Recommendations For Best Practices Research Articles

Managing couples with recurrent miscarriage: A narrative review and practice recommendations.

There is significant variation in practice when managing couples with recurrent miscarriage (RM), with guidelines differing on the definition of RM, recommended investigations, and treatment options. In the absence of evidence-based guidance, and following on from a paper by the authors-FIGO Good Practice Recommendations on the use of progesterone in the management of recurrent first-trimester miscarriage-this narrative review aims to propose a global holistic approach. We present graded recommendations based on best available evidence.

Student support services: Perceptions and recommendations for the next generation.

Student support services/student affairs are central to the student academic experience and success at US and Canadian dental schools. This manuscript evaluates student and administrator perceptions of support services and offers recommendations for best practices in student services in predoctoral dental education to help institutions improve the student experience. A survey of administrators and dental students found perceptions of student support services vary between these groups. Seventeen student services administrators and 263 students started the survey, and 12 administrators and 156 students completed the full survey. Survey comments indicated access to student support services is a concern. Results of the student survey, in conjunction with current literature, were utilized to develop recommendations for dental student support services. Recommendations for student support services in dental schools include accessibility of student services, and ensuring students have access to support in the domains of wellness, academic support, and peer support as well as implementation of humanistic practices. Wellness supports should include behavioral health services, physical health services, and access to mindfulness interventions. Academic support services should include study skills, time management training, and academic supports such as tutoring. Structured peer support programs should also be implemented. Dental schools should also be mindful of the changing support needs of incoming dental students.

Consolidated Health Economic Evaluation Reporting Standards - Value of Information (CHEERS-VOI): Explanation and Elaboration

ObjectivesAlthough the ISPOR Value of Information (VOI) Task Force’s reports outline VOI concepts and provide good-practice recommendations, there is no guidance for reporting VOI analyses. VOI analyses are usually performed alongside economic evaluations for which the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Statement provides reporting guidelines. Thus, we developed the CHEERS-VOI checklist to provide reporting guidance and checklist to support the transparent, reproducible, and high-quality reporting of VOI analyses. MethodsA comprehensive literature review generated a list of 26 candidate reporting items. These candidate items underwent a Delphi procedure with Delphi participants through 3 survey rounds. Participants rated each item on a 9-point Likert scale to indicate its relevance when reporting the minimal, essential information about VOI methods and provided comments. The Delphi results were reviewed at 2-day consensus meetings and the checklist was finalized using anonymous voting. ResultsWe had 30, 25, and 24 Delphi respondents in rounds 1, 2, and 3, respectively. After incorporating revisions recommended by the Delphi participants, all 26 candidate items proceeded to the 2-day consensus meetings. The final CHEERS-VOI checklist includes all CHEERS items, but 7 items require elaboration when reporting VOI. Further, 6 new items were added to report information relevant only to VOI (eg, VOI methods applied). ConclusionsThe CHEERS-VOI checklist should be used when a VOI analysis is performed alongside economic evaluations. The CHEERS-VOI checklist will help decision makers, analysts and peer reviewers in the assessment and interpretation of VOI analyses and thereby increase transparency and rigor in decision making.

The case for implementing legal clinical supervision within legal practice, and recommendations for best practice

ABSTRACT While the concept of clinical supervision is well-developed within clinical legal education, its application within broader legal practice is less explored. This paper aims to contribute to this emerging conversation by providing recommendations for the effective incorporation of clinical supervision within legal practice. The paper provides an initial overview of the current state of research on clinical supervision in legal practice, subsequently outlining the benefits and key considerations for its implementation. The paper argues that clinical supervision can yield a multitude of benefits, including the reduction of burnout, minimisation of vicarious trauma, and enhancement of the quality of legal practice by fostering emotional and interpersonal skills. The paper further discusses the importance of self-reflection, debriefing, and supervision that facilitates self-care in the context of clinical supervision. The potential benefits of this approach extend to all members of the profession, from new lawyers to seasoned practitioners, and could lead to improved professionalism, reduced attrition, and enhanced wellbeing within the legal profession.

A Critical Interpretation of Ethics in Research

The moral standards that direct a person's behavior are known as ethics. Doing what is morally and legally correct in research is sometimes referred to as practicing research ethics. They are standards of behavior that set boundaries between what is morally correct and inappropriate. The article discusses the value of ethics in relation to organizing, carrying out, and disseminating research. Good Clinical Practice and several recommendations have been explored. The legal concerns that are pertinent to research procedures have been discussed in the essay. Researchers, ethics committees, and journal editors are just a few of the stakeholders who are very concerned about research misconduct and its consequences. The importance of research ethical awareness has been emphasized. Methodology: The material of research ethics has been collected from different, articles, authentic literatures, manuscripts, and authentic net sources, like NCBI, PubMed etc. Conclusion: For the researchers, a diligent mindset is crucial. To safeguard research participants from damage, it is crucial to uphold protocol compliance, informed consent processes, openness and integrity, confidentiality, and other standards.

Analyzing Digital Propaganda in the Indian Sub-continent

Regional This article examines the existing response strategies of Pakistan to Indian digital propaganda. By analyzing selected hashtags over the past five years, media reports, policy matters 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, should include news actors and utilize the void created by Modi’s ideological populism in India.

Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour

Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.

Recommendations on the Selection, Development, and Modification of Performance Outcome Assessments: A Good Practices Report of an ISPOR Task Force

In evaluating the clinical benefit of new therapeutic interventions, it is critical that the treatment outcomes assessed reflect aspects of health that are clinically important and meaningful to patients. Performance outcome (PerfO) assessments are measurements based on standardized tasks actively undertaken by a patient that reflect physical, cognitive, sensory, and other functional skills that bring meaning to people’s lives. PerfO assessments can have substantial value as drug development tools when the concepts of interest being measured best suit task performance and in cases where patients may be limited in their capacity for self-report. In their development, selection, and modification, including the evaluation and documentation of validity, reliability, usability, and interpretability, the good practice recommendations established for other clinical outcome assessment types should continue to be followed, with concept elicitation as a critical foundation. In addition, the importance of standardization, and the need to ensure feasibility and safety, as well as their utility in patient groups, such as pediatric populations, or those with cognitive and psychiatric challenges, may enhance the need for structured pilot evaluations, additional cognitive interviewing, and evaluation of quantitative data, such as that which would support concept confirmation or provide ecological evidence and other forms of construct evidence within a unitary approach to validity. The opportunity for PerfO assessments to inform key areas of clinical benefit is substantial and establishing good practices in their selection or development, validation, and implementation, as well as how they reflect meaningful aspects of health is critical to ensuring high standards and in furthering patient-focused drug development.

DE05 Designing and implementing dermatology procedural video education for trainees

Abstract Surgical exposure can be varied during specialty training in dermatology. During the COVID-19 pandemic, this was compounded by the reduction in face-to-face teaching, adding a further barrier for trainees trying to access practical skills training. We sought to enable uniform, accessible and inclusive teaching of common biopsy techniques to improve the confidence and proficiency of dermatology trainees in performing these procedures, through a virtual self-directed format. We produced a series of concise educational videos detailing the biopsy consent process and instructional videos on techniques for punch biopsy, shave biopsy, incisional biopsy and simple excisions. Each video was ∼10 min in length with demonstration of the technique on porcine skin in real-time and step-by-step narration. The videos were developed according to up-to-date recommendations of best practice, including those from the British Society of Dermatological Surgery. We used multidisciplinary expert input from Mohs surgeons, specialist nurse practitioners, dermatopathologists, clinicians with expertise in medical education, learning innovation advisors and media experts. We highlighted important learning points for trainees during the videos such as common biopsy indications and complications, practical pitfalls and techniques to enhance biopsy efficiency, diagnostic yield and cosmetic outcome. Our educational videos were launched initially at a large teaching hospital in the UK and watched by 25 dermatology trainees, with plans for upcoming open-access via our education website. The effectiveness of our learning material was evaluated through a preintervention survey of trainees to gauge prior exposure to dermatology surgery, followed by a postintervention survey. We found evidence of a lack of exposure to procedural dermatology among trainees in the preintervention survey, with improvements in trainee confidence reported following the educational videos. Delivering procedural videos through an accessible online resource is beneficial for dermatology trainees and allied healthcare professionals performing biopsies and diversifies the modality of procedural dermatology education. An online video format provides self-directed education that has flexibility and enables repeated access to reinforce learning, which complements and enhances in-person practical teaching.

Transdisciplinarity 101: Short-Term Training in Knowledge CoProduction to Face Global Environmental Change

The Belmont Forum and the Inter-American Institute for Global Change Research (IAI) organized an online training workshop on transdisciplinary (TD) approaches at the Sustainability, Research, and Innovation Congress (SRI) in 2022. The IAI is an intergovernmental organization that brings together 19 countries from the Americas to support adaptation to the world’s changing environment. The Belmont Forum is a consortium of major funders and international science councils to promote knowledge about sustainability science. The workshop aimed to create a safe environment for participants to share their impressions of and experiences about transdisciplinary research, using the Americas (IAI mandate) as a launching point for TD approaches globally. The workshop consisted of two online sessions: Transdisciplinary Approach 101 and Transdisciplinary Case Studies. The objectives of the current workshop report are: 1) to identify the key takeaways regarding common challenges and opportunities for transdisciplinary practice among workshop participants’ experiences, upon which to base recommendations for best practices, e.g., managing power imbalances, conflicting priorities and timeframes, enhancing communication and consolidating contextual awareness. 2) to offer insights to build better strategies for “train the trainers'' processes around transdisciplinarity, especially in congresses and short-term events, including using an experience-based approach, offering specific tools and increasing the participation of non-academic partners. This report encourages the implementation of other training processes by experienced transdisciplinary researchers, practitioners, and funders, in order to build capacities for collaborative approaches in diverse scientific communities.

P-485 Performance of ERA test after PGT-A in RIF patients defined according to ESHRE 2023 good practice recommendations: a retrospective case-control study

Abstract Study question Is Endometrial-Receptivity-Array (ERA) test clinically-useful among Repeated-Implantation-Failure (RIF) women defined according to ESHRE 2023 good-practice-recommendations (GPR) and undergoing single euploid blastocyst transfer? Summary answer ERA-test showed a higher “non-receptive endometrium” rate among RIF. Nevertheless, the live-birth-rate (LBR) per first euploid transfer was independent from progesterone timing according to ERA-test. What is known already ERA-test evaluates the expression of 238 genes from an endometrial biopsy. It aims at predicting the window of implantation and adjust progesterone timing accordingly. The data are controversial due to poor study design and/or limited sample size. Few studies investigated ERA-test in a setting with euploid transfers and/or among RIF patients. Moreover, RIF definition is largely inconsistent leading to a significant bias in the interpretation of the existing literature and treatment. ESHRE 2023 GPR revised RIF definition. Here, we leveraged this updated definition and PGT-A to assess ERA-test diagnostic/therapeutic performance in these women. Study design, size, duration Retrospective case-control study during 2013-2021 including 2211 patients with at least one euploid blastocyst after PGT-A. Hysteroscopy was conducted in case of suspect uterine pathologies, biopsy in case of suspect inflammation, and therapy in case of endometritis. 265 patients (12%) were classified RIF according to the ESHRE GPR (= no successful implantation despite an estimated cumulative chance ≥60%). 48 RIF patients requested ERA-test before undergoing vitrified-warmed euploid single blastocyst transfer, while 217 did not. Participants/materials, setting, methods qPCR/NGS-based PGT-A was conducted to assess non-mosaic aneuploidies. Normal thyroid function, vitamin-D levels, uterine cavity, and absence of sactosalpynx were confirmed. Whenever the ERA test suggested altered receptivity, progesterone timing was modified accordingly. The primary outcome was LBR per first euploid transfer in the non-ERA versus ERA groups, with a sub-analysis in ERA receptive versus non-receptive. Outcomes were adjusted for confounders assessed via logistic regressions. Main results and the role of chance RIF patients requesting ERA-test were older (39.1±4.5 versus 36.7±3.5 years, p < 0.01), and had already undergone 3.7±2.0 transfers resulted in implantation failures (1.5±1.3 of euploid blastocysts) versus 2.6±1.7 transfers (1.0±0.8 of which of euploid blastocysts) in the control (p < 0.01). Nevertheless, all these variables were not associated with the primary outcome under investigation. 44 non-RIF patients requested ERA-test in the same study period. Notably, the rate of pre-/post-receptive endometria was 39.6% (N = 19/48) among RIF and 13.6% (N = 6/44) among non-RIF women (p < 0.01). In fact, maternal age was not associated with “non-receptive” responses after ERA-test, the number of previous implantation failures showed an Odds-Ratio 1.29, 95%CI 1.03-1.62, p = 0.03. Blastocyst quality and day of full-blastulation were similar in ERA and non-ERA patients, as well as in ERA receptive and non-receptive patients. Positive pregnancy test, biochemical-pregnancy-loss, and miscarriage rates were all similar among non-ERA and ERA, and among ERA receptive and non-receptive patients. Indeed, also the LBR was similar among non-ERA and ERA (N = 98/220, 44.5% versus N = 17/48, 35.4%, p = 0.26; Odds-Ratio adjusted for blastocyst quality and day of full-blastulation: 0.76, 95%CI:0.39.1.48, p = 0.42) and among ERA receptive and non-receptive patients (N = 10/29, 34.5% versus N = 7/19, 36.8%, p = 0.99; Odds-Ratio adjusted for blastocyst quality and day of full-blastulation: 0.99, 95%CI:0.3-3.4, p = 0.99). Limitations, reasons for caution Our standard clinical workflow does not entail ERA-test, but the couple may request it. The study is retrospective with limited sample size. Patients requesting ERA-test were older with more previous failures. Non-ERA and ERA receptive patients underwent either Hormone-Replacement-Therapy or Modified-Natural-Cycle. Cost-effectiveness analyses are missing. Wider implications of the findings A promising association was reported between the novel definition of RIF and “non-receptive” responses, suggesting that ERA-test might unveil endometrial receptivity issues. Nevertheless, positive, and negative predictive values upon implantation are largely missing and its clinical utility as a therapeutic tool in RIF women remains questionable. Trial registration number none

O-101 Add-ons in the ART lab

Abstract Study question Which laboratory based add-ons are effective and safe to use in ART treatment? Summary answer In total, more than thirty recommendations were formulated on the use of add-ons, with about a third being laboratory based tests or interventions What is known already Treatment add-ons are defined as not essential for the treatment, but optional additional treatments that are sometimes offered on top of routine fertility treatment. There are a wide range of treatment add-ons available, including diagnostic tests, drugs, equipment, holistic or alternative therapies, laboratory and surgical interventions, all claiming to potentiate the effect of the treatment and/or to lessen side effects, improve pregnancy or live birth rate, reduce the risk of miscarriage or shorten the time to pregnancy. Add-ons and can be at extra cost (or not), and evidence on efficacy and safety is often missing. Presumably they can be both beneficial or non-beneficial, as there may be absence of evidence to either. Study design, size, duration The ESHRE working group for good practice recommendations on add-ons in ART has produced recommendations useful for professionals, patients and policy makers. More than 30 add-ons were identified, and evaluated for efficiency and safety, and wherever possible also for cost. The literature was identified in a systematic search, reviewed and critically appraised. In the absence of any clear scientific evidence, judgement was based on the professional experience and consensus of the multidisciplinary development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by independent international reviewers. Participants/materials, setting, methods Interventions were characterized in three sections: 1) Diagnosis and diagnostic tests, 2) Laboratory tests and intervention, and 3) Clinical management. Outcomes were efficacy (pregnancy or live birth rate), risk of miscarriage, time to pregnancy, cost, and safety/risk aspects. Some examples of add-ons in the group of laboratory tests and interventions are oocyte and sperm activation, mitochondria load and transfer, sperm selection, assisted hatching, genetic testing and addition of hyaluronic acid to media. Main results and the role of chance The guideline development group formulated more than 30 recommendations. This lecture will focus on the rationale and the recommendations of the laboratory add-ons currently used in fertility clinics. We will discuss the potential beneficial effects on the IVF treatment, its efficacy, and its safety. While most add-ons are not recommended for the general population of ART patients, where specific patient populations might benefit, indications were formulated. The guideline has been in stakeholder review and is prepared for submission in 2023. Limitations, reason for caution Of the recommendations, none are based on high quality evidence and only a few are based on moderate quality evidence. Hence 90% of the recommendations are supported only by low quality RCTs, observational data, professional experience, or consensus of the development group. Wider implications of the findings These recommendations aim to provide guidance to health care professionals and laboratory experts in the field of reproductive medicine, to help towards safe and efficient ART treatments for patients where they can participate in informed decision making with realistic expectations and be fully informed about their chances to pregnancy and live birth. Study funding and competing interest(s) All costs relating to the development process were covered from ESHRE funds. There was no external funding of the development process or manuscript production.

O-100 Recurrent implantation failure

Abstract Study question How should Recurrent Implantation Failure (RIF) in ART patients be defined and managed? Summary answer This is the first ESHRE good practice recommendations paper providing a definition for RIF and guidance on how to investigate causes and contributing factors and how to improve the chances of a pregnancy. What is known already RIF is a challenge in the ART Clinic, with a multitude of investigations and interventions offered and applied in clinical practice, often without biological rational or unequivocal evidence of benefit. Study design, size, duration This recommendations document was developed according to a predefined methodology for ESHRE good practice recommendations. Recommendations are supported by data from the literature, if available, the results of a previously published survey on clinical practice in RIF and the expertise of the working group. A literature search was performed in PubMed and Cochrane focusing on “recurrent reproductive failure", "recurrent implantation failure" and "repeated implantation failure“. Participants/materials, setting, methods The ESHRE RIF Working Group included 8 members representing the ESHRE Special Interest Groups of Implantation and Early Pregnancy, Reproductive Endocrinology, and Embryology, and completed with an independent chair and an expert in statistics. The recommendations for clinical practice were formulated based on the expert opinion of the Working Group, while taking into consideration the published data and results of the survey on uptake in clinical practice. The draft document was then opened for online peer review to ESHRE members and revised in light of the comments received. Main results and the role of chance RIF describes the scenario in which the transfer of embryos considered to be viable has failed to result in a positive pregnancy test sufficiently often in a specific patient to warrant consideration of further investigations and/or interventions. The recommended threshold for the cumulative predicted chance of implantation to identify RIF for the purposes of initiating further investigation is 60%. When a couple have not had a successful implantation by a certain number of embryo transfers and the cumulative predicted chance of implantation associated with that number is greater than 60%, then they should be counselled on further investigation and/or treatment options. This term defines clinical RIF for which further actions should be considered. Nineteen recommendations were formulated on investigations when RIF is suspected, and 13 on interventions. Limitations, reason for caution While awaiting the results of further studies and trials, the ESHRE Working group recommends identifying of RIF based on the chance of successful implantation for the individual patient or couple and to restrict investigations and treatments to those supported by a clear rationale and data indicating their likely benefit. Wider implications of the findings This paper provides good practice advise, but also highlights the investigations and interventions that need further research. This research, when well-conducted, will be key to making progress in the clinical management of RIF. Study funding and competing interest(s) Yes. The other authors had nothing to disclose.

O-102 Add-ons in the ART clinic

Abstract Study question Which add-ons are effective and safe to use in the ART clinic? Summary answer More than thirty recommendations were formulated on the use of add-ons in diagnosis and diagnostic tests, laboratory tests and intervention, and clinical management. What is known already Treatment add-ons are not essential for the treatment but optional additional treatments that are sometimes offered on top of routine fertility treatment. There are a wide range of treatment add-ons on offer including tests, drugs, equipment, holistic or alternative therapies, laboratory and surgical interventions, but consistently, they aim to potentiate the effect of treatment or to lessen side effects herein improve pregnancy or live birth rate, reduce the risk of miscarriage or shorten the time to pregnancy. Evidence on whether some treatment add-ons are effective and safe is often missing or absent. Add-ons can be proven or evidence-based (or not) and can be at extra cost (or not), presumable they can be both beneficial and non-beneficial, as there may be absence of evidence to either. Study design, size, duration The ESHRE working group for good practice recommendations on add-ons in ART has produced recommendations useful for professionals, patients and policy makers and identified more than 30 add-ons and evaluated each one of them for efficiency and safety and wherever possible also costs. The literature was identified in a systematic search, was reviewed and critically appraised. In the absence of any clear scientific evidence, judgement was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by independent international reviewers. Participants/materials, setting, methods Interventions were characterized in three sections: 1) Diagnosis and diagnostic tests, 2) Laboratory tests and intervention, and 3) Clinical management. Outcomes were efficacy (pregnancy or live birth rate), risk of miscarriage, time to pregnancy, costs, and safety/risk aspects. This lecture will focus on the recommendations relevant for the ART clinic including endometrial receptivity tests, assisted hatching, freeze-all (elective), ICSI (elective), uterine flushing and endometrial scratching. Main results and the role of chance The multidisciplinary development group formulated more than 30 recommendations. This lecture provides a summary of the recommendations of the add-ons currently used in fertility clinics. First it is described how an add-on is hypothesized to have beneficial effects on the IVF treatment, its efficacy, and its safety. While most add-ons are not recommended for the general population of ART patients, indications were formulated where specific patient populations might benefit. The guideline has been in stakeholder review and is prepared for submission in 2023. Limitations, reason for caution Of the recommendations, none are based on high quality evidence and only a few are based on moderate quality evidence. Hence 90% of the recommendations are supported only by low quality RCTs, observational data, professional experience, or consensus of the development group. Wider implications of the findings These recommendations provide guidance to health care professionals and laboratory experts in the field of reproductive medicine, and will help towards safe and efficient ART treatment, where patients can participate in informed decision making with realistic expectations and are fully informed about their changes to pregnancy and live birth. Study funding and competing interest(s) All costs relating to the development process were covered from ESHRE funds. There was no external funding of the development process or manuscript production. The authors have stated their conflicts of interest if any.

Reliability of the P3 component in a 3-stimulus concealed information test with known and unknown stimuli

The parietal P3 amplitude of the event-related potential (ERP) has been highlighted to signal stimulus salience in concealed information tests (CITs) with known and unknown stimuli. To extend previous validity investigations in deception research, the reliability of the early parietal P3 amplitude in a 3-stimulus CIT including known and unknown stimuli has been investigated in a sample of N = 68 participants. Variations of Cronbach’s Alpha and split-half reliability (odd–even, 1st vs. 2nd half) of the early parietal P3 amplitude were considered for ERP quantification method (peak-to-peak, mean, baseline-to-peak), epoch selection strategies (chronological vs. random) and number of epochs (10–40) in three stimulus types (probe, target, irrelevant). Excellent reliability coefficients have been summarized for number of epochs, P3 quantifications, and epoch selection strategies. Moreover, the best-practice recommendations highlight mandatory combinations of epoch selection strategy, number of epochs and P3 quantifications to ensure robust and excellent reliabilities of the early parietal P3 amplitude in a 3-stimulus CIT with known (probe, target) and unknown (irrelevant) stimuli. The robustness of mandatory excellent reliability coefficients for the early parietal P3 has been discussed for two data tracks in single-case analyses.

Every state for itself: A comparison of states’ visitation guidelines with research studies

Contact between children in care and their families and affiliates is an important component of child welfare practice. Depending on how visitation is handled and the readiness of the parties to interact, contact can result in positive or negative effects. However, scholars find that workers who supervise and arrange visitation often lack the requisite skills and knowledge to conduct visits in the most beneficial ways. As agency policies, particularly when they are research-informed, influence practice, this study analyzes the guidelines on visitation collected from the state child welfare agencies in the United States of America (USA) and compares them with research findings and researchers’ recommendations for best practices. The materials analyzed were collected from 43 states and included pages from policy manuals or administrative standards, tip sheets for case workers, brochures developed for families, stand-alone guidelines, and documentation forms. The guidelines vary widely in terms of the amount and specificity of information they contain, but their overall coverage of topics is sparse and not always in line with research findings. A need exists to update and expand the guidelines, which could then function as one tool to improve practice.

Adverse sequelae of the COVID -19 pandemic on mental health services in Chile.

This study seeks to describe the adverse effects of the COVID-19 pandemic on mental health services in Chile. This study is part of ongoing multicountry research known as the Mental Health Care - Adverse Sequelae of COVID-19 study (or the MASC study) that includes seven countries. Chile is the only one in Latin America. This study used a convergent mixed methods design. The quantitative component analyzed data about public mental health care collected between January 2019 and December 2021 from the open-access database at the Ministry of Health. The qualitative component analyzed data collected from focus groups of experts that included professionals in charge of mental health services, policy-makers, service users and caregivers. Finally, the data synthesis was performed by triangulation of both components. By April 2020, mental health service provision had been reduced by 88% in primary care; moreover, secondary and tertiary levels had also reduced their mental health activities by, respectively, 66.3% and 71.3% of pre-COVID levels. Negative sequelae were described at the health systems level, and full recovery had not been achieved by the end of 2021. The pandemic affected the essential characteristics of community-based mental health services, with adverse impacts on the continuity and quality of care, reduced psychosocial and community support, and negative effects on health workers' mental health. Digital solutions were widely implemented to enable remote care, but challenges included the availability of equipment, its quality and the digital divide. The COVID-19 pandemic has had significant and enduring adverse effects on mental health care. Lessons learned can inform recommendations for good practices for the ongoing and future pandemics and health crises, and highlight the importance of prioritizing the strengthening of mental health services in response to emergencies.

Décès par asphyxie lors des états d’agitation aiguë, à propos d’un cas, physiopathologie et alternatives thérapeutiques

Controversial, the constant questioning of restraint measures and the dangers associated with their use makes it possible for us to improve and update the recommendations for good practice in psychiatry. The case study of the death by asphyxiation of a patient hospitalized in psychiatric care and who had been restrained allows us to question the methods and procedures that can be used to restrain patients suffering from “agitated delirium syndrome” as described in the literature. A discussion of the current recommendations on physical and chemical restraint, as well as the so-called non-violent de-escalation methods, seems essential for developing an approach to improving practices, whether intra-hospital or extra-hospital (an initial contact with the police).

Implementing Integrated Early Childhood Mental Health Services in Primary Care: Relationships, Vision, and Sustainability

The Massachusetts Multi-City Young Children’s System of Care Project was a federally funded program to provide integrated early childhood mental health (ECMH) services in primary care for families of very young children (birth-six years old) with Serious Emotional Disturbances across three cities in Massachusetts, U.S.A. This study describes lessons learned from the implementation of this program and makes recommendations for best practices to improve the delivery and efficacy of ECMH services in primary care settings. Staff and leadership (n = 35) from 11 agencies (primary care practices, community service agencies, and local health departments) that co-implemented this program participated in focus groups and semi-structured key informant interviews. Thematic analysis was used to characterize specific facilitators and barriers to successfully implementing system-wide programming for ECMH. Four main themes were identified: (1) Strong multilevel working relationships are critical for integration, (2) Capacity-building activities can be leveraged to improve implementation, (3) Financial challenges are a primary barrier to building efficacious systems of care, and (4) Flexibility and resourcefulness can help overcome logistical challenges in integration. Implementation lessons learned may serve as guidance for other states and institutions in the U.S. seeking to improve the integration of ECMH services into primary care. They may also provide strategies to adapt and scale these interventions to improve the mental health and well-being of young children and their families.

HR+/HER2- Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review.

The approval of CDK4/6 inhibitors has dramatically improved care for the treatment of HR+/HER2- advanced breast cancer, but navigating the rapidly-expanding treatment evidence base is challenging. In this narrative review, we provide best-practice recommendations for the first-line treatment of HR+/HER2- advanced breast cancer in Canada based on relevant literature, clinical guidelines, and our own clinical experience. Due to statistically significant improvements in overall survival and progression-free survival, ribociclib + aromatase inhibitor is our preferred first-line treatment for de novo advanced disease or relapse ≥12 months after completion of adjuvant endocrine therapy and ribociclib or abemaciclib + fulvestrant is our preferred first-line treatment for patients experiencing early relapse. Abemaciclib or palbociclib may be used when alternatives to ribociclib are needed, and endocrine therapy can be used alone in the case of contraindication to CDK4/6 inhibitors or limited life expectancy. Considerations for special populations-including frail and fit elderly patients, as well as those with visceral disease, brain metastases, and oligometastatic disease-are also explored. For monitoring, we recommend an approach across CDK4/6 inhibitors. For mutational testing, we recommend routinely performing ER/PR/HER2 testing to confirm the subtype of advanced disease at the time of progression and to consider ESR1 and PIK3CA testing for select patients. Where possible, engage a multidisciplinary care team to apply evidence in a patient-centric manner.