Foreign body (FB) ingestion is a relatively frequent occurrence in the pediatric population with multiple potential sequelae. Appropriate intervention may range from urgent endoscopic retrieval to watchful waiting, with multiple variables influencing the decision. The four key variables include the type of object ingested, the anatomical location of the FB, the presence and severity of symptoms, and the time since ingestion. In this position paper, we provide an evidence-based approach to the management of ingested foreign bodies, incorporating expert opinion where existent evidence alone is insufficient to guide clinical judgement. We offer a clear, clinically relevant guide, with user-friendly algorithms, to assist in real-time decision making. We also include practical tips from experts on how to safely and effectively perform endoscopic removal of an ingested FB.

Adolescent and Young Adult Vaccination: A Position Paper of the Society for Adolescent Health and Medicine.

ACP position paper opposes referring to physicians as "providers."

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common reason for elevated liver enzymes in children in Europe, affecting more than 5% of all children. Since the last iteration of this position paper, there have been substantial advances in our understanding of the disease. After a detailed literature review and thorough discussion, we established consensus recommendations for the diagnosis and assessment of MASLD in children. Alanine aminotransferase (ALT) ≥ 30 IU/L is a suitable screening test for MASLD in children over 10 years of age with obesity (body mass index z-score ≥+2), or in children of any age with additional risk factors. All patients with suspected MASLD should be assessed for alternative or concomitant diagnoses, as well as comorbidities. Patients who are not overweight, under 8 years old, or have any other red flags should be promptly referred for specialist assessment. Liver biopsy remains the gold standard for diagnosis and staging of MASLD, but should be reserved for diagnostic uncertainty, to guide treatment decisions, and risk stratification (e.g., prior to transition to adult care). While there is emerging data for non-invasive tests (e.g., transient elastography), it is unclear how to routinely implement these investigations in clinical practice. Combined changes of ≥20% in both ALT and gamma-glutamyl transferase may represent a useful non-invasive tool for monitoring disease severity over time. Most patients are appropriately investigated and managed by non-specialists where the focus is on holistic management of obesity and its complications. Future research should focus on how to use non-invasive tests to risk-stratify children, in particular, how to identify those with advanced fibrosis.

The rapid digital transformation of health systems worldwide demands an interdisciplinary public health workforce proficient in digital technologies, ethical frameworks and systems-level thinking. However, current public health curricula remain largely discipline-specific and fail to systematically embed digital competencies or foster collaboration across sectors such as technology, ethics, law, and policy. This position paper emerges from a high-level workshop held during the Digital Public Health Conference 2025, where international experts and educators debated strategies for advancing interdisciplinary education. Drawing on multilevel evidence, including participant reflections, international frameworks, and case studies, we identify and analyse five critical challenges shaping the future of digital public health education: (1) embedding ethics and regulation into digital public health education; (2) strengthening digital public health literacy with a salutogenic approach; (3) defining interdisciplinary competencies for the future workforce; (4) integrating real-world applications into classroom learning; and (5) enabling long-term, cross-border collaboration in education. For each theme, we propose actionable goals rooted in pedagogical innovation, policy alignment, and institutional governance. Designing inclusive, ethical, and practice-informed education models is essential to prepare a digitally fluent and socially accountable public health workforce.

Cancer screening is a cornerstone of cancer control in Europe yet marked disparities persist in access, implementation, and quality assurance among national or regional programs. Building on the EU Council's 2022 recommendations and the European Union's Beating Cancer Plan, the European Consensus Project (ECP) was established to provide harmonized, evidence-based recommendations for major cancer screening programs and to promote a shift toward risk-adapted, technology-enabled, and equitable prevention models. A structured expert panel meeting was convened under the auspices of the European Cancer Prevention Organization, integrating systematic literature review and multidisciplinary discussion to formulate validated, evidence-based recommendations. For each primary cancer site (breast, lung, colo-rectum, cervix, prostate, and stomach), systematic literature reviews identified evidence on reductions in mortality, stage distribution, participation, cost-effectiveness, and organizational quality. The consensus reaffirmed the evidence of mortality reduction with organized breast, lung, colorectal, and cervical screening, endorsed structured risk-adapted prostate-specific antigen testing for prostate cancer, and recommended Helicobacter pylori 'screen-and-treat' strategies for gastric cancer in high-incidence regions. Insights into future perspectives of liquid biopsy approaches are outlined. The ECP Consensus outlines a European roadmap for precision screening, grounded in quality assurance, individual risk stratification, artificial intelligence integration, and public health literacy. These recommendations align with the EU Mission on Cancer and Europe's Beating Cancer Plan, providing a harmonized roadmap toward precision prevention and equitable implementation of screening across Europe.

The position paper of the Working Group "Cross-sectoral urological care" addresses the profound challenges currently facing urological healthcare. Demographic change, workforce shortages, increasing financial pressure, digital transformation, and the political shift toward outpatient care are placing growing strain on both hospitals and private practices. To maintain comprehensive, high-quality care, structural changes are essential. This paper outlines how such atransformation can succeed through coordinated, cross-sectoral collaboration-by developing integrated care networks, hybrid surgical centers linked to hospitals, specialized emergency structures, and flexible employment and training models. Guided by the principle "digital before outpatient before inpatient", the goal is to establish apatient-centered, efficient, and future-oriented care system. Achieving this requires stable conditions, sustainable investment, reduced bureaucracy, digital interoperability, and continuous scientific evaluation. Only through joint efforts between hospitals and outpatient providers can this transformation be successfully achieved and urological care be secured for the future. With its broad clinical spectrum, strong professional networking, and established organizational structures, urology is particularly well positioned to take aleading role in developing cross-sectoral models of care.

Iridology is an alternative diagnostic practice that claims to identify systemic diseases and organ dysfunction through visual inspection of iris features, including pigmentation patterns, crypts, furrows, and discolorations. Despite its continued presence within complementary and alternative medicine, iridology has not been incorporated into mainstream medical practice. This review critically examines iridology from an ophthalmologic perspective, addressing its historical origins and epistemological foundations, proposed mechanisms, biological plausibility, and clinical evidence. A systematic appraisal of the available literature, including the most recent government-commissioned evidence evaluation, demonstrates a consistent lack of diagnostic accuracy, reproducibility, and pathophysiological rationale. The ethical and clinical implications of iridology use are discussed, with particular attention to the risk of delayed diagnosis and patient misinformation. Based on the totality of evidence, iridology cannot be supported as a diagnostic or screening tool in ophthalmology or general medicine.

Pancreatic cystic lesions represent an increasingly common clinical finding due to the widespread use of cross sectional imaging, encompassing a heterogeneous spectrum ranging from benign entities to premalignant and malignant neoplasms. Their rising incidence poses significant challenges in diagnosis, risk stratification, and management, requiring a careful balance between avoiding unnecessary interventions and preventing malignant progression. This position paper, developed by an intersocietal multidisciplinary panel of experts in pancreatic disease, aims to provide a comprehensive and evidence-based overview of these lesions. Current classifications, imaging features, and differential diagnosis are discussed, with particular emphasis on the role of magnetic resonance imaging. Key entities including serous cystic neoplasms, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and rarer cystic tumors are analyzed in terms of biological behavior and radiological characteristics. Furthermore, the document reviews available international guidelines and proposes a pragmatic approach to clinical management, including indications for surveillance, endoscopic evaluation, and surgical treatment. Special attention is given to risk stratification based on high-risk stigmata and worrisome features, as well as to individualized patient management. In conclusion, this paper provides a shared expert perspective to support standardized and personalized management of pancreatic cystic lesions in clinical practice.

Honey bee venom (HBV) represents a unique interface between allergy and oncology, exemplifying how allergen-derived molecules can be repurposed as anti-cancer agents. Melittin, the principal component of HBV, accounts for 40%-50% of its dry weight and is responsible for most of its biological activity. Beyond its well-established role as a potent allergen and mast cell activator, melittin displays broad anti-tumour properties across multiple cancer models. Preclinical evidence demonstrates that melittin induces cancer cell death through membrane disruption, mitochondrial and death receptor-mediated apoptosis, ferroptosis, and inhibition of key oncogenic pathways, including PI3K/Akt/mTOR, NF-κB, and HIF-1α/VEGF signalling. Additional effects include suppression of angiogenesis, epithelial-mesenchymal transition, invasion, and metastatic dissemination, as well as modulation of the tumour immune microenvironment. However, the clinical translation of melittin is limited by its intrinsic haemolytic activity, systemic toxicity, and high allergenic potential. Advances in nanotechnology, targeted delivery systems, and venom-inspired peptide engineering are addressing these barriers, enabling tumour-selective delivery while reducing off-target effects. This EAACI Task Force Position Paper integrates current evidence on melittin within the emerging field of AllergoOncology. It highlights its dual relevance for allergists and oncologists and outlines the translational challenges to be overcome and opportunities to enable safe clinical application.

Robotic-assisted surgery (RAS) has evolved from a procedural innovation into an increasingly integrated component of contemporary digital surgical ecosystems. Nevertheless, most current Health Technology Assessment (HTA) frameworks continue to evaluate robotic systems primarily through comparator-based models focused on isolated perioperative and oncological outcomes. In this EFISDS-TROGSS position paper, we critically examine the methodological limitations of conventional HTA paradigms when applied to robotic surgical platforms, using the recent Italian AGENAS appraisal as a representative case study. While the AGENAS document represents one of the most comprehensive national evaluations of RAS performed to date, its heterogeneous recommendations across procedures highlight unresolved tensions regarding perioperative benefit, real-world implementation, learning curves, organizational impact, and long-term healthcare value. We argue that RAS should increasingly be interpreted not simply as a surgical device, but as a platform technology interacting with simulation-based training, digital infrastructure, surgical data science, artificial intelligence, telecommunication systems, and institutional organization. Rather than a surgical device alone, RAS should be interpreted and regarded as a combination of technological advances and approaches that integrate various degrees of artificial intelligence autonomy, image navigation, telesurgery, and other benefits to empower the surgical team. Conventional HTA models, originally developed for relatively discrete therapeutic interventions, may incompletely capture the multidimensional interaction between robotic technologies and modern healthcare systems. Particular attention is dedicated to real-world evidence, implementation maturity, reimbursement limitations, and the growing mismatch between current Diagnosis-Related Group (DRG) structures and technologically integrated surgical care. Finally, we propose more flexible and multidimensional assessment frameworks integrating procedural outcomes with organizational sustainability, digital interoperability, workforce implications, and longitudinal healthcare value.

ABSTRACT This position paper examines the growing dominance of health economics in Swedish healthcare governance and argues that its elevated epistemic authority produces significant risks for the sustainability and ethical integrity of care systems. Drawing on feminist theories of care and critical political economy, the paper interrogates the assumption that care can be adequately represented, valued, or prioritized through economic models. Three core critiques are developed. First, the commodification of care imposes rationalizing logics onto practices that are intrinsically relational, affective, and resistant to market measurement. Second, prevailing economic theories of value—rooted in neoclassical assumptions—fail to recognize the substantial social, reproductive, and moral value generated by care work, while enabling exploitative labour conditions and rent-seeking behavior in medical industries. Third, the integration of financial incentives into governance structures crowds out ethical commitments embedded in Swedish health legislation, creating moral distress for care workers and policy contradictions that undermine equitable care provision. While acknowledging the role of economic expertise, the paper ultimately argues for more pluralistic forms of knowledge in healthcare decision‑making.

Despite well-documented health benefits, outdoor stays remain limited for older adults living in residential care facilities (RCFs) across Europe. This position paper compares governance, policy, and research in the Netherlands, Finland, and Sweden, identifying key barriers, particularly for persons experiencing physical or cognitive decline. Drawing on three theoretical models, the paper highlights a persistent gap between evidence and practice, and calls for the establishment of legal rights, national strategies, and international guidelines to ensure equitable access to outdoor stays. Contact with nature and outdoor stays should be recognized not as optional amenities, but as fundamental human needs in later life.

The increasing complexity of interventional radiology procedures, combined with limited anesthesiology resources, makes it essential for interventional radiologists to independently provide safe and effective sedation and analgesia. To ensure responsible and timely patient care, a structured and comprehensive development of these competencies within interventional radiology is necessary. While established guidelines and training curricula exist in fields like gastroenterology and cardiology, comparable standards are still lacking in German-speaking countries for radiology. This position paper highlights the urgent need to develop a unified curriculum for sedation and pain management tailored to interventional radiology. This curriculum should be integrated into specialist and assistant training programs. Beyond clinical education, the availability of adequate infrastructure, standardized workflows, clear documentation, and emergency protocols are critical for ensuring patient safety. Collaboration with anesthesiology departments, particularly in complex or deep sedation cases, remains indispensable. Sedation performed by radiology teams is not intended to compete with anesthesiology, but rather to augment patient care capacity in a structured and safe manner. Expanding these competencies strengthens the autonomy of interventional radiology, supports the broader trend toward outpatient care, and enables timely, efficient, and comfortable procedures. This represents an important step in establishing interventional radiology as an independent clinical discipline actively involved in patient treatment. · Growing need for autonomous analgosedation in IR - The increasing complexity of interventional radiology procedures combined with limited anesthesiology capacity makes competent sedation and analgesia performed by the IR team itself essential for timely and patient-centered care.. · International evidence supports safety and feasibility - Multiple guidelines (CIRSE, ASA, ESAIC, RCR) and recent studies - including CT-guided brachytherapy and percutaneous tumor ablation - confirm that non-anesthesiologist-administered sedation can be performed safely and effectively.. · Clear risk stratification and sedation boundaries - Minimal and moderate sedation in ASA I/II patients can be independently performed by trained interventional radiologists; deep sedation remains the domain of anesthesiologists or intensivists. Standardized patient selection and pre-procedural risk assessment are mandatory.. · Infrastructure, training, and documentation as minimum requirements - Standardized operating procedures, continuous monitoring, dedicated sedation personnel, regular simulation-based training, and structured post-procedural care - including a recovery unit and discharge management - are non-negotiable prerequisites.. · Urgent need for binding standards in the DACH region - While internationally established guidelines exist, comparable mandatory curricula and standards for IR are currently absent in German-speaking countries. This position paper provides the first practice-oriented recommendations and calls for the rapid development of competency frameworks within IR departments.. · Minko P, Auer TA, Gebauer B et al. Analgosedation in interventional radiology. Rofo 2026; DOI 10.1055/a-2863-2198.

ABSTRACT The integration of artificial intelligence (AI) into education presents both opportunities and challenges, particularly in inquiry-based and context-sensitive science classrooms. Although commercial AI tools are increasingly available, it remains unclear how teachers can move from passive consumers of technology to active designers of AI-mediated instruction. This position paper proposes two professional competencies needed for teachers to maintain and enact expertise in AI-enhanced environments, digital integration competency and automation design competency. Digital integration competency refers to teachers’ ability to collect, connect, and analyze educational data for instructional purposes. Automation design competency refers to teachers’ ability to design digital automated workflows that are aligned with pedagogical goals. Both competencies depend on data preparation and require teachers to exercise professional judgment in evaluating and transforming instructional data. This conceptualization extends the TPACK framework by addressing the practical demands of AI integration in science teaching. These competencies support teachers’ professional agency, responsible innovation, and capacity to resist the risks of technological colonization in the age of AI. Drawing on classroom examples, international policy frameworks, and current research, this paper offers a conceptual foundation for rethinking teacher expertise in AI-integrated science education. It ultimately reimagines the teacher not as a passive user of technology, but as a designer of AI-supported instructional environments.

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of bisphosphonate therapy, whose risk is currently assessed through qualitative staging systems that do not integrate pharmacological determinants of cumulative drug exposure. The aim of this study is to present the Bisphosphonate Accumulation Index (BAI), a pharmacologically derived, dimensionless scalar quantifying cumulative exposure to bone-targeted antiresorptive agents by integrating relative potency, administered dose, dosing frequency, route-specific bioavailability, and treatment duration, for use as a pre-procedural assessment tool in patients receiving bisphosphonates. Methods: The BAI combines five pharmacologically grounded parameters from peer-reviewed literature: (1) relative antiresorptive potency referenced to etidronate; (2) dose per administration (mg); (3) monthly dosing frequency; (4) bioavailability route; and (5) years of treatment within the preceding 10-year window. The model includes nine bisphosphonates registered in Italy. Results: The BAI spans approximately five orders of magnitude (from <1000 for short-term oral therapy to >120,000 for monthly intravenous zoledronic acid). Four analyses support the model: sensitivity analysis identifies relative potency as the main source of variance; ecological calibration against nine MRONJ incidence data points yielded r = 0.911 (p = 0.0006, R2 = 0.829), indicating that the BAI accounts for approximately 83% of the population-level variance in published incidence rates across heterogeneous regimens (ecological correlation; this does not establish individual-level predictive validity); Monte Carlo simulation on 10,000 patients generated a plausible exposure-strata distribution (6.1% low, 66.6% moderate, 27.3% high); and concordance analysis with a DDD-based metric showed discordance in 7/8 regimens. Conclusions: The BAI is a transparent, reproducible, pharmacologically grounded metric of cumulative antiresorptive exposure addressing the quantitative gap identified in the AAOMS 2022 Position Paper. The BAI measures pharmacological exposure, which is a necessary but insufficient component of MRONJ risk; clinical modifiers such as corticosteroid co-administration, diabetes, renal function, and procedure type are not integrated and must be evaluated independently. The provisional exposure strata reported here (<1000, 1000-10,000, >10,000) are hypothesis-generating and intended solely to guide the design of validation studies; they should not be used as clinical decision rules until prospective patient-level validation has been completed.

From fragmentation to transtheoretical models of psychological therapy.

The Sociedad Española de Patología Digestiva (SEPD) has developed a position statement setting out expert-consensus recommendations considered essential for the structure, organization, and functioning of Bariatric and Metabolic Endoscopy Units (BMEU) operating within Departments of Gastroenterology, with the aim of enabling these units to carry out their activities efficiently and with high quality. The document defines the BMEU -including a proposed minimum activity volume as a certification criterion- and establishes provisional certification criteria relating to their organization, structure, service portfolio, processes, articulation with the pharmacological treatment of obesity, framework criteria for patient selection, safety, and aspects concerning training and research. The provisional certification criteria have been classified as mandatory (recommendations whose fulfilment is required to qualify for SEPD certification) and recommendations. These provisional certification criteria should be reviewed within no more than five years, on the basis of the experience gained in Spanish BMEUs and the evolution of scientific knowledge in bariatric and metabolic endoscopy and in the comprehensive management of obesity. The development of performance indicators-including patient-reported outcome measures (PROMs)-is identified as a relevant challenge, as is the generation of evidence on the association between consensus-based recommendations on BMEU structure and activity and health outcomes. The methodological limitations of the present document and the need to incorporate the patient perspective in future updates are explicitly acknowledged.

The importance of quality assurance in colposcopy in the elimination of cervical cancer: A position paper by the European Federation for Colposcopy.

IASLC Update on Classification of Pulmonary Neuroendocrine Neoplasms.