Practical Recommendations Research Articles

Insights on High-Value Procedures From the ISASS 4-Part Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery Based on Surgeon Experience.

The authors conducted a comprehensive review and integration of insights from 4 webinars hosted by the International Society for the Advancement of Spine Surgery (ISASS) to arrive at recommendations for best clinical practices for guideline development for endoscopic spine surgery. This perspective article discusses the limitations of traditional surgical trials and amalgamates surgeons' experience and research on various cutting-edge techniques. Data were extracted from surveys conducted during each webinar session involving 3639 surgeons globally. The polytomous Rasch model was employed to analyze responses, ensuring a robust statistical assessment of surgeon endorsements and educational impacts and focusing on operative nuances and experience-based outcomes. Bias detection was performed using the differential item functioning test. The ISASS webinars provided a dynamic platform for discussing advances in endoscopic spine surgery, identifying a range of high-value procedures from basic discectomies to complex lumbar interbody fusions. Each high-value endoscopic spine surgery was highlighted in separate peer-reviewed publications, which form the basis for this summary document that synthesizes key takeaways from these webinars. High-value clinical applications of endoscopic spine surgery, primarily defined as higher-intensity endorsement transformation from the pre- to postwebinar survey with a shift to higher mean logit locations of test items both with unbiased and orderly threshold progression, were: (a) Percutaneous interlaminar endoscopic decompression for lateral canal stenosis, (b) transforaminal debridement of low-grade degenerative spondylolisthesis, (c) transforaminal full-endoscopic interbody fusion for hard disc herniation, (d) endoscopic standalone lumbar interbody fusion, (e) endoscopic debridement of spondylolytic spondylolisthesis, and (f) posterior cervical foraminotomy for herniated disc and bony stenosis. The ISASS webinar series has significantly impacted surgeons' education and contributed to the identification of high-value endoscopic spine surgery practices that may serve as a cornerstone for surgeon training standards, policy, and guidelines development. Ongoing research on technological advancements and expansions of clinical indications combined with systematic review is expected to refine the recommendations on high-value endoscopic spinal surgeries recommended for enhanced reimbursement. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

A tied-weight autoencoder for the linear dimensionality reduction of sample data

Dimensionality reduction is a method used in machine learning and data science to reduce the dimensions in a dataset. While linear methods are generally less effective at dimensionality reduction than nonlinear methods, they can provide a linear relationship between the original data and the dimensionality-reduced representation, leading to better interpretability. In this research, we present a tied-weight autoencoder as a dimensionality reduction model with the merit of both linear and nonlinear methods. Although the tied-weight autoencoder is a nonlinear dimensionality reduction model, we approximate it to function as a linear model. This is achieved by removing the hidden layer units that are largely inactivated by the input data, while preserving the model’s effectiveness. We evaluate the proposed model by comparing its performance with other linear and nonlinear models using benchmark datasets. Our results show that the proposed model performs comparably to the nonlinear model of a similar autoencoder structure to the proposed model. More importantly, we show that the proposed model outperforms the linear models in various metrics, including the mean square error, data reconstruction, and the classification of low-dimensional projections of the input data. Thus, our study provides general recommendations for best practices in dimensionality reduction.

Pendidikan Inklusi dalam Perspektif Pendidikan Islam: Mewujudkan Keadilan dan Kesetaraan untuk Semua

Inclusive education in the context of Islamic education is an important and relevant topic in efforts to create a fair and equitable education system for all individuals, including children with special needs. This research aims to describe, analyze, and provide a deep understanding of inclusive education in Islamic education. Using a qualitative method and a literature review approach, this research presents findings that demonstrate the importance of inclusion in creating education that embraces all children, amidst multicultural complexity. These findings have significant implications for inclusive education practices in Islamic schools and provide recommendations for future policies and practices. This research also offers suggestions for further research in this area, including more in-depth studies on effective inclusive education implementation strategies.

The Impact of Social Media Use Among Millennial Couples

Social media use (SMU) among millennials (i.e., persons born between 1981 and 1996) is considered a hallmark behavior, with nearly 79% of individuals in this age bracket reportedly using social media multiple times a day. Despite the potential benefits of social media access, this communication method impedes forming deep connections, posing detrimental consequences to enduring romantic relationships among millennials. In recent years, SMU among millennials has skyrocketed, potentially contributing to the increased relational ruptures during this time, such as increased conflict and infidelity rates. With social media providing an outlet for individuals to text, share thoughts, photos, and intimate messages—all with the possibility of evading being caught, the millennial culture is shifting the dynamics of romantic relationships. As a result, therapists are seeing an increased number of couples from the millennial culture with heightened relational dysfunction due to social media and the digital world. Now more than ever, clinicians must be equipped with the necessary skills and competencies to assist millennial romantic relationships impacted by SMU. An in-depth literature review will provide a landscape to examine the role of social media, online dating, partner selection, and issues surrounding infidelity over the last decade. This article will conclude with a case study and recommendations for best practices to help facilitate healing among millennial relationships affected by negative SMU.

5.K. Scientific session: Health literacy in Ireland: A participatory action approach with Sláintecare Healthy Communities

Abstract This workshop offers a comprehensive exploration of the dynamics, challenges, and opportunities surrounding health literacy in Ireland. In 2023, Dublin City University and Sláintecare Healthy Communities, driven by a commitment to foster equitable healthcare access and outcomes, embarked on a research project aimed at deciphering the intricacies of health literacy and its implications for public health in Ireland. The series of interactive presentations will transparently share learnings from the process and outcomes of this project, which can be applied across different sectors, contexts, and countries. The workshop will begin with an overview of the rationale underpinning Sláintecare Healthy Communities’ engagement in this research project. This is one of the first pilot programmes of its kind. By transparently exploring the driving forces and strategic approaches of this organisation, participants will gain insight into the imperative of addressing health literacy from the perspective of a cross-government and multi-discipline initiative. Following from this, a series of presentations will detail the rigorous scientific approaches undertaken. This includes an umbrella review of international conceptualisations of health literacy and a systematic review of health literacy research conducted on the island of Ireland in the last decade. Findings from these reviews highlight the evolving challenges and emerging trends shaping health literacy practices nationally and internationally. It is also recognised that responsive health literacy development requires thoughtful involvement of diverse local communities. Programmes and actions that ‘leave people behind’ can exacerbate health inequalities. As a result, meaningful community based participatory research, including innovative design thinking approaches, were utilised throughout this project. The Sláintecare Healthy Communities Programme identified two contrasting areas to participate in this work, presenting both an urban and rural context. The health literacy strengths, needs and issues encountered in these communities will be presented in the community members own words. This workshop will close with the presentation of a series of co-designed, and crucially actionable, recommendations for evidence-based best practices in health literacy promotion in Ireland. Leveraging the synthesis of research findings and stakeholder insights, a number of actions aimed at enhancing health literacy proficiency and fostering health equity will be detailed. This presentation in particular will be interactive, and will challenge participants to identify health literacy promoting actions that may be suitable for their own contexts. This workshop offers a timely and pragmatic exploration of health literacy promotion in Ireland. By fostering dialogue, knowledge exchange, and collaboration, the workshop serves as a catalyst for transformative change, paving the way towards more inclusive, equitable, and health-literate societies, both in Ireland and beyond. Key messages • This workshop offers a timely and pragmatic exploration of health literacy promotion in Ireland. • Presenters from both practice and research will detail how the needs analysis was conducted, and how we suggest these co-designed recommendations can be actioned.

Quantitative systems toxicology modeling in pharmaceutical research and development: An industry-wide survey and selected case study examples.

Quantitative systems toxicology (QST) models are increasingly being applied for predicting and understanding toxicity liabilities in pharmaceutical research and development. A European Federation of Pharmaceutical Industries and Associations (EFPIA)-wide survey was completed by 15 companies. The results provide insights into the current use of QST models across the industry. 73% of responding companies with more than 10,000 employees utilize QST models. The most applied QST models are for liver, cardiac electrophysiology, and bone marrow/hematology. Responders indicated particular interest in QST models for the central nervous system (CNS), kidney, lung, and skin. QST models are used to support decisions in both preclinical and clinical stages of pharmaceutical development. The survey suggests high demand for QST models and resource limitations were indicated as a common obstacle to broader use and impact. Increased investment in QST resources and training may accelerate application and impact. Case studies of QST model use in decision-making within EFPIA companies are also discussed. This article aims to (i) share industry experience and learnings from applying QST models to inform decision-making in drug discovery and development programs, and (ii) share approaches taken during QST model development and validation and compare these with recommendations for modeling best practices and frameworks proposed in the literature. Discussion of QST-specific applications in relation to these modeling frameworks is relevant in the context of the recently proposed International Council for Harmonization (ICH) M15 guideline on general principles for Model-Informed Drug Development (MIDD).

A (sub)field guide to quality control in hippocampal subfield segmentation on high-resolution T2-weighted MRI.

Inquiries into properties of brain structure and function have progressed due to developments in magnetic resonance imaging (MRI). To sustain progress in investigating and quantifying neuroanatomical details in vivo, the reliability and validity of brain measurements are paramount. Quality control (QC) is a set of procedures for mitigating errors and ensuring the validity and reliability of brain measurements. Despite its importance, there is little guidance on best QC practices and reporting procedures. The study of hippocampal subfields in vivo is a critical case for QC because of their small size, inter-dependent boundary definitions, and common artifacts in the MRI data used for subfield measurements. We addressed this gap by surveying the broader scientific community studying hippocampal subfields on their views and approaches to QC. We received responses from 37 investigators spanning 10 countries, covering different career stages, and studying both healthy and pathological development and aging. In this sample, 81% of researchers considered QC to be very important or important, and 19% viewed it as fairly important. Despite this, only 46% of researchers reported on their QC processes in prior publications. In many instances, lack of reporting appeared due to ambiguous guidance on relevant details and guidance for reporting, rather than absence of QC. Here, we provide recommendations for correcting errors to maximize reliability and minimize bias. We also summarize threats to segmentation accuracy, review common QC methods, and make recommendations for best practices and reporting in publications. Implementing the recommended QC practices will collectively improve inferences to the larger population, as well as have implications for clinical practice and public health.

A-202 Quality control design survey reveals 399 ways to do it wrong

Abstract Background The effectiveness of statistical quality control processes to detect unacceptable patient risk depends on the choices that laboratory professionals make for the design of quality control charts and acceptable patient risk. Recommended best practice consists of putting a meaningful recent mean and SD on the QC chart, selecting rules based on the method’s margin for error to unacceptable risk or Sigma value, and basing acceptable risk on clinical need. Methods A survey was circulated through LinkedIn and Labvine. Forty respondents who included their credentials were included in the final analysis. Respondents were asked to select the one most correct answer four questions regarding the parameters that govern the effectiveness of quality control processes. 1. The best source of the mean on the QC chart? (Four choices) 2. Best source of the SD on the QC chart? (Five choices) 3. Best way to select QC rules for each QC sample? (Six choices) 4. If an analytical process “fails,” we should stop reporting before [errors are reported.] (Five choices) A total of 400 potential patterns of QC selections were chosen. (4 * 5 * 5 * 4). Results When asked acceptable error rate if an analytical process “fails,” responses were More than 5% errors are reported - 11%. Any errors are reported - 66% It varies with clinical use of the test - 16% It varies with capabilities of our method - 8% While most respondents chose at least one of the recommended answers for QC chart design and rules, only three chose the best choice for all parameters. Conclusions Despite decades of recommendations of best practice for quality control, typical practice throughout the laboratory community in general does not reflect this. It is time to consider a new approach to teaching, validating and certifying competency in medical laboratory quality control.

The Effects of an Evidence-Based Instructional Program on Science Teaching to Students with Special Needs in Inclusive Classrooms

Abstract: The current study aimed to investigate the impact of an evidence-based instructional program consisting of: Explicit Instruction (EI) along with Numbered Heads Together (NHT) in comparison to the traditional, hand raising (HR) technique on fourth-grade students with and without special needs’ daily science quiz scores. Additionally, the researchers sought to explore the impact of the interventional program on the cumulative, pre and post-test performances of participants. Using mixed methods—single-subject, alternating treatment (comparing the interventional program [EI & NHT] to HR), and quasi-experimental designs—data were collected. Data were analyzed using a measure of central tendency (mean scores) of daily science quiz scores, and t-tests to derive results from the pre and post-test cumulative scores. The findings revealed all students in the experimental group, including those with special needs, improved their mean scores on daily science quizzes, along with cumulative, post-test performances. This improvement was achieved after the delivery of the interventional program. Social validity interview with the classroom teacher demonstrated that the instructional program provided a motivational, engaging learning atmosphere for all students including those with special needs. Recommendations for future research and practices were provided.

Prevalence and Description of High-Grade Intraepithelial Lesions of Cervical Mucosa Cells in a Screening Programme for Cervical Cancer in Isère, France.

This study aims to analyse high-grade intraepithelial lesions (LIEHG) observed in a screening programme from 2010 to 2018 to more accurately describe them and formulate recommendations for best practices in the context of screening evolution following the introduction of an HPV test in primary cervical cancer screening in 2020. This study included 305,940 asymptomatic women aged 25-65 years. The eligible population was invited to undergo a screening cervico-uterine-smear every 3 years. If this smear was normal, the woman received a new invitation. In the case of a positive screen, the patient underwent further diagnostic procedures, such as colposcopy and biopsy to confirm the diagnosis. Only those diagnosed with LIEHG and above proceeded to treatment. The diagnoses associated with LIEHG were those related to the WHO Classification of tumours of the uterine cervix. Positive smears led to the diagnosis of 3230 LIEHG. The prevalence of LIEHG in the screened population was 0.4%. The LIEHG distribution varied significantly according to the age of the women. The probability of diagnosing LIEHG in young women was 12.2% at 25-29 years. This probability decreased by half after 50 years. We observed that the type of smear was significantly associated with LIEHG detection. The positive predictive value for diagnosing LIEHG was 70.3% for high-grade squamous intraepithelial lesion (HSIL) smears and 35.1% for atypical squamous cells cannot exclude HSIL (ASC-H) smears. In the study population, the prevalence of LIEHG was high in women under 35 years. Low-grade smears were correlated with the risk of LIEHG and should prompt screening facilities to allocate resources to ensure active follow-up of LSIL and ASC-US smears. Adherence to cytological screening recommendations was associated with a reduced risk of LIEHG in multivariate analysis.

Identifying and mitigating racial/ethnic disparities in clinical trials with screening data.

63 Background: ASCO and Association of Community Cancer Centers (ACCC) released a statement on increasing racial/ethnic equity, diversity, and inclusion (EDI) in cancer trials (1). It included recommendations for clinical practices and research sites to 1) screen every patient for trial eligibility; and 2) routinely collect and analyze screening and enrollment data by patient demographic characteristics, including race/ethnicity. Most of the 62 sites that completed a 2021 pilot study reported that screening data were not readily available by patient race/ethnicity (2). ASCO conducted a follow-up study about challenges, resource needs, and effective strategies for collecting and analyzing these data. Methods: Semi-structured interviews were conducted with research team members from sites that completed the 2021 pilot study. Sites were purposefully selected based on pilot study data quality and insights, diversity of patient population, and site type, size, and region. Sites completed a pre-interview questionnaire on site characteristics and screening and enrollment processes before participating in a 1-hour interview focused on challenges and effective strategies for collecting and analyzing screening and enrollment data, by race/ethnicity. Anticipated themes and relationships, stemming from the pilot study findings, informed a conceptual framework. Up to 20 interviews were planned and halted sooner when there was theme saturation. Results: Thirteen research sites participated in the study, representing academic centers (62%) and community-based practices/health systems (38%) with racially/ethnically diverse patient populations (median 31% non-white; range 11% to 63%). 53 research team members participated in the interviews (typically 4 per site), including investigators (23%), directors/managers (56%), and coordinators (21%). Aggregated responses were interpreted through content analysis and concepts were quantified for both frequency and extensiveness. Several barriers to patient screening, data collection, and analysis were cited, including lack of standardized procedures and documentation, dedicated staff and time, quality and/or accessible data on race/ethnicity and/or screening, and integrated technology that facilitates screening and documentation. Conclusions: Collecting and analyzing screening and enrollment data are critical to identifying and mitigating racial/ethnic disparities in trial access and EDI. Many sites do not systematically screen every patient for a trial and/or document outcomes. Lack of resources, including dedicated staff and time and integrated technology, make it difficult for them to do so in systematic and reliable ways. Greater investment in resources will help to facilitate routine screening of every patient and ensure underrepresented populations are not being overlooked for trials. 1. Oyer et al, JCO, 2022 . 2. Pressman et al, JCO, 2022 .

Digital Propaganda in South Asia: An Analytical Perspective

This article examines the existing response strategies of Pakistan to Indian digital propaganda on the Kashmir Issue. By analyzing key propaganda strategies on X (formerly Twitter), state-sponsored X accounts, media reports, and academic scholarship, the researcher has identified a number of deficiencies in the prevalent approach and offers policy recommendations for better practices. Overall, this article recommends that Pakistan should articulate a response strategy that has clear objectives, is powered by algorithms and computational techniques, should include news actors, and utilize the void created by India's state-backed digital propaganda machinery.

Teaching for a sustainable future case studies from the green schools project in bulgaria

This article examines the implementation and impact of green education activities in primary schools across Bulgaria, as part of the Green Schools Project, supported by Erasmus+ Programme. Through detailed case studies, the research highlights how seven primary teachers integrated environmental education into their classrooms, fostering ecological awareness and sustainable practices among their students. The activities ranged from recycling projects and nature observation walks to role-playing games that traced the journey of food from seed to consumption. The findings demonstrate significant improvements in students' knowledge of ecological principles, increased motivation and engagement in green topics, and positive behavioral changes towards environmental stewardship. This study underscores the importance of integrating green education into the primary curriculum, providing insights and recommendations for future educational policies and practices aimed at nurturing responsible and proactive environmental citizens.

Parenting in Overdrive: A Meta-analysis of Helicopter Parenting Across Multiple Indices of Emerging Adult Functioning

AbstractPrevious research suggests helicopter parenting may be disproportionately associated with lower levels of adjustment during emerging adulthood. However, the size, direction, and significance of the effects of helicopter parenting across different indicators of emerging adult functioning has not been empirically established. Therefore, the purpose of this meta-analytic investigation was to clarify the magnitude of the effect of helicopter parenting across multiple indices of well-being, including: internalizing behaviors (anxiety and depressive symptoms), academic adjustment, self-efficacy and regulatory skills. We also explored whether parent gender moderates these associations. An analysis of 53 studies and 111 effect sizes revealed that helicopter parenting was associated with increased internalizing behaviors and reduced academic adjustment, self-efficacy and regulatory skills. Parent gender did not moderate these associations. The findings are discussed in terms of future directions, particularly the need to identify potential moderators. In conclusion, these findings support recommendations for autonomy-supportive parenting practices during emerging adulthood.

Nursing Education in the Era of ChatGPT: Implications and Opportunities

ChatGPT is a generative pre-trained transformer language model developed by OpenAI. ChatGPT is designed to generate conversational, human-like text responses and has been trained with diverse textual data to provide coherent and contextually relevant answers to user queries. This article highlights the advantages of using ChatGPT in nursing education, emphasizing the benefit of enhancing teaching and learning experiences, supporting critical thinking, and providing personalized learning opportunities. The article also discusses barriers to use of ChatGPT, such as limited access to technology and concerns about information accuracy. Discussion of ethical concerns related to AI, including biases, data privacy, transparency, and other psychosocial concerns is also included, along with an overview of efforts to address these potential dilemmas. The article concludes by providing recommendations for best practices to responsibly integrate artificial intelligence products into nursing education, emphasizing the need for educators to become informed about AI technologies and guide cautious and ethical use of AI within nursing education. The work herein underscores the importance of transforming nursing curricula to equip future nurses with digital and data literacy skills necessary for working in today’s increasingly AI-driven environments.

Research Progress on Ecological Carrying Capacity and Ecological Security, and Its Inspiration on the Forest Ecosystem in the Karst Desertification Control

Social progress and the improvement of living standards are often accompanied by the intensification of ecological crises. The long-term abuse of natural resources has led to the accumulation of ecological liabilities, which in turn seriously hinders economic development. This has prompted all sectors of society to recognize the importance of ecological carrying capacity (ECC) and ecological security (ES). Remarkable progress has been made in karst desertification control (KDC), which has helped reshape the ECC and ES pattern of forests. Currently, the research field of ECC and ES is experiencing rapid development. Further studies in these areas have immeasurable value in promoting regional sustainable development strategies and strengthening ecological civilization construction. The objective of this paper is to provide an overview of the current research status and potential challenges in the field of ECC and ES, with a view to optimizing the program of forest restoration and protection in KDC. This study systematically analyzed 350 relevant studies and found that (1) research on forest ECC and ES has shown a strong growth trend overall, especially after 2017, with a growth rate exceeding 75%; (2) the literature predominantly focuses on the assessment of forest ECC (40.58%) and the enhancement of forest ES (23.42%); and (3) geographically, research findings are heavily concentrated in Asia, representing 95.40% of the total. Notably, China emerges as the primary contributor to research in this field, accounting for a substantial 94.12%. Based on the above analysis, this review summarizes the significant advancements in forest ecosystems, ECC, and ES, while also delving into the key scientific issues that need to be addressed. Furthermore, it offers valuable insights from forest ecosystems in tackling KDC, with the goal of offering guidance and strategic recommendations for future research and practices in managing delicate ecological environments.

On the role of the Bernoulli force in stuck pipe during oil and gas well drilling

Stuck pipe is one of the most prevalent and costly complications encountered during drilling operations in the oil and gas industry. It represents a significant challenge, contributing to delays and increased financial costs that cumulatively amount to billions of dollars annually. Understanding and addressing the root causes of pipe sticking are crucial for minimizing these adverse impacts. This paper provides a comprehensive analysis of the various factors contributing to stuck pipe incidents, highlighting both traditional and newly identified mechanisms. Key factors leading to pipe sticking include mechanical issues such as rock particles drilled out during the process, inadequate well cleanup, wellbore instability, and differential sticking forces, which are primarily due to the disparity between hydrostatic pressure and formation pressure. These issues are particularly prevalent in horizontal or inclined wells, where the dynamics of drilling differ significantly from vertical wells, exacerbating the risks of pipe sticking. The occurrence of stuck pipe not only increases the duration of drilling operations but also significantly escalates the associated costs, thereby impacting the overall economic viability of drilling projects. A novel factor contributing to stuck pipe is the Bernoulli force, a phenomenon that has been discussed in detail in this article. The Bernoulli force acts perpendicular to the flow axis from the edges towards the center of the flow. In the context of cylindrical flow within a wellbore, this force is magnified as the density difference between the drilled rock particles and the drilling fluid increases, along with the diameter of the mechanical cuttings. As a result, the Bernoulli force facilitates the migration of drilled rock particles towards the flow center, leading to an accumulation that increases local resistance due to friction. This intensified resistance can significantly contribute to the occurrence of a stuck pipe, presenting a new challenge for drilling operations that must be addressed. This paper discusses the comprehensive mechanisms of stuck pipe, including the differential and mechanical factors, and provides an in-depth analysis of these aspects. The study emphasizes the importance of understanding these factors to develop effective strategies for prevention and mitigation. By exploring the key features necessary to minimize the risks associated with differential and mechanical sticking, this article offers valuable insights into improving well drilling practices. The findings underscore the need for thorough well cleanup, effective management of wellbore instability, and a nuanced understanding of pressure dynamics to prevent stuck pipe incidents. The paper concludes with recommendations for industry practices and further research to mitigate the impact of stuck pipe on drilling operations.

Qualitative Interviews with Stakeholders in Herbal Pharmacovigilance and Recommendations for Best Practices to be Applied Worldwide.

The use of herbal products globally is substantial, but varying definitions and regulatory frameworks have led to differences in their status as medicinal products and in approaches to monitoring their safety. This article explores the current landscape of herbal pharmacovigilance, drawing insights from interviews with global experts in the field, and offers recommendations for best practices to enhance the safety and benefit-to-harm balance of herbal products. This study comprised semi-structured interviews with members of the International Society of Pharmacovigilance-Herbal and Traditional Medicines Special Interest Group and the Nutrivigilance Information Exchange Network, recruited using purposive sampling. Data were stored and coded using NVIVO® and analysed thematically using a qualitative inductive approach. Sixteen participants from 11 countries were interviewed, revealing diverse regulatory approaches and challenges in herbal pharmacovigilance. Key themes included legal status, awareness, identification and coding of herbal products, pre-/post-marketing product control, reporting of adverse drug reactions, causality assessment and signals of herbal products. This study yielded five general recommendations to further improve herbal pharmacovigilance worldwide. This study offers an overview of the global landscape of herbal pharmacovigilance, highlighting challenges in monitoring herbal products and presenting universal recommendations. These recommendations encompass increasing awareness, enhancing education and improving legislative frameworks. Given the growing use of herbal products, the implementation of strong pharmacovigilance practices is crucial to ensure consumer safety.

B - 74 The Effect of Perimenopause on Women’s Executive Functioning: a Systematic Review

Abstract Objective This systematic review aims to examine the existing literature on the impact of perimenopause/menopause on cognitive function, identify overlaps with adult ADHD symptoms, and provide evidence-based recommendations for distinguishing between the two conditions, guiding clinical practice and identifying considerations for selection of neuropsychological testing with this population. Data Selection A search of electronic databases, including PubMed, PsycINFO, and MEDLINE, will be conducted to identify relevant peer-reviewed studies published between 2000 and 2024. Studies examining cognitive changes during perimenopause/menopause, diagnostic challenges in distinguishing perimenopause/menopause-related cognitive decline from adult ADHD symptoms, and interventions for accurate assessment and management will be included. Data extraction and synthesis will be performed following PRISMA guidelines. Data Synthesis The analysis will review a range of literature on the cognitive changes associated with perimenopause/menopause, including deficits in attention, memory, and executive function, which may overlap with symptoms of adult ADHD. Attention will be paid to looking for distinct patterns of cognitive impairment and hormonal profiles between perimenopause/menopause-related cognitive decline and adult ADHD. Various screening tools and neuropsychological assessments will be examined for their utility in differentiating between the two conditions. Conclusions The current systematic review, with its focus on the impact of menopause and perimenopause on women’s cognitive functioning, particularly executive functioning, has the potential to significantly advance our understanding in this area. It will be able to provide clinical recommendations and considerations for individuals administering and interpreting neuropsychological testing with this population. Recommendations for best practices will be proposed, potentially revolutionizing the way we approach and manage these conditions.

Association between consumption of non-nutritive sweeteners and gestational diabetes mellitus in Chilean pregnant women: A secondary data analysis of the CHiMINCs-II cohort

ObjectiveTo evaluate the association between consumed non-nutritive sweeteners (NNS) and gestational diabetes mellitus (GDM) in a cohort of pregnant women from Santiago, Chile. MethodsThis secondary data analysis of a cohort.involved 1,472 pregnant women from the Chilean Maternal-Infant Cohort Study-II (CHiMINCs-II). These women received care at primary health care centers in Puente Alto county, South-Eastern Metropolitan Health Service of Santiago, Chile. NNS consumption was estimated using 24-h dietary recalls and linked to the packaged foods nutrition facts panel. Plasma glucose values were extracted from clinical records. GDM was defined according to national criteria: 1) fasting plasma glucose (FPG) ≥100 and <126 mg/dL at the first antenatal visit; 2) FPG ≥100 mg/dL or 2-hour plasma glucose ≥140 mg/dL in the 75 g oral glucose tolerance test at 24–28 weeks. Cases with a GDM diagnosis in their medical records were also considered regardless of test results. The association between each NNS and GDM was assessed using logistic regression models. ResultsA total of 77.8% of the participants consumed NNS. The most consumed was sucralose (66%), followed by acesulfame-K (43.6%), and steviol glycosides (41.1%). Beverages (82%), dairy (12.4%) and candy products (4.4%) were the primary dietary sources of NNS. The GDM incidence was 18.9%, higher among consumers of any NNS compared to non-consumers (20.3% vs. 14.2%, p < 0.05). The adjusted model showed a significant association between the consumption of any NNS and sucralose and the risk of GDM (OR for any NNS = 1.58; 95% CI: 1.10–2.26; P = 0.014; OR sucralose = 1.44; 95% CI 1.06–1.95; P = 0.020). ConclusionsThe consumption of NNS, particularly sucralose, is associated with an increased risk of GDM in pregnant women. Further studies are essential to validate these results in other contexts and to guide future recommendations for healthier dietary practices among pregnant populations.