americans, Competing for a Place in Stem Programs

This position paper seeks to shine a spotlight on the urgent challenges that African American students encounter in their pursuit of STEM (Science, Technology, Engineering, and Mathematics) programs. It will also delve into the contentious debates between advocates for Asian and Black students regarding school admission policies. A crucial case that will serve as a focal point for fostering dialogue on this important issue is the recent court case, Students for Fair Admissions v. Harvard. By examining these complexities, we can better understand the need for equitable opportunities and support for all students in their educational journeys.

Definition of Skills and Roles of the Digestive Endoscopy Nurse: Italian Consensus of ANOTE-ANIGEA.

Endoscopy nurses work in all phases of endoscopic procedures, guaranteeing privacy, respect for dignity, comfort, and safety by applying specific theoretical knowledge and practical skills. However, in several countries, a structured training process in this specific area is lacking. This document defines the skills and roles of nurses working in the endoscopy and gastroenterology units in Italy. The National Association of Endoscopic Technique Operators - National Association of Gastroenterology Nurses and Associates (ANOTE-ANIGEA) National Committee created a working group including 20 expert nurses and 2 physicians, divided into 4 working groups. Each group worked on one level of training: trainee endoscopy nurse, competent endoscopy nurse, advanced endoscopy nurse, and nontechnical skills. For the final declaration, the Delphi method was adopted. This position paper defined the role and training of endoscopy nurses, proposing three progressive levels of professional preparation. This is the first document aimed at defining the role and training of endoscopy nurses, suggesting progressive levels of professional preparation. It could be an appropriate tool for both nurses who are beginning to work in an endoscopic unit, as well as for all subjects involved in training nurses practicing in digestive endoscopy.

Gender and Diversity Responsive Coaching: Building Capacity Through Relational, Feminist-Informed, Intersectional, Transdisciplinary, and E/Affective Coach Development

Attempts towards achieving gender equality are widely considered to be ‘wicked’ problems and continue to be a global priority in line with other United Nations Sustainable Development Goals. In sport, longstanding gender inequities are reproduced and perpetuated through problematic heteropatriarchal, ableist, and colonial sporting structures and cultures. These negatively impact women and girls and gender expansive people, as well as their access to quality sporting experiences across different pathways. As key actors within sporting ecosystems, sport coaches have a critical role to play in terms of supporting the development of inclusive, ethical, and equitable sporting environments and, more broadly, in the mainstreaming of quality sporting experiences for all. Therefore, the development of a gender and diversity-sensitive, -responsive, and -transformative coaching workforce should be a critical concern. This position paper builds on previous empirical work which has identified gaps in coaching knowledge alongside a range of problematic understandings and assumptions which currently shape coaches’ ‘gender-responsive’ coaching practices. It does so by identifying challenges and ways forward for enhanced coach learning and development strategies targeting the development of a more gender and diversity-responsive coaching workforce.